Evaluation of the effect of meteorological risk forecasting service intervention on acute onset and medical expenses of patients with COPD in Pudong New Area of Shanghai / 上海预防医学

ObjectiveTo evaluate the intervention effect of meteorological risk forecasting service on acute onset and medical expenses of chronic obstructive pulmonary disease（COPD） patients， and to provide scientific basis for the establishment of health management model for chronic obstructive pulmonary disease（COPD） patients. MethodsStudy subjects were recruited from chronic obstructive pulmonary patients aged ≥40 in Pudong New Area. Propensity score matching method was used to determine the intervention group and the control group. The control group received regular health education and follow-up management， and the intervention group was provided with meteorological and environmental risk forecasting services through WeChat， mobile phone short message service（SMS）and telephone. Finally， a total of2 589 subjects were included in the analysis， including 1 300 in the intervention group and 1 289 in the control group. General demographic data， past medical history and family history of COPD， COPD related knowledge and practice survey， COPD related symptom assessment， acute onset， health service utilization and medical expenses before and after intervention were collected through questionnaire survey. The differences of acute attack， health service utilization and related medical expenses between the two groups before and after intervention were compared to evaluate the intervention effect. ResultsIn terms of acute attacks， after intervention， the incidence of acute attacks in the intervention group was lower than that before intervention（χ2=52.901， P<0.001）， and the incidence of acute attacks in the groups with different intervention methods was lower than that before intervention （P<0.001）. WeChat had the best effect， decreasing the incidence by 14.4%， followed by mobile phone SMS SMS decreasing by 12.3%. In terms of utilization of health services， the outpatient rate due to acute attack was lower in the intervention group after intervention than that before intervention （χ2=7.129， P=0.008）， and the outpatient rate due to acute attack was lower in the subjects who received the forecast service through mobile phone SMS than that before intervention （χ2=4.675， P<0.001）. In terms of medical expenses， there was no significant difference between control group and intervention group with different intervention methods before intervention （P>0.05）. After intervention， the difference between the control group and the intervention group with different intervention methods was statistically significant （H=11.864， P<0.05）. The results of multiple comparisons showed that compared with the control group， the average annual medical expenses of patients receiving mobile phone SMS and telephone forecasting services after intervention were lower than those of the control group， and the difference was statistically significant （P<0.05）. ConclusionMeteorological risk forecasting service can reduce the acute onset of COPD， reduce the rate of consultation and medical expenses due to acute onset， and provide scientific basis for the basic COPD health management model.

Measurement of optic nerve sheath diameter on computed tomography for the differentiation of transient ischemic attacks

SUMMARY OBJECTIVE: The objective of this study was to investigate whether the measurement of mean optic nerve sheath diameter in patients with transient ischemic attack could be used to distinguish between control groups, the acute ischemic stroke group, and subgroups within the acute ischemic stroke category. METHODS: Retrospectively, the mean optic nerve sheath diameters of patients aged 18 years and older belonging to control, transient ischemic attack, acute ischemic stroke, and subgroups within the acute ischemic stroke category were measured with initial computed tomography conducted in the emergency department. RESULTS: Out of the 773 patients included in the study, 318 (41.1%) were in the control group, 77 (10%) had transient ischemic attack, and 378 (49%) were categorized as stroke patients. The average mean optic nerve sheath diameter was significantly higher in both the stroke and transient ischemic attack groups compared with the control group (p<0.001 for both comparisons). Furthermore, the mean optic nerve sheath diameter in the stroke subgroups was significantly higher than in both the transient ischemic attack and control groups (p<0.001 for all comparisons). In transient ischemic attack patients, the mean optic nerve sheath diameter showed a significant ability to predict transient ischemic attack (AUC=0.913, p<0.001), with a calculated optimal cutoff value of 4.72, sensitivity of 94.8%, and specificity of 73.9%. CONCLUSION: The mean optic nerve sheath diameter of patients in the transient ischemic attack group was lower compared with those in the stroke subgroups but higher compared with the control group.

Aspects épidémiologiques, cliniques et thérapeutiques de l'asthme de l'enfant dans le département de pédiatrie du CHU Gabriel Touré / Epidemiological, clinical and therapeutic aspects of childhood asthma in the department of pediatrics of the Gabriel Touré university hospital

Introduction: L'asthme est la maladie chronique de l'enfant la plus fréquente. Il estl'une des principales causes de consultations aux urgences, d'hospitalisation et d'absentéisme scolaire.L'asthme est un véritable problème de santé publique. La prévalence de cette maladie ne cesse d'augmenter dans le monde entier. Patients et méthode : Nous avions mené une étude prospective, auprès des enfants asthmatiques sur une période d'une année, de Janvier 2018à décembre 2018. Résultats : Nous avions recensé105 patients asthmatiques pour un total de 14344 consultations soit une fréquence de 0,73%. Le sex ratio était de 1.9, La tranche d'âge 2-5 ans était la plus fréquente soit 52%, l'âge de la première crise se situait généralement entre 1 et 2 ans soit 75.24%. Nous avions observé que près de 22% des crises survenaient au mois de décembre (21.90%). La fumée et l'humiditéétaient les principaux facteurs déclenchants. Tous les malades avaient bénéficié de la nébulisation par lesB 2 mimétiques. Conclusion : l'éducation de l'enfant asthmatique ainsi que de sa famille et la mise en place de protocoles standards de prise en charge pourraient réduire de façon considérable la morbidité liée à l'asthme dans nos pays

Introduction : Asthma is the most common chronic disease of children. It is a leading cause of emergency room visits, hospitalization and school absenteeism. Asthma is a real public health problem. The prevalence of this disease is increasing worldwide. Patients and method: We had conducted a prospective study, among children with asthma over a period of one year, from January 2018 to December 2018. Results: We counted 105 asthmatic patients for a total of 14344 consultations, or a frequency of 0,73%. The sex ratio was 1,9, the age group 2-5 years was the most frequent, (52%), the age of the first attack was generally between 1 and 2 years, ( 75,24%). We observed that almost 22% of the attacks occurred in December (21,90%). Smoke and humidity were the main triggers. All the patients had benefited from nebulization with B 2 mimetics. Conclusion: Education of asthmatic children, their families and the establishment of standard management protocols could significantly reduce asthmarelated morbidity in our countries.

