Manejo del aneurisma de aorta abdominal sintomático no roto: últimos adelanto / Management of symptomatic unruptured abdominal aortic aneurysms: state of the art

RESUMEN El aneurisma de aorta abdominal (AAA) sintomático no roto es una patología que involucra a aquellos pacientes con AAA intacto, pero que presentan dolor abdominal y/o lumbar atribuido al aneurisma. Esta forma de presentación clínica es po tencialmente mortal dado que su etiopatogenia comprende cambios agudos en la pared aórtica, incluyendo inflamación, lo que incrementa la probabilidad de ruptura inminente. Está claro que estos pacientes deben ser derivados a reparación del AAA. Sin embargo, el momento de la intervención es controvertido. Por lo tanto, el objetivo del presente trabajo fue revisar la información actualizada sobre el abordaje diagnóstico-terapéutico del AAA sintomático no roto.

ABSTRACT Symptomatic unruptured abdominal aortic aneurysm (AAA) refers to a group of patients with intact AAA but who present abdominal and/or lumbar pain attributed to the aneurysm. This form of clinical presentation is potentially fatal since its etiopathogenesis, involving acute changes in the aortic wall, including inflammation, increases the probability of impending rupture. It is clear that these patients should be referred to AAA repair. However, the timing of the intervention is contro versial. Therefore, the aim of the present work was to review updated information on the diagnostic-therapeutic approach of symptomatic unruptured AAA.

Outcome of Laparoscopic Cholecystectomy in a District Level Hospital

Background: Laparoscopic cholecystectomy is a type of surgery that uses smaller incision than open cholecystectomy. LC has been performed as outpatient procedure for many years. Few studies have been conducted with primary focus on patient acceptance and preferences in terms of safety and satisfaction. We tried to explore its feasibility in otherwise healthy individuals undergoing laparoscopic cholecystectomy. The aim of the study of laparoscopic cholecystectomy is significantly affected by acute cholecystitis. Mechanical, biochemical, and bacteriological factors which are believed to participate in this inflammatory process are responsible for the different pathological processes observed in acute cholecystitis and in symptomatic cholelithiasis. Material & Methods: Data from 57 patients between the age group 20 to 70 years with cholelithiasis who underwent laparoscopic cholecystectomy in a private Hospital, Madaripur, Bangladesh from April 2018 to June 2020 as ambulatory surgery (hospital stay 23 Hours) with or without overnight stay were analyzed. Complications, admissions and readmissions, patient satisfaction and treatment expenditure were assessed. Results: There were 48 (84.2%) female and 9 (15.8%) male with a median age of 42 years. Only 2.4% patients required readmission while 9.2% patients had unplanned admission. 76.4% percent patients were highly satisfied with the procedure. Treatment cost was about 15% lower than routine inpatient operation. Conclusion: Laparoscopic cholecystectomy is safe and feasible. LC can be performed as an outpatient procedure with a low rate of complications and admissions/readmissions. Patient acceptance in terms of satisfaction is high.

The Bidimensional Model of Mental Health: an empirical approach in a general population sample / El Modelo Bidimensional de Salud Mental: una aproximación empírica en una muestra de la población general

Background: Comprehensive mental health research is proposed as an important resource for individual well-being, as opposed to indicators of psychopathology. Objectives: We present an approach to the Bidimensional Model of Mental Health (BDSM) that considers psychological distress and subjective well-being as two separate but related dimensions. Methods: In a sample of 290 adults from the community, with 55.2% women and a mean age of 28.6 (Dt = 12.0). Results: The continuous results confirm a two-dimensional structure of psychopathology (PS) and subjective well-being (BS). The proposed model proposes classification into four groups according to the above result, namely, complete mental health (high BS, low PS, 62.2%), vulnerable (low BS, low PS, 11.4%), symptomatic but content (high BS, high PS, 11.4%) and troubled (low BS, high PS, 15%). The categorical results indicate that the problem and symptomatic groups obtained higher mean scores in trait worry, experiential and behavioral avoidance, and in turn, the symptomatic group scored higher in resistance to distress and in the more adaptive cognitive emotional regulation strategies; on the contrary, the vulnerable group obtained lower means in the latter. The results of the vulnerable and symptomatic groups confirm the coexistence of well-being and psychopathology. Conclusions: The promotion of subjective well-being is proposed when considering health in a more comprehensive way, because of its potential to generate profound and lasting benefits for individuals and the community in general.

Introducción: La regulación de las emociones implica modular las experiencias de las emociones para facilitar el logro de los objetivos, por el contrario, las dificultades en las mismas son un patrón de experiencias emocionales que interfieren con el comportamiento dirigido a un objetivo. Objetivos: Presentamos una aproximación al Modelo Bidimensional de Salud Mental (BDSM) que consideran la angustia psicológica y el bienestar subjetivo como dos dimensiones separadas pero relacionadas. Método: En una muestra es de 290 personas adultas de la comunidad, con un 55,2% mujeres y una media de edad de 28,6 (Dt = 12.0). Resultados: Los resultados confirman una estructura bidimensional de psicopatología (PS) y bienestar subjetivo (BS), negativamente relacionados. El modelo propone la clasificación en cuatro grupos atendiendo al resultado anterior, a saber, salud mental completa (BS alto, PS baja, 62,2%), vulnerable (BS bajo, PS baja, 11,4%), sintomático pero contento (BS alto, PS alta, 11,4%) y con problemas (BS bajo, PS alta, 15%). Los resultados señalan que los grupos con problemas y sintomáticos obtienen puntuaciones medias más elevadas en la preocupación rasgo, la evitación experiencial y conductual, y a su vez, el grupo sintomático puntúa más elevado en resistencia al malestar y en las estrategias de regulación emocional cognitivas más adaptativas. El grupo vulnerable obtiene medias más bajas en estas últimas. Los resultados de los grupos vulnerables y sintomáticos confirman la coexistencia del bienestar y la psicopatología. Conclusiones: Los resultados se discuten atendiendo a los estudios revisados, y dada la relevancia de las estrategias de regulación emocional en la satisfacción con la vida y la resistencia al malestar, se proponen tratamientos transdiagnósticos de la regulación de las emociones.

El Modelo Bidimensional de Salud Mental: una aproximación empírica en una muestra de la población general

Introducción: La regulación de las emociones implica modular las experiencias de las emociones para facilitar el logro de los objetivos, por el contrario, las dificultades en las mismas son un patrón de experiencias emocionales que interfieren con el comportamiento dirigido a un objetivo. Objetivos: Presentamos una aproximación al Modelo Bidimensional de Salud Mental (BDSM) que consideran la angustia psicológica y el bienestar subjetivo como dos dimensiones separadas pero relacionadas. Método: En una muestra es de 290 personas adultas de la comunidad, con un 55,2% mujeres y una media de edad de 28,6 (Dt = 12.0). Resultados: Los resultados confirman una estructura bidimensional de psicopatología (PS) y bienestar subjetivo (BS), negativamente relacionados. El modelo propone la clasificación en cuatro grupos atendiendo al resultado anterior, a saber, salud mental completa (BS alto, PS baja, 62,2%), vulnerable (BS bajo, PS baja, 11,4%), sintomático pero contento (BS alto, PS alta, 11,4%) y con problemas (BS bajo, PS alta, 15%). Los resultados señalan que los grupos con problemas y sintomáticos obtienen puntuaciones medias más elevadas en la preocupación rasgo, la evitación experiencial y conductual, y a su vez, el grupo sintomático puntúa más elevado en resistencia al malestar y en las estrategias de regulación emocional cognitivas más adaptativas. El grupo vulnerable obtiene medias más bajas en estas últimas. Los resultados de los grupos vulnerables y sintomáticos confirman la coexistencia del bienestar y la psicopatología. Conclusiones: Los resultados se discuten atendiendo a los estudios revisados, y dada la relevancia de las estrategias de regulación emocional en la satisfacción con la vida y la resistencia al malestar, se proponen tratamientos transdiagnósticos de la regulación de las emociones.

Background: Comprehensive mental health research is proposed as an important resource for individual well-being, as opposed to indicators of psychopathology. Objectives: We present an approach to the Bidimensional Model of Mental Health (BDSM) that considers psychological distress and subjective well-being as two separate but related dimensions. Methods: In a sample of 290 adults from the community, with 55.2% women and a mean age of 28.6 (Dt = 12.0). Results: The continuous results confirm a two-dimensional structure of psychopathology (PS) and subjective well-being (BS). The proposed model proposes classification into four groups according to the above result, namely, complete mental health (high BS, low PS, 62.2%), vulnerable (low BS, low PS, 11.4%), symptomatic but content (high BS, high PS, 11.4%) and troubled (low BS, high PS, 15%). The categorical results indicate that the problem and symptomatic groups obtained higher mean scores in trait worry, experiential and behavioral avoidance, and in turn, the symptomatic group scored higher in resistance to distress and in the more adaptive cognitive emotional regulation strategies; on the contrary, the vulnerable group obtained lower means in the latter. The results of the vulnerable and symptomatic groups confirm the coexistence of well-being and psychopathology. Conclusions: The promotion of subjective well-being is proposed when considering health in a more comprehensive way, because of its potential to generate profound and lasting benefits for individuals and the community in general.

Correlation between food-specific IgG antibodies and phenotypes of chronic spontaneous urticaria / 中华皮肤科杂志

