Impacto de la pandemia por COVID-19 en la conducta alimentaria de niñas, niños y adolescentes con trastorno del espectro autista / Impact of the COVID-19 pandemic on the eating behaviors of children and adolescents with autism spectrum disorder

Introducción. Los niños con trastorno del espectro autista (TEA) presentan dificultades de adaptación a situaciones estresantes, como la pandemia por COVID-19. Objetivo. Evaluar el impacto del primer año de pandemia en las dificultades alimentarias de niños con TEA. Población y métodos. Se invitó a participar a cuidadores de niños con TEA no sindromático (edad: 2-18 años) de una unidad de neurodesarrollo. Los participantes respondieron en línea un cuestionario y la escala de evaluación de problemas de conducta alimentaria (BPFAS por su sigla en inglés) antes y durante el primer año de pandemia. Se calculó un puntaje de prioridad (producto entre promedio de frecuencia y problema) para cada ítem del BPFAS. Resultados. El 56,6 % (86/152) de los cuidadores contestó la encuesta (madre 74,4 %), mediana de edad 6,3 años (p25-p75: 4,7-8,2); el 80,2 % de los niños eran de sexo masculino; el 58,1 % mantuvo terapia durante la pandemia y el 61,6 % presentaba problemas de comportamiento previo a esta. Durante el primer año de pandemia, los niños presentaron mayor intensidad en dificultades conductuales (34,9 %) y de alimentación (61,6 %); sin embargo, el 31,4 % refirió mejoría en la alimentación. No existieron diferencias significativas entre puntajes BPFAS antes y durante la pandemia. Los ítems con mayor puntaje de prioridad fueron "se levanta de la mesa durante la hora de comer", "no probar alimentos nuevos", "no come verduras", "no come frutas". Conclusiones. Hubo alta frecuencia de dificultades en las conductas alimentarias durante el primer año de pandemia. No se presentaron diferencias en las características de estas conductas antes y durante la pandemia.

Introduction. Children with autism spectrum disorder (ASD) have difficulties adapting to stressful situations, such as the COVID-19 pandemic. Objective. To assess the impact of the first year of the pandemic on feeding difficulties in children with ASD. Population and methods. The caregivers of children and adolescents with non-syndromic ASD (age: 2­18 years) from a neurodevelopment unit were invited to participate. Participants completed a questionnaire and the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) online before and during the first year of the pandemic. A priority score (product between the average frequency and the problem) for each BPFAS item was estimated. Results. Among the caregivers, 56.6% (86/152) completed the survey (mother: 74.4%); children's median age was 6.3 years (p25­p75: 4.7­8.2); 80.2% of children were males; 58.1% continued with their therapy during the pandemic; and 61.6% had behavioral problems before the pandemic. During the first year of the pandemic, children had greater behavioral problems (34.9%) and feeding difficulties (61.6%); however, 31.4% of caregivers referred improvements in feeding. There were no significant differences in the BPFAS scores before and during the pandemic. The following items obtained the highest priority scores: gets up from table during meal, does not try new food, does not eat vegetables, does not eat fruits. Conclusions. A high frequency of feeding difficulties was noted during the first year of the pandemic. No differences were observed in feeding characteristics before and during the pandemic.

Trasplante cardíaco y autólogo de células progenitoras hematopoyéticas en pacientes con amiloidosis AL / Cardiac and autologous stem cell transplantation hematopoietic in patients with AL amyloidosis

Resumen Objetivo: Describir la evolución de las cadenas livianas libres séricas (CLL) en el período comprendido entre el trasplante cardíaco ortotópico (TCO) y el trasplante de células progenitoras hematopoyéticas (TCPH), la respuesta hematológica al año tras el TCPH y el tratamiento quimioterápico e inmunosupresor en pacientes con amiloidosis AL. Método: Serie de casos de pacientes consecutivos con diagnóstico de amiloidosis AL que recibieron TCO seguido de TCPH del Registro Institucional de Amiloidosis del Hospital Italiano de Buenos Aires, entre enero de 2010 y noviembre de 2021. Se reportaron los valores de CLL entre trasplantes y al año del TCPH. Las variables cuantitativas se describieron como mediana e intervalo intercuartil, y las variables categóricas como frecuencias absolutas y relativas. Resultados: De 106 pacientes con amiloidosis AL, seis tuvieron TCO seguido de TCPH. La mediana de edad fue de 55 años. La mayoría eran hombres (n = 5). En el período entre trasplantes, la CLL involucrada disminuyó en dos pacientes y se mantuvo estable en tres. Todos lograron la remisión hematológica completa al año del TCPH. Un solo paciente presentó recaída en el órgano sólido trasplantado. Tacrolimus, micofenolato de mofetilo y corticoides fue el esquema inmunosupresor utilizado después del TCO. Conclusiones: El TCO representa una opción de tratamiento en pacientes con falla cardíaca grave por amiloidosis, permitiendo luego un tratamiento intensivo con quimioterapia de inducción y TCPH. Si bien faltan estudios, la terapia inmunosupresora después del TCO podría tener algún efecto sobre las células plasmáticas clonales.

Abstract Objective: To describe the evolution of serum free light chains (FLC) in the period between orthotopic heart transplantation (OHT) and autologous stem cell transplantation (ASCT), the hematological response one year after ASCT and chemotherapy and immunosuppressive treatment in patients with AL amyloidosis. Method: Case series of consecutive patients diagnosed with AL amyloidosis who received OHT followed by ASCT from the Institutional Registry of Amyloidosis of the Italian Hospital of Buenos Aires, between January 2010 and November 2021. FLC values between transplants and at year post ASCT. Quantitative variables were described with their median and interquartile range. Categorical variables as absolute and relative frequencies. Results: Of 106 patients with AL amyloidosis, 6 had an OHT followed by ASCT. The median age was 55 years. Most were men (n = 5). In the period between transplants, the involved CLL decreased in two patients and remained stable in three. All achieved complete hematologic remission 1 year after ASCT. A single patient presented relapse in the transplanted solid organ. Tacrolimus, mycophenolate mofetil, and corticosteroids were the immunosuppressive regimen used after OHT. Conclusions: OHT represents a treatment option in patients with severe heart failure due to amyloidosis, allowing later intensive treatment with induction chemotherapy and ASCT. Although studies are lacking, immunosuppressive therapy after OHT might have some effect on clonal plasma cells.

