Exploratory study on gastrostomy in patients with neurological diseases: usefulness and impact.

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is a useful intervention for patients with impaired swallowing and a functional gastrointestinal system. Neurological diseases that cause neuromotor dysphagia, brain tumors, and cerebrovascular disease are the most frequent indications; complications are rare, and morbidity and mortality rates are low. OBJECTIVE: To describe the usefulness of PEG in patients with neurological diseases, and its impact on care, survival, and costs and benefits. MATERIAL AND METHODS: We performed a retrospective observational study, reviewing clinical files of patients hospitalised at the National Institute of Neurology and Neurosurgery (years 2015-2017) who underwent PEG placement. RESULTS: The sample included 51 patients: 62.7% were women and the mean (SD) age was 54.4 (18.6) years (range, 18-86). Diagnosis was tumor in 37.3% of cases and cerebrovascular disease in 33.3%. Sixteen patients (33.3%) died and 11 presented minor complications. The PEG tube remained in place for a mean of 9.14 months; in 52.9% of patients it was removed due to lack of improvement and/or tolerated oral intake, with removal occurring after a mean of 5.1 (4.4) months. Among patients' family members, 78.4% reported a great benefit, 43.1% reported difficulty caring for the PEG, and 45.1% reported complicated care in general. The monthly cost of maintaining the PEG was €175.78 on average (range, 38.38-293.45). DISCUSSION AND CONCLUSIONS: This preliminary study reveals that PEG was well indicated in patients with neurological diseases, with survival rates similar to those reported in other studies with long follow-up periods. In patients with cerebrovascular disease, the PEG tube remained in place a mean of 9.14 months, during recovery of swallowing function; however, the cost is high for our population.

Estudio exploratorio sobre gastrostomía en pacientes con enfermedades neurológicas: utilidad e impacto / Exploratory study on gastrostomy in patients with neurological diseases: usefulness and impact

Introducción: La gastrostomía endoscópica percutánea (GEP) es útil para personas con problemas de la vía oral con viabilidad de la vía gástrica. Las enfermedades neurológicas que producen disfagia neuromotora, tumores cerebrales y enfermedad vascular cerebral son las que tienen mayor indicación; las complicaciones son escasas y baja la morbimortalidad. Objetivo: Describir la utilidad de la GEP en pacientes con enfermedades neurológicas y el impacto en el cuidado, sobrevida y coste-beneficio. Material y métodos: Estudio observacional retrospectivo, mediante revisión de expedientes clínicos de pacientes hospitalizados en el Instituto Nacional de Neurología y Neurocirugía (años 2015-2017) que se realizó GEP. Resultados: Se incluyeron 51 pacientes: 62,7% mujeres, edad promedio 54,4 ± 18,6 años (rango; 18 a 86). Diagnósticos: tumor del SNC 37,3% y EVC 33,3%. Mortalidad 33,3% (16 pacientes): 11 presentaron complicaciones menores. Permanencia de la GEP: promedio 9,14 meses. Al 52,9% se le retiró por mejoría y/o toleró la VO, con tiempo promedio 5,1 ± 4,4 meses. El 78,4% de los familiares reportó gran beneficio, el 43,1% percibió difícil el cuidado de la GEP y el 45,1% refirió complicado el cuidado en general. El coste de mantener la GEP mensual fue de 175,78 € en promedio (rango de 38,38 a 293,45 €). Discusión y conclusiones: Este primer estudio revela que la GEP fue bien indicada en pacientes con enfermedades neurológicas, con sobrevida similar a la reportada en otras investigaciones con seguimiento prolongado. En pacientes con EVC la permanencia de la GEP fue de 9,14 meses en promedio, por recuperación de la vía oral; sin embargo, el coste es elevado para nuestra población. (AU)

