Experiences and perceptions of people with celiac disease, food allergies and food intolerance when dining out.

Introduction: Eating out is a common practice in modern society. Celiac disease (CeD) and food allergy (FA) are among the most common conditions responsible for adverse reactions to food. Despite their different origins, both require treatment with restrictive diets (avoidance of gluten and/or specific allergens) and this results posing similar challenges when eating out. Our objective was to learn about the experiences/perceptions of consumers with CeD and FA when dining out, as well as the challenges they face in food service environments. Methods: An ad hoc questionnaire was used to record consumer perceptions, food service characteristics and resulting adverse reactions. Results: 377 individuals living in Santiago, Chile, provided complete information and were analyzed (160 CeD, 105 FA). 301 participants (79.8%) declared eating out, 33.6% reported experiencing an adverse reaction at least once while eating out. 94.4% of the 377 participants believed that the serving staff had little or no knowledge about his/her condition. Consumers reporting symptoms as severe adverse reactions were more common among celiac than allergic patients (p < 0.001). Discussion: The study showed no significant differences based on consumer-related characteristics (p:NS). The consequences of eating out did not vary based on individual's data, including diagnosis, age, frequency of eating out, adverse reactions experienced, or intensity. These findings suggest that the most important determinants of risk associated with eating out are characteristics of the food service, like availability of information, staff training, and establishment's facilities like equipment available, exclusive utensils for customers with special dietary needs and kitchen and bathrooms organization.

IL-6, IL-10, sFas, granulysin and indicators of intestinal permeability as early biomarkers for a fatal outcome in COVID-19.

The clinical presentation of coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), ranges between mild respiratory symptoms and a severe disease that shares many of the features of sepsis. Sepsis is a deregulated response to infection that causes life-threatening organ failure. During sepsis, the intestinal epithelial cells are affected, causing an increase in intestinal permeability and allowing microbial translocation from the intestine to the circulation, which exacerbates the inflammatory response. Here we studied patients with moderate, severe and critical COVID-19 by measuring a panel of molecules representative of the innate and adaptive immune responses to SARS-CoV-2, which also reflect the presence of systemic inflammation and the state of the intestinal barrier. We found that non-surviving COVID-19 patients had higher levels of low-affinity anti-RBD IgA antibodies than surviving patients, which may be a response to increased microbial translocation. We identified sFas and granulysin, in addition to IL-6 and IL-10, as possible early biomarkers with high sensitivity (>73 %) and specificity (>51 %) to discriminate between surviving and non-surviving COVID-19 patients. Finally, we found that the microbial metabolite d-lactate and the tight junction regulator zonulin were increased in the serum of patients with severe COVID-19 and in COVID-19 patients with secondary infections, suggesting that increased intestinal permeability may be a source of secondary infections in these patients. COVID-19 patients with secondary infections had higher disease severity and mortality than patients without these infections, indicating that intestinal permeability markers could provide complementary information to the serum cytokines for the early identification of COVID-19 patients with a high risk of a fatal outcome.

Bone marrow aspiration in a patient with systemic microsporidium.

A 34-year-old female presented with several weeks of fever, fatigue, weight loss, abdominal pain and hemoptysis. PE revealed moderate pallor, RUQ pain, mild dyspnea, conjunctival injection and hepatomegaly. The CBC showed anemia, mild leukocytosis, hypoalbuminemia, hypertransaminasemia, presence of nucleated red blood cells. Microsporidium was found in BMA.

Steady-state persistence of respiratory syncytial virus in a macrophage-like cell line and sequence analysis of the persistent viral genome.

