Idiopathic inflammatory myopathies are a heterogeneous group of rare autoimmune disorders characterized by progressive muscle weakness and the histopathologic findings of inflammatory infiltrates in ...muscle tissue. Although their pathogenesis remains indefinite, the association of autoantibodies with clinical manifestations and the evidence of high effectiveness of depleting therapies suggest that B cells could be implicated. Therefore, we explored the landscape of peripheral B cells in this disease by multiparametric flow cytometry, finding significant numerical decreases in memory and double negative subsets, as well as an expansion of the naïve compartment relative to healthy controls, that contribute to defining disease-associated B cell subset signatures and correlating with different clinical features of patients. Additionally, we determined the potential value of these subsets as diagnostic biomarkers, thus positioning B cells as neglected key elements possibly participating in idiopathic inflammatory myopathies onset or development.
Resumo Fundamento A ecocardiografia é essencial para o diagnóstico e a quantificação da insuficiência aórtica (IA). A integral velocidade-tempo (IVT) do fluxo da IA pode estar relacionada à gravidade ...da IA. Objetivo Este estudo tem por objetivo avaliar se a IVT é um marcador ecocardiográfico de gravidade da IA. Métodos Foram incluídos todos os pacientes com IA nativa moderada ou grave e ritmo sinusal que visitaram o nosso laboratório de imagem entre janeiro e outubro de 2016. Todos os indivíduos foram submetidos a um ecocardiograma completo com medição da IVT da IA. A associação entre a IVT e a gravidade da IA foi analisada por regressão logística e modelos de regressão multivariada. Valores p<0,05 foram considerados estatisticamente significativos. Resultados Entre os 62 pacientes incluídos (68,5±14,9 anos; 64,5%: IA moderada; 35,5%: IA grave), a IVT foi maior em indivíduos com IA moderada em comparação àqueles com IA grave (2,2±0,5 m versus 1,9±0,5 m, p=0,01). Pacientes com IA grave apresentaram valores maiores de diâmetro diastólico final do ventrículo esquerdo (DDFVE) (56,1±7,1 mm versus 47,3±9,6 mm, p=0,001), volume diastólico final do ventrículo esquerdo (VDFVE) (171±36,5 mL versus 106±46,6 mL, p<0,001), orifício regurgitante efetivo (0,44±0,1 cm2 versus 0,18±0,1 cm2, p=0,002) e volume regurgitante (71,3±25,7 mL versus 42,5±10,9 mL, p=0,05), assim como menor fração de ejeção do ventrículo esquerdo (FEVE) (54,1±11,2% versus 63,2±13,3%, p=0,012). A IVT mostrou ser um marcador de gravidade da IA, independentemente do DDFVE, VDFVE e FEVE ( odds ratio 0,160, p=0,032) e da frequência cardíaca e pressão arterial diastólica (PAD) ( odds ratio 0,232, p=0,044). Conclusões A IVT do fluxo da IA apresentou associação inversa com a gravidade da IA, independentemente do diâmetro e volume do ventrículo esquerdo, frequência cardíaca, PAD e FEVE. A IVT pode ser um marcador de gravidade da IA em pacientes com IA nativa e ritmo sinusal. (Arq Bras Cardiol. 2020; online.ahead print, PP.0-0)
Abstract Background Diagnosis delay may negatively influence the clinical course of major depression; however, few studies have analysed the role of environmental factors on diagnosis delay. This ...study was aimed to identify personal and environmental factors related to a longer delay. Methods A cross-sectional observational study with 3615 primary care patients with a first diagnosis of major depression was conducted. Diagnosis delay was defined as the time between onset of symptoms and diagnosis of major depression. Results Mean of delay was 9.89 weeks. Lower years of education, triggering stressful life events before the current episode, history of previous undiagnosed depressive episodes and somatic comorbidity were related to longer delay. Health system variables, such as urban setting, public health care setting, younger doctors and female doctors were also related to a longer delay. Limitations Onset of first depressive symptoms was retrospectively collected. The cross-sectional design does not allow making inferences about the temporal ordering between predictors and outcomes. Conclusions Both personal and environmental variables were related to diagnosis delay. Identification of these factors helps to design early diagnosis programs to ultimate reduce the morbidity associated with major depression.
Mexican consensus on cow's milk protein allergy Alfonso, Ramírez Mayans Jaime; Rubí, Ignorosa Arellano Karen; Manuel, Toro Monjaraz Erick ...
