Background
Bronchiolitis is the most common reason for hospitalization of children worldwide. Many scoring systems have been developed to quantify respiratory distress and predict outcome, but none ...of them have been validated. We hypothesized that the ultrasound evaluation of the diaphragm could quantify respiratory distress and therefore we correlated the ultrasound diaphragm parameters with outcome.
Methods
Prospective study of infants with bronchiolitis (1‐12 months) evaluated in a pediatric emergency department. Ultrasonography examinations of the diaphragm was performed (diaphragm excursion DE, inspiratory excursion IS, inspiratory/expiratory relationship I/E, and thickness at end‐expiration TEE and at end‐inspiration TEI; thickening fraction TF).
Results
We evaluated 61 infants, 50.8 % males. Mean TF was 47% (IQR 28.6‐64.7), mean I/E 0.47 (± 0.15), mean DE 10.39 ± 4 mm. There was a linear correlation between TF and oxygen saturation at first evaluation (P = 0.006, r = 0.392). All children with lower values of TF required HFNC and one of them required CPAP. A higher IS was associated with the future need of respiratory support during admission (P = 0.007). IS correlated with the hours of oxygen delivery needed (P = 0.032, r = 0.422). TEI (t = 3.701, P = 0.002) was found to be main predictor of hours of oxygen delivery needed.
Conclusion
This study described ultrasound diaphragmatic values of previously healthy infants with bronchiolitis. DE, IS, and TEI correlated with outcome. If confirmed in larger studies, bedside ultrasound semiology of the diaphragm can be a new objective tool for the evaluation and outcome prediction of infants with bronchiolitis.
Highlights • Common variable immunodeficiency (CVI) is the commonest primary antibody disorder. • A higher frequency of malignancy, especially lymphoma, has been reported. • The reasons for the ...increased susceptibility to lymphoid malignancies are unclear. • This review discusses the latest insights into the links CVI and malignancies.
In 2019, an infection provoked by SARS-CoV-2 virus arose in Wuhan, China. Currently, there is still no definite and efficacious therapy for SARS-CoV-2 infection. Moreover, our understanding of the ...physiopathology of the infection, and risk elements for severity and mortality, is incomplete.
One largely neglected element that could affect prognosis of SARS-CoV-2 infection is the vitamin status of population. The purpose of this review is to evaluate whether a vitamin insufficiency could provoke an augmented risk of SARS-CoV-2 infection or the appearance of major complications. In particular, we evaluated the presence of studies related to the state and effects of vitamin D, C, B, and A in subjects with SARS-CoV-2 disease.
Although, actually, the interest in a possible use for vitamin supplementation in SARS-CoV-2 patients is essentially based on indirect data, we tried to examine the evidence about a favorable effect of vitamin supplementation in the therapy of the infection and its complications.
Supplements with vitamin A, B, C, D, and E could represent an inexpensive and sufficiently safe approach, and a useful therapeutic complement. However, solid clinical research data are expected to support such claim.
The optimal duration of treatment with vitamin K antagonists (VKA) after venous thromboembolism (VTE) in patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) is uncertain. To ...tackle this issue, we retrospectively studied 206 patients with MPN-related VTE (deep venous thrombosis of the legs and/or pulmonary embolism). After this index event, we recorded over 695 pt-years 45 recurrences, venous in 36 cases, with an incidence rate (IR) of 6.5 per 100 pt-years (95% confidence interval (CI): 4.9-8.6). One hundred fifty-five patients received VKA; the IR of recurrent thrombosis per 100 pt-years was 4.7 (95% CI: 2.8-7.3) on VKA and 8.9 (95% CI: 5.7-13.2) off VKA (P=0.03). In patients receiving VKA, the IR of recurrent thrombosis per 100 pt-years was 5.3 (95% CI: 3.2-8.4) among 108 patients on long-term VKA and 12.8 (95% CI: 7.3-20.7) after discontinuation among the 47 who ceased treatment (P=0.008), with a doubled risk of recurrence after stopping VKA (hazard ratio: 2.21, 95% CI: 1.19-5.30). The IR of major bleeding per 100 pt-years was 2.4 (95%: CI: 1.1-4.5) on VKA and 0.7 (95% CI: 0.08-2.5) off VKA (P=0.08). In conclusion, in MPN patients with VTE recurrent thrombosis is significantly reduced by VKA and caution should be adopted in discontinuation; however, the incidence of recurrence on treatment remains high, calling for clinical trials aimed to improve prophylaxis in this setting.
