Cardiac function in bronchiolitis: Not only a right ventricle matter.

OBJECTIVES: Extrapulmonary manifestations of bronchiolitis have been previously studied, with some identifying right ventricle (RV) diastolic/systolic dysfunction. We hypothesized that severe cases of bronchiolitis would have cardiac dysfunction resulting an increase in N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) values and worse outcomes. Therefore, the objective was to evaluate the existence of cardiac dysfunction and to determine its association with severe bronchiolitis. METHODS: This prospective cohort study included children hospitalized for bronchiolitis under 1-year old between January 2019 and March 2020. At admission, an echocardiography was performed and plasma levels of NT-proBNP were measured. To analyze outcomes, the cohort was divided into two groups based on the need for positive pressure respiratory support (PPRS), and both were compared to healthy infants. STATISTICS: bivariant analysis, significant differences p < 0.05. RESULTS: One hundred eighty-one patients were included; median age was 2 months. Seventy-three patients required PPRS. Compared to controls, patients requiring PPRS showed worse RV systolic function, with lower tricuspid annular-plane systolic excursion (p = 0.002) and parameters of worse right and left diastolic function (trans-tricuspid E and A wave [p = 0.004 and p = 0.04, respectively] and tricuspid tissue doppler imaging [TDI] e' [p = 0.003], trans-mitral E and mitral TDI a' [p = 0.02 and p = 0.005, respectively]). An NT-ProBNP greater than 3582 pg/dl predicts the need for longer necessity of PPRS in patients younger than 2 months. CONCLUSIONS: In addition to the expected RV systolic dysfunction, patients with severe bronchiolitis have parameters of global diastolic worse function possibly secondary to intrinsic myocardial involvement. NT-ProBNP values at admission had strong discriminatory power to predict worse outcomes.

Association Between Anxiety Level, Eating Behavior, and Nutritional Status in Adult Women.

Objective: During menopause there appear hormonal changes that have an impact on physiological aspects, such as weight gain, and psychological ones, such as the presence of anxiety, which could affect eating behavior. The study objective is to assess the association between anxiety level and eating behavior as well nutritional status in adult woman.Materials and methods: A descriptive, observational, cross-sectional study was conducted on women (aged 40-65 years). A sociodemographic and lifestyle survey was performed. Anxiety was determined by the State-Trait Anxiety Inventory (STAI) and eating behavior (EB) through the Three Factor Food Questionnaire (TEFQ-R18). Nutritional status was measured considering body mass index (BMI) and waist circumference (WC). Statistical analysis was performed through SPSS 19.0.Results: One hundred twenty-eight women were included, 20.3% at the premenopausal stage and 79.7% at the postmenopausal stage. No association was found between biological stage and nutritional status (p = 0.61) or WC (p = 0.57). State anxiety was experienced by 26.6% of the women and trait anxiety by 53.9% of them; there were no significant differences according to biological stage or nutritional status. The median values of emotional eating (EE), uncontrolled eating (UE), and cognitive restraint eating (CRE) were 5.0 (4.0-7.0), 16.0 (13.0-21.0) and 14.0 (10.0-17.0), respectively, being higher in premenopausal women, whereas there were no significant differences on biological stage. Clinically detectable state anxiety was associated with EE (p = 0.035), UE (p = 0.002), and CRE (p = 0.004), and trait anxiety only with UE (p = 0.016) and EE (p = 0.001). However, anxiety and nutritional status were not related.Conclusions: Anxiety was associated to eating behavior, although it was not related to nutritional status.

Uso de pantallas en niños pequeños en una ciudad de Argentina / Screen use among young children in a city of Argentina

La utilización de dispositivos móviles se ha generalizado en las familias, en todas las clases sociales y desde edades tempranas. Objetivos: Evaluar el uso de pantallas fijas y móviles en niños pequeños, el tiempo dedicado a actividades infantiles tradicionales y su relación con el nivel educativo materno. Material y métodos: Diseño descriptivo, transversal. Población: niños de 6 meses a 5 años atendidos en Río Cuarto, Córdoba, de julio a septiembre de 2016. Variables: demográficas, ingreso familiar, edad de comienzo, frecuencia de uso, minutos diarios, otras actividades. Resultados: Se incluyeron 160 encuestas; 99% de los hogares tenía televisión y 98,75%, smartphones. Promedio de aparatos electrónicos: 5,68; los de menores ingresos: 5,1 (DE 1,57); y los de mayores ingresos: 6,32 (DE 1,18) (p = 0,0000). Antes de los 2 años, 80,3% de los niños miraba televisión y 37,4% utilizaba pantallas táctiles con ayuda. Entre 2 y 4 años, 38,7% utilizaba pantallas sin ayuda. El 93% de los niños miró televisión y el 56% utilizó pantallas móviles con mucha frecuencia. Miraron un promedio de 75,6 minutos diarios de televisión y utilizaron otras pantallas 31,3 minutos; la lectura ocupó 20,4 minutos. Las madres con estudios terciarios dedicaron más tiempo a la lectura de libros que las que tenían estudios secundarios o primarios (análisis de la varianza: p = 0,00007). Conclusiones: El equipamiento tecnológico de los hogares es prácticamente universal; la exposición de los niños a las pantallas es temprana. La televisión es más utilizada, pero las pantallas móviles ocupan un tiempo importante. Las madres con estudios superiores dedican más tiempo a la lectura.