THE EVOLUTION OF CYBERSECURITY: ASSESSING THE EFFECTIVENESS OF LEGAL FRAMEWORKS IN THE FACE OF EMERGING TECHNOLOGIES AND TRANSNATIONAL CYBER ATTACKS

This research article aims to examine the impact of emerging technologies on cybersecurity and evaluate the effectiveness of legal frameworks in addressing transnational cyber-attacks. With the rapid advancement of technology, cyber threats have become more sophisticated and interconnected, requiring robust legal measures to combat them. With the emergence of new technologies, the threat landscape for cyber security has also evolved. The continuous development of new technologies like (A.I) artificial intelligence, (I.O.T) Internet of Things & cloud computing has led to a rapid increase in cyber-attacks and has made it even more challenging for organizations to protect their assets. This study utilizes a mixed-methods approach, incorporating both qualitative and quantitative research methods. The qualitative aspect involves an analysis of existing literature, case studies, and legal frameworks, while the quantitative component includes surveys and interviews with cybersecurity professionals and legal experts. By integrating these methods, this research aims to provide valuable insights into the effectiveness of current legal measures in mitigating transnational cyber-attacks and propose strategies to enhance cybersecurity in the face of emerging technologies.

Papel de la neuropatía diabética en la aparición y desarrollo del síndrome del pie diabético / Role of Diabetic Neuropathy in the Onset and Development of Diabetic Foot Syndrome

Introducción: La neuropatía diabética es la complicación más frecuente de la diabetes mellitus y una de sus posibles consecuencias es el síndrome del pie diabético. Los médicos del primer nivel de atención deben conocer el comportamiento clínico de la neuropatía diabética y, sobre todo, como influye en la aparición y desarrollo del síndrome del pie diabético. Objetivo: Describir el papel de la neuropatía diabética en la aparición y desarrollo del síndrome del pie diabético. Métodos: Para la obtención de la información se utilizaron como motores de búsqueda de información científica los correspondientes a Scielo, Pubmed, y Google Académico. Se usaron como palabras clave: diabetes mellitus; neuropatía diabética; pie diabético; síndrome de pie diabético; úlcera de pie diabético; ataque de pie diabético. Se evaluaron diferentes trabajos de revisión, investigación y páginas web, y se excluyeron los artículos que tuvieran más de 10 años de publicados, en idiomas diferentes al español, portugués e inglés y que no se refirieran al tema de estudio a través del título. Esto permitió la cita de 45 referencias bibliográficas. Conclusiones: La neuropatía diabética constituye el principal factor de riesgo en la aparición y desarrollo del síndrome del pie diabético, sobre todo cuando se asocia a artropatía (defectos podálicos), enfermedad vascular periférica y/o sepsis. El control de la glucemia, la detección temprana del pie de riesgo y el cuidado preventivo de los miembros inferiores, repercutirá favorablemente en la salud y bienestar del paciente(AU)

Introduction: Diabetic neuropathy is the most frequent complication of diabetes mellitus and one of its possible consequences is diabetic foot syndrome. First level of care physicians should know the clinical behavior of diabetic neuropathy and, above all, how it influences the appearance and development of diabetic foot syndrome. Objective: To describe the role of diabetic neuropathy in the appearance and development of diabetic foot syndrome. Methods: To obtain the information, SciELO, PubMed and Google Scholar were used as search engines for scientific information. The keywords used were: diabetes mellitus; diabetic neuropathy; diabetic foot; diabetic foot syndrome; diabetic foot ulcer; diabetic foot attack. Different review papers, research papers and web pages were evaluated and articles that were more than 10 years old and published in languages other than Spanish, Portuguese and English and that did not refer to the subject of the study through the title were excluded. This allowed the citation of 45 bibliographic references. Conclusions: Diabetic neuropathy constitutes the main risk factor in the appearance and development of diabetic foot syndrome, especially when associated with arthropathy (foot defects), peripheral vascular disease and/or sepsis. Glycemic control, early detection of the foot at risk and preventive care of the lower limbs will have a favorable impact on the patient's health and well-being(AU)

Violencia intrafamiliar en Colombia en los últimos doce años

La presente investigación consiste en evaluar y comparar estadísticamente el número de casos de violencia intrafamiliar en Colombia entre los años 2010-2021, con base en los reportes de la Policía Nacional. La base de datos está compuesta por 896.017 casos de violencia denunciados. Se empleó distribución de frecuencias, análisis comparativo por el método GLM y proyección Biplot. Cundinamarca diverge estadísticamente respecto a las demás regiones evaluadas, donde las mujeres presentan el mayor porcentaje de violencia intrafamiliar. Factores como las restricciones de movilidad, la incertidumbre, el estrés entre otros componentes, son la raíz de situaciones complejas familiares.

The present research consists of evaluating and statistically comparing the number of cases of intrafamily violence in Colombia between the years 2010-2021, based on the reports of the National Police. The database is made up of 896,017 reported cases of violence. Frequency distribution, comparative analysis by the GLM method and Biplot projection were used. Cundinamarca differs statically with respect to the other regions evaluated, where women present the highest percentage of domestic violence. Factors, such as mobility restrictions, uncertainty, stress, among other components, are at the root of complex family situations.