Objective:To investigate the correlation between food-specific IgG (sIgG) antibodies and phenotypes of chronic spontaneous urticaria (CSU) .Methods:Serum samples were collected from outpatients with active CSU, symptomatic dermographism (SD) , or acute urticaria (AU) , and healthy controls from 5 third-grade class-A hospitals such as the First Hospital of China Medical University between April 2014 and March 2015. Enzyme-linked immunosorbent assay was conducted to detect serum levels of 90 food-sIgG antibodies and total IgE, Western blot analysis to detect levels of 20 allergen-specific IgE antibodies, and chemiluminescent microparticle immunoassay to detect levels of anti-thyroid peroxidase IgG antibodies and anti-thyroglobulin IgG antibodies. Comparisons of normally distributed quantitative data between two groups and among several groups were performed by t test and one-way analysis of variance, respectively; comparisons of non-normally distributed quantitative data between two groups were performed by Mann-Whitney U test; for comparisons of proportions, chi-square test and Fisher′s exact test were used. Results:A total of 248 patients with CSU, 22 with SD, 15 with AU and 13 healthy controls were recruited. The cut-off level for sIgG positivity was 100 U/ml (at least 2+) , and the positive rate of food-sIgG antibodies was slightly higher in the patients with CSU (176/248, 70.97%) , SD (15/22, 68.18%) and AU (11/15) than in the healthy controls (7/13; χ2 = 1.80, P = 0.615) . Among the 248 CSU patients, the proportion of patients with family history of allergic diseases was significantly higher in the sIgG-positive group (71/176, 40.34%) than in the sIgG-negative group (19/72, 26.39%; χ2 = 4.30, P = 0.042) , while no significant difference was observed in the 1-day urticaria activity score (UASday) between the two groups ( Z = 0.18, P = 0.859) . Totally, 177 CSU patients completed 12- to 40-week treatment; their condition could be completely controlled by second-generation H1-antihistamines, and there was no significant difference in the required dosage of second-generation H1-antihistamines between the sIgG-positive group (128 cases) and sIgG-negative group (49 cases; Z = -1.06, P = 0.298) . Conclusions:The prevalence of family history of allergic diseases was relatively high in food-sIgG-positive patients with CSU. However, food-sIgG could not be used as an indicator to reflect the disease activity of CSU and treatment response.

YAG laser vitreolysis for floaters / 国际眼科杂志(Guoji Yanke Zazhi)

Floaters are entopic phenomenon created by vitreous opacities. Some researchers term it as “symptomatic vitreous turbidity”, which usually refers to primary type in clinic. With the increasing prevalence and aging of myopia worldwide, vitreous floaters are becoming increasingly prevalent in clinics but receiving less attention. Floaters can impair patients' vision and quality of life due to their discomfort and disorientation. A few patients become intolerable and express a strong desire for treatment. YAG laser vitreolysis for floaters has garnered considerable attention in recent years. Although some doctors still have concerns about its efficacy and safety, a handful of studies have found some beneficial effects in recent years. The author has gained expertise in clinical practice in recent years. In this review, we talk about what causes floaters and how to classify them. We also talk about the clinical indications, how YAG laser ablation works, and whether or not it is safe.

Evaluación de la calidad de vida de los pacientes con osteoartritis sintomática de rodilla / Evaluation of the quality of life of patients with symptomatic osteoarthritis of the knee

Introducción: El estudio de la morbilidad y el impacto de la enfermedad en el estilo de vida se conocen como medición de la calidad de vida. Objetivo: Evaluar el nivel de la calidad de vida de pacientes con diagnóstico de osteoartritis sintomática de rodilla. Métodos: Se realizó una investigación descriptiva, transversal, en pacientes con diagnóstico de osteoartritis sintomática de rodilla del Centro de Referencia de Enfermedades Reumáticas entre noviembre de 2017 a junio de 2020. La muestra quedó conformada por 213 pacientes, evaluados con el índice de WOMAC de calidad de vida. Resultados: En el grupo de edad de 55-64 años y discapacidad grave se obtuvo la mayor frecuencia de casos (18,3 por ciento; 39). Los pacientes con sobrepeso y discapacidad grave representaron el 28,2 por ciento (60). Predominaron los que tuvieron más de 5 años de evolución de la enfermedad y discapacidad grave (21,0 por ciento; 45). El mayor porcentaje de pacientes se presentó con deformidad de genu varo y discapacidad grave (29,6 por ciento; 63). Hubo relación entre la calidad de vida y el sexo, el índice de masa corporal y el tiempo de evolución de la enfermedad. Conclusiones: La intensidad del dolor se relaciona con un grado radiográfico avanzado, en tanto la calidad de vida con el sexo, el tiempo de evolución de la enfermedad y el índice de masa corporal(AU)

Introduction: The study of morbidity and the impact of the disease on lifestyle is known as quality of life measurement. Objective: To evaluate the level of quality of life of patients diagnosed with symptomatic osteoarthritis of the knee. Methods: A descriptive, cross-sectional investigation was carried out in patients diagnosed with symptomatic knee osteoarthritis from the Reference Center for Rheumatic Diseases between November 2017-June 2020. The sample was made up of 213 patients, who were evaluated with the WOMAC index of quality of life. Results: In the age group of 55-64 years and severe disability, the highest frequency of cases was obtained (18.3percent; 39). Patients with overweight and severe disability represented 28.2percent60). Those who had more than 5 years of evolution of the disease and severe disability prevailed (21.0percent; 45). The highest percentage of patients presented with genu varus deformity and severe disability (29.6percent; 63). There was a relationship between quality of life and sex, body mass index and the time of evolution of the disease. Conclusions: The intensity of the pain is related to an advanced radiological degree, while the quality of life is related to sex, the time of evolution of the disease and the body mass index(AU)

Clinical profile and etiological spectrum of acute symptomatic seizures in the elderly populace

Aim: The current study aimed to analyze the etiology and the clinical spectrum of acute symptomatic seizures (ASS) and the predictors of in-hospital mortality in the elderly population. Materials and Methods: We evaluated 94 elderly (?60 years of age) hospitalized patients with ASS for clinical profile, etiologies, and predictors of in?hospital mortality. Results: Mean age of onset of ASS was 67.63 ± 11.48 years. The main seizure type was focal seizure in 62 (59.7%) cases, followed by tonic?clonic seizures in 30 (31.9%) cases. The most common aetiologies in ASS were stroke in 61.7%, followed by infective cause in 30.9% of cases. In?hospital mortality in the ASS in the elderly was 21 (22.3%) in our series, and stroke was the most common cause of mortality. Conclusion: Stroke was the most common etiology of ASS in the elderly and was also related to mortality. It is necessary for us to analyze the causes of ASS in the elderly, to reduce in hospital mortality.

