Vitreous metastasis from cutaneous melanoma: diagnosis and management / Metástase vítrea de melanoma cutâneo: diagnóstico e tratamento

ABSTRACT Purpose: To report the clinical findings, treatments, and outcomes in a series of patients with vitreous metastasis from cutaneous melanoma. Methods: This single-center, retrospective, interventional case series included patients with biopsy-confirmed vitreous metastasis from cutaneous melanoma diagnosed between 1997 and 2020. Standard 23- or 25-gauge pars plana vitrectomy was performed for diagnostic sampling. Sclerotomies were treated with double or triple freeze-thaw cryotherapy. Perioperative intravitreal injections of melphalan (32 µg/0.075 mL) were administered, when indicated. Visual acuity, intraocular pressure, and systemic and ocular treatment responses were reported. Results: Five eyes of five patients with unilateral vitreous metastasis from cutaneous melanoma were identified. The median age at diagnosis was 84 (range, 37-88) years. The median follow-up after ophthalmic diagnosis was 28 (8.5-36) months; one patient did not have a follow-up. The initial visual acuity ranged from 20/30 to hand motions. Baseline clinical findings included pigmented or non-pigmented cellular infiltration of the vitreous (5/5), anterior segment (4/5), and retina (3/5). Four patients had secondary glaucoma. Systemic therapy included checkpoint inhibitor immunotherapy (n=3, all with partial/complete response), systemic chemotherapy (n=2), surgical resection (n=3), and radiation (n=2). The median time from primary diagnosis to vitreous metastasis was 2 (2-15) years. One patient had an active systemic disease at the time of vitreous metastasis. The final visual acuity ranged from 20/40 to no light perception. Ophthalmic treatment included vitrectomy in all five patients, intravitreal administration of melphalan in three, and intravitreal administration of methotrexate in one. One patient required enucleation, and histopathology revealed extensive invasion by melanoma cells. Conclusions: Vitreous metastasis from cutaneous melanoma can present as a diffuse infiltration of pigmented or non-pigmented cells into the vitreous and may be misdiagnosed as uveitis. Diagnostic pars plana vitrectomy and periodic intravitreal chemotherapy may be indicated.

RESUMO Objetivo: Descrever os achados clínicos, tratamentos, e desfechos em uma série de pacientes com me tástases vítreas de melanoma cutâneo. Métodos: Série retrospectiva de casos de único centro com intervenção. Pacientes incluídos tiveram seu diagnóstico de MVMC confirmado por biópsia entre 1997 e 2020. Vitrectomia via pars plana com 23 ou 25 gauge foram realizadas para obter espécimens. Esclerotomias foram tratadas com crioterapia em duplo ou triplo congelamento. Injeção intravítrea perioperatória de melfalano (32 ug/0,075 mL) foi administrada quando necessário. Foram relatados acuidade visual, pressão intraocular, resposta terapêutica sistêmica e ocular. Resultados: Cinco olhos de 5 pacientes com metástases vítreas de melanoma cutâneo unilateral foram identificados. Idade média de diagnóstico foi 84 anos (variando de 37-88). Seguimento médio após diagnóstico oftalmológico foi 28 (8,5-36) meses; 1 paciente não teve acompanhamento. Acuidade visual inicial variou de 20/30 a movimentos de mão. Achados clínicos iniciais incluíram infiltração de células pigmentadas e não-pigmentadas no vítreo (5/5), segmento anterior (4/5), e retina (3/5). Quatro pacientes tiveram glaucoma secundário. Tratamento sistêmico incluiu imunoterapia com inibidores da via de sinalização (3 - todos com resposta parcial/completa), quimioterapia sistêmica (2), ressecção cirúrgica (3), e irradiação (2). Intervalo médio entre diagnóstico primário e metástases vítreas foi 2 (2-15) anos. Um paciente teve doença sistêmica ativa simultânea as metástases vítreas. Acuidade visual final variou entre 20/40 e SPL. Tratamento oftalmológico incluiu vitrectomia nos 5 pacientes, melfalano intravítreo em 3 e metotrexato intravítreo em 1. Um paciente precisou de enucleação. A histopatologia revelou invasão celular extensa de melanoma. Conclusões: Metástases vítreas de melanoma cutâneo pode se manifestar como uma infiltração difusa de células pigmentadas e não-pigmentadas no vítreo e erroneamente diagnosticada como uveites. Vitrectomia diagnóstica e quimioterapia intravítrea periódica podem estar indicadas.

