Cervical dorsal root ganglion stimulation for complex regional pain syndrome: Technical description and results of seven cases.

INTRODUCTION: Complex regional pain syndrome (CRPS) is characterized by nociplastic pain with alterations in sympathetic function. Neuromodulation could be a useful alternative therapy option. Dorsal root ganglion (DRG) stimulation has demonstrated better results than conventional spinal cord stimulation (SCS) for patients with CRPS in lower limbs. METHODS: We report a case series of seven patients treated with cervical DRG stimulation for CRPS of the hand that required neuromodulation for pain relief, after no response with other analgesic techniques (medication and interventional). We report retrospective data collection of seven consecutive patients with a 1-year follow-up. RESULTS: Seven patients were trialed, and six were implanted with a permanent pulse generator after achieving more than 50% pain relief during 2-7 days of trial phase. The average pain relief (rated on a standard 100 mm visual analog scale) after 1 year of treatment was 64.3% ± 16.6. No major complications were observed during a 1-year follow-up. DISCUSSION: The results for cervical DRG stimulation are similar to other DRG stimulation studies for the treatment of refractory CRPS at lower levels. The cervical DRG implant technique guided with C-arm fluoroscopy and under conscious sedation could be a safe and effective option for relieving pain of the upper limbs CRPS. Monitoring neural status is required for cervical DRG stimulation either with a responder awake patient or with intraoperative neural monitoring in non-responder patients.

Livelihood challenges of 'double strike' disasters: Evidence from rural communities of southwest coastal Bangladesh during the Covid-19 pandemic and cyclone Amphan.

The Covid-19 pandemic has adversely affected livelihoods in the Global South and exacerbated the effects of natural disaster. This study examines the 'double strike' of the Covid-19 lockdown and 'super-cyclone' Amphan on the 12 villages of Dakshin Bedkashi Union, southwest Bangladesh. It employs questionnaire surveys to assess the impact of the compound disaster on rural livelihoods over a period of five months, comparing pre-lockdown, post-lockdown, and post-Amphan phases. The results demonstrate the severe impact of the pandemic on income, occupation, and workdays, and consequently on livelihood resilience leading up to Amphan. Although effects vary moderately by livelihood category, village, and socio-spatial characteristics, overall rates of income reduction (58%) and occupation loss (77%) between the advent of the lockdown and the aftermath of Amphan are high. Thus, livelihood resilience to the double strike is generally poor. The study analyses the predictors of lost working days to illuminate the influences on livelihood resilience throughout the double strike. We conclude that the pandemic has presented novel challenges to this region, complicating vulnerability to more common cyclonic natural hazards. Finding that the degree of livelihood diversification is low in the sample, we recommend implementing diversification policies and strengthening local networks and community trust to better anticipate and combat the complex, varied impacts of double strike scenarios in future.

[Behavior of blood glucose level with the administration of micronutrients vitamin d3 and calcium in nondiabetic patients with hyperglycemia in adult intensive care unit]. / COMPORTAMIENTO DE CIFRAS DE GLUCEMIA CON LA ADMINISTRACIÓN DE LOS MICRONUTRIENTES VITAMINA D3 Y CALCIO EN PACIENTES NO DIABÉTICOS CON HIPERGLUCEMIA EN UNA UNIDAD DE CUIDADO INTENSIVO DE ADULTOS.

UNLABELLED: Hyperglycemia without previous history of diabetes mellitus (DM) is observed in a high percentage of patients in intensive care units (ICU). OBJECTIVE: To determine the behavior of glycemia in nondiabetic patients with hyperglycemia by administering two micronutrients. METHODS: A clinical trial was conducted in 32 patients, 16 in the intervention group and 16 in the control group. To the intervention group was given, since the admission, the micronutrients vitamin D3 in doses of 1.000 international units (IU) and calcium in doses 1.000 mg every 24 hours, for a period of 72 hours. RESULTS: No significant differences were observed in blood glucose income between the intervention and control groups (152,6 and 153,3 mg / dl, respectively p = 0,922), but after 72 hours the behavior of the glycemia decreased significantly in the intervention group compared to the control group (98,41 and 141,6 mg / dl respectively p 100 mg/ dl), showing that 2,29 patients should be treated to decrease an undesirable event (NNT). CONCLUSION: The use of the analyzed micronutrients in critically ill patients with no previous diagnosis of diabetes requires more research that addresses te limitations posed here. Due to the limited literature found about similar studies, this investigation would provide another alternative for reducing hyperglycemia in these patients.

