Seguimiento de niños con diagnóstico de asma grave antes y durante la pandemia por COVID-19 / Follow-up of children diagnosed with severe asthma before and during the COVID-19 pandemic

En la pandemia por COVID-19 se exploraron estrategias de atención para garantizar el seguimiento de niños con asma grave. Estudio prospectivo, observacional, comparativo. Se incluyeron pacientes del programa de asma grave de un hospital pediátrico de tercer nivel (n 74). Se evaluó el grado de control, exacerbaciones y hospitalizaciones durante un período presencial (PP), marzo 2019-2020, y uno virtual (PV), abril 2020-2021. En el PP, se incluyeron 74 pacientes vs. 68 (92 %) del PV. En el PP, el 68 % (46) de los pacientes presentaron exacerbaciones vs. el 46 % (31) de los pacientes en el PV (p 0,003). En el PP, se registraron 135 exacerbaciones totales vs. 79 en el PV (p 0,001); hubo una reducción del 41 %. En el PP, el 47 % (32) de los pacientes tuvieron exacerbaciones graves vs. el 32 % (22) de los pacientes en el PV (p 0,048). Hubo 91 exacerbaciones graves en el PP vs. 49 en el PV (p 0,029), reducción del 46 %. No hubo diferencias en las hospitalizaciones (PP 10, PV 6; p 0,9). La telemedicina fue efectiva para el seguimiento de pacientes con asma grave

During the COVID-19 pandemic, health care strategies were explored to ensure the follow-up of children with severe asthma. This was a prospective, observational, and comparative study. Patients in the severe asthma program of a tertiary care children's hospital were included (n: 74). The extent of control, exacerbations, and hospitalizations during an in-person period (IPP) (March 2019­2020) and an online period (OP) (April 2020­2021) was assessed. A total of 74 patients were enrolled in the IPP compared to 68 (92%) in the OP. During the IPP, 68% (46) of patients had exacerbations versus 46% (31) during the OP (p = 0.003). During the IPP, 135 total exacerbations were recorded compared to 79 during the OP (p = 0.001); this accounted for a 41% reduction. During the IPP, 47% (32) of patients had severe exacerbations versus 32% (22) during the OP (p = 0.048). A total of 91 severe exacerbations were recorded during the IPP compared to 49 during the OP (p = 0.029); the reduction was 46%. No differences were observed in terms of hospitalization (IPP: 10, OP: 6; p = 0,9). Telemedicine was effective for the follow-up of patients with severe asthma.

Variability in indigenous Pakistani tomato lines and worldwide reference collection for Tomato Mosaic Virus (ToMV) and Tomato Yellow Leaf Curl Virus (TYLCV) infection / Variabilidade em linhagens indígenas de tomate do Paquistão e coleção de referência global para infecção por vírus do mosaico do tomateiro (ToMV) e vírus da folha amarela do tomate (TYLCV)

Local and exotic germplasm of tomato remains a major source for genetic improvement. Assessment of such lines for biotic stresses particularly viral diseases are the most important criteria for selection in Pakistan, where Tomato Yellow Leaf Curl Virus (TYLCV) and Tomato Mosaic Virus (ToMV) are the major diseases/viruses. A set of 40 accessions (including indigenous Pakistani lines and exotic germplasm from Europe, the United States, and Asia) were evaluated for their resistance/infection response to ToMV with artificial inoculation under greenhouse conditions. Infection response was quantified through disease scoring and DAS-ELISA test (for ToMV). A subset of 24 lines, was further screened for TYLCV using disease scoring and TAS-ELISA. The tested lines showed significant variability for resistance to ToMV. Only one accession (Acc-17878) was resistant to the ToMV whereas seven accessions i.e. Acc-17890, AVR-261, CLN-312, AVR-321, EUR-333, CLN-352, and CLN-362 expressed resistance to TYLCV. Correlation between phenotypic evaluation was confirmed by the ELISA results in both diseases, although both tools complemented to assess the viral infection status. In future, tomato breeding programs must consider breeding for ToMV and TYLCV resistance (using identified germplasm in our study) so as to deliver virus resistant tomato varieties.

O germoplasma local e exótico do tomate continua sendo uma importante fonte de melhoramento genético. A avaliação de linhagens para estresses bióticos, particularmente as doenças virais, é o critério mais importantes para seleção no Paquistão, onde o vírus da folha amarela do tomate (TYLCV) e o vírus do mosaico do tomateiro (ToMV) são as principais doenças/vírus. Um conjunto de 40 acessos (incluindo linhagens indígenas do Paquistão e germoplasma exótico da Europa, dos Estados Unidos e da Ásia) foi avaliado quanto à resistência/resposta à infecção ao ToMV com inoculação artificial em casa de vegetação. A resposta à infecção foi quantificada por meio de pontuação da doença e de teste DAS-ELISA (para ToMV). Um subconjunto de 24 linhas foi posteriormente rastreado para TYLCV usando pontuação de doença e TAS-ELISA. As linhas testadas apresentaram variabilidade significativa para resistência ao ToMV. Apenas um acesso (Acc-17878) foi resistente ao ToMV, enquanto sete acessos (Acc-17890, AVR-261, CLN-312, AVR-321, EUR-333, CLN-352 e CLN-362) expressaram resistência ao TYLCV. A correlação entre a avaliação fenotípica foi confirmada pelos resultados do ELISA nas duas doenças, embora ambas as ferramentas tenham se complementado para avaliar o estado da infecção viral. No futuro, os programas de melhoramento de tomate devem considerar aperfeiçoamentos para resistência ao ToMV e TYLCV (usando germoplasma identificado em nosso estudo) de modo a fornecer variedades de tomate resistentes a vírus.

