After NICU discharge: Feeding and growth of low-income urban preterm infants through the first year.

BACKGROUND: Little is known about preterm infant feeding and growth in the outpatient setting, and there are no standardized post-hospital discharge feeding guidelines. This study aims to describe post-neonatal intensive care unit (NICU) discharge growth trajectories of very preterm (<32 weeks gestational age (GA)) and moderately preterm (32-34 0/7 weeks GA) infants managed by community providers and to determine the association between post-discharge feeding type and growth Z-scores and z-score changes through 12 months corrected age (CA). METHODS: This retrospective cohort study included very preterm infants (n = 104) and moderately preterm infants (n = 109) born 2010-2014 and followed in community clinics for low-income, urban families. Infant home feeding and anthropometry were abstracted from medical records. Repeated measures analysis of variance calculated adjusted growth z-scores and z-score differences between 4 and 12 months CA. Linear regression models estimated associations between 4 months CA feeding type and 12 months CA anthropometry. RESULTS: Moderately preterm infants on nutrient-enriched vs. standard term feeds at 4 months CA had significantly lower length z-scores at NICU discharge that persisted to 12 months CA (-0.04 (0.13) vs. 0.37 (0.21), respectively, P = .03), with comparable length z-score increase for both groups between 4 and 12 months CA. Very preterm infants' 4 months CA feeding type predicted 12 month CA body mass index z-scores (ß=-0.66 (-1.28, -0.04)). CONCLUSION: Community providers may manage preterm infant post-NICU discharge feeding in the context of growth. Further research is needed to explore modifiable drivers of infant feeding and socio-environmental factors that influence preterm infant growth trajectories.

Características clínico-epidemiológicas del queratocono en Asturia / Clinical-epidemiological characteristics of keratoconus in Asturias

Introducción El queratocono es la ectasia corneal más frecuente y la segunda causa de queratoplastia en el mundo. Las características clínicas y epidemiológicas del queratocono no han sido apenas estudiadas en España y, hasta la fecha, no se ha hecho ningún trabajo en Asturias. Material y métodos Se realizó un estudio transversal analizando todos los casos de queratocono diagnosticado en las primeras consultas de la sección de Córnea y Superficie de los centros Hospital Universitario Central de Asturias (Oviedo) y Hospital Universitario de Cabueñes (Gijón) entre 2017 y 2020. A todos los pacientes se les recogieron datos demográficos, agudeza visual y se les realizó una topografía corneal. Resultados Se incluyeron un total de 112 pacientes (42,0% mujeres y 58,0% hombres). La edad media era de 36,84±15,59, teniendo un 39,3% una edad superior a 40 años. Un 31,8; 28,0; 15,0 y 25,2% se encontraban en los estadios i, ii, iii y iv, respectivamente, en la escala Amsler-Krumeich. En un 7,5% se implantaron segmentos corneales, en un 4,7% se realizó cross-linking y en un 13,2% se realizó queratoplastia. Conclusión Aproximadamente un 40% de los queratoconos se detectan en estadios avanzados y otro 40% a una edad superior a los 40 años. Un 13% de los mismos requieren queratoplastia, por lo que sigue siendo una indicación frecuente en nuestro medio. Es necesario, por tanto, realizar un diagnóstico precoz para actuar antes de que exista una pérdida visual irreversible. (AU)

Introduction Keratoconus is the most frequent corneal ectasia and second most common cause of keratoplasty worldwide. The clinical and epidemiological characteristics of keratoconus have rarely been studied in Spain, and to date, no study has been done in Asturias. Material and methods A cross-sectional study was conducted to analyze all cases of keratoconus diagnosed in the first consultations of the cornea and surface section of the Hospital Universitario Central de Asturias (Oviedo) and Hospital Universitario de Cabueñes (Gijón) between 2017 and 2020. Demographic data, visual acuity and corneal topography were collected. Results A total of 112 patients (42.0% women and 58.0% men) were included. The mean age was 36.84±15.59, with 39.3% being older than 40 years. 31.8%, 28.0%, 15.0%, and 25.2% were in stages i, ii, iii and iv, Amsler–Krumeich scale, respectively. Corneal segments were implanted in 7.5% of patients, cross-linking was performed in 4.7%, and keratoplasty was performed in 13.2%. Conclusion Approximately 40% of keratoconus cases are detected at advanced stages and another 40% are detected at an age over 40 years. 13% of these patients require keratoplasty, which is why it is frequently performed in our setting. Therefore, early diagnosis before irreversible visual loss is necessary. (AU)

Clinical-epidemiological characteristics of keratoconus in Asturias.