La hiperglucemia sin antecedentes previos de diabetes mellitus (DM) se observa en un alto porcentaje en pacientes de unidades de cuidado intensivo (UCI). Objetivo: Determinar el comportamiento de cifras de glucemia en pacientes no diabéticos con hiperglucemia mediante la administración de 2 micronutrientes. Metodología: se realizó un ensayo clínico a 32 pacientes, 16 en el grupo a intervenir y 16 en el grupo control. Al grupo intervenido se le administró desde su ingreso los micronutrientes vitamina D3 en dosis de 1.000 unidades internacionales (UI) y calcio en dosis de 1.000 mg cada 24 horas por un periodo de 72 horas. Resultados: no se observaron diferencias estadísticamente significativas en la glucemia de ingreso entre los grupos intervenidos y control (152,6 y 153,3 mg/dl respectivamente (p= 0,922), sin embargo a las 72 horas el comportamiento de las glucemias disminuyó significativamente en el grupo intervenido comparado con el grupo control (98,41 y 141,66 mg/dl respectivamente p= < 0,000). Así mismo, se evidenció que la intervención con vitamina D3 y Calcio redujo el riesgo (47%) de desarrollo del evento indeseado (glucemia > 100 mg/dl), mostrando que se deben tratar 2.29 pacientes para disminuir el evento indeseable (NNT). Conclusión: la utilización de los micronutrientes analizados en pacientes críticos sin diagnóstico previo de diabetes requiere de más investigaciones que contemplen las limitaciones aquí planteadas. Dada la poca literatura encontrada de estudios similares, esta investigación proporcionaría otra alternativa en la disminución de la hiperglucemia de éstos pacientes.

Comportamiento de cifras de glucemia con la administración de los micronutrientes vitamina D3 y calcio en pacientes no diabéticos con hiperglucemia en una unidad de cuidado intensivo de adultos / Behavior of blood glucose level with the administration of micronutrients vitamin d3 and calcium in nondiabetic patients with hyperglycemia in adult intensive care unit

La hiperglucemia sin antecedentes previos de diabetes mellitus (DM) se observa en un alto porcentaje en pacientes de unidades de cuidado intensivo (UCI). Objetivo: Determinar el comportamiento de cifras de glucemia en pacientes no diabéticos con hiperglucemia mediante la administración de 2 micronutrientes. Metodología: se realizó un ensayo clínico a 32 pacientes, 16 en el grupo a intervenir y 16 en el grupo control. Al grupo intervenido se le administró desde su ingreso los micronutrientes vitamina D3 en dosis de 1.000 unidades internacionales (UI) y calcio en dosis de 1.000 mg cada 24 horas por un periodo de 72 horas. Resultados: no se observaron diferencias estadísticamente significativas en la glucemia de ingreso entre los grupos intervenidos y control (152,6 y 153,3 mg/dl respectivamente (p= 0,922), sin embargo a las 72 horas el comportamiento de las glucemias disminuyó significativamente en el grupo intervenido comparado con el grupo control (98,41 y 141,66 mg/dl respectivamente p= < 0,000). Así mismo, se evidenció que la intervención con vitamina D3 y Calcio redujo el riesgo (47%) de desarrollo del evento indeseado (glucemia > 100 mg/dl), mostrando que se deben tratar 2.29 pacientes para disminuir el evento indeseable (NNT). Conclusión: la utilización de los micronutrientes analizados en pacientes críticos sin diagnóstico previo de diabetes requiere de más investigaciones que contemplen las limitaciones aquí planteadas. Dada la poca literatura encontrada de estudios similares, esta investigación proporcionaría otra alternativa en la disminución de la hiperglucemia de éstos pacientes (AU)

Hyperglycemia without previous history of diabetes mellitus (DM) is observed in a high percentage of patients in intensive care units (ICU). Objective: To determine the behavior of glycemia in nondiabetic patients with hyperglycemia by administering two micronutrients. Methods: A clinical trial was conducted in 32 patients, 16 in the intervention group and 16 in the control group. To the intervention group was given, since the admission, the micronutrients vitamin D3 in doses of 1.000 international units (IU) and calcium in doses 1.000 mg every 24 hours, for a period of 72 hours. Results: No significant differences were observed in blood glucose income between the intervention and control groups (152,6 and 153,3 mg / dl, respectively p = 0,922), but after 72 hours the behavior of the glycemia decreased significantly in the intervention group compared to the control group (98,41 and 141,6 mg / dl respectively p 100 mg/ dl), showing that 2,29 patients should be treated to decrease an undesirable event (NNT). Conclusion: The use of the analyzed micronutrients in critically ill patients with no previous diagnosis of diabetes requires more research that addresses te limitations posed here. Due to the limited literature found about similar studies, this investigation would provide another alternative for reducing hyperglycemia in these patients (AU)

Impact of vaccination against Haemophilus influenzae type b with and without a booster dose on meningitis in four South American countries.

