Presentation of fatal stroke due to SARS-CoV-2 and dengue virus coinfection.

Herein, we report a case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and dengue coinfection, presented as a fatal stroke in our hospital, in São José do Rio Preto, São Paulo State, a Brazilian city hyperendemic for dengue viruses and other arthropod-borne viruses (arboviruses) and currently facing a surge of SARS-CoV-2 cases. This case is the first described in the literature and contributes to the better understanding of clinical presentations of two important diseases in a tropical setting.

Disease burden and remaining unmet need in patients with haemophilia A treated with primary prophylaxis.

AIMS: There is evidence that people with haemophilia A still experience morbidity and functional limitation due to joint damage despite prophylaxis. This study aimed to compare their quality of life and work-related function with that of the general population and patients with osteoarthritis. METHODS: Data from the Cost of Haemophilia in Europe: a Socioeconomic Survey (CHESS) database were compared with published data from normative populations and patients with osteoarthritis in Europe and the United States. RESULTS: In the predominantly young (age 18-35 years) adult CHESS population treated with primary prophylaxis, about 30% reported a target joint; the average frequency of bleeds was one per year; half reported chronic pain. Levels of anxiety and depression were similar to those reported by people using on-demand treatment. Employment and productivity were lower than in the general population. The level of presenteeism (attending work with impairment) was comparable with that reported for a much older population with osteoarthritis who had more extensive joint damage and greater prevalence of pain. CONCLUSION: Compared with the general population, clinical outcomes and quality of life are indicated to be impaired for young adults whose haemophilia is managed by primary prophylaxis. Primary prophylaxis is not associated with lower levels of anxiety and depression than on-demand treatment, and pain is common. The level of presenteeism is comparable to that reported in people with osteoarthritis, an older population with more joint disease. Further studies are needed to fully assess the implications of compromised work performance among young adults with haemophilia as they seek to build a career.

Prevention of postoperative bleeding in hip fractures treated with prosthetic replacement: efficacy and safety of fibrin sealant and tranexamic acid. A randomised controlled clinical trial (TRANEXFER study).

INTRODUCTION: We assessed the efficacy of fibrin sealant (FS) and tranexamic acid (TXA) administered topically in patients with a hip fracture treated with prosthetic replacement. MATERIALS AND METHODS: Parallel, multicentre, open label, randomised, clinical trial. We compared three interventions to reduce blood loss: (1) 10 ml of FS, (2) 1 g of topical TXA, both administered at the end of the surgery, and (3) usual haemostasis (control group). The main outcome was blood loss collected in drains. Other secondary variables were total blood loss, hidden blood loss, transfusion rate, average hospital stay, complications, adverse events, and mortality. RESULTS: A total of 158 patients were included, 56 in the FS group, 52 in the TXA group, and 50 in the control group. The total amount of blood collected in drains was lower in the TXA group (148.6 ml, SD 122.7 in TXA; 168.2 ml, SD 137.4 in FS; and 201.5 ml, SD 166.5 in control group) without achieving statistical significance (p = 0.178). The transfusion rate was lower in the TXA group (32.7%), compared with FS group (42.9%) and control group (44.0%), without statistical significance (p = 0.341). There were no complications or adverse effects related to the evaluated interventions. CONCLUSIONS: The use of TXA and FS administered topically prior to surgical closure in patients with a sub-capital femoral fracture undergoing arthroplasty did not significantly reduce either postoperative blood loss or transfusion rate, compared with a group that only received usual haemostasis.

Permanencia del dispositivo intrauterino TCu 380A insertado después de algún procedmiento obstétrico / Stay of the TCU 380A IUD inserted after of the obstetric event

Resumen OBJETIVO: Determinar la permanencia del dispositivo intrauterino TCu 380A insertado después de algún procedimiento obstétrico efectuado a pacientes atendidas en el Hospital General Dr. Aurelio Valdivieso. MATERIAL Y MÉTODOS: Estudio transversal y descriptivo efectuado en pacientes que concluyeron el embarazo entre el 1 de octubre de 2016 y el 31 de marzo de 2017, en el Hospital General Dr. Aurelio Valdivieso y que aceptaron se les colocara el dispositivo intrauterino TCu 380A después de algún procedimiento obstétrico y antes de darlas de alta del hospital. Variables de estudio: cantidad de embarazos, terminación de estos, médico responsable de la colocación, técnica y permanencia. El análisis estadístico implementado fue el univariado. RESULTADOS: Se incluyeron 182 pacientes con media de edad de 23 años y límites de 14 y 43 años. En el seguimiento de la permanencia del dispositivo 42.3% (n = 77) se encontró in situ, 28.5% (n = 52) en mala posición, y 0.55% (n = 1) lo expulsó. CONCLUSIONES: La permanencia del dispositivo intrauterino parece tener una relación estrecha con la forma correcta de insertarlo y, desde luego, con la experiencia acumulada del médico. En las primeras inserciones el médico debe ser supervisado por otro de mayor experiencia o, simplemente, con la vigilancia de los médicos adscritos.

