Poor Sleep quality and health-related quality of life impact in adolescents with and without chronic immunosuppressive conditions during COVID-19 quarantine

OBJECTIVE: To assess the possible factors that influence sleep quality in adolescents with and without chronic immunosuppressive conditions quarantined during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This cross-sectional study included 305 adolescents with chronic immunocompromised conditions and 82 healthy adolescents. Online surveys were completed, which included questions on socio-demographic data and self-rated healthcare routine during COVID-19 quarantine and the following validated questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Pediatric Quality of Life Inventory 4.0 (PedsQL4.0), and Pediatric Outcome Data Collection Instrument (PODCI). RESULTS: The median current age [14 (10-18) vs. 15 (10-18) years, p=0.847] and frequency of female sex (62% vs. 58%, p=0.571) were similar in adolescents with chronic conditions compared with healthy adolescents. The frequency of poor sleep quality was similar in both groups (38% vs. 48%, p=0.118). Logistic regression analysis, including both healthy adolescents and adolescents with chronic conditions (n=387), demonstrated that self-reported increase in screen time (odds ratio [OR] 3.0; 95% confidence interval [CI] 1.3-6.8; p=0.008) and intrafamilial violence report (OR 2.1; 95% CI 1.2-3.5; p=0.008) were independently associated with poor sleep quality in these adolescents. However, the PODCI global function score was associated with a lower OR for poor sleep quality (OR 0.97; 95% CI 0.94-0.99; p=0.001). Further logistic regression, including only adolescents with chronic conditions (n=305), demonstrated that self-reported increase in screen time (OR 3.1; 95% CI 1.4-6.8; p=0.006) and intrafamilial violence report (OR 2.0; 95% CI 1.2-3.4; p=0.011) remained independently associated with poor quality of sleep, whereas a lower PODCI global function score was associated with a lower OR for sleep quality (OR 0.96; 95% CI 0.94-0.98; p<0.001). CONCLUSION: Self-reported increases in screen time and intrafamilial violence report impacted sleep quality in both healthy adolescents and those with chronic conditions. Decreased health-related quality of life was observed in adolescents with poor sleep quality.

Expanding the limits of endoscopic intraorbital tumor resection using 3-dimensional reconstruction / Expandindo os limites da ressecção endoscópica de tumor intraorbital utilizando reconstrução tridimensional

Abstract Introduction: Endoscopic orbital surgery is a nascent field and new tools are required to assist with surgical planning and to ascertain the limits of the tumor resectability. Objective: We purpose to utilize three-dimensional radiographic reconstruction to define the theoretical lateral limit of endoscopic resectability of primary orbital tumors and to apply these boundary conditions to surgical cases. Methods: A three-dimensional orbital model was rendered in 4 representative patients presenting with primary orbital tumors using OsiriX open source imaging software. A 2-Dimensional plane was propagated between the contralateral nare and a line tangential to the long axis of the optic nerve reflecting the trajectory of a trans-septal approach. Any tumor volume falling medial to the optic nerve and/or within the space inferior to this plane of resectability was considered theoretically resectable regardless of how far it extended lateral to the optic nerve as nerve retraction would be unnecessary. Actual tumor volumes were then superimposed over this plan and correlated with surgical outcomes. Results: Among the 4 lesions analyzed, two were fully medial to the optic nerve, one extended lateral to the optic nerve but remained inferior to the plane of resectability, and one extended both lateral to the optic nerve and superior to the plane of resectability. As predicted by the three-dimensional modeling, a complete resection was achieved in all lesions except one that transgressed the plane of resectability. No new diplopia or vision loss was observed in any patient. Conclusion: Three-dimensional reconstruction enhances preoperative planning for endoscopic orbital surgery. Tumors that extend lateral to the optic nerve may still be candidates for a purely endoscopic resection as long as they do not extend above the plane of resectability described herein.