To inform World Health Organization recommendations regarding use of Haemophilus influenzae type b (Hib) vaccines in national immunization programs, a multi-country evaluation of trends in Hib meningitis incidence and prevalence of nasopharyngeal Hib carriage was conducted in four South American countries using either a primary, three-dose immunization schedule without a booster dose or with a booster dose in the second year of life. Surveillance data suggest that high coverage of Hib conjugate vaccine sustained low incidence of Hib meningitis and low prevalence of Hib carriage whether or not a booster dose was used.

Esteatosis hepática y grasa corporal en pacientes coinfectados por los virus de la inmunodeficiencia humana y de la hepatitis C / Liver steatosis and body fat in patients coinfected by human immunodeficiency and hepatitis C virus

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Cytokines and lipid peroxidation in alcoholics with chronic hepatitis C virus infection.

A major cause of liver cirrhosis and hepatocarcinoma is chronic infection by hepatitis C virus. Ethanol consumption is the most significant environmental factor that exacerbates the progression of chronic hepatitis C to liver cirrhosis and hepatocarcinoma, perhaps due to increased cytokine secretion together with increased lipid peroxidation. In this study, we compare the intensity of lipid peroxidation (estimated as malondialdehyde (MDA) serum levels), the antioxidant status, (measured as glutathione peroxidase (GPX) and superoxide dismutase (SOD) activities in red blood cells), and levels of cytokines derived from Th1 cells (such as interferon gamma (IFNG)), Th2 cells (such as interleukin (IL)-4), Th3 cells (such as transforming growth factor beta (TGF-beta)), and IL-6, IL-8, and tumor necrosis factor (TNF)-alpha in patients affected by chronic hepatitis C virus infection, 26 drinkers of alcohol and 40 nondrinkers of alcohol. Patients showed significantly higher TNF-alpha (Z = 4.92, P < 0.001), IL-8 (Z = 4.95, P < 0.001), IFNG (Z = 2.81, P = 0.005), TGF-beta (t = 2.12, P = 0.037), MDA (Z = 5, P < 0.001), but lower IL-6 (Z = 3.61, P < 0.001) and GPX (F = 4.30, P < 0.05) than controls, whereas no differences were observed regarding IL-4 (Z = 0.35, P = 0.72), GPX and SOD activities. Alcoholics showed significantly higher TNF-alpha, but lower IL-4, MDA, and GPX, than nonalcoholics. TNF-alpha was significantly related to albumin and prothrombin activity, whereas TGF-beta was significantly related to MDA levels. Thus, cytokine secretion is altered in HCV infection. This alteration mainly consists of a stimulation of Th1 cytokines and an inhibition--or at least, no stimulation--of Th2 cytokines; these changes are especially marked among alcoholics with HCV infection, and are accompanied by raised TGF-beta.

Pro-inflammatory cytokines in stable chronic alcoholics: relationship with fat and lean mass.

Cytokines are mediators of the inflammatory response, secreted by many tissues, including adipocytes. Chronic alcoholic liver disease and alcoholic hepatitis are associated with elevated serum cytokine levels which yield prognostic value in this situation. Most studies have been performed in patients with acute alcoholic hepatitis. However, cytokine alterations in stable alcoholics have been less studied, as is also the case for the relationship between cytokines and fat and lean mass in these patients. The aim of the present study was to analyse the relationships between some proinflammatory serum cytokine levels and lean mass, fat mass, nutritional status, and liver function parameters in stable alcoholic patients. We determined serum TNF-alpha, interleukin (IL)-6, IL-8 and TNF receptor 2 (TNFr2) in 77 male alcoholic patients in a stable phase (before hospital discharge). In all patients we performed a total-body composition analysis (Hologic DEXA), nutritional assessment including body mass index, triceps skinfold, brachial perimeter, and assessment of liver function. Forty-two healthy volunteer health workers served as controls. IL-8, TNF-alpha and TNFr2 were significantly higher in patients than in controls. No differences were observed between patients and controls regarding fat mass, but alcoholics showed significantly decreased lean mass than controls. Only IL-6 was significantly related with body fat in patients with elevated IL-6 levels. Poor relationships were observed between lean mass and cytokines; some nutritional parameters showed inverse relationships with serum TNF, whereas TNF and IL-8 were inversely related with albumin and prothrombin activity. Thus, cytokine levels were elevated in stable alcoholic patients, and IL-6 levels showed significant correlation with body fat mass, raising the possibility that adipose tissue contributes to the persistence of high levels of cytokines in stable alcoholics.

