Weekend admissions with ascites are associated with delayed paracentesis: A nationwide analysis of the 'weekend effect'.

INTRODUCTION AND OBJECTIVES: Weekend admissions has previously been associated with worse outcomes in conditions requiring specialists. Our study aimed to determine in-hospital outcomes in patients with ascites admitted over the weekends versus weekdays. Time to paracentesis from admission was studied as current guidelines recommend paracentesis within 24h for all patients admitted with worsening ascites or signs and symptoms of sepsis/hepatic encephalopathy (HE). PATIENTS: We analyzed 70 million discharges from the 2005-2014 National Inpatient Sample to include all adult patients admitted non-electively for ascites, spontaneous bacterial peritonitis (SBP), and HE with ascites with cirrhosis as a secondary diagnosis. The outcomes were in-hospital mortality, complication rates, and resource utilization. Odds ratios (OR) and means were adjusted for confounders using multivariate regression analysis models. RESULTS: Out of the total 195,083 ascites/SBP/HE-related hospitalizations, 47,383 (24.2%) occurred on weekends. Weekend group had a higher number of patients on Medicare and had higher comorbidity burden. There was no difference in mortality rate, total complication rates, length of stay or total hospitalization charges between the patients admitted on the weekend or weekdays. However, patients admitted over the weekends were less likely to undergo paracentesis (OR 0.89) and paracentesis within 24h of admission (OR 0.71). The mean time to paracentesis was 2.96 days for weekend admissions vs. 2.73 days for weekday admissions. CONCLUSIONS: We observed a statistically significant "weekend effect" in the duration to undergo paracentesis in patients with ascites/SBP/HE-related hospitalizations. However, it did not affect the patient's length of stay, hospitalization charges, and in-hospital mortality.

Efficacy and Safety of Endoscopic Sleeve Gastroplasty at Mid Term in the Management of Overweight and Obese Patients: a Systematic Review and Meta-Analysis.

BACKGROUND: Endoscopic sleeve gastroplasty (ESG) has emerged as a promising technique in endoscopic bariatric and metabolic therapies (EBMTs). We aimed to perform a systematic review and meta-analysis to provide an update on its efficacy and safety. METHODS: This is a systematic review and meta-analysis was performed following the PRISMA guidelines. MEDLINE, Cochrane, EMBASE, and LILACS were searched to identify the studies related to ESG. RESULTS: Eleven studies with a total of 2170 patients were included. The average BMI pre-ESG was 35.78 kg/m2. Pooled mean %TWL observed at 6, 12, and 18 months was 15.3%, 16.1%, and 16.8% respectively. Pooled mean %EWL at 6, 12, and 18 months was 55.8%, 60%, and 73% respectively. No procedure-related mortality was reported. CONCLUSION: ESG is a safe and effective procedure for primary obesity therapy with promising short- and mid-term results.

Investigation of the anti-inflammatory and the analgesic effects of the extracts from Smilax ornata Lem. (Jamaican sarsaparilla) plant.

ETHNOPHARMACOLOGICAL RELEVANCE: Smilax ornata Lem. is used in folklore medicine to treat rheumatoid arthritis and rheumatic pain. This particular claim has never been scientifically validated before in this plant species and hence, it forms the reason for this investigation. OBJECTIVE: To investigate whether the methanol and ethyl acetate extracts of Smilax ornata Lem. possess anti-inflammatory and analgesic properties in Sprague-Dawley rats. METHODS: The anti-inflammatory and analgesic activities were investigated using carrageenan-induced paw oedema model and the tail-flick model respectively. RESULTS: The methanol extracts (200 and 400 mg/kg) and the ethyl acetate extract (400 mg/kg) exhibited significant (P < 0.05) anti-inflammatory activity when compared with that of their control groups (saline and vegetable oil respectively), with an onset of 150 min and a duration of 2.5 h. The methanol extract (200 mg/kg) exhibited significant (P < 0.05) analgesic activity, with an onset of 60 min and a duration of 2 h. Also, the methanol and the ethyl acetate extracts (400 mg/kg) exhibited significant (P < 0.05) analgesic activity when compared with that of their control groups (saline and vegetable oil respectively), with an onset of 30 min and a duration of 2.5 h. CONCLUSION: The present study provided scientific justification that the extracts of Smilax ornata Lem. possess significant anti-inflammatory and analgesic activities.

Optimum plot size of planting and bio-agroeconomic revenues from arugula-carrot intercropping systems in a semi-arid region.

