Avaliação da concordância entre os resultados da genotipagem do polimorfismo C/T-13910 e do teste de tolerância à lactose: um estudo retrospectivo populacional no Brasil / Evaluation of agreement between c/t-13910 polymorphism genotyping results and lactose tolerance test results: a retrospective population-based study in brazil

ABSTRACT Background: Lactose tolerant test (LTT) is the most broadly used diagnostic test for lactose intolerance in Brazil, is an indirect, minimally invasive and a low-cost test that is widely available in primary care and useful in clinical practice. The C/T-13910 polymorphism in lactase persistence has been well characterized in Caucasian populations, but there are no studies evaluating the concordance between C/T-13910 polymorphism genotyping results and LTT results in Brazil, where the population is highly mixed. Objective: We aimed to evaluate agreement between presence of C/T-13910 polymorphism genotyping and malabsorption in LTT results. Methods: This is a retrospective analysis of a Brazilian population whose data were collected from a single laboratory database present in several Brazilian states. Results of individuals who underwent both genetic testing for lactose intolerance (C/T-13910 polymorphism genotyping) and an LTT from April 2016 until February 2019 were analysed to evaluate agreement between tests. Groups were classified according to age (<10-year-old (yo), 10-17 yo, ≥18 yo groups) and state of residence (São Paulo or Rio Grande do Sul). Results: Among the 404 patients evaluated, there was agreement between the genotyping and LTT results in 325 (80.4%) patients and discordance in 79 (19.6%) patients (k=0.42 -moderate agreement). Regarding the genotype, 47 patients with genotype C/C (lactase nonpersistence) had normal LTT results, and 32 with genotype C/T or T/T (indicating lactase persistence) had abnormal LTT results. Neither age nor state of residence (Rio Grande do Sul or São Paulo) affected the agreement between test results. Conclusion: Considering the moderate agreement between C/T-13910 polymorphism genotyping and LTT results (κ=0.42) in the Brazilian population, we hypothesize that an analysis of other polymorphisms could be a strategy to improve the agreement between genotyping and established tests and suggest that additional studies should focus on exploring this approach.

RESUMO Contexto: O teste de tolerancia à lactose (TTL) é ampliamente utilizado por ser minimamente invasivo e de baixo custo, disponível na atenção primária e muito útil na prática clínica. Está bem estabelecido o polimorfismo C/T-13910 na persistência da lactase em populações caucasianas, mas não há estudos avaliando a concordância entre os resultados da genotipagem do polimorfismo C/T-13910 e do TTL no Brasil, onde a população é altamente miscigenada. Objetivo: Avaliar a concordância entre a presença do polimorfismo C/T-13910 e a má absorção nos resultados do TTL. Métodos: Análise retrospectiva de dados coletados de um laboratorio presente em vários estados brasileiros. Os resultados dos pacientes que realizaram um teste genético para intolerância à lactose (genotipagem do polimorfismo C/T-13910) e um TTL de abril de 2016 a fevereiro de 2019 foram analisados para avaliar a concordância entre os testes. Os grupos foram classificados de acordo com a idade (<10 anos; 10-17 anos, ≥18 anos) e estado de residência (São Paulo ou Rio Grande do Sul). Resultados: Entre os 404 pacientes avaliados, houve concordância entre os resultados de genotipagem e TTL em 325 (80,4%) pacientes e discordância em 79 (19,6%) pacientes (K=0,42 - concordância moderada). Em relação ao genótipo, 47 pacientes com genótipo C/C (não persistência de lactase) apresentaram TTL normal e 32 com genótipo C/T ou T/T (indicando persistência da lactase) apresentaram TTL anormal. A idade e o estado de residência (Rio Grande do Sul ou São Paulo) não afetaram a concordância entre os resultados dos exames. Conclusão: Considerando a concordância moderada entre a genotipagem do polimorfismo C/T-13910 e os resultados de TTL (κ=0,42) na população brasileira, sugerimos que a análise de outros polimorfismos poderia ser uma estratégia para melhorar a concordância entre os testes.

Os Discursos de Ódio na Contemporaneidade: Da Face Subjetiva à Face Política / Hate Speeches in Contemporaneity: From the Subjective to the Political Aspects / Los Discursos de Odio en la Contemporaneidad: De la Vista Subjetiva a la Vista Política

O presente artigo propõe apresentar algumas contribuições da psicanálise para entender os aspectos subjetivos e políticos presentes no ódio. No atual contexto sociopolítico brasileiro este afeto tem figurado enquanto discurso predominante e espaços como as redes sociais digitais têm se tornado cada vez mais um campo fértil para a sua propagação e legitimação, sendo por vezes sustentado e fomentado pelo aparato institucional público. Esta pesquisa teve como ponto de partida a releitura e reflexão crítica dos textos freudianos, como os que trazem os conceitos de identificação e narcisismo, centrais para entender o que mobiliza e potencializa a incidência deste afeto bem como seus efeitos na contemporaneidade. Neste percurso foi constatado que o ódio comparece sempre na relação com o outro a partir da intolerância a alguma diferença que representa uma ameaça às ilusões narcísicas do sujeito. Embora seja considerado um afeto constitutivo do ser humano, é também um fenômeno cultural, social e político, podendo tornar-se potencialmente destrutivo para a humanidade quando o objetivo se torna segregar pessoas e grupos a fim de se eliminar as diferenças.

This article presents some contributions of psychoanalysis to understand the subjective and political aspects of hatred. In the current Brazilian sociopolitical context, hatred has figured as a predominant discourse, thus, spaces like digital social networks have become a fertile field for its propagation and legitimation, sometimes with the support and instigation of the public institutional apparatus. This study has as its starting point the critical reflection of Freudian texts that address concepts of identification and narcissism, central to understanding what mobilizes and enhances the incidence of this emotion, as well as its effects in contemporary times. In this analysis, it was found that hatred always appears in relationships based on intolerance to differences that might represent a threat to the subject's narcissistic illusions. Although it is considered a constitutive emotion of the human being, hatred is also a cultural, social and political phenomenon, and can become potentially destructive for humanity if used to segregate people and groups in order to eliminate differences.

