RESUMO
Thiamine is present in many foods and is well recognised as an essential nutrient critical for energy metabolism. While thiamine deficiency is commonly recognised in alcoholism, it can present in many other settings where it is often not considered and goes unrecognised. One challenging aspect to diagnosis is that it may have varied metabolic, neurological and cardiac presentations. Here we present an overview of the disorder, focusing on the multiple causes and clinical presentations. Interestingly, thiamine deficiency is likely increasing in frequency, especially among wildlife, where it is linked with changing environments and climate change. Thiamine deficiency should be considered whenever neurological or cardiological disease of unknown aetiology presents, especially in any patient presenting with lactic acidosis.
Assuntos
Acidose Láctica , Alcoolismo , Deficiência de Tiamina , Humanos , Deficiência de Tiamina/diagnóstico , Deficiência de Tiamina/etiologia , Tiamina , Acidose Láctica/complicações , Acidose Láctica/diagnóstico , Alcoolismo/complicações , AlimentosRESUMO
PURPOSE: Limited data exist on the characteristics, risk factors, and management of blunt trauma pelvic fractures causing genitourinary (GU) and lower gastrointestinal (GI) injury. We sought to determine these parameters and elucidate independent risk factors. METHODS: The National Trauma Data Bank for years 2010-2014 was queried for pelvic fractures by ICD-9-CM codes. Exclusion criteria included age ≤ 17 years, penetrating injury, or incomplete records. Patients were divided into three cohorts: pelvic fracture, pelvic fracture with GU injury, and pelvic fracture with GU and GI injury. Between-group comparisons were made using stratified analysis. Multivariable logistic regression was used to determine independent risk factors for concomitant GI injury. RESULTS: In total, 180,931 pelvic fractures were found, 3.3% had GU, and 0.15% had GU and GI injury. Most common mechanism was vehicular collision. Injury severity score, pelvic AIS, and mortality were higher with combined injury (p < 0.001), leading to longer hospital and ICU stays and ventilator days (p < 0.001) with more frequent discharges to acute rehabilitation (p < 0.01). Surgical management of concomitant injuries involved both urinary (62%) and rectal repairs (81%) or diversions (29% and 46%, respectively). Male gender (OR = 2.42), disruption of the pelvic circle (OR = 6.04), pubis fracture (OR = 2.07), innominate fracture (OR = 1.84), and SBP < 90 mmgh (OR = 1.59) were the strongest independent predictors of combined injury (p < 0.01). CONCLUSION: Pelvic fractures with lower GU and GI injury represent < 1% of pelvic fractures. They are associated with more severe injuries and increased hospital resource utilization. Strongest independent predictors are disruption of the pelvic circle, male gender, innominate fracture, and SBP < 90mm Hg.
Assuntos
Traumatismos Abdominais/complicações , Fraturas Ósseas/complicações , Traumatismo Múltiplo , Ossos Pélvicos/lesões , Sistema Urinário/lesões , Doenças Urológicas/etiologia , Ferimentos não Penetrantes/complicações , Traumatismos Abdominais/diagnóstico , Adulto , Feminino , Seguimentos , Fraturas Ósseas/diagnóstico , Humanos , Escala de Gravidade do Ferimento , Masculino , Morbidade/tendências , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia , Doenças Urológicas/epidemiologia , Ferimentos não Penetrantes/diagnósticoRESUMO
OBJECTIVES: To investigate independent relationships of childhood linear growth (height gain) and relative weight gain to adult cardiovascular disease (CVD) risk traits in Asian Indians. STUDY DESIGN: Data from 2218 adults from the Vellore Birth Cohort were examined for associations of cross-sectional height and body mass index (BMI) and longitudinal growth (independent conditional measures of height and weight gain) in infancy, childhood, adolescence, and adulthood with adult waist circumference (WC), blood pressure (BP), insulin resistance (homeostatic model assessment-insulin resistance [HOMA-IR]), and plasma glucose and lipid concentrations. RESULTS: Higher BMI/greater conditional relative weight gain at all ages was associated with higher adult WC, after 3 months with higher adult BP, HOMA-IR, and lipids, and after 15 years with higher glucose concentrations. Taller adult height was associated with higher WC (men ß = 2.32 cm per SD, women ß = 1.63, both P < .001), BP (men ß = 2.10 mm Hg per SD, women ß = 1.21, both P ≤ .001), and HOMA-IR (men ß = 0.08 log units per SD, women ß = 0.12, both P ≤ .05) but lower glucose concentrations (women ß = -0.03 log mmol/L per SD P = .003). Greater height or height gain at all earlier ages were associated with higher adult CVD risk traits. These positive associations were attenuated when adjusted for adult BMI and height. Shorter length and lower BMI at birth were associated with higher glucose concentration in women. CONCLUSIONS: Greater height or weight gain relative to height during childhood or adolescence was associated with a more adverse adult CVD risk marker profile, and this was mostly attributable to larger adult size.