Diurnal differences in acute gout attacks: A clinical study of male gout patients / 北京大学学报(医学版)

OBJECTIVE@#To observe the diurnal difference of acute gout attacks in men, and provide reference for accurate clinical prevention and treatment.@*METHODS@#Using a single-center, cross-sectional study design, the patients diagnosed with gout in the outpatient department of Rheumatology and Immuno-logy of PLA Joint Logistic Support Force No.980 Hospital from October 2021 to April 2022 were selected. The information about the patient's current/last acute gout attacks (less than 2 weeks from visit), date and time of attacks, joint symptoms and signs, medication use, and relevant biochemical tests on the day of visit was recorded. The diurnal time difference of acute gout attacks in male patients was analyzed, and univariate comparison and multivariate Logistic regression analyses were conducted to compare the diurnal difference of acute gout attacks with clinical characteristics and biochemical indicators.@*RESULTS@#A total of 100 male gout patients were included, and 100 acute attacks were recorded. Diurnal distribution of acute gout attacks: morning (6:00~11:59, 18, 18%), afternoon (12:00~17:59, 11, 11%), the first half of the night (18:00~23:59, 22, 22%), the second half of the night (0:00~05:59, 49, 49%); During the day (included morning and afternoon, 29, 29%) and at night (included the first half of the night and the second half of the night, 71, 71%). The rate of acute gout attack was significantly higher at night than in the day (about 2.5 ∶1). No matter the first or recurrent gout, no matter the duration of the disease, the number of acute gout attacks had the difference of less in the day and more in the night. Serum urate (SU) level was higher in the patients with nocturnal attack than in those with daytime attack (P=0.044). Comorbidities were significantly different in the day-night ratio of the number of acute gout attack (P=0.028). Multiple Logistic regression analysis showed that SU level (OR=1.005, 95%CI: 1.001-1.009) and comorbidities (OR=3.812, 95%CI: 1.443-10.144) were the correlative factors of nocturnal acute gout attacks.@*CONCLUSION@#No matter the first or recurrent gout, no matter the duration of the disease, it has a diurnal variation characterized by multiple attacks at night, increased SU level and comorbidities are correlative factors for nocturnal acute attack of gout.

Efficacy analysis of anti-platelet in the treatment of high-risk non-disabling ischemic cerebrovascular events guided by point-of-care testing of CYP2C19 gene / 中华神经科杂志

Objective:To explore the efficacy and safety of different anti-platelet regimens in the treatment of high-risk non-disabling ischemic cerebrovascular events (HR-NICE) guided by point-of-care testing of CYP2C19 gene. Methods:A single-centre, prospective, randomised, open-label, and blinded endpoint design was uesd in the study. From July 2020 to January 2022, HR-NICE patients were enrolled in the Stroke Green Channel and Department of Neurology of Xuzhou Central Hospital, and all patients were scraped the buccal mucosa for screening for CYP2C19 loss-of-function allele carriers by point-of-care testing . Patients with intermediate metabolism were defined as those who carried 1 loss-of-function allele and patients with poor metabolism were those who carried 2 loss-of-function alleles. This study reduced the test turnaround time to 1 hour by using a fully automated medical polymerase chain reaction analyzer for a point-of-care test of CYP2C19 genotype. CYP2C19 loss-of-function allele carriers were divided according to the random number table method into the conventional treatment group (clopidogrel 75 mg, once a day), the ticagrelor group (ticagrelor 90 mg, twice a day) and the intensive dose group (clopidogrel 150 mg, once a day) separately combined with aspirin (100 mg, once a day) dual antiplatelet for 21 days. Baseline information, Acute Stroke Org 10172 Treatment Trial staging, 90-day modified Rankin Scale score, occurrence of adverse events and severe adverse events were collected for all the 3 groups. The primary efficacy outcome was new stroke within 90 days, and the primary safety outcome was severe or moderate bleeding within 90 days. Results:A total of 716 patients were included: 240 in the conventional treatment group, 240 in the ticagrelor group and 236 in the intensive dose group. There was no statistically significant difference between the 3 groups at baseline (all P>0.05). There were 26 cases (10.8%) with new stroke events in the conventional treatment group, 11 cases (4.6%) in the ticagrelor group and 4 cases (1.7%) in the intensive dose group, with statistically significant differences among the 3 groups (χ 2=19.28, P<0.05), and the differences between the conventional treatment group and the ticagrelor group (χ 2=6.59, P=0.010) and between the conventional treatment group and the intensive dose group (χ 2=16.83, P<0.001) were statistically significant, whereas the difference between the ticagrelor group and the intensive dose group was not statistically significant ( P>0.05). In the 3 groups, there was 1 case (0.4%) of severe bleeding in the conventional treatment group, 6 cases (2.5%) in the ticagrelor group and none in the intensive dose group, which showed statistically significant differences (χ 2=7.23, P<0.05), and there was statistically significant difference between the ticagrelor group and the intensive dose group ( P=0.030). Among the patients with intermediate CYP2C19 metabolism, there were 13 cases (13/158, 8.2%) with 90-day recurrent stroke in the conventional treatment group, 4 cases (4/153, 2.6%) in the ticagrelor group, and 0 case (0/159) in the intensive dose group, with statistically significant difference (χ 2=16.04, P<0.001), and the differences between the intensive dose group and the conventional treatment group were statistically significant (χ 2=13.64, P<0.001), whereas there was no statistically significant difference between the intensive dose group and the ticagrelor group ( P>0.05). In the patients with 90-day recurrent stroke in the intensive dose group, there was 0 case (0/159) with intermediate metabolism and 4 cases (4/77,5.2%) with poor metabolism, with statistically significant differences ( P=0.011), whereas there were no statistically significant differences in the conventional treatment group and the ticagrelor group ( P>0.05). Conclusions:Screening carriers of CYP2C19 loss-of-function alleles by point-of-care testing can quickly and precisely guide the treatment of patients with non-cardiogenic HR-NICE. An intensive clopidogrel dose of 150 mg, once a day combined with aspirin was effective in reducing stroke recurrence with less occurrence of any bleeding and adverse events, and patients with intermediate CYP2C19 metabolism may be the best population to benefit.

