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Aim: Abrocitinib is a JAK-1 inhibitor approved for the treatment of moderate-to-severe atopic dermatitis (AD). We conducted a 16-week multicenter retrospective study to assess the short-term effectiveness and safety of abrocitinib in patients with moderate-to-severe AD.Our retrospective study included 85 adult patients from 14 Italian Dermatology Units affected by moderate-to-severe AD treated with abrocitinib 100/200 mg.Methods: Effectiveness of abrocitinib at weeks 4 and 16 was assessed by using the Eczema Area and Severity Index (EASI), the Investigator Global Assessment (IGA), the peak pruritus and sleep- Numerical Rating Scale (PP-NRS and S-NRS, respectively).Results: At week 16, improvement of at least 90% in EASI (EASI90) and IGA 0/1 was observed in 49.4% and 61.2% of patients, respectively. A reduction of at least 4 points in PP-NRS and S-NRS compared with baseline was achieved by 70.6% of patients for both endpoints. No significant safety reports were observed during the study period. Naïve patients had better rates of EASI 90 compared to patients who previously failed dupilumab.Conclusion: Our data confirm the effectiveness of abrocitinib in a real-world setting with better clinical responses at weeks 4 and 16, compared with Phase-III clinical trials. Longer analyses are required to further establish the safety profile of abrocitinib.

Rabies merupakan masalah kesehatan masyarakat yang cukup serius terutama di daerah dan telah masuk dalam program daerah namun terabaikan selama masa pandemi. Seorang anak laki-laki berusia empat tahun dibawa ke RSUD TC Hillers Maumere datang dengan keluhan demam dan mual muntah lebih dari lima kali. Dari anamnesis melalui keluarganya diketahui bahwa pasien memiliki riwayat gigitan anjing di area wajah dan pergelangan tangan kanan pada 14 hari sebelum muncul keluhan. Pada kasus ini pasien sudah mendapatkan perawatan luka dan Vaksin Anti Rabies (VAR) dosis kedua tetapi tidak mendapatkan Serum Anti Rabies (SAR). Pada kasus dengan area gigitan berisiko tinggi, pemberian VAR harus disertai pemberian SAR untuk mengurangi moralitas

IntroductionA prognostic model to predict liver severity in people with metabolic dysfunction-associated steatotic liver disease (MASLD) is very important, but the accuracy of the most commonly used tools is not yet well established.ObjectiveThe meta-analysis aimed to assess the accuracy of different prognostic serological biomarkers in predicting liver fibrosis severity in people with MASLD.MethodsAdults ≥18 years of age with MASLD were included, with the following: liver biopsy and aspartate aminotransferase-to-platelet ratio (APRI), fibrosis index-4 (FIB-4), non-alcoholic fatty liver disease fibrosis score (NFS), body mass index, aspartate aminotransferase/alanine aminotransferase ratio, diabetes score (BARD score), FibroMeter, FibroTest, enhanced liver fibrosis (ELF), Forns score, and Hepascore. Meta-analyses were performed using a random effects model based on the DerSimonian and Laird methods. The study’s risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2.ResultsIn total, 138 articles were included, of which 86 studies with 46,514 participants met the criteria for the meta-analysis. The results for the summary area under the receiver operating characteristic (sAUROC) curve, according to the prognostic models, were as follows: APRI: advanced fibrosis (AF): 0.78, any fibrosis (AnF): 0.76, significant fibrosis (SF): 0.76, cirrhosis: 0.72; FIB-4: cirrhosis: 0.83, AF: 0.81, AnF: 0.77, SF: 0.75; NFS: SF: 0.81, AF: 0.81, AnF: 0.71, cirrhosis: 0.69; BARD score: SF: 0.77, AF: 0.73; FibroMeter: SF: 0.88, AF: 0.84; FibroTest: SF: 0.86, AF: 0.78; and ELF: AF: 0.87.ConclusionThe results of this meta-analysis suggest that, when comparing the scores of serological biomarkers with liver biopsies, the following models showed better diagnostic accuracy in predicting liver fibrosis severity in people with MASLD: FIB-4 for any fibrosis, FibroMeter for significant fibrosis, ELF for advanced fibrosis, and FIB-4 for cirrhosis.Clinical trial registration: [https://clinicaltrials.gov/], identifier [CRD 42020180525].

Snowpack is an important temporal water storage for downstream areas, a potential source of natural hazards (avalanches or floods) and a prerequisite for winter tourism. Here, we use thousands of manual measurements of the water equivalent of the snow cover (SWE) from almost 30 stations between 1,200 and 2,900 m a.s.l. from four long-term monitoring programs (earliest start in 1937) in the center of the European Alps to derive daily SWE based on snow depth data for each station. The inferred long-term daily SWE time series were analyzed regarding spatial differences, as well as potential temporal changes in variability and seasonal averages during the last 7 decades (1957–2022). The investigation based on important hydro-climatological SWE indicators demonstrates significant decreasing trends for mean SWