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1.
Ital J Pediatr ; 46(1): 143, 2020 Oct 06.
Artículo en Inglés | MEDLINE | ID: mdl-33023602

RESUMEN

The Veneto region is one of the most affected Italian regions by COVID-19. Chronic lung diseases, such as chronic obstructive pulmonary disease (COPD), may constitute a risk factor in COVID-19. Moreover, respiratory viruses were generally associated with severe pulmonary impairment in cystic fibrosis (CF). We would have therefore expected numerous cases of severe COVID-19 among the CF population. Surprisingly, we found that CF patients were significantly protected against infection by SARS-CoV-2. We discussed this aspect formulating some reasonable theories.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Fibrosis Quística/epidemiología , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Adulto , Técnicas de Laboratorio Clínico/métodos , Estudios de Cohortes , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Fibrosis Quística/diagnóstico , Femenino , Humanos , Incidencia , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Neumonía Viral/prevención & control , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Valores de Referencia , Estudios Retrospectivos , Medición de Riesgo
2.
Medicine (Baltimore) ; 99(38): e22214, 2020 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-32957357

RESUMEN

Anti-thyroid peroxidase antibody (TPO-Ab), which is the known cause of autoimmune thyroid disease, enhances proinflammatory cytokine responses. Since low-grade inflammation is a known risk factor for atherosclerosis, a normal range of TPO-Ab (TPO-Ab negative) could be positively associated with atherosclerosis among participants with normal thyroid function. However, no study reported the association between normal range of TPO-Ab and atherosclerosis among eu-thyroid participants. A cross-sectional study was conducted with 1165 Japanese individuals with normal thyroid function (ie, normal range of free triiodothyronine [free T3] and free thyroxine [free T4]), aged 40 to 74 years, who participated in an annual health checkup in 2014. Among the study population, 115 were diagnosed as having atherosclerosis. A normal range value of TPO-Ab titer is revealed to be positively associated with atherosclerosis; sex, age, thyroid function (free T3 and thyroid-stimulating hormone), and known cardiovascular risk factor adjusted odds ratio and 95% confidence interval of atherosclerosis for logarithmic values of TPO-Ab was 2.23 (1.11, 4.47). When we limited the analysis to participants with normal levels of thyroid-stimulating hormone, this association became slightly stronger (2.65 [1.27,5.51]). Among the eu-thyroid general population, a normal range of TPO-Ab titer is revealed to be positively associated with atherosclerosis. Even though a TPO-Ab titer is not clinically relevant and is not associated with autoimmune thyroid disease, it could influence endothelial remodeling including atherosclerosis.


Asunto(s)
Aterosclerosis/sangre , Autoanticuerpos/sangre , Yoduro Peroxidasa/inmunología , Anciano , Grupo de Ascendencia Continental Asiática , Aterosclerosis/inmunología , Autoanticuerpos/inmunología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , Tirotropina/sangre
3.
Emerg Med Clin North Am ; 38(4): 819-839, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32981620

RESUMEN

Pediatric cardiac arrest is a relatively rare but devastating presentation in infants and children. In contrast to adult patients, in whom a primary cardiac dysrhythmia is the most likely cause of cardiac arrest, pediatric patients experience cardiovascular collapse most frequently after an initial respiratory arrest. Aggressive treatment in the precardiac arrest state should be initiated to prevent deterioration and should focus on support of oxygenation, ventilation, and hemodynamics, regardless of the presumed cause. Unfortunately, outcomes for pediatric cardiac arrest, whether in hospital or out of hospital, continue to be poor.


Asunto(s)
Paro Cardíaco/terapia , Resucitación/métodos , Manejo de la Vía Aérea , Glucemia/análisis , Niño , Maltrato a los Niños/terapia , Cardioversión Eléctrica , Electroencefalografía , Servicio de Urgencia en Hospital , Epinefrina/uso terapéutico , Oxigenación por Membrana Extracorpórea , Paro Cardíaco/etiología , Cardiopatías Congénitas/terapia , Frecuencia Cardíaca , Humanos , Hipotermia/complicaciones , Hipotermia/terapia , Hipotermia Inducida , Enfermedades Pulmonares/terapia , Padres , Examen Físico , Envenenamiento/terapia , Evaluación de Procesos, Atención de Salud , Valores de Referencia , Insuficiencia Respiratoria/terapia , Frecuencia Respiratoria , Órdenes de Resucitación , Sepsis/terapia , Choque/etiología , Choque/terapia , Vasoconstrictores/uso terapéutico , Heridas y Traumatismos/terapia
4.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(8): 1286-1290, 2020 Aug 10.
Artículo en Chino | MEDLINE | ID: mdl-32867437

