Síndrome de Wells: presentación con un gran polimorfismo clínico

El síndrome de Wells es una afección dérmica que presenta un gran polimorfismo clínico. Es una patología autolimitada, recurrente y su origen es incierto. Reportamos el caso de una paciente de 29 años, procedente del área Central de Paraguay, comerciante, sin patología de base que consultó por edema de manos y piel. El tratamiento indicado fue corticoide vía oral y desparasitación con buena evolución y sin recidivas.

Wells syndrome is a dermal condition with a high clinical polymorphism. It is a self-limited, recurrent pathology and its origin is uncertain. We report the case of a 29-year-old female patient from the central area of Paraguay, a shopkeeper, with no underlying pathology, who consulted for hand and skin edema. The indicated treatment was oral corticosteroid and deworming with good evolution and no recurrences.

Wind-driven roof turbines' effectiveness in enhancing household ventilation: a potential tool to reduce tuberculosis infection

Background: South Africa's overburdened healthcare systems have led to criticism of its unsustainable tuberculosis management interventions. In 2011, the National Department of Health implemented an outpatient, decentralised care model, but this increased costs and jeopardised the long-term viability of prevention measures. Home confinement is now recognised as a viable intervention option, when combined with safety precautions such as ventilation and medical support. However, little is known about the risk of infection in this context. Objectives: To assess the effectiveness of wind-driven roof turbines in enhancing ventilation and their potential to lower the risk of Mycobacterium tuberculosis infection in a residential setting. Methods: Eight houses were selected and divided equally into intervention (wind turbines installed) and control groups, using a pairwise comparison method. The CO2 decay method was used as a proxy to determine ventilation in the houses. The wind-driven roof turbines' potential to lower the risk of Mycobacterium tuberculosis infection was stochastically evaluated using the Wells-Riley mathematical model. Results: During two seasons, installation of a roof turbine resulted in twofold ventilation rates compared to the control houses. Consequently, the WellsRiley model predicted a twofold reduction in the probability of infection in the intervention compared to the control households. Conclusion: Low-cost, low-maintenance wind-driven roof turbines are effective in increasing ventilation in houses, and should be considered as an additional layer of protection against Mycobacterium tuberculosis and other infections in residential settings.

Predictive value of three kinds of thrombosis risk assessment scale for lower extremity deep vein thrombosis after hip fracture in elderly patients / 中国骨伤

OBJECTIVE@#To explore predictive value of Caprini score, Wells score and Autar score for lower extremity deep vein thrombosis (DVT) after hip fracture in elderly patients.@*METHODS@#A total of 310 elderly patients with hip fracture were selected from January 2018 to September 2022. According to the lower extremity color ultrasound examination results, 155 patients with DVT were divided into thrombosis group, included 42 males and 113 females, aged from 60 to 101 years old with an average of (80.58±8.84) years old; and 155 patients without DVT were divided into control group, included 58 males and 97 females, aged from 60 to 94 years old with an average of (79.01±8.99) years old. Caprini score, Wells score and Autar score immediately after admission were collected and compared between two groups. Receiver operating characteristic (ROC) curve was used to evaluate predictive value of three thrombus risk assessment tables for DVT after hip fracture in elderly patients.@*RESULTS@#Caprini score, Wells score and Autar score in thrombus group were significantly higher than those in control group (P<0.001). ROC curve analysis results showed that the best cut-off value of Caprini score was 8.5 points, the sensitivity was 46.5%, the specificity was 99.4%, and area under the curve(AUC) was 0.763. The best cut-off value of Wells score was 1.5, the sensitivity was 100%, the specificity was 99.4%, and AUC was 0.998. The best cut-off value of Autar score was 10.5 points, the sensitivity was 58.1%, the specificity was 84.5%, and AUC was 0.717.@*CONCLUSION@#Caprini scale, Wells scale and Autar scale all have good predictive efficacy for the risk of DVT in elderly patients with hip fracture, and could provide an important reference for clinical guidance for prevention, management and treatment of DVT after hip fracture in elderly patients, among which Wells scale has a higher predictive value.

Effects of Myofascial Mobilization on Flexibility in Young Men Adults / Efeito da Mobilização Miofascial na Flexibilidade em Homens Adultos Jovens

The aim of the study is to control the effect of myofascial mobilization on flexibility values ​​in young men. 23 young adult men, aged between 18 and 30 years (74.8 ± 9.8 kg; 1.74 ± 0.06 cm; 24.7 ± 3.0 kg/m2), participated in the study, separated into experimental and control groups. Participants of the experimental group received an instrument assisted soft-tissue mobilization (IASTM) session, bilateral, in the muscular region of the quadriceps femoris, hamstrings and triceps surae. The rectus femoris, vastus lateralis and medial, biceps femoris, semitendinosus, semimembranosus, gastrocnemius and soleus muscles were mobilized for a period of 60 seconds. In the control session, participants remained at rest for a period of 15 minutes. The flexibility assessments were performed pre- and- immediately, 24 hours, and 48 hours post-sessions of both groups. The myofascial mobilization session promoted percentage increases in flexibility significantly higher at 24 hours when compared to values ​​immediately after, 24 hours and 48 hours after the control session (P < 0.05). The percentage increases in flexibility 48 hours after the myofascial mobilization session were significantly greater when compared to values ​​immediately post and 24 hours after the control session (P < 0.05). The findings of the present study suggest that an instrument assisted soft-tissue mobilization (IASTM) session promotes increases in flexibility in young adults one and two days after the intervention. (AU)

