Epidemiology and estimated economic impact of musculoskeletal injuries in polytrauma patients in a level one trauma centre in Singapore

INTRODUCTION@#Musculoskeletal injuries are the most common reason for surgical intervention in polytrauma patients.@*METHODS@#This is a retrospective cohort study of 560 polytrauma patients (injury severity score [ISS] >17) who suffered musculoskeletal injuries (ISS >2) from 2011 to 2015 in National University Hospital, Singapore.@*RESULTS@#560 patients (444 [79.3%] male and 116 [20.7%] female) were identified. The mean age was 44 (range 3-90) years, with 45.4% aged 21-40 years. 39.3% of the patients were foreign migrant workers. Motorcyclists were involved in 63% of road traffic accidents. The mean length of hospital stay was 18.8 (range 0-273) days and the mean duration of intensive care unit (ICU) stay was 5.7 (range 0-253) days. Patient mortality rate was 19.8%. A Glasgow Coma Scale (GCS) score <12 and need for blood transfusion were predictive of patient mortality (p < 0.05); lower limb injuries, road traffic accidents, GCS score <8 and need for transfusion were predictive of extended hospital stay (p < 0.05); and reduced GCS score, need for blood transfusion and upper limb musculoskeletal injuries were predictive of extended ICU stay. Inpatient costs were significantly higher for foreign workers and greatly exceeded the minimum insurance coverage currently required.@*CONCLUSION@#Musculoskeletal injuries in polytrauma remain a significant cause of morbidity and mortality, and occur predominantly in economically productive male patients injured in road traffic accidents and falls from height. Increasing insurance coverage for foreign workers in high-risk jobs should be evaluated.

Circulation of influenza and other respiratory viruses during the COVID-19 pandemic in Australia and New Zealand, 2020–2021

@#Objective: Circulation patterns of influenza and other respiratory viruses have been globally disrupted since the emergence of coronavirus disease (COVID-19) and the introduction of public health and social measures (PHSMs) aimed at reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. Methods: We reviewed respiratory virus laboratory data, Google mobility data and PHSMs in five geographically diverse regions in Australia and New Zealand. We also described respiratory virus activity from January 2017 to August 2021. Results: We observed a change in the prevalence of circulating respiratory viruses following the emergence of SARS-CoV-2 in early 2020. Influenza activity levels were very low in all regions, lower than those recorded in 2017–2019, with less than 1% of laboratory samples testing positive for influenza virus. In contrast, rates of human rhinovirus infection were increased. Respiratory syncytial virus (RSV) activity was delayed; however, once it returned, most regions experienced activity levels well above those seen in 2017–2019. The timing of the resurgence in the circulation of both rhinovirus and RSV differed within and between the two countries. Discussion: The findings of this study suggest that as domestic and international borders are opened up and other COVID-19 PHSMs are lifted, clinicians and public health professionals should be prepared for resurgences in influenza and other respiratory viruses. Recent patterns in RSV activity suggest that these resurgences in non-COVID-19 viruses have the potential to occur out of season and with increased impact.

Adolescent mothers, self-care and childcare: content validation of an Event History Calendar / Madres adolescentes, autocuidado y cuidado de los hijos: validación del contenido de un calendario histórico de acontecimientos / Mães adolescentes, autocuidado e cuidado infantil: validação de conteúdo de um calendário histórico de eventos

ABSTRACT Objective: To validate the content of the tool Event History Calendar Adolescent Mother: strengthening self-care and child care. Method: Methodological study using the Delphi technique, conducted in two rounds, involving 37 nursing specialists. In data collection, from December/2019 to August/2020, a semi-structured questionnaire composed of 47 items related to the two dimensions of the tool: Self-care and Child Care was used. The Content Validity Index ≥ 0.80 was used to assess agreement among the experts. Qualitative elements were analyzed for clarity and comprehensiveness of content. Results: In the first round, 46 items showed Content Validity Index ≥ 0.80. The qualitative elements pointed out more clarity for the adolescent audience. After the changes, the tool presented 30 items. In the second round, the 30 items evaluated achieved Content Validity Index ≥ 0.80. The qualitative considerations were translated into modifications in the content and sequence in the final version of the tool. Conclusion: The validated tool obtained adequate evaluation of the items of each dimension, related to adolescent mother self-care and child care, with a high degree of comprehensibility.

RESUMEN Objetivo: Validar el contenido de la herramienta Event History Calendar Madre Adolescente: fortaleciendo el autocuidado y el cuidado de los hijos. Método: Estudio metodológico mediante la técnica Delphi, realizado en dos rondas, en el que participaron 37 expertos en enfermería. En la recopilación de datos, de diciembre de 2019 a agosto de 2020, se utilizó un cuestionario semiestructurado compuesto por 47 ítems relacionados con dos dimensiones de la herramienta: Autocuidado y Cuidado del niño. Se utilizó el Índice de Validez del Contenido ≥ 0,80 para evaluar el acuerdo entre los expertos. Se analizaron los elementos cualitativos para comprobar la claridad y exhaustividad del contenido. Resultados: En la primera ronda, 46 ítems presentaron Índice de Validez de Contenido ≥ 0,80. Los elementos cualitativos apuntan a la necesidad de una mayor claridad para el público adolescente. Tras los cambios, la herramienta presentaba 30 ítems. En la segunda ronda, los 30 ítems evaluados alcanzaron un Índice de Validez de Contenido ≥ 0,80. Las consideraciones cualitativas se tradujeron en modificaciones del contenido y la secuencia en la versión final de la herramienta. Conclusión: El instrumento validado obtuvo evaluación adecuada de los ítems de cada dimensión, relacionados al autocuidado de la madre adolescente y al cuidado del niño, con alto grado de comprensibilidad.

