An overview on the current available treatment for COVID-19 and the impact of antibiotic administration during the pandemic

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has caused several problems in healthcare systems around the world, as to date, there is no effective and specific treatment against all forms of COVID-19. Currently, drugs with therapeutic potential are being tested, including antiviral, anti-inflammatory, anti-malarial, immunotherapy, and antibiotics. Although antibiotics have no direct effect on viral infections, they are often used against secondary bacterial infections, or even as empiric treatment to reduce viral load, infection, and replication of coronaviruses. However, there are many concerns about this therapeutic approach as it may accelerate and/or increase the long-term rates of antimicrobial resistance (AMR). We focused this overview on exploring candidate drugs for COVID-19 therapy, including antibiotics, considering the lack of specific treatment and that it is unclear whether the widespread use of antibiotics in the treatment of COVID-19 has implications for the emergence and transmission of multidrug-resistant bacteria.

An overview on the current available treatment for COVID-19 and the impact of antibiotic administration during the pandemic.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has caused several problems in healthcare systems around the world, as to date, there is no effective and specific treatment against all forms of COVID-19. Currently, drugs with therapeutic potential are being tested, including antiviral, anti-inflammatory, anti-malarial, immunotherapy, and antibiotics. Although antibiotics have no direct effect on viral infections, they are often used against secondary bacterial infections, or even as empiric treatment to reduce viral load, infection, and replication of coronaviruses. However, there are many concerns about this therapeutic approach as it may accelerate and/or increase the long-term rates of antimicrobial resistance (AMR). We focused this overview on exploring candidate drugs for COVID-19 therapy, including antibiotics, considering the lack of specific treatment and that it is unclear whether the widespread use of antibiotics in the treatment of COVID-19 has implications for the emergence and transmission of multidrug-resistant bacteria.

Access to Liver Transplantation in Different ABO-Blood Groups and "Exceptions Points" in a Model for End-Stage Liver Disease Allocation System: A Brazilian Single-Center Study.

BACKGROUND: In the Model for End-Stage Liver Disease (MELD) system, patients with "MELD exceptions" points may have unfair privilege in the competition for liver grafts. Furthermore, organ distribution following identical ABO blood types may also result in unjust organ allocation. The aim of this study was to investigate access to liver transplantation in a tertiary Brazilian center, regarding "MELD exceptions" situations and among ABO-blood groups. METHODS: A total of 465 adult patients on the liver waitlist from August 2015 to August 2016 were followed up until August 2017. Patients were divided into groups according to ABO-blood type and presence of "exceptions points." RESULTS: No differences in outcomes were observed among ABO-blood groups. However, patients from B and AB blood types spent less time on the list than patients from A and O groups (median, 46, 176, 415, and 401 days, respectively; P = .03). "Exceptions points" were granted for 141 patients (30.1%), hepatocellular carcinoma being the most common reason (52.4%). Patients with "exceptions points" showed higher transplantation rate, lower mortality on the list, and lower delta-MELD than non-exceptions patients (56.7% vs 19.1% [P < .01]; 18.4% vs 38.5% [P < .01], and 2.0 ± 2.6 vs 6.9 ± 7.0 [P < .01], respectively). Patients with refractory ascites had a higher mortality rate than those with other "exceptions" or without (48%). CONCLUSIONS: The MELD system provides equal access to liver transplantation among ABO-blood types, despite shorter time on the waitlist for AB and B groups. The current MELD exception system provides advantages for candidates with "exception points," resulting in superior outcomes compared with those without exceptions.

Better Selection Criteria With Prognostic Factors for Liver Transplantation.