O objetivo do presente estudo foi verificar o efeito da mobilização miofascial nos valores da flexibilidade em homens jovens. Participaram do estudo 23 homens adultos jovens, com idade entre 18 e 30 anos (74,8 ± 9,8 kg; 1,74 ± 0,06 cm; 24,7 ± 3,0 kg/m2), separados em grupo experimental e controle. Os participantes do grupo experimental receberam uma sessão mobilização miofascial assistida por instrumento (IASTM), bilateralmente, na região muscular do quadríceps femural, isquiotibiais e tríceps sural. Os músculos reto femural, vasto lateral e medial, bíceps femoral, semitendinoso, semimembranoso, gastrocnêmio e sóleo foram mobilizados por um período de 60 segundos. Na sessão controle, os participantes permaneceram em repouso por um período de 15 minutos. As avaliações da flexiblidade foram realizadas pré, imediatamente após, 24 horas e 48 horas após as sessões de ambos os grupos. A sessão de mobilização miofascial promoveu aumentos percentuais da flexibilidade 24 horas significativamente maiores quando comparado aos valores imediatamente pós, 24 horas e 48 horas da sessão controle (P < 0,05). Os aumentos percentuais da flexibilidade 48 horas após a sessão mobilização miofascial foram significativamente maiores quando comparado aos valores imediatamente pós e 24 horas da sessão controle (P < 0,05). Os achados do presente estudo sugerem que uma sessão de mobilização miofascial assistida por instrumento promove aumentos da flexibilidade em adultos jovens após um e dois dias à intervenção.(AU)

Arterial partial pressure of carbon dioxide combined with Wells score helps predict acute pulmonary embolism / 中华急诊医学杂志

Objective:To explore the clinical value of arterial partial pressure of carbon dioxide (PaCO 2) combined with Wells score in predicting acute pulmonary embolism (PE). Methods:Patients with suspected acute PE admitted to Emergency Department of Beijing Chaoyang Hospital, Capital Medical University from January 1, 2016 to August 31, 2021 were screened. Patients with positive computed tomography pulmonary angiography (CTPA) results were classified as the PE group, and those with negative CTPA results were classified as the non-PE group. Demographic characteristics, symptoms, vital signs, underlying diseases, risk factors for venous thrombosis, arterial blood gas analysis and Wells scores were statistically analyzed and compared between the two groups, and the clinical efficacy of PaCO 2 combined with Wells score in predicting acute PE was evaluated. Results:A total of 1 869 patients with suspected acute PE were screened, and 1 492 patients were finally selected. There were 537 cases in the PE group and 955 cases in the non-PE group. The frequency of chest pain, dyspnea, unilateral lower limb edema, history of PE or deep venous thrombosis, history of surgery or immobilization within 3 months, history of fracture within 3 months, active malignant tumor, elevated Wells score and reduced PaCO 2 in the PE group was significantly higher than that in the non-PE group (all P< 0.05). The area under receiver operating characteristic (ROC) curve (AUC) of Wells score was 0.784 (95% CI: 0.758-0.810), and the sensitivity and specificity of predicting acute pulmonary embolism were 61.64% and 88.48%, respectively. The AUC of reduced PaCO 2 was 0.679 (95% CI: 0.651-0.707), and the sensitivity and specificity of predicting acute pulmonary embolism were 79.89% and 55.92%, respectively. The AUC of reduced PaCO 2 combined with Wells score was 0.837 (95% CI: 0.816-0.858), and the sensitivity and specificity of predicting acute pulmonary embolism were 74.12% and 77.07%, respectively. The AUC of reduced PaCO 2 combined with Wells score was significantly greater than the AUC of Wells score ( P<0.001) and the AUC of reduced PaCO 2 ( P<0.001). Conclusions:The efficacy of PaCO 2 reduction combined with Wells score in predicting acute PE was superior to that of either of them alone. This was a beneficial supplement to the screening of patients with acute PE, and would also help reduce the abuse of CTPA in the emergency department.