RESUMEN

Objective: To study and establish the percentile reference values of waist circumference (WC) for Chinese children aged 3-7 years. Methods: A total of 26 480 children aged 3-7 years were collected as part of the National Survey on Physical Growth and Development of Children in nine cities (Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou and Kunming) in China from June to November 2015. Sex- and age-specific smoothed percentile reference values of WC were established using the Lambda Mu Sigma method. The P(75) and P(90) curves of WC for children aged 3-7 years in this study were linked with the published P(75) and P(90) cut-off points for Chinese children and adolescents aged 7-18 years. The P(50) percentile of WC in this study was compared with the corresponding percentiles of several foreign studies. Results: The P(5), P(10), P(15), P(20), P(25), P(50), P(75), P(80), P(85), P(90) and P(95) reference values of WC were obtained for boys and girls aged 3-7 years biannually, at the interval of every six months. Results showed that WC at the P(50) had significantly increased from 47.5 cm at the age of 3 to 54.2 cm at the age of 7 for boys and from 47.0 cm at the age of 3 to 52.2 cm for girls at the age of 7. The corresponding WC percentile values appeared a bit higher in boys than those in girls at the same age, with the differences from 0.4 to 3.6 cm. The differences between measured and fitted WC at each empirical percentile ranged from -0.3 to 0.5 cm for both boys and girls aged 3-7 years. The P(75) and P(90) values of WC for boys and girls aged 3-7 years in this study presented a consistent, continuous tendency on age with the published WC cut-off points (P(75) and P(90)) for Chinese children and adolescent aged 7-18. The increasing trend of WC by age in Chinese children aged 3-7 years was consistent with those of foreign studies, at the middle level for boys and lower middle level for girls. Conclusions: Through this study, we established the WC percentile values for Chinese children aged 3-7 years and achieved the continuity in age with the published WC cut-off points for Chinese children and adolescents aged 7-18. These established WC percentile values can be used as reference for clinical practice, health care and scientific research.


Asunto(s)
Circunferencia de la Cintura , Niño , Preescolar , China , Ciudades , Femenino , Humanos , Masculino , Valores de Referencia
5.
Medicine (Baltimore) ; 99(35): e21891, 2020 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-32871919

RESUMEN

To analyze the relationship between aortic measures and biometric parameters in a large cohort of consecutive patients undergoing computed tomography coronary angiography.1170 patients (717 men/453 women) performing computed tomography coronary angiography for coronary evaluation were retrospectively evaluated. Aortic diameters and areas were measured at reproducible anatomic landmarks, perpendicular to the axis of vessel, at the level of the aortic root (AoR), the sinotubular junction (STJ), and the tubular ascending aorta (TAo). Biometric parameters and cardiovascular risk factors were recorded.The average values of AoR, STJ, and TAo were 35.63 ±â€Š5.00 mm, 30.56 ±â€Š4.82 mm, 35.07 ±â€Š5.84 mm. Hypertension was significantly associated with aortic dimensions.Aortic measures were significantly different between men and women (37.56 ±â€Š4.77 mm vs 32.58 ±â€Š3.68 mm for AoR, 31.88 ±â€Š4.84 mm vs 28.47 ±â€Š3.98 mm for STJ and 35.93 ±â€Š5.86 mm vs 33.70 ±â€Š5.54 mm for TAo) (P < .001) and linearly increased with age. Low Spearman correlation coefficients were found and the correlation of TAo diameters with age displayed the highest values (ρ = 0.372 for male and ρ = 0.373 for female, P < .001). Multiple linear regression analysis models were compared by R. The best model used body surface area (BSA) and age as independent variables and TAo diameter as dependent variable (R = 0.29 for AoR; R = 0.21 for STJ, and R = 0.20 for TAo).In conclusion, in our population low correlation between aortic dimensions and biometric parameters highlights the difficulty of identifying normal ranges, as well as issues related to normalization using conventional biometric parameters.


Asunto(s)
Aorta/anatomía & histología , Aorta/diagnóstico por imagen , Biometría , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Cardiovasculares/patología , Angiografía Coronaria , Tomografía Computarizada por Rayos X , Factores de Edad , Anciano , Superficie Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales
6.
Cochrane Database Syst Rev ; 9: CD010315, 2020 09 09.
Artículo en Inglés | MEDLINE | ID: mdl-32905623

