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BACKGROUND: Controversy exists surrounding the use of the phrenic nerve for transfer in severe brachial plexus injuries. The objectives of this study are: (1) to present the experience of the authors using the phrenic nerve in a single institution; and (2) to thoroughly review the existing literature to date. METHODS: Adult patients with C5-D1 and C5-C8 lesions and a phrenic nerve transfer were retrospectively included. Patients with follow-up shorter than 18 months were excluded. The MRC muscle strength grading system was used to rate the outcome. Clinical repercussions relating to sectioning of the phrenic nerve were studied. An intense rehabilitation program was started after surgery, and compliance to this program was monitored using a previously described scale. Statistical analysis was performed with the obtained data. RESULTS: Fifty-one patients were included. The mean time between trauma and surgery was 5.7 months. Three-quarters of the patients had C5-D1, with the remainder C5-C8. Mean post-operative follow-up was 32.5 months A MRC of M4 was achieved in 62.7% patients, M3 21.6%, M2 in 3.9%, and M1 in 11.8%. The only significant differences between the two groups were in graft length (9.8 vs. 15.1 cm, p = 0.01); and in the rehabilitation compliance score (2.86 vs. 2.00, p = 0.01). CONCLUSIONS: Results of phrenic nerve transfer are predictable and good, especially if the grafts are short and the rehabilitation is adequate. It may adversely affect respiratory function tests, but this rarely correlates clinically. Contraindications to the use of the phrenic nerve exist and should be respected.
Subject(s)
Brachial Plexus Neuropathies/surgery , Brachial Plexus/injuries , Nerve Transfer/methods , Phrenic Nerve/transplantation , Adolescent , Adult , Brachial Plexus/surgery , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Neutrophil extracellular trap formation (NETosis) is a mechanism used by neutrophils to capture pathogens with their own DNA. However, the exacerbation of this immune response is related to serious inflammatory diseases. Aging is known to lead to an excessive increase in NETosis associated with various diseases. Under this scenario, the search for strategies that regulate the release of NETosis in older people becomes relevant. High-intensity interval training (HIIT) involves repeated bouts of relatively intense exercise with alternating short recovery periods. This training has shown beneficial effects on health parameters during aging and disease. However, little is known about the potential role of HIIT in the regulation of NETosis in healthy older people. The aim of this study was to evaluate the induction of NETosis by serum from healthy young and older men, before and after 12 weeks of HIIT using healthy neutrophils as a biosensor. HIIT was performed 3 times per week for 12 weeks in young (YOUNG; 21 ± 1 years, BMI 26.01 ± 2.64 kgâ m-2, n = 10) and older men (OLDER; 66 ± 5 years, BMI 27.43 ± 3.11 kgâ m-2, n = 10). Serum samples were taken before and after the HIIT program and NETosis was measured with live cell imaging in donated neutrophils cultured with serum from the participants for 30 h. Our results showed that serum from older men at baseline induced greater baseline NETosis than younger men (p < 0.05; effect size, ≥0.8), and 12 weeks of HIIT significantly reduced (Interaction Effect, p < 0.05; effect size, 0.134) the induction of NETosis in older men. In conclusion, HIIT is a feasible non-invasive training strategy modulating NETosis induction. Additionally, the use of neutrophils as a biosensor is an effective method for the quantification of NETosis induction in real time.
Subject(s)
Biosensing Techniques , Extracellular Traps , High-Intensity Interval Training , Male , Humans , Aged , Neutrophils , AgingABSTRACT
Introduction: Long-term pulmonary dysfunction (L-TPD) is one of the most critical manifestations of long-COVID. This lung affection has been associated with disease severity during the acute phase and the presence of previous comorbidities, however, the clinical manifestations, the concomitant consequences and the molecular pathways supporting this clinical condition remain unknown. The aim of this study was to identify and characterize L-TPD in patients with long-COVID and elucidate the main pathways and long-term consequences attributed to this condition by analyzing clinical parameters and functional tests supported by machine learning and serum proteome profiling. Methods: Patients with L-TPD were classified according to the results of their computer-tomography (CT) scan and diffusing capacity of the lungs for carbon monoxide adjusted for hemoglobin (DLCOc) tests at 4 and 12-months post-infection. Results: Regarding the acute phase, our data showed that L-TPD was favored in elderly patients with hypertension or insulin resistance, supported by pathways associated with vascular inflammation and chemotaxis of phagocytes, according to computer proteomics. Then, at 4-months post-infection, clinical and functional tests revealed that L-TPD patients exhibited a restrictive lung condition, impaired aerobic capacity and reduced muscular strength. At this time point, high circulating levels of platelets and CXCL9, and an inhibited FCgamma-receptor-mediated-phagocytosis due to reduced FcγRIII (CD16) expression in CD14+ monocytes was observed in patients with L-TPD. Finally, 1-year post infection, patients with L-TPD worsened metabolic syndrome and augmented body mass index in comparison with other patient groups. Discussion: Overall, our data demonstrated that CT scan and DLCOc identified patients with L-TPD after COVID-19. This condition was associated with vascular inflammation and impair phagocytosis of virus-antibody immune complexes by reduced FcγRIII expression. In addition, we conclude that COVID-19 survivors required a personalized follow-up and adequate intervention to reduce long-term sequelae and the appearance of further metabolic diseases.
