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BACKGROUND: Much has been documented about the physical sequelae of Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Whilst less documented, it is recognised that patients can have long lasting psychological sequelae. There is a lack of qualitative research on the quality of life (QoL) experiences of adults who have been diagnosed with SJS/TEN. OBJECTIVES: To explore the experiences of adults who had SJS/TEN and how these experiences relate to their QoL. METHODS: Using an interpretative descriptive qualitative study, a purposive sample of 18 adults with SJS/TEN were interviewed using in depth semi structured interviews. Data were analysed using content analysis. RESULTS: Two themes were constructed, each with two categories. Theme 1, Psychosocial Impacts included the categories 'The Self and Others', and 'A Changed Perspective on Life'. Theme 2, The Chronicity of Sequelae comprised the categories 'Multi Organ Involvement', and 'Further Consequences of TEN'. CONCLUSIONS: Findings highlighted that SJS/TEN had a significant impact on the different quality-of-life experiences of participants including psychological, physical, social, educational and occupational. Many expressed challenges they faced following discharge from hospital, including gaps in psychological care, navigating disjointed care pathways and lack of coordinated care. If SJS/TEN is viewed as a chronic condition, it is important that researchers and clinicians study the long-term effects of SJS/TEN on people's lives to aid in developing a plan of care to enhance the QoL for this cohort. Psychological and quality of life assessments following discharge from hospital require consideration.
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PURPOSE: The use of postoperative prophylactic antibiotics in pediatric upper urinary tract reconstruction remains controversial. In this study, we examined whether low dose antibiotics administered following pediatric pyeloplasty reduce the incidence of febrile urinary tract infections at our institution. As a secondary outcome, in those patients with infection, additional analysis was performed to better quantify which patient population benefits the most from low dose prophylactic antibiotics. METHODS: Institutional review board approval (IRB) was obtained. All methods were carried out in accordance with relevant guidelines and regulations. A retrospective study was performed in patients who underwent pyeloplasty (2011-2017) at our institution. Surgical approach (laparoscopic versus robotic assisted versus open, with or without internal JJ ureteral stent) were based on surgeon preference. Patients of 8 fellowship trained pediatric urologists were included in the study period. Patients with prior history of urologic interventions or other congenital genitourinary tract abnormalities were excluded. Demographics (age, gender, ethnicity, insurance status), prior history of culture proven urinary tract infection, surgical details (administration of perioperative antibiotics), and postoperative outcomes including; 1) re-admission 30 days post-surgery, 2) any urine cultures collected due to suspected urinary tract infection. RESULTS: A total of 209 patients (149 boys, 60 girls) met our inclusion criteria with 55/209 (26%) receiving postoperative prophylactic antibiotics. The average age was 6 years (range: 2 months-18 years). Indwelling ureteral stent was used in 176 (84%) patients. Eleven patients (5%) had a culture-proven urinary tract infection within 30-days postoperatively. No significant differences were seen in postoperative complications or incidence of urinary tract infection when comparing surgical approaches, +/- ureteral stent, or the use of antibiotics. Secondary analysis noted statistically significant increase in post-operative urinary tract infection in younger children (2.8 v. 6.2 years, p = 0.02), those patients who had a positive preoperative urine culture (8/11, p = 0.01) and those with public health insurance (p = 0.038). CONCLUSION: The incidence of postoperative urinary tract infection following pyeloplasty in our cohort was relatively low. There was a higher incidence of urinary tract infection in patients less than 3 years old. The use of antibiotics in patients post pyeloplasty did not appear to affect the incidence of post-operative urinary tract infection, however, they may have a role in children who have not yet potty trained and in patients with positive preoperative urine culture.
