Gastrointestinal manifestations of COVID-19 in a Colombian population. A cross-sectional study

Introduction: gastrointestinal involvement in COVID-19 occurs in approximately 20% of patients and may include nausea, vomiting, abdominal pain, diarrhea or abnormal liver function tests. In our country, the characteristics of gastrointestinal involvement in COVID-19 patients have not been studied. Objectives: to determine the prevalence of gastrointestinal and liver involvement in patients with COVID-19 treated at two hospitals in Bogotá, Colombia. To determine the association between COVID-19 gastrointestinal involvement and length of hospital stay, severity and mortality. Design and methodology: a cross-sectional study carried out at two hospitals in a hospital subnetwork in Bogotá, Colombia from February 2020 to March 2021. Results: a total of 1,176 patients with a positive reverse transcription polymerase chain reaction (RT-PCR) were included. Gastrointestinal manifestations occurred in 50% (95%CI 47-52%), with the most frequent being diarrhea in 18.4%, odynophagia in 17.6%, anorexia in 14.7% and abdominal pain in 8.8%. An association was found between diarrhea during hospitalization and prolonged hospitalization (OR 1.93 95%CI 1.19-3.13), and between gastrointestinal bleeding on admission and death (OR 3.13, 95%CI 1.1-9.1), among others. Abnormal liver function tests occurred in 46% (95%CI 43-49%) and were more frequent in patients with severe disease and those who died. Conclusions: the prevalence of gastrointestinal manifestations in patients with COVID-19 was 50%. Diarrhea was associated with a longer hospital stay, and gastrointestinal bleeding was associated with respiratory failure and death. Forty-six percent of patients had abnormal liver function tests, with elevated transaminases being the most frequent. Elevated aspartate transaminase (AST) on admission was associated with greater mortality. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2729).

Personality and affections in university students: implications of circadian typology.

The chronotype refers to the individual differences related to the preference to perform activities or to rest during the wake or in the preferences for a certain period of the day. In this study, we evaluated how the chronotype can be considered a variable of interest for individual personality differences. Still, it was verified how the positive and negative effects and self-esteem interact with the quality of sleep and the circadian personality according to the Big Five personality factors. This study included 150 volunteers of both sexes (41 men and 109 women) aged between 16 and 44 years old (M=22.08; SD=3.8 in age). The analysis of variance showed significant differences for Horne and Ostberg [F(2.148) = 401.69; η2=0.85] usual sleep efficiency [F(2.148) = 4.83; η2=0.6] and the sleep quality index [F(2.148) = 3.25; η2=13.0]. Morning subjects had better behavioral indexes of sleep quality when compared to evening subjects. Regarding positive affects [F(2.147) = 3.54; η2=0.53], morning subjects had a higher score than afternoon subjects (p=0.34) and consequently had higher scores in kindness traits [F(2,148) = 6.81; η2=0.95] and emotional stability [F(2.188) = 6.58; η2=0.91]. The chronotype is associated with personality factors and sleep behavior (efficiency and sleep latency as basic requirements for good quality of sleep) and variables such as sleep efficiency and quality of sleep can be moderators of this behavior.

Social Neuroscience and Mental Processes: How Does Our Brain Process Social Information?

Neural mechanisms are traditionally examined from different theoretical angles. Similarly, social neuroscience emphasizes the important role that the social environment and neural systems play in the development of social behavior. Thus, this study aims to describe how social neuroscience uses the brain mapping theory and hypothesis testing approach to explain the functioning of social cognition. This approach points out that brain areas, such as the ventromedial prefrontal cortex (vmPFC), lateral temporal cortex, and dorsal anterior cingulate cortex, are specialized in processing social information. These areas are also linked to the regulation of interpersonal relationships, social cooperation, values, empathy, and moral behavior. However, how does social neuroscience explain the phenomena of social behavior? What is the explanation of the social self? Social neuroscience has theoretical and methodological features that bring it closer to a paradigm of social research and neuroscience; the form of mechanistic analysis of biological and cognitive structures broadly describes a neurocognitive mechanism for explaining human social behavior.