Curso clínico y supervivencia de pacientes cubanos con colangitis biliar primaria. Instituto de Gastroenterología, 2003-2020 / Clinical course and response to treatment of Cuban patients with primary biliary cholangitis. Institute of Gastroenterology, 2003-2020

Introducción: La colangitis biliar primaria es una enfermedad hepática colestásica. La historia natural y el pronóstico de esta enfermedad ha sido difícil de caracterizar. En el área de Latinoamérica y el Caribe son muy escasos los trabajos que investigan el tema. Objetivo: Describir las características clínicas, evolutivas, y supervivencia en pacientes con colangitis biliar primaria. Material y Métodos: Estudio descriptivo, longitudinal y ambispectivo de pacientes mayores de 18 años, con diagnóstico de CBP, atendidos en el Instituto de Gastroenterología entre septiembre de 2003 y enero de 2020; se evaluaron variables demográficas, clínicas, bioquímicas e histológicas a partir de los registros de historias clínicas. Para el procesamiento de los datos se utilizó el paquete estadístico SPSS versión 21.0. Resultados: Se incluyeron 45 pacientes, la mayoría del sexo femenino (95 %) y con forma de presentación sintomática (55,6 %). El 71,1 % de los pacientes presentó alguna complicación, siendo la cirrosis la más frecuente, en 28,8 % de los cirróticos hubo complicaciones secundarias a la lesión hepática predominando la ascitis, seguido del sangrado digestivo variceal, la encefalopatía, el carcinoma hepatocelular (CHC) y las infecciones bacterianas asociadas a la cirrosis. La supervivencia acumulativa superó 95 % a los cinco años. Conclusiones: La supervivencia de los pacientes con CBP fue elevada en el tiempo a pesar del elevado índice de complicaciones.

Introduction: Primary biliary cholangitis (PBC) is a cholestatic liver disease. The natural history and prognosis of PBC has been difficult to characterize. In ​​Latin America and the Caribbean, there are very few research works on the subject. Objective: To describe the clinical and developmental characteristics and survival of patients with PBC. Material and Methods: Descriptive, longitudinal and ambispective study of patients older than 18 years with a diagnosis of PBC, treated at the Institute of Gastroenterology between September 2003 and January 2020. Demographic, clinical, biochemical and histological variables were evaluated from the data of medical records. For data processing, the statistical package SPSS version 21,0 was used. Results: A total of 45 patients were included, most of them female (95 %) and with symptomatic presentation (55,6 %). In addition, 71,1 % of the patients presented some complications, cirrhosis being the most frequent; in 28,8 % of the cirrhotic patients, there were complications secondary to liver injury, predominantly ascites, followed by variceal digestive bleeding, encephalopathy, hepatocellular carcinoma (HCC), and bacterial infections associated with cirrhosis. Cumulative survival exceeded 95 % at five years. Conclusions: The survival of patients with PBC was high over time despite the high rate of complications.

A multiplicidade de efeitos da repetição: da estruturação ao sintoma / Repetition and its multiplicity of effects: from structurating element to symptom / La répétition et la multiplicité des ses effets: de la structure au symptôme / La multiplicidad de los efectos de la repetición: de la estructuración al síntoma

Abordarei, neste artigo, as repetições de fala sintomáticas e sua relação com a estruturação subjetiva do sujeito. Com base nos princípios do interacionismo brasileiro e da clínica de linguagem, numa visada pela psicanálise, serão discutidos os princípios da repetição enquanto estruturante do sujeito na aquisição de linguagem e como esse fenômeno passa a ser sintoma - lido como ecolalia na clínica de linguagem. Com base nessas teorias, discute-se a incorporação de fragmentos da fala de outros sujeitos como mecanismo de entrada da criança na linguagem como algo estrutural, e por isso mesmo também tem a face de aprisionar o falante, dizendo assim de uma estruturação subjetiva que foge à lógica da chamada "normalidade".

This article discusses the symptomatic speech repetitions and their relation to the subjective structuring of the individual. Based on the principles of Brazilian Interactionism and the language clinic, towards a psychoanalytical perspective, the text discusses the principles of repetition as structuring elements of the subject during language acquisition and how this phenomenon becomes a symptom - called echolalia by the language clinic. Based on these theories, the incorporation of speech fragments produced by others is seen as a structuring element for language acquisition during childhood, and thus may imprison the speaker - resulting in a subjective structuring that escapes the so-called 'normality.'

