RESUMO
PURPOSE: Data on short courses of antibiotic therapy for Enterobacterales bacteremia in high-risk neutropenic patients are limited. The aim of the study was to describe and compare the frequency of bacteremia relapse, 30-day overall and infection-related mortality, Clostridiodes difficile infection and length of hospital stay since bacteremia among those who received antibiotic therapy for 7 or 14 days. METHODS: This is a multicenter, prospective, observational cohort study in adult high-risk neutropenic patients with hematologic malignancies or hematopoietic stem cell transplant and monomicrobial Enterobacterales bacteremia. They received appropriate empirical antibiotic therapy, had a clinical response within 7 days, and infection source control. Clinical, epidemiological and outcomes variables were compared based on 7 or 14 days of AT. RESULTS: Two hundred patients were included (100, 7-day antibiotic therapy; 100, 14-day antibiotic therapy). Escherichia coli was the pathogen most frequently isolated (47.5%), followed by Klebsiella sp. (40.5%). Among those patients that received 7-day vs. 14-day antibiotic course, a clinical source of bacteremia was found in 54% vs. 57% (p = 0.66), multidrug-resistant Enterobacterales isolates in 28% vs. 30% (p = 0.75), and 40% vs. 47% (p = 0.31) received combined empirical antibiotic therapy. Overall mortality was 3% vs. 1% (p = 0.62), in no case related to infection; bacteremia relapse was 7% vs. 2% (p = 0.17), and length of hospital stay since bacteremia had a median of 9 days (IQR: 7-15) vs. 14 days (IQR: 13-22) (p = < 0.001). CONCLUSIONS: These data suggest that seven-day antibiotic therapy might be adequate for patients with high-risk neutropenia and Enterobacterales bacteremia, who receive appropriate empirical therapy, with clinical response and infection source control.
Assuntos
Antibacterianos , Bacteriemia , Infecções por Enterobacteriaceae , Neutropenia , Humanos , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Prospectivos , Neutropenia/complicações , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/mortalidade , Infecções por Enterobacteriaceae/microbiologia , Adulto , Idoso , Enterobacteriaceae/efeitos dos fármacos , Resultado do Tratamento , Tempo de Internação , Neoplasias Hematológicas/complicações , Adulto JovemRESUMO
Obesity is a well-recognized risk factor for adolescent depressive symptoms, but mediating mechanisms of this association have scarcely been studied. This study is unique in examining an indirect pathway of this link via body esteem (BE) prospectively from childhood (8-12 years) to adolescence (13-18 years). In addition, potential gender moderation was examined. This study utilized data from a case-control study comparing 100 children with and without obesity matched on important confounders (age, gender, and socioeconomic status). Our findings provide support for the mediating role of BE in the link between childhood weight status and adolescent depressive symptoms at a 5-year follow-up. This mediation effect did not differ between boys and girls. The findings suggest the relevance of specifically targeting children's BE in preventive intervention programs among children with obesity to prevent future mental health problems.
Assuntos
Imagem Corporal , Depressão , Obesidade Infantil , Humanos , Adolescente , Masculino , Feminino , Obesidade Infantil/psicologia , Criança , Depressão/psicologia , Estudos de Casos e Controles , Imagem Corporal/psicologia , Seguimentos , Fatores Sexuais , Fatores de Risco , Autoimagem , Estudos ProspectivosRESUMO
INTRODUCTION AND OBJECTIVES: Multiple sclerosis (MS) is a disease of the central nervous system associated with immune dysfunction, demyelination, and neurodegeneration. The disease has heterogeneous clinical phenotypes such as relapsing-remitting MS (RRMS) and progressive multiple sclerosis (PMS), each with unique pathogenesis. Metabolomics research has shown promise in understanding the etiologies of MS disease. However, there is a paucity of clinical studies with follow-up metabolomics analyses. This 5-year follow-up (5YFU) cohort study aimed to investigate the metabolomics alterations over time between different courses of MS patients and healthy controls and provide insights into metabolic and physiological mechanisms of MS disease progression. METHODS: A cohort containing 108 MS patients (37 PMS and 71 RRMS) and 42 controls were followed up for a median of 5 years. Liquid chromatography-mass spectrometry (LC-MS) was applied for untargeted metabolomics profiling of serum samples of the cohort at both baseline and 5YFU. Univariate analyses with mixed-effect ANCOVA models, clustering, and pathway enrichment analyses were performed to identify patterns of metabolites and pathway changes across the time effects and patient groups. RESULTS AND CONCLUSIONS: Out of 592 identified metabolites, the PMS group exhibited the most changes, with 219 (37%) metabolites changed over time and 132 (22%) changed within the RRMS group (Bonferroni adjusted P < 0.05). Compared to the baseline, there were more significant metabolite differences detected between PMS and RRMS classes at 5YFU. Pathway enrichment analysis detected seven pathways perturbed significantly during 5YFU in MS groups compared to controls. PMS showed more pathway changes compared to the RRMS group.
