Meckel’s diverticulitis is an extremely rare event during pregnancy. Its diagnosis is often difficult and can result in higher maternal and fetal morbimortality. We describe a case of a 40-year-old ...healthy pregnant woman at 33 weeks of gestation who presented with abdominal pain and tender abdomen, leukocytosis, and elevated PCR. The imagiological exams were not conclusive. After an urgent caesarean section due to worsening of clinical status and nonreassuring fetal well-being, a laparotomy revealed a distended, necrotic, and perforated Meckel’s diverticulum.
A Síndrome de Sheehan, também conhecida como necrose pituitária pós-parto, refere-se ao desenvolvimento de hipopituitarismo em consequência da necrose da hipófise. Este evento é, habitualmente, ...precipitado por hemorragia uterina maciça durante o parto e/ou no período pós-parto mas acredita-se que outras condições também possam estar na origem da síndrome como a aumento fisiológico da glândula que não é acompanhado pelo aumento da irrigação sanguínea, alterações na coagulação que podem predispor a trombose e, possivelmente, uma sela turca de dimensões inferiores ao normal. A perpetuação e agravamento da disfunção podem estar associadas a alterações autoimunitárias. Devido a relações anatómicas, a hipófise anterior é mais frequentemente lesada resultando em défice de hormona do crescimento, hipoadrenalismo, hipotiroidismo, hipoprolactinémia, e hipogonadismo secundário. A Diabetes Insípida é a forma clínica associada à disfunção da hipófise posterior. A sua instalação pode ser súbita ou crónica e, com maior frequência, desenvolve-se hipopituitarismo parcial com sintomas muito pouco específicos e insidiosos. A clínica mais sugestiva consiste na história de hemorragia pós-parto e subsequente agalactia e amenorreia. Ainda assim, muitas mulheres permanecem anos sem diagnóstico. Achados laboratoriais, imagiológicos e testes dinâmicos auxiliam e permitem estabelecer o diagnóstico definitivo. O tratamento consiste na substituição dos défices hormonais em falta. A Síndrome de Sheehan é uma condição com elevada morbilidade e mortalidade e, como tal, a comunidade médica deve estar mais sensibilizada para que o diagnóstico e tratamento possa ser feito o mais precocemente possível.
Determina la relación entre el índice de masa corporal y la esteatosis hepática no alcohólica evaluada mediante imagenología ultrasonográfica, según sus grados realizado en el Centro de Apoyo al ...Diagnóstico Médico Medical. Es un estudio observacional, descriptivo, prospectivo y de corte transversal. Participan todos los pacientes con sintomatología de disfunción hepática que acuden ambulatoriamente al servicio de ecografía y que cumplan con los criterios de inclusión y exclusión. Encuentra que más del 50% de pacientes corresponde al grupo etario adulto (38 a 57 años), el 70.8% del total corresponde al sexo femenino, el total de pacientes presentaron un IMC elevado, sobrepeso (45.8%), obesidad tipo I (39.6%) y obesidad tipo II (14.6%), según la procedencia, el 47.9% provienen del distrito de Ate y el 54.16% del total correspondieron a personas con un nivel socioeconómico de ingresos menores al sueldo mínimo. Según los grados de la EHGNA, el 62.5% del total corresponde al grado, el 35.4% corresponde al grado II y el 2% corresponde al grado III. La relación entre el IMC y la EHGNA según grados es para el grado I, un 63.3% presenta sobrepeso, en el grado II, la mayor parte corresponde a la obesidad tipo I (47.1%) y en el grado III, el 100% corresponde a obesidad tipo II. La prevalencia estimada para el periodo de julio a diciembre del 2016 en el Centro de Apoyo al Diagnóstico Médico Medical es de 47% de pacientes con características de EHGNA.