Este artículo se propone presentar algunos aportes del psicoanálisis para comprender los aspectos subjetivos y políticos presentes en el odio. En el contexto sociopolítico brasileño actual, este afecto ha figurado como un discurso predominante y espacios, como las redes sociales digitales, se han convertido cada vez más en un campo fértil para su propagación y legitimación, siendo a veces apoyado y fomentado por el aparato institucional público. Esta investigación tuvo como punto de partida la relectura y reflexión crítica de textos freudianos, como aquellos que traen los conceptos de identificación y narcisismo, centrales para comprender lo que moviliza y potencia la incidencia de este afecto, así como sus efectos en la contemporaneidad. En ese camino, se constató que el odio siempre aparece en la relación con el otro a partir de la intolerancia a alguna diferencia que representa una amenaza para las ilusiones narcisistas del sujeto. Aunque se considera un afecto constitutivo del ser humano, también es un fenómeno cultural, social y político, y puede volverse potencialmente destructivo para la humanidad cuando el objetivo pasa a ser segregar personas y grupos para eliminar las diferencias.

Sentidos de Intolerância Religiosa Contra Religiões Afro-brasileiras por Grupos com e sem Religião / Meanings of Religious Intolerance Against Afro-Brazilian Religions by Groups with and without Religion / Sentidos de Intolerancia Religiosa Contra las Religiones Afrobrasileñas por Grupos con y sin Religión

Neste artigo, discutimos os resultados de pesquisa sobre sentidos atribuídos às minorias religiosas, Religiões Afro-brasileiras (RAb's) por participantes com e sem religião e suas relações com a Intolerância Religiosa (IR). Adotamos a Teoria das Representações Sociais em articulação com as Relações Intergrupais e Identidades Sociais. O método é qualitativo com técnicas de análise auxiliadas pelo software Iramuteq em questionários de associação livre de palavras aplicados a 165 participantes e análises de conteúdo das justificativas das associações evocadas. Os resultados sugerem mudanças e permanências: de uma parte, um pensamento social de exclusão influenciado pelos discursos religiosos dominantes; de outra, a representação das RAb's como religiões, com indícios de ambiguidades no Núcleo Central. Foi observada objetivação com elementos novos (religião e cultura) e antigos (rituais, espírito, terreiro, orixás). Nos núcleos de sentido do grupo com religião: exclusão de negros e ancoragem em rituais; ênfase na corporalidade ritualística, visual e performática expressando sentidos simbólicos de malignidade e demonização das pessoas de bem (com religião) X pessoas do mal (Rab's). Os resultados sugerem crença institucionalizada nas pessoas e sentido de pertencimento social, inclusão à identidade grupal e exclusão dos "diferentes", o que pode provocar acirramento da intolerância.

In this article we discuss the results of research on meanings attributed to religious minorities, Afro-Brazilian Religions (RAb's) by participants with and without religion and their relations with Religious Intolerance (IR). We adopted the Theory of Social Representations in conjunction with Intergroup Relations and Social Identities. The method is qualitative with analysis techniques aided by the Iramuteq software in free word association questionnaires applied to 165 participants and content analysis of the justifications for the evoked associations. The results suggest changes and continuities: on the one hand, a social thought of exclusion influenced by dominant religious discourses; on the other hand, the representation of RAb's as religions, with indications of ambiguities in the Central Nucleus. Objectification with new elements (religion and culture) and old ones (rituals, spirit, terreiro, orixás) was observed. In the nuclei of meaning of the group with religion: exclusion of black people and anchoring in rituals; emphasis on ritualistic, visual and performative corporeality expressing symbolic meanings of malignity demonization of good people (with religion) X evil people (Rab's). The results suggest an institutionalized belief in people and a sense of social belonging, inclusion in the group identity and exclusion of the 'different', which can lead to an intensification of intolerance.

En este artículo, discutimos los resultados de investigación los significados a las minorías religiosas, Religiones Afrobrasileñas (RAb's) por los participantes con/sin religión y sus relaciones con la Intolerancia Religiosa -IR. Adoptamos la Teoría de las Representaciones Sociales en conjunto con las Relaciones Intergrupales y las Identidades Sociales. El método es cualitativo con técnicas de análisis auxiliadas por el software Iramuteq en cuestionarios de asociación libre de palabras aplicados a 165 participantes y análisis de contenido de las justificaciones de las asociaciones evocadas. Los resultados sugieren cambios y continuidades: por un lado, un pensamiento social de exclusión influido por los discursos religiosos dominantes; por otro lado, la representación de los RAb como religiones, con indicios de ambigüedades en el Núcleo Central. Objetivación con elementos nuevos (religión y cultura) y antiguos (rituales, espíritu, terrero, orixás). En los núcleos de significación del grupo con la religión: exclusión de negros y anclaje en rituales; énfasis en la corporalidad ritualista, visual y performativa que expresa significados simbólicos de malignidad y demonización de personas buenas (con religión) X personas malas (Rab's). Los resultados sugieren creencia institucionalizada en las personas un sentido de pertenencia social e inclusión en la identidad grupal exclusión de los 'diferentes', lo que puede conducir a intensificación de la intolerancia.

