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Background: Coronavirus disease 2019 (COVID-19) novel severe acute respiratory syndrome affected the world population with an infectious condition for which therapeutic forms are limited and vascular sequelae are major challenges. Pregnant women are physiologically immunocompromised and can be more affected by the pandemic than the general population. Extra precaution measures against COVID-19 during and after the outbreak are essential to ensure the safety of the newborn. The aim of the present study was to report the cesarean birth of a female child with Klippel-Trenaunay of a mother currently infected by COVID-19. Case Description: A newborn of a 21-year-old mother with COVID-19 in the final stage of the disease was born through a cesarean section at full term. The physical examination at birth revealed substantial edema of the left lower limb associated with port-wine stains on the limb and left torso. The ultrasound revealed venous-lymphatic malformation affecting the entire left lower limb, suprapubic region and ipsilateral abdominal region. Two evaluations for COVID-19 were performed and both were negative. Infants of mothers with active COVID-19 infection during the birth period have a low probability of being positive for the disease, but precautions should be taken. Conclusions: The association with malformations, such as the rare Klippel-Trenaunay syndrome (KTS), constitutes another challenge regarding the diagnosis and proper conduct to be taken with these children.
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CLINICAL DATA: A nine-month-old female infant diagnosed with transposition of the great arteries with symptoms of heart failure associated with cyanosis and difficulty in gaining weight was referred to our center with late diagnosis (at nine months of age). CHEST RADIOGRAPHY: Cardiomegaly; attenuated peripheral vascular markings.Electrocardiography: Sinus rhythm with biventricular overload and aberrantly conducted supraventricular extra systoles. ECHOCARDIOGRAPHY: Wide atrial septal defect, ventricular axis torsion with concordant atrioventricular connection and discordant ventriculoarterial connection. COMPUTED TOMOGRAPHY ANGIOGRAPHY: Concordant atrioventricular connection, right ventricle positioned superiorly and left ventricle positioned inferiorly; discordant ventriculoarterial connection with right ventricle connected to the aorta and left ventricle connected to pulmonary artery. DIAGNOSIS: Crisscross heart is a rare congenital heart defect, accounting for 0.1% of congenital heart diseases. It consists of the 90º rotation of ventricles' axis in relation to their normal position; therefore, ventricles are positioned in the superior-inferior direction rather than anterior-posterior. Most cases have associated cardiac anomalies, and in this case, it is associated with transposition of the great arteries. The complexity and rarity of its occurrence make diagnosis and surgical treatment challenging. OPERATION: Modified Senning procedure using the pericardial sac in the construction of a tunnel from pulmonary veins to the right atrium. Cardiopulmonary bypass time of 147 minutes with nine minutes of total circulatory arrest.
Subject(s)
Crisscross Heart , Transposition of Great Vessels , Humans , Female , Transposition of Great Vessels/surgery , Transposition of Great Vessels/diagnostic imaging , Infant , Crisscross Heart/surgery , Crisscross Heart/diagnostic imaging , Echocardiography , Treatment Outcome , Arterial Switch Operation/methods , Computed Tomography Angiography , ElectrocardiographyABSTRACT
La distribución inequitativa del talento humano en salud afecta la capacidad de los sistemas de ofrecer servicios esenciales. En la provincia de Córdoba, el primer nivel de atención es responsabilidad de los municipios, pero el nivel provincial procura sostener la rectoría y ser garante del derecho a la salud. En ese marco, se desarrolló un programa para reducir las brechas en la distribución de médicos: el Plan Cordobés de Médicos del Interior. Acompañando ese plan se ejecutó un convenio específico con la Universidad Nacional de Córdoba para garantizar la formación en la especialidad de Medicina Familiar y General. Ingresaron al programa 170 personas, y hoy contamos con 98 médicos en formación o seguimiento. En este artículo damos cuenta de la experiencia docente, los desafíos y dificultades que supuso afrontar una formación en lugares de práctica variados, y con el aporte de las tecnologías de la información y comunicación. Esperamos que la experiencia sirva para transmitir los aprendizajes de nuestra práctica (AU)
The inequitable distribution of human talent in health affects the capacity of systems to offer essential services. In the province of Córdoba, the primary level of care is the responsibility of municipalities, but the provincial level aims to maintain leadership and guarantee the right to health. Within this framework, a program was developed to reduce gaps in the distribution of physicians: the Cordobés Plan for Interior Physicians. Accompanying this plan, a specific agreement was executed with the National University of Córdoba to ensure training in the specialty of Family and General Medicine. 170 individuals entered the program, and today we have 98 physicians in training or under supervision. In this article, we give an account of the teaching experience, the challenges, and difficulties involved in facing training in various practice settings, along with the contribution of information and communication technologies. We hope that this experience serves to transmit the lessons learned from our practice (AU)
Subject(s)
