Qualifying information on deaths and serious injuries caused by road traffic in five Brazilian capitals using record linkage.

INTRODUCTION: Road traffic crashes (RTC) are an important public health problem, accounting for 1.2 million deaths per year worldwide. In Brazil, approximately 40,000 deaths caused by RTC occur every year, with different trends in the Federal Units. However, these figures may be even greater if health databases are linked to police records. In addition, the linkage procedure would make it possible to qualify information from the health and police databases, improving the quality of the data regarding underlying cause of death, cause of injury in hospital records, and injury severity. OBJECTIVE: This study linked different data sources to measure the numbers of deaths and serious injuries and to estimate the percentage of corrections regarding the underlying cause of death, cause of injury, and the severity injury in victims in matched pairs from record linkage in five representative state capitals of the five macro-regions of Brazil. METHODS: This cross-sectional, population-based study used data from the Hospital Information System (HIS), Mortality Information System (MIS), and Police Road Traffic database of Belo Horizonte, Campo Grande, Curitiba, Palmas, and Teresina, for the year 2013 for Teresina, and 2012 for the other capitals. RecLink III was used to perform probabilistic record linkage by identifying matched pairs to calculate the global correction percentage of the underlying cause of death, the circumstance that caused the road traffic injury, and the injury severity of the victims in the police database. RESULTS: There was a change in the cause of injury in the HIS, with an overall percentage of correction estimated at 24.4% for Belo Horizonte, 96.9% for Campo Grande, 100.0% for Palmas, and 33.2% for Teresina. The overall percentages of correction of the underlying cause of death in the MIS were 29.9%, 11.9%, 4.2%, and 33.5% for Belo Horizonte, Campo Grande, Curitiba, and Teresina, respectively. The correction of the classification of injury severity in police database were 100.0% for Belo Horizonte and Teresina, 48.0% for Campo Grande, and 51.4% for Palmas after linkage with hospital database. The linkage between mortality and police database found a percentage of correction of 29.5%, 52.3%, 4.4%, 74.3 and 72.9% for Belo Horizonte, Campo Grande, Palmas, Curitiba and Teresina, respectively in the police records. CONCLUSIONS: The results showed the importance of linking records of the health and police databases for estimating the quality of data on road traffic injuries and the victims in the five capital cities studied. The true causes of death and degrees of severity of the injuries caused by RTC are underestimated in the absence of integration of health and police databases. Thus, it is necessary to define national rules and standards of integration between health and traffic databases in national and state levels in Brazil.

Leptin, a mediator of cardiac damage associated with obesity.

Obesity and excess of adipose tissue are associated with the development of cardiovascular risk factors such as diabetes, hypertension, and hyperlipidemia. At the cardiac level, various morphological adaptations in cardiac structure and function occur in obese individuals. Different mechanisms linking obesity to these modifications have been postulated. Adipose tissue and epicardial fat releases a large number of cytokines and bioactive mediators such as leptin. Leptin circulates in proportion to body fat mass, thus serving as a satiety signal and informing central metabolic control centers as to the status of peripheral energy stores. It participates in numerous other functions both peripherally and centrally, as indicated by the wide distribution of leptin and the different isoforms of its receptor in different tissues including the heart. This hormone has distinct effects on the reproductive, cardiovascular, and immune systems; however, its role in the heart could mediate wide physiological effects observed in obese individuals. Oxidative stress is associated with obesity and may be considered to be a unifying mechanism in the development of obesity-related comorbidities. It has been reported that obesity may induce systemic oxidative stress; in turn, oxidative stress is associated with an irregular production of adipokines. We herein review the current knowledge of cardiac effects of leptin and the possible mechanisms that are involved, including oxidative stress that plays a major role in the development of cardiovascular damage.

The potential role of leptin in the vascular remodeling associated with obesity.

