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2.
Genes (Basel) ; 13(12)2022 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-36553529

RESUMEN

Despite extensive industrial use, the biocompatibility of nanocomposites has not been extensively explored. The present study was designed to report the effect of variable doses of a newly synthesized nanocomposite, Neodymium Zirconate Zinc Sulfide, on selective serum and complete blood count parameters and on the oxidative stress markers from the vital organs of albino mice. Albino mice (C57BL/6 strain, 5 weeks old) of both sexes were orally treated for 11 days, either with 10 mg (low dose) or 20 mg/mL saline/kg body weight (high dose) of Neodymium Zirconate Zinc Sulfide nanocomposite. A control group that was not treated with the nanocomposite but with saline solution was also maintained. Data analysis revealed that high-dose nanocomposite-treated male mice had significantly reduced hemoglobin concentration as compared to the control males. Female mice treated with both doses of nanocomposite had higher serum triglyceride levels than controls. High-dose-treated female mice had elevated serum cholesterol concentration compared to their saline-treated controls. Oxidative stress marker analysis from selected organs indicated that concentrations of malonaldehyde (MDA) in the kidney and liver, Superoxide dismutase (SOD) levels in the brain and catalase in the kidney of male mice treated with the nanocomposite were significantly higher than in the control group, whereas SOD in the heart, MDA in the heart and kidney and catalase levels in the kidney were significantly disrupted in female mice compared to their respective controls.


Asunto(s)
Antioxidantes , Neodimio , Ratones , Masculino , Femenino , Animales , Catalasa/metabolismo , Antioxidantes/farmacología , Neodimio/farmacología , Ratones Endogámicos C57BL , Estrés Oxidativo , Superóxido Dismutasa/metabolismo
3.
Oxid Med Cell Longev ; 2022: 5066167, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35308168

RESUMEN

From the past few decades, attention towards the biological evaluation of nanoparticles (NPs) has increased due to the persistent and extensive application of NPs in various fields, including biomedical science, modern industry, magnetic resonance imaging, and the construction of sensors. Therefore, in the current study, magnetic nickel ferrite (NiFe2O4) nanoparticles (NFNPs) were synthesized and evaluated for their possible adverse effects in rabbits. The crystallinity of the synthesized NFNPs was confirmed using X-ray diffraction (XRD) technique. The saturation magnetization (46.7 emug-1) was measured using vibrating sample magnetometer (VSM) and 0.35-tesla magnetron by magnetic resonance imaging (MRI). The adverse effects of NFNPs on blood biochemistry and histoarchitecture of the liver, kidneys, spleen, brain, and heart of the rabbits were determined. A total of sixteen adult rabbits, healthy and free from any apparent infection, were blindly placed in two groups. The rabbits in group A served as control, while the rabbits in group B received a single dose (via ear vein) of NFNPs for ten days. The blood and visceral tissues were collected from each rabbit at days 5 and 10 of posttreatment. The results on blood and serum biochemistry profile indicated significant variation in hematological and serum biomarkers in NFNP-treated rabbits. The results showed an increased quantity of oxidative stress and depletion of antioxidant enzymes in treated rabbits. Various serum biochemical tests exhibited significantly higher concentrations of different liver function tests, kidney function tests, and cardiac biomarkers. Histopathologically, the liver showed congestion, edema, atrophy, and degeneration of hepatocytes. The kidneys exhibited hemorrhages, atrophy of renal tubule, degeneration, and necrosis of renal tubules, whereas coagulative necrosis, neutrophilic infiltration, and severe myocarditis were seen in different sections of the heart. The brain of the treated rabbits revealed necrosis of neurons, neuron atrophy, and microgliosis. In conclusion, the current study results indicated that the highest concentration of NPs induced adverse effects on multiple tissues of the rabbits.


