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Objectives were to evaluate differences in the uterine and serum metabolomes associated with metritis in dairy cows. Vaginal discharge was evaluated using a Metricheck device (Simcro) at 5, 7, and 11 d in milk (DIM; herd 1) or 4, 6, 8, 10, and 12 DIM (herd 2). Cows with reddish or brownish, watery, and fetid discharge were diagnosed with metritis (n = 24). Cows with metritis were paired with herdmates without metritis (i.e., clear mucous vaginal discharge or clear lochia with ≤50% of pus) based on DIM and parity (n = 24). Day of metritis diagnosis was considered study d 0. All cows diagnosed with metritis received antimicrobial therapy. The metabolome of uterine lavage collected on d 0 and 5, and serum samples collected on d 0 were evaluated using untargeted gas chromatography time-of-flight mass spectrometry. Normalized data were subjected to multivariate canonical analysis of population using the MultBiplotR and MixOmics packages in R Studio. Univariate analyses including t-test, principal component analyses, partial least squares discriminant analyses, and pathway analyses were conducted using Metaboanalyst. The uterine metabolome differed between cows with and without metritis on d 0. Differences in the uterine metabolome associated with metritis on d 0 were related to the metabolism of butanoate, amino acids (i.e., glycine, serine, threonine, alanine, aspartate, and glutamate), glycolysis and gluconeogenesis, and the tricarboxylic acid cycle. No differences in the serum metabolome were observed between cows diagnosed with metritis and counterparts without metritis on d 0. Similarly, no differences in uterine metabolome were observed between cows with metritis and counterparts not diagnosed with metritis on d 5. These results indicate that the establishment of metritis in dairy cows is associated with local disturbances in amino acid, lipid, and carbohydrate metabolism in the uterus. The lack of differences in the uterine metabolome on d 5 indicates that processes implicated with the disease are reestablished by d 5 after diagnosis and treatment.
Assuntos
Doenças dos Bovinos , Endometrite , Doença Inflamatória Pélvica , Descarga Vaginal , Gravidez , Feminino , Bovinos , Animais , Lactação , Endometrite/veterinária , Endometrite/diagnóstico , Útero , Doença Inflamatória Pélvica/veterinária , Descarga Vaginal/veterinária , Metaboloma , Doenças dos Bovinos/diagnóstico , Período Pós-PartoRESUMO
BACKGROUND: The chance to compare patterns of differential gene expression in related ecologically distinct species can be particularly fruitful to investigate the genetics of adaptation and phenotypic plasticity. In this regard, a powerful technique such as RNA-Seq applied to ecologically amenable taxa allows to address issues that are not possible in classic model species. Here, we study gene expression profiles and larval performance of the cactophilic siblings Drosophila buzzatii and D. koepferae reared in media that approximate natural conditions and evaluate both chemical and nutritional components of the diet. These closely related species are complementary in terms of host-plant use since the primary host of one is the secondary of the other. D. koepferae is mainly a columnar cactus dweller while D. buzzatii prefers Opuntia hosts. RESULTS: Our comparative study shows that D. buzzatii and D. koepferae have different transcriptional strategies to face the challenges posed by their natural resources. The former has greater transcriptional plasticity, and its response is mainly modulated by alkaloids of its secondary host, while the latter has a more canalized genetic response, and its transcriptional plasticity is associated with the cactus species. CONCLUSIONS: Our study unveils a complex pleiotropic genetic landscape in both species, with functional links that relate detox responses and redox mechanisms with developmental and neurobiological processes. These results contribute to deepen our understanding of the role of host plant shifts and natural stress driving ecological specialization.
