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Summary Introduction The voice disorder can cause limitations at work, as it affects the communication and the performance of the teaching function. Objective To analyze the limitation at work because of the voice and to examine possible associations with sociodemographic characteristics, life and health habits and work conditions among Basic Education teachers in Brazil. Methods Cross-sectional epidemiological study, with a representative sample, carried out between October 2015 and March 2016, with 6,324 teachers working in Basic Education in Brazil. Data collection was carried out through the application of a questionnaire via telephone with questions regarding health and working conditions. The “limitation at work because of the voice” was considered a dependent variable, whose response options were a scale with four Likert items that varied from frequently to never. The independent variables were grouped in blocks for ordinal logistic regression analysis with hierarchical entry. The magnitude of the association was assessed by the Odds Ratio (OR) with the respective confidence intervals (95% CI). Results One third of Brazilian teachers (32.7%) reported some frequency of limitation at work (sometimes; rarely, frequently) because of the voice at some moment in the month before the survey and, of these, 5% declared high frequency. The factors that increased the chance of a greater frequency of limitation at work because of the voice were: being female (OR = 1.32; 95% CI = 1.15–1.51); teaching for elementary school (OR = 1.35; 95% CI = 1.02–1.78); use anxiolytic or antidepressant medications (OR = 1.46; 95% CI = 1.20–1.78); losing sleep due to concerns (OR = 1.69; CI = 95% = 1.46–1.95); high noise at school (OR = 2.09; 95% CI = 1.78–2.46); agitated environment by students' indiscipline (OR = 1.37; 95% CI =1.15–1.63); high demands at work (OR = 1.18; 95% CI = 1.02–1.36); not having social support (OR = 1.19; 95% CI = 1.04–1.38); having suffered verbal violence by the students (OR = 1.43; 95% CI = 1.23–1.67). On the other hand, the practice of regular physical activity (OR = 0.86; 95% CI = 0.75–1.00) and the fact of having enough time to complete work tasks (OR = 0.71; 95% CI = 0,62–0.82) decreased the chance of a higher frequency of limitation at work due to vocal problems. The perception that the work limits the teaching performance because of the voice was more frequent among teachers in the North (OR=1.41; 95% CI = 1.17–1.71) and Northeast (OR=1.46; 95% CI = 1.22–1.76) compared to the Southeast region. Conclusion Factors associated with an increase in the chance of higher frequency of reporting work limitations due to the voice: being female, lack of physical activity, losing sleep due to concern, using anxiolytic or antidepressant medication, school location in the North and Northeast, teaching for the elementary school stage, high noise at school and psychosocial aspects of work organization. The Brazilian educational sector needs public policies that take into account regional inequalities and the health and work conditions of teachers.

Immunohistochemistry (IHC) and/or MSI-PCR (microsatellite instability-polymerase chain reaction) tests are performed routinely to detect mismatch repair deficiency (MMR-D). Classical MMR-D tumors present a loss of MLH1/PMS2 or MSH2/MSH6 with MSI-High. Other profiles of MMR-D tumors have been described but have been rarely studied. In this study, we established a classification of unusual MMR-D tumors and determined their frequency and clinical impact. All MMR-D tumors identified between 2007 and 2017 were selected. Any profile besides the classical MMR-D phenotype was defined as unusual. For patients with unusual MMR-D tumors, IHC, and PCR data were reviewed, the tumor mutation burden (TMB) was evaluated and clinical and genetic features were collected. Of the 4948 cases of MMR testing, 3800 had both the available IHC and MSI-PCR results and 585 of these had MMR-D. After reviewing the IHC and PCR, 21% of the cases initially identified as unusual MMR-D were reclassified, which resulted in a final identification of 89 unusual MMR-D tumors (15%). Unusual MMR-D tumors were more often associated with non-CRC than classical MMR-D tumors. Unusual MMR-D tumors were classified into four sub-groups: i) isolated loss of PMS2 or MSH6, ii) classical loss of MLH1/PMS2 or MSH2/MSH6 without MSI, iii) four MMR proteins retained with MSI and, iv) complex loss of MMR proteins, with clinical characteristics for each sub-group. TMB-high or -intermediate was shown in 96% of the cancers studied (24/25), which confirmed MMR deficiency. Genetic syndromes were identified in 44.9% (40/89) and 21.4% (106/496) of patients with unusual and classical MMR-D tumors, respectively (P

Objetivo: Evaluar la anemia y la parasitosis en niños de 6 a 60 meses de edad, atendidos en un Centro de Salud Alto andina de Perú, durante periodo 2015 al 2020. Método: El estudio fue descriptivo – retrospectivo, se aplicó el método científico, con un diseño no experimental, la población y la muestra fueron compuestos por 1097 niños atendidos en el Centro de Salud de Ascensión, durante los años 2015 al 2020, se incluyó todo niño que padezca anemia y/o parasitosis. Resultado: 515 niñas que componen un 46.9%, y 582 niños que componen 53.1 % padecen de anemia, de los cuales el 83% padecen anemia leve, y un 17 % padecen de anemia moderada; en cuanto a género 83,7% niñas y 82,3% niños presentan anemia, en relación a edad los de 6 a 12 mes presentaron anemia leve en un 37.5% y moderado 48.1% ; Por otro lado de un total de 240 niños, un 53.3 % fueron niñas y un 46.7 fueron niños que padecen parasitosis intestinal. Conclusión: En las zonas alto andinas de Perú, de niños y niñas que presentan anemia, predomina la anemia leve, así mismo este problema de salud no diferencia en su afección al género; en relación a la edad predomina de 6 a 12 meses con anemia leve y moderado. Por otro lado, se evidencia un porcentaje considerable de parasitosis intestinal, de igual forma esta enfermedad en cuanto al género no diferencia; sin embargo en cuanto a la edad se evidencia mayor parasitosis intestinal en niños y niñas de 24, 36 y 60 meses; lo que implica que la parasitosis intestinal no necesariamente es un factor predominante para la anemia.

Purpose: Depression is a major mental disorder and has drastic effects on people suffering from other terminal illnesses like cancer. Many patients struggling with chronic or fatal illnesses rely on spirituality to cope. Spirituality in Indian culture has always been a vital component in indigenous health systems.Objective: To determine the relationship between spirituality and depression among patients with cancer visiting a tertiary care institute of Uttarakhand State in northern India. Design: A descriptive cross-sectional survey.Sample: A total of 103 cancer patients visiting inpatient and outpatient departments of a selected tertiary care institute of Uttarakhand state of northern India. Methods: Participants were administered the socio-demographic proforma, Patient Health Questionnaire (PHQ-9) (Kroenke, Spitzer, and Williams, 2001), System of Belief Inventory (SBI-15R). Findings: The mean score of depression among cancer patients was 9.12±6.537 (CI, 7.84-10.39). Patients with high spirituality have minimal or no depression. We found a statistically significant negative correlation between depression and spirituality (r=-0.209, p=0.05).Conclusions: Health care professionals can incorporate spirituality in caring for cancer patients to develop a positive outlook on living despite the illness. Implications for Psychosocial Providers Or Policy: Establishing a spiritual support program as an integral part of a multidisciplinary approach can better cancer treatment in the Indian setting.

Digital, Introduction: Cardiovascular risk factors have been measured under different conditions, there is some missing information related to specific occupations, such as penitentiary staff which due to their characteristics could have an increased cardiovascular risk. Objective: To determine cardiovascular risk factors on military staff from penitentiary institutions in Santander—Colombia. Methods: Cross-sectional study conducted with 182 workers. Anthropometric parameters, blood pressure, serum lipid profile, and glucose levels were measured. Univariate and bivariate analyses were carried out to establish differences between individuals. Results: Anthropometric and biochemical measures showed that 71.3% participants were overweight or obese, 29.4% presented high blood pressure with increased levels of total cholesterol (27.5%), triglycerides (40.7%), glucose (9.3%), and 84.1% presented low levels of HDL cholesterol. Bivariate analysis found a negative correlation between BMI and HDL cholesterol (p, Ciencias Médicas y de la Salud

People with voice disorders and their problems are always at the centre of attention of several sciences, in particular medicine, pedagogy, psychology, and sociology. The use of quantitative procedures in this paper is mainly ready to lend a hand in sorting out some of the significant issues surrounding speech therapy intervention in both clinical and research contexts. After the removal of the throat, the patient, having the means of communication - the word, but losing one of the components of expressive speech - the voice, has pronounced difficulties in the process of communication. Some patients, realizing their inadequacy due to absence of voice, try to take various measures to overcome the problem, while others become discouraged, frustrated, lose optimism, the desire to overcome the problem and return to a full life. Patients, within the frame of this study, had certain prerequisites for vocal cords, such as verbal breathing and expressive mobility problems.

