Diagnosis and clinical management of thrombotic thrombocytopenic purpura (TTP): a consensus statement from the TTP Catalan group.

Thrombotic thrombocytopenic purpura (TTP) is a low prevalence disease characterized by severe deficiency of the enzyme ADAMTS13, leading to the development of thrombotic microangiopathy (TMA) and often resulting in severe organ disfunction. TTP is an extremely serious condition and, therefore, timely and appropriate treatment is critical to prevent life-threatening complications.Over the past 25 years, significant advances in the understanding of the pathophysiology of immune TTP have led to the development of readily available techniques for measuring ADAMTS13 levels, as well as new drugs that are particularly effective in the acute phase and in preventing relapses. These developments have improved the course of the disease.Given the complexity of the disease and its various clinical and laboratory manifestations, early diagnosis and treatment can be challenging.To address this challenge, a group of experienced professionals from the Catalan TTP group have developed this consensus statement to standardize terminology, diagnosis, treatment and follow up for immune TTP, based on currently available scientific evidence in the field. This guidance document aims to provide healthcare professionals with a comprehensive tool to make more accurate and timely diagnosis of TTP and improve patient outcomes.

Adoption of a novel smart mobile-health application technology to track chronic immunosuppression adherence in solid organ transplantation: Results of a prospective, observational, multicentre, pilot study.

BACKGROUND: Low adherence to chronic immunosuppression is associated with suboptimal transplantation outcomes. Mobile-health technology is a promising tool to monitor medication adherence, but data on patient engagement to these tools are lacking. METHODS: Prospective, observational, multicenter, 2-phase trial in kidney and liver transplant recipients, investigating the degree of engagement to TrackYourMed® (TYM), a novel m-Health technology with a QR code-scan app to track immunosuppression adherence and its association with drug monitoring. RESULTS: Out of 204 consecutive transplant patients, 90 patients were eligible to participate. 61 (68%) used TYM regularly, 21 (23%) never or barely used it, 5 (5.5%) were irregular users, and 3 (3.3%) were lost to follow-up. 6-month total correct intakes (CIN) ranged between 69%-76%, 12%-19% intakes were out-of-time (OUT), and 9%-12% were missed (MIS). Notably, a rate of intakes out of the scheduled time higher than 20% in the 6 days prior to blood immunosuppressant trough levels was associated with a higher intra-patient variability (17 IQR 13-21% vs. 29 IQR 23%-36%, p = .001), and with a higher dose-adjustment (p < .001). At 1 year, 53(59%) patients were still active users of TYM. CONCLUSIONS: Implementing m-Health technologies promoting immunosuppression adherence may be useful for a relevant number of transplant patients and help transplant physicians identifying erratic immunosuppression adherence.

A multi-mechanism approach reduces length of stay in the ICU for severe COVID-19 patients.

PURPOSE: COVID-19 pandemic has multifaceted presentations with rising evidence of immune-mediated mechanisms underplay. We sought to explore the outcomes of severe COVID-19 patients treated with a multi-mechanism approach (MMA) in addition to standard-of-care (SC) versus patients who only received SC treatment. MATERIALS AND METHODS: Data were collected retrospectively for patients admitted to the intensive care unit (ICU). This observational cohort study was performed at five institutions, 3 in the United States and 2 in Honduras. Patients were stratified for MMA vs. SC treatment during ICU stay. MMA treatment consists of widely available medications started immediately upon hospitalization. These interventions target immunomodulation, anticoagulation, viral suppression, and oxygenation. Primary outcomes included in-hospital mortality and length of stay (LOS) for the index hospitalization and were measured using logistic regression. RESULTS: Of 86 patients admitted, 65 (76%) who had severe COVID-19 were included in the study; 30 (46%) patients were in SC group, compared with 35 (54%) patients treated with MMA group. Twelve (40%) patients in the SC group died, compared with 5 (14%) in the MMA group (p-value = 0.01, Chi squared test). After adjustment for gender, age, treatment group, Q-SOFA score, the MMA group had a mean length of stay 8.15 days, when compared with SC group with 13.55 days. ICU length of stay was reduced by a mean of 5.4 days (adjusted for a mean age of 54 years, p-value 0.03) and up to 9 days (unadjusted for mean age), with no significant reduction in overall adjusted mortality rate, where the strongest predictor of mortality was the use of mechanical ventilation. CONCLUSION: The finding that MMA decreases the average ICU length of stay by 5.4 days and up to 9 days in older patients suggests that implementation of this treatment protocol could allow a healthcare system to manage 60% more COVID-19 patients with the same number of ICU beds.