Humans , Physicians/supply & distribution , Education, Distance , Education, Medical, Graduate/organization & administration , Job Market , Family Practice/education , Argentina , Local Health Systems , Access to Primary CareABSTRACT
Important physiological changes are observed in patients with obesity, such as intestinal permeability, gastric emptying, cardiac output, and hepatic and renal function. These differences can determine variations in the pharmacokinetics of different drugs and can generate different concentrations at the site of action, which can lead to sub therapeutic or toxic concentrations. Understanding the physiological and immunological processes that lead to the clinical manifestations of COVID-19 is essential to correlate obesity as a risk factor for increasing the prevalence, severity, and lethality of the disease. Several drugs have been suggested to control COVID- 19 like Lopinavir, Ritonavir, Ribavirin, Sofosbuvir, Remdesivir, Oseltamivir, Oseltamivir phosphate, Oseltamivir carboxylate, Hydroxychloroquine, Chloroquine, Azithromycin, Teicoplanin, Tocilizumab, Anakinra, Methylprednisolone, Prednisolone, Ciclesonide and Ivermectin. Similarly, these differences between healthy people and obese people can be correlated to mechanical factors, such as insufficient doses of the vaccine for high body mass, impairing the absorption and distribution of the vaccine that will be lower than desired or can be linked to the inflammatory state in obese patients, which can influence the humoral immune response. Additionally, different aspects make the obese population more prone to persistent symptoms of the disease (long COVID), which makes understanding these mechanisms fundamental to addressing the implications of the disease. Thus, this review provides an overview of the relationship between COVID-19 and obesity, considering aspects related to pharmacokinetics, immunosuppression, immunization, and possible implications of long COVID in these individuals.
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Background: Current gold standard diagnostic techniques for dengue are expensive and time-consuming. Rapid diagnostic tests (RDTs) have been proposed as alternatives, although data about their potential impact in non-endemic areas is scarce. Methods: We performed a cost-effectiveness analysis comparing the costs of dengue RDTs to the current standard of care for the management of febrile returning travelers in Spain. Effectiveness was measured in terms of potential averted hospital admissions and reduction of empirical antibiotics, based on 20152020 dengue admissions at Hospital Clinic Barcelona (Spain). Results: Dengue RDTs were associated with 53.6% (95% CI: 33.972.5) reduction of hospital admissions and were estimated to save 289.08389.31 per traveler tested. Moreover, RDTs would have avoided the use of antibiotics in 46.4% (95% CI: 27.566.1) of dengue patients. Discussion: Implementation of dengue RDTs for the management of febrile travelers is a cost-saving strategy that would lead to a reduction of half of dengue admissions and a reduction of inappropriate antibiotics in Spain.(AU)
Introducción: El actual gold standard para el diagnóstico de dengue se basa en técnicas caras y que requieren tiempo. Los tests de diagnóstico rápido (TDR) se han propuesto como una posible alternativa, aunque los datos sobre su posible impacto en áreas no endémicas son escasos. Métodos: Realizamos un análisis de coste-efectividad comparando los costes del uso de TDR para dengue con el manejo habitual de viajeros con fiebre en España. Para medir la efectividad se estimaron las hospitalizaciones potencialmente evitables y la reducción de antibióticos empíricos de acuerdo con las hospitalizaciones por dengue entre 2015-2020 en el Hospital Clínic Barcelona (España). Resultados: El uso de TDR para dengue se asoció con una reducción de 53.6% (IC 95%: 33.972.5) de las hospitalizaciones y un ahorro de 289.08-389.31 por viajero testado. Además, el uso de TDR hubiese evitado el tratamiento de antibióticos en 46.4% (IC 95%: 27.566.1) de los casos de dengue. Discusión: La implementación de TDR de dengue para el manejo de viajeros con fiebre es una medida de reducción de gastos que disminuiría a la mitad los ingresos hospitalarios por dengue y supondría una reducción del uso inapropiado de antibióticos en España.(AU)
Subject(s)
Humans , Male , Female , Dengue/microbiology , Drug Prescriptions , Arboviruses , Spain/epidemiology , Microbiology , Microbiological Techniques , Diagnostic Techniques and Procedures/statistics & numerical dataABSTRACT
BACKGROUND: Current gold standard diagnostic techniques for dengue are expensive and time-consuming. Rapid diagnostic tests (RDTs) have been proposed as alternatives, although data about their potential impact in non-endemic areas is scarce. METHODS: We performed a cost-effectiveness analysis comparing the costs of dengue RDTs to the current standard of care for the management of febrile returning travelers in Spain. Effectiveness was measured in terms of potential averted hospital admissions and reduction of empirical antibiotics, based on 2015-2020 dengue admissions at Hospital Clinic Barcelona (Spain). RESULTS: Dengue RDTs were associated with 53.6% (95% CI: 33.9-72.5) reduction of hospital admissions and were estimated to save 289.08-389.31 per traveler tested. Moreover, RDTs would have avoided the use of antibiotics in 46.4% (95% CI: 27.5-66.1) of dengue patients. DISCUSSION: Implementation of dengue RDTs for the management of febrile travelers is a cost-saving strategy that would lead to a reduction of half of dengue admissions and a reduction of inappropriate antibiotics in Spain.
