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OBJECTIVE: Patients with multisystem inflammatory syndrome in children (MIS-C) often require hospital admission. Treatment of MIS-C has included intravenous immunoglobulin, systemic corticosteroids, and/or immunomodulators. There is no standardized approach to when steroids should be initiated during treatment. The study objective was to determine whether early initiation of steroids in patients with MIS-C is associated with the duration of hospital length of stay (LOS). METHODS: This is a single-center retrospective cohort study of patients younger than 21 years who were hospitalized with MIS-C between March 2020 and September 2021 and received steroids. Cases were obtained from an institutional MIS-C log. Patients with culture proven sepsis and/or those who received intravenous immunoglobulin or steroids within the previous 30 days were excluded. We used a multivariable linear regression model, controlling for potential confounders, to assess the association between early steroids and LOS. RESULTS: A total of 56 patients hospitalized with MIS-C were identified; 38 received systemic corticosteroids and were included in the study. The mean time from admission to steroid administration was 9.8 hours (SD = 7.7) in the early group and 44.6 hours (SD = 14.2) in the late group. There was a statistically significant difference in baseline characteristics of patients receiving early versus late steroids in initial C-reactive peptide, procalcitonin, brain natriuretic peptide, and cardiac dysfunction. After controlling for confounders, initiating steroids within 24 hours of admission for MIS-C was associated with a decreased hospital LOS: in patients treated with early steroids, LOS was 58.3 hours less (95% confidence interval, -100.0 to -16.6; P = 0.007) than in those who received late steroids. CONCLUSIONS: Among patients with MIS-C, initiating systemic corticosteroids within 24 hours of admission was associated with decreased hospital LOS.
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Corticosteroides , Tempo de Internação , Síndrome de Resposta Inflamatória Sistêmica , Humanos , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Estudos Retrospectivos , Feminino , Masculino , Tempo de Internação/estatística & dados numéricos , Criança , Corticosteroides/uso terapêutico , Corticosteroides/administração & dosagem , Pré-Escolar , Adolescente , Lactente , COVID-19/complicaçõesRESUMO
OBJECTIVES: The objectives are to determine whether diphenhydramine coadministered with prochlorperazine versus prochlorperazine only is associated with a difference in the risk of migraine treatment failure, as measured by the need for additional therapy, hospitalization rates, and 72-hour return rates, and to compare extrapyramidal adverse effects between groups. METHODS: Retrospective cohort of patients aged 7 to 18 years treated in the emergency department for migraines using prochlorperazine with or without diphenhydramine between 2013 and 2019. Patients were included if they had International Classification of Diseases, Ninth or Tenth Revision, codes for migraine or unspecified headache and were treated with prochlorperazine as part of their initial migraine therapy. Data collected included demographics, medications administered, pain scores, neuroimaging, disposition, return visits, and documentation of extrapyramidal adverse effects. Multivariable logistic regression was used to estimate the association between diphenhydramine coadministration and each of the outcomes. RESULTS: A total of 1683 patients were included. Overall, 13% required additional therapy with a 16.7% admission rate and a 72-hour return rate of 5.3%. There was no association between initial treatment with diphenhydramine and the odds of additional therapy (adjusted odds ratio [aOR], 0.74 [95% confidence interval {CI}, 0.53-1.03]), admission rates (aOR, 1.22 [95% CI, 0.89-1.67]), or return visit rates (aOR, 0.91 [95% CI, 0.55-1.51]). Extrapyramidal adverse effects occurred in 2.4% of patients in the prochlorperazine group and 0% in the prochlorperazine with diphenhydramine group. CONCLUSIONS: There was no association between diphenhydramine coadministration and the need for additional therapy, 72-hour return visit rates or admission rates. Extrapyramidal effects did not occur in patients treated with diphenhydramine.