BACKGROUND/OBJECTIVES: Extracellular matrix (ECM) participates in the vascular remodeling associated with obesity. We investigated the effects of leptin on the production of ECM components in primary cultured vascular smooth muscle cells (VSMCs) and whether leptin could be a mediator of obesity-induced vascular remodeling. METHODS: T he effects of leptin (100 ng ml(-1)) on ECM components and superoxide anion production (O(2)(.-)) were evaluated in presence or absence of the antioxidant melatonin (10(-)(3) mmol l(-1)) or the inhibitor of phosphatidylinositol 3'-kinase (PI3K), LY294002 (2 × 10(-)(4) mmol l(-1)) in VSMCs from adult rats in order to explore the role of both oxidative stress and the participation of PI3K/Akt pathway in the effects of leptin. ECM components and O(2)(.-) were quantified in the aortic media of male Wistar rats fed a high-fat diet (HFD; 33.5% fat), or a standard diet (CT; 3.5% fat) for 6 weeks. RESULTS: In VSMCs, leptin enhanced gene and protein levels of collagen I, fibronectin, transforming growth factor (TGF)-ß and connective tissue growth factor (CTGF) but did not change those of collagen III and galectin-3. Leptin also increased O(2)(.-) and Akt phosphorylation in VSMCs. These effects were prevented by the presence of either melatonin or LY294002, except O(2)(.-) production in the case of PI3K inhibition. The increase in body weight in HFD rats was accompanied by aorta thickening due to an increase in media area. The aortic fibrosis observed in HFD rats was associated with high levels of leptin, collagen type I, fibronectin, TGF-ß, CTGF, phosphorylated Akt and O(2)(.-). Aortic leptin levels were positively correlated with total collagen, collagen I, TGF-ß and CTGF levels. No differences were observed in the levels of collagen III, elastin or galectin-3 between both the groups. CONCLUSIONS: Leptin could participate in the vascular remodeling and stiffness associated with obesity by ECM production in VSMCs through the activation of oxidative stress-PI3K/Akt pathway and the production of the profibrotic factors TGF-ß and CTGF.

Study of hyperglycemia in non critically-ill patients receiving parenteral nutrition; incidence and risk factors / Estudio de hiperglicemia en pacientes no críticos tratados con nutrición parenteral; incidencia y factores de riesgo

Background: The objectives of our study on non-critically ill patients receiving parenteral nutrition (PN) are to assess the incidence of hyperglycemia, the risk factors associated to its development and its influence in patient's evolution. Methods: A multicentric prospective observational study was performed in 9 hospitals. Four multivariate studies were developed to study the temporal risk in the occurrence of hyperglycemia (endpoint), intensive care unit (ICU) admission, length of stay (LOS) and death. Demographics, nutrients, drugs and clinical variables were collected. Independent variables studied as a possible risk factors were: sex, diabetes mellitus 2, baseline glycemia, albuminemia, pancreatitis, surgery in the 7 days prior to the end point, infection, insulin/somatostatin/corticoids administration during the study, glomerular filtration rate (GFR), and difference in the amount of glucose administration between the endpoint and one day before. Results: 119 patients were enrolled in the study, 25 cases of hyperglycemia were detected. In the clinical factors associated with PN hyperglycemia, significant variables were: surgery in the 7 days before the end point, GFR, glucose load in the 24 hours previous to the end point insulin administration and somatostatine/octreotide (AU)

Antecedentes y objetivo: El estudio está dirigido a pacientes no críticos tratados con nutrición parenteral (NP) y tiene como objetivo evaluar la incidencia de hiperglucemia, los factores de riesgo asociados a su aparición y su influencia sobre su evolución clínica. Métodos: Estudio multicéntrico prospectivo y observacional en 9 hospitales. Se construyeron 4 modelos multivariantes para estudiar el riesgo de aparición de hiperglucemia (evento final), el ingreso en cuidados intensivos (UCI), el tiempo de hospitalización y muerte. Se recogieron variables demográficas, de nutrientes aportados, medicación y variables clínicas. La variables independientes estudiadas como posibles factores de riesgo fueron: sexo, diabetes mellitus tipo 2, glucemia basal, pancreatitis, cirugía en los 7 días previos al evento final, infección, administración durante el estudio de insulina/somatostatina/corticoides, nivel de filtración glomerular (GFR) y las diferencias entre el aporte de glucosa administrada entre el evento final y el día previo. Resultados: Se incluyeron 119 pacientes, de los cuales 25 presentaron hiperglucemia. Entre los factores clínicos asociados a la aparición de hiperglucemia, las variables significativas fueron: la cirugía en los 7 días previos al evento final, GFR, carga de glucosa en las 24 horas previas al evento final, administración de insulina y de somatostatina/octreotido. La hiperglucemia se asoció significativamente al ingreso en UCI y a la estancia hospitalaria. Conclusión: La administración de glucosa en pacientes no críticos en tratamiento con NP debería ser reevaluada con criterios restrictivos, especialmente en el postoperatorio inmediato, en insuficiencia renal y en pacientes tratados con análogos de la somatostatina. Debería tenerse en cuenta que los incrementos del aporte de glucosa se asocian a hiperglucemia, y esta se correlaciona con un incremento de la estancia hospitalaria y a una mayor frecuencia de ingresos en UCI (AU)

