Evaluación funcional del adulto mayor con enfermedad cardiovascular durante la hospitalización: Scoping Review / Funtional evaluation during hospitalization of older patients with cardiovascular disease

RESUMEN INTRODUCCIÓN: Un evento cardiovascular puede reducir o alterar la capacidad funcional de las personas y, por ende, afectar el desempeño adecuado en el ámbito físico, familiar, social y laboral. La OMS ha definido la salud de los adultos mayores por su capacidad funcional y no por sus limitaciones, discapacidades o enfermedades. Por lo tanto, la calidad de vida de los adultos mayores está estrechamente relacionada con la capacidad funcional y el conjunto de condiciones que le permiten participar en su propio autocuidado, en la vida social y familiar. OBJETIVO: El objetivo de este estudio es explorar la evidencia existente en la última década acerca de las pruebas y escalas de funcionalidad usadas en población adulta mayor con enfermedad cardiovascular durante su hospitalización y que reciben tratamiento de terapia física. MÉTODOS: Se usó la metodología Scoping Review, usando los términos DeCS/MeSH: cardiac, rehabilitation, cardiovascular disease, physical therapy, elderly, inpatient, y functionality. La revisión siguió el modelo PRISMA para ordenar y sintetizar los resultados. Las bases de datos consultadas fueron: Pubmed, Scielo, Sciencedirect y Scopus, Lilacs, PeDro. RESULTADOS: 20 artículos fueron seleccionados en los cuales se identificó que las escalas de valoración funcional más utilizadas fueron: caminata de 6 minutos, escala de independencia (FIM), Percepción de salud SF -36. CONCLUCIONES: La evidencia encontrada para guiar la rehabilitación física en paciente adulto mayor muestra cambios significativos en el incremento de la capacidad funcional.

ABSTRACT: INTRODUCTION: A cardiovascular event can reduce or alter the functional capacity of people affecting the physical capacity, and the performance in family, social and work environments. The WHO has defined the health of older adults by their functional capacity and not by their limitations, disabilities or illnesses. Therefore, the quality of life of older adults is closely related to the functional capacity and the set of conditions that allow them to participate in their own self-care, in social and family life. The aim of this study was to explore the existing evidence in the last decade about the tests and scales of functionality used in older adults with cardiovascular disease receiving physical therapy during hospitalization. METHODS: The Scoping Review methodology was used. Mesh and DeCS/MeSH terms included were cardiac, rehabilitation, cardiovascular disease, physical therapy, elderly, inpatient and functionality. The review followed the PRISMA model to sort and synthesize the results. The databases consulted were: Pubmed, Scielo, Science direct and Scopus, Lilacs, PeDro. RESULTS: 20 articles were selected in which it was identified that the most used functional assessment scales were: The 6-minute walk test, the Independence scale (FIM) and the Health Perception scale (SF-36). CONCLUSION: In older patients the functional tests identified allowed to detect significant improvements in functional capacity following cardiac rehabilitation.

Prevalence of Drugs as Triggers of Exacerbations in Chronic Urticaria.

BACKGROUND AND OBJECTIVE: Many patients with chronic spontaneous urticaria (CSU) report various drugs as triggers of their symptoms and often avoid medication unnecessarily. Objective: To estimate the clinical impact of the drugs patients most frequently suspect of inducing CSU exacerbations. METHODS: The prevalence of self-reported drug reactions was evaluated by questioning patients about their clinical history of urticaria and drug reactions and performing challenge tests with the suspect drugs. A group of healthy persons were included as controls to evaluate the prevalence of self-reported drug reactions. RESULTS: The study population comprised 245 patients with CSU and 127 healthy individuals. At least 1 adverse drug reaction was reported by 92 (37.5%) patients and 30 (23.6%) controls. Nonsteroidal anti-inflammatory drugs (NSAIDs) (27.7%) and ß-lactams (9.4%) were the most commonly reported drugs in the CSU group and the control group, respectively. Positive results in the challenge tests were less common than self-reports in the CSU group (13%) and the control group (0.7%). CONCLUSIONS: Self-reporting is generally not sufficient to confirm a drug reaction. Drug reactions to NSAIDs and ß-lactams are more frequent among patients who experience CSU than in those who do not. Drug challenge tests should be offered early during medical evaluation to avoid unnecessary restrictions.