BACKGROUND: Liver transplantation has evolved significantly in recent years, with each advancement part of the effort toward increasing patient and graft survival as well as quality of life. The objective of this study was to evaluate the prognostic factors and selection criteria for liver transplantation. METHODS: Our study was a statistical analysis, logistic regression, and survival evaluation of a total of 80 liver transplants that were performed between June 1, 2016 and September 24, 2016. Recipient factors evaluated included age, retransplantation, hemodialysis, cardiac risk, portal vein thrombosis, hospitalization, fulminant hepatitis, previous surgery, renal failure, and Model for End-stage Liver Disease (MELD) score. Donor factors included age, cardiac arrest, acidosis, days in the intensive care unit, steatosis, and vasoactive drug use. RESULTS: Of the 80 patients transplanted, 65 deceased donor liver transplants (DDLTs) and 15 living donor liver transplants (LDLTs) were performed. LDLT overall 1-year patient survival was 77.5% and graft survival 75%, and DDLT overall patient survival was 89.23% and graft survival was 86.15%. On evaluated score criteria analyzed we observed a significant score on recipient (P = .01) and not significant on donor (P =.45). Isolated factors evaluated included recipient age (relative risk [RR] 3.15, 95% confidence interval [CI] 0.89 to 11.09; P = .074), retransplant (RR 4.22, 95% CI 1.36 to 13.1; P = .013), and hemodialysis (RR 4.23, 95% CI 1.45 to 12.31, P = .008). On donor evaluation, we observed moderate and severe steatosis (RR 3.8, 95% CI 0.86 to 16.62; P = .06). CONCLUSION: In conclusion, we demonstrate a relevant model of criteria selection of liver transplant patients that is able to make a better match between the donor and recipient allocation for a better graft and patient survival.

Long-distance transport of hair lambs: effect of location in pot-belly trailers on thermo-physiology, welfare and meat quality.

Livestock transport exposes animals to a range of potential stressors that may compromise their welfare and final product quality, and those effects typically increase with the distance travelled. In North America, producers often use pot-belly vehicles for long hauls but little is known about their suitability for transporting lambs. We followed two long-distance trips using pot-belly trailers carrying 500 lambs (each) from Northern to Central Mexico in winter, to measure possible effects on animal welfare and meat quality. Sixty lambs per trip were placed at different locations within the pot-belly trailer. Animals were equipped with iButton Thermochron® temperature devices, which registered body temperature throughout pre- and post-slaughter stages. Despite the rather cool winter conditions, lambs placed in the "belly" and "nose" compartments had higher body temperatures at loading, during transport and lairage and after slaughter (carcass temperature). Those lambs also had higher levels of plasma cortisol, glucose and creatine kinase (CK), and a higher neutrophil/lymphocyte ratio. Regarding meat quality, ultimate pH (24 h) was higher in all locations, especially in LT4 location. Overall, the results suggest a link between thermal stress during transport, elevated physiological indicators of stress and poorer meat quality.

The absence of birthweight paradox as a marker of disadvantages faced by low maternal education children.

Background: This study tested the hypothesis that the birthweight paradox would not be observed when assessing the effect of maternal education on neonatal mortality in the presence of socioeconomic inequality in access to health care. Methods: Non-concurrent cohort study. Passive follow-up of live-born infants using probabilistic record linkage of birth and death records for Rio de Janeiro (2004-2010; n = 1 445 367). Maternal age, birthweight and neonatal death were evaluated according to maternal educational level strata (<4, 4-11 and ≥12 years of study). We estimated the association between maternal educational level and neonatal mortality using logistical regression models adjusted for maternal age and birthweight (<2500 g and ≥2500 g). Results: Neonatal mortality was 1.8 times higher in low educational level group compared with high educational level. We did not find birthweight-specific mortality curves crossing over in the stratum under 2500 g (birthweight paradox). The odds of a low birthweight child being born in facilities without neonatal intensive care units was about 70% higher in the group of low education when compared with mothers with high education. Conclusions: The absence of crossing birthweight-specific mortality curves may be a reason for concern about the severity of the disadvantages faced by low maternal education women.

Modified Sugiura Operation for Idiopathic Portal Hypertension with Bleeding Oesophageal Varices. A Case Report.

