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ObjectiveThere is still a great deal to learn about the influence of sex in systemic sclerosis (SSc). In this respect, national registries provide large and homogeneous patient cohorts for analytical studies. We therefore investigated a wide-ranging and well-characterized SSc series with the aim of identifying sex differences in disease expression, with a special focus on demographic, clinical, and serological characteristics.MethodsA multicenter SSc cohort of 2281 patients, including 247 men, was recruited in the Italian Systemic sclerosis PRogression INvestiGation (SPRING) registry. Demographic data, disease manifestations, serological profile, and internal organ involvement were compared.ResultsThe overall female/male ratio was 8.2:1. Female/male ratios for limited cutaneous SSc, diffuse cutaneous SSc, and SSc sine scleroderma subsets were 8.7:1, 4.9:1, and 10.7:1, respectively. A shorter time from onset of Raynaud phenomenon to SSc diagnosis, an increased prevalence of the diffuse cutaneous subset, renal crisis, and digital ulcers were found in males, whereas a significantly higher percentage of sicca syndrome, serum antinuclear antibodies, antiextractable nuclear antigens, anti-La/SSB, and anticentromere protein B was detected in the female group. Males exhibited lower left ventricular ejection fraction, as well as higher prevalence of conduction blocks, arrhythmias, ground glass, and honeycombing. Moreover, forced vital capacity and total lung capacity were medially lower in men than in women. Finally, males were more frequently treated with immunosuppressive drugs.ConclusionOur study further supports the presence of several sex-related differences in patients with SSc. These differences were pronounced in the severity of cutaneous, peripheral vascular, and cardiopulmonary involvement for male patients, whereas an increased prevalence of sicca syndrome and a specific autoantibody profile characterized the female sex.

Background: Adverse neurological events during extracorporeal membrane oxygenation (ECMO) are common and may be associated with devastating consequences. Close monitoring, early identification and prompt intervention can mitigate early and late neurological morbidity. Neuromonitoring and neurocognitive/neurodevelopmental follow-up are critically important to optimize outcomes in both adults and children. Objective: To assess current practice of neuromonitoring during ECMO and neurocognitive/neurodevelopmental follow-up after ECMO across Europe and to inform the development of neuromonitoring and follow-up guidelines. Methods: The EuroELSO Neurological Monitoring and Outcome Working Group conducted an electronic, web-based, multi-institutional, multinational survey in Europe. Results: Of the 211 European ECMO centres (including non-ELSO centres) identified and approached in 23 countries, 133 (63%) responded. Of these, 43% reported routine neuromonitoring during ECMO for all patients, 35% indicated selective use, and 22% practiced bedside clinical examination alone. The reported neuromonitoring modalities were NIRS ( n = 88, 66.2%), electroencephalography ( n = 52, 39.1%), transcranial Doppler ( n = 38, 28.5%) and brain injury biomarkers ( n = 33, 24.8%). Paediatric centres (67%) reported using cranial ultrasound, though the frequency of monitoring varied widely. Before hospital discharge following ECMO, 50 (37.6%) reported routine neurological assessment and 22 (16.5%) routinely performed neuroimaging with more paediatric centres offering neurological assessment (65%) as compared to adult centres (20%). Only 15 (11.2%) had a structured longitudinal follow-up pathway (defined followup at regular intervals), while 99 (74.4%) had no follow-up programme. The majority ( n = 96, 72.2%) agreed that there should be a longitudinal structured follow-up for ECMO survivors. Conclusions: This survey demonstrated significant variability in the use of different neuromonitoring modalities during and after ECMO. The perceived importance of neuromonitoring and follow-up was noted to be very high with agreement for a longitudinal structured follow-up programme, particularly in paediatric patients. Scientific society endorsed guidelines and minimum standards should be developed to inform local protocols.

The aim of this review is to identify and discuss randomized clinical trials conducted in patients with connective tissue diseases, including systemic lupus erythematosus, idiopathic inflammatory myopathies, vasculitis, Sjögren’s syndrome, and systemic sclerosis. Although limited, the results obtained with bioactive compounds, namely n-3 polyunsaturated and short-chain fatty acids, demonstrate that dietary intervention and nutritional counseling might have an important role as adjuvant therapy in patients with connective tissue diseases, particularly in the light of the comorbidities which characterize these conditions.

Introduction: Primary heart involvement in systemic sclerosis may cause morpho-functional and electrical cardiac abnormalities and is a common cause of death. The absence of a clear definition of primary heart involvement in systemic sclerosis limits our understanding and ability to focus on clinical research. We aimed to create an expert consensus definition for primary heart involvement in systemic sclerosis. Methods: A systematic literature review of cardiac involvement and manifestations in systemic sclerosis was conducted to inform an international and multi-disciplinary task force. In addition, the nominal group technique was used to derive a definition that was then subject to voting. A total of 16 clinical cases were evaluated to test face validity, feasibility, reliability and criterion validity of the newly created definition. Results: In total, 171 publications met eligibility criteria. Using the nominal group technique, experts added their opinion, provided statements to consider and ranked them to create the consensus definition, which received 100% agreement on face validity. A median 60(5–300) seconds was taken for the feasibility on a single case. Inter-rater agreement was moderate (mKappa (95% CI) = 0.56 (0.46–1.00) for the first round and 0.55 (0.44–1.00) for the second round) and intra-rater agreement was good (mKappa (95% CI) = 0.77 (0.47–1.00)). Criterion validity showed a 78 (73–84)% correctness versus gold standard. Conclusion: A preliminary primary heart involvement in systemic sclerosis consensus-based definition was created and partially validated, for use in future clinical research.

Introduction: Central auditory processing refers to the efficiency and effectiveness with which the central nervous system uses auditory information: it may be altered in neurological disorders and brain injuries, such as strokes. However, despite evidence of probable alterations in the pediatric population, functional abilities and post-stroke limitations are still not well documented in the literature. Objective: To analyze the findings of the electrophysiological and behavioral evaluations of central auditory processing of children and adolescents diagnosed with stroke from a reference outpatient clinic, as well as to investigate possible associations with the variables: type and location of the stroke and age group. Methods: The present study is characterized as comparative cross-sectional. The sample, for convenience, included individuals aged 7–18 years divided into two groups: study group, composed of individuals with a diagnosis of stroke, and control group, composed of individuals with typical development. The evaluation consisted of the following procedures: anamnesis, basic audiological evaluation, behavioral evaluation of the auditory processing disorder (dichotic digit test, dichotic consonant-vowel, synthetic sentence identification/pediatric speech intelligibility, gaps in noise, pitch pattern sequence, masking level difference), and electrophysiological evaluation (P300 and mismatch negativity). Results: Nineteen children and adolescents were included in the study group. The control group was composed of 19 children and adolescents with typical development. In the comparison between the groups, a worse performance is observed for the study group in all the evaluated tests, behavioral and electrophysiological. In the behavioral evaluation of central auditory processing, there was a statistical difference for all tests, except for masking level difference and dichotic digit test, binaural separation step on the left. In the electrophysiological evaluation, there was a statistical difference in the latency of mismatch negativity and P300. No associations were found between the behavioral and electrophysiological findings and the location of the stroke and age group variables. Conclusion: Children and adolescents diagnosed with stroke present a worse performance in the electrophysiological and behavioral evaluations of central auditory processing when compared to a control group. Resumo Introdução: O processamento auditivo central refere-se à eficiência e eficácia com que o sisPotenciais evocados tema nervoso central usa informações auditivas e pode estar alterado em distúrbios neurológicos e lesões cerebrais, como acidentes vasculares cerebrais. No entanto, apesar das evidências de Distúrbios possíveis alterações na população pediátrica, as habilidades funcionais e as limitações pósperceptivos -acidente vascular cerebral ainda não estão bem documentadas na literatura. Objetivo: Analisar os achados das avaliações eletrofisiológicas e comportamentais do procesDoenças auditivas samento auditivo central de crianças e adolescentes diagnosticados com acidente vascular cerebral em um ambulatório de referência, bem como investigar possíveis associações com Criança as variáveis: tipo e localização do acidente vascular cerebral e faixa etária. Método: Estudo transversal comparativo. A amostra, por conveniência, incluiu indivíduos de 7 a 18 anos, divididos em dois grupos: grupo de estudo (GE), composto por indivíduos com diagnóstico de acidente vascular cerebral, e grupo controle (GC), composto por indivíduos com desenvolvimento típico. A avaliação consistiu nos seguintes procedimentos: anamnese, avaliação audiológica básica, avaliação comportamental do distúrbio de processamento auditivo (teste dichotic digit, dichotic consonant-vowel, synthetic sentence identification/pediatric speech intelligibility, gaps in noise, pitch pattern sequence, masking level difference) e avaliação eletrofisiológica (P300 e mismatch negativity -). Resultados: Dezenove crianças e adolescentes foram incluídos no GE. O GC foi composto por 19 crianças e adolescentes com desenvolvimento típico. Na comparação entre os grupos, observa-se pior desempenho para o GE em todos os testes avaliados, comportamentais e eletrofisiológicos. Na avaliação comportamental do processamento auditivo central, houve diferença estatística para todos os testes, exceto masking level difference e teste dichotic digit, na fase de separação binaural na orelha esquerda. Na avaliação eletrofisiológica, houve diferença estatística na latência do mismatch negativity e P300. Não foram encontradas associações entre os achados comportamentais e eletrofisiológicos e as variáveis localização do acidente vascular cerebral e faixa etária. Conclusão: Crianças e adolescentes diagnosticados com acidente vascular cerebral apresentam pior desempenho nas avaliações eletrofisiológicas e comportamentais do processamento auditivo central quando comparados a um grupo controle.

