Low absolute risk of thrombotic and cardiovascular events in outpatient pregnant women with COVID-19.

INTRODUCTION: Pregnancy may contribute to an excess risk of thrombotic or cardiovascular events. COVID-19 increases the risk of these events, although the risk is relatively limited among outpatients. We sought to determine whether outpatient pregnant women with COVID-19 are at a high risk for cardiovascular or thrombotic events. MATERIALS & METHODS: We analyzed pregnant outpatients with COVID-19 from the multicenter CORONA-VTE-Network registry. The main study outcomes were a composite of adjudicated venous or arterial thrombotic events, and a composite of adjudicated cardiovascular events. Events were assessed 90 days after the COVID-19 diagnosis and reported for non-pregnant women ≤45 years, and for men ≤45 years, as points of reference. RESULTS: Among 6585 outpatients, 169 were pregnant at diagnosis. By 90-day follow-up, two pregnant women during the third trimester had lower extremity venous thrombosis, one deep and one superficial vein thrombosis. The cumulative incidence of thrombotic events was 1.20 % (95 % confidence interval [CI]: 0.0 to 2.84 %). Respective rates were 0.47 % (95 % CI: 0.14 % to 0.79 %) among non-pregnant women, and 0.49 % (95 % CI: 0.06 % to 0.91 %) among men ≤45 years. No non-thrombotic cardiovascular events occurred in pregnant women. The rates of cardiovascular events were 0.53 % (95 % CI: 0.18 to 0.87) among non-pregnant women, and 0.68 % (95 % CI: 0.18 to 1.18) in men aged ≤45 years. CONCLUSIONS: Thrombotic and cardiovascular events are rare among outpatients with COVID-19. Although a higher event rate among outpatient pregnant women cannot be excluded, the absolute event rates are low and do not warrant population-wide cardiovascular interventions to optimize outcomes.

Veterinary anesthesia: an opportunity to reduce the environmental footprint of clinical care.

Volatile anesthetic agents are potent greenhouse gases with warming potential hundreds to thousands of times greater than CO2. As health systems, both human and veterinary, seek to reduce their environmental impacts, responsible anesthetic stewardship is a topic of great interest. Through an online survey, we explored the levels of awareness, beliefs, interest, needs, and current actions of veterinary anesthesia professionals around the climate impacts of anesthetic care. We found that even within a respondent group with specialized training and experience, there were significant knowledge gaps about anesthesia's environmental impacts. We also found there is much interest in learning more about climate-friendly anesthesia and broader sustainability initiatives for the veterinary profession. Fortunately, there already exist many ways for the profession to reduce our environmental impact while still providing excellent patient care. In this article, we explore 5 broad categories of action: (1) reducing the overall quantity of anesthetic agent used; (2) choosing lower-impact anesthetics; (3) considering the fate of the anesthetic end product; (4) expanding learning through formal education, experience, and research; and (5) reaching beyond anesthesia to implement a range of sustainability initiatives at veterinary workplaces. Together, we have an opportunity to create a healthier future for our world, our patients, and each other.

Hydrothermal Synthesis of Bismuth Ferrite Hollow Spheres with Enhanced Visible-Light Photocatalytic Activity.

In recent years, semiconductor hollow spheres have gained much attention due to their unique combination of morphological, chemical, and physico-chemical properties. In this work, we report for the first time the synthesis of BiFeO3 hollow spheres by a facile hydrothermal treatment method. The mechanism of formation of pure phase BiFeO3 hollow spheres is investigated systematically by variation of synthetic parameters such as temperature and time, ratio and amount of precursors, pressure, and calcination procedures. The samples were characterized by X-ray powder diffraction, scanning electron microscopy, energy dispersive X-ray spectroscopy, and UV-vis diffuse reflectance spectroscopy. We observe that the purity and morphology of the synthesized materials are very sensitive to synthesis parameters. In general, the chemically and morphologically very robust hollow spheres have diameters in the range of 200 nm to 2 µm and a wall thickness of 50-200 nm. The synthesized BiFeO3 hollow spheres were applied as catalysts in the photodegradation of the model pollutant Rhodamine B under visible-light irradiation. Notably, the photocatalyst demonstrated exceptionally high removal efficiencies leading to complete degradation of the dye in less than 150 min at neutral pH. The superior efficiencies of the synthesized material are attributed to the unique features of hollow spheres. The active species in the photocatalytic process have been identified by trapping experiments.