Carotid endarterectomy for symptomatic carotid artery near-occlusion / 中华普通外科杂志

Objective:To investigate the effect of carotid endarterectomy(CEA) in the treatment of symptomatic carotid artery near-occlusion(CNO).Methods:Clinical symptoms, imaging examination, treatment and prognosis of 122 symptomatic CNO patients admitted to China-Japan Friendship Hospital from Jan 2014 to Jan 2020 undergoing CEA were retrospectively analyzed. Patients were divided into two groups based on the collapse condition,full collapse group(54 cases) and non-full collapse group(68 cases).Results:The difference was insignificant between the two groups at the 30-day and 12-month occurrence rate of primary endpoints(1.85% vs. 4.41%, P=0.629;7.41% vs. 4.41%, P=0.698).Postoperative re-stenosis occurred in one case in the non-full collapse group 8 months after CEA. Conclusions:CEA can achieve good curative effect for patients with CNO with recurrent symptoms, irrelevant to the existence of distal full collapse. The shunt can prevent intraoperative hypoperfusion and postoperative hyperperfusion.

Analysis of willingness-to-pay for the treatment of acute facial inflammatory dermatoses with red and yellow light from light-emitting diodes / 中华皮肤科杂志

Objective:To analyze the willingness-to-pay (WTP) for the treatment of acute facial inflammatory dermatoses with red and yellow light from light-emitting diodes (LEDs), and to evaluate their cost-effectiveness.Methods:A questionnaire survey was conducted on outpatients with or without acute facial inflammatory dermatoses, which mainly manifested as erythema and swelling, in Department of Dermatology, Xiangya Hospital from August 2019 to June 2020. The WTP for the treatment of acute facial inflammatory dermatoses of varying severity with red and yellow light from LEDs were investigated, clinical data on the prevalence of facial skin diseases, previous medical visits and quality of life were collected, and a benefit-cost analysis was conducted. Logistic regression analysis was conducted to investigate factors influencing the patients′ WTP for the LED treatment.Results:The median WTP of the subjects was 200, 300 and 300 RMB yuan for 1-session treatment of three cases of acute facial inflammatory dermatoses of increasing severity assumed to require 1-, 3-, and 5-session LED treatments respectively, and the WTP for 1-session treatment of case 2 and case 3 was higher than the cost of 1-session LED treatment (217 RMB yuan). The subjects with high family incomes (≥ 100 000 RMB yuan/year) were significantly more willing to pay for the treatment than those with low family incomes (< 100 000 RMB yuan/year) (case 1: 40.46% vs. 27.50%, χ2 = 7.00, P = 0.008; case 2: 60.69% vs. 44.5%, χ2 = 9.75, P = 0.002; case 3: 51.20% vs. 48.8%, χ2 = 6.54, P = 0.011), and the subjects who never suffered from facial inflammatory dermatoses were significantly more willing to pay for the treatment than those who ever suffered (case 1: 35.49% vs. 28.82%, χ2 = 1.56, P = 0.212; case 2: 56.10% vs. 42.34%, χ2 = 5.92, P = 0.015; case 3: 68.32% vs. 56.75%, χ2 = 4.58, P = 0.032). No significant difference in the WTP was observed among patients with different facial dermatoses, different degrees of impairment on quality of life, or different treatment experience (all P>0.05) . Conclusion:The cost of red and yellow light from LEDs for the treatment of acute facial inflammatory dermatoses manifesting as erythema and swelling was highly acceptable in this population, and it was worthy of clinical promotion.

Influencing factors of intracranial in-stent restenosis / 国际脑血管病杂志

Intracranial atherosclerotic stenosis (ICAS) is the main cause of ischemic stroke. Endovascular therapy (EVT) is a method of treating symptomatic ICAS, and in-stent restenosis (ISR) is an important factor affecting the efficacy of EVT. This article summarizes the influencing factors of ISR in patients with ICAS receiving EVT treatment.

Encephalo-duro-arterio-synangiosis for intracranial arterial steno-occlusive disease: a retrospective case series study of 40 cases / 国际脑血管病杂志

Objective:To investigate the efficacy and safety of encephalo-duro-arterio-synangiosis (EDAS) for intracranial atherosclerotic steno-occlusive disease (ICASD).Methods:Patients with symptomatic ICASD received EDAS treatment in the Department of Neurosurgery, the PLA General Hospital from January 2018 to January 2019 were retrospectively included. The baseline information, perioperative complications, primary endpoint events, and changes in modified Rankin Scale (mRS) scores before and after surgery were collected. The primary endpoint event was any stroke/death that occurred within 30 d after enrollment. The secondary endpoint events were any stroke/death, non-stroke bleeding (subdural or epidural bleeding), and clinical functional improvement after 30 d. The clinical functional improvement was defined as a decrease of ≥1 in the mRS score compared to before surgery.Results:A total of 40 patients were included, including 30 males and 10 females, aged 53.9±8.6 years old. The clinical symptoms were mainly limb weakness and dizziness. One case of ischemic stroke and one case of hemorrhagic stroke occurred during the perioperative period. The primary endpoint event incidence was 2.5%. The patients were followed up for 49.75±2.99 months after surgery. One patient died of cerebral hemorrhage 31 months after surgery, and one patient developed acute ischemic stroke 35 months after surgery. The postoperative mRS scores of 34 patients decreased compared to before surgery, and the clinical function improvement rate was 85%. The mRS score increased in 2 cases after surgery compared to before surgery and 4 cases had no change.Conclusion:EDAS can improve the clinical function of patients with symptomatic ICASD and reduce the incidence of long-term stroke.

Two Cases of Cesarean Sections Performed with Combined Spinal-Epidural Anesthesia with Perioperative Asthma Attacks / 日本東洋医学雑誌

Asthma attack difficulty breathing rapidly worsens the condition over time. Especially when the condition worsens before surgery, general anesthesia (GA) may be indicated depending on the type of surgery. In Japan, there is a tendency to avoid GA in cesarean section (C/S) due to the risk of difficult intubation, adverse effects on the fetus, and concerns about resuscitation of the newborn. This time, foreign body sensation in the throat (baikakuki) was found in a case of asthma-like attack accompanied by difficulty breathing caused by disturbance symptoms on the day of C/S and in a case of difficulty breathing due to preoperative antibiotic intravenous drip. After oral administration of hangekobokuto to the patients, dyspnea disappeared in either case, and I was able to avoid GA and perform C/S with combined spinal-epidural anesthesia. Considering asthma in Kampo medicine, it is thought that psychoactive predispositions such as anxiety and impatience are the triggers that cause qi counter flow and qi stagnation, which causes phlegm to condense, resulting in baikakuki and symptoms. Therefore, it was thought that hangekobokuto, which remove phlegm, was adapted.