Background: The Covid-19 pandemic may have a deleterious impact on patients with autoimmune systemic diseases (ASD) due to their deep immune-system alterations. Objective: This study aims to investigate the prevalence of symptomatic Covid-19 and its correlations with both organ involvement and ongoing treatments in a large series of Italian ASD patients during the first wave of pandemic. Methods: Our multicenter telephone 6-week survey included 3,029 unselected ASD patients enrolled at 36 tertiary referral centers of northern, central, and southern Italian macro-areas with different diffusion of the pandemic. Symptomatic SARS-CoV-2 infection was classified as definite Covid-19 (presence of symptoms plus positive oral/nasopharyngeal swabs) or highly suspected Covid-19 (highly suggestive symptoms, in the absence of a swab testing). Results: A significantly higher prevalence of definite plus highly suspected Covid-19 compared to the Italian general population was detected in the whole ASD series (p=.000), as well as in patients from the three macro-areas (p=.000 in all). Statistically higher prevalence of Covid-19 was also found in connective tissue diseases compared to chronic arthritis subgroup (p=.000) and in ASD patients with pre-existing interstitial lung involvement (p=.000). Patients treated with either conventional disease-modifying anti-rheumatic drugs (DMARDs) and/or biological DMARDs showed a significantly lower prevalence of Covid-19 (p=.000 in both). Finally, scleroderma patients undergoing low-dose aspirin showed a significantly lower rate of Covid-19 compared to those without (p=0.003). Conclusion: The higher prevalence of Covid-19 in ASD patients, along with the significant correlations with important clinical features and therapeutic regimens, suggests the need to develop targeted prevention/management strategies during the current pandemic wave.

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This study aimed to investigate whether cranberry extract could reduce lower urinary tract (LUT) and gastro-intestinal (GI) signs in feline idiopathic cystitis (FIC). Twenty-one client-owned cats were randomly allocated to two groups: a treated group (T, n = 10) receiving daily an oral nutritional supplement containing cranberry extract and a control group (C, n = 11). Owners were trained to recognise daily LUT and GI signs. Physical examination, urinalysis and bladder ultrasonography were performed at day 0 (T0), 15 (T15), 30 (T30), 60 (T60). Both groups showed an improvement for dysuria and periuria from T0 to T30 (p < 0.05), but only in cats of the T group, LUT signs disappeared at T60. A significant improvement in the T group was also observed for GI signs and bladder ultrasonography at T60 (p = 0.03). Urinalysis did not show any significant differences. This preliminary study suggests that cranberry could be effective in reducing LUT and GI signs in FIC.

The case of a toddler with long-channel cloaca, mild chronic kidney disease (CKD) due to renal dysplasia, and early onset of ulcerative colitis (UC) is herein reported. The patient underwent definitive repair of cloaca, that included vaginal elongation with colon, at 5 months of age and was admitted for episodes of vaginal bleeding at 22 months of age. A vaginoscopy revealed a severe inflammation of the colonic neovagina. As rectal bleeding was also noticed, she underwent a colonscopy that showed the same macroscopic inflammatory picture. Neovaginal and colonic biopsies confirmed UC. The mother turned out to be affected by UC since adolescence. The patient is now on oral therapy with mesalazine and topical steroid and mesalazine in the neovagina. The association between cloaca and inflammatory bowel disease (IBD) is anecdotal, but the family history of IBD should be considered when planning the surgical reconstruction of patients with cloaca. In this patient, the occurrence of UC may require a new neovagina in the future and the concomitance of CKD may complicate the overall management due to the potential nephrotoxicity of drugs used for UC therapy.

Purpose Women with anorectal malformation (ARM) are expected to have a normal life span, therefore, gynecological and psycho-sexual issues are also important. Aim of the study was to assess these aspects in adult females with history of ARM. Methods Thirty-seven women from two ARM referral centers, aged ≥ 16, were identified. Gynecologic visit, cervicovaginal swab, pelvic ultrasound, FSH, LH, prolactin, progesterone, 17–β–estradiol, DHEAS, testosterone, TSH during follicular and luteal phases, and administration of FSFI questionnaire to screen the female sexual functioning were performed. Data were compared with six controls. Results Nineteen patients, mean age 21.7 (16–45), participated to the study. Associated anomalies, mostly affecting limbs, vertebrae and genitalia, were present in 57.8% of cases. Mullerian anomalies were retrieved in 36.8%. Hormones’ levels were normal. Concerning sexual functioning, four women (21%) reported dyspareunia or impossible penetration, four did not answer the FSFI questionnaire due to lack of confidence about their sexuality, and three scored lower than the cut-off value for female sexual function. Conclusion This study confirms the importance of a multidisciplinary long-term follow-up for ARM patients, including a careful study of the reproductive tract to detect and treat those conditions that could affect the fertility. Moreover, an appropriate psychological support should be provided.