Introduction: Percutaneous endoscopic gastrostomy (PEG) is a useful intervention for patients with impaired swallowing and a functional gastrointestinal system. Neurological diseases that cause neuromotor dysphagia, brain tumors, and cerebrovascular disease are the most frequent indications; complications are rare, and morbidity and mortality rates are low. Objective: To describe the usefulness of PEG in patients with neurological diseases, and its impact on care, survival, and costs and benefits. Material and methods: We performed a retrospective observational study, reviewing clinical files of patients hospitalised at the National Institute of Neurology and Neurosurgery (years 2015-2017) who underwent PEG placement. Results: The sample included 51 patients: 62.7% were women and the mean (SD) age was 54.4 (18.6) years (range, 18-86). Diagnosis was tumor in 37.3% of cases and cerebrovascular disease in 33.3%. Sixteen patients (33.3%) died and 11 presented minor complications. The PEG tube remained in place for a mean of 9.14 months; in 52.9% of patients it was removed due to lack of improvement and/or tolerated oral intake, with removal occurring after a mean of 5.1 (4.4) months. Among patients’ family members, 78.4% reported a great benefit, 43.1% reported difficulty caring for the PEG, and 45.1% reported complicated care in general. The monthly cost of maintaining the PEG was €175.78 on average (range, 38.38-293.45). Discussion and conclusions: This preliminary study reveals that PEG was well indicated in patients with neurological diseases, with survival rates similar to those reported in other studies with long follow-up periods. In patients with cerebrovascular disease, the PEG tube remained in place a mean of 9.14 months, during recovery of swallowing function; however, the cost is high for our population. (AU)

Caractéristiques de l'automédication en ORL à l'Hôpital d'Instruction des Armées-Cotonou au Bénin / Characteristics of self-medication in ENT at Military Teaching Hospital Cotonou in Benin

Etudier l'ampleur et les caractéristiques de l'automédication en consultation ORL. Méthode: Etude descriptive du 1er juin 2020 au 1er février 2021 dans le service d'ORL-CCF/ Hôpital d'Instruction des Armées. Ont été inclus tous les patients reçus en consultation ORL ayant déclaré avoir utilisé des substances actives sans prescription médicale pour soulager leur plainte actuelle. 6 Résultats: L'automédication a été retrouvée chez 373 patients soit une prévalence de 47,88%. La moyenne d'âge était 32,26 ans (02 mois et 80 ans). Les sujets âgés 0 à 20 étaient plus représenté (68,4%). La sex-ratio était de 0,86. Les professions libérales étaient plus représentées (30%). La quasi-totalité des patients (98%) a pu énumérer au moins deux effets nocifs de l'automédication. Les médicaments en cause étaient les médicament en vente libre OTC (80%). Les principales raisons ayant motivé l'automédication ont été le coût élevé des prestations médicales (41,3%) et le manque de temps (33,2%). Conclusion: L'automédication a été retrouvée chez des patients volontiers jeunes, de sexe féminin, porteurs d'affections rhinologiques. Les OTC étaient en cause dans huit cas sur dix. Les principales motivations à l'automédication ont été le coût élevé des prestations médicales et le manque de temps.

Quality of life in patients with multiple sclerosis and its association with depressive symptoms and physical disability.

OBJECTIVE: The aim of this work was to evaluate the quality of life of patients with multiple sclerosis and its association with depressive symptoms and physical health. METHOD: A total of 117 patients clinically diagnosed with Multiple Sclerosis (MS) were studied. The MSQOL-54 scale was applied. The depressive symptoms were assessed using the Beck Depression Inventory (BDI), while degree of physical disability was evaluated with the EDSS (Expanded Disability Status Scale). The results of these last two instruments were associated with MSQOL-54 to determine its influence on the perception of quality of life. RESULTS: We evaluated 65 women (56%) and 52 men (44%), with a mean age of 35 years, a mean age of 27 years at the time of diagnosis, and a mean evolution of 8 years. 88% of the patients showed the relapsing-remitting subtype; 42% had paid employment; 29% of the studied patients required help to perform daily activities; 75% took disease-modifying medications. They obtained on average a score of 3.62 ±â€¯2.30 on the EDSS and 11.5 ±â€¯9.21 on the BDI. The general average in MSQOL-54 was 64.67 ±â€¯17.52. CONCLUSIONS: Quality of life, in patients with multiple sclerosis is an issue that worries health personnel, it is essential to implement strategies for reducing the impact of the disease on patients' lives, mainly through the application of programs aimed to decrees depression and improve social support.