Acurácia do escore de referência endoscópico para esofagite eosinofílica em crianças / Accuracy of the eosinophilic esophagitis endoscopic reference score in children

ABSTRACT Background: To assess the efficacy of applying the endoscopic reference score for EoE (EREFS) in children with symptoms of esophageal dysfunction naïve to proton pump inhibitor (PPI) therapy. Methods: An observational cross-sectional study was conducted by reviewing reports and photographs of upper gastrointestinal endoscopies (UGE) and esophageal biopsies of patients with symptoms of esophageal dysfunction. Patients who were treated with PPI or had other conditions that may cause esophageal eosinophilia were excluded. Results: Of the 2,036 patients evaluated, endoscopic findings of EoE were identified in 248 (12.2%) and more than one abnormality was observed in 167 (8.2%). Among all patients, 154 (7.6%) presented esophageal eosinophilia (≥15 eosinophils per high power field) (P<0.01). In this group, 30 patients (19.5%) had normal endoscopy. In patients with EoE, edema (74% vs 6.5%, P<0.01) and furrows (66.2% vs 2.4%, P<0.01) were more prevalent than in the control group. Association of edema and furrows was more frequent in patients with EoE than in the control group (29.2% vs 1.6%, P<0.01, OR=24.7, CI=15.0-40.5). The presence of more than one endoscopic finding had sensitivity of 80.5%, specificity of 93.4%, positive predictive value (PPV) of 50%, negative predictive value (NPV) of 98.3%, and accuracy of 92.4%. Conclusion: In conclusion, this study showed that endoscopic features suggestive of EoE had high specificity and NPV for diagnosing EoE in children naïve to PPI therapy. These findings highlight the importance of the EREFS in contributing to early identification of inflammatory and fibrostenosing characteristics of EoE, making it possible to identify and to avoid progression of the disease.

RESUMO Contexto: Avaliar a eficácia da aplicação do escore de referência endoscópico para EoE (EREFS) em crianças com sintomas de disfunção esofágica sem tratamento prévio com inibidores da bomba de prótons (IBP). Métodos: Foi realizado um estudo transversal observacional por meio de revisão de laudos e fotos de endoscopia digestiva alta (EDA) e biópsias de esôfago de pacientes com sintomas de disfunção esofágica. Pacientes tratados com IBP ou com outras condições que podem causar eosinofilia esofágica foram excluídos. Resultados: Dos 2.036 pacientes avaliados, os achados endoscópicos de EoE foram identificados em 248 (12,2%) e mais de uma anormalidade foi observada em 167 (8,2%). Entre todos os pacientes, 154 (7,6%) apresentaram eosinofilia esofágica (≥15 eosinófilos por campo de grande aumento) (P<0,01). Nesse grupo, 30 pacientes (19,5%) apresentaram endoscopia normal. Em pacientes com EoE, edema (74% vs 6,5%, P<0,01) e linhas verticais (66,2% vs 2,4%, P<0,01) foram mais prevalentes quando comparados ao grupo controle. A associação de edema e linhas verticais foi mais frequente em pacientes com EoE do que no grupo controle (29,2% vs 1,6%, P<0,01, OR=24,7, IC=15,0-40,5). A presença de mais de um achado endoscópico teve sensibilidade de 80,5%, especificidade de 93,4%, valor preditivo positivo de 50%, valor preditivo negativo de 98,3% e acurácia de 92,4%. Conclusão: Em conclusão, esse estudo mostrou que as características endoscópicas sugestivas de EoE apresentam especificidade e VPN elevados para o diagnóstico da enfermidade em crianças sem tratamento prévio com IBP. Estes achados reforçam a importância do EREFS em contribuir para a identificação precoce de características inflamatórias e fibroestenosantes, possibilitando identificar e evitar a progressão da doença.

Relationship between semen parameters, serum InhB, and INSL-3 levels, and the degree of varicocele

Abstract Background Varicocele is an abnormal expansion of the pampininias venous plexus in the scrotum, resulting in impaired sperm production and reduced sperm quality. The exact pathophysiological mechanism leading to varicocele-related infertility has not been fully elucidated. Although treatable, varicocele may lead to male infertility. Objective To investigate the relationship between semen parameters, serum InhB and INSL-3 levels, and the degree of varicocele in male patients. Methods Serum InhB and INSL-3 were detected. To evaluate the relationship between semen parameters and serum InhB and INSL-3 levels. To evaluate the value of semen parameters and serum InhB and INSL-3 levels in distinguishing disease severity in patients with varicocele. Results Serum INSL-3 in patients with varicocele decreased with the severity of the disease. Serum INSL-3 was positively correlated with total sperm count and frequency of normal sperm morphology. There was a weak correlation between serum InhB and semen volume, concentration, and total sperm. Patients with different disease severity were similar within the groups, with partial overlap or similarity between varicocele Grade I and Grade II, and significant differences between Grade III and Grade I and II. Semen volume, concentration, total sperm, normal sperm morphology, and serum InhB and INSL-3 levels could distinguish the degree of varicocele. Conclusion Semen parameters and the combination of serum InhB and INSL-3 levels in patients with varicocele are closely related to the severity of the disease. Serum INSL-3 is expected to be a potential biomarker for early clinical intervention.