A case of a 36 years old man presenting massive upper GI bleeding due to oesophageal varices developed in the context of an idiopathic portal cavernoma and extensive porto-splenic thrombosis is discussed. He underwent a successful modified Sugiura operation (oesophago-gastric devascularisation and splenectomy [OGDS]) completed with interventional endoscopic treatment of residual oesophageal varices. The benefit of the modified Sugiura procedure proposed for the treatment of upper GI variceal bleeding developed in the context of splanchnic venous thrombosis is discussed. The procedure is a valid therapy in the treatment of symptomatic extra-hepatic hypertension when other options are inapplicable.

Quantification of ruminal microbiota and production of methane and carbonic dioxide from diets with inclusion of glycerin / Quantificação da microbiota ruminal e produção de metano e gás carbônico de dietas com inclusão de glicerina

The aim of this study was to quantify the liquid-associated bacteria and protozoa of the rumen and to evaluate the potential of in vitro production of gases CH4 and CO2 of diets with inclusion of glycerin for sheep. Two diets were formulated with a roughage:concentrate ratio of 20:80, according to the presence or absence of glycerin: G0 - control, without glycerin; and G10 - 10% glycerin as part of the concentrate. To quantify the liquid-associated bacteria and protozoa from the rumen and production of CH4 and CO2 gases, a completely randomized design was used. The diets had no effect (P>0.05) on production and composition of liquid-associated protozoa and bacteria from the rumen of lambs. Likewise, a (P>0.05) diet effect was not observed on production of CH4 and CO2 in vitro, which presented average concentrations of 24.55mL/g MS and 51.52mL/g MS, respectively. The use of 10% glycerin did not alter production or composition of ruminal microflora, and moreover, did not negatively impact the production of CH4 and CO2 gases in vitro.

Objetivou-se com este estudo quantificar as bactérias e protozoários líquido-associados do rúmen e avaliar o potencial de produção dos gases CH4 e CO2 in vitro de dietas com inclusão de glicerina para ovinos. Duas dietas foram formuladas, na proporção volumoso:concentrado de 20:80, conforme a presença ou ausência de glicerina: G0 - controle sem glicerina, G10 - 10% glicerina como parte do concentrado. Para a quantificação das bactérias e protozoários líquido-associados do rúmen e produção dos gases CH4 e CO2, utilizou-se o delineamento inteiramente ao acaso. Não foi observado efeito de dieta (P>0,05) sobre a produção e composição de protozoários e bactérias líquido-associados do rúmen de cordeiros. Da mesma forma, não houve efeito de dieta (P>0,05) sobre a produção de CH4 e CO2 in vitro, os quais apresentaram concentrações médias de 24,55mL/g MS e 51,52mL/g MS, respectivamente. O uso de 10% glicerina não altera a produção ou composição da microflora ruminal, e também não impacta negativamente a produção dos gases CH4 e CO2 in vitro.

Manejo pré-abate de ovelhas de descarte: perdas de peso corporal, qualidade da carne e comportamento animal / Pre-slaughter management of discard ewes: body weight losses, meat quality and animal behavio

Objetivou-se com este estudo conhecer o comportamento de ovelhas da raça Santa Inês em diferentes estágios fisiológicos durante o manejo pré-abate, assim como a perda de peso corporal, valores de hematócrito do sangue das mesmas e a qualidade da carne. Utilizaram-se 21 ovelhas de descarte, que foram distribuídas nos respectivos tratamentos: T1 = ovelhas que permaneceram por 60 dias em lactação com seus respectivos cordeiros e abatidas um dia após o desmame dos mesmos; T2 = ovelhas que permaneceram por 60 dias em lactação com seus respectivos cordeiros e mais um período aproximado de 30 dias sem os cordeiros e posteriormente foram abatidas; e T3 = ovelhas que permaneceram por 60 dias em confinamento e que não pariram durante o ano. O peso das ovelhas após o transporte foi menor para as do tratamento 1 em comparação às do tratamento 2. Os valores de hematócrito no sangue das ovelhas antes do transporte, após o mesmo e após o jejum dos animais no curral de espera não diferiram entre si, com valor médio de 58,50%. Concluiu-se que a qualidade da carne proveniente de ovelhas de descarte em diferentes estágios fisiológicos não é alterada pelo manejo pré-abate, quando realizado de maneira correta (evitando o estresse animal), quanto ao pH da carne.