Tesis
•Most COVID-19 associated ARDS survivors have persistent symptoms beyond 8 months.•At 8 months, COVID survivors with ARDS often have decreased exercise capacity.•Almost all COVID survivors with ARDS ...develop at least one mental disorder.•Female sex, non-Caucasian race, and Charlson>2 were risk factors for a worse MCS score on the SF-36.•Female sex and COPD were independent risk factors for a worse PCS score on the SF-36.
To determine the health status, exercise capacity, and health related quality of life (HRQoL) of COVID-19 associated acute respiratory distress syndrome (ARDS) survivors, 8 months after diagnosis.
All eligible patients were interviewed and underwent a physical examination, chest X-ray, and 6 min walk test (6MWT). Scales to evaluate post-traumatic stress disorder, depression, anxiety, and HRQoL were applied.
Of 1295 patients, 365 suffered ARDS and 166 survived to hospital discharge. Five died after discharge and 48 were lost to follow-up. Of the 113 remaining patients, 81% had persistent symptoms. More than 50% of patients completed less than 80% of the theoretical distance on the 6MWT, 50% had an abnormal X-ray and 93% of patients developed psychiatric disorders. Mean SF-36 scores were worse than in the general population. After multivariate regression analysis, female sex, non-Caucasian race, and Charlson index>2 were independent risk factors for a worse mental health component summary score on the SF-36, and age was associated with a better prognosis. Female sex and chronic obstructive pulmonary disease were independently associated with a worse physical component summary score.
COVID-19 associated ARDS survivors have long-term consequences in health status, exercise capacity, and HRQoL. Strategies addressed to prevent these sequelae are needed.
Objetive. The objective of this article is to analyze the scientific production on creative tourism indexed in the Scopus database and to identify gaps, trends and future lines of research. Method. ...The bibliometric method was used to map the state of the art and identify trends, gaps and future lines of research. A search was made in the Scopus database for scientific articles that included the terms creative tourism in the title, abstract or keywords. Bibexcel software was used to calculate productivity indicators and h-index. The VOSviewer software allowed the analysis of bibilometric networks of citation, co-citation and co-occurrence of keywords. Results. A total of 120 articles corresponding to the period 2002-2020 were found. The scientific production on creative tourism is growing and presents a high rate of topicality. Greg Richards was the most prolix author with the highest h-index, which confirms him as a reference in the subject. The most productive journals are Current Issues in Tourism and Annals of Tourism Research. Creative tourism has been studied from three fundamental thematic lines: tourism and creativity, creative experience and creative space. Conclusions. The implications of the results of the study for academics, researchers and tourism managers were presented. Studies on the profile of the creative tourist, the role of new technologies, co-creation of experiences, as well as the inclusion of variables such as repetition intention, image, motivation and the role of the community in creative tourism were proposed as research opportunities.
Abstract Innovation is a key tool for the commercialization of creative experiences. The article aims to identify the challenges and perspectives for tourism innovation in Holguin tourism ...destination, Cuba. To this end, the features of innovation in tourism and the relevant factors for the design of creative experiences were identified. A Scopus search on tourism innovation was carried out, the processing in Bibexcel software allowed to analyze the productivity of articles and the use of VOSviewer to identify the main contributions through the co-citation of authors. The identification of relevant factors for designing creative experiences was carried out through the analysis of keywords in VOSviewer of the articles published in Scopus on the subject. An Occurrence-Strength matrix of keyword links was developed to identify the priority level of each factor. An exchange was carried out with academics and researchers of Holguin destination to know its current situation. The results show that, although tourism is characterized as an innovative sector, there are important gaps to be filled. Tourism innovation should be oriented to the creative experience through the development of factors such as co-creation. Among the main challenges facing the destination is the need for flexible and integrative thinking in organizations.