2021 Brazilian Thoracic Association recommendations for the management of severe asthma.

Advances in the understanding that severe asthma is a complex and heterogeneous disease and in the knowledge of the pathophysiology of asthma, with the identification of different phenotypes and endotypes, have allowed new approaches for the diagnosis and characterization of the disease and have resulted in relevant changes in pharmacological management. In this context, the definition of severe asthma has been established, being differentiated from difficult-to-control asthma. These recommendations address this topic and review advances in phenotyping, use of biomarkers, and new treatments for severe asthma. Emphasis is given to topics regarding personalized management of the patient and selection of biologicals, as well as the importance of evaluating the response to treatment. These recommendations apply to adults and children with severe asthma and are targeted at physicians involved in asthma treatment. A panel of 17 Brazilian pulmonologists was invited to review recent evidence on the diagnosis and management of severe asthma, adapting it to the Brazilian reality. Each of the experts was responsible for reviewing a topic or question relevant to the topic. In a second phase, four experts discussed and structured the texts produced, and, in the last phase, all experts reviewed and approved the present manuscript and its recommendations.

Validez de APACHE II y SAPS II como predictores de mortalidad precoz y a los 3 meses en pacientes con sepsis / Validity of APACHE II and SAPS II scores as predictors of early global mortality at 3 months from sepsis

Background: Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS) II have become a necessary tool to describe intensive care unit (ICU) patients and to predict differences in mortality. Both are calculated in the first 24 hours of hospitalization, in whichhigher levels correspond to more serious diseases and a higher risk of death. Sepsis is a major cause of morbidity in ICU, it is estimated that about half of the patients have a healthcare-associated infection and are, therefore, at a higher risk of death. This study aims to determine the comparative efficacy of different scoring system (APACHE II and SAPS II scores) in assessing the prognosis of critically ill patients that were admitted to the ICU by sepsis in a tertiary hospital and compare them for prediction of the outcome in these patients in early mortality (up to 3 months). Methods: We performed a retrospective review of five hundred and thirty three patients admitted to the ICU from January 2018 to December 2019. We included all patients (medical or surgical patients) over the age 16 years old, and we selected those with the first diagnosis of “sepsis”. Patient selection and data collection were obtained through medical records. Predicted mortality was calculated using APACHE II and SAPS II and also the early mortality. Group comparisons between survivors and non-survivors from sepsis were performed using the Student-T test to compare continuous with categorical variables and chi square test for categorical variables. Pearson’s correlation was used to compare two continuous variables Statistical analysis was performed using SPSS software version 27.0 (IBM, Armonk, NY, USA). Results: Out of 533 patients, 71 had sepsis (13%). Of these 71 patients, 36 (50.7%) died during the 3 month follow-up... (AU)

Soil contamination by zoonotic parasites in leisure areas: an integrative review / Contaminação do solo por parasitas zoonóticos em áreas de lazer: uma revisão integrativa / Contaminación del suelo por parásitos zoonóticos en áreas de ocio: una revisión integradora

Enteropasites are a risk to both human and animal health, and soil is an important route for their propagation and perpetuation, due to the easy animal access to leisure environments. Furthermore, the contamination of these areas is a public health problem, due to the high number of people who visit these places and can acquire these parasitoses. The purpose of this study was to research information described in the scientific literature on the prevalence of parasites with zoonotic potential in leisure areas, their distribution and associated factors. This is an integrative review of the literature in which scientific studies on parasites of zoonotic potential in leisure areas were selected from the Virtual Health Library, with MEDLINE and LILACS as its database, in addition to PUBMED, SCIELO and "Periódicos Capes" published between 2010 and 2020 in Portuguese, English and Spanish. Eleven articles were selected from the 494 found after applying criteria for inclusion, exclusion and content evaluation. Ancylostoma spp. and Toxocara spp. proved to be widely distributed, and soil contamination by parasites is directly linked to the presence of animals in these environments, due to their feces and favorable environmental conditions.