The aim of this study was to know the behavior of Santa Inês ewes in different physiological stages during the pre-slaughter management, as well as their body weight loss, blood hematocrit values and meat quality. 21 discard ewes were used, arranged into the following treatments: T1 = ewes which remained in lactation for 60 days with their respective lambs and slaughtered one day after weaning; T2 = ewes which remained in lactation for 60 days with their respective lambs and one more period of approximately 30 days without the lambs and afterwards slaughtered; and T3 = ewes which remained in confinement for 60 days and did not give birth during the year. The weight of ewes after transportation was lower for T1 in comparison with T2. Blood hematocrit values of ewes before and after transportation and after fast in the waiting pen were not different among the treatments, with mean value of 58.50%. We concluded that the quality of meat of discard ewes in different physiological stages is not altered by pre-slaughter management, when correctly performed (avoiding animal stress), concerning meat pH.

Beef quality of young Angus×Nellore cattle supplemented with rumen-protected lipids during rearing and fatting periods.

This work evaluated the beef quality parameters of 108 bulls randomly administered to three treatments during rearing in pastures and two treatments during fatting in feedlots, including mineral and rumen-protected lipids. Meat and fat color, cooking yield, shear force, sensorial traits and chemical and fatty acid compositions were evaluated. Generally, the beef quality parameters were not affected by the rumen protected lipids; however, supplementation with rumen-protected lipids during the rearing period yielded darker beef and brighter fat and increased beef tenderness in meat aged for 28days compared to the meat from animals that received only mineral supplementation. In addition, the percent of meat polyunsaturated fatty acids was negatively affected by the inclusion of protected lipids, yielding 5.58 and 3.72% in animals fed with and without rumen-protected lipids, respectively, during the fatting period.

Ten years' evaluation of potential pancreas donors in São Paulo, Brazil.

BACKGROUND: Pancreas transplantation is a treatment for advanced type 1 diabetes and offers significant improvement in quality of life. Recent advances in surgical techniques and immunosuppression regimes lead to good outcomes. However, despite significant higher rates of multiorgan donors in Brazil, pancreas transplantation seems to have remained stable. This study aimed to investigate the acceptance rate of potential pancreas donors in the past 10 years in São Paulo State. METHODS: We retrospectively evaluated potential pancreas donors characteristics and its acceptance rate in São Paulo State in the past 10 years. We divided this period into 2 eras: 1st era from January 2003 to January 2008; and 2nd era from January 2008 to January 2013. Data were obtained from São Paulo's government official website. RESULTS: During the whole period, 5,005 deceased donors of all ages were available for pancreas transplantation. According to eras, we had 1,588 donors in the 1st and 3,417 in the 2nd era. In the 2nd era, donors >49 years old were significantly more common (P < .001). Blood test abnormalities, donor comorbidities, and high dosage of vasopressors also were significantly higher in the 2nd era. Rate of graft acceptance had a significant decrease in the 2nd era, from 46.4% to 25% (P < .05). CONCLUSIONS: Despite greater organ availability, pancreas transplantations performed in São Paulo State remained stable. Rate of graft acceptance is dramatically lower in more recent years.

