Eosinophilic Granulomatosis with Polyangiitis - description of a pediatric patient with severe disease.

INTRODUCTION: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare vasculitis of small and medium sized blood vessels. CASE DESCRIPTION: Thirteen-year-old male, with history of rhinitis and asthma, who presented to the emergency room with one week of asthenia, arthralgias and myalgias and two days of fever. A diffuse petechial rash, palpable purpura and polyarthritis were detected on examination. Leukocytosis (34990/µL) with eosinophilia (66%) and elevated C-reactive protein were identified. The patient was admitted and ceftriaxone and doxycycline were started. The clinical status deteriorated in the following days. The patient developed myopericarditis, bilateral pulmonary infiltrates and pleural effusion, requiring mechanical ventilation and aminergic support. Non-clonal eosinophils were detected on the bone marrow aspiration and the skin biopsy showed leukocytoclastic vasculitis with eosinophils. Antineutrophil cytoplasmic antibodies and genetic analysis for hypereosinophilic syndrome mutations were negative. After treatment with methylprednisolone for three days a fast clinical, laboratory and radiological improvement occurred. The patient started azatiophrine and reduced steroids progressively. No relapses occurred since diagnosis five years ago. DISCUSSION: Clinical suspicion and early treatment of EGPA are crucial to improve prognosis.

Mechanical power in pediatric acute respiratory distress syndrome: a PARDIE study.

BACKGROUND: Mechanical power is a composite variable for energy transmitted to the respiratory system over time that may better capture risk for ventilator-induced lung injury than individual ventilator management components. We sought to evaluate if mechanical ventilation management with a high mechanical power is associated with fewer ventilator-free days (VFD) in children with pediatric acute respiratory distress syndrome (PARDS). METHODS: Retrospective analysis of a prospective observational international cohort study. RESULTS: There were 306 children from 55 pediatric intensive care units included. High mechanical power was associated with younger age, higher oxygenation index, a comorbid condition of bronchopulmonary dysplasia, higher tidal volume, higher delta pressure (peak inspiratory pressure-positive end-expiratory pressure), and higher respiratory rate. Higher mechanical power was associated with fewer 28-day VFD after controlling for confounding variables (per 0.1 J·min-1·Kg-1 Subdistribution Hazard Ratio (SHR) 0.93 (0.87, 0.98), p = 0.013). Higher mechanical power was not associated with higher intensive care unit mortality in multivariable analysis in the entire cohort (per 0.1 J·min-1·Kg-1 OR 1.12 [0.94, 1.32], p = 0.20). But was associated with higher mortality when excluding children who died due to neurologic reasons (per 0.1 J·min-1·Kg-1 OR 1.22 [1.01, 1.46], p = 0.036). In subgroup analyses by age, the association between higher mechanical power and fewer 28-day VFD remained only in children < 2-years-old (per 0.1 J·min-1·Kg-1 SHR 0.89 (0.82, 0.96), p = 0.005). Younger children were managed with lower tidal volume, higher delta pressure, higher respiratory rate, lower positive end-expiratory pressure, and higher PCO2 than older children. No individual ventilator management component mediated the effect of mechanical power on 28-day VFD. CONCLUSIONS: Higher mechanical power is associated with fewer 28-day VFDs in children with PARDS. This association is strongest in children < 2-years-old in whom there are notable differences in mechanical ventilation management. While further validation is needed, these data highlight that ventilator management is associated with outcome in children with PARDS, and there may be subgroups of children with higher potential benefit from strategies to improve lung-protective ventilation. TAKE HOME MESSAGE: Higher mechanical power is associated with fewer 28-day ventilator-free days in children with pediatric acute respiratory distress syndrome. This association is strongest in children <2-years-old in whom there are notable differences in mechanical ventilation management.

As Strong as We Are United: Effects of Intrapersonal and Interpersonal Emotion Regulation on Quality of Life in Women With Breast Cancer.

Women diagnosed with breast cancer often experience unpleasant emotions, resulting in higher levels of emotional burden and decreased levels of wellbeing and quality of life. The present correlational and cross-sectional study aims to compare the implementation of two regulatory levels, intrapersonal and interpersonal (as social sharing of emotions), and two types of strategies, antecedent-focused and response-focused, and explore their impact on breast cancer patients' perception of quality of life. Sixty-eight women previously diagnosed with the disease participated in this study, with a mean age of 63years old (SD=11.58). Data were collected through a self-report questionnaire to assess emotional experience, intrapersonal regulation, social sharing of emotions, and breast cancer-related wellbeing and quality of life. Data yielded that most of the participants regulated their negative emotions within social interactions and made more use of antecedent-focused strategies to cognitively reformulate the emotional episode. Social and family wellbeing were positively associated with antecedent-focused strategies, as well as intrapersonal and interpersonal regulatory levels. Moreover, the occurrence of sharing episodes and social interactions played an important and beneficial role on patients' perceived quality of life. These findings reinforce the importance of promoting an adaptive intrapersonal regulation among breast cancer patients. Results also suggest that social sharing of emotions is an efficient process to help them to better cope with the psychological and emotional burden of the disease, thus positively influencing the way they perceive their social and family wellbeing, as well as their quality of life.

A partilha social de emoções na conjugalidade e seu impacto na satisfação conjugal / The social sharing of emotions in conjugality and its impact on marital satisfaction

Na tentativa de integrar a teoria da partilha social de emoções (PSE) com a conjugalidade, esse estudo avaliou o impacto da qualidade da PSE na satisfação conjugal e se há diferenças entre homens e mulheres nesse processo. Para isso, 185 participantes, de nacionalidade portuguesa, com idade igual ou superior a 30 anos, que estavam em relacionamento conjugal, responderam a um questionário sociodemográfico, à Escala de Avaliação da Satisfação em Áreas da Vida Conjugal (EASAVIC), à Differential Emotion Scale, a um conjunto de medidas e indicadores da PSE, a questões do Inquérito Social Europeu sobre bem-estar subjetivo e à versão reduzida da Escala de Apoio Social (Haslam et al., 2005). Os resultados obtidos relacionaram a qualidade da PSE à satisfação conjugal, sendo que maiores níveis na qualidade da PSE parecem estar relacionados a maiores níveis de satisfação conjugal. Ao contrário do esperado, homens e mulheres não demonstraram diferenças significativas em relação ao impacto da PSE na satisfação conjugal. Visto a possível influência da PSE nos níveis de satisfação conjugal, o estudo demonstrou a importância de serem conduzidas investigações relacionadas à qualidade da PSE nas relações conjugais.

In an attempt to integrate social sharing of emotions (SSE) theory with conjugality, this study evaluated the impact of SSE quality on marital satisfaction and whether if there is difference between men and women in this process. For this purpose, 185 participants, of Portuguese nationality, aged 30 years or more, who were in a marital relationship, answered a sociodemographic questionnaire, the Satisfaction Assessment Scale in Areas of Conjugal Life (EASAVIC), the Differential Emotion Scale, a set of measures and indicators related to SSE, an European Social Survey questions related to subjective well-being and a reduced version of the Social Support Scale (Haslam et al., 2005). The obtained results related SSE quality with marital satisfaction suggesting that higher levels of SSE quality seem to be related to higher levels of marital satisfaction. On the opposite of what was expected, men and women did not demonstrated significant differences. Considering the possible influence of SSE on the levels of marital satisfaction, this research supports the importance of being conduct researches related to the quality of SSE in marital relationships.