Subject(s)
Cost-Effectiveness Analysis , Dengue , Humans , Anti-Bacterial Agents/therapeutic use , Spain , Rapid Diagnostic Tests , Health Care Costs , Fever , Hospitalization , Dengue/diagnosis , Dengue/drug therapyABSTRACT
La Federación Argentina de Medicina Familiar y General apoyó el desarrollo, la difusión y la implementación de una propuesta educativa sobre investigación en atención primaria. Consiste en 4 módulos independientes, destinado para miembros interesados/as, con 2 encuentros virtuales teórico-prácticos, que favorecieran el intercambio de opiniones y experiencias entre colegas. El objetivo del primer módulo fue proporcionar conocimiento, brindar pautas y ofrecer herramientas para la búsqueda bibliográfica y el uso de gestores de citas. Se realizó difusión mediante sociedades y redes sociales. Se incluyó una evaluación individual, que diera cuenta de lectura complementaria y la aplicación práctica de los contenidos. Se llevó a cabo en Junio, con 39 preinscripto/as, mayoritariamente residentes. Hubo 24 participantes efectivos (61%), asistieron 17 y 20 personas respectivamente, y 11 (46%) obtuvieron el certificado de aprobación por responder la consigna en tiempo y forma. En cuanto a los/as asistentes, hubo predominio de mujeres (79%), provenientes de Asociación Metropolitana de Medicina Familiar (25%), Asociación Cordobesa de Medicina Familiar y Comunitaria (16%), Asociación Misionera de Medicina General/Familiar y del Equipo de Salud (16%), Asociación Tucumana de Medicina Familiar, General y Comunitaria (12%), y otras minorías. Expresaron satisfacción, agradecimiento y reconocimiento por la actividad, destacando la buena predisposición de organizadores y equipo docente, la utilidad práctica de la temática, la evidente planificación, y el apoyo político-económico. Esta valiosa experiencia educativa (planteada como necesidad pendiente) resultó exitosa, ya que los/as participantes demostraron un alto nivel de interés, de asistencia de diferentes provincias, y de compromiso. Los certificados emitidos otorgan créditos educativos válidos para la recertificación (AU)
The Federación Argentina de Medicina Familiar y General supported the development, dissemination and implementation of an educational proposal on research in primary care. It consists of 4 independent modules, intended for interested members, with 2 virtual theoretical-practical meetings, which favored the exchange of opinions and experiences among colleagues. The objective of the first module was to provide knowledge, guidelines and tools for bibliographic search and the use of citation managers. Dissemination was carried out through societies and social networks. An individual evaluation was included, to account for complementary reading and the practical application of the contents. It was carried out in June, with 39 pre-registered participants, mostly residents. There were 24 effective participants (61%), 17 and 20 people attended respectively, and 11 (46%) obtained the certificate of approval for answering the instructions in due time and form. As for the attendees, there was a predominance of women (79%), coming from Asociación Metropolitana de Medicina Familiar (25%), Asociación Cordobesa de Medicina Familiar y Comunitaria (16%), Asociación Misionera de Medicina General/Familiar y del Equipo de Salud (16%), Asociación Tucumana de Medicina Familiar, General y Comunitaria (12%), and other minorities. They expressed satisfaction, gratitude, and recognition for the activity, highlighting the good predisposition of the organizers and teaching team, the practical usefulness of the subject matter, the evident planning, and the political-economic support. This valuable educational experience (raised as a pending need) was successful since the participants showed a high level of interest, attendance from different provinces, and commitment. The certificates issued grant educational credits valid for recertification (AU)
Subject(s)
Humans , Primary Health Care , Knowledge Management for Health Research , Training Courses , Information Seeking Behavior , Medical Writing , Research , Systems Analysis , Database , Scholarly CommunicationABSTRACT
Lymphedema is a clinical condition resulting from a failure in the drainage of the lymphatic system and the consequent formation of edema and is a chronic progressive condition; its development is an active dynamic process. Physiotherapy techniques are the most widely used method for such cases. However, novel concepts and treatment techniques have emerged in recent years. Godoy & Godoy have developed novel therapy concepts proposing the normalization or near normalization of all clinical stages of lymphedema, including elephantiasis.The Godoy & Godoy method has undergone continual evolution, with the improvement of established and the emergence of novel concepts making contributions to the understanding of the causes and treatment of lymphedema. These researchers developed a novel concept of manual lymphatic drainage based on linear movements, cervical lymphatic therapy, a novel concept in mechanical lymphatic drainage, and hand-crafted stockings made with grosgrain material. Therefore, the aim of the present study is to report the new concepts of treatment for lymphedema and the maintenance of such results by the Godoy & Godoy technique in all stages. The Godoy & Godoy method enables the normalization or near normalization of lymphedema in all clinical stages, including elephantiasis.
