Reporting of Child Maltreatment During the COVID-19 Pandemic in a Southern State in the United States.

OBJECTIVES: COVID-19-related stay-at-home orders (SAHOs) created an immediate physical barrier between children and professionals such as pediatricians and teachers, who are often first to identify and report signs of child maltreatment. Our objective was to determine how the SAHO in a southern state was associated with reports of child maltreatment and whether this association was modified by sociodemographic characteristics. METHODS: We linked data on reports of child maltreatment from a southern state in the United States from October 1, 2018, through September 30, 2020, to data from the US Census Bureau to obtain data on county-level socioeconomic characteristics. We fit a segmented regression model to evaluate changes in reports before and after the SAHO, March 20, 2020. We evaluated potential disparities by child age, case and allegation severity, and socioeconomic characteristics. RESULTS: Of 374 885 hotline calls, 276 878 (73.9%) were made before the SAHO and 98 007 (26.1%) after it. Although an immediate decrease in reports of child maltreatment occurred on the day of the SAHO, the rates of reporting within socioeconomic groups started increasing thereafter. While we found no significant change in the overall rate of change in hotline calls after versus before the SAHO (0.23; 95% CI, -0.11 to 0.58), stratified analyses indicate that the rates at which reporting increased varied by education level, health insurance coverage, median annual household income, and unemployment. CONCLUSIONS: Evaluating these trends is important for policy makers and practitioners to understand how policies enforced during the pandemic influence child maltreatment reporting and how these policies may affect reporting differently across socioeconomic groups.

Stem Cell-Enriched Hybrid Breast Reconstruction Reduces Risk for Capsular Contracture in a Hybrid Breast Model.

BACKGROUND: Hybrid breast reconstruction (HBR) combines silicone implants with fat grafting to improve implant coverage, treating local tissue deficiencies and leading to a more natural breast appearance. Recent data also indicated less capsular contracture after HBR. The authors developed a novel technique and animal model of cell-assisted (CA) HBR to illuminate its effects on capsular contracture. METHODS: Animals received silicone implants in a dorsal submuscular pocket. Although animals of the HBR group received fat grafting around the implant without stem cell enrichment, rats of the CA-HBR1 and the CA-HBR2 groups received stem cell-enriched fat grafting with 2 × 10 6 and 4 × 10 6 adipose-derived stem cells immediately after implant insertion. On day 60, animals underwent sonography and elastography imaging and were euthanized, and outcome analysis was performed by means of histology, immunohistochemistry, chemical collagen quantification, and gene expression analysis. RESULTS: With this novel technique, long-term survival of adipose-derived stem cells within the implant pocket was demonstrated after 60 days after implant insertion. CA-HBR led to significantly reduced thickness and collagen density of capsular contractures. In addition, CA-HBR resulted in reduced fibrotic responses with less occurrence of collagen type I and transforming growth factor-ß in capsule tissue. Moreover, the addition of stem cells suppressed fibrotic and inflammatory responses on a genetic level with significant underexpression of collagen type I and transforming growth factor-ß1. CONCLUSIONS: With this new technique and animal model, the authors observed a preventive effect on capsular contracture substantiating the basis of clinical outcomes of HBR. The authors propose that the addition of stem cells to HBR might booster its beneficial results. CLINICAL RELEVANCE STATEMENT: Stem cell-enriched fat grafting around silicone implants may reduce the risk for capsular contracture after silicone breast implantation. While fat grafting alone already shows beneficial effects, the addition of stem cells to the fat graft can potentiate this effect.

The impact of previous surgery on scaphoid nonunion reconstruction: a retrospective study of 95 cases.

We retrospectively compared 64 scaphoid reconstructions in cases that had not undergone previous surgery with 31 cases in which previous surgery had been performed. The characteristics of the groups were similar except that there were more smokers in the group without previous surgery and a more frequent use of vascularized bone grafts in the group with previous surgery. At final follow-up, 66 and 65 months, respectively, after reconstruction, union incidence was 89% and 90%. In patients with previous surgery, grip strength was higher but not when expressed in percent of the contralateral hand. There were no differences in pinch strength, active wrist motion, functional scores, carpal height or scapholunate angle. We conclude that repeat surgery to the scaphoid did not seem to be a major risk factor for the overall outcomes, keeping in mind that a vascularized bone graft was more frequently used for secondary reconstructions.Level of evidence: III.

The collagenase of the bacterium Clostridium histolyticum does not favor metastasis of breast cancer.