The use of mobile devices has become ubiquitous in the family, across all social strata, and from an early age.Objectives: To assess the use of mobile and fixed screens among young children, the time spent doing traditional childhood activities, and the relationship to the maternal level of education. Material and methods: Descriptive, cross-sectional design. Population:Children aged 6 months to 5 years seen in Río Cuarto, Córdoba, between July and September 2016. Outcome measures: Demographics, family income, age at initiation, frequency of use, daily minutes, other activities. Results: 160 surveys were included; 99% of households had a TV and 98.75%, a smartphone. Average number of electronic devices: 5.68; among lower income households: 5.1 (standard deviation [SD]: 1.57); and among higher income households: 6.32 (SD: 1.18) (p = 0.0000).By the age of 2, 80.3% of children watched TV and 37.4% used touchscreen devices with help. Between 2 and 4 years old, 38.7% used screens without help.Also, 93% of children watched TV and 56% used mobile screens very frequently. Children watched TV for an average of 75.6 daily minutes and used other screens for 31.3 minutes, whereas reading only accounted for 20.4 minutes. Mothers who had completed tertiary education spent more time reading books than those who had completed primary or secondary education (analysis of variance: p = 0.00007). Conclusions: Household technological equipment is practically universal; children's exposure to screens starts at an early age. TV is the most commonly used screen although mobile screens take up a significant time. Mothers who had completed higher education spent more time reading.

Screen use among young children in a city of Argentina. / Uso de pantallas en niños pequeños en una ciudad de Argentina.

INTRODUCTION: The use of mobile devices has become ubiquitous in the family, across all social strata, and from an early age. OBJECTIVES: To assess the use of mobile and fixed screens among young children, the time spent doing traditional childhood activities, and the relationship to the maternal level of education. MATERIAL AND METHODS: Descriptive, crosssectional design. POPULATION: Children aged 6 months to 5 years seen in Río Cuarto, Córdoba, between July and September 2016. OUTCOME MEASURES: Demographics, family income, age at initiation, frequency of use, daily minutes, other activities. RESULTS: 160 surveys were included; 99% of households had a TV and 98.75%, a smartphone. Average number of electronic devices: 5.68; among lower income households: 5.1 (standard deviation [SD]: 1.57); and among higher income households: 6.32 (SD: 1.18) (p = 0.0000). By the age of 2, 80.3% of children watched TV and 37.4% used touchscreen devices with help. Between 2 and 4 years old, 38.7% used screens without help. Also, 93% of children watched TV and 56% used mobile screens very frequently. Children watched TV for an average of 75.6 daily minutes and used other screens for 31.3 minutes, whereas reading only accounted for 20.4 minutes. Mothers who had completed tertiary education spent more time reading books than those who had completed primary or secondary education (analysis of variance: p = 0.00007). CONCLUSIONS: Household technological equipment is practically universal; children's exposure to screens starts at an early age. TV is the most commonly used screen although mobile screens take up a significant time. Mothers who had completed higher education spent more time reading.

INTRODUCCIÓN: La utilización de dispositivos móviles se ha generalizado en las familias, en todas las clases sociales y desde edades tempranas. OBJETIVOS: Evaluar el uso de pantallas fijas y móviles en niños pequeños, el tiempo dedicado a actividades infantiles tradicionales y su relación con el nivel educativo materno. MATERIAL Y MÉTODOS: Diseño descriptivo, transversal. POBLACIÓN: niños de 6 meses a 5 años atendidos en Río Cuarto, Córdoba, de julio a septiembre de 2016. VARIABLES: demográficas, ingreso familiar, edad de comienzo, frecuencia de uso, minutos diarios, otras actividades. RESULTADOS: Se incluyeron 160 encuestas; 99% de los hogares tenía televisión y 98,75%, smartphones. Promedio de aparatos electrónicos: 5,68; los de menores ingresos: 5,1 (DE 1,57); y los de mayores ingresos: 6,32 (DE 1,18) (p = 0,0000).Antes de los 2 años, 80,3% de los niños miraba televisión y 37,4% utilizaba pantallas táctiles con ayuda. Entre 2 y 4 años, 38,7% utilizaba pantallas sin ayuda. El 93% de los niños miró televisión y el 56% utilizó pantallas móviles con mucha frecuencia. Miraron un promedio de 75,6 minutos diarios de televisión y utilizaron otras pantallas 31,3 minutos; la lectura ocupó 20,4 minutos. Las madres con estudios terciarios dedicaron más tiempo a la lectura de libros que las que tenían estudios secundarios o primarios (análisis de la varianza: p = 0,00007). CONCLUSIONES: El equipamiento tecnológico de los hogares es prácticamente universal; la exposición de los niños a las pantallas es temprana. La televisión es más utilizada, pero las pantallas móviles ocupan un tiempo importante. Las madres con estudios superiores dedican más tiempo a la lectura.

