Acute graft rejection mimicking constrictive pericarditis after heart transplantation. A case report.

Constrictive pericarditis (CP) is an infrequent complication following heart transplantation (HTx) and arises from diverse postoperative occurrences, including mediastinitis, pericardial effusion, or allograft rejection. Indeed, this rare clinical entity can be misdiagnosed as a rejection episode or restrictive cardiomyopathy. In this report, we present the case of a 43-year-old male who underwent HTx 1.5 years prior and was subsequently admitted to our center due to the gradual onset of symptoms indicative of right congestive heart failure, with an initial diagnosis of constrictive pericarditis.

La pericarditis constrictiva (PC) representa una complicación rara después de un trasplante de corazón (TC), derivada de diversos eventos posoperatorios como mediastinitis, derrame pericárdico o rechazo del injerto. De hecho, esta entidad clínica poco común puede ser diagnosticada erróneamente como un episodio de rechazo o miocardiopatía restrictiva. En este informe presentamos el caso de un hombre de 43 años que se sometió a un TC 1,5 años antes y que fue ingresado posteriormente a nuestra institución debido al inicio gradual de síntomas indicativos de insuficiencia cardíaca congestiva derecha, con diagnóstico inicial de pericarditis constrictiva.

Prognostic Factors of the Latarjet Procedure.

Objective To investigate the factors that influence the functional results of patients submitted to the Latarjet procedure. Methods Evaluation of 26 patients submitted to surgical treatment following the Latarjet technique due to traumatic recurrent anterior dislocation of the glenohumeral joint, with glenoidal bone loss greater than 20% and/or off-track injury. The minimum follow-up time was of 12 months. The Visual Analogue Scale (VAS), The Western Ontario Shoulder Instability Index (WOSI), and the Subjective Shoulder Value (SSV) scales, as well as objective data from the participants, were evaluated. Results Most patients (84.62%) did not present recurrence of the dislocation, and 92.31% were satisfied. Regarding the functional analysis, the physical component score (PCS) and the mental component score (MCS) found were within the mean quality of life of the population. The physical symptoms, according to the WOSI, presented the best percentage (8.5%), while the worst result was observed regarding lifestyle (20%). On the VAS, pain was classified as moderate (3/10) by 15.38% of the patients (4/26). In relation to sports, patients who practice sports showed improvement in SSV parameters, which had an inverse relationship with the number of relapses. It was also observed that the shorter the time between the first dislocation and the surgery, the greater the patient's satisfaction. Conclusion Early indication of surgical treatment of anterior glenohumeral instability may provide better subjective functional results to the patient.

Prognostic Factors of the Latarjet Procedure / Fatores prognósticos da cirurgia de Latarjet

Abstract Objective To investigate the factors that influence the functional results of patients submitted to the Latarjet procedure. Methods Evaluation of 26 patients submitted to surgical treatment following the Latarjet technique due to traumatic recurrent anterior dislocation of the glenohumeral joint, with glenoidal bone loss greater than 20% and/or off-track injury. The minimum follow-up time was of 12 months. The Visual Analogue Scale (VAS), The Western Ontario Shoulder Instability Index (WOSI), and the Subjective Shoulder Value (SSV) scales, as well as objective data from the participants, were evaluated. Results Most patients (84.62%) did not present recurrence of the dislocation, and 92.31% were satisfied. Regarding the functional analysis, the physical component score (PCS) and the mental component score (MCS) found were within the mean quality of life of the population. The physical symptoms, according to the WOSI, presented the best percentage (8.5%), while the worst result was observed regarding lifestyle (20%). On the VAS, pain was classified as moderate (3/10) by 15.38% of the patients (4/26). In relation to sports, patients who practice sports showed improvement in SSV parameters, which had an inverse relationship with the number of relapses. It was also observed that the shorter the time between the first dislocation and the surgery, the greater the patient's satisfaction. Conclusion Early indication of surgical treatment of anterior glenohumeral instability may provide better subjective functional results to the patient.