Assuntos
Esclerose Múltipla Crônica Progressiva , Esclerose Múltipla , Humanos , Seguimentos , Estudos de Coortes , MetabolômicaRESUMO
BACKGROUND AND PURPOSE: Oxidative stress biomarkers are increased in multiple sclerosis (MS) lesions. Antioxidant defense enzymes regulate reactive oxygen species that can cause tissue injury in MS. METHODS: The study of 91 subjects included 64 relapsing-remitting MS (RR-MS; 72% female, baseline age ± SD = 44.6 ± 11 years, disease duration = 13.3 ± 8.8 years, median Expanded Disability Status Scale [EDSS] = 2.0, interquartile range = 1.8) and 27 healthy controls (HC) at baseline and 5-year follow-up (5YFU). Serum glutathione peroxidase (GPX), glutathione-S-transferase (GST), glutathione reductase (GSHR), superoxide dismutase, and paraoxonase-1 (PON1) arylesterase and paraoxonase activities were measured using kinetic enzyme assays. Total cholesterol (TC), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), and an apolipoprotein (Apo) panel with ApoA-I, ApoA-II, ApoB, ApoC-II, and ApoE were obtained. Serum neurofilament (sNfL) was used to assess axonal injury. Disability was measured on the EDSS. RESULTS: GSHR activity was lower in HC compared to RR-MS at baseline and 5YFU. GPX (p = 0.008) and PON1 arylesterase and paraoxonase activities (both p = 0.05) increased between baseline and 5YFU in HC but did not increase in RR-MS. At baseline and 5YFU, GPX and GST were associated with TC, LDL-C, and ApoA-II; GSHR was associated with ApoA-II and ApoC-II. Antioxidant enzymes were not associated with sNfL or EDSS in RR-MS. CONCLUSIONS: RR-MS patients did not exhibit the changes in antioxidant enzyme activities over 5YFU found in HC; however, the differences were modest. Antioxidant enzyme activities are not associated with disability.
Assuntos
Esclerose Múltipla , Humanos , Feminino , Masculino , Seguimentos , Antioxidantes , LDL-Colesterol , Arildialquilfosfatase , Apolipoproteína A-II , Apolipoproteínas CRESUMO
PURPOSE: Current study aimed to empirically test the Hemmingsson's theoretical model of childhood obesity which emphasizing the importance of family environment and the emotional distress of parents as influential variables in the emotional distress of the child and subsequent weight gain. This study also tested the hypothesis that the emotional distress of the child triggers a weight gain-inducing behavior (loss of control eating) to suppress negative emotions. METHODS: Families of 220 Spanish children participated in the study (28.2% normal, 35.1% overweight and 32.2% obesity), aged between 8 and 12. The evaluation included a clinical interview and a battery of questionnaires. RESULTS: Structural equation models were computed according to the steps proposed by theoretical model. Fit indices were acceptable suggesting that the data adequately fit the hypothesized model. Path coefficients in the final model were statistically significant showing a relationship between socioeconomic status, the emotional distress of parents, family environment, the emotional distress of children, loss of control eating and child's BMI Z-score. CONCLUSION: Considering this relation between emotional distress and child weight status, childhood obesity intervention programs may benefit from targeting family environment and the potential role that food is playing in the regulation of children's distress. LEVEL OF EVIDENCE: Level III: Cohort analytic study.