Behçet's disease departs the 'Silk Road': a case report and brief review of literature with geographical comparison.

Behçet's disease (BD) is a chronic multisystem inflammatory disease most prevalent in Eastern Asia and along the Mediterranean basin, an area referred to as the 'Silk Road'. The diagnosis of BD is largely based on the International Study Group (ISG) criteria, which are more specific than sensitive. ISG criteria do not include intestinal manifestations, a feature more commonly seen in the West. Intestinal BD is one of several findings that are not typically seen along the 'Silk Road'. Herein we report a rare case of intestinal BD and compare Western versus traditional BD. A 25-year-old male with a history of painful oral aphthous ulcers, pericarditis, and diffuse papulopustular rash presented to the emergency department with two terminal ileal perforations. Pathology demonstrated mucosal necrosis with active inflammation and no chronic inflammatory changes. Post-surgical laboratory studies showed an elevated c-reactive protein of 35.57 mg/dL, erythrocyte sedimentation rate of 82 mm/h, and a positive anti-Saccharomyces cerevisiae antibody. Rheumatological workup including ANA, RF, PR3 antibody, MPO antibody, ANCA, SSA and SSB, Smith antibody, SCL-70, and anti-Jo-1 antibodies were all negative. His pericarditis symptoms improved with colchicine and prednisone prior to discharge. Our patient did not meet the current ISG criteria for traditional BD; however, he clearly showed findings typically seen in Western patients with BD, which include intestinal manifestations, cardiac involvement, and lack of pathergy reaction and ocular changes. Our investigation demonstrates that the clinical manifestations common to this disorder vary among geographic and ethnic populations. Commonly used criteria for the diagnosis of BD may not be sensitive for some populations, such as Western BD, potentially leading to underdiagnoses and mismanagement. Recognition and select inclusion of these differences may be one way to assist with diagnosing Western BD in the future. As our knowledge of BD continues to evolve, so must the population-specific criteria used to define BD.

Therapeutic options for the management of pancreatic cancer.

Since its initial characterization, pancreatic ductal adenocarcinoma has remained one of the most devastating and difficult cancers to treat. Pancreatic cancer is the fourth leading cause of death in the United States, resulting in an estimated 38460 deaths annually. With few screening tools available to detect this disease at an early stage, 94% of patients will die within five years of diagnosis. Despite decades of research that have led to a better understanding of the molecular and cellular signaling pathways in pancreatic cancer cells, few effective therapies have been developed to target these pathways. Other treatment options have included more sophisticated pancreatic cancer surgeries and combination therapies. While outcomes have improved modestly for these patients, more effective treatments are desperately needed. One of the greatest challenges in the future of treating this malignancy will be to develop therapies that target the tumor microenvironment and surrounding pancreatic cancer stem cells in addition to pancreatic cancer cells. Recent advances in targeting pancreatic stellate cells and the stroma have encouraged researchers to shift their focus to the role of desmoplasia in pancreatic cancer pathobiology in the hopes of developing newer-generation therapies. By combining novel agents with current cytotoxic chemotherapies and radiation therapy and personalizing them to each patient based on specific biomarkers, the goal of prolonging a patient's life could be achieved. Here we review the most effective therapies that have been used for the treatment of pancreatic cancer and discuss the future potential of therapeutic options.

Presynaptic calcium stores modulate afferent release in vestibular hair cells.

Hair cells, the mechanoreceptors of the acoustic and vestibular system, are presynaptic to primary afferent neurons of the eighth nerve and excite neural activity by the release of glutamate. In the present work, the role played by intracellular Ca2+ stores in afferent transmission was investigated, at the presynaptic level, by monitoring changes in the intracellular Ca2+ concentration ([Ca2+]i) in vestibular hair cells, and, at the postsynaptic level, by recording from single posterior canal afferent fibers. Application of 1-10 mm caffeine to hair cells potentiated Ca2+ responses evoked by depolarization at selected Ca2+ hot spots, and also induced a graded increase in cell membrane capacitance (DeltaCm), signaling exocytosis of the transmitter. Ca2+ signals evoked by caffeine peaked in a region located approximately 10 microm from the base of the hair cell. [Ca2+]i increases, similarly localized, were observed after 500 msec depolarizations, but not with 50 msec depolarizations, suggesting the occurrence of calcium-induced calcium release (CICR) from the same stores. Both Ca2+ and DeltaCm responses were inhibited after incubation with ryanodine (40 microm) for 8-10 min. Consistent with these results, afferent transmission was potentiated by caffeine and inhibited by ryanodine both at the level of action potentials and of miniature EPSPs (mEPSPs). Neither caffeine nor ryanodine affected the shape and amplitude of mEPSPs, indicating that both drugs acted at the presynaptic level. These results strongly suggest that endogenous modulators of the CICR process will affect afferent activity elicited by mechanical stimuli in the physiological frequency range.