RESUMO Objetivo: Validar o conteúdo da ferramenta Event History Calendar Mãe Adolescente: fortalecendo o autocuidado e o cuidado da criança. Método: Estudo metodológico com a técnica Delphi, realizado em duas rodadas, envolvendo 37 especialistas de enfermagem. Na coleta de dados, de dezembro/2019 a agosto/2020, foi utilizado um questionário semiestruturado composto por 47 itens relacionados às duas dimensões da ferramenta: Autocuidado e Cuidado da criança. O Índice de Validade de Conteúdo ≥ 0,80 foi utilizado para avaliar a concordância entre os especialistas. Elementos qualitativos foram analisados quanto à clareza e abrangência do conteúdo. Resultados: Na primeira rodada, 46 itens apresentaram Índice de Validade de Conteúdo ≥ 0,80. Os elementos qualitativos apontaram necessidade de maior clareza para o público adolescente. Após as alterações, a ferramenta apresentou 30 itens. Na segunda rodada, os 30 itens avaliados alcançaram Índice de Validade de Conteúdo ≥ 0,80. As considerações qualitativas foram traduzidas em modificações no conteúdo e sequência na versão final da ferramenta. Conclusão: A ferramenta validada obteve avaliação adequada dos itens de cada dimensão, relacionados ao autocuidado da mãe adolescente e cuidado da criança, com alto grau de compreensibilidade.

La epilepsia mioclónica juvenil y las disfunciones neurocognitivas y ejecutivas asociadas / Juvenile myoclonic epilepsy and associated neurocognitive and executive dysfunctions

Resumen La epilepsia mioclónica juvenil (EMJ) es un trastorno benigno con buena respuesta a la medicación antiepiléptica. Evaluaciones neuropsicológicas revelaron trastornos cognitivos leves. El objetivo de este estudio es determinar el desempeño cognitivo y síntomas anímicos de la EMJ comparados con controles normales. Se evaluaron en forma prospectiva 30 pacientes con EMJ y 29 controles pareados por edad, género, y escolaridad. Se analizaron las características clínicas de la EMJ. Se administró una batería cognitiva completa, un cuestionario auto-administrado de dificultades ejecutivas (DEX), un inventario de depresión validado para epilepsia NDDI-E, escala de depresión de Beck (BDI), escala de ansiedad (GAD-7) y escala de riesgo de suicidio (MINI). Sin diferencias significativas en edad y escolaridad ent re EMJ y controles. Tiempo medio de evolución de la enfermedad, 18 años. El 53% presentó tres tipos de crisis, mioclonías, ausencias y convulsiones tónico-clónicas generalizadas. Hubo diferencias significativas con mayores fallas en atención, funciones ejecutivas, un puntaje significativamente mayor en el DEX en pacientes con EMJ. Se encontró un mayor puntaje en el NDDI-E, BDI y GAD-7 en EMJ. No se hallaron diferencias en el riesgo de suicidio respecto a controles. El estudio confirma que la EMJ presenta mayores fallas en el funcionamiento atencional y las habilidades ejecutivas relacionadas con la flexibilidad e inhibición, siendo en la mayoría de los casos los pacientes conscientes de sus dificultades. Conocer estas dificultades permitirá un mejor abordaje terapéutico, y mejorar síntomas muchas veces desestimados.

Abstract Juvenile myoclonic epilepsy (JME) is a benign disorder with a good response to antiepileptic drugs. Neurop sychological evaluations revealed mild cognitive deficits. The objective of this study is to determine the cognitive profile and mood symptoms in JME compared to normal controls. 30 patients with JME and 29 controls matched for age, gender, and education level were prospectively evaluated. The clinical characteristics were analysed. They were given a complete cognitive battery, a self-administered questionnaire of executive difficulties (DEX), the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Beck Depression Inventory (BDI), Generalized Anxiety Disorder Scale (GAD-7) and suicide risk scale (MINI). No significant differences in age and education were observed between JME and controls. Average time of evolution of the disease 18 years, 53% have three types of seizures: myoclonic, absence seizures and tonic-clonic seizures. Significant differences were found with greater failures in attention, executive function, a significantly higher score values in DEX in JME subjects. A higher score was found in the NDDI-E; BDI and GAD-7. No differences were found in the risk of suicide with respect to controls. The study confirms that JME presents greater failures in attentional functioning and executive skills related to flexibility and inhibition, with patients being aware of their difficulties in most cases. Knowing these difficulties would allow a better therapeutic approach to improve symptoms usually dismissed.

