Treatment and preliminary outcomes of 150 acute care patients with COVID-19 in a rural health system in the Dakotas.

The majority of available US-published reports present populations with community spread in urban areas. The objective of this report is to describe a rural healthcare system's utilisation of therapeutic options available to treat Coronavirus Disease 2019 (COVID-19) and subsequent patient outcomes. A total of 150 patients were treated for COVID-19 at three hospitals in the Dakotas from 21 March 2020 to 30 April 2020. The most common pharmacological treatment regimens administered were zinc, hydroxychloroquine plus azithromycin and convalescent plasma. Adjunctive treatments included therapeutic anticoagulation, tocilizumab and corticosteroids. As of 1 June 2020, 127 patients have survived to hospital discharge, 12 patients remain hospitalised and 11 patients have expired. The efficacy of hydroxychloroquine and azithromycin use has yet to be determined but was not without risks of corrected QT interval prolongation and arrhythmias in our cohort. We did not appreciate any adverse effects that appeared related to tocilizumab or convalescent plasma administration in those patient subsets. These findings may provide insight into disease severity and treatment options in the rural setting with limited resources to participate in clinical trials and encourage larger comparative studies evaluating treatment efficacy.

[Insomnia: prevalence in Cordoba city hospital]. / Insomnio: prevalencia en un hospital de la ciudad de Cordoba.

INTRODUCTION: Insomnia is a sleep disorder characterized by a deficient or poor quality sleep, with adverse daytime consequences. Prevalence is 30-50% in adults and can be associated with depression or lead to the development of this condition. Despite the high prevalence rates, is a unrecognized, misdiagnosis and undertreated. There is not much publications about its prevalence in patients with chronic diseases. OBJECTIVES: to determine prevalence and clinical characteristics of insomnia in outpatients with chronic diseases. MATERIALS AND METHODS: Prospective observational cross-sectional descriptive study. Insomnia was defined based on ICSD-2criteria. The data collection was performed by a questionnaire. RESULTS: We surveyed 100 patients who attended the consultation of various clinical specialties, mean age 50 years old, 57% were women. Sixty nine per cent of them met criteria for insomnia. The most prevalent diseases were hypertension: 57%, asthma 20%, diabetes: 18% and hypothyroidism: 17%. Among patients with insomnia, 62% were women, 35% had insomnia without another illness, and the remaining 65% had secondary conditions associated with insomnia (60% depression). 25% of patients consulting for insomnia ever. The prevalence of criteria for depression in outpatients with chronic diseases was 52%, amounting to 63% in patients suffering from insomnia. DISCUSSION: The prevalence of insomnia in patients with chronic diseases is high (in outpatients with chronic disease: 69%), higher than the average rate described in the general population. It is an undertreated condition. CONCLUSIONS: The prevalence of insomnia in patients with chronic diseases is high, it is underdiagnosed and undertreated. It is associated with depression in high rate.

Introducción: Insomnio es el trastorno caracterizado por sueño deficiente o de mala calidad con consecuencias diurnas adversas. La prevalencia es 30-50% en adultos y puede llevar al desarrollo de depresión. A pesar de las altas tasas de prevalencia es una entidad poco reconocida, subdiagnosticada y subtratada. Poco se ha publicado acerca de la prevalencia en pacientes con enfermedades crónicas. Objetivos: conocer prevalencia y características clínicas del insomnio en pacientes ambulatorios con enfermedades crónicas. Materiales y métodos: Estudio prospectivo descriptivo observacional de corte transversal. Se definió insomnio en base a los criterios del ICSD-2. La obtención de los datos se realizó por un cuestionario autoadministrado. Resultados: Encuestamos a 100 pacientes que acudieron a la consulta de diferentes especialidades clínicas, edad promedio 50 años. El 57% mujeres. El 69% cumplía criterios de insomnio. Las enfermedades más prevalente fueron HTA: 57%; asma: 20%, diabetes: 18% e hipotiroidismo: 17%. Entre los pacientes con insomnio, el 62% fueron mujeres, el 35 % lo presentaban de manera aislada y el restante 65% presentaba condiciones asociadas a insomnio secundario (el 60% presentaban depresión). La cuarta parte de los pacientes consultó por insomnio alguna vez. La prevalencia de criterios de depresión en los enfermos crónicos analizados fue de 52%, y asciende a 63% en los pacientes que padecen insomnio. Discusión: La prevalencia de insomnio en pacientes con enfermedades crónicas es alta, siendo en pacientes ambulatorios con enfermedades crónicas del 69%, muy superior a la media descripta en la población general. Es una entidad subtratada. Conclusiones: La prevalencia de insomnio en pacientes con enfermedades crónicas es alta, está subdiagnosticada y subtratada. Presenta una asociación significativa con depresión.