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PURPOSE OF REVIEW: The response to natural stressors involves both cardiac stimulation and vascular changes, primarily triggered by increases in sympathetic activity. These effects lead to immediate flow redistribution that provides metabolic support to priority target organs combined with other key physiological responses and cognitive strategies, against stressor challenges. This extremely well-orchestrated response that was developed over millions of years of evolution is presently being challenged, over a short period of time. In this short review, we discuss the neurogenic background for the origin of emotional stress-induced hypertension, focusing on sympathetic pathways from related findings in humans and animals. RECENT FINDINGS: The urban environment offers a variety of psychological stressors. Real or anticipatory, emotional stressors may increase baseline sympathetic activity. From routine day-to-day traffic stress to job-related anxiety, chronic or abnormal increases in sympathetic activity caused by emotional stressors can lead to cardiovascular events, including cardiac arrhythmias, increases in blood pressure and even sudden death. Among the various alterations proposed, chronic stress could modify neuroglial circuits or compromise antioxidant systems that may alter the responsiveness of neurons to stressful stimuli. These phenomena lead to increases in sympathetic activity, hypertension and consequent cardiovascular diseases. The link between anxiety, emotional stress, and hypertension may result from an altered neuronal firing rate in central pathways controlling sympathetic activity. The participation of neuroglial and oxidative mechanisms in altered neuronal function is primarily involved in enhanced sympathetic outflow. The significance of the insular cortex-dorsomedial hypothalamic pathway in the evolution of enhanced overall sympathetic outflow is discussed.
Subject(s)
Hypertension , Psychological Distress , Animals , Humans , Hypertension/etiology , Heart , Blood Pressure/physiology , Hypothalamus , Sympathetic Nervous SystemABSTRACT
OBJECTIVES: Therapeutic drug monitoring aims to quantify the concentration of a drug in a biological matrix. In oncology, the therapeutic arsenal is vast and therapeutic drug monitoring optimizes treatment and reduces costs. This review will analyze the financial impact of therapeutic monitoring of anticancer drugs in healthcare institutions. METHODS: Keywords were selected using Decs (MeSH). Through the Pubmed, Scopus, and Virtual Health Library (VHL) databases, 74 articles were found, of which 4 meet the inclusion criteria. Methodological quality and risk of bias were assessed according to the Research Triangle Institute Item Bank (RTI-Item Bank) scale. KEY FINDINGS: Therapeutic drug monitoring is an important tool for dose reduction or dose increase due to toxicity and lack of response, respectively. The main barriers are associated costs and lack of cost-benefit data. An alternative is to use population pharmacokinetic models, measured plasma concentration(s) and relevant patient characteristics, estimated individual pharmacokinetic parameters, and predicted drug concentrations at any point in the dosing range. CONCLUSIONS: Therapeutic drug monitoring is understood as a technology that adds costs to payers. Future studies should generate clinical evidence of population pharmacokinetics from therapeutic drug monitoring studies.
Subject(s)
Antineoplastic Agents , Economics, Pharmaceutical , Humans , Cost-Benefit AnalysisABSTRACT
OBJECTIVE: To implement the diagnostic technique for LAD by evaluating the expression of CD18 and CD15 in healthy patients and in a group with clinical suspicion. METHODS: Observational, descriptive, and cross-secctional study, carried out in pediatric patients attended in the Instituto de Investigaciones en Ciencias de la Salud, and patients from public hospitals with clinical suspicion of LAD were studied. The molecules CD18 and CD15 in peripheral blood leukocytes was evaluated by flow cytometry, establishing a normal range in healthy patients. The presence of LAD was established by decreased expression of CD18 or CD15. RESULTS: Sixty pediatric patients were evaluated: 20 apparently healthy and 40 with clinical suspicion of leukocyte adhesion deficiency; 12 of 20 healthy patients were male (median age: 14 years) and 27 of 40 with suspected disease were female (median age: 2 years). Persistent leukocytosis and respiratory tract (32%) infections predominated. The expression range of CD18 and CD15 in healthy patients was 95%-100%, and in patients with clinical suspicion it was 0%-100%. One patient with 0% of CD18 (LAD-1) and one patient with 0% of CD15 (LAD-2) were detecte. CONCLUSIONS: The implementation of a new diagnostic technique allowed to establish a normal range of CD18 and CD15 by flow cytometry, and it was possible to detect the first two cases of LAD in Paraguay.