Comportamiento de la infección neonatal en la Unidad de Cuidados Intensivos Neonatales del Hospital Dr Ernesto Guevara de la Serna / Behaviour of neonatal infection in the intensive neonatal care unit of Dr Ernesto Guevara de la Serna Hospital

Se realizó un estudio retrospectivo observacional, de corte transversal de los recién nacidos con infección neonatal en el Hospital Dr Ernesto Guevara de la Serna durante el período de enero de 2006 a diciembre de 2008, con el objetivo de determinar el comportamiento de la infección neonatal en la Unidad de Cuidados Intensivos Neonatales. La muestra fue de 62 neonatos con infección neonatal. Para la recolección de la información se consultaron los expedientes clínicos de los recién nacidos y de las gestantes, el libro de registro de ingresos y el libro de recién nacidos del departamento de estadística. La ruptura prematura de las membranas ocupó el mayor por ciento dentro de los factores de riesgo materno. El bajo peso, menor de 1500 gramos, tuvo una mayor susceptibilidad de infecciones. En la mayoría de los pacientes los síntomas aparecieron en las primeras 72 horas, o sea, sepsis de inicio precoz. Las principales bacterias aisladas fueron el Estafilococo coagulasa negativa que tuvo una alta incidencia(AU)

An observational retrospective and transversal study of newborns with neonatal infection was carried out at Dr Ernesto Guevara de la Serna Provincial Teaching Hospital in the period between January 2006 and December 2008, with the objective of determining the behaviour of neonatal infection in the neonatal intensive care unit. The sample was 62 neonates with neonatal infection . To collect the information, the neonates and pregnant womens clinical charts were analyzed, and the admissions record book and the neonate Record book from the statistics department were reviewed. Premature rupture of membranes had the highest percent among the maternal risk factors. Low birth weight, less than 500 grams, had a major susceptibility for infections. In most of patients, the symptoms appeared in the first 72 hours, that is sepsis of precocious onset. The principal isolated bacteria were coagulase negative staphilococus, which had a high incidente(AU)

Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study.

INTRODUCTION: Excessive bleeding (EB) after cardiopulmonary bypass (CPB) may lead to increased mortality, morbidity, transfusion requirements and re-intervention. Less than 50% of patients undergoing re-intervention exhibit surgical sources of bleeding. We studied clinical and genetic factors associated with EB. METHODS: We performed a nested case-control study of 26 patients who did not receive antifibrinolytic prophylaxis. Variables were collected preoperatively, at intensive care unit (ICU) admission, at 4 and 24 hours post-CPB. EB was defined as 24-hour blood loss of > 1 l post-CPB. Associations of EB with genetic, demographic, and clinical factors were analyzed, using SPSS-12.2 for statistical purposes. RESULTS: EB incidence was 50%, associated with body mass index (BMI) < 26.4 (25-28) Kg/m2, (P = 0.03), lower preoperative levels of plasminogen activator inhibitor-1 (PAI-1) (P = 0.01), lower body temperature during CPB (P = 0.037) and at ICU admission (P = 0.029), and internal mammary artery graft (P = 0.03) in bypass surgery. We found a significant association between EB and 5G homozygotes for PAI-1, after adjusting for BMI (F = 6.07; P = 0.02) and temperature during CPB (F = 8.84; P = 0.007). EB patients showed higher consumption of complement, coagulation, fibrinolysis and hemoderivatives, with significantly lower leptin levels at all postoperative time points (P = 0.01, P < 0.01 and P < 0.01). CONCLUSION: Excessive postoperative bleeding in CPB patients was associated with demographics, particularly less pronounced BMI, and surgical factors together with serine protease activation.

Repercusión Económico social de las Infecciones Intrahospitalarias / Economic and social impact of nosocomial infections

Se realizó un estudio observacional, analítico y retrospectivo para determinar la repercusión económica y social de las Infecciones Intrahospitalarias en el Hospital Pediátrico Provincial “Mártires de Las Tunas” en la etapa de enero a diciembre del 2004, se investigaron las variables sexo, edad, estadía hospitalaria, presencia o no de factores de riesgo y la repercusión económica, familiar e institucional de estas, se recogieron los datos en un formulario de encuestas y se llegó a las conclusiones de que la mayoría de los niños eran del sexo femenino y menores de un año, que el 81 por ciento de los pacientes no tenía factores de riesgo para las IIH, la madre fue el familiar acompañante en casi todos los casos y existió dificultades familiares en cuanto al cuidado de otros menores de 15 años, se encontró importante repercusión económica relacionada con las IIH, tanto por estadía como por medicamentos, una vez más se demostró que prevenir las infecciones intrahospitalarias, cumpliendo las normas establecidas, debe ser un importante deber de cada trabajador (AU)