RESUMEN

BACKGROUND: This is the second update of the review first published in 2017. Hypertension is a prominent preventable cause of premature morbidity and mortality. People with hypertension and established cardiovascular disease are at particularly high risk, so reducing blood pressure to below standard targets may be beneficial. This strategy could reduce cardiovascular mortality and morbidity but could also increase adverse events. The optimal blood pressure target in people with hypertension and established cardiovascular disease remains unknown. OBJECTIVES: To determine if lower blood pressure targets (135/85 mmHg or less) are associated with reduction in mortality and morbidity as compared with standard blood pressure targets (140 to 160/90 to 100 mmHg or less) in the treatment of people with hypertension and a history of cardiovascular disease (myocardial infarction, angina, stroke, peripheral vascular occlusive disease). SEARCH METHODS: For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials (RCTs) up to November 2019: Cochrane Hypertension Specialised Register, CENTRAL, MEDLINE (from 1946), Embase (from 1974), and Latin American Caribbean Health Sciences Literature (LILACS) (from 1982), along with the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov. We also contacted authors of relevant papers regarding further published and unpublished work. We applied no language restrictions. SELECTION CRITERIA: We included RCTs with more than 50 participants per group that provided at least six months' follow-up. Trial reports had to present data for at least one primary outcome (total mortality, serious adverse events, total cardiovascular events, cardiovascular mortality). Eligible interventions involved lower targets for systolic/diastolic blood pressure (135/85 mmHg or less) compared with standard targets for blood pressure (140 to 160/90 to 100 mmHg or less). Participants were adults with documented hypertension and adults receiving treatment for hypertension with a cardiovascular history for myocardial infarction, stroke, chronic peripheral vascular occlusive disease, or angina pectoris. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed search results and extracted data using standard methodological procedures expected by Cochrane. We used GRADE to assess the quality of the evidence. MAIN RESULTS: We included six RCTs that involved 9484 participants. Mean follow-up was 3.7 years (range 1.0 to 4.7 years). All RCTs provided individual participant data. None of the included studies was blinded to participants or clinicians because of the need to titrate antihypertensives to reach a specific blood pressure goal. However, an independent committee blinded to group allocation assessed clinical events in all trials. Hence, we assessed all trials at high risk of performance bias and low risk of detection bias. Other issues such as early termination of studies and subgroups of participants not predefined were also considered to downgrade the quality evidence. We found there is probably little to no difference in total mortality (risk ratio (RR) 1.06, 95% confidence interval (CI) 0.91 to 1.23; 6 studies, 9484 participants; moderate-quality evidence) or cardiovascular mortality (RR 1.03, 95% CI 0.82 to 1.29; 6 studies, 9484 participants; moderate-quality evidence). Similarly, we found there may be little to no differences in serious adverse events (RR 1.01, 95% CI 0.94 to 1.08; 6 studies, 9484 participants; low-quality evidence) or total cardiovascular events (including myocardial infarction, stroke, sudden death, hospitalization, or death from congestive heart failure) (RR 0.89, 95% CI 0.80 to 1.00; 6 studies, 9484 participants; low-quality evidence). The evidence was very uncertain about withdrawals due to adverse effects. However, studies suggest more participants may withdraw due to adverse effects in the lower target group (RR 8.16, 95% CI 2.06 to 32.28; 2 studies, 690 participants; very low-quality evidence). Systolic and diastolic blood pressure readings were lower in the lower target group (systolic: mean difference (MD) -8.90 mmHg, 95% CI -13.24 to -4.56; 6 studies, 8546 participants; diastolic: MD -4.50 mmHg, 95% CI -6.35 to -2.65; 6 studies, 8546 participants). More drugs were needed in the lower target group (MD 0.56, 95% CI 0.16 to 0.96; 5 studies, 7910 participants), but blood pressure targets were achieved more frequently in the standard target group (RR 1.21, 95% CI 1.17 to 1.24; 6 studies, 8588 participants). AUTHORS' CONCLUSIONS: We found there is probably little to no difference in total mortality and cardiovascular mortality between people with hypertension and cardiovascular disease treated to a lower compared to a standard blood pressure target. There may also be little to no difference in serious adverse events or total cardiovascular events. This suggests that no net health benefit is derived from a lower systolic blood pressure target. We found very limited evidence on withdrawals due to adverse effects, which led to high uncertainty. At present, evidence is insufficient to justify lower blood pressure targets (135/85 mmHg or less) in people with hypertension and established cardiovascular disease. Several trials are still ongoing, which may provide an important input to this topic in the near future.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Enfermedades Cardiovasculares/tratamiento farmacológico , Hipertensión/tratamiento farmacológico , Antihipertensivos/efectos adversos , Sesgo , Presión Sanguínea/fisiología , Enfermedades Cardiovasculares/mortalidad , Diástole , Humanos , Hipertensión/complicaciones , Hipertensión/mortalidad , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto , Valores de Referencia , Sístole
7.
Medicine (Baltimore) ; 99(39): e22392, 2020 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-32991461