BACKGROUND: Breast cancer is the most common malignancy among women worldwide. As survival rates increase, breast reconstruction and quality of life gain importance. Of all women undergoing breast reconstruction, approximately, 70% opt for silicone implants and 50% of those develop capsular contracture, the most prevalent long-term complication. The collagenase of the bacterium Clostridium histolyticum (CCH) showed promising results in the therapy of capsule contracture; however, its influence on residual cancer cells is unknown. The aim of this study was to investigate whether CCH-treatment negatively impacts breast cancer cells in vitro and in vivo. METHODS: MDA-MB-231 and MCF-7 cells were used in this study. In vitro, we tested the influence of CCH on proliferation, wound healing, migration and cell cycle by MTT-assay, scratch-assay, transwell-migration-assay, and flow cytometry. In vivo, solid tumors were induced in immune-deficient mice. CCH was injected into the tumors and tumor growth and metastasis formation was monitored by caliper measurement, in vivo bioluminescence imaging and histology. Gene expression analysis was performed by microarray including 27,190 genes. RESULTS: CCH-incubation led to a dose-dependent reduction in proliferation for both cell lines, while wound healing was reduced only in MDA-MB-231 cells. No morphological alterations were monitored in cell cycle or apoptosis. In vivo, bioluminescence imaging and histology did not show any evidence of metastasis. Although CCH led to changes in gene expression of breast cancer cells, no relevant alterations in metastasis-related genes were monitored. CONCLUSION: CCH has no impact on tumor growth or metastasis formation in vitro and in vivo. This paves the way for first clinical trials.

The Impact of Digital Nerve Injury on the Outcome of Flexor Tendon Tenolysis: A Retrospective Case-Control Study.

BACKGROUND: Tenolysis is an established treatment for flexor tendon adhesions at the hand. Concomitant finger nerve injuries with incomplete reinnervation may negatively influence outcomes. This study investigates the impact of finger nerve injuries on outcomes of flexor tendon tenolysis. METHODS: A retrospective pair-matched study was conducted, including patients undergoing tenolysis for flexor tendon adhesion after primary repair of isolated superficial and deep flexor tendon injury and both finger nerves (test group [TG]). These were compared with patients (control group [CG]) with similar injuries without affection of nerves and pair-matched in age, zone of injury and follow-up. Patients' demographics, finger sensitivity, total active range of motion (TAM) before and after tenolysis and complications were retrieved. RESULTS: For both study groups, 10 patients each were included in this study. There were no significant differences regarding patients' demographics and follow-up. Mean follow-up was 37 (CG) and 41 (TG) months. Total active range of motion was preoperatively 81 ± 47° (CG) and 68 ± 54° (TG) and reached postoperatively 125 ± 57° (CG) and 79 ± 43° (TG). Hence, TAM improvement was significantly higher in patients without nerve damage (58 ± 16 vs 21 ± 11%; P > 0.05). Tendon ruptures occurred significantly more frequent in patients with nerve injury (n = 0.4 ± 0.52) compared with patients of the CG (n = 0; P < 0.05). CONCLUSIONS: This study shows that finger nerve injury with incomplete recovery after combined flexor tendon and nerve injuries of the finger negatively influences the outcomes of flexor tendon tenolysis.

Risk factors for delirium among hospitalized patients in Zambia.

OBJECTIVE: To identify risk factors for delirium among hospitalized patients in Zambia. METHODS: We conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. We report associations of exposures including sociodemographic and clinical factors with delirium over the first three days of hospital admission, assessed using a modified Brief Confusion Assessment Method (bCAM). FINDINGS: 749 patients were included for analysis (mean age, 42.9 years; 64.8% men; 47.3% with HIV). In individual regression analyses of potential delirium risk factors adjusted for age, sex and education, factors significantly associated with delirium included being divorced/widowed (OR 1.64, 95% CI 1.09-2.47), lowest tercile income (OR 1.58, 95% CI 1.04-2.40), informal employment (OR 1.97, 95% CI 1.25-3.15), untreated HIV infection (OR 2.18, 95% CI 1.21-4.06), unknown HIV status (OR 2.90, 95% CI 1.47-6.16), history of stroke (OR 2.70, 95% CI 1.15-7.19), depression/anxiety (OR 1.52, 95% CI 1.08-2.14), alcohol overuse (OR 1.96, 95% CI 1.39-2.79), sedatives ordered on admission (OR 3.77, 95% CI 1.70-9.54), severity of illness (OR 2.00, 95% CI 1.82-2.22), neurological (OR 7.66, 95% CI 4.90-12.24) and pulmonary-system admission diagnoses (OR 1.91, 95% CI 1.29-2.85), and sepsis (OR 2.44, 95% CI 1.51-4.08). After combining significant risk factors into a multivariable regression analysis, severity of illness, history of stroke, and being divorced/widowed remained predictive of delirium (p<0.05). CONCLUSION: Among hospitalized adults at a national referral hospital in Zambia, severity of illness, history of stroke, and being divorced/widowed were independently predictive of delirium. Extension of this work will inform future efforts to prevent, detect, and manage delirium in low- and middle-income countries.