Tumor neuroendocrino y terapia con lutecio / Neuroendocrine tumor and lutetium therapy / Tumor neuroendócrino e terapia com lutecio

Resumen: Introducción: los tumores neuroendocrinos gastroenteropancreáticos (GEP-NET) son un grupo diversos de tumores de origen en las células neuroendocrinas, la mayoría son esporádicos. Se clasifican según origen, secreción hormonal y diferenciación celular. El tratamiento con péptidos radiomarcados o Peptide Receptor Radionuclide Therapy (PRRT) con lutecio 177-DOTATATE fue aprobado por la FDA en el 2018, ya que ha mostrado buenos resultados en tumores avanzados comparado con otras terapias. Presentamos un caso de una paciente con tumor neuroendocrino pancreático con secundarismo hepático tratada con este fármaco. Caso clínico: paciente de sexo femenino de 65 años, portadora de un tumor neuroendocrino pancreático con secundarismo hepático diagnosticado por biopsia y con expresión de receptores de somatostatina. Por su extensión lesional se indica tratamiento médico con análogos de somatostatina que son mal tolerados, tras lo cual se plantea quimioterapia (QT), con progresión tumoral bajo tratamiento. Dada la mala evolución se inicia tratamiento con PRRT como es lutecio 177-DOTATATE. Se observó que los ciclos con lutecio 177-DOTATATE lograron una disminución mínima del tamaño y de la captación tumoral a nivel pancreático, las metástasis hepáticas no presentaron cambios, y la paciente persistió clínicamente estable. Conclusión: El tratamiento con lutecio 177-DOTATATE en una paciente con un tumor neuroendocrino no funcionante con metástasis, irresecable quirúrgicamente, produjo una respuesta aceptable para un tratamiento paliativo, ya que no se produjo progresión tumoral. La paciente persiste clínicamente estable, asintomática, con un seguimiento a 8 años. El tratamiento con lutecio 177-DOTATATE es una opción efectiva con efectos adversos limitados en tumores GEP-NET irresecables o con metástasis.

Summary: Introduction: gastroenteropancreatic neuroendocrine neoplasms (GEP-NET) are a group of several tumors originated in neuroendocrine cells, most of which are sporadic. These tumors are classified according to hormone secretion and cell differentiation. Treatment with radiomarked peptides or Peptide Receptor Radio- nuclide Therapy (PRRT) with lutetium 177-DOTATATE was approved by the FDA in 2018, since it has evidenced good results in advanced tumors compared to other therapies. The study presents the case of a patient with a pancreatic neuroendocrine tumor with secondary hepa tic disease who was treated with this drug. Clinical case: 65-year-old female patient carrier of a pancreatic neuroendocrine tumor with secondary hepatic disease who was diagnosed with a biopsy and presented somatostatin receptor (SSTR) expression. Given the extension of the lesion, medical treatment is indicated with somatostatin analogues that are poorly tolerated. Consequently, chemotherapy is indicated, with low performance tumor progression. Given the poor outcome, PRRT treatment as lutetium 177-DOTATATE is initiated. Cycles with lutetium 177-DOTATATE were observed to cause a minimum reduction in size and tumor uptake in the liver. Liver metastases evidenced no change and the patient remained clinically stable. Conclusion: lutetium 177-DOTATATE therapy in a patient with a metastatic nonfunctioning neuroendocrine tumor, that could not be surgically resected produced an acceptable response for palliative treatment, since the tumor failed to progress. The patient continues to be clinically stable, asymptomatic, after 8 years of follow-up. Lutetium 177-DOTATATE therapy constitutes an effective option with limited side effects in unresectable GEP-NET tumors, or in the presence of metas tases.

Resumo: Introdução: os tumores neuroendócrinos gastroenteropancreáticos (GEP-NET) são um grupo diverso de tumores de origem em células neuroendócrinas, a maioria das quais esporádicos. São classificados de acordo com a origem, secreção hormonal e diferenciação celular. O tratamento com peptídeos radiomarcados ou terapia com radionuclídeos com receptor de peptídeos (PRRT) com 177 Lutecio-Dotatate foi aprovado pela FDA em 2018, pois mostrou bons resultados em tumores avançados em comparação com outras terapias. Apresentamos o caso de um paciente com tumor neuroendócrino pancreático com secundarismo hepático tratado com esse medicamento. Caso clínico: paciente do sexo feminino, 65 anos, portadora de tumor neuroendócrino pancreático com doença hepática secundária diagnosticada por biópsia e com expressão de receptores de somatostatina. Devido à extensão da lesão, o tratamento clínico é indicado com análogos da somatostatina que são pouco tolerados, após o que se considera a quimioterapia (TC), com progressão do tumor em tratamento. Dada a má evolução, foi iniciado tratamento com PRRT, como o 177 Lutecio-Dotatate. Observou-se que os ciclos com 177 Lutecio-Dotatate obtiveram diminuição mínima no tamanho e captação do tumor em nível pancreático, as metástases hepáticas não apresentaram alterações e o paciente manteve-se clinicamente estável. Conclusão: o tratamento com 177Lutecio-Dotatate em um paciente com tumor neuroendócrino não funcionante com metástases, não ressecável cirurgicamente, produziu uma resposta aceitável para o tratamento paliativo, uma vez que não ocorreu progressão do tumor. O paciente permanece clinicamente estável, assintomático, com seguimento de 8 anos. O tratamento com 177Lu-Dotatate é uma opção eficaz com efeitos adversos limitados em tumores GEP-NET não ressecáveis ou metastáticos.