Cet article traite des répétitions symptomatiques de la parole et de leur relation avec la structuration subjective du sujet. En se basant sur les principes de l'interactionnisme brésilien et de la clinique du langage, vers une perspective psychanalytique, le text discute les principes de la répétition comme facteur structurant du sujet pendant l'acquisition du langage et comment ce phénomène devient un symptôme, appelé écholalie par la clinique du langage. Sur la base de ces théories, l'incorporation de fragments de discours produits par d'autres sujets est considérée comme quelque chose de structurant dans l'entrée de l'enfant dans le langage, et peut ainsi emprisonner le locuteur - ce qui entraîne une structuration subjective qui échappe à la soi-disant "normalité".

En este artículo abordaré las repeticiones sintomáticas del habla y su relación con la estructuración subjetiva del sujeto. Con base en los principios del interaccionismo brasileño y de la clínica del lenguaje, desde la perspectiva del psicoanálisis, se discutirán los principios de la repetición como factor estructurante del sujeto en la adquisición del lenguaje y cómo ese fenómeno se convierte en síntoma, y se entiende como ecolalia en la clínica del lenguaje. Con base en estas teorías, se discute la incorporación de fragmentos del habla de otros sujetos como un mecanismo para la entrada del niño en el lenguaje como algo estructural y que aprisiona al hablante, lo que nos muestra una estructuración subjetiva que se escapa de la lógica de la llamada "normalidad".

Clinico Etiological Profile of “First Seizure” in Children. Experience from an Armed Forces Tertiary Care Hospital in Eastern India

Introduction: Seizure in the pediatric group is one of the most common emergencies encountered. The aim of this study was the evaluation of the etiology of a first episode of seizure in children so as to assess the short term as well as long‑term prognosis. MaterialsandMethods: We evaluated 86 children 2 months − 12 years presenting to the emergency/outpatient department with the first episode of seizure. Children were further sub‑grouped into two age groups of 2 months − 5 years (n = 60) and 5–12 years (n = 26) and acute symptomatic versus unprovoked seizures. Variables assessed were demographics, seizure semiology, laboratory tests, neuroimaging, and outcome at discharge. Results: 69.7% and 30.2% of children were in the age group 2 months to 5 years and 5–12 years, respectively. The mean age of the children was 4.11 ± 3.44 years. 45.3% of cases of acute symptomatic seizures and 54.6% of cases of unprovoked seizures were observed. Acute symptomatic seizures predominated in 2 months − 5 years (60%) while unprovoked seizures predominated in 5–12 years (88.4%). Focal seizures were predominant in the older age group (46.1%) as compared to the younger age group. About 10.4% of cases of seizures first presented as status epilepticus. The most common etiology identified was febrile seizures (27.9%) followed by central nervous system (CNS) structural lesions (19.7%) and CNS infections (10.4%). CSF was done in 18.6% of patients out of which 56.25% samples were positive for CNS infections. 68.6% of children underwent neuroimaging and abnormalities were reported in 67.7% of cases. About 18.6% of children had focal neurological deficits at discharge. Mortality in the entire cohort was 2.3% with 1 child in each vascular and CNS infections group. Conclusions: Children with a first episode of seizure should be evaluated for co‑existence of fever, preexisting developmental delays, other associated symptomatology, head trauma, and seizure semiology. Investigations should be done based on a detailed history and clinical examination. Despite a meticulous approach allowing identification of etiology of the first episode of seizure in children, it is possible that no etiology be identified in a substantial number of children, especially in the older age group

Relación entre manifestaciones neurológicas y severidad de la COVID-19. Hospital San Vicente de Paúl. Ecuador 2021 / Relationship between neurological manifestations and severity of COVID-19. San Vicente de Paul Hospital. Ecuador 2021

Introducción: El SARS-CoV-2 afecta principalmente al sistema respiratorio, pero el daño producido por este virus también se extiende a otros sistemas, incluido el sistema nervioso, y los mecanismos de infección neurológica pueden ser directos o indirectos. Objetivo: Determinar la relación entre las manifestaciones neurológicas y la severidad de la enfermedad en pacientes sintomáticos positivos a la COVID-19. Hospital San Vicente de Paúl. 2021. Material y Métodos: Estudio observacional de corte transversal, empleando el registro de historias clínicas de los pacientes hospitalizados con la COVID-19 y manifestaciones neurológicas, las cuales se clasificaron en manifestaciones del sistema nervioso central y manifestaciones del sistema nervioso periférico. Resultados: 74,1 por ciento pacientes presentaron manifestaciones neurológicas, el mayor porcentaje se concentró en pacientes que desarrollaron enfermedad grave (15 [60 por ciento], SNC; 91 [77,1 por ciento], SNP; 125 [65,4 por ciento], SNC y SNP). La presencia conjunta de manifestaciones neurológicas centrales y periféricas se asoció significativamente con la COVID-19 crítica (P valor= 0,011; OR: 2,005). El índice de mortalidad alcanzó 2,69 por ciento. Conclusiones: Las manifestaciones neurológicas en pacientes hospitalizados con la COVID-19 son muy frecuentes, y la COVID-19 crítica tiene mayor probabilidad de presentar manifestaciones neurológicas(AU)