Effects of ADRB2 gene regulatory region polymorphism on the efficacy of SABA in the treatment of acute asthma attack in children / 中国药房

OBJECTIVE To explore the effects of ADRB2 gene regulatory region polymorphism on the efficacy of short-acting beta 2 receptor agonists （SABA） in the treatment of acute asthma attack in children. METHODS A total of 127 children with acute mild to moderate bronchial asthma who received SABA treatment for 7 days in the General Hospital of Northern Theater Command from October 2016 to October 2020 were selected to detect their genotype distribution and compare the improvement of pulmonary functional indicators and curative effect among different genotypes. The effect of the high-order interaction of gene polymorphism on therapeutic effect was investigated. RESULTS Among 127 children， there were 80， 44 and 3 cases of TT， TA and AA types at locus rs2895795， 93， 32 and 2 cases of CC， CG and GG types at locus rs11168070， and 41， 64 and 22 cases of GG， GA and AA types at locus rs12654778， respectively， in accordance with Hardy-Weinberg equilibrium （P＞0.05）. After treatment， the improvement rate of the peak expiratory flow in percent predicted value （PEF%pred） and the improvement rate of the forced expiratory flow at 75% vital capacity in percent predicted value （FEF75%pred） in children with TA type were significantly lower than that of TT type at locus rs2895795 （P＜0.05）； the improvement rates of PEF%pred and FEF75%pred in children with CG type were significantly lower than that of CC type at locus rs11168070 （P＜0.05）； the improvement rates of PEF%pred in children with GA and AA type were significantly lower than that of GG type at locus rs12654778 （P＜0.05）. The differences in fractional exhaled nitric oxide before and after treatment were not statistically significant among different genotypes at each locus （P＞0.05）. The proportion of remarkable improvement of children with TT type at locus rs2895795 was 2.358 times that of children with TA+ AA type （P＜0.05）， and there was no significant effect of higher-order interaction of ADRB2 polymorphism on the efficacy in children with asthma （P＞0.05）. CONCLUSIONS Polymorphisms in the regulatory region of the ADRB2 gene in children with bronchial asthma are associated with the efficacy of SABA in the treatment of acute asthma attack in children. At locus rs2895795， rs11168070 and rs12654778， the improvement of lung function of children with wild-type is more obvious， and the efficacy of SABA treatment on children with TT type is better at locus rs2895795.

Histologia do miocárdio normal e infartado / Histology of normal and infarcted myocardial

Introdução: O infarto do miocárdio é uma patologia que apresenta grande morbidade e mortalidade. Ele é resultado da necrose de cadiomiócitos provocada por dificuldade de oxigenação. Objetivo: O objetivo deste estudo foi rever a histologia do miocárdio e suas alterações histológicas quando infartado. Método: Trata-se de uma revisão narrativa em livros técnicos e artigos cinetíficos publicados na SciELO e PubMed. Resultados: O miocárdio é formado por cardiomiócitos, que se contraem em função dos sarcômeros dispostos em suas miofibrilas e apresentam eficiente comunicação elétrica entre si por meio de junções comunicantes. O infarto do miocárdio promove morte dos cardiomiócitos, alterações em elementos citoplasmáticos e na condução elétrica além da formação de tecido cicatricial fibroso. Conclusão: Em conclusão, o miocárdio é altamente vascularizado e formado por cardiomiócitos contráteis alongados e de composição sarcométrica. Em condições isquêmicas, como no infarto do miocárdio, há uma remodelação histológica no tecido muscular cardíaco que leva à fibrose e perda das funções contráteis.

Introduction: Myocardial infarction is a pathology that presents high morbidity and mortality. It is the result of cardiomyocyte necrosis caused by oxygenation difficulties. Objective: The aim of this study was to review the histology of the myocardium and its histological changes when infarcted. Method: This is a narrative review of technical books and scientific articles published in SciELO and PubMed. Results: The myocardium is formed by cardiomyocytes, which contract due to the sarcomeres arranged in their myofibrils and present efficient electrical communication with each other through gap junctions. Myocardial infarction promotes the death of cardiomyocytes, alterations in cytoplasmic elements and electrical conduction, in addition to the formation of fibrous scar tissue. Conclusion: In conclusion, the myocardium is highly vascularized and formed by elongated contractile cardiomyocytes with a sarcometric composition. In ischemic conditions, such as myocardial infarction, there is histological remodeling in cardiac muscle tissue that leads to fibrosis and loss of contractile functions

Nivel de información sobre factores de riesgo de Infarto agudo de miocardio en pacientes ambulatorios, Corrientes año 2021 / Level of information on risk factors for acute myocardial infarction in outpatients, Corrientes year 2021