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Ureter , Infecções Urinárias , Masculino , Feminino , Humanos , Criança , Lactente , Pré-Escolar , Estudos Retrospectivos , Incidência , Ureter/cirurgia , Infecções Urinárias/epidemiologia , Infecções Urinárias/prevenção & controle , Infecções Urinárias/etiologia , Antibacterianos/uso terapêutico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
BACKGROUND: The composition of diets consumed following weight loss (WL) can have a significant impact on satiety and metabolic health. OBJECTIVE: This study was designed to test the effects of including a nondigestible carbohydrate to achieve weight maintenance (WM) following a period of WL. METHODS: Nineteen volunteers [11 females and 8 males, aged 20-62 y; BMI (kg/m2): 27-42] consumed a 3-d maintenance diet (15%:30%:55%), followed by a 21-d WL diet (WL; 30%:30%:40%), followed by 2 randomized 10-d WM diets (20%:30%:50% of energy from protein:fat:carbohydrate) containing either resistant starch type 3 (RS-WM; 22 or 26 g/d for females and males, respectively) or no RS (C-WM) in a within-subject crossover design without washout periods. The primary outcome, WM after WL, was analyzed by body weight. Secondary outcomes of fecal microbiota composition and microbial metabolite concentrations and gut hormones were analyzed in fecal samples and blood plasma, respectively. All outcomes were assessed at the end of each dietary period. RESULTS: Body weight was similar after the RS-WM and C-WM diets (90.7 and 90.8 kg, respectively), with no difference in subjectively rated appetite. During the WL diet period plasma ghrelin increased by 36% (P < 0.001), glucose-dependent insulinotropic polypeptide (GIP) decreased by 33% (P < 0.001), and insulin decreased by 46% (P < 0.001), but no significant differences were observed during the RS-WM and C-WM diet periods. Fasting blood glucose was lower after the RS-WM diet (5.59 ± 0.31 mmol/L) than after the C-WM diet [5.75 ± 0.49 mmol/L; P = 0.015; standard error of the difference between the means (SED): 0.09]. Dietary treatments influenced the fecal microbiota composition (R2 = 0.054, P = 0.031) but not diversity. CONCLUSIONS: The metabolic benefits, for overweight adults, from WL were maintained through a subsequent WM diet with higher total carbohydrate intake. Inclusion of resistant starch in the WM diet altered gut microbiota composition positively and resulted in lower fasting glucose compared with the control, with no apparent change in appetite. This trial was registered at clinicaltrials.gov as NCT01724411.
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Fibras na Dieta/farmacologia , Microbioma Gastrointestinal , Sobrepeso/dietoterapia , Redução de Peso , Adulto , Bactérias/classificação , Bactérias/genética , DNA Bacteriano/genética , Dieta Redutora , Fibras na Dieta/administração & dosagem , Fezes/microbiologia , Feminino , Intolerância à Glucose , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , RNA Bacteriano/genética , RNA Ribossômico 16S/genética , Adulto JovemRESUMO
BACKGROUND: The purpose of this paper is to provide an overview of key aspects of specialised dermatology nursing practice in the management of patients with moderate to severe atopic dermatitis. The role of dermatology nurse specialists in supporting patients and promoting disease understanding, education and treatment adherence continues to evolve. As features of specialised nursing care can also inform other nursing staff in a wide range of care settings, an overview of key components is examined. Observations presented are from a pan-European perspective and represent the collected view of a group of dermatology nurse specialists, dermatologists and patient advocates following two round-table discussions. MAIN BODY: Atopic dermatitis is a common, chronic, inflammatory disease characterised by erythematous/scaling skin lesions, with often intense pruritus. Disease course is cyclic with periodic disease flares of varying intensity, presenting management challenges to patients and families. Dermatology nurse specialists play a key role in providing education and substantial patient support to improve treatment outcomes and quality of life to patients and their family, delivered within a multidisciplinary team framework. Nurse-led education and 'eczema schools' are of benefit in reducing disease severity and improving quality of life by enhancing self-management, adherence and patient engagement. eHealth tools, such as patient portals or online training platforms, can provide online learning, individualised education, and help to improve engagement. These and other initiatives, such as written action plans, are all essential to improve or maintain treatment adherence, self-management and quality of life. CONCLUSIONS: Dermatology nurse specialists play a central role in the assessment and management of moderate to severe atopic dermatitis patients and families. This places them in an ideal position to build strong and often long-term relationships with patients and parents. Such engagement promotes trust, assists in setting realistic expectations of treatment and outcomes, and enhances self-management and engagement in their own care. Providing emotional support, as well as formal and systematic education (including individualised practical advice) all contribute to improved treatment adherence and can enhance the quality of life of patients and their families throughout the course of this long-term condition.