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Difenidramina , Serviço Hospitalar de Emergência , Transtornos de Enxaqueca , Proclorperazina , Falha de Tratamento , Humanos , Proclorperazina/uso terapêutico , Proclorperazina/efeitos adversos , Proclorperazina/administração & dosagem , Difenidramina/uso terapêutico , Difenidramina/administração & dosagem , Difenidramina/efeitos adversos , Criança , Feminino , Masculino , Estudos Retrospectivos , Adolescente , Transtornos de Enxaqueca/tratamento farmacológico , Quimioterapia Combinada , Hospitalização/estatística & dados numéricos , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Antagonistas dos Receptores Histamínicos H1/efeitos adversos , Antagonistas dos Receptores Histamínicos H1/administração & dosagemRESUMO
Head and neck cancer is the seventh most common cancer in the world, and most cases manifest as head and neck squamous cell carcinoma. Despite the prominent role of fucosylated carbohydrate antigens in tumor cell adhesion and metastasis, little is known about the functional role of fucose-modified glycoproteins in head and neck cancer pathobiology. Inactivating polymorphisms of the fut2 gene, encoding for the α1,2-fucosyltransferase FUT2, are associated with an increased incidence of head and neck cancer among tobacco users. Moreover, the presence of the α1,2-fucosylated Lewis Y epitope, with both α1,2- and α1,3-linked fucose, has been observed in head and neck cancer tumors while invasive regions lose expression, suggesting a potential role for α1,2-fucosylation in the regulation of aggressive tumor cell characteristics. Here, we report an association between fut2 expression and head and neck cancer survival, document differential surface expression of α1,2-fucosylated epitopes in a panel of normal, dysplastic, and head and neck cancer cell lines, identify a set of potentially α1,2-fucosylated signaling and adhesion molecules including the epidermal growth factor receptor (EGFR), CD44 and integrins via tandem mass spectrometry, and finally, present evidence that EGFR is among the α1,2-fucosylated and LeY-displaying proteins in head and neck cancer. This knowledge will serve as the foundation for future studies to interrogate the role of LeY-modified and α1,2-fucosylated glycoproteins in head and neck cancer pathogenesis. Data are available via ProteomeXchange with identifier PXD029420.
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Fucose , Neoplasias de Cabeça e Pescoço , Receptores ErbB , Fucose/metabolismo , Fucosiltransferases/genética , Fucosiltransferases/metabolismo , Glicoproteínas/metabolismo , Neoplasias de Cabeça e Pescoço/genética , Humanos , Carcinoma de Células Escamosas de Cabeça e Pescoço/genéticaRESUMO
BACKGROUND: We compared those patients who left without being seen (LWBS) with those who stay for evaluation and determined which subsets were more likely to depart prematurely in the largest pediatric population studied to date. METHODS: We retrospectively extracted data from the electronic medical records of all pediatric patients who visited the emergency department between January 1, 2013, and December 31, 2015. The demographics and visit characteristics were compared between patients who LWBS and those seen by a provider. Bivariate and multivariate analyses were used to determine the odds for premature departure of specific groups within the population. RESULTS: Of the 271,364 pediatric patients visiting the emergency department during the 3-year study period, 3835 (1.4%) LWBS by a provider. The mean age of those LWBS was younger, and the odds of leaving slightly decreased as the patient's age increased (odds ratio [OR], 0.98). Those triaged as having "nonurgent" medical conditions had a statistically significant increase in odds of premature departure when compared with those with "urgent" medical conditions (OR, 1.16). Patients arriving during the evening and overnight hours had a much greater odds of LWBS (OR, 6.7 and 7.3, respectively). CONCLUSIONS: Our findings demonstrated and confirmed that age, time of arrival, and acuity level upon presentation were predictors of patients leaving before evaluation. This can guide institutions with staffing and flow processes as they attempt to reduce LWBS rates but also raises further questions as to whether these subsets go forward to have worse clinical outcomes after leaving prematurely.
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Serviço Hospitalar de Emergência , Pacientes Desistentes do Tratamento , Criança , Demografia , Humanos , Estudos Retrospectivos , TriagemRESUMO
STUDY OBJECTIVE: We determine whether an ondansetron prescription for pediatric patients with vomiting or gastroenteritis is associated with decreased return visits to the emergency department (ED), and whether alternate diagnoses are more frequent on return visits in patients prescribed ondansetron. METHODS: This is a retrospective cohort study of patients 6 months to 18 years of age, presenting to a pediatric ED or its affiliated urgent care centers between 2012 and 2017 with an International Classification of Diseases, Ninth Revision or International Statistical Classification of Diseases and Related Health Problems, 10th Revision diagnosis of gastroenteritis, gastritis, vomiting, or vomiting with diarrhea. Multivariate logistic regression analysis was used to measure the association between an ondansetron prescription and the odds of 72-hour return visits. Rates of alternate diagnoses on return visits (appendicitis, intussusception, intracranial mass, meningitis, and diabetic ketoacidosis) were compared between patients who were prescribed ondansetron for home use and those who were not. RESULTS: A total of 82,139 patients were studied, with a median age of 4 years. An ondansetron prescription was given to 13.4% of patients on discharge. The 72-hour return visit rate was 4.7%. Patients receiving an ondansetron prescription had decreased odds of 72-hour return visits (adjusted odds ratio 0.84; 95% confidence interval 0.75 to 0.93). The subgroup of patients specifically receiving a diagnosis of gastroenteritis had decreased odds of 72-hour return visits (adjusted odds ratio 0.82; 95% confidence interval 0.72 to 0.95). There was no significant difference between groups in the diagnosis of appendicitis on return visit (odds ratio 0.97; 95% confidence interval 0.37 to 2.18). CONCLUSION: An ondansetron prescription is associated with reduced 72-hour ED return visit rates for children with vomiting or acute gastroenteritis and is not associated with masking alternate diagnoses.