Determinar el nivel de información sobre factores de riesgo de Infarto agudo de miocardio en los pacientes ambulatorios que asisten a una institución de salud de la provincia de Corrientes año 2021. Metodología: Estudio cuantitativo descriptivo, transversal y observacional. Muestra obtenida mediante muestreo probabilístico aleatorio simple compuesta por 108 pacientes que asistieron a los consultorios de Diabetes, Presurometría y Hospital de Día. Se aplicó un cuestionario validado mediante una prueba piloto. Variables: edad, sexo, nivel de instrucción, Nivel de información sobre alimentación, hábitos nocivos, actividad física y preguntas generales. Los resultados fueron volcados a una matriz diseñada en programa Excel. Resultados: La población en estudio presento una mediana de edad de 43, moda 39 y predomino del sexo masculino 56%, sobre el femenino 44%, en el nivel de instrucción prevaleció el secundario completo 19% seguido de primario incompleto 15%. Abordando los niveles de información sobre factores de riesgo de Infarto agudo de miocardio predominaron los niveles altos en todas las variables trabajadas, obteniendo un nivel general de información alto del 82%, se apreció en la alimentación 65%, hábitos nocivos 70%, aspectos generales un 86% y actividad física 48%. Conclusión: Esta investigación remarca la importancia de la educación permanente y en etapas tempranas sobre los factores de riesgo de Infarto Agudo de Miocardio. La población en estudio presento un nivel alto de información. No obstante, la educación debe fomentarse para llegar al 37% restante que obtuvo niveles inferiores[AU]

To determine the level of information on risk factors for acute myocardial infarction in outpatients attending a health institution in the province of Corrientes in 2021. Methodology: Quantitative descriptive, cross-sectional and observational study. Sample obtained by simple random probabilistic sampling made up of 108 patients who attended the Diabetes, Blood Pressure and Day Hospital clinics. A validated questionnaire was applied by means of a pilot test. Variables: age, sex, level of education, level of information on food, harmful habits, physical activity and general questions. Te results were dumped into a matrix designed in Excel program. Results: Te population under study presented a median age of 43, mode 39 and a predominance of males 56%, over females 44%, on the level of education the complete secondary prevailed 19% followed by incomplete primary 15%. Addressing the levels of information on risk factors for acute myocardial infarction, high levels predominated in all the variables worked on, obtaining a high general level of information of 82%, disaggregating 65%, harmful habits 70%, aspects general 86% and physical activity 48%. Conclusion: Tis research highlights the importance of permanent education and in early stages about the risk factors of Acute Myocardial Infarction. Te study population presented a high level of information. However, education should be encouraged to reach the remaining 37% who obtained lower levels[AU]

: Determinar o nível de informação sobre fatores de risco para infarto agudo do miocárdio em pacientes ambulatoriais atendidos em uma instituição de saúde na província de Corrientes em 2021. Metodologia: Estudo quantitativo descritivo, transversal e observacional. Amostra obtida por amostragem probabilística aleatória simples composta por 108 pacientes atendidos nas clínicas de Diabetes, Pressão Arterial e Hospital Dia. Foi aplicado um questionário validado por meio de teste piloto. Variáveis: idade, sexo, escolaridade, nível de informação sobre alimentação, hábitos nocivos, atividade física e questões gerais. Os resultados foram despejados em uma matriz projetada no programa Excel. Resultados: A população em estudo apresentou mediana de idade de 43 anos, moda 39 e predominância do sexo masculino 56%, sobre o feminino 44%, no nível de escolaridade o ensino médio completo prevaleceu 19% seguido do ensino fundamental incompleto 15%. Abordando os níveis de informação sobre fatores de risco para infarto agudo do miocárdio, predominaram níveis elevados em todas as variáveis trabalhadas, obtendo um nível geral de informação elevado de 82%, desagregando 65%, hábitos nocivos 70%, aspectos gerais 86% e atividade física 48%. Conclusão: Esta pesquisa destaca a importância da educação permanente e precoce sobre os fatores de risco do Infarto Agudo do Miocárdio. A população do estudo apresentou um alto nível de informação. No entanto, a educação deve ser incentivada para atingir os 37% restantes que obtiveram níveis mais baixos[AU]

Offensive Difference Styles and Technical Situational Variables Between European and South American Elite Football Leagues / Diferencias de estilos ofensivos y variables situacionales técnicas entre las ligas de fútbol de élite europeas y sudamericanas

Abstract We aimed to compare teams' attack styles in Europe and South America elite football in the two most valued domestic leagues in both continents (Spanish La Liga & English Premier League in Europe, and Argentinian Superliga & Brazilian Série A in South America). For this purpose, we used a sample of 84 teams and 3,780 cases in 1,214 games. Using an observational tool, we analyzed performance indicators (goals, shots, dribbles, and passes) and attack situations. Effect size (ES) and non-clinical magnitude-based inference (MBI) were used to evaluate uncertainty. Results revealed that European teams scored more goals per game related to fast (ES = 0.35; likely MBI) and positional attack (ES = 0.36; likely MBI). In addition, teams from the European leagues spent more time playing in the opposition third zone of the pitch, performed a higher number of assists (ES = 0.38; likely MBI) and through-ball assists (ES = 0.46; likely MBI) than South American ones. Finally, South American teams made higher numbers of shots out of the box (ES = 1.52, almost certain MBI) and off-target shots (ES = 1.08; almost certain MBI), and they also spent more time playing in the middle third zone (ES = 1.65; almost certain MBI). No differences were identified in set-pieces goals, length passing, and aerial duels. These findings may provide information regarding attack style profiles from each continent league. Also, it could be highly beneficial for coaches to be able to continuously design the specific training situations of the offensive process.

Resumen El objetivo fue comparar estilos de ataque de los equipos en el fútbol de élite de Europa y Sudamérica en las dos ligas nacionales más valoradas de ambos continentes (Europa: Liga española y Premier League inglesa; Sudamérica: Superliga argentina y Serie A brasileña). Para ello, se empleó una muestra de 84 equipos y 3780 casos en 1214 partidos. Mediante una herramienta de observación, se analizaron indicadores de rendimiento (goles, tiros, regates y pases) y situaciones posicionales de ataque. Para evaluar la incertidumbre, se calculó el tamaño del efecto (ES) y la inferencia basada en la magnitud no clínica (MBI). Los resultados revelaron que los equipos europeos lograron más goles por partido mediante transición rápida (ES = 0,35; ''probable'' MBI) y ataque posicional (ES = 0,36; ''probable'' MBI). Además, los europeos pasaron más tiempo jugando en el último tercio del campo rival, realizaron más asistencias (ES = 0,38; ''probable'' MBI) y asistencias con pase entre defensores rivales (ES = 0,46; ''probable'' MBI) que los sudamericanos. Finalmente, los equipos sudamericanos realizaron más tiros desde fuera del área (ES = 1,52; ''casi seguro'' MBI) y tiros fuera de la portería (ES = 1,08; ''casi seguro'' MBI), y también pasaron más tiempo jugando en el tercio medio del campo (ES = 1,65; ''casi seguro'' MBI). No se identificaron diferencias en goles mediante jugadas a balón parado, pases largos y duelos aéreos. Estos hallazgos informan sobre estilos de ataque de cada liga continental y podrían ayudar a diseñar situaciones de entrenamiento del proceso ofensivo.