Entre lo personal y lo político: experiencias de vida durante la pandemia de covid-19 en Tucumán, Argentina, en el periodo 2020-2022 / Between the personal and the political: life experiences during the covid-19 pandemic in Tucumán, Argentina, 2020-2022

Resumen Este artículo analiza sentimientos, experiencias, prácticas y acciones que subyacen a los significados atribuidos a la pandemia por covid-19. A partir de un estudio de caso situado en la provincia de Tucumán (Argentina), se desarrolló una investigación mixta, interesada en captar experiencias de vida. Los discursos evidencian la resignificación de la propia vida, la valorización de los vínculos, el capital social comunitario, el Estado y la política. Desde lo personal o desde lo político, el marco interpretativo con el que las personas significan las experiencias de vida durante la pandemia por covid-19 configura sentimientos, experiencias, prácticas y acciones diferenciadas.

Abstract This article analyzes feelings, experiences, practices, and actions that underlie the meanings attributed to the covid-19 pandemic. Based on a case study located in the province of Tucumán (Argentina), a mixed-methods investigation was developed, interested in capturing life experiences. Discourse analysis show the resignification of life itself, the valorization of close ties, community social capital, the State and politics. From the personal to the political, the interpretive frames people use to signify life experiences during the covid-19 pandemic exhibit differentiated feelings, experiences, practices, and actions.

Prevalence of COVID-19 at the Wahgnion-Gold mining site in Burkina Faso and use of RT-PCR initial cycle threshold to monitor the dynamics of SARS-CoV-2 load

Background: To control the spread of coronavirus disease-19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), it is necessary to adequately identify and isolate infectious patients particularly at the work place. Real time polymerase chain reaction (RT-PCR) assay is the recommended confirmatory method for the diagnosis of SARS-CoV-2 infection. The aim of this study was to determine the prevalence of SARSCoV-2 infection in Burkina Faso and to use the initial cycle threshold (Ct) values of RT-PCR as a tool to monitor the dynamics of the viral load. Methodology: Between September 2021 and February 2022, oropharyngeal and/or nasopharyngeal swab samples of consecutively selected COVID-19 symptomatic and apparently healthy workers from the Wahgnion mining site in the South-western Burkina Faso who consented to the study were collected according to the two weeks shift program and tested for SARS-CoV-2 using RT-PCR assay. Patients positive for the virus were followed-up weekly until tests were negative. Association of the initial RT-PCR Ct values with disease duration was assessed by adjusted linear regression approach. Two-sided p value < 0.05 was considered statistically significant. Results: A total of 1506 (92.9% males) participants were recruited into the study, with mean age and age range of 37.18.7 and 18-68 years respectively. The overall prevalence of SARS-CoV-2 infection was 14.3% (216/1506). Of the 82 patients included in the follow-up study, the longest duration of positive RT-PCR test, from the first positive to the first of the two negative RT-PCR tests, was 33 days (mean 11.6 days, median 10 days, interquartile range 8- 14 days). The initial Ct values significantly correlated with the duration of RT-PCR positivity (with ß=-0.54, standard error=0.09 for N gene, and ß=-0.44, standard error=0.09 for ORF1ab gene, p<0.001). Participants with higher Ct values corresponding to lower viral loads had shorter viral clearance time than those of lower Ct values or higher viral loads. Conclusion: Approximately 1 out of 7 tested miners had SARS-CoV-2 infection and the duration of their RT-PCR tests positivity independently correlated with the initial viral load measured by initial Ct values. As participants with lower initial Ct values tended to have longer disease duration, initial RT-PCR Ct values could be used to guide COVID-19 patient quarantine duration particularly at the work place.