Assuntos
Estatura , Doenças Cardiovasculares/epidemiologia , Aumento de Peso , Adolescente , Adulto , Índice de Massa Corporal , Criança , Pré-Escolar , Feminino , Crescimento , Humanos , Lactente , Masculino , Prognóstico , Estudos Prospectivos , Medição de Risco , Adulto JovemRESUMO
BACKGROUND.: Inappropriate footwear may be a major cause of foot ulceration among patients with diabetic neuropathy in India. No study has specifically examined the types of footwear or its components in patients with diabetes mellitus and their role in causing foot ulcers. We analysed the role of commonly used footwear in India in inducing first foot ulcers (FFU) in people with diabetes. METHODS.: Of 4800 patients with diabetes attending our centre over 1 year, 301 had FFU from different causes. Sixty-six patients with diabetic neuro-/vasculopathy presenting with ulcers due to footwear were included as cases. An equal number of patients with diabetes but without foot ulcers were enrolled as controls. Cases and controls were matched demographically and clinically for type of diabetes, metabolic control, duration of diabetes, comorbid conditions and foot neurovascular status. We did a detailed foot examination for neurological, vascular and wound status. We also evaluated the footwear in both groups. RESULTS.: In one-fifth of 335 limbs (301 patients), the primary cause for the FFU was use of inappropriate footwear. The patients used seven different models of footwear, six of which were found to be inappropriate. The straps of footwear caused over 50% of ulcers. Another one-third were due to penetration of sharp objects through the outer sole of footwear; among these cases, 1 3.6% of ulcers were caused by not using soft inner soles. CONCLUSIONS.: The use of softer insole is least effective in preventing foot ulcers. Similarly, straps contribute to a higher percentage of foot ulcers. Foot ulcers can be prevented by a combination of soft insole, with midsole and hard outsole with proper back counter and adjustable front and back straps.
Assuntos
Pé Diabético/epidemiologia , Sapatos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Equine recurrent uveitis (ERU) is characterized by recurrent bouts of inflammation interrupted by periods of quiescence that vary in duration. There is little consensus on the clinical manifestations, the underlying causes, or the management. The 3 commonly recognized syndromes of ERU (classic, insidious, and posterior) do not accurately separate the clinical manifestations of disease into distinct categories. An accurate diagnosis and early intervention are essential to minimizing the effects of disease and preserving vision. There are multiple medical and surgical options for controlling ERU as long as the disease is recognized early and targeted treatment is initiated immediately.