Resumo O objetivo era comparar os estilos de ataque das equipes de futebol de elite europeu e sul-americano nas duas ligas nacionais mais valorizadas de ambos os continentes (Europa: Liga espanhola e Premier League inglesa; América do Sul: Superliga argentina e Serie A Brasileira). Para este fim, foi utilizada uma amostra de 84 equipes e 3780 casos em 1214 jogos. Usando uma ferramenta de observação, foram analisados indicadores de desempenho (metas, tiros, dribles e passes) e situações de ataque posicional. Para avaliar a incerteza, foram calculados o tamanho do efeito (ES) e a inferência baseada em magnitude não-clínica (MBI). Os resultados revelaram que os times europeus marcaram mais gols por jogo através de uma transição rápida (ES = 0,35; MBI "provável") e ataque posicional (ES = 0,36; MBI "provável"). Além disso, os europeus passaram mais tempo jogando no último terço do campo rival, fizeram mais assistências (ES = 0,38; MBI 'provável') e assistência com um passe entre os defensores adversários (ES = 0,46; MBI 'provável') do que os sul-americanos. Finalmente, as equipes sul-americanas chutaram mais fora da área (ES = 1,52; 'quase certamente' MBI) e chutes fora do gol (ES = 108; 'quase certamente' MBI), e passaram mais tempo jogando no meio terço do campo (ES = 1,65; 'quase certamente' MBI). Não foram identificadas diferenças nos gols por meio de jogos com a bola parada, nos passes longos e nos passes aéreos. Estas descobertas informam os estilos de ataque de cada liga continental e poderiam ajudar a projetar situações de treinamento para o processo de ataque.

Perfil dos agravos com animais potencialmente transmissores da raiva, Mato Grosso do Sul, Brasil, 2019 a 2021 / Profile of injury by potential rabies-transmitting animals in Mato Grosso do Sul, Brazil, from 2019 to 2021 / Perfil de enfermedades con animales potencialmente transmisores de rabia en Mato Grosso do Sul, Brasil, de 2019 a 2021

Considerada uma das mais graves doenças tropicais negligenciadas (DTN) do mundo, a raiva promove grande impacto à saúde pública devido a sua evolução letal e ao elevado custo social e econômico. O objetivo desta pesquisa foi descrever o perfil epidemiológico das agressões por animais potencialmente transmissores de raiva, no estado de Mato Grosso do Sul, durante os anos de 2019 a 2021. Foi realizado um estudo epidemiológico retrospectivo, transversal, qualiquantitativo, com dados secundários codificados do Sistema de Informação de Agravos de Notificação: ano e mês, município e zona de ocorrência, idade, sexo, raça, escolaridade, tipo de exposição, região anatômica atingida, características do ferimento, espécie e condição do animal agressor e tratamento preconizado. Foram registradas 24.362 notificações de agressões, com prevalência média de 8,7/1.000 hab. Janeiro apresentou o maior número de notificações. Destacaram-se, entre os agredidos, crianças entre 1 e 9 anos de idade do sexo masculino. A zona de ocorrência de 89,5% dos agravos foi urbana e 81,7% foram provocados por cães. Dentre os indivíduos agredidos, 79,2% receberam tratamento antirrábico pós-exposição com uso de imunobiológico. O estado registrou baixa prevalência de agravos por animais. Notaram-se falhas de preenchimento das fichas de notificação e nos critérios de inclusão de agravos com animais potencialmente transmissores da raiva.

Considered as one of the most serious neglected tropical diseases (NTD) worldwide, rabies greatly impacts public health due to its lethal evolution and high social and economic cost. Given this scenario, this study describes the epidemiological profile of attacks by potential rabies-transmitting animals in the state of Mato Grosso do Sul, Brazil, from 2019 to 2021. A retrospective, cross-sectional, qualitative-quantitative epidemiological study was conducted with secondary data obtained from the Information System for Notifiable Diseases, namely: year and month; municipality and area of occurrence; age; gender; race; education; type of exposure; anatomical region affected; characteristics of the wound; species and condition of the animal; and recommended treatment. A total of 24,362 notifications of animal attacks were reported, with average prevalence of 8.7/1000 inhabitants. January registered the highest number of notifications. Among the victims, male children aged one to nine years stood out. Of the total injuries reported, 89.5% occurred in urban areas and 81.7% were done by dogs. Among the attacked individuals, 79.2% received post-exposure anti-rabies treatment with immunobiological drugs. The state recorded a low prevalence of animal attacks. Results revealed poorly filled out forms and issues with the inclusion criteria used for classifying injuries caused by potential rabies-transmitting animals.