Qualidade microbiológica e perfil de sensibilidade a antimicrobianos em águas de poços artesianos em um município do noroeste do Rio Grande do Sul / Microbiological quality and sensitivity profile to antimicrobials in artesian well waters in a municipality in the northwest of Rio Grande do Sul

RESUMO A qualidade da água utilizada para consumo tem influência direta sobre a saúde e o bem-estar das pessoas, demonstrando a necessidade de criação de mecanismos de controle e acompanhamento de potenciais contaminações. Este estudo teve como objetivo determinar e quantificar coliformes totais e Escherichia coli, bem como avaliar o seu perfil de sensibilidade a antimicrobianos em águas de poços artesianos da área rural de um município do noroeste do Rio Grande do Sul. Foram realizadas coletas e análises microbiológicas em amostras de 40 poços artesianos cadastrados no Sistema de Informação de Vigilância da Qualidade da Água para Consumo Humano (SISAGUA). Os resultados mostraram que 85% das amostras apresentaram resultados positivos para coliformes totais e 22,5% foram identificadas como E. coli. Dos 8 antibióticos testados, apenas amoxicilina, ampicilina e nitrofurantoína apresentaram 100% de inibição do crescimento bacteriano. Conclui-se que a maioria dos poços analisados apresentou água fora dos padrões de qualidade para consumo, sendo necessárias ações corretivas do poder público como forma de prevenção de doenças infecciosas. Além disso, deve-se buscar racionalizar o tratamento farmacológico com antibióticos, em função de indicativos de resistência bacteriana apresentada pelas cepas isoladas neste estudo.

ABSTRACT The quality of water used for consumption has a direct influence on people's health and quality of life, demonstrating the need to create mechanisms to control and monitor potentials contaminations. This study aimed to determine and quantify total coliforms, Escherichia coli, and to evaluate their antimicrobial susceptibility profile in waters from rural wells in a northwestern municipality of Rio Grande do Sul State. Microbiological collections and analyses were carried out in samples from 40 artesian wells, registered in the Water Quality Surveillance Information System for Human Consumption (Sistema de Informação de Vigilância da Qualidade da Água para Consumo Humano - SISAGUA). The results show that 85% of the samples were positive for total coliforms and 22.5% were identified as E. coli. Of the eight antibiotics tested, only Amoxicillin, Ampicillin, and Nitrofurantoin showed 100% inhibition of bacterial growth. It is concluded that an important part of the analyzed wells did not present water with quality standards for consumption, requiring corrective actions by public authorities as a way of preventing infectious diseases. In addition, one must seek to rationalize the pharmacological treatment with antibiotics, due to indications of bacterial resistance presented by the strains isolated in this study.

Estudo microbiológico de águas de poços artesianos para consumo humano na região de Santa Maria, RS / Microbiological study of artesian wells water for human consumption in the region of Santa Maria, RS

Objetivo: A água é de extrema importância para a saúde humana e essencial para a sobrevivência dos seres vivos. Águas subterrâneas de poços artesianos são menos contaminadas por não estarem expostas aos poluentes. Este estudo efetuou a análise microbiológica de águas de poços artesianos para o consumo humano. Métodos: As análises foram realizadas no Laboratório de Análises Microbiológicas, Departamento de Microbiologia e Parasitologia, Centro de Ciências da Saúde da Universidade Federal de Santa Maria. Através da técnica dos tubos múltiplos e do número mais provável por mililitro de amostra se obteve a contagem de coliformes totais e coliformes termotolerantes. A contagem de bactérias heterotróficas foi realizada em placas de Petri com meio Ágar Padrão Contagem. E a pesquisa e confirmação de Escherichia coli por Ágar Eosina Azul de Metileno e testes bioquímicos, respectivamente. Resultados: Verificou-se que 68% das amostras estavam próprias para consumo humano, em 21% foi emitido um alerta e 11% estavam impróprias. Foi confirmada E. coli em 96% das amostras impróprias. Além disso, Pseudomonas aeruginosa foi encontrada em oito das amostras analisadas. Em relação ao tratamento com cloro, 85% das amostras cloradas estavam próprias. Dividiu-se o estudo em quatro períodos para efetuar um comparativo da potabilidade, o último período do estudo demonstrou um maior nível de potabilidade quando comparado ao primeiro. Conclusão: Estes dados são de grande relevância para a população e a conscientizam sobre um controle microbiológico frequente a fim de obter níveis menores ou isentos de bactérias, evitando contaminações que podem ser nocivas à saúde humana.

Objective: Water is very important for human health and essential to survival of living beings. Groundwater from artesian wells is the least contaminated because it is not exposed to pollutants. This study performed the microbiological analysis of artesian well water to human consumption. Methods: These analyses were performed at the Microbiological Analysis Laboratory, Department of Microbiology and Parasitology, Health Sciences Center of the Federal University of Santa Maria. Using the multiple tube technique and the Most Probable Number per milliliter of the sample, the Total Coliform and Thermotolerant Coliform counts were obtained. Heterotrophic Bacteria counts were performed in Plate Count Agar Petri dishes. And the research and confirmation of Escherichia coli by Methylene Blue Eosin Agar and biochemical tests, respectively. Results: Checked that 68% of the samples were found to be safe to human consumption, 21% were alerted and 11% were inappropriate. E. coli was confirmed in 96% of improper samples. In addition, Pseudomonas aeruginosa was found in eight of the samples analyzed. Regarding chlorine treatment, 85% of chlorinated samples were safe to human consumption. The study was divided into four periods to make a potability comparison, the last period of the study showed a higher level of potability when compared to the first one. Conclusion: These data are of great relevance to the population and make them aware of frequent microbiological control in order to obtain lower or bacteria-free levels. This avoids contamination that can be harmful to human health.