The aim of this paper is to infer the effects that change on human mobility had on the transmission dynamics during the first four months of the SARS-CoV-2 pandemic in Costa Rica, which could have played a role in delaying community transmission in the country. First, by using parametric and non-parametric change-point detection techniques, we were able to identify two different periods when the trend of daily new cases significantly changed. Second, we explored the association of these changes with data on population mobility. This also allowed us to estimate the lag between changes in human mobility and rates of daily new cases. The information was then used to establish an association between changes in population mobility and the sanitary measures adopted during the study period. Results showed that during the initial two months of the pandemic in Costa Rica, the implementation of sanitary measures and their impact on reducing human mobility translated to a mean reduction of 54% in the number of daily cases from the projected number, delaying community transmission. UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Básicas::Centro de Investigaciones en Matemáticas Puras y Aplicadas (CIMPA) UCR::Vicerrectoría de Docencia::Ciencias Básicas::Facultad de Ciencias::Escuela de Matemática

Objective This work aimed to evaluate the factors associated with Streptococcus pneumoniae nasopharyngeal colonization and antimicrobial susceptibility among pediatric outpatients in southwestern Colombia, 2019. Methods A cross-sectional study was performed using survey-based interviews and the collection of nasopharyngeal-swab specimens for microbiological characterization and antimicrobial susceptibility testing. Logistic regression analyses were performed for factors associated with nasopharyngeal carriage. Results A total of 452 children under the age of 5 years were examined in which 41.8% carried S. pneumoniae. Higher pneumococcal carriage frequencies were observed among participants aged Conclusion The 41.8% of participants carrying S. pneumoniae show a scenario with the presence of multidrug and extensively drug-resistant strains, which constitutes important reservoirs of bacterial transmission by children aged

Epithelioid mesothelioma is the most prevalent subtype of diffuse malignant peritoneal mesothelioma. A recently described nuclear-grading system predicted survival in patients with epithelioid malignant pleural mesothelioma. The present study was undertaken to validate this grading system in epithelioid malignant peritoneal mesothelioma (EMPM) and to compare to combined grade, including nuclear atypia, mitotic count, and tumor necrosis. Cases of EMPM, from 1995 to 2018, were analyzed from 7 French institutions from RENAPE network. Solid growth, tumor necrosis, nuclear atypia, and mitotic count were evaluated by at least 3 pathologists from the RENAPATH group. The predictions in terms of OS and PFS of nuclear grade and combined grade were analyzed. Nuclear grade was computed combining nuclear atypia score and mitotic count into a grade of I–III. Another system combining nuclear atypia score, mitotic score, and tumor necrosis was evaluated and defined as a combined grade I–III. A total of 138 cases were identified. The median follow-up was 38.9 months (range: 1.1–196.6). Nuclear and combined grades III were independently associated with a shorter OS (p

Background Current evidence regarding the optimal length of hospital stay (LOS) following myocardial infarction (MI) is limited. This study aimed to examine LOS policy for MI patients and to assess the safety of early discharge. Methods A prospective observational study that included patients with STEMI and NSTEMI enrolled in the Acute Coronary Syndrome Israeli Survey (ACSIS) during the years 2000–2016. Patients were divided into three subgroups according to their LOS: 6 days (long‐LOS). We compared baseline characteristics, management strategies and clinical outcomes at 30 days and 1 year in these groups. Results Ten thousand four hundred and fifty eight patients were enrolled in the study. The LOS of MI patients gradually decreased over time. Short‐LOS and intermediate‐LOS patients had similar clinical characteristics while patients in the long‐LOS group were older with more co‐morbidity. There was no difference in the clinical outcomes, including re‐MI, arrhythmias, 30 days MACE, and 30 days mortality between the short‐LOS and intermediate‐LOS groups. However, the rate of re‐hospitalizations was higher in the short‐LOS group (20.9% vs. 17.8%, p = .004) without evidence of increased cardiovascular events. In multivariate analysis, the LOS did not predict either 30 days mortality (HR: 1.3; CI:0.45–5.48), nor MACE at 30 days (HR: 1.1; CI:0.79–1.56). Conclusion Our study suggests that an early discharge strategy of up to 3 days from admission is safe for low and intermediate‐risk patients after both STEMI and NSTEMI. Nevertheless, this strategy is associated with an increased risk of potential avoidable readmission and there might be psychological and social factors that may warrant a longer stay.

Medically complex children including infants undergoing cardiac surgery are at increased risk for hospital readmissions. Investigation of this population may reveal opportunities to optimize systems and coordination of care. A retrospective study of all infants undergoing cardiac surgery from 2015 through 2016 at a large tertiary institution who were readmitted within 1 year of discharge from cardiac surgical hospitalization was performed. Data specific to patient characteristics, surgical hospitalization, and readmission hospitalization are described. Unplanned readmissions within 1 year of hospital discharge were analyzed with Cox proportional hazard regression to identify factors associated with increased hazard for earlier unplanned readmission. Comparable to previous reports, 12% (78/658) of all surgical hospitalizations were associated with unplanned readmission within 30 days. Infectious etiology, followed by cardiac and gastrointestinal problems, was the most common reasons for unplanned 30-day readmission. Unplanned readmissions within 2 weeks of discharge were multifactorial and less commonly related to cardiac or surgical care. Primary nasogastric tube feeding at the time of discharge was the only significant risk factor for earlier unplanned readmission (p = 0.032) on multivariable analysis. Increased care coordination with particular attention to feeding and comorbidity management may be future targets to effectively mitigate readmissions and improve quality of care in this population.

Introduction Assisted reproductive technology including in vitro fertilization (IVF) and oocyte donation (OD) may increase risk for placenta-mediated diseases. Comprehensive analysis of histopathological placental lesions according to source of oocytes used in the IVF procedure – recipient derived (RD-IVF) vs oocyte donation (OD-IVF), has not been conducted in a population with a hypertensive disorder of pregnancy (HDP) and/or intrauterine growth restriction (IUGR). Methods A retrospective cohort study of archived placenta specimens from RD-IVF and OD-IVF pregnancies affected by HDP and/or IUGR was conducted with blinded histopathological placental examination. Three categories of lesions were differentiated and defined as main outcomes: maternal vascular malperfusion (MVM), chronic inflammation, and fetal vascular malperfusion (FVM). To determine the relationship between conception method and placental lesions, multivariable regressions were performed with maternal age, gestational age, HDP, birth and placental weight percentiles as model covariates. Results 115 placentas were included 83 (72.2%) RD-IVF, 32 (27.8%) OD-IVF. Adjusted OR (aOR) for conception method was 5.05 (95%CI 0.58–43.90, p=0.142) for MVM, 1.87 (95%CI 0.68–5.15, p=0.228) for chronic inflammatory and 0.61 (95%CI 0.15–2.37, p=0.471) for FVM lesions. Multiple gestation demonstrated borderline association with MVM (aOR=0.24, 95%CI 0.04–1.51, p=0.129) and total pathology score (aRR=0.79, 95%CI 0.62–1.01, p=0.058). Subgroup analysis suggested greater odds of villitis of unknown etiology (VUE) for OD-IVF (aOR=2.98, 95%CI 1.12–7.93, p=0.029). Discussion Source of oocyte derivation demonstrated no evidence of association with main outcomes in cases of HDP and/or IUGR. Subgroup analysis demonstrated increased rates of inflammatory lesions for OD-IVF. Multiple gestation may be associated with decreased MVM and total lesions.

Epithelioid mesothelioma is the most prevalent subtype of diffuse malignant peritoneal mesothelioma. The relationship between a strong adaptive immune response and a better prognosis in malignant solid tumors is widely known. Due to the low incidence of epithelioid malignant peritoneal mesothelioma (EMPM), very little is known about their immune micro-environment. We encountered several cases of tertiary lymphoid structures in EMPM in a previous study and aimed to investigate in the same series the prevalence, clinicopathological features, and the prognostic impact associated with tertiary lymphoid structures in EMPM (TLS-EMPM). Cases of EMPM, from 1995 to 2018, were retrieved from 7 French institutions from the RENAPE Network. The predictions in terms of overall survival (OS) and progression-free survival (PFS) of TLS-EMPM were analyzed. We report 52 cases of TLS-EMPM among a series of 138 cases of EMPM. TLS-EMPM was significantly associated with neoadjuvant chemotherapy, and was not a prognostic indicator for OS (p = 0.652) and PFS (p = 0.804) in our series. TLS is a component of the host immune response to EMPM significantly associated with neoadjuvant chemotherapy, but was not a predictor of prognosis for overall and progression-free survivals in this series. These findings provide another possible etiology for tertiary lymphoid structures.