Pituitary tumor resection in a patient with SARS-CoV-2 (COVID-19) infection. A case report and suggested airway management guidelines / Assistência perioperatória de paciente com infecção pelo SARS-CoV-2 (COVID-19) submetido a ressecção de tumor de hipófise urgente. Relato de caso e diretrizes para manejo de via aérea

Abstract The 2020 pandemic caused by the novel coronavirus, COVID-19, had its headquarters in China. It causes Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and presents a broad spectrum of clinical manifestations, ranging from entirely asymptomatic through severe acute respiratory failure and death. Presuming a significant quantity of ventilator-dependent patients, several institutions strategically delayed elective surgeries. Particularly procedures performed involving the nasal mucosa, such as a transsphenoidal approach of the pituitary gland, considering the tremendous level of viral shedding. Nevertheless, critical cases demand expeditious resolution. Those situations are severe pituitary apoplexy, declining consciousness level, or risk of acute visual loss. This case presents a successful urgent perioperative management of a 47 year-old male COVID-19 positive patient who presented to the Emergency Department with a left frontal headache that culminated with diplopia, left eye ptosis, and left visual acuity loss after 5 days. Transsphenoidal hypophysectomy was uneventfully performed, and the patient was discharged from the hospital on postoperative day four. It additionally describes in detail the University of Mississippi Medical Center airway management algorithm for patients infected with the novel coronavirus who need emergent surgical attention.

Resumo A pandemia de 2020 causada pelo novo coronavírus, COVID-19, teve seu epicentro na China. Causa Síndrome Respiratória Aguda Grave pelo Coronavírus 2 (SARS-CoV-2) e apresenta um amplo espectro de manifestações clínicas, que vão desde nenhum sintoma a insuficiência respiratória aguda grave e óbito. Com a expectativa de um número significativo de pacientes dependentes de ventilador, várias instituições estrategicamente adiaram cirurgias eletivas. Esse é o caso principalmente de procedimentos envolvendo a mucosa nasal, como a via transesfenoidal para a hipófise, devido ao nível imenso de disseminação de material viral. Não obstante, casos críticos requerem resolução acelerada. Essas situações são grave apoplexia hipofisária, diminuição do nível de consciência ou risco de perda visual aguda. O presente caso relata o manejo perioperatório bem sucedido de urgência de paciente do sexo masculino de 47 anos de idade com COVID-19 que chegou ao Pronto Socorro com cefaleia frontal à esquerda que culminou com diplopia, ptose do olho esquerdo e perda de acuidade visual à esquerda após 5 dias. A hipofisectomia transesfenoidal ocorreu sem intercorrências e o paciente recebeu alta do hospital no quarto dia do pós-operatório. Adicionalmente, descrevemos em detalhe o algoritmo de manejo de via aérea da University of Mississippi Medical Center para pacientes infectados pelo novo coronavírus e que necessitam de atenção cirúrgica de emergência.

Sesenta y cuatro nuevos registros para la flora del Perú a través de inventarios biológicos rápidos en la Amazonía peruana

Durante el período 2000 - 2016, se llevaron a cabo 15 inventarios biológicos en áreas remotas en el pie de monte andino y el llano amazónico del Perú. En estos inventarios, 27 botánicos colectaron un total de 9397 especímenes de plantas vasculares fértiles. Hasta finales del 2017, más de la mitad de estos especímenes se han identificado a nivel de especie, de los cuales 64 especies y 2 géneros (Dicorynia y Monopteryx) representan nuevos registros para la flora del Perú. Si esta tasa de novedades se mantiene, el número de registros nuevos en el material de los inventarios podría aumentar, lo cual nos indica que aún queda mucho por descubrir en la flora andino-amazónica del Perú.

Between 2000 and 2016 we carried out 15 rapid biological inventories in remote areas of the Andean foothills and Amazon basin in Peru. During these inventories, 27 botanists collected 9397 fertile vascular plant specimens. By the end of 2017, more than half of these specimens had been identified to species. Of the 2303 species identified to date, 64 species and 2 genera (Dicorynia and Monopteryx) are new records for the flora of Peru. If this rate of discovery proves typical, the number of new records for Peru in the rapid inventory material could increase, which indicates that there is still much to discover in the Peruvian flora.