Assuntos
Obesidade Infantil , Índice de Massa Corporal , Criança , Comportamento Alimentar/psicologia , Humanos , Análise de Classes Latentes , Pais , Fatores Socioeconômicos , Inquéritos e Questionários , Aumento de PesoRESUMO
Gray platelet syndrome (GPS) is a rare (<1/1 000 000) and inherited platelet function disorder characterized by macrothrombocytopenia, α-granule deficiency, and hemorrhages. Bleeding intensity does not correlate with platelet count nor with functional test results. We hereby describe the perioperative bleeding prevention and management of a patient with GPS requiring multiple redo cardiac surgeries.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Transfusão de Eritrócitos/métodos , Síndrome da Plaqueta Cinza/cirurgia , Hemorragia/prevenção & controle , Assistência Perioperatória , Transfusão de Plaquetas/métodos , Adulto , Humanos , Masculino , Plasma , Doenças Raras , Reoperação , Resultado do TratamentoRESUMO
Childhood obesity is a growing problem with a complex aetiology, for which multidisciplinary interventions are required. Our programme describes a novel structured psychosocial family-based intervention targeting the emotional regulation in childhood obesity, using a train trip metaphor aimed at improving healthy lifestyles for the family. The aims were (a) to describe the feasibility and acceptability of this psychosocial family-based intervention among children with overweight or obesity in primary care and (b) to examine the effectiveness of the "ENTREN-F" programme (with family intervention) compared with the "ENTREN" programme (without family intervention) among Spanish children regarding anthropometric variables, physical activity, emotional well-being, and family functioning. Children were randomly allocated to either ENTREN-F programme (n = 30) or psychological intervention for children (ENTREN, n = 40), and assessments were carried out over time (T0 baseline vs. T1 post/6-month vs. T2 6-month follow-up). Both parent groups expressed high levels of satisfaction with the interventions. ENTREN-F resulted in higher adherence to treatment and was more effective in improving z-body mass index, reducing children's anxiety, and increasing family adaptability than the ENTREN programme. There were no significant changes in parents' emotional well-being and expressed emotion. Both groups improved in the children's emotional well-being and light physical activity. In summary, this multidisciplinary psychosocial family-based intervention was succesful.
Assuntos
Regulação Emocional/fisiologia , Exercício Físico/fisiologia , Família/psicologia , Estado Nutricional/fisiologia , Obesidade Infantil/terapia , Adolescente , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Resultado do TratamentoRESUMO
OBJECTIVE: The aim of this study is to compare the levels of physical activity and sedentary behaviours in children with obesity and normal weight through accelerometer measures, and analyze the family environment related to physical activity. DESIGN: Case-control study. LOCATION: A health center and colleges of the Community of Madrid. PARTICIPANTS: A total of 50 obese children between 8 and 12 years of age (P > 97) and their mothers were matched by age, sex and socioeconomic status of their parents (1: 1) with 50 children with normopeso (GN; P < 85). MAIN MEASUREMENTS: Physical activity levels were measured by accelerometer (ActiGraph GT3X), levels of physical activity of the primary caregiver were measured through physical activity questionnaire (IPAQ) and the environment in relation to the physical activity was measured by the Home Environment Scale (HES-S). RESULTS: The group GO showed less vigorous physical activity than their peers in the GN group. Vigorous physical activity in the GO group was associated with modeling and parental policies regarding physical activity. A multiple regression analysis revealed that 21% of the variance of weight status of children was explained by sex, vigorous physical activity and maternal body mass index. CONCLUSIONS: The levels of vigorous physical activity and the family environment differ between children with obesity and normal weight. Therefore, it is important to continue working on the awareness of illness and the promotion of healthy habits from Primary Care and the school and institutional context.
Assuntos
Exercício Físico , Características da Família , Obesidade Infantil/epidemiologia , Comportamento Sedentário , Actigrafia/estatística & dados numéricos , Índice de Massa Corporal , Peso Corporal , Cuidadores , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Mães , Poder Familiar , Análise de Regressão , Fatores Sexuais , Classe Social , Espanha/epidemiologiaRESUMO
Representatives of the Argentine Society of Infectious Diseases (SADI) and the Argentine Society of Intensive Therapy (SATI) joined together to issue specific recommendations for the diagnosis, treatment, and prevention of intravascular catheter related infections (CRI). The methodology used was the analysis of the literature published in the last 10 years, complemented with the opinion of experts and local data. This document aims to promote effective measures to reduce the risk of CRI and to offer basic tools for diagnosis optimization based on clinical and microbiological criteria, orientation on empirical and targeted antibiotic schemes, posology, and administration of antibiotics in critical patients. It also offers a diagnostic and treatment algorithm for use in the care activity, as well as considerations on the dosage of antibiotics. The joint work of both societies highlights the concern for the management of CRI and the importance of ensuring improvement in daily practices. Through this recommendation, local guidelines are established to optimize the diagnosis, treatment and prevention of CRI in order to reduce morbidity and mortality, days of hospitalization, costs, and antimicrobial resistance.