Adherence to pharmacotherapy improves school performance in children with rhinitis and asthma.

BACKGROUND: Adherence to pharmacotherapy reduces symptoms of asthma and rhinitis, however, little is known of its impact on school performance. OBJECTIVE: To evaluate the impact of pharmacotherapy in absenteeism and school performance in a child population. METHODS: A cross-sectional study, carried out in eight schools. All participants and their parents were given a questionnaire assessing parameters related to respiratory diseases and pharmacotherapy. Data on school performance was obtained from the academic history of each child who participated in the study. Adherence to pharmacotherapy was classified as a correct use of therapy for more than five days per week. RESULTS: 1109 children agreed to participate. Students were divided into two groups: symptomatic (36%) and asymptomatic (63%). The symptomatic group had a higher frequency of school absenteeism (1 vs. 3.1days/year/patient p<0.01) and lower academic performance (failed: 20% vs. 33% p<0.01). After dividing the symptomatic group between adherents and non-adherents to the pharmacotherapy, the group of adherents had a similar school performance to the asymptomatic group and it was significantly different from the no-adherent group. CONCLUSION: Respiratory symptoms are associated with poor school performance and with an increase in school absenteeism, but adherence to pharmacotherapy can reduce these negative impacts in children.

Pythiosis with atypical location in the soft palate in a horse in Southern Brazil / Pitiose com localização atípica no palato mole em um equino na região Sul do Brasil

A pitiose é uma enfermidade piogranulomatosa causada pelo oomiceto aquático Pythium insidiosum, que acomete várias espécies domésticas, assim como a humana. O presente relato refere-se à descrição de um caso de pitiose em um equino, fêmea, da raça Crioula, criado na região Sul do Brasil com história clínica de emagrecimento progressivo, disfagia e dificuldade respiratória. Macroscopicamente, o palato mole estava aumentado de tamanho e deslocado caudalmente, resultando em obstrução física da nasofaringe. Ao corte, essa massa era branca-amarelada, fibrosa e com áreas de ulceração. Na análise histopatológica, havia inflamação piogranulomatosa, com focos necróticos associados a imagens negativas tubuliformes de hifas fúngicas. A coloração de Grocott demonstrou inúmeras hifas septadas e ramificadas, as quais foram marcadas positivamente para anticorpos contra P. insidiosum na imuno-histoquímica. O diagnóstico de pitiose foi baseado nos achados macro e microscópicos e confirmado pela técnica de imuno-histoquímica.(AU)

Divertículo rectal. reporte de un caso / Rectal diverticulum. clinical case report

RESUMEN Introducción: La enfermedad diverticular del colon es frecuente en la población general, afectando al 50% de las personas mayores de 50 años, sin embargo, los divertículos ubicados en el recto son excepcionalmente raros. El objetivo de este estudio es informar el caso de un hombre de 67 años con enfermedad diverticular de colon sigmoides y colon transverso, con un divertículo rectal que se diagnosticó durante una colonoscopia ambulatoria. Caso clínico: Hombre de 67 años quien consultó al servicio de gastroenterología por cuadro de diarrea crónica. Se le realizó una colonoscopia y se evidenció un agujero diverticular de 3 cm de diámetro, a 6 cm del margen anal. Se concluyó que la enfermedad diverticular no era la causa de su cuadro diarreico. Discusión: Hay diversas teorías que tratan de explicar la etiología y el porqué de la baja frecuencia de los divertículos rectales, incluyendo los procedimientos quirúrgicos en esta zona; las presentaciones asintomáticas no ameritan cirugía, aunque debe realizarse evaluación periódica de estos pacientes.