Avoidant restrictive eating disorder and panic attacks in an adult man: A case report / Trastorno evitativo restrictivo de la ingesta alimentaria y ataques de pánico en un hombre adulto: Reporte de caso

Abstract Avoidant or Restrictive Food Intake Disorder (ARFID) is an eating disorder (ED) not common in adults. In this article we present a clinical case of ARFID in a 37-year-old male patient treated in an ED center in Medellin, Colombia; displaying anxious symptoms that began a year earlier and concomitant weight loss, following a traumatic event causing an overall impairment with that patient. Several medical evaluations/examinations looking for organic causes, were excluded. Interventions were implemented by a psychiatry, a psychotherapist using cognitive-behavior therapy (CBT), and a nutritionist, all in face-to-face modality, which were carried out weekly for the first three months, then biweekly and subsequently quarterly. each lasting approximately 40-60 minutes. After the set of pharmacological interventions and psychotherapy, a great improvement in the functionality of the patient was observed. Improvement was found with respect to eating in public, food variation and panic attacks. In the absence of guidelines, it is important to use standardized and replicable treatments in this population.

Resumen El trastorno evitativo restrictivo de la ingesta (TERIA) es un trastorno alimentario (TCA) raro en adultos. Se presenta el caso de un hombre de 37 años con TERIA y trastorno de pánico atendido en un centro para TCA en Medellín, Colombia, quien presentó un año de síntomas ansiosos y pérdida de peso después de evento traumático, generando disfuncionalidad. Fue evaluada y excluida organicidad. Se realizaron intervenciones por parte de psiquiatría, psicoterapia con enfoque cognitivo conductual y nutrición, todas en modalidad presencial, las cuales se realizaron semanalmente los primeros tres meses, luego quincenalmente y posteriormente trimestralmente. Cada una con una duración de 40-60 minutos aproximadamente por sesión. Posterior al conjunto de intervenciones farmacológicas y psicoterapia, se observó una gran mejoría la funcionalidad del paciente, se encontró mejoría con respecto a comer en público, variación en los alimentos y ataques de panico. Ante la ausencia de guías de manejo de TERIA en adultos es relevante realizar tratamientos estandarizados que puedan ser replicados.

Strabismus in pediatric orbital wall fractures

Purpose: To assess the clinical profiles and outcomes of strabismus in pediatric patients with orbital wall fractures. Methods: A retrospective interventional study of all consecutive children of age ?16 years who presented with traumatic orbital wall fractures with and without resultant strabismus was conducted. The details of patient demographics, clinical features, interventions, and outcomes were obtained. Results: Forty?three children presented with traumatic orbital fractures to a tertiary care center. The mean age at presentation was 11 years and there was a male predominance (72.09%). Isolated floor fracture involvement was the most common (n = 24, 55.81%), and almost half of the children had a white?eyed or trapdoor fracture (n = 21, 48.83%). Twenty?six (60.46%) children had surgical repair of fracture(s). Manifest strabismus following orbital fracture was documented in 12 children (27.90%). Of these, an exotropia was noted in seven (58.33%), hypotropia in two (16.67%), hypertropia in one (8.33%), and esotropia in one patient (8.33%), while an exotropia with hypotropia was noted in one patient (8.33%). Restrictive nature of strabismus due to either muscle entrapment or local trauma was more commonly observed in 11/12 patients (91.66%). Primary position diplopia before orbital wall fracture repair was observed in four children and after repair was observed in two children with manifest strabismus. Four children underwent strabismus surgery post?fracture repair. Conclusion: An improvement in strabismus and ocular motility was noted in majority of the patients after fracture repair. The few that underwent strabismus surgery had a restrictive nature of strabismus. Trapdoor fractures and the nature of trauma in children vary compared to adults. Persistence of strabismus may be due to an excessive time interval between trauma and fracture repair or the extensive nature of trauma

Epidemiological analysis of Mycoplasma pneumoniae infection in hospitalized children with community-acquired pneumonia in Hunan from 2013 to 2021 / 中华微生物学和免疫学杂志

Objective:To analyze the epidemiological characteristics of Mycoplasma pneumoniae ( Mp) infection in hospitalized children with community-acquired pneumonia in Hunan Province and to provide a theoretical basis for clinical diagnosis and treatment. Methods:The epidemiological characteristics of Mp infection in children hospitalized for community-acquired pneumonia in the Children′s Medical Center of the First Affiliated Hospital of Hunan Normal University (Hunan Provincial People′s Hospital) from January 1, 2013 to December 31, 2021 were retrospectively analyzed. Results:A total of 55 681 children with community-acquired pneumonia were enrolled during the study period, of whom 27.24% (15 170/55 681) were tested positive for Mp. The positive rate was lower in boys than in girls (23.39% vs 33.39%, χ 2=665.998, P<0.001). The positive rate of Mp infection increased with age with the highest rate in children who were 5-14 years old (67.92%) and the lowest in infants less than one year old (6.38%). The detection rates of Mp infection varied between years with the highest rate in 2019 (38.31%). The positive rates of Mp infection during the COVID-19 epidemic in 2020-2021 were similar to those in 2013-2018. Among the children hospitalized for community-acquired pneumonia, the detection rate of Mp was significantly higher in summer and autumn than in winter and spring (χ 2=648.753, P<0.001), with the highest detection rate reaching to 56.91% in the summer of 2019. In contrast, the detection rates of Mp in the spring and summer of 2020 were 15.60% and 17.44%, respectively, being the lowest detection rates ever for spring and summer, while the detection rates in the autumn and winter rebounded (31.22% and 28.48%). During the Mp epidemic in 2019, the age at onset, the proportion of severe pneumonia and the cost of treatment were higher as compared with those in other years. In 2020, the number of cases positive for Mp was the lowest on record, as was the proportion of severe pneumonia and admission rate to PICU ( P<0.001). Conclusions:In hospitalized children with community-acquired pneumonia, there were gender, age and season differences in Mp infection. In the summer of 2019, there was a Mp epidemic in Hunan Province, which increased the proportion of severe pneumonia and the cost of treatment. After the outbreak of COVID-19, the rate of Mp infection dropped significantly in the spring of in 2020 as well as in the summer, but rebounded in the autumn and winter. This might be due to the strict restrictive measures taken early during the COVID-19 pandemic that effectively controlled the spread of Mp.