Asunto(s)
Compuestos Férricos , Nanopartículas , Animales , Compuestos Férricos/farmacología , Nanopartículas/toxicidad , Níquel/toxicidad , Estrés Oxidativo , Conejos
4.
Environ Sci Pollut Res Int ; 29(15): 21380-21395, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34757555

RESUMEN

Bisphenol A (BPA) is one of the highest volume chemicals produced in the world and is frequently used in dental sealants, water bottles, food, and beverage packaging. Due to persistent applications, BPA has become a potential threat to a variety of organisms including public health. In this study, a total of 80 bighead carps were randomly placed in different four groups (A-D). Fish in groups B, C, and D were exposed to BPA @500, 1000, and 1500 µg/L, respectively for 60 days. Fish in group A served as an untreated control group. The body weight was significantly decreased while the absolute and relative weight of different visceral organs increased significantly (p < 0.05) in fish exposed to higher concentration (1500 µg/L) of BPA. Results on proximate analysis showed significantly lower values of crude proteins, lipids, and moisture contents while increased contents of ash in muscles of treated fish. The erythrocyte counts, hemoglobin concentration, lymphocytes, and monocytes significantly decreased while total leukocyte and neutrophil counts significantly increased in treated fish. Results exhibited that different serum biochemistry parameters like serum albumin and total proteins decreased significantly (p < 0.05) while alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP), urea, creatinine, glucose, cholesterol, and lactate dehydrogenase (LDH) increased significantly (p < 0.05) in treated fish. Histopathological ailments like pyknosis, degeneration of glomeruli, increased Bowman's space, ceroid formation in kidneys while ceroid formation, hemorrhages, pyknosis, karyorrhexis, karyolysis, nuclear hypertrophy, and eccentric nuclei were observed in the liver of treated fish. Histological observation of different sections of the brain of treated fish exhibited degeneration of neurons in the cerebellum, lipofuscin deposition, microgliosis, necrotic neurons, inflammatory cells, and hemorrhage. Results on light microscopic observation of different sections of the heart of bighead carp revealed necrosis, inflammatory reaction, neutrophilic myocarditis, and hemorrhages. In conclusion, it is suggested that BPA induces adverse effects on physical, blood-biochemical parameters, and histopathological changes in multiple visceral tissues of exposed fish.


Asunto(s)
Carpas , Animales , Compuestos de Bencidrilo , Biomarcadores , Fenoles
5.
Environ Pollut ; 268(Pt A): 115896, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33187850

RESUMEN

Bisphenol A (BPA) is one of the emerging contaminants associated with deleterious health effects on both public and wildlife and is extensively incorporated into different industrial products. Therefore, the current trial was conducted to determine the oxidative stress, status of different antioxidant enzymes and genotoxic potential of bisphenol A in fresh water fish at low concentrations. For this purpose, a total of 80 fresh water bighead carp (Aristicthys nobilis) received from commercial fish center were randomly divided and kept in four groups (A-D). Fish in groups (B-D) were exposed to different levels of BPA for a period of 60 days while fish of group A served as control group. Treated fish exhibited different physical and behavioral ailments in a time and treatment manners. Results showed significantly (p < 0.05) increased quantity of different oxidative stress biomarkers such as thiobarbituric acid reactive substance (TBARS), reduced glutathione (GSH) and the contents of reactive oxygen species (ROS) in gills, liver, kidneys and brain of exposed fish. Concentration of different antioxidant enzymes like catalase, superoxide dismutase, peroxidase and total proteins was significantly (p < 0.05) decreased in gills, liver, kidneys and brain of exposed fish. Results showed significantly (p < 0.05) increased frequency of morphological alterations, nuclear changes in red blood cells and increased DNA damage potential of bisphenol A in gills, liver, kidneys and brain tissues. The current trial concludes that even at very low concentrations bisphenol A causes toxic effects via turbulences in physiological and biochemical parameters in multiple tissues of fish.


Asunto(s)
Carpas , Contaminantes Químicos del Agua , Animales , Antioxidantes/metabolismo , Compuestos de Bencidrilo , Carpas/metabolismo , Catalasa/metabolismo , Daño del ADN , Agua Dulce , Branquias/metabolismo , Hígado/metabolismo , Estrés Oxidativo , Fenoles , Superóxido Dismutasa/metabolismo , Contaminantes Químicos del Agua/metabolismo , Contaminantes Químicos del Agua/toxicidad
6.
Drug Chem Toxicol ; 44(4): 372-379, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31088177