Anne-Claire Fougerousse,1 Laure Mery-Bossard,2 Josiane Parier,3 Charles Taieb,4 Antoine Bertolotti,5,6 Francois Maccari3 On behalf of GEM ResoPso1Dermatology Department, Hôpital d’Instruction des Armées Bégin, Saint Mandé, 94160, France; 2Dermatology Department, Centre Hospitalier Intercommunal Poissy Sant Germain en Laye, Saint-Germain-en-Laye, 78100, France; 3Private Practice, La Varenne Saint Hilaire, Saint-Maur-des-Fossés, 94210, France; 4European Market Maintenance Assessment, Patients Priority Department, Fontenay sous-Bois, France; 5Infectious Diseases and Dermatology Department, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, La Réunion, France; 6Inserm CIC1410, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, La Réunion, FranceCorrespondence: Anne-Claire FougerousseDermatology Department, Hôpital d’Instruction des Armées Bégin, 69 Avenue de Paris, Saint Mandé, 94160, FranceTel + 331 43 98 50 00Fax + 331 43 98 49 15Email ac.fougerousse@gmail.comPurpose: To evaluate the modalities of methotrexate prescription for moderate to severe psoriasis by dermatologists in France.Patients and Methods: We performed a national online practice survey between October and December 2020.Results: A total of 254 dermatologists responded, 237 reported prescribing methotrexate for moderate to severe psoriasis in adults, of which 57% as a first line systemic treatment. Nineteen percent reported performing a test dose at the initiation of treatment. Methotrexate was prescribed orally in 54.7% of cases, subcutaneously in 44.8% of cases and intramuscularly in 0.4% of cases. The initial weekly dose of methotrexate was < 15 mg for 30% of the dermatologists and ≥ 15 mg for 70% of them. Two hundred and three dermatologists had already change the route of administration for methotrexate from the oral to injectable form due to poor tolerance (48.3%), lack of efficacy (35%) or lack of compliance (16.7%). Two hundred thirty-four dermatologists (98.7%) reported prescribing folic acid with methotrexate, and 79.3% reported prescribing tests evaluating the risk of hepatic fibrosis. Forty-three percent of dermatologists have not initiated or have reduced their prescriptions since the beginning of the pandemic of COVID-19. Prescribing patterns were different according to the type of practice (private practice versus hospital/mixed practice).Conclusion: Methotrexate is used by the majority of dermatologists interviewed for moderate to severe psoriasis in adults, with heterogeneity of practices.Keywords: psoriasis, methotrexate, practice survey, dermatologists

SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function.

Morphological features including interarterial course, intramural course, high ostial location and slit-like ostium are presumed risk factors for sudden cardiac death in children with anomalous aortic origin of the coronary artery (AAOCA). To facilitate clinical risk stratification, the diagnostic accuracy of CT angiography for individual risk factors in the setting of AAOCA must be established. We assessed diagnostic accuracy of standardized CT angiography interpretation for morphological characteristics that might determine risk in children with AAOCA by comparing them to surgical findings. We created a standardized protocol for CT angiography of AAOCA and retrospectively evaluated diagnostic performance in 25 consecutive surgical patients. Relevant morphological variables in AAOCA were assessed by three independent blinded readers, with surgery as the reference standard. We used Cohen kappa coefficients and accuracies to assess agreement between readers and surgical findings, and we calculated intraclass correlation coefficients to compare length of the intramural course. CT angiography correctly identified AAOCA in all patients. For the three readers, accuracies for detecting ostial stenosis were 84%, 94% and 96%; for high ostial origin, accuracies were 76%, 78% 82%; for intramurality using the peri-coronary fat sign, accuracies were 98%, 96% and 92%; and for intramurality using oval shape of coronary artery, accuracies were 98%, 94% and 92%. The intraclass correlation coefficients (ICCs) for predicting intramural length among the three readers were 0.67, 0.75 and 0.81 using peri-coronary fat, and 0.69, 0.50 and 0.81 using oval shape, respectively. CT angiography reliably identified AAOCA in all children and detected the presence of intramurality with high accuracy.

Background Aneurysm clipping requires the proficiency of several skills, yet the traditional way of practicing them has been recently challenged, especially by the growth of endovascular techniques. The use of simulators could be an alternative educational tool, but some of them are cumbersome, expensive to implement, or lacking in realism. The aim of this study is to evaluate a reusable low-cost 3-dimensional printed training model we developed for aneurysm clipping. Methods The simulator was designed to replicate the bone structure, arteries, and targeted aneurysms. Thirty-two neurosurgery residents performed a craniotomy and aneurysm clipping using the model and then filled out a survey. They were divided into Junior and Senior groups. Descriptive, exploratory, and confirmatory factor analysis was performed using IBM SPSS statistical software. Results The overall residents' response was positive, with high scores to face validity and content validity questions. There was no significant statistical difference between the Junior and Senior groups. The confirmatory factor and internal consistency analysis confirmed that the evaluation was highly reliable. Globally, 97% of the residents found the model was useful and would repeat the simulator experience. The financial cost is $2500 USD for implementation and only $180 USD if further training sessions are required. Conclusions The main strengths of our training model are its highlighted realism, adaptability to trainees of different levels of expertise, sustainability, and low cost. Our data support the concept that it can be incorporated as a new training opportunity during professional specialty meetings and/or within residency academic programs.

Background: Anomalous aortic origin of a coronary artery (AAOCA) is associated with sudden death in the young. We sought to determine quality of life (QOL) in patients/families affected by AAOCA. Methods: Patients with AAOCA (8-18 years) were prospectively included from January 2016 to May 2017. Parent proxy and patient Pediatric Cardiac Quality of Life Inventory (PCQLI) were used to evaluate QOL and Pediatric Quality of Life Inventory (PedsQL) Family Impact Module to assess the impact of AAOCA on families, as primary outcomes. Secondary outcomes included peer relationship, anxiety, and depression assessed using patient-reported outcomes measurement information system. Patients deemed high-risk were offered surgery/exercise restriction. Generalized linear mixed regression models were used to determine significant predictors of outcomes. Results: Fifty-three patients, the majority (n = 31, 59%) unrepaired, and 49 caregivers were included. Using PCQLI, patient and parent proxy QOL scores were similar to published scores for children with long-QT syndrome. Patients’ QOL score was associated with exertional symptoms, perceived chronic disease, and altered parent’s concentration ability. Likewise, parent proxy QOL scores were associated with mother’s living situation, exertional symptoms, parent missing work for ≥1 day, and disturbed parental functioning at work. Family impact scores were associated with lower maternal education, among other measures. Risk categories or surgical status did not impact patient, parent proxy reported, or family impact QOL. Conclusion: Anomalous aortic origin of a coronary artery is associated with decreased QOL as perceived by patients and caregiver and is associated with numerous facets of family functioning. These findings are independent of risk categorization or surgical status.

The study was conducted in two stages. At the first stage, quantitative methods were chosen as methodologies, since the object that is studied by this method is a quantitative unit, which in the future allows to draw conclusions, based on the results, using certain numerical models to develop or confirm new hypotheses, or/and refute existing ones. At the second stage, a qualitative study was conducted on the basis of the results of the first stage, accordingly developing recommendations on ergotherapy for each code issue. According to the study results, in today's Armenia, it is possible to issue all the problems that children with Cerebral Palsy face in self-care and life by using certain assessing tools of occupational therapy. In this case, the study shows that the evaluation of the World Health Organization International Classification of Functioning and Disability, Children and Youth (2008) allows to observe and issue the existing problems of this sphere in a more accurate and comprehensive way․ It also provides an objective basis for identifying the problems in the field of children's self-service and life, which, in its turn, allows the occupational therapist to conduct a detailed assessment to find out which self-service actions are available to the child, to what extent the child’s actions and personal roles are compatible with the current state of the disease, and to what extent the actions correspond to their age.