Exploratory study on gastrostomy in patients with neurological diseases: usefulness and impact. / Estudio exploratorio sobre gastrostomía en pacientes con enfermedades neurológicas: utilidad e impacto.

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is a useful intervention for patients with impaired swallowing and a functional gastrointestinal system. Neurological diseases that cause neuromotor dysphagia, brain tumors, and cerebrovascular disease are the most frequent indications; complications are rare, and morbidity and mortality rates are low. OBJECTIVE: To describe the usefulness of PEG in patients with neurological diseases, and its impact on care, survival, and costs and benefits. MATERIAL AND METHODS: We performed a retrospective observational study, reviewing clinical files of patients hospitalised at the National Institute of Neurology and Neurosurgery (years 2015-2017) who underwent PEG placement. RESULTS: The sample included 51 patients: 62.7% were women and the mean (SD) age was 54.4 (18.6) years (range, 18-86). Diagnosis was tumor in 37.3% of cases and cerebrovascular disease in 33.3%. Sixteen patients (33.3%) died and 11 presented minor complications. The PEG tube remained in place for a mean of 9.14 months; in 52.9% of patients it was removed due to lack of improvement and/or tolerated oral intake, with removal occurring after a mean of 5.1 (4.4) months. Among patients' family members, 78.4% reported a great benefit, 43.1% reported difficulty caring for the PEG, and 45.1% reported complicated care in general. The monthly cost of maintaining the PEG was €175.78 on average (range, 38.38-293.45). DISCUSSION AND CONCLUSIONS: This preliminary study reveals that PEG was well indicated in patients with neurological diseases, with survival rates similar to those reported in other studies with long follow-up periods. In patients with cerebrovascular disease, the PEG tube remained in place a mean of 9.14 months, during recovery of swallowing function; however, the cost is high for our population.

A comparison of morphokinetic markers predicting blastocyst formation and implantation potential from two large clinical data sets.

PURPOSE: To demonstrate whether the standard morphokinetic markers used for embryo selection have a similar relationship to blastocyst formation and implantation in two large clinical data sets. METHODS: This is a retrospective cohort analysis striving to answer two distinct questions utilizing data sets from two large IVF clinics. Blastocysts (BL) and implanted blastocysts (I) in both clinics, IVI-Valencia (BL = 11,414, I = 479) and WMC (BL = 15,902; I = 337), were cultured in a time-lapse system (EmbryoScope, Vitrolife, Sweden). The study was designed to assess the relationship between early morphokinetic hallmarks and BL development, with a secondary analysis of implantation rates following single-embryo day 3 and day 5 transfers. RESULTS: We performed a detailed graphical analysis for t3, t5, duration of the second cell cycle (cc2) (t3-t2), and the ratio (t5-t3)/(t5-t2). The t5 timing was not affected between the clinics. However, Weill Cornell Medicine's (WCM) proportions were significantly affected by having BL vs. not. A significant decrease of blastocysts with longer t5 in WCM data, while t5 was more informative in the IVI data set for the implantation rate. CONCLUSIONS: Morphokinetic intervals for early cleavages were distributed differently between the clinics. Incorporation of embryo-selection algorithms depends on the individual clinic's selected developmental hallmarks, all of which must be validated before incorporation into clinical practice.

Active middle-ear implant fixation in an unusual place: clinical and audiological outcomes.

