McKittrick-Wheelock Syndrome: A Case Series

McKittrick-Wheelock syndrome is a rare and life-threatening disease characterized by the triad of (1) chronic mucous diarrhea, (2) renal function impairment with hydroelectrolyte imbalance, and (3) a giant colorectal tumor. Often, the tumor is a rectal adenoma. With the mortality being certain, if left untreated, it is important to raise awareness on the presentation, diagnosis, and management of this disease entity. Here, we presented 3 cases of McKittrick-Wheelock syndrome that were successfully managed with surgical resection at the Philippine General Hospital from August 2018 to May 2019. Resolution of their symptoms, reversal of their renal impairment, and correction of their electrolyte depletion were noted after removal of the tumor with a sphincter-saving operation.

Outcomes of surgical management of buschke-lowenstein tumor in a Philippine tertiary hospital

Buschke-Lowenstein tumor (BLT) is a sexually transmitted infection (STI) caused by the human papillomavirus. This study investigated the profile, management, and outcomes of patients who underwent surgery for BLT from 2015 to 2019 at the Philippine General Hospital. Seven patients underwent surgery for BLT. All were male, with ages ranging from 21 to 41 years. Presenting symptoms were anal mass, foul-smelling discharge, pain, bleeding, and pruritus. All were positive for human immunodeficiency virus. All admitted to having engaged in both insertive and receptive anal intercourse, with multiple partners. All underwent excision with healing by secondary intention. Two had recurrence of warts. Four had an anal stricture. Of these, 3 underwent anal dilatation, while 1 had to undergo proximal bowel diversion. One had intraepithelial carcinoma without dermal invasion on histopathologic analysis. BLT is a rare STI characterized by local aggressiveness but with low malignant potential. Wide excision remains to be the mainstay of treatment.

Improved outcomes with implementation of an Enhanced Recovery After Surgery pathway for patients undergoing elective colorectal surgery in the Philippines

Purpose@#This study aims to evaluate surgical outcomes (i.e. length of stay [LOS], 30-day morbidity, mortality, reoperation, and readmission rates) with the use of the Enhanced Recovery After Surgery (ERAS) pathway, and determine its association with the rate of compliance to the different ERAS components. @*Methods@#This was a prospective cohort of patients, who underwent the following elective procedures: stoma reversal (SR), colon resection (CR), and rectal resection (RR). The primary endpoint was to determine the association of compliance to an ERAS pathway and surgical outcomes. These were then retrospectively compared to outcomes prior to the implementation of ERAS. @*Results@#A total of 267 patients were included in the study. The overall compliance to the ERAS component was 92.0% (SR, 91.8%; CR, 93.1%; RR, 90.7%). There was an associated decrease in morbidity rates across all types of surgery, as compliance to ERAS increased. The average total LOS decreased in all groups but was only found to have statistical significance in SR (12.1±6.7 days vs. 10.0±5.4 days, P=0.002) and RR (19.9±11.4 days vs. 16.9±10.5 days, P=0.04) groups. Decreased postoperative LOS was noted in all groups. Morbidity rates were significantly higher after ERAS implementation, but reoperation and mortality rates were found to be similar. @*Conclusion@#Increased compliance to ERAS protocol is associated with a decrease in morbidity across all surgery types. The implementation of an ERAS protocol significantly decreased mean hospital LOS, without any increase in major surgical complications. Having your own hospital ERAS pathway improves documentation and accuracy of reporting surgical complications.

Clinical profile and outcomes of patients undergoing a Turnbull-Cutait transanal pullthrough procedure with Delayed Coloanal Anastomosis (DCAA) at the Philippine General Hospital