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Objective: To determine the association between Obstructive Sleep Apnea (OSA) with long-term symptoms and inflammatory cytokines, exploring the changes between 4-months and 1-year after COVID-19 infection. Methods: We conducted an observational, prospective cohort study, including patients ≥18 years old with confirmed diagnosis of COVID-19 between April to July 2020. All participants underwent two clinical follow-up visits, the first at 4-months (Visit 1) and the second at 1 year, after SARS-CoV-2 infection (Visit 2). Plasma glucose, total cholesterol, HDL, and triglycerides. Regarding pulmonary function, spirometry and lung diffusion capacity tests were assessed. For mental and neurocognitive evaluation, a short-form (SF-12), Beck depression and Hospital-Anxiety depression questionnaires were conducted at both time-points, whereas the Montreal Cognitive assessment was conducted during the second follow-up. Regarding to sleep evaluation, Epworth Sleepiness Scale, Insomnia Severity index and STOP-BANG questionnaire were conducted. Additionally, a home sleep apnea test and 7-day wrist actigraphy were performed in all participants. Inflammatory cytokines were measured using an inflammatory cytokine bead array kit. p-values < 0.05 were considered statistically significant and statistical analyses were performed using R software. Results: A total of 60 patients were included in the first follow-up, from which 57 completed the second follow-up. The mean age was 46.4 years-old (SD ± 13.1) and 53.3% were male. 30% of cases reported mild COVID-19 infection, 28.3% with moderate illness, and 41.6% with severe illness. Moreover, 56.6% of them were admitted to the ICU. Regarding to metabolic values, the OSA group showed higher values of insulin resistance (IR) (27%), systolic blood pressure (SBP) 135.2 (±19.1), dyslipidemia (67.5%), total cholesterol 202.1 (±60.5), triglycerides 176.1 (±119.0) and HOMA-IR 9.0 (±18.8) in comparison with the non-OSA group. 1 year after COVID-19 infection, DLCO test remains abnormal in OSA patients (25% OSA vs. 3.6% non-OSA, p = 0.02). Finally, those participants with OSA who develop ARDS reported an adjusted OR 20.4 (95%-CI, 1.04-504) risk of neurocognitive impairment. Discussion: Among patients with previous COVID-19, OSA impact the development of incident glycemic, neurocognitive impairment, and abnormal functional pulmonary changes that persist up to 1 year since acute phase.
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Objetivos: Describir, analizar y explorar los mitos, creencias y prácticas de cuidadores de niños con asma en relación al tratamiento con inhaladores en la provincia de Chiclayo durante el año 2013. Material y métodos: Estudio cualitativo, de perspectiva explicativa, con base en la etnografía; se realizaron grupos focales y triangulación de la información; participaron 20 cuidadores de niños asmáticos, distribuidos en cuatro grupos focales y siete médicos pediatras; fueron captados mediante muestreo por conveniencia. Los resultados fueron grabados, transcritos, codificados y categorizados según análisis temático, en forma manual. Resultados: El 90% de los cuidadores fueron mujeres; en 55% sus hijos tuvieron asma mal controlada. Se identificaron algunos mitos: posibilidad de daño cardiaco, dependencia, alteraciones en el sistema nervioso, alteración del coeficiente intelectual e incremento de peso; además las siguientes creencias: alteraciones de la conducta, efectos en el crecimiento y en el sistema osteomuscular y una mayor efectividad de las nebulizaciones frente a los inhaladores. Se halló una técnica deficiente en el uso inhaladores y una elevada frecuencia de uso de plantas medicinales. Conclusiones: los cuidadores de niños asmáticos poseen mitos y creencias sobre los inhaladores, la mayoría ya reportados en realidades similares y diferentes a la nuestra. La técnica descrita del uso de inhaladores fue deficiente. Los médicos conocen la mayoría de los mitos, creencias y prácticas de sus pacientes. Es recomendable que el médico pregunte a los cuidadores sobre estos mitos y creencias para explicar, aclarar y brindar la ayuda necesaria, para mejorar adherencia y lograr un control mejor del problema
Objectives: To describe and analyze myths, beliefs, and practices of asthmatic children caregivers with respect to inhaler therapy in Chiclayo province during 2013. Material and methods: This is a qualitative study that used an explanatory perspective, and it was based on ethnography. Focus groups were implemented and data triangulation was performed. Twenty asthmatic children caregivers and seven pediatricians participated, which were divided in 4 focus groups. These persons were selected using a convenience sampling model. Results were recorded, transcribed, coded and manually categorized according to a thematic analysis. Results: Ninety per cent of caregivers were female; in 55% asthma in their children was poorly controlled. Some myths about the use of inhaled medications for