Reacciones adversas a múltiples antibióticos / Adverse drug reactions to multiple antibiotics

Resumen La información sobre reacciones adversas es fundamental para conocer la seguridad real de los medicamentos comercializados. Existen casos de pacientes con síndrome de intolerancia a múl tiples drogas, una entidad poco reportada, la que puede presentarse cuando en un mismo paciente ocurren reacciones adversas a más de dos medicamentos no relacionados farmacológicamente. Se describe el caso de una mujer con diagnóstico de endocarditis por Staphylococcus aureus multisensible, que cursó con reacciones adversas a cinco antibióticos estructuralmente no relacionados y con mecanismos de acción diferentes, en dos internaciones consecutivas. Las reacciones fueron secundarias a cefazolina (tricitopenia), vancomicina (injuria renal), daptomicina (elevación de creatina fosfoquinasa) y linezolid (hepatotoxicidad) en la primera internación, y a cotrimoxazol (plaquetopenia) en la segunda. En todos los casos se observó daño transitorio en diferentes sistemas de órganos. Finalmente, se otorgó alta hospitalaria con clindamicina sin nuevas intercurrencias hasta finalizar tratamiento. Este caso podría corresponder al síndrome antes mencionado o a una entidad aún no caracterizada.

Abstract Adverse reaction reporting is essential to understand the actual safety of marketed medicines. There are cases of patients with multidrug intolerance syndrome, an under-reported entity, which can occur when adverse reactions to more than two pharmacologically unrelated drugs occur in the same patient. We describe the case of a woman diagnosed with multisensitive Staphylococcus aureus endocarditis who experienced adverse reactions to five structurally unrelated antibiotics with different mechanisms of action in two consecutive hospitalisations. The reactions were secondary to cefazolin (tricytopenia), vancomycin (renal injury), daptomycin (elevated creatine phosphokinase) and linezolid (hepatotoxicity) in the first hospitalization, and to cotrimoxazole (thrombocytopenia) in the second. Transient damage to different organ systems was observed in all cases. Finally, hospital discharge was granted with clindamycin without further intercurrences until treatment was completed. This case could cor respond to the aforementioned syndrome or to an as yet uncharacterized entity.

Associations of human intestinal Dorea and glucose intolerance in people with obesity / 中华内分泌代谢杂志

Objective:To evaluate the role of Dorea in glucose intolerance of people with obesity. Methods:This study recruited 113 young individuals with obesity and varying degree of glucose tolerance [body mass index(BMI)≥30 kg/m 2] and 105 controls, comparing the metabolic phenotypes and Dorea abundance. Correlation analysis and ROC analysis were performed to assess the association between Dorea and clinical parameters and its predictive role in predicting glucose intolerance. Results:(1) Metabolic parameters were higher in obesity group than the control group. There was no difference in body weight, BMI and WHR among subgroups classified by glucose tolerance in people with obesity. (2) The abundance of Dorea, Dorea formicigenerans were higher in obese individuals, however showing a downward trend in accordance with glucose intolerance. The abundance was inversely associated with OGTT-2 h plasma glucose and HbA 1C, while positively associated with HOMA-β. Logistic regression demonstrated that Dorea formicigenerans was an independent protective factor after adjusting confounders such as age and gender in the prevention of glucose intolerance. (3) ROC analysis exhibited that the AUC values of Dorea formicigenerans was 0.73 in the total population. Conclusion:Dorea and Dorea formicigenerans exert protective effect on glucose metabolism in obese subjects. The abundance of Dorea and Dorea formicigenerans can be used as predictors of glucose intolerance risk in obese subjects, which facilitate the early screening and monitoring.

Progress in diagnosis and treatment of orthostatic intolerance / 中华老年医学杂志

Orthostatic intolerance is a syndrome characterized by a series of symptoms that occur when standing upright, resulting in the loss of ability to maintain an upright position.This condition can be further classified into orthostatic hypotension, postural orthostatic tachycardia syndrome, and vasovagal syncope.Some scholars suggest that orthostatic hypertension may also be considered a part of this syndrome.The most significant risk associated with orthostatic intolerance is falls, which can lead to physical injury and psychological distress.This article aims to review the advancements made in the diagnosis and treatment of orthostatic intolerance, so as to enhance the standardization of clinical diagnosis and improve the effectiveness of treatment.

The intolerance of uncertainty on state worry and state anxiety of college students with medium and low trait anxiety / 中华行为医学与脑科学杂志

Objective:To investigate the effect of intolerance of uncertainty (IU) on state worry, state anxiety, and galvanic skin response in college students with medium and low trait anxiety.Methods:The trait anxiety inventory (TAI) and the intolerance of uncertainty scale (IUS) were used to investigate 1 378 college students in Beijing. A total of 537 individuals with medium or low trait anxiety (TAI score ≤54) were selected, from which high IU individuals (IUS score ≤58) and low IU individuals (IUS score > 58) were selected and allocated to uncertain group ( n=28) and certain group ( n=28) according to gender, age, education level and IU score. The modified NPU paradigm task, the penn state worry questionnaire(PSWQ)and the brief state anxiety measurement(BSAM) were used to assess the subjects' worry and anxiety.The galvanic skin response of individuals completing the NPU paradigm task was recorded.SPSS 26.0 was used for a two factor analysis of variance (classification: high IU, low IU; group: uncertain group, certain group). Results:The results of the two factor analysis of variance showed that the interaction between individual state anxiety classification and group was not significant( F(1, 55)=0.05, P>0.05, η2=2.16). The main effect of classification was significant( F(1, 55)=24.17, P<0.05, η2=1143.01). The anxiety level of individuals with high IU was significantly lower than that of individuals with low IU( P<0.05). The group main effect was not significant( F(1, 55)=0.03, P>0.05, η2=1.45), and there was no significant difference between the uncertainty group and the certainty group in terms of worry( P>0.05). The interaction between individual state anxiety classification and group was significant ( F(1, 55)=4.38, P<0.05, η2=3.02). The simple analysis results showed that in the uncertain group, the state anxiety of individuals with high IU was significantly lower than that of individuals with low IU ( P<0.05). In the certain group, there was no significant difference in state anxiety between individuals with high and low IU ( P>0.05). The interaction between individual galvanic skin response classification and group was not significant ( F(1, 55)=0.03, P>0.05, η2=0.00). The classification main effect was not significant( F(1, 55)=0.07, P>0.05, η2=0.00), and there was no significant difference in skin electrical activity between individuals with high and low IU ( P>0.05). But the main effect of the group was significant( F(1, 55)=4.86, P<0.05, η2=0.03). The skin electrical activity of the uncertain group was higher than that of the certain group( P<0.05). Conclusion:In the college students with medium and low trait anxiety, IU is an effective predictor of individual state worry and state anxiety under uncertain conditions.