Resumo Objetivo Investigar os fatores que influenciam os resultados funcionais dos pacientes submetidos ao procedimento de Latarjet. Métodos Avaliação de 26 pacientes submetidos ao tratamento cirúrgico, seguindo a técnica de Latarjet, devido a luxação anterior recidivante traumática da articulação glenoumeral, com perda óssea glenoidal maior do que 20% e/ou lesão off-track. O tempo mínimo de seguimento foi de doze meses. Foram avaliadas as seguintes escalas: Escala Visual Analógica (EVA), The Western Ontario Shoulder Instability Index (WOSI), e Subjective Shoulder Value (SSV), além dos dados objetivos dos participantes. Resultados A maioria dos pacientes (84,62%) não apresentou recidiva de luxação, e 92,31% ficaram satisfeitos. Em relação à análise funcional, a pontuação do componente físico (PCF) e a pontuação do compenente mental (PCM) encontradas estavam dentro da média de qualidade de vida da população. Os sintomas físicos, pela escala WOSI, apresentaram a melhor porcentagem (8,5%), ao passo que o pior resultado foi observado com relação ao estilo de vida (20%). Na EVA, a dor foi classificada como moderada (3/10) por 15,38% dos pacientes (4/26). Em relação aos esportes, os pacientes que praticavam alguma atividade esportiva apresentaram melhora nos parâmetros da escala SSV, que tiveram relação inversa com o número de recidivas. Observou-se ainda que, quanto menor foi o tempo entre a primeira luxação e a realização da cirurgia, maior foi a satisfação do paciente. Conclusão A indicação precoce do tratamento cirúrgico da instabilidade anterior glenoumeral pode proporcionar melhores resultados funcionais subjetivos ao paciente.

Impacto de COVID-19 en la formación de los alumnos de la Carrera de Posgrado de Cirugía General en un Hospital COVID / Impact of COVID-19 pandemic on trainees' education in the Postgraduate Program in General Surgery in a COVID-19-dedicated hospital

RESUMEN Antecedentes: El Hospital Eva Perón de la ciudad de Granadero Baigorria se destinó a la atención casi exclusiva de pacientes afectados por COVID-19, lo que implicó modificar las actividades que allí se desarrollan. Allí se realizan actividades correspondientes al Posgrado de Cirugía General de la Facultad de Ciencias Médicas de la Universidad Nacional de Rosario. El objetivo es describir los cambios y el funcionamiento del posgrado de Cirugía General en el HEEP durante la pandemia por COVID-19, y el impacto que esta tuvo sobre la formación de los alumnos. Material y métodos: se realizó un trabajo descriptivo, comparativo. Período 20 de marzo de 2020 al 30 de septiembre de 2020 y el mismo período del año 2019. Variables analizadas: número de cirugías, horas en el hospital, número de guardias, actividad en consultorio y pacientes evaluados, seminarios teóricos, cursado de la carrera de posgrado. Resultados: las cirugías totales se redujeron un 74,88%. Las cirugías programadas se redujeron un 85,59%. Las cirugías de guardia se redujeron un 63,19%. Las guardias de R1, R2 y R3 se vieron disminuidas, al contrario de R4. Las horas en el hospital se redujeron en todos los alumnos. Los pacientes ingresados disminuyeron el 74,06%. La atención en todos los consultorios se vio reducida. Las actividades académicas se incrementaron, de forma no presencial. Conclusión: la pandemia por COVID-19 afectó significativamente la formación de los alumnos del posgrado de Cirugía General del HEEP. Se recurrió a métodos no tradicionales de enseñanza para realizar actualizaciones y discutir trabajos científicos.