Study of hyperglycemia in non critically-ill patients receiving parenteral nutrition: incidence and risk factors.

BACKGROUND: The objectives of our study on non-critically ill patients receiving parenteral nutrition (PN) are to assess the incidence of hyperglycemia, the risk factors associated to its development and its influence in patient's evolution. METHODS: A multicentric prospective observational study was performed in 9 hospitals. Four multivariate studies were developed to study the temporal risk in the occurrence of hyperglycemia (endpoint), intensive care unit (ICU) admission, length of stay (LOS) and death. Demographics, nutrients, drugs and clinical variables were collected. Independent variables studied as a possible risk factors were: sex, diabetes mellitus 2, baseline glycemia, albuminemia, pancreatitis, surgery in the 7 days prior to the end point, infection, insulin/somatostatin/corticoids administration during the study, glomerular filtration rate (GFR), and difference in the amount of glucose administration between the endpoint and one day before. RESULTS: 119 patients were enrolled in the study, 25 cases of hyperglycemia were detected. In the clinical factors associated with PN hyperglycemia, significant variables were: surgery in the 7 days before the end point, GFR, glucose load in the 24 hours previous to the end point insulin administration and somatostatine/octreotide administration during the study. Hyperglycemia was significantly associated with ICU admission and increased LOS. CONCLUSIONS: Glucose administration in non-critically ill patients receiving PN should be reassessed downwards, especially in the immediate postsurgery, renal impairment and in patients treated with somatostatin analogues. It should be taken into account that an increase in glucose dose may lead to hyperglycemia in these patients and hyperglycemia correlates with longer hospital stay and increased frequency of ICU admissions.

Effect of eplerenone on hypertension-associated renal damage in rats: potential role of peroxisome proliferator activated receptor gamma (PPAR-γ).

UNLABELLED: Several factors, including mineralocorticoids, have been implicated in the renal damage associated with hypertension. Peroxisome proliferator activated receptor gamma (PPAR-γ) agonists improve renal damage associated with different pathologies. Therefore, our hypothesis was that mineralocorticoid receptor blockade ameliorates renal damage associated with hypertension and that this improvement may be mediated by PPAR-γ. Spontaneously hypertensive rats (SHR) were treated with either vehicle or eplerenone, a mineralocorticoid receptor antagonist, at two different doses: 30 and 100 mg/kg/day for 10 weeks. Age-matched Wistar Kyoto rats (WKY) were used as a normotensive reference group. SHR showed tubulointersticial fibrosis and mild tubular atrophy. These alterations were accompanied by increases in renal cortex gene expression of transforming growth factor beta (TGF-ß) connective tissue growth factor (CTGF) and phosphorylated Smad2 protein levels, factors involved in the fibrotic response. Interleukin 1-beta (IL-1ß) and tumor necrosis factor alpha (TNF-α) gene expression were also increased. By contrast, lysyl oxidase (LOX) expression and PPAR-γ protein levels were decreased in SHR as compared with normotensive animals. Only the high dose of eplerenone was able to reduce blood pressure and partially prevent LOX down-regulation in SHR. Both eplerenone doses significantly ameliorated interstitial fibrosis and tubular atrophy, reduced TGF-ß, CTGF and cytokine gene expression, and decreased Smad2 activation, while normalizing PPAR-γ protein levels. CONCLUSIONS: Mineralocorticoid receptor activation participates in hypertension-associated renal damage. This effect seems to involve stimulation of both fibrotic and inflammatory processes mediated (at least in part) by a down-regulation of PPAR-γ that can favour an up-regulation of the TGF-ß/Smad signalling pathway.