Allergologia et immunopathologia,
2024, Volume:
52, Issue:
1
Journal Article
Peer reviewed
Open access
The aim of this study is to present the current views of a diverse group of experts on the diagnosis and treatment of Cow's Milk Protein Allergy (CMPA) in children under 2 years of age in Mexico.
The ...study, led by a scientific committee of five experts in CMPA, was divided into six phases, including a modified Delphi process. A total of 20 panelists, all of whom were pediatric specialists, participated in administering a comprehensive 38-item questionnaire. The questionnaire was divided into two blocks: Diagnosis and Treatment (20 items each).
Consensus was reached on all the proposed items, with an agreement rate of over 70% for each of them. As a result, a diagnostic and treatment algorithm was developed that emphasized the reduction of unnecessary diagnostic studies and encouraged breastfeeding whenever possible. In cases where breast milk is not available, appropriate use of hypoallergenic formulas was recommended. In addition, recommendations on treatment duration and gradual reintroduction of cow's milk protein were provided.
The recommendations endorsed by 20 Mexican pediatricians through this study are applicable to everyday clinical practice, thereby enhancing the diagnosis and treatment of children under 2 years of age with CMPA. This, in turn, will foster improved health outcomes and optimize the utilization of healthcare resources.
The primary aim of our study was to investigate the association between intubation timing and hospital mortality in critically ill patients with coronavirus disease 2019 (COVID-19)-associated ...respiratory failure. We also analysed both the impact of such timing throughout the first four pandemic waves and the influence of prior noninvasive respiratory support on outcomes.
This is a secondary analysis of a multicentre, observational and prospective cohort study that included all consecutive patients undergoing invasive mechanical ventilation due to COVID-19 from across 58 Spanish intensive care units (ICUs) participating in the CIBERESUCICOVID project. The study period was between 29 February 2020 and 31 August 2021. Early intubation was defined as that occurring within the first 24 h of ICU admission. Propensity score matching was used to achieve a balance across baseline variables between the early intubation cohort and those patients who were intubated after the first 24 h of ICU admission. Differences in outcomes between early and delayed intubation were also assessed. We performed sensitivity analyses to consider a different time-point (48 h from ICU admission) for early and delayed intubation.
Of the 2725 patients who received invasive mechanical ventilation, a total of 614 matched patients were included in the analysis (307 for each group). In the unmatched population, there were no differences in mortality between the early and delayed groups. After propensity score matching, patients with delayed intubation presented higher hospital mortality (27.3%
37.1%; p=0.01), ICU mortality (25.7%
36.1%; p=0.007) and 90-day mortality (30.9%
40.2%; p=0.02) compared with the early intubation group. Very similar findings were observed when we used a 48-h time-point for early or delayed intubation. The use of early intubation decreased after the first wave of the pandemic (72%, 49%, 46% and 45% in the first, second, third and fourth waves, respectively; first
second, third and fourth waves p<0.001). In both the main and sensitivity analyses, hospital mortality was lower in patients receiving high-flow nasal cannula (HFNC) (n=294) who were intubated earlier. The subgroup of patients undergoing noninvasive ventilation (n=214) before intubation showed higher mortality when delayed intubation was set as that occurring after 48 h from ICU admission, but not when after 24 h.
In patients with COVID-19 requiring invasive mechanical ventilation, delayed intubation was associated with a higher risk of hospital mortality. The use of early intubation significantly decreased throughout the course of the pandemic. Benefits of such an approach occurred more notably in patients who had received HFNC.
Influenza vaccination (IV) aims primarily to protect high-risk groups against severe influenza-associated disease and death. It is recommended in Spain for high-risk groups, including Healthcare ...workers (HCWs). However, vaccination uptake has been consistently below desirable levels. The objective of this study were to evaluate influenza vaccination coverage using data from the regional vaccination registry, during 2021–2022 season, among HCWs in public hospitals in Autonomous Community of Madrid (CAM) and to explore factors associated with influenza vaccination. We conducted a cross-sectional study using administrative data retrieved from the Regional Department of Health data repositories. A multilevel logistic regression model was designed to estimate Level 1 (individual) and Level 2 (contextual) variables that are associated with HCẂs vaccination. The study population was HCWs from 25 public hospitals in CAM who were active during the period of the influenza 2021–2022 vaccination campaign. The global influenza vaccination coverage (IVC) was 52.1 %. All study Level 1 variables were significantly associated with vaccine uptake. Greater IVC is associated with individual characteristics: female (OR1.14; 95 %CI 1.09–1.19), older age 59–69 years old (OR1.72; 95 %CI 1.60–1.84), born in Spain, medical staff, more than one high-risk condition (OR1.24; 95 %CI 1.10–1.40; respectively) and vaccinated in two previous campaigns (OR25.64; 95 %CI 24.27–27.09). IVC was highest among HCWs celiac disease (65.5 %) followed by diabetes mellitus (65.1 %) and chronic inflammatory disease (64.3 %). The hospital where the study subject worked also showed an effect on the vaccination uptake, although Level 2 variable (hospital complexity) was not positively associated. IVC in HCWs remains suboptimal. These findings may prove useful to tailor strategies to reach specific groups. It is recommended to delve into the identification of factors associated with the HCWs workplace that may have a positive impact on IV.