Background In response to COVID-19 pandemic outbreak, healthcare procedures and modalities have changed considerably. Video calls may supply valid support for health care professionals, contributing to maintaining the communication between hospitalized patients and their families. The present study aimed to observe the experience of a group of respiratory therapists who conducted video calls between patients and their families in a COVID-19 unit. Method Semistructured interviews (20-30 minutes duration) with the respiratory therapists who conducted the video calls in a COVID-19 unit in the North of Italy were performed. Participants joined the study voluntarily and, after receiving the informed consent, the interviews were audio-recorded. To better understand healthcare professionals' experience, the Interpretive Description methodology was adopted. Results Seven respiratory therapists (three males, four females; mean age 45.1 ± 14.4) were recruited. Sixteen codes emerged from the analysis, constituting five primary themes: Contact, Impact, Challenges, Centering, and Future. Conclusions The findings shed light on the usability of video calls during this emergency period and their potential for future implementation. Specifically, this type of call may bridge the distances in such periods of care and help professionals to emotionally support patients and caregivers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

In a modern world, where day-to-day worry and stress prevails, along with an ever-increasing workday, care with diet is often overlooked and, combined with a sedentary lifestyle, increases obesity rates in all the world. The purpose of this work is to analyze society's view about the treatment of obesity with medications, comparing it with the treatment of other diseases, such as high blood pressure and diabetes. Through a questionnaire, on the internet, carried out from July to September 2020, with 14 multiple-choice questions answered by 520 people, 91.7% of the participants answered that obesity is a disease, however, 47.3% of people still think that the use of drugs for their treatment is not necessary and only 37.7% believe in the effectiveness of such a method. In addition, 26.2% believe that all obese people eat a high amount of food and practice little physical activity. As for the comparison with other diseases, 33.3% of the respondents believe that diabetes should be treated with medication and obesity should not, and 32.3% believe that hypertension should use this method and obesity should not. With such results, it was concluded that the society's view is still quite stigmatized regarding the treatment of obesity by drugs, which implies prejudice and the difficulty in adhering to this method by obese people and, with this, is the difficulty in reducing the rates obesity and all comorbidities related to it.

Resistant hypertension (RH) is characterized by the use of three or more antihypertensive drugs without reaching the goal of controlling blood pressure (BP). For a definitive diagnosis of RH, it is necessary to exclude causes of pseudoresistance, including the white-coat effect, errors in BP measurement, secondary hypertension, therapeutic inertia, and poor adherence to lifestyle changes and pharmacological treatment. Herein, we report the history of a patient with long-standing uncontrolled BP, even when using seven antihypertensive drugs. Causes of secondary hypertension that justified the high BP levels were investigated, in addition to the other causes of pseudo-RH. In view of the difficult-to-control BP situation, it was decided to hospitalize the patient for better investigation. After 5 days, he had BP control with practically the same medications previously used. Finally, all factors related to the presence of pseudo-RH are discussed, especially poor adherence to treatment. Poor adherence to antihypertensive treatment is common in daily medical practice, and its investigation is of fundamental importance for better management of BP.

Introduction: Prematurity is a public health problem in Brazil, with 12% of deliveries occurring before 37 weeks of gestation. The measurement of the cervix in the second trimester is already established as a method of screening for prematurity and some studies point out advantages to start this screening in the first trimester. Objective: To define the correlation between the length of the endocervix by transvaginal ultrasound in the first trimester (11 to 14 weeks) with spontaneous early deliveries. Method: A prospective and observational study realized in a suplementar and private ultrasound clinic and hospital of Porto Alegre, Brazil between 2019-2020. Ultrasound screening of cervix was performed in singleton pregnancies in first and second trimester of pregnancy and correlated with age of delivery. Results: 142 pregnant women were studied, 80% were in the first pregnancy. The average age was 33.8 years. The rate of prematurity was 18% before 37 weeks and 4% before 34 weeks. The average of cervix measured in the first and second trimesters in deliveries before 34 weeks was 32.7 mm and 29.3 mm, respectively. In term deliveries the median cervical length was 38.8 mm and 37.8 mm, respectively. When analyzing the measurements of the cervix in the second trimester, the cervix was smaller (p = 0.008) among deliveries below 34 weeks (29 mm) than deliveries after 37 weeks. No statistically related differences were found between preterm birth and first trimester cervix measurements. Conclusions: In this study, we did not observe a statistically significant relationship between first trimester cervix measurement and prematurity. More studies are needed to evaluate this finding. However, the measurement of the cervix in the second trimester is different from that found in the literature. This suggests a possible new cut-off point that increases the sensitivity of transvaginal ultrasound as a method of preventing prematurity.

Introduction: Workplace violence against health care professionals is a highly prevalent problem and is considered a public health concern by the World Health Organization. Yet most studies on the topic focus on its negative impact on the mental health of workers rather than the causes of these incidents. Objectives: To describe the frequency of workplace violence and its impact on professionals working in Psychosocial Care Centers (Centros de Atenção Psicossocial [CAPS]) in a large city in the state of São Paulo. Methods: A quantitative cross-sectional study was conducted on a non-probabilistic sample of 193 health care workers across 11 Psychosocial Care Centers. Participants completed two self-administered instruments: a biosocial questionnaire and the Survey Questionnaire on Workplace Violence. Results: The results showed that 42.4% of respondents had suffered physical violence; 64.8% had experienced psychological violence; and 29.5% had been victims of bullying/mobbing. In most cases, the victims responded to these incidents by taking no action, asking the perpetrator to stop, or speaking of the incident to a colleague or superior. A verbal warning was issued to perpetrators in only 21% of cases of physical violence. Mobbing had the greatest negative impact on respondents, followed by psychological and physical violence. Conclusions: Workplace violence is a part of everyday work in Psychosocial Care Centers. Though this violence is often naturalized and considered a collective defense against suffering, it did not prevent participants from reporting high levels of job satisfaction, reflecting the degree to which professionals at Psychosocial Care Centers are committed to their colleagues and to service users, as well as their search for professional recognition.

Objectives We aimed to clarify the definition, distribution, clinical association and outcomes of large calcinosis in patients with systemic sclerosis (SSc). Methods We conducted a systematic literature review (SLR) focusing on SSc-related large calcified masses. Upon updating the terminology and definition, all cases of “pseudotumoral” calcinosis seen at the Cochin and Padova University Hospitals were reviewed. Results The SLR yielded 30 SSc cases, with large calcified masses mainly defined as “tumoral” or “pseudotumoral”. Among the 629 SSc cases included in the Cochin and Padova cohorts, 19 (3%) living and 7 deceased patients were affected by pseudotumoral calcinosis; among these, the great majority had a severe vascular phenotype. The mean age in the whole population (56 cases) was 59 ± 11.4 years with a median disease duration at calcinosis onset of 7 (5–10) years. Twenty-five out of 56 patients (44.6%) had the diffuse cutaneous form of SSc. Anti-topisomerase I and anticentromere were found equally. Pseudotumoral calcinosis were commonly symmetrical and the size ranged from 2 to 15.5 cm. Most patients had multiple site involvement: 52% hand/wrist, 29% shoulders and elbows, 20% hips and 25% spinal calcinosis. Fistulization/ulceration and infections were reported in 32% and 23% of cases, respectively; nerve compression was found in 40% of spinal calcinosis and in one patient with limb calcinosis. There was no clear evidence of clinical and radiological improvement with any treatment. A partial improvement was seen in 7 patients that underwent surgery. Conclusion Pseudotumoral calcinosis may occur in about 3% of SSc patients, commonly symmetrical and in multiple sites without differences regarding the cutaneous subtypes but often in those with a severe vascular phenotype. Medical treatment seems ineffective, whereas a surgical approach may be considered.

Summary Objective To report the exceptional occurrence of ossifying fibromyxoid tumour (OFMT) as a primary bone lesion. OFMT is a rare soft tissue tumour of uncertain differentiation and variable malignant potential, that occurs in adults with a slight male predominance. It is typically located in the subcutis or in the skeletal muscles of the extremities, followed by trunk or head and neck. Methods Two cases of OFMT proven to arise from bone are presented. The first is a 65-year old female with a history of rib “osteosarcoma”, presenting with an inferior lobe left lung mass. The second is a man with a lytic lesion of the 5th cervical vertebra that recurred shortly after resection. Following H&E and immunohistochemical examination, tumour samples were analysed by NGS and by break-apart FISH to detect rearrangement of the PHF1 and TFE3 genes. Results PHF1 gene-rearrangement was identified by FISH on both the primary and the metastatic lesion of first patient. NGS identified a PHF1(intron1) and EPC1 (exon 10) fusion transcript later confirmed by positive PHF1 rearrangement on FISH in the second case. Conclusions The demonstration of PHF1 gene rearrangements represents a fundamental ancillary diagnostic test when presented with challenging examples of OFMT.