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Cactaceae , Drosophila , Adaptação Fisiológica , Animais , Cactaceae/genética , Drosophila/fisiologia , Larva/genética , TranscriptomaRESUMO
Two clinical isolates of the opportunist pathogen Pseudomonas aeruginosa named PAO1 and PA14 are commonly studied in research laboratories. Despite the isolates being closely related, PA14 exhibits increased virulence compared to that of PAO1 in various models. To determine which players are responsible for the hypervirulence phenotype of the PA14 strain, we elected a transcriptomic approach through RNA sequencing. We found 2,029 genes that are differentially expressed between the two strains, including several genes that are involved with or regulated by quorum sensing (QS), known to control most of the virulence factors in P. aeruginosa Among them, we chose to focus our study on QslA, an antiactivator of QS whose expression was barely detectable in the PA14 strain according our data. We hypothesized that lack of expression of qslA in PA14 could be responsible for higher QS expression in the PA14 strain, possibly explaining its hypervirulence phenotype. After confirming that QslA protein was highly produced in PAO1 but not in the PA14 strain, we obtained evidence showing that a PAO1 deletion strain of qslA has faster QS gene expression kinetics than PA14. Moreover, known virulence factors activated by QS, such as (i) pyocyanin production, (ii) H2-T6SS (type VI secretion system) gene expression, and (iii) Xcp-T2SS (type II secretion system) machinery production and secretion, were all lower in PAO1 than in PA14, due to higher qslA expression. However, biofilm formation and cytotoxicity toward macrophages, although increased in PA14 compared to PAO1, were independent of QslA control. Together, our findings implicated differential qslA expression as a major determinant of virulence factor expression in P. aeruginosa strains PAO1 and PA14.IMPORTANCEPseudomonas aeruginosa is an opportunistic pathogen responsible for acute nosocomial infections and chronic pulmonary infections. P. aeruginosa strain PA14 is known to be hypervirulent in different hosts. Despite several studies in the field, the underlining molecular mechanisms sustaining this phenotype remain enigmatic. Here we provide evidence that the PA14 strain has faster quorum sensing (QS) kinetics than the PAO1 strain, due to the lack of QslA expression, an antiactivator of QS. QS is a major regulator of virulence factors in P. aeruginosa; therefore, we propose that the hypervirulent phenotype of the PA14 strain is, at least partially, due to the lack of QslA expression. This mechanism could be of great importance, as it could be conserved among other P. aeruginosa isolates.
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Proteínas de Bactérias/genética , Pseudomonas aeruginosa/genética , Percepção de Quorum/genética , Transdução de Sinais/genética , Biofilmes/crescimento & desenvolvimento , Regulação Bacteriana da Expressão Gênica/genética , Sistemas de Secreção Tipo VI/genética , Virulência/genética , Fatores de Virulência/genéticaAssuntos
Neoplasias dos Ductos Biliares/diagnóstico por imagem , Tomada de Decisão Clínica , Simulação por Computador , Imageamento Tridimensional , Tumor de Klatskin/diagnóstico por imagem , Software , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Humanos , Tumor de Klatskin/patologia , Tumor de Klatskin/cirurgia , Imageamento por Ressonância Magnética , Medicina de Precisão , Cuidados Pré-Operatórios , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: In staged liver resections, associating liver partition and portal ligation for staged hepatectomy (ALPPS) achieves sufficient hypertrophy of the future liver remnant (FLR) in 7 days. This is based on portal vein ligation and transection, and on occlusion of intrahepatic collaterals. This article presents a new surgical technique for achieving rapid hypertrophy of the FLR, which also involves adding intrahepatic collateral occlusion to portal vein transection. METHODS: Patients scheduled for two-stage liver resection for primary or secondary liver tumours, in whom the FLR was considered too small, were enrolled prospectively. In the first stage, a tourniquet was placed around the parenchymal transection line, and the right portal vein was ligated and cut (associating liver tourniquet and portal ligation for staged hepatectomy, ALTPS). The tourniquet was placed on the umbilical ligament if a staged right trisectionectomy was planned, and on Cantlie's line for staged right hepatectomy. RESULTS: From September 2011, 22 ALTPS procedures were carried out (right trisectionectomy in 15, right hepatectomy in 7). Median FLR at 7 days increased from 410 to 700 ml (median increase 61 (range 33-189) per cent). The median duration of the first stage was 125 min and no patient received a blood transfusion. The median duration of the second stage was 150 min and five patients required a blood transfusion. Fourteen patients had complications, most frequently infected collections, and five patients developed postoperative liver failure. Two patients died. CONCLUSION: The ALTPS technique achieved adequate hypertrophy of the FLR after 7 days. It may provide a less aggressive modification of the ALPPS procedure.
