Prevalence and functional status of children with complex chronic conditions in Brazilian PICUs during the COVID-19 pandemic

Abstract Objective The proportion of children with complex chronic conditions is increasing in PICUs around the world. We determined the prevalence and functional status of children with complex chronic conditions in Brazilian PICUs during the COVID-19 pandemic. Methods The authors conducted a point prevalence cross-sectional study among fifteen Brazilian PICUs during the COVID-19 pandemic. The authors enrolled all children admitted to the participating PICUs with complex chronic conditions on three different days, four weeks apart, starting on April 4th, 2020. The authors recorded the patient's characteristics and functional status at admission and discharge days. Results During the 3 study days from March to June 2020, the authors enrolled 248 patients admitted to the 15 PICUs; 148 had CCC (prevalence of 59.7%). Patients had a median of 1 acute diagnosis and 2 chronic diagnoses. The use of resources/devices was extensive. The main mode of respiratory support was conventional mechanical ventilation. Most patients had a peripherally inserted central catheter (63.1%), followed by a central venous line (52.5%), and 33.3% had gastrostomy or/and tracheostomy. The functional status score was significantly better at discharge compared to admission day due to the respiratory status improvement. Conclusions The prevalence of children with CCC admitted to the Brazilian PICUs represented 59.7% of patients during the COVID-19 pandemic. The functional status of these children improved during hospitalization, mainly due to the respiratory component.

Fat profile of Jamaican ackees, oleic acid content and possible health implications / Perfil de grasas del seso vegetal jamaicano, contenido de ácido oleico, y posibles implicaciones para la salud

OBJECTIVE: To re-investigate the composition of ackee oil and unequivocally determine its principal fatty acid components. METHODS: Oil was extracted from the edible portion of ackees harvested in three different studies (I - III) by several analysts; studies I and II utilized composite samples from several trees while study III consisted of ackees from seven separate trees. The oils were either saponified and methylated or trans-methylated and the fatty acid methyl ester content analysed by gas chromatography-mass spectrometry (GC-MS). Relative fatty acid composition was quantified based on chromatographic peak areas while fatty acids were identified by mass spectrometry. The degree of unsaturation of the ackee oils was characterized by determination of the iodine value. RESULTS: Gas chromatography-mass spectrometry data from the three studies were assessed. Relative fatty acid composition for the ackee oils was consistent across the three studies. The major fatty acid components were oleic acid (55.44%), palmitic acid (25.57%) and stearic acid (12.59%); linoleic acid was present in minor to undetectable amounts. An iodine value of 49 was determined which is consistent with the high oleic acid content of the ackee oil. CONCLUSION: The ackee samples analysed were rich in the monounsaturated fatty acid (MUFA) oleic acid.Consideration should be given to potential protective health effects of diets which include ackee.

OBJETIVO: Re-investigar la composición del aceite del seso vegetal (ackee) y determinar de manera inequívoca sus componentes principales de ácidos grasos. MÉTODOS: Se extrajo el aceite de la porción comestible de sesos vegetales de la Blighia sapida (ackee), cosechados como parte de tres estudios diferentes (I - III) por varios analistas. Los estudios I y II utilizaron muestras combinadas de varios árboles de Blighia sapida, en tanto que el estudio III estuvo formado por muestras de siete árboles de Blighia sapida por separado. Los aceites fueron saponificados y metilados o transmetilados, y el contenido de éster metílico de ácidos grasos fue analizado mediante técnicas de cromatografía de gases y espectrometría de masas (GC-MS). La composición relativa de ácidos grasos se cuantificó sobre la base de las áreas cromatográficas pico, mientras que los ácidos grasos se identificaron mediante espectrometría de masas. El grado de insaturación de los aceites de seso vegetal fue caracterizado mediante la determinación del valor de yodo. RESULTADOS: Se evaluaron los datos de la cromatografía de gases acoplada con espectrometría de masas de los tres estudios. La composición relativa de ácido grasos de los aceites de seso vegetal, fue constante a través de los tres estudios. Los componentes principales del ácido graso fueron el ácido oleico (55.44%), el ácido palmítico (25.57%), y el ácido esteárico (12.59%). El ácido linoleico estuvo presente en cantidades que fluctuaron de menores a indetectables. Se determinó un valor de yodo de 49, el cual está en correspondencia con el alto contenido de ácido oleico en el seso vegetal. CONCLUSIÓN: Las muestras analizadas de sesos vegetales de la Blighia sapida (ackee) eran ricas en ácidos grasos monoinsaturados (MUFA por sus siglas en inglés) y ácidos oleicos. Debe prestarse atención a los posibles efectos protectores de la salud de dietas que incluyen sesos vegetales.