The review article discusses the current status and recent findings of our investigations on the synthesis and characterization of carbon-supported PtRuMo electrocatalysts for direct alcohol fuel ...cells. In particular, the effect of the carbon support and the composition on the structure, stability and the activity of the PtRuMo nanoparticles for the electrooxidation of CO, methanol and ethanol have been studied. Different physicochemical techniques have been employed for the analysis of the catalysts structures: X-ray analytical methods (XRD, XPS, TXRF), thermogravimetry (TGA) and transmission electron microscopy (TEM), as well as a number of electrochemical techniques like CO adsorption studies, current-time curves and cyclic voltammetry measurements. Furthermore, spectroscopic methods adapted to the electrochemical systems for in situ studies, such as Fourier transform infrared spectroscopy (FTIRS) and differential electrochemical mass spectrometry (DEMS), have been used to evaluate the oxidation process of CO, methanol and ethanol over the carbon-supported PtRuMo electrocatalysts.
Un manejo óptimo de la técnica instrumental y la mantención de la postura facial;
durante la conformación de la embocadura, son aspectos importantes para el Instrumentista de;
Viento al momento de la ...interpretación. Es por esta razón que la presente investigación tiene;
por objetivo describir y caracterizar las estructuras y funciones de los Órganos;
Fonoarticulatorios y la identificación de malos hábitos orales, en 20 estudiantes de;
interpretación musical, mención Caña Simple y Bisel de la Facultad de Artes de la Universidad;
de Chile. Se utilizó para la recolección de datos la Ficha de Evaluación Fonoaudiológica de;
Motricidad Orofacial modificada, de la unidad de Motricidad Orofacial de la Escuela de;
Fonoaudiología de la Universidad de Chile. Los parámetros de ejecución fueron evaluados;
mediante una pieza musical elaborada específicamente para este estudio. Entre los hallazgos;
observados en las estructuras orofaciales, se evidenció la presencia de giroversiones,;
alteraciones en el escalón y en la articulación temporomandibular tanto en Caña Simple como;
Bisel, y alteración en el resalte solo en los Biseles. En cuanto a las funciones orofaciales, se;
evidenció deglución atípica y tipo respiratorio mixto, en reposo y ejecución, con una alta;
frecuencia de presentación tanto en Caña Simple como Bisel. La realización de un abordaje;
fonoaudiológico, en conjunto con los profesores de cátedra en los instrumentistas de Viento,;
permitiría otorgar al músico las competencias para una utilización óptima de los sistemas;
fisiológicos implicados en la ejecución, con la finalidad de entregar protección ante el deterioro;
fisiológico y la carga excesiva producto de una mala ejecución.
An optimal use of the instrumental technique and the maintenance of the facial position;
during the formation of the mouthpiece are important aspects for the wind instrument player by;
the time of the musical interpretation. The purpose of this research is to describe the structures;
and functions of the speech organs and to distinguish the presence of bad oral habits in 20;
students of musical performance, on Simple Reed and Bevel mouthpieces, from the Faculty of;
Arts of the University of Chile. For the data collection it was used the Orofacial Motor Speech;
modified Evaluation Fact Sheet, from the Orofacial Motor Unit of the Speech and Language;
School of the University of Chile. The musical performance parameters were evaluated using a;
piece of music made specifically for this research. The results in orofacial structures showed the;
presence of dental giroversions, overjet and temporomandibular joint alterations, in both Simple;
Reed and Bevel mouthpieces, and overbite alterations only in Bevel mouthpiece. The results of;
orofacial functions showed atypical swallowing and mixed breathing type, at rest and execution,;
with a high frequency of occurrence in both Simple Reed and Bevel mouthpieces. A;
phonoaudiological approach, in collaboration with academic teachers of wind instrument, would;
give to the musician the skills for an optimal use of the physiological systems involved in the;
performance, in order to provide protection against physiological deterioration and excessive;
loading as a result of a poor execution.
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