De Novo Crohn's Disease Diagnosed in the Setting of Acute SARS-Cov-2 Infection Requiring Escalation of Infliximab Therapy Guided by Personalized Pharmacokinetics.

Here, we describe a 7-year-old girl who was diagnosed with an early-onset Crohn's disease in the setting of COVID-19 illness. Her disease process responded poorly to standard infliximab dosing, necessitating repeat hospitalizations and red blood cell transfusions. Remission was subsequently induced using a personalized infliximab pharmacokinetic profile based on therapeutic drug monitoring. While the initial data does not support a link, several case reports suggest an association between COVID-19 illness and de-novo development of IBD, especially in young female patients. We report, to our knowledge, the youngest patient who developed early-onset Crohn's disease in the setting of concomitant SARS-CoV-2 infection.

"Effect of pulmonary artery catheterization in patients with non-ischemic cardiogenic shock: a nationwide analysis".

BACKGROUND: Pulmonary artery catheterization (PAC) has been widely used in critically ill patients, yielding mixed results. Prior studies on cardiogenic shock (CS) predominantly included patients with acute myocardial infarction. This study aims to examine the effect of PAC use in patients with non-ischemic CS. METHODS: This retrospective cohort study employed data from the National Inpatient Sample (NIS) database, including weighted hospitalizations of adult patients with non-ischemic CS during 2017 to 2019. In-hospital outcomes were compared between groups using inverse probability of treatment weighting. RESULTS: A total of 303,970 patients with non-ischemic CS were included, of whom 17.5% received a PAC during their hospitalization. The median age was 67 years (interquartile range: 57 - 77) and 61% were male. After inverse probability of treatment weighting, patients in the PAC group had significantly lower in-hospital mortality (24.8% vs. 35.3%, p < 0.001), renal replacement therapy (10.7% vs. 12.4%, p = 0.002), in-hospital cardiac arrest (7.1% vs. 9.6%, p < 0.001), and mechanical ventilation (44.6% vs. 50.4%, p < 0.001) compared to non-PAC group. In contrast, the PAC group had higher use of intra-aortic balloon pump (15.4% vs. 3.4%, p < 0.001), percutaneous ventricular assist devices (12.6% vs. 2.6%, p < 0.001), extracorporeal membrane oxygenation (3.9% vs. 2.5%, p < 0.001), and heart transplantation (2.1% vs. 0.4%, p < 0.001). CONCLUSION: In the real-world setting, invasive hemodynamic monitoring with PAC in patients with non-ischemic CS is associated with survival benefits and a reduction in adverse events, including reduced need for renal replacement therapy, mechanical ventilation and risk of in-hospital cardiac arrest.

Efecto de la motivación del entrenador sobre la carga interna y el rendimiento físico de un juego de fútbol reducido / Efect of coach motivation in training load and physical performance of small sided games / Efeito motivação do treinador em carga de treinamento e desempenho físico de pequenos jogos lados

Los juegos reducidos de fútbol son una estrategia de entrenamiento muy empleada en la actualidad. Manipulando sus parámetros configuradores, el entrenador puede conseguir diferentes propósitos. El objetivo del trabajo fue analizar la influencia de la motivación del entrenador sobre la intensidad de un juego reducido (JR) de 3 contra 3 y su efecto sobre el rendimiento físico de jugadores de categoría alevín. Doce futbolistas realizaron el mismo juego reducido con motivación del entrenador (JME) y sin motivación del técnico (JSME). La carga interna de cada tarea fue cuantificada mediante el registro de la frecuencia cardíaca. Antes y después del JR los jugadores realizaron un test de velocidad (sprint de 30-m), un test de fuerza explosiva de piernas (test triple Hop) y un test de agilidad (test de Illinois). La participación motivante del entrenador provoca una frecuencia cardíaca media, expresada como porcentaje de la frecuencia cardíaca máxima, significativamente mayor que la obtenida sin la motivación del entrenador (89.12±4.29% vs. 82.15±3.12% respectivamente). Además, se ha observado una pérdida significativa de rendimiento en el test de velocidad (5.15±0.21s pre-test y 5.43±0.27 s post-test), agilidad (20.25 ± 0.86s pre-test y 21.01±0.99s post-test) y salto con pierna hábil (4.88±0.43 m pre-test y 4.58±0.41 m post-test) tras realizar el JME. El JSME sólo provoca un descenso significativo del rendimiento en el test de velocidad (5.28±0.27s pre-test y 5.51±0.22s post-test). La motivación del entrenador aumenta la intensidad del JR 3 contra 3 (AU)