Difference Between Cardiopulmonary Bypass Time and Aortic Cross-Clamping Time as a Predictor of Complications After Coronary Artery Bypass Grafting

ABSTRACT Introduction: Along with cardiopulmonary bypass time, aortic cross-clamping time is directly related to the risk of complications after heart surgery. The influence of the time difference between cardiopulmonary bypass and cross-clamping times (TDC-C) remains poorly understood. Objective: To assess the impact of cardiopulmonary bypass time in relation to cross-clamping time on immediate results after coronary artery bypass grafting in the Registro Paulista de Cirurgia Cardiovascular (REPLICCAR) II. Methods: Analysis of 3,090 patients included in REPLICCAR II database was performed. The Society of Thoracic Surgeons outcomes were evaluated (mortality, kidney failure, deep wound infection, reoperation, cerebrovascular accident, and prolonged ventilation time). A cutoff point was adopted, from which the increase of this difference would affect each outcome. Results: After a cutoff point determination, all patients were divided into Group 1 (cardiopulmonary bypass time < 140 min., TDC-C < 30 min.), Group 2 (cardiopulmonary bypass time < 140 min., TDC-C > 30 min.), Group 3 (cardiopulmonary bypass time > 140 min., TDC-C < 30 min.), and Group 4 (cardiopulmonary bypass time > 140 min., TDC-C > 30 min.). After univariate logistic regression, Group 2 showed significant association with reoperation (odds ratio: 1.64, 95% confidence interval: 1.01-2.66), stroke (odds ratio: 3.85, 95% confidence interval: 1.99-7.63), kidney failure (odds ratio: 1.90, 95% confidence interval: 1.32-2.74), and in-hospital mortality (odds ratio: 2.17, 95% confidence interval: 1.30-3.60). Conclusion: TDC-C serves as a predictive factor for complications following coronary artery bypass grafting. We strongly recommend that future studies incorporate this metric to improve the prediction of complications.

Effect of upper eyelid blepharoplasty on the ocular surface, tear film, and corneal microstructure

ABSTRACT Purpose: This study aimed to investigate the effect of upper eyelid blepharoplasty with the removal of the skin and a strip of orbicularis oculi muscle on the ocular surface, tear film, and dry eye-related symptoms. Methods: Twenty-two eyes of 22 consecutive patients operated by a single surgeon (21 females; mean age, 61 years; age range, 41-75 years) were included. All subjects completed the Ocular Surface Disease Index questionnaire, underwent in vivo confocal microscopy, tear film breakup time measurements, the Schirmer test with anesthesia, and fluorescein and lissamine green staining measurements before, 1 month, and 6 months after upper blepharoplasty alone with preseptal orbicularis excision. Results: A significant increase in Ocular Surface Disease Index, and corneal fluorescein and lissamine green staining and a significant decrease in tear film breakup time were observed after 1 month (p=0.003, p=0.004, p=0.029, and p=0.024 respectively) and 6 months (p=0.001 for all findings). No significant difference in the Schirmer test score was observed during the follow-up. None of the in vivo confocal microscopy parameters showed significant changes during the study. Conclusions: An increase in dry eye symptoms and a decrease in tear film stability along with ocular surface staining were observed in patients undergoing upper eyelid blepharoplasty.

Variability in indigenous Pakistani tomato lines and worldwide reference collection for Tomato Mosaic Virus (ToMV) and Tomato Yellow Leaf Curl Virus (TYLCV) infection

Abstract Local and exotic germplasm of tomato remains a major source for genetic improvement. Assessment of such lines for biotic stresses particularly viral diseases are the most important criteria for selection in Pakistan, where Tomato Yellow Leaf Curl Virus (TYLCV) and Tomato Mosaic Virus (ToMV) are the major diseases/viruses. A set of 40 accessions (including indigenous Pakistani lines and exotic germplasm from Europe, the United States, and Asia) were evaluated for their resistance/infection response to ToMV with artificial inoculation under greenhouse conditions. Infection response was quantified through disease scoring and DAS-ELISA test (for ToMV). A subset of 24 lines, was further screened for TYLCV using disease scoring and TAS-ELISA. The tested lines showed significant variability for resistance to ToMV. Only one accession (Acc-17878) was resistant to the ToMV whereas seven accessions i.e. Acc-17890, AVR-261, CLN-312, AVR-321, EUR-333, CLN-352, and CLN-362 expressed resistance to TYLCV. Correlation between phenotypic evaluation was confirmed by the ELISA results in both diseases, although both tools complemented to assess the viral infection status. In future, tomato breeding programs must consider breeding for ToMV and TYLCV resistance (using identified germplasm in our study) so as to deliver virus resistant tomato varieties.

RESUMO O germoplasma local e exótico do tomate continua sendo uma importante fonte de melhoramento genético. A avaliação de linhagens para estresses bióticos, particularmente as doenças virais, é o critério mais importantes para seleção no Paquistão, onde o vírus da folha amarela do tomate (TYLCV) e o vírus do mosaico do tomateiro (ToMV) são as principais doenças/vírus. Um conjunto de 40 acessos (incluindo linhagens indígenas do Paquistão e germoplasma exótico da Europa, dos Estados Unidos e da Ásia) foi avaliado quanto à resistência/resposta à infecção ao ToMV com inoculação artificial em casa de vegetação. A resposta à infecção foi quantificada por meio de pontuação da doença e de teste DAS-ELISA (para ToMV). Um subconjunto de 24 linhas foi posteriormente rastreado para TYLCV usando pontuação de doença e TAS-ELISA. As linhas testadas apresentaram variabilidade significativa para resistência ao ToMV. Apenas um acesso (Acc-17878) foi resistente ao ToMV, enquanto sete acessos (Acc-17890, AVR-261, CLN-312, AVR-321, EUR-333, CLN-352 e CLN-362) expressaram resistência ao TYLCV. A correlação entre a avaliação fenotípica foi confirmada pelos resultados do ELISA nas duas doenças, embora ambas as ferramentas tenham se complementado para avaliar o estado da infecção viral. No futuro, os programas de melhoramento de tomate devem considerar aperfeiçoamentos para resistência ao ToMV e TYLCV (usando germoplasma identificado em nosso estudo) de modo a fornecer variedades de tomate resistentes a vírus.