Cytotoxic effects of Euterpe oleraceae fruit oil (açaí) in rat liver and thyroid tissues

Abstract Euterpe oleracea Mart., Arecaceae, fruit (açaí) presents considerable potential for the development of new medicines due to its phytochemical composition and antioxidant activity. More recently, special attention has been given to the pharmacological potential of the fruit's oil. This study analysed the histological and histochemical effects of different dosages of açaí oil on rat's liver and thyroid cells, in order to evaluate its cytotoxic potential after administration for consecutive days. Male Wistar rats were treated with the açaí oil by gavage at doses of 30, 100 and 300 mg/kg, for 14 days, within a 24 h interval. Liver and thyroid fragments were collected for histology (hematoxylin and eosin) and histochemistry analysis (blue of Nilo (lipids), Baker (lipids), bromophenol blue (protein), PAS (polysaccharides)). The results showed that animals exposed to açaí oil presented alterations in the liver cells, where the integrity of the liver tissue was increasingly lost as the açaí oil doses increased. Nuclear pyknosis was observed in several hepatocytes, evidencing the occurrence of cell death. Alteration in the amount of lipids, polysaccharides, vacuoles in the cytoplasm, and proliferation of Kupffer cells were observed in histochemical analyzes. As for the thyroid of the treated rats, alterations were observed in the size of the follicular lumen and also in the connective tissue found between the follicles. Under the experimental conditions employed in the present study, the cytotoxicity observed in this work is worrying, specially considering the liver, when frequent or continuous damage could lead pathological disorders in this organ.

Translation, cross-cultural adaptation, and reliability of the Understanding COPD questionnaire for use in Brazil / Tradução, adaptação transcultural e confiabilidade do questionário Understanding COPD para uso no Brasil

ABSTRACT Objective: To translate the Understanding COPD (UCOPD) questionnaire into Portuguese, adapt it for use in Brazil, and assess its reliability. Methods: The UCOPD questionnaire consists of two sections, designated section A and section B. Section A comprises 18 items divided into three domains: "About COPD", "Managing Symptoms of COPD", and "Accessing Help and Support". Section B includes five questions regarding patient satisfaction with the educational component of pulmonary rehabilitation programs. The UCOPD questionnaire was applied twice on the same day by two different raters (with a 10-min interval between applications) and once again 15-20 days later. The Wilcoxon test was used in order to compare the scores among applications. Reliability was assessed by the intraclass correlation coefficient and Bland-Altman plots. Results: The study sample consisted of 50 COPD patients (35 men; mean age, 65.3 ± 7.91 years; mean FEV1, 36.4 ± 16.2% of the predicted value). Inter-rater intraclass correlation coefficients for section A total scores and domain scores ranged from moderate to high. Section A scores and domain scores had no significant differences regarding test-retest reliability (p < 0.05). The test-retest and inter-rater Cronbach's alpha coefficients for section A total scores were 0.93 and 0.86, respectively (p < 0.001). There were no floor or ceiling effects. Conclusions: The Brazilian Portuguese version of the UCOPD questionnaire is reliable.

RESUMO Objetivo: Traduzir o questionário Understanding COPD (UCOPD) para o português, adaptá-lo para uso no Brasil e avaliar sua confiabilidade. Métodos: O questionário UCOPD é dividido em duas seções, denominadas seção A e seção B. A seção A compreende 18 itens, divididos em três domínios: "Sobre a DPOC", "Manejo dos Sintomas da DPOC" e "Acesso a Ajuda e Suporte". A seção B inclui cinco itens referentes à satisfação do paciente com o componente educacional dos programas de reabilitação pulmonar. O questionário UCOPD foi aplicado duas vezes no mesmo dia por dois observadores diferentes (com 10 min de intervalo entre uma aplicação e outra) e mais uma vez 15-20 dias depois. O teste de Wilcoxon foi usado para comparar a pontuação obtida em cada aplicação. A confiabilidade foi avaliada por meio do coeficiente de correlação intraclasse e de gráficos de dispersão de Bland-Altman. Resultados: A amostra foi composta por 50 pacientes com DPOC (35 homens; média de idade = 65,3 ± 7,91 anos; média do VEF1 = 36,4 ± 16,2% do valor predito). Os coeficientes de correlação intraclasse referentes à análise interobservador da pontuação total da seção A e seus domínios variaram de moderados a elevados. A pontuação obtida na seção A e em seus domínios não apresentou diferenças significativas quanto à confiabilidade teste-reteste (p < 0,05). Os coeficientes alfa de Cronbach de teste-reteste e interobservador referentes à pontuação total da seção A foram de 0,93 e 0,86, respectivamente (p < 0,001). Não foram observados efeitos de piso ou teto. Conclusões: A versão em português do Brasil do questionário UCOPD é confiável.

A comparison of Streptococcus agalactiae septic arthritis and non-Streptococcus agalactiae septic arthritis

<p><b>INTRODUCTION</b>Streptococcus agalactiae (Group B Streptococcus, GBS) is an uncommon cause of septic arthritis in the adult population. In recent years, there has been an increase in the incidence of GBS septic arthritis. This study aims to compare the clinical presentation, investigations, microbiology and outcome of management in patients with GBS and non-GBS septic arthritis.</p><p><b>METHODS</b>Retrospective review of hospital surgical records was done to identify all patients treated surgically at our institution from January 2011 to January 2016 for primary septic arthritis. Patients were categorised into two groups: those with culture-proven GBS septic arthritis and those with causative pathogens that were not GBS. Patients who were medically unfit for surgical intervention as well as those who declined interventional procedures were excluded from the study.</p><p><b>RESULTS</b>A total of 83 patients were included in the study: 62 (74.7%) had non-GBS septic arthritis and 21 (25.3%) had GBS septic arthritis. Patients with GBS septic arthritis were more likely to have polyarticular involvement (p < 0.001) and involvement of less common sites such as the elbow joint. They were also more likely to have elevated inflammatory markers (C-reactive protein > 150 mg/L; p = 0.017) and positive blood cultures (p = 0.02), and were typically healthy adults with no medical comorbidities (p = 0.012).</p><p><b>CONCLUSION</b>Patients with GBS septic arthritis were more likely to present with polyarticular involvement, positive blood cultures and higher levels of C-reactive protein on admission, and tended to be healthier individuals with no medical comorbidities.</p>