OBJECTIVO: Implementar la técnica diagnóstica para deficiencia de adhesión leucocitaria mediante la evaluación de la expresión de CD18 y CD15 en pacientes sanos y con sospecha clínica de la enfermedad. MÉTODOS: Estudio observacional, descriptivo y transversal, llevado a cabo en pacientes pediátricos sanos que acudieron al Instituto de Investigaciones en Ciencias de la Salud y pacientes de hospitales públicos con sospecha clínica de deficiencia de adhesión leucocitaria. Se evaluaron las moléculas CD18 y CD15 en leucocitos periféricos por citometría de flujo, con la intención de estadarizar un rango normal en pacientes sanos. Se estableció el diagnóstico de deficiencia de adhesión lecuocitaria, según la expresión disminuida de CD18 o CD15. RESULTADOS: Se evaluaron 60 pacientes pediátricos: 20 aparentemente sanos y 40 con sospecha clínica de deficiencia de adhesión leucocitaria; 12 de 20 pacientes sanos fueron varones (mediana de edad: 14 años) y 27 de 40 con sospecha de la enfermedad fueron mujeres (mediana de edad: 2 años). Predominaron la leucocitosis persistente y las infecciones respiratorias (32%). La expresión de CD18 y CD15 en pacientes sanos fue del 95-100% y en pacientes con sospecha de deficiencia de adhesión leucocitaria de 0-100%. Se identificó una paciente con 0% de expresión de CD18 (LAD-1) y otro con 0% de CD15 (LAD-2). CONCLUSIONES: La evaluación de las moléculas CD18 y CD15 permitió detectar los primeros casos de deficiencia de adhesión leucocitaria en Paraguay, que sirve de precedente y pone a punto la técnica para el diagnóstico de la enfermedad a nivel local.
Subject(s)
Leukocyte-Adhesion Deficiency Syndrome , Primary Immunodeficiency Diseases , Humans , Female , Male , Child , Adolescent , Child, Preschool , Paraguay , LeukocytesABSTRACT
A novel type of cell underwent identification between 2005 and 2008 and was denominated the "telocyte" in 2010. In 2012, transmission electron microscopy revealed the presence of telocytes in the dermis. The aim of the present study was to report important changes in immunostained CD34 cells following the treatment of lower limb lymphedema using a specific lymphatic therapy technique. A clinical trial involving the evaluation of changes in immunostained CD34 cells in the epidermis and dermis (10 randomly selected histological fields) of a patient before and after intensive treatment for clinical stage II lymphedema was conducted using the Godoy Method, which was adapted to the treatment of skin fibrosis. The evaluation involved the use of the Weibel multi-point morphometric method. Comparisons were performed using the t-test with a 95% significance level. An important increase in CD34 cells was found with redistribution occurring following treatment. The treatment of primary lymphedema of the lower limbs resulted in the clinical reversal of fibrosis and an increase in the number of immunomarked CD34 cells.
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The use of combined chemotherapy is an essential alternative in treating breast cancer. However, knowledge of the pharmacokinetics of drugs is necessary to obtain maximum efficiency of the protocol and reduce adverse reactions. This study suggests for the first time the effect of the association of carboplatin with ivermectin and carboplatin with cyclophosphamide. This investigation was performed with 36 healthy Wistar rats, divided into four groups: group control, carboplatin (C), carboplatin preceded by ivermectin (C + IV), and carboplatin associated with cyclophosphamide (C + CI). Plasma concentrations quantification was performed using the High-Performance Liquid Chromatographic (HPLC) equipment with an Ultraviolet (UV) detector at eight different time points. Then, the animal was euthanized and necropsied. The bioanalytical method was validated for the two matrices (dogs and rats' plasma), with full validation in female dogs and partial validation in rats, as recommended by the EMA. In both matrices, the method was linear and reproducible. Here, we show the results in female rats' plasma. When comparing the experimental rats' groups (C; C + IV, and C + CI), there is a tendency to increase the bioavailability of carboplatin when used in association, a slight increase for C + IV and more evident to the C + CI group with an AUC rise higher than 2-fold (AUC0-∞ = 2983.61 for C; 4459.06 for C + CI; 7064.68 for C + CI min·mg·mL-1). The blood count, biochemistry profile, and histopathology of the organs revealed only alterations inherent to the metabolic effects of the drugs used. The carboplatin association with ivermectin appeared safe for this pilot group. We believe the carboplatin dose can be maintained without risk to the patient. However, in the carboplatin association with cyclophosphamide, a slight reduction in carboplatin's amount is suggested, seeking to avoid increased effects due to cyclophosphamide. Thus, studies with a more significant number per group must confirm the relevance of this pilot study.