RESUMEN

Assessment of skeletal maturity is crucial for managing growth related problems. Tanner and Whitehouse (TW) hand and wrist bone age assessment is an accurate method; however, it is complex and labor-intensive. Several simplified methods derived from the TW method were proposed, and each had its own character. The purpose of this study is to explore the relationship between these methods for accurate usage.Between 2018 and 2019, a cross-sectional study was performed with consecutive left hand and wrist x-rays obtained from a pediatric orthopedic clinic. Bone age assessments included the distal radius and ulna (DRU) classification, Sanders staging (S), thumb ossification composite index (T), and TW method. Somers delta correlation was conducted to determine the interchangeability of these stages. The mean bone age and standard deviation (SD) of each subgrade were compared and analyzed.Totally 103 films (92 girls) were analyzed with mean age of 12.1 years (range: 8.0-17.9 years). The radius (R) stages had good correlation with S, T, and U stages with a very high Somers delta correlation (P < .05). R5 had relatively large SD (1.5) and referred to T2 and T3; R6 and R7 had the smallest SD (0.3) with reference to T4 or S2; R8 referred to T5 or S3, S4, S5; R9 referred to S6 and S7.The internal relationship between the DRU and digital stages system was well proven. We also provided a simple and accurate way to assess the bone age by combination of some subgrades with smaller SD: 10y-proximal thumb covered without sesamoid (T2); 10.5y-sesamoid just appearing (T3); 11y-distal radial physis just covered (medial double joint line, R6); 11.5y-medial capping of distal radial physis (R7); 12y-bilateral capping of distal radial physis (R8) / phalangeal capping without fusion (S3); 12.5y-distal phalangeal physes start to fuse (S4); 13y-distal phalangeal physes fused (S5); 13.5y-proximal phalangeal physes start to fuse (S6); 14.5y-proximal phalangeal physes fused (S7); 15y-distal radial physis almost fused (R10).Level of Evidence: Diagnostic study, level III.


Asunto(s)
Determinación de la Edad por el Esqueleto/métodos , Huesos de la Mano/diagnóstico por imagen , Articulación de la Muñeca/diagnóstico por imagen , Adolescente , Niño , Estudios Transversales , Femenino , Humanos , Valores de Referencia
8.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32948657

RESUMEN

OBJECTIVES: To determine the natural history of pediatric hypertension. METHODS: We conducted a 72-month retrospective cohort study among 165 primary care sites. Blood pressure measurements from two consecutive 36 month periods were compared. RESULTS: Among 398 079 primary care pediatric patients ages 3 to 18, 89 347 had ≥3 blood pressure levels recorded during a 36-month period, and 43 825 children had ≥3 blood pressure levels for 2 consecutive 36-month periods. Among these 43 825 children, 4.3% (1881) met criteria for hypertension (3.5% [1515] stage 1, 0.8% [366] stage 2) and 4.9% (2144) met criteria for elevated blood pressure in the first 36 months. During the second 36 months, 50% (933) of hypertensive patients had no abnormal blood pressure levels, 22% (406) had elevated blood pressure levels or <3 hypertensive blood pressure levels, and 29% (542) had ≥3 hypertensive blood pressure levels. Of 2144 patients with elevated blood pressure in the first 36 months, 70% (1492) had no abnormal blood pressure levels, 18% (378) had persistent elevated blood pressure levels, and 13% (274) developed hypertension in the second 36-months. Among the 7775 patients with abnormal blood pressure levels in the first 36-months, only 52% (4025) had ≥3 blood pressure levels recorded during the second 36-months. CONCLUSIONS: In a primary care cohort, most children initially meeting criteria for hypertension or elevated blood pressure had subsequent normal blood pressure levels or did not receive recommended follow-up measurements. These results highlight the need for more nuanced initial blood pressure assessment and systems to promote follow-up of abnormal results.


Asunto(s)
Determinación de la Presión Sanguínea/estadística & datos numéricos , Hipertensión/diagnóstico , Adolescente , Factores de Edad , Estatura , Niño , Preescolar , Intervalos de Confianza , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Valores de Referencia , Análisis de Regresión , Estudios Retrospectivos , Factores Sexuales , Factores de Tiempo
9.
Adv Clin Exp Med ; 29(9): 1091-1099, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32937041