RATIONALE/OBJECTIVES@#The Turnbull-Cutait transanal pullthrough procedure with delayed coloanal anastomosis has been widely used before the advent of intestinal stapling devices. It is a viable option for rectal reconstruction for benign and malignant conditions, and is able to maintain intestinal continuity without the use of a temporary diversion. It has also been used in salvage operations for pelvic sepsis, failed anastomosis, and tumor recurrence that will otherwise require a permanent ileostomy. This study will describe the technique, as well as the outcomes of patients who underwent the procedure.@*METHODS@#This is a retrospective descriptive study conducted to report the outcomes of patients who underwent the Turnbull-Cutait transanal pull-through with delayed coloanal anastomosis at the Philippine General Hospital from January 2008 to December 2013. Eleven patients were identified using an institutional retrospective database. Clinical data and outcomes were collected using a standard form.@*RESULTS@#Ten of the 11 patients had an unremarkable postoperative course. One patient had an anastomotic dehiscence. The mean operative time was 229.9 minutes for the 1st stage and 28.2 minutes for the second stage, with a mean blood loss of 463.6 cc for both stages. The mean interval between the two stages was 7.9 days, with an average postoperative length of stay of 8.27 days. The average follow-up was 4.5 years. Functional outcomes were acceptable (average Wexner score 5.63), except for one patient who had an anastomotic dehiscence. No perioperative mortality was noted.@*CONCLUSION@#Turnbull-Cutait trans-anal pullthrough procedure with delayed coloanal anastomosis appears to be a safe procedure. The study suggests that it is an alternative strategy in rectal cancer in providing a sphincter-saving surgery, with the establishment of gastrointestinal continuity, and without the need for a proximal diversion. Stoma-less surgery has a notable health economic impact especially in developing countries because it eliminates the costs associated with the use of stoma appliances.

Evaluation of External Abdominal Wall Hernia Surgery in a Secondary Level Facility in Kumasi, Ghana

Aims: We aimed at auditing hernia surgeries performed at a secondary care centerand determine the outcome of surgery based on the grade of operating surgeon. Study Design: A single center retrospective study.Place and Duration of Study: Department of Surgery of Ashanti regional Hospitalbetween October 2015 to September 2018.Methodology: We included 259 patients, age ranging between 1 and 84 years, who underwent external hernia surgeries.Information retrieved included patient demographics, type of hernia, duration of hernia, whether hernia was emergency or elective, method of repair, whether surgery was performed by a surgeon or non-surgeon and early post-operative complications. Datawas analyzed using PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc SPSS. Bivariate analysis was done to ascertain relationship between complications and operating doctor.Results: A total of 259 hernia surgeries were performed over the study period. There were186 (71.8 %) males and 73 (28.2 %) females, age range of 1 to 84 years. There were 66 (25.5%) children and 193(74.5%) adults. Children in their first decade were the majority (22.4%) age group followed by adults in their 5thdecade (17%). Inguinal hernia was the most common (75.7%) type of hernia, 49 (18.9%) children and 147(56.6%) adults. There were 32 (12.4%) emergencies. Small bowel (20) was the most common content found in the hernia sac with 6 of them being gangrenous. Hematoma was the most common early complication.The majority (63.7%) of the cases were performed by the general surgeon and (20.1%) by house officers (interns) under supervision. Complications like haematoma, surgical site infection and acute urinary retention were more likely to occur in the non-surgeon operators. There was no statistically significant relation between the grade of operating surgeon and Haematoma (p= 0.28) and surgical site infection (p= 0.76).Conclusion: Hernias are common in children in the first decade and in adults in the 5thdecade. With a well-structured training programme non-surgeon physicians can be trained to perform hernia surgeries with relatively low complication.

Association of Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) to disease activity in Filipino lupus patients

Background@#Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disease characterized by autoantibody production, immune complex deposition and excessive pro-infl ammatory cytokine production due to an aberrant and dysfunctional immune system. Disease activity markers for SLE are helpful in the management and prognostication of the disease. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been studied as a novel infl ammatory marker and prognostic markers for cardiovascular diseases, infl ammatory disorders and malignancies.@*Objective@#The aim of the study is to investigate the association of NLR and PLR to disease activity of Filipino patients with SLE.@*Methods@#This is a cross-sectional study done through a retrospective chart review of 135 Filipino SLE patients divided into two groups. Group 1 (SLEDAI-2K score of <3) had 64 patients who were in low disease activity/remission and group 2 (SLEDAI2K score of ≥3) had 71 patients who were in active disease. Clinical characteristics and disease activity parameters (C3, anti-dsDNA, ESR) and NLR and PLR were compared in the two groups. Correlations of NLR and PLR with established clinical and laboratory disease activity markers of SLE (C3, anti-dsDNA, SLEDAI-2K scores) were analyzed.@*Results@#The group 2 or those with active disease had signifi cantly higher NLR (2.947 ± 1.756 vs. 1.868 ± 0.832, p-value of <0.001) and PLR (205.9 ± 122.2 vs. 140.2 ± 53.0, p-value of <0.001) levels compared to group 1. NLR and PLR values were also signifi cantly higher in patients with lupus nephritis. NLR was positively correlated with anti-dsDNA (r = +0.490, p-value of <0.001) and SLEDAI-2K scores (r = +0.496, p-value of <0.001). NLR was negatively correlated with C3 (r = -0.336, p-value of <0.001). PLR was also positively correlated with anti-dsDNA (r = +0.301, p-value of <0.001) and SLEDAI-2K scores (r = +0.369, p-value <0.001). PLR was also negatively correlated with C3 levels (r = -0.215, p-value 0.012). Using the ROC curve analysis, the cut-off values in predicting active disease in SLE were 1.968 (sensitivity 77.5%, specifi city 75%) for NLR and 144.53 (sensitivity 63.4%, specifi city 60%) for PLR. The cut-off values in predicting lupus nephritis were 2.121 (sensitivity 73.1%, specifi city 60%) for NLR and 167.0 (sensitivity 65.4%, specifi city 68%) for PLR.@*Conclusions@#NLR and PLR were signifi cantly higher among Filipino SLE patients with active disease including lupus nephritis refl ecting active infl ammation. NLR and PLR correlated well with established disease activity markers for SLE namely C3, anti-dsDNA, and SLEDAI-2K scores. NLR and PLR could be a useful and convenient disease activity marker for SLE patients.