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Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Torniquetes , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos ProspectivosRESUMO
Although different techniques of physiotherapy have been described for the treatment of haemophilic arthropathy (HA) of ankle, hardly any studies have been applied manual therapy or educational physiotherapy and home exercises. The aim of this study was to assess the effectiveness of manual therapy and educational physiotherapy in the treatment of HA of the ankle. Thirty-one patients with HA of the ankle with a mean age of 35.29 (SD: 12.877) years randomized to manual therapy group (n = 11), educational group (n = 10) and a control group (n = 10). The two physiotherapy programmes were one with manual therapy articular traction, passive stretching of the gastrocnemius muscles, and exercises for muscle strength and proprioception (MT group) and the other with educational sessions and home exercises (E group). The study lasted for 12 weeks. The treatment with manual therapy improved the gastrocnemius muscle circumference, and the pain of ankle (P < 0.05). Six months later, MT group still enjoyed improvement. In the educational group there were improvements, but not significant, in the measured variables. No patient had ankle haemarthrosis during the study. The treatment with manual therapy improved the circumference of gastrocnemius and lessened pain in the patients with haemophilic arthropathy of the ankle.
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Articulação do Tornozelo/patologia , Hemartrose/etiologia , Hemartrose/terapia , Hemofilia A/complicações , Hemofilia B/complicações , Modalidades de Fisioterapia , Terapia por Exercício , Humanos , Medição da Dor , Modalidades de Fisioterapia/efeitos adversos , Amplitude de Movimento Articular , Resultado do TratamentoRESUMO
OBJECTIVES: The aim of this study was to study the association of adherence to the Mediterranean diet in early pregnancy maternal and the offspring's risk of gastroschisis. METHODS: Case-control study. We describe 11 cases of gastroschisis in the region of Murcia from 2007 to 2012 and 34 concurrent controls. At the time of diagnosis each of the cases completed a validated Food Frequency Questionnaire (FFQ) consisting of 98 items on the periconceptional diet. Confounding factors: smoking, exposure to cannabis / marihuana, age of the parents, BMI, income and educational level. We conducted a descriptive and multivariate logistic regression statistical analysis. RESULTS: Mothers of children with gastroschisis were younger (20.8 years, 95% CI 17.3 to 24.2) and their diet consisted of less caloric intake, saturated fat and monounsaturated fats and proteins than controls. The Odds Ratio (OR) in the multivariate model controlling for confounding factors: maternal age (year) 0.70 (95% CI 0.51 to 0.96), monounsaturated fatty acids (oleic acid, g) 0.79 (95% CI 0.65 to 0, 97) and vegetable intake (rations/week) 0.70 (95% CI 0.48 to 1.00). CONCLUSION: A maternal diet rich in oleic acid and vegetable products may prevent vascular risk of onphalomesenteric arteries reducing the risk of gastroschisis.
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Dieta Mediterrânea , Gastrosquise/epidemiologia , Cooperação do Paciente/estatística & dados numéricos , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Gravidez , Fatores de Risco , Adulto JovemRESUMO
Campylobacter jejuni is considered as the main pathogen in human food-borne outbreaks worldwide. Over the past years, several studies have reported antimicrobial resistance (AMR) in C. jejuni strains. In Europe, the official monitoring of AMR comprises the testing of Campylobacter spp. from food-producing animals because this microorganism is responsible for human infections and usually predominant in poultry. Food-producing animals are considered to be a major source of campylobacteriosis through contamination of food products. Concerns are growing due to the current classification of C. jejuni by the WHO as a 'high priority pathogen' due to the emergence of resistance to multiple drugs such as those belonging to the fluoroquinolones, macrolides and other classes, which limits the treatment alternatives. Knowledge about the contributions of different food sources to gastrointestinal disease is fundamental to prioritise food safety interventions and to establish proper control strategies. Assessing the genetic diversity among Campylobacter species is essential to the understanding of their epidemiology and population structure. Using a population genetic approach and grouping the isolates into sequence types within different clonal complexes, it is possible to investigate the source of the human cases. The work programme was aimed for the fellow to assess the AMR of C. jejuni isolated from humans, poultry and birds from wild and urban Italian habitats. Given the public health concern represented by resistant pathogens in food-producing animals and the paucity of data about this topic in Italy, the aim was to identify correlations between phenotypic and genotypic AMR and comparing the origin of the isolates. The work programme allowed the fellow to acquire knowledge, skills and competencies on the web-based tools used by IZSAM to process the NGS data and perform bioinformatics analyses for the identification of epidemiological clusters, the study of AMR patterns in C. jejuni isolates, and the assessment of the human exposure to such AMR pathogens. Furthermore, the fellow became able to transfer the acquired knowledge through innovative web-based didactical tools applied to WGS and clustering of specific food-borne pathogens, with particular reference to C. jejuni. To achieve this objective, 2,734 C. jejuni strains isolated from domestic and wild animals and humans, during the period 2011-2021 were analysed. The resistance phenotypes of the isolates were determined using the microdilution method with EUCAST breakpoints, for the following antibiotics: nalidixic acid, ciprofloxacin, chloramphenicol, erythromycin, gentamicin, streptomycin, tetracycline. The data were complemented by WGS data for each strain, uploaded in the Italian information system for the collection and analysis of complete genome sequence of pathogens isolated from animal, food and environment (GENPAT) developed and maintained at IZSAM; information like clonal complex and sequence type to understand the phylogenetical distance between strains according to their origins were also considered. This work underlines that a better knowledge of the resistance levels of C. jejuni is necessary, and mandatory monitoring of Campylobacter species in the different animal productions is strongly suggested.