La anorexia nerviosa en la practica hospitalaria / Nerveous anorexia in hospital practice

El interes por los trastornos de la conducta alimentaria no cesa de acrecentarse. Esta atraccion refleja probablemente el aumento de frecuencia de la demanda de asistencia por estas afecciones

La anorexia nerviosa en la practica hospitalaria / Nerveous anorexia in hospital practice

El interes por los trastornos de la conducta alimentaria no cesa de acrecentarse. Esta atraccion refleja probablemente el aumento de frecuencia de la demanda de asistencia por estas afecciones

Relationship between EABR thresholds and levels used to program the CLARION speech processor.

The purpose of this study was 1) to describe the relationship between electrically evoked auditory brain stem response (EABR) thresholds and the behavioral measures needed to program the speech processor of the CLARION Multi-Strategy Cochlear Implant, and 2) to determine whether the relationship between EABR threshold and the behavioral levels used to program the Clarion device was correlated with the temporal integration abilities of these subjects. The EABR thresholds, psychophysical thresholds, and the Clarion speech processor programming levels were recorded from 29 postlingually deafened adults. The mean EABR thresholds approximated most comfortable levels (M levels) for the programming stimulus. However, intrasubject variability was substantial. Significant intrasubject variability in temporal integration also was observed. Correlations were found between the ability of a cochlear implant user to perform temporal integration and the relationship between his or her EABR threshold and the threshold for the programming stimulus.

p75 and TrkA neurotrophin receptors in human skin after spinal cord and peripheral nerve injury, with special reference to sensory corpuscles.

Human skin, including nerves and sensory corpuscles, displays immunoreactivity (IR) for low- (p75) and high-affinity (TrkA-like) receptors for nerve growth factor (NGF), the best characterized member of the family of neurotrophins. This study was designed to analyze the changes induced by spinal cord and peripheral nerve injuries in the expression of neurotrophin receptors in digital skin, with special reference to nerves and sensory corpuscles. Skin biopsy samples were obtained from 1) the hand and toes of normal subjects, 2) below the level of the lesion of patients with spinal cord injury affecting dorsal and lateral funiculi, 3) the cutaneous territory of entrapped peripheral nerves (median and ulnar nerves), and 4) the cutaneous territory of sectioned and grafted nerves (median nerve). The pieces were formalin-fixed and paraffin-embedded, cut in serial sections, and processed for immunohistochemistry using antibodies against human p75 and TrkA proteins. The percentage of sensory corpuscles displaying IR for p75 and TrkA-like, as well as the intensity of IR developed within them, was assessed using quantitative image analysis. Spinal cord severance causes a decrease in p75 IR in Meissner and Pacinian corpuscles, whereas TrkA-like IR did not vary. In other nonnervous tissues (i.e., epidermis, sweat glands), both p75 and TrkA-like IR was diminished or even absent. Similar but more severe changes were encountered in the skin from the territory of entrapped nerves. Finally, in subjects with sectioned-grafted nerves, p75 IR was found close to controls in nerves, reduced in Meissner corpuscles, and absent in the inner core of the Pacinian ones; TrkA-like IR was in the perineurium, a small percentage of Meissner corpuscles (about 7%), and the outer core and capsule of the Pacinan corpuscles. In the nonnervous tissues, p75 IR was practically absent, whereas TrkA-like IR did not change. No changes in the expression of neurotrophin receptors were observed in Merkel cells of the different groups. Present results show the following: 1) expression of nerve p75 IR in human cutaneous sensory corpuscles is sensitive to central deafferentation, to blockade or difficulty in axonal transport, and to disruption of axonal continuity independently of possible restoration of axonal integrity due to grafts; 2) expression of TrkA-like IR in nerves and sensory corpuscles is sensitive only to nerve transection; 3) the corpuscular Schwann-related cells are the only cells involved in the above modifications, the perineurial cells remaining unchanged; 4) the expression of p75 and TrkA-like IR by Merkel cells is independent of normal innervation; 5) an adequate innervation of the skin seems to be necessary for the expression of p75 but not TrkA-like in nonneuronal cells, especially in the epidermis. A role for NGF in the maintenance of epidermis integrity is discussed.

The role of medications in geriatric failure to thrive.

Geriatric failure to thrive (GFTT) is a syndrome associated with functional decline, depression and malnutrition. Adverse drug reactions are cited as one of the most common causes of GFTT. Two distinct drug-related issues should be considered. Firstly, failure to provide appropriate treatment for conditions such as anaemia, depression, nutritional deficiencies and pain may precipitate GFTT. Secondly, drug-induced functional decline and decreased nutrient intake may cause or contribute to the syndrome. Pharmacological intervention may include discontinuing potentially offending agents for a trial period, or drug treatment of anorexia and depression.

Innovative techniques in pediatric liver transplantation: reduced-, split- and living-donor related liver transplantation.