Papel de la aldosterona en las alteraciones vasculares funcionales y en el proceso inflamatorio asociados a la hipertensión en ratas / Role of aldosterone in vascular functional alterations and the inflammatory process associated to hypertension in rats

Objetivos: Estudiar la participación de la aldosterona en la disfunción vascular, el proceso inflamatorio y estrés oxidativo vascular asociado a hipertensión. Material y método: Se utilizaron ratas (n = 16) espontáneamente hipertensas (SHR) de 22 semanas de edad. La mitad de las ratas fueron tratadas durante 10 semanas con eplerenona a una dosis de 30 mg/kg/día (E-30). Se utilizaron ratas (n = 8) normotensas (WKY) como grupo de referencia. La presión arterial se midió de manera indirecta en la arteria caudal de la cola de las ratas. Al final del tratamiento las ratas se sacrificaron y se pesaron los corazones. Se evaluó la función endotelial en anillos aórticos en respuesta a la acetilcolina. La expresión del ARN mensajero (ARNm) de las interleucinas 1 β y 6 (IL-1β e IL-6), del factor de necrosis tumoral α (TNF-α), de la enzima óxido nítrico endotelial (eNOS) y de la subunidad p22phox de la enzima NAD(P)H oxidasa se midió en la aorta de las ratas. Resultados: Las SHR presentaron unos valores de presión arterial sistólica mayores (p < 0,05) que las ratas controles WKY (199,8±4,2 frente a 125,3±2,0 mmHg). El tratamiento con eplerenona redujo (p < 0,05) ligeramente las cifras de presión arterial en las ratas hipertensas (E30; 181,0±2,0 mmHg). No hubo diferencias en el peso corporal de las ratas, sin embargo el peso relativo del corazón de las ratas hipertensas era significativamente mayor respecto a las ratas normotensas y se normalizó con el tratamiento con eplerenona. La relajación a acetilcolina estaba significativamente reducida en las ratas SHR así como la expresión vascular de la eNOS. Sin embargo, las ratas hipertensas presentaron una sobreexpresión vascular del ARNm de IL-1β, IL-6, TNF-α y p22phox respecto a las WKY (p < 0,05). El tratamiento con eplerenona normalizó la función endotelial en las ratas hipertensas; aumento la expresión del ARNm de eNOS y redujo la expresión vascular de las citocinas IL-1β, IL-6, TNF-α, así como de la p22phox. Conclusiones: La aldosterona participa en las alteraciones funcionales vasculares en las SHR reduciendo la biodisponibilidad de óxido nítrico, aumentando el estrés oxidativo y el proceso inflamatorio vascular(AU)

Objetives: To study the participation of aldosterone in the vascular dysfunction, inflammatory process and vascular oxidative stress associated to hypertension. Material and methods: Half of the group of 22 week-old spontaneously hypertensive rats (n=16) were treated with eplerenone (E-30; 30 mg/kg/day) for 10 weeks. Normotensive rats (WKY; n = 8) were used as reference group. Systolic arterial pressure (SAP) was measured by the tail-cuff method. Body weight and heart weight were measured at the end of the treatment. Endothelium-dependent relaxations, as well as vascular mRNA expression of interleukin 1 β and 6 (IL-1β and IL-6), tumor necrosis factor alpha (TNF-α), of endothelial nitric oxide synthase (eNOS), NAD(P)H oxidase subunit p22phox were studied in aorta from SHR untreated or treated with eplerenone. Results: SHR showed higher levels of systolic blood pressure (p < 0.05) as compare with control rats (199.8±4.2 vs. 125.33±2.0 mmHg). Although there were no differences in the body weight among the groups, hypertensive rats had a higher relative heart weight compare to normotensive rats and it was normalize with the treatment of eplerenone (p < 0.05). SHR showed higher vascular mRNA expression of IL-1β, IL-6, TNF-α and p22phox compared to WKY (p < 0.05). Treatment with eplerenone slightly reduced (p < 0.05) blood pressure in hypertensive rats (E30; 181.0±2.0 mmHg) and normalized acetylcholine relaxations. Eplerenone enhanced (p < 0.05) eNOS and reduced p22phox, IL-1β, IL-6, TNF-α of aortic mRNA expressions in SHR. Conclusions: In SHR, aldosterone participates in the functional vascular alterations through the diminution of nitric oxide availability and the enhancement of the inflammatory process and the increase of vascular oxidative stress(AU)