RESUMEN

Despite the rapid increase of nanotechnology in a wide array of industrial sectors, the biosafety profile of nanomaterials remains undefined. The accelerated use of nanomaterials has increased the potential discharge of nanomaterials into the environment in different ways. The aquatic environment is mainly susceptible as it is likely to act as an ultimate sink for all contaminants. Therefore, this study assessed the toxicological impacts of waterborne engineered copper nanoparticles (Cu-NPs) on histology, lipid peroxidation (LPO), catalase (CAT), and glutathione (GSH) levels in the gills of common carp (Cyprinus carpio). Nanoparticles were characterized by XRD and SEM techniques. Before starting the sub-acute toxicity testing, 96 h LC50 of Cu-NPs for C. carpio was calculated as 4.44 mg/l. Then based on LC50, C. carpio of 40-45 g in weight were exposed to three sub-lethal doses of waterborne engineered Cu-NPs (0 or 0.5 or 1 or 1.5 mg/l) for a period of 14 days. The waterborne Cu-NPs have appeared to induce alterations in gill histology and oxidative stress parameters in a dose-dependent manner. The gill tissues showed degenerative secondary lamellae, necrotic lamella, fused lamella, necrosis of the primary and secondary lamella, edema, complete degeneration, epithelial lifting, degenerative epithelium, and hyperplasia in a dose-dependent manner. In the gill tissues, waterborne Cu-NPs caused a decreased level of CAT and elevated levels of LPO, and GSH in the fish exposed to the highest dose of 1.5 mg Cu-NPs/l of water. Our results indicate that the exposure to waterborne Cu-NPs was toxic to the aquatic organisms as shown by the oxidative stresses and histological alterations in C. carpio, a freshwater fish of good economic value.


Asunto(s)
Antioxidantes/metabolismo , Cobre/química , Nanopartículas del Metal/toxicidad , Estrés Oxidativo/efectos de los fármacos , Animales , Carpas , Catalasa/metabolismo , Relación Dosis-Respuesta a Droga , Exposición a Riesgos Ambientales/efectos adversos , Branquias/efectos de los fármacos , Branquias/patología , Glutatión/metabolismo , Dosificación Letal Mediana , Peroxidación de Lípido/efectos de los fármacos , Nanopartículas del Metal/administración & dosificación , Contaminantes Químicos del Agua/administración & dosificación , Contaminantes Químicos del Agua/toxicidad
8.
Ann Hum Genet ; 83(6): 426-433, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31069794

RESUMEN

Tuberculosis (TB) is a global issue as one-third of the population worldwide is considered to be infected. TB has become a critical public health problem as a result of increasing drug resistance, which poses a challenge to current control strategies. Similar to environmental factors, genetic makeup of the host equally contributes to disease onset. We performed genotypic analysis to examine the relationship between IFNG and TB onset and drug resistance in a Pakistani population comprising 689 subjects. Notable differences were observed in the IFNG polymorphism (+874T/A) between the case and control groups. The frequency of the wild-type genotype (TT) in the controls (43.2%) was significantly higher than in the cases (25.3%) (odds ratio [OR] = 0.77, p < 0.0001), while the mutant genotype frequency (AA) (38.57%) in the cases was significantly higher than in the controls (22.6%) (OR = 1.46, p < 0.0001). The heterozygous genotype frequency (TA) did not significantly differ between the control and case groups. Compared with the controls, the variant allele (A) was approximately twice as frequent in the cases. Females and older people have a higher chance of disease development. Finally, the IFNG (+874T/A) polymorphism was not associated with drug sensitivity or resistance. However, a genotypic polymorphism of IFNG (+874T/A) was significantly associated with susceptibility to TB, and the T allele conferred protection against TB. Additional studies involving larger cohorts are needed to further explore this relationship between genetics and disease vulnerability.


Asunto(s)
Predisposición Genética a la Enfermedad , Interferón gamma/genética , Polimorfismo de Nucleótido Simple , Tuberculosis/epidemiología , Tuberculosis/genética , Adolescente , Adulto , Anciano , Niño , Farmacorresistencia Bacteriana , Femenino , Estudios de Asociación Genética , Genotipo , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Pakistán/epidemiología , Fenotipo , Vigilancia de la Población , Tuberculosis/diagnóstico , Adulto Joven
9.
Braz J Microbiol ; 50(2): 429-434, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30805894

RESUMEN

Tuberculosis is becoming a global issue with raising occurrences; particularly in developing countries, the situation is alarming. Besides environmental factors, host genetic factors are vital in disease development. A demographical and genotypic analysis in relation to tuberculosis commencement is conducted in a Pakistani population, and genotypic frequency of EBI3 (rs4740) was analyzed. Allelic frequencies of EBI3 (rs4740) were significantly associated with disease susceptibility in the reviewed population. Analysis for EBI3 (rs4740) genotyping showed a significant association of "GG" with reduced risk for disease. Moreover, females and older age found to be more perilous to develop TB while smoking and a family history of TB are additional risk factors for disease development. Further work with a larger population is necessary to identify the true causative variants of tuberculosis.


Asunto(s)
Predisposición Genética a la Enfermedad/genética , Interleucinas/genética , Antígenos de Histocompatibilidad Menor/genética , Tuberculosis Pulmonar/genética , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Niño , Femenino , Frecuencia de los Genes , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/inmunología , Pakistán , Polimorfismo de Nucleótido Simple/genética , Factores de Riesgo , Fumar/efectos adversos , Tuberculosis Pulmonar/inmunología , Tuberculosis Pulmonar/microbiología , Adulto Joven
10.
Singapore Med J ; 60(3): 110-118, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30009320

RESUMEN

Since the first use of the flexible fibreoptic bronchoscope, a plethora of new airway equipment has become available. It is essential for clinicians to understand the role and limitations of the available equipment to make appropriate choices. The recent 4th National Audit Project conducted in the United Kingdom found that poor judgement with inappropriate choice of equipment was a contributory factor in airway morbidity and mortality. Given the many modern airway adjuncts that are available, we aimed to define the role of flexible fibreoptic intubation in decision-making and management of anticipated and unanticipated difficult airways. We also reviewed the recent literature regarding the role of flexible fibreoptic intubation in specific patient groups who may present with difficult intubation, and concluded that the flexible fibrescope maintains its important role in difficult airway management.


Asunto(s)
Manejo de la Vía Aérea/métodos , Broncoscopía/métodos , Tecnología de Fibra Óptica , Intubación Intratraqueal/instrumentación , Laringoscopios , Obstrucción de las Vías Aéreas/complicaciones , Anestesia/métodos , Diseño de Equipo , Humanos , Intubación Intratraqueal/métodos , Maniquíes , Obesidad/complicaciones , Sistema Respiratorio , Fracturas Craneales/complicaciones
11.
Nanotechnology ; 29(46): 464003, 2018 Nov 16.
Artículo en Inglés | MEDLINE | ID: mdl-30168446

RESUMEN

Nanoparticles (NPs) enter the environment mainly through waste water effluents, accidental spillage, and industrial runoffs. This is worrying because NPs can enter the human body owing to their large aspect-to-size ratio and reactive surfaces that facilitate their penetration through biological barriers and thus can induce oxidative stress in host cells. Therefore, there is a growing concern about the toxicity of NPs, which needs to be addressed. Thus, this study investigated the ameliorative effects of Moringa oleifera seed extract (MOSE) in Cyprinus carpio exposed to copper nanoparticles (Cu-NPs). For the in vivo assessment of the shielding effects of MOSE, 240 samples of C. carpio (40-45 g) were randomly allocated to 24 experimental tanks (10 fish/tank of 40 L) 24 h prior to the start of this experiment. The experimental fish were faced with the water-born exposure of a pre-determined dose of 1.5 mg Cu-NPs/l along with pre- and post-treatment with different doses (100 or 200 or 300 mg l-1) of MOSE for 28 days. The MOSE showed significant ameliorative effect on the antioxidant defense, in response to the elevated levels of Cu-NP-induced oxidative stress. It also played a protective role as indicated by the suppression of the histological alterations in the gills and liver of fish exposed to the Cu-NPs. It was concluded that the Cu-NP-induced toxicity in C. carpio was ameliorated by the use of MOSE in this study. Moreover, the post-Cu-NP treatment stage showed more protective effects of MOSE than the pre-Cu-NP treatment phase. Further studies are suggested to determine the optimum dose and delivery method of MOSE for similar or different NP exposed fish.


Asunto(s)
Antioxidantes/farmacología , Carpas/fisiología , Cobre , Nanopartículas del Metal/toxicidad , Moringa oleifera/química , Estrés Oxidativo/efectos de los fármacos , Extractos Vegetales/farmacología , Animales , Acuicultura , Carpas/metabolismo , Cobre/química , Branquias/efectos de los fármacos , Branquias/metabolismo , Branquias/patología , Hígado/efectos de los fármacos , Hígado/metabolismo , Hígado/patología , Nanopartículas del Metal/química , Semillas/química , Contaminantes Químicos del Agua/toxicidad
12.
Interface Focus ; 8(3): 20170054, 2018 Jun 06.
Artículo en Inglés | MEDLINE | ID: mdl-29696086

RESUMEN

Biomolecular fractions affect the fate and behaviour of quantum dots (QDs) in living systems but how the interactions between biomolecules and QDs affect the bioavailability of QDs is a major knowledge gap in risk assessment analysis. The transport of QDs after release into a living organism is a complex process. The majority accumulate in the lungs where they can directly affect the inhalation process and lung architecture. Here, we investigate the bioavailability of graphene quantum dots (GQDs) to the lungs of rats by measuring the alterations in macromolecular fractions via Fourier transform infrared spectroscopy (FTIR). GQDs were intravenously injected into the rats in a dose-dependent manner (low (5 mg kg-1) and high (15 mg kg-1) doses of GQDs per body weight of rat) for 7 days. The lung tissues were isolated, processed and haematoxylin-eosin stained for histological analysis to identify cell death. Key biochemical differences were identified by spectral signatures: pronounced changes in cholesterol were found in two cases of low and high doses; a change in phosphorylation profile of substrate proteins in the tissues was observed in low dose at 24 h. This is the first time biomolecules have been measured in biological tissue using FTIR to investigate the biocompatibility of foreign material. We found that highly accurate toxicological changes can be investigated with FTIR measurements of tissue sections. As a result, FTIR could form the basis of a non-invasive pre-diagnostic tool for predicting the toxicity of GQDs.

13.
Biol Trace Elem Res ; 182(1): 57-69, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28631137

RESUMEN

This study assessed the protective effects of Cinnamomum cassia (cinnamon) bark extract in rats exposed to titanium dioxide nanoparticles or titanium dioxide bulk salt. For in vivo evaluation of the ameliorative role of the cinnamon extract, the experimental groups were orally administered with the cinnamon extract at different dose levels (50 or 100 or 150 mg/kg bodyweight) along with the subcutaneous injections of 150 mg/kg bodyweight titanium dioxide nanoparticles or titanium dioxide bulk salt. The extract showed significant ameliorative role on the antioxidant system in response to elevated levels of titanium dioxide nanoparticles or titanium dioxide bulk salt-induced oxidative stress. It aided in the recovery of the antioxidant system as well as protective role in histological damages and some haematological parameters in the rat liver treated with titanium dioxide nanoparticles or titanium dioxide bulk salt.


Asunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas/prevención & control , Cinnamomum aromaticum/química , Hígado/efectos de los fármacos , Nanopartículas del Metal/toxicidad , Extractos Vegetales/farmacología , Titanio/toxicidad , Animales , Antioxidantes/farmacología , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Enfermedad Hepática Inducida por Sustancias y Drogas/metabolismo , Daño del ADN , Relación Dosis-Respuesta a Droga , Hígado/metabolismo , Hígado/patología , Masculino , Fitoterapia/métodos , Corteza de la Planta/química , Extractos Vegetales/administración & dosificación , Sustancias Protectoras/farmacología , Ratas Sprague-Dawley
14.
Int J Biol Macromol ; 101: 254-272, 2017 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-28300586

RESUMEN

Pectins are natural complex heteropolysaccharides, composed of (1, 4)-linked α-d-galacturonic acid residues and variety of neutral sugars such as rhamnose, galactose and arabinose. It is second most abundant component of the cell wall of all land plants. It has wide applications in various fields due to its use as gelling, emulsifying or stabilizing agent and as well as its non-toxic, biocompatible and biodegradable nature. Considering these versatile properties this review sheds a light on the synthesis, modification, characterization and applications of pectin based polymers. Most of them are used in industries, pharmaceutics, nutraceutics, drug delivery, tissue engineering, food packaging and cosmetics. Properties of pectin can be improved and modified by forming derivatives, blends and composites.


Asunto(s)
Materiales Biocompatibles , Investigación Biomédica , Pectinas , Animales , Materiales Biocompatibles/química , Humanos , Hidrogeles/química , Pectinas/química , Polietilenglicoles/química
15.
Int J Biol Macromol ; 94(Pt A): 10-27, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27697492

RESUMEN

Exopolysaccharides are synthesized by bacteria and secreted into the external environment and they may be homopolymeric or heteropolymeric in configuration. They are believed to protect bacterial cells from heavy metals, desiccation or other environmental effect. EPS exhibit antitumor, anti-HIV, emulsion stabilization capacity, shear-thinning activity, suspension ability, high viscosities, excellent biocompatibility, high biodegradability and immunomodulatory properties. They are widely used in herbicides, functional food, nutraceuticals, cosmeceuticals, pharmaceuticals, insecticides, immunomodulation and anticoagulants. This review shed light on the properties and versatile applications of xanthan, curdlan, hyaluronic acid and dextran blends and composites with natural and synthetic polymers.