Contexte: Pour contrôler la propagation de la maladie à coronavirus 19 (COVID-19) causée par le syndrome respiratoire aigu sévère coronavirus-2 (SRAS-CoV-2), il est nécessaire d'identifier et d'isoler de manière adéquate les patients infectieux, en particulier sur le lieu de travail. Le test de réaction en chaîne par polymérase en temps réel (RT-PCR) est la méthode de confirmation recommandée pour le diagnostic de l'infection par le SRAS-CoV-2. Le but de cette étude était de déterminer la prévalence de l'infection par le SRAS-CoV-2 au Burkina Faso et d'utiliser les valeurs du seuil initial du cycle (Ct) de la RT-PCR comme outil de suivi de la dynamique de la charge virale. Méthodologie: Entre septembre 2021 et février 2022, des écouvillonnages oropharyngés et/ou nasopharyngés de travailleurs symptomatiques COVID-19 et apparemment en bonne santé sélectionnés consécutivement du site minier de Wahgnion dans le sud-ouest du Burkina Faso qui ont consenti à l'étude ont été prélevés selon les deux programme de quart de semaines et testé pour le SRAS-CoV-2 à l'aide d'un test RT-PCR. Les patients positifs pour le virus ont été suivis chaque semaine jusqu'à ce que les tests soient négatifs. L'association des valeurs Ct initiales de la RT-PCR avec la durée de la maladie a été évaluée par une approche de régression linéaire ajustée. Une valeur p bilatérale < 0,05 a été considérée comme statistiquement significative. Résultats: Un total de 1506 participants (92,9% d'hommes) ont été recrutés dans l'étude, avec un âge moyen et une tranche d'âge de 37,1 à 8,7 ans et de 18 à 68 ans, respectivement. La prévalence globale de l'infection par le SRAS-CoV-2 était de 14,3% (216/1506). Sur les 82 patients inclus dans l'étude de suivi, la plus longue durée de test RT-PCR positif, du premier test positif au premier des deux tests RT-PCR négatifs, était de 33 jours (moyenne 11,6 jours, médiane 10 jours, intervalle interquartile 8-14 jours). Les valeurs Ct initiales étaient significativement corrélées à la durée de positivité de la RT-PCR (avec ß=-0,54, erreur standard=0,09 pour le gène N et ß=-0,44, erreur standard=0,09 pour le gène ORF1ab, p<0,001). Les participants avec des valeurs de Ct plus élevées correspondant à des charges virales plus faibles avaient un temps de clairance virale plus court que ceux avec des valeurs de Ct plus basses ou des charges virales plus élevées. Conclusion: Environ 1 mineur testé sur 7 était infecté par le SRAS-CoV-2 et la durée de la positivité de ses tests RTPCR était indépendamment corrélée à la charge virale initiale mesurée par les valeurs Ct initiales. Comme les participants avec des valeurs Ct initiales inférieures avaient tendance à avoir une durée de maladie plus longue, les valeurs Ct initiales de la RT-PCR pourraient être utilisées pour guider la durée de la quarantaine des patients COVID19, en particulier sur le lieu de travail.

Borderzone Infarcts and Recurrent Cerebrovascular Events in Symptomatic Intracranial Arterial Stenosis: A Systematic Review and Meta-Analysis / 대한뇌졸중학회지

Background@#and Purpose Intracranial arterial stenosis (ICAS)-related stroke occurs due to three primary mechanisms with distinct infarct patterns: (1) borderzone infarcts (BZI) due to impaired distal perfusion, (2) territorial infarcts due to distal plaque/thrombus embolization, and (3) plaque progression occluding perforators. The objective of the systematic review is to determine whether BZI secondary to ICAS is associated with a higher risk of recurrent stroke or neurological deterioration. @*Methods@#As part of this registered systematic review (CRD42021265230), a comprehensive search was performed to identify relevant papers and conference abstracts (with ≥20 patients) reporting initial infarct patterns and recurrence rates in patients with symptomatic ICAS. Subgroup analyses were performed for studies including any BZI versus isolated BZI and those excluding posterior circulation stroke. The study outcome included neurological deterioration or recurrent stroke during follow-up. For all outcome events, corresponding risk ratios (RRs) and 95% confidence intervals (95% CI) were calculated. @*Results@#A literature search yielded 4,478 records with 32 selected during the title/abstract triage for full text; 11 met inclusion criteria and 8 studies were included in the analysis (n=1,219 patients; 341 with BZI). The meta-analysis demonstrated that the RR of outcome in the BZI group compared to the no BZI group was 2.10 (95% CI 1.52–2.90). Limiting the analysis to studies including any BZI, the RR was 2.10 (95% CI 1.38–3.18). For isolated BZI, RR was 2.59 (95% CI 1.24–5.41). RR was 2.96 (95% CI 1.71–5.12) for studies only including anterior circulation stroke patients. @*Conclusion@#This systematic review and meta-analysis suggests that the presence of BZI secondary to ICAS may be an imaging biomarker that predicts neurological deterioration and/or stroke recurrence.

Timing and Predictors of Recanalization After Anticoagulation in Cerebral Venous Thrombosis / 대한뇌졸중학회지

Background@#and Purpose Vessel recanalization after cerebral venous thrombosis (CVT) is associated with favorable outcomes and lower mortality. Several studies examined the timing and predictors of recanalization after CVT with mixed results. We aimed to investigate predictors and timing of recanalization after CVT. @*Methods@#We used data from the multicenter, international AntiCoagulaTION in the Treatment of Cerebral Venous Thrombosis (ACTION-CVT) study of consecutive patients with CVT from January 2015 to December 2020. Our analysis included patients that had undergone repeat venous neuroimaging more than 30 days after initiation of anticoagulation treatment. Prespecified variables were included in univariate and multivariable analyses to identify independent predictors of failure to recanalize. @*Results@#Among the 551 patients (mean age, 44.4±16.2 years, 66.2% women) that met inclusion criteria, 486 (88.2%) had complete or partial, and 65 (11.8%) had no recanalization. The median time to first follow-up imaging study was 110 days (interquartile range, 60–187). In multivariable analysis, older age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03–1.07), male sex (OR, 0.44; 95% CI, 0.24–0.80), and lack of parenchymal changes on baseline imaging (OR, 0.53; 95% CI, 0.29–0.96) were associated with no recanalization. The majority of improvement in recanalization (71.1%) occurred before 3 months from initial diagnosis. A high percentage of complete recanalization (59.0%) took place within the first 3 months after CVT diagnosis. @*Conclusion@#Older age, male sex, and lack of parenchymal changes were associated with no recanalization after CVT. The majority recanalization occurred early in the disease course suggesting limited further recanalization with anticoagulation beyond 3 months. Large prospective studies are needed to confirm our findings.

