Marchiafava‑Bignami disease is a rare condition associated with chronic alcohol consumption and/or malnutrition, characterized by demyelination of the corpus callosum, generally attributed to a ...deficiency in B complex vitamins. We report the case of a 34‑year‑old male with a 10‑year history of alcohol dependence who was admitted to the hospital, after having been found lying on the floor of his house, malnourished and with pressure ulcers on his chest and knees. On clinical observation he was found to be alert but mute. He followed some simple orders. Generalized spastic hypertonia was present. Magnetic resonance imaging showed demyelination of the corpus callosum, suggesting the diagnosis of Marchiafava‑Bignami disease. He was admitted to the Psychiatry Inpatient Unit and evaluated by a multidisciplinary team. He received thiamine, corticosteroids and rehabilitation. After a week, his speech was slurred but comprehensible and he could walk with aid; magnetic resonance imaging findings had improved. After three months in a Convalescence Unit, he was discharged with total autonomy.
Short-term infusions of single vasodilators, usually given in a fixed dose, have not improved outcomes in patients with acute heart failure (AHF).
To evaluate the effect of a strategy that emphasized ...early intensive and sustained vasodilation using individualized up-titrated doses of established vasodilators in patients with AHF.
Randomized, open-label blinded-end-point trial enrolling 788 patients hospitalized for AHF with dyspnea, increased plasma concentrations of natriuretic peptides, systolic blood pressure of at least 100 mm Hg, and plan for treatment in a general ward in 10 tertiary and secondary hospitals in Switzerland, Bulgaria, Germany, Brazil, and Spain. Enrollment began in December 2007 and follow-up was completed in February 2019.
Patients were randomized 1:1 to a strategy of early intensive and sustained vasodilation throughout the hospitalization (n = 386) or usual care (n = 402). Early intensive and sustained vasodilation was a comprehensive pragmatic approach of maximal and sustained vasodilation combining individualized doses of sublingual and transdermal nitrates, low-dose oral hydralazine for 48 hours, and rapid up-titration of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or sacubitril-valsartan.
The primary end point was a composite of all-cause mortality or rehospitalization for AHF at 180 days.
Among 788 patients randomized, 781 (99.1%; median age, 78 years; 36.9% women) completed the trial and were eligible for primary end point analysis. Follow-up at 180 days was completed for 779 patients (99.7%). The primary end point, a composite of all-cause mortality or rehospitalization for AHF at 180 days, occurred in 117 patients (30.6%) in the intervention group (including 55 deaths 14.4%) and in 111 patients (27.8%) in the usual care group (including 61 deaths 15.3%) (absolute difference for the primary end point, 2.8% 95% CI, -3.7% to 9.3%; adjusted hazard ratio, 1.07 95% CI, 0.83-1.39; P = .59). The most common clinically significant adverse events with early intensive and sustained vasodilation vs usual care were hypokalemia (23% vs 25%), worsening renal function (21% vs 20%), headache (26% vs 10%), dizziness (15% vs 10%), and hypotension (8% vs 2%).
Among patients with AHF, a strategy of early intensive and sustained vasodilation, compared with usual care, did not significantly improve a composite outcome of all-cause mortality and AHF rehospitalization at 180 days.
ClinicalTrials.gov Identifier: NCT00512759.
The accurate early diagnosis of acute kidney injury (AKI) in patients with acute heart failure (AHF) is an unmet clinical need. Cystatin C might improve the early detection of AKI.
207 patients ...presenting to the emergency department with AHF were enrolled. Cystatin C was measured in plasma in a blinded fashion at presentation and serially thereafter. The potential of Cystatin C levels to predict AKI was assessed as the primary endpoint. Long-term mortality was assessed as a secondary endpoint.
At presentation, creatinine (140μmol/L 91–203 vs. 97μmol/L 76–132, p<0.01) and Cystatin C (2.00mg/L 1.30–3.08 vs. 1.45mg/L 1.00–1.90, p<0.01) levels were significantly higher in AKI compared to Non-AKI patients. The diagnostic accuracy for AKI quantified by the area under the receiver operating characteristic curve was mediocre and comparable for both markers (creatinine 0.68; 95%CI 0.58–78 vs. Cystatin C 0.67; 95%CI 0.58–0.76). Serial measurements of Cystatin C did not further increase the prognostic accuracy for AKI. Cystatin C levels were significantly higher in decedents than in survivors (1.90mg/L 1.30–2.70 vs. 1.30mg/L 1.0–1.6, p<0.001). The combination of Cystatin C and BNP levels significantly improved the prediction of mortality provided by either parameter alone. In multivariable regression analysis Cystatin C remained independently associated with mortality (HR 1.41; 95%CI 1.02–1.95).