Changes of postoperative pulmonary function in lung transplant recipients / 器官移植

Objective To analyze the changes of postoperative pulmonary function in lung transplant recipients. Methods Clinical data of 81 recipients undergoing bilateral lung transplantation and combined heart-lung transplantation were collected, and postoperative status of the recipients was analyzed. Pulmonary ventilation and diffusion function indexes at 1 month, 3 months, every 3 months (3-18 months after lung transplantation) and every 6 months (18-36 months after lung transplantation) were analyzed in the recipients. The characteristics of the optimal pulmonary function in the recipients were assessed. Results Postoperative mechanical ventilation time was 4 (2, 9) d, and the length of postoperative ICU stay was 10 (7, 20) d. Among 81 recipients, 27 recipients developed primary graft dysfunction (PGD) after lung transplantation, with an incidence rate of 33%. Postoperative forced vital capacity (FVC) to predicted value ratio (FVC%pred), forced expiratory volume in one second (FEV1) to predicted value ratio (FEV1%pred), FEV1/FVC to predicted value ratio (FEV1/FVC%pred) and corrected diffusion lung capacity for CO to predicted value ratio (DLCOc%pred) were changed over time (all P<0.001). FVC%pred and FEV1%pred were gradually increased within postoperative 9 months, and DLCOc%pred was gradually elevated within postoperative 3 months (all P<0.05). Thirty-six recipients had FVC%pred≥80%, FEV1%pred≥80% in 41 cases, FEV1/FVC%pred≥92% in 76 cases, FVC%pred≤40% in 1 case and FEV1%pred≤40% in 1 case, respectively. Sixteen recipients had DLCOc%pred≥80%, corrected diffusion lung capacity for CO/alveolar volume to predicted value ratio (DLCOc/VA%pred) ≥80% in 63 cases, DLCOc%pred≤40% in 4 cases and DLCOc/VA%pred≤40% in 1 case, respectively. Postoperative FVC%pred, FEV1/FVC%pred and DLCOc%pred in recipients with a primary disease of obstructive pulmonary disease were significantly higher than those in their counterparts with restrictive pulmonary disease (all P<0.05). Postoperative DLCOc%pred in recipients with PGD was significantly lower than that in those without PGD (P<0.05). Conclusions Pulmonary ventilation function in lung transplant recipients reaches the optimal state and maintains a steady state at postoperative 9 months, and pulmonary diffusion function reaches a steady state at postoperative 3 months. Primary diseases and the incidence of PGD may affect postoperative pulmonary function.

Association of body fat distribution with depression and social anxiety in children and adolescents: A cross-sectional study based on dual-energy X-ray detection / 北京大学学报(医学版)

OBJECTIVE@#To investigate the status of depression and social anxiety in children and adolescents, and to analyze the association between body fat distribution and depression, social anxiety in children and adolescents.@*METHODS@#A total of 1 412 children aged 7 to 18 years in Beijing were included by stratified cluster random sampling method. Body fat distribution, including total body fat percentage (total BF%), Android BF%, Gynoid BF% and Android-to-Gynoid fat ratio (AOI), were obtained by dual-energy X-ray absorption method. Depression and social anxiety were evaluated by Children Depression Inventory and Social Anxiety Scale for Children. Multivariate linear regression and restricted cubic spline analysis were used to estimate the linear and non-linear correlation between body fat distribution and depression and social anxiety.@*RESULTS@#13.1% and 31.1% of the children and adolescents had depressive symptoms and social anxiety symptoms respectively, and the detection rate of depression and social anxiety in the boys and young groups was significantly lower than those in the girls and old groups. There was no significant linear correlation between total BF%, Android BF%, Gynoid BF%, AOI and depression and social anxiety in the children and adolescents. However, total BF% and Gynoid BF% had significant nonlinear correlation with depression, showing an inverted U-shaped curve relationship with the tangent points of 26.8% and 30.9%, respectively. In terms of the nonlinear association of total BF%, Android BF%, Gynoid BF% and AOI with depression and social anxiety, the change trends of the boys and girls, low age group and high age group were consistent. The overall anxiety risk HR of body fat distribution in the boys was significantly higher than that in the girls, and the risk HR of depression and social anxiety were significantly higher in the high age group than those in the low age group.@*CONCLUSION@#There was no significant linear correlation between body fat distribution and depression and social anxiety in children and adolescents. Total BF% and depression showed an inverted U-shaped curve, mainly manifested in Gynoid BF%, and this trend was consistent in different genders and different age groups. Maintaining children and adolescents' body fat distribution at an appropriate level is the future direction of the prevention and control of depression and social anxiety in children and adolescents.