Abstract OBJECTIVE: To determine the permanence of the TCu 380A IUD inserted after the obstetric event in the Dr. Aurelio Valdivieso Hospital. MATERIAL AND METHODS: Cross-sectional and descriptive study carried out in patients who concluded their pregnancy, between October 1, 2016 and March 31, 2017, at the Dr. Aurelio Valdivieso General Hospital (Oaxaca, Mexico) and who accepted the placement of the TCu 380A intrauterine device during the postpartum period. and before discharge from the hospital. Study variables: number of pregnancies, termination of these, doctor responsible for the placement, technique and permanence. The statistical analysis implemented was univariate. RESULTS: The study was conducted in 182 patients with a mean age of 23 years, a minimum of 14 years and a maximum of 43 years. In the monitoring of the permanence of the IUD TCu 380A with 42.31% (77) was found in situ, 28.57% (52) in poor position, and 0.55% (1) was expelled. CONCLUSIONS: The permanence of the intrauterine device seems to have a close relationship with the correct way to insert it and, of course, with the accumulated experience of the doctor. In the first insertions the doctor must be supervised by another one of greater experience or, simply, with the surveillance of the assigned doctors.

Hereditary thrombophilia by factor V Leiden G1691A (heterozygous) and FII prothrombin G20210A (homozygous) mutations in a patient with ischemic cerebrovascular accident / Trombofilia hereditária por mutações G1691A do fator V Leiden (heterozigota) e G20210A do FII protrombina (homozigota) em paciente com acidente vascular cerebral isquêmico

ABSTRACT Mutations related to Factor V Leiden (G1691A) and prothrombin (G20210A) are associated with a significantly increased risk of venous thromboembolism. The identification of a patient affected by episodes of venous thromboembolism and carrier of G1691A (heterozygous) and G20210A (homozygous) polymorphisms was determined by molecular tests [real-time polymerase chain reaction (PCR) methodology, Genexpert system] during attendance at the Base Hospital of São José do Rio Preto-SP, Brazil.

RESUMO Mutações relacionadas com o fator V de Leiden (G1691A) e a protrombina (G20210A) estão associadas a um significativo aumento do risco de tromboembolismo venoso. Por meio da realização de exames moleculares [metodologia de reação em cadeia da polimerase (PCR) em tempo real, sistema Genexpert], em pacientes atendidos no Hospital de Base de São José do Rio Preto-SP, Brasil, foi determinada a identificação de uma paciente afetada por episódios de tromboembolismo venoso e portadora dos polimorfismos G1691A (heterozigota) e G20210A (homozigota).

Positively Selected Sites at HCMV gB Furin Processing Region and Their Effects in Cleavage Efficiency.

Human cytomegalovirus is a ubiquitous infectious agent that affects mainly immunosuppressed, fetuses, and newborns. The virus has several polymorphic regions, in particular in the envelope glycoproteins. The UL55 gene encodes the glycoprotein B that has a variable region, containing a furin cleavage site and according to the variability different genotypes are characterized. Here we investigated variability and existence of selective pressure on the UL55 variable region containing the furin cleavage site in 213 clinical sequences from patients worldwide. We showed the occurrence of positive selective pressure on gB codons 461 and 462, near the furin cleavage site. Cleavage analysis of synthesized peptides demonstrated that most mutations confer better cleavage by furin, suggesting that evolution is acting in order to increase the efficiency cleavage and supporting the hypothesis that gB processing is important in the host. We also demonstrated that peptides containing sequences, that characterize genotypes gB2 and 3, are differentially cleaved by furin. Our data demonstrate for the first time that variability in the cleavage site is related to degree of gB processing by furin.