Asunto(s)
Polisacáridos Fúngicos/química , Polisacáridos Bacterianos/química , Animales , Fármacos Anti-VIH/química , Fármacos Anti-VIH/farmacología , Antineoplásicos/química , Antineoplásicos/farmacología , Polisacáridos Fúngicos/farmacología , Humanos , Polisacáridos Bacterianos/farmacología , beta-Glucanos/química
16.
Pak J Pharm Sci ; 27(1): 183-6, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24374447

RESUMEN

The aim of this study was to analyze and compare the chemical composition of 8 tetra pack milk samples, Olpers (S1), Haleeb (S2), Good milk (S3), Everyday (S4), Milk Pack (S5), Dairy Queen (S6), Dairy Umang (S7), Nurpur (S8) available in local markets and to detect the presence of various chemical adulterants in tetra pack milk samples in Southern Punjab (Pakistan). Density, pH, solid not fat, total solids, lactometer reading, specific gravity and fat contents were analyzed to determine the chemical composition of milk samples. Our results revealed that all the studied parameters had statistically non significant differences (P>0.05) except total fat in milk samples which was significantly different (P=0.03) among the 8 studied milk samples. Presence of a number of chemical adulterants, formalin, cane sugar, starch, glucose, ammonium sulphate, salt, pulverized soap, detergents, skim milk powder, benzoic acid, salicylic acid, borax, boric acid and alkalinity were also detected in milk samples following standard procedures. Results indicated that formalin, cane sugar, glucose, alkalinity and benzoic acid were present in all samples while salt test was positive only for Olper milk. All other studied adulterants were not detected in 8 milk samples under study. % fat was the only significantly different feature among the studied milk quality parameters with S8 containing lowest while S5 having the maximum % fat.


Asunto(s)
Contaminación de Alimentos , Leche/química , Animales , Pakistán
17.
Crit Care ; 10(1): R28, 2006 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-16507152

RESUMEN

INTRODUCTION: A health care system is a complex adaptive system. The effect of a single intervention, incorporated into a complex clinical environment, may be different from that expected. A national database such as the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme in the UK represents a centralised monitoring, surveillance and reporting system for retrospective quality and comparative audit. This can be supplemented with real-time process monitoring at a local level for continuous process improvement, allowing early detection of the impact of both unplanned and deliberately imposed changes in the clinical environment. METHODS: Demographic and UK Acute Physiology and Chronic Health Evaluation II (APACHE II) data were prospectively collected on all patients admitted to a UK regional hospital between 1 January 2003 and 30 June 2004 in accordance with the ICNARC Case Mix Programme. We present a cumulative expected minus observed (E-O) plot and the risk-adjusted p chart as methods of continuous process monitoring. We describe the construction and interpretation of these charts and show how they can be used to detect planned or unplanned organisational process changes affecting mortality outcomes. RESULTS: Five hundred and eighty-nine adult patients were included. The overall death rate was 0.78 of predicted. Calibration showed excess survival in ranges above 30% risk of death. The E-O plot confirmed a survival above that predicted. Small transient variations were seen in the slope that could represent random effects, or real but transient changes in the quality of care. The risk-adjusted p chart showed several observations below the 2 SD control limits of the expected mortality rate. These plots provide rapid analysis of risk-adjusted performance suitable for local application and interpretation. The E-O chart provided rapid easily visible feedback of changes in risk-adjusted mortality, while the risk-adjusted p chart allowed statistical evaluation. CONCLUSION: Local analysis of risk-adjusted mortality data with an E-O plot and a risk-adjusted p chart is feasible and allows the rapid detection of changes in risk-adjusted outcome of intensive care patients. This complements the centralised national database, which is more archival and comparative in nature.


Asunto(s)
Cuidados Críticos , Mortalidad Hospitalaria , Unidades de Cuidados Intensivos , Ajuste de Riesgo , Bases de Datos Factuales , Humanos , Estudios Prospectivos , Tasa de Supervivencia
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