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Mucosa-associated microbial populations of the gastrointestinal tract are in intimate contact with the outer mucus layer. This proximity offers these populations a higher potential, than lumenal microbiota, in exerting effects on the host. Functional characteristics of the microbiota and influences of host-physiology shape the composition and activity of the mucosa-associated bacterial community. We have shown previously that inclusion of an artificial sweetener, SUCRAM, included in the diet of weaning piglets modulates the composition of lumenal-residing gut microbiota and reduces weaning-related gastrointestinal disorders. In this study, using Illumina sequencing we characterised the mucosa-associated microbiota along the length of the intestine of piglets, and determined the effect of SUCRAM supplementation on mucosa-associated populations. There were clear distinctions in the composition of mucosa-associated microbiota, between small and large intestine, concordant with differences in regional oxygen distribution and nutrient provision by the host. There were significant differences in the composition of mucosa-associated compared with lumenal microbiota in pig caecum. Dietary supplementation with SUCRAM affected mucosa-associated bacterial community structure along the length of the intestinal tract. Most notably, there was a substantial reduction in predominant Campylobacter populations proposing that SUCRAM supplementation of swine diet has potential for reducing meat contamination and promoting food safety.
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Microbioma Gastrointestinal , Mucosa Intestinal/microbiologia , Suínos/microbiologia , Animais , Dieta , Suplementos Nutricionais , Trato Gastrointestinal/microbiologia , DesmameAssuntos
Prurigo , Administração Cutânea , Humanos , Prurigo/complicações , Prurigo/tratamento farmacológico , PeleRESUMO
PURPOSE: It is common to evaluate children who have sustained minor head trauma with computed tomography (CT) of the head. Scalp swelling, in particular, has been associated with intracranial injury. A subset of patients, however, present in delayed fashion, often days after the head trauma, as soft tissue edema progresses and their caregiver notices scalp swelling. We explore the value of further workup in this setting. METHODS: We conducted a retrospective review of a prospectively collected cohort of children ≤24 months of age presenting to the Texas Children's Hospital with scalp swelling more than 24 h following a head trauma. Cases were collected over a 2-year study period from June 1, 2014 to May 31, 2016. RESULTS: Seventy-six patients comprising 78 patient encounters were included in our study. The mean age at presentation was 8.8 months (range 3 days-24 months). All patients had noncontrast CT of the head as part of their evaluation by emergency medicine, as well as screening for nonaccidental trauma (NAT) by the Child Protection Team. The most common finding on CT head was a linear/nondisplaced skull fracture (SF) with associated extra-axial hemorrhage (epidural or subdural hematoma), which was found in 31/78 patient encounters (40%). Of all 78 patient encounters, 43 patients (55%) were discharged from the emergency room (ER), 17 patients (22%) were admitted for neurologic monitoring, and 18 patients (23%) were admitted solely to allow further NAT evaluation. Of those patients admitted, none experienced a neurologic decline and all had nonfocal neurologic exams on discharge. No patient returned to the ER in delayed fashion for a neurologic decline. Of all the patient encounters, no patient required surgery. CONCLUSIONS: Pediatric patients ≤24 months of age presenting to the ER in delayed fashion with scalp swelling after minor head trauma-who were otherwise nonfocal on examination-did not require surgical intervention and did not experience any neurologic decline. Further radiographic investigation did not alter neurosurgical management in these patients; however, it should be noted that workup for child abuse and social care may have been influenced by CT findings, suggesting the need for the future development of a clinical decision-making tool to help safely avoid CT imaging in this setting.