Os enteropasitas são um risco para a saúde humana e animal, sendo o solo uma importante via para sua propagação e perpetuação, devido ao fácil acesso dos animais aos ambientes de lazer. Além disso, a contaminação dessas áreas é um problema de saúde pública, devido ao grande número de pessoas que visitam esses locais e podem adquirir essas parasitoses. O objetivo deste estudo foi pesquisar informações descritas na literatura científica sobre a prevalência. de parasitas com potencial zoonótico em áreas de lazer, sua distribuição e fatores associados. Trata-se de uma revisão integrativa da literatura em que foram selecionados estudos científicos sobre parasitos de potencial zoonótico em áreas de lazer, da Biblioteca Virtual em Saúde, tendo como base de dados MEDLINE e LILACS, além de PUBMED, SCIELO e "Periódicos Capes" publicados entre 2010 e 2020 em português, inglês e espanhol. Onze artigos foram selecionados dos 494 encontrados após aplicação dos critérios de inclusão, exclusão e avaliação de conteúdo. Ancylostoma spp. e Toxocara spp. provou ser amplamente distribuída, e a contaminação do solo por parasitas está diretamente ligada à presença de animais nesses ambientes, devido às suas fezes e às condições ambientais favoráveis.

Las enteropasitas son un riesgo para la salud tanto humana como animal, y el suelo es una vía importante para su propagación y perpetuación, debido al fácil acceso de los animales a los entornos de ocio. Además, la contaminación de estas áreas es un problema de salud pública, debido a la gran cantidad de personas que visitan estos lugares y pueden adquirir estas parasitosis. El propósito de este estudio fue investigar información descrita en la literatura científica sobre la prevalencia de parásitos con potencial zoonótico en áreas de ocio, su distribución y factores asociados. Se trata de una revisión integradora de la literatura en la que se seleccionaron estudios científicos sobre parásitos de potencial zoonótico en áreas de ocio de la Biblioteca Virtual en Salud, con MEDLINE y LILACS como base de datos, además de PUBMED, SCIELO y "Capas Periódicos" publicados entre 2010. y 2020 en portugués, inglés y español. Se seleccionaron once artículos de las 494 encontradas tras aplicar criterios de inclusión, exclusión y evaluación de contenido. Ancylostoma spp. y Toxocara spp. demostró estar ampliamente distribuida, y la contaminación del suelo por parásitos está directamente relacionada con la presencia de animales en estos ambientes, debido a sus heces y condiciones ambientales favorables.

Specific management of total laryngectomy patients during the COVID-19 pandemic in the Brazilian reality

The aim of this "letter to editor" is to present a reflection on specific management of total laryngectomy patients during the COVID-19 pandemic in Brazil.

Autologous bone marrow-derived mononuclear cell therapy in three patients with severe asthma.

BACKGROUND: Despite recent advances in understanding its pathophysiology and development of novel therapies, asthma remains a serious public health issue worldwide. Combination therapy with inhaled corticosteroids and long-acting ß2-adrenoceptor agonists results in disease control for many patients, but those who exhibit severe asthma are often unresponsive to conventional treatment, experiencing worse quality of life, frequent exacerbations, and increasing healthcare costs. Bone marrow-derived mononuclear cell (BMMC) transplantation has been shown to reduce airway inflammation and remodeling and improve lung function in experimental models of allergic asthma. METHODS: This is a case series of three patients who presented severe asthma, unresponsive to conventional therapy and omalizumab. They received a single intravenous dose of autologous BMMCs (2 × 107) and were periodically evaluated for 1 year after the procedure. Endpoint assessments included physical examination, quality of life questionnaires, imaging (computed tomography, single-photon emission computed tomography, and ventilation/perfusion scan), lung function tests, and a 6-min walk test. RESULTS: All patients completed the follow-up protocol. No serious adverse events attributable to BMMC transplantation were observed during or after the procedure. Lung function remained stable throughout. A slight increase in ventilation of the right lung was observed on day 120 after BMMC transplantation in one patient. All three patients reported improvement in quality of life in the early post-procedure course. CONCLUSIONS: This paper described for the first time the effects of BMMC therapy in patients with severe asthma, providing a basis for subsequent trials to assess the efficacy of this therapy.