OBJECTIVE: The Vibrant Soundbridge is an active middle-ear implant for hearing rehabilitation that is usually placed in the long process of the incus or round window. This study reports on the unusual implant attachment to the short process of the incus in a patient with ear malformation, and describes their audiological and clinical outcomes. METHODS: Case report and literature review. RESULTS: Audiological evaluation with the Vibrant Soundbridge implant showed a pure tone average of 31 dB. The speech test, at 65 dB HL, revealed correct recognition of 92 per cent of disyllabic words. The Glasgow Hearing Aid Benefit Profile showed high levels of satisfaction, hearing aid use and benefit. CONCLUSION: Fixation of the Vibrant Soundbridge implant on the short process of the incus is a feasible option, with good clinical and audiological outcomes. Coupling the floating mass transducer to the short process of the incus is a good surgical option, especially when the long process and the oval or round window are inaccessible.

Rheology and dynamic light scattering of octa-ethyleneglycol-monododecylether/chitosan solutions.

In this work we used rheometry and DLS to probe relaxation phenomena in solutions of chitosan and octa-ethyleneglycol-monododecylether. The dispersions had a marked pseudoplastic behavior, which became less evident, as surfactant concentration was increased. Arrhenius plots showed that systems with surfactant presented a characteristic temperature at which apparent enthalpy of activation (varying from 3 to 40 kJ mol(-1)) changed: this change was correlated to a possible transition of colloidal aggregates to a wormlike configuration. DLS intensity correlation functions were described by KWW equation: pure chitosan solutions had relaxation rate distributions centered at a characteristic relaxation rate around 4.6×10(-6) µS(-1); as surfactant was added, a new component, with a faster characteristic relaxation rate with a magnitude order of 10(-3) µs(-1), appeared. It was shown that the dependence between these relaxation rates and surfactant concentration could be used to describe DLS-related relaxation phenomena as an Arrhenius-activated process, agreeing with results obtained using rheometry.

Occlusal contact in children with Temporomandibular Disorders. A pilot study.

AIM: The aim of the present study was to perform a comparative analysis of occlusal contact points in children with and without signs and symptoms of Temporomandibular Disorders (TMD). STUDY DESIGN: Cross-sectional study. One hundred fifty children between 6 and 14 years of age were evaluated using the Helkimo questionnaire and a clinical exam. The occlusal contact points in each child were recorded during maximal intercuspation with the aid of carbon strips. Digital photographs were taken of the upper and lower arches before and after recording the occlusal contacts. The number of contact points between sides were compared and recorded on individual charts (occlusograms). STATISTICS: Student's t-test and Pearson's chi-square test were used for the statistical analysis, with the level of significance set at 0.05, which revealed no statistically significant differences between genders. The Student's t-test revealed a statistically significant difference in the mean number of occlusal contact points between the participants with and without TMD, with a higher number of contact points among those without TMD. There was no significant difference between sides. RESULTS The results of this study show a difference in the number of occlusal contact points in centric occlusion between children with and without TMD. CONCLUSION Regardless of the degree of severity, the number of occlusal contact points is lower among children with TMD.

Determination of deacetylation degree of chitosan: a comparison between conductometric titration and CHN elemental analysis.

Chitosan is a polysaccharide used in a broad range of applications. Many of its unique properties come from the presence of amino groups in its structure. A proper quantification of these amino groups is very important, in order to specify if a given chitosan sample can be used in a particular application. In this work, a comparison between the determination of chitosan degree of deacetylation by conductometry and CHN elemental analysis was carried out, using a rigorous error analysis. Accurate expressions relating CHN composition, conductometric titration, and degree of deacetylation, in conjunction with their associated errors, were developed and reported in this note. Error analysis showed conductometric analysis as an inexpensive and secure method for the determination of the degree of deacetylation of chitosan.

Neurotropism and neuropathological effects of selected rhabdoviruses on intranasally-infected newborn mice.