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Traumatismos Craniocerebrais/complicações , Couro Cabeludo/fisiopatologia , Pré-Escolar , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/psicologia , Diagnóstico Tardio , Edema/etiologia , Feminino , Escala de Coma de Glasgow , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Qualidade de Vida/psicologia , Estudos Retrospectivos , Couro Cabeludo/diagnóstico por imagem , Tomógrafos ComputadorizadosRESUMO
PURPOSE: We present a small series consisting of eight children with unilateral facet injury of the cervical spine treated surgically. METHODS: A retrospective review was performed. Injury data, radiographs, surgical data, and outcomes (Neck Disability Index (NDI), Short Form 36 (SF-36), and Visual Analog Scale for Neck Pain (VAS-NP)) were collected from seven patients. A literature review was performed for one additional case. RESULTS: Motor vehicle accidents (62 %, n = 5) and falls (38 %, n = 3) accounted for all injuries. The C6-7 level accounted for most of the injuries (37.5 %, n = 3). The mean NDI score with at least 3 months follow-up was 5.3 (n = 6, range, 1-12; standard deviation, 4.5), corresponding to mild disability. Of the norm-based SF-36 scale scores available (n = 6), the mean physical functioning (PF), role-physical (RP), and role-emotional (RE) scores were significantly less than the adult, age 18-24, norm-based means, with a mean difference of -6.4, -9.13, and -11.3, respectively (p value = 0.03, 0.001, and 0.01, respectively). The mean general health (GH) and vitality (VT) scores, however, were significantly greater than the adult, age 18-24, norm-based mean, with a mean difference of 7.82 and 10.3 (p = 0.04 and 0.02, respectively). VAS-NP showed a return to the "no pain" level at 3 months or more follow-up in all patients. CONCLUSIONS: We suggest that surgical treatment of these injuries in the pediatric age group may lead to satisfactory clinical and radiographic outcomes, but HRQoL analysis suggests that patients remain physically and emotionally disabled to some degree after surgery.
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Vértebras Cervicais/lesões , Vértebras Cervicais/cirurgia , Luxações Articulares/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Articulação Zigapofisária/cirurgia , Adolescente , Criança , Pré-Escolar , Avaliação da Deficiência , Feminino , Humanos , Masculino , Medição da Dor , Fusão Vertebral , Resultado do TratamentoRESUMO
Heterogeneity between individual cells is a common feature of dynamic cellular processes, including signaling, transcription, and cell fate; yet the overall tissue level physiological phenotype needs to be carefully controlled to avoid fluctuations. Here we show that in the NF-kappaB signaling system, the precise timing of a dual-delayed negative feedback motif [involving stochastic transcription of inhibitor kappaB (IkappaB)-alpha and -epsilon] is optimized to induce heterogeneous timing of NF-kappaB oscillations between individual cells. We suggest that this dual-delayed negative feedback motif enables NF-kappaB signaling to generate robust single cell oscillations by reducing sensitivity to key parameter perturbations. Simultaneously, enhanced cell heterogeneity may represent a mechanism that controls the overall coordination and stability of cell population responses by decreasing temporal fluctuations of paracrine signaling. It has often been thought that dynamic biological systems may have evolved to maximize robustness through cell-to-cell coordination and homogeneity. Our analyses suggest in contrast, that this cellular variation might be advantageous and subject to evolutionary selection. Alternative types of therapy could perhaps be designed to modulate this cellular heterogeneity.
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NF-kappa B/metabolismo , Motivos de Aminoácidos , Animais , Fibroblastos/metabolismo , Humanos , Quinase I-kappa B/metabolismo , Interleucina-1beta/metabolismo , Camundongos , Modelos Teóricos , Oscilometria/métodos , Fenótipo , Transdução de Sinais , Processos Estocásticos , Transcrição Gênica , Fator de Necrose Tumoral alfa/metabolismoRESUMO
Health reform is a major driver in shifting the focus toward population health. Partnerships between nurses, neighborhood health coaches (NHC), and families, linked by technology and extended over time, are key to enhancing neighborhood health. Including faculty practice and students in this work creates a new platform for nursing education in primary care; everyone wins.