Isolated pulmonary artery (PA) of ductal origin (IPADO) is a rare cardiac defect which requires surgical repair, with or without preceding palliation. We sought to determine the impact of treatment strategy on outcomes. Retrospective study of consecutive patients with IPADO that underwent staged or primary repair from 1/05 to 9/16 at 6 Congenital Cardiac Research Collaborative centers. Patients with single ventricle physiology, major aortopulmonary collaterals, or bilateral IPADO were excluded. Primary outcome was isolated PA z-score at late follow-up. Secondary outcomes included PA symmetry index (isolated:confluent PA diameter) and reintervention burden. Propensity score adjustment was used to account for baseline differences. Of 60 patients in the study cohort, 26 (43%) underwent staged and 34 (57%) primary repair. The staged and primary repair groups differed in weight at diagnosis and presence of other heart disease but not in baseline PA dimensions. Staged patients underwent ductal stent (n = 16) or surgical shunt (n = 10) placement followed by repair at 210 vs. 21 days in the primary repair group (p < 0.001). At median follow-up of 4.5 years post-repair, after adjustment, isolated PA z-score (− 0.74 [− 1.75, − 0.26] vs. − 1.95 [− 2.91, − 1.59], p = 0.012) and PA symmetry index (0.81 [0.49, 1.0] vs. 0.55 [0.48, 0.69], p = 0.042) significantly favored the staged repair group. Freedom from PA reintervention was not different between groups (adjusted HR 0.78 [0.41, 1.48]; p = 0.445). A staged approach to repair of IPADO is associated with superior isolated PA size and symmetry at late follow-up. Consideration should be given to initial palliation in IPADO patients, when feasible.

The aim of our study was to assess concordance of staging laparoscopy and cytoreductive surgery (CRS) peritoneal cancer index (PCI) when applying a two-step surgical protocol. We also aimed to evaluate the accuracy of diagnostic laparoscopy to triage patients for complete cytoreduction, and to define optimal time between staging laparoscopy and CRS. We designed a retrospective review of prospectively collected data from patients with advanced ovarian cancer who underwent a diagnostic laparoscopy followed by a CRS a few weeks later (two-step surgical protocol), from January 2010 to April 2019. Only patients selected for complete cytoreduction, and with available PCI score from both surgeries were included. PCI concordance was assessed using intraclass correlation coefficient (ICC). During the study period 543 patients underwent a laparoscopic staging for ovarian carcinomatosis. Among them, 43 patients fulfilled inclusion criteria. ICC between laparoscopic and laparotomic PCI was 0.54. After applying the linear regression equation: laparoscopic PCI + 0.2 x [days between surgeries] + 2, ICC increased to 0.79. Completeness cytoreduction score and laparoscopic PCI were significantly associated (OR 1.27, 95% CI 1.03–1.57, p = 0.03). AUC of laparoscopic PCI to predict complete cytoreduction was 0.90. Concordance between laparoscopic PCI assessment and PCI score at the end of CRS is fair within a two-step surgical management. Laparoscopic assessment underestimates final PCI score by two points, and this difference increases with the delay between both surgeries. Diagnostic laparoscopy can adequately select patients for CRS, and optimal time to perform it is no more than 10 days after laparoscopy.

Coronavirus Disease 2019 (COVID-19) adalah penyakit menular yang disebabkan oleh Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). SARS-CoV-2 merupakan coronavirus jenis baru yang belum pernah diidentifikasi sebelumnya pada manusia. Indonesia melaporkan kasus pertama COVID-19 pada tanggal 2 Maret 2020 dan jumlahnya terus bertambah hingga sekarang. Sampai dengan tanggal 15 Oktober 2020 Kementerian Kesehatan melaporkan 349.160 kasus konfirmasi COVID-19 dengan 12.268 kasus meninggal. Aplikasi Self-Assessment COVID-19 dapat membantu skrining mandiri bagi masyarakat dan petugas kesehatan guna mempercepat penemuan kasus dan mempermudah petugas kesehatan memberikan upaya kuratif. Sosialisasi Aplikasi Self-Assessment COVID-19 telah dilaksanakan berkoordinasi dengan Puskesmas Dadok Tunggul Hitam dan Kelurahan Kampung Lapai. Kegiatan meliputi pengenalan aplikasi, instalasi aplikasi, implementasi aplikasi, serta monitoring dan evaluasi penggunaan aplikasi. Peserta mengunduh aplikasi pada perangkat Android dan mengimplementasikan aplikasi dengan antusias. Diharapkan aplikasi ini dapat memudahkan masyarakat mengakses informasi terkait COVID-19 dan melakukan skrining secara mandiri.

Population-based cancer registries (PBCR) are the only means to provide reliable incidence and survival data as a basis for policy-making and resource allocations within cancer care. Yet less than 3% and 10% of the respective populations of Central America and South America are covered by high-quality cancer registries. The Global Initiative for Cancer Registry Development (GICR) provides support to improve this situation via the IARC Regional Hub for Latin America. In this paper, we summarize activities (advocacy, technical assistance, training and research) over the last five years, their impact and current challenges, including the implementation of new PBCR in four countries in the region. Despite the favorable political support to cancer registration in many countries, the sustainability of cancer registration remains vulnerable. Renewed efforts are needed to improve data quality in Latin America while ensuring maximum visibility of the data collected by disseminating and promoting their use in cancer control. This article is protected by copyright. All rights reserved.

Background The sentinel lymph node (SLN) biopsy may be an alternative to systematic lymphadenectomy in early cervical cancer. The SLN biopsy is less morbid and has been shown to have high sensitivity for metastasis detection. However, the sensitivity of the SLN technique might be overevaluated because SLNs are examined with ultra-staging, and non-sentinel nodes usually are examined only with routine techniques. This study aimed to validate the negative predictive value (NPV) of the SLN technique by the ultra-staging of SLNs and non-sentinel nodes (NSLNs). Methods The SENTICOL 1 study data published in 2011 were used. All nodes (i.e., SLNs and NSLNs) were secondarily subjected to ultra-staging. The ultra-staging consisted of sectioning every 200 µm, in addition to immunohistochemistry. Moreover, the positive slides and 10% of the negative slides were reviewed. Results The study enrolled 139 patients, and SLNs were detected in 136 (97.8%) of these patiets. Bilateral SLNs were detected in 104 (76.5%) of the 136 patients. A total of 2056 NSLNs were identified (median, 13 NSLNs per patient; range 1–54). Of the 136 patients with SLNs, 23 were shown to have positive SLNs after serial sectioning and immunohistochemical staining. The NSLNs were metastatic in six patients. In the case of bilateral SLN detection, the NPV was 100%, with no false-negatives (FNs). Conclusions The pelvic SLN technique is safe and trustworthy for determining the nodal status of patients with early-stage cervical cancer. In the case of optimal mapping with bilateral detection, the NPV was found to be 100%.

Bekicot (Achatinafulica) is a gastropod class animal consumed by TNS community. It is processed in several ways including fried, boiled, and roasted. This study aims at determining the amount of bacteria found in snails that are processed in accordance with the habits of the community and stored for 3 hours, 6 hours, and 9 hours. This type of research is a descriptive study to see the quality of bicrobiology. This research was conducted in TNS sub-district for sampling and a microbiology test was carried out in the Basic Laboratory of Biology Education at Pattimura University. The results showed that among the three treatments, the lowest number of colonies was 3 hours treatment. The lowest amount of bacteria was found in bekicot meat by roasting with an average of 11.3 Cfu / g. In the storage period of 6 and 9 hours the meat is not safe to be consumed because it contains more than 5x105 Cfu / g bacteria, the highest number of bacteria or cannot be counted (CNbC) is found in meat by boiling.

To the EditorSecond malignant neoplasms (SMN) are well-recognized long-term health problems in individuals diagnosed and treated for acute lymphoblastic leukemia (ALL) at infancy and adolescence. A...

The Tepary bean (Phaseolus acutifolius) lectin fraction (TBLF) exhibits differential cytotoxicity on colon cancer cells and inhibition of early tumorigenesis in the colon (50 mg/kg, three times per week, for 6 weeks). TBLF showed low toxicity with the ability to activate the immune system; however, some adverse effects are the loss in body weight gain, intestinal atrophy, and pancreatic hyperplasia. After a recovery period of 2 weeks after treatment, reversion of pancreatic hyperplasia but no recovery of intestinal atrophy was observed. As TBLF has shown anticancer effects on the colon, it is important to characterize the adverse effects and how they can be reversed. Sprague Dawley rats were administered with TBLF (50 mg/kg) for 6 weeks, three times per week, and then allowed to recover for 6 weeks post-treatment. After TBLF administration, small intestine atrophy, villus atrophy, and cryptic hyperplasia were confirmed, as well as increased intestinal mucus production, increased permeability and a decrease in the apparent ileal digestibility of crude proteins. The colon showed damage in the simple prismatic tissue and decreased crypt depth, and changes in microbiota and a decrease in the apparent fecal digestibility of crude protein were determined. Our results show that the adverse effects provoked by TBLF were partially reversed after 6 weeks of recovery post-treatment, suggesting that increasing the recovery period it could be possible to reverse all adverse effects observed.

