Synthetic cathinones and cardiotoxicity risks.

Abstract: Recently, there has been a worldwide rise in the popularity and abuse of synthetic cathinones. The spectrum of side effects caused by the intake of these drugs of abuse is very wide since they act on different systems with various mechanisms of action, they appear to be involved in different cardiac events, including myocardial infarction and sudden cardiac death due to fatal arrhythmias. Overall, khat users have a higher risk of death, recurrent myocardial ischemia, cardiogenic shock, ventricular arrhythmia, and stroke compared with non-khat user.

Is the issue of Chemsex changing?

In this letter, which is meant as a response to the letter titled "Sex enhancers: challenges, threats and the need for targeted measures", the Authors discuss the evolution of Chemsex phenomenon towards at least two directions: firstly, the use of psychoactive and non-psychoactive substances usually implicated in Chemsex, such as GHB/GBL, ketamine, mephedrone and other synthetic cathinones and erectile dysfunction medications, is currently accompanied by the use of illicit opioids, which have recently been indicated as a new serious health threat for consumers. In addition, as reported by the last European Drug report, the simultaneous use of illicit benzodiazepines with non-medical opioids misuse has also been observed. Secondly, strictly linked to the rising use of non-medical opioids is the risk of transition towards heroine followed by the adoption of risky injection practices frequently accompanied by high-risk sexual behaviors. In this sense, the current definition of the phenomenon as "the voluntary intake of certain psychoactive and non- psychoactive drugs in the context of sex parties and sexual intercourses with the intention of facilitating and/or enhancing the sexual encounter mostly among men who have sex with other men (MSM)" has been expanded to "heterosexual chemsex".

Defining palliative care in cystic fibrosis: A Delphi study.

BACKGROUND: The goal of palliative care is to improve quality of life for people with serious illness. We aimed to create a cystic fibrosis (CF)-specific definition of palliative care. METHODS: A working group of 36 CF care providers, researchers, palliative care providers, quality improvement experts, individuals with CF, and CF caregivers completed a series of questionnaires to rate the value of each of 22 attributes of palliative care, rank top attributes to construct definitions of palliative care, and then rate proposed definitions. RESULTS: An average of 28 participants completed each of four questionnaires, with consistent distribution of stakeholder roles across questionnaires. Many identified overlaps in routine CF care and palliative care and highlighted the importance of a definition that feels relevant across the lifespan. CONCLUSION: Modified Delphi methodology was used to define palliative care in CF. The definition will be used as the foundation for development of CF-specific palliative care guidelines.

La práctica de actividad física en personas mayores del Valle del Paraíba, São Paulo, Brasil / Prática de atividade física entre idosos do Vale do Paraíba, São Paulo, Brasil

La inactividad física en las personas mayores a menudo se deriva de las limitaciones socio-culturales, en lugar de una discapacidad. Así, este estudio tiene como objetivo caracterizar el perfil de los adultos mayores que participan en el Centro de Convivencia de Ancianos (CCI). Estudio descriptivo, transversal, de carácter exploratorio, cuantitativo, desarrollado en los Centros Sociales para la Tercera Edad en el Valle del Paraíba. La población de estudio se caracterizó por el predominio de mujeres, con edad media de 72 años, de etnia autodeclarada blanca, madres solteras, con educación primaria incompleta y ocupación manual especializada. Según los datos recogidos, se observa que la actividad física mejora la vida de las personas mayores, no sólo por las condiciones físicas, sino sobre todo porque ocasiona la vuelta o el mantenimiento de sus actividades sociales, que son la base de su bienestar emocional (AU)

(Physical inactivity in the elderly often stems from socio-cultural constraints, rather than a disability. Thus this study aims to characterize the profile of seniors who participate in the Elderly Community Centre. Descriptive study, cross-sectional, exploratory, quantitative approach developed in the Social Centers for the Elderly in the Paraíba Valley. The study population was characterized by the predominance of women, average age 72 years, the ethnic self-declared white color, single mothers with incomplete primary education and specialized manual occupation. According to the data collected, we can see that physical activity changes to better the lives of the elderly, not only for the physical conditions, but mainly because it leads to the return or retention of their social activities, that support for welfare these emotional (AU)