ABSTRACT Introduction: Diverticular colon disease is common in the general population affecting 50% of people over the age of 50. However, diverticula located in the rectum are exceptionally rare. This study aims to report the case of a 67 years old man with diverticular disease of the sigmoid colon and transverse colon with a rectal diverticulum diagnosed during an ambulatory colonoscopy. Case report: A 67-year-old man who consulted the gastroenterology service for chronic diarrhea. A colonoscopy was performed, and a 3 cm in diameter diverticular hole was evident, 6 cm from the anal margin. It was concluded that diverticular disease was not the cause of diarrhea. Discussion: There are several theories to explain the etiology and the reason for the low frequency of rectal diverticula, including surgical procedures in this area. Asymptomatic presentations do not need surgery, although periodic evaluation of these patients should be performed.

Apendicitis atípica diagnosticada durante una colonoscopia: reporte de caso clínico / Atypical Appendicitis Diagnosed During a Colonoscopy

Resumen Se presenta el caso clínico de una apendicitis atípica diagnosticada durante una colonoscopia en un paciente masculino de 85 años, en estudio por síndrome anémico y hospitalizado por un cuadro de infección neumónica en la Clínica Versalles de Manizales (Caldas). Durante la exploración del ciego, se observa un orificio apendicular prominente, con salida de material purulento hacia la luz del colon. La apendicitis atípica es un cuadro que puede presentarse en ancianos y, en ocasiones, se diagnostica durante una colonoscopia. El manejo de estos pacientes es poco claro y suele ser determinado por el médico tratante.

Abstract We present a case of atypical appendicitis diagnosed during a colonoscopy in a 85 year old male patient under study for anemic syndrome while hospitalized because of pneumonia at Clínica Versalles in Manizales, Caldas, Colombia. During the exploration of the cecum, a prominent appendicular orifice discharge purulent material into the lumen of the colon was found. Atypical appendicitis can occur in the elderly and is sometimes diagnosed during a colonoscopy. The management of these patients is unclear and is usually determined by the treating physician.

Prediction of the Efficacy of Antihistamines in Chronic Spontaneous Urticaria Based on Initial Suppression of the Histamine- Induced Wheal.

BACKGROUND: Antihistamines are the first line of treatment for chronic spontaneous urticaria. However, there is no effective method to predict whether an antihistamine will have a beneficial clinical effect or not. OBJECTIVE: To assess whether the change in histamine-induced wheal and flare measurements 24 hours after administration of antihistamine can predict the efficacy of treatment. METHODS: We performed a multicenter, triple-blind, randomized study. Patients received a daily oral dose of cetirizine, fexofenadine, bilastine, desloratadine, or ebastine over 8 weeks. After 4 weeks, a higher dose of antihistamine was administered to patients who did not experience a clinical response. A histamine skin prick test was carried out at baseline and 24 hours after the first dose of antihistamine. Disease severity (Urticaria Activity Score [UAS]), response to the histamine skin prick test, and impact on the patient's quality of life (Dermatology Life Quality Index [DLQI]) were determined every 2 weeks. RESULTS: The study population comprised 150 patients (30 per group) and 30 controls. Twenty-four hours after administration of antihistamine, inhibition of the histamine wheal by >75% was significantly associated with better UAS and DLQI scores. The safety and efficacy of the 5 antihistamines were similar. After updosing, rates of disease control (DLQI score <5) increased from 58.7% to 76.7%. CONCLUSIONS: Measurement of the histamine-induced wheal can predict which patients will have a strong clinical response to antihistamines but has limited utility for identifying nonresponders. The clinical significance of these data could be relevant in the search for new urticaria treatment regimens.