Research progress on feeding intolerance and the relationship between feeding intolerance and ultrasonic monitoring of gastric residual volume / 中国小儿急救医学

Feeding intolerance is a common cause of enteral nutrition interruption, which has a high incidence in the pediatric intensive care unit.It seriously affects the nutritional management of critically ill children, affects the treatment effect of critically ill children, and can lead to serious complications and even death.There is a lack of standardized and unified standards for the assessment of feeding intolerance in clinical practice, and there is an urgent need for objective and standard assessment tools.Ultrasound is a non-invasive, simple and non-radiation clinical technique, which can be used to measure gastric residual volume at the bedside in critically ill children, and evaluate feeding intolerance.

The impact of chronic comorbidity in elderly people on relatives’ physical and mental health during the nursing home confinement:A multiple mediator analysis / 西安交通大学学报(医学版)

【Objective】 To explore the relationship between chronic comorbidity and the physical and mental health of relatives of elderly people during the nursing home confinement, and to analyze the mediating effects of perceived stress and intolerance of uncertainty in this context. 【Methods】 A total of 568 family members of elderly people in nine elderly institutions in Shaanxi Province were selected. The survey included the short version of the Perceived Stress Scale, Intolerance of Uncertainty Scale, and The World Health Organization-5 Well-being Index. The data were analyzed with Stata for correlation and mediation effects. 【Results】 ① The comorbidities of chronic diseases was positively correlated with the perceived stress (r=0.16, P<0.001) and intolerance of uncertainty (r=0.11, P=0.006) of the family members, but negatively correlated with the physical and mental health of the family members (r=-0.13, P=0.002). ② The mediating effect of perceived stress between chronic disease co-morbidity and physical and mental health of family members in older adults was -0.023, accounting for 18.8% of the total effect; the mediating effect of intolerance of uncertainty between chronic disease co-morbidity and physical and mental health of family members in older adults was -0.041, accounting for 33.5% of the total effect. 【Conclusion】 During closed management in a nursing facility, the physical and mental health of family members of older adults with chronic co-morbidities is poorer than that of family members of non-chronic co-morbidities. And it can lead to a decline in physical and mental health of family members through increased perceived stress and intolerance of uncertainty.

Influencing factors of red blood cell transfusion volume for premature neonatal pneumonia and its predictive value for feeding intolerance / 中国输血杂志

【Objective】 To investigate the influencing factors of red blood cell transfusion volume for premature neonatal pneumonia and its predictive value for feeding intolerance. 【Methods】 272 infants of premature neonatal pneumonia treated with red blood cell transfusion were collected as the research objects. Red blood cell transfusion volume was investigated and its influencing factors were analyzed by multiple linear regression. Receiver operating curve (ROC) was used to analyze the predictive value of red blood cell transfusion volume on feeding intolerance in infants with premature neonatal pneumonia. 【Results】 The average red blood cell transfusion volume in infants with premature neonatal pneumonia was (76.19±26.03) mL. Multiple linear regression analysis showed that gestational age, birth weight, volume of blood collection and hemoglobin level before blood transfusion were influencing factors of red blood cell transfusion volume in infants with premature neonatal pneumonia (B=-1.930, -6.215, 1.041, -0.249, P<0.05). The incidence of feeding intolerance in infants with premature neonatal pneumonia was 19.5%. The transfusion volume of feeding intolerance group was significantly higher than that of the non-feeding intolerance group(P<0.05). ROC analysis showed that the area under curve (AUC) of red blood cell transfusion volume for predicting feeding intolerance was 0.755. 【Conclusion】 Gestational age, birth weight, volume of blood collection and hemoglobin level before blood transfusion are influencing factors of red blood cell transfusion volume in infants with premature neonatal pneumonia. The incidence of feeding intolerance in premature neonatal pneumonia is high. The red blood cell infusion volume is of good predictive value for the occurrence of feeding intolerance. Latrogenic blood loss and red blood cell transfusion volume should be minimized clinically.

Influence and mechanism of intolerance of uncertainty on anxiety / 四川精神卫生

The purpose of this paper is to review the research on the influence and mechanism of intolerance of uncertainty （IU） on anxiety both at home and abroad in recent years. IU refers to the individual's disgust response due to the intolerance of perceived lack of prominent， critical or sufficient information， and it has individual tendency. IU plays an important role in the occurrence and development of anxiety， but the specific process and mechanism remain unclear. This paper reviews the influence of IU on anxiety， and clarifies its mechanism of action on the generation and development of anxiety from the perspectives of cognition， emotion and behavior， so as to provide references for preventing the development of general anxiety into anxiety disorders and developing new psychological intervention and treatment strategies.

Enteral nutrition support for lysinuric protein intolerance: a case report and literature review / 中国当代儿科杂志

OBJECTIVES@#To summarize the clinical characteristics and nutrition therapy for children with lysinuric protein intolerance (LPI).@*METHODS@#The clinical manifestations, laboratory test results and enteral nutrition treatment in a girl with LPI diagnosed in Xiangya Hospital, Central South University were retrospective analyzed. Additionally, the data of the children with LPI reported in China and overseas were reviewed.@*RESULTS@#A case of 4-year-old girl was presented, who exhibited significant gastrointestinal symptoms, such as chronic abdominal distension, prolonged diarrhea, recurrent pneumonia, and limited growth. She had a poor response to anti-infection treatment. After receiving enteral nutrition therapy, she did not experience any gastrointestinal discomfort, and there were improvements in the levels of hemoglobin, albumin, and blood ammonia. Unfortunately, due to serious illness, she declined further treatment and later passed away. A total of 92 cases of pediatric patients with LPI have been reported to date, including one case reported in this study. Most children with LPI experienced disease onset after weaning or introduction of complementary foods, presenting with severe digestive system symptoms, malnutrition, and growth retardation. It is noteworthy that only 50% (46/92) of these cases received nutritional therapy, which effectively improved their nutritional status. Among the 92 children, 8 (9%) died, and long-term follow-up data were lacking in other reports.@*CONCLUSIONS@#LPI often involves the digestive system and may result in growth restriction with a poor prognosis. Nutritional therapy plays a crucial role in the comprehensive treatment of LPI.