Assuntos
Doenças dos Cavalos/terapia , Uveíte/veterinária , Animais , Doença Crônica , Doenças dos Cavalos/cirurgia , Cavalos , Recidiva , Uveíte/cirurgia , Uveíte/terapiaRESUMO
PURPOSE: Motor vehicle collisions are the most common cause of blunt genitourinary trauma. We compared renal injuries with no protective device to those with seat belts and/or airbags using NTDB. Our primary end point was a decrease in high grade (grades III-V) renal injuries with a secondary end point of a nephrectomy rate reduction. MATERIALS AND METHODS: The NTDB research data sets for hospital admission years 2010, 2011 and 2012 were queried for motor vehicle collision occupants with renal injury. Subjects were stratified by protective device and airbag deployment. The AIS was converted to AAST renal injury grade and nephrectomy rates were evaluated. Intergroup comparisons were analyzed for renal injury grades, nephrectomy, length of stay and mortality using the chi-square test or 1-way ANOVA. The relative risk reduction of protective devices was determined. RESULTS: A review of 466,028 motor vehicle collisions revealed a total of 3,846 renal injuries. Injured occupants without a protective device had a higher rate of high grade renal injuries (45.1%) than those with seat belts (39.9%, p = 0.008), airbags (42.3%, p = 0.317) and seat belts plus airbags (34.7%, p <0.001). Seat belts (20.0%), airbags (10.5%) and seat belts plus airbags (13.3%, each p <0.001) decreased the nephrectomy rate compared to no protective device (56.2%). The combination of seatbelts and airbags also decreased total hospital length of stay (p <0.001) and intensive care unit days (p = 0.005). The relative risk reductions of high grade renal injuries (23.1%) and nephrectomy (39.9%) were highest for combined protective devices. CONCLUSIONS: Occupants of motor vehicle collisions with protective devices show decreased rates of high grade renal injury and nephrectomy. Reduction appears most pronounced with the combination of seat belts and airbags.
Assuntos
Traumatismos Abdominais/epidemiologia , Acidentes de Trânsito , Air Bags , Rim/lesões , Nefrectomia/estatística & dados numéricos , Cintos de Segurança , Ferimentos não Penetrantes/epidemiologia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/prevenção & controle , Adulto , Feminino , Humanos , Incidência , Rim/cirurgia , Tempo de Internação/tendências , Masculino , Estudos Retrospectivos , Índices de Gravidade do Trauma , Estados Unidos/epidemiologia , Ferimentos não Penetrantes/prevenção & controle , Ferimentos não Penetrantes/cirurgiaRESUMO
Actinobacteriophage Djungelskog was isolated from a sample of degraded organic material in Poughkeepsie, NY, using Arthrobacter globiformis B-2979. Its genome is 54,512 bp and encodes 86 putative protein-coding genes. Djungelskog has a siphovirus morphology and is assigned to cluster AW based on gene content similarity to actinobacteriophages.
RESUMO
OBJECTIVES: To assess the effectiveness of social skills training in leprosy patients to raise self-esteem and reduce self-perceived stigma. DESIGN: Five leprosy patients were given 10 day-long group-sessions of social skills training over 3 weeks. Training involved: identification of the emotions and concerns of patients when interacting socially; analysis of positive and negative social interactions and non-verbal and verbal skills training. Role-plays, videos and live models were used. Self-esteem and a reduction in self-perceived stigma were assessed qualitatively before and after training using semi-structured interviews. Assessment of change was scored under the indicators: self-perception, family, wider community and job. Patients were assessed for displaying new ways of interacting with people and changes in expectations for the future. RESULTS: Qualitative analysis of the interviews before and after training suggested that social skills training could raise the self-esteem of leprosy patients and combat self-perceived stigma. Increase in self-esteem, as evident through the verbal interactions with the interviewers and behavioural changes in the community, were noted in the majority of patients. CONCLUSION: Social skills training along with counseling may be able to increase the self-esteem of leprosy patients, and so be a useful part of leprosy rehabilitation schemes to try and combat the stigma of leprosy.