Prospective cohort study of referred Malawian children and their survival by hypoxaemia and hypoglycaemia status

Objective To investigate survival in children referred from primary care in Malawi, with a focus on hypoglycaemia and hypoxaemia progression. Methods The study involved a prospective cohort of children aged 12 years or under referred from primary health-care facilities in Mchinji district, Malawi in 2019 and 2020. Peripheral blood oxygen saturation (SpO2) and blood glucose were measured at recruitment and on arrival at a subsequent health-care facility (i.e. four hospitals and 14 primary health-care facilities). Children were followed up 2 weeks after discharge or their last clinical visit. The primary study outcome was the case fatality ratio at 2 weeks. Associations between SpO2 and blood glucose levels and death were evaluated using Cox proportional hazards models and the treatment effect of hospitalization was assessed using propensity score matching. Findings Of 826 children recruited, 784 (94.9%) completed follow-up. At presentation, hypoxaemia was moderate (SpO2: 90­93%) in 13.1% (108/826) and severe (SpO2: < 90%) in 8.6% (71/826) and hypoglycaemia was moderate (blood glucose: 2.5­4.0 mmol/L) in 9.0% (74/826) and severe (blood glucose: < 2.5 mmol/L) in 2.3% (19/826). The case fatality ratio was 3.7% (29/784) overall but 26.3% (5/19) in severely hypoglycaemic children and 12.7% (9/71) in severely hypoxaemic children. Neither moderate hypoglycaemia nor moderate hypoxaemia was associated with mortality. Conclusion Presumptive pre-referral glucose treatment and better management of hypoglycaemia could reduce the high case fatality ratio observed in children with severe hypoglycaemia. The morbidity and mortality burden of severe hypoxaemia was high; ways of improving hypoxaemia identification and management are needed.

Efficacy and Safety of Glecaprevir/Pibrentasvir in Korean Patients with Chronic Hepatitis C: A Pooled Analysis of Five Phase II/III Trials

Background/Aims@#Glecaprevir/pibrentasvir (G/P) is the first pan-genotypic direct-acting antiviral combination therapy approved in Korea. An integrated analysis of five phase II and III trials was conducted to evaluate the efficacy and safety of G/P in Korean patients with chronic hepatitis C virus (HCV) infection. @*Methods@#The study analyzed pooled data on Korean patients with HCV infection enrolled in the ENDURANCE 1 and 2, SURVEYOR II part 4 and VOYAGE I and II trials, which evaluated the efficacy and safety of 8 or 12 weeks of G/P treatment. The patients were either treatment-naïve or had received sofosbuvir or interferon-based treatment. Efficacy was evaluated by assessing the rate of sustained virologic response at 12 weeks posttreatment (SVR12). Safety was evaluated by monitoring adverse events (AEs) and laboratory assessments. @*Results@#The analysis included 265 patients; 179 (67.5%) were HCV treatment-naïve, and most patients were either subgenotype 1B (48.7%) or 2A (44.5%). In the intention-to-treat population, 262 patients (98.9%) achieved SVR12. Three patients did not achieve SVR12: one had virologic failure and two had non-virologic failures. Most AEs were grade 1/2; eight patients (3.0%) expe-rienced at least one grade ≥3 AE. No serious AEs related to G/P treatment were reported, and grade ≥3 hepatic laboratory abnormalities were rare (0.8%). @*Conclusions@#G/P therapy was highly efficacious and well tolerated in Korean patients with HCV infection, with most patients achieving SVR12. The safety profile was comparable to that observed in a pooled analysis of a global pan-genotypic population of patients with HCV infection who received G/P.