Reducing ultrasound in diagnosing deep vein thrombosis by using clinical scores and D-dimer testing

Background: To reduce unnecessary venous ultrasound examination in cases suspected to have deep venous thrombosis (DVT) in emergency department by using D dimer and wells score. venous duplex is widely used to diagnose DVT increasing burden on ultrasound in overcrowded emergency department. Authors can decrease this burden by using clinical probability scores and D dimer.Methods: This is prospective study done on 50 consecutive patients suspected to have DVT represented to emergency department of   Menoufia University Hospital during the period from June 2018 to June 2019. Full history, physical examination, assessment of clinical probability score, d dimer level and results of venous duplex collection.Results: According to wells score, the majority of cases diagnosed as DVT were of high probability group 13(68.4%), 5 patients with moderate probability and only one patient with low probability was diagnosed as DVT. The mean of D dimer level in cases diagnosed as DVT is (4173.6±2173.1) and in cases without DVT is (927.4±1064.6). Using wells score and D dimer together, sensitivity is 100%, Specificity is 94%. PPV is 90%, and NPV is 100% in predicting DVT. All cases with negative d dimer and low risk probability do not have DVT.Conclusions: Based on this result, using wells score and d dimer level in early work up of patients suspected to have DVT will decrease overusing and cost of venous duplex.

Wide diversity of fungal species found in wellwater for human consumption: an analytical cross-sectional study

ABSTRACT BACKGROUND: Fungi are ubiquitous in the environment. They are able to grow in water and many of them may be opportunistic pathogens. OBJECTIVE: The aims were to identify fungi in registered wells (RWs) and nonregistered wells (NRWs) that tap into groundwater; and to correlate the results from physicochemical assays on this water (free residual chlorine and pH) with the presence of fungi. DATA AND SETTING: Analytical cross-sectional quantitative study on groundwater wells in São José do Rio Preto, São Paulo, Brazil. METHODS: 52 samples of 500 ml of water were collected from RWs and 107 from NRWs. These were sent to a microbiology laboratory to identify any fungi that were present. In addition, free residual chlorine and pH were measured immediately after sample collection. Several statistical analysis tests were used. RESULTS: Fungal contamination was present in 78.8% of the samples from RWs and 81.3% from NRWs. Filamentous fungi were more prevalent than yeast in both types of wells. There was no significant difference in presence of fungi according to whether chloride and pH were within recommended levels in RWs; or according to whether pH was within recommended levels in NRWs. Furthermore, there was no statistical difference in the levels of fungal contamination between RWs and NRWs. CONCLUSION: Both RWs and NRWs are potential reservoirs for many types of fungi. Many of these may become opportunistic pathogens if they infect immunosuppressed individuals. Furthermore, this study confirms that fungi are able to grow even when chlorine and pH parameters are within the standards recommended.

Avaliação da presença e quantificação de coliformes totais e Escherichia coli em amostras de água destinada ao consumo humano proveniente de poços artesianos / Evaluation of the presence and quantification of total coliforms and Escherichia coli in samples of water intended for human consumption from artesian wells

A água é indispensável à vida e a sua contaminação com microrganismos patogênicos oferece grande risco à saúde humana, podendo causar doenças que variam de gastroenterites brandas a doenças fatais. Dessa forma, a água para o consumo humano deve estar livre de microrganismos patogênicos e não deve conter bactérias indicadoras de contaminação fecal, sendo a Escherichia coli o principal representante desse grupo de bactérias. Tendo em vista a importância da potabilidade da água para a saúde, o presente trabalho teve por objetivo verificar a qualidade bacteriológica da água utilizada para o consumo humano proveniente de 200 poços artesianos localizados na cidade de Cambé/Paraná, no período de 2013 a 2017, utilizando-se para tanto a análise da presença de coliformes totais e de E. coli como indicador de contaminação fecal. A metodologia empregada para a pesquisa de coliformes totais e E. coli foi o método do substrato cromogênico Colilert®. Dentre as 200 amostras analisadas, 113 (56,5%) estavam contaminadas com coliformes totais e 35 (17,5%) com E. coli. As análises realizadas durante o período de cinco anos possibilitaram encontrar 14 (7%) amostras de água tratadas que apresentavam contaminação por bactérias do grupo coliforme. A partir dos resultados obtidos nesse trabalho, espera-se conscientizar tanto a população quanto os órgãos públicos sobre a importância do controle da qualidade da água para a prevenção de doenças transmitidas por esse meio (AU)

Water is essential for life and its contamination by pathogenic microorganisms offers great risk to human health and may cause illnesses ranging from mild gastroenteritis to life threatening diseases. Thus, water for human consumption should be free of pathogenic microorganisms and must not contain indicators of faecal contamination such as Escherichia coli presence. Given the importance of drinking water quality for health, this study aimed to verify the bacteriological quality of water used for human consumption from 200 artesian wells located in the city of Cambé - Paraná, from 2013 to 2017. The methodology used for the research of total coliforms and E. coli was the Colilert® chromogenic substrate method. Among the 200 analysed water samples, 113 (56.5%) were contaminated with total coliforms and 35 (17,5%) with E. coli. The analyses carried out during the five-year period allowed finding 14 (7%) treated water samples that showed contamination by bacteria of the coliform group. Based on the results obtained in this study, it is expected that both the population and the public agencies will be aware of the importance of water quality control for the prevention of diseases transmitted by this means (AU)