Highlights • Gallbladdercarcinosarcoma is a rare disease: The first case of a carcinosarcoma of the gallbladder (CSGB) was reported by Landsteiner in 1907. Up to now less than 100 Cases have been reported in the literature. • Non-specific signs: the clinical (abdominal pain, weight loss and jaundice, biological (including inflammatory sign, hepatic result), and radiological signs are nonspecific of gallbladder carcinosarcoma, The final diagnosis is anatomopathological of the specimen. • The diagnosis is delayed: Because of the nonspecific symptoms, a delayed diagnosis is generally associated with CSGB. Only 54 cases have undergone surgical resection as a treatment. • Surgical treatment remains the only cure for gallbladder carcinosarcoma: Chemotherapy and/or radiotherapy’s roles, they remain unclear because of the limited number of cases described in the literature, as chemotherapy has shown no a significant benefit in terms of morbidity or mortality. • Prognosis: The prognosis of this disease is normally poor. Most cases present with locally advanced disease and metastasis., Introduction Gallbladder Carcinosarcoma is a rare and fatal cancer characterized by the presence of a combination of a cancerous epithelial and mesenchymal components. Presentation of case We present the case of a 66 years old patient with a carcinoma gallbladder carcinoma who received a surgical treatment. The histological assessment revealed two histological components consisting of an adenocarcinoma and a spindle cell sarcoma compatible with the carcinosarcoma. Discussion This cancer is known to be extremely severe in that less than 100 cases have been documented in international medical review of literature. surgical treatment remains the only cure for gallbladder carcinosarcoma, The prognosis of this disease is extremely poor because it normally presents at advanced stages. Conclusion We present an extremely rare example of carcinosarcoma, and its attributes might be suggestive of a greater malignant potential. Consequently, the later the diagnosed worse is the prognosis.

Unemployment is associated with binge drinking (BD) as a means to combat psychological suffering. Also, the context of employment, working conditions and occupational stress have been associated with the consumption of alcoholic beverages. This article examines the role of employment status and gender differences in BD in Brazilian adults at least 18 years of age. Logistic regression models were used to analyse data from 33,632 participants (54.5% women) in the National Health Survey (Pesquisa Nacional de Saude, PNS, 2013) who were part of the workforce and who answered questions about BD. The sample was stratified by gender, with each group being classified into two subgroups according to employment status (ES), namely, employed (workers paid in cash by one or more employers) and unemployed (people without work in the reference period of the PNS). The final model by gender was fit according to ES-related exposure and the explanatory variables, with only those significant at a 5% level remaining in the model. The prevalence of BD was 15.2%. A higher chance of BD was observed in the employed group compared to the unemployed group, and in men compared to women. Younger age, living without a partner, not practising physical activity and smoking were associated with the outcome, regardless of gender. For women, interactions with income affected the association between ES and the outcome. Gender differences and high prevalence and overlapping of harmful behaviours provide clues for the evaluation of the future needs of health services, as well as guidance for employment protection policies.

Background Disordered eating (DE), defined as unhealthy eating attitudes and behaviors, is considered a major public health problem among adolescents. Nevertheless, rates of DE among Arab and Jewish adolescents in Israel are still unknown. Furthermore, while previous studies have highlighted the role of frequent family meals as a protective factor against DE, studies examining home family dinners relative to other common dinner options (e.g., eating at home alone, eating out of the home, not eating dinner at all) are largely unavailable. We sought to use representative data of middle and high-school children in Israel in order to identify rates of DE among Arabs and Jews, while examining the relations of home family dinners (vs. other dinner options) with DE. Methods A nationally representative school-based survey of 4926 middle and high-school children (11–19 years old) was conducted during 2015–2016. Participants indicated where and with whom they had eaten dinner the day before. The 5-item SCOFF questionnaire was used (> 2 affirmative items were considered a likely case of DE). Height and weight were measured by personnel. Results DE was more prevalent among girls (29.7%) relative to boys (12.2%), Arabs (25.1%) relative to Jews (19.5%), and older (25.3%) relative to younger (17.6%) adolescents. Arabs were more likely to eat dinner at home with parents/family (chi2 = 10.75, p = .001), or not to eat dinner at all (chi2 = 63.27, p 2 = 5.37, p = .021) or to eat dinner out of the home (chi2 = 67.65, p Conclusion There are differences between Arab and Jewish adolescents in terms of rates of yesterday’s family dinners and DE. Given that eating dinner with the family was linked with lower rates of DE, possible interventions to reduce DE may include educating parents of both Arab and Jewish adolescents regarding the importance of family meals.

Background: The Alberta Stroke Program Early CT Score (ASPECTS) scale was developed for monitoring early ischemic changes on CT, being associated with clinical outcomes. The ASPECTS can also associate with peripheral biomarkers that reflect the pathophysiological response of the brain to the ischemic stroke. Objective: To investigate the association between peripheral biomarkers with the Alberta Stroke Program Early CT Score (ASPECTS) in individuals after ischemic stroke. Methods: Patients over 18 years old with acute ischemic stroke were enrolled in this study. No patient was eligible for thrombolysis. The patients were submitted to non-contrast CT in the first 24 hours of admission, being the Alberta Stroke Program Early CT Score and clinical and molecular evaluations applied on the same day. The National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale and the Mini-Mental State Examination for clinical evaluation were also applied to all subjects. Plasma levels of BDNF, VCAM-1, VEGF, IL-1β, sTNFRs and adiponectin were determined by ELISA. Results: Worse neurological impairment (NIHSS), cognitive (MEEM) and functional (Rankin) performance was observed in the group with changes in the NCTT. Patients with NCTT changes also exhibited higher levels of IL-1β and adiponectin. In the linear multivariate regression, an adjusted R coefficient of 0.515 was found, indicating adiponectin and NIHSS as independent predictors of ASPECTS. Conclusion: Plasma levels of adiponectin are associated with the ASPECTS scores.

Background Tattooing is a widespread phenomenon, with an estimated prevalence of 10-30% in Western populations. For psoriasis patients, current recommendations are to avoid having a tattoo if the disease is active and they are receiving immunosuppressive treatments. Although scientific data supporting these recommendations are lacking, dermatologists are often reluctant to advocate tattooing in psoriasis patients. Objective We aimed to evaluate the frequency of tattoo complications in patients with psoriasis and determine whether the occurrence of complications was associated with psoriasis status and treatments received at the time of tattooing. Methods We performed a multicentre cross-sectional study. Adults with psoriasis were consecutively included and classified as tattooed or non-tattooed. Prevalence of complications associated with tattoos was then evaluated according to psoriasis onset and treatments. The study was divided into three parts, in which data were collected through a series of questionnaires filled in by the dermatologist. Complications included pruritus, oedema, allergic reaction/eczema, infection/superinfection, granuloma, lichenification, photosensitivity, Koebner phenomenon and psoriasis flare after tattooing. Diagnosis of complications was made retrospectively. Results We included 2053 psoriatic patients, 20.2% had 894 tattoos. Amongst non-tattooed patients, 15.4% had wished to be tattooed, with psoriasis being stated as a reason for not having a tattoo by 44.0% and 5.7% indicating that they planned to have a tattoo in the future. Local complications, such as oedema, pruritus, allergy and Koebner phenomenon, were reported in tattoos in 6.6%, most frequently in patients with psoriasis requiring treatment at the time of tattooing (P

Objectives: Crossed cerebro-cerebellar BOLD activations have recently come to light as additional diagnostic features for patients with brain tumors. The covert verb generation (VG) task is a widely used language paradigm to determine these language-related crossed activations. Here we demonstrate these crossed activations in two additional language paradigms, the semantic and phonological association tasks. We propose the merit of these tasks to language lateralization determination in the clinic as they are easy to monitor and suitable for patients with aphasia. Methods: Patients with brain tumors localized at different cortical sites (n = 71) performed three language paradigms, namely the VG task as well as the semantic (SA) and phonological (PA) association tasks with button-press responses. Respective language activations in disparate cortical regions and the cerebellum were assigned laterality. Agreements in laterality between the two new tasks and the verb generation task were tested using Cohen’s kappa. Results: Both tasks significantly agreed in cortical and cerebellar lateralization with the verb generation task in patients. Additionally, a McNemar test confirmed the presence of crossed activations in the cortex and the cerebellum in the entire subject population. Conclusion: We demonstrated that the semantic and phonological association tasks resulted in crossed cerebro-cerebellar language lateralization activations as those observed due to the covert verb generation task. This may suggest the possibility of these tasks being used conjointly with the traditional verb generation task, especially for subjects that may be unable to perform the latter. Key Points: • The semantic and phonological association tasks can be useful as additional presurgical fMRI language lateralization paradigms for brain tumor patients along with the standard verb generation task. • All three tasks also confirm the presence of crossed cerebro-cerebellar language activations in the current subject population.