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Antieméticos/uso terapêutico , Gastroenterite/tratamento farmacológico , Ondansetron/uso terapêutico , Vômito/tratamento farmacológico , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Modelos Logísticos , Masculino , Recidiva , Estudos RetrospectivosRESUMO
AIM: Building strategies for the country-level dissemination of Kangaroo mother care (KMC) to reduce the mortality rate in preterm and low birth weight babies and improve quality of life. KMC is an evidence-based healthcare method for these infants. However, KMC implementation at the global level remains low. METHODS: The international network in Kangaroo mother brought 172 KMC professionals from 33 countries together for a 2-day workshop held in conjunction with the XIIth International KMC Conference in Bogota, Colombia, in November 2018. Participants worked in clusters to formulate strategies for country-level dissemination and scale-up according to seven pre-established objectives. RESULTS: The minimum set of indicators for KMC scale-up proposed by the internationally diverse groups is presented. The strategies for KMC integration and implementation at the country level, as well as the approaches for convincing healthcare providers of the safety of KMC transportation, are also described. Finally, the main aspects concerning KMC follow-up and KMC for term infants are presented. CONCLUSION: In this collaborative meeting, participants from low-, middle- and high-income countries combined their knowledge and experience to identify the best strategies to implement KMC at a countrywide scale.
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Método Canguru , Criança , Colômbia , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido de Baixo Peso , Recém-Nascido , Qualidade de VidaRESUMO
OBJECTIVE: This study aimed to verify the hypothesis that the lunar cycle influences the number of pediatric psychiatric emergency department (ED) visits. METHODS: Pediatric psychiatric ED visits between 2009 and 2011 were obtained retrospectively. Patients aged between 4 and 21 years presenting to Miami Children's Hospital ED with a primary psychiatric complaint were included in the study. Patients with a concomitant psychiatric problem and a secondary medical condition were excluded. The number of psychiatric visits was retrieved for the full moon dates, control dates as well as the day before and after the full moon when the moon appears full to the naked eye (full moon effect). A comparison was made using the 2-sample independent t test. RESULTS: Between 2009 and 2011, 36 dates were considered as the true full moon dates and 108 dates as the "full moon effect." A total of 559 patients were included in the study. The 2-sample independent t tests were performed between the actual full moon date and control dates, as well as between the "full moon effect" dates and control dates. Our results failed to show a statistical significance when comparing the number of pediatric psychiatric patients presenting to a children's hospital ED during a full moon and a non-full moon date. CONCLUSIONS: Our study's results are in agreement with those involving adult patients. The full moon does not affect psychiatric visits in a children's hospital.
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Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviços de Emergência Psiquiátrica/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Lua , Admissão do Paciente/estatística & dados numéricos , Periodicidade , Adolescente , Criança , Pré-Escolar , Feminino , Florida/epidemiologia , Folclore , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/etiologia , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
OBJECTIVES: We determined the pulse oximetry benefit in pediatric pneumonia mortality risk stratification and chest-indrawing pneumonia in-hospital mortality risk factors. METHODS: We report the characteristics and in-hospital pneumonia-related mortality of children aged 2-59 months who were included in the Pneumonia Research Partnership to Assess WHO Recommendations dataset. We developed multivariable logistic regression models of chest-indrawing pneumonia to identify mortality risk factors. RESULTS: Among 285,839 children, 164,244 (57.5%) from hospital-based studies were included. Pneumonia case fatality risk (CFR) without pulse oximetry measurement was higher than with measurement (5.8%, 95% confidence interval [CI] 5.6-5.9% vs 2.1%, 95% CI 1.9-2.4%). One in five children with chest-indrawing pneumonia was hypoxemic (19.7%, 95% CI 19.0-20.4%), and the hypoxemic CFR was 10.3% (95% CI 9.1-11.5%). Other mortality risk factors were younger age (either 2-5 months [adjusted odds ratio (aOR) 9.94, 95% CI 6.67-14.84] or 6-11 months [aOR 2.67, 95% CI 1.71-4.16]), moderate malnutrition (aOR 2.41, 95% CI 1.87-3.09), and female sex (aOR 1.82, 95% CI 1.43-2.32). CONCLUSION: Children with a pulse oximetry measurement had a lower CFR. Many children hospitalized with chest-indrawing pneumonia were hypoxemic and one in 10 died. Young age and moderate malnutrition were risk factors for in-hospital chest-indrawing pneumonia-related mortality. Pulse oximetry should be integrated in pneumonia hospital care for children under 5 years.