The Association between Prolonged Antibiotic Use in Culture Negative Infants and Length of Hospital Stay and Total Hospital Costs.

OBJECTIVE: This study aimed to determine if prolonged antibiotic use at birth in neonates with a negative blood culture increases the total cost of hospital stay. STUDY DESIGN: This was a retrospective study performed at a 60-bed level IV neonatal intensive care unit. Neonates born <30 weeks of gestation or <1,500 g between 2016 and 2018 who received antibiotics were included. A multivariate linear regression analysis was conducted to determine if clinical factors contributed to increased hospital cost or length of stay. RESULTS: In total, 190 patients met inclusion criteria with 94 infants in the prolonged antibiotic group and 96 in the control group. Prolonged antibiotic use was associated with an increase length of hospital stay of approximately 31.87 days, resulting in a $69,946 increase in total cost of hospitalization. CONCLUSION: Prolonged antibiotics in neonates with negative blood culture were associated with significantly longer hospital length of stay and increased total cost of hospitalization. KEY POINTS: · Prolonged antibiotic use at birth is associated with prolonged hospital stay.. · Prolonged antibiotic use at birth is associated with increased cost of hospitalization.. · Prolonged antibiotic use at birth is associated with increased days on total parenteral nutrition.. · Prolonged antibiotic use at birth is associated with increased subsequent courses of antibiotics..

Comparison of Long-Term Complications of COVID-19 Illness among a Diverse Sample of Children by MIS-C Status.

Most pediatric COVID-19 cases are asymptomatic; however, a small number of children are diagnosed with multisystem inflammatory syndrome in children (MIS-C), a rare but severe condition that is associated with SARS-CoV-2 infection. Persistent symptoms of COVID-19 illness in children diagnosed with/without MIS-C is largely unknown. A retrospective EHR review of patients with COVID-19 illness from one pediatric healthcare system to assess the presence of acute (<30 days) and chronic (≥30, 60-120, and >120 days) long-term COVID symptoms was conducted. Patients/caregivers completed a follow-up survey from March 2021 to January 2022 to assess the presence of long COVID. Results showed that non-MIS-C children (n = 286; 54.49% Hispanic; 19.23% non-Hispanic Black; 5.77% other ethnicity; 79.49% government insurance) were younger (mean age 6.43 years [SD 5.95]) versus MIS-C (n = 26) children (mean age 9.08 years, [SD 4.86]) (p = 0.032). A share of 11.5% of children with MIS-C and 37.8% without MIS-C reported acute long COVID while 26.9% and 15.3% reported chronic long COVID, respectively. Females were almost twice as likely to report long symptoms versus males and those with private insurance were 66% less likely to report long symptoms versus those with government insurance. In conclusion, a substantial proportion of ethnically diverse children from low resource backgrounds with severe COVID illness are reporting long-term impacts. Findings can inform pediatric professionals about this vulnerable population in post-COVID-19 recovery efforts.

[Quality of life and disease activity assessment in juvenile idiopathic arthritis]. / Evaluación de la calidad de vida y la actividad de la enfermedad en artritis idiopática juvenil.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatological disease in children. It is a multisystemic, dynamic pathophysiology of unknown cause and genetically heterogeneous. OBJECTIVE: To compare the quality of life and illness' activity in patients with juvenile idiopathic arthritis, from urban, suburban and rural areas. MATERIAL AND METHODS: Comparative, observational, and cross-sectional study in pediatric patients treated in a second-level medical care hospital, during the period from August to October 2015. The following questionnaires were applied: The Childhood Health Assessment Questionnaire for Quality of Life and The Disease Activity Score-28, in addition to the facial pain and verbal numerical scales for disease activity, both for patients and parents. The Kruskal-Wallis test was used for data analysis. RESULTS: 42 patients of three geostatistical areas were included: urban, suburban and rural; the middle age was 12.7 years, with predominance of the feminine sex (3:1). The polyarticulate type is more prevalent in the rural area. The pain is similar in the three regions. The population of the areas did not find significant difference for activity of the illness and quality of life between geostatistical areas (p ≤ 0.05). CONCLUSIONS: The patients with juvenile idiopathic arthritis are usually older of eight years. The quality of life is better in the patients of the urban area, compared to those of other areas.