Assuntos
Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/tratamento farmacológico , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Antibacterianos/uso terapêutico , Humanos , Guias de Prática Clínica como AssuntoRESUMO
The shared family environment is an important risk factor in the development of childhood obesity. This study aims to examine differences in maternal psychopathology, family functioning, expressed emotion and coping skills between families of a child with obesity and those with a normal-weight child. This case-control study consisted of 50 mothers with a child (age 8-12 years) with obesity (p ≥ 97) and a control group of 50 mothers of a child with normal weight (p < 85), matched for age, sex and socio-economic status. Compared with families with normal-weight children, those with children with obesity showed significant differences in levels of trait anxiety, criticism and over-protectiveness, and maladaptive coping skills. Structural equation modelling revealed that the mothers' psychopathology predicted children's body mass index (BMI) z-scores through expressed emotion and maladaptive coping scores. There were significant direct and indirect relations among maternal BMI, psychopathology, expressed emotion and coping, which all together explained 26.5% of variance of children's BMI z-scores. Considering this relation between maternal variables and child weight status, childhood obesity intervention programs may benefit from targeting maternal BMI, psychopathology, expressed emotion and coping skills. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
Assuntos
Adaptação Psicológica , Família/psicologia , Transtornos Mentais/epidemiologia , Mães/psicologia , Obesidade Infantil/epidemiologia , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Fatores de RiscoRESUMO
OBJECTIVE: Homer1a is a protein that regulates metabotropic glutamate receptors involved in neural plasticity processes. Recently, we demonstrated that Homer1a mRNA is enhanced after pilocarpine-induced status epilepticus. Here, we investigated whether a single acute seizure triggered by means of pentylenetetrazole (PTZ) injection or maximal electroshock (MES) stimulation (2 different seizure models) would alter Homer1a expression in the hippocampus. METHODS: Male Wistar rats subjected to the PTZ or MES model were analyzed 2h, 8h, 24h, and 7days after seizure induction. Homer1a, mGluR1, and mGluR5 mRNA expression levels in hippocampal extracts were analyzed by quantitative PCR. RESULTS: Quantitative PCR revealed Homer1a overexpression at 2h after MES-induced tonic-clonic seizures compared to control, but the overexpression did not remain elevated after 8h. Pentylenetetrazole-induced seizures, in contrast, were not able to change Homer1a mRNA expression. No differences were observed at these time points after seizures for mGluR1 and mGluR5 mRNA expression in any of the models. SIGNIFICANCE: Our data indicate that the levels of Homer1a mRNA were transiently increased only after MES-induced tonic-clonic seizures (and not after PTZ-induced seizures). We suggest that Homer1a expression may be dependent on seizure intensity or on specific brain circuit activation. We suggest that Homer1a may contribute to counteract hyperexcitability processes.