O sedentarismo no idoso advém muitas vezes de imposições sócio-culturais, mais do que de uma incapacidade funcional. Desta forma este estudo tem o objetivo de caracterizar o perfil dos idosos que participam do Centro de Convivência do Idoso (CCI). Estudo do tipo descritivo, transversal, exploratório, de abordagem quantitativa, desenvolvida nos Centros de Convivência para Idosos no Vale do Paraíba. A população estudada caracterizou-se pelo predomínio de mulheres, com idade média de 72 anos, de etnia de cor auto declarada branca, solteiras, de ensino fundamental incompleto e ocupação manual especializada. De acordo com os dados coletados, podem observar que a atividade física muda para melhor a vida do idoso, não só para as condições físicas, mas principalmente porque ocasiona o retorno ou a manutenção de suas atividades sociais, que dão suporte para o bem-estar emocional destes(AU)

Propofol en perfusión continua en niños en estado crítico / Continuous propofol perfusion in critically ill children

Objetivo: Describir la sedación con perfusión continua de propofol en niños en estado crítico. Diseño: Estudio observacional descriptivo retrospectivo. Ámbito: Unidad de cuidados intensivos pediátricos. Pacientes: Pacientes que requirieron sedoanalgesia entre el 1 de octubre de 2009 y el 30 de septiembre de 2010.Intervenciones: Ninguna. Variables recogidas: Demográficas, clínicas, de laboratorio, diagnóstico, tratamiento, complicaciones y evolución de cada paciente. Se analizaron los posibles efectos adversos asociados a la administración de propofol, comparando el grupo de pacientes a los que se les administró con el resto de los niños críticos. Resultados: Recibieron propofol en perfusión continua 71 de los 222 pacientes recogidos (32%). Los fármacos sedoanalgésicos más utilizados fueron el midazolam, seguido del fentanilo y del propofol. La dosis media de propofol fue de 2,1mg/kg/h [desviación estándar (DE) 1,3, rango: 0,5-6)] y la duración media de 6,7 días (DE 8,5; rango: 0,5-40). La edad media fue de 45,8 meses (mediana 24; rango intercuartil: 7-65), siendo el 52% varones. Ningún paciente presentó síndrome de infusión por propofol ni otros efectos adversos graves. Los pacientes tratados con propofol presentaron con mayor frecuencia algunas alteraciones analíticas que el resto, pero no se demostró relación causa efecto con la administración del fármaco. No existieron diferencias significativas en los niveles de lactato ni en la incidencia de infecciones entre ambos grupos. Conclusión: el propofol a una dosis de 1 a 4mg/kg/h puede utilizarse como un fármaco alternativo para la sedación de mantenimiento en los niños críticamente enfermos. Sin embargo son necesarios más estudios que valoren su eficacia y seguridad (AU)

Objective To describe sedation with continuous perfusion of propofol in critically ill children. Design A retrospective, descriptive observational study was carried out. Setting A pediatric intensive care unit. Patients Pediatric patients requiring sedoanalgesia between October 1, 2009 and September 30, 2010. Interventions None. Data collected Demographic, clinical and laboratory test variables, diagnosis, treatment, complications and evolution in each patient. In addition, the potential adverse effects associated with propofol administration were analyzed. Results: Midazolam, fentanyl and propofol were the most commonly used sedative and analgesic drugs. Seventy-one out of 222 patients (32%) received propofol in continuous infusion. The average dose was 2.1mg/kg/h (SD 1.3, range: 0.5 to 6), and the average duration of treatment was of 6.7 days (SD 8.5 range 0.5-40). Fifty-two percent were males, and the mean patient age was 45.8 months (median: 24; interquartile range: 7-65). No patient developed propofol infusion syndrome or other serious drug-related adverse effects. Patients treated with propofol showed more abnormal laboratory test findings, although no relationship to drug administration could be demonstrated. There were no significant differences in lactate level or in the incidence of infection in either group. Conclusions: Propofol at a dose of 1 to 4mg/kg/h is a safe alternative for sustained sedation in critically ill children. However, further studies are needed to assess its effects and safety profile (AU)

[Continuous propofol perfusion in critically ill children]. / Propofol en perfusión continua en niños en estado crítico.