We retrospectively studied 181 patients with polycythaemia vera (n=67), essential thrombocythaemia (n=67) or primary myelofibrosis (n=47), who presented a first episode of splanchnic vein thrombosis ...(SVT). Budd-Chiari syndrome (BCS) and portal vein thrombosis were diagnosed in 31 (17.1%) and 109 (60.3%) patients, respectively; isolated thrombosis of the mesenteric or splenic veins was detected in 18 and 23 cases, respectively. After this index event, the patients were followed for 735 patient years (pt-years) and experienced 31 recurrences corresponding to an incidence rate of 4.2 per 100 pt-years. Factors associated with a significantly higher risk of recurrence were BCS (hazard ratio (HR): 3.03), history of previous thrombosis (HR: 3.62), splenomegaly (HR: 2.66) and leukocytosis (HR: 2.8). Vitamin K-antagonists (VKA) were prescribed in 85% of patients and the recurrence rate was 3.9 per 100 pt-years, whereas in the small fraction (15%) not receiving VKA more recurrences (7.2 per 100 pt-years) were reported. Intracranial and extracranial major bleeding was recorded mainly in patients on VKA and the corresponding rate was 2.0 per 100 pt-years. In conclusion, despite anticoagulation treatment, the recurrence rate after SVT in myeloproliferative neoplasms is high and suggests the exploration of new avenues of secondary prophylaxis with new antithrombotic drugs and JAK-2 inhibitors.
Human beings are inhabited by innumerable microorganisms that interrelate with the host in a reciprocal way, establishing a combined and efficient ecosystem - the microbiota - that can affect ...healthiness as well as disease. There is evidence that the conformation of the microbiota may influence, and is controlled by, the human immune system. Microbes existing in human tissues offer a multiplicity of advantages that participate in functional actions in the host through the adjustment of essential processes such as immunity, signal transduction, and metabolism. The imbalance of this microbial structure has been connected with the pathogenesis and progression of cancer. We reviewed the present knowledge of the diverse microbial ecosystems and we investigated their potential link to carcinogenesis, and the possibility of using advantageous microbes in controlling and preventing hematologic malignancies.
This phase 2 trial evaluated three low-dose intensity subcutaneous bortezomib-based treatments in patients ⩾75 years with newly diagnosed multiple myeloma (MM). Patients received subcutaneous ...bortezomib plus oral prednisone (VP, N=51) or VP plus cyclophosphamide (VCP, N=51) or VP plus melphalan (VMP, N=50), followed by bortezomib maintenance, and half of the patients were frail. Response rate was 64% with VP, 67% with VCP and 86% with VMP, and very good partial response rate or better was 26%, 28.5% and 49%, respectively. Median progression-free survival was 14.0, 15.2 and 17.1 months, and 2-year OS was 60%, 70% and 76% in VP, VCP, VMP, respectively. At least one drug-related grade ⩾3 non-hematologic adverse event (AE) occurred in 22% of VP, 37% of VCP and 33% of VMP patients; the discontinuation rate for AEs was 12%, 14% and 20%, and the 6-month rate of toxicity-related deaths was 4%, 4% and 8%, respectively. The most common grade ⩾3 AEs included infections (8-20%), and constitutional (10-14%) and cardiovascular events (4-12%); peripheral neuropathy was limited (4-6%). Bortezomib maintenance was effective and feasible. VP, VCP and VMP regimens demonstrated no substantial difference. Yet, toxicity was higher with VMP, suggesting that a two-drug combination followed by maintenance should be preferred in frail patients.
Abstract Accelerometry (ACC) shows promise as an easily implemented clinical measure of balance. The purpose of the study was to estimate test–retest reliability of ACC measures and determine the ...relationship between ACC measured at the pelvis and underfoot center of pressure (COP) measures during sensory organization test (SOT) conditions. Eighty-one subjects were recruited from the community with no known orthopedic or vestibular deficits (19–85 years). Subjects completed three consecutive, ninety second trials for each of the six SOT conditions, while wearing the accelerometer. ACC and COP time series were described by calculating the normalized path length, root mean square (RMS), and peak-to-peak values. The test–retest reliability of the three measures within each SOT condition was estimated over three trials using the intraclass correlation coefficient. ACC and COP test–retest reliability were similar, ranging from 0.63 to 0.80 using ACC and 0.42 to 0.81 using COP for the measure of normalized path length. Linear regression between ACC and COP measures showed significant correlation under almost every SOT condition using both single and average measures across trials. The degree of association between COP and ACC was equivalent when using the first trial or the 3-trial average, suggesting that one trial may be sufficient. The use of accelerometry may have value in estimating balance function and minimizing clinical evaluation time.
Clinically nonfunctioning pituitary adenomas (NFPA) are the most common pituitary tumors after prolactinomas. The absence of clinical symptoms of hormonal hypersecretion can contribute to the late ...diagnosis of the disease. Thus, the majority of patients seek medical attention for signs and symptoms resulting from mass effect, such as neuro-ophthalmologic symptoms and hypopituitarism. Other presentations include pituitary apoplexy or an incidental finding on imaging studies. Mass effect and hypopituitarism impose high morbidity and mortality. However, early diagnosis and effective treatment minimizes morbidity and mortality. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism is to provide a review of the diagnosis and treatment of patients with NFPA, emphasizing that the treatment should be performed in reference centers. This review is based on data published in the literature and the authors' experience. Arch Endocrinol Metab. 2016;60(4):374-90.
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