Effect of restrictive fluid resuscitation on the coagulation function and hemodynamic parameters in patients with hemorrhagic traumatic shock

Abstract Objectives To investigate the changes in the coagulation function and hemodynamic parameters in patients with Hemorrhagic Traumatic Shock (HTS) after restrictive fluid resuscitation. Methods A total of 139 patients with HTS admitted to our hospital were enrolled, among which 69 HTS patients were divided into the control group and the remaining 70 HTS patients as the observation group. Patients in the control group underwent regular fluid resuscitation, while those in the observation group underwent restrictive fluid resuscitation. Results During treatment, 70 patients in the observation group had a lower bleeding amount, infusion amount, and blood transfusion volume than those in the control group (p < 0.05). After treatment, patients in the observation group had better hemodynamic parameters and blood coagulation than those in the control group (p < 0.05), and the incidence rate in the observation group was only 12.9%, which was significantly lower than 60.87% in the control group, while the cure rate in the observation group was 100%, which was significantly higher than that in the control group (p < 0.05). Conclusions Restrictive fluid resuscitation could remarkably increase the cure rate and reduce the bleeding amount during HTS treatment, thereby benefiting the recovery of the patient's blood coagulation.

Fisiología respiratoria: fisiología de las enfermedades pulmonares restrictivas / Pathophysiology of pulmonary restrictive diseases

Las enfermedades restrictivas comprenden un grupo heterogéneo de trastornos que se caracterizan por una alteración en la distensibilidad pulmonar, generada por enfermedades del parénquima o intersticio pulmonar o por problemas extrapulmonares (alteraciones de la caja torácica o enfermedades neuromusculares). Presentan un patrón característico en las pruebas de función pulmonar, relación VEF1/ FVC normal o aumentada con CVF disminuida, VEF1 disminuido leve o normal y capacidad pulmonar total disminuida (CPT). Su manejo es complejo debido a la dificultad para establecer el diagnóstico diferencial, por lo que se recomienda una derivación precoz a un especialista en enfermedades respiratorias y el enfrentamiento por un equipo multidisciplinario.

Restrictive diseases comprise a heterogeneous group of disorders characterized by an alteration in lung compliance, generated by diseases of the lung parenchyma or interstitium, as well as by extrapulmonary problems (abnormalities of the rib cage or neuromuscular diseases). They present a characteristic pattern in pulmonary function tests, with decreased FVC (forced vital capacity), slightly decreased or normal FEV1 (forced expiratory volume in 1 second), normal or increased FEV1/FVC ratio, and decreased total lung capacity. Its management is complex due to the difficulty in establishing the differential diagnosis, so early referral to a specialist in respiratory diseases and confrontation by a multidisciplinary team is recommended.

Therapeutic assessment as a brief and intensive intervention for avoidant restrictive food intake disorder, belching, and histrionic personality disorder: A case report

A 26-year-old female was hospitalized with complaints of repeated vomiting and weight loss (18 kg in 8 months); and incessant belching and nausea/regurgitation for 30 days subsequent to her COVID-19 treatment. After all the normal medical radiological reports, appropriate psychological and psychiatric evaluations were done. Incessant belching warranted a simple and flexible cognitive psychotherapy for histrionic personality with a therapeutic assessment technique. A total of 6 h of psychotherapy was delivered in three sessions. The belching and vomiting came down by 75% after the first extensive session, and almost 100% after the second session. However, mild belching reappeared, and after the termination-cum-booster session belching subsided till discharge and the first follow-up after 2 weeks

Fibrosis Endomiocárdica: Presentación de Caso Clínico y Revisión de la literatura / Endomyocardial Fibrosis: Case Report and Literature Review

La fibrosis endomiocárdica (FEM) es una enfermedad rara y potencialmente letal caracterizada por la infiltración de tejido fibrótico en el endocardio y miocardio. Es más comúnmente observada en regiones tropicales y subtropicales, y se cree que es causada por la combinación de factores genéticos y ambientales. Su patogénesis aún no está del todo clara, pero es posible que esté relacionada con una respuesta inmune anormal ante múltiples estímulos, incluyendo infecciones virales, parásitos, trastornos hematológicos y deficiencias alimentarias. Esta condición es una de las principales manifestaciones de los síndromes hipereosinofílicos (SHE). Pese a los avances en el manejo, el pronóstico de los pacientes con FEM persiste siendo pobre, con un alto riesgo de recurrencia y de progresión hacia insuficiencia cardiaca. A continuación, presentaremos el caso de un paciente joven con un cuadro de insuficiencia cardiaca de predominio derecho en el contexto de un síndrome hipereosinofílico de base, en quien se establece el diagnóstico de FEM según lo documentado en las imágenes cardiacas.

Endomyocardial Fibrosis: Case Report and Literature Review. Endomyocardial fibrosis (EMF) is a rare and potentially life-threatening cardiac disorder characterized by the infiltration of fibrotic tissue into the endocardium and myocardium of the heart. It is most seen in tropical and subtropical regions, and it is believed to be caused by a combination of environmental and genetic factors. The exact pathogenesis of EMF is not fully understood, but it is thought to be related to an abnormal immune response to various stimuli, including viral infections, parasites, and dietary deficiencies. This condition is one of the main manifestations of hypereosinophilic syndromes. Despite advances in treatment, the prognosis for patients with EMF remains poor, with a high risk of recurrence and progression to heart failure. We present a case of a young male patient with an episode of right heart failure in the context of a chronic hypereosinophilic syndrome in which the diagnosis of EMF is made with the aid of cardiovascular imaging.