Validación de la escala de gravedad percibida de la violencia de pareja contra la mujer en población ecuatoriana

Introducción: La violencia de pareja contra la mujer (VPM) es un problema de salud pública a nivel global cuya prevalencia en Ecuador es de las más elevadas de Latinoamérica. La gravedad percibida de la VPM influye en las actitudes públicas hacia la VPM, como la aceptabilidad, el sentido de responsabilidad personal o la disposición a intervenir en casos de VPM. Método: En este estudio se presenta la adaptación de la escala española de gravedad percibida de la VPM (PS-IPVAW) al contexto cultural ecuatoriano, en una muestra de 652 participantes. Resultados: Los resultados mostraron que la escala PS-IPVAW tiene una buena consistencia interna, que sus ítems tienen una baja carga de deseabilidad social, que es invariante entre géneros y que se relaciona con la culpabilidad a la víctima, la aceptabilidad de la VPM y el sexismo hostil. Discusión: La escala PS-IPVAW es un instrumento con suficientes evidencias de fiabilidad y validez para evaluar la gravedad percibida de la VPM en Ecuador y representa un importante aporte para mejorar las estrategias de prevención, intervención y erradicación de este tipo de violencia en el contexto ecuatoriano.

Introduction: Intimate partner violence against women (IPVAW) is a global public health problem whose prevalence in Ecuador is among the highest in Latin America. The perceived severity of IPV influences public attitudes toward IPVAW, such as acceptability, sense of personal responsibility, or willingness to intervene in cases of IPV. Method: This study presents the adaptation of the Spanish scale of perceived severity of IPVAW (PS-IPVAW) to the Ecuadorian cultural context, in a sample of 652 participants. Results: Our results showed that the PS-IPVAW scale has good internal consistency, its items presented low loadings of social desirability, that it is invariant across genders and that it is related to victim blaming, acceptability of IPV and hostile sexism. Discussion: The PS-IPVAW scale showed adequate evidence.

Asociación entre severidad del asma bronquial, nivel de control y calidad de vida en niños

Fundamento el asma bronquial es una de las enfermedades crónicas de mayor prevalencia en la infancia. Las guías para el diagnóstico y tratamiento se rigen según severidad, nivel de control y calidad de vida, sin embargo, no existen evidencias que demuestren su asociación estadística. Objetivo medir el grado de asociación entre la severidad del asma bronquial, nivel de control y calidad de vida en niños. Métodos estudio de corte transversal, realizado en el periodo enero-diciembre de 2022, en una muestra de 189 pacientes con diagnóstico confirmado de asma bronquial. Se analizaron las variables: edad, sexo, severidad, nivel de control y calidad de vida. Se calcularon estadígrafos, frecuencia absoluta, porcentaje, media aritmética y desviación estándar. Para medir asociación se utilizó la prueba de Chi cuadrado (p<0,01) y para evaluar la fuerza de la asociación el coeficiente de V-Cramer. Resultados la edad media resultó 9,17 años (DE ± 0,67). Predominaron los varones, representativos del 53,54 %. Prevalecieron el asma intermitente (39,15 %), el nivel de control parcial (59,79 %) y la calidad de vida alta (50,26 %). Al relacionar severidad con nivel de control, el estadígrafo de asociación indicó X2=190,461 (VC= 0,662); en el caso de severidad y calidad de vida, X2=252,673 (VC=0,762); y entre nivel de control y calidad de vida, X2=66,733 (VC=0,401). Conclusiones existió asociación fuerte entre severidad del asma bronquial-nivel de control y entre la severidad del asma-calidad de vida; así como asociación moderada entre nivel de control-calidad de vida.

Foundation bronchial asthma is one of the most prevalent chronic diseases in childhood. The guidelines for diagnosis and treatment are governed by severity, level of control and quality of life, however, there is no evidence that demonstrates its statistical association. Objective to measure the association degree between the severity of bronchial asthma, control level and quality of life in children. Methods cross-sectional study, carried out from January to December 2022, in a sample of 189 patients with a bronchial asthma confirmed diagnosis. The analyzed variables were: age, sex, severity, level of control and quality of life. Statisticians, absolute frequency, percentage, arithmetic mean and standard deviation were calculated. The Chi-square test (p<0.01) was used to measure association and the V-Cramer coefficient was used to evaluate the strength of the association. Results the mean age was 9.17 years (SD ± 0.67). Males predominated, representing 53.54%. Intermittent asthma (39.15%), partial control level (59.79%) and high quality of life (50.26%) prevailed. When relating severity with level of control, the association statistician indicated X2=190.461 (VC= 0.662); in the case of severity and quality of life, X2=252.673 (VC=0.762); and between level of control and quality of life, X2=66.733 (VC=0.401). Conclusions there was a strong association between severity of bronchial asthma-level of control and between severity of asthma-quality of life; as well as a moderate association between level of control-quality of life.