Long-term infection by human respiratory syncytial virus (hRSV) has been reported in immunocompromised patients. Cell lines are valuable in vitro model systems to study mechanisms associated with viral persistence. Persistent infections in cell cultures have been categorized at least as in "carrier-state", where there exist a low proportion of cells infected by a lytic virus, and as in "steady-state", where most of cells are infected, but in absence of cytophatic effect. Here, we showed that hRSV maintained a steady-state persistence in a macrophage-like cell line after 120 passages, since the viral genome was detected in all of the cells analyzed by fluorescence in situ hybridization, whereas only defective viruses were identified by sucrose gradients and titration assay. Interestingly, eight percent of cells harboring the hRSV genome revealed undetectable expression of the viral nucleoprotein N; however, when this cell population was sorted by flow cytometry and independently cultured, viral protein expression was induced at detectable levels since the first post-sorting passage, supporting that sorted cells harbored the viral genome. Sequencing of the persistent hRSV genome obtained from virus collected from cell-culture supernatants, allowed assembling of a complete genome that displayed 24 synonymous and 38 nonsynonymous substitutions in coding regions, whereas extragenic and intergenic regions displayed 12 substitutions, two insertions and one deletion. Previous reports characterizing mutations in extragenic regulatory sequences of hRSV, suggested that some mutations localized at the 3' leader region of our persistent virus might alter viral transcription and replication, as well as assembly of viral nucleocapsids. Besides, substitutions in P, F and G proteins might contribute to altered viral assembly, budding and membrane fusion, reducing the cytopathic effect and in consequence, contributing to host-cell survival. Full-length mutant genomes might be part of the repertoire of defective viral genomes formed during hRSV infections, contributing to the establishment and maintenance of virus persistence.

Survival and prognostic factors in non-small cell lung cancer patients with mutation of the EGFR gene treated with tyrosine kinase inhibitors in a peruvian hospital.

The identification of the epidermal growth factor mutation (EGFR) is a positive prognostic factor for survival and therapeutic response to tyrosine kinase inhibitors (TKIs) in patients with non-small cell lung cancer (NSCLC). TKIs are considered first line treatment in Patients with stages IIIB and IV NSCLC. We investigated the survival and prognostic factors in NSCLC patients with the mutation of the EGFR in routine clinical practice. We conducted a retrospective cohort observational study of 72 patients with non-small cell lung cancer (NSCLC) with EGFR gene mutations that received treatment with erlotinib from January 2009 to December 2015. Kaplan-Meier curves were presented. The association between independent variables and survival was analyzed using the Long-Rank test in bivariate analysis and for multivariate analysis, Cox proportional hazards method was used to calculate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). We included data from 72 patients, which were followed for a total of 1144 patient-months. The majority of patients were female (61.11%), non-smokers (62.50%), and with histological type corresponding to adenocarcinoma (76.38%). The most frequent EGFR gene mutation was the deletion of exon 19 (65.27%). The majority of patients presented with comorbidities (77.78%), most commonly hypertension. Almost all patients had stage IV NSCLC. Out of the 72 cases, 65 (90.28%) died. The median survival was 9.3 months (95% CI, 7.01-16.93). When comparing the survival curves when using the Log Rank Test, histological type (P = 0.01), place of mutation (P = 0.06), hemoglobin (P = 0.01) and age (P = 0.01) were significant associated to overall survival (OS). In multivariate analysis, only age (HR, 1.02; 95% CI, 1-1.04, P = 0.009) and hemoglobin (HR, 0.70; 95% CI, 0.55-0.89, P = 0.003) remained significant. In conclusion, the median OS of NSCLC patients with positive EGFR gene mutation treated with TKI was 9.3 months. Bivariate and multivariate analysis showed that younger age and a higher hemoglobin level were the most important factors associated with survival.

Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study / Predicción de la ventilación mecánica prolongada en pacientes de la unidad de cuidado intensivo: Estudio de cohorte

Abstract Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.