Closed reduction of humeral condylar fracture and elbow luxation in a dog / Reducción cerrada de fractura condilar de húmero y luxación de codo en un canino

Fractures of the distal humerus that involving the condyles often requires extensive surgical approach for treatment, leading to a prolonged recovery time. In a West Highland White Terrier dog two years old, with a fracture of the lateral humeral condyle portion and elbow luxation, was performed a closed technique for luxation reduction, fracture reduction was performed by digital pressure and percutaneous osteosynthesis by introduction of a Kirschner wire of 2 mm diameter, accompanied by Robert-Jones bandage modified for 6 weeks. Limb function was recovered in the immediate postoperative, the wire was removed six weeks after, non-was observed postoperative complications, and full functional recovery of the limb was clinically evident. This suggests that this technique could be an option in cases of condylar fractures in small-sized dogs.

Las fracturas de la porción distal del húmero que involucran los cóndilos, frecuentemente exigen para su reparación un amplio abordaje quirúrgico, que conlleva un tiempo de recuperación prolongado. En un canino West Highland White Terrier de dos años de edad, con una fractura de la porción lateral del cóndilo humeral y luxación de codo, se realizó una técnica cerrada de reducción de la luxación, reducción de la fractura mediante presión digital, y osteosíntesis percutánea mediante la introducción de un clavo de kirschner de 2 mm de diámetro, acompañado de vendaje de Robert-Jones modificado durante 6 semanas. El paciente recuperó la función del miembro en el posquirúrgico inmediato, no se evidenciaron complicaciones posquirúrgicas, seis semanas después se retiro el clavo y se evidenció clínicamente recuperación total de la funcionalidad del miembro. Lo anterior sugiere que esta técnica podría ser una opción en casos de fracturas condilares en perros de pequeño porte.

Safety of immunotherapy in patients with rhinitis, asthma or atopic dermatitis using an ultra-rush buildup. A retrospective study.

BACKGROUND: Allergen-specific immunotherapy is a proven, highly effective treatment for IgE-mediated diseases. However, ultra-rush immunotherapy is prescribed infrequently because of the perception that accelerated immunotherapy buildup leads to a higher rate of systemic reactions. OBJECTIVE: To evaluate the frequency of adverse reactions in patients with IgE-mediated diseases receiving house dust mite (HDM) ultra-rush immunotherapy. METHODS: A retrospective, observational study was conducted for patients with IgE-mediated diseases receiving allergen-specific immunotherapy. Subcutaneous immunotherapy with depigmented polymerized mites extract was administered in two refracted doses of 0.2 and 0.3 ml at first injection, and in single 0.5 ml doses in subsequent monthly injections. A 30 min observation time was required after each injection. Systemic reactions were graded using the World Allergy Organisation grading system. RESULTS: 575 patients were included. The age range was 1-83 years. Most patients had respiratory diseases (544) and 101 patients had atopic dermatitis. A total of 27 patients (4.6%) experienced 139 reactions (reactions/injections: 1.9%); 22 patients (3.8%) experienced 134 local reactions (local reactions/injections: 1.8%). Eight patients (1.3%) experienced eight systemic reactions (systemic reactions/injections: 0.1%). Five systemic reactions were grade 2 and three grade 1. Two systemic reactions were reported during buildup. There were no fatalities. CONCLUSION: Taking into account the possible bias for the retrospective design of this study we observed that immunotherapy for patients with IgE-mediated diseases using a depigmented polymerized mites extract, with an ultra-rush buildup, has similar frequency of systemic reactions than that seen in slower buildup immunotherapy in other studies. Accelerated buildup could improve patients' adherence and reduce dropout rates.

Design configurations affecting flow pattern and solids accumulation in horizontal free water and subsurface flow constructed wetlands.