RESUMEN

BACKGROUND: Experimental and clinical studies evaluating the Tp-Te interval and Tp-Te/QT ratio have reported conflicting data. The overlap between normal Tp-Te/QT ratios (0.17 ±0.02-0.27 ±0.06 ms) and pathological values (0.20 ±0.03-0.30 ±0.06 ms) measured in earlier studies has raised questions about this ECG measurement technique. OBJECTIVES: To analyze normal values of the Tp-Te interval, Tp-Te dispersion Tp-Te(d) and the Tp-Te/QT ratio based on electrocardiographic (ECG) assessment across sex and age groups in a healthy Turkish population. MATERIAL AND METHODS: A total of 1,485 healthy participants (723 men) were enrolled into the study. The age of the participants ranged 17-75 years and they did not have either any cardiovascular/systemic disorders or risk factors for atherosclerosis which were detected with physical examination and laboratory tests. The Tp-Te interval, Tp-Te(d) and Tp-Te/QT ratio were determined from V1-V6 derivations. RESULTS: For the entire study, the median Tp-Te interval was 66.0 (64.0-70.0) ms, the Tp-Te(d) was 15.0 (10.0-20.0) ms, and the Tp-Te/QT ratio was 0.18 (0.17-0.19). The Pearson's correlation test demonstrated that the Tp-Te/QT ratio significantly correlated with older age (r = 0.297; p < 0.0001), left ventricular (LV) end-diastolic diameter (LVEDD; r = 0.481; p < 0.0001), body mass index (BMI; r = 0.421; p < 0.0001), body surface area (BSA; r = 0.191; p < 0.0001), LV end-diastolic volume (LVEDV; r = 0.484; p < 0.0001), LVEDV index (r = 0.450; p < 0.0001), LV mass (r = 0.548; p < 0.0001), and LV mass index (r = 0.539; p < 0.0001). CONCLUSIONS: The reference values for Tp-Te interval, Tp-Te(d) and Tp-Te/QT ratio are associated with age, BMI, BSA, LVEDV, LVEDV index, LV mass, and LV mass index. These structural elements should be considered when using these ECG parameters for assessing repolarization inhomogeneity. These findings may guide further studies assessing healthy and diseased populations.


Asunto(s)
Enfermedades Cardiovasculares , Electrocardiografía , Adolescente , Adulto , Femenino , Sistema de Conducción Cardíaco , Ventrículos Cardíacos , Humanos , Masculino , Valores de Referencia , Adulto Joven
10.
Respir Res ; 21(1): 252, 2020 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-32993656

RESUMEN

SARS-CoV-2 is causing a pandemic with currently > 29 million confirmed cases and > 900,000 deaths worldwide. The locations and mechanisms of virus entry into the human respiratory tract are incompletely characterized. We analyzed publicly available RNA microarray datasets for SARS-CoV-2 entry receptors and cofactors ACE2, TMPRSS2, BSG (CD147) and FURIN. We found that ACE2 and TMPRSS2 are upregulated in the airways of smokers. In asthmatics, ACE2 tended to be downregulated in nasal epithelium, and TMPRSS2 was upregulated in the bronchi. Furthermore, respiratory epithelia were negative for ACE-2 and TMPRSS2 protein expression while positive for BSG and furin, suggesting a possible alternative entry route for SARS-CoV-2.


Asunto(s)
Asma/virología , Infecciones por Coronavirus/genética , Regulación de la Expresión Génica , Neumonía Viral/genética , Serina Endopeptidasas/genética , Síndrome Respiratorio Agudo Grave/virología , Fumar/epidemiología , Asma/fisiopatología , Bases de Datos Factuales , Humanos , Pandemias , Receptores Virales/genética , Valores de Referencia , Sistema Respiratorio/metabolismo , Sistema Respiratorio/virología , Estudios Retrospectivos , Síndrome Respiratorio Agudo Grave/metabolismo , Fumar/fisiopatología , Internalización del Virus
11.
Medicine (Baltimore) ; 99(37): e21730, 2020 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-32925715

RESUMEN

Abdominal aorta calcification (AAC) is associated with worse clinical outcomes in dialysis patients. However, the long-term prognostic values of AAC to cardiovascular (CV) and non-CV mortality in patients starting peritoneal dialysis (PD) remain unknown. This study is aimed to the analyze the predictive power of AAC to CV and non-CV mortality in PD patients. We prospectively enrolled 123 patients undergoing PD. All patients received quantitative analysis of AAC via abdominal computer tomography at enrollment. The AAC ratio was measured by the area of the whole aorta affected by aortic calcification above the iliac bifurcation. The CV mortality and non-CV mortality during the follow-up period were investigated using the Cox proportional hazard model and time-dependent receiver operating characteristic (ROC) analysis. After median 6.8 (interquartile range, 3.6-9.2) years of follow-up, there were 18 CV mortality, 24 non-CV mortality and 42 total mortality. The age and AAC ratio were significantly higher in CV mortality group compared with others without CV mortality. In time-dependent ROC analysis, AAC had excellent predictive power of CV mortality (AUC:0.787) but not non-CV mortality (AUC:0.537). The best cutoff value of AAC ratio to predict CV mortality was 39%. In addition, AAC was not associated with non-CV mortality but remained to be a significantly predictor of CV mortality after adjusted with clinical covariates in different Cox proportional hazard models. AAC has excellent prognostic value of CV mortality but is unable to predict non-CV morality in patients undergoing PD.


