To characterize and describe clinical experience with childhood-onset non-infectious uveitis.
A multicenter retrospective multidisciplinary national web-based registry of 507 patients from 21 ...hospitals was analyzed. Cases were grouped as immune disease-associated (IMDu), idiopathic (IDIu) or ophthalmologically distinct. Characteristics of juvenile idiopathic arthritis-associated (non-HLA-B27-related) uveitis (JIAu), IDIu, and pars planitis (PP) were compared.
IMDu (62.3%) and JIAu (51.9%) predominated in young females; and IDIu (22.7%) and PP (13.6%) in older children, without sex imbalance. Ocular complications occurred in 45.3% of cases (posterior synechiae 28%, cataracts 16%, band keratopathy 14%, ocular hypertension 11% and cystoid macular edema 10%) and were associated with synthetic (86%) and biologic (65%) disease-modifying antirheumatic drug (DMARD) use. Subgroups were significantly associated (
< 0.05) with different characteristics. JIAu was typically anterior (98%), insidious (75%), in ANA-positive (69%), young females (82%) with fewer complications (31%), better visual outcomes, and later use of uveitis-effective biologics. In contrast, IDIu was characteristically anterior (87%) or panuveitic (12.1%), with acute onset (60%) and more complications at onset (59%: synechiae 31% and cataracts 9.6%) and less DMARD use, while PP is intermediate, and was mostly bilateral (72.5%), persistent (86.5%) and chronic (86.8%), with more complications (70%; mainly posterior segment and cataracts at last visit), impaired visual acuity at onset, and greater systemic (81.2%), subtenon (29.1%) and intravitreal (10.1%) steroid use.
Prognosis of childhood uveitis has improved in the "biologic era," particularly in JIAu. Early referral and DMARD therapy may reduce steroid use and improve outcomes, especially in PP and IDIu.
To measure thrombopoietin (TPO) levels in the serum and aqueous humors of patients with noninfectious acute anterior uveitis.
A prospective, comparative, controlled study. Serum and aqueous humors ...were obtained from the eyes of 16 patients with noninfectious acute anterior uveitis. TPO levels were measured using an enzyme-linked immunosorbent assay (ELISA). The results obtained were compared with those of a control group.
Serum concentrations of TPO were not significantly different between control individuals and patients with active anterior uveitis. Aqueous humor TPO levels were 54.46±16.24 pg/mL in the eyes of patients with uveitis, and 34.32±11.63 pg/mL in the eyes of controls. The difference between the two groups was significant (Mann-Whitney U-test for independent data, P=0.0008), with uveitis patients exhibiting significantly higher levels of TPO.
The high levels of TPO in the aqueous humors of uveitis patients points toward a cytoprotective role of this factor in inflammatory repair processes and the recovery of tissue homeostasis.
Lipoid proteinosis (LP) is a rare autosomal recessive disorder characterized by a hoarse voice, variable scarring, and infiltration of the skin and mucosa. This disease is associated with mutations ...of the gene encoding extracellular matrix protein 1 (ECM1).
This was a clinical and molecular study of a new case of LP with a severe phenotype. A 35-year-old female born to nonconsanguineous parents developed dermatological and extracutaneous symptoms in her 9th month of life. The neurological abnormalities of the disease began to appear at the age of 19 years. Computed tomography revealed cranial calcifications.
The diagnosis of LP was confirmed by histopathological findings and direct sequencing of ECM1. A new homozygous nonsense mutation was identified in exon 7 of ECM1, c.1076G>A (p.Trp359(*)). This mutation was not detected in 106 chromosomes of healthy individuals with a similar demographic origin. Microsatellite markers around ECM1 were used to construct the haplotype in both the parents and the patient. Reports on genotype-phenotype correlations in LP point to a milder phenotype in carriers of missense mutations in the Ecm1a isoform, whereas mutations in the Ecm1b isoform are thought to be associated with more severe phenotypes. The present findings in a Spanish patient carrying a truncating mutation in exon 7 revealed complete dermatological and neurological manifestations.
abad‐corpa e., carrillo‐alcaraz a., royo‐morales t., pérez‐garcía m.c., rodríguez‐mondejar j.j., sáez‐soto a. & iniesta‐sánchez j. (2010) Effectiveness of planning hospital discharge and follow‐up in ...primary care for patients with chronic obstructive pulmonary disease: research protocol. Journal of Advanced Nursing 66(6), 1365–1370.
Title. Effectiveness of planning hospital discharge and follow‐up in primary care for patients with chronic obstructive pulmonary disease: research protocol.
Aim. To evaluate the effectiveness of a protocolized intervention for hospital discharge and follow‐up planning for primary care patients with chronic obstructive pulmonary disease.
Background. Chronic obstructive pulmonary disease is one of the main causes of morbidity and mortality internationally. These patients suffer from high rates of exacerbation and hospital readmission due to active problems at the time of hospital discharge.
Methods. A quasi‐experimental design will be adopted, with a control group and pseudo‐randomized by services (protocol approved in 2006). Patients with pulmonary disease admitted to two tertiary‐level public hospitals in Spain and their local healthcare centres will be recruited. The outcome variables will be readmission rate and patient satisfaction with nursing care provided. 48 hours after admission, both groups will be evaluated by specialist coordinating nurses, using validated scales. At the hospital, a coordinating nurse will visit each patient in the experimental group every 24 hours to identify the main caregiver, provide information about the disease, and explain treatment. In addition, the visits will be used to identify care problems and needs, and to facilitate communication between professionals. 24 hours after discharge, the coordinating nurses will inform the primary care nurses about patient discharge and nursing care planning. The two nurses will make the first home visit together. There will be follow‐up phone calls at 2, 6, 12 and 24 weeks after discharge.