Risk factors of mortality among dengue patients admitted to a tertiary care setting in Kerala, India

Dengue is one of the most serious and rapidly emerging tropical mosquito-borne diseases. The state of Kerala in India is hyperendemic for the disease and is one of the leading states in the reporting of deaths due to dengue. As primary prevention of dengue has had limited success, the prevention of mortality through the identification of risk factors and efficient patient management is of utmost importance. Hence, a record-based case control study was conducted in the Medical College Hospital in Thiruvananthapuram to identify the risk factors of mortality in patients admitted with dengue. Dengue patients over 40 years of age were 9.3 times [95% CI; 1.9-44.4] more likely to die compared with younger patients. The clinical features associated with mortality from dengue were altered sensorium [odds ratio [OR] - 156, 95% CI; 12.575-1935.197], abnormal reflexes [OR - 8.5, 95% CI; 1.833-39.421] and edema [OR - 13.22, 95% CI; 2.651-65.951]. Mortality was also higher in those patients with co-morbidities such as diabetes mellitus [OR - 26, 95% CI; 2.47-273.674] and hypertension [OR - 44, 95% CI; 6.23-315.499]. The independent predictors of mortality were altered sensorium and hypertension. Dengue fever patients with these clinical features and those who are elderly should be more rigorously monitored and promptly referred from lower settings when required to reduce mortality.

Tratamento artroscópico do impacto femoroacetabular / Arthroscopic treatment of femoroacetabular impingement

OBJETIVOS: O propósito deste estudo é avaliar os resultados em curto prazo do tratamento artroscópico do impacto femoroacetabular. A hipótese é a de que os resultados do tratamento artroscópico são favoráveis. MÉTODOS: Entre agosto de 2003 e agosto de 2007, 28 quadris foram submetidos ao tratamento do impacto femoroacetabular pela via artroscópica. A idade média dos pacientes foi de 34 anos, com média de seguimento de 27 meses. Quanto à melhora clínica, os pacientes foram avaliados pré e pósoperatoriamente pelo Harris Hip Score (HHS) modificado por Byrd. Os pacientes foram avaliados pré e pós-operatoriamente em relação à rotação interna do quadril acometido. Os valores obtidos nos índices acima foram analisados estatisticamente através do método de Wilcoxon para a avaliação de variáveis não paramétricas. RESULTADOS: O Harris Hip Score médio pré-operatório foi de 54,2 e o pós-operatório, de 94,8 (p < 0,001). O aumento médio do HHS foi de 37,5 pontos. Houve quatro resultados bons (15 por cento) e 24 excelentes (85 por cento). Pré-operatoriamente os pacientes apresentavam rotação interna do quadril média de 17º e pós-operatoriamente, de 36º. O aumento médio de rotação interna foi de 19º (p < 0,001). CONCLUSÃO: O tratamento artroscópico do impacto femoroacetabular tem resultados satisfatórios.