Comparison of values between Wells score and YEARS algorithm in dignosis of pulmonary embolism / 吉林大学学报(医学版)

Objective: To explore the diagnostic values of Wells score and YEARS algorithm in the patients with pulmonary embolism and to compare the areas under receiver operating characteristic (ROC) curves (AUC) of Wells score and YEARS algorithm, and to find the more suitable score method for pulmonary embolism in clinic. Methods: A total of 139 patients who were suspected with pulmonary embolism were collected, among them 48 patients were clinically as confirmed pulmonary embolism. The disease history, clinical manifestation and results of auxilliary examinations of the patients were collected. All the patients were assessed by Wells score and YEARS algorithm, respectively; the computed tomographic pulmonary angiography (CTPA) was considered as golden standard. The sensitivities, specificities, misdiagnosis rates and omission diagnostic rates, and the accuracies of Wells score and YEARS algorithm of the patients in two groups were analyzed with SPSS 22.0 software; the conformities of results of Wells socre, YEARS algorithm, and CTPA were analyzed. Then ROC curves of Wells score and YEARS algorithm in diagnosis of pulmonary embolism were made, and the AUC was calculated and compared. Results: Compared with YEARS algorithm, the specificity and accuracy of Wells score in diagnosis of pulmonary embolism were markedly increased (P<0.05), the misdiagnosis rate was decreased (P= 0.037), however the sensitivity and the misdiagnosis rate had no significant differences ( PX). 05). The Kappa value of Wells score and CTPA was 0. 45, the conformity was moderate; the Kappa value of YEARS algorithm and CTPA was 0.22, the conformity was passable; the Kappa value of Wells score and YEARS algorithm was 0. 11, the conformity was bad. The AUC of Wells score and YEARS algorithm were 0. 753 + 0. 044 ( P<0. 01) and 0. 585 + 0. 049 ( P=0. 101). Conclusion: The Wells score is superior to the YEARS algorithm in the diagnosis of pulmonary embolism.

Investigation and risk assessment for water quality hygiene in self-supply well water in four northern provinces of China / 中华疾病控制杂志

Objective To understand the water quality of self-supply wells in four provinces of northern China (Heilongjiang, Beijing, Inner Mongolia and Tibet), so as to provide a reference for supervision and management of self-supply wells. Methods Water were sampled from 233 self-supply wells in four northern provinces of China according to standard examination methods for drinking water (GB/T 5750-2006). In total, The samples were tested for 27 kinds of water quality parameters involving sensory properties, chemistry, bacteriology and toxicology, and then evaluated. Results The total unqualified rate of water quality in self-supply well water in four northern provinces of China was 52.36%. The water quality varied greatly among provinces. As for Heilongjiang, the main unqualified indicators of self-supply wells water involved turbidity, visible to the naked eye, manganese, arsenic and nitrate. In relation to Beijing, these referred to the nitrate and microorganism. In case of Inner Mongolia province, these included sulfate and fluoride. With reference to Tibet, these were zinc and chloride. Conclusions To ensure the safety of drinking water for residents, the management, disinfection and purifying measures of self-supply wells should be strengthened basing on their regional differences and water quality characteristics.

Comparison of values between Wells score and YEARS algorithm in dignosis of pulmonary embolism / 吉林大学学报(医学版)

Objective:To explore the diagnostic values of Wells score and YEARS algorithm in the patients with pulmonary embolism and to compare the areas under receiver operating characteristic (ROC) curves (AUC) of Wells score and YEARS algorithm, and to find the more suitable score method for pulmonary embolism in clinic.Methods:A total of 139patients who were suspected with pulmonary embolism were collected, among them48patients were clinically as confirmed pulmonary embolism.The disease history, clinical manifestation and results of auxilliary examinations of the patients were collected.All the patients were assessed by Wells score and YEARS algorithm, respectively;the computed tomographic pulmonary angiography (CTPA) was considered as golden standard.The sensitivities, specificities, misdiagnosis rates and omission diagnostic rates, and the accuracies of Wells score and YEARS algorithm of the patients in two groups were analyzed with SPSS 22.0software;the conformities of results of Wells socre, YEARS algorithm, and CTPA were analyzed.Then ROC curves of Wells score and YEARS algorithm in diagnosis of pulmonary embolism were made, and the AUC was calculated and compared.Results:Compared with YEARS algorithm, the specificity and accuracy of Wells score in diagnosis of pulmonary embolism were markedly increased (P＜0.05) , the misdiagnosis rate was decreased (P=0.037) , however the sensitivity and the misdiagnosis rate had no significant differences (P＞0.05) .The Kappa value of Wells score and CTPA was 0.45, the conformity was moderate;the Kappa value of YEARS algorithm and CTPA was 0.22, the conformity was passable;the Kappa value of Wells score and YEARS algorithm was 0.11, the conformity was bad.The AUC of Wells score and YEARS algorithm were 0.753±0.044 (P＜0.01) and 0.585±0.049 (P=0.101) .Conclusion:The Wells score is superior to the YEARS algorithm in the diagnosis of pulmonary embolism.