Asunto(s)
Aorta Abdominal/patología , Enfermedades de la Aorta/mortalidad , Enfermedades Cardiovasculares/mortalidad , Diálisis Peritoneal/mortalidad , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Calcificación Vascular/mortalidad , Anciano , Enfermedades de la Aorta/complicaciones , Enfermedades Cardiovasculares/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Curva ROC , Valores de Referencia , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/terapia , Factores de Riesgo , Calcificación Vascular/complicaciones
12.
Medicine (Baltimore) ; 99(37): e22120, 2020 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-32925760

RESUMEN

The purpose of this study is to study sonoelastographic features of the saphenous nerve.The study included 72 saphenous nerves in 36 healthy subjects. High resolution ultrasound and Shearwave elastography were used to evaluate the saphenous nerve. Cross sectional area (CSA) and stiffness were measured.The mean CSA of the saphenous nerve was 5.7 mm. The mean shear elastic modulus of the saphenous nerve in the short axis was 29.5 kPa. The mean shear elastic modulus of the saphenous nerve in long axis was 29.9 kPa. The saphenous nerve elastic modulus also showed no correlation with CSA in neither the long axis nor short axis. Positive correlation between elasticity measurements in the long and short axes. Age, height, weight, and BMI showed no correlation with saphenous nerve elastic modulus in short or long axes.The elastic modulus of the saphenous nerve has been determined in healthy subjects and can serve as a reference for future assessment of the saphenous nerve before different procedures.


Asunto(s)
Diagnóstico por Imagen de Elasticidad , Elasticidad/fisiología , Nervios Periféricos/diagnóstico por imagen , Nervios Periféricos/fisiología , Muslo/inervación , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , Muslo/diagnóstico por imagen , Adulto Joven
13.
J Assoc Physicians India ; 68(9): 36-42, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32798344

RESUMEN

Objectives: Ideally, the upper reference limit of plasma or serum homocysteine (Hcy) is to be defined from the studies done on individuals with normal cobalamin and folate status. It is difficult to separate the truly healthy (Cobalamin/Folate Replete) individuals from the randomly selected, apparently healthy individuals who are sub-clinically deficient of cobalamin/folate. The present study was aimed at defining the reference values for the serum homocysteine from individuals with normalized cobalamin and folate status. Methods: In our study, 215 patients with cobalamin, folic acid deficiency were treated accordingly till complete restoration of clinical and laboratory abnormalities. The post-therapy serum Hcy values were used as reference values. Results: Post-therapy serum Hcy values 12.56 µmol/L (95th percentile), 11.4 µmol/L (85th percentile), 9.8 µmol/L (67th percentile) were seen. The hyperhomocysteinemia was more visible (17.3% gain in prevalence) in the same patient group if interpreted using the post-therapy Hcy value (11.4 µmol/L) as the cut-off. There was no difference between the genders and age groups in the pre or post-therapy Hcy values. Conclusions: The benefit of the gain in prevalence of disease or the increase in the sensitivity of the test, though small, gets magnified in common diseases and in populous countries. Selection of the individuals is as important as the method or the reagent used in the method when a particular parameter is studied. Repleting the vitamin stores in the confirmed vitamin-deficient patients is more appropriate and easily feasible, since anyway they require treatment, than doing the same on the apparently healthy people. The data thus obtained can be better used as the reference value, for a more meaningful interpretation. The reference range can in turn be used to identify the sub-clinically deficient but asymptomatic people and managed accordingly.


Asunto(s)
Deficiencia de Ácido Fólico , Ácido Fólico/uso terapéutico , Deficiencia de Vitamina B 12 , Vitamina B 12/uso terapéutico , Femenino , Deficiencia de Ácido Fólico/tratamiento farmacológico , Homocisteína , Humanos , Masculino , Valores de Referencia , Deficiencia de Vitamina B 12/tratamiento farmacológico
14.
Medicine (Baltimore) ; 99(31): e21486, 2020 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-32756177

RESUMEN

The diameter of femoral vessels was angiographically explored in pediatric patients with congenital heart disease (CHD) and compared with anthropometric and demographic indexes.A total of 153 pediatric patients younger than 3 years old were recruited. The sex, age, weight, and height of patients were recorded daily, and the body surface area (BSA) was calculated with the Mosteller formula.The values of mean left-right diameters were 3.13 (0.32) mm for the femoral artery (FA) and 5.14 (0.68) mm for the femoral vein (FV). The FA diameter (FA-Dm) and FV diameter (FV-Dm) were clearly related (R = 0.84, P < .001), and the FA-Dm/FV-Dm ratio ranged from 0.61 to 0.622. The diameters of femoral vessels were significantly correlated with age, height, weight and BSA (R = 0.63 to 0.73, P < .001). The FA-Dm and FV-Dm were most closely associated with the height of patients (FA-Dm: R = 0.73, P < .001; FV-Dm: R = 0.69, P < .001).The FV-Dm and FA-Dm were consistent with the weight, height, age and BSA in the surveyed pediatric patients. The FA-Dm and FV-Dm were closely associated with the height of pediatric patients. Furthermore, the FA-Dm/FV-Dm ratio was stable in these patients. Such estimations could help clinicians select the appropriate diameter of cannulation needles and catheters for interventional therapy pediatric patients with CHD.