Introduction/Background* The aim was to evaluate the concordance between preoperative ESMO-ESGO-ESTRO risk classification in early-stage endometrial cancer (EC) assessed by endometrial biopsy and magnetic resonance imaging (MRI) with this classification based on histology of surgical specimen. Methodology This bicentric retrospective study included women diagnosed with early-stage EC (≤ stage II) who had a complete preoperative assessment and underwent a surgical management from January 2011 to December 2018. Patients were preoperatively classified into three degrees of risk of lymph node (LN) involvement based on endometrial biopsy and MRI. Based on final histological report, patients were re-classified using the preoperative classification. Concordance between the preoperative assessment and definitive histology was calculated with Cohen’s weighed kappa coefficient. Result(s)* A total of 333 women were included and kappa coefficient of preoperative risk classification was 0.49. The risk was underestimated and overestimated in 37% and 10% of cases, respectively. Twenty-nine percent of patients had an incomplete LN staging according to the degree of risk of the re-classification. The observed discordance in the risk classification was attributed to MRI in 75% of cases, to the biopsy in 18% and in 7% to both (p Conclusion* Concordance between preoperative ESMO-ESGO-ESTRO risk classification and final histology is weak. Given that the risk was underestimated in the majority of patients wrongly classified, sentinel LN procedure instead of no LN dissection could be an option offered to preoperative low risk patients to decrease the indication of second surgery for re-staging and/or to avoid toxicity of adjuvant radiotherapy.

Anomalous aortic origin of a coronary artery is a congenital condition associated with sudden cardiac death. There are no current recommendations for the acute management and urgency for this patient population. This manuscript describes and discusses two patients who presented with an acute coronary event and needed emergent intervention despite initial clinical stabilization and improvement.

Introduction L’organisation du systeme de sante en France comprend classiquement trois niveaux d’evaluation des patients. Le premier est le medecin generaliste qui peut se referer a un specialiste dans un cabinet principalement prive. Dans les cas complexes, les patients sont volontiers adresses dans les hopitaux. Certaines idees communes suggerent des differences entre les patients consultant en ville et a l’hopital telles que les patients vus a l’hopital auraient des maladies plus severes, plus complexes (comorbidites plus frequentes), mais aussi un milieu social plus modeste du fait de la « gratuite » des soins. Aucune etude n’a cependant evalue ces differences. Le but de notre etude etait d’evaluer ces eventuelles differences chez les patients psoriasiques. Materiel et methodes Il s’agissait d’une etude transversale, multicentrique, menee dans 40 centres de dermatologie, hospitaliers ou liberaux, avec inclusions consecutives pendant 11 mois. Tous les patients adultes consultant pour une premiere fois dans le centre pour un psoriasis pouvaient etre inclus. Resultats Pendant ces 11 mois, 1297 patients consultant une premiere fois pour un psoriasis ont ete inclus, 266 consultaient dans un cabinet prive, 1031 dans un hopital. En analyse univariee, les patients consultant a l’hopital etaient plus souvent des hommes (p = 0,01), plus âges (p = 0,009), hypertendus (p = 0,003), depressifs (p = 0,02), tabagiques (p = 0,0002), obeses (p = 0,003) et pratiquaient moins souvent du sport (p = 0,02). Leur psoriasis etait a debut plus precoce (p Conclusion Les patients atteints de psoriasis qui consultent des praticiens en milieu liberal ont un psoriasis moins severe mais sont par ailleurs sensiblement les memes patients que ceux vus a l’hopital (memes caracteristiques sociodemographiques, comorbidites cardiovasculaires et metaboliques et depression).

Background data A new pilon fracture classification system based on CT scan data was recently published, showing almost perfect interobserver and intraobserver agreement among the authors who developed it. However, an independent assessment has not been done. Objective To do an independent agreement evaluation of the new pilon fracture classification system with physicians with different levels of expertise in the management of pilon fractures. Methods Seventy-one cases of acute pilon fracture were retrospectively collected. Fractures were classified by six evaluators (three foot and ankle surgeons and three orthopaedic surgery residents) using CT scans according to the morphological grading of the new pilon fracture classification system developed by Leonetti et al. Cases were presented to the same evaluators in a random sequence after a 6-week interval to determine intraobserver agreement. The kappa coefficient (κ) was used to determine agreement among evaluators. Results The interobserver agreement was substantial regarding the main fracture type (I, II, III, or IV), with an overall κ value of 0.69 (0.65 to 0.72). When including the II and III subtypes, the overall agreement was still substantial, with a κ value of 0.61 (95% confidence interval: 0.58 to 0.64). The intraobserver agreement was substantial when considering the main fracture categories (I, II, III, or IV), with a κ value of 0.78 (confidence interval: 0.72 to 0.84), and full agreement at the type level was observed in 76% (324/426) of evaluations. There was no notable difference between the foot and ankle surgeons and orthopaedic surgery residents in the interobserver and intraobserver agreement. Conclusion The new classification system demonstrated substantial interobserver and intraobserver agreement between evaluators with different levels of expertise in the management of pilon fractures. Prospective studies should be done to evaluate its prognostic value and utility in clinical practice.

Background This single-institution study assessed the midterm outcomes of patients undergoing complete vascular ring (CVR) repair and the need for reintervention. Methods The study included all patients who underwent surgical repair of an isolated CVR from 1996 to 2018 at our institution. Patients who underwent concomitant intracardiac repair were excluded. Data analysis included demographics, type of anomaly, other congenital heart disease, clinical symptomatology, operative technique, perioperative outcomes, reoperation rates, and mortality. Results CVR repair through open thoracotomy was performed in 148 patients (80 boys [54%]), median age, 1.04 years (interquartile range, 0.4-5.2 years), and median weight, 12.8 kg (interquartile range, 7.5-26.5 kg). The cohort included 72 patients with double aortic arch (DAA), 69 with right aortic arch (RAA) with aberrant left subclavian artery and left ligamentum arteriosum (LLA), 5 with RAA with left descending aorta and LLA, and 2 with RAA with mirror-image branching and LLA. There was 1 outpatient perioperative death (0.7%) 15 days postoperatively. Perioperative complications occurred in 20 patients (14%): 18 (12%) with chylothorax (3 required reintervention), 1 pneumothorax, and 1 vocal cord paresis. Two of 36 patients (5.5%) without primary diverticulum resection required reoperation and subclavian reimplantation at 3 and 4 years, and 1 patient required aortic translocation 9 years later for persistent symptoms. Conclusions Freedom from reoperation after CVR repair was 93% at 5 years and 86% at 10 years. A small proportion of patients who do not undergo diverticulum resection and aberrant left subclavian artery reimplantation at the time of CVR repair will require reintervention in the future.

We aimed to assess, in patients with Parkinson's disease (PD), the association between obstructive sleep apnea (OSA), progression of motor dysfunction and the effect of OSA treatment.Data were analysed from a prospective cohort study of idiopathic PD patients from a movement disorders clinic. Patients found to have OSA on polysomnography (apnea-hypopnea index [AHI] ≥15 events/h, OSA+) were offered treatment using continuous positive airway pressure (CPAP). CPAP+ was defined as an average ≥ 2 h/night use at each follow-up. Motor symptoms were assessed using the motor section of the Movement Disorder Society Unified Parkinson's Disease Rating Scale (mUPDRS) and the Timed-Up-And-Go (TUG). Follow-up times were 3, 6 and 12 months. Mixed models were constructed, adjusting for age, sex, body mass index, levodopa equivalent dose and comorbidities.We studied 67 individuals (61.2% male) of mean age 64.7 years (SD = 10.1). Baseline mUPDRS was higher in OSA+ compared to OSA- (24.5 [13.6] vs. 16.2 [7.2], p 0.001). Motor dysfunction increased at comparable rates in OSA- and OSA+CPAP-. However, in OSA+CPAP+, mUPDRS change was significantly lower compared to OSA- (β = -0.01 vs. 0.61, p = 0.03; p = 0.12 vs. OSA+CPAP- [β = 0.39]) and TUG change was lower compared to OSA+CPAP- (β = -0.01 vs. 0.13, p = 0.002; p = 0.05 vs. OSA- [β = 0.02]).In this PD cohort, OSA was associated with higher baseline mUPDRS. In those with OSA, CPAP use was associated with stabilization of motor function (mUPDRS and TUG) over 12 months. These observations support further research to clarify the role of OSA in PD pathophysiology and motor dysfunction.