Neurological symptoms and comorbidity profile of hospitalized patients with COVID-19 / Sintomas neurológicos e perfil de comorbidades de pacientes hospitalizados com COVID-19

Abstract Background The neurological manifestations in COVID-19 adversely impact acute illness and post-disease quality of life. Limited data exist regarding the association of neurological symptoms and comorbid individuals. Objective To assess neurological symptoms in hospitalized patients with acute COVID-19 and multicomorbidities. Methods Between June 2020 and July 2020, inpatients aged 18 or older, with laboratory-confirmed COVID-19, admitted to the Hospital São Paulo (Federal University of São Paulo), a tertiary referral center for high complexity cases, were questioned about neurological symptoms. The Composite Autonomic Symptom Score 31 (COMPASS-31) questionnaire was used. The data were analyzed as a whole and whether subjective olfactory dysfunction was present or not. Results The mean age of the sample was 55 ± 15.12 years, and 58 patients were male. The neurological symptoms were mostly xerostomia (71%), ageusia/hypogeusia (50%), orthostatic intolerance (49%), anosmia/hyposmia (44%), myalgia (31%), dizziness (24%), xerophthalmia (20%), impaired consciousness (18%), and headache (16%). Furthermore, 91% of the patients had a premorbidity. The 44 patients with subjective olfactory dysfunction were more likely to have hypertension, diabetes, weakness, shortness of breath, ageusia/hypogeusia, dizziness, orthostatic intolerance, and xerophthalmia. The COMPASS-31 score was higher than that of previously published controls (14.85 ± 12.06 vs. 8.9 ± 8.7). The frequency of orthostatic intolerance was 49% in sample and 63.6% in those with subjective olfactory dysfunction (2.9-fold higher risk compared to those without). Conclusion A total of 80% of inpatients with multimorbidity and acute COVID-19 had neurological symptoms. Chemical sense and autonomic symptoms stood out. Orthostatic intolerance occurred in around two-thirds of the patients with anosmia/hyposmia. Hypertension and diabetes were common, mainly in those with anosmia/hyposmia.

Resumo Antecedentes As manifestações neurológicas na COVID-19 impactam adversamente na enfermidade aguda e na qualidade de vida após a doença. Dados limitados existem em relação a associação de sintomas neurológicos e indivíduos com comorbidades. Objetivo Avaliar os sintomas neurológicos em pacientes de hospitalizados com COVID-19 aguda e múltiplas comorbidades. Métodos Entre junho e julho de 2020, pacientes de hospitais com idade 18 anos ou acima e COVID-19 laboratorialmente confirmada, admitidos no Hospital São Paulo (Universidade Federal de São Paulo), um centro de referência terciário para casos de alta complexidade, foram perguntados sobre sintomas neurológicos. O questionário Pontuação composta de sintoma autonômico (COMPASS-31) foi usado. Os dados foram analisados no geral e se a disfunção olfatória subjetiva estava presente ou não. Resultados A média de idade da amostra foi 55 ± 15.12 anos. 58 pacientes eram homens. Os sintomas neurológicos foram principalmente xerostomia (71%), ageusia/hipogeusia (50%), intolerância ortostática (49%), anosmia/hiposmia (44%), mialgia (31%), tontura (24%), xeroftalmia (20%), comprometimento na consciência (18%) e cefaleia (16%). Além disso, 91 % dos pacientes tinham uma pré-morbidade. Os 44 pacientes com disfunção olfatória tinham maior chance de ter hipertensão, diabetes, fraqueza, falta de ar, ageusia/hipogeusia, tontura, intolerância ortostática e xeroftalmia. A pontuação do COMPASS-31 foi maior do que a de controles previamente publicados (14,85 ± 12,06 vs. 8,9 ± 8,7). A frequência de intolerância ortostática foi 49% na amostra e 63,6% naqueles com disfunção olfatória subjetiva (risco 2.9 vezes maior comparado com os sem). Conclusão Um total de 80% dos pacientes hospitalizados com múltiplas morbidades e COVID-19 aguda tinham sintomas neurológicos. Os sintomas do sentido químico e autonômicos se destacaram. A intolerância ortostática ocorreu em cerca de dois terços dos pacientes com anosmia/hiposmia. A hipertensão e o diabetes foram comuns, principalmente naqueles com anosmia/hiposmia.