Assuntos
Promoção da Saúde/métodos , Hanseníase/psicologia , Educação de Pacientes como Assunto/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Estigma Social , Adulto , Exercício Físico , Humanos , Índia/epidemiologia , Relações Interpessoais , Entrevistas como Assunto , Hanseníase/epidemiologia , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/organização & administração , Educação de Pacientes como Assunto/organização & administração , Postura , Pesquisa Qualitativa , Serviços de Saúde Rural/organização & administração , População Rural , Autoimagem , Comportamento Social , Classe Social , Comportamento Verbal , Adulto JovemRESUMO
OBJECTIVE: Resources for management of epilepsy in Africa are extremely limited reinforcing the need to develop innovative strategies for optimizing care. Studies have shown that the prevalence of epilepsy in low- and middle-income countries is substantially greater than in more resourced countries. The objective of this report was to demonstrate that mobile Health (mHealth) technologies have the potential to improve the management of epilepsy in Africa. METHODS: The feasibility of technology-based home monitoring was investigated in an observational study of 40 children with refractory epilepsy or epilepsy associated with intellectual disability and/or behavior difficulties in South Africa. Technology-based home monitoring was implemented for six months. Physical activity, sleep, and heart rate were continuously monitored with a wearable device. Caregivers completed regular mobile Patient Reported Outcomes (mPROs) and reported seizures and ad hoc events using a dedicated app. Feasibility was assessed and descriptively measured for recruitment, retention, and engagement of the participants. RESULTS: The mHealth technology was able to capture important information that gives an impression of the overall experience of the children and their caregivers. Thirty-seven participants (94.9%) reported at least one clinical event. Seventy-nine percent of caregivers reported seizure events in their children, which were the primary event anticipated. Median engagement with the wearable device and monthly mPROs was 30.8% and 57.1%, respectively. However, most participants (87%) had to be given smartphones for them to have Bluetooth capabilities and access to the study app. Tolerability to the device was impacted by the difficult living circumstances of caregivers that induced fear of loss or theft. SIGNIFICANCE: The study showed how the use of remote patient monitoring in the form of mHealth can benefit epilepsy patients, despite highly variable engagement with the technology. The combination of mPROs and wearable devices generated informative datasets that will allow clinicians but also the children and their caregivers to better understand and manage the disease.
Assuntos
Exercício Físico , Dispositivos Eletrônicos Vestíveis , Criança , Estudos de Viabilidade , Humanos , Smartphone , África do SulRESUMO
Benzo[a]pyrene (B[a]P) is a polycyclic aromatic hydrocarbon (PAH) commonly found in cigarette smoke, automobile exhaust fumes, grilled meat, and smoked food among others. Exposure to B[a]P is associated with a range of toxic effects including developmental, neurological, oxidative, inflammatory, mutagenic, carcinogenic and mortal. Efficient and more affordable experimental models like Drosophila melanogaster could provide more insight into the mechanism of PAH toxicity and help develop new strategies for prevention, diagnosis and treatment of PAH-related conditions. In this study, we examined the induction of some biochemical changes along with mortality and functional senescence by B[a]P and its metabolite, benzo[a]pyrene- 7,8-dihydrodiol-910-epoxide (BPDE) in the Canton-S strain of Drosophila melanogaster, with the aim to establish an alternative assay medium for B[a]P toxicity in flies. Flies were exposed to 2-200 µM of B[a]P and 1-10 µM of BPDE through diet for a seven-day survival assay followed by a four-day treatment to determine the effects of the compounds on negative geotaxis, fecundity and some biochemical parameters of oxidative damage. BPDE significantly reduced the survival rate of flies along the 7 days of exposure whereas B[a]P did not cause any significant change in the survival rate of flies. B[a]P and BPDE significantly reduced the climbing ability of flies after 4 days of exposure. Rate of emergence of flies significantly reduced at 10-200 µM of B[a]P and 5-10 µM of BPDE. Both compounds caused various levels of alterations in the values of reduced glutathione (GSH), total thiol (T-SH), glutathione-S-transferase (GST), catalase (CAT), hydrogen peroxide (H2O2), nitric oxide (NO) and acetylcholinesterase (AChE) of the flies. The compounds also exhibited high binding affinities and molecular interactions with the active site amino acid residues of Drosophila GST and the inhibitor binding site of Drosophila AChE in an in silico molecular docking analysis, with BPDE forming stable hydrogen bonds with AChE. Hence, the Canton-S strain of Drosophila melanogaster could offer a simple and affordable assay medium to study B[a]P toxicity.