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This study represents the first report on the distribution of KIR genes in 205 unrelated healthy mestizo Venezuelan individuals. Genotyping analysis showed that all KIR genes are present in this population. Frequency of inhibitory killer cell immunoglobulin-like receptors (KIRs) exceeded 0.69, except for KIR2DL2 (0.29) and 2DL5 (0.37). Activating KIRs showed low frequencies (0.11-0.29), except for KIR2DS4 (0.68). Forty-five different KIR genotypes were identified, with a predominance of three genotypes found in 50.7% of the population of which 25.9% were individuals homozygous for haplotype A. The frequencies of KIR genes reflect the ethnic admixture existing in the mestizo Venezuelan population.
Assuntos
Frequência do Gene , População/genética , Receptores KIR/genética , Humanos , Filogenia , VenezuelaRESUMO
Neonates with Treacher Collins syndrome can present difficult airways. Ventilation through a face mask and laryngoscopy for tracheal intubation may prove impossible due to the craniofacial malformations that are characteristic of this syndrome. Furthermore, patients with this syndrome are at high risk of airway obstruction, meaning that awake fiberoptic endoscopy provides the best option for tracheal intubation. This technique is especially difficult in children, however, and material required for performing it in neonates is not always available. We report the case of a 5-day-old infant boy with Treacher Collins syndrome and bilateral choanal atresia in whom we used a flexible metal guide inserted into the working channel of a fiberoptic scope. The tracheal tube could then be inserted.
Assuntos
Obstrução das Vias Respiratórias/etiologia , Atresia das Cóanas/complicações , Endoscópios , Tecnologia de Fibra Óptica/instrumentação , Intubação Intratraqueal/métodos , Disostose Mandibulofacial/complicações , Cateterismo , Atresia das Cóanas/cirurgia , Desenho de Equipamento , Humanos , Recém-Nascido , Masculino , Obstrução Nasal/etiologia , Obstrução Nasal/cirurgia , Insuficiência Respiratória/etiologiaRESUMO
The vast amount in complexity of data generated in Genomic Research implies that new dedicated and powerful computational tools need to be developed to meet their analysis requirements. Blast2GO (B2G) is a bioinformatics tool for Gene Ontology-based DNA or protein sequence annotation and function-based data mining. The application has been developed with the aim of affering an easy-to-use tool for functional genomics research. Typical B2G users are middle size genomics labs carrying out sequencing, ETS and microarray projects, handling datasets up to several thousand sequences. In the current version of B2G. The power and analytical potential of both annotation and function data-mining is somehow restricted to the computational power behind each particular installation. In order to be able to offer the possibility of an enhanced computational capacity within this bioinformatics application, a Grid component is being developed. A prototype has been conceived for the particular problem of speeding up the Blast searches to obtain fast results for large datasets. Many efforts have been done in the literature concerning the speeding up of Blast searches, but few of them deal with the use of large heterogeneous production Grid Infrastructures. These are the infrastructures that could reach the largest number of resources and the best load balancing for data access. The Grid Service under development will analyse requests based on the number of sequences, splitting them accordingly to the available resources. Lower-level computation will be performed through MPIBLAST. The software architecture is based on the WSRF standard.
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Genômica , Oncologia , Design de Software , Biologia Computacional , Europa (Continente) , Humanos , Armazenamento e Recuperação da InformaçãoRESUMO
Sleep is indispensable for maintaining regular daily life activities and is of fundamental physiological importance for cognitive performance. Sleep deprivation (SD) may affect learning capacity and the ability to form new memories, particularly with regard to hippocampus-dependent tasks. Transcranial magnetic stimulation (TMS) is a non-invasive procedure of electromagnetic induction that generates electric currents, activating nearby nerve cells in the stimulated cortical area. Several studies have looked into the potential therapeutic use of TMS. The present study was designed to evaluate how TMS could improve learning and memory functions following SD in Octodon degus. Thirty juvenile (18 months old) females were divided into three groups (control, acute, and chronic TMS treatment-with and without SD). TMS-treated groups were placed in plastic cylindrical cages designed to keep them immobile, while receiving head magnetic stimulation. SD was achieved by gently handling the animals to keep them awake during the night. Behavioral tests included radial arm maze (RAM), Barnes maze (BM), and novel object recognition. When TMS treatment was applied over several days, there was significant improvement of cognitive performance after SD, with no side effects. A single TMS session reduced the number of errors for the RAM test and improved latency and reduced errors for the BM test, which both evaluate spatial memory. Moreover, chronic TMS treatment brings about a significant improvement in both spatial and working memories.
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Transtornos Cognitivos/fisiopatologia , Aprendizagem/fisiologia , Memória/fisiologia , Privação do Sono/complicações , Estimulação Magnética Transcraniana , Animais , Encéfalo/fisiopatologia , Transtornos Cognitivos/etiologia , Feminino , Octodon , Reconhecimento Psicológico/fisiologiaRESUMO
The Caldariomyces fumago chloroperoxidase (CPO) is synthesised as a 372-aa precursor which undergoes two proteolytic processing events: removal of a 21-aa N-terminal signal peptide and of a 52-aa C-terminal propeptide. The Aspergillus niger expression system developed for CPO was used to get insight into the function of this C-terminal propeptide. A. niger transformants expressing a CPO protein from which the C-terminal propeptide was deleted failed in producing any extracellular CPO activity, although the CPO polypeptide was synthesised. Expression of the full-length gene in an A. niger strain lacking the KEX2-like protease PclA also resulted in the production of CPO cross-reactive material into the culture medium, but no CPO activity. Based on these results, a function of the C-terminal propeptide in CPO maturation is indicated.
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Ascomicetos/enzimologia , Cloreto Peroxidase/química , Sequência de Aminoácidos , Ascomicetos/genética , Aspergillus niger/genética , Sequência de Bases , Cloreto Peroxidase/biossíntese , Cloreto Peroxidase/genética , Primers do DNA/genética , Precursores Enzimáticos/biossíntese , Precursores Enzimáticos/química , Precursores Enzimáticos/genética , Expressão Gênica , Chaperonas Moleculares/biossíntese , Chaperonas Moleculares/química , Chaperonas Moleculares/genética , Dados de Sequência Molecular , Conformação ProteicaRESUMO
The antidepressant efficacy and safety of milnacipran, a dual action antidepressant drug which inhibits the reuptake of serotonin and noradrenaline, was compared with that of the tricyclic antidepressant, imipramine, in a multi-centre, double-blind, randomised, parallel group, comparative trial in 5 hospital centres in Spain. One hundred patients hospitalised with a diagnosis of major depressive disorder according to the Diagnostic and Statistical Manual of the American Psychiatry Association (third revision), with a minimum score of 25 on the Montgomery and Asberg Depression Rating Scale were treated for 6 weeks with milnacipran (100 mg/day) or imipramine (150 mg/day). Both treatments showed similar efficacy in reducing depressive symptoms. The frequency of most adverse events in the milnacipran-treated patients was lower than that observed in the imipramine group, particularly those related to anticholinergic symptoms. Dysuria and shivering, however, were more common with milnacipran. The results of this study support others which have demonstrated that milnacipran has equivalent efficacy but superior tolerability to a tricyclic antidepressant such as imipramine.