Subject(s)
Dog Diseases , Neoplasms , Female , Dogs , Animals , Rats , Carboplatin/adverse effects , Carboplatin/pharmacokinetics , Pilot Projects , Ivermectin , Rats, Wistar , Cyclophosphamide , Neoplasms/veterinary , Dog Diseases/chemically inducedABSTRACT
INTRODUCTION: Butyrylcholinesterase (BChE), an important biomarker of exposure to anticholinesterases, varies its activity according to the intensity and duration of exposure to these agents. Their normal values may vary in different populations. It is important to determine the reference values for the local population, mostly black/brown. OBJECTIVE: The objective was to investigate the baseline values of BChE activity in a sample of the Salvador city population (Bahia, Brazil), evaluating the sociodemographic characteristics. METHOD: A descriptive, quantitative study with a cross-sectional approach was carried out in 304 voluntary and healthy blood donors. BChE activity was determined using the integrated chemical system Dimension RxLMax and analyses of sociodemographic characteristics were performed. RESULTS: For the 304 participants (18 to 67 years old), BChE activity values range were 7.4 to 19.8 U/mL (male) and 6.0 to 19.6 U/mL (female), without significant inter-racial differences (p = 0.986; Mann-Whitney). The participates were predominantly black (44.7%) and brown (40.5%), with higher levels of BchE activity in males (64.8%) (p-value = 0.01) than females (35.2%). There was no relationship between alcohol use and lower BChE activity (p = 0.725, Mann-Whitney). Women using hormonal contraceptives had a median activity 9.2% lower than the non-users. CONCLUSION: Despite the high miscegenation and predominance of the black race in Salvador, contrary to what was expected, the sample did not show statistically significant intra-racial differences in BChE activity, being able to use the same reference values currently used, observing factors such as sex, use of contraceptives, and drinking alcohol.
Subject(s)
Butyrylcholinesterase , Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Brazil , Biomarkers , Reference ValuesABSTRACT
Eating habits developed during childhood can be perpetuated along life and contribute to the emergence of disorders. We aimed to investigate the influence of distractors during experimental meals on the energy intake of children and adolescents. We followed the PRISMA guidelines and the study was registered in PROSPERO (CRD42021259946). The PICOS strategy consisted of children and adolescents (P), exposed to distractors during meals (I), compared with no distraction (C) and the outcome was energy intake (Kcal) (O) evaluated in crossover and parallel randomized clinical trials (RCTs) (S). Searches were conducted in PubMed, Scopus, Web of Science, Cochrane, Proquest, Embase, and LILACs databases. We employed RoB 2 tool and NutriGrade. Databases searches returned 9,576 references. Thirteen articles were selected (five crossover and eight parallel RCTs). Volunteers aged 3 to 17 years-old. All studies evaluated TV as distractor. Most studies presented high/moderate risk of bias. Meta-analysis of parallel RCT indicated no significant difference in energy intake while eating with TV (MD = 0.05; 95% CI -0.13 - 0.23, P = 0.57), with moderate certainty level. In conclusion, under laboratory conditions, eating with distractors seems to barely alter energy intake for children and adolescents.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2022.2055525 .