Resumen Introducción: No existen guías establecidas para seleccionar los pacientes para traqueostomía precoz. El objetivo del estudio fue determinar los factores que pueden predecir la posibilidad de intubación mayor a 7 días en pacientes adultos en la UCI. Métodos: Este es un estudio de cohorte realizado en la UCI. Los pacientes en ventilación mecánica mayor a 48 horas fueron incluidos. Se recogieron los datos clínicos y fisiológicos de cada paciente al tercer día de intubación. Se realizaron análisis uní y multivariado para determinar las variables asociadas a intubación prolongada. Resultados: 163 (62%) fueron hombres y la edad media fue de 59±17 años. Aproximadamente un tercio de los pacientes (36%) requirieron ventilación mecánica mayor a 7 días. Las variables asociadas con ventilación mecánica prolongada fueron: edad (HR 0.97 (95% CI 0.96-0.99); diagnóstico de urgencia quirúrgica en un paciente con enfermedad médica (HR 3.68 (95% CI 1.62-8.35),diagnostico de necesidad de cirugía no urgente (HR 8.17 (95% CI 2.12-31.3); diagnóstico de enfermedad medica no quirúrgica (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) y puntaje SAPS II (HR 1.04 (95% CI 1.00-1.09). El área bajo la curva ROC para predicción fue de 0.52. 16% de los pacientes fueron extubados después de 8 días de intubación. Conclusiones: No fue posible predecir la extubation precoz en pacientes de la unidad de cuidado intensivo en ventilación mecánica con las variables comúnmente usadas. La probabilidad de destete de ventilación mecánica después de 8 días de intubación sin realizar traqueostomía es baja.

Prediction of prolonged mechanical ventilation in patients in the intensive care unit A cohort study.

INTRODUCTION: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. METHODS: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. RESULTS: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. CONCLUSIONS: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.

INTRODUCCIÓN: No existen guías establecidas para seleccionar los pacientes para traqueostomía precoz. El objetivo del estudio fue determinar los factores que pueden predecir la posibilidad de intubación mayor a 7 días en pacientes adultos en la UCI. MÉTODOS: Este es un estudio de cohorte realizado en la UCI. Los pacientes en ventilación mecánica mayor a 48 horas fueron incluidos. Se recogieron los datos clínicos y fisiológicos de cada paciente al tercer día de intubación. Se realizaron análisis uní y multivariado para determinar las variables asociadas a intubación prolongada. RESULTADOS: 163 (62%) fueron hombres y la edad media fue de 59±17 años. Aproximadamente un tercio de los pacientes (36%) requirieron ventilación mecánica mayor a 7 días. Las variables asociadas con ventilación mecánica prolongada fueron: edad (HR 0.97 (95% CI 0.96-0.99); diagnóstico de urgencia quirúrgica en un paciente con enfermedad médica (HR 3.68 (95% CI 1.62-8.35),diagnostico de necesidad de cirugía no urgente (HR 8.17 (95% CI 2.12-31.3); diagnóstico de enfermedad medica no quirúrgica (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) y puntaje SAPS II (HR 1.04 (95% CI 1.00-1.09). El área bajo la curva ROC para predicción fue de 0.52. 16% de los pacientes fueron extubados después de 8 días de intubación. CONCLUSIONES: No fue posible predecir la extubation precoz en pacientes de la unidad de cuidado intensivo en ventilación mecánica con las variables comúnmente usadas. La probabilidad de destete de ventilación mecánica después de 8 días de intubación sin realizar traqueostomía es baja.

Tiroidectomía total basada en la evidencia, análisis de impacto presupuestario / Evidence-based total thyroidectomy, analysis of budgetary impact

Introducción. La tiroidectomía total es el procedimiento quirúrgico más común practicado en el cuello. Existen recomendaciones basadas en la evidencia que pueden causar un impacto en el costo del procedimiento. Dicho impacto no ha sido evaluado en el sistema de salud colombiano. El objetivo de este estudio fue evaluar el impacto presupuestario de la implementación de las recomendaciones basadas en la evidencia, en tiroidectomía total. Materiales y métodos. Se obtuvo información institucional del uso de recursos en tiroidectomía total. Se hizo un microcosteo utilizando los precios SOAT 2010 y los precios de insumos a partir de las convocatorias públicas para Colombia disponibles en internet. Los costos se dividieron en honorarios, estancia, hospitalización, insumos quirúrgicos, exámenes de laboratorio y medicamentos. Se calculó el valor total del procedimiento y se diseñó un análisis de impacto presupuestario, comparando la práctica actual y la práctica recomendada según criterios de la medicina basada en la evidencia. Como variables de evaluación se utilizaron: la frecuencia de vaciamiento central, el uso de antibióticos profilácticos y drenaje, la estancia hospitalaria, la solicitud de calcio posquirúrgico y la administración de gluconato de calcio en el posoperatorio. Resultados. Se incluyeron 55 pacientes para la evaluación del uso de recursos. La aplicación de un modelo de tiroidectomía basado en la evidencia, puede disminuir el valor global del procedimiento de 20 a 35 %, según el seguimiento de las recomendaciones. Discusión. La aplicación de las recomendaciones de la medicina basada en la evidencia en tiroidectomía total, tiene un impacto presupuestario positivo en el sistema de salud.