Prevalencia de Porphyromonas gingivalis en fluido gingival y su relación con la periodontitis / Prevalence of Porphyromonas gingivalis in gingival fluid and its relationship with periodontitis

Introducción: la periodontitis es una enfermedad infecciosa multifactorial asociada a un biofilm de microorganismos patógenos. Objetivo: el objetivo del trabajo fue establecer la prevalencia de Porphyromonas gingivalis en pacientes con periodontitis y relacionarla con la severidad de la enfermedad. Material y métodos: participaron 45 pacientes, sistémicamente saludables, con edades entre 35 y 65 años. El grado de periodontitis se definió según los criterios de Papapanou y colaboradores. Como grupo control, se incluyeron 20 sujetos de ambos sexos sin periodontitis y sin enfermedades sistémicas. Se tomaron muestras de fluido gingival en dos sitios más profundos. Porphyromonas gingivalis se detectó por PCR (reacción en cadena de la polimerasa). Resultados: la frecuencia relativa de periodontitis fue de 13.3% grado I, 46.7% grado II y 40% grado III. El sexo masculino presentó periodontitis grado III 72.2% y grado II 52.3%. El grado I se registró con mayor frecuencia en el sexo femenino, 66.7%. La prevalencia de Porphyromonas gingivalis en la población con periodontitis fue de 44.4%. Se obtuvieron diferencias estadísticamente significativas entre los grados de severidad de periodontitis y la presencia de Porphyromonas gingivalis (p = 0.0002, α = 5%). Conclusión: la periodontitis predominó en el sexo masculino. La prevalencia de Porphyromonas gingivalis en la población con periodontitis crónica fue de 44.4% y su presencia está relacionada con la severidad (AU)

Introduction: periodontitis is a multifactorial infectious disease associated with a biofilm of pathogenic microorganisms. Objective: the objective of the work was to establish the prevalence of Porphyromonas gingivalis in patients with periodontitis and relate it to the severity of the disease. Material and methods: 45 systemically healthy patients, aged between 35 and 65 years old, participated. The degree of periodontitis was defined according to the criteria of Papapanou et al. As a control group, 20 patients of both sexes without periodontitis and without systemic diseases were included. Gingival fluid samples were taken from two deeper sites. Porphyromonas gingivalis was detected by PCR (polymerase chain reaction). Results: the relative frequency of periodontitis was 13.3% grade I, 46.7% grade II and 40% grade III. The male sex presented periodontitis grade III 72.2% and grade II 52.3%. Grade I was recorded more frequently in the female sex, 66.7%. The prevalence of Porphyromonas gingivalis in the population with periodontitis was 44.4%. Statistically significant differences were obtained between the degrees of severity of periodontitis and the presence of Porphyromonas gingivalis (p = 0.0002, α = 5%). Conclusion: periodontitis predominated in males. The prevalence of Porphyromonas gingivalis in the population with chronic periodontitis was 44.4% and its presence is related to severity (AU)

Is post-traumatic stress disorder related to the severity of physical trauma?

SUMMARY OBJECTIVE: Trauma can cause physical morbidity and even result in death. Besides, it can lead to serious mental problems as well. The most well-known mental health problem is post-traumatic stress disorder. Through this study, it was primarily aimed to find out whether the severity of physical trauma is effective on post-traumatic stress disorder and other risk factors if any. METHODS: The reports of the patients who were transferred to the Turkish Council of Forensic Medicine Third Speciality Board between January 01, 2019, and December 31, 2020, for post-traumatic invalidity or disability evaluation and whose psychiatric examinations were performed were retrospectively analyzed in the electronic environment. RESULTS: It was found that 34 (26.4%) of the patients had a diagnosis of post-traumatic stress disorder (under treatment for at least 6 months), while 76 (58.9%) of them did not have a psychiatric disease and 19 (14.7%) of them had mental disorders not associated with trauma (i.e., affective disorder, anxiety disorder, etc.). No significant correlation was found between trauma scores and post-traumatic stress disorder (p>0.05). CONCLUSION: Based on the results of our study, post-traumatic stress disorder and the severity of physical trauma are not significantly correlated. Being of female gender, sustaining a non-accidental injury, and witnessing a fatal event stand out as significant risk factors.

Total oxidant capacity, total antioxidant capacity, ischemic modified albumin, microRNA levels, and their relationship with psoriasis area and severity index

Aims: To examine the differences in the levels of microRNA, ischemic modified albumin (IMA), total oxidant capacity (TOC), and total antioxidant capacity (TAC) of persons with and without psoriasis and, in the case group, the relationship between these parameters and psoriasis area and severity index (PASI). Methods: Blood samples were collected from patients and healthy participants to examine levels of these parameters. Results: The mean serum TOC level was higher in the case group. The mean serum TAC and IMA levels were significantly lower in the case group (P <0.001). It was observed that the mean serum miR-203 and miR-146a levels were increased in psoriasis patients. It was determined that there was only a significant positive weak correlation between miR-203 and PASI (r = 0.232, P = 0.027). Limitations: The small sample size, not controlling serum albumin and not evaluating the effects of the treatment agents used by the patients on oxidative and inflammatory processes. Conclusion: In the case group changes in the mean serum TOC and TAC levels provide evidence that oxidative stress may play a critical role in disease pathogenesis. The increase in the mean serum miR-203 and miR-146a levels suggest the possibility of therapies targeting these microRNAs as a new option

Translating measurement into practice: Brazilian norms for depressive symptom assessment with the Patient Health Questionnaire (PHQ-9)

Objectives: To provide practical norms for measuring depressive symptoms with the Patient Health Questionnaire 9 (PHQ-9) in Brazil through a state-of-the-art psychometrics analysis. Methods: We used a large representative dataset from the 2019 Brazilian National Health Survey (Pesquisa Nacional de Saúde - 2019), which included 90,846 Brazilian citizens. To assess scale structure, we assessed a unidimensional model using confirmatory factor analysis. Item response theory was used to characterize the distribution of depressive symptoms. Summed- and mean-based PHQ-9 scores were then linked using item response theory-based scores in generalized additive models. Finally, percentiles, T scores, and a newly developed score, called the decimal score (D score), were generated to describe PHQ-9 norms for the Brazilian population. Results: Confirmatory factor analysis revealed a good fit to the unidimensional model, being invariant to age and sex. Item response theory captured item-level information about the latent trait (reliable from 1 to 3 SDs above the mean). Brazilian norms were presented using summed scores, T scores, and D scores. Conclusion: This is the first study to determine Brazilian norms for the PHQ-9 among a large representative sample using robust psychometric tools. More precise PHQ-9 scores are now available and may be widely used in primary and specialized clinical care settings.