Perfil de casos de tuberculose notificados e fatores associados ao abandono, Belo Horizonte, MG / Profile of notified tuberculosis cases and factors associated with treatment dropout

OBJETIVO: Descrever o perfil dos casos notificados de tuberculose e analisar os fatores associados ao abandono do tratamento. MÉTODOS: Foram descritos 178 casos de tuberculose notificados na Regional Oeste de Belo Horizonte, em 2001-2002, e registrados no Sistema Nacional de Agravos de Notificação. Realizou-se estudo caso-controle não pareado, com dados coletados por entrevistas, comparando pacientes que abandonaram o tratamento com aqueles que evoluíram para cura. Foram analisadas as variáveis: características sociodemográficas, comportamentais, associação com Aids, efeitos colaterais, informação sobre a doença e interesse no tratamento. Utilizou-se análise univariada e regressão logística não condicional na análise multivariada, com odds ratio ajustado como medida de associação e intervalo de confiança de 95 por cento. RESULTADOS: O coeficiente de incidência foi de 56,6/100.000 habitantes. Houve predomínio de homens, de 30 a 49 anos, da forma pulmonar (76,4 por cento), e 72,5 por cento de bacilíferos. Entre as notificações verificou-se 65,2 por cento de curas, 12,4 por cento abandonos e 9,6 por cento óbitos, sem influência do local do tratamento. No estudo caso-controle não houve diferença quanto ao gênero, cor, escolaridade, renda, ocupação, apoio familiar, associação com Aids e etilismo. O uso de drogas, interesse em se tratar e informação sobre a doença mostraram-se independentemente associados ao abandono. CONCLUSÕES: A adesão ao tratamento representa um desafio no controle da tuberculose. Os fatores de proteção - interesse em se tratar e nível de informação sobre a doença - e o reconhecimento do uso de droga como fator de risco devem integrar estratégias de cuidado ao doente, buscando reduzir os índices de abandono para recuperação da saúde.

OBJECTIVE: To describe the profile of notified tuberculosis cases and analyze the factors associated with treatment dropout. METHODS: A total of 178 cases of tuberculosis notified in the western region of Belo Horizonte (Southeastern Brazil) in 2001 and 2002 and recorded in the National System for Notifiable Diseases were described. An unmatched case-control study was conducted, with data collected by means of interviews, to compare patients who dropped out of treatment with those who achieved cure. The following variables were analyzed: sociodemographic and behavioral characteristics, associations with AIDS, side effects, information on the disease and interest in treatment. Univariate analysis and unconditional logistic regression for multivariate analysis were used. Adjusted odds ratios with 95 percent confidence limits were used as the measurement for associations. RESULTS: The coefficient of incidence was 56.6/100,000 inhabitants. There was predominance of men aged 30 to 49 years and of the pulmonary form (76.4 percent) and bacillary form (72.5 percent). Among the notified cases, 65.2 percent achieved cure, 12.4 percent dropped out of treatment and 9.6 percent died. Treatment location had no influence on the results. In the case-control study, there was no difference regarding gender, color, schooling, income, occupation, family support, association with AIDS and alcohol consumption. The use of drugs, interest in treatment and information about the disease were shown to be independently associated with dropout. CONCLUSIONS: Adherence to treatment is a challenge in controlling tuberculosis. The protection factors (interest in treatment and information about the disease) and recognition that drug use is a risk factor must form part of the strategies for patient care in order to reduce dropout rates and restore health.

[Profile of notified tuberculosis cases and factors associated with treatment dropout]. / Perfil de casos de tuberculose notificados e fatores associados ao abandono, Belo Horizonte, MG.