The surgical correction of Hirschsprung's Disease in adults using the Modified Duhamel procedure

BACKGROUND@# Hirschsprung’s disease (HD) is rare in adults, since a majority of cases are corrected in childhood.@*OBJECTIVES@#The authors describe the profile of patients with HD who reached adulthood without having undergone corrective surgery. Also, they describe the outcomes of a modified Duhamel procedure in these patients, in terms of morbidity and mortality.@*METHODS@#This retrospective study, included patients 18 years old and above, diagnosed with HD who reached adulthood without having undergone definitive repair and managed surgically by the Division of Colorectal Surgery, UP-PGH from January 1, 2004 to December 31, 2014. A review from the Department Surgical Database was used and patients’ hospital records were used to fill out a Data Collection Form. Descriptive statistics were used to summarize the data.@*RESULTS@# The 13 patients included in the study were diagnosed at an average age of 16.6 (± 13.16) years. The mean age at the time of definitive surgery was 23.46 (± 6.96) years. The M:F ratio was 5.5:1. The most common presenting symptom was constipation (69.23%). All had a prior proximal bowel diversion, with a transverse loop colostomy (61.54%) being the most common. The transition zone was located in the sigmoid in a third of patients. The mean time from diagnosis to definitive surgery was 6.69 years. Eight (61.54%) have since undergone stoma reversal. There was only one (7.69%) morbidity, a superficial surgical site infection. No mortalities were reported.@*CONCLUSION@#The modified Duhamel procedure is a safe definitive surgical procedure for the adult patient with HD.

Tocilizumab for refractory adult-onset still’s disease: Report of three cases

OBJECTIVES@#To present three cases of adult-onset still’s disease (AOSD) who was initially refractory to corticosteroid therapy but were successfully treated with an interleukin-6 (IL-6) inhibitor, tocilizumab (TCZ). @*BACKGROUND@# Adult-onset Still’s Disease (AOSD) is a systemic inflammatory disorder of unknown etiology characterized by quotidian fever, evanescent rash, and arthritis/arthralgia. The pro-inflammatory cytokine interleukin (IL) – 6 has been implicated in its pathogenesis. @*CASE PRESENTATION@#Three patients (40F, 37F, and 27M) presented with quotidian fever, evanescent maculopapular rash, arthritis, anemia, leukocytosis, elevated acute phase reactants and hyperferritinemia of 3 to 4 months duration. All were diagnosed AOSD by Yamaguchi criteria after extensive work up to exclude other diagnostic possibilities. Each patient received high dose corticosteroids and 2 patients also received methotrexate (MTX) with initial improvement of symptoms. However, there was recurrence and exacerbation of clinical symptoms on tapering of steroid doses. Each patient was then given TCZ at 8 mg/kg. Within a month of the initial dose of TCZ, there was dramatic clinical and laboratory improvement, enabling rapid steroid dose tapering. @*CONCLUSION@#This series substantiates the role of IL-6 in the pathomechanisms of AOSD and demonstrates use of TCZ in the management of AOSD refractory to corticosteroids.