Nursing strategies for child health surveillance / Estratégias de enfermeiros para a vigilância à saúde da criança / Estrategias de enfermeros para la vigilancia a la salud del niño

ABSTRACT Objective: to appreciate the strategies promoted by nurses in the context of child health surveillance relevant to early childhood development. Method: this is a qualitative study with an inductive thematic analysis of the data, based on the conceptual principles of child health surveillance, and developed through semi-structured interviews with Brazilian nurses working with families in primary health care. Results: the nurses' strategies in favor of child health surveillance focus on actions that anticipate harm with continuous follow-up and monitoring of health indicators. The process of child growth and development is the basis for responses and benefits to health, connection with the daily lives of families, active search, articulations between professionals and services, access to comprehensive care, and intrinsic actions between promotion, prevention and health follow-up. Conclusion: child health surveillance actions developed by nurses with families involve knowledge sharing, favor the resolution of problems, increase child health indicators, and strengthen the relationship between health and children's rights, which support the promotion of development in early childhood.

RESUMO Objetivo: apreender as estratégias impulsionadas por enfermeiros no contexto da vigilância à saúde da criança, relevantes ao desenvolvimento na primeira infância. Método: estudo qualitativo, com análise temática indutiva dos dados, fundamentado nos princípios conceituais da vigilância à saúde da criança, a partir de entrevistas semiestruturadas gravadas com enfermeiras brasileiras que atuam com famílias, no âmbito da atenção primária à saúde. Resultados: as estratégias das enfermeiras a favor da vigilância à saúde da criança focam em ações que se antecipam aos danos com acompanhamento contínuo e monitorização de indicadores de saúde. O processo de crescimento e desenvolvimento da criança é a base para respostas e benefícios à saúde, conexão com o cotidiano das famílias, busca ativa, articulações entre profissionais e serviços, acesso a cuidado abrangente, ações intrínsecas entre promoção, prevenção e seguimento da saúde. Conclusão: as ações em vigilância à saúde da criança, que os enfermeiros realizam com e junto às famílias, envolvem compartilhamento de saberes, favorecem a resolutividade, incrementam os indicadores de saúde infantil e estreitam relações entre saúde e direitos da criança, as quais sustentam a promoção do desenvolvimento na primeira infância.

RESUMEN Objetivo: aprovechar las estrategias impulsadas por enfermeros en el contexto de la vigilancia a la salud del niño, relevantes al desarrollo en la primera infancia. Método: estudio cualitativo, con análisis temática inductiva de los datos, fundamentado en los principios conceptuales de la vigilancia a la salud del niño, a partir de entrevistas semi-estructuradas grabadas con enfermeras brasileras que actúan con familias, en el ámbito de la atención primaria a la salud. Resultados: las estrategias de las enfermeras a favor de la vigilancia a la salud del niño enfocan en acciones que se anticipan a los daños con acompañamiento continuo y monitoreo de indicadores de salud. El proceso de crecimiento y desarrollo del niño es la base para respuestas y beneficios a la salud, conexión con lo cotidiano de las familias, busca activa, articulaciones entre profesionales y servicios, acceso a cuidado completo, acciones intrínsecas entre promoción, prevención y seguimiento de la salud. Conclusión: las acciones de vigilancia a la salud del niño, que los enfermeros realizan con y junto a las familias, implican compartir saberes, favorecen la resolución, incrementan los indicadores de salud infantil y estrechan relaciones entre salud y derechos del niño, los cuales sustentan la promoción del desarrollo en la primera infancia.

Current Concepts in Non-Gastrointestinal Stromal Tumor Soft Tissue Sarcomas: A Primer for Radiologists

Non-gastrointestinal stromal tumor (GIST) soft tissue sarcomas (STSs) are a heterogeneous group of neoplasms whose classification and management continues to evolve with better understanding of their biologic behavior. The 2013 World Health Organization (WHO) has revised their classification based on new immunohistochemical and cytogenetic data. In this article, we will provide a brief overview of the revised WHO classification of soft tissue tumors, discuss in detail the radiology and management of the two most common adult non-GIST STS, namely liposarcoma and leiomyosarcoma, and review some of the emerging histology-driven targeted therapies in non-GIST STS, focusing on the role of the radiologist.

Update on Gastrointestinal Stromal Tumors for Radiologists

The management of gastrointestinal stromal tumors (GISTs) has evolved significantly in the last two decades due to better understanding of their biologic behavior as well as development of molecular targeted therapies. GISTs with exon 11 mutation respond to imatinib whereas GISTs with exon 9 or succinate dehydrogenase subunit mutations do not. Risk stratification models have enabled stratifying GISTs according to risk of recurrence and choosing patients who may benefit from adjuvant therapy. Assessing response to targeted therapies in GIST using conventional response criteria has several potential pitfalls leading to search for alternate response criteria based on changes in tumor attenuation, volume, metabolic and functional parameters. Surveillance of patients with GIST in the adjuvant setting is important for timely detection of recurrences.