Viral neurotropism is the ability of viruses to infect neuronal cells. This is well studied for herpesviruses, rabies-related viruses, and a few others, but it is poorly investigated among almost all arboviruses. In this study, we describe both the neurotropism and the neuropathological effects of Amazonian rhabdoviruses on the brains of experimentally infected-newborn mice. Suckling mice were intranasally infected with 10(-4) to 10(-8) LD50 of viruses. Animals were anaesthetized and perfused after they had become sick. Immunohistochemistry using specific anti-virus and anti-active caspase three antibodies was performed. All infected animals developed fatal encephalitis. Survival time ranged from 18 h to 15 days. Viruses presented distinct species-dependent neurotropism for CNS regions. Histopathological analysis revealed variable degrees of necrosis and apoptosis in different brain regions. These results showed that viruses belonging to the Rhabdoviridae family possess distinct tropism for CNS structures and induce different pattern of cell death depending on the CNS region.

Biomonitoring of trace metal contamination in the Potengi estuary, Natal (Brazil), using the oyster Crassostrea rhizophorae, a local food source.

The oyster Crassostrea rhizophorae was collected in September 1997 from 10 stations along the Potengi estuary, Natal, Brazil, a mangrove-lined estuary receiving anthropogenic inputs of trace metals. C. rhizophorae is a net accumulator of trace metals and can be used as a biomonitor, the accumulated soft tissue concentrations representing integrated records of bioavailable metal fractions over the life of the oyster. Significant differences in oyster accumulated concentrations (and hence bioavailabilities) of Fe, Zn, Cu, Cr, Pb, Cd, Ni and Ag (but not Mn) were found between stations, and attributed to anthropogenic inputs including discharges of sewage and industrial effluent. The oysters are also a local food source, and concentrations of zinc, copper and lead in some of the oysters are above typical public health recommended limits.

[Physician-patient communication in oncology]. / Comunicação médico doente em oncologia.

The authors analyse the problems of doctor/patient communication in Oncology with a particular incidence on the matter of diagnosis information. In a short theoretical review on the subject are debated the reasons that lead to an unbalanced power in doctor/patient relation, ships. It is pointed a general view of medical attitude along the last 25 years in several countries concerning diagnosis information and cultural differences, among other aspects. The AA seek to foresee reasons that may lead to a change on this matter. The medical class has been questioned about it's attitude on the diagnosis information of cancer. For that purpose a questionnaire was made and 80 doctors of HUC and CHC were interviewed. From the results the AA consider it is to be noted the following: 59% of the colleagues interviewed usually don't reveal the whole truth about the diagnosis; -Fear of patient's emotional reactions, is the most frequent reason to not to inform; There's the feeling among doctors that the knowledge of the truth has commonly a positive effect on doctor/patient relations.

Continuous venous oximetry for hemodynamic and oxygen transport stability post cardiac surgery.

Under the diagnostic-related group (DRG) reimbursement system, hospitals are looking to decrease costs related to unnecessary laboratory measurements. To assess the efficacy of continuous SvO2 as the only means to monitor the balance of the oxygen transport of the stable postoperative cardiac patient in the ICU, we studied 26 adult patients undergoing cardiac surgery with an uneventful postoperative course. All subjects had an Opticath fiberoptic PA catheter inserted for 29.6. +/- 11.0 hours (range 16-66) and spent an average of 42.4 +/- 17.5 hours in the Intensive Care Unit (range 20-87). Cardiac output, and Hemoglobin/Hematocrit were determined serially every 2 hours during the first 6 postoperative hours and 4 hours respectively according to our ICU practice. Arterial blood gases were determined freely in relation to changes in the hemodynamic and respiratory status. No clinical decisions were undertaken on the basis of SvO2. Retrospectively it was determined whether basing decisions on the SvO2 would have reduced the number of unnecessary cardiac outputs, ABGs and Hgb/Hcts. Using the SvO2 as potential indicator of hemodynamic and oxygen transport stability it could significantly reduce the number of determinations per patient, ie, cardiac output (11.7 +/- 4.2 vs 2.1 +/- 0.3, p less than 0.05), ABGs (11.3 +/- 2.8 vs 2.8 +/- 0.4, p less than 0.05) and Hgb/Hcts (5.7 +/- 1.3 vs 2.0 +/- 0.0, p less than 0.05). The use of SvO2 would save the hospital $84.5 +/- 27.5 (range 31.5 +/- 140.9) per stable patient in the ICU and a total of 220.4 +/- 69.9 minutes (range 90-300) of ICU nursing time.(ABSTRACT TRUNCATED AT 250 WORDS)