Wells' Syndrome Associated with Molluscum Contagiosum in a Child: A Case Report / 대한피부과학회지

Wells' syndrome or eosinophilic cellulitis is usually observed in adults who present with pruritic, erythematous and edematous plaques associated with papules or vesicles. It is a rare inflammatory dermatosis of unknown etiology showing an eosinophil-mediated immune response. Classical histopathological features observed in patients are eosinophil-predominant inflammatory infiltration and marked dermal edema, along with ‘flame figures’. An 11-year-old boy presented with edematous plaques surmounted by vesicles on his abdomen and lower extremities. A month prior to presentation, these skin lesions occurred on other parts of his abdomen; however, they resolved spontaneously within a week. Skin biopsies from the recurrent lesions showed features consistent with Wells' syndrome and a few molluscum bodies in the epidermis. Laboratory tests showed peripheral eosinophilia. We concluded that Wells' syndrome in this young patient was caused by preceding molluscum contagiosum infection.

The First Report on Clinical Manifestation of Cryopyrin-Associated Periodic Syndrome in Korean Children

PURPOSE: The aim of this study was to evaluate the clinical characteristics of children diagnosed as cryopyrin-associated periodic syndrome (CAPS) in Korea. METHODS: Diagnosis was made based on clinical features and confirmed by a mutation in the cold-induced autoinflammatory syndrome 1 (CIAS1) gene. Especially, osteocartilaginous overgrowth in the patella or distal femur was so characteristic that its presence warranted a diagnosis of chronic infantile neurologic cutaneous and articular/NOMID. RESULTS: We observed the clinical features of 9 Korean CAPS patients. All the patients suffered from an urticarial rash with recurrent fever. Among the 9 patients, 6 presented with rash and 4 with fever on the 1st or 2nd days of birth. Eight patients showed myalgia, and 7 patients showed arthralgia in the joints, and 6 patients showed radiologic findings of arthropathy including cupping of the metaphysis, excessive growth of the epiphysis, osteopenia or overgrowth of the cartilage. Four patients showed brain atrophy, enlarged ventricles or leptomeningeal enhancement on magnetic resonance imaging. Intellectual disability was observed in 1 patient. Five patients had eye involvement as conjunctivitis, uveitis, chorioretinitis, avascular area or papillary edema, and 3 patients showed progressive hearing loss. All 9 patients showed increased C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). CONCLUSIONS: All the patients carried a mutation on exon 3 of the CIAS1 gene. After the anakinra (interleukin-1 receptor antagonist) therapy, the fever and rash immediately disappeared, and CRP and ESR were improved.

Relación entre la flexibilidad de los isquiotibiales y la fuerza del soleo con el salto y la velocidad en jugadores de ultimate frisbee / Relationship between the flexibility of the hamstring and the strength of soleus muscle with jump and speed in ultimate frisbee players / Relação entre a flexibilidade dos isquiotibiais, a força do sóleo com o salto e a velocidade emjogadores de ultimate frisbee

Problema: la reducción de la flexibilidad de los isquiotibiales es común en adolescentes, asociándose con dolor lumbar, hernia de disco y riesgo de lesiones musculares. El ultimate frisbee implica aceleraciones y desaceleraciones en cortas distancias. Los antecedentes reportan lesiones en miembros inferiores, sin correlacionarlas con patrones de movimiento como fuerza, velocidad o salto. Objetivo: determinar la relación entre la flexibilidad de los isquiotibiales y la fuerza del soleo, con el salto y la velocidad en jugadores de ultimate frisbee. Método: estudio descriptivo, correlacional, con 103 deportistas universitarios de Medellín, Colombia. La información se recolectó mediante encuesta y observación. Se evaluó la flexibilidad, la velocidad y el salto. Los datos se analizaron con SPSS, versión 24.0. Resultados: la flexibilidad de los isquiotibiales se correlacionó positivamente con la velocidad, pero inversamente con el salto. Conclusión: a mayor flexibilidad de los isquiotibiales, mayor desarrollo de velocidad, pero menor capacidad de salto.

Problem: Reduction of hamstring flexibility is common in adolescents, associating with low back pain, disc herniation, andrisk of muscle injuries. Ultimate frisbee implies accelerations and decelerations over short distances. The background reports injuries in thelower limbs, without correlating them with movement patterns such as strength, speed or jump. Objective: To determine the relationship between hamstring flexibility and the strength ofthe soleus muscle with jump and speed in ultimate frisbee players. Method: Descriptive and correlational study, with 103 university athletes from Medellin, Colombia. Information wascollected through survey and observation. Flexibility, speed and jump were evaluated. Data were analyzed with SPSS® version 24.0. Results: Hamstring flexibility was positively correlated with speed, but inversely with jump. Conclusion: A greater flexibility of the hamstrings, greater speed development, but lessjumping ability.