Why Do Some People Choose Opportunistic Rather Than Organized Cancer Screening? The Korean National Health and Nutrition Examination Survey (KNHANES) 2010-2012 / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Although the Korean government has implemented a universal screening program for common cancers, some individuals choose to participate in opportunistic screening programs. Therefore, this study was conducted to identify factors contributing to the selection of organized versus opportunistic screening by the Korean general population. MATERIALS AND METHODS: Data from 11,189 participants aged ≥ 40 yearswho participated in the fifth Korean National Health and Nutrition Examination Survey (2010-2012) were analyzed in this study. RESULTS: A total of 6,843 of the participants (58.6%) underwent cancer screening, of which 6,019 (51.1%) participated in organized and 824 (7.5%) participated in opportunistic screening programs. Being female, older, highly educated, in the upper quartile of income, an ex-smoker, and a light drinker as well as having supplementary private health insurance and more comorbid conditions and engaging in moderate physical activity 1-4 days per week were related to participation in both types of screening programs. Being at least a high school graduate, in the upper quartile for income, and a light drinker, as well as having more comorbid conditions and engaging in moderate physical activities 1-4 days per week had a stronger effect on those undergoing opportunistic than organized screening. CONCLUSION: The results of this study suggest that socioeconomic factors such as education and income, as well as health status factors such as health-related quality of life and number of comorbid conditions and health behaviors such as drinking and engaging in moderate physical activity 1-4 days per week had a stronger influence on participation in an opportunistic than in an organized screening program for cancer.

Why Do Some People Choose Opportunistic Rather Than Organized Cancer Screening? The Korean National Health and Nutrition Examination Survey (KNHANES) 2010-2012 / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Although the Korean government has implemented a universal screening program for common cancers, some individuals choose to participate in opportunistic screening programs. Therefore, this study was conducted to identify factors contributing to the selection of organized versus opportunistic screening by the Korean general population. MATERIALS AND METHODS: Data from 11,189 participants aged ≥ 40 yearswho participated in the fifth Korean National Health and Nutrition Examination Survey (2010-2012) were analyzed in this study. RESULTS: A total of 6,843 of the participants (58.6%) underwent cancer screening, of which 6,019 (51.1%) participated in organized and 824 (7.5%) participated in opportunistic screening programs. Being female, older, highly educated, in the upper quartile of income, an ex-smoker, and a light drinker as well as having supplementary private health insurance and more comorbid conditions and engaging in moderate physical activity 1-4 days per week were related to participation in both types of screening programs. Being at least a high school graduate, in the upper quartile for income, and a light drinker, as well as having more comorbid conditions and engaging in moderate physical activities 1-4 days per week had a stronger effect on those undergoing opportunistic than organized screening. CONCLUSION: The results of this study suggest that socioeconomic factors such as education and income, as well as health status factors such as health-related quality of life and number of comorbid conditions and health behaviors such as drinking and engaging in moderate physical activity 1-4 days per week had a stronger influence on participation in an opportunistic than in an organized screening program for cancer.

Evolving Cancer Classification in the Era of Personalized Medicine: A Primer for Radiologists

Traditionally tumors were classified based on anatomic location but now specific genetic mutations in cancers are leading to treatment of tumors with molecular targeted therapies. This has led to a paradigm shift in the classification and treatment of cancer. Tumors treated with molecular targeted therapies often show morphological changes rather than change in size and are associated with class specific and drug specific toxicities, different from those encountered with conventional chemotherapeutic agents. It is important for the radiologists to be familiar with the new cancer classification and the various treatment strategies employed, in order to effectively communicate and participate in the multi-disciplinary care. In this paper we will focus on lung cancer as a prototype of the new molecular classification.

Tuberculosis colónica: A propósito de un caso / Colonic tuberculosis: Report of a case

La tuberculosis (TB) es una enfermedad causada por una bacteria alcohol-ácido resistente, el Mycobacterium tuberculosis (MT). Se estima que en la actualidad un tercio de la población mundial está infectada con este bacilo,1,2 sin embargo, no todos los individuos infectados tienen enfermedad clínica, presentándose esta cuando el sistema inmune está comprometido. Esta enfermedad puede comprometer diferentes aparatos y sistemas, con afección principalmente pulmonar. La TB intestinal representa el 3 al 5% de todas las manifestaciones extrapulmonares.2,3,4 Para el diagnóstico de TB en colon se requiere un alto índice de sospecha por ser el colon un sitio que se afecta poco y porque los síntomas no son específicos.5,6 Presentamos el caso clínico de un paciente ingresado por TB pulmonar a quien solicitan interconsulta a gastroenterología por examen de sangre oculta positivo, realizándosele colonoscopia con toma de biopsia que concluye TB de colon.