RESUMO
Human bocavirus (HBoV) is a parvovirus, belonging to the genus Bocavirus. The virus was identified recently in Sweden, and has now been detected in several different countries. Although it is associated with lower respiratory tract infections in pediatric patients, the incidence of HBoV infection in a developed country in South East Asia, has not been examined. The objective of this study was to determine the importance of HBoV as a cause of lower respiratory tract infections among children admitted to hospital in Singapore. Five hundred nasopharyngeal swabs were collected from anonymized pediatric patients admitted to the Kandang Kerbau Women's and Children's Hospital for acute respiratory infections. The specimens were tested for the presence of HBoV using polymerase chain reactions. HBoV was detected in 8.0% of the patients tested, and a majority of these HBoV patients exhibited lower respiratory tract infections. A significant level of coinfection with respiratory syncytial viruses and rhinoviruses was also observed in these HBoV patients. The data suggest that HBoV is an important cause of lower respiratory tract infections among children admitted to hospital in Singapore, and is the first study examining the incidence of HBoV infection in a developed country in South East Asia.
Assuntos
Bocavirus/isolamento & purificação , Infecções por Parvoviridae/epidemiologia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/virologia , Criança , Comorbidade , DNA Viral/química , DNA Viral/genética , Hospitais , Humanos , Incidência , Dados de Sequência Molecular , Nasofaringe/virologia , Filogenia , Reação em Cadeia da Polimerase/métodos , Vírus Sincicial Respiratório Humano/isolamento & purificação , Rhinovirus/isolamento & purificação , Análise de Sequência de DNA , Singapura/epidemiologiaRESUMO
BACKGROUND: Renal trauma may be managed differently in tiered trauma systems and among those who requireinterfaculty transfer. OBJECTIVE: To evaluate the initial management of renal trauma, assess patterns of management based on hospital trauma level designation and interfacility transfer status, and analyze management trends over time. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of renal trauma from the National Trauma Data Bank 2010-2015. INTERVENTION: Nephrectomy, angioembolization, or nonoperative management. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS: We used generalized estimating equations to compare odds of each management outcome in patients transferred and directly admitted to a level I center, versus those directly admitted to a non-level I center, adjusting for vital signs, injury, demographic, and facility characteristics. We also used generalized estimating equations to examine linear time trends in management outcome, adjusting for injury characteristics. RESULTS AND LIMITATIONS: A total of 51798 renal trauma records were included: 44 838 low-grade (American Association for the Surgery of Trauma I-III) and 6359 high grade (IV-V) injuries. After adjusting for comorbidities, demographics, and hospital characteristics, odds of nephrectomy, angioembolization, and nonoperative management were similar in patients transferred or directly admitted to a level I center compared with those treated at a non-level I center. Changes in management over time demonstrated a decreased rate of nephrectomy (p=0.007) in high-grade injuries, while the rate of angioembolization remained constant (p=0.33). Study limitations include mortality prior to hospital transfer or arrival, and its retrospective nature. CONCLUSIONS: In this contemporary trauma analysis, outcomes of both low- and high-grade renal trauma are similar across patients managed in tiered trauma centers and those undergoing transfer, signifying dissemination of collective renal trauma management. The rate of nephrectomy has decreased for high-grade renal injury over our study period, suggesting new adoption of kidney-sparing management. PATIENT SUMMARY: Renal trauma is now managed similarly in tiered trauma centers and in patients requiring interfacility transfer. The rate of nephrectomy for high-grade renal injuries has decreased over time.