INTRODUCTION: Keratoconus is the most frequent corneal ectasia and second most common cause of keratoplasty worldwide. The clinical and epidemiological characteristics of keratoconus have rarely been studied in Spain, and to date, no study has been done in Asturias. MATERIAL AND METHODS: A cross-sectional study was conducted to analyze all cases of keratoconus diagnosed in the first consultations of the Cornea and Surface section of the Hospital Universitario Central de Asturias (Oviedo) and Hospital Universitario de Cabueñes (Gijón) between 2017 and 2020. Demographic data, visual acuity and corneal topography were collected. RESULTS: A total of 112 patients (42.0% women and 58.0% men) were included. The mean age was 36.84 ±â€¯15.59, with 39.3% being older than 40 years. 31.8%, 28.0%, 15.0%, and 25.2% were in stages I, II, III and IV, Amsler-Krumeich scale, respectively. Corneal segments were implanted in 7.5% of patients, cross-linking was performed in 4.7%, and keratoplasty was performed in 13.2%. CONCLUSION: Approximately 40% of keratoconus cases are detected at advanced stages and another 40% are detected at an age over 40 years. 13% of these patients require keratoplasty, which is why it is frequently performed in our setting. Therefore, early diagnosis before irreversible visual loss is necessary.

Correlation of GREB1 mRNA with protein expression in breast cancer: validation of a novel GREB1 monoclonal antibody.

Studies of gene regulated by estrogen in breast cancer 1 (GREB1) have focused on mRNA levels with limited evidence about GREB1 protein expression in normal and breast cancer cells. A monoclonal antibody that recognizes GREB1 protein in breast tissues could be applied to correlate protein expression with established mRNA expression data. A hybridoma expressing a murine monoclonal antibody targeting a 119 amino acid peptide specific to human GREB1 was generated. The novel monoclonal GREB1 antibody (GREB1ab) was validated for use in Western blotting as well as immunohistochemical (IHC) applications. GREB1ab detects a 216 kDa protein corresponding to GREB1 in estrogen receptor alpha (ERalpha+) breast cancer cells as well as ERalpha- breast cancer cells transduced with a GREB1 expression vector. GREB1ab specificity was verified using an ERalpha antagonist to prevent GREB1 induction as well as a silencing siRNA targeting GREB1 mRNA. GREB1ab was further validated for detection of GREB1 by IHC in breast cancer cell lines and breast tissue microarrays (TMA). ERalpha+ cell lines were observed to express GREB1 while ERalpha- cell lines did not express detectable levels of the protein. Using breast cancer tissue whole sections, IHC with the GREB1ab identified protein expression in ERalpha+ breast cancer tissue as well as normal breast tissue, with little GREB1 expression in ERalpha- breast cancer tissue. Furthermore, these data indicate that GREB1 mRNA expression correlates well with protein expression. The novel monoclonal GREB1ab is specific for GREB1 protein. This antibody will serve as a tool for investigations focused on the expression, distribution, and function of GREB1 in normal breast and breast cancer tissues.

Case report: Liposarcoma of the sinonasal tract.

Nasal and paranasal malignant tumours account for less than 5% of all head and neck malignancies. Epithelial malignancies overwhelmingly predominate, with squamous cell carcinomas representing the most frequent histological subtype in this location. Soft-tissue sarcomas of the nasal cavity and paranasal sinuses are exceedingly rare. Here, we report two cases of myxoid liposarcomas that occurred in the nasal and paranasal regions, both of which presented diagnostic challenges and could not be diagnosed definitively from intraoperative frozen sections. These cases reinforce the notion that, while they are uncommon, sarcomas in general and liposarcomas in particular should still be considered as part of the differential diagnosis in patients presenting with obstructive symptoms in the nasal and paranasal sinuses.

Two cases of cyclic vomiting syndrome in systemic autoimmune conditions: SLE and autoimmune hepatitis.

Vomiting directly attributable to SLE occurs in approximately 8% of patients, and its causes are sometimes obscure when common conditions are ruled out. Cyclic vomiting syndrome is a common functional disorder which usually starts from childhood. We report the first two cases of patients affected by systemic autoimmune conditions associated to cyclic vomiting syndrome. Identification and proper treatment may guide to diagnosis and alleviate neglected manifestations of autoimmune patients.