Background There is a significant variability in survival rates for cardiopulmonary resuscitation (CPR) in out of-hospital cardiac arrest (OHCA), and some data indicate that ultrasound improves CPR. Objectives We evaluated the feasibility of ultrasound for monitoring chest compressions in OHCA. Methods We planned a prospective study in patients with an ultrasound-integrated CPR for OHCA. Chest compressions were performed on the intermammillary line (IML), but the position was changed according to the quality of the heart squeezing, evaluated by ultrasound. End-tidal carbon dioxide (ETCO2) was used as the control parameter. Then we compared the area with the highest squeezing with the position of the heart in the chest computed tomography (CT) scans of 20 hospitalized patients. Results Chest compressions were good, partial, and inadequate on the IML in 58.4%, 48.9%, and 2.8% of cases, respectively. These percentages were 75%, 25%, and 0% after these modifications: none (47.2%), increased depth (8.3%), hands moved on the lower third of the sternum (27.8%), on left parasternal line of the lower part of the sternum (13.9%), and on the center of the sternum (1 case). Accordingly, ETCO2 improved significantly (20.37 vs. 37.10, p Conclusions Our study has demonstrated that CPR in OHCA can be improved using ultrasound and changing the position of the hands. This finding was connected with the ETCO2 and confirmed by chest CT scans.

A alimentação e o estilo de vida materno influenciam diretamente na saúde da criança. Atentar-se a essas ações torna-se essencial para desenvolver a saúde de puérperas e neonatos, os quais devem ser alimentados exclusivamente com leite materno até o sexto mês de vida, pois este supre as necessidades do bebê até este período, uma vez que transmite anticorpos que auxiliam na imunidade e evitando doenças. Isso possibilita um desenvolvimento significativo da criança, além de oferecer diversos benefícios à mãe. O presente trabalho teve por objetivo avaliar o conhecimento acerca da amamentação de puérperas internadas em um hospital privado de Cascavel – PR, para, posteriormente, avaliar o resultado dos dados obtidos e identificar os aspectos que necessitam de melhoria. O estudo foi realizado de forma transversal-descritiva e avaliou um grupo de mulheres por meio de um questionário que abordou o assunto ‘amamentação’. Foram avaliadas 60 puérperas, sendo possível verificar que 58% delas já amamentaram anteriormente; 62% receberam orientações acerca da amamentação; apenas 15% realizaram acompanhamento nutricional; 80% amamentaram seus filhos imediatamente após o nascimento; 78,3% tiveram a intenção de amamentar em livre demanda; 100% acreditam que o leite materno oferece imunidade e nutrição aos bebês; enquanto 85% não acreditam na teoria do leite fraco e relatam que o estado emocional pode influenciar o aleitamento materno. Diante desses resultados, sugere-se uma maior disseminação de informação e orientações acerca do ato de amamentar e seus benefícios. PALAVRAS-CHAVE: Aleitamento materno, Gestante, Nutricional.

O uso de suplementos como ferro, ácido fólico, vitamina D, ômega 3 e polivitamínicos durante o período gestacional, muitas vezes, faz-se necessário, devido a um aumento na demanda de micronutrientes, pois ocorrem transformações anabólicas de forma desigual durante todo o período. O presente trabalho teve como objetivo verificar o uso da suplementação durante o período gestacional de puérperas internadas pelo Sistema Único de Saúde (SUS), em um hospital particular na cidade de Cascavel – PR. O estudo foi realizado nos leitos da maternidade, durante o mês de agosto de 2019, após aprovação pelo Comitê de Ética e Pesquisa, com 60 puérperas. Os dados foram coletados por meio de um questionário, também consultando os prontuários médicos e as informações presentes na carteira da gestante, e posteriormente tabulados no Excel. Observou-se que, da população amostral, 90% eram adultas e 51,7% trabalhavam, mas apenas 35% apresentavam carteira assinada. Em relação ao grau de escolaridade, foi observado que dez mulheres apresentavam ensino superior; quarenta e três, ensino médio; sete, ensino fundamental, porém, algumas não concluíram os estudos. Além disso, verificou-se quanto ao uso de suplementos que 58,3% usaram ferro; 46,7%, ácido fólico; 18,3%, multivitamínicos; 6,7%, ômega 3; e 5%, vitamina D, sendo que 25% não suplementaram. Com isso, observou-se baixa suplementação entre o número de puérperas, necessitando de acompanhamento nutricional e novas políticas de saúde pública a fim de evitar carências nutricionais.

Medulloblastoma is an embryonal neuroepithelial tumor that affects mainly childhood and more rarely adults. Medulloblastoma occurring as multiple nodules at diagnosis is a rare and tricky presentation. Here, we describe the case of a previously healthy 47-year-old woman with multiple posterior fossa cerebellar tumors. Histological, immunohistochemical, and molecular analyses were performed to best characterize the two excised lesions. The histopathological analysis revealed different variants of medulloblastoma in the excised nodules, one being extensive nodularity, rare in adults, and the other desmoplastic/nodular with areas of anaplasia. Immunostains and molecular analysis classified both nodules as SHH medulloblastoma. Adult medulloblastoma is extremely rare. Important differences exist between adult medulloblastoma and medulloblastoma arising in children and infants. Such differences are in location, distribution of histological variants and of molecular subgroups, survival rates, and therapeutic options. An extensive morphological and molecular characterization of such rare tumors is necessary to choice the best-tailored therapy.

Background An abnormal ankle-brachial pressure index (ABI) is a marker of the risk for increased total and cardiovascular (CV) mortality. However, it is not clear whether it is associated with an even worse prognosis in patients with previous CV events or with cancer mortality. Materials and Methods Consecutive subjects undergoing ABI assessment for suspected peripheral artery disease or for stratification of CV risk in ten centers in the Veneto Region (northeast Italy), between 2011 and 2014 were enrolled. The ABI was expressed as normal ≥0.9 to ≤1.3, and abnormal 1.3. All-cause mortality and CV or cancer mortality and hospitalizations for CV disease were collected from administrative databases up to December 2018. Results The study enrolled 1,177 patients. ABI was abnormal in 57.2%. Median follow-up was 61.6 months (53.4–70.1). All-cause, CV and cancer mortality were higher in patients with abnormal than normal ABI, with hazard ratios (HR) respectively 2.0 (95% CI 1.48–2.69), 1.98 (95% CI 1.24–3.17) and 1.85 (95% CI 1.09–3.15). Among subjects with abnormal ABI, the risk of overall mortality, HR 1.57 (95% CI 1.17–2.12), and CV mortality, HR 2.39 (95% CI 1.43–3.99), was higher in those with previous CV events. These latter also had a higher risk of hospitalization for myocardial infarction and stroke: HR 1.85 (95% CI 1.023.37) and 2.17 (95% CI 1.10–4.28). Conclusions The co-existence of abnormal ABI and a history of CV events identifies subjects at higher risk, who call for a more aggressive approach. Abnormal ABI is also a predictor of cancer mortality.