OBJECTIVE: To describe the profile of notified tuberculosis cases and analyze the factors associated with treatment dropout. METHODS: A total of 178 cases of tuberculosis notified in the western region of Belo Horizonte (Southeastern Brazil) in 2001 and 2002 and recorded in the National System for Notifiable Diseases were described. An unmatched case-control study was conducted, with data collected by means of interviews, to compare patients who dropped out of treatment with those who achieved cure. The following variables were analyzed: sociodemographic and behavioral characteristics, associations with AIDS, side effects, information on the disease and interest in treatment. Univariate analysis and unconditional logistic regression for multivariate analysis were used. Adjusted odds ratios with 95% confidence limits were used as the measurement for associations. RESULTS: The coefficient of incidence was 56.6/100,000 inhabitants. There was predominance of men aged 30 to 49 years and of the pulmonary form (76.4%) and bacillary form (72.5%). Among the notified cases, 65.2% achieved cure, 12.4% dropped out of treatment and 9.6% died. Treatment location had no influence on the results. In the case-control study, there was no difference regarding gender, color, schooling, income, occupation, family support, association with AIDS and alcohol consumption. The use of drugs, interest in treatment and information about the disease were shown to be independently associated with dropout. CONCLUSIONS: Adherence to treatment is a challenge in controlling tuberculosis. The protection factors (interest in treatment and information about the disease) and recognition that drug use is a risk factor must form part of the strategies for patient care in order to reduce dropout rates and restore health.

[Reflections on betalactam antibiotics administered by continuous infusion]. / Algunas reflexiones acerca de la administración de antibióticos betalactámicos en infusión continua.

Numerous studies on continuous intravenous infusion of betalactam antibiotics have indicated that this could be a useful strategy for treating nosocomial infections as well as exacerbations of pulmonary infections in patients with cystic fibrosis and episodes of febrile neutropenia. From the pharmacodynamic viewpoint, betalactam antibiotics have a time-dependent behavior. Thus, the pharmacokinetic/pharmacodynamic index that best correlates with therapeutic efficacy appears to be the time during which free antibiotic concentrations remain above the minimum inhibitory concentration (MIC) of the infecting microorganism. Continuous infusion of betalactams successfully optimizes this pharmacokinetic/ pharmacodynamic index. Furthermore, some studies have shown that this therapeutic strategy may be favorable economically.

Algunas reflexiones acerca de la administración de antibióticos betalactámicos en infusión continua / Reflections on betalactam antibiotics administered by continuous infusion

Son numerosos los trabajos de investigación que se han publicado acerca de la administración de antibióticos betalactámicos en infusión continua. Los resultados obtenidos indican que podría tratarse de una estrategia terapéutica de gran utilidad en el tratamiento de la infección nosocomial, las agudizaciones de las infecciones pulmonares de pacientes con fibrosis quística y el tratamiento de la neutropenia febril. Desde el punto de vista farmacodinámico, los antibióticos betalactámicos tienen un patrón de actividad dependiente del tiempo y es el tiempo durante el cual la concentración de antibiótico libre supera la concentración inhibitoria mínima del microorganismo responsable de la infección, el índice farmacocinético/farmacodinámico que mejor se correlaciona con la eficacia clínica. La administración de betalactámicos en infusión continua logra maximizar el citado índice, y además algunos estudios indican que podría resultar también ventajosa en términos económicos (AU)

Numerous studies on continuous intravenous infusion of betalactam antibiotics have indicated that this could be a useful strategy for treating nosocomial infections as well as exacerbations of pulmonary infections in patients with cystic fibrosis and episodes of febrile neutropenia. From the pharmacodynamic viewpoint, betalactam antibiotics have a time-dependent behavior. Thus, the pharmacokinetic/pharmacodynamic index that best correlates with therapeutic efficacy appears to be the time during which free antibiotic concentrations remain above the minimum inhibitory concentration (MIC) of the infecting microorganism. Continuous infusion of betalactams successfully optimizes this pharmacokinetic/ pharmacodynamic index. Furthermore, some studies have shown that this therapeutic strategy may be favorable economically (AU)