Background: Optimizing antiretroviral therapy is an essential step to reach the 90 - 90 - 90 targets. Despite tremendous progress made for antiretroviral treatment (ART) to be accessible in countries with limited resources, health care providers continue to face challenges due to the under-optimization of ART due to therapeutic failures and poor retention. Objectives: To determine the prevalence of adverse therapeutic outcomes in a decentralized health care center and to determine associated factors. Patients and Methods: This is a cross-sectional descriptive and analytical study targeting PLHIV, aged 18 years and over, on first line antiretroviral treatment (ART), monitored onsite from February 1st to December 31st, 2018. A data collection form was completed from medical records (clinical, immuno-virological, therapeutic and evolutionary). Data were also collected from interviews with patients for additional socio-demographic information including the level of HIV knowledge. Data were captured and analyzed using EPI 2002 and R software. Proportions were compared using the chi -square and Fisher tests and logistic regression. A value of p Results: 331 patients were enrolled with HIV-1 profile in 89% of the cases. A proportion of 55% was married and 98% came from the rural area. 80% were either not or poorly educated. The median of age was 44 ± 11 years with a F/M ratio of 3.5. 30% that had not shared their HIV status, and more than half had a low knowledge of HIV transmission. At baseline, 56% were symptomatic at WHO stage 3 or 4. They had severe immunosuppression with a median CD4 count of 217 ± 187 cells/mm3; the viral load was detectable in half of the patients with a median viral load (VL) of 97,000 ± 70,569 cp/ml. The antiretroviral regimens combined 2 nucleoside reverse transcriptase inhibitor (NRTI) with 1 no nucleoside reverse transcriptase inhibitor (NNRTI) in 88% of the cases. The median duration of follow-up was estimated at 60 ± 43 months. The prevalence of adverse therapeutic outcomes was 36% (119 patients). The proportion of virological failure was 19%, lost follow up was 20% and the mortality was 4%. The adverse therapeutic outcomes were associated with the age less than 25 years (p = 0.007) and with a late diagnosis (CD4 T cells at baseline less than 200 cell/mm3, p = 0.02). Conclusion: These results suggest the need to make new therapeutic classes available for first-line treatment and to promote actions improving retention in care.

We aimed to describe the short- and long-term outcomes of patients after an arterial switch operation (ASO) at a single institution during a 23-year period. A retrospective chart review of all patients18 months of age who underwent an ASO between January 1995 and March 2018 at Texas Children's Hospital, Houston, TX was performed. Primary endpoints include mortality and reintervention. Perioperative mortality was defined as mortality occurring in-hospital and/or30 days after surgery. Survival and freedom-from-reintervention were analyzed using Kaplan-Meier method, log-rank tests, and Cox regression models. The cohort included 394 patients. Diagnoses included 204 patients (52%) with intact ventricular septum, 137 (35%) with a ventricular septal defect, 17 (4%) with a ventricular septal defect and left ventricular outflow tract obstruction (LVOTO), and 36 (9%) with Taussig-Bing anomaly. Median age at surgery was 8 days (range: 1 day to 17 months) and median weight was 3.4 (range: 0.8-12.0) kg. Overall perioperative mortality was 1.3% (n = 5), 0.3% (n = 1) since 1999. Overall survival at 5, 10, and 15 years was 98.2%, 97.8%, and 97.8%, respectively. Perioperative morality was associated with prematurity (P = 0.012),2.5 kg (P0.001), and longer circulatory arrest (P = 0.024) after univariate analysis. Reintervention was associated with a longer cross-clamp time (P0.001),2.5 kg (P = 0.009), LVOTO resection (P = 0.047), and genetic syndrome (P= 0.011) after multivariable analysis. Current ASO expectations should include a perioperative mortality risk of1% and good long-term survival. Reinterventions are more frequent in patients2.5 kg, concomitant LVOTO resection, a genetic syndrome, and longer cross-clamp time.

Introducción: El dermatofibrosarcoma protuberans (DFSP), es uno de los tumores cutáneos menos frecuentes, se clasifica dentro de los sarcomas fibrohistociticos y está caracterizado por un crecimiento lento y progresivo. Métodos: Se realizó una serie de casos retrospectiva de los pacientes con DFSP atendidos en el Centro de la Piel (CEPI) entre 2010 y 2019, se tomó en cuenta la información demográfica, características clínicas, tratamiento y su evolución. Resultados: Seis pacientes fueron diagnosticados y tratados por DFSP en el período evaluado, existió un predominio de mujeres (4 mujeres, 2 hombres) con una media de edad de 58.2 (DE =19,6), tres de ellos presentaron lesiones en forma de placa indurada y los restantes presentaron nódulo único, la localización de las lesiones fueron en hombro, cuello e hipogastrio. El tratamiento más utilizado fue la escisión amplia, ninguno de los pacientes presentó recidivas al primer y quinto año del seguimiento. Conclusión: Es necesario el reconocimiento de las características clínicas típicas de DFSP ya que podría pasar como una tumoración benigna de piel, por lo cual se debe apoyar con el estudio histopatológico frente a la sospecha de este tipo de lesión.

Hypereosinophilic syndrome (HES) is a rare and potentially life-threatening disorder. While many conditions can cause eosinophilia, it can also be provoked by rarer diseases such as vasculitis or myeloproliferative disorders. Here we present an almost fatal presentation of HES characterized with both vasculitis and clonal features. Treatment with combined chemo-immunotherapy allowed reversal of most of the complications. There is still much uncertainty in the diagnosis and management of HES, and research should be done to improve knowledge on pathophysiology and cytogenetics of this disease in order to improve treatment and prevent life-threatening complications.

Summary Background Testicular Germ Cell Tumors (TGCTs) represent the most frequent malignant tumour among young male adults. Orchiectomy alone cure 80% of stage I. Standard options after orchiectomy include radiotherapy (RT), chemotherapy (CT) by 1 cycle of carboplatin AUC 7 or active surveillance (SV) for seminomatous GCTs (SGCT) and retroperitoneal lymphadenectomy (RPLND), CT by 1 or 2 cycles of Bleomycine Etoposide Cisplatine (BEP) or active surveillance for nonseminomatous GCTs (NSGCT). Adjuvant treatments decrease the relapse rate after orchiectomy with substantial toxicities without any benefit on overall survival. Recent guidelines accorded utmost importance on SV rather than adjuvants strategies. The main objective of this study was to describe our current practice over the 10 past years in regard of these recommendations. Methods Data of 50 patients with stage I GCT treated in our institute were collected between 2006 and 2016. Demographic and anatomopathologic data were reported. Clinical practice in our center was analyzed during two periods [2006–2011] and [2012–2016] according to the European Association of Urology Guidelines in 2011. Results Patient's median age was 35.3 years. The analysis of clinical practice during the last 10 years showed that in SGCT, main treatment was RT than SV and CT. This option declined over the years (89% between 2006–2010 versus 53% between 2011–2016) whereas SV was more often employed (27% between 2011-2016 versus none between 2006–2010). Surveillance was used for 64% of NSGCT. Conclusions In our center, RT was less used over the years for the benefit of SV which is recommended by guidelines.

Background Anatomic lesions are a common cause of decompensation during the interstage period after Norwood stage 1 palliation (S1P). This study describes the risk factors for and outcomes after unplanned surgical and catheter-based interstage cardiac interventions. Methods Participants in the National Pediatric Cardiology Quality Improvement Collaborative registry discharged from the hospital after S1P between 2008 and 2016 were studied. Variables at S1P, interstage, and at stage 2 palliation (S2P) hospitalizations were examined. Multivariable logistic regression was used to compare those who had an unplanned interstage intervention to those who did not. Results Of 1994 participants from 60 programs, 343 (17.1%) had at least 1 unplanned interstage intervention. Aortic valve dilation before S1P, longer S1P cardiopulmonary bypass time, pulmonary artery stent placement between S1P and discharge, aortic arch obstruction on the S1P discharge echocardiogram, and lower weight at S1P discharge were independently associated with receiving an unplanned interstage intervention. Interstage mortality between groups was similar at 6%, as was interstage duration. Participants undergoing unplanned interstage interventions were more likely to undergo heart transplant before S2P or deemed to be unsuitable for S2P (7.3% vs 2.7%, P Conclusions Unplanned interstage interventions after S1P did not increase interstage mortality, but participants with an unplanned intervention were less likely to progress to S2P. Residual anatomic lesions are risk factors for unplanned interstage interventions. For those with progressive ventricular dysfunction in the presence of arch obstruction by echocardiogram, aortic arch reintervention is warranted.