Cumplimiento de la política transfusional restrictiva en el Instituto de Cardiología y Cirugía Cardiovascular 2019-2021 / Compliance with the restrictive transfusional policy at the Institute of Cardiology and Cardiovascular Surgery 2019-2021

Introducción: A principios del siglo XXI el déficit de sangre y los riesgos de la transfusión, determinaron la adopción de una política transfusional restrictiva, con cifras de hemoglobina entre 70 y 100 g/L para pacientes cardiovasculares en el mundo. En el Instituto de Cardiología y Cirugía Cardiovascular se adoptó esta política, por lo cual es necesario controlar su cumplimiento, para hacer un uso racional y seguro de este recurso. Objetivo: Evaluar el cumplimiento de la política transfusional restrictiva del Instituto de Cardiología y Cirugía Cardiovascular entre 2019 y 2021. Métodos: Se realizó un estudio observacional descriptivo transversal, mediante la revisión del registro de pacientes transfundidos y las órdenes de transfusión, lo que permitió llegar a resultados. Resultados: Se transfundieron 5408 hemocomponentes, 64,1 por ciento concentrados de eritrocitos. Los servicios con mayor consumo fueron: la unidad de cuidados intensivos posquirúrgicos 53,2 por ciento, el salón de operaciones 22,8 por ciento y la unidad de cuidados intensivos de emergencia 10,8 por ciento. La media de las cifras de hematocrito/hemoglobina de los pacientes transfundidos fue 0,24/79,2 g/L, inferior 0,22/72,6 g/L para los operados por valvulopatías cardíacas severas. El 95,9 por ciento de las órdenes de transfusión reunieron los requisitos normados. El principal problema fue la omisión de los antecedentes transfusionales. Conclusiones: Se cumplió la política transfusional restrictiva. La media de las cifras de hematocrito/hemoglobina fue menor a las recomendadas para pacientes cardiovasculares en las guías cubanas. La calidad de las órdenes de transfusión fue adecuada(AU)

Introduction: At the beginning of the 21st century, the blood deficit and transfusion risks determined the adoption of a restrictive transfusion policy, with hemoglobin levels between 70 and 100 g/L for cardiovascular patients in the world. In the Institute of Cardiology and Cardiovascular Surgery, this policy was adopted for which it is necessary to control compliance, to make a rational and safe use of this resource. Objective: Evaluate compliance with the restrictive transfusion policy of the Institute of Cardiology and Cardiovascular Surgery between 2019 and 2021. Method: An observational descriptive cross-sectional study was carried out by reviewing the records of transfused patients and transfusion orders, which allowed reaching results. Results: 5 408 hem components were transfused, 64,1 percent were packed erythrocytes. The services with the highest consumption were the post-surgical intensive care unit 53,2 percent, the operating room 22,8 percent and the emergency intensive care unit 10,8 percent. The mean of the hematocrit/hemoglobin values of the transfused patients was 0,24/79,2 g/L, lower 0,22/72,6 g/L for those operated on for severe heart valve disease. 95,9 percent of the transfusion orders met the regulatory requirements. The main problem was the omission of transfusion history. Conclusion: The restrictive transfusion policy was complied with. The mean hematocrit/hemoglobin values were lower than those recommended for cardiovascular patients in The Cuban guidelines. The quality of the transfusion orders was adequate(AU)

Effect of left ventricular geometric remodeling on restrictive filling pattern and survival in ischemic cardiomyopathy

Background: To evaluate the effects of Left ventricular remodeling patterns in patients with left ventricular restrictive filling pattern (RFP; E/A>2) in ischemic cardiomyopathy (ICM) on prognosis. Methods: Patient data was retrospectively analyzed over a period of 4.5 years to determine the effect of LV geometry by Echocardiographic parameterson survival and re-admission for heart failure. All patients with previous history of transmural myocardial infarction were studied and all were on guideline directed medical therapy. None underwent device therapy or surgery. The stored 2D Echocardiograms were studied. Left ventricular dimensions were noted, including the relative wall thickness (RWT). The patients were grouped based on RWT<0.34 and _x0001_ 0.34 and were compared for clinical outcomes of mortality and re-admissions for heart failure, over a period of 54 months. Results: There were 102 ICM patients who had baseline RFP. We identified two sub-groups based on geometric phenotypes of left ventricular eccentric remodeling and dilated remodeling based on the relative wall thickness (RWT >0.34 or <0.34). The patients with preserved RWT had significantly more dilated ventricles (LVIDd and LVIDs), greater pulmonary artery systolic pressures (PASP), greater diatolic dysfunction (E/A) and less left ventricular ejection fraction (LVEF); p < 0.001. The number of deaths was higher in the reduced RWT patients, as were the number of re-admissions, although the time to survival and time to re-admission was not significant. Conclusions: In this pilot study on ICM patients in advanced heart failure with baseline RFP, the presence of preserved RWT indicative of eccentric remodelling demonstrated a better clinical outcome

Diagnóstico de amiloidosis sistémica: bases hematológicas útiles para el cardiólogo clínico / Diagnosis in systemic amiloydosis: useful hematological bases for the clinical cardiologist / Diagnóstico de amiloidose sistémica: bases hematológicas úteis para o cardiologista clínico

Las amiloidosis son un grupo heterogéneo de patologías caracterizado por el depósito extracelular de proteínas fibrilares anormalmente plegadas que se depositan en los tejidos y ocasionan su disfunción. La calidad y expectativa de vida depende del órgano afectado y del grado de compromiso, la afectación cardíaca es la principal determinante de la sobrevida y calidad de vida. El diagnóstico requiere la biopsia tisular y tipificación de la proteína. Su detección tardía se asocia a inferior pronóstico y sobrevida. La forma más común de amiloidosis es la causada por depósito de cadenas livianas monoclonales (AL), para la cual nuevos agentes de inmuno y quimioterapia dirigidas a suprimir la clona de células plasmáticas han demostrado mejorar la sobrevida. Para la amiloidosis por transtiretina (ATTR), segunda en frecuencia, existen terapias estabilizadoras de la proteína y terapias dirigidas a detener su síntesis a través del silenciamiento genético. Esta revisión se dirige a describir las bases hematológicas útiles para el cardiólogo clínico.