OBJECTIVE: The purpose of this study is to evaluate the short-term follow-up results of arthroscopic treatment of femoroacetabular impingement. Our hypothesis is that arthroscopic treatment results are favorable. METHODS: Between August 2003 and August 2007, 28 hips had femoroacetabular impingement treated by hip arthroscopy. The mean age was 34 years, with mean follow-up period of 27 months. Clinical results were graded with the modified Harris hip score, which was measured pre-and postoperatively. Patients had also their internal rotation analyzed. These parameters were calculated by using Wilcoxon's t test for analysis of nonparametric paired samples performed. RESULTS: The mean preoperative Harris Hip Score was 54.2, improving to 94.8 postoperatively (p<0,001). The mean increase was 37.5 points. We had 4 good results (15 percent) and 24 excellent results (85 percent). Preoperatively, the patients had a mean internal rotation of 17º, and, postoperatively, 36º. The average internal rotation increase was 19º (p<0,001). CONCLUSIONS: The arthroscopic treatment of femoroacetabular impingement presents satisfactory results.

Importância do diagnóstico da fratura subcondral da cabeça do fêmur, suas diferenças com a necrose avascular e seu tratamento / The importance of the diagnosis of subchondral fracture of the femoral head, how to differentiate it from avascular necrosis and how to treat it

A fratura subcondral da cabeça femoral é afecção pouco conhecida e, consequentemente, pouco diagnosticada. O quadro clínico de dor aguda ou insidiosa com piora progressiva na região inguinal, exacerbada com carga e com alívio em repouso, deve levar à suspeita diagnóstica. O erro comumente feito com o diagnóstico de necrose avascular da cabeça do fêmur pode induzir a indicação de procedimentos invasivos desnecessários no quadril. Com o advento da ressonância nuclear magnética, o diagnóstico dessa afecção pode ser realizado observando os diferentes padrões de edema medular na cabeça do fêmur, possibilitando o tratamento precoce correto.

Subchondral fracture of the femoral head is an uncommon and underdiagnosed affection. The abrupt or gradual onset of groin pain with functional disability on weight-bearing that improves with a resting period should alert the orthopedic surgeon to the possibility of this diagnosis. The differential diagnosis from osteonecrosis of the femoral head can be provided by assessing the different patterns of bone edema on MRI studies of the hip, thus avoiding unnecessary invasive operations on the hip.

Infl ammatory bowel disease and coronary artery disease.

Chronic infl ammation with the presence of excess serum acute-phase proteins, cytokines and cell adhesion molecules is increasingly being implicated in atherosclerosis. The association between infl ammatory bowel disease (IBD) and coronary artery disease (CAD) is unstudied. This is a preliminary, thesis-generating cross-sectional study aimed at evaluating the presence of traditional atherosclerotic risk factors in patients with IBD and CAD compared with the control population. The medical records of 42 consecutive IBD patients with CAD from 1999 to 2005 (27 men) were reviewed for the Framingham risk factors. The Framingham risk score (FRS) is calculated based on age, sex, hypertension, diabetes and hyperlipidemia. FRS of patients with IBD and CAD was compared with the FRS of 137 age- and sex-matched (102 men) consecutive patients with CAD (controls). When the Framingham risk score adjusted for group and gender with age as a covariate, the adjusted total FRS score was higher in patients with CAD alone (10.0 [3.75]) as compared to those with; IBD and CAD: (8.1 [3.47]; p = 0.001). FRS is lower in cases (patients with IBD and CAD) when compared with the controls (CAD alone).

Somatic growth and clinical manifestation in formula fed infants born to HIV--infected mothers during the first year of life.

This was a comparative study of the growth and clinical manifestation between infected and uninfected HIV infants both of whom were fed with a limited quantity of powder milk from birth until one year of age. HIV-infected pregnant women were enrolled from the second trimester or the beginning of the third trimester. After birth, infants had physical examinations, body weight and height were recorded at 2, 4, 6, 9 and 12 month visits. All mothers were given 7 kilograms of infant formula at each infant visit until the infant was one year old. Diagnosis for HIV infection in these infants was made by two positive concordant results of DNA PCR or RNA PCR or HIV RNA. One hundred and two infants were diagnosed for HIV status and 21.5 per cent were infected. The infected infants showed signs of malnutrition. From 2-4 months of age, the averages of their weights and heights were lower than those of non-infected infants. Abnormal clinical signs were found in most infected infants by the time they were 9-12 months old. In conclusion for the infants born to HIV- infected mothers, monitoring signs and symptoms including their weight and height from birth till 9-12 months old, is predictive of the infectious status of most infected infants. The administration and management of infant formula in a limited quantity to HIV infected mothers in upper northern provinces of Thailand is possible without causing abnormal infant growth.