Predicting Exertion from Metabolic, Physiological and Cognitive Variables in Older Adults / Predicción del esfuerzo con variables metabólicas, fisiológicas y cognitivas en adultos mayores / Predição do esforço com variáveis metabólicas, fisiológicas e congênitas em idosos

Abstract Objective. To determine the association between perceived exertion (RPE) and physiological variables and to determine the predictive factors of RPE during submaximal and maximal exertion in older adults. Method. Older adults from Kansas (n = 100) and Costa Rica (n = 79) performed a submaximal and maximal stress test. RPE, education level and a total score of cognitive function (CFTS) were collected. Correlation and multiple regression analyses were computed using RPE as the criterion variable and oxygen consumption (VO2), respiratory exchange ratio (RER), CFTS and education level as predictors. Results. There was a significant correlation between VEP and RER (r = 0.22, p = 0.029) at maximal exertion. The RPE predictors for women were VO2, RER, and CFTS at different stages of the test. For men, VEP was predicted by RER, education level, and VO2 at different stages. Conclusion. Metabolic and physiological variables predicted RPE in older adults. Age, cognition, and heart rate were unrelated to RPE at maximal exertion, and RER predicted RPE scores during submaximal and maximal exertion.

Resumen Objetivo. Determinar la asociación entre el esfuerzo percibido (VEP) y variables fisiológicas y determinar los factores predictivos de VEP durante el esfuerzo submáximo y máximo en adultos mayores. Método. Adultos mayores de Kansas (n = 100) y Costa Rica (n = 79) realizaron una prueba de esfuerzo submáxima y máxima. Se recopiló la VEP, nivel de educación y una puntuación total de la función cognitiva (PTFC). Se usaron análisis de correlación y regresión múltiple utilizando VEP como variable criterio y el consumo de oxígeno (VO2), tasa de intercambio respiratorio (RER), PTFC y nivel de educación como predictores. Resultados. Se encontró una correlación significativa entre la VEP y la RER (r = 0.22, p = 0.029) en el esfuerzo máximo. Los predictores de VEP para las mujeres fueron VO2, RER y PTFC en diferentes etapas de la prueba. Para los hombres, la VEP fue predicha por RER, nivel de educación y VO2 en diferentes etapas. Conclusión. Las variables metabólicas y fisiológicas predijeron los valores de VEP en adultos mayores. La edad, la cognición y la FC no se relacionaron con la VEP en el esfuerzo máximo y la RER predijo las puntuaciones de la VEP durante el esfuerzo submáximo y máximo.

Resumo Escopo. Determinar a associação entre o esforço percebido (VEP) e as variáveis fisiológicas e determinar os fatores preditivos de VEP durante o esforço submáximo e máximo em idosos. Metodologia. Idosos de Kansas (n= 100) e Costa Rica (n= 79) realizaram uma prova de esforço submáxima e máxima. Foi recopilada o VEP, nível de educação e pontuação total da função cognitiva (PTFCO. Foram usadas análises de correlação e regressão múltipla utilizando VEP como variável critério e o consumo de oxigeno (VO2), taxa de intercambio respiratório (RER), PTFC e nível de educação como preditores. Resultados. Foi encontrada uma correlação significativa entre a VEP e a RER (r = 0.22, p = 0.029)) no esforço máximo. Os preditores de VEP para as mulheres foram VO2, RER e PTFC em diferentes etapas da prova. Para os homens, a VEP foi predita por RER, nível de educação e VO2 em diferentes etapas. Conclusão. As variáveis metabólicas e fisiológicas predisseram os valores de VEP em idosos. A idade, a cognição e a FC não estiveram relacionadas com a VEP no esforço máximo e a RER predizia as pontuações da VEP durante o esforço submáximo e máximo.

Insulin use and clinical outcomes in patients undergoing coronary artery bypass graft surgery

Abstract Objective: To describe insulin use and postoperative glucose control in patients undergoing coronary artery bypass graft (CABG) surgery. Methods: We examined 2,390 patients with and without diabetes enrolled in the Contemporary Analysis of Perioperative Cardiovascular Surgical Care (CAPS-Care) Study who underwent CABG surgery (01/2004 - 06/2005) to describe postoperative insulin use, variation in insulin use across different hospitals, and associated in-hospital complications and clinical outcomes. Logistic regression was used to assess the adjusted relationship between insulin use and clinical outcomes. Results: Overall, insulin was used in 82% (n=1,959) of patients, including 95% (n=1,203) with diabetes (n=1,258) and 67% (n=756) without diabetes (n=1,132). Continuous insulin was used in 35.5% of patients in the operating room and in 56% in the intensive care unit. Continuous insulin use varied significantly among centers from 8-100% in patients with diabetes. When compared with all patients not receiving insulin, insulin use in patients without diabetes was associated with a higher rate of death or major complication (adjusted odds ratio [OR]=1.54; 95% confidence interval [CI] 1.15-2.04; P=0.003). In patients with diabetes, insulin use was not associated with a higher risk of adverse outcomes (adjusted OR=1.01; 95% CI 0.52-1.98; P=0.98). Conclusion: The postoperative use of insulin is high among CABG patients in the United States of America. Insulin use in patients without diabetes was associated with worse clinical outcomes compared to patients (both with and without diabetes) who did not receive insulin. Further investigation is needed to determine the optimal use of postoperative insulin after CABG.