Rare cause of dysphagia in children

Dysphagia in children is generally caused by strictures secondary to gastroesophageal reflux disease or post-repair of trachea-esophageal atresia/fistula

A four-year-old female presented with a history of dysphagia for solid food and vomiting of undigested food. Barium swallow showed esophageal duplication cyst, which was confirmed by esophagoscopy

Surgical resection was curative

Causes other than stricture or dysmotility should be considered in children with unrelenting dysphagia.

clinicopathological study of emergency appendectomy

Background: Acute appendicitis is one of the most frequent reasons for admission to the surgical unit and appendectomy is the most common emergency procedure performed worldwide. The accuracy of diagnosis is not straightforward at all times. A lower negative appendectomy rate [NAR] is regarded internationally as a quality indicator of the treating center

Objective: To determine the diagnostic accuracy of appendicitis by clinical, radiological and histopathological findings. Design: A Retrospective Review. Setting: King Hamad University Hospital, Bahrain

Method: Patients who had appendectomy were included in the study. Data were documented between January 2013 and December 2014. All patients above 14 years of age were included. Incidental appendectomy and appendicitis during pregnancy were excluded from the study

Result: The medical records of 286 patients who underwent appendectomy were reviewed; 187 [65.4%] were males. The mean age was 29.3 years. The negative appendectomy rate [appendix is normal on histopathology] was 29 [10.1 %] while another pathology other than appendicitis was found in one [0.349%]. Twenty-nine patients had a normal appendix, 20 were females. The total perforation rate was 28 [10%]. Complications were encountered in 2 [0.69%] patients. Ultrasound was used in 86 [30.1%] patients and conventional tomography used in 67 [23.43%] cases. The overall accuracy of both clinical and radiological diagnosis was 89.16%. The mean age was 29.3 years

Conclusion: The diagnostic accuracy, in our study, was 89.16%. Clinical diagnosis and radiological imaging, especially in females, could decrease the NAR to an acceptable rate

Caracterização bromatológica e agronômica de genótipos de milho para produção de silagem / Chemical characterization and agronomic genotypes of maize for silage

O objetivo deste trabalho foi avaliar as características bromatológicas e agronômicas dos genótipos de milho para a produção de silagem dos cultivares do Ensaio Centro Superprecoce da Rede Nacional de Genótipos de Milho, bem como avaliar se a base genética (híbridos simples, duplos, tripos, intervarietais e variedades cultivadas) ou a dureza dos grãos (duro, semiduro e dentado mole) alteram a indicação de cultivares de milho para silagem. O experimento foi realizado na área experimental da Universidade Tecnológica Federal do Paraná (campus Dois Vizinhos). Os trinta e dois genótipos avaliados foram colhidos quando os grãos encontravam-se no estádio pastoso a farináceo, ensilados em microssilos de PVC e desensilados após 53 dias. Avaliou-se a relação entre as bases genéticas, a dureza do grão e as características individuais dos genótipos quanto à aptidão para a produção de silagem. Não se verificaram diferenças significativas entre os contrastes formados entre as bases genéticas, bem como a dureza dos grãos, para os caracteres estudados. Porém, foi possível identificar genótipos superiores para a produção de silagem pela produção de matéria seca pelos genótipos AS 1555 YG, AS 1572 YG, 30A37, 30A77, 20A78, Dx 908, Dx 603, 2A550, 2B433, AL2007A, Embrapa 1F640, PRE 22T10, PREXT0109, PRE 22D11, DKB330 YG (Test).

The aim of this study was to evaluate the nutritive value and agronomic characteristics of maize genotypes for the silage production cultivars test center network of Super Early National Corn Genotypes; and to assess whether the genetic background (hybrids simple, doubles, triples, intervarieties and cultivated varieties) or the hardness of the grains (hard, soft flint and dent) may change the indication of maize cultivars for silage. The experiment was conducted at the experimental Federal Technological University of Paraná (Campus Dois Vizinhos). Thirty-two genotypes were harvested when the grains were in the dough soft dough stage, micro-ensiled in PVC silos, silage cutters and after 53 days after silage cutters. We evaluated the characteristics and chemical plant parameters of each genotype. We evaluated the relationship between genetic bases, hardness of the grain and individual characteristics of genotypes related to the production of corn silage. There was no significant difference between the contrast formed between the genetic and hardness of the grains for the characteristics studied. However, it was possible to identify superior genotypes for the production of silage whit bases in dry matter production by genotype YG AS 1555, AS 1572 YG, 30A37, 30A77, 20A78, DX 908, DX 603, 2A550, 2B433, AL2007A, EMBRAPA 1F640, PRE 22T10, PREXT0109, PRE 22D11, DKB330 YG (Test).