Leche materna deslactosada con la enzima beta galactosidasa para lactantes intolerantes / Leite materno sem lactose com a enzima beta-galactosidase para lactentes intolerantes / Lactose-free breast milk with the enzyme beta galactosidase for intolerant infants

Introducción: los bebés deben beneficiarse de la leche materna, incluso cuando presentan intolerancia a la lactosa. Por esto, se debe recurrir a la obtención de leche materna deslactosada. Objetivo: analizar el efecto de la enzima beta galactosidasa en la hidrólisis de la lactosa de leche materna madura para bebés clínicamente diagnosticados con intolerancia a la lactosa. Materiales y método: estudio exploratorio, descriptivo y explicativo. El contenido de lactosa se cuantificó desde el inicio hasta el final del tratamiento, controlando temperatura, tiempos y cantidad de enzima ß-galactosidasa adicionada en la leche materna. Se recolectaron 1000 ml de leche materna, obtenidos del Banco de Leche del Hospital General de Medellín (Antioquia, Colombia). Resultados: las muestras donadas se encontraban pasteurizadas y posteriormente fueron sometidas a la acción de la enzima lactasa. Se cuantificó el contenido de lactosa sin la enzima, reportando en promedio 6,34 mg/100 ml ± 0,23. El mayor aporte de lactosa obtenido posterior a la exposición a la enzima (30 minutos) fue de 6,07 mg/ml ± 0,35 (correspondiente a 95 % del contenido inicial), finalizando con un aporte de 0,35 % a una concentración de 0,4 % tras 24 horas, porcentaje que representa 95 % de la hidrólisis total en la leche materna. Conclusiones: en todas las muestras analizadas de diferentes madres se pudo obtener leche materna con bajas concentraciones de lactosa tras 24 horas de haber sido sometidas a la acción de ß-galactosidasa. Lo anterior se establece como una alternativa para los bebés intolerantes a la lactosa, que permitiría no privarlos de todos los beneficios que ofrece este alimento.

Introduction: Babies should benefit from breast milk, even when they are lactose intolerant. For this reason, parents should resort to obtaining lactose-free breast milk. Objective: To examine the effect of the enzyme ß-galactosidase on the hydrolysis of lactose in mature breast milk for babies clinically diagnosed with lactose intolerance. Materials and method: Exploratory, descriptive, and explanatory study. The lactose content was quantified from the beginning to the end of the treatment, controlling variables such as temperature, times, and the amount of ß-galactosidase enzyme added in breast milk. A total of 1000 ml of breast milk were obtained from the milk bank at Hospital General de Medellín (Antioquia, Colombia). Results: Donated samples were first pasteurized and subsequently subjected to the action of the enzyme lactase. The lactose content without the enzyme was quantified, reporting an average of 6.34 mg/100 mL±0.23. The highest contribution of lactose obtained after exposure to the enzyme was 6.07 mg/mL±0.35 (corresponding to 95% of the initial content), at 30 minutes, ending with a contribution of 0.35% at a concentration of 0.4% in 24 hours, percentage that represents 95% of total hydrolysis in breast milk. Conclusions: In all the examined samples from different mothers, it was possible to obtain breast milk with low concentrations of lactose 24 hours after these were exposed to the action of ß-galactosidase. This becomes an alternative for feeding lactose intolerant babies and not deprive them from all the benefits offered by breast milk.

Introdução: os bebês se devem beneficiar do leite materno, mesmo quando tenham intolerância à lactose, razão pela qual se deve recorrer à obtenção de leite materno sem lactose. Objetivo: analisar o efeito da enzima beta-galactosidase na hidrólise da lactose no leite materno maduro para bebês diagnosticados clinicamente com intolerância à lactose. Materiais e método: estudo exploratório, descritivo, explicativo. O teor de lactose foi quantificado do início ao fim do tratamento; temperatura, tempos e quantidade de enzima beta-galactosidase adicionada no leite materno foram controlados; foram coletados 1000ml de leite materno, obtidos no Banco de Leite do Hospital General de Medellín (Antioquia, Colômbia). VResultados: as amostras doadas foram pasteurizadas e posteriormente submetidas à ação da enzima lactase. O teor de lactose sem a enzima foi quantificado, relatando uma média de 6,34mg/100ml±0,23. A maior contribuição de lactose obtida após a exposição à enzima foi de 6,07mg/ml±0,35 (correspondendo a 95% do conteúdo inicial) em 30 minutos, finalizando com uma contribuição de 0,35% na concentração de 0,4% em 24 horas, percentual que representa 95% da hidrólise total no leite materno. Conclusões: em todas as amostras analisadas de diferentes mães, foi possível obter leite materno com baixas concentrações de lactose 24 horas após ser submetido à ação da beta galactosidase, como alternativa para bebês intolerantes à lactose e não os privar de todos os outros benefícios oferecidos por esse alimento ideal.

Embolización transcatéter del injerto renal en pacientes con síndrome de intolerancia: reporte de tres casos en un grupo de trasplantes

Introducción el síndrome de intolerancia es un proceso inflamatorio que ocurre hasta en un tercio de los pacientes con pérdida del injerto. Cuando no se obtiene una mejoría de los síntomas con el manejo médico, se indica la realización de nefrectomía del riñón trasplantado, sin embargo, este es un procedimiento invasivo que puede estar asociado a mayor morbilidad y mortalidad. Dada la fragilidad de estos pacientes, se plantea la embolización transcatéter del injerto como una alternativa válida y menos invasiva para el tratamiento de este síndrome. Objetivo describir el uso de la embolización transcatéter como tratamiento al síndrome de intolerancia del injerto. Presentación del caso se reportan tres casos clínicos de pacientes con sintomatología de entre 15 y 20 días de evolución, consistentes en dolor y tumefacción sobre riñón trasplantado y otros signos y síntomas reportados fueron fiebre, hiporexia, pérdida de peso y hematuria macroscópica. Se describe la evolución de los síntomas que en ninguno de los casos expuestos tuvieron mejoría con el ajuste inmunosupresor, descartando en todos los casos etiología infecciosa y estableciéndose así la sospecha síndrome de intolerancia del injerto. Los pacientes fueron manejados con embolización transcatéter de la arteria del riñón trasplantado y el éxito del tratamiento se definió por la resolución de los síntomas. Discusión y conclusión entre las primeras 24-48 horas posprocedimiento, los pacientes presentaron una evolución satisfactoria y, finalmente, egreso. La embolización transcatéter del injerto es una alternativa segura a la nefrectomía del trasplante y que es menos invasiva para el tratamiento del síndrome de intolerancia del injerto.