Assuntos
Proteínas de Transporte/metabolismo , Convulsivantes/farmacologia , Eletrochoque/métodos , Pentilenotetrazol/farmacologia , RNA Mensageiro/metabolismo , Convulsões/metabolismo , Animais , Anticonvulsivantes/uso terapêutico , Modelos Animais de Doenças , Proteínas de Arcabouço Homer , Masculino , Ratos , Ratos Wistar , Receptores de Glutamato Metabotrópico , Convulsões/induzido quimicamente , Convulsões/etiologiaRESUMO
OBJECTIVES: There is increasing evidence that serum lipoprotein cholesterol biomarkers are associated with disease progression in clinically isolated syndromes (CIS). Apolipoproteins (Apo) are recognition ligands that mediate the physiological interactions of cholesterol-containing lipoproteins. The objective of this study was to investigate whether serum Apo levels are associated with CIS disease progression. METHODS: ApoB, ApoAI, ApoAII, ApoE and lipoprotein (a) (Lpa) levels were measured in serum samples obtained prior to the start of treatment from 181 CIS patients (123 women, 58 men, 68% women; mean age: 28.1±SD 8.1â years). All patients were treated with intramuscular interferon-ß as part of the prospective study. Clinical and MRI assessments were obtained at baseline, 6, 12 and 24â months after start of interferon-ß treatment. RESULTS: Greater ApoB levels were associated with increased number of new T2 lesions (p<0.001) and increased number of new or enlarging T2 lesions (p<0.001) over 2â years. Each 10â mg/dL of greater baseline ApoB is associated with a 16% increase in the number of new T2 lesions over 2â years. ApoAI, ApoAII, ApoE and Lpa were not associated with T2 lesions. Greater ApoE levels were associated with greater deep grey matter atrophy (partial correlation rp=-0.28, p<0.001). Each 1â mg/dL increment in ApoE levels was associated with a 1% increase in deep grey matter atrophy over 2â years. CONCLUSIONS: Serum ApoB levels are associated with new lesion accumulation whereas ApoE levels are associated with deep grey matter atrophy in high risk CIS patients treated with interferon ß-1a.
Assuntos
Apolipoproteínas/metabolismo , Encéfalo/patologia , Esclerose Múltipla/metabolismo , Esclerose Múltipla/patologia , Adolescente , Adulto , Anti-Inflamatórios/uso terapêutico , Apolipoproteínas E/sangue , Atrofia , Interpretação Estatística de Dados , Progressão da Doença , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Lipídeos/sangue , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
BACKGROUND: Retinol, tocopherols, and carotenoids (RTC) have physiological roles as vitamins, pro-vitamins, and antioxidants, and provide biomarkers of dietary vegetable and fruit intake. The goal was to investigate RTC in multiple sclerosis (MS). METHODS: This exploratory study included 106 people with MS (71 relapsing-remitting MS or RR-MS; and 35 progressive MS or PMS) and 31 healthy controls (HC) at baseline and 5-year follow-up (5YFU). Serum retinol, α-carotene, ß-carotene, α-tocopherol, δ-tocopherol, γ-tocopherol, ß-cryptoxanthin, lutein/zeaxanthin, and lycopene were measured using high performance liquid chromatography. Serum neurofilament light chain (sNfL) levels were measured using the single molecule array method. Expanded Disability Status Scale (EDSS) and low contrast letter acuity (LCLA) were used as disability measures. RESULTS: Retinol in MS was positively correlated with α-carotene, ß-carotene, ß-cryptoxanthin, lutein/zeaxanthin, and α-tocopherol but negatively correlated with δ-tocopherol. EDSS was associated with α-tocopherol, δ-tocopherol, and lycopene. Greater retinol levels were associated with greater LCLA in RR-MS and PMS; high contrast visual acuity was not associated. Greater γ-tocopherol levels were associated with lower LCLA and high contrast visual acuity in PMS. CONCLUSIONS: RTC exhibit distinctive associations with LCLA and EDSS in MS.
Assuntos
Esclerose Múltipla , Vitamina A , Humanos , Tocoferóis , Seguimentos , beta Caroteno , Licopeno , gama-Tocoferol , alfa-Tocoferol , Luteína , Zeaxantinas , beta-Criptoxantina , Carotenoides , VitaminasRESUMO
BACKGROUND: Bone marrow is an accessible source of progenitor cells, which have been investigated as treatment for neurological diseases in a number of clinical trials. Here we evaluated the potential benefit of bone marrow cells in protecting against convulsive seizures induced by maximum electroconvulsive shock (MES), a widely used model for screening of anti-epileptic drugs. Behavioral and inflammatory responses were measured after MES induction in order to verify the effects promoted by transplantation of bone marrow cells. To assess the anticonvulsant effects of bone marrow cell transplantation, we measured the frequency and duration of tonic seizure, the mortality rate, the microglial expression and the blood levels of cytokine IL-1, IL-6, IL-10 and TNF-α after MES induction. We hypothesized that these behavioral and inflammatory responses to a strong stimulus such as a convulsive seizure could be modified by the transplantation of bone marrow cells. RESULTS: Bone marrow transplanted cells altered the convulsive threshold and showed anticonvulsant effect by protecting from tonic seizures. Bone marrow cells modified the microglial expression in the analyzed brain areas, increased the IL-10 and attenuate IL-6 levels. CONCLUSIONS: Bone marrow cells exert protective effects by blocking the course of electroconvulsive seizures. Additionally, electroconvulsive seizures induced acute inflammatory responses by altering the pattern of microglia expression, as well as in IL-6 and IL-10 levels. Our findings also indicated that the anticonvulsant effects of these cells can be tested with the MES model following the same paradigm used for drug testing in pharmacological screening. Studies on the inflammatory reaction in response to acute seizures in the presence of transplanted bone marrow cells might open a wide range of discussions on the mechanisms relevant to the pathophysiology of epilepsies.