OBJECTIVE: To describe sedation with continuous perfusion of propofol in critically ill children. DESIGN: A retrospective, descriptive observational study was carried out. SETTING: A pediatric intensive care unit. PATIENTS: Pediatric patients requiring sedoanalgesia between October 1, 2009 and September 30, 2010. INTERVENTIONS: None. DATA COLLECTED: Demographic, clinical and laboratory test variables, diagnosis, treatment, complications and evolution in each patient. In addition, the potential adverse effects associated with propofol administration were analyzed. RESULTS: Midazolam, fentanyl and propofol were the most commonly used sedative and analgesic drugs. Seventy-one out of 222 patients (32%) received propofol in continuous infusion. The average dose was 2.1 mg/kg/h (SD 1.3, range: 0.5 to 6), and the average duration of treatment was of 6.7 days (SD 8.5 range 0.5-40). Fifty-two percent were males, and the mean patient age was 45.8 months (median: 24; interquartile range: 7-65). No patient developed propofol infusion syndrome or other serious drug-related adverse effects. Patients treated with propofol showed more abnormal laboratory test findings, although no relationship to drug administration could be demonstrated. There were no significant differences in lactate level or in the incidence of infection in either group. CONCLUSIONS: Propofol at a dose of 1 to 4 mg/kg/h is a safe alternative for sustained sedation in critically ill children. However, further studies are needed to assess its effects and safety profile.

Bilateral lung transplantation for pediatric idiopathic pulmonary arterial hypertension: a multi-center experience.

Many children with idiopathic pulmonary arterial hypertension (IPAH) experience disease progression despite advanced medical therapy. In these children, heart-lung or bilateral lung transplantation (BLTx) remain the only therapeutic options when other treatments fail. Data on functional outcome after BLTx in children with IPAH are limited. We report a multi-center experience of BLTx for pediatric IPAH. We performed a retrospective study including 25 centers within the International Pediatric Lung Transplant Collaborative. Children with IPAH who underwent BLTx were included (1996-2006). Twenty-three children underwent BLTx for IPAH, most of whom were in WHO class III or IV level of function pre-transplantation. At 6 months post-transplantation, 82% of children reported improvement in level of function to WHO class I. The median FEV(1) was 89% (12-126) of predicted at 12 months post-transplantation. Ten patients (44%) developed BOS at a median of 42 months (3-85), of whom five died at a median of 27 months (4-86) post-transplantation. Overall mortality was 4% at 3 months post-transplantation. The median survival for children in this cohort was 45 months (2-123). Our data suggest that BLTx is a valuable therapeutic option for children with end-stage IPAH with outcomes comparable to that after heart-lung transplantation in children with pulmonary arterial hypertension or those patients undergoing lung transplantation for other indications. In the majority of children, a good cardiopulmonary function is possible following BLTx, making BLTx a good therapeutic option and maximizing donor organ utilization by allowing more hearts to be available for children needing cardiac transplantation.

Respiratory viral infections within one year after pediatric lung transplant.