Background The renal graft intolerance syndrome is an inflammatory process that occurs in one third of the kidney transplant patients with graft loss. If medical treatment for intolerance graft syndrome is not effective, there is an indication of graft nephrectomy. However, graft nephrectomy has higher morbidity and mortality compared to non-invasive techniques. Due to a high fragility in kidney transplant patients, the renal arterial embolization has become a useful minimally invasive therapeutic option for intolerance graft syndrome. Objective We aim to describe the use of renal arterial embolization for renal graft intolerance syndrome. Case presentation We report three clinical cases who were admitted to the emergency department for a history of twenty days of graft pain and swelling. These patients had fever, hyporexia, weight loss and macroscopic hematuria. None of the cases had clinical improvement with immunosuppression adjustment and a diagnosis of renal graft intolerance syndrome was made dismissing infection. Patients were treated with renal arterial embolization and its procedure success were determined as the symptom's resolution. Discussion and conclusion After 24- and 48-hours post-embolization, patients were successfully recovered and discharged in the hospital. Renal graft arterial embolization is a safe and non-invasive alternative to graft nephrectomy to treat renal intolerance syndrome.

Intolerancia a la lactosa: mitos y verdades. Actualización / Lactose intolerance: myths and facts. An update

La lactosa es el principal carbohidrato de la leche materna. Es un disacárido conformado por glucosa y galactosa. Su producción en la glándula mamaria es independiente de la dieta materna. Además de proveer energía, es la única fuente de galactosa de la dieta, necesaria para la síntesis de macromoléculas como oligosacáridos, glicoproteínas y glicolípidos. Favorece la absorción y retención de calcio, magnesio y cinc. Su digestión por la enzima lactasa y posterior absorción tienen lugar en intestino delgado. El déficit de lactasa, que puede ser primario congénito (muy infrecuente), primario tardío o secundario por lesión intestinal, puede generar intolerancia con síntomas como dolor, distensión abdominal, flatulencia y diarrea. En el colon, bifidobacterias y lactobacilos pueden hidrolizarla. El manejo nutricional de la intolerancia deberá hacerse siempre preservando la lactancia materna. La reducción o suspensión de la lactosa deberá ser transitoria y se reemplazarán alimentos suspendidos por otros con adecuados aportes calóricos, proteicos y de minerales y vitaminas.

Lactose is the main carbohydrate present in humanmilk. It is a disaccharide made up of glucoseand galactose. It is produced in the mammaryglands, regardless of maternal diet. In addition toproviding energy, it is the only source of dietarygalactose, necessary for macromolecule synthesis,including oligosaccharides, glycoproteins, andglycolipids. It favors calcium, magnesium, andzinc absorption and retention. Its digestion bylactase and subsequent absorption occurs inthe small intestine. Lactase deficiency may beclassified into congenital primary (very rare),late-onset primary or secondary due to an injuryof the intestine; it may cause intolerance withpain, abdominal distension, abdominal gas, anddiarrhea. In the colon, it may be hydrolyzed bybifidobacteria and lactobacilli. The nutritionalmanagement of intolerance should alwayspreserve breastfeeding. Lactose reduction orelimination should be transient, and eliminatedfood should be replaced with other similar incalorie, protein, mineral, and vitamin content.

The effect of goat’s milk consumption on the clinical health of middle-aged adults with lactose intolerance

@#Introduction: People with lactose intolerance are suggested to consume dietary items containing less lactose, such as goat’s milk. This study aimed to investigate the effects of goat’s milk powder on the health of lactose intolerant middle-aged adults. Methods: A total of 60 subjects were recruited into this randomised controlled trial. They were divided into four groups and received different dietary interventions (goat’s milk, goat’s milk with curcumin, goat’s milk with coffee, lactose-free milk) for five weeks. Health effects were compared between pre- and post-intervention. Anthropometric and biochemical parameters (blood glucose, insulin, lipid profile, C-reactive protein, and lactoferrin) were evaluated. Dietary intake was recorded using a food record. Results: Fifty-one lactose intolerant subjects completed the study. After ingestion of goat’s milk, there were significant reductions in body fat (p=0.033) and a significant increase in the percentage of muscle (p=0.021). Waist circumference (WC) decreased in both the goat’s milk with curcumin and goat’s milk with coffee groups (p<0.05 for all). Unfortunately, high-density lipoprotein cholesterol (HDL-C) dropped after the five-week intervention in the goat’s milk group (p=0.002). Lactoferrin level of the goat’s milk group was higher than other groups at post-intervention (p<0.001). Besides, the goat’s milk with coffee group seemed to consume more carbohydrates after completing the intervention (p=0.034). Conclusion: A five-week intake of goat’s milk reduced the risk of abdominal obesity among middle-aged adults. In addition, it resulted in improved lactoferrin levels.

Changes and influencing factors of splanchnic regional oxygenation before and after feeding in preterm infants with feeding intolerance / 中国新生儿科杂志

Objective:To study the changes and influencing factors of splanchnic regional saturation before and after feeding in preterm infants with feeding intolerance (FI).Methods:From December 2018 to August 2019, preterm infants with FI admitted to the neonatal intensive care unit of our hospital within 24 hours after birth were prospectively enrolled in this same-patient before-after study. Splanchnic regional saturation (rSsO 2) and cerebral regional oxygenation (rSc0 2) 5 minutes before feeding and 1 hour after feeding were monitored using near-infrared spectroscopy (NIRS). The average values of rScO 2, rSsO 2 and splanchnic-cerebral oxygenation ratio (SCOR) before and after feeding were calculated. The clinical data including postnatal age, corrected gestational age and feeding methods (breastfeeding or formula feeding) were collected. Single-factor correlation analysis and multiple linear regression were used to analyze the influencing factors of rSsO 2 before and after feeding. Results:A total of 41 preterm infants were included. No significant differences existed in rSsO 2, rScO 2 and SCOR before and after feeding ( P>0.05). The feeding methods showed relative prominent influences on the changes of rSsO 2 and SCOR before and after feeding. The breastfeeding infants had smaller changes of rSsO 2 and SCOR before and after feeding compared with formula feeding infants, the regression equations were Y=5.538-4.065X (model complex correlation coefficient was 0.414 determination coefficient R2=0.171, F=8.050, P<0.01) and Y=0.109-0.075X (model complex correlation coefficient was 0.405 determination coefficient R=0.1642, F=7.655, P<0.01). Conclusions:Proper feeding will not increase rSsO 2 in preterm infants with FI. Comparing with formula feeding infants, breastfeeding infants has more stable post-feeding rSsO 2.Breastfeeding should be the first choice for preterm infants with FI.