Asunto(s)
Angiografía/estadística & datos numéricos , Arteria Femoral/diagnóstico por imagen , Vena Femoral/diagnóstico por imagen , Cardiopatías Congénitas/diagnóstico por imagen , Angiografía/métodos , Antropometría , Superficie Corporal , Femenino , Cardiopatías Congénitas/patología , Humanos , Lactante , Masculino , Valores de Referencia
15.
PLoS One ; 15(8): e0232733, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32764762

RESUMEN

Ferrets (Mustela putorius furo) are a valuable animal model used in biomedical research. Like many animals, ferrets undergo significant variation in body weight seasonally, affected by photoperiod, and these variations complicate the use weight as an indicator of health status. To overcome this requires a better understanding of these seasonal weight changes. We provide a normative weight data set for the female ferret accounting for seasonal changes, and also investigate the effect of fluid regulation on weight change. Female ferrets (n = 39) underwent behavioural testing from May 2017 to August 2019 and were weighed daily, while housed in an animal care facility with controlled light exposure. In the winter (October to March), animals experienced 10 hours of light and 14 hours of dark, while in summer (March to October), this contingency was reversed. Individual animals varied in their body weight from approximately 700 to 1200 g. However, weights fluctuated with light cycle, with animals losing weight in summer, and gaining weight in winter such that they fluctuated between approximately 80% and 120% of their long-term average. Ferrets were weighed as part of their health assessment while experiencing water regulation for behavioural training. Water regulation superimposed additional weight changes on these seasonal fluctuations, with weight loss during the 5-day water regulation period being greater in summer than winter. Analysing the data with a Generalised Linear Model confirmed that the percentage decrease in weight per week was relatively constant throughout the summer months, while the percentage increase in body weight per week in winter decreased through the season. Finally, we noted that the timing of oestrus was reliably triggered by the increase in day length in spring. These data establish a normative benchmark for seasonal weight variation in female ferrets that can be incorporated into the health assessment of an animal's condition.


Asunto(s)
Peso Corporal , Hurones/anatomía & histología , Crianza de Animales Domésticos , Animales , Animales de Laboratorio/anatomía & histología , Animales de Laboratorio/fisiología , Agua Corporal/fisiología , Estro/fisiología , Femenino , Hurones/fisiología , Modelos Lineales , Modelos Animales , Modelos Biológicos , Fotoperiodo , Valores de Referencia , Estaciones del Año
16.
Anesthesiology ; 133(3): 559-568, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32788558

RESUMEN

BACKGROUND: To improve understanding of the respiratory behavior of oliceridine, a µ-opioid receptor agonist that selectively engages the G-protein-coupled signaling pathway with reduced activation of the ß-arrestin pathway, the authors compared its utility function with that of morphine. It was hypothesized that at equianalgesia, oliceridine will produce less respiratory depression than morphine and that this is reflected in a superior utility. METHODS: Data from a previous trial that compared the respiratory and analgesic effects of oliceridine and morphine in healthy male volunteers (n = 30) were reanalyzed. A population pharmacokinetic-pharmacodynamic analysis was performed and served as basis for construction of utility functions, which are objective functions of probability of analgesia, P(analgesia), and probability of respiratory depression, P(respiratory depression). The utility function = P(analgesia ≥ 0.5) - P(respiratory depression ≥ 0.25), where analgesia ≥ 0.5 is the increase in hand withdrawal latency in the cold pressor test by at least 50%, and respiratory depression ≥ 0.25 is the decrease of the hypercapnic ventilatory response by at least 25%. Values are median ± standard error of the estimate. RESULTS: The two drugs were equianalgesic with similar potency values (oliceridine: 27.9 ± 4.9 ng/ml; morphine 34.3 ± 9.7 ng/ml; potency ratio, 0.81; 95% CI, 0.39 to 1.56). A 50% reduction of the hypercapnic ventilatory response by morphine occurred at an effect-site concentration of 33.7 ± 4.8 ng/ml, while a 25% reduction by oliceridine occurred at 27.4 ± 3.5 ng/ml (potency ratio, 2.48; 95% CI, 1.65 to 3.72; P < 0.01). Over the clinically relevant concentration range of 0 to 35 ng/ml, the oliceridine utility function was positive, indicating that the probability of analgesia exceeds the probability of respiratory depression. In contrast, the morphine function was negative, indicative of a greater probability of respiratory depression than analgesia. CONCLUSIONS: These data indicate a favorable oliceridine safety profile over morphine when considering analgesia and respiratory depression over the clinical concentration range.