Aceitação sensorial e composição centesimal da carne de ovelhas abatidas em diferentes estágios fisiológicos / Sensorial acceptance and centesimal composition in the meat of ewes slaughtered in different physiological stages

Estudaram-se a composição centesimal do músculo Longissimuslumborum e a aceitação sensorial do músculo Longissimus thoracis, provenientes de ovelhas de descarte da raça Santa Inês, abatidas em distintos estágios fisiológicos. Foram utilizadas 21 ovelhas, distribuídas nos seguintes grupos: OL = ovelhas que permaneceram por 60 dias em lactação com seus respectivos cordeiros e que foram abatidas um dia após o desmame deles; OSC = ovelhas que permaneceram por 60 dias em lactação com seus respectivos cordeiros e mais um período aproximado de 30 dias sem os cordeiros e que, posteriormente, foram abatidas; e ONP = ovelhas que não pariram durante o ano. Os teores de proteína e de cinzas da carne ovina foram semelhantes entre os grupos experimentais, e os valores de umidade e de gordura da carne diferiram entre os grupos. Não houve diferença significativa na aceitação sensorial da carne, segundo os grupos. Concluiu-se que o abate de ovelhas de descarte em diferentes estágios fisiológicos promove alteração na composição centesimal, quanto ao teor de gordura e de umidade da carne, e que não há diferença da aceitação sensorial da carne, de acordo com os grupos experimentais.

The objective of this research was to know the centesimal composition of the Longissimus lumborum muscle and the sensorial quality of the Longissimus thoracis muscle, proceeding from Santa Inês discard ewes slaughtered in distinct physiological stages. 21 ewes were used, arranged into the following groups: EL = ewes which remained in lactation for 60 days with their respective lambs and slaughtered one day after weaning; EWL = ewes which remained in lactation for 60 days with their respective lambs for one more period of approximately 30 days without the lambs and slaughtered afterwards; and ENC = ewes which did not give birth during the year. Protein and ashes contents of the sheep meat were close to each other among experimental groups; however, moisture and fat values of the meat were different among them. Significant difference was not found in the sensorial evaluation of the meat proceeding from the distinct groups. It is concluded that the slaughter of discard ewes in different physiological stages promotes alteration in the centesimal composition of the meat concerning its fat and moisture content and there is no difference in the sensorial quality of the meat in the distinct experimental groups.

Modifying effect of prenatal care on the association between young maternal age and adverse birth outcomes.

OBJECTIVES: The objectives were to investigate the prevalence of adverse birth outcomes according to maternal age range in the city of Rio de Janeiro, Brazil, in 2002, and to evaluate the association between maternal age range and adverse birth outcomes using additive interaction to determine whether adequate prenatal care can attenuate the harmful effect of young age on pregnancy outcomes. METHODS: A cross-sectional analysis was performed in women up to 24 years of age who gave birth to live children in 2002 in the city of Rio de Janeiro. To evaluate adverse outcomes, the exposure variable was maternal age range, and the outcome variables were very preterm birth, low birth weight, prematurity, and low 5-minute Apgar score. The presence of interaction was investigated with the composite variable maternal age plus prenatal care. The proportions and respective 95% confidence intervals were calculated for adequate schooling, delivery in a public maternity hospital, and adequate prenatal care, and the outcomes according to maternal age range. The chi-square test was used. The association between age range and birth outcomes was evaluated with logistic models adjusted for schooling and type of hospital for each prenatal stratum and outcome. Attributable proportion was calculated in order to measure additive interaction. RESULTS: Of the 40,111 live births in the sample, 1.9% corresponded to children of mothers from 10-14 years of age, 38% from 15-19 years, and 59.9% from 20-24 years. An association between maternal age and adverse outcomes was observed only in adolescent mothers with inadequate prenatal care, and significant additive interaction was observed between prenatal care and maternal age for all the outcomes. CONCLUSION: Adolescent mothers and their newborns are exposed to greater risk of adverse outcomes when prenatal care fails to comply with current guidelines.

Delay from fracture to hospital admission: a new risk factor for hip fracture mortality?