Population Pharmacokinetic-Pharmacodynamic Modeling for Propofol Anesthesia Guided by the Bispectral Index (BIS).

This study aimed to develop a population pharmacokinetic-pharmacodynamic (PKPD) model for propofol using data prospectively collected from a heterogeneous group of adult, elderly, and obese patients using the bispectral index (BIS) as a pharmacodynamic guide. Adult, obese (body mass index ≥35 kg/m2 ), and elderly patients (aged >65 years) were included. Propofol infusion was started at 2000 mg/h until loss of consciousness and then guided by target BIS values (40-60). Measurements of propofol plasma concentration were performed using gas chromatography. A PKPD model was developed using NONMEM. The data set contained 423 propofol concentrations and 483 897 BIS values from 60 patients (20-92 years, 42-136 kg). A 3-compartment model was used to describe the plasma concentrations of propofol. An allometric model using lean body weight calculated by the Janmahasatian formula was found to describe the data better than total body weight for all clearance parameters, V1 and V2. An age effect was found on Q2, Q3, V1, and V3. With respect to the PD model, the use of a 2-compartment model significantly improved the model fit. Age and total body weight were included as covariates in the final pharmacodynamic model. We propose a PKPD model for propofol anesthesia with acceptable performance accuracy in a heterogeneous group of adult, elderly, and obese patients. A new method to predict propofol induction dose is presented. This method and the possibility to directly change target BIS values in opposition to the assumed target effect-site concentration constitutes certain advantages to the clinical practice.

Brain Injury Biomarker Behavior in Spontaneous Intracerebral Hemorrhage.

BACKGROUND: S100B and neuron-specific enolase (NSE) have been widely studied in diverse neurocritical pathologies, being recognized as the most promising biomarkers for brain injury assessment. However, their role in intracerebral hemorrhage (ICH) has not been widely analyzed. METHODS: This was an observational prospective cohort study of patients with ICH admitted to a neurocritical care unit. Blood samples were collected on admission and at 24 hours, 48 hours, and 72 hours. Patient outcomes were assessed at 6 months after the event. RESULTS: Thirty-six patients with ICH were included in the study. The mortality rate was 36%. Nonsurvivors had higher S100B values than survivors at admission, 24 hours, and 48 hours (P < 0.05). Likewise, S100B levels were higher in patients with poor outcomes (modified Rankin Scale [mRS] score >4) compared with those with good outcome (mRS score ≤3) in the 24-hour, 48-hour, and 72-hour samples. Receiver operating characteristic (ROC) curve analysis showed that S100B at admission, 24 hours, and 48 hours can discriminate between patients who survive and those who die as a consequence of ICH. The 48-hour sample (area under the ROC curve, 0.817; P = 0.003) reached the best values for sensitivity (75%) and specificity (80%); cutoff, 0.250 µg/L. For 6-month functional outcome, S100B protein could differentiate between groups at 24, 48, and 72 hours. The S100B 24-hour sample had the best values for sensitivity (82.6%) and specificity (72.7%), with a cutoff of 0.202 µg/L. We found no clear relationship between NSE values and clinical characteristics. CONCLUSIONS: S100B protein acts as early predictor of mortality and functional outcome in patients with ICH. This biomarker measurement can provide additional information beyond clinical and radiologic findings to guide physicians in the management of these patients.

Influence of Expectation Measure on the Sensory Acceptance of Petit Suisse Product.