Introduction: SARS-CoV-2 mainly affects the respiratory system, but the damage caused by this virus also extends to other systems, including the nervous system, and the mechanisms of neurological infection can be direct or indirect. Objective: To determine the relationship between neurological manifestations and disease severity in symptomatic COVID-19 positive patients at San Vicente de Paul Hospital in 2021. Material and Methods: A cross-sectional observational study was conducted using medical records of patients hospitalized with COVID-19 and neurological manifestations, which were classified into manifestations of the central nervous system and manifestations of the peripheral nervous system. Results: The results show that 74,1 percent of patients presented neurological manifestations; the highest percentage was concentrated in patients who developed severe disease (15 [60 percent], CNS; 91 [77,1 percent], PNS; 125 [65,4 percent], CNS and PNS). The joint presence of central and peripheral neurological manifestations was significantly associated with critical COVID-19 (P value= 0,011; OR: 2,005). The mortality rate reached 2,69 percent. Conclusions: Neurological manifestations in hospitalized COVID-19 patients are very common, and critical COVID-19 is more likely to have neurological manifestations(AU)

Peripheral lymphocyte subset alteration in patients with COVID-19 having differential clinical manifestations

Background & objectives: The COVID-19 disease profile in Indian patients has been found to be different from the Western world. Changes in lymphocyte compartment have been correlated with disease course, illness severity and clinical outcome. This study was aimed to assess the peripheral lymphocyte phenotype and subset distribution in patients with COVID-19 disease from India with differential clinical manifestations. Methods: Percentages of peripheral lymphocyte subsets were measured by flow cytometry in hospitalized asymptomatic (n=53), mild symptomatic (n=36), moderate and severe (n=30) patients with SARS-CoV-2 infection, recovered individuals (n=40) and uninfected controls (n=56) from Pune, Maharashtra, India. Results: Percentages of CD4+Th cells were significantly high in asymptomatic, mild symptomatic, moderate and severe patients and recovered individuals compared to controls. Percentages of Th memory (CD3+CD4+CD45RO+), Tc memory (CD3+CD8+CD45RO+) and B memory (CD19+CD27+) cells were significantly higher in the recovered group compared to both asymptomatic, mild symptomatic patient and uninfected control groups. NK cell (CD56+CD3-) percentages were comparable among moderate +severe patient and uninfected control groups. Interpretation & conclusions: The observed lower CD4+Th cells in moderate+severe group requiring oxygen support compared to asymptomatic+mild symptomatic group not requiring oxygen support could be indicative of poor prognosis. Higher Th memory, Tc memory and B memory cells in the recovered group compared to mild symptomatic patient groups might be markers of recovery from mild infection; however, it remains to be established if the persistence of any of these cells could be considered as a correlate of protection.

Advances in the Diagnosis and Treatment of Multiple System Atrophy / 罕见病研究

Multiple system atrophy (MSA) is a rare and rapidly-progressive neurodegenerative disorder, characterized by the combination of dysautonomia, poor levodopa responsive parkinsonism, cerebellar ataxia, and pyramidal tract signs. Insidious onset, clinical heterogeneity and progression of the disease complicate the difficulty of early diagnosis and challenge, the development of neuroprotective drugs. In order to improve the knowledge of diagnosis and treatment of the disease, this paper reviews advances in its diagnostic criteria, biomarkers of early diagnosis and management of the disease.

Controversy of subtalar arthroereisis in symptomatic flatfoot / 中国骨伤

Flatfoot could be divided into flexible flatfoot and rigid flatfoot. Flatfoot with symptoms is called symptomatic flatfoot, surgical treatment is required if conservative treatment is not effective. Subtalar arthroereisis is a minimally invasive procedure which has been used for many years with good results in flexible flatfoot, however, still has many controversial points. Controversial points focus on indications and contraindications, optimal age, subtalar arthroereisis alone or not, efficacy and safety of absorbable material implants, and implant removal. The paper reviewed and summarized the use and controversies of subtalar arthroereisis in symptomatic flatfoot as follows:the best indication for subtalar arthroereisis was pediatric flexible flatfoot syndrome and aged from 10 to 12 years old was optimal age for treatment;tarsal coalitions with flatfoot and adult flatfoot were relative indications. Stiff flatfoot, joint laxity, and subtalar arthritis were contraindications;obesity and neurogenic flexible flatfoot were relative contraindications. The correction ability of subtalar arthroereisis alone was limited, and it's combined with other procedures depending on patient's situation. The safety and efficacy of absorbable material implants had been reported. Routine removal of the implant was not necessary, the main reason of which was tarsal sinus pain.

Research progress on oral characterization of Corona Virus Disease 2019 / 口腔疾病防治

@#Corona Virus Disease 2019 (Corona Virus Disease 2019,COVID-19) has become a public health emergency that has attracted global attention because of its large-scale outbreak resulting in numerous human infections and deaths. COVID-19 is a highly contagious respiratory disease caused by novel coronavirus 2019-nCoV. Due to a large number of infections and fast transmission speed, it's significant to diagnose the infected people quickly and detect the asymptomatic infected people as soon as possible. At present, the preliminary screening is judged by the clinical manifestations of the patients, mainly involving the respiratory system, but recent studies have found that the patients infected with COVID-19 have unique oral manifestations, such as taste disturbance, xerostomia, halitosis, inflammation of salivary glands, necrotizing periodontal disease and some of them are earlier than typical symptoms such as dry cough, fever, etc. Paying attention to the oral manifestations of patients can further improve the COVID-19 screening procedure. At present, symptomatic treatment is mainly used for these oral symptoms.