INTRODUCCIÓN: la artritis idiopática juvenil (AIJ) es la enfermedad reumatológica crónica más frecuente en niños. Es una fisiopatología multisistémica, dinámica, de causa desconocida y genéticamente heterogénea. OBJETIVO: comparar la calidad de vida y la actividad de la enfermedad en pacientes con artritis idiopática juvenil, originarios de áreas urbanas, suburbanas y rurales. MATERIAL Y MÉTODOS: estudio comparativo, observacional y transversal, en pacientes pediátricos atendidos en un hospital de segundo nivel de atención médica, durante el periodo de agosto a octubre de 2015. Se aplicaron los cuestionarios: Childhood Health Assessment Questionnaire para calidad de vida y Disease Activity Score-28, además de las escalas facial del dolor y verbal numérica para actividad de la enfermedad, tanto a los pacientes como a los padres. Se utilizó la prueba de Kruskal-Wallis para el análisis de los datos. RESULTADOS: se incluyeron 42 pacientes de tres áreas geoestadísticas: urbana, suburbana y rural; la edad media fue de 12.7 años, con predominio del sexo femenino (3:1). El tipo de clasificación poliarticular es el más prevalente en el área rural. El dolor es similar en las tres regiones. No se encontró diferencia significativa para actividad de la enfermedad y calidad de vida entre la población de las áreas geoestadísticas (p ≤ 0.05). CONCLUSIONES: los pacientes con artritis idiopática juvenil suelen ser mayores de ocho años. La calidad de vida es mejor en los pacientes del área urbana, en comparación con los de las otras áreas.

SARS-CoV-2-Related Subacute Thyroiditis, Myocarditis, and Hepatitis After Full Resolution of COVID-19 Serum Markers.

BACKGROUND Subacute thyroiditis, myocarditis, and hepatitis are inflammatory disorders that may develop after viral infections, including SARS-CoV-2. These entities may appear after resolution of the respiratory syndrome. CASE REPORT A previously healthy 64-year-old male patient came to the hospital reporting severe chest pain. He had a history of a COVID-19 pneumonia with PCR confirmation 4 weeks before. On admission to the Coronary Care Unit (CCU), the patient had a negative PCR for SARS-CoV-2; the following tests were performed: total T3 643.4 ng/dl (reference 35-193 ng/dl), total thyroxine 12.0 µg/dl (reference 4.8-11.7 µg/dl), free T4 1.85 ng/dl (reference 0.7-1.48 ng/dl), TSH 0.01 µIU/ml (reference 0.35-4.94 µIU/ml); total bilirubin 0.76 mg/dl (reference 0.0-1.5 mg/dl), alkaline phosphatase 185 U/L (reference 40-150 U/L), alanine aminotransferase 194.6 U/L (reference 6-66 U/L), aspartate aminotransferase 93.4 U/L (reference 9-55 U/L); on admission to the CCU high-sensitivity troponin I 548.3 pg/ml (reference 0.0-34.2 pg/ml), after 24 h in the CCU 801 pg/ml, and after 11 days (as an outpatient) 4.5 pg/ml. A thyroid gammagram revealed absent uptake of the radionuclide. Normal cardiac gammagraphy and cardiac enzymes ruled out myocardial ischemia and infarction. The following diagnoses were made: myocarditis, subacute thyroiditis, and reactive hepatitis due to SARS-CoV-2 infection. CONCLUSIONS COVID-19 has been demonstrated to be a multisystemic inflammatory disorder. The serious illness that developed in our patient after relief of his pulmonary disease underlines this nature. We suggest close follow-up of patients even after apparent clinical resolution, and performing thyroid, myocardial, and liver tests if clinically indicated.