The amyloidoses are a heterogeneous group of diseases caused by the extracellular deposition of abnormally folded fibrillar proteins in organs and tissues, causing their dysfunction. The quality and life expectancy depend on the affected organ, with cardiac involvement being the main determinant of survival and quality of life. Diagnosis requires tissue biopsy and protein typing. Its late detection is associated with a lower prognosis and survival. The most common form of amyloidosis is caused by monoclonal light chain (AL) deposition, for which new immunological agents and chemotherapy aimed at suppressing plasma cell cloning have been shown to improve survival. For transthyretin amyloidosis (ATTR), the second in frequency, there are protein-stabilizing therapies and therapies aimed at stopping its synthesis through genetic silencing. This review focuses on the hematological bases for the clinical cardiologist.

As amiloidoses são um grupo heterogêneo de patologias caracterizadas pela deposição extracelular de proteínas fibrilares anormalmente dobradas, que se depositam nos tecidos, causando sua disfunção. A qualidade e expectativa de vida dependem do órgão afetado e do grau de comprometimento, sendo o acometimento cardíaco o principal determinante da sobrevida e qualidade de vida. O diagnóstico requer biópsia tecidual e tipagem de proteínas. Sua detecção tardia está associada a um menor prognóstico e sobrevida. A forma mais comum de amiloidose é causada pela deposição monoclonal de cadeia leve (AL), para a qual novos agentes imuno e quimioterápicos destinados a suprimir a clonagem de plasmócitos demonstraram melhorar a sobrevida. Para a amiloidose por transtirretina (ATTR), segunda em frequência, existem terapias estabilizadoras de proteínas e terapias destinadas a interromper sua síntese por meio do silenciamento genético. Esta revisão enfoca a amiloidose sistêmica, com foco em bases hematológicas úteis para o cardiologista clínico.

Research progress on the role of exosome in rejection after lung transplantation / 器官移植

Rejection after lung transplantation, including acute rejection (AR) and chronic rejection manifested with chronic lung allograft dysfunction (CLAD), is the main factor affecting the long-term survival of allografts. Exosome, a type of extracellular nanovesicle for intercellular communication among eukaryotic cells, could carry complex biological information and participate in various physiological and pathological processes. Exosome has become a critical immune medium in rejection, regulates the incidence and development of rejection through multiple pathways, and also plays a key role in the monitoring and management of rejection. In this article, the type of rejection after lung transplantation, the mechanism underlying the role of exosome in regulating rejection, exosome acting as biomarkers and the application in rejection treatment were reviewed, aiming to provide a novel direction for comprehensive diagnosis and treatment of rejection following lung transplantation.

Proteomic analysis of extraocular muscles from patients with thyroid-associated ophthalmopathy by tandem mass tag / 中华实验眼科杂志

Objective:To identify the proteins differentially expressed in extraocular muscles between restrictive strabismus patients with thyroid-associated ophthalmopathy (TAO) and concomitant esotropia patients by proteomic analysis using tandem mass tag (TMT).Methods:Extraocular muscles samples from 5 restrictive strabismus patients with TAO and 5 concomitant esotropia patients were collected at Peking University People's Hospital from August 2019 to December 2020.All the patients received strabismus surgery.Differentially expressed proteins (DEPs) in extraocular muscles samples were identified by quantitative proteomic analysis and bioinformatic analysis based on TMT.Fold change≥1.2 or≤0.83 and P value<0.05 was regarded as the threshold to screen DEPs.GO annotation, KEGG pathways enrichment analysis and protein-protein interaction (PPI) network of DEPs were conducted through UniProtGOA and STRING.This study protocol was approved by the Ethics Committee of Peking University People's Hospital (No.2021PHB058-001). Results:A total of 53 DEPs were identified, 34 of which were up-regulated and 19 were down-regulated.The biological processes DEPs mainly participated included response to stimulation, multicellular organismal process, metabolism, developmental process, intracellular signal transduction, and positive regulation of biological process.DEPs were involved in pathways including focal adhesion, tight junction, regulation of action cytoskeleton, and apoptosis.Six key proteins identified using PPI network were myosin heavy chain 2, myosin heavy chain 7, myosin regulatory light chain, α-actinin-2, fibrinogen alpha chain and fibrinogen beta chain.Conclusions:There are DEPs in extraocular muscles between restrictive strabismus patients with TAO and concomitant esotropia patients.Myosin, actinin and filamin may be involved in the pathogenesis of TAO through regulation of actin cytoskeleton and focal adhesion.

Fibrosis endomiocárdica: una revisión actualizada a propósito de unos casos en un programa de falla cardiaca / Endomyocardial fibrosis: an updated review, about some cases in a heart failure program

Resumen Introducción La fibrosis endomiocárdica es una enfermedad cardiovascular olvidada, principal causa de cardiomiopatía restrictiva. Se estima que en el mundo hay 10-12 millones de personas con la enfermedad. La mayoría se restringen a zonas de África, Asia y, en Latinoamérica, en Brasil y Colombia. La etiología y la fisiopatología son poco comprendidas. Para su diagnóstico se deben tener en cuenta los datos del paciente, el cuadro clínico y los hallazgos ecocardiográficos. Presentamos los casos confirmados en un centro de referencia cardiovascular. Descripción de los casos: Se han documentado tres casos, de los cuales dos son mujeres. Todos debutaron con un cuadro insidioso de disnea con esfuerzo. Los hallazgos ecocardiográficos fueron disfunción diastólica con patrón restrictivo, insuficiencia moderada de válvulas auriculoventriculares e hipertensión pulmonar; en dos casos se encontraron imágenes anormales endocárdicas en el ventrículo izquierdo y se realizó biopsia endomiocárdica para confirmar el diagnóstico. Ninguno mejoró la clase funcional ni la frecuencia de hospitalizaciones. Conclusiones La fibrosis endomiocárdica debe considerarse en todo paciente con falla cardiaca con un patrón restrictivo asociado y con poca respuesta al manejo farmacológico convencional. Los pacientes presentados tenían hallazgos típicos de la enfermedad, con la particularidad de ser de edades mayores.