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Desnutrição , Pneumonia , Criança , Humanos , Feminino , Lactente , Pré-Escolar , Mortalidade Hospitalar , Pneumonia/diagnóstico , Oximetria , Organização Mundial da Saúde , Medição de RiscoRESUMO
Background: The existing World Health Organization (WHO) pneumonia case management guidelines rely on clinical symptoms and signs for identifying, classifying, and treating pneumonia in children up to 5 years old. We aimed to collate an individual patient-level data set from large, high-quality pre-existing studies on pneumonia in children to identify a set of signs and symptoms with greater validity in the diagnosis, prognosis, and possible treatment of childhood pneumonia for the improvement of current pneumonia case management guidelines. Methods: Using data from a published systematic review and expert knowledge, we identified studies meeting our eligibility criteria and invited investigators to share individual-level patient data. We collected data on demographic information, general medical history, and current illness episode, including history, clinical presentation, chest radiograph findings when available, treatment, and outcome. Data were gathered separately from hospital-based and community-based cases. We performed a narrative synthesis to describe the final data set. Results: Forty-one separate data sets were included in the Pneumonia Research Partnership to Assess WHO Recommendations (PREPARE) database, 26 of which were hospital-based and 15 were community-based. The PREPARE database includes 285 839 children with pneumonia (244 323 in the hospital and 41 516 in the community), with detailed descriptions of clinical presentation, clinical progression, and outcome. Of 9185 pneumonia-related deaths, 6836 (74%) occurred in children <1 year of age and 1317 (14%) in children aged 1-2 years. Of the 285 839 episodes, 280 998 occurred in children 0-59 months old, of which 129 584 (46%) were 2-11 months of age and 152 730 (54%) were males. Conclusions: This data set could identify an improved specific, sensitive set of criteria for diagnosing clinical pneumonia and help identify sick children in need of referral to a higher level of care or a change of therapy. Field studies could be designed based on insights from PREPARE analyses to validate a potential revised pneumonia algorithm. The PREPARE methodology can also act as a model for disease database assembly.
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Pneumonia , Masculino , Criança , Humanos , Lactente , Recém-Nascido , Pré-Escolar , Feminino , Pneumonia/tratamento farmacológico , Administração de Caso , Organização Mundial da Saúde , Algoritmos , PesquisaRESUMO
INTRODUCTION: Existing risk assessment tools to identify children at risk of hospitalised pneumonia-related mortality have shown suboptimal discriminatory value during external validation. Our objective was to derive and validate a novel risk assessment tool to identify children aged 2-59 months at risk of hospitalised pneumonia-related mortality across various settings. METHODS: We used primary, baseline, patient-level data from 11 studies, including children evaluated for pneumonia in 20 low-income and middle-income countries. Patients with complete data were included in a logistic regression model to assess the association of candidate variables with the outcome hospitalised pneumonia-related mortality. Adjusted log coefficients were calculated for each candidate variable and assigned weighted points to derive the Pneumonia Research Partnership to Assess WHO Recommendations (PREPARE) risk assessment tool. We used bootstrapped selection with 200 repetitions to internally validate the PREPARE risk assessment tool. RESULTS: A total of 27 388 children were included in the analysis (mean age 14.0 months, pneumonia-related case fatality ratio 3.1%). The PREPARE risk assessment tool included patient age, sex, weight-for-age z-score, body temperature, respiratory rate, unconsciousness or decreased level of consciousness, convulsions, cyanosis and hypoxaemia at baseline. The PREPARE risk assessment tool had good discriminatory value when internally validated (area under the curve 0.83, 95% CI 0.81 to 0.84). CONCLUSIONS: The PREPARE risk assessment tool had good discriminatory ability for identifying children at risk of hospitalised pneumonia-related mortality in a large, geographically diverse dataset. After external validation, this tool may be implemented in various settings to identify children at risk of hospitalised pneumonia-related mortality.