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Redes Comunitárias/organização & administração , Comportamento Cooperativo , Reforma dos Serviços de Saúde/organização & administração , Promoção da Saúde/organização & administração , Prática do Docente de Enfermagem/organização & administração , HumanosRESUMO
BACKGROUND: The existing evidence demonstrates that survivors of SJS/TEN have reported long-lasting psychological effects of their condition. Burns patients experience similar psychological effects. It is important to look at ways to help allay the psychological complications of SJS/TEN. As there is an absence of evidence on SJS/TEN psychotherapeutic interventions, it was judged to be beneficial to determine the evidence underpinning psychotherapeutic interventions used with burns patients. AIMS AND OBJECTIVES: The aim of this systematic integrative review was to synthesize the evidence relating to psychotherapeutic interventions used with adult burns patients and patients with SJS/TEN. METHOD: The systematic review was guided by Whittemore and Knafl's integrative review process and the PRISMA guidelines. Nine databases were searched for English and French language papers published January 2008 to January 2021. The protocol for the review was registered with PROSPERO. RESULTS: Following a screening process, 17 studies were included in the review. Two themes were identified using content analysis, (i) Empirically supported psychotherapeutic treatments, (ii) Alternative psychotherapeutic treatments. This review revealed no evidence on specific psychotherapeutic interventions for patients with SJS/TEN. Some of the interventions used with burns patients, viz. relaxation therapy, hypnosis and cognitive behavioral therapy showed some significant benefits. However, the evidence for burns patients is mainly focused on pain and pain anxiety as outcomes. CONCLUSION: Following further research, some of the interventions deployed in burns patients may be applicable to SJS/TEN patients, particularly stress reduction techniques. In addition, the caring behaviours such as compassion, respect, and getting to know the patient as a person are important components to psychological care.
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Queimaduras , Síndrome de Stevens-Johnson , Adulto , Queimaduras/complicações , Queimaduras/terapia , Bases de Dados Factuais , Humanos , Dor/complicações , Estudos Retrospectivos , Síndrome de Stevens-Johnson/tratamento farmacológicoRESUMO
BACKGROUND: If primary percutaneous coronary intervention (PCI) is performed promptly, the procedure is superior to fibrinolysis in restoring flow to the infarct-related artery in patients with ST-segment elevation myocardial infarction. The benchmark for a timely PCI intervention has become a door-to-balloon time of less than 90 minutes. Whether regional strategies can be developed to achieve this goal is uncertain. METHODS: We developed an integrated-metropolitan-area approach in which all patients with ST-segment elevation myocardial infarction were referred to a specialized center for primary PCI. We sought to determine whether there was a difference in door-to-balloon times between patients who were referred directly from the field by paramedics trained in the interpretation of electrocardiograms and patients who were referred by emergency department physicians. RESULTS: Between May 1, 2005, and April 30, 2006, a total of 344 consecutive patients with ST-segment elevation myocardial infarction were referred for primary PCI: 135 directly from the field and 209 from emergency departments. Primary PCI was performed in 93.6% of patients. The median door-to-balloon time was shorter in patients referred from the field (69 minutes; interquartile range, 43 to 87) than in patients needing interhospital transfer (123 minutes; interquartile range, 101 to 153; P<0.001). Door-to-balloon times of less than 90 minutes were achieved in 79.7% of patients who were transferred from the field and in 11.9% of those transferred from emergency departments (P<0.001). CONCLUSIONS: Guideline door-to-balloon-times were more often achieved when trained paramedics independently triaged and transported patients directly to a designated primary PCI center than when patients were referred from emergency departments.