Siringoma vulvar: reporte de caso y revisión de la literatura / Vulvar syringoma: case report and literature review

Se presenta el caso de una mujer de 32 años, quien consultó por presentar desde hace 6 meses nódulos múltiples y pruriginosos en ambos labios mayores, prurito que se exacerbaba durante la menstruación. El estudio anatomo-patológico demostró una proliferación dérmica de conductos pequeños revestidos por una doble capa de células cuboídeas normotípicas, y rodeados por un estroma fibroso compatibes con un siringoma...

We report a case of a 32 year-old woman, who consulted to present for 6 months and multiple and itchy nodules in both labia majora, itching that was exacerbated during menstruation. The pathological study showed a dermal proliferation of small ducts lined by a double layer of normotipic cuboidal cells, and surrounded by a fibrous stroma compatibes a syringoma...

Medicina integradora: un puente entre la biomedicina y la medicina alternativa que se ajusta al espíritu de la época / Integrative Medicine: A Bridge between Biomedicine and Alternative Medicine Fitting the Spirit of the Age

Complementary and alternative medicine (CAM) are increasingly used by people in first world countries, almost always in combination with biomedicine. The combination of CAM and biomedicine is now commonly referred to as "integrative medicine" (IM). In Groningen, The Netherlands, we founded a center for integrative psychiatry, offering conventional and complementary mental health care. Like other centers for integrative (mental) health we have mostly received positive reactions although there have been negative and even hostile reactions as well, using phrases like "quackery" and "betrayal". We will try to illustrate that these polarising qualifications, in which "the good" is being positioned against "the bad" in an over-simplified manner, are unnecessary and not useful. Moreover, it is unlikely that this polarisation will stall the growth of IM. It seems that integration is not only a current tendency in medicine, but also a trend fitting the contemporary spirit of the age in which integration seems to be the most common focus. It can be observed in religion, philosophy, spirituality and psychotherapy as well. This article will discuss the difference between differentiation and integration and will show that the focus on differentiation or integration varies with time, mostly rising as a reaction to each other. The transition from one period to the next is often met with resistance and criticism. If the integrative movement is to survive, it cannot do without differentiation and must find a middle way in which appropriate attention is being paid to keeping the integrated parts sufficiently differentiated and allowing them to keep their own identity.

Desfechos clínicos por região geográfica em pacientes com implante de stent eluidor de Zotarolimus / Clinical outcomes by geographic region for patients implanted with the zotarolimus-eluting stent / Desenlaces clínicos por región geográfica en pacientes con implante de Stent liberador de Zotarolimus

FUNDAMENTO: Diferenças entre regiões geográficas em relação à características de pacientes e desfechos, particularmente em síndromes coronarianas agudas, tem sido demonstradas em testes clínicos. Os desfechos clínicos após intervenções coronarianas percutâneas com o stent eluidor de Zotarolimus em uma população real foram analisados com o tempo. OBJETIVO: A influência da localização geográfica sobre os desfechos clínicos com o stent eluidor de Zotarolimus foi avaliada em três regiões: Pacífico Asiático, Europa e América Latina. MÉTODOS: Um total de 8.314 pacientes (6.572 da Europa, 1.522 do Pacífico Asiático e 220 da América Latina) foram acompanhados por 1 ano; 2.116 desses (1.613, 316, e 187, respectivamente) foram acompanhados por 2 anos. Características dos pacientes e lesões, terapia antiplaquetária dupla e desfechos clínicos foram comparados entre a América Latina e as outras duas regiões. RESULTADOS: Os pacientes da América Latina apresentavam a maior proporção de fatores de risco e infarto do miocárdio prévio. O uso da terapia antiplaquetária dupla declinou rapidamente na América Latina, de 44,9 por cento em 6 meses para 22,5 por cento em 1 ano e 7,8 por cento em 2 anos (Europa: 87,4 por cento, 61,5 por cento, 19,7 por cento; Pacífico Asiático: 82,4 por cento, 67,0 por cento, 45,7 por cento, respectivamente). Não houve diferenças significantes entre a América Latina e a Europa ou Pacífico Asiático para qualquer desfecho em qualquer ponto do tempo. A incidência de trombose de stent provável e definitiva pelo Academic Research Consortium foi baixa (<1,2 por cento) entre todos os pacientes em 1 ano e 2 anos. CONCLUSÃO: Os desfechos clínicos foram comparáveis entre os pacientes da América Latina e Europa, e América Latina e Pacífico Asiático, a despeito dos subgrupos clínicos menos favoráveis na América Latina, perfil de risco mais elevado e menor uso acentuado de terapia antiplaquetária dupla com o tempo.