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Pneumonia , Criança , Humanos , Renda , Lactente , Pneumonia/diagnóstico , Medição de RiscoRESUMO
OBJECTIVE: The aim was to describe how selected health research funding agencies active in low- and middle-income countries promote the translation of their funded research into policy and practice. METHODS: We conducted inductive analysis of semi-structured interviews with key informants from a purposive sample of 23 national and international funding agencies that fund health research in Brazil, Colombia, India, the Philippines, South Africa and Thailand. We also surveyed web sites. FINDINGS: We found a commitment to knowledge translation in the mandate of 18 of 23 agencies. However, there was a lack of common terminology. Most of the activities were traditional efforts to disseminate to a broad audience, for example using web sites and publications. In addition, more than half (13 of 23) of the agencies encouraged linkage/exchange between researchers and potential users, and 6 of 23 agencies described "pull" activities to generate interest in research from decision-makers. One-third (9 of 23) of funding agencies described a mandate to enhance health equity through improving knowledge translation. Only 3 of 23 agencies were able to describe evaluation of knowledge translation activities. Furthermore, we found national funding agencies made greater knowledge translation efforts when compared to international agencies. CONCLUSION: Funding agencies are engaged in a wide range of creative knowledge translation activities. They might consider their role as knowledge brokers, with an ability to promote research syntheses and a focus on health equity. There is an urgent need to evaluate the knowledge translation activities of funding agencies.
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Países em Desenvolvimento , Difusão de Inovações , Medicina Baseada em Evidências/organização & administração , Comunicação Interdisciplinar , Agências Internacionais/economia , Administração em Saúde Pública/economia , Apoio à Pesquisa como Assunto/organização & administração , Orçamentos , Análise Custo-Benefício , Coleta de Dados , Medicina Baseada em Evidências/economia , Humanos , Disseminação de Informação , Entrevistas como Assunto , Bases de Conhecimento , Política , Informática em Saúde Pública , Apoio à Pesquisa como Assunto/economiaRESUMO
The arbuscular mycorrhizal (AM) symbiosis has been shown to improve maize tolerance to different drought stress scenarios by regulating a wide range of host plants aquaporins. The objective of this study was to highlight the differences in aquaporin regulation by comparing the effects of the AM symbiosis on root aquaporin gene expression and plant physiology in two maize cultivars with contrasting drought sensitivity. This information would help to identify key aquaporin genes involved in the enhanced drought tolerance by the AM symbiosis. Results showed that when plants were subjected to drought stress the AM symbiosis induced a higher improvement of physiological parameters in drought-sensitive plants than in drought-tolerant plants. These include efficiency of photosystem II, membrane stability, accumulation of soluble sugars and plant biomass production. Thus, drought-sensitive plants obtained higher physiological benefit from the AM symbiosis. In addition, the genes ZmPIP1;1, ZmPIP1;3, ZmPIP1;4, ZmPIP1;6, ZmPIP2;2, ZmPIP2;4, ZmTIP1;1, and ZmTIP2;3 were down-regulated by the AM symbiosis in the drought-sensitive cultivar and only ZmTIP4;1 was up-regulated. In contrast, in the drought-tolerant cultivar only three of the studied aquaporin genes (ZmPIP1;6, ZmPIP2;2, and ZmTIP4;1) were regulated by the AM symbiosis, resulting induced. Results in the drought-sensitive cultivar are in line with the hypothesis that down-regulation of aquaporins under water deprivation could be a way to minimize water loss, and the AM symbiosis could be helping the plant in this regulation. Indeed, during drought stress episodes, water conservation is critical for plant survival and productivity, and is achieved by an efficient uptake and stringently regulated water loss, in which aquaporins participate. Moreover, the broader and contrasting regulation of these aquaporins by the AM symbiosis in the drought-sensitive than the drought-tolerant cultivar suggests a role of these aquaporins in water homeostasis or in the transport of other solutes of physiological importance in both cultivars under drought stress conditions, which may be important for the AM-induced tolerance to drought stress.