The aim of this study was to evaluate the effect of different horizontal constructed wetland (CW) design parameters on solids distribution, loss of hydraulic conductivity over time and hydraulic behaviour, in order to assess clogging processes in wetlands. For this purpose, an experimental plant with eight CWs was built at mesocosm scale. Each CW presented a different design characteristic, and the most common CW configurations were all represented: free water surface flow (FWS) with different effluent pipe locations, FWS with floating macrophytes and subsurface flow (SSF), and the presence of plants and specific species (Typha angustifolia and Phragmites australis) was also considered. The loss of the hydraulic conductivity of gravel was greatly influenced by the presence of plants and organic load (representing a loss of 20% and c.a. 10% in planted wetlands and an overloaded system, respectively). Cattail seems to have a greater effect on the development of clogging since its below-ground biomass weighed twice as much as that of common reed. Hydraulic behaviour was greatly influenced by the presence of a gravel matrix and the outlet pipe position. In strict SSF CW, the water was forced to cross the gravel and tended to flow diagonally from the top inlet to the bottom outlet (where the inlet and outlet pipes were located). However, when FWS was considered, water preferentially flowed above the gravel, thus losing half the effective volume of the system. Only the presence of plants seemed to help the water flow partially within the gravel matrix.

Omalizumab beyond asthma.

INTRODUCTION: Omalizumab has been demonstrated to be a successful therapy in the management of asthma through reduction of patient's symptoms and use of inhaled corticosteroids. The effect of omalizumab is achieved by immunoglobulin E (IgE) blockage and other secondary mechanisms resulting from this blockage. Because other diseases have an important IgE mediation in their physiopathology, the question arises as to if omalizumab would be useful in the treatment of other IgE-mediated diseases. OBJECTIVE: We present an overview of the experimental studies and clinical reports evaluating the use of omalizumab in diseases different to asthma including atopic dermatitis, urticaria, eosinophilic gastrointestinal disorders, idiopathic anaphylaxis, latex allergy, hymenoptera venom allergy, and other IgE diseases. METHODS: We reviewed the literature using PUBMED, EMBASE, and LILACS for publications which used omalizumab in the treatment of patients with allergic diseases or any other diseases. Complete articles published in English, Spanish or Portuguese were included. CONCLUSION: There is not enough evidence to support the regular use of omalizumab in IgE diseases other than asthma. However, some experimental and clinical investigations indicate that omalizumab could be a therapeutic option in several allergic diseases like atopic dermatitis, urticaria, and eosinophilic gastrointestinal disorders. More control studies are needed in each IgE disease to evaluate the efficacy and safety of omalizumab in IgE mediated diseases.

Influence of design, physico-chemical and environmental parameters on pharmaceuticals and fragrances removal by constructed wetlands.

The ability of several mesocosm-scale and full-scale constructed wetlands (CWs) to remove pharmaceuticals and personal care products (PPCPs) from urban wastewater was assessed. The results of three previous works were considered as a whole to find common patterns in PPCP removal. The experiment took place outdoors under winter and summer conditions. The mesocosm-scale CWs differed in some design parameters, namely the presence of plants, the vegetal species chosen (Typha angustifolia versus Phragmites australis), the flow configuration (surface flow versus subsurface flow), the primary treatment (sedimentation tank versus HUSB), the feeding regime (batch flow versus continuous saturation) and the presence of gravel bed. The full-scale CWs consisted of a combination of various subsystems (ponds, surface flow CWs and subsurface flow CWs). The studied PPCPs were ketoprofen, naproxen, ibuprofen, diclofenac, salicylic acid, carbamazepine, caffeine, methyl dihydrojasmonate, galaxolide and tonalide. The performance of the evaluated treatment systems was compound dependent and varied as a function of the CW-configuration. In addition, PPCP removal efficiencies were lower during winter. The presence of plants favoured naproxen, ibuprofen, diclofenac, salicylic acid, caffeine, methyl dihydrojasmonate, galaxolide and tonalide removal. Significant positive correlations were observed between the removal of most PPCPs and temperature or redox potential. Accordingly, microbiological pathways appear to be the most likely degradation route for the target PPCPs in the CWs studied.