A debate over the link between Salvador Allende, Max Westenhöfer, and Rudolf Virchow: contributions to the history of social medicine in Chile and internationally / Una discusión sobre el vínculo entre Salvador Allende, Max Westenhöfer y Rudolf Virchow: aportes a la historia de la medicina social chilena e internacional*

Abstract In the history of Latin American social medicine, numerous works have presented a harmonious link between Rudolf Virchow, Max Westenhöfer, and Salvador Allende, which establishes the origin of ideas of Latin American social medicine in a prestigious European source, represented by Virchow. A key to that story is that Allende was a student of Westenhöfer, a disciple of Virchow who lived in Chile three times (1908-1911, 1929-1932, and 1948-1957). Based on primary sources and contextual data, this article problematizes the relationship between Allende and Westenhöfer, and questions the influence of Virchow in Chilean social medicine.

Resumen En el marco de la historia de la medicina social latinoamericana, numerosos trabajos historiográficos han presentado un vínculo armónico entre Rudolf Virchow, Max Westenhöfer y Salvador Allende, afirmando una procedencia virtuosa de las ideas de la medicina social latinoamericana en una prestigiosa fuente europea, como es la que representa Virchow. Un dato crucial en ese relato es que Allende habría sido estudiante de Westenhöfer; un discípulo de Virchow que vivió en Chile en tres ocasiones (1908-1911, 1929-1932 y 1948-1957). Este trabajo problematiza, usando fuentes primarias y datos de contexto, la relación entre Allende y Westenhöfer, y cuestiona la influencia de Virchow sobre el pensamiento médico-social en Chile.

Analysis of Quaternary Sediments of Quartz Grains Applied to the Identification of the Environment of Some Ivory Beaches East of Abidjan (Côte d'Ivoire)

Morphoscopic and exoscopic analysis of quartz grains collected on the Ivorian beaches of the gulf of Guinea between Abidjan (Côte d'Ivoire) and Aforenou (Ghana) during topographic surveys between March 2007 and March 2009 on the examination of quartz at the binocular loupe, reveals blunting grains shining on all beaches (50% to 70%). In Abidjan area, the majority of the grains are reddish, indicates a ferrous and inherited environment. The exoscopy for the fine and detailed study of the morphology and the surface of the quartz grains was made with the Scanning Electron Microscope (SEM). This approach makes it possible to interpret traces related to events (energy level) or environments (transport, transition and storage environments). These observations indicate that the quartz after a long transport in a fluvial environment have been reworked in a marine environment. They were finally deposited in a low-energy aquatic continental medium marked by the polishing of the crystalline points and the siliceous corpuscles dotting the surface of the grains. The energy of the transport environments crossed is high in a turbulent environment through traces of shock, as large and numerous as they are. SEM examination of the samples reveals that beach quartz has generally been transported by river and recovered in an intertidal and/or subtidal environment. They have a continental and marine origin.

Lower and Upper Gastrointestinal Symptoms Differ Between Individuals With Irritable Bowel Syndrome With Constipation or Chronic Idiopathic Constipation

BACKGROUND/AIMS: We evaluated the distribution of lower and upper gastrointestinal (GI) symptoms among individuals with irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC) in a nationwide survey. METHODS: Individuals (≥ 18 years of age) were identified from a nationwide sample of > 70 000 United States adults. Participants completed the National Institutes of Health GI Patient Reported Outcomes Measurement Information System (NIH GI-PROMIS) questionnaire. Symptom frequency and intensity in the prior 7 days were assessed using validated PROMIS scores. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to compare symptom prevalence in IBS-C vs CIC, and one-way ANOVA was used to assess differences in PROMIS scores. Regression analysis was performed to adjust for demographic variables. RESULTS: Nine hundred and seventy adults met eligibility criteria (275 with IBS-C, 734 with CIC). Demographics were similar among groups except for education, marital and employment status, and income. Adjusting for demographic differences, GI-PROMIS scores of global GI symptoms were higher in IBS-C (251.1; 95% CI, 230.0–273.1) compared to CIC (177.8; 95% CI 167.2–188.4) (P < 0.001). Abdominal pain was more prevalent (OR, 4.3; 95% CI, 2.9–6.6) and more severe (P = 0.007) in IBS-C. Constipation was more severe in IBS-C (P = 0.011). Incontinence was more common (OR, 2.9; 95% CI, 1.3–6.3) but just as severe (P = 0.389) in IBS-C versus CIC. Regarding upper GI symptoms, the prevalence of dysphagia, heartburn, and nausea were similar. However, IBS-C individuals had more severe heartburn (P = 0.001). CONCLUSION: GI symptoms are generally more severe in IBS-C compared to CIC, however abdominal pain, bloating, and upper GI symptoms still commonly occur in CIC.