BACKGROUND: Differences between geographic regions in patient characteristics and outcomes, particularly for acute coronary syndromes, have been demonstrated in clinical trials. Clinical outcomes after percutaneous coronary interventions with the Zotarolimus-eluting stent in a real-world population were assessed over time. OBJECTIVE: The influence of geographic location on clinical outcomes with the Zotarolimus-eluting stent was assessed in 3 regions: Asia Pacific, Europe, and Latin America. METHODS: A total of 8,314 patients (6,572 Europe, 1,522 Asia Pacific, and 220 Latin America) were followed for 1 year; 2,116 of these (1,613, 316, and 187, respectively) were followed for 2 years. Patient and lesion characteristics, dual antiplatelet therapy, and clinical outcomes were compared between Latin America and the other regions. RESULTS: Patients in Latin America had the highest proportions of risk factors and prior myocardial infarction. Dual antiplatelet therapy usage rapidly declined in Latin America, from 44.9 percent at 6 months to 22.5 percent at 1 year and 7.8 percent at 2 years (Europe: 87.4 percent, 61.5 percent, 19.7 percent; Asia Pacific: 82.4 percent, 67.0 percent, 45.7 percent). There were no significant differences between Latin America and Europe or Asia Pacific for any outcome at either time point. The incidence of Academic Research Consortium definite and probable stent thrombosis was low (<1.2 percent) among all patients at 1 year and 2 years. CONCLUSION: Clinical outcomes were comparable between patients in Latin America and Europe, and Latin America and Asia Pacific, despite less favorable clinical subsets in Latin America, a higher risk profile, and markedly lower use of dual antiplatelet therapy over time.

FUNDAMENTO: Las diferencias entre las regiones geográficas en relación con las características de pacientes y desenlaces, sobre todo en los síndromes coronarios agudos se ha demostrado en ensayos clínicos. Los desenlaces clínicos después de las intervenciones coronarias percutáneas con stent liberador de zotarolimus en una población real se analizaron a través del tiempo. Objetivos: La influencia de la ubicación geográfica sobre los desenlaces clínicos con el stent liberador de zotarolimus se evaluó en tres regiones: Pacífico Asiático, Europa y América Latina. MÉTODOS: A total of 8,314 patients (6.572 Europe, 1.522 Asia Pacific, and 220 Latin America) were followed for 1 year; 2.116 of these (1.613, 316, and 187, respectively) were followed for 2 years. Patient and lesion characteristics, dual antiplatelet therapy, and clinical outcomes were compared between Latin America and the other regions. RESULTADOS: Los pacientes en América Latina tuvieron la mayor proporción de factores de riesgo e infarto de miocardio previo. Hubo un rápido descenso en el uso de la terapia antiplaquetaria en América Latina, el 44,9 por ciento en 6 meses para 22,5 por ciento en 1 año y 7,8 por ciento en 2 años (Europa: un 87,4 por ciento, un 61,5 por ciento, un 19,7 por ciento; Pacífico Asiático: un 82,4 por ciento, un 67,0 por ciento, un 45,7 por ciento, respectivamente). No hubo diferencias significativas entre América Latina y Europa o Pacífico Asiático para cualquier desenlace en cualquier momento. La incidencia de trombosis de stent probable y definitiva por el Academic Research Consortium fue baja (< 1,2 por ciento) entre todos los pacientes en 1 año y 2 años. CONCLUSIONES: Los desenlaces clínicos fueron comparables entre los pacientes de América Latina y Europa, y América Latina y Pacífico Asiático, pese a los subgrupos clínicos menos favorables en América Latina, perfil de riesgo más elevado y menor uso acentuado de terapia antiplaquetaria doble con el ...