The cost-effectiveness of 5-FU-SA in the treatment of actinic keratoses of the face and scalp in the UK secondary care setting.

OBJECTIVE: The objective of this analysis was to estimate the relative cost-effectiveness of Actikerall 1 (5-FU-SA) vs cryotherapy in a secondary care setting in the UK, for lesion-directed treatment in patients with actinic keratoses (AK) of the face and scalp. METHODS: The model was a simple decision tree, with a 6-month time horizon. The perspective was that of the UK National Health Service (NHS). Modeled treatment effects included reported per-patient histological clearance and recurrence rates. Cost inputs comprised professional consultation time and cost of medication. Health-related utility estimation followed previously published methodology. Adverse events were not modeled. The key data and model structural assumptions followed expected UK practice. One-way and probabilistic sensitivity analyses were conducted to assess structural and parameter uncertainty. RESULTS: 5-FU-SA was found to be less costly (-£204) and more effective (+0.001 QALY) in base case and sensitivity analyses. In the probabilistic analysis there was 100% probability of being cost-effective over cryotherapy at £20,000 willingness to pay. Cost of professional time was a key driver of the model outcome. 5-FU-SA remained dominant across a range of scenario analyses, including exploration of assumptions around setting of care. LIMITATIONS: The time horizon of the analysis was short and data were not extrapolated beyond the duration of the clinical trial; however, this approach is consistent with likely follow-up of an AK patient. The clinical outcomes observed in the trial were based on a large proportion of cryotherapy patients undergoing an additional cycle of treatment; this may not occur or be required in an experienced secondary care setting. CONCLUSION: 5-FU-SA could be considered as a cost-effective choice for treatment of AK lesions of the face and scalp in secondary and mixed care settings in the UK. Use of 5-FU-SA in patients who would otherwise be managed with cryotherapy has the potential to result in cost savings.

Bilateral Forearm Transplantation in Mexico: 2-Year Outcomes.

BACKGROUND: Patients with proximal forearm and arm transplantation have obtained and/or maintained function of the elbow joint and full active range of motion of the extrinsic muscles of the hand, but with diminished protective sensibility and a lack of good function of the intrinsic muscles. These patients have improved function, as measured by the Disabilities of the Arm, Shoulder and Hand questionnaire. METHODS: We report the case of a 52-year-old man who suffered a high-voltage electrical burn requiring amputation of his upper limbs. He underwent bilateral proximal forearm transplantation in Mexico City in May 2012. RESULTS: At 2-year follow-up, immunosuppressive treatment has not led to metabolic, oncologic, or infectious complications. Keloid scars developed at the graft-recipient interface. There have been 4 acute rejections: the fourth was treated with methylprednisolone, rituximab, and immunoglobulin. Chronic rejection has not been detected. The extrinsic muscles of the wrist and digits have good function. Although the intrinsic muscles demonstrated electrical activity 15 months postoperatively, clinically, they are nonuseful. After 2 years, hand function is sufficient to allow the patient to grasp lightweight and medium-sized objects. The patient's Disabilities of the Arm, Shoulder and Hand questionnaire score improved from 50.00 points to 30.83 points, and his Hand Transplantation Score System rating is good, at 69/73 (right/left) of 100. The patient and his family are very satisfied with the functional and aesthetic outcomes. CONCLUSIONS: Upper arm or proximal forearm transplantation is a reconstructive option for patients who have experienced amputation because of trauma.

Cost-effectiveness of Sativex in multiple sclerosis spasticity: new data and application to Italy.

Multiple sclerosis (MS) is a chronic progressive disease that carries a high socioeconomic burden. Spasticity (rigidity and spasms) is common in MS and contributes to MS-related disability. This study aims to evaluate the cost-effectiveness of Sativex(®) (9-delta-tetrahydrocannabinol plus cannabidiol oromucosal spray) when used as add-on therapy for management of resistant MS-related spasticity in the context of the Italian healthcare system. A previously published Markov model-based analysis for the German and Spanish context was replicated, adapting it to the Italian setting. Model parameters were updated to reflect recent findings about MS-related spasticity and use of Sativex in daily clinical practice. The base case incremental cost-effectiveness ratio for Sativex use in Italy over a 5-year period was estimated to be €4968 per quality-adjusted life-year gained (year of costing: 2013). Sativex remained an efficient option in the Italian healthcare context - below the commonly accepted incremental threshold of €30,000 per quality-adjusted life-year gained - when deterministic and probabilistic sensitivity analyses were conducted. Sativex can be regarded as a cost-effective treatment option for patients with MS-related spasticity in Italy.