Destaques do VII international symposium of thrombosis and anticoagulation (ISTA) / Highlights of VII international symposium of thrombosis and anticoagulation (ISTA)

O VII Simpósio Internacional de Trombose e Anticoagulação (ISTA) foi realizado em São Paulo, SP, Brasil, nos dias 24 e 25 de outubro de 2014, tendo como principais propósitos a discussão e o compartilhamento de conhecimentos sobre os avanços recentes na abordagem diagnóstica e terapêutica de pacientes com distúrbios trombóticos, nas suas diversas formas de apresentação clínica. O programa científico deste simpósio foi cuidadosamente desenvolvido por líderes de três importantes institutos de pesquisa clínica: o Instituto Brasileiro de Pesquisa Clínica(BCRI), o Duke Clinical Research Institute (DCRI), e Instituto de Pesquisa do Hospital do Coração. Composto por dois dias de apresentações acadêmicas e discussão aberta, o simpósio teve como principal objetivo educar, motivar e inspirar os clínicos, cardiologistas, hematologistas, e outros médicos através de apresentações e discussões de aspectos práticos de condutas que envolvem síndromes relacionadas à trombose e suas respectivas terapias antitrombóticas. Estas atividades possibilitaram uma interação direta entre a plateia e o corpo de palestrantes, composto por médicos de grande experiência clínica e pelos médicos pesquisadores que desenvolveram os principais estudos publicados que guiam nossas condutas em situações relacionadas ao tema "trombose e anticoagulação". Este artigo resume os anais deste simpósio.

The VII International Symposium on Thrombosis and Anticoagulation (ISTA) was held in São Paulo, Brazil, on 24 and 25 October 2014, with the main objectives to discuss and share knowledge on recent advances in the diagnosis and management of patients with thrombotic disorders. The scientific program of this symposium was carefully developed by leaders of three major clinical research institutes: the Brazilian Institute of Clinical Research (BCRI), the Duke Clinical Research Institute from Duke University, and the Research Institute from Hospital do Coração. Comprising two days of academic presentations and open discussion, the symposium aimed to educate, motivate and inspire clinicians, cardiologists, hematologists, and other doctors through presentations and discussions of practical aspects in themes related to thrombosis and anticoagulation. These activities were presented by physicians of great clinical experience and who participated in the main publications that guide our approach on situations related to the theme "thrombosis and anticoagulation". This article summarizes the proceedings of this symposium.

Uso de agentes antiarrítmicos y resultados clínicos en pacientes añosos con fibrilación auricular y enfermedad coronaria concomitante

Objetivo: la fibrilación auricular (FA) y la enfermedad coronaria (EC) son comunes en los pacientes añosos. En este estudio nos propusimos describir el uso de agentes antiarrítmicos (AAA) y los resultados clínicos en estos pacientes. Métodos y resultados: se analizó el tratamiento con AAA y los resultados observados en 1.738 pacientes mayores (edad ³65) con FA y EC registrados en el Banco de Datos para Enfermedad Cardiovascular de Duke. Los resultados primarios fueron mortalidad y rehospitalización al año y a los cinco años. En términos generales, 35% de los pacientes recibían un AAA al inicio, 43% eran mujeres y 85% eran blancos. Fueron frecuentes los antecedentes de infarto de miocardio (IM, 31%) e insuficiencia cardíaca (41%). La amiodarona era el AAA más frecuente (21%), seguida de agentes de Clase III pura (sotalol 6,3%, dofetilida 2,2%). La persistencia de los AAA fue baja (35% al año). Luego del ajuste, el uso de AAA al inicio no se asoció con la mortalidad al año (cociente de riesgo ajustado (HR) 1,23, intervalo de confianza (IC) 95%: 0,94-1,60) o con la mortalidad cardiovascular (HR ajustado 1,27, IC 95% 0,90-1,80). Sin embargo, el uso de AAA sí se asoció con un aumento de la rehospitalización por todas las causas (HR ajustado 1,20, IC 95%: 1,03-1,39) y rehospitalización cardiovascular (HR ajustado 1,20, IC 95% 1,01-1,43) al año. Esta asociación no se mantiene a los cinco años; sin embargo, estos pacientes tuvieron un elevado riesgo de muerte (55% para los >75 años y que recibían AAA) y rehospitalización (87% para aquellos >75 años que recibían AAA) a los cinco años. Conclusiones: en pacientes añosos que padecen FA y EC, la terapia antiarrítmica se acompañó de aumento de la rehospitalización al año. En términos generales, estos pacientes presentan un alto riesgo de internación y muerte a largo plazo. Se necesitan desarrollar terapias más seguras, mejor toleradas y que brinden un control de los síntomas más eficaz en esta población de alto riesgo.