Abstract Introduction Endomyocardial fibrosis is one of the neglected cardiovascular disease, the main cause of restrictive cardiomyopathy. There are an estimated 10-12 million people with the disease worldwide. Most are restricted to areas of Africa, Asia and in Latin America in Brazil and Colombia. The etiology and pathophysiology are poorly understood. For its diagnosis, the patient's data, the clinical picture and the echocardiographic findings must be taken into account. We present the confirmed cases in a cardiovascular referral center. Description of the cases Three cases have been documented of which two are women. All debuted with insidious dyspnea on exertion. The echocardiographic findings were diastolic dysfunction with a restrictive pattern, moderate atrioventricular valve insufficiency, and pulmonary hypertension. In two cases, endocardial abnormal images were found in the left ventricle and an endomyocardial biopsy was performed to confirm the diagnosis. None improved functional class or frequency of hospitalizations. Conclusions Endomyocardial fibrosis should be considered in a patient with heart failure with an associated restrictive pattern, and with little response to conventional pharmacological management. The patients presented had typical findings of the disease with the particularity of being older.

Escorbuto una Enfermedad del Pasado en Nuestros Tiempos. A Propósito de un Caso / Scurvy a Disease of the Past in Our Times. About a case

El término escorbuto procede de una palabra del antiguo escandinavo, scorbruck, que significa "hinchazones ulceradas". Es una entidad infrecuente en pediatría, causada por deficiencia nutricional exógena de ácido ascórbico. Los seres humanos, a diferencia de otros seres vivos, no pueden sintetizar la vitamina C y, en consecuencia, dependen estrictamente de su aporte exógeno. El escorbuto puede simular varios desórdenes reumatológicos. Aunque es poco común, puede presentarse como pseudovasculitis o artritis crónica. Para el diagnóstico en pacientes que presentan síntomas músculo esqueléticos se requiere un alto índice de sospecha. Se reporta el caso de un paciente masculino de 9 años que desarrolló la enfermedad por un hábito alimentario selectivo de larga evolución, sin ingesta de frutas ni verduras. El objetivo del presente reporte es alertar al pediatra acerca del desarrollo de escorbuto como potencial consecuencia de las dietas restrictivas, y la importancia de realizar una anamnesis alimentaria completa ante la sospecha diagnóstica

The term scurvy comes from a word from the old Scandinavian, scorbruck, which means ulcerated swellings. Scurvy is an infrequent entity in pediatrics caused by exogenous nutritional deficiency of ascorbic acid. Human beings, unlike other living beings, can not synthesize vitamin C and, consequently, they depend strictly on their exogenous contribution. Scurvy can simulate several rheumatological disorders. Although it is uncommon, it can present as pseudovasculitis or chronic arthritis. A high index of suspicion is required to diagnose patients with musculoskeletal symptoms. We report a case of a 9-year-old male patient who developed the disease due to a long-term selective eating habit, without fruits or vegetables intake. The objective of this report is to alert the pediatrician about the development of scurvy as a potential consequence of restrictive diets, and the importance of performing a complete dietary history to suspect diagnosis

Adolescents' healthy sports behavior model based on the theory of social-ecological system / Modelo de comportamento esportivo saudável de adolescentes baseado na teoria do sistema socioecológico / Modelo de comportamiento deportivo saludable de adolescentes basado en la teoría del sistema socioecológico

ABSTRACT Introduction: Education administrative departments and schools should regard sports as an integral part of school education and allow students to use sports every day. Guarantee the time for sports activities; schools should organize various forms of extracurricular sports activities". Objective: Based on the ecological system theory, the paper constructs a three-factor structural model that restricts youth sports participation and compiles a scale of factors restricting youth sports participation. Methods: The thesis selected 1,800 primary and secondary school students as the research object and used exploratory factor analysis to explore the questionnaire structure on the obstacles to sports participation. Results: 1) Exploratory factor analysis, the cumulative contribution rate of the first three factors extracted was 58.90%, and the load of each factor was more significant than 0.4. The three factors were school factors, family factors, and personal factors in order; 2) Reselected subjects, Exploring the three-factor structural model of obstacles to sports participation were verified. The final modified model RMSEA was 0.071, CFI was 0.98, and χ2/df was 8.55. The three factors were school factors, family factors, and personal factors. Conclusions: The fit of the three-factor structural indicators restricting youth sports participation is ideal, and the model is relatively stable. The "Questionnaire on Restricting Factors of Youth Sports Participation" can be used as a measurement tool to evaluate and understand youth sports participation constraints. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: Departamentos administrativos de educação e escolas devem considerar os esportes como parte integrante da educação escolar e permitir que os alunos pratiquem esportes todos os dias. Garantia de tempo para atividades esportivas; as escolas devem organizar várias formas de atividades esportivas extracurriculares. Objetivo: Com base na teoria do sistema ecológico, o artigo constrói um modelo estrutural de três fatores que restringe a participação em esportes de jovens e compila uma escala de fatores que restringem a participação em esportes de jovens. Métodos: a tese selecionou 1.800 alunos do ensino fundamental e médio como objeto de pesquisa e utilizou uma análise fatorial exploratória para explorar a estrutura do questionário sobre obstáculos à participação esportiva. Resultados: 1) Análise fatorial exploratória, a taxa de contribuição cumulativa dos três primeiros fatores extraídos foi de 58,90% e a carga de cada fator foi mais significativa do que 0,4. Os três fatores eram fatores escolares, fatores familiares e fatores pessoais em ordem; 2) Foram verificados os temas reelecionados, explorando o modelo estrutural de três fatores de obstáculos à participação esportiva. O modelo RMSEA modificado final foi 0,071, CFI foi 0,98 e χ2 / df foi 8,55. Os três fatores eram fatores escolares, fatores familiares e fatores pessoais. Conclusões: O ajuste dos indicadores estruturais de três fatores que restringem a participação dos jovens em esportes é ideal e o modelo é relativamente estável. O "Questionário sobre Fatores Restritivos da Participação em Esportes de Jovens" pode ser usado como uma ferramenta de medição para avaliar e compreender as limitações da participação em esportes de jovens. Nível de evidência II; Estudos terapêuticos: investigação dos resultados do tratamento.

