Effect of a quality improvement intervention to reduce the length of stay in appendicitis.

AIM: Determine the effect of an intervention to reduce the length of stay (LOS) in appendectomies. METHODS: A four-quarter quality improvement initiative was developed after approval by the facility Quality Management Department, including educational sessions about the best practices regarding the hospital care for patients with appendicitis and recommendations to limit the LOS for no complicated appendicitis unless associated conditions were present, monitoring of the LOS and feedback to the staff and leaders. RESULTS: 692 appendectomies were performed, 365 (52.7%)) of them during the intervention. The mean LOS was 3.94 days with a decreasing trend during the study period. The complicated appendicitis had a mean LOS of 6.42 days (SD, 3.85) during the baseline and 5.27 days (SD 2.50) during the intervention (p=0.03), representing a 17.9% reduction. The not complicated appendicitis during baseline had LOS of 3.82 days (SD 4.17) with a subsequent reduction to 2.95 days (SD 1.53) in the intervention. The total saving bed days during the intervention were 338.04 days, which 254.04 days (75.2%) were in non complicated appendectomies. One patient required readmission during the intervention because of an organ space surgical site infection, with proper recovery after antibiotic treatment. CONCLUSION: Our study provides evidence about the possibility to optimize the bed use with a simple educational intervention, and should be considered a step to achieve additional reductions in the hospital stay of patients who undergo laparoscopic appendectomies.

[Building of a genomic library of Leishmania amazonensis and its expression in BALB/c mice's muscle]. / Construcción de una biblioteca genómica de Leishmania amazonensis y su expresión en músculo de ratones BALB/c.

A genomic library of Leishaminia amazonensis was built through a pcDNA3 vector, with expression promoter in eukaryot cells, to contribute to the application of immunization technology with nucleic acids in leishmaniasis. To show the expression genomic library in the muscles of mice immunized with it, the indirect immunofluoresce technique was used. A mix of sera with high antileishmania titers from an area where L.braziliensis infection is predominant was used as primary antibody. A library of 80% recombinant clones was obtained. Antigen determinant expression was confirmed in immunized BALB/c mice's muscles, according to the results of immunofluorescence testing.

[Evaluation of the humoral immune response by Western Blot test in mice immunized with expression genomic library of Trypanosoma cruzi]. / Evaluación de la respuesta inmune humoral por western blot en ratones inmunizados con una biblioteca genómica de expresión de Trypanosoma cruzi.

An expression genomic library of Trypanosoma cruzi was built by using plasmid pc DNA3 as a vector. This library served to immunize by intramuscular administration BALB/c inbred mice. A positive control group to which T. cruzi soluble antigens were administered and other group which was given the same plasmid used for the building of the genomic library were included in this study; another group was not immunized. Blood was extracted from the retrorbital plexus of all the mice two weeks after the third vaccination so as to study the specific antibody response to soluble parasite anigens through the Western Blot technique. The antibody response was shown in animals immunized with the expression genomic library and with soluble parasite antigens.

Intestinal absorption of triglyceride and vitamin D3 in aged and young rats.

[3H]Trioleyl glycerol (TO) and [14C]vitamin D3 were perfused intraduodenally for 5 hr in aged (19-21 months) and young adult (4-5 months) Sprague-Dawley rats. The rate of intestinal uptake from the gastrointestinal lumen and transport into the body of these lipids were decreased in the aged animals. Since the distribution of TO lipolytic products in the lumen was unchanged, reduced intestinal uptake rate probably occurred at the mucosal membrane. Furthermore, in the aged rats, the rate of transintestinal transport of both trioleyl glycerol and vitamin D3 was impaired. No evidence for impaired mucosal TO reesterification or for accumulation of vitamin D3 metabolites was found, suggesting that intestinal lipid accumulation resulted from a defect in lipoprotein assembly or in discharge from the mucosal cell. Impaired absorption of lipids may contribute to malnutrition and osteopenia of advancing age.

Triton-induced hyperlipidemia: a model for studies of intestinal lipoprotein production.

To estimate intestinal very low-density lipoprotein (VLDL) contribution to the circulating plasma triglyceride (TG) pool, mesenteric, hepatic, and total TG production rates were measured in mesenteric lymph-cannulated male rats after Triton WR-1339 blockage of systemic VLDL metabolism. The intestinal contribution (4.92 +/- 0.5 mg TG/h) was calculated to be 19% of total TG production rate. Triton WR-1339 administration caused profound hyperlipoproteinemia but did not alter total lymph TG or VLDL apoprotein output. The percent of lymph VLDL apoprotein present as apo A-I and apo A-IV fell dramatically after Triton with a concomitant increase in apo E and apo C peptides. Studies in this Triton-treated rat model suggest that the intestinal contribution to systemic TG formation is small but that changes in circulating apolipoproteins may alter the composition of intestinal VLDL.