Asunto(s)
Analgésicos Opioides/farmacología , Morfina/farmacología , Insuficiencia Respiratoria/inducido químicamente , Compuestos de Espiro/farmacología , Tiofenos/farmacología , Adulto , Analgésicos Opioides/efectos adversos , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Morfina/efectos adversos , Valores de Referencia , Medición de Riesgo , Compuestos de Espiro/efectos adversos , Tiofenos/efectos adversos , Adulto Joven
17.
Medicina (B Aires) ; 80(4): 359-370, 2020.
Artículo en Español | MEDLINE | ID: mdl-32841139

RESUMEN

The diffusing capacity for carbon monoxide (DLCO) is, after spirometry the standard and noninvasive pulmonary function test of greater clinical use. However, there are substantial errors in the interpretation of the physiological significance of the DLCO, its derived measures and, therefore the clinical significance of its alterations. In addition to the use of different nomenclatures, other sources of confusion have contributed to some negative view of the test. The technical aspects of the DLCO test have the advantage of being well standardized. But unlike what happens with other pulmonary function tests where we have reference values which allow us to determine their "normality or abnormality", it is difficult to apply this route of analysis in the case of DLCO. The central fact in the analysis of DLCO, transference factor for CO (KCO), and alveolar volume (VA) is that for a correct interpretation it is necessary to think about the mechanism by which the pathology induces change. A KCO of 100% can be considered normal in some circumstances or pathological in others and, for the moment, the automated study report cannot discriminate. This article will address the principles of the DLCO test; present different models of analysis submit concrete examples and provide guidelines for their correct interpretation. It is considered essential to carry out an integrated analysis of the DLCO test in relation to other functional tests and clinical data.


Asunto(s)
Capacidad de Difusión Pulmonar , Monóxido de Carbono , Valores de Referencia , Pruebas de Función Respiratoria , Espirometría
18.
Acta Derm Venereol ; 100(15): adv00249, 2020 Aug 19.
Artículo en Inglés | MEDLINE | ID: mdl-32812055

RESUMEN

Only recently histopathological studies of patients with dermatosis and concomitant SARS-Cov-2 viral infection were published. Seven months into the COVID-19 pandemic, more skin biopsies of COVID-19 positive patients are taking place. We examined the histological features of 30 skin biopsies from two groups of patients: Ten specimens of patients tested positive for COVID-19 with an active systemic infection and associated dermatosis. Twenty specimens were from patients not considered COVID-positive (due to PCR swab negativity or not tested at all) with cutaneous lesions either showing viral infection symptoms (fever, cough, ageusia and severe immunocompromised condition due to HIV infection and malignancies), or presented a high risk of being infected (such as cohabitation with COVID-19 positive parents and siblings with simultaneous chilblains). This study analyses the histological and immunohistochemical (SARS-CoV-2 2019-nCoV nucleocapsid antibody) characteristics of the two groups and identifies 4 histopathological patterns. The histopathological features of the two groups present similar features that may help to identify an ongoing COVID-19 infection even in asymptomatic carriers with dermatosis.


Asunto(s)
Enfermedades Asintomáticas/epidemiología , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Enfermedades de la Piel/patología , Biopsia con Aguja , Estudios de Cohortes , Comorbilidad , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Masculino , Pandemias , Reacción en Cadena de la Polimerasa/métodos , Valores de Referencia , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Enfermedades de la Piel/epidemiología , Manejo de Especímenes
19.
PLoS One ; 15(8): e0236555, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32756598

RESUMEN

INTRODUCTION: The active workforce is increasingly aging. However workload, as well as working time and intensity, sometimes remains unchanged. This can be an even more critical situation in older people, since occupational exposure associated with aging, will further reduce the muscle's ability to generate energy, which in turn facilitates the development of these age-related syndromes. This study aims to identify the normative values of handgrip strength for Portuguese workers in the automotive industry. METHODS: About 1225 employees were invited to participate in the study. The final sample consisted of 656 employees in the assembly area. The handgrip strength was measured in kilograms (kg) using the Jamar digital dynamometer. Sex-specific profiles of handgrip strength were designed by the Ordinary Least Square regression (OLS) analysis, where height, age, age squared, and height squared are entered into the models as determining factors of the maximum grip strength in both female and male groups. RESULTS: The peak mean values of handgrip strength in the group of women was 34 kg in the age group of 35-39 years, and in the group of men the peak mean was 52 kg in the age group of 25-34 years. The most pronounced decline in the female group appears in the age of 30-34 years of about 4 kg and the male group the decline occurs at 2kg below the peak force, in the age group of 40-57 year-olds. This study used a cut-off at 2 SD below by the sex-specific peak mean. CONCLUSION: Normative values can help delineate the career path of workers because they portray risk values according to age, height, and gender. The normative values assist health and engineering professionals and ergonomists in adjusting task demands to the morphological and strength characteristics of the workers.


Asunto(s)
Envejecimiento/fisiología , Fuerza de la Mano/fisiología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Portugal/epidemiología , Valores de Referencia , Factores Sexuales
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