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Angioplastia Coronária com Balão/normas , Protocolos Clínicos/normas , Serviços Médicos de Emergência/normas , Infarto do Miocárdio/terapia , Encaminhamento e Consulta , Idoso , Cateterismo Cardíaco , Angiografia Coronária , Eletrocardiografia , Auxiliares de Emergência , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Transferência de Pacientes/estatística & dados numéricos , Guias de Prática Clínica como Assunto/normas , Encaminhamento e Consulta/normas , Fatores de Tempo , Resultado do Tratamento , Triagem , Serviços Urbanos de Saúde/normasRESUMO
BACKGROUND: Delirium is a common condition with poorly understood pathophysiology. Various theories have been proposed including that delirious patients have reduced cerebral blood flow. We hypothesised that patients with delirium could have abnormal autonomic nervous system function, as assessed by tilt table testing, which would explain the alteration in blood flow. METHODS: A prospective cohort study of medical inpatients aged 65 years and older was undertaken. Delirium was assessed using DRS-R98 and DSM-IV criteria. Beat-to-beat blood pressure (BP) was recorded during tilt testing. Differences in BP changes between the two groups (those with delirium and those without) were explored. The association between severity of delirium and magnitude of BP changes was also examined. RESULTS: 64 participants were recruited during hospitalisation. 29 completed follow-up Head-Up Tilt testing. The mean age of participants was 80.8 years (SD 6.2 years). The control group (n = 12) had a median decrease in systolic BP of 17.5 mmHg (IQR 20.75). The delirium group (n = 17) had a median decrease in systolic BP of 1 mmHg (IQR 38.5), p = 0.04. As delirium severity scores increased, systolic BP change during tilting also increased (rs = 0.42, p = 0.03). CONCLUSION: Participants in the delirium group showed different BP responses to tilt test which may represent abnormal sympathetic response. This would be consistent with other features of delirium such as treatment response to centrally acting alpha-2 blockers. Equity of access to research for older, frail and delirious cohorts is essential but feasibility and acceptability needs to be optimised and factored into study design.
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Delírio , Hipotensão Ortostática , Idoso de 80 Anos ou mais , Sistema Nervoso Autônomo , Pressão Sanguínea , Delírio/diagnóstico , Humanos , Estudos Prospectivos , Teste da Mesa InclinadaRESUMO
Psoriasis is a complex chronic non-infectious inflammatory skin disease with a variety of different presentations. The classic presentation is of well-defined red plaques with silver scale. The characteristic scale makes the disorder highly visible and intrusive on the patient's lifestyle. The visible nature of the disease ensures that psoriasis has both physical and psychosocial effects. In normal skin, epidermal cell reproduction and proliferation takes 28 days. In psoriasis this process is considerably accelerated to approximately 4 days, resulting in the deposit of immature cells on the skin. While the exact cause of this process is unknown, certain environmental and genetic factors are known to be triggers. Disease management depends on disease severity, psychosocial effects and the patient's lifestyle. To effectively treat this disease the nurse must be skilled in psoriasis management, and in patient education and motivation. This article reviews the characteristics, aetiology, psychosocial effects and treatment strategies of psoriasis.