Plasma Cystatin C levels do not adequately predict AKI in patients with AHF. However, in multivariable regression analysis Cystatin C predicted mortality after the adjustment for baseline renal function, AKI, BNP levels and heart failure risk factors.
•Cystatin C levels at presentation do not improve the early detection of AKI over serum creatinine in patients with AHF.•Cystatin C levels are significantly higher in decedents than in survivors.•Cystatin C levels are independently associated with long-term mortality after adjustment baseline renal function, the occurrence of early AKI, BNP levels and known heart failure risk factors.•In contrast, serum creatinine levels are not independently associated with long-term mortality after the adjustment for Cystatin C and BNP levels.•The mortality prediction provided by Cystatin C is synergistic to the prognostic information provided by BNP.
A Rede Médicos-Sentinela tem elevada importância no âmbito da vigilância e epidemiologia da gripe a nível mundial. No entanto, atualmente, para além dos Sistemas Participativos tradicionais, existem ...também os Sistemas de monitorização online que, num esforço conjunto, com os países pertencentes à União Europeia, com participação ativa no Projecto I-MOVE/EuroEVA, tornam possível antecipar a composição da vacina antigripal através das informações fornecidas em estudos de eficácia da vacina antigripal. Para além dos estudos relativamente à eficácia da vacina, estes Sistemas Participativos online são muito vantajosos pois transmitem a informação, à Organização Mundial de Saúde, em tempo real, de forma a ocorrer uma vigilância epidemiológica eficaz durante toda a época de gripe. Este trabalho insere-se no âmbito da análise da importância destes Sistemas Participativos na vigilância e epidemiologia do vírus Influenza e na efetividade da vacina antigripal, precisamente com o objetivo de analisar as suas funções e qual o impacto das mesmas durante a época de gripe.
Purpose: Transient global amnesia (TGA) is described has a benign neurological condition, defined by a presence of an amnestic period, with duration of no longer then 24h. The purpose of the presence ...study is to characterize the patients with TGA.Methods: From January 2004 to November 2017, 50 patients were admitted with TGA diagnosis, 39 were eligible for this study. A comprehensive analysis of the clinical data (including neuropsychological evaluation and follow up period) was performed. Results: 30 patients were female. Mean age was 63u00b115y. Prevalent vascular risk factors were dyslipidemia and HBP. In 15 patients, the episode occurred in the afternoon, with duration of <8 hours. An emotional stressful life event was present in 35 patients. At admission, more than half presented a systolic >140mmHg. In the MRI hyperintensive signal in hippocampus was observed in 12 patients (either bilateral or unilateral). During follow up period, new MRI showed no abnormalities, 2 patients had a cerebrovascular event, and in neuropsychological evaluation was observed slow processing speed, impairment in verbal fluency and severe anxiety symptoms.Discussion and Conclusions: TGA was prevalence in women, with dyslipidemia and HBP as the most common vascular risk factors. From the follow up: no abnormalities on control MRI, the neuropsychological profile showed slow processing speed, impairment in verbal fluency and anxiety symptomatology. Vascular risk factors were present, although an ischemic etiology seems to be a faraway possible explanation due to the nonexistent atherosclerotic factor. Can it be a vascular response to stress?
Investment in technological research is imperative to stimulate the development of sustainable solutions for the agricultural sector. Advances in Internet of Things, sensors and sensor networks, ...robotics, artificial intelligence, big data, cloud computing, etc. foster the transition towards the Agriculture 4.0 era. This fourth revolution is currently seen as a possible solution for improving agricultural growth, ensuring the future needs of the global population in a fair, resilient and sustainable way. In this context, this article aims at characterising the current Agriculture 4.0 landscape. Emerging trends were compiled using a semi-automated process by analysing relevant scientific publications published in the past ten years. Subsequently, a literature review focusing these trends was conducted, with a particular emphasis on their applications in real environments. From the results of the study, some challenges are discussed, as well as opportunities for future research. Finally, a high-level cloud-based IoT architecture is presented, serving as foundation for designing future smart agricultural systems. It is expected that this work will positively impact the research around Agriculture 4.0 systems, providing a clear characterisation of the concept along with guidelines to assist the actors in a successful transition towards the digitalisation of the sector.