Assuntos
Rim/lesões , Transferência de Pacientes/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/terapia , Adulto , Estudos de Casos e Controles , Comorbidade , Gerenciamento Clínico , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Feminino , Humanos , Escala de Gravidade do Ferimento , Rim/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Nefrectomia/estatística & dados numéricos , Tratamentos com Preservação do Órgão/métodos , Transferência de Pacientes/tendências , Estudos Retrospectivos , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/mortalidadeRESUMO
The majority of patients with penetrating thoracic trauma are managed non-operatively. Those requiring surgery usually go to theater with physiological instability. The critical condition of these patients coupled with the rarity of penetrating thoracic trauma in most European countries makes their surgical management challenging for the occasional trauma surgeon, who is usually trained as a general surgeon. Most general surgeons have a general knowledge of basic cardiothoracic operative surgery, knowledge originating from their training years and possibly enhanced by reading operative surgery textbooks. Unfortunately, the details included in most of these books are not extensive enough to provide him with enough armamentaria to tackle the difficult case. In this anatomical region, their operative dexterity and knowledge cannot be compared to that of their cardiothoracic colleagues, something that is taken for granted in their cardiothoracic trauma textbooks. Techniques that are considered basic and easy by the cardiothoracic surgeons can be unfamiliar and difficult to general surgeons. Knowing the danger points and the pitfalls that will be encountered in cardiothoracic trauma surgery will help them to avoid intraoperative errors and improve patient outcome. The purpose of this manuscript is to highlight the commonly encountered pitfalls by trauma surgeons operating on penetrating trauma to the chest.
Assuntos
Traumatismos Torácicos/cirurgia , Procedimentos Cirúrgicos Torácicos/normas , Ferimentos Penetrantes/cirurgia , Humanos , Procedimentos Cirúrgicos Torácicos/métodos , Índices de Gravidade do Trauma , Traumatologia/métodos , Traumatologia/normas , Resultado do TratamentoRESUMO
INTRODUCTION: Given the limited evidence about the benefits of orthodontic treatment, many health care systems have rationed access to orthodontic care with the Index of Orthodontic Treatment Need (IOTN) being one tool used to attempt to allocate resources based on need. However, it is not clear whether patient and public valuations of different levels of need (as described by the IOTN) reflect the resource allocation decisions. The aim of this project was therefore to determine the values parents placed on correction of malocclusions at different IOTN levels using the willingness to pay (WTP) technique. METHOD: 401 parents of children attending hospital-based orthodontic clinics in the North of England were recruited to complete a questionnaire eliciting WTP for the correction of seven malocclusions with different IOTN scores. In addition demographic and orthodontic history characteristics were collected. Results were analysed with appropriate pairwise significance tests and regression. RESULTS: A significant difference in WTP was noted between all the possible pairs of malocclusions with the exception of overjets with moderate versus great need of treatments. At moderate levels, correction of crowding was valued less than overjet but this was reversed at great need levels. Very little of the variance in WTP was explained by the variables collected. When looking at factors affecting percentage difference between values for different pairs of malocclusions, in general, no factors predicted the magnitude of difference. CONCLUSION: Median valuations for correction of malocclusions vary significantly for different levels of need (as judged by IOTN), with increasing levels of need generating higher values. However, there was a limited effect of demographic or orthodontic characteristics on the magnitude of percentage difference in values for correcting malocclusions different levels of need.