Cultivares de trigo duplo propósito submetidos ao manejo nitrogenado e a regimes de corte / Dual-purpose wheat cultivars submitted to nitrogen fertilization and cutting regimes

Avaliaram-se a produção e a qualidade da forragem em cultivares de trigo duplo propósito submetidos a doses de nitrogênio e a regimes de corte. O delineamento experimental foi o de blocos ao acaso com três repetições. Os tratamentos constituíram-se de quatro cultivares de trigo duplo propósito - BRS Figueira, BRS Umbu, BRS Guatambu e BRS Tarumã -, cinco doses de nitrogênio - 0, 45, 90, 135 e 180kg ha-1 - e três manejos de corte - sem corte, um e dois cortes. As variáveis avaliadas foram: produção de forragem, relação de folhas, proteína bruta, digestibilidade in vitro da matéria orgânica e nutrientes digestíveis totais. A adubação nitrogenada apresentou comportamento linear crescente sobre a produção de massa e proteína da forragem e não houve efeito sobre as demais variáveis. A produção de forragem aumentou no segundo corte e sua qualidade decresceu. Os resultados quantitativos e qualitativos da forragem foram distintos entre os cultivares. Os cultivares de trigo duplo propósito de ciclo mais longo apresentaram maior qualidade forrageira e menor produção de forragem.

Production and quality of forage were evaluated in four dual-purpose wheat cultivars submitted to nitrogen fertilization and cutting regimes. The experimental design was randomized blocks with three replicates. The treatments consisted of four dual purpose wheat (BRS Figueira, BRS Umbu, BRS Guatambu, and BRS Tarumã), five nitrogen doses (0, 45, 90, 135, and 180kg ha-1 ), and three cutting managements (no cuts, one and two cuts). The studied variables were: forage production, leaf ratio, crude protein, in vitro digestibility of organic matter and total digestible nutrients. The nitrogen fertilizer showed a linear increase on the fodder yield and protein and there was no effect on other variables. Forage production increased in the second harvest and its quality decreased. The quantitative and qualitative results of the forage were different among cultivars. The longer cycle dual-purpose wheat had higher nutritional quality and lower forage production.

Autoavaliação de saúde e fatores associados em adolescentes do Estado de Santa Catarina, Brasil / Self-rated health and associated factors in adolescents from Santa Catarina, Brazil

OBJETIVO: Identificar a prevalência e os fatores associados à autopercepção negativa de saúde em adolescentes catarinenses. MÉTODOS: Foi realizado um estudo de delineamento transversal com adolescentes do ensino médio das escolas públicas do Estado de Santa Catarina (n=5.028). A autopercepção negativa de saúde foi analisada em função das variáveis: sexo, renda familiar, prática de atividade física, tabagismo, etilismo, drogas ilícitas e autopercepção de estresse. Aplicou-se a regressão logística binária para medidas de associação. RESULTADOS: A prevalência de autopercepção negativa de saúde foi maior nas moças (17,6 por cento) em relação aos rapazes (9,6 por cento; p<0,0001). Valores superiores de Odds Ratio (OR) foram observados para as moças (OR 1,99; IC95 por cento 1,66-2,38), adolescentes pertencentes às famílias de menor renda (OR 1,54; IC95 por cento 1,08-2,20), fumantes (OR 2,00; IC95 por cento 1,35-2,94) e que referiram autopercepção negativa de estresse (OR 3,36; IC95 por cento 2,74-4,12). CONCLUSÕES: Os adolescentes do sexo feminino, os de menor renda familiar, além dos fumantes e os que perceberam negativamente o estresse apresentaram níveis de autopercepção negativa de saúde superiores aos dos seus pares.

OBJECTIVE: To identify the prevalence and factors associated with negative self-rated health among adolescents in the State of Santa Catarina, Brazil. METHODS: A cross-sectional investigation was conducted with a representative sample of 5,028 adolescents who were attending public highschools. The negative self-rated health was analyzed in relation to the following variables: gender, income, physical activity practice, smoking, alcohol consumption, drug use and self-rated stress. The binary logistic regression was carried out to test associations. RESULTS: The prevalence of negative self-rated health was higher among girls (17.6 percent) in comparison to boys (9.6 percent; p<0.0001). Higher values of Odds Ratio (OR) were associated with female gender (OR 1.99; 95 percentCI 1.66-2.38), lower socioeconomic status (OR 1.54; 95 percentCI 1.08-2.20), smoking (OR 2.00; 95 percentCI 1.35-2.94), and negative self-rated stress (OR 3.36; 95 percentCI 2.74-4.12). CONCLUSIONS: Female adolescents, those with lower socioeconomic status, smokers and those who negatively perceived stress presented higher levels of negative self-rated health.