The consumer's expectation has an important role in the consumption of food products. It is one of the factors that influence the perception of sensory attributes and interact with the physiological, behavioral and cognitive factors influencing consumer decisions. The present study aimed to analyze the influence of consumer's expectations on the acceptance of Petit Suisse. Products of 4 different brands were used for the sensory analysis, 2 international brands and 2 regional ones. The 9-point regular hedonic scale was employed to carry out affective sensory and expectation measure tests (with and without product information). Concerning the present research, photos of the packaging of each product were printed in color and presented to the participants. These photos displayed the following pieces of information: the product brand, pictures, colors, product name, nutritional information and date of manufacture. International samples obtained higher grades when presented with their packaging, and obtained lower values both in the blind test and in the real expectation test evaluation. It can be concluded that the sensory analysis of the expectation measure showed that the brand influences the acceptance of the product, for the consumer's expectations for international brands had positively confirmed and disconfirmed acceptance. PRACTICAL APPLICATION: This study generated a significant contribution, especially for companies that aim for a wider market. The application of sensory analysis with a focus on expectation measure, it shows that the brand determines the purchase, based on the results of this study. Therefore, the product's visual identity must be invested in; it must arouse children and adults' attention. That is, it reinforces that the image of the product, the label and what it arouses in the consumers are extremely important for the final choice.

O uso da combinação LABA/LAMA em pacientes com DPOC / LABA/LAMA combination in COPD

Neste artigo de atualização discutiremos, à luz dos mais recentes e relevantes trabalhos, a terapia dupla com broncodilatadores de longa ação para os pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) no período estável, destacando sua proteção quanto a exacerbações, dispneia, qualidade de vida, utilizando como orientador de sua oportunidade de uso a recomendação mais recente do Iniciativa Global para Doenças Pulmonares (GOLD) da sigla em língua inglesa.

In this update article we will discuss the light of the most recent and relevant studies on dual therapy with long acting bronchodilators for patients with chronic obstructive pulmonary disease (COPD) in the stable period, highlighting their protection against exacerbations, dyspnea, quality of life, Using the most recent recommendation of the Global Initiative for Lung Disease (GOLD) as the guideline of their opportunity to use the English acronym.

Autoavaliação de aspectos respiratórios e vocais após uso do umidificador de traqueostomia em laringectomizados totais / Breathing and voice self-assessments after the use of a heat and moisture exchange in total laryngectomyzed patients

RESUMO Introdução O umidificador de traqueostomia é um dispositivo permutador de calor e umidade que pode interferir nas condições respiratórias e vocais de laringectomizados totais. Objetivo Verificar a autoavaliação de aspectos respiratórios e vocais antes e após o uso do umidificador de traqueostomia, em pacientes submetidos à laringectomia total. Métodos A amostra foi composta por 15 indivíduos acompanhados no serviço de Fonoaudiologia de um hospital oncológico, sendo uma mulher e 14 homens, com idade entre 49 e 76 anos, submetidos à laringectomia total. Foi aplicado um questionário de autoavaliação, relacionado a aspectos respiratórios e vocais antes e após o uso do umidificador de traqueostomia, durante duas semanas. Resultados Permaneceram no estudo 13 indivíduos que referiram melhora da tosse, diminuição do acúmulo de secreção e melhor qualidade respiratória e de voz esofágica, após uso do umidificador de traqueostomia. Conclusão Pacientes laringectomizados totais perceberam melhora na autoavaliação de aspectos respiratórios e vocais após duas semanas de uso do umidificador de traqueostomia.

ABSTRACT Introduction A heat and moisture exchange device could modify respiratory and vocal conditions in patients who received a total laryngectomy. Purpose To verify breathing and voice self-assessments before and after the use of a heat and moisture exchange device in patients who had received a total laryngectomy. Methods The sample included 15 subjects of the Speech Therapy department of a cancer hospital; subjects included 1 woman and 14 men aged 49 to 76 years who had undergone a total laryngectomy. Patients completed a self-assessment questionnaire about breathing and voice before and after two weeks of use of a heat and moisture exchange device. Results Thirteen individuals completed the study and reported improvement in cough, secretion accumulation, sleep, breathing, and esophageal voice after use of a heat and moisture exchange device. Conclusion Patients who had received a total laryngectomy perceived improvements in breathing and voice after two weeks of the use of a heat and moisture exchange device, as measured by self-assessment.