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Antidepressivos/uso terapêutico , Ciclopropanos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Imipramina/uso terapêutico , Adolescente , Adulto , Idoso , Antidepressivos/administração & dosagem , Ciclopropanos/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Imipramina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Milnaciprano , Resultado do TratamentoRESUMO
STUDY DESIGN: A quasi-experimental study with 3 x 4 design was performed. OBJECTIVE: To improve the level of knowledge and motor skills and thereby avert the development of painful symptoms. SUMMARY OF BACKGROUND DATA: Despite the fact that low back pain affects a high percentage of the population, little research has been carried out to prevent low back pain through health education. METHODS: The participants in this study were 106 third-grade (9-year-old) students. The program included 11 sessions. The teacher attended the placebo group sessions. No intervention was used with the control group. RESULTS: The level of knowledge and motor skills in the experimental group showed a significant increase immediately after the intervention finished, and at 6- and 12-month intervals after completion of the postural hygiene program (P = 0.00). Some positive changes were generalized to natural situations (P = 0.00). In an independent health check carried out by the local school health services 4 years after application of the postural hygiene program, the results tended slightly to favor the experimental condition over the control conditions (placebo + no intervention). A greater number of the control subjects required medical treatment for low back pain, although this difference was only marginally significant (P = 0.07). CONCLUSIONS: The findings from this study support the hypothesis that programs involving practice and motivating strategies impart health knowledge and habits more efficiently than those restricted to the mere transmission of information.
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Promoção da Saúde/métodos , Higiene , Dor Lombar/prevenção & controle , Postura , Criança , Humanos , Conhecimento , Motivação , Destreza Motora , Instituições AcadêmicasRESUMO
BACKGROUND: Impact of hospital admissions for pneumonia during 1998 in the Hospital Clínic, Barcelona. PATIENTS AND METHOD: Retrospective information on the hospitalizations for pneumonia was collected. RESULTS: During 1998 a total of 626 adult were admitted with a hospital diagnosis of pneumonia (72% were >/= 65 years). The average length of stay was 10 days. Half of these patients were previously hospitalized during the preceding 5 years. CONCLUSIONS: Hospital admissions due to pneumonia (17 cases per 1.000 hospitalizations) accounted for an estimated cost of 2.3% of the cost of all the hospitalized patients.
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Hospitalização/estatística & dados numéricos , Pneumonia/epidemiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , EspanhaRESUMO
A case of rupture of the oesophagus due to the accidental passage of compressed air through the mouth is reported. Two longitudinal lacerations were present in the thoracic oesophagus; they were treated by radical oesophagectomy cervical oesophagostomy and gastrostomy for feeding. Reconstruction was made by retrosternal coloplasty. The course of the patient was uneventful.
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Acidentes de Trabalho , Esôfago/lesões , Esôfago/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , RupturaRESUMO
The authors report the case of a hepatic artery aneurysm which ruptured into the peritoneal cavity in the course of acute, gangrenous cholecystitis, which was treated successfully. The clinical aspects of the case, its evolution and the histological study, which appeared to indicate that adjacent inflammation was the cause of the rupture, are discussed. Treatment of hepatic artery aneurysms is conditioned to a great degree by the gravity of the onset, and in most cases ligature is the only feasible procedure. Other forms of treatment may be possible when the aneurysm is intrahepatically located or it is diagnosed before rupture.
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Aneurisma/diagnóstico , Colecistite/diagnóstico , Artéria Hepática , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Aneurisma/patologia , Aneurisma/cirurgia , Arteriosclerose/complicações , Colecistectomia , Colecistite/patologia , Colecistite/cirurgia , Gangrena , Artéria Hepática/patologia , Artéria Hepática/cirurgia , Humanos , Masculino , Ruptura EspontâneaRESUMO
AIM: To assess the feasibility and results of application of Ambulatory Patient Groups (APG) patient's classification system to the case-mix of patients seen at the Emergency Departments (ED) of 6 Barcelona metropolitan area hospitals. METHODS: Development of a minimum discharge data set specific for the Emergency Departments (CMBDAU). Gathering of relevant variables from a random sample of patients seen at the ED using the ED discharge reports. Use of the APG classification system to those episodes. RESULTS: A total of 11.188 episodes were codified and grouped with the APG system. Fifteen diagnostics identified 25% of all episodes. Nearly 50% of all procedures performed at the ED were common and simple procedures. Fifteen APG's grouped 50% of all cases seen at the ED. CONCLUSIONS: The ED Uniform Discharge Data Set (CMBDAU) developed is a valid instrument for describing the case-mix seen at the ED, and its grouping by means of the APG system provides consistent and meaningful results. The widespread use of systems like APG in the ED requires a former validation of relative weights assigned in the US system. The availability of human and technical resources must also be assessed, in order to guarantee the quality and sustainability of such a system.