UNLABELLED: The relationship between surgical timing and hip fracture mortality is unknown in the context of developing countries where large delays to surgery are common. We observed that delay from fracture to hospital admission is associated with decreased survival after a hip fracture. INTRODUCTION: To examine the relationship between the time interval from fracture to surgery as well as its subcomponents (time from fracture to hospital admission and time from admission to surgery) and hip fracture survival. METHODS: The medical records of all patients aged 60 years and older admitted to a public university hospital in the city of Rio de Janeiro with a primary diagnosis of hip fracture between 1995 and 2000 were reviewed. Survival to hospital discharge and at 1 year were examined. RESULTS: Among 343 patients included in the study, there were 18 (5.3%) in-hospital deaths, and 297 (86.6%) patients remained alive 1 year after surgery. Very long delays from the time of fracture to hospital admission (mean 3 days) and from hospital admission to surgery (mean 13 days) were identified. Increased time from fracture to hospital admission was associated with reduced survival to hospital discharge (hazard ratio [HR] 1.09, 95% CI 1.03-1.15, p = 0.005) and reduced survival at 1 year after surgery (HR 1.07, 95% CI 1.03-1.10, p < 0.001). The interval of time from hospital admission to surgery was not associated with reduced survival to hospital discharge (HR 1.03, 95% CI 0.96-1.10, p = 0.379) or at 1 year after surgery (HR 1.03, 95% CI 0.99-1.07, p= 0.185). CONCLUSIONS: If the association estimated in our study is causal, our results provide evidence that some hip fracture-related deaths could be prevented by improved patient access to appropriate and timely hospital care in the context of a developing country.

Management of uncommon hernias in cirrhotic patients.

BACKGROUND: Abdominal hernias are a common disease among cirrhotic patients, because of malnutrition and persistently high intra-abdominal pressure due to ascites. When tense ascites is present, life-threatening complications are likely to occur. In such cases, the morbidity and mortality rates are high. OBJECTIVE: We describe 3 cirrhotic patients with rare complicated hernias that needed surgical repair. We discuss optimal timing for surgical approaches and the necessity of ascites control before surgery, as well as the technical details of the procedures. METHOD: Review of hospital charts of selected rare cases of herniae in cirrhotic patients. CONCLUSION: Elective surgical approaches can treat even uncommon hernias in cirrhotic patients with good results.

Coloração da gordura e qualidade da carne de ovelhas de descarte abatidas em distintos estágios fisiológicos / Fat coloring and meat quality of culling ewes slaughtered at distinct physiological stages

Avaliaram-se a qualidade física do músculo Longissimus lumborum de ovelhas de descarte da raça Santa Inês, abatidas em diferentes estágios fisiológicos, a cor da gordura subcutânea desse músculo e as possíveis correlações entre as variáveis de qualidade da carne. Utilizaram-se 21 ovelhas, distribuídas nos seguintes tratamentos: T1= ovelhas que permaneceram por 60 dias em lactação com seus respectivos cordeiros e abatidas um dia após o desmame das crias; T2= ovelhas que permaneceram por 60 dias em lactação com seus respectivos cordeiros e mais um período aproximado de 30 dias sem os cordeiros e posteriormente abatidas; e T3= ovelhas que não pariram durante o ano. A cor da carne e da gordura subcutânea não foram influenciadas pelo estágios fisiológico dos animais no momento do abate, com exceção da luminosidade da carne (T1= 41,13; T2= 37,56 e T3= 38,12 L*). A qualidade física da carne apresentou pouca variação entre os tratamentos, porém a força de cisalhamento (T1= 4,08; T2=2,86 e T3=2,35 kgf/cm²) e as perdas por cocção (T1=31,97; T2=35,70 e T3= 31,91 por cento) da carne diferiram entre os tratamentos. Não se observou alta correlação entre a maioria das características avaliadas.