Tiempos acelerados y espacios nómades de la hipermodernidad.: Reflexiones abiertas

Estamos viviendo una verdadera mutación civilizatoria que nos habla de la vertiginosidad del pasaje del tiempo, de la aceleración de las transformaciones tecnológicas, de la aparición de un universo virtual donde el cybermundo construye y deconstruye subjetividades. De nuevas alternativas comunicacionales, de nuevas formas de vivir los vínculos y de vivirse como sujeto social complejo (Rhéaume) en estas sociedades contemporáneas, verdaderas sociedades de riesgo que generan valores y ritos, nuevos signos y símbolos, nuevas éticas y estéticas. En estas sociedades de winners y loosers, donde, retomando a Lipovetsky, el mundo de lo efímero se articula con el crepúsculo de la ética, nos enfrentamos a una verdadera mutación. Con el desafío que ella comporta, con posibles alternativas a un cambio.

We are living a real civilizing mutation which speaks of the vertiginous passage of time, the acceleration of technological change, the emergence of a virtual universe where the cyberworld builds and deconstructs subjectivities. New communication alternatives, new ways of living the relations and lived as complex social subject (Rhéaume) in these contemporary societies, real risk society, that generate values and rituals, new signs and symbols, new ethical and aesthetic. In these societies from winners and loosers, retaking Lipovetsky, where the world of the ephemeral articulates with the twilight of ethics, we face a real mutation. Beside the challenge of possible options of change.

Utilização do gel de clorexidina em crianças com hiperplasiagengival induzida pela ciclosporina / Use of chlorhexidine gel in children with cyclosporine-induced gingival hyperplasia

Crianças que apresentam insuficiência hepática e transplante de fígado tem uma condição sistêmica comprometida. Algumas alterações bucais podem ocorrer nessas crianças, inclusive hiperplasia gengival. OBJETIVO: Utilizar um gel de clorexidina para controlar e minimizar a hiperplasia gengival ocasionada pelo uso de ciclosporina associada a corticosteróide. RELATO DO CASO: Em uma criança de 2 anos e 8 meses, submetida a transplante de fígado com prescrição de ciclosporina associada à corticosteróide, que apresentava hiperplasia gengival em que a opção de remoção cirúrgica do aumento gengival não foi autorizada, foi aplicado gel inibidor de placa clorexidina, uma vez por semana durante quatro semanas. CONSIDERAÇÕES FINAIS: O gel de clorexidina mostrou-se eficaz como auxiliar na terapêutica de impedir a hiperplasia gengival...

Oroantral communication is a pathological communication that occurs between the oral cavity and the maxillary sinus. When this communication suffers epithelialization it is called oroantral fistula. It can occur mainly after extraction of posterior maxillary teeth, due to the close relationship between their roots and the maxillary sinus floor. Aim: To present the surgical options for the treatment of oroantral communication and report a case of a large oroantral fistula, explaining the technique step. Case Report: Female patient female, 37-year-old, presented bucossinusal fistula in the left upper molars area and was surgically treated for its closure. Under local anesthesia an incision was made around the fistula, cutting epithelial tissue to allow the union of the wound edges, and it was sutured by layers: initially sinus mucosa with 4-0 catgut and then the gums, with nylon. The suture was removed 10 days later and by this time the complete closure of the fistula was observed. Conclusion: The decision of which treatment modality to use for oroantral communication is influenced by many factors, such as its size, the tissue conditions and the surgeon’s skills. The surgical technique presented in this case proved effective and easy to perform, with a confortable postoperative period for the patient and with no recurrence of the communication...