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Fármacos Dermatológicos/uso terapêutico , Psoríase/terapia , Fármacos Dermatológicos/efeitos adversos , Humanos , Fototerapia , Psoríase/enfermagem , Psoríase/patologia , Psoríase/psicologia , Isolamento SocialRESUMO
BACKGROUND: High content live cell imaging experiments are able to track the cellular localisation of labelled proteins in multiple live cells over a time course. Experiments using high content live cell imaging will generate multiple large datasets that are often stored in an ad-hoc manner. This hinders identification of previously gathered data that may be relevant to current analyses. Whilst solutions exist for managing image data, they are primarily concerned with storage and retrieval of the images themselves and not the data derived from the images. There is therefore a requirement for an information management solution that facilitates the indexing of experimental metadata and results of high content live cell imaging experiments. RESULTS: We have designed and implemented a data model and information management solution for the data gathered through high content live cell imaging experiments. Many of the experiments to be stored measure the translocation of fluorescently labelled proteins from cytoplasm to nucleus in individual cells. The functionality of this database has been enhanced by the addition of an algorithm that automatically annotates results of these experiments with the timings of translocations and periods of any oscillatory translocations as they are uploaded to the repository. Testing has shown the algorithm to perform well with a variety of previously unseen data. CONCLUSION: Our repository is a fully functional example of how high throughput imaging data may be effectively indexed and managed to address the requirements of end users. By implementing the automated analysis of experimental results, we have provided a clear impetus for individuals to ensure that their data forms part of that which is stored in the repository. Although focused on imaging, the solution provided is sufficiently generic to be applied to other functional proteomics and genomics experiments. The software is available from: fhttp://code.google.com/p/livecellim/
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Biologia Computacional/métodos , Processamento de Imagem Assistida por Computador/métodos , Gestão da Informação/métodos , Microscopia , Bases de Dados Factuais , Armazenamento e Recuperação da Informação , SoftwareRESUMO
The capacity of Listeria monocytogenes to withstand low pH is important for growth in low-pH foods, successful passage through the gastric barrier and survival within the macrophage phagosome. The ability of this pathogen to survive and adapt to acidic conditions is therefore predicted to play a significant role in the infectious cycle. In silico analysis of the L. monocytogenes genome revealed the presence of putative arginine deiminase (ADI) genes, which have been shown to play a role in the acid tolerance of other bacterial genera. In the present study, we show that L. monocytogenes possesses a functional ADI system and analysis of deletion mutants reveals that it contributes to both growth and survival of the bacterium under acidic conditions. An RT-PCR approach demonstrated that expression of ADI genes is increased in environments of low pH and anaerobicity and in the presence of arginine. A putative activator of ADI genes, namely ArgR, was identified and was shown to contribute to transcriptional regulation at this locus. Furthermore, expression of ADI genes was shown to be modulated by both the alternative stress sigma factor sigma(B) and the central virulence regulator PrfA. Finally, using the murine model of infection, we have established a role for the ADI system in the virulence of L. monocytogenes.
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Ácidos/metabolismo , Regulação Bacteriana da Expressão Gênica , Hidrolases/genética , Hidrolases/metabolismo , Listeria monocytogenes/genética , Listeria monocytogenes/metabolismo , Ácidos/farmacologia , Anaerobiose , Animais , Antibacterianos/metabolismo , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Deleção de Genes , Perfilação da Expressão Gênica , Concentração de Íons de Hidrogênio , Listeria monocytogenes/efeitos dos fármacos , Listeriose/microbiologia , Camundongos , Viabilidade Microbiana , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Baço/microbiologia , Virulência , Fatores de Virulência/genética , Fatores de Virulência/metabolismoRESUMO
Psoriasis is a complex chronic non-infectious inflammatory skin disease with many different presentations. The classic presentation is of well-defined red plaques with silver scale. The characteristic scale makes the disorder highly visible and intrusive on the patient's lifestyle. The visible nature of the disease ensures that psoriasis has both physical and psychosocial effects. In normal skin, epidermal cell reproduction and proliferation takes 28 days. In psoriasis, this process is considerably accelerated to approximately four days, resulting in the deposit of immature cells on the skin. While the exact cause of this process is unknown, certain environmental and genetic factors are known to be provoking factors. Disease management will be dependent on disease severity, psychosocial effects and the patient's lifestyle. To effectively treat this disease the nurse must be skilled in psoriasis management, and in patient education and motivation. This article reviews the characteristics, aetiology, psychosocial effects and treatment strategies of psoriasis.
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Psoríase , Corticosteroides/uso terapêutico , Antralina/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Alcatrão/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Emolientes/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Ceratolíticos/uso terapêutico , Estilo de Vida , Herança Multifatorial , Papel do Profissional de Enfermagem , Fototerapia , Psoríase/etiologia , Psoríase/psicologia , Psoríase/terapia , Qualidade de Vida/psicologia , Fatores de Risco , Vitamina D/análogos & derivadosRESUMO
[This corrects the article DOI: 10.3389/fped.2018.00180.].