Introduction: Total thyroidectomy is the most common endocrine surgical procedure perormed in the neck. There are recommendations based on evidence that can impact the cost of the procedure. This impact has not been assessed in the Colombian health system. The objective of this study was to evaluate the budgetary impact by the implementation of the evidence-based recommendations in performing a total thyroidectomy. Methods: Institutional information on the use of resources in performing total thyroidectomy was recorded. Prices of resources were obtained from a national registry (SOAT) and available data at Internet. Cost included honoraria, length of stay, hospital costs, surgical devices, laboratory tests, and drugs. A model of budgetary impact analysis using Excel software (Microsoft) was designed in order to compare the usual thyroidectomy practice versus the thryroidectomy practice based on evidence. The variables analyzed were frequency of central node dissection, prophylactic antibiotics, use of drains, hospital stay, postoperative serum calcium determination, and the administration of calcium gluconate to prevent hypocalcemia. Results: Ffty five patients were included for the evaluation of the use of resources. The application of a model of thyroidectomy based on evidence can diminish the total cost of the procedure in the order of 20% to 35%. Conclusion: Application of the recommendations of evidence-based medicine in performing a total thyroidectomy has a positive economic impact on the national health system.

Anestesia y cirugía en revascularización coronaria en un paciente trasplantado cardiaco: reporte de un caso / Anesthesia and coronary revascularization surgery in a cardiac transplanted patient: a case report

Dado el aumento de la sobrevida de los pacientes trasplantados cardiacos es cada vez más frecuente que se sometan a otras cirugías, tanto cardíacas, como no cardíacas. En este artículo se presenta un caso clínico de un paciente trasplantado cardíaco sometido a una cirugía de revascularización coronaria, y posteriormente una revisión de la literatura y discusión del caso.

Arteritis de celulas gigantes: clásicos y novedades que vale la pena recordar / Giant cells arteritis: classics and innovations for remember

La Arteritis de Células Gigantes (ACG) es una vasculitis frecuente que ocurre en personas mayores y que afecta principalmente vasos craneanos. Generalmente se acompaña de síntomas sistémicos, claudicación mandibular y alteraciones visuales. La Polimialgia Reumática (PMR) se caracteriza por dolor y rigidez de cintura escapular y pelviana que presenta síntomas constitucionales y reacciones sistémicas. En los últimos años, ha aparecido evidencia que relaciona ambas entidades como componentes de una misma enfermedad. En este artículo se revisan aspectos nuevos en diagnóstico, terapia y etiopatogenia de la ACG y sus relaciones con PMR.

The Giant cell arteritis (GCA) is a common vasculitic syndrome occurring in older persons and it preferentially affects cranial arteries. Generally accompanied by constitutional symptoms and typical findings like jaw claudication and vision disorder.Polymyalgia Rheumatica (PMR) is caracterized by pain and stiffness involving shoulder and pelvic girdless with constitutional symptoms and findings of a systemic reaction. In recents years, evidence linking both conditions as components of asingle disease process has been accumulated. In the present article, we review new aspects of the diagnosis, therapy and pathogenesis of the GCA, and their relationship.

Fisioterapia rehabilitadora y tratamiento en pacientes hemofílicos pediátricos / Rehabilitadora fisioterapia and processing in pediátricos patients hemophiliac