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Grafting provides a tool aimed to increase low-P stress tolerance of crops, however, little is known about the mechanism (s) by which rootstocks can confer resistance to P deprivation. In this study, 4 contrasting groups of rootstocks from different genetic backgrounds (Solanum lycopersicum var. cerasiforme and introgression and recombinant inbred lines derived from the wild relatives S. pennellii and S. pimpinellifolium) were grafted to a commercial F1 hybrid scion and cultivated under control (1 mM, c) and P deficient (0.1 mM, p) conditions for 30 days, to analyze rootstocks-mediated traits that impart low (L, low shoot dry weight, SDW) or high (H, high SDW) vigor. Xylem sap ionic and hormonal anlyses leaf nutritional status suggested that some physiological traits can explain rootstocks impacts on shoot growth. Although xylem P concentration increased with root biomass under both growing conditions, shoot biomass under low-P was explained by neither changes in root growth nor P transport and assimilation. Indeed, decreased root P export only explained the sensitivity of the HcLp rootstocks, while leaf P status was similarly affected in all graft combinations. Interestingly, most of the nutrients analyzed in the xylem sap correlated with root biomass under standard fertilization but only Ca was consistently related to shoot biomass under both control and low-P, suggesting an important role for this nutrient in rootstock-mediated vigor. Moreover, foliar Ca, S, and Mn concentrations were (i) specifically correlated with shoot growth under low-P and (ii) positively and negatively associated to the root-to-shoot transport of the cytokinin trans-zeatin (t-Z) and the ethylene precursor 1-aminocyclopropane-1-carboxylic acid (ACC), respectively. Indeed, those hormones seem to play an antagonistic positive (t-Z) and negative (ACC) role in the rootstock-mediated regulation of shoot growth in response to P nutrition. The use of Hp-type rootstocks seems to enhance P use efficiency of a commercial scion variety, therefore could potentially be used for increasing yield and agronomic stability under low P availability.
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Earlier research has identified a remarkable number of related factors to resilience during adolescence. Historically, theoretical treatments of resilience have been focused almost exclusively on psychosocial levels of analysis to derive explanatory models. However, there is insufficient understanding of the role of emotion regulation explaining competent functioning despite the experience of adversity (resilience), especially during adolescence. This study explores the relationship between both, emotional regulation abilities and strategies, and resilience in a sample of adolescents from suburbs high-schools (Jerez de la Frontera, Spain). The study also examines how using different emotional regulation strategies may help the development of resilience levels at this stage. Participants of the study were 164 adolescents ranging from 13 to 16 years old (M = 13.98; SD = 0.66). Emotion regulation was measured using the Cognitive Emotional Regulation Questionnaire (CERQ, Garnefski et al., 2001), and sections D and H of Mayer-Salovey-Caruso Emotional Intelligence Test, a performance test (Emotion Regulation Ability sections, MSCEIT, Spanish version, Mayer et al., 2003). Resilience was evaluated with ERE (Educative Resilience Scale for children and adolescents, Saavedra and Castro, 2009). Verbal Intelligence (Yuste, 1997) and personality traits (Cattell and Cattell, 1986) were assessed as two independent variables. Results supported the idea that emotion regulation ability (MSCEIT, D and H sections, Extremera et al., 2006) is a significant predictor of adolescents' resilience. Moreover, cognitive regulation strategies, such as positive reappraisal, predicted perceived resilience among students. Sociability (A factor of HSPQ, sociability) also correlated with resilience levels. Hence, these results are promising, implying that emotion regulation ability may act as a helpful tool preventing adolescents from irrational risky behaviors, commonly assumed at this developmental stage.
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BACKGROUND: Injectable penicillin is the recommended treatment for WHO-defined severe pneumonia (lower chest indrawing). If oral amoxicillin proves equally effective, it could reduce referral, admission, and treatment costs. We aimed to determine whether oral amoxicillin and parenteral penicillin were equivalent in the treatment of severe pneumonia in children aged 3-59 months. METHODS: This multicentre, randomised, open-label equivalency study was undertaken at tertiary-care centres in eight developing countries in Africa, Asia, and South America. Children aged 3-59 months with severe pneumonia were admitted for 48 h and, if symptoms improved, were discharged with a 5-day course of oral amoxicillin. 1702 children were randomly allocated to receive either oral amoxicillin (n=857) or parenteral penicillin (n=845) for 48 h. Follow-up assessments were done at 5 and 14 days after enrollment. Primary outcome was treatment failure (persistence of lower chest indrawing or new danger signs) at 48 h. Analyses were by intention-to-treat and per protocol. FINDINGS: Treatment failure was 19% in each group (161 patients, pencillin; 167 amoxillin; risk difference -0.4%; 95% CI -4.2 to 3.3) at 48 h. Infancy (age 3-11 months; odds ratio 2.72, 95% CI 1.95 to 3.79), very fast breathing (1.94, 1.42 to 2.65), and hypoxia (1.95, 1.34 to 2.82) at baseline predicted treatment failure by multivariate analysis. INTERPRETATION: Injectable penicillin and oral amoxicillin are equivalent for severe pneumonia treatment in controlled settings. Potential benefits of oral treatment include decreases in (1) risk of needle-borne infections; (2) need for referral or admission; (3) administration costs; and (4) costs to the family.