RESUMO
India is experiencing an epidemic of Type 2 diabetes mellitus (DM) in young adults. This study reports the prevalence of glucose intolerance, and insulin profiles, and their relationship to lifestyle factors in 2218 young adults (aged 26-32 years; 997 urban, 1221 rural) in south India. They were drawn from a cohort of 10,691 individuals born during 1969-1973 in Vellore and nearby villages. Family history, socio-economic status, physical activity and tobacco and alcohol use were recorded. Oral glucose tolerance tests were performed for diagnosis (WHO recommendations). Insulin resistance and secretion were derived from plasma insulin concentrations. Median BMI was 20.0kg/m(2). The prevalence of Type 2 DM and impaired glucose tolerance (IGT) was higher in urban than in rural subjects (3.7% versus 2.1%, p=0.02; 18.9% versus 14.3%, p=0.002, respectively), while prevalence of impaired fasting glycaemia (IFG) was similar in urban and rural populations (3.8% versus 3.4%, p=0.04). Type 2 DM, IGT, IFG or higher insulin resistance and increment were associated with higher socio-economic status (more household possessions) and higher percentage body fat, body mass index and waist/hip ratio. Insulin increment was lower in men with higher alcohol consumption. Our data suggest high levels of glucose intolerance in young rural and urban adults highlighting an urgent need for preventive action to avert a public health catastrophe in India.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Intolerância à Glucose/epidemiologia , Adulto , Estudos de Coortes , Feminino , Morte Fetal/epidemiologia , Inquéritos Epidemiológicos , Humanos , Índia/epidemiologia , Insulina/sangue , Masculino , Estado Civil , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Obesidade/epidemiologia , Sobrepeso , Gravidez , Prevalência , População Rural , População UrbanaRESUMO
BACKGROUND: Limited data exist on risk factors for the failure of nonoperative management of renal trauma. Our study objective was to determine the incidence, salvage procedure, and risk factors for failure of nonoperative management of renal trauma. METHODS: The National Trauma Data Bank research data sets for admission years 2010-2014 were queried for renal injury by Abbreviated Injury Score code. Patients were stratified by interventional therapy (renal procedure code <24 hours from admission) and nonoperative management (no surgical renal procedure <24 hours). Abbreviated Injury Score was converted to American Association for the Surgery of Trauma renal injury grade. Demographics, patient and injury characteristics were compared between groups using stratified analysis. Multivariable logistic regression models were used to determine variables that were associated with failure of nonoperative management. RESULTS: A review of 3,977,634 cases revealed 19,572 renal injuries that met study criteria. A total of 16.6% were managed with interventional therapy, and 83.4% were managed nonoperatively, of which 2.7% failed nonoperative management. Risk-adjusted multivariate regression indicated that penetrating injury (stab: odds ratio [OR], 1.61; 95% confidence interval [CI], 1.02-2.53 [p = 0.040]; and gunshot wound: OR, 1.40; 95% CI, 1.04-1.90 [p = 0.029]), highest abdominal injury grade for nonrenal organs (OR, 2.06; 95% CI, 1.65-2.57), and highest renal injury grade (OR, 1.85; 95% CI, 1.54-2.21) were associated with failure of nonoperative management (all p < 0.001). Increasing injury grades were associated with increasing risk of failing nonoperative management (Grade III: OR, 1.94; 95% CI, 1.35-2.90; Grade IV: OR, 9.79; 95% CI, 7.04-13.63; and Grade V: OR, 9.45; 95% CI, 6.02-14.86 [all p < 0.001]). CONCLUSIONS: Nonoperative management in the first 24 hours after fails in up to 2.7%. Renal injury grade, nonrenal abdominal injuries, and penetrating injuries predict for nonoperative management failure. Highest-grade renal injuries are at increased risk of failure. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III; therapeutic study, level IV.
Assuntos
Traumatismos Abdominais/terapia , Rim/lesões , Escala Resumida de Ferimentos , Traumatismos Abdominais/cirurgia , Adulto , Canadá , Feminino , Humanos , Masculino , Nefrectomia , Estudos Retrospectivos , Fatores de Risco , Terapia de Salvação , Centros de Traumatologia , Falha de Tratamento , Estados UnidosRESUMO
Eosinophilic esophagitis (EE) is characterized by eosinophilic infiltration of the esophageal mucosa and results in clinical signs and symptoms that may be indistinguishable from those of gastroesophageal reflux disease (GERD). While demographic, clinical, and endoscopic features may be suggestive of EE, esophageal biopsy with tissue eosinophils averaging 24 per 400 x microscopic field remains the most specific diagnostic criterion. Previously rare, EE has been diagnosed in adults and children with increased frequency over the last decade; it appears to be a chronic disease and has a yearly incidence approximating 1:10,000 in the pediatric population. Dietary and respiratory antigen exposure with subsequent production of inflammatory chemokines is essential for development of EE in animal models of the disease. In humans, glucocorticoids and elimination of relevant dietary antigens have proved efficacious treatments for EE, resolving the disease at the mucosal level. Other therapies, including montelukast, partial dietary elimination, and bouginage have reduced symptoms without affecting mucosal inflammation. Evidence-based guidelines for the management of EE are not currently available. Current medical practice involving the management of reflux merits awareness and understanding of this emerging mimic. We present a review of the current understanding of this disorder.