Subject(s)
Energy Intake , Research Design , Child , Humans , Adolescent , Child, PreschoolABSTRACT
Purpose: The purpose of this study is to evaluate the interference of the continuous use of drug classes in the expression of biomarkers during the first week of hospitalization and in the prognosis of patients with COVID-19. Methods: The patients diagnosed with COVID-19 and confirmed with SARS-CoV-2 by RT-qPCR assay underwent the collection of fasting whole blood samples for further analysis. Other data also extracted for this study included age, sex, clinical symptoms, related comorbidities, smoking status, and classes of continuous use. Routine serum biochemical parameters, including alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, C-reactive protein, N-terminal fragment of B-type natriuretic peptide, and cardiac troponin, were measured. Results: In this cross-sectional study, a total of 176 patients with COVID-19 hospitalizations were included. Among them, 155 patients were discharged (88.5%), and 21 patients died (12%). Among the drug classes evaluated, we verified that the continuous use of diuretic 4.800 (1.853-11.67) (p = 0.0007) and antihypercholesterolemic 3.188 (1.215-7.997) (p = 0.0171) drug classes presented a significant relative risk of death as an outcome when compared to the group of patients who were discharged. We evaluated biomarkers in patients who used continuous antihypercholesterolemic and diuretic drug classes in the first week of hospitalization. We observed significant positive correlations between the levels of CRP with cardiac troponin (r = 0.714), IL-6 (r = 0.600), and IL-10 (r = 0.900) in patients who used continuous anticholesterolemic and diuretic drug classes and were deceased. In these patients, we also evaluated the possible correlations between the biomarkers AST, NT-ProBNP, cardiac troponin, IL-6, IL-8, and IL-10. We observed a significantly negative correlations in AST levels with NT-ProBNP (r = -0.500), cardiac troponin (r = -1.00), IL-6 (r = -1.00), and IL-10 (r = -1.00) and a positive correlation with IL-8 (r = 0.500). We also observed significant negative correlation in the levels of NT-ProBNP with IL-10 (r = -0.800) and a positive correlation with cardiac troponin (r = 0.800). IL-6 levels exhibited positive correlations with cardiac troponin (r = 0.800) and IL-10 (r = 0.700). Conclusion: In this study, we observed that hospitalized COVID-19 patients who continued using anticholesterolemic and diuretic medications showed a higher number of correlations between biomarkers, indicating a poorer clinical prognosis. These correlations suggest an imbalanced immune response to injuries caused by SARS-CoV-2.
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The aim of this manuscript is to report the case of a 22-year-old adolescent who presented with brownish patches on the skin of her lower legs persistent since the age of eleven years. She was treated by a dermatologist since the age of twelve years with a clinical diagnosis of ochre dermatitis confirmed by a biopsy. The patient was treated for two years without a success and was sent to a vascular surgeon at fourteen years of age. The diagnosis was confirmed, and the venous duplex scan discarded the possibility of a macrocirculation abnormality. The patient was treated with aminaphtone with the normalization of the skin for two years, after which the patches returned and were controlled again with the same medication. As ochre dermatitis may be associated with capillary fragility, the use of aminaphtone is a therapeutic option.
Subject(s)
Humans , Female , Adolescent , Capillary Fragility , Hyperpigmentation , Dermatitis/therapy , Varicose Veins , HemosiderinABSTRACT
RESUMO Um em cada quatro pacientes acometidos por trauma maxilofacial terão concomitantemente fraturas da órbita e lesão ocular. Por isso, uma avaliação oftalmológica minuciosa é recomendada para todos os pacientes que sofrem um trauma de face. Alguns exames oftalmológicos logo após o trauma podem ser decisivos para a preservação da acuidade visual. Sujeitos com achados de exame físico de acuidade visual deficitárias, defeito pupilar aferente e imagens radiográficas com alta profundidade da fratura da órbita estão em maior risco de perda de visão e justificam preocupação específica para avaliação de lesão ocular. O objetivo deste estudo foi reunir as manifestações clínicas oftalmológicas prevalentes em pacientes acometidos por fraturas orbitárias, com o intuito de adquirir melhor perspectiva e entendimento acerca das consequências que a patologia traz ao indivíduo, no que tange à oftalmologia e aos tratamentos mais adequados. Trata-se de estudo de revisão integrativa, utilizando as bases de dados Pubmed®/Medline®, SciELO, Biblioteca Virtual em Saúde e Lilacs, com um vocabulário controlado segundo a estratégia de busca em cada uma das bases de dados bibliográficas, por meio dos termos "ophthalmologic complications", "prevalence", "orbital fracture", em estudos publicados de 2013 a 2023. A qualidade dos artigos foi avaliada usando o Study Quality Assessment Tool from the Department of Health and Human Services. Foram encontradas 46 referências, sendo 20 no Pubmed®/Medline®, 17 na SciELO, 9 na Biblioteca Virtual em Saúde e nenhuma na Lilacs. Após excluir referências duplicadas, foram selecionadas 44 referências para avaliação de elegibilidade. Após leitura dos títulos e resumos (n=44), 36 estudos foram excluídos pelas seguintes razões: artigos que não respondiam a nossa pergunta científica (n=11) e publicação superior a 10 anos (n=25). Identificaram-se, nos oito artigos selecionados, o objetivo do estudo, a população estudada o nível de evidência. Os oito estudos tiveram como objetivo analisar traumas orbitais com alterações funcionais significativas oculares e visuais pelo prejuízo ao tecido ósseo, nervoso, vascular e até parenquimatoso cerebral na região do assoalho e paredes de cavidades orbital. Dentre as manifestações clínicas oftalmológicas mais importantes, listam-se manifestação de enoftalmia, diplopia, hifema traumático, hemorragia retiniana, amaurose, quemose, neuropatia óptica traumática e hematoma retrobulbar. Considerando os oito estudos analisados, verificou-se a presença unânime de manifestações clínicas oftalmológicas na totalidade dos pacientes acometidos, sendo predominantes a baixa acuidade visual e o hifema. No que tange aos achados de menor prevalência, ao equipará-los às manifestações clínicas oftalmológicas mais encontradas, verifica-se que possuem como fator principal o estado transitório, concluindo-se que, mesmo com toda a gravidade do quadro de fratura orbitária, sua tendência é não deixar sequelas permanentes em grande partes dos casos, ainda que não seja nítida a relação estabelecida pela ausência de sequelas permanentes, especulando-se que essa ausência se deve à identificação do quadro e à intervenção adequada em tempo hábil.