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Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Penicilinas/administração & dosagem , Pneumonia Bacteriana/tratamento farmacológico , Administração Oral , Pré-Escolar , Países em Desenvolvimento , Feminino , Infecções por Haemophilus/diagnóstico , Infecções por Haemophilus/tratamento farmacológico , Infecções por Haemophilus/mortalidade , Haemophilus influenzae , Hospitalização , Humanos , Lactente , Injeções Intravenosas/efeitos adversos , Masculino , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/mortalidade , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/tratamento farmacológico , Pneumonia Pneumocócica/mortalidade , Taxa de Sobrevida , Falha de TratamentoRESUMO
OBJECTIVE: To determine the efficacy and safety of high-frequency oscillatory ventilation (HFOV) compared to conventional ventilation (CV) for the treatment of respiratory failure in term and near-term infants in Colombia. STUDY DESIGN: Eligible infants with moderate to severe respiratory failure were randomized to early treatment with CV or HFOV. Ventilator management and general patient care were standardized. The main outcome was neonatal death or pulmonary air leak. RESULTS: A total of 119 infants were enrolled (55 in the HFOV group; 64 in the CV group) during the study period. Six infants in the HFOV group (11%) and two infants in the CV group (3%) developed the primary outcome (RR: 3.6, 95% CI: 0.8-16.9). Five infants in the HFOV group (9%) and one infant in the CV (2%) died before 28 days of life (RR: 5.9 CI: 0.7-48.2). Secondary outcomes were similar between groups. CONCLUSION: HFOV may not be superior to CV as an early treatment for respiratory failure in this age group. Standardization of ventilator management and general patient care may have a greater impact on the outcome in Colombia than mode of ventilation.
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Ventilação de Alta Frequência , Respiração Artificial , Insuficiência Respiratória/terapia , Humanos , Lactente , Resultado do TratamentoRESUMO
OBJECTIVE: The epidemiology of nosocomial infections (NI) in neonatal intensive care units in developing countries has been poorly studied. We conducted a prospective study in selected neonatal units in Colombia, SA, to describe the incidence rate, causative organisms, and interinstitutional differences. STUDY DESIGN: Data were collected prospectively from February 20 to August 30, 2001 from eight neonatal units. NI was defined as culture-proven infection diagnosed after 72 h of hospitalization, resulting in treatment with antibiotics for >3 days. Linear regression models were used to describe associations between institutional variables and NI rates. RESULTS: A total of 1504 infants were hospitalized for more than 72 h, and therefore, at risk for NI. Of all, 127 infections were reported among 80 patients (5.3%). The incidence density rate was 6.2 per 1000 patient-days. Bloodstream infections accounted for 78% of NIs. Gram-negative organisms predominated over gram-positive organisms (55 vs 38%) and were prevalent in infants < or =2000 g (54%). The most common pathogens were Staphylococcus epidermidis (26%) and Klebsiella pneumonia (12%). CONCLUSION: Gram-negative organisms predominate in Colombia among infants <2000 g. The emergence of gram-negative organisms and their associated risk factors requires further study.