The physical quality of the Longissimus lumborum muscle of Santa Inês culled ewes slaughtered at different physiological stages was evaluated as well as the color of the subcutaneous fat of the same muscle, and the correlations between meat quality traits. Twenty-one ewes were randomly allotted in the following treatments: T1= ewes which remained in lactation for 60 days with their respective lambs and slaughtered one day after weaning of the lambs; T2= ewes which remained in lactation for 60 days with their respective lambs, followed by an additional period of 30 days without the lambs and slaughtered afterwards; and T3= non pregnant ewes. The colors of meat and subcutaneous fat were not influenced by the physiological stage of the animals at the moment of slaughtering, except meat luminosity (T1= 41.13; T2= 37.56 and T3= 38.12 L*) . The physical quality of the meat presented little variation between treatments; however, shear force (T1= 4.08; T2=2.86 and T3=2.35 kgf/cm2) and losses by cooking (T1=31.97; T2=35.70 and T3= 31.91 percent) were affected by treatments. No high correlation between most of the evaluated traits was observed.

Mortality within 1 year after hip fracture surgical repair in the elderly according to postoperative period: a probabilistic record linkage study in Brazil.

OBJECTIVE: The purpose of this study was to assess, by applying probabilistic record linkage (PRL) methodology, the excess mortality and underlying causes of death in a cohort of elderly patients who underwent hip fracture surgical repair during 1995 in Rio de Janeiro, Brazil. DISCUSSION: We searched the Brazilian Hospital Admission Information System (HAIS) for the city of Rio de Janeiro, identifying all cases of elderly patients who had hip fracture surgery between January 1 and December 31, 1995, and by means of the PRL methodology and RecLink software, crosslinked those data with the Brazilian Mortality Information System (MIS) for the same region for a follow-up period of 1 year. We calculated age- and gender-adjusted standardized mortality ratios (SMR) for three periods of time-1-30 days, 31-90 days, and 91-365 days after hospital admission-and analyzed the basic cause of death as reported in the death certificates and noted the death occurred at the index admission or after hospital discharge. RESULTS: We found an overall 21.5% (95% CI 18.2-24.9) mortality rate in 1 year and a statistically significant SMR of 1,080 (95% CI 794-1450) and 512.8 (95% CI 366.4-698.3) for the first two periods, 1-30 days and 31-90 days after hospital admission, respectively. For the last period the SMR displayed a statistically nonsignificant trend of 137 (95% CI 99-183). Even in the first 15 days after the index hospital admission, most deaths (55.1%) occurred after hospital discharge, reinforcing the importance of linking hospital mortality databases with general population mortality information systems. The leading three basic causes of death, as reported in death certificates, were cardiovascular events, falls, and infections. This study represents an example of the application of PRL methodology to produce relevant data on hip fracture, a subject of rising epidemiological importance in developing countries.

Accessibility of selected hospitals and medical procedures by means of aerial and transit network-based measures.

OBJECTIVE: This report investigates the use of linear and travelled route (transit network-based) distances in estimating the accessibility of hospitals to patients, for some selected hospital admission diagnostics. METHODS: For patients admitted to 14 public hospitals in Rio de Janeiro City, during 1996, under the ICD-9 headings "Complications of Pregnancy, Childbirth and the Puerperium" and "Disorders of the Circulatory System", average distances between the patient's district of residence and hospital of admission were calculated (both as Euclidean and as network-based distances). Data were obtained from the country's public health data processing agency. Geographic co-ordinates were obtained for districts of residence from the postal codes of the patients' residences. Distances were estimated with the TransCAD Geographical Information System, based on a map of the city transit network. There were 8654 patients admitted under the "Complications of Pregnancy" heading and 3439 under "Disorders of Circulatory System". RESULTS: Variations of up to a factor of 5.3, and up to 34 km, could be identified between linear and network estimates. CONCLUSION: While recognizing that network estimates have advantages, the literature on accessibility frequently argues that aerial estimates are a good approximation for those. The present results show that this is not necessarily the case.