ABSTRACT Background: Hospital Eva Perón in the city of Granadero Baigorria was almost exclusively dedicated to the care of COVID-19 patients; thereby, it was necessary to modify its activities, as those of the postgraduate program in General Surgery of Facultad de Ciencias Médicas, Universidad Nacional de Rosario, which take place in this hospital. The aim of this study is to describe the changes made and the performance of the postgraduate program in general surgery at HEEP during the COVID-19 pandemic, and its impact on trainees' education. Material and methods: We conducted a descriptive study comparing the period between March 20, 2020, and September 30, 2020, with the same period in 2019. The variables analyzed included number of surgeries, hours spent in hospital, number of in-house call shifts, activities in the outpatient clinic and evaluation of patients, theoretical seminars, attendance to classes of the postgraduate programs and research work. Results: The total number of surgeries decreased by 74.88%, scheduled surgeries by 85.59% and emergency surgeries by 63.19%. The numbers of in-house call shifts of PGY-1, PGY-2 and PGY-3 residents decreased but not those of PGY-4 residents. The hours spent in hospital decreased in all the trainees. The number of patients hospitalized decreased by 74.06% and there was a reduction in all the activities of the outpatient clinics. The academic activities, performed non-face-to-face, increased. Conclusion: The COVID-19 pandemic significantly affected trainees' education in the postgraduate program in General Surgery at HEEP. Non-traditional teaching methods were used for updating and discussing scientific papers.

Increasing Environmental Complexity by Providing Different Types of Litter and Perches during Early Rearing Boosts Coping Abilities in Domestic Fowl Chicks.

Early experience of a complex environment can improve biologically relevant traits related to coping abilities. However, the mechanisms underlying these positive effects have not been well explored. We hypothesized that giving chicks possibilities to express choices within relevant resources could be an important part of the mechanism, as well as a novel way to increase environmental complexity. In a balanced design, laying hen hatchlings of the white hybrid Bovans Robust were reared in a "single-choice" environment (single litter and perch type) or a "multi-choice" environment (four different litter and perch types). Immunological and behavioral indicators of chicks' coping abilities were explored in this experimental study at three weeks of age. Chicks from "multi-choice" environments had shorter durations of tonic immobility, lower heterophil/lymphocyte ratios, higher natural antibody concentrations, and were more successful in gaining novel food rewards in a repeated opportunity test. These results imply that chicks having access to variation within resource types were less fearful, experienced less chronic stress, would be more able to cope with pathogenic challenges, and potentially had an improved learning ability. To conclude, the more complex environment, achieved by increasing chicks' possibilities to choose, seemed to make chicks better prepared for potential challenges, boosting their adaptive capacities and their ability to make the most of opportunities.

El cuidado invisible en pacientes críticos desde la perspectiva del equipo de enfermeria / nvisible care in critical patients from the perspective of the nursing team

Introducción: es cierto que existen cuidados que son visiblemente notorios y de hecho quedan asentados en los registros de enfermería e historia clínica. Sin embargo, existen otros cuidados, comúnmente llamados cuidados invisibles. Estos últimos son acciones y cuidados que la mayoría de las veces son intangibles pero que contribuyen al bienestar y mejoría de las personas, tanto o más que las acciones técnicas y/o delegadas, dirigidas al plano físico/clínico del paciente. Objetivos: Comprender e interpretar los cuidados invisibles de enfermería y su importancia en la evolución del paciente crítico en el servicio de Terapia Intensiva, de un hospital del departamento de San Martín, Mendoza, durante el mes de Junio de 2019. Material y Método: estudio cualitativo fenomenológico. La población estuvo dada por enfermeros del servicio de terapia intensiva de adultos. Muestreo por saturación. Se emplearon entrevistas abiertas en profundidad. Se registraron de manera manual escrita los datos y luego se realizó un análisis detallado de la información. Se entregó previamente a cada entrevistado un consentimiento informado explicativo. Conclusiones: El enfermero crítico ejerce un rol fundamental durante la estancia de sus pacientes, ya que su papel involucra muchas más cosas que solo los procedimientos técnicos. Esta relación vincular requiere no solo de conocimiento científico sino también de valores y cuidados éticos. El enfermero es por consideración, un buen acompañante terapéutico, ya que es capaz de ser educador, poseer actitud empática, ejercer escucha activa, contener frente a situaciones estresantes, brindar afecto y ser fiel frente a las necesidades de los pacientes[AU]