In order to identify the perception of good death by physicians who work at a teaching hospital, a cross sectional study with a convenience sample (100 physicians) is proposed, using the reduced version of the perceived dignified death scale (Brazilian reduced version of Good Death Inventory). All factors of the instrument were considered as highly needed, emphasizing good relationship with the family (98.9%), maintenance of hope and pleasure (97.8%) and not being a burden to others (92.3%). Women prioritized good relationships with family and team; doctors over 45 years old, not being a burden to others; and those without religion, not being a burden to others and having control over the future. The perception of good death presented by physicians valued social aspects such as affectivity and acquaintanceship, by prioritizing these three factors, in addition to showing that age, sex and religiosity influence this perception.

Aim The aim of the present study was to evaluate whether periodontitis is independently associated with oral health-related quality of life (OHRQoL) in individuals with end-stage renal disease (ESRD). Materials and methods Calibrated examiners assessed 180 adults with ESRD. A full-mouth periodontal examination was performed at six sites on each tooth. Periodontitis was considered a categorical variable (absent, mild/moderate or severe). OHRQoL was assessed using the simplified version of the Oral Health Impact Profile (OHIP14 ) questionnaire. Adjusted multivariate Poisson regression analysis was used with a conceptual hierarchical approach to calculate the rate ratio (RR) of OHIP14 scores for periodontitis according to the severity categories. Results In the adjusted model, mild/moderate and severe periodontitis were significantly associated with poorer OHRQoL compared to the absence of periodontitis [RR = 1.49 (95% confidence interval: 1.16-1.91) and RR 1.77 (95% CI: 1.36-2.30), respectively]. The adjusted domain-specific analysis revealed that mild/moderate periodontitis significantly impacted the psychological disability domain and severe periodontitis significantly impacted the physical pain, psychological discomfort, physical disability and psychological disability domains. Conclusions Periodontitis exerts an influence on OHRQoL in individuals with ESRD, with a more severe condition impacting different domains.

Patient: Female, 83-year-old Final Diagnosis: Sclerosing mesenteritis Symptoms: Abdominal pain • intestinal obstruction • vomiting Medication: — Clinical Procedure: — Specialty: Surgery Objective: Rare disease Background: The term “sclerosing mesenteritis” includes a spectrum of rare idiopathic diseases involving the small and/or large bowel. It appears as a diffuse, localized, or multinodular thickening of the mesentery, with a variable degree of chronic non-specific inflammation, fat necrosis, and fibrosis. Case Report: Here, we report a case of 83-year-old woman with symptoms of intestinal occlusion, vomiting, and abdominal pain. Radiographic examinations showed air fluid levels in right and left quadrants and in the mesogastric site, while computed tomography (CT) documented a strangulated inguinal hernia with ileal obstruction. Based on clinical examination and radiologic findings, the patient underwent surgery for inguinal hernia reduction. The examination of viscera revealed 2 tracts of ileum with ischemic signs and covered by fibrin; thus, the 2 intestinal loops were resected. Histological examination revealed chronic non-specific inflammation of the whole intestinal wall, including the subserosa in the resected tract of proximal ileum, while the distal ileal loop (not herniated tract) showed a subserosal fibrous nodule of 2 cm in greatest diameter, composed of a proliferation of spindle cells haphazardly arranged in a collagenized stroma. The diagnosis of sclerosing mesenteritis was rendered. Conclusions: The present case shows the possibility of an incidental diagnosis during another intervention such as hernia surgery. Pathologists should be aware of this disease to avoid confusion with aggressive tumors such as intra-abdominal desmoid-type fibromatosis and gastrointestinal stromal tumor.

Objectives Vascular disease in SSc is associated with significant morbidity and mortality. Preliminary data may lead to the suggestion of a modifiable unified-vascular endophenotype. Our aim was to determine whether the prevalence, mortality and severity of SSc-vascular disease have changed over time. Methods We performed a systematic review and meta-analysis of the literature in PubMed 1950–2019 related to SSc-digital ulcers (DUs), pulmonary artery hypertension (PAH) and scleroderma renal crisis (SRC). We included full-text articles and extracted study characteristics and assessed risk of bias/quality. We examined the prevalence, mortality and surrogate measures of SSc-associated vascular disease severity. Results We included 55 studies in our meta-analysis. The pooled prevalence of DUs (41.0%), PAH (9.5%) and SRC (4.9%) remained largely stable over time. There was significant improvement in PAH 1-year (P = 0.001) and SRC mortality (P Conclusion Despite the heterogeneity and scarcity of the disease, there have been major improvements obtained in the various vascular complications in SSc leading to benefit in survival. This is supported by a trend towards improvement in several surrogate markers and demonstrates that progress in vascular management translates into major patient benefit.

A unique specimen of argyria is preserved in the Morgagni Museum of Pathological Anatomy at the University of Padua (Italy). It is a stuffed head belonging to a man who decided to cure his syphilis by himself with the so-called infernal stone (silver nitrate) every day for years, thus developing argyria in the second half of the nineteenth century. Paleopathological and historical studies were performed on the specimen to confirm the diagnosis of argyria. Furthermore, a morphological investigation of the specimen was conducted with histological and ultrastructural investigations, including environmental scanning electron microscopy and electron dispersive x‐ray spectroscopy, recording high presence of silver in the dermis and epidermis and also other chemical elements correlated to the “infernal stone.” A comparison with actual cases may also lead to a common feature: a potential dependence on the perceived benefits brought by silver compound that may sustain a further prolonged intake.

Among the available techniques for gingival recession treatment, the main surgical technique for gain of keratinized tissue is the free gingival graft. This procedure is also indicated for vestibule extension and frenulum removal. The technique consists of the epithelial and connective tissues removal from a donor site and its repositioning on to a recipient site, being an effective primary stability mandatory for the healing process. The aim of this study was to describe a case report of a 35-year-old male, who reported a postoperative complication in donor area, after a free gingival graft which occurred 07 days later. This situation occurred after patient reported having rinsed his mouth with hot water during shower. Due to that, a 1mm thick acetate tray was readymade for the donor site comfort and protection. Among the demands presented in this case, free gingival graft was the primary surgical choice to increase keratinized tissue. Despite the patient’s morbidity, due to the two surgical sites, the use of the acetate tray showed great reduction in patient’s discomfort and trauma. This approach proved to be successful since the patient described increase in self-esteem and oral hygiene facilitation which in combination contributed to satisfactory final results. Keywords: Periodontics. Gingival Recession. Postoperative Complications. ResumoEntre as técnicas disponíveis para o tratamento da recessão gengival, a principal técnica cirúrgica para ganho de tecido queratinizado é o enxerto gengival livre. Este procedimento também é indicado para extensão do vestíbulo e remoção do frênulo. A técnica consiste na remoção de tecidos epiteliais e conectivos de um local doador e seu reposicionamento no local receptor, sendo necessária uma estabilidade primária eficaz para o processo de cicatrização. O objetivo deste estudo foi descrever um relato de caso de um homem de 35 anos, que relatou uma complicação pós-operatória na área doadora, 07 dias após a realização de um enxerto gengival livre. Essa situação ocorreu depois que o paciente relatou ter enxaguado a boca com água quente durante o banho. Devido a isso, uma placa de acetato de 1 mm de espessura foi preparada para conforto e proteção do local doador. Entre as demandas apresentadas neste caso, o enxerto gengival livre foi a principal opção cirúrgica para aumentar o tecido queratinizado. Apesar da morbidade do paciente, devido aos dois locais cirúrgicos, o uso da placa de acetato demonstrou grande redução no desconforto e trauma do paciente. Essa abordagem mostrou-se bem-sucedida, uma vez que o paciente descreveu aumento da autoestima e facilitação da higiene bucal, o que em conjunto contribuiu para resultados finais satisfatórios. Palavras-chave: Periodontia. Recessão Gengival. Complicações Pós-Operatórias