Assuntos
Transplante de Medula Óssea/métodos , Encéfalo/citologia , Microglia/citologia , Convulsões/terapia , Animais , Citocinas/sangue , Eletrochoque/efeitos adversos , Imuno-Histoquímica , Camundongos , Camundongos Endogâmicos C57BLRESUMO
OBJECTIVES: To investigate the associations of serum lipid profile with disease progression in high-risk clinically isolated syndromes (CIS) after the first demyelinating event. METHODS: High density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) were obtained in pretreatment serum from 135 high risk patients with CIS (≥ 2 brain MRI lesions and ≥ 2 oligoclonal bands) enrolled in the Observational Study of Early Interferon ß-1a Treatment in High Risk Subjects after CIS study (SET study), which prospectively evaluated the effect of intramuscular interferon ß-1a treatment following the first demyelinating event. Thyroid stimulating hormone, free thyroxine, 25-hydroxy vitamin D3, active smoking status and body mass index were also obtained. Clinical and MRI assessments were obtained within 4 months of the initial demyelinating event and at 6, 12 and 24 months. RESULTS: The time to first relapse and number of relapses were not associated with any of the lipid profile variables. Higher LDL-C (p=0.006) and TC (p=0.001) levels were associated with increased cumulative number of new T2 lesions over 2 years. Higher free thyroxine levels were associated with lower cumulative number of contrast-enhancing lesions (p=0.008). Higher TC was associated as a trend with lower baseline whole brain volume (p=0.020). Higher high density lipoprotein was associated with higher deseasonalised 1,25-dihydroxy vitamin D3 (p=0.003) levels and a trend was found for deseasonalised 25-hydroxy vitamin D3 (p=0.014). CONCLUSIONS: In early multiple sclerosis, lipid profile variables particularly LDL-C and TC levels are associated with inflammatory MRI activity measures.
Assuntos
Adjuvantes Imunológicos/uso terapêutico , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Colesterol/sangue , Doenças Desmielinizantes/tratamento farmacológico , Interferon beta/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Adulto , Índice de Massa Corporal , Encéfalo/efeitos dos fármacos , Encéfalo/patologia , Calcifediol/sangue , Estudos de Coortes , República Tcheca , Doenças Desmielinizantes/sangue , Intervenção Médica Precoce , Feminino , Humanos , Injeções Intramusculares , Interferon beta-1a , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/sangue , Esclerose Múltipla/diagnóstico , Estudos Prospectivos , Fumar/efeitos adversos , Fumar/sangue , Tireotropina/sangue , Tiroxina/sangue , Adulto JovemAssuntos
Aorta Torácica , Doenças da Aorta/complicações , Bloqueio Cardíaco/etiologia , Hematoma/complicações , Doenças da Aorta/diagnóstico , Doenças da Aorta/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia Transesofagiana , Bloqueio Cardíaco/diagnóstico , Hematoma/diagnóstico , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
There is an unclear association between the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and amyotrophic lateral sclerosis (ALS), with few reports in the literature. We report the case of an 80-year-old man admitted to our emergency room with asthenia, dysphonia, dysphagia, weight loss, and euvolemic hyponatremia, indicating a SIADH. Posteriorly, the patient also developed respiratory failure, which, in association with the previous clinical presentation, led to the diagnosis of ALS. During her permanence at the hospital, the hyponatremia improved with noninvasive positive-pressure ventilation, and the association between these two identities was made. This case also shows that patients with ALS commonly suffer from chronic respiratory failure and still have a reserved prognosis.