Detecção dos anticorpos regulares abo maternos em recém-nascidos pelo método de tipagem sangüínea reversa estendida até fase de antiglobulina humana / Detection of the mother's abo regulars antibodies in newborns by the reverse blood typing

Neste estudo foram definidos os índices de detecção dos anticorpos regulares ABO maternos em recém-nascidos pelo método de tipagem sangüínea reversa estendida até fase de antiglobulina humana (TRAGH) e a relação destes resultados com os achados de outras metodologias envolvidas no diagnóstico da incompatibilidade materno-fetal pelo sistema ABO (IABO). Foram colhidasamostras sangüíneas para análise imuno-hematológica de 38 recém-nascidos com tipo sangüíneo A ou B, apresentando até 30 dias de vida (sem conhecimento prévio dos fenótipos ABO maternos) e realização dos testes de tipagem ABO direta, TRAGH, Coombs direto e eluato-LUI, visando detectar anti-A e/ou anti-B. Os resultados demonstraram que a TRAGH efetuou a detecção dos anticorpos regulares ABO maternos na maioria das amostras analisadas nas quais foram confirmados os casos de IABO (09 de 15 amostras), constituindo-se, mediante a análise conjunta com os demais dados imuno-hematológicos, em um útil parâmetro laboratorial na adequação imunológica do hemocomponente ao receptor ena confirmação diagnóstica de IABO.

In this study were defined the exponents of the detection of mother’s ABO regulars antibodies in newborns by the reverse blood typing extend up to stage of the antihuman globulin method (RTAGH) and the relacion this results with the faind other methods include in the diagnosis of the ABO maternal-fetal incompatibility (IABO). Samples of blood were picked for immunohematology analysis from 38 newborns with the blood type A our B , with until 30 days of life ( without previous knowing of the ABO mother’s types) and make of the ABO typing direct, RTAGH, Coombs direct and elution by freezing tests, purposing the detection of the anti-A and/our anti-B. The results demonstrate with the RTAGH maked the detection of the mother’s ABO regulars antibodies in the most samples analyses with the were confirmated the cases of the IABO (09 of 15 samples), constitute, trough the completeness analyse with too much tests immunohematology, in the useful laboratory information in the imunology adjust of the hemocomponent to the pacient and in the diagnosis of IABO confirmation.

PREVALÊNCIA DE HIPERTENSÃO ARTERIAL EM POPULAÇÃO ADULTA DA UBSF ZONA URBANA DO MUNICÍPIO TACURU/MS

A hipertensão arterial sistêmica (HAS) está definida como a pressão sanguínea de valor igual ou superior a 140/90 mmHg para um adulto jovem. As doenças do aparelho circulatório estão em primeiro lugar como causa de morte no mundo, seguidas pelas neoplasias, causas externas e doenças do aparelho respiratório. Dentre as doenças do aparelho circulatório, as isquêmicas e o infarto agudo do miocárdio são as principais causas de mortalidade, seguidas das hipertensivas, evidenciando as doenças cardiovasculares como problema primordial de saúde pública do Brasil. Os objetivos do trabalho foram Promover o acompanhamento e adesão ao tratamento anti-hipertensivo pelo paciente na ESF Nair Maria Bressan, zona urbana, município de Tacuru/MS; identificar fatores de risco mais frequentes que influem na Hipertensão arterial da população estudada e estabelecer estratégias de prevenção contra a doença. A abrangência da UBSF é responsável pela cobertura de 1.143 famílias, totalizando 4.573 pessoas dentre os quais 2.563 são adultos e destes 438 (17,1%) cadastrados por Hipertensão arterial. A intervenção foi realizada por meio de Oficinas temáticas com os Hipertensos cadastrados e acompanhados na ESF. Na população estudada houve predomínio do sexo feminino (61,2%). Os riscos mais frequente associado à patologia foram o tabagismo, a dislipidemia e não realização de exercícios físicos. Conscientização de equipe de saúde do trabalho integral em todos os espaços de intervenção com a participação do individuo, família e fatores comunidade. Conclui-se que é necessário à adesão do paciente ao tratamento, já que a HAS é uma doença crônica.