Context Current data about the cardiovascular manifestations of mild primary hyperparathyroidism (pHPT) are often conflicting. Pulse wave velocity (PWV) is the gold standard for assessing aortic stiffness, and it predicts cardiovascular morbidity and mortality. Objective Primary outcomes were to investigate if mild pHPT was associated with higher PWV and if parathyroidectomy (PTX) reduced PWV in mild pHPT. Secondary outcome was to investigate blood pressure changes after PTX. Methods Sources were PubMed, Google Scholar, SCOPUS, Web of Science, and the Cochrane Library. Eligible studies included reports of PWV in patients with mild pHPT and controls, or in patients with mild pHPT before and after PTX. Two investigators independently identified eligible studies and extracted data. Pooled mean difference (MD) was the summary effect measure. Data were presented in forest plots with outlier and influential case diagnostics. Nine observational studies and one randomized clinical trial were selected, including 433 patients with mild pHPT, 171 of whom underwent PTX, and 407 controls. PWV was significantly higher in mild pHPT than in controls (MD = 1.18, 0.67 to 1.68, P < .0001). Seven studies evaluated the effect of PTX on PWV. PTX significantly reduced PWV (MD = –0.48, –0.88 to –0.07, P = .022). Conclusion Aortic stiffness is increased in patients with mild pHPT, supporting the notion that mild pHPT is also associated with adverse cardiovascular manifestations. PTX significantly reduced arterial stiffness in mild pHPT, indicating that the benefit of PTX over cardiovascular manifestations should not be dismissed but it deserves further studies.

Cardiovascular disease is one of the most common causes of hospitalization and is associated with high morbidity and mortality rates. Among the most important modifiable and well-known risk factors are an unhealthy diet and sedentary lifestyle. Nevertheless, adherence to healthy lifestyle regimes is poor. The present study examined longitudinal trajectories (pre-event, 6-, 12-, 24-, 36-, and 60-month follow-ups) of protein intake (fish, legumes, red/processed meat) and physical activity in 275 newly-diagnosed patients with acute coronary syndrome. Hierarchical Generalized Linear Models were performed, controlling for demographic and clinical variables, the season in which each assessment was made, and the presence of anxiety and depressive symptoms. Significant changes in protein intake and physical activity were found from pre-event to the six-month follow-up, suggesting the adoption of healthier behaviors. However, soon after the six-month follow-up, patients experienced significant declines in their healthy behaviors. Both physical activity and red/processed meat intake were modulated by the season in which the assessments took place and by anxiety symptoms over time. The negative long-term trajectory of healthy behaviors suggests that tailored interventions are needed that sustain patients’ capabilities to self-regulate their behaviors over time and consider patient preference in function of season.

Malignant gastrointestinal neuroectodermal tumor (M-GNET) and clear cell sarcoma (CCS) of soft tissue represent closely related, extremely rare, malignant mesenchymal neoplasm of uncertain differentiation. Both entities are characterized genetically by the same molecular alterations represented by the presence of EWSR1-ATF1 and, more rarely, EWSR1-CREB1 fusion genes. The latter translocation seems to be more represented in M-GNET that, despite significant morphologic overlap with CCS, tends to lack overt features of melanocytic differentiation. Most M-GNET occur in the lower gastrointestinal tract, whereas occurrence in the upper tract has been reported only exceptionally. The differential diagnosis represents a major challenge, and accurate diagnosis impact significantly on therapeutic planning. We herein report the clinicopathologic features of a molecularly confirmed M-GNET that arose at the base of the tongue and review the pertinent literature.

This study aimed to evaluate the levels of eicosanoids derived from arachidonic acid (ARA) in the lungs of asthmatic rats supplemented with fish oil. The present data gives insight into the action of fish oil in asthma, related to its inability to modify the contractile capacity of tracheal smooth muscle reported previously in a model of asthma in rats. Male Wistar rats were supplemented daily with 1 g of fish oil/kg of body weight for 21 days. They were exposed to ovalbumin (OVA) after previous sensitization with OVA to induce asthma. Pulmonary levels of five eicosanoids were measured using immunoassay kits: PGE2, TXB2, LTB4, LXA4, and 8-iso PGF2α. In asthmatic rats, supplementation with fish oil resulted in lower concentrations of lung eicosanoids produced by cyclooxygenase-2 and 15-lipoxygenase: PGE2, TXB2, and LXA4, respectively. Fish oil supplementation also decreased the non-enzymatically produced eicosanoid 8-iso PGF2α. Fish oil supplementation did not affect LTB4, a metabolite of 5-lipoxygenase. The limited efficacy of fish oil supplementation in asthmatic rats is associated with a lack of action in reducing the levels of LTB4 in the lungs. Thus, fish oil differentially modulates the concentrations of eicosanoids derived from ARA via specific pathways in an animal model of asthma., Highlights • Unraveling the action of fish oil in the lungs of asthmatic rats. • Fish oil modifies inflammatory pathways with enzymatic specificity. • Leukotriene B4 remains unchanged with fish oil supplementation in asthmatic rats., Fish oil, Asthma, Eicosanoid, Leukotriene.

The present case reports a 13-year-old patient with an intradural arachnoid cyst, which manifested itself with a sudden loss of strength and sensitivity in the lower and upper limbs and a severe pain in the cervical and thoracic region. On examination, a lesion displayed as an intradural hematoma; however, a laminotomy was performed and it was realized that the lesion was an arachnoid spinal cyst of the cervical-dorsal spine.

BackgroundPatients with diffuse cutaneous systemic sclerosis (dcSSc) have a poor prognosis. The importance of monitoring subjective measures of functioning and disability, such as the Health Assessment Questionnaire-Disability Index (HAQ-DI), is important as dcSSc is rated by patients as worse than diabetes or hemodialysis for quality of life impairment. This European Scleroderma Trials and Research (EUSTAR) database analysis was undertaken to examine the importance of impaired functionality in dcSSc prognosis. The primary objectives were to identify predictors of death and HAQ-DI score progression over 1 year. HAQ-DI score, major advanced organ involvement, and death rate were also used to develop a comprehensive model to predict lifetime dcSSc progression.MethodsThis was an observational, longitudinal study in patients with dcSSc registered in EUSTAR. Death and HAQ-DI scores were, respectively, analyzed by Cox regression and linear regression analyses in relation to baseline covariates. A microsimulation Markov model was developed to estimate/predict natural progression of dcSSc over a patient’s lifetime.ResultsThe analysis included dcSSc patients with (N = 690) and without (N = 4132) HAQ-DI score assessments from the EUSTAR database. Baseline HAQ-DI score, corticosteroid treatment, and major advanced organ involvement were predictive of death on multivariable analysis; a 1-point increase in baseline HAQ-DI score multiplied the risk of death by 2.7 (p p p ConclusionsHAQ-DI score and major advanced organ involvement were comparable predictors of mortality risk in dcSSc. Baseline mRSS and baseline HAQ-DI score were predictive of HAQ-DI score progression at 1 year, indicating a correlation between these endpoints in monitoring disease progression. It is hoped that this EUSTAR analysis may change physician perception about the importance of the HAQ-DI score in dcSSc.