Relationship between the blood test results of thyroid function and intolerance to 14 kinds of foods in physical examination population / 中华健康管理学杂志

Objective:To investigate the relationship between the blood test results of seven items of thyroid function and intolerance to 14 kinds of foods in physical examination population.Methods:Total of 45 764 participants who received physical examination and accepted 14-kind food intolerance and 7-item thyroid function detection from August 2016 to September 2019 in Chinese People′s Liberation Army General Hospital were included in this study. The data were analyzed based on age, gender, body mass index, smoking and drinking status, and laboratory test indexes. Chi square test and univariate or multivariate logistic regression were applied to analyze the correlation between food intolerance and thyroid function in the physical examination population.Results:In the subjects, there were 29 361 cases (64.16%) with at least intolerance to one kind of food, and 15 011 (32.80%) were in Grade 1, 9 037 (19.75%) in grade 2 and 5 313 (11.61%) in grade 3. The positive rate of egg intolerance was the highest (34.06%), and that of beef intolerance was the lowest (1.24%). Of the participants, 11 337 (24.77%) had at least one item thyroid dysfunction, among them, the highest abnormal rate was found in thyroid stimulating hormone (TSH), followed by anti-thyroglobulin antibodies and anti-thyroid peroxidase antibodies. The proportion (26.32%) of abnormal thyroid function in the participants with at least intolerance to one kind of food was significantly higher than that (22.00%) in the participants without intolerance to the 14 kinds of foods ( χ2=105.78, P<0.001). After adjusting for other significantly related factors, the positive results of intolerance to 14 kinds of foods was still the significant influencing factor of thyroid function abnormalities ( OR=1.14, Z=5.68, 95% CI: 1.09-1.20, P<0.001). Further analysis showed that, after adjusted for age, gender, smoking and drinking status, intolerance to four kinds of foods (egg, soybean, crab and pork) were the significant influencing factors of abnormal thyroid function. Conclusions:Food intolerance is an independent risk factor of thyroid dysfunction. Among them, egg, soybean, crab and pork may be the most important food varieties should be paid more attention to.

Effects of probiotics on feeding intolerance and early growth and development of preterm and very low birth weight infants / 中华健康管理学杂志

Objective:To explore the effects of probiotics on feeding intolerance and early growth and development of preterm and very low birth weight infants (VLBWI).Methods:A total of 446 patients with VLBWI were enrolled in Henan Children′s Hospital from March 20, 2019 to March 20, 2022. They were divided into breast milk group (119 cases), breast milk+probiotic group (108 cases), formula group (115 cases) and formula+probiotic group (104 cases) according to the feeding mode and whether they received early probiotic supplement or not. The feeding programs of each group were carried out according to the “2013 Clinical Application Guide of nutritional support for newborn infants” and “the feeding guidelines for VLBWI”. On this basis, the probiotic supplement group was treated with Clostridium butyricum powder at a dose of 0.25 g/twice a day for 2 weeks, nasal feeding or bottle administration. The incidence of feeding intolerance, the time of recovery of birth weight, the time of reaching total gastrointestinal feeding, and the time of hospitalization in each group were observed, and the average increment of body mass, head circumference and body length in each group at 28 days after birth were compared.Results:In breast milk group, the incidence of feeding intolerance, total gastrointestinal feeding time, and hospital stay were significantly lower than those in the formula group [40.3% vs 47.8%, (13.2±2.4) vs (14.9±1.9) d, (26.5±7.5) vs (29.8±9.6) d], besides, the average increments of early growth and developmental indexes such as body mass, head circumference, and body length at 28 days of birth were significantly lower than those in the formula group [(15.4±2.7) vs (17.7±3.7) g/d, (5.8±1.0) vs (6.2±1.0) mm/week, (6.8±0.7) vs (7.3±0.8) mm/week], however, the recovery time of birth weight in the breast milk group was significantly higher than that in the formula group [(6.2±1.2) vs (5.3±1.4) d] (all P<0.05). The incidence of feeding intolerance, the recovery time of birth weight, the total gastrointestinal feeding time and the hospital stay in the breast milk+probiotics group were significantly lower than those in the breast milk group [34.3% vs 40.3%, (5.4±1.2) vs (6.2±1.2) d, (10.4±1.9) vs (13.2±2.4) d, (22.9±5.6) vs (26.5±7.5) d], besides, the average increments of body mass, head circumference and body length at 28 days of birth was significantly higher than that in the breast milk group [(17.2±3.5) vs (15.4±2.7) g/d, (6.2±1.0) vs (5.8±1.0) mm/week, (7.2±0.8) vs (6.8±0.7) mm/week] (all P<0.05). The incidence of feeding intolerance, total gastrointestinal feeding time and hospital stay in breast milk+probiotics group were significantly lower than those in formula+probiotics group [34.3% vs 47.1%, (10.4±1.9) vs (15.3±2.0) d, (22.9±5.6) vs (30.4±8.2) d] (all P<0.05), besides, there was no significant difference in the average increments of early growth and developmental indexes between the breast milk+probiotics group and the formula+probiotics group (all P>0.05). There were no significant difference in the above indexes between the formula+probiotics group and the formula group (all P>0.05). Conclusion:Probiotics can improve the clinical outcome of feeding intolerance and promote early growth and development of breast feeding VLBWI.