El turismo creativo está posicionándose como una nueva oferta capaz de satisfacer las necesidades y expectativas de los consumidores por su alto nivel de cocreación de la experiencia. En este ...contexto, se reconocen al street y el grafiti como elementos configurantes de varias ofertas. Este estudio tuvo como objetivo identificar las principales potencialidades existentes en la ciudad de Holguín para el desarrollo del street art (graffitis) con el fin de aportar creatividad a la oferta turística cultural actual. Para ello se realizó una búsqueda en la base de datos Sciendirect que permitió identificar las principales líneas temáticas mediante el empleo del software VOSviewer y el análisis de contenido de los principales artículos, así como de otras fuentes que abordaran la temática. El análisis de contenido permitió conocer varias experiencias exitosas en el marco internacional e identificar factores clave de éxito para el desarrollo de este producto con fines turísticos. Se identificaron las potencialidades del destino Holguín para su desarrollo con implicaciones prácticas para los gestores turísticos del destino, que incluyen la presencia del proyecto Undergraff como principal fortaleza, la necesidad de rehabilitar varios espacios de la ciudad y la presencia de eventos culturales internacionales para posicionar esta nueva oferta.
To analyze trends in the prescription of COVID-19 treatments for hospitalized patients during the pandemic.
Multicenter, ecological, time-series study of aggregate data for all adult patients with ...COVID-19 treated in five acute-care hospitals in Barcelona, Spain, between March 2020 and May 2021. Trends in the monthly prevalence of drugs used against COVID-19 were analyzed by the Mantel-Haenszel test.
The participating hospitals admitted 22,277 patients with COVID-19 during the study period, reporting an overall mortality of 10.8%. In the first months of the pandemic, lopinavir/ritonavir and hydroxychloroquine were the most frequently used antivirals, but these fell into disuse and were replaced by remdesivir in July 2020. By contrast, the trend in tocilizumab use varied, first peaking in April and May 2020, declining until January 2021, and showing a discrete upward trend thereafter. Regarding corticosteroid use, we observed a notable upward trend in the use of dexamethasone 6 mg per day from July 2020. Finally, there was a high prevalence of antibiotics use, especially azithromycin, in the first three months, but this decreased thereafter.
Treatment for patients hospitalized with COVID-19 evolved with the changing scientific evidence during the pandemic. Initially, multiple drugs were empirically used that subsequently could not demonstrate clinical benefit. In future pandemics, stakeholders should strive to promote the early implementation of adaptive randomized clinical trials.
Between 2.5 and 28% of people infected with SARS-CoV-2 suffer Long COVID or persistence of symptoms for months after acute illness. Many symptoms are neurological, but the brain changes underlying ...the neuropsychological impairments remain unclear. This study aimed to provide a detailed description of the cognitive profile, the pattern of brain alterations in Long COVID and the potential association between them. To address these objectives, 83 patients with persistent neurological symptoms after COVID-19 were recruited, and 22 now healthy controls chosen because they had suffered COVID-19 but did not experience persistent neurological symptoms. Patients and controls were matched for age, sex and educational level. All participants were assessed by clinical interview, comprehensive standardized neuropsychological tests and structural MRI. The mean global cognitive function of patients with Long COVID assessed by ACE III screening test (Overall Cognitive level - OCLz= -0.39± 0.12) was significantly below the infection recovered-controls (OCLz= +0.32± 0.16, p< 0.01). We observed that 48% of patients with Long COVID had episodic memory deficit, with 27% also impaired overall cognitive function, especially attention, working memory, processing speed and verbal fluency. The MRI examination included grey matter morphometry and whole brain structural connectivity analysis. Compared to infection recovered controls, patients had thinner cortex in a specific cluster centred on the left posterior superior temporal gyrus. In addition, lower fractional anisotropy (FA) and higher radial diffusivity (RD) were observed in widespread areas of the patients' cerebral white matter relative to these controls. Correlations between cognitive status and brain abnormalities revealed a relationship between altered connectivity of white matter regions and impairments of episodic memory, overall cognitive function, attention and verbal fluency. This study shows that patients with neurological Long COVID suffer brain changes, especially in several white matter areas, and these are associated with impairments of specific cognitive functions.
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