Puntuación de trauma revisado como predictor de mortalidad intrahospitalaria en pacientes politraumatizados atendidos en el Hospital Belén de Trujillo, Perú

Objetivo: Determinar si el score de trauma revisado es predictor de mortalidad intrahospitalaria en pacientes politraumatizados atendidos en el Hospital Belén de Trujillo. Material y métodos: Se realizó un estudio observacional, analítico, retrospectivo, transversal de pruebas diagnósticas, se identificaron pacientes que fueron admitidos por politraumatismo y fueron hospitalizados en el Departamento de Cirugía General durante el periodo comprendido entre enero del 2017 a diciembre del 2021; en una muestra de 100 pacientes se evaluó la mortalidad. Resultados: La edad promedio fue 47,18 ± 20,40 vs 41,13 ± 18,37 en aquellos que fallecieron y sobrevivieron; el 55% y 63,33% de los fallecidos y sobrevivientes fueron varones en los grupos de estudio. La coagulopatía, acidosis metabólica y SRIS estuvieron asociadas a la mortalidad. Se observó una proporción de 72,50% y 3,33% de RTS < 6 en los pacientes politraumatizados que fallecieron y sobrevivieron (p = 0,001); se obtuvieron valores de sensibilidad: 73% IC 95% (59% - 86%), especificidad: 97% IC 95% (92% - 100%), valor predictivo positivo: 94% IC 95% (85% - 100%) y valor predictivo negativo: 84% IC 95% (75% - 93%). El área bajo la curva fue del 96,50% en la predicción de mortalidad por el RTS en pacientes con politraumatismo. Conclusión: El score de trauma revisado es un buen predictor de mortalidad en politraumatizados.

Objective: To determine whether the revised trauma score is a predictor of in-hospital mortality in polytrauma patients treated at Hospital Belén de Trujillo. Material and methods: An observational, analytical, retrospective, cross-sectional study of diagnostic tests was conducted, identifying patients who were admitted for polytrauma and were hospitalized in the Department of General Surgery during the period from January 2017 to December 2021; mortality was assessed in a sample of 100 patients. Results: Mean age was 47.18 ± 20.40 vs 41.13 ± 18.37 in those who died and survived; 55% and 63.33% of the deceased and survivors were male in the study groups. Coagulopathy, metabolic acidosis and SIRS were associated with mortality. A proportion of 72.50% and 3.33% STR < 6 was observed in polytrauma patients who died and survived (p = 0.001); sensitivity: 73% CI 95% (59% - 86%), specificity: 97% CI 95% (92% - 100%), positive predictive value: 94% CI 95% (85% - 100%) and negative predictive value: 84% CI 95% (75% - 93%). The area under the curve was 96.50% in predicting mortality by RTS in polytrauma patients. Conclusion: The revised trauma score is a good predictor of mortality in polytrauma patients.

Post mastectomy pain syndrome at an Indian tertiary cancer centre and its impact on quality of life

Background: Literature on Post mastectomy pain in the Indian population is scarce. Most literature is from the West. The current study aimed to identify the incidence of post?mastectomy pain syndrome (PMPS), pain severity, and its impact on quality of life in Indian patients. Method: Prospective observational study of 120 women undergoing mastectomy between March and December 2017, followed until 6 months after surgery. The Brief Pain Inventory (BPI) questionnaire and the quality of life questionnaire (QLQ) by the European Organization for Research and Treatment of Cancer (EORTC) and known as (EORTC?QLQ 30) were used to identify the impact on function and quality of life. Results: A 35.8% PMPS incidence was identified at 6 months after mastectomy. Pain was located in the anterior chest wall (41.8%), axilla (32.6%), and medial upper arm (25.6%). Most (48.8%) patients described it as dull aching and of mild intensity (55.8%). No significant association of age, BMI, surgery, Intercostobrachial nerve (ICBN) dissection, postoperative pain severity, pain history {dysmenorrhea, headache}, and postoperative radiotherapy with PMPS was found. Pain interfered with daily activities and quality of life in those with PMPS, as deduced from BPI and EORTC?QLQ. Conclusion: PMPS is very much a problem affecting the quality of life in our set of patients. Most women tried to cope and accept the pain as part of the treatment process. This shows the need for creating awareness about PMPS among healthcare providers and patients alike. Early identification and treatment of post mastectomy pain should be an essential aspect of patient care

A STUDY OF HEMATOLOGICAL AND BIOCHEMICAL PARAMETERS IN ASSESSING SEVERITY IN COVID-19 PATIENTS

Background: The severity of COVID-19 could be evaluated by examining several blood parameters mainly white blood cell (WBC) count, granulocytes, platelet, and novel hemocytometric markers neutrophils to lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR),lymphocyte to monocyte ratio (LMR) and biochemical parameters such as CRP,D-dimer,Serum ferritin, LFT, KFT etc. The present study has been carried out Methods and Material: on 100 RTPCR conrmed covid-19 patients over a period of one year from July 2021 to June 2022. Clinical features, investigations, and history of associated risk factors were extracted from case records.Samples were processed in Medonic M series ve part haematology analyzer.SELECTRA PRO M and ARCHITECT plus machine was used for LDH, AST, ALT,C- reactive protein (CRP),Serum creatinine and serum urea.Samples for electrolytes were processed in INNOLYTE MACHINE. The sample for D-dimer and PT INR were processed in STA SETELLITE Max haemostasis analyser. Samples for procalcitonin were processed in CARDIAMARKER HIA-1200 machine.Chi squre test was used for analyzing signicant correlation among different parameters and covid-19 severity.P value<0.05 was dened as statistically signicant for all statistical test. Statistical analysis used: Results:Retrospective observational study Among 100 RTPCR conrmed cases,40,36,20 and 4 were mild, moderate, severe and critical respectively.Total total neutrophils count signicantly raised in critical patients(p value<0.05) while absolute lymphocyte count was signicantly decreased in critical patients(p value<0.05).NLR was signicantly raised in critical patients and LMR,PLR were also signicantly related to disease severity.CRP,S.ferritin and D- dimer were signicantly raised in critical patients(p value<0.05).Besides above parameters, Serum LDH,Serum electrolytes,AST,AL,.PT-INR were also raised in critically ill patients(p value<0.05). The severity of COVID-19 can Conclusions: be identied at an early stage by following the different routine biochemical marker levels and subsequently improve prognosis.parameters