IgG4-Related Fibrous Thyroiditis (Riedel's Thyroiditis): A Case Report.

BACKGROUND Riedel's thyroiditis is a rare form of immunoglobulin G (IgG) 4-related invasive fibrosis of the thyroid gland; given its scarce incidence, standardized therapeutic guidelines are unavailable. Although complications are unusual, obstructive symptoms produced by the stony-hard goiter may put patients' lives at risk. The diagnosis must be biopsy-proven, and treatment consists of thyroid hormone replacement and anti-inflammatory drugs, although sometimes thyroidectomy may be required. CASE REPORT A 69-year-old woman presented with a 7-month history of progressive hypothyroidism and obstructive dysphagia. On physical examination, she had a large, stony-hard goiter. A Doppler ultrasound study revealed a massive, avascular enlargement of the thyroid gland. A computed tomography scan failed to demonstrate any extrathyroidal extension of the abnormal tissue. A Tru-Cut biopsy of the thyroid was performed. Extensive replacement of thyroid follicles by prominent bands of fibrous tissue was observed, with follicular obliteration and mild focal occlusive phlebitis. A lymphoplasmacytic infiltrate was clearly identified; no oxyphilic nor giant cells were found. On immunohistochemistry, the immunoglobulin G (IgG) 4/IgG ratio in the plasma cell infiltrate was 40%; increased serum IgG4 levels were also found, supporting the diagnosis of Riedel's thyroiditis. The patient was successfully treated with levothyroxine replacement and tamoxifen with prompt resolution of obstructive symptoms. CONCLUSIONS Fibrous thyroiditis should be considered in the differential diagnosis of primary hypothyroidism in a patient with a stony-hard goiter. Although steroids are often used as a therapeutic strategy for this disease, our patient had an excellent therapeutic response to tamoxifen, avoiding adverse effects associated with steroid therapy, the higher cost of monoclonal antibody therapy, and surgery-associated risks.

Female Androgenetic Alopecia with Male Pattern Caused by an Androgen-Producing Tumor.

Female androgenetic alopecia (FAGA) is a common cause of hair loss in women. Typically, it is characterized by a reduction of hair density on biparietal and vertex regions of the scalp with preservation of the anterior hair implantation line. However, it can also appear with recession of the anterior hairline known as FAGA with male pattern (FAGA-M). In these cases, it is important to consider a state of hyperandrogenism and look for other signs such as hirsutism, acne, and menstrual irregularities. A sudden onset in a postmenopausal woman must make us suspicious of an androgen-secreting tumor. We present two cases of FAGA-M secondary to an ovarian tumor that was successfully resolved after surgical treatment.

Ingested insecticide to control Aedes aegypti: developing a novel dried attractive toxic sugar bait device for intra-domiciliary control.

BACKGROUND: Illnesses transmitted by Aedes aegypti (Linnaeus, 1762) such as dengue, chikungunya and Zika comprise a considerable global burden; mosquito control is the primary public health tool to reduce disease transmission. Current interventions are inadequate and insecticide resistance threatens the effectiveness of these options. Dried attractive bait stations (DABS) are a novel mechanism to deliver insecticide to Ae. aegypti. The DABS are a high-contrast 28 inch2 surface coated with dried sugar-boric acid solution. Aedes aegypti are attracted to DABS by visual cues only, and the dried sugar solution elicits an ingestion response from Ae. aegypti landing on the surface. The study presents the development of the DABS and tests of their impact on Ae. aegypti mortality in the laboratory and a series of semi-field trials. METHODS: We conducted multiple series of laboratory and semi-field trials to assess the survivability of Ae. aegypti mosquitoes exposed to the DABS. In the laboratory experiments, we assessed the lethality, the killing mechanism, and the shelf life of the device through controlled experiments. In the semi-field trials, we released laboratory-reared female Ae. aegypti into experimental houses typical of peri-urban tropical communities in South America in three trial series with six replicates each. Laboratory experiments were conducted in Quito, Ecuador, and semi-field experiments were conducted in Machala, Ecuador, an area with abundant wild populations of Ae. aegypti and endemic arboviral transmission. RESULTS: In the laboratory, complete lethality was observed after 48 hours regardless of physiological status of the mosquito. The killing mechanism was determined to be through ingestion, as the boric acid disrupted the gut of the mosquito. In experimental houses, total mosquito mortality was greater in the treatment house for all series of experiments (P < 0.0001). CONCLUSIONS: The DABS devices were effective at killing female Ae. aegypti under a variety of laboratory and semi-field conditions. DABS are a promising intervention for interdomiciliary control of Ae. aegypti and arboviral disease prevention.

