Venous thromboembolism prophylaxis in a general hospital.

OBJECTIVE: To evaluate the use of venous thromboembolism (VTE) prophylaxis in a general hospital. METHODS: A cross-sectional cohort study at the Hospital Nossa Senhora da Conceição, located in the city of Porto Alegre, Brazil, involving a random sample of patients admitted between October of 2008 and February of 2009. We included patients over 18 years of age and hospitalized for more than 48 h. The exclusion criteria were anticoagulant use, pregnancy, puerperium, and a history of thromboembolic disease. The adequacy of prophylaxis was evaluated in accordance with a protocol created by the Hospital and principally based on the American College of Chest Physicians guidelines, eighth edition. RESULTS: We included 262 patients. The mean age was 59.1 ± 16.6 years. The most common risk factors were immobilization (in 70.6%), infection (in 44.3%), cancer (in 27.5%), obesity (in 23.3%), and major surgery (in 14.1%). The risk of VTE was classified as high and moderate in 143 (54.6%) and 117 (44.7%) of the patients, respectively. Overall, 46.2% of the patients received adequate prophylaxis, 25% of those with > three risk factors for VTE and 18% of those with cancer, the differences between these last two groups and their counterparts (patients with < three risk factors and those without cancer) being statistically significant (p < 0.001 for both). CONCLUSIONS: Our data reveal that nearly all patients at our hospital were at risk for VTE, and that less than half received adequate VTE prophylaxis, which is in agreement with the literature. It is surprising that inadequate prophylaxis is more common in high-risk patients.

Profilaxia para tromboembolia venosa em um hospital geral / Venous thromboembolism prophylaxis in a general hospital

OBJETIVO: Avaliar a prática de profilaxia para tromboembolia venosa (TEV) em pacientes em um hospital geral. MÉTODOS: Estudo de coorte transversal conduzido no Hospital Nossa Senhora da Conceição, localizado na cidade de Porto Alegre (RS), com uma amostra constituída de pacientes internados selecionados randomicamente entre outubro de 2008 e fevereiro de 2009. Foram incluídos pacientes maiores de 18 anos e internados por mais de 48 h. Os critérios de exclusão foram pacientes em uso de anticoagulantes, história de doença tromboembólica, gestação e puerpério. A adequação da profilaxia foi avaliada seguindo as recomendações de um protocolo criado pela instituição e tendo como base principal a diretriz da American College of Chest Physician, oitava edição. RESULTADOS: Foram incluídos 262 pacientes com média de idade de 59,1 ± 16,6 anos. Os fatores de risco mais comuns foram imobilização (70,6 por cento), infecção (44,3 por cento), câncer (27,5 por cento), obesidade (23,3 por cento) e cirurgia maior (14,1 por cento). Na avaliação do nível de risco para TEV, 143 (54,6 por cento) e 117 pacientes (44,7 por cento), respectivamente, foram classificados como de risco alto e moderado. No geral, 46,2 por cento dos pacientes tiveram profilaxia adequada, assim como 25 por cento dos pacientes com três ou mais fatores de risco e 18 por cento dos pacientes com câncer, e houve diferenças estatisticamente significativas entre esses grupos quando comparados àqueles com menos de três fatores de risco e sem câncer (p < 0,001 para ambos). CONCLUSÕES: Os dados demonstram que quase a totalidade dos pacientes do hospital estava em risco para TEV e que menos da metade deles recebeu profilaxia adequada, dados esses semelhantes aos da literatura. A inadequação da profilaxia é surpreendentemente maior em pacientes de alto risco.

OBJECTIVE: To evaluate the use of venous thromboembolism (VTE) prophylaxis in a general hospital. METHODS: A cross-sectional cohort study at the Hospital Nossa Senhora da Conceição, located in the city of Porto Alegre, Brazil, involving a random sample of patients admitted between October of 2008 and February of 2009. We included patients over 18 years of age and hospitalized for more than 48 h. The exclusion criteria were anticoagulant use, pregnancy, puerperium, and a history of thromboembolic disease. The adequacy of prophylaxis was evaluated in accordance with a protocol created by the Hospital and principally based on the American College of Chest Physicians guidelines, eighth edition. RESULTS: We included 262 patients. The mean age was 59.1 ± 16.6 years. The most common risk factors were immobilization (in 70.6 percent), infection (in 44.3 percent), cancer (in 27.5 percent), obesity (in 23.3 percent), and major surgery (in 14.1 percent). The risk of VTE was classified as high and moderate in 143 (54.6 percent) and 117 (44.7 percent) of the patients, respectively. Overall, 46.2 percent of the patients received adequate prophylaxis, 25 percent of those with > three risk factors for VTE and 18 percent of those with cancer, the differences between these last two groups and their counterparts (patients with < three risk factors and those without cancer) being statistically significant (p < 0.001 for both). CONCLUSIONS: Our data reveal that nearly all patients at our hospital were at risk for VTE, and that less than half received adequate VTE prophylaxis, which is in agreement with the literature. It is surprising that inadequate prophylaxis is more common in high-risk patients.

Behavioral and cognitive profile of mice with high and low exploratory phenotypes.

Temperament is the heritable and relatively stable pattern of basic emotions, such as fear and anger. We explored behavioral features in mice to select distinct phenotypes with extremes of temperament. In a new environment (open-field) with a central object, two groups of 15 mice from 79 screened were separated according to high or low exploration of the object to compose the high and low exploratory groups, respectively. Their performance was mostly identical in the same task 1 week later and still distinguishable 8 months later, suggesting the presence of trait or temperamental features. These mice were further tested in other behavioral tasks. Compared to low exploratory mice, high exploratory mice were less anxious in the light/dark task and the elevated plus maze, showed increased locomotion in an open-field, improved their performance along trials in the Lashley maze (with appetitive stimulus) and had higher latency to step-down in the inhibitory avoidance task (with aversive stimulus). High exploratory mice were aggressive in the intruder test, whereas low exploratory mice were non-aggressive or submissive. These results show that individual differences in temperament influence a range of behaviors in mice. The behavioral profile of low and high exploratory mice resembled the depressive and hyperthymic temperaments of patients with unipolar depression and bipolar disorders, respectively, which may be relevant for modeling mood disorders.

Atypical antipsychotic profile of flunarizine in animal models.

RATIONALE: Flunarizine is known as a calcium channel blocker commonly used in many countries to treat migraine and vertigo. Parkinsonism has been described as one of its side-effects in the elderly, which is in agreement with its recently characterized moderate D2 receptor antagonism. OBJECTIVES: To perform a pre-clinical evaluation of flunarizine as a potential antipsychotic. METHODS: We evaluated the action of orally administered flunarizine in mice against hyperlocomotion induced by amphetamine and dizocilpine (MK-801) as pharmacological models of schizophrenia, induction of catalepsy as a measure for extrapyramidal symptoms and impairment induced by dizocilpine on the delayed alternation task for working memory. RESULTS: Flunarizine robustly inhibited hyperlocomotion induced by both amphetamine and dizocilpine at doses that do not reduce spontaneous locomotion (3-30 mg/kg). Mild catalepsy was observed at 30 mg/kg, being more pronounced at 50 mg/kg and 100 mg/kg. Flunarizine (30 mg/kg) improved dizocilpine-induced impairment on the delayed alternation test. CONCLUSIONS: These results suggest a profile comparable to atypical antipsychotics. The low cost, good tolerability and long half-life (over 2 weeks) of flunarizine are possible advantages for its use as an atypical antipsychotic. These results warrant clinical trials with flunarizine for the treatment of schizophrenia.