Feasibility of northern Thai factory workers as participants in HIV vaccine trials.

To determine the feasibility of establishing a cohort of HIV-1 seronegative factory workers for potential HIV vaccine trials, and other HIV preventive interventions, we enroled and followed 499 male and female industrial workers in Lamphun Province, northern Thailand. A baseline demographic and HIV seroprevalence survey was conducted by a mobile team at worker's housing units in Lamphun Province in 1994. Follow-up HIV and syphilis incidence rates were measured 6 months later. The study was voluntary, anonymous, and included HIV pre- and post-test counseling, HIV and syphilis serology, and a self-administered fact sheet. A total of 106 men and 393 women were recruited. The median age was 22 years, and the mean 23.4 years. Educational levels were moderate; 41.9% had some secondary school and 23.6% had completed secondary school. HIV prevalence was 2.4% overall but differed by sex; among men it was 7/106, 6.6%, among women 5/393, 1.3%, OR = 5.49 (95% CI = 1.52, 20.39). Low educational levels were associated with HIV infection, OR = 7.2 (95% CI = 2.2, 23.4). Syphilis prevalence was 3.8%. Follow-up at 6 months was successful for 420/499 subjects, 84.2%, and varied by sex: 73/106 men, 68.9%, returned while 347/393 women, 88.3%, did so, RR = 1.21 (95% CI = 1.07, 1.37). There were 5 incident HIV-1 infections, a rate of 2.1/100 person years. The HIV seroconversion rate differed by sex, but not significantly; it was 4.1/100 person years for men and 1.5/100 person years for women. This population is largely young, female, and at considerable HIV risk. If follow-up could be improved, factory workers in northern Thailand could be an appropriate population in which to mount HIV preventive efficacy studies, including vaccine trials.

Seroprevalence of HIV antibodies and risk factors in healthy young males from upper north Thailand.

In the Spring of 1991 a random sample of young men from Upper Northern Thailand (mean age = 21 years) was interviewed by trained medical students from Chiang Mai University, serum samples were obtained and analyzed for prevalence of HIV-1 antibodies and for syphilis, and risk factors for HIV infection were assessed. It was found that Commercial Sex Workers (CSW) were the principal risk factor, that consistent condom use is rare, and the rates of HIV infection are rising rapidly. Sociodemographic background, homosexual behavior, drug use, and history of STD's were found to be not significant risk factors. The conclusions are that the education campaigns should be intensified to reduce the frequency of contact with CSW and to encourage consistent use of condoms.

Incidence of HIV-1 infection in a rural region of Uganda

The objective was to determine the incidence of infection which HIV-1 and the risk factors associated with seroconversion in three geographical strata of a rural Ugandan district. Design-Serological; sociodemographic; and behavioural surveys of everyone aged 13 or more in 21 randomly selected communities at baseline and one year later. Setting - Rural population of Rakai district; south-western Uganda; residing in main road trading centres; secondary trading villages; and agricultural villages. Subjects - In 1989; 1292 adults provided a blood sample and interview data; one year later; 778 survivors (77) who had been seronegative at baseline provided follow up data. Main outcome measures - Incidence of HIV infection in relation to individual characteristics and risk factors; including place of residence. The results showed that the incidence of HIV infection in all adults was 2.1/100 person years of observation (SE 0.5(95) confidence interval 1.1 to 3.1); in people aged 15-39 the incidence was 3.2/100 person years. Incidence was highest in men and women aged 20-24 (9.2/100 person years (3.9) and 6.8/100 person years (2.9) respectively). Risk factors significantly associated with seroconversion were age 24 and under and two or more sexual partners. Between the surveys the proportion of all respondents reporting high risk behaviour (two or more partners) significantly increased from 8.9to 12.3. Despite preventive programmes and substantial knowledge about AIDS the incidence of HIV infection remains high in this rural population. Prevention aimed at vulnerable rural communities is urgently needed to contain the HIV epidemic