Hemorragia digestiva baja: factores de riesgo de gravedad, necesidad de cirugía de urgencia y mortalidad hospitalaria / Lower gastrointestinal bleeding: risk factors of severity, need for emergency surgery and in-hospital Mortality

RESUMEN Antecedentes: Últimamente creció el interés en poder determinar, en etapas tempranas de las hemorragias digestivas bajas (HDB), aquellos factores de riesgo relacionados con la posibilidad de presentar resultados evolutivos adversos. Objectivo: Determinar los factores de riesgo asociados a sangrados graves, cirugía de urgencia y mortalidad hospitalaria. Material y métodos: Realizamos un estudio observacional y retrospectivo sobre 1.850 pacientes, atendidos en forma consecutiva entre enero de 1999 y diciembre de 2018 por HDB. Para evaluar el riesgo de gravedad analizamos trece variables en las primeras cuatro horas desde la admisión. Para determinar los factores relacionados con la cirugía de urgencia, agregamos la enfermedad diverticular y, para evaluar mortalidad, la cirugía de urgencia y el puntaje (score) preoperatorio de la Sociedad Americana de Anestesiología (ASA). Resultados: De los 1.850 casos, 194 fueron graves y 1656 leves/moderados. Resultaron estadísticamente significativos como factores de mayor gravedad: > 70 años, FC > 120 lat/min., TA < 90 mm Hg, oliguria, hematoquecia masiva, hematocrito < 30%, hemoglobina < 7 g/% y necesidad transfusional. Resultaron predictores significativos de cirugía de urgencia: > 70 años, anti-coagulación, hipotensión arterial, taquicardia, hemoglobina < 7 g/%, oliguria, transfusiones y hematoquecia masiva. Se construyó una fórmula pronóstica de requerimiento de cirugía (sensibilidad 94%, especificidad 74%, valor predictivo positivo 91% y valor predictivo negativo 81%). AUC: 0,89%. Fueron significativos para mortalidad: > 70 años, anticoagulados, hematoquecia masiva, transfusiones y cirugía urgente. De los dieciséis pacientes operados y fallecidos de la serie, quince presentaban un ASA ≥ IV. Conclusiones: Las variables utilizadas resultaron simples, fiables y estadísticamente significativas para predecir gravedad, cirugía de urgencia y mortalidad.

ABSTRACT Background: Background: There has been a growing interest in determining those risk factors associated with adverse outcomes in early stages of lower gastrointestinal bleeding (LGIB). Objective: The aim of our study was to analyze the risk factors associated with severe bleeding, emergency surgery and in-hospital mortality. Material and methods: We conducted an observational and retrospective study on 1850 patients consecutive managed between January 1999 and December 2018 for LGIB. We analyzed thirteen variables within the first four hours of hospitalization to evaluate risk severity. Diverticular disease was considered to determine factors associated with emergency surgery, and the preoperative American Society of Anesthesiologists (ASA) score was used to assess mortality and emergency surgery. Results: Out of 1850 cases, 194 were severe and 1656 were mild/moderate, Patients > 70 years, with HR > 120 beats/min, BP < 90 mm Hg, oliguria, massive hematochezia, hematocrit < 30%, hemoglobin < 7 g% and need for transfusions presented statistically significant associations with severe bleeding. Age > 70 years, anticoagulation, hypotension, tachycardia, hemoglobin < 7 g%, oliguria, need for transfusion and massive hematochezia were significant predictors of emergency surgery. A prognostic formula was constructed to predict the need for surgery (sensitivity 94%, specificity 74%, positive predictive value 91% and negative predictive value 81%). AUC-ROC: 0,89%. Age > 70 years, anticoagulation, massive hematochezia transfusions and emergency surgery were identified as predictors of mortality. Fifteen of the sixteen patients who underwent surgery and died had ASA ≥ grade 4. Conclusions: The variables analyzed are simple, reliable and statistically significant to estimate the risk of severe bleeding, need for emergency surgery and mortality.

Indian food habit & food ingredients may have a role in lowering the severity & high death rate from COVID-19 in Indians: findings from the first nutrigenomic analysis