Small sided games are a training strategy widely used currently. Manipulating their parameters, the coach can achieve different purposes. The aim was to analyze the influence of coach motivation on the intensity of small sided games of 3 vs. 3 and their effect on physical performance in youth male football players (U11). Twelve players made the same game with (JME) and without (JSME) coach motivation. The internal load of each task was quantified by recording heart rate. Before and after small sided games, soccer players perform a speed test (sprint 30-m), explosive strength (triple Hop test) and agility test (Illinois test). Small sided games with coach motivation get a greater mean hear rate, expressed as percentage of HRmax (89.12±4.29% vs. 82.15±3.12%). In addition small sided games with coach motivation significantly decreases performance in sprint test (5.15±0.21s pre-test and 5.43±0.27 s post-test) agility tests (20.25 0.86s pre-test and 21.01±0.99s post-test) and jump test (4.88±0.43 m pre-test and 4.58±0.4 m post-test). Small sided games without coach motivation only significantly decrease performance in sprint test (5.28±0.27s pre-test and 5.51±0.22s post-test). Motivation coach increases intensity in small sided games of 3 vs. 3 (AU)

Jogos de futebol reduzida são uma estratégia de treinamento muito usado hoje. Manipulando seus parâmetros configurators, o treinador pode obter efeitos diferentes. O objetivo foi analisar a influência da motivação do treinador da intensidade de um jogo pequeno (JR) 3 em 3, e seu efeito sobre o desempenho físico dos jogadores na categoria júnior. Doze jogadores fizeram o mesmo jogo pequeno, treinador motivado (JME) sem a motivação do técnico (JSME). A carga interna de cada tarefa foi quantificada através da gravação de freqüência cardíaca. Antes e depois de jogadores JR realizado um teste de velocidade (sprint de 30-m), um teste de força explosiva perna (test triple Hop) e um teste de agilidade (test de Illinois). A participação treinador motivador causa uma frequência cardíaca média, expresso em percentagem da frequência cardíaca máxima, significativamente mais elevada do que a obtida sem a motivação do treinador (89.12±4.29% vs. 82.15±3.12% respectivamente). Além disso, verificou-se uma perda significativa de desempenho no teste de velocidade (5.15±0.21s pre-test e 5.43±0.27 s post-test), agilidade (20.25 ± 0.86s pre-test e 21.01±0.99s post-test) e saltar com a perna de trabalho (4.88±0.43 m pre-test e 4.58±0.41 m post-test) depois JME. O JSME só provoca uma queda significativa no desempenho em teste de velocidade (5.28±0.27s pre-test e 5.51±0.22s post-test). A motivação do treinador, aumenta a intensidade do JR de 3 em 3 (AU)

[Massive neonatal hemorrhage of the adrenal glands]. / Hemorragia suprarrenal neonatal masiva.

We report the case of a three week old newborn who developed bilateral adrenal hemorrhage. This is an extraordinary case because of the late presentation of the hemorrhage as well as the excessive amount of blood involved. The newborn was the product of a normally evolved to full-term pregnancy, with a prolonged and traumatic delivery. The child had severe neonatal hypoxia and encephalopathy which required intensive care. The child was discharged in good conditions a week later. A week after that, the child is readmitted due to circulatory collapse, extreme paleness and a hemoglobin count of 3 g/dL. The newborn was treated for hypovolemic shock and improved substantially. The bilateral intraabdominal mass was detected and using an intravenous pyelography, ultrasonography and a CAT scan, a severe bilateral adrenal hemorrhage was seen. Adrenal failure was excluded and the child's care allowed for him to be discharged a week later in excellent conditions an followed as an outpatient until the hematomas subsided. This problem should be suspected in hypoxic newborns for which they should be submitted to abdominal ultrasonography before being discharged.