The cerebrospinal fluid lactate is decreased in early stages of multiple sclerosis

BACKGROUND: The purpose of this study was to investigate if the concentration of lactate can provide additional information for pathologies that need examination of the cerebrospinal fluid (CSF) in their diagnostic controls or protocols. METHODS: A prospective study carried out in the year 2001 at the University Hospital of Bellvitge (Barcelona), on 92 samples of CSF from patients who needed this examination. The concentration of lactate, glucose, and the cell count was determined. One year later, the diagnosis revealed from the previous analyzed samples were sorted into groups according to the diagnosis. RESULTS: In the group with multiple sclerosis (MS) (n = 30), there was a significant decrease in lactate concentration (1.52 +/- 0.19 mmol/L) compared to the control group (1.89 +/- 0.11 mmol/L) (p < 0.001). The glucose concentration remained within the normal range and the cell count was < 4 cell/microL even in the relapses. CONCLUSIONS: In the early stages of MS, the lactate concentration in CSF is decreased and this could be related to alterations in sensitivity observed in those patients. Further studies are needed to evaluate if this lactate concentration is a prognostic indicator of the disease.

[Macroamylasaemia in paediatrics]. / Macroamilasemia en pediatría.

Macroamylasaemia should be considered in any patient with high plasma amylase, no clinical signs and negative additional investigations for pancreatic or parotid diseases. It is characterised by an increase in serum amylase due to circulating high molecular mass macrocomplexes, most often formed due the binding of the amylase to an immunoglobulin. With a normal renal function, a hyperamylasaemia without an increase in urine amylase suggests the diagnosis, and is confirmed by identifying the macromolecular components. It is an uncommon entity in paediatrics. It has been described as a casual finding associated to abdominal pain and to celiac disease. We report two paediatric cases of macroamylasaemia, and a review of the tests needed for its diagnosis. The better understanding of this biochemical anomaly allows us to differentiate it from other situations associated to hyperamylasaemia, in order to avoid additional invasive explorations and unnecessary treatments.

First Report of Exserohilum rostratum Associated with Rice Seed in Venezuela.

Rice (Oryza sativa L.) is an important cereal crop in Venezuela and is planted on approximately 200,000 ha. Fungal diseases caused by the Helminthosporium complex of fungi are considered a major constraint to rice production. In 2005, a blotter method was used to identify fungi associated with rice seed. Seeds (150) of cv. INIA-017 were placed on a plate with moistened filter paper and incubated at 26 ± 2°C with a 12-h light/12-h dark cycle for 5 days until fungal sporulation. Single spores were transferred to 2% water agar (WA). Germinated spores were then transferred to potato dextrose agar (PDA), and resultant colonies were preserved until used. To induce sporulation, 4-mm-diameter discs were cut from 72-h-old cultures, transferred to WA, and incubated at 26 ± 2°C for 48 h (modified technique of Alcorn [1]). Discolored seed yielded isolates of Bipolaris oryzae (Berda de Haan) Shoemaker and Exserohilum rostratum (Drechs.) Leonard and Suggs (2). Pathogenicity tests were performed on 60-day-old rice plants of cv. Blue Bonnet 50. Four plants per pot were used for each isolate. Before inoculation, plants were placed in humidity chambers for 48 h. Spores were harvested from discs into a beaker containing 50 mL of a dilute gelatin solution (Gelatin Difco; 5 g/100 mL of sterile distilled water [SDW]). Spore suspensions were filtered through cheesecloth and adjusted to 7 × 104 spores per ml. The inoculated plants were placed in humidity chambers for 72 h. Control plants were sprayed with SDW. Inoculated plants were removed from humidity chambers and placed on a greenhouse bench. Plants inoculated with B. oryzae were symptomatic 5 days after inoculation; resultant lesions were red-brown with chlorotic borders. Lesions subsequently turned gray with reddish borders and were rhombic in shape. Plants inoculated with E. rotratum were symptomatic 7 days after inoculation with elliptical lesions that were orange-brown along venation. These lesions turned gray with reddish borders. Both fungi were reisolated from symptomatic leaf tissue. To our knowledge, this is the first report of E. rostratum from rice in Venezuela. References: (1) J. L. Alcorn. Mycotaxon. 17:1, 1983. (2) A. Sivanesam. Mycol. Pap. 158, 1987.