Resumo Introdução: A cirurgia orbital endoscópica é um campo emergente e são necessárias novas ferramentas para auxiliar no planejamento cirúrgico e determinar os limites da ressecabilidade tumoral. Objetivo: Usar a reconstrução radiográfica tridimensional para definir o limite lateral teórico de ressecabilidade endoscópica de tumores orbitais primários e aplicar essas condições de limites a casos cirúrgicos. Método: Um modelo orbital tridimensional foi aplicado a quatro pacientes representativos com tumores orbitais primários utilizando o software de imagem de fonte aberta OsiriX. Um plano bidimensional foi propagado entre a narina contralateral e uma linha tangencial ao eixo longo do nervo óptico que reflete a trajetória de uma abordagem transeptal. Qualquer volume de tumor situado medialmente ao nervo óptico e/ou dentro do espaço inferior a esse plano de ressecabilidade foi teoricamente considerado ressecável, independentemente de quão longe ele se estendia até o nervo óptico, pois a retração do nervo seria desnecessária. Os volumes reais do tumor foram então sobrepostos sobre esse plano e correlacionados com os resultados cirúrgicos. Resultados: Entre as quatro lesões analisadas, duas eram totalmente mediais ao nervo óptico, uma se estendia lateralmente ao nervo óptico, mas permaneceu inferior ao plano de ressecabilidade, e uma se estendia lateralmente ao nervo óptico e superior ao plano de ressecabilidade. Conforme previsto pelo modelo tridimensional, uma ressecção completa foi obtida em todas as lesões, exceto uma, que transgrediu o plano de ressecabilidade. Nenhuma nova diplopia ou perda de visão foi observada em qualquer paciente. Conclusão: A reconstrução tridimensional melhora o planejamento pré-operatório para a cirurgia orbital endoscópica. Os tumores que se estendem lateralmente ao nervo óptico podem ainda ser candidatos à ressecção puramente endoscópica, desde que não se estendam além do plano de ressecabilidade aqui descrito.

El perfil de los intentadores de suicidio atendidos en el Instituto Especializado de Salud Mental "Honorio Delgado-Hideyo Noguchi" 2003 / The profile of the assisted attempter of suicide in the Specialized Institute of Mental Health

Se trata de un estudio prospectivo y descriptivo que registra a 548 pacientes atendidos en el Programa de Prevención del Suicidio del IESM.H. Delgado-H. Noguchi durante el año 2003, considerando variables sociodemográficas y clínicas. Se aprecia que el perfil que destaca está configurado por características tales como: pertenecer al sexo femenino, cada vez más jóvenes, predominantemente solteras, con educación secundaria o superior, procedentes de distritos empobrecidos, que acuden mayormente de su domicilio, acompañadas generalmente por la progenitora y que cursan con estados básicamente depresivos, generalmente comórbidos con desórdenes de la personalidad, especialmente borderline, abuso de sustancias, Bulimia Nervosa o Trastorno Disfórico Pre-Menstrual, que han tenido conflictos de pareja o familiares, y que habían presentado ya un intento de suicidio al menos en casi la mitad de casos alguna vez en su vida, y registraban antecedentes familiares o personales de violencia física o sexual, y que presentaron intercurrencias propias de su género como abortos o uso de anticonceptivos, siendo el método principal del intento de sobredosis de medicamentos. Este panorama obliga a una aproximación consistente por la tendencia al incremento y a la desintegración que provoca el intento de suicidio.

Los vómitos que aproximan a la muerte: el complejo problema de la bulimia y el intento de autoeliminarse / Vomits to death: bulimia's complex trouble and suicide attempt

El artículo resalta la complicación sombría del padecimiento alimentario bulímico, es decir la intencionalidad suicida que podría ser explicada por una situación comórbida con un estado despresivo, o como parte de la personalidad de las pacientes bulímicas, a la luz de los registros de intentos de suicidio en la Institución atendidos durante el primer semestre del presente año, y la revisión de la literatura correspondiente.

Management of upper airway obstruction: Intubation us tracheotomy

Management of the obstructed upper airway may be very challenging. It requires careful clinical evaluation as well as supportive laboratory data and physiologic monitoring. A team approach is essential. This paper is an overall review of the subject of airway control intended to guide health care providers dealing with such patients. Various options of intervention including endotracheal intubation, tracheotomy and transtracheal jet ventilation are discussed. The indications, advantages disadvantages and potential complications of each of these methods are detailed. Recent advances in this field are described such as new tube material and technology, non invasive physiologic monitoring [oxygen saturation measurements] and modifications of the surgical techniques