Hepatitis B antigen and antibody in patients with leprosy: a study of three resettlement villages in Thailand.

It remains uncertain whether the cellular immune abnormalities of patients with lepromatous leprosy interfere with resolution of hepatitis B virus (HBV) infections. To investigate this question in an area coendemic for the two diseases, we determined the prevalence of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) in: 1) 204 leprosy patients living in three leprosy resettlement villages; 2) 198 contacts living in the same villages; and 3) 44 newly diagnosed leprosy patients in Thailand. Within the villages, the prevalence of HBsAg positivity was inversely related to age, tended to be more frequent in patients with tuberculoid than lepromatous leprosy, and was similar after age adjustment among persons with and without leprosy. The prevalence of HBV markers found in newly diagnosed patients was similar to that in the villagers. We conclude that extensive HBV transmission had occurred in the resettlement villages and that the natural history of HBV infection was similar in persons with, whether tuberculoid or lepromatous, and without leprosy.

Fraturas ipsilaterais do fêmur e da tíbia / Ipsilateral fractures of the femur and tibia

De 1976 a 1983, foram tratados no Departamento de Ortopedia e Traumatologia da Santa Casa de Säo Paulo - "Pavilhäo Fernandinho Simonsen, 42 pacientes adultos com 43 fraturas ipsilaterais do fêmur e da tíbia: 26 foram submetidos ao tratamento cirúrgico, com fixaçäo das duas fraturas; 13 com fixaçäo de uma das fraturas; e 4 foram tratados por método incruento em ambas as fraturas. O tempo médio de seguimento foi de 36 meses. Do total de fraturas, 25 eram expostas; 27 pacientes apresentavam lesöes associadas (trauma craniano, torácico ou abdominal, incluindo-se também outras fraturas); 18 pacientes necessitaram de cuidados de terapia intensiva. Como intercorrências, foram observadas uma pseudartrose do fêmur, uma da tíbia, 3 amputaçöes de perna e 4 infecçöes. Considerando-se todos os tipos de tratamento empregados, foram obtidos 97% de consolidaçäo nas fraturas do fêmur e 91% de consolidaçäo nas fraturas da tíbia. Os resultados funcionais (grau de mobilidade articular e presença ou näo de dores nessa articulaçäo) mostraram 55,8% de bons resultados, 23,2% de resultados regulares e 21% de maus resultados. Os melhores resultados, favorecem a fixaçäo cirúrgica da fratura femoral, enquanto a fratura tibial pode ser tratada tanto cirúrgica quanto incruentamente. Entre as diversas opçöes terapêuticas utilizadas, a cirurgia global foi a mais eficiente nos casos mais graves e o tratamento incruento foi o mais insatisfatório

Lymphocyte transformation in lepromatous leprosy: a study of the influence of disease activity and symptom duration.

The lymphocyte hyporesponsiveness to M. leprae of patients with active lepromatous leprosy has been well described. This immune defect is less well understood in terms of its time of origin, possible reversibility and specificity. To further examine the persistence and specificity of this abnormality, lymphocyte transformation tests of 93 leprosy patients to lepromin, BCG and PHA were studied. Among lepromatous patients, a decreased response to M. leprae was seen, whether the disease was active or inactive. Decreased responses to BCG were found in lepromatous patients with active disease, but not in those with inactive disease. The duration of patient symptoms was not associated with differences in LTT responses among the active lepromatous patients.