A double blind randomized clinical trial on the efficacy of citronella shampoo versus 5% permethrin lotion in the treatment of head lice infestation

@#<p style="text-align: justify;"><strong>BACKGROUND: </strong>Resistance to standard permethrin lotion has been reported. There is a continuing search for more natural and safe remedies for head lice infestation among children. Citronella, a natural repellant, has been reported as a pediculocide.<br /><strong>OBJECTIVE:</strong>To compare the efficacy of Citronella shampoo versus 5% permethrin lotion in controlling head lice (Pediculosis humanus capitis) among children between 5 years old.<br /><strong>METHODS:</strong> A double-blind randomized clinical trial was performed at the community outpatient department of MPI-Medical Center Muntinlupa Foundation, PNR (Phil. National Railway) Site Bgy. Putatan, City of Muntinlupa. Children living in areas endemic for head lice were screened, and if found positive, were randomized equally to daily citronella shampooing (CS) or permethrin lotion (PL). Subjects were manually 2nd, 7th and 14th day of treatment. Chi-square test was used to compare proportions, which considered p-values less than .05 as statistically significant.<br /><strong>RESULTS:</strong> Eighty-two children with head lice were included in the final analysis. Children in both groups were comparable in terms of age, sex, family size with head lice, anthropometric measures, frequency of bathing and shampooing and baseline severity of head lice infestation. Citronella shampoo was as effective as the standard 5% permethrin lotion in eradicating head lice in children. The cure rates were comparable for day 2 (CS=65.1% versus PL=72.1%, p=.76), day 7 (CS=65.1% versus PL= 79.1%, p=.30), and day 14 (CS=81.4% versus PL =90.7%, p=33) of treatment. There were no re-infestations and adverse reactions noted for the use of Citronella and the refragrance was more acceptable.<br /><strong>CONCLUSION:</strong> Citronella is a effective as Permethrin lotion in the eradication of headlice and Citronella shampooing can be an alternative natural remedy of headlice and Citrone for pediatric head lice.</p>

Estimating the Contribution of Acute Gastroenteritis to the Overall Prevalence of Irritable Bowel Syndrome

BACKGROUND/AIMS: Recent studies reveal that acute gastroenteritis can precipitate irritable bowel syndrome (IBS) symptoms leading to the concept of post-infectious IBS. However, the overall contribution of gastroenteritis to the total IBS prevalence is unknown. In this exercise we try to estimate the contribution of gastroenteritis in IBS using the published literature and a longitudinal approach. METHODS: Existing literature was reviewed to determine the incidence of IBS after gastroenteritis, the rate of remission over time, data on rates of gastroenteritis in a given population and any patterns of resistance to these effects in human populations. This produced 3 models. The first assumed all humans were susceptible to gastroenteritis and its ability to produce IBS. The second assumed (using meta-analysis data) that 90% of humans in a given outbreak would be resistant to this effect. The third model used a high gastroenteritis exposure rate as might be seen in military deployment. RESULTS: In model 1, the prevalence was unrealistically high with an eventual steady state of 43.6% of the population affected by IBS. In a very conservative approach (model 2), steady state was achieved after 10 years to an overall prevalence of 8.9%. Interestingly, based on a high 1 year exposure rate such as military deployment, the maximum prevalence (steady state) was reached before 1 year suggesting high risk. CONCLUSIONS: Although hypothetical in approach, based on conservative estimates in existing literature the contribution of gastroenteritis to the overall prevalence of IBS is substantial.

Regulação da expressão gênica por oxigênio em microrganismos eucariotos: análises de ESTs ("Expressed Sequence Tags") e "microrrays" de cDNA de Trichoderma reesei / Gene expression regulation by oxigen karyotype microorganisms: ESTs (

Glicose e oxigênio são moléculas essenciais para a maioria dos organismos vivos. Além de sua importância nos processos de produção de energia - glicose como fonte de carbono e energia e oxigênio como aceptor dos elétrons doados por NADH e FAD'H IND.2'- estes dois compostos funcionam como efetuadores, modulando vários processos metabólicos e fisiológicos nas células. Visto que a mitocôndria é um dos alvos afetados pelas disponibilidades destas duas moléculas, nós isolamos e seqüenciamos o genoma mitocondrial de Trichoderma reesei, um fungo multicelular empregado neste trabalho como sistema modelo. Foi estudado o efeito da variação de concentração de glicose e oxigênio sobre a expressão de transcritos do genoma mitocondrial...