Tuberculosis (TB) is a disease caused by an acid-alcohol resistant bacteria, Mycobacterium tuberculosis (MT). It is estimated that currently one third of the world population is infected with this bacillus, however, not all individuals infected develop the clinical disease, presenting this when the immune system is compromised. This disease may involve different organ systems with mainly pulmonary condition and intestinal TB accounts for 3 to 5% of all extrapulmonary manifestations.2,3,4 The diagnosis of TB in colon requires a high index of suspicion for being the colon a site that has little affection and because the symptoms are not specific.5,6 We report a case of a patient admitted for pulmonary TB who had positive occult blood test, they request evaluation to Gastroenterology performing a colonoscopy with biopsy that report colon TB.

Manifestaciones extraintestinales en rectocolitis úlcerativa: a propósito de un caso / Extraintestinal manifestations in ulcerative proctocolitis: a case report

La colitis ulcerativa (CU) forma más común de la enfermedad inflamatoria intestinal (EII),¹ es una enfermedad crónica que cursa con inflamación recurrente no controlada del colon,² caracterizada por ulceración de la mucosa, sangrado rectal, diarrea y dolor abdominal.³ Un tercio de los pacientes pueden desarrollar una manifestación extraintestinal.4,5 En la CU estas manifestaciones suelen estar relacionadas con la actividad de la enfermedad.5,6 Presentamos un caso clínico de una paciente con CU quien presenta manifestaciones extraintestinales cutáneas, oculares y en mucosa bucal, con resolución de las mismas posterior a tratamiento médico

Ulcerative colitis (UC) the most common form of inflammatory bowel disease (IBD),¹ is a chronic disease that causes uncontrolled recurrent inflammation of the colon,² characterized by mucosal ulceration, rectal bleeding, diarrhea and abdominal pain.³ A third of patients may develop extraintestinal manifestation.4,5 In UC these manifestations are often associated with disease activity.5,6 We present a case of a patient with UC who presented extraintestinal cutaneous, ocular and oral mucosa, with resolution of the same post-treatment

Intergenerational Differences in Materialist and Post-materialist Values in a Sample of Hispanic New York City Residents / Diferencias intergeneracionales en valores materialistas y post-materialistas en una muestra de residentes hispanos de la ciudad de Nueva York

The present study evaluates the personal values reported by a sample of New York Hispanic residents using an open evaluation format in which the participants identified and prioritized their personal values. Four hundred and forty-five participants were assigned to one of three groups: Young (N= 159), Adult (N= 168) and Senior (N= 118). The values reported were categorized into post-materialist, materialist or non-classifiable. The Percentage Difference Index between post-materialist and materialist values was calculated in order to determine the value profile for each age group. The results showed that reports of personal values and values attributed to the participants' own generation were similar in Adult and Senior groups, but were very different in the Young Group, with a differential report of post-materialist values. Furthermore, exposure to American culture did not appear to have a significant effect on the reported values of NYC Hispanics. To confirm these findings, we need to conduct additional studies with larger samples of culturally diverse populations.

Se exploran los valores en una muestra de hispanos de New York, empleando un formato abierto en el que los participantes identifican y priorizan su valores personales y los de su generación. Los 445 participantes se distribuyeron en tres grupos: Jóvenes (N = 159), Adultos (N = 168) y Mayores (N = 118). Los informes de valores se categorizaron como postmaterialistas, materialistas o no clasificables, y se calculó el Percentage Difference Index entre valores postmaterialistas y materialistas para determinar el perfil de valores de cada grupo. Los resultados mostraron que los informes de valores personales y generacionales fueron similares en los grupos Adulto y Mayor, y diferentes en el Grupo Joven con un reporte diferencial entre valores personales y generacionales. Por otro lado, el tiempo vivido bajo la influencia de la cultura norteamericana parece no tener un efecto significativo en el informe de valores para esta población. Para confirmar estos hallazgos son necesarios estudios adicionales con muestras más amplias y en poblaciones culturalmente diversas.

Maxillaria jostii Dodson (Orchidaceae) un nuevo registro para la Flora del Perú

Se presenta a Maxillaria jostii Dodson (Orchidaceae) como una nueva adición a la Flora del Perú procedente de los substratos de roca arenisca de la Cordillera subandina de Huarango (provincia San Ignacio, departamento Cajamarca), una prolongación sureña de la Cordillera del Cóndor rica en especies. Maxillaria jostii ha sido considerada como una especie endémica para Ecuador (Zamora-Chinchipe, Morona-Santiago); sin embargo, con el presente estudio se amplía su distribución geográfica hacia el Perú. Esta nueva contribución al conocimiento de la flora del país es el resultado del trabajo de campo y de herbario, gracias al Proyecto Binacional «Inventario Botánico de la Región de la Cordillera del Cóndor, Ecuador y Perú, 2005-2007», desarrollado entre las instituciones: MO, HUT, LOJA y QCNE. La contrastación específica se realizó con las especies documentadas en el «Catálogo de las Angiospermas y Gimnospermas del Perú» (Brako & Zarucchi 1993), «Diez años de adiciones a la flora del Perú: 1993-2003» (Ulloa Ulloa et al. 2004) y «Nuevas Adiciones de Angiospermas a la Flora del Perú» (Rodríguez et al. 2006b)