Pulmonary arterial hypertension (PAH) carries a high morbidity and mortality burden in Systemic Sclerosis (SSc). Therefore, PAH screening and early detection are pivotal. A systematic literature review (SLR) to search for all screening tools and modalities for SSc-PAH was performed in reference to right heart catheterization as diagnostic gold standard. Papers from 2 previously published SLRs and derived from a systematic search on Pubmed, EMBASE, Web of Science for papers published from 03/10/2017 to 31/12/2018 were manually included. A total of 199 papers were reviewed and 32 were extracted, with a low bias risk according to QUADAS2. Echocardiography, pulmonary function tests, clinical features and serum biomarkers were the most frequently tools used for screening, with different parameters combined in a variable fashion, as single item or as part of composite algorithms. Among the composite algorithms, the DETECT score, ESC/ERS 2009 or 2015 guidelines, ASIG and ITINER-air algorithms were the most commonly used in a wide range of patients. In different cohorts, DETECT and ASIG showed higher sensitivity and negative predictive value than ESC/ERS 2009. In conclusion, the literature shows echocardiography as the leading screening tool for SSc-PAH. In particular, systolic pulmonary arterial pressure (sPAP) and tricuspid regurgitation velocity (TRV), both as single items or part of composite algorithms, including also serum biomarkers, clinical and functional items, are the most frequent parameters evaluated.

SMARCB1 inactivation is a well-established trigger event in atypical teratoid/rhabdoid tumor. Recently, a role for SMARCB1 inactivation has emerged as a mechanism of clonal evolution in other tumor types, including rare brain tumors. We describe an unusual malignant intra-axial SMARCB1-deficient spindle cell desmoplastic neoplasm, occurring in a 6-year-old child with meningioangiomatosis and a long history of seizures. Striking features of the tumor were a storiform pattern and strong CD34 expression. Undifferentiated round cell areas with isolated rhabdoid cells showing high mitotic index and focal necrosis with INI1 expression loss were present. The meningioangiomatosis component showed few chromosomal imbalances, including chromosomal 22 monosomy (where SMARCB1 maps) and gain at 6q14.3. In addition to these abnormalities, the spindle cell desmoplastic neoplasm and its dedifferentiated SMARCB1-deficient component shared several other aberrations, including homozygous deletion at 9p21.3, losses at 1p, 3p, 3q, 10p, and 13q, gains and losses at 5p and 11p. In line with INI1 loss, the dedifferentiated component showed remarkably decreased levels of SMARCB1 transcript. The residual SMARCB1 allele was wildtype. Our findings suggest progression from the meningioangiomatosis to the malignant desmoplastic neoplasm through the occurrence of complex chromosomal abnormalities, and point to functional silencing of SMARCB1 in the dedifferentiation component.

SARS-CoV-2, o novo coronavírus, surpreendeu o mundo com a sua capacidade de infecção, causando uma preocupação emergente de saúde pública com mais de 3 milhões de pessoas afetadas em apenas quatro meses. A taxa de mortalidade é variável entre os países, considerando as suas estruturas etárias e o percentual de comorbilidades. Os Idosos e as pessoas com doenças subjacentes são mais suscetíveis ao desenvolvimento de casos graves de COVID-19 e têm maior taxa de mortalidade. As doenças cardiovasculares têm uma importância particular, uma vez que a sua prevalência é elevada e considerando a fisiopatologia da infecção. O vírus usa os receptores da enzima de conversão da angiotensina (ECA) 2 para invadir as células humanas. Esses receptores estão principalmente nos pulmões e no coração. Além do dano viral direto, a hipóxia, a tempestade de citocinas e a libertação de catecolaminas também afetam esses órgãos. No coração, estudos mostraram que a COVID-19 pode causar miocardite, arritmias ventriculares, síndrome coronária aguda e insuficiência cardíaca. Além disso, a lesão cardiovascular pode ser a primeira manifestação de infecção viral em alguns casos, motivo de maior preocupação durante esta pandemia. Os inibidores da ECA e os bloqueadores dos receptores da angiotensina (BRA) são medicamentos de suma importância no tratamento de doenças cardiovasculares. No entanto, alguns estudos sugeriram preocupação com esses medicamentos na COVID-19, pois eles poderiam causar um aumento da ECA2 e aumentar a gravidade da infeção. Até onde sabemos, nenhum estudo demonstrou que inibidores da ECA ou ARA são prejudiciais e as principais sociedades cardiovasculares recomendam a continuidade do tratamento., Medicina Interna, Vol. 28 N.º 1 (2021): Janeiro - Março

Background Since the beginning of coronavirus disease 2019 (COVID-19), the development of predictive models has sparked relevant interest due to the initial lack of knowledge about diagnosis, treatment, and prognosis. The present study aimed at developing a model, through a machine learning approach, to predict intensive care unit (ICU) mortality in COVID-19 patients based on predefined clinical parameters. Results Observational multicenter cohort study. All COVID-19 adult patients admitted to 25 ICUs belonging to the VENETO ICU network (February 28th 2020-april 4th 2021) were enrolled. Patients admitted to the ICUs before 4th March 2021 were used for model training (“training set”), while patients admitted after the 5th of March 2021 were used for external validation (“test set 1”). A further group of patients (“test set 2”), admitted to the ICU of IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan, was used for external validation. A SuperLearner machine learning algorithm was applied for model development, and both internal and external validation was performed. Clinical variables available for the model were (i) age, gender, sequential organ failure assessment score, Charlson Comorbidity Index score (not adjusted for age), Palliative Performance Score; (ii) need of invasive mechanical ventilation, non-invasive mechanical ventilation, O2 therapy, vasoactive agents, extracorporeal membrane oxygenation, continuous venous-venous hemofiltration, tracheostomy, re-intubation, prone position during ICU stay; and (iii) re-admission in ICU. One thousand two hundred ninety-three (80%) patients were included in the “training set”, while 124 (8%) and 199 (12%) patients were included in the “test set 1” and “test set 2,” respectively. Three different predictive models were developed. Each model included different sets of clinical variables. The three models showed similar predictive performances, with a training balanced accuracy that ranged between 0.72 and 0.90, while the cross-validation performance ranged from 0.75 to 0.85. Age was the leading predictor for all the considered models. Conclusions Our study provides a useful and reliable tool, through a machine learning approach, for predicting ICU mortality in COVID-19 patients. In all the estimated models, age was the variable showing the most important impact on mortality.

Canine leishmaniasis (CanL) is a zoonotic vector-borne disease that is endemic in the Mediterranean Basin including Morocco. Dogs play a major epidemiological role in this zoonosis as reservoir hosts. This study investigated the clinical manifestations of CanL in dogs naturally infected with Leishmania infantum. A total of 96 dogs presented to the Small Animal Clinic of the Hassan II Agronomy and Veterinary Institute (IAV Hassan II) of Rabat, Morocco, and were tested by RT-PCR and/or serology. Among them, 32 (33.3%) were positive to Leishmania infantum infection. The majority of the positive dogs (93.7%) came from urban areas. Most of them were male (62.5%) and purebreds (65.6%), were aged between 3 and 7 years (71.8%), and had outside activities (guarding, hunting, livestock guarding, and service activities) (71.8%) and all of them were living exclusively outdoor or had free access to the outdoor environment. Lymphadenomegaly (81.2%), dermatological disorders (65.6%) (mostly exfoliative dermatitis), weight loss (59.3%), exercise intolerance (56.2%), anorexia (28.1%), hyporexia (15.6%), and ocular lesions (28.1%) were the most frequent clinical signs and complaints recorded. Anemia and hyperproteinemia due to hyperglobulinemia were observed in 68.7% and 72.7% of the cases, respectively. These results suggest that CanL leads to various nonspecific clinical signs as described previously, making the diagnosis challenging. Since CanL is endemic in Morocco, it should be recommended to systematically test dogs displaying clinical signs compatible with this disease and to regularly screen asymptomatic at-risk dogs. It is also crucial to educate dog owners about the zoonotic aspect of the disease and to encourage intersectorial collaboration following the “One Health” concept, in order to contribute to a more effective control/prevention of human and canine leishmaniasis.