To characterize epidemiology and risk factors for respiratory viral infections (RVI) in pediatric lung transplant recipients within the first post-transplant year, a retrospective multicenter study of pediatric lung transplant recipients from 1988 to 2005 was conducted at 14 centers in the United States and Europe. Data were recorded for 1 year post transplant. Associations between RVI and continuous and categorical risk factors were assessed using Wilcoxon's rank-sum and chi(2) tests, respectively. Associations between time to RVI and risk factors or survival were assessed by multivariable Cox proportional hazards models. Of 576 subjects, 79 subjects (14%) had 101 RVI in the first year post transplant. Subjects with RVI were younger than those without RVI (median ages 9.7, 13; P<0.01). Viruses detected included adenovirus (n=25), influenza (n=9), respiratory syncytial virus (n=21), parainfluenza virus (n=19), enterovirus (n=4), and rhinovirus (n=22). In a multivariable model for time to first RVI, etiology other than cystic fibrosis (CF), younger age, and no induction therapy were independently associated with risk of RVI. Cytomegalovirus serostatus and acute rejection were not associated with RVI. RVI was independently associated with decreased 12-month survival (hazard ratio 2.6, 95% confidence interval 1.6-4.4). RVI commonly occurs after pediatric lung transplantation with risk factors including younger age and non-CF diagnosis. RVI is associated with decreased 1-year survival.

Lung transplantation in infants and toddlers from 1990 to 2004 at St. Louis Children's Hospital.

In a retrospective, single-center cohort study, outcomes of infants and toddlers undergoing lung transplant at St. Louis Children's Hospital between 1990 and 2004 were compared to older children. Patients with cystic fibrosis (exclusively older children) and those who underwent heart-lung, liver-lung, single lung or a second transplantation were excluded from comparisons. One hundred nine lung transplants were compared. Thirty-six were in infants <1 year old, 26 in toddlers 1-3 years old and 47 in children >3 years old. Graft survival was similar for infants and toddlers (p = 0.35 and p = 0.3, respectively) compared to children over 3 years old at 1 and 3 years after transplant. Significantly more infants (p < 0.0001 and p = 0.003) and toddlers (p = 0.002 and p = 0.03) were free from acute rejection and bronchiolitis obliterans compared to older patients. While most infants and toddlers had only minimal lung function impairment, and achieved normal to mildly delayed developmental scores, somatic growth remained depressed 5 years after transplant. Lung transplantation in infants and young children carries similar survival rates to older children and adults. Further insights into the unique immunologic aspects of this group of patients may elucidate strategies to prevent acute and chronic rejection in all age groups.

American Society of Transplantation executive summary on pediatric lung transplantation.

Lung transplantation in children poses distinctly different challenges from those seen in the adult population. This consensus statement reviews the experience in the field of pediatric lung transplantation and highlights areas that deserve further investigation.

An automated tool for face recognition using visual attention and active shape models analysis.

An entirely automated approach for the recognition of the face of a people starting from her/his images is presented. The approach uses a computational attention module to find automatically the most relevant facial features using the Focus Of Attentions (FOA) These features are used to build the model of a face during the learning phase and for recognition during the testing phase. The landmarking of the features is performed by applying the active contour model (ACM) technique, whereas the active shape model (ASM) is adopted for constructing a flexible model of the selected facial features. The advantages of this approach and opportunities for further improvements are discussed.

A multi-facets analysis of the driver status by EEG and fuzzy hardware processing.

In the paper, EEGs are used to perform a multi facets analysis of the driver status. The EEG tracks, taken by means of electrodes installed in a basket dressed by the driver, are processed by a fuzzy model consisting of rules able to predict possible temporary driver attention deficit due to stress or disease conditions. The driving behavior is evaluated in real time by a hardware fuzzy processing. The possibility of taking into account different facets of the driver status is claimed to give rise to a driver control system with good safety and predictive features.

Analysis of early deaths after isolated lung transplantation.