Seasonal and geographic variation in insecticide resistance in Aedes aegypti in southern Ecuador.

Insecticide resistance (IR) can undermine efforts to control vectors of public health importance. Aedes aegypti is the main vector of resurging diseases in the Americas such as yellow fever and dengue, and recently emerging chikungunya and Zika fever, which have caused unprecedented epidemics in the region. Vector control remains the primary intervention to prevent outbreaks of Aedes-transmitted diseases. In many high-risk regions, like southern Ecuador, we have limited information on IR. In this study, Ae. aegypti IR was measured across four cities in southern Ecuador using phenotypic assays and genetic screening for alleles associated with pyrethroid IR. Bottle bioassays showed significant inter-seasonal variation in resistance to deltamethrin, a pyrethroid commonly used by the Ministry of Health, and alpha-cypermethrin, as well as between-city differences in deltamethrin resistance. There was also a significant difference in phenotypic response to the organophosphate, Malathion, between two cities during the second sampling season. Frequencies of the resistant V1016I genotype ranged from 0.13 to 0.68. Frequencies of the resistant F1534C genotype ranged from 0.63 to 1.0, with sampled populations in Machala and Huaquillas at fixation for the resistant genotype in all sampled seasons. In Machala and Portovelo, there were statistically significant inter-seasonal variation in genotype frequencies for V1016I. Resistance levels were highest in Machala, a city with hyperendemic dengue transmission and historically intense insecticide use. Despite evidence that resistance alleles conferred phenotypic resistance to pyrethroids, there was not a precise correspondence between these indicators. For the F1534C gene, 17.6% of homozygous mutant mosquitoes and 70.8% of heterozygotes were susceptible, while for the V1016I gene, 45.6% homozygous mutants and 55.6% of heterozygotes were susceptible. This study shows spatiotemporal variability in IR in Ae. aegypti populations in southern coastal Ecuador, and provides an initial examination of IR in this region, helping to guide vector control efforts for Ae. aegypti.

Evidence-based physiotherapy clinical practice in the public health-care service in Ecuador.

OBJECTIVE: The aim of the study was to determine if evidence-based physiotherapy (EBP) was being applied in the public physiotherapy and physical rehabilitation departments in Ecuador, Zone 3. METHODS: A cross-sectional study was developed applying the "Evidence-Based Practice: Beliefs, Attitudes, Knowledge, and Behaviors of Physical Therapists" questionnaire, designed by Jette et al. and validated in Spanish by Guerra et al. to 67 physiotherapists working in the public service in the provinces of Chimborazo, Cotopaxi, Pastaza, and Tungurahua. RESULTS: Of the physiotherapists, 65.67% fully agree in being necessary to implement EBP in their clinical setting; however, 44.78% identified EBP as highly time demanding. Insufficient time (95.52%), lack of information resources (53.73%), and absence of support among co-workers (50.75%) were reported as the main barriers that prevent physiotherapists from practicing EBP. CONCLUSIONS: Physiotherapists showed a positive attitude and interest towards EBP, although there is unawareness on how to accomplish EBP on daily basis in addition to little specific training during preprofessional studies in relation to scientific research.