Considerada una de las enfermedades tropicales desatendidas (ETD) más graves del mundo, la rabia tiene un gran impacto en la salud pública debido a su evolución letal y alto costo social y económico. El objetivo de esta investigación es describir el perfil epidemiológico de las agresiones por animales potencialmente transmisores de la rabia, en el estado de Mato Grosso do Sul (Brasil), durante los años de 2019 a 2021. Se realizó un estudio epidemiológico retrospectivo, transversal, cualicualitativo, con datos secundarios codificados del Sistema de Información de Enfermedades de Declaración Obligatoria que contienen: año y mes, municipio y zona de ocurrencia, edad, sexo, raza, nivel de educación, tipo de exposición, región anatómica afectada, características de la herida, especie y condición del animal agresor y tratamiento recomendado. Se registraron 24.362 notificaciones de agresiones, con una prevalencia media de 8,7/1.000 hab. Enero tuvo el mayor número de notificaciones. Entre las víctimas se destacaron niños de entre 1 y 9 años de edad y varones. El área donde ocurrieron el 89,5% de las lesiones fue urbana, y el 81,7% de ellas fueron causadas por perros. Entre los agredidos, el 79,2% recibió tratamiento antirrábico postexposición con uso de inmunobiológicos. El estado registró una baja prevalencia de lesiones causadas por animales. Se observaron fallas en el llenado de los formularios de notificación y en los criterios de inclusión de enfermedades con animales potencialmente transmisores de la rabia.

Aspectos clinicoepidemiológicos, electrocardiográficos, ecocardiográficos y terapéuticos en pacientes diabéticos con infarto agudo de miocardio / Clinical epidemiological, electrocardiographic, echocardiographic and therapeutic aspects in diabetic patients with acute heart attack

Introducción: La diabetes mellitus se encuentra entre las enfermedades crónicas no transmisibles más comunes en el mundo, y se estima que para el 2030 será diagnosticada en 7,7 % de la población mayor de 18 años, es decir, en 430 millones de individuos. Objetivo: Caracterizar a pacientes diabéticos que presentaron infarto agudo de miocardio con elevación del segmento ST, según variables clinicoepidemiológicas, electrocardiográficas, ecocardiográficas y terapéuticas. Métodos: Se realizó un estudio descriptivo, desde enero hasta diciembre de 2019, de 137 pacientes con antecedente de diabetes mellitus que presentaron infarto agudo de miocardio con elevación del segmento ST, atendidos en el Servicio de Cardiología del Hospital Provincial Clínico-Quirúrgico Docente Saturnino Lora de Santiago de Cuba. Entre las variables analizadas figuraron la edad, el sexo, la clase funcional, las complicaciones, la función sistólica y la diastólica del ventrículo izquierdo, la terapia de reperfusión empleada y el estado del paciente al egreso. Resultados: En la serie predominaron el sexo masculino y el grupo etario mayor de 60 y más años. Se observó que el infarto agudo de miocardio en la topografía anterior presentara más complicaciones, así como mayor número de pacientes con tratamiento trombolítico y combinado. Asimismo, la mayoría de los pacientes egresaron vivos, lo cual se correspondió, además, con que recibieran terapia trombolítica. Al analizar a los pacientes con alteraciones segmentarias en el estudio ecocardiográfico, se obtuvo una primacía de los fallecidos en ese grupo en cuestión. Conclusiones: Los pacientes diabéticos que presentan infarto agudo de miocardio con elevación del segmento ST constituyen un grupo independiente con especificidades clínicas y ecocardiográficas y mayor riesgo de complicaciones mortales.

Introduction: Diabetes mellitus is not among the most common chronic non communicable diseases in the world, and is considered that by 2030 it will be diagnosed in the 7.7 % of the population over 18 years, that is to say, in 430 million individuals. Objective: To characterize diabetic patients that presented acute heart attack with elevation of the ST segment, according to clinical epidemiological, electrocardiographic, echocardiographic and therapeutic variables. Methods: A descriptive study was carried out from January to December, 2019 of 137 patients with history of diabetes mellitus that presented acute heart attack with elevation of the ST segment, assisted in the Cardiology Service of Saturnino Lora Teaching Clinical-Surgical Provincial Hospital in Santiago de Cuba. Among the analyzed variables figured the age, sex, functional class, complications, systolic and dyastolic function of the left ventricle, the therapy of reperfusion used and the state of the patient when discharged from the hospital. Results: In the series there was a prevalence of the male sex and the 60 and over age group. It was observed that the acute heart attack in the previous topography presented more complications, as well as higher number of patients with thrombolitic and combined treatment. Also, most of the patients were alive when discharged from the hospital, which also corresponded with the thrombolitic therapy received. When analyzing the patients with segmental alterations in the echocardiographic study, a primacy of the deceaseds was obtained in that group. Conclusions: The diabetic patients that present acute heart attack with elevation of the ST segment constitute an independent group with clinical and echocardiographic specificities, and more risk of mortal complications.

Coexisting Coronary and Carotid Artery Disease: What We Did, What Happened

ABSTRACT Introduction: There is no complete consensus on the three surgical methods and long-term consequences for coexisting coronary and carotid artery disease. We retrospectively evaluated the surgical results in this high-risk group in our clinic for a decade. Methods: Between 2005 and 2015, 196 patients were treated for combined carotid and coronary artery disease. A total of 50 patients were operated on with the staged method, 40 of which had carotid endarterectomy (CEA) priority, and 10 had coronary artery bypass grafting (CABG) priority. CABG and CEA were simultaneously performed in 82 patients; and in 64 asymptomatic patients with unilateral carotid artery lesions and stenosis over 70%, only CABG was done (64 patients). Results were evaluated by uni-/multivariate analyses for perioperative, early, and late postoperative data. Results: In the staged group, interval between the operations was 2.82±0.74 months. Perioperative and early postoperative (30 days) parameters did not differ between groups (P-value < 0.05). Postoperative follow-up time was averaged 94.9±38.3 months. Postoperative events were examined in three groups as (A) deaths (all cause), (B) cardiovascular events (non-fatal myocardial infarction, recurrent angina, congestive heart failure, palpitation), and (C) fatal neurological events (amaurosis fugax, transient ischemic attack, and stroke). When group C events were excluded, event-free actuarial survival rates were similar in all three methods (P=0.740). Actuarial survival rate was significantly different when all events were included (P=0.027). Neurological events increased markedly between months 34 and 66 (P=0.004). Conclusion: Perioperative and early postoperative event-free survival rates were similar in all three methods. By the beginning of the 34th month, the only CABG group has been negatively separated due to neurological events. In the choice of methodology, "most threatened organ priority'' was considered as clinical parameter.