ABSTRACT One in four patients affected by maxillofacial trauma will have concomitant orbital fractures and ocular injuries; therefore, an ophthalmological evaluation is recommended for all patients who have been affected by facial trauma. Some ophthalmological exams soon after the trauma can be decisive for the preservation of visual acuity. Patients with physical examination findings of poor visual acuity, afferent pupillary defect, radiographic images with high depth of orbital fracture, are at greater risk of vision loss and specific concern for evaluation of ocular injury. The objective of this study was to gather the prevalent ophthalmologic clinical manifestations in patients affected by orbital fractures, to achieve a better perspective and understanding about the consequences that the pathology brings to the individual regarding ophthalmology and the most appropriate treatments. This is an integrative review study, using the Pubmed®/Medline®, SciELO, Virtual Health Library and Lilacs databases, with a controlled vocabulary according to the search strategy in each of the bibliographic databases, using the terms "ophthalmologic complications", "prevalence", "orbital fracture", in studies published from 2013 to 2023. The quality of the articles was assessed using the Study Quality Assessment Tool from the Department of Health and Human Services. A total of 46 references were found, 20 in Pubmed®/Medline®, 17 in SciELO, 9 in the Virtual Health Library and none in Lilacs. After excluding duplicate references, 44 references were selected for eligibility assessment. After reading the titles and abstracts (n=44), 36 studies were excluded for the following reasons: articles that did not answer our scientific question (n=11) and publication over 10 years (n=25). In the eight selected articles, the objective of the study, the population studied, and the level of evidence were identified. The eight studies aimed to analyze orbital trauma with significant ocular and visual functional changes due to damage to bone, nerve, vascular, and even brain parenchymal tissue in the region of the floor and walls of orbital cavities. Among the most important ophthalmologic clinical manifestations, there are enophthalmos, diplopia, traumatic hyphema, retinal hemorrhage, amaurosis, chemosis, traumatic optic neuropathy and retrobulbar hematoma. Considering the eight studies analyzed, there was a unanimous presence of ophthalmological clinical manifestations in all affected patients, with low visual acuity and hyphema being predominant. Regarding the findings of lower prevalence, when equating them to the most common ophthalmologic clinical manifestations, they have as main factor the transient state, which can be concluded that, even with all the severity of the orbital fracture, its tendency is not to leave permanent sequelae in most cases, although the relationship established by the absence of permanent sequelae is not clear, speculating that this absence is due to the identification of the condition and the appropriate intervention in a timely manner.
ABSTRACT
Background: Hallermann-Streiff syndrome (HSS) is a rare congenital abnormality involving multiple craniofacial malformations, such as micrognathia, prominent frontal and nasal bones, vision defects, and dental anomalies, which can result in obstructive sleep apnea syndrome. The aim of the present study was to report a case of nasal obstruction in an individual with Hallermann-Streiff syndrome who had never breathed through the nose during treatment for lower limb lymphedema involving cervical lymphatic therapy. Case Report. An 18-year-old female adolescent with a diagnosis of HSS was sent from the genetics service of a teaching school for the treatment of lower limb lymphedema. At around 11 years of age, the patient began to present edema in the left leg, accompanied by broadening of the face and neck. The patient reported having obstructed nostrils and breathing through the mouth her entire life. On the second day of treatment, the patient reported being able to breathe through one of the nostrils, this had never occurred before. Based on this finding, the decision was made to include linear facial lymphatic drainage using the Godoy method, which led to the complete resolution of the nasal obstruction in the first 15 minutes of treatment. Nasal obstruction in children with Hallermann-Streiff syndrome may be caused by lymphedema. Conclusion: A specific lymphatic drainage technique, such as cervical lymphatic therapy and facial linear lymphatic therapy, can resolve the obstruction and maintain the nostrils unblocked for months.