Expone un estudio restrospectivo desde 1965 a 1994, de pacientes hemofílicos, atendidos en la Cruz Roja Ecuatoriana de Quito. El universo comprende 221 pacientes, de los cuales el 72.8xciento (n=161) padecen de hemofilia A, enfermedad de Von Willebrand 10xciento (n=24), Hemofilia B 7.2xciento (n=16), déficit de factor I 1.2xciento (n=6), déficit de factor X 1.8xciento (n=4), déficit de factor XI 1.3xciento (n=3). En cuanto a la incidencia por sexo, predomina en el sexo masculino con el 90.9xciento (n=201). El sitio mas frecuente de sangrado a nivel articular comprende rodilla derecha 28.7xciento, codo derecho 17.3xciento, tobillo derecho 12.7xciento, codo izquierdo 9.1xciento, tobillo izquierdo 6.3xciento, hombro derecho 4.5xciento; en músculos, el sangrado se observó en pantorrilla 30xciento, psoas 20xciento, muslo 20xciento, antebrazo 20xciento y glúteo 10xciento. Se determinó una razón de 10:1 entre lesiones articulares y musculares. Los pacientes recibieron tratamientos derivados de sangre (crioprecipitados, plasma fresco congelado, plasma refrigerado y concentrado de glóbulos rojos. La terapia de rehabilitación implementadas incluyeron ejercicios en el 24.8xciento de casos, rayos láser 23.13xciento, compresas frías 22.8xciento, ultrasonido 17.7xciento, hidromasaje 5.2xciento y compresas químicas 5xciento.

Recien nacido de madre adolescente. Hospital Pablo Arturo Suárez. Abril de 1993 a abril de 1995

De los 3753 casos de partos atendidos en el servicio de Ginecología 750 casos (19.98 por ciento) fueron de madres adolecentes. Las madres de 19 años fueron 238 (32.16 por ciento): 18 años, 209 (28.24 por ciento): 17 años, 160 (21.62 por ciento). La edad gestacional de los recien nacidos fue 37-41 semanas, 667 (90.13 por ciento): 35-36 sem. 31 (4.18 por ciento) : 42 o más semanas 23 (3.1 por ciento): 32-34 sem., 15 (2.09 por ciento) y de 28-31 sem., 4 (0.54 por ciento), los antecedentes gineco-obstétrico en cuanto a gestas, predominó la primigestas. 580 (78.37 por ciento): las segundigestas, 129 (17.43 por ciento) y cesáreas, 133 (17.97 por ciento). El peso del recien nacido fue menos de 2500 gr., 247 (33.42 por ciento) y más de 35oo gr. 352 (47.63 por ciento): 3001-3500 gr., 247 (33.42 por ciento) y más de 3500 gr. 53 (7.17 por ciento). El apgar de los recién nacidos fue: 8-10, 385 (52.02 por ciento): 6-7, 172 (23.24 por ciento) 4.5, 59 (7.97 por ciento): 0-3, 10 (1.25 por ciento). En cuanto al peso edad gestacional: para la edad gestacional. 684 (92.43 por ciento), pequeños para la edad, 51 (6.89 por ciento) y grandes para la edad, 51 (6.89 por ciento) y grandes para la edad 5 (0.67 por ciento). Las conclusiones diagnósticas de los recién nacidos normales, 475(64.18 por ciento) y recién nacidos patológicos. 275 (35.88 por ciento), la mortalidad, 9(1.21 por ciento). Las patologías encontradas fueron: sufrimiento fetal agudo, 92: hiperbilirrubinemia, 41: SDR tipo 2, 22; infecciones, 19 y traumas obstétricos significativos,16...

Recién nacido de madre adolescente Hosp. Pablo Arturo Suárez / New born of adolescent mother Hosp. Pablo Arturo Suárez

De los 3753 casos de partos atendidos en el Servicio de Ginecología fueron de madres adolescentes. Las madres de 19 años fueron 238 (32.16 por ciento); 18 años, 209 recién nacidos fue 37-41 semanas, 667 (90.13 por ciento); 35-36 sem. 31 (4.18 por ciento); 42 o más sem. 23 (3.1 por ciento); 32-34 sem., 15 (2.02 por ciento) y de 28-31 sem.., 4 (0.54 por ciento), los antecedentes gineco-obstétrico en cuanto a gestas, predominó la primigestas, 580 (78,37 por ciento); y las segundigestas, 129 (17.43 por ciento) y cesáreas, 133 (17.97 por ciento). El peso del recién nacido fue menos de 2500 gramos, 87 (11.77 por ciento); 2500-3000 gr., 352 (47.63 por ciento); 3001-3500 gr., 247 (33.42 por ciento) y más de 3500 gr., 53...