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AIMS: To understand the paradox of an increased fracture risk despite increased bone mineral density (BMD) in persons with type 2 diabetes (DM2). PATIENTS AND METHODS: We studied 80 old persons with DM2. Mineral metabolism, parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), bone turnover - osteocalcin, procollagen type 1â¯N-terminal propeptide (P1NP) and C-terminal telopeptide of type 1 collagen (CTX) - were measured and BMD was assessed at the lumbar spine (LS) and femoral neck (FN). Data was analyzed with the Statistical Package for the Social Sciences Program. RESULTS: Low levels of 25OHD (84%) and high values of PTH (20%) were found. Osteocalcin was directly related to CTX, pâ¯<â¯0.001, with increased bone formation and increased BMD (z-score) at LS and FN. PTH was directly related to osteocalcin and CTX and inversely related to BMD at the FN, pâ¯<â¯0.05. Patients with dyslipidemia presented higher P1NP, pâ¯<â¯0.05 and patients with hypertension presented higher BMD at LS and FN, pâ¯<â¯0.01. CONCLUSION: Old type 2 diabetics present increased bone formation, PTH-driven. Low grade secondary hyperparathyroidism may explain the paradox of an increased fracture risk despite increased BMD.
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INTRODUCTION: Acute bacterial pneumonia is a common and potentially fatal disease where early recognition and treatment are crucial. Increasing medical literature suggests worse outcomes in patients admitted for medical and surgical conditions during the weekend. Little is known about this effect in patients with acute bacterial pneumonia. Obective: The aim of this study was to evaluate the impact of weekend and holiday hospital admission on the outcomes of acute bacterial pneumonia. MATERIAL AND METHODS: Retrospective analysis of adult patients (> 18 years) with acute bacterial pneumonia collected from a tertiary referral center database. Length of stay, total cost, admission to intensive care unit, development of sepsis and organ failure, and mortality were compared between patients admitted on a weekday and patients admitted during a weekend or holiday. RESULTS: We analyzed 53 854 hospital admissions from 42 512 patients (median age 84.0 years, range 18 - 118 years), corresponding to 30 554 admissions during weekdays, 21 222 at weekends and 2078 during public holidays. Weekend and holiday admission was not associated with increased costs, length of stay, intensive care unit admission, development of sepsis, organ failure, and mortality. CONCLUSION: A weekend/holiday effect in acute bacterial pneumonia was not evident in our series.
Introdução: A pneumonia aguda bacteriana é uma entidade comum e potencialmente fatal em que o diagnóstico e tratamento precoces são cruciais. A literatura médica, de forma crescente, reporta piores resultados clínicos em doentes admitidos por doenças médicas e cirúrgicas durante o fim-de-semana. Pouco se sabe deste efeito em doentes com pneumonia aguda bacteriana. Objetivo: O objetivo deste estudo foi avaliar o impacto das admissões durante o fim-de-semana e feriados nos resultados clínicos de doentes admitidos com pneumonia aguda. Material e Métodos: Análise retrospetiva de doentes adultos (> 18 anos) com pneumonia aguda bacteriana recolhidos de uma base de dados de um centro hospitalar terciário. A duração do internamento, custos, admissão em unidade de cuidados intensivos, desenvolvimento de sépsis ou lesão de órgão alvo e mortalidade foram comparados entre doentes admitidos durante a semana e doentes admitidos durante o fim-de-semana ou feriados. Resultados: Verificaram-se 53 854 admissões hospitalares correspondendo a 42 512 doentes (idade mediana 84,0 anos, 18 - 118 anos). Um total de 30 554 admissões ocorreram durante os dias da semana, 21 222 durante o fim-de-semana e 2078 durante feriados. A admissão durante o fim-de-semana ou feriado não se associou a custos mais elevados, internamentos mais prolongados, maior admissão em unidade de cuidados intensivos, desenvolvimento de sépsis ou lesão de órgão alvo e mortalidade. Conclusão: A hipótese dos internamentos durante o fim-de-semana e feriados se associarem a piores resultados clínicos não se verificou no nosso estudo.
Assuntos
Admissão do Paciente/estatística & dados numéricos , Pneumonia Bacteriana/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Férias e Feriados , Humanos , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto JovemRESUMO
The article focuses on the work to demarcate borders and chart the Brazilian northwest from 1907 to 1915, a project aimed at national integration and undertaken by the Rondon Commission for the Construction of Telegraph Lines from Mato Grosso to Amazonas, which was organized by the Brazilian ministries of War, Transportation and Public Works, and Agriculture. The study explores the ways in which topographic surveys were conducted by the military engineers sent by the Ministry of War and also endeavors to understand their activities in the field. Of further interest are the demands made by the War Ministry and how they were responded to within the commission.
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Tem como objeto os trabalhos de demarcação de fronteiras e inventário do território noroeste do país entre 1907 e 1915, ocasião em que se destacam as realizações da Comissão Construtora de Linhas Telegráficas Estratégicas do Mato Grosso ao Amazonas, organizada pelos ministérios da Guerra, Viação e Obras Públicas e Agricultura, com vistas à integração nacional. A pesquisa tem por finalidade apresentar as formas pelas quais se desenvolviam os trabalhos de levantamento topográfico, realizados pelos engenheiros militares enviados pelo Ministério da Guerra, e compreender as atividades desses militares em campo. Além disso, há interesse nas demandas do Ministério da Guerra e em como o atendimento a elas se dava no interior da comissão.
The article focuses on the work to demarcate borders and chart the Brazilian northwest from 1907 to 1915, a project aimed at national integration and undertaken by the Rondon Commission for the Construction of Telegraph Lines from Mato Grosso to Amazonas, which was organized by the Brazilian ministries of War, Transportation and Public Works, and Agriculture. The study explores the ways in which topographic surveys were conducted by the military engineers sent by the Ministry of War and also endeavors to understand their activities in the field. Of further interest are the demands made by the War Ministry and how they were responded to within the commission.