Problema: a redução da flexibilidade dos isquiotibiais é um quadro clínico comum emadolescentes, esta redução foi reportada como um fator associado à prevalência de dor lombar, hérnia de disco e alto risco de lesões musculares. O ultimatefrisbee combina padrões de movimento similares ao futebol e ao handebol, onde se realizam cortes, arremessos, saltos, velocidade, voos e aceleração ­desaceleração em curtas distâncias. Os antecedentes encontrados nesse esporte reportam índices de lesões em membros inferiores, mas não se constataramcorrelações entre padrões de movimento específico com o salto, a força e a velocidade. Objetivo: determinar a relação da flexibilidade dos isquiotibiais, a força do sóleo com o salto e avelocidade em jogadores de ultimate frisbee. Método: realizou-se um estudo descritivo com alcance correlacional e amostra de conveniência de 103 jogadoresuniversitários de ultimate frisbee da cidade de Medellin-Colômbia. Os esportistas cumpriram os critérios de inclusão e assinaram o consentimentoinformado. No que se refere às técnicas de coleta de informação, utilizou-se a pesquisa de opinião e a observação. Avaliou-se a flexibilidade, a velocidade eo salto. Os dados se analisaram com o programa estadístico SPSS versão 24.0. Realizou-se uma análise uni-variada de estadística descritiva, que confirmou asfrequências absolutas e relativas. Além disso, determinou-se a distribuição da normalidade de todas as variáveis através do teste Kolmogorov-Smirnov, queassinalou normalidade para as variáveis com um valor < 0,05. Resultados: estabeleceu-se que a flexibilidade dos isquiotibiais tem correlação positivacom a velocidade, mas inversa com o salto. Conclusão: quanto maior a flexibilidade dos isquiotibiais, maior o desenvolvimento da velocidade, porémmenor a capacidade de salto.

Comparison of predictive power for deep vein thrombosis among hip and knee joint replacement patients using two risk assessment scales / 中华护理杂志

Objective To compare predictive power for deep vein thrombosis among hip and knee joint replacement patients using Autar scale and Wells scale.Methods Convenience sampling method was used.Totally 331 patients from ten tertiary hospitals receiving hip and knee joint replacement were recruited.General information questionnaire,Autar scale and Wells scale were used to collect data.Telephone follow-up was performed at 2 weeks,1 month and 3 months after hospital discharge.The primary endpoint of follow-up was occurrence of DVT,and the secondary endpoint was no occurrence of DVT within 3 months after hospital discharge.Results The Cronbach's α coefficients of Autar scale ranged from 0.716 to 0.762 for scores 24h before operation,24h after operation and at the day of discharge,and those of Wells scale ranged from 0.580 to 0.603.The area under the ROC curve of Autar scale ranged from 0.726 to 0.798.The area under the ROC curve of Wells scale ranged from 0.568 to 0.628.Conclusion The predictive power of Autar scale was higher than that of Wells scale which enabled Autar scale to better predict deep vein thrombosis for patients receiving hip and knee joint replacement.

A Case of Ankyloblepharon-Ectodermal Defect-Cleft Lip and/or Palate (AEC) Syndrome with Missense Mutation in TP63 1657(th)

Ankyloblepharon-ectodermal defects-cleft lip and/or palate (AEC) syndrome, also known as Hay-Wells syndrome, is a rare autosomal dominant disorder characterized by congenital ectodermal dysplasia. It is caused by mutations in p63 gene. Six isoforms are generated from the TP63 gene mutation and the main isoform expressed in postnatal skin is Np63a, which functions as a key regulator of epidermal integrity. We have experienced a 1-day-old female baby with skin erosions, ankyloblepharosis, and cleft palate that require treatment for skin care and feeding difficulties. Missense mutation in TP63 1657(th) T → A transition was found in the genetic test performed in the patient, and this genotype has not been reported in a previously variant. The patient was found dead at 91days of birth and the cause of death was estimated by aspiration.

Determinação do volume específico de Light Non-Aqueous Phase Liquids a partir de espessuras aparentes de fase livre em poços de monitoramento: análise de sensibilidade dos parâmetros envolvidos / Specific volume determination based on the apparent thickness of Light Non-Aqueous Phase Liquids free phase in monitoring wells: Sensitivity analysis of the parameters