Objetivo: identificar os recursos disponíveis em aplicativos móveis que favoreçam o autocuidado e o autogerenciamento do Diabetes Mellitus tipo I. Método: trata-se de uma revisão integrativa realizada nas bases de dados: BVS, PubMed e Scopus, com os descritores Diabetes Mellitus AND Aplicativos móveis, nos idiomas português, espanhol e inglês. Resultados: foram analisados 16 artigos e neles identificados os principais recursos para o autocuidado e o autogerenciamento do Diabetes Mellitus tipo I: glicosímetro, diário digital de diabetes, ações corretivas de glicose, controle alimentar e comunicação entre usuário e profissional de saúde e usuário com seus pares. Conclusões: evidenciou-se a escassez de estudos cujo público alvo são pessoas que convivem com Diabetes Mellitus tipo I. Os resultados indicam que os recursos identificados nos aplicativos para dispositivos móveis auxiliam os indivíduos com Diabetes Mellitus tipo I no autocuidado e autogerenciamento da doença.

Intravenous iodinated contrast (IVIC) medium is routinely administered to dogs. Scattered information exists regarding the serum biochemical or urinary profiles associated with the administration of IVIC in dogs. The aim of the study was to describe, compare, and discuss from the perspective of previous studies the alterations in serum biochemical and urinary parameters before (T0) and within one week (T1) of the IVIC administration during routine computed tomography (CT) scan evaluation of 22 dogs. Mature dogs presenting for CT scan evaluation for preoperative oncology staging/surgical planning were included. T1 evaluation was performed within one week of IVIC administration. Statistically significant differences in serum total protein, albumin, chloride, calcium, and phosphorus concentrations, urine protein to creatinine ratio, and urine specific gravity were found between T1 and T0. At T1, the serum creatinine concentration was within reference ranges in all dogs but one. An increase in the urine protein to creatinine ratio was observed in four samples, one of which was non-proteinuric at T0. Changes in biochemistry and urine parameters between T0 and T1 were not considered clinically significant.

Objective Juvenile systemic sclerosis (JSSc) is a rare condition in childhood and its variety with no skin involvement, sine scleroderma (ssJSSc), is anecdotal. We report the first case series of patients with ssJSSc. Methods Demographic, clinical and laboratory data of patients with JSSc followed at our centre were retrospectively collected. Patients with no skin involvement but with all of the features RP, positive ANA, intestinal dysmotility and/or interstitial lung disease (ILD) or pulmonary arterial hypertension (PAH) and/or cardiac or renal involvement typical of scleroderma were defined as having ssJSSc and compared with those with classic JSSc (cJSSc). Results Among 52 JSSc patients seen in 20 years, five (9.6%) presented with ssJSSc. Their clinical features and those of the only two patients reported in the literature so far were compared with classic JSSc with available complete data. Six patients had cardiac involvement as presenting feature, three primary cardiomyopathy, three secondary to PAH. Two patients died after a brief disease course and one rapidly underwent heart transplantation. In comparison with cJSSc, ssJSSc showed a significantly longer diagnostic delay (20.1 vs 8.3 months, P = 0.017), higher frequency of cardiac involvement (85.7 vs 15.6%, P = 0.001) and worse outcome, intended as mortality or end-stage organ failure rates (42.9% vs 6.2%, P Conclusion Cardiac involvement represents the most important characteristic of ssJSSc and carries a high morbidity and mortality rate. The longer delay in diagnosis underlines the need for a comprehensive rheumatological work-up in patients with isolated cardiomyopathy or PAH/ILD.

Primary myocardial involvement is common in systemic sclerosis (SSc). Ventricular-arterial coupling (VAC) reflecting the interplay between ventricular performance and arterial load, is a key determinant of cardiovascular (CV) performance. We aimed to investigate VAC, VAC-derived indices, and the potential association between altered VAC and survival free from death/hospitalization for major adverse CV events (MACE) in scleroderma. Only SSc patients without any anamnestic and echocardiographic evidence of primary myocardial involvement who underwent three-dimensional echocardiography (3DE) were included in this cross-sectional study and compared with healthy matched controls. 3DE was used for noninvasive measurements of end-systolic elastance (Ees), arterial elastance (Ea), VAC (Ea/Ees) and end-diastolic elastance (Eed), the occurrence of death/hospitalization for MACE was recorded during follow-up. Sixty-five SSc patients (54 female, aged 56 ± 14 years) were included. Ees (p = 0.04), Ea (p = 0.04) and Eed (p = 0.01) were higher in patients vs. controls. Thus, VAC was similar in both groups. Ees was lower and VAC was higher in patients with diffuse cutaneous form (dcSSc) vs. patients with limited form (lcSSc) (p = 0.001 and p = 0.02, respectively). Over a median follow-up of 4 years, four patients died for heart failure and 34 were hospitalized for CV events. In patients with VAC &gt, 0.63 the risk of MACE was higher (HR 2.5, 95% CI 1.13–5.7, p = 0.01) and survival free from death/hospitalization was lower (p = 0.005) than in those with VAC &lt, 0.63. Our study suggests that VAC may be impaired in SSc patients without signs and symptoms of primary myocardial involvement. Moreover, VAC appears to have a prognostic role in SSc.

Objective To know situations of vulnerabilities experienced by children and adolescents with cancer and their implications on health rights. Method A qualitative study, developed from 2017 to 2018, in two Santa Catarina hospitals. The interviewees were 11 family members of children/adolescents with cancer, a prevalent chronic disease identified in hospitalizations in 2017. A descriptive and thematic analysis was carried out based on the vulnerability and human rights framework. Results Among the chronic diseases, cancer was prevalent. Vulnerability situations were discussed considering the trajectories in the health care network, the challenges facing the care routine and the support networks for the exercise of the right to health. Final considerations Chronic diseases such as cancer require timely, decisive and effective responses from the health system with a view to maintaining human rights. RESUMEN Objetivo Conocer las situaciones de vulnerabilidad experimentadas por niños y adolescentes con cáncer y sus implicaciones para el derecho a la salud. Método Estudio cuantitativo, desarrollado de 2017 a 2018, en dos hospitales de Santa Catarina. Se entrevistó a 11 familiares de niños/adolescentes con cáncer. Se realizó un análisis descriptivo y temático basado en el marco de vulnerabilidad y derechos humanos. Resultados Entre las enfermedades crónicas, hubo prevalencia de cáncer. Se discutieron las situaciones de vulnerabilidad considerando las trayectorias en la red de atención de la salud, los desafíos en la rutina de atención y las redes de apoyo para el ejercicio del derecho a la salud. Consideraciones finales Las enfermedades crónicas como el cáncer requieren respuestas oportunas, decisivas y efectivas por parte del sistema de salud con miras a mantener los derechos humanos. RESUMO Objetivo Conhecer as situações de vulnerabilidades vivenciadas por crianças e adolescentes com câncer e suas implicações no direito à saúde. Método Estudo qualitativo, desenvolvido de 2017 a 2018, em dois hospitais de Santa Catarina. Foram entrevistados 11 familiares de crianças/adolescentes com câncer, doença crônica prevalente identificada nas internações de 2017. Realizou-se análise descritiva e temática ancorada no referencial da vulnerabilidade e dos direitos humanos. Resultados As situações de vulnerabilidades foram discutidas considerando as trajetórias na rede de atenção à saúde, os desafios frente à rotina de cuidado e as redes de apoio para o exercício do direito à saúde. Considerações finais Doenças crônicas como o câncer infanto-juvenil exigem respostas pontuais, resolutivas e efetivas pelo sistema de saúde com vistas a mitigar as situações de vulnerabilidades e promover os direitos à saúde.