Simulações da SAR na cabeça e antenas planares para telefones móveis / SAR simulations and planar antennas for mobile phones

A Taxa de Absorção Específica (SAR) na cabeça dos usuários de telefones móveis é simulada utilizando o método das Diferenças Finitas no Domínio do Tempo (FDTD) quando antenas tipo monopolo convencionais e quando antenas diretivas planares são utilizadas. São também resumidos o projeto de antenas tipo patch retangular em microstrip, suas características de desempenho esperadas e medidas são apresentadas. São calculados entre outros, a taxa de onda estacionária e a largura de banda simuladas no software Ensemble®, o diagrama de irradiação no plano horizontal e o campo na região próxima, claculado em simulação em três dimensões - 3D com algoritmo baseado em FDTD. Medidas da taxa de Onda Estacionária VSWR e dos diagramas de irradiação horizontal são mostradas. Verifica-se uma excelente correlação entre os resultados das medidas e os obtidos com o método FDTD em simulações com plano de terra finito e sem aterramento efetivo. Observa-se que este tipo de antena pode ser utilizado em uma nova geração de telefones móveis, constituindo-se em uma alternativa conveniente para melhorar o desempenho destes transcetores, diminuindo também os riscos à saúde dos usuários

Normal endometrial cells in Papanicolaou smears: prevalence in women with and without endometrial disease.

OBJECTIVE: To determine whether the prevalence of normal endometrial cells in Papanicolaou smears of women with and those without endometrial carcinoma or hyperplasia differs significantly. METHODS: Papanicolaou smears of women with biopsy-proved endometrial hyperplasia or carcinoma diagnosed between 1990 and 1998 were reviewed for the presence of normal endometrial cells. Chi-square and a power analysis were used to compare these smears with results of smears from women older than 35 years of age with tissue diagnoses other than hyperplasia or carcinoma. All Papanicolaou smears obtained within the 5 years before endometrial sampling were reviewed. Each patient had at least one smear done within the previous 12 months. Clinical information was available for all patients. RESULTS: Of the 201 women in whom endometrial hyperplasia (n = 103) or carcinoma (n = 98) was diagnosed, 4 (2%) had normal endometrial cells in otherwise negative Papanicolaou smears. Of the 289 women in the comparison group, 15 (5%) had normal endometrial cells in their Papanicolaou smears. The prevalence of normal endometrial cells did not differ significantly between the two groups (P =.071). The study had 80% power to detect a 5% or greater difference between groups. CONCLUSION: The prevalence of normal endometrial cells in Papanicolaou smears of women with endometrial carcinoma or hyperplasia does not significantly differ from that in women without these conditions. Reporting normal endometrial cells in Papanicolaou smears according to the recommendations of the Bethesda System may lead to unnecessary procedures and patient anxiety.

Reporting normal endometrial cells in Pap smears: an outcome appraisal.

OBJECTIVE: The purpose of this study was to determine the clinical relevance of reporting the presence of normal endometrial cells in the Pap smears of women over the age of 35 years and the significance of this practice as it relates to patient management. METHODS: From January 1992 to December 1995, normal endometrial cells were reported in 206 consecutive Pap smears of women over the age of 35 years. Clinical follow-up was available for all patients, including the results of diagnostic procedures whenever performed. RESULTS: Of the 206 women with normal endometrial cells in their Pap smears, 162 presented with the chief complaint of abnormal vaginal bleeding. They were all evaluated by direct endometrial sampling, resulting in detection of 10 endometrial hyperplasias and 7 endometrial carcinomas. The remaining 44 women who were clinically asymptomatic were followed up with only routine annual gynecologic examinations for a minimum of 3 years. All had negative clinical courses. CONCLUSION: Reporting the presence of normal endometrial cells in Pap smears has little, if any, impact on subsequent patient management. Women who present with abnormal uterine bleeding are worked up for endometrial disease regardless of their Pap smear findings. In clinically asymptomatic patients, practitioners may, and in our experience often do, choose to disregard normal endometrial cells in Pap smear reports. The negative follow-up for the asymptomatic women in our study supports this practice. Therefore, reporting the presence of normal endometrial cells in Pap smears is of no clinical relevance and may, in fact, create a management dilemma for clinicians.

Mycobacterium fortuitum epidemics after open-heart surgery.

We present the clinical and epidemiological features of Mycobacterium fortuitum epidemics involving 19 patients who underwent open-heart surgery. The source of the infection could not be identified. However, bone wax and homografts utilized at that time have been suspected. The infected patients responded poorly to antibiotic management and their courses in most cases were influenced beneficially by total sternectomy and transplantation of the omentum into the mediastinum. The emergence of M. fortuitum may represent an aggressive bacterial strain resistant to presently used broad-spectrum antibiotic drugs.

Tissue invasion by unnamed marine vibrios.

Vibrio parahaemolyticus is an extremely common organism of major importance as a cause of gastroenteritis, but not common as a cause of tissue infection. Of three patients who had serious localized tissue infections, one died because of an unnamed marine Vibrio infection. Vibrios are easily isolated, although their final speciation is quite difficult in view of their unsettled taxonomic position. It is hoped that agreement can be reached as to bacteriologic genealogy; perhaps then the specific pathogenic manifestations will be clarified. The clinician should consider the possibility of this pathogen in any patient with a wound related to saltwater or seafood.