Assuntos
Eosinofilia/diagnóstico , Esofagite/diagnóstico , Refluxo Gastroesofágico/diagnóstico , Criança , Diagnóstico Diferencial , Eosinofilia/terapia , Esofagite/imunologia , Esofagite/terapia , Refluxo Gastroesofágico/imunologia , Refluxo Gastroesofágico/terapia , HumanosRESUMO
Residency training programs requirements state, "Residents should participate in scholarly activity." However, there is little consensus regarding how best to achieve these requirements. The objective of this study is to implement a resident research program that emphasizes resident participation in quantitative or qualitative empirical work. A three-step program "Think, Do, Write" roughly follows the 3 years of the residency. During the first phase, the resident chooses a topic, formulates a hypothesis, and completes standard research certifications. Phase 2 involves obtaining Institutional Review Board approval, and conducting the study. The final phase entails analyzing and interpreting the data, and writing an abstract to present during an annual research day. Residents are encouraged to submit their projects for presentation at scientific conferences and for publication. Multiple departmental resources are available, including a Resident Research Fund, and full support of the faculty. Prior to the new program, most scholarly activity consisted of case reports, book chapters, review articles, or other miscellaneous projects; only 27 % represented empirical studies. Starting in 2012, the new program was fully implemented, resulting in notable growth in original empirical works among residents. Currently there is almost 100 % participation in studies, and numerous residents have presented at national conferences, and have peer-reviewed publications. With a comprehensive and supported program in place, emergency medicine residents proved capable of conducting high-quality empirical research within their relatively limited time. Overall, residents developed valuable skills in research design and statistical analysis, and greatly increased their productivity as academic and clinical researchers.
Assuntos
Medicina de Emergência/educação , Pesquisa Empírica , Internato e Residência , Desenvolvimento de Programas , HumanosRESUMO
OBJECTIVE: Disease-associated isoforms of the prostate-specific antigen (PSA) have recently been identified. We evaluated the efficacy of using precursor isoforms of PSA (pPSA) and their ratios for the detection of prostate cancer. METHODS: Serum concentrations of [-2], [-4], and [-7]pPSA, BPSA, and free PSA (fPSA) were retrospectively measured in 43 selected men. Of the 43 men, 15 had clinical T2 prostate cancer with ultrasound-estimated prostate volumes (PVs) of >50 cm(3), 13 had clinical T2 prostate cancer with (PVs) <25 cm(3), and 15 were prostate cancer-free with PV >50 cm(3). We calculated sum pPSA ([-2]+[-4]+[-7]pPSA). We also compared the ratios of: free/total PSA, [-2]pPSA/fPSA, [-2]pPSA/BPSA, [-2]pPSA/(fPSA-BPSA), [-2]pPSA/(fPSA-sum pPSA), and [-2]pPSA/{fPSA-(sum pPSA+BPSA)} among these three groups. RESULTS: The median [-2]pPSA/(fPSA-sum pPSA) ratio was significantly higher in men with prostate cancer with or without large PV compared with men with large PV without prostate cancer. Values for median [-2]pPSA/free PSA ratio were higher in men with prostate cancer with or without large PV compared with men with large PV, and without prostate cancer, but the differences were not statistically significant. CONCLUSIONS: In this preliminary study, [-2]pPSA/(fPSA-sum pPSA) ratio was not associated with prostate gland volume but was associated with prostate cancer. This ratio may be useful in the detection of prostate cancer, particularly in men with larger glands.