The production of vegetable crops has been characterized as a highly intensive activity in the use of soil, water, inputs and labor in semi-arid regions, being practiced mostly by small family farmers as a way of subsistence, or in the small-scale commercialization of surplus production. Among the agricultural practices that have been successfully used by vegetable producers are intercrop systems that, when implemented with adequate management, present gains in productivity, nutritional, economic, and environmental value. The aim of this study was to estimate the optimal plot sizes of plantings of carrot (Daucus carota L.) intercropped with arugula (Eruca sativa L.) in bi-cultivation in three spatial arrangements, as well as to determine bio-agroeconomic revenues from associations between these vegetable crops in a semi-arid region. Estimates of optimal sizes of experimental plots in intercropping systems, provided by the methods of bootstrap resampling and of sampling intensity (10%), were four, four and three basic units, respectively, for the spatial arrangements 2R:2C, 3R:3C, and 4R: 4C, between rows of arugula (R) intercropped with carrot (C), and by the Hatheway method, all spatial arrangements were of four basic units. The best bio-agroeconomic performance of carrot intercropped with arugula in bi-cultivation was obtained in the spatial arrangement 2R:2C.

À espera da seca que vem: capacidade adaptativa em comunidades rurais do semiárido / Waiting for the coming drought: adaptive capacity in rural communities of the Brazilian semiarid / Esperando de la sequía que viene: la capacidad de adaptación de las comunidades rurales en el Semiárido brasileño

Este artigo avalia a disponibilidade de recursos necessários para criação de capacidade adaptativa em comunidades rurais do semiárido brasileiro. A pesquisa utiliza dados primários obtidos por meio de aplicação de questionários. Dada a grande extensão geográfica da região, adota-se como recorte uma amostra de comunidades rurais inseridas em áreas susceptíveis à desertificação no Estado do Ceará. A discussão é feita a partir de um sistema de indicadores definido por meio de consultas a especialistas (método Delphi) e subdividido em quatro dimensões da capacidade adaptativa: capital social, capital econômico, capital humano e capital natural, pressupondo que a capacidade adaptativa é definida pela disponibilidade de um conjunto de recursos capazes de promover o bem-estar local. A análise da distribuição dos indicadores selecionados mostra que as comunidades possuem baixos níveis de recursos necessários para adaptação, sendo que os pontos mais críticos são destacados na dimensão de capital humano. No contexto observado acredita-se que as ações governamentais que poderiam melhorar a capacidade adaptativa das comunidades rurais do semiárido em relação às secas não encontram ambiente social propício para expressarem seu potencial, sendo o maior desafio a adoção de estratégias integradas de educação e capacitação da população que atuem de forma transversal em todas as políticas voltadas para o desenvolvimento local.

Abstract This article evaluates the availability of resources needed to create adaptive capacity in rural communities of the Brazilian semiarid. The research uses primary data obtained with the application of questionnaires. Given the large geographic extent of the region, rural communities inserted in areas susceptible to desertification of Ceará were selected to the sample. The discussion is made based on a system of indicators defined by consulting with experts (DELPHI - Methodology ), and divided into four dimensions of adaptive capacity: social capital, economic capital, human capital and natural capital, assuming that adaptive capacity is the availability of a set of resources to promote local welfare. The analysis of the distribution of selected indicators shows that communities have lower levels of resources needed for adaptation, and the critical points are highlighted in the human capital dimension. It is believed that government actions that could improve adaptive capacity of rural communities in the semiarid does not find user-friendly environment for expressing their potential. The biggest challenge is the adoption of integrated strategies for education, and training of the population, which act crosswise in all public policies aimed to local development.

Resumen Este artículo evalúa la disponibilidad de los recursos necesarios para crear la capacidad de adaptación de las comunidades rurales de la región semiárida de Brasil. La investigación utiliza datos primarios obtenidos mediante la aplicación de cuestionarios. Dada la gran extensión geográfica de la región, se adopta una muestra de comunidades rurales situadas en áreas propensas a la desertificación en el estado de Ceará. La discusión se produce a partir de indicadores definidos con consultas a expertos (Delphi) y divididos en cuatro dimensiones de la capacidad de adaptación: capital social, capital económico, capital humano y capital natural, suponiendo que la capacidad de adaptación se define como la disponibilidad de un conjunto de recursos que puede promover el bienestar de la población. El análisis de la distribución de los indicadores seleccionados muestra que las comunidades tienen niveles bajos de los recursos necesarios para la adaptación, y los puntos más críticos están en la dimensión del capital humano. Se cree que las acciones del gobierno que podrían mejorar la capacidad de adaptación de las comunidades rurales no encuentran un ambiente social propicio para expresar su potencial, siendo el mayor reto la adopción de estrategias integradas de educación y formación de la población actuando de de forma transversal en todas las políticas de desarrollo local.