RESUMO
Childhood obesity and mental disorders often co-exist. To date, most of the studies are cross-sectional, involve the assessment of a specific disorder, and rely on self-report questionnaires. This study aimed to provide a comprehensive psychological assessment to examine the concurrent and prospective association between childhood obesity and mental health problems. We compared 34 children with obesity with 37 children with normal weight at baseline, and at a five-year follow-up, to examine the development of mental health disorders from childhood (8-12 years) to adolescence (13-18 years). Both assessments included a clinical interview and self-reported measures of psychosocial and family markers. Findings showed that the obesity group had a higher prevalence of mental disorders, and psychological comorbidity increased in five years. Prospectively, childhood obesity was associated with a psychological diagnosis in adolescence. Moreover, the obesity group displayed higher severity of symptoms at both times. Finally, body esteem contributed to predicting mental health disorders in adolescence regardless of weight status, while eating symptomatology was a specific marker for the obesity group. Therefore, in the management of childhood obesity is suggested to address also psychosocial variables such as weight-related teasing and body esteem, to prevent the onset or development of mental health problems.
Assuntos
Transtornos Mentais , Obesidade Infantil , Humanos , Criança , Adolescente , Obesidade Infantil/psicologia , Estudos Prospectivos , Saúde Mental , Estudos Transversais , Transtornos Mentais/epidemiologia , Transtornos Mentais/diagnósticoRESUMO
Identifying the risk factors for carbapenem-resistant Enterobacterales (CRE) bacteremia in cancer and hematopoietic stem cell transplantation (HSCT) patients would allow earlier initiation of an appropriate empirical antibiotic treatment. This is a prospective multicenter observational study in patients from 12 centers in Argentina, who presented with cancer or hematopoietic stem-cell transplant and developed Enterobacterales bacteremia. A multiple logistic regression model identified risk factors for CRE bacteremia, and a score was developed according to the regression coefficient. This was validated by the bootstrap resampling technique. Four hundred and forty-three patients with Enterobacterales bacteremia were included: 59 with CRE and 384 with carbapenem-susceptible Enterobacterales (CSE). The risk factors that were identified and the points assigned to each of them were: ≥10 days of hospitalization until bacteremia: OR 4.03, 95% CI 1.88-8.66 (2 points); previous antibiotics > 7 days: OR 4.65, 95% CI 2.29-9.46 (2 points); current colonization with KPC-carbapenemase-producing Enterobacterales: 33.08, 95% CI 11.74-93.25 (5 points). With a cut-off of 7 points, a sensitivity of 35.59%, specificity of 98.43%, PPV of 77.7%, and NPV of 90.9% were obtained. The overall performance of the score was satisfactory (AUROC of 0.85, 95% CI 0.80-0.91). Finally, the post-test probability of CRE occurrence in patients with none of the risk factors was 1.9%, which would virtually rule out the presence of CRE bacteremia.
RESUMO
Cardiac troponin T (encoded by TNNT2) is involved in the contraction of cardiomyocytes during beating. The alternative splicing of TNNT2 results in four transcript variants with differential Ca2+ sensitivity. The splicing of TNNT2 involves phosphorylation of the splicing factor SRSF6 by DYRK1A. Altered TNNT2 splicing patterns have been identified in failing human hearts. There is a paucity of studies describing DYRK1A-SRSF6-TNNT2 interplays in human cardiomyocytes. Also, it is not known whether the sensitivity of cardiomyocytes to cardiotoxic anthracyclines is modified in the context of variable DYRK1A-TNNT2 expression. In this study, we investigated the impact of DYRK1A on the endogenous expression of TNNT2 splicing variants in iPSC-derived cardiomyocytes. We also examined whether DYRK1A expression modifies the sensitivity of cardiomyocytes to the cardiotoxic drug daunorubicin (DAU). DYRK1A over-expression increased the abundance of TNNT2 fetal variants by ~ 58% whereas the abundance of the adult cTnT3 variant decreased by ~ 27%. High DYRK1A expression increased the phosphorylation of SRSF6 by ~ 25-65%. DAU cytotoxicity was similar between cardiomyocytes with variable levels of DYRK1A expression. DYRK1A over-expression ameliorated the impact of DAU on beating frequency. This study lays the foundation to further investigate the contribution of variable DYRK1A-TNNT2 expression to Ca2+ handling and beating in human cardiomyocytes.