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Objective: Review outcomes of Prune Belly Syndrome (PBS) with the hypothesis that contemporary management improves mortality. Methods: A retrospective chart review of inpatient and outpatient PBS patients referred between 2000 and 2018 was conducted to assess outcomes at our institution. Data collected included age at diagnosis, concomitant medical conditions, imaging, operative management, length of follow-up, and renal function. Results: Forty-five PBS patients presented during these 18 years. Prenatal diagnoses were made in 17 (39%); 65% of these patients underwent prenatal intervention. The remaining patients were diagnosed in the infant period (20, 44%) or after 1 year of age (8, 18%). Twelve patients died from cardiopulmonary complications in the neonatal period; the neonatal mortality rate was 27%. The mean follow-up among patients surviving the neonatal period was 84 months. Forty-two patients had at least one renal ultrasound (RUS); of the 30 patients with NICU RUSs, 26 (89%) had hydronephrosis and/or ureterectasis. Of the 39 patients who underwent voiding cystourethrogram (VCUG), 28 (62%) demonstrated VUR. Fifty-nine percent had respiratory distress. Nine patients (20%) were oxygen-dependent by completion of follow up. Thirty-eight patients (84%) had other congenital malformations including genitourinary (GU) 67%, gastrointestinal (GI) 52%, and cardiac 48%. Sixteen patients (36%) had chronic kidney disease (CKD) of at least stage 3; three patients (7%) had received renal transplants. Eighty-four percent of patients had at least one surgery (mean 3.4, range 0-6). The most common was orchiopexy (71%). The next most common surgeries were vesicostomy (39%), ureteral reimplants (32%), abdominoplasty (29%), nephrectomy (25%), and appendicovesicostomy (21%). After stratifying patients according to Woodard classification, a trend for 12% improvement in mortality after VAS was noted in the Woodard Classification 1 cohort. Conclusions: PBS patients frequently have multiple congenital anomalies. Pulmonary complications are prevalent in the neonate while CKD (36%) is prevalent during late childhood. The risk of CKD increased significantly with the presence of other congenital anomalies in our cohort. Mortality in childhood is most common in infancy and may be as low as 27%. Contemporary management of PBS, including prenatal interventions, reduced the neonatal mortality rate in a subset of our cohort.
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Objective: While small non-obstructive stones in the adult population are usually observed with minimal follow-up, the same guidelines for management in the pediatric population have not been well-studied. We evaluate the clinical outcomes of small non-obstructing kidney stones in the pediatric population to better define the natural history of the disease. Methods: In this IRB-approved retrospective study, patients with a diagnosis of kidney stones from January 2011 to March 2017 were identified using ICD9 and ICD10 codes. Patients with ureteral stones, obstruction, or stones >5 mm in size were excluded. Patients with no follow-up after initial imaging were also excluded. Patients with a history of stones or prior stone interventions were included in our population. Frequency of follow-up ultrasounds while on observation were noted and any ER visits, stone passage episodes, infections, and surgical interventions were documented. Results: Over the 6-year study period, 106 patients with non-obstructing kidney stones were identified. The average age at diagnosis was 12.5 years and the average stone size was 3.6 mm. Average follow-up was 17 months. About half of the patients had spontaneous passage of stones (54/106) at an average time of 13 months after diagnosis. Stone location did not correlate with spontaneous passage rates. Only 6/106 (5.7%) patients required stone surgery with ureteroscopy and/or PCNL at an average time of 12 months after initial diagnosis. The indication for surgery in all 6 cases was pain. 17/106 (16%) patients developed febrile UTIs and a total of 43 ER visits for stone-related issues were noted, but no patients required urgent intervention for an infected obstructing stone. Median interval for follow-up was every 6 months with renal ultrasounds, which then was prolonged to annual follow up in most cases. Conclusions: The observation of pediatric patients with small non-obstructing stones is safe with no episodes of acute obstructive pyelonephritis occurring in these patients. The sole indication for intervention in our patient population was pain, which suggests that routine follow-up ultrasounds may not be necessary for the follow-up of pediatric non-obstructive renal stones ≤5 mm in size.