RESUMO: No presente artigo apresenta- se e discute-se a implantação de um modelo (algoritmo) derivado de um modelo teórico que foi desenvolvido com o propósito de determinar o volume específico (isto é, o volume de produto presente em subsuperfície por unidade de área planimétrica do aquífero) de Light Non-Aqueous Phase Liquids (LNAPL), a partir de medidas de espessura de fase livre registradas em poços de monitoramento. Utilizando esse modelo, contabilizou- se o volume específico de óleo para um caso real de pluma de fase livre em um posto de abastecimento de combustíveis, localizado no estado do Paraná, Brasil. Por fim, foi realizada uma análise de sensibilidade dos principais parâmetros envolvidos, tomando- se como referência esse caso real. A estimativa de volume de óleo no meio poroso mostrou-se mais sensível aos parâmetros relacionados à massa específica aparente seca do solo, à distribuição do tamanho dos grãos e à porosidade do solo, seguindo essa ordem de relevância. Os parâmetros relacionados ao contaminante (massa específica do óleo e fatores de escala) foram os que menos impactaram nos resultados de volume específico de LNAPL no meio poroso, para as faixas de variação consideradas nesse trabalho. Os resultados obtidos apontam para a necessidade da medição de alguns parâmetros que não são usualmente medidos durante a etapa de investigação ambiental. Sugere-se, portanto, a inclusão da medição desses parâmetros na etapa de investigação ambiental de um sítio contaminado por LNAPL.

ABSTRACT: In the present article it is presented and discussed a model (algorithm) derived from a theoretical model developed to determine the specific volume (i.e. the volume of the product in the soil by planimetric unit area of the aquifer) of Light Non-Aqueous Phase Liquids (LNAPL) in the subsurface from free phase thickness measurements recorded in monitoring wells. Using this model the specific volume of oil was accounted for in a real case of a free phase plume at a gas station, located in the state of Paraná, Brazil. Finally, a sensitivity analysis of key parameters involved was performed, using as reference this real case. The estimated volume of oil in the porous medium was more sensitive to the parameters related to dry bulk density, the grain size distribution and the porosity of the soil, in this order of relevance. Parameters related to the contaminant (oil density and scale factors) presented the least impact on the results of specific volume of LNAPL in porous media, for the variation ranges considered in this work. The results point to the need of measuring some parameters that are not usually measured during environmental field survey stage of a site contaminated by LNAPL.

Diretrizes de conduta e tratamento de síndromes febris periódicas associadas à criopirina (criopirinopatias – CAPS) / Guidelines for the management and treatment of periodic fever syndromes

Resumo Objetivo: Estabelecer diretrizes baseadas em evidências científicas para manejo das síndromes periódicas associadas à criopirina (criopirinopatias – Caps). Descrição do método de coleta de evidência: A diretriz foi elaborada a partir de quatro questões clínicas que foram estruturadas por meio do PICO (Paciente, Intervenção ou Indicador, Comparação e Outcome), com busca nas principais bases primárias de informação científica. Após definir os estudos potenciais para sustento das recomendações, esses foram graduados pela força da evidência e pelo grau de recomendação. Resultado: Foram recuperados, e avaliados pelo título e resumo, 1.215 artigos e selecionados 42 trabalhos para sustentar as recomendações. Recomendações: 1. O diagnóstico de Caps é baseado na anamnese e nas manifestações clínicas e posteriormente confirmado por estudo genético. Pode se manifestar sob três fenótipos: FCAS (forma leve), MWS (forma intermediária) e Cinca (forma grave). Avaliações neurológica, oftalmológica, otorrinolaringológica e radiológica podem ser de grande valia na distinção entre as síndromes; 2. O diagnóstico genético com análise do gene NLRP3 deve ser conduzido nos casos suspeitos de Caps, isto é, indivíduos que apresentam, antes dos 20 anos, episódios recorrentes de inflamação expressa por urticária e febre moderada; 3. As alterações laboratoriais incluem leucocitose e elevação nos níveis séricos de proteínas inflamatórias; 4. Terapias alvo dirigidas contra a interleucina 1 levam a rápida remissão dos sintomas na maioria dos pacientes. Contudo, existem limitações importantes em relação à segurança em longo prazo. Nenhuma das três medicações anti-IL1β evita progressão das lesões ósseas.

Abstract Objective: To establish guidelines based on cientific evidences for the management of cryopyrin associated periodic syndromes. Description of the evidence collection method: The Guideline was prepared from 4 clinical questions that were structured through PICO (Patient, Intervention or indicator, Comparison and Outcome), to search in key primary scientific information databases. After defining the potential studies to support the recommendations, these were graduated considering their strength of evidence and grade of recommendation. Results: 1215 articles were retrieved and evaluated by title and abstract; from these, 42 articles were selected to support the recommendations. Recommendations: 1. The diagnosis of CAPS is based on clinical history and clinical manifestations, and later confirmed by genetic study. CAPS may manifest itself in three phenotypes: FCAS (mild form), MWS (intermediate form) and CINCA (severe form). Neurological, ophthalmic, otorhinolaryngological and radiological assessments may be highly valuable in distinguishing between syndromes; 2. The genetic diagnosis with NLRP3 gene analysis must be conducted in suspected cases of CAPS, i.e., individuals presenting before 20 years of age, recurrent episodes of inflammation expressed by a mild fever and urticaria; 3. Laboratory abnormalities include leukocytosis and elevated serum levels of inflammatory proteins; and 4. Targeted therapies directed against interleukin-1 lead to rapid remission of symptoms in most patients. However, there are important limitations on the long-term safety. None of the three anti-IL-1β inhibitors prevents progression of bone lesions.