Background The Fontan procedure is the accepted standard for single-ventricle palliation. The goal of this study was to determine short- and midterm outcomes of patients undergoing a Fontan operation at a single institution and to identify contemporary risk factors for acute and chronic failure. Methods All patients undergoing a Fontan operation between 1995 and 2016 were included. Failure was defined as death, transplantation, Fontan takedown or revision, fenestration creation or enlargement, plastic bronchitis, protein-losing enteropathy, or major perioperative reintervention. Multivariable logistic and Cox regression models were used to identify risk factors for acute (perioperative) and chronic failure (after hospital discharge or 30 days postoperatively, or both). Results The cohort included 610 patients. Median age at surgery was 4 years. Median follow-up was 6.8 years. Trends showed increasing use of extracardiac conduits, nonfenestrated Fontan, and extubation in the operating room. Perioperative mortality was 0.5% (n = 3). Transplant-free survival at 5, 10, and 15 years was 97%, 94%, and 92%, respectively; freedom from failure was 91%, 89%, and 87%, respectively. Extubation in the operating room was associated with lower risk of acute failure (odds ratio, 0.30; 95% confidence interval [CI], 0.11 to 0.87). Independent risk factors for chronic failure included genetic syndrome (hazard ratio [HR], 2.54; 95% CI, 1.11 to 5.83), ventricular dysfunction (HR, 3.86; 95% CI, 1.81 to 8.24), cardiopulmonary bypass time in 30-minute intervals (HR, 1.242; 95% CI, 1.100 to 1.402), and persistent pleural effusions (HR, 4.26; 95% CI, 2.25 to 8.07). Moderate or severe atrioventricular valve regurgitation (HR, 2.61; 95% CI, 1.13 to 6.02) and cardiopulmonary bypass time (HR, 1.22; 95% CI, 1.03 to 1.45) were associated with reduced long-term transplant-free survival. Conclusions Contemporary midterm outcomes for Fontan patients are reassuring. Lifelong follow-up is mandatory to determine long-term outcomes and need for additional surgery as patients reach adulthood.

espanolIntroduccion: Se estima que los trastornos musculoesqueleticos representan la patologia mas frecuente en trabajadores y es la causa de mayor cantidad de dias no laborados por incapacidad. Objetivo: Determinar la frecuencia de trastornos musculoesqueleticos en los trabajadores de una refineria de Lima durante el ano 2017. Metodos: Estudio transversal. Se realizo la revision de las historias clinicas ocupacionales de los trabajadores para obtener los datos demograficos y el registro donde se emitio el diagnostico de trastorno musculoesqueletico en base a los resultados de pruebas de imagen y de la evaluacion clinica realizada por un especialista. Resultados: La muestra incluyo a 223 trabajadores y se encontro una frecuencia de trastornos musculoesqueleticos del 52,9%. Los mas frecuentes fueron: lumbago asociado a hernia discal (25,1%), lumbago (13%), sindrome del manguito rotador (10,3%) y cervicalgia asociada a hernia discal (3,6 %). Conclusiones: Se encuentra en esta poblacion una elevada prevalencia de trastornos musculoesqueleticos en tronco y extremidades superiores EnglishIntroduction: It is estimated that musculoskeletal disorders represent the most frequent pathology in workers and is the cause of more days not worked due to disability. Objective: To determine the frequency of musculoskeletal disorders in workers of a refinery in Lima during the year 2017. Methods: A cross-sectional study. The demographic data and the registry of the diagnosis of musculoskeletal disorder, was based on results of imaging tests and clinical evaluation performed by a specialist, which was obtained through the review of occupational clinical records. Results: The sample included 223 workers and the frequency of musculoskeletal disorders was 52,9%; the most frequent musculoskeletal disorders were low back pain associated with herniated disc (25,1%), low back pain (13,4%), rotator cuff syndrome (5,8%) and neck pain with herniated disc (3,6 %). Conclusions: There is a high prevalence of musculoskeletal disorders in the trunk and upper extremities.

Background Environmental enteric dysfunction (EED) is thought to increase the risk of micronutrient deficiencies, but few studies adjust for dietary intakes and systemic inflammation. Objective We tested whether EED is associated with micronutrient deficiency risk independent of diet and systemic inflammation, and whether it mediates the relation between intake and micronutrient status. Methods Using data from 1283 children in the MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) birth cohort we evaluated the risk of anemia, low retinol, zinc, and ferritin, and high transferrin receptor (TfR) at 15 mo. We characterized gut inflammation and permeability by myeloperoxidase (MPO), neopterin (NEO), and α-1-antitrypsin (AAT) concentrations from asymptomatic fecal samples averaged from 9 to 15 mo, and averaged the lactulose:mannitol ratio z-score (LMZ) at 9 and 15 mo. Nutrient intakes from complementary foods were quantified monthly from 9 to 15 mo and densities were averaged for analyses. α-1-Acid glycoprotein at 15 mo characterized systemic inflammation. Relations between variables were modeled using a Bayesian network. Results A greater risk of anemia was associated with LMZ [1.15 (95% CI: 1.01, 1.31)] and MPO [1.16 (1.01, 1.34)]. A greater risk of low ferritin was associated with AAT [1.19 (1.03, 1.37)] and NEO [1.22 (1.04, 1.44)]. A greater risk of low retinol was associated with LMZ [1.24 (1.08, 1.45)]. However, MPO was associated with a lower risk of high transferrin receptor [0.86 (0.74, 0.98)], NEO with a lower risk of low retinol [0.75 (0.62, 0.89)], and AAT with a lower risk of low plasma zinc [0.83 (0.70, 0.99)]. Greater nutrient intake densities (vitamins A and B6, calcium, protein, and zinc) were negatively associated with EED. Inverse associations between nutrient densities and micronutrient deficiency largely disappeared after adjustment for EED, suggesting that EED mediates these associations. Conclusions EED is independently associated with an increased risk of low ferritin, low retinol, and anemia. Greater nutrient density from complementary foods may reduce EED, and the control of micronutrient deficiencies may require control of EED.

Background This study sought to evaluate outcomes of patients undergoing congenital heart surgery who underwent peritoneal dialysis (PD) vs a diuretic regimen. Methods This study conducted a comprehensive search in Medline, EMBASE, Scopus, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from the databases’ inception through April 24, 2018. Independent reviewers selected studies and extracted data. A random effects meta-analysis was performed to pool the outcomes of interest across studies. Results A total of 8 studies (2 prospective studies, 2 randomized clinical trials, and 4 retrospective studies) with 507 patients were included in this review. A total of 204 (40%) patients underwent PD, whereas the remaining patients underwent fluid removal with diuretics. The analyses demonstrated a significantly shorter time of mechanical ventilation in those patients who underwent PD (mean difference, −1.25 days; 95% confidence interval, −2.18 to −0.33; P = .008) and increased odds of mortality (odds ratio, 2.27; 95% confidence interval, 1.13 to 4.56; P = .02) compared with the diuretic group. No differences were identified in terms of incidence of negative fluid balance by postoperative day 1, presence of peritonitis, and intensive care unit length of stay. Conclusions The meta-analysis did not identify differences between the 2 groups with regard to negative fluid balance after postoperative day 1, incidence of peritonitis, or length of intensive care unit stay. There is a need for large, prospective, multicenter studies to evaluate the benefits and complications associated with PD use further in selected children after congenital heart surgery. Because some of the outcomes were present in only 2 studies, results from the pooled analysis may be underpowered.

Introducción: A nivel mundial los traumatismos son un problema de salud pública, dejando secuelas físicas, emocionales y psicológicas. El papel del profesional de enfermería es fundamental para disminuir las complicaciones y ofrecer un cuidado integral, asegurando una atención de calidad. Las experiencias de cuidado de los estudiantes son de gran utilidad, que dejan grandes enseñanzas, no solo en busca de un fin científico, sino también para determinar la sensibilidad y responsabilidad hacia el sujeto de cuidado. La investigación tuvo como objetivo, describir la experiencia de los estudiantes de enfermería en el cuidado de pacientes hospitalizados con trauma craneoencefálico. Materiales y Método: Investigación cualitativa de carácter fenomenológico. El muestreo se realizó por conveniencia, pertinencia, adecuación, oportunidad y disponibilidad. Se utilizaron como instrumentos la entrevista a profundidad y el diario de campo. Resultados: Se identificaron las categorías: “Me enfrento con la realidad”, “Cuidado integral, es lo que siempre me han inculcado”, “Mi relación con el otro”, “Enseñándole a mi paciente y su familia”, y “La Familia, pilar fundamental”. Conclusiones: La experiencia expresada por los estudiantes generó expectativas inesperadas, pero se aplicaron los conocimientos necesarios para brindar un mejor cuidado individualizado. En cada participante emergió la sensibilidad, lo que le permitió situarse en la posición del otro, comprendiendo la impotencia, frustración y pérdida de control. El proceso de Atención de Enfermería es el esquema necesario para brindar el cuidado integral del paciente.