Background & objectives: During the COVID-19 pandemic, the death rate was reportedly 5-8 fold lower in India which is densely populated as compared to less populated western countries. The aim of this study was to investigate whether dietary habits were associated with the variations in COVID-19 severity and deaths between western and Indian population at the nutrigenomics level. Methods: In this study nutrigenomics approach was applied. Blood transcriptome of severe COVID-19 patients from three western countries (showing high fatality) and two datasets from Indian patients were used. Gene set enrichment analyses were performed for pathways, metabolites, nutrients, etc., and compared for western and Indian samples to identify the food- and nutrient-related factors, which may be associated with COVID-19 severity. Data on the daily consumption of twelve key food componentsacross four countries were collected and a correlation between nutrigenomics analyses and per capita daily dietary intake was investigated. Results: Distinct dietary habits of Indians were observed, which may be associated with low death rate from COVID-19. Increased consumption of red meat, dairy products and processed foods by western populations may increase the severity and death rate by activating cytokine storm-related pathways, intussusceptive angiogenesis, hypercapnia and enhancing blood glucose levels due to high contents of sphingolipids, palmitic acid and byproducts such as CO2 and lipopolysaccharide (LPS). Palmitic acid also induces ACE2 expression and increases the infection rate. Coffee and alcohol that are highly consumed in western countries may increase the severity and death rates from COVID-19 by deregulating blood iron, zinc and triglyceride levels. The components of Indian diets maintain high iron and zinc concentrations in blood and rich fibre in their foods may prevent CO2 and LPS-mediated COVID-19 severity. Regular consumption of tea by Indians maintains high high-density lipoprotein (HDL) and low triglyceride in blood as catechins in tea act as natural atorvastatin. Importantly, regular consumption of turmeric in daily food by Indians maintains strong immunity and curcumin in turmeric may prevent pathways and mechanisms associated with SARS-CoV-2 infection and COVID-19 severity and lowered the death rate. Interpretation & conclusions: Our results suggest that Indian food components suppress cytokine storm and various other severity related pathways of COVID-19 and may have a role in lowering severity and death rates from COVID-19 in India as compared to western populations. However, large multi-centered case?control studies are required to support our current findings.

Risk Factors Associated with Severity of COVID-19 Infections Among Older Patients – A Prospective Study

Background: The coronavirus disease 2019 (COVID-19) is a novel coronavirus infection disease causing respiratory failure and a high death rate in vulnerable populations. Prior studies have identified age, male sex, and metabolic comorbidities, such as hypertension and diabetes as risk factors for poor outcomes in patients with COVID-19. These comorbidities are more common among older age groups, and overwhelming evidence from around the world suggests that age itself is the most significant risk factor for severe disease and death from COVID-19. The aim of this study was to determine the associated risk factors of severe COVID-19 infections among older patients. Material & Methods: This was a prospective study and was conducted in the Department of Pharmacology of Shaheed Syed Nazrul Islam Medical College Hospital, Kishoreganj, Bangladesh during the period from March, 2021 to March, 2022. In this study, we took 80 confirmed cases of COVID 19 positive who attended and took admission in Shaheed Syed Nazrul Islam Medical College Hospital, Kishoreganj, Bangladesh. Results: In our study we found majority (48.75%) of our study patients were aged between 65-74 years old, most of our patients were male (61.25%). The mean age of our patients was 76.54 ± 21.04 years. Among all patients, 89% had respiratory difficulty, 86% came with nausea & vomiting, 83% came with fever, 74% had ache all over body, 76% & 64% came with chest pain & running nose respectively. We found 51% patients with DM,80% with CKD, 70% with respiratory failure, 49% with arrhythmia, 74% with IHD, 46% with Sepsis, 55% with acute liver injury, 26% with coagulopathy. Some risk factors co-exist among our patients. Conclusion: In our study, we included the elderly patients with COVID 19 associated with severe illness who had a high mortality rate. We found aged above 80 years, male gender, DM, CKD, respiratory failure, arrhythmia, IHD, Sepsis, acute liver injury are most common risk factors that triggers the severity of COVID 19 infections.

Trauma severity predictors / Preditores de gravidade no trauma

This review aimed to determine which are the indexes for early detection and evaluation of clinical and physiological deterioration of traumatized patients. A Scoping Review according to the methods proposed by Joanna Briggs Institute (JBI) was performed from February 2018 to December 2018 on LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde), National Library of Medicine (PubMed), and SCOPUS databases. Sixty-two studies were included, of which 43 evaluated patients with general trauma. A variety of physiological variables, such as Glasgow Coma Score, Glucose, Days in the Intensive Care Unit, Lactate, and predictor indexes - Injury Severity Score (ISS), Trauma Injury Severity Score (TRISS), Revisited Trauma Score (RTS), and APACHE II were identified. The values observed in the studies among patients were compared to the ones determined by the basic literature, being called Critical Values (CV). The group of gravity indexes, besides clinical and regulatory protocols, found in this review are the solidification of the healthcare process involving the traumatized patient's responses to the actions of the healthcare team. The analysis of these indexes must be emphasized to determine, with greater reliability, the prognosis of the patient. With these data, it may be possible to effectively predict mortality rates (AU).

O objetivo desta revisão é determinar os índices para detecção precoce e avaliação clínica e fisiológica para deterioração de pacientes do trauma. Conduziu-se uma revisão de escopo de acordo com os métodos propostos pelo Joanna Briggs Institute (JBI) entre fevereiro de 2018 a dezembro de 2018 nas bases de dados LILACS (Literatura Latina-Americana e do Caribe em Ciências da Saúde), National Library of Medicine (PubMed) e SCOPUS. Foram incluídos 62 estudos, dos quais 43 sobre trauma geral. Encontrou-se grande diversidade de variáveis fisiológicas, como Escala de Coma de Glasgow, Glicose, dias em Unidade de Terapia Intensiva, lactato e índices preditores­Injury Severity Score (ISS), Trauma Injury Severity Score (TRISS), Reviseted Trauma Score (RTS) e APACHE II. Os valores observados nos pacientes dos estudos encontrados foram comparados com os da literatura básica, sendo denominados Valores Críticos (CV). O grupo de índices de gravidade encontrados neste estudo, além de protocolos reguladores e clínicos, são a solidificação do processo de cuidado envolvendo a resposta das ações da equipe em saúde ao paciente de trauma. A análise desses índices deve ser enfatizada para determinar com maior confiabilidade o prognóstico do paciente. Com esses dados, pode ser possível predizer a taxa de mortalidade com maior acurácia (AU).