asthma were identified: likelihood for cardiac adverse effects, dependence, alterations in the central nervous system, alterations in the intellectual quotient, and weight gain. Also, the following beliefs were found: behavioral disorders, side effects in growth and the musculoskeletal system, and greater effectiveness of nebulizations compared to that of inhalers. We also found a poor technique for inhaler use, and a high frequency of concomitant use of medicinal plants. Conclusions: Caregivers of asthmatic children have myths and beliefs about inhalers, similar to those reported in similar and different scenarios. The technique described for the use of inhalers was poor. Physicians know most myths, beliefs and practices of their patients. It is recommended that physicians actively ask caregivers about these myths and beliefs in order to explain, clarify and provide necessary assistance in order to improve adherence to therapy and achieve better asthma control
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Objetivos: Describir y analizar los mitos, creencias y prácticas de cuidadores de niños con asma en relación al tratamiento con inhaladores en la provincia de Chiclayo - 2013. Material y métodos: Estudio cualitativo, perspectiva explicativa, con base en la teoría fundamentada. Muestreo por saturación teórica; se realizaron grupos focales y triangulación de información. Los participantes: 20 cuidadores de niños asmáticos, distribuidos en 4 grupos focales y 7 pediatras. Los resultados fueron grabados, transcritos y categorizados según análisis temático, en forma manual. Resultados: El 55% de participantes tuvieron niños asmáticos mal controlados. Se identificaron mitos: daño cardiaco, dependencia, incremento de peso, alteraciones en el sistema nervioso y coeficiente intelectual; además las creencias: alteraciones de la conducta, efectos en el crecimiento y sistema osteomuscular. Se halló uso de plantas medicinales, técnica deficiente en uso inhaladores y preferencia por nebulizaciones. Consideraciones finales: Cuidadores poseen mitos y creencias sobre el tratamiento con inhaladores, también hallados en la literatura. Técnica deficiente en uso de inhaladores. Médicos coinciden en mencionar la mayoría de mitos, creencias y prácticas de sus pacientes. Los cuidadores de consulta particular tienen mejor conocimiento y control. El médico debe explicar y brindar la ayuda necesaria, mejorando la adherencia y control del asma.
Subject(s)
Humans , Plants, Medicinal , Asthma , Child Care , Peru , Nebulizers and Vaporizers , Focus GroupsABSTRACT
El trasplante cardíaco es sin duda alguna, una de las propuestas terapéuticas nacidas en los últimos tiempos que vuelve a dar esperanza de mejorar la calidad de vida al paciente cardíopata en estado terminal. El cuidado riguroso en la escogencia del receptor y del donante, el perfeccionamiento de las técnicas quirúrgicas, de vigilancia y control, pero sobretodo el advenimiento de drogas inmunosupresoras como la Ciclosporina a partir de 1980, dieron a esta cirugía un vuelco total, convirtiéndola hoy en día en una intervención completamente arreglada, obteniéndose así una sobrevida de cerca del 80 por ciento al primer año y de 70 por ciento a los cinco años. La falta de donantes y en otros casos, de programas de trasplante, hacen que muchos de estos pacientes continúen muriendo sobra las listas de espera
Subject(s)
Humans , Heart TransplantationABSTRACT
El objétivo básico de las fístulas paliativas (Shunts) en enfermedades cardiacas congénitas es, aumentar el flujo sanguineo pulmonar para mejorar la oxigenación hacia los tejidos corporales de pacientes con malformaciones congénitas complejas, cuya corrección en edades tempranas es peligrosa o técnicamente demasiado difícil
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Arteriovenous Fistula , Heart Defects, Congenital/surgery , Arteriovenous Fistula/surgeryABSTRACT
Evaluando pacientes sometidos a revascularización miocárdica, Loop demostró permeabilidad del 92 por ciento a los 12 años con arteria mamaria contra únicamente 21 por ciento con vena safena al cabo de este mismo período de tiempo. La arteria mamaria se puede utilizar en el 95 por ciento de los pacientes. Las complicaciones, especialmente pulmonares y de sangrado postoperatorio, se han disminuido con la disección extrapleural de la arteria y una técnica quirúrgica cuidadosa y adecuada. En 96 pacientes operados en el Centro Médico de Los Andes no hubo mortalidad operatoria ni tardia y un paciente presentó infarto transoperatorio. Ocho de nueve pacientes reestudiados con arteriografía coronaria tenían la arteria permeable con visualización satisfactoria de la anastomosis. La rehabilitación funcional fue excelente en noventa y tres pacientes de noventa y seis. Los resultados a largo plazo, utilizando la arteria mamaria interna con anastomosis termino-laterales o secuenciales a los diferentes vasos de la circulación coronaria, demuestran que en la actualidad es el procedimiento de elección en revascularización miocárdica quirúrgica