Insatisfação com o peso corporal e fatores associados em adolescentes / Body weight dissatisfaction and associated factors among adolescents

OBJETIVO: Estimar a ocorrência de insatisfação com peso corporal e os fatores associados em adolescentes. MÉTODOS: Estudo transversal, representativo dos escolares de 15 a 19 anos de escolas públicas de Santa Catarina, no ano de 2002. O desfecho do estudo foi a satisfação com o peso corporal, avaliada pela pergunta: "Você está satisfeito(a) com seu peso corporal?". As variáveis avaliadas foram: sexo, idade, renda familiar, local de residência, estado nutricional, tempo semanal assistindo televisão, tabagismo e autopercepção de saúde. Investigaram-se também os seguintes comportamentos alimentares: tomar remédios para emagrecer, provocar vômitos após as refeições e realizar, no mínimo, três refeições/dia. Empregou-se regressão multinomial nas análises bruta e ajustada. RESULTADOS: Dentre os adolescentes avaliados (n=5.028), 16,7 por cento (IC95 por cento: 15,7-17,7) estavam insatisfeitos com seu peso e gostariam de aumentá-lo, e 36,2 por cento (IC95 por cento: 34,9-37,5) gostariam de diminui-lo. Tomar remédios para emagrecer, provocar vômitos após as refeições e não realizar, no mínimo, três refeições/dia foram mais frequentes entre aqueles que gostariam de reduzir o peso. Após análise ajustada, os fatores associados ao desejo de aumentar o peso foram: sexo masculino, idade >17 anos, residir na zona urbana, não ter excesso de peso e autopercepção de saúde negativa. Já os fatores associados ao desejo de diminuir o peso foram: sexo feminino, residir na zona urbana, ter excesso de peso e uma percepção negativa de saúde. CONCLUSÕES: Encontrou-se alta prevalência de insatisfação com o peso, sendo as variáveis sexo, estado nutricional e autopercepção de saúde os fatores mais fortemente associados a tal comportamento.

OBJECTIVE: To assess the prevalence of body weight dissatisfaction among adolescents and the associated factors. METHODS: Population-based cross-sectional study covering a sample of students with ages from 15 to 19 years, attending public high schools in Santa Catarina, Brazil, in the year 2002. The outcome of the study was body weight satisfaction, assessed by the question: "Are you satisfied with your body weight?" The variables analyzed were gender, age, family income, home neighborhood, nutritional status, time of television viewing per week, smoking and self-rated health. Some feeding behaviors were also investigated: taking weight loss medication, vomiting after meals, and having at least three meals per day. A multinomial regression model was used in the crude and adjusted analyses. RESULTS: Among the adolescents evaluated (n=5,028), 16.7 percent (95 percentCI: 15.7-17.7) were unsatisfied and would like to gain weight, and 36.2 percent (95 percentCI: 34.9-37.5) would like to reduce it. Frequent behaviors among those who wanted to reduce their body weight included: taking weight loss medication, vomiting after meals, and not having at least three meals per day. Adjusted analyses showed that factors associated with the desire to gain weight were: male gender, >17 years old, living in the urban area, without overweight, and having a negative self-perception of health. Factors associated with the desire to lose weight included: female gender, living in the urban area, with overweight, and having a negative self-perception of health. CONCLUSIONS: A high prevalence of body weight dissatisfaction was found in this sample, and the factors more associated with this behavior included gender, nutritional status and self-perception of health.

A 3-month study on the efficacy of brimonidine as an adjunct to a topical beta-blocker in patients with an open angle glaucoma : Chiang Mai study

Brimonidine tartrate, a drug composed of 5-bromo-6-(2-imidazolidinylidene-amino) guinoxaline L-tartrate, is a highly selective a2 adrenergic agonist that can decrease intraocular pressure in human eyes through a decrease aqueous humor production and an increase uveoscleral outflow. Fourteen patients with primary open angle glaucoma were given brimonidine tartrate topically. The patients were examined at the pre-study, the base line, the 2nd week, 4th week, 8th week and 12th week visit. Every patient had blood pressure, heart rate and other ocular findings especially intraocular pressure (IOP) checked. The IOP was significantly decreased during the 2nd week visit, and was steady from that period to the end of the study. The blood pressure, heart rate and other ocular findings showed no significant changes. In conclusion, brimonidine significantly decreased IOP in primary open angle glaucoma patients without significant changes in blood pressure, heart rate and other ocular findings. This topical drug could be an alternative treatment for glaucoma patients, and could delay surgery, which could have more serious side effects.