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Infecção Hospitalar/epidemiologia , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Colômbia/epidemiologia , Infecções por Bactérias Gram-Negativas/epidemiologia , Humanos , Incidência , Recém-Nascido , Modelos Lineares , Prevalência , Estudos ProspectivosRESUMO
OBJECTIVE: This study was designed to identify risk factors for nosocomial infections among infants admitted into eight neonatal intensive care units in Colombia. Knowledge of modifiable risk factors could be used to guide the design of interventions to prevent the problem. STUDY DESIGN: Data were collected prospectively from eight neonatal units. Nosocomial infection was defined as culture-proven infection diagnosed after 72 hours of hospitalization, resulting in treatment with antibiotics for >3 days. Associations were expressed as odds ratios. Logistic regression was used to adjust for potential confounders. RESULTS: From a total of 1504 eligible infants, 80 were treated for 127 episodes of nosocomial infection. Logistic regression analysis identified the combined exposure to postnatal steroids and H2-blockers, and use of oral gastric tubes for enteral nutrition as risk factors significantly associated with nosocomial infection. CONCLUSION: Nosocomial infections in Colombian neonatal intensive care units were associated with modifiable risk factors including use of postnatal steroids and H2-blockers.
Assuntos
Infecção Hospitalar/etiologia , Unidades de Terapia Intensiva Neonatal , Colômbia/epidemiologia , Infecção Hospitalar/epidemiologia , Antagonistas dos Receptores H2 da Histamina/efeitos adversos , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Intubação/efeitos adversos , Modelos Logísticos , Estudos Prospectivos , Fatores de Risco , Esteroides/efeitos adversos , EstômagoRESUMO
A cDNA library was constructed with RNA from Glomus intraradices-colonized lettuce roots and used for differential screening. This allowed the identification of a cDNA (Gi-1) that was expressed only in mycorrhizal roots and was of fungal origin. The function of the gene product is unknown, because Gi-1 contained a complete open reading frame that was predicted to encode a protein of 157 amino acids which only showed little homology with glutamine synthetase from Helicobacter pylori. The time-course analysis of gene expression during the fungal life cycle showed that Gi-1 was expressed only during the mycorrhizal symbiosis and was not detected in dormant or germinating spores of G. intraradices. P fertilization did not significantly change the pattern of Gi-1 expression compared with that in the unfertilized treatment, whereas N fertilization (alone or in combination with P) considerably enhanced the Gi-1 transcript accumulation. This increase in gene expression correlated with plant N status and growth under such conditions. The possible role of the Gi-1 gene product in intermediary N metabolism of arbuscular mycorrhizal symbiosis is further discussed.
Assuntos
Fungos/genética , Simbiose , Sequência de Aminoácidos , Northern Blotting , Bradyrhizobium/efeitos dos fármacos , Bradyrhizobium/crescimento & desenvolvimento , Clonagem Molecular , DNA Complementar/química , DNA Complementar/genética , Fertilizantes , Fungos/crescimento & desenvolvimento , Regulação Fúngica da Expressão Gênica/efeitos dos fármacos , Dados de Sequência Molecular , Nitrogênio/farmacologia , Fósforo/farmacologia , Raízes de Plantas/genética , Raízes de Plantas/microbiologia , Análise de Sequência de DNA , Homologia de Sequência de Aminoácidos , Glycine max/genética , Glycine max/microbiologia , Regulação para Cima/efeitos dos fármacos , Água/farmacologia , Água/fisiologiaRESUMO
PURPOSE: To present the 7-year experience of the treatment of benign and malignant tracheobronchial stenoses using metallic stents. PATIENTS AND METHODS: One hundred twenty-three stents were inserted in 86 patients (74 benign and 12 malignant stenoses). Ninety-seven stents were placed in the trachea and 26 in the bronchi. The procedures were performed under fluoroscopic and flexible bronchoscopic guidance with the patient under light sedation. In cases of severe stenotic lesions or obstructions, laser resection was performed before stent placement. Clinical and functional pulmonary data were recorded before and 3 months after the procedure. Follow-up involved clinical data and radiographic techniques at 48 h and at 1-, 3-, 6-, and 12-month intervals. RESULTS: The technical success was 100 %. Dyspnea disappearance, forced expiratory volume in the first second, and pulmonary functional data improvement was observed in all patients (p < 0.001). Complications were detected in 23 patients (26.7 %). Mean follow-up time was 6.3 ± 1.2 months in patients with malignant lesions and 76.2 ± 2.3 months patients with in benign lesions. By the end of the study, 100 % of patients with malignant pathology and 6.7 % of patients with benign lesions had died. CONCLUSION: Endoluminal treatment of tracheobronchial stenosis with metallic stents is a therapeutic alternative in patients who are poor candidates for surgery. In unresectable malignant lesions, the benefit of metallic stenting is unquestionable. In benign lesions, the results are satisfactory, but sometimes other interventions are required to treat complications. New stent technology may improve these results.