Introduction: it is true that there are care that are clearly visible and in fact are recorded in the nursing records and clinical history. However, there are other care, commonly called invisible care. The latter are actions and care that most of the time are intangible but that contribute to the welfare and improvement of people, as much or more than the technical and / or delegated actions, directed to the physical / clinical plane of the patient. Objectives: To understand and interpret the invisible nursing care and its importance in the evolution of the critical patient in the Intensive Therapy service of the Alfredo Italo Perrupato Hospital, in the department of San Martín, Mendoza during the month of June 2019. Material and Method: qualitative phenomenological study. The population was given by nurses of the adult intensive care service. Saturation sampling. Open interviews were used n depth. The data was recorded manually and then a detailed analysis of the information was made. An explanatory informed consent was previously given to each respondent. Conclusions: The critical nurse plays a fundamental role during the stay of his patients, since his role involves many more things than just the technical procedures. This relationship requires not only scientific knowledge but also values and ethical care. The nurse is, by consideration, a good therapeutic companion, since he is able to be an educator, have an empathic attitude, exercise active listening, contain stressful situations, provide affection and be faithful to the needs of patients[AU]

Introdução: é verdade que existem cuidados que são claramente visíveis e de fato estão registrados nos registros de enfermagem e na história clínica. No entanto, existem outros cuidados, comumente chamados de cuidados invisíveis. Estas últimas são ações e cuidados que na maioria das vezes são intangíveis, mas que contribuem para o bem-estar e a melhoria das pessoas, tanto ou mais do que as ações técnicas e / ou delegadas, direcionadas ao plano físico / clínico do paciente. Objetivos: Compreender e interpretar o cuidado invisível de enfermagem e sua importância na evolução do paciente crítico no serviço de Terapia Intensiva do Hospital Alfredo Italo Perrupato, no departamento de San Martín, Mendoza, durante o mês de junho de 2019. Material e Metodo: estudo fenomenológico qualitativo. A população foi atendida por enfermeiras do serviço de terapia intensiva adulto. Amostragem de saturação. Entrevistas abertas foram usadas em profundidade. Os dados foram registrados manualmente e, em seguida, foi feita uma análise detalhada das informações. Um consentimento informado explicativo foi dado previamente a cada respondente. Conclusões: O enfermeiro crítico desempenha um papel fundamental durante a internação de seus pacientes, visto que sua atuação envolve muito mais coisas do que apenas os procedimentos técnicos. Essa relação requer não apenas conhecimento científico, mas também valores e cuidados éticos. O enfermeiro é, por consideração, um bom companheiro terapêutico, pois pode ser educador, ter atitude empática, exercer a escuta ativa, conter situações estressantes, proporcionar carinho e ser fiel às necessidades dos pacientes[AU]

Insights into thermal stress in Japanese quail (Coturnix coturnix): dynamics of immunoendocrine and biochemical responses during and after chronic exposure.

Avian require comfortable temperatures for optimal development and heat stress is a high concern in warm weather countries. We aimed to assess the dynamics of immunoendocrine and biochemical variables responses of birds exposed to a heat stressor applied during daylight hours, during the chronic stress and the recovery periods. We hypothesize that variables involved in the birds response will be differentially and gradually modified during those periods. Female quail (n = 210) were housed in six rearing boxes. At 29 days of age, the temperature in three boxes was increased from 24 to 34 °C during the light period throughout the nine days (Stress Treatment). The other three boxes remained at 24 °C and were used as controls. The subsequent 12 days were considered as recovery period. Different sets of 12 birds/treatment were blood-sampled at 29 (basal), 32, 35, 38 (stress), 41, 44, 47, and 50 (recovery) days of age, respectively. Immunoendocrine (corticosterone, lymphoproliferation, heterophil/lymphocyte ratio (H/L), and antibody response) and biochemical (glucose, total proteins, globulins, and albumin) variables were assessed. During stress, progressive corticosterone and H/L increments, and antibody titers and lymphoproliferation decreases were detected. No clear pattern of changes was found in biochemical variables. During recovery, while corticosterone and lymphoproliferation had recovered three days after the stressor ended, H/L and antibody responses required respectively nine and 12 days to recover to their basal levels, respectively. Findings suggest that immunity is already threatened when heat stress is sustained for three or more days. However, the system appears resilient, needing six to 12 days to recover to their basal responses.