Lupus eritematoso sistémico activo, síndrome deactivación macrofágica y sepsis / Active systemic lupus erythematosus, macrophage activation syndrome and sepsis

El síndrome de activación macrofágica (SAM) es una entidad poco frecuente y grave, caracterizadapor una excesiva activación y proliferación de macrófagos y linfocitos T. Los factoresdesencadenantes son las infecciones, drogas, enfermedades malignas y autoinmunes. Ellupus eritematoso sistémico frecuentemente se asocia al SAM. En la práctica clínica, eldiagnóstico diferencial entre lupus eritematoso sistémico activo, SAM e infección es ungran desafío para el médico internista. Esto se debe a que los signos, síntomas y datos delaboratorio de estas entidades se superponen. El propósito de nuestro trabajo es el reportarlos casos de 2 pacientes con lupus eritematoso sistémico activo, SAM y sepsis...

Macrophage activation syndrome (MAS) is a rare and severe entity characterized by excessive activation and proliferation of macrophages and T-lymphocytes. The usual triggers are infections, drugs, malignancy and autoimmune diseases. Systemic lupus erythematosus is frequently associated with MAS. In clinical practice, differential diagnosis between active systemic lupus erythematosus, MAS and an infection is a great challenge for the internist. This happens because signs, symptoms and laboratory data from these illnesses overlap to a large degree. The purpose of this paper is to present a report on two patients with active systemic lupus erythematosus, MAS, and sepsis...

Diseño de intervención de consejería nutricional para pacientes con insuficiencia renal crónica en etapa compensada / Intervention design of nutritional advisory for kidney failure chronic patient in compensing stage

Introducción: La consejería nutricional, si bien tiene características comunes a toda intervención dietoterápica, se diferencia de los tratamientos tradicionales en su enfoque bio-psico-social, centrado en el paciente y su contexto, más que en la patología en sí.Objetivos: Se diseñó un modelo de intervención de consejería nutricional para pacientes con insuficiencia renal crónica (IRC) en etapa compensada.Metodología: Se seleccionó un paciente hipotético normopeso, mayor de 18 años, sin comorbilidades. Para implementar la Consejería se dividió la intervención en cinco etapas, cada una de ellas con un objetivo específico a corto, mediano y largo plazo, con estrategias y recursos también específicos. Evaluaciones acordes a este diseño.Resultados: Etapa 1: Establecer vínculo, empatía, confianza mutua. A través del diálogo, la información y la propuesta compartida. Se utiliza el lenguaje analógico, la actitud receptiva, material didáctico y cuestionarios.Etapa 2: Control de proteínas. Manejo de grupos de alimentos, macro y micronutrientes. Registro de consumo diario. Manual práctico para contabilizar fácilmente proteínas contenidas en alimentos ingeridos. Evaluación de la etapa anterior.Etapa 3: Control de agua y sodio. Información, material ilustrativo. Sales y sustitutos. Técnicas culinarias. Folleto informativo y planilla de registro. Diálogo con el paciente y su entorno.Etapa 4: Control del fósforo. Presencia en los alimentos. Guía práctica para identificar y cuantificar fósforo. Juego para evaluar comprensión e internalización de contenidos de etapas anteriores.Etapa 5: Integración de todas las etapas. Elaboración conjunta de menúes. Evaluación de progresos alcanzados y de dificultades no superadas. Concertación de futuros encuentros y de estrategias a aplicar. Recetario personalizado. Acompañamiento al paciente y su entorno.El tiempo dedicado a cada etapa dependerá de los resultados, llevándose a cabo al menos cinco encuentros, pudiendo ser más, si la evolución del proceso así lo requiere. Cada encuentro durará entre 50 y 60 minutos y no mediarán más de 15 días entre encuentros.Conclusiones: La Consejería Nutricional se recomienda particularmente en patologías crónicas progresivas y, para ser exitosa, requiere del prestador tanto la aptitud que le aportan sus conocimientos, como la actitud de genuino interés por ayudar al paciente...