STUDY OBJECTIVES: To determine the causes of death in patients dying within 30 days after lung transplantation at the University of Florida, to assess the importance of several diagnostic modalities for determining the causes of their decline, and to construct an algorithm for the evaluation of patients with severe respiratory compromise occurring early after lung transplantation. DESIGN: Retrospective review of medical records and pathology slides from all patients dying within 30 days after lung transplantation, and biopsy specimen diagnoses from all lung allograft recipients at the University of Florida. PATIENTS: Nine deaths occurred during the first 30 days after transplantation among 117 patients undergoing 123 isolated lung transplantation operations. RESULTS: Infections accounted for the greatest number of deaths (bacterial pneumonia, four patients; catheter-related bacteremia, one patient). Persistent pneumonia confirmed by biopsy specimen was usually accompanied by histologic manifestations of acute cellular rejection and was associated with poor patient outcome (ie, death or subsequent development of bronchiolitis obliterans syndrome). In two patients, antibody-mediated rejection either was the immediate cause of death (hyperacute rejection, one patient) or preceded a fatal case of pneumonia (accelerated antibody-mediated rejection, one patient). Other causes of death included hypoxic-ischemic encephalopathy secondary to an intraoperative cardiac arrest (one patient), pulmonary venous thrombosis with bacterial colonization of the thrombotic material (one patient), and ischemic reperfusion injury (one patient). In most patients, more than one type of diagnostic technique was needed to ascertain the cause of the catastrophic decline. CONCLUSIONS: The causes of early posttransplant death in our patient group included infections, antibody-mediated rejection, hypoxic-ischemic encephalopathy secondary to cardiac arrest, pulmonary venous thrombosis, and ischemic reperfusion injury. Because these processes often demonstrate overlapping clinical and morphologic features requiring multiple diagnostic techniques for resolution, a systematic multimodality approach to diagnosis is advantageous for determining the causes of decline in individual patients and for estimating the incidences of the different causes of early graft and patient loss in the lung transplant population.

Cystic fibrosis in three children with bronchopulmonary dysplasia.

Cystic fibrosis (CF) and bronchopulmonary dysplasia (BPD) are two common causes of chronic lung disease in children. Patients with BPD or CF often have recurrent respiratory symptoms, failure to thrive, and/or metabolic alkalosis during infancy and childhood. Thus, recognizing the diagnosis of CF in an infant with BPD can be difficult. We present three infants with both BPD and CF. The infants shared a history of respiratory distress and prolonged oxygen requirements. All three also had difficulty gaining weight, even after pancreatic enzyme supplementation was instituted. Metabolic alkalosis was observed in two infants. Previous studies in children with CF suggest that early diagnosis may impact both lung health and nutritional status. A high index of suspicion is necessary for clinicians to identify these children early and intervene with appropriate therapy.

Intravenous ribavirin and hyperammonemia in an immunocompromised patient infected with adenovirus.

Ribavirin is a synthetic guanosine analog with activity against DNA and RNA viruses. It was studied in human trials, and no marked adverse effect was reported beyond the potential for teratogenicity and reversible mild anemia. An 8-year-old girl received a multivisceral transplant and developed adenoviral pneumonia. She was treated with intravenous ribavirin and became hyperammonemic. Discontinuation of ribavirin led to a decrease in ammonia levels. This pattern was repeated when the drug was restarted and discontinued. We hypothesize that in a toxic environment the interaction of ribavirin with hepatocellular mitochondrial enzymes may lead to hyperammonemia.

Cytokine mRNA profiles in Epstein-Barr virus-associated post-transplant lymphoproliferative disorders.

Cytokine mRNA patterns were analyzed in 11 post-transplant lymphoproliferative disorder (PTLD) specimens using qualitative reverse-transcriptase polymerase chain reaction (RT-PCR). In each case, a pattern of IL2-, IFN gamma-, IL4+, IL10+ was seen. A similar pattern was observed in a spleen sample from 1 patient with contemporaneous PTLD elsewhere. Semiquantitative RT-PCR for cytokine message was performed using RNA from bronchoalveolar lavage (BAL) specimens obtained from 2 patients with pulmonary PTLD. In both cases, IL4 message predominated. Reduction of message coincided with resolution of the tumors. The pattern differed from that seen in 1 patient with acute pulmonary rejection, in which RT-PCR of BAL cells showed predominance of IL6 and IFN gamma. We conclude that at least some PTLDs exist within a T-helper cell type 2 (Th2)-like cytokine microenvironment. The presence of a similar mRNA pattern in an extratumoral specimen at the time of PTLD suggests that it may reflect a systemic phenomenon. Disappearance of this pattern following PTLD resolution indicates its dynamic nature and is consistent with the hypothesis that specific cytokines contribute to the development of PTLDs.