Novos valores de referência veterinários para volume plaquetário médio (MVP), amplitude de distribuição plaquetária (PDW) e plaquetócrito (PCT) na microrregião de Curitibanos / New veterinary reference values for mean platelet volume (MVP), platelet distribution width (PDW) and platelet count (PCT) in the Curitibanos microregion

Objetivo: O objetivo desse estudo foi elaborar os valores de referência desses parâmetros, baseado na casuística do Laboratório de Análises Clínicas Veterinárias (LaClin) da Universidade Federal de Santa Catarina para a microrregião de Curitibanos. Métodos: Avaliaram-se os novos índices plaquetários MPV, PDW e PCT de 100 caninos (41 machos e 59 fêmeas) e 40 felinos (13 machos e 27 fêmeas) saudáveis, atendidos no período de junho de 2015 até agosto de 2017 na faculdade de Medicina Veterinária da UFSC, na microrregião de Curitibanos, Santa Catarina. O valor de referência para MPV e PDW foi elaborado de acordo com a média dos valores obtidos dos animais avaliados ± 2 desvios-padrão, e, para PCT utilizou-se ± 1 DP. Resultados: Os valores de referência de MPV(fL), PDW(%) e PCT(%) [média (limite inferior ­ limite superior)] propostos para caninos foram, respectivamente 9,08 (7,44 -10,71), 16,07 (15,32 -16,82) e 0,32 (0,21-0,42), e para felinos, respectivamente 9,90 (8,07-11,74), 16,26 (15,21-17,32) e 0,24 (0,11-0,37). Conclusão: Os valores encontrados no presente estudo não condizem com outros estudos ou nunca foram investigados.

Aplicação de bactérias probióticas para profilaxia e tratamento de doenças gastrointestinais / Application of probiotic bacteria for prevention and treatment of gastrointestinal diseases

Bactérias probióticas como Bifidobactéria e Lactobacilos são importantes para a saúde humana, pois quando consumidas, podem aumentar o número e a atividade dos microrganismos intestinais com propriedades úteis ao hospedeiro. São muitas as doenças em que os probióticos tem efeitos benéficos, facilitando a formação da chamada barreira probiótica no intestino, impedindo, assim, a colonizaçãoda microbiota por bactérias patogênicas. Alguns dos mecanismos descritos para esse impedimento é a competição que ocorre no intestino favorecendo as bactérias probióticas, o estimulo do sistema imunológico facilitando a defesa do organismo, significativa redução dos níveis de colesterol total com diminuição do LDL colesterol, melhora da digestão de proteínas e aumento da absorção de vitaminas e minerais. Os alimentos que contém probióticos são chamados de Alimentos Funcionais, como, por exemplo, os leites fermentados que ajudam hoje pessoas com câncer de colo de intestino, doença de Cronh, diarréias causadas por vírus e bactérias, e diarréia do viajante. Porém, para que essas bactérias probióticas sejam realmente eficazes, é necessário que sejam resistentes ao suco gástrico e à bile, para que possam chegar até a microbiota e desempenhem suas funções. Esse trabalho salienta a importância das bactérias probióticas como Bifidobacteria e/ou Lactobacilos para a saúde humana.

Probiotics bacteria such as Bifidobacterium ssp and Lactobacillus ssp are important for the health ofhuman beings; therefore , whenever consumed , they increase the number and the activity of intestinalmicroorganisms with useful properties to the host , being essential for the production of symbioticproducts. Probiotics has a positive effect on many diseases, facilitating to the formation of the probioticbarrier in the intestine, thus hindering the settling of microbiota for pathogenic bacteria. Some ofthe described mechanisms for this impediment are: competition in the intestine favoring the bacteriaprobiotics, stimulation of the Immunologic System thus facilitating the defense of the organism, reductionof cholesterol levels with reduction of the LDL cholesterol, improvement of the protein digestion andincrease of vitamin absorption. Foods with probiotics are known as Probiotics Food, as for example,fermented milk which nowadays helps people with intestine cancer, Crohn’s disease , diarrheas causedfor virus and bacteria and traveler’s diarrhea. However, for these probiotics bacteria to be really efficient,they must be resistant to the gastric juice and bile, so that they can reach the microbiota and performtheir functions. This work had the purpose to point out the importance of probiotics bacteria such asBifidobacterium and/or Lactobacillus for the health of human beings.