Discussion. The characteristics of patients with this pulmonary disease make it necessary to include them in hospital discharge planning programmes using coordinating nurses.
We have analysed whether pulmonary arterial hypertension (PAH) alters the rat faecal microbiota. Wistar rats were injected with the VEGF receptor antagonist SU5416 (20 mg/kg s.c.) and followed for 2 ...weeks kept in hypoxia (10% O
, PAH) or injected with vehicle and kept in normoxia (controls). Faecal samples were obtained and microbiome composition was determined by 16S rRNA gene sequencing and bioinformatic analysis. No effect of PAH on the global microbiome was found (α- or β-diversity). However, PAH-exposed rats showed gut dysbiosis as indicated by a taxonomy-based analysis. Specifically, PAH rats had a three-fold increase in Firmicutes-to-Bacteroidetes ratio. Within the Firmicutes phylum, there were no large changes in the relative abundance of the bacterial families in PAH. Among Bacteroidetes, all families were less abundant in PAH. A clear separation was observed between the control and PAH clusters based on short chain fatty acid producing bacterial genera. Moreover, acetate was reduced in the serum of PAH rats. In conclusion, faecal microbiota composition is altered as a result of PAH. This misbalanced bacterial ecosystem might in turn play a pathophysiological role in PAH by altering the immunologic, hormonal and metabolic homeostasis.
•Microbes in a cropland was more responsive to biochar than to climate alteration.•Predicted bacterial functionality was modified by both factors.•Gram negative and fungal biomasses were affected by ...the interaction of two factors.•Climate manipulation altered the composition of the soil fungal community.
Changing climatic conditions (warming and decreasing precipitation) have been found to be a threat to the agricultural sustainability of Mediterranean croplands. From the climate change perspective, biochar amendment may interact with the effects of warming and drought stresses on soil ecosystems. However, the responses of soil microbial communities to the joint effects of climate change and biochar in Mediterranean croplands are not sufficiently known. To help fill this knowledge gap, in this work we used a field experiment to determine the effects of partial rain exclusion alone or combined with a soil temperature increase in biochar-amended (20 t ha−1) and unamended plots under crop rotation on soil chemical properties, enzyme activities, and the microbial community activity, structure, composition, abundance, and functions. The biomass, composition, and activity of the soil bacterial and fungal communities were more responsive to biochar addition than to climate manipulation. Thus, soil chemical parameters, enzyme activities and the relative abundances of bacterial populations were not responsive to the interaction of biochar and climate manipulation, while the predicted functionality of the bacterial community was modified by both factors. Soil β-glucosidase activity significantly decreased in response to biochar addition and climate manipulation, while urease activity was significantly increased by biochar, and protease activity was significantly decreased by climate manipulation. Gram negative and fungal biomasses were significantly affected by the interaction of biochar with climate manipulation. Climate manipulation produced changes in the composition of the soil fungal community without loss of diversity. This study illustrates how the interactions between biochar amendment and future climate change scenarios influence microbially-driven ecosystem services related to the maintenance of nutrient cycles and biodiversity in a Mediterranean agroecosystem.
Thromboembolic disease is fairly common in patients with lung cancer 1–3. This incidence seems to be higher in patients with lung adenocarcinomas 4, with approximately 15% of those with advanced ...stage disease developing venous thromboembolisms (VTE) during the whole course of their disease 5–7. Pulmonary adenocarcinomas are a heterogeneous group of diseases that can be stratified according to the presence of major oncogenic driver alterations. Anaplastic lymphoma kinase (ALK) rearrangements are detected in approximately 4% of these cases 8. Isolated reports have suggested that patients bearing ALK-rearranged tumours might have a higher than expected incidence of thromboembolisms 9, 10. In the present study, we have analysed the incidence, predictors and prognostic significance of thromboembolic events in a large, multi-institutional and homogeneous cohort of advanced stage patients with ALK-rearranged lung cancers from Spain and Portugal. Our primary objective was to estimate the incidence of thromboembolic events and their association with overall survival in these patients.
To find out the socio-demographic and clinical profile of the patient with Chronic Obstructive Pulmonary Disease (COPD): characteristics, state of health, situation of disease and social resources.
A ...descriptive, longitudinal and prospective study, in the Morales Meseguer and Reina Sofía Hospitals in Murcia (Spain), was performed between June 2007 and April 2008. The inclusion criteria was hospital admission due to COPD and patients with cognitive deterioration, a hospital stay > 30 days or < 2 days, or were institutionalised, were excluded. Socio-demographic, state of health and social variables were collected using the patient's clinical history and an interview during hospital stay and at discharge. The descriptive statistical analysis was carried out using SPSS v.15.
A total of 143 patients were studied, of which 90.2% were males who had a mean age of 72.76 ± 8.04 years, 95.1% were in an inactive work situation and had a mean score on the social problem scale of 8.08 ± 2.1. Most were in a fragile state (71.3%), approximately half (44.8%) suffered heart disease as the main co-morbidity factor, and the impact of the disease on quality of life was 55.1 ± 19.01. The level of knowledge on the therapeutic regime was 3.13 ± 0.7. A total of 72% were independent for carrying out Basic Activities of Daily Living (BADL) after hospital discharge.
Most of the population that suffers from COPD were elderly males, who were retired without social problems, with a high percentage of co-morbidity, an intermediate alteration in their quality of life, having a moderate level of knowledge about the therapeutic regime and were independent for BADL, but fragile.
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