Isoflurano associado à hipocapnia em anestesia para neurocirurgia / Isoflurane combined with hypocapnia in neurosurgical patients

foi utilizado o isoflurano, associado a hipocapnia, na anestesia em 20 pacientes submetidos a procedimentos neurocirúrgicos, com média etária de 51,8 ñ 16,1 anos e média ponderal de 67,4 ñ 20,2 Kg. A anestesia foi induzida com tiopental-fentanil-pancurônio e, após intubaçäo orotraqueal, foi mantida com isofluorano em concentraçöes adequadas para conservar a PAM entre 50 e 100 mmHg (6,66 e 13,33 KPa). Manteve-se ventilaçäo controlada mecânica, sendo os parâmetros ventilatórios regulados para proporcionar hipocapnia, com média de PaCO2 30,22 ñ 7,57 mmHg (4,02 ñ 1,00 KPa). A média de consumo de isoflurano foi 7,69 + 1,92 horas-CAM. Näo se observaram alteraçöes significativas dos parâmetros cardiovasculares (PAM, PVC, FC e FC x PAS) durante o procedimento, em relaçäo ao controle. Os pacientes recobraram a consciência em média 32,5 ñ 8,12 min após a interrupçäo do isoflurano. Os resultados obtidos sugerem ser a associaçäo de isoflurano e hipocapnia uma opçäo válida para anestesia de pacientes operados por tumores ou aneurismas intracranianos

Etomidato na induçäo em paciente submetido a cirurgia cardíaca / Anesthetic induction with etomidate in cardiac surgery

Foi utilizado o etomidato na induçäo da anestesia em 30 pacientes submetidos a cirurgia cardíaca, com média etária 50,4 ñ 11,6 anos e média ponderal 66,2 ñ 16,5 Kg. O etomidato foi administrado por via venosa na dose inicial de 0,3 mg.Kg-1, seguida, 5-6 minutos depois de uma segunda fase de 0,15 mg.Kg-1, imediatamente antes da intubaçäo traqueal. Entre ambas as doses foram administradas fentanil e pancurônio; após a intubaçäo, a anestesia foi mantida com isoflurano em concentraçöes de 1,0-2,0%, elevadas na medida do necessário para manter a PAM abaixo de 100 mmHg. Foram monitorizados: FC, PAM, PVC, Produto FC x PAS, ECG. A induçäo com etomidato näo se acompanhou de variaçöes significativas de FC, PAM, PC+VC e Produto FC x PAS nem de novas alteraçöes eletrocardiográficas, inclusive após a intubaçäo traqueal e a incisäo torácica. Os resultados sugerem que o etomidato, combinado ao fentanil, constitui alternativa válida para a induçäo da anestesia em cardiopatas submetidos a cirurgia cardíaca

Spectrophotometric study of the equilibria in aqueous copper(II) azide solutions.

The reaction between copper (II) and azide has been studied spectrophotometrically at four wavelengths, at 25 degrees , and ionic strength 4.00M (sodium perchlorate). The formation constants beta(2) and beta(3) found are 2.90 +/- 0.08 x 10(4) and 3.02 +/- 0.07 x 10(6) respectively. The results obtained from potentiometric measurements with a solid-state electrode disagree with those calculated from the spectrophotometric data. Causes of the discrepancy are discussed.