In spite of the increased number of organ donations, the amount of livers available for pediatric patients does not meet requirements. In an attempt to expand the pool of grafts, several techniques of size reduction (RST) have been developed: reduced-liver transplantation (RLT), liver segment transplantation (LST), "split" liver transplantation (SLT) and living-donor liver transplantation (LDLT). The aim of this work is to study the contribution of these techniques to reduction of mortality in the waiting list and the increased risks that we inflict to our patients by using these procedures. We report our experience on RST in the last nine years (23 RLT, 5 LST, 2 SLT and 3 LDLT). More than a half of them were performed in an emergency. Overall survival in children with RST (67%) is similar to that of patients receiving a "whole graft" (74%). We did not find significant differences in the incidence of graft-related complications, only reintervention for abdominal bleeding was needed more often in the RST group (30%) than in whole graft group (24%). Our data confirm the safety of the RST procedures in the pediatric liver transplantation programs and they decrease the waiting-list mortality (2.5%) among the pediatric patients.

Brain large neutral amino acids and catecholamines in parenterally nourished preterm rabbits.

Total parenteral nutrition (TPN) has been adapted as a standard for providing nutrition to ill term and preterm infants. The availability of tyrosine in amino acid preparations utilized for TPN is limited and may potentiate a tyrosine-deficient state. Phenlyalanine hydroxylase activity, responsible for catalyzing tyrosine synthesis, has been suggested to be decreased in fetal and neonatal animals. Parenterally nourished premature rabbits (n = 16) and suckled rabbits (n = 19) were studied in order to compare growth parameters and amino acids in the plasma and brain, as well as whole brain catecholamine concentrations. Influx velocities into the brain of amino acids were also determined in these two groups. The preterm rabbit's average birth weight (42.6 +/- 6.0) was less than that of term rabbits (56.7 +/- 8.7, P < 0.005). Significantly lower concentrations of the catecholamine precursor tyrosine were found in both the plasma and brain of the parenterally nourished animals compared to the suckled animals. Tyrosine is reduced in the brain in TPN-supported animals reflecting both low tyrosine intake and increased plasma concentrations of large neutral amino acids that compete for uptake at the blood-brain barrier. However, no difference was observed between the two groups in their brain catecholamine concentrations. The seven-day parenterally nourished rabbit appears to be tyrosine-deficient but no evident effects on brain catecholamine concentrations were seen. The effects and impact of a tyrosine-deficient state might better be evaluated by regional evaluation of catecholaminergic areas of the brain or over a longer period of parenteral nutrition.

Impact of a pharmacist on medication discontinuation in a hospital-based geriatric clinic.

The effect of a pharmacist on drug prescribing in a hospital-based geriatric clinic was studied. On July 1, 1987, a geriatric clinical pharmacist began participating in a geriatric ambulatory-care clinic at a Veterans Administration medical center. In this retrospective study, patients who had been seen at the clinic a minimum of every two months during both the control period (January 1 through June 30) and the study period (July 1 through December 31) were included. During the study period, the pharmacist reviewed each patient's medication profile and assessed whether drug dosages should be adjusted or medications should be discontinued. The pharmacist and the geriatrician who coordinated care at the clinic reviewed the cases before changes were made. The total number of prescription and nonprescription medications (excluding one-time orders for short-term therapy) was determined for each time period, as well as the average number of prescriptions per patient. Those drugs most frequently associated with adverse drug reactions (ADRs) in the elderly were analyzed separately. During the control period, the 72 patients in the study group received 414 prescriptions, 246 of which were for medications associated with ADRs in the elderly. During the study period, there was a 32% reduction in the total number of prescriptions; the number of medications associated with ADRs in the elderly was reduced by 42%. A direct cost savings of +3872, or +53.75 per patient, was realized over the six-month study period. The addition of a pharmacist to the staff of a hospital-based geriatric clinic resulted in a 32% reduction in the total number of medications prescribed.

Tratamiento de fistula vesicovaginal por metodos no quirurgicos. / Treatment of vesico-vaginal fistula by means non surgical methods

Se trataron conservadoramente tres pacientes con fistula vesicovaginal de 1 mm o menos de diametro, consecutivas a cirugia vaginal en un caso y a cirugia abdominal en dos. Las fistulas fueron corroboradas mediante instilacion de medio de contraste en vejiga, asi como por cistoscopia. La conducta terapeutica consistio en reposo absoluto contralateral al sitio de la fistula, taponamiento vaginal y drenaje libre de orina con sonda de Foley a permanencia durante 12 dias. Con este tratamiento se obtuvo remision completa de las manifestaciones clinicas y no hubo morbilidad, evitandose ademas el gran inconveniente de una segunda intervencion quirurgica

Some epidemiologic features of disasters in guatemala.

Epidemiological procedures can be organised under disaster conditions by means of a simple surveillance system and with few personnel. In the aftermath of the 4 February 1976 earthquake in Guatemala, an information system was organized by which the requisite information for decision-making was obtained with adequate speed and promptness. The initial epidemiologic informution was based on reports collected during the early days on symptoms observed at hospitals and health centers and in localities and villages in the stricken area. At a second, post-emergency stage a more elaborate surveillance system was instituted to provide guidance in the investigntwn of outbreaks, evaluate the health activities and establish basic criteria for preventive and control measures.