A Pediatric provincial hospital “Martires de Las Tunas” from january to december of 2004, an observational, retrospective and analitic study to know social and economical repercution of nosocomial infections. Different variables as sex, age Hospital stay, risk factors and economical, familiar and institutional reprecussion were studied. The data were collect in a questorial. In the results were found that most of the patients were female and from o years old to 1 year old, 81 per cent of patients did not present risk present risk factors. In almost all the cases, the mothers were who take care of children, but in some other cases there were difficulties in the care of children younger than 15 years old. Important economical repercussion of nosocomial infection was found. To precent nosocomial infections fulfilling the established patierns must be an important duty of each health worker(AU)

Alteraciones del neurodesarrollo en recién Nacidos con un peso inferior a 1500gr: maternidad Las Tunas 1999-2002 / Neurodevelopmental alterations in newborns weighing less than 1500 g: las Tunas Maternity 1999 - 2002

Se realizó un estudio descriptivo de tipo transversal de las alteraciones del neurodesarrollo observadas en el seguimiento de recién nacidos muy bajo peso que ingresaron en unidad de cuidados intensivos neonatales del Hospital General Docente Dr Ernesto Guevara de la Serna en Las Tunas durante el período de 1999 al 2002. El universo estuvo constituido por el total de pacientes egresados de nuestro servicio con un peso al nacer inferior a 1500gr (66). Para la recolección de la información se utilizó la historia clínica individual, para el análisis estadístico se calcularon las tasas de incidencia y frecuencia. Los principales resultados mostraron que de un total de 66 pacientes, culminaron el estudio 53, en estos las alteraciones del neurodesarrollo mas frecuentes fueron parálisis cerebral infantil, retraso mental severo, epilepsia y sordera, el mayor número tuvo como antecedentes perinatales un peso al nacer de 1000 a 1499gr, con una edad gestacional de 29 a 32 semanas y Sepsis neonatal(AU)

Descriptive study was carried out neurodevelopment alterations observed in the follow up of under weight new born in the neonatal intensive care unit of the general teaching hospital “Dr Ernesto Guevara de la Serna ” from 1999 to 2002. The universe was constituted from the total patients discharged from our facility with an inferior weight at birth of 1500 g . For the recollection of the information the individual clinical history was used for the estadistic analysis the incidence and frequency rates were calculated. The principal results showed that from a total of 66 patients, the study was ended with 53, from them, in the follow -up of the early stimulation consultation, among them, the most frequent alteration of the neurodevelopment were cerebral infant paralysis, severe retarded disorders, epilepsies and deafness the highest number had as Perinatal antecedents a weight from 1000 to 1499 at birth with a gestational age from 29 to 32 weeks and neonatal sepsis(AU)

Usos diagnósticos de la saliva / Diagnostic usages of saliva

El campo de acción en que se desarrolla el cirujano dentista no debe restringirse al trabajo habitual del consultorio, sino que debe formar parte de un equipo médico en donde su colaboración con otros especialistas sea de apoyo terapéutico y diagnóstico en padecimientos tanto bucales como sistémicos. El presente trabajo consistió en efectuar una revisión de la literatura relacionada con los usos diagnósticos de la saliva. Asimismo, se reportan dos casos de mujeres sometidas a hiperestimulación ovárica, a quienes se les efectuaron determinaciones seriadas de estradiol sérico y salival simultáneamente, encontrándose un alto grado de efectividad y confiabilidad del uso de la saliva como un medio no invasivo para efectuar procedimientos diagnósticos de utilidad práctica no solo para el odontólogo, sino para el médico en general

Psicoballet, una experiencia psicoterapéutica / Psychoballet, a psychotherapeutic experience

El presente trabajo constituye la experiencia obtenida de la aplicación del psicoballet como actividad terapéutica con un grupo de niños. Las edades están comprendidas entre cuatro y seis años, siendo el grupo heterogéneo en diagnóstico y homogéneo en sexo (varones). El ciclo de tratamiento tuvo una duración de cuatro meses, desarrollando las sesiones terapéuticas una vez por semana. El método fue utilizado de acuerdo a las normas de trabajo del psicoballet del Hospital Psiquiátrico de la Habana (HPH), de donde recibimos todo el asesoramiento técnico y metodológico que posibilitó el desarrollo exitoso del trabajo

Psicoballet, una experiencia psicoterapéutica / Psychoballet, a psychotherapeutic experience

El presente trabajo constituye la experiencia obtenida de la aplicación del psicoballet como actividad terapéutica con un grupo de niños. Las edades están comprendidas entre cuatro y seis años, siendo el grupo heterogéneo en diagnóstico y homogéneo en sexo (varones). El ciclo de tratamiento tuvo una duración de cuatro meses, desarrollando las sesiones terapéuticas una vez por semana. El método fue utilizado de acuerdo a las normas de trabajo del psicoballet del Hospital Psiquiátrico de la Habana (HPH), de donde recibimos todo el asesoramiento técnico y metodológico que posibilitó el desarrollo exitoso del trabajo (AU)