Helping others has been identified as an important component in recovery and resilience for women following intimate partner violence (IPV). However, little is known about the experiences of women ...who are IPV survivors and who also engage in formal and informal violence against women (VAW) advocacy work, such as supporting IPV survivors in a social work role or volunteering on VAW advocacy committees. Using in-depth semistructured interviews with nine “survivor–advocates” who were part of a larger study on IPV and resilience, this study extends the existing literature to examine the multidirectional relationship between IPV, advocacy work, and resilience using narrative analysis. Three distinct narratives were identified in survivor–advocates’ accounts of their experiences of abuse and advocacy work. The working through the abuse narrative focused on using the knowledge and experience from advocacy work that began prior to IPV to critically reflect on the abuse and its meaning for women. The second narrative, helping others, focused on using personal experiences of abuse to help other IPV survivors. The third narrative, personal strength, focused on a personal identity as a lifelong advocate and inner strength and determination as central to resilience. The findings of this study demonstrate the multitude of ways that engaging in advocacy work interacts with abuse experiences and women’s recovery and resilience processes. The findings of this study can inform approaches for promoting resilience and recovery for IPV survivors and highlight the importance of cultivating a critical understanding of abuse to support resilience and recovery following IPV.
Summary
Weight stigma, defined as pervasive misconceptions and stereotypes associated with higher body weight, is both a social determinant of health and a human rights issue. It is imperative to ...consider how weight stigma may be impeding health promotion efforts on a global scale. The World Obesity Federation (WOF) convened a global working group of practitioners, researchers, policymakers, youth advocates, and individuals with lived experience of obesity to consider the ways that global obesity narratives may contribute to weight stigma. Specifically, the working group focused on how overall obesity narratives, food and physical activity narratives, and scientific and public‐facing language may contribute to weight stigma. The impact of weight stigma across the lifespan was also considered. Taking a global perspective, nine recommendations resulted from this work for global health research and health promotion efforts that can help to reduce harmful obesity narratives, both inside and outside health contexts.
While resilience research in the context of intimate partner violence (IPV) is increasing, there remains little known about women’s lived experience of resilience. Using a phenomenological approach, ...this study examined the experience of resilience for adult female survivors of IPV. Sixteen women who were currently experiencing or had previously experienced abuse by an intimate partner participated in semi-structured interviews. Resilience was experienced as multiple cognitive, emotional, and behavioral shifts across three theme areas: toward resistance, in the experience of control, and toward positivity. The results of this study suggest a number of applications for clinical practice and intervention.
In this work, we studied the ecological interactions between grape berry microorganisms and Drosophila sp. flies involved in sour rot disease during grape ripening. After veráison the total microbial ...counts of grape berries affected by sour rot increased from about 2 log CFU/g of berries to more than 7 log CFU/g. Berry damage provoked a clear shift in yeast diversity from basidiomycetes to ascomycetous fermentative species. The latter were mostly Pichia terricola, Hanseniaspora uvarum, Candida zemplinina, and Zygoascus hellenicus. However, these species were not able to produce the metabolites characteristic of sour rot (gluconic and acetic acids) in inoculated berries. On the contrary, the acetic acid bacteria Gluconacetobacter saccharivorans produced high levels of these acids, mainly when berries were incubated in the presence of the insect Drosophila sp. Sour rot was not observed when grape bunches were physically separated from insects, even when berries were artificially injured. The wounds made in berry skin healed in the absence of insects, thus preventing the development of sour rot. Therefore, in the vineyard, the induction of sour rot depends on the contamination of wounded berries by a microbial consortium—yeasts and acetic acid bacteria—transported by drosophilid insects which disseminate sour rot among damaged berries. In the absence of these insects, plant defense mechanisms are effective and lead to skin healing, preventing disease spread. Thus, we showed that Drosophila sp. act as a vector for microorganisms associated with grape sour rot disease.
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