Role of acupuncture in the present and future / 全日本鍼灸学会雑誌

Currently, disease patterns in Japan are centered mainly on lifestyle-related diseases and diseases of the elderly, but in addition to these, mental illnesses, including stress and depression, are also increasing. This situation is expected to worsen in the future, and therefore, more efforts for health maintenance and its promotion, disease prevention, treatment of pre-symptomatic diseases, and care after illness are required more than ever before. Acupuncture and moxibustion have set "mibyo-chi" (treatment of pre-symptomatic diseases) as the highest behavioral health goal, and it recommends health maintenance and its promotion through "regimen." Acupuncture and moxibustion are based on the principle of maximum utilization of the body's self-control system through its natural healing power, which is, so to speak, the human body's renewable energy. Acupuncture and moxibustion have been trying to apply this power for the purpose of health maintenance and its promotion, disease prevention, treatment of pre-symptomatic diseases, and care after illness, respectively. The most important objectives of acupuncture and moxibustion have been health maintenance and its promotion and treatment of pre-symptomatic diseases. In the future, if society requires medical care that incorporates a social model, the era of acupuncture and moxibustion will have arrive. Acupuncture and moxibustion are based on the principle of maximum utilization of the body's self-control system through its natural healing power.

La edad avanzada en forma aislada no constituye una limitación para el reemplazo valvular aórtico quirúrgico / Old Age Alone is not a Limitation for Surgical Aortic Valve Replacement

RESUMEN Introducción: El reemplazo quirúrgico de la válvula aórtica (REEAO) en pacientes con valvulopatía aórtica grave sintomática, es el tratamiento definido como el de referencia. Sin embargo, el implante valvular aórtico transcatéter (TAVI) se posiciona actualmente como una alternativa en pacientes de diferentes riesgos según los scores internacionales. Algunas guías consideran al TAVI como el procedimiento preferible en los pacientes añosos. Objetivos: Conocer el riesgo y resultados de morbimortalidad del REEAO en pacientes adultos clasificados según la edad en mayores de 75 años, o de 75 años o menos. Material y métodos: Estudio retrospectivo sobre 228 pacientes consecutivos intervenidos mediante REEAO entre el 1 de enero de 2011 y el 31 de diciembre de 2020 por valvulopatía aórtica grave sintomática. Del total de pacientes operados, 46 (16%) eran mayores de 75 años (Grupo 1, G1) y 182 pacientes (84%) tenían 75 años o menos (Grupo 2, G2). Se excluyeron pacientes con enfermedad coronaria concomitante, endocarditis bacteriana u otras valvulopatías asociadas. Resultados: Los pacientes del G1 tenían mayor riesgo de morbimortalidad quirúrgica analizado por scores de riesgo validados: ArgenSCORE de 1,55 (RIC 0,99-3,33) vs 1,08 (RIC 0,68-2,23), p = 0,02 y STS score de 2,33 (RIC 1,57-3,23) vs. 0,94 (RIC 0,721,44), p = 0,0001, con respecto al G2; no se encontraron en cambio diferencias significativas en el EuroSCORE II : 2,37 (RIC 1,19-3,61) vs. 1,83 (RIC 1,16-3,04), p = 0,2. La mortalidad registrada global fue del 1,7% (G1: 2,1% vs. G2: 1,6% , p NS); no se observaron accidente cerebrovascular (ACV) ni infarto agudo de miocardio (IAM) perioperatorios. Conclusiones: La escasa presentación de muerte, ACV e IAM sugiere que el tratamiento seleccionado para estos pacientes fue adecuado, con excelentes resultados sin diferencias entre los dos grupos etarios.

ABSTRACT Background: Surgical aortic valve replacement (SAVR) is the reference treatment in patients with symptomatic severe aortic valve disease. However, according to international scores, transcatheter aortic valve implantation (TAVI) is currently an alternative in different risk patients, and some guidelines consider TAVI as a preferable procedure in elderly patients. Objectives: The aim of this study was to assess SAVR morbidity and mortality risk and results in adult patients, classified according to age as >75 years or ≤75 years. Methods: A retrospective study was performed on 228 consecutive patients undergoing SAVR between January 1, 2011 and December 31, 2020 for symptomatic severe aortic valve disease. Among the total number of patients operated on, 46 (16%) were >75 years (Group 1, G1) and 182 (84%) were ≤75 years (Group 2, G2). Patients with concomitant coronary heart disease, bacterial endocarditis or other associated valve diseases were excluded from the analysis. Results: Group 1 patients had greater risk of surgical morbidity and mortality analyzed by validated risk scores: ArgenSCORE 1.55 (IQR 0.99-3.33) vs 1.08 (IQR 0.68-2.23), p = 0.02 and STS score 2.33 (IQR 1.57-3.23) vs. 0.94 (IQR 0.72-1.44), p = 0.0001, with respect to G2, while no significant differences were found for EuroSCORE II: 2.37 (IQR 1.19-3.61) vs. 1.83 (IQR 1.163.04), p = 0.2. Overall mortality was 1.7% (G1: 2.1% vs. G2: 1.6%, p=NS), with no perioperative stroke or acute myocardial infarction (AMI). Conclusions: The low number of deaths, stroke and AMI observed suggests that the selected treatment for these patients was adequate, with excellent results and without significant differences between these two age groups.