[The economic costs of pneumonia in children under 2 years of age in Colombia]. / Costos económicos de las neumonías en niños menores de 2 años de edad, en Colombia.

OBJECTIVE: To analyze the costs of pneumonias presumed to be of viral or bacterial origin, as diagnosed by chest X ray, in four reference center hospitals in three cities in Colombia. METHODS: A total of 128 cases of pneumonia (64 bacterial cases and 64 viral cases) that had consecutively entered the hospitals in the study between July 2001 and January 2003 were investigated. The diagnosis of pneumonia was based on chest X rays. The study population was composed of children under 2 years of age who required hospitalization. In order to estimate the costs for bacterial pneumonias and viral pneumonias, the cost of each activity was determined for each case, and then average costs were calculated. RESULTS: The average cost of the presumably bacterial pneumonia cases was US $611.50 (95% confidence interval (95% CI), US $532.20-690.80); that of the presumably viral cases was US $472.20 (95% CI, US $331.80-612.60). The observed differences were due to direct expenses, especially drugs (antibiotics), special services, and diagnostic tests. In the two groups the families were similar in their incomes and the indirect costs that they had to bear, so the indirect costs were not considered relevant in terms of distinguishing between the costs caused by the two forms of pneumonia. CONCLUSIONS: The study found differences in the direct costs of care between the presumably bacterial cases and the presumably viral ones. The study results also gave an approximation of the indirect costs to the patients' families caused by the pneumonias. The differences found in the direct costs also indicate that X-ray diagnosis is useful for differentiating between viral and bacterial pneumonia. Few studies in Latin America have assessed the economic costs of pneumonia in children, so this study can serve as a reference for future research on the impact of interventions against pneumonia.

Effectiveness of Haemophilus influenzae type b vaccination against bacterial pneumonia in Colombia.

AIMS: To assess the effectiveness of a Hib vaccination program against X-ray defined bacterial pneumonia in children <2 years in Colombia. METHODS: 389 cases of radiologically confirmed pneumonia were recruited from hospitals in Bogota and Medellin, Colombia. Two controls per case, matched on age, sex, and socio-economic level, were selected from children attending child health services at the hospitals where pneumonia cases were admitted. RESULTS: The risk of having X-ray confirmed pneumonia decreased with each Hib dose received; the vaccine effectiveness was 47% (2-72%) among those receiving one dose; 52% for two doses received, and 55% for three doses. These effectiveness levels remained after adjusting for other factors associated with risk of pneumonia. CONCLUSIONS: This study indicates that trials may have underestimated the proportion of radiological pneumonia in the under 2s that is due to Hib. This suggests that the impact of the vaccination will be greater than expected if it can be extended to reach the poorest children, who are at the greatest risk.

Neurinoma laríngeo. Diagnóstico diferencial de tumoraciones submucosas laríngeas / Laryngeal neurinoma. Differential diagnosis of submucosal laryngeal tumors

El neurinoma laríngeo es un tumor benigno raro que se presenta como una masa submucosa generalmente supraglótica. Presentamos el caso de un paciente con disfonía de larga evolución causada por un neurinoma, mostrando los hallazgos radiológicos de este tumor y el valor de la Tomografía Computarizada (TC) en el diagnóstico de ésta y de otras lesiones submucosas laríngeas (AU)

Vólvulo de intestino medio: una rara causa de crisis oclusivas en el adulto / Midgut volvulus: a rare cause of episodes of intestinal obstruction in an adult

El vólvulo de intestino medio es una entidad bien reconocida en lactantes y niños pero infrecuente en el adulto. Presentamos un caso de malrotación intestinal, complicado con un vólvulo de intestino medio, en una mujer joven con dolor abdominal crónico intermitente de intensidad creciente. El diagnóstico radiológico se realizó principalmente con un estudio baritado gastrointestinal alto y se confirmó quirúrgicamente (AU)