RESUMEN Introducción: Los departamentos administrativos de educación y las escuelas deben considerar los deportes como una parte integral de la educación escolar y permitir que los estudiantes utilicen los deportes todos los días. Garantizar el tiempo para actividades deportivas; las escuelas deberían organizar diversas formas de actividades deportivas extracurriculares. Objetivo: Basado en la teoría del sistema ecológico, el artículo construye un modelo estructural de tres factores que restringe la participación deportiva juvenil y compila una escala de factores que restringen la participación deportiva juvenil. Métodos: La tesis seleccionó a 1.800 estudiantes de primaria y secundaria como objeto de investigación y utilizó un análisis factorial exploratorio para explorar la estructura del cuestionario sobre los obstáculos a la participación deportiva. Resultados: 1) Análisis factorial exploratorio, la tasa de contribución acumulada de los tres primeros factores extraídos fue de 58,90% y la carga de cada factor fue más significativa que 0,4. Los tres factores fueron factores escolares, factores familiares y factores personales en orden; 2) Se verificaron sujetos reselegidos, Explorando el modelo estructural de tres factores de obstáculos a la participación deportiva. El modelo final modificado RMSEA fue 0.071, CFI fue 0.98 y χ2 / df fue 8.55. Los tres factores fueron factores escolares, factores familiares y factores personales. Conclusiones: El ajuste de los indicadores estructurales de tres factores que restringen la participación deportiva juvenil es ideal y el modelo es relativamente estable. El "Cuestionario sobre factores restrictivos de la participación deportiva juvenil" puede utilizarse como una herramienta de medición para evaluar y comprender las limitaciones de la participación deportiva juvenil. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Fibrosis endomiocárdica: una cardiomiopatía restrictiva en países en vía de desarrollo / Endomyocardial fibrosis: a restrictive cardiomyopathy in developing countries

Resumen Objetivo: La fibrosis endomiocárdica (FE) es una cardiomiopatía restrictiva infrecuente. En América Latina son escasos los reportes. En el presente trabajo se realiza una descripción de una serie de pacientes diagnosticados de FE en Colombia. Método: Realizamos una búsqueda en los registros de imágenes de resonancia magnética (RM) cardiaca realizadas en nuestra institución entre 2016 y 2019 en busca de pacientes con diagnóstico de FE. Se describieron sus características sociodemográficas, clínicas y de imagen. Resultados: Nueve pacientes fueron diagnosticados de FE (el 66.7% mujeres), con una edad promedio de 69 años. Los pacientes presentaron un promedio de 2.6 años de evolución. El principal síntoma referido fue disnea, seguido de síncope, dolor torácico y palpitaciones. En ninguno de ellos se sospechó FE como diagnóstico inicial. En cuanto a los hallazgos ecocardiográficos, se identificó compromiso predominante del ventrículo izquierdo, seguido de compromiso biventricular. Todos los pacientes presentaron patrón de llenado restrictivo con dilatación auricular izquierda severa. En el análisis retrospectivo se cumplieron los criterios de Mocumbi para el diagnóstico de FE en el 100% de los pacientes con gravedad moderada (77.8%). Las imágenes de RM mostraron función sistólica biventricular y volúmenes preservados. Se observó depósito focal de gadolinio subendocárdico a nivel apical y se confirmó la presencia de trombo en el 66% de los casos Conclusión:: La FE es una cardiomiopatía restrictiva infrecuente circunscrita a países tropicales. La mayoría de los pacientes en nuestra serie presentaron compromiso aislado del ventrículo izquierdo, seguido de compromiso biventricular, con función ventricular usualmente preservada.

Abstract Objective: Endomyocardial fibrosis (EF) is an unusual restrictive cardiomyopathy. In Latin America there are few reports. Here, we made a description of patients diagnosed with EF in Colombia. Method: We conducted a search in the records of cardiac magnetic resonance imaging (MRI) performed in our institution between 2016-2019 looking for patients with a diagnosis of EF; sociodemographic, clinical and imaging characteristics were described. Results: Nine patients were diagnosed with EF (66.7% female), with an average age of 69 years. Patients presented an average evolution of 2.6 years. The main reported symptom was dyspnea, followed by syncope, chest pain, and palpitations. None of them was initially suspected for EF. Regarding echocardiographic findings, predominant left ventricular involvement was identified, followed by bi-ventricular involvement. All the patients presented a restrictive filling pattern with severe left atrial dilation. In a retrospective analysis, Mocumbi criteria for diagnosis of EF were met in 100% of the patients, majority with moderate severity (77.8%). Cardiac MRI showed biventricular systolic function and volumes preserved. Focal subendocardial late gadolinium enhancement was observed on the apex and apical thrombus was confirmed in 66% of the patients Conclusion: FE is an uncommon restrictive cardiomyopathy limited to tropical countries. Most of patients in our series presented isolated involvement of left ventricle, followed by bi-ventricular involvement, with ventricular function usually preserved.