Comparación de las características clínicas y epidemiológicas entre pacientes asintomáticos y sintomáticos con la COVID-19 / Comparison of the clinical and epidemiological characteristics between asymptomatic and symptomatic patients with COVID-19

Introducción: La COVID-19 presenta formas clínicas asintomáticas y sintomáticas, ambas con similar frecuencia, pero con diferencias clínicas y epidemiológicas. Objetivo: Comparar la características clínicas y epidemiológicas entre pacientes asintomáticos y sintomáticos de la COVID-19. Métodos: Estudio comparativo de 91 pacientes positivos a la COVID-19, desde marzo hasta julio de 2020. Según las formas clínicas, se conformaron dos grupos (asintomáticos y sintomáticos). Fueron comparados en cuanto a edad, sexo, antecedentes epidemiológicos, clínicos, manifestaciones clínicas y comorbilidades. Resultados: Los pacientes asintomáticos fueron más jóvenes (media 37,2), pero similares en el sexo. Prevaleció la fuente de infección contacto con caso confirmado (83,3 por ciento) y los municipios Holguín y Gibara. El número reproductivo básico fue similar. Ser adulto mayor (63,0 por ciento) y portador de hipertensión arterial (44,4 por ciento) predominó en casos sintomáticos, la mayoría de los asintomáticos no tenían comorbilidades (56,8 por ciento). Prevalecieron como síntomas la fiebre, tos seca y manifestaciones extrapulmonares digestivas y neurológicas. Se encontraron diferencias significativas en la edad (p = 0,02) y factores de riesgo: adulto mayor (p = 0,00) e hipertensión arterial (p = 0,00). Conclusiones: Existió similitud entre los grupos comparados, excepto en la edad y los factores de riesgo: adulto mayor e hipertensión arterial(AU)

Introduction: COVID-19 presents asymptomatic and symptomatic clinical forms, both with similar frequency, but with clinical and epidemiological differences. Objective: To compare the clinical and epidemiological characteristics between asymptomatic and symptomatic patients of COVID-19. Methods: Comparative study of 91 COVID-19 positive patients, from March to July 2020. According to the clinical forms, two groups were created (asymptomatic and symptomatic). They were compared regarding age, sex, epidemiological and clinical antecedents, clinical manifestations and comorbidities. Results: Asymptomatic patients were younger (mean 37,2), but similar in gender. The source of infection, contact with a confirmed case (83,3 percent) and the municipalities Holguín and Gibara prevailed. The basic reproductive number was similar. Being elderly (63,0 percent) and a carrier of arterial hypertension (44,4 percent) predominated in symptomatic cases, most of the asymptomatic did not have comorbidities (56,8 percent). Fever, dry cough and extrapulmonary digestive and neurological manifestations prevailed as symptoms. Significant differences were found in age (p = 0,02) and risk factors: older adult (p = 0,00) and arterial hypertension (p = 0,00). Conclusions: There was similarity between the groups compared, except for age and risk factors: elderly and arterial hypertension(AU)

Study on the relationship between acute stress disorder and symptom group in stroke patients with motor impairment / 中国综合临床

Objective:To explore the influence of symptom group of stroke patients with exercise disorder on acute stress disorder.Methods:Patients with stroke and motor impairment hospitalized in the Department of Neurology and surgery of North China University of technology from October 2018 to August 2019 were selected as the research objects.The general information of patients, brain injury subscale (BIS) and Stanford acute stress reaction questionnaire (SARSQ) were investigated by questionnaire.Results:A total of 324 patients with stroke and motor disorders were investigated.The demographic characteristics of education, age, degree of motor function, number of combined dysfunction and Activity Of Daily Living Scale(ADL) grade had effects on acute stress disorder, and the differences were statistically significant( P<0.05). The score of acute stress disorder in stroke patients with motor disorders was (99.60±13.69 ) points.From the highest to the lowest symptom group, the scores were obsessive symptom (11.35±2.71), depression (7.44±1.86), hostility (7.23±2.26), somatization (3.69±1.42) and psychosis (2.81±1.09). The results of correlation analysis showed that somatization, depression, obsessiveness, hostility and psychosis were positively correlated with the total score of acute stress disorder and the scores of each dimension ( r=0.164, 0.355, 0.329, 0.298, 0.279, all P<0.05), the symptoms were also positively correlated with all the dimensions of acute stress disorder(all P<0.05). Multiple linear regression analysis showed that age(Regression coefficient=7.682, 95% CI: 4.930-10.435, P<0.001), the number of combined dysfunction(Regression coefficient=3.937, 95% CI: 0.268-7.605, P=0.036), depression(Regression coefficient=1.662, 95% CI: 0.727-2.597, P=0.001) had influence on ASD of stroke patients. Conclusion:The level of acute stress disorder in stroke patients with motor impairment is on the high side, and the characteristics of symptom group are obvious, which has a positive correlation with acute stress disorder.Medical staff should pay attention to the characteristics of symptom group and acute stress reaction level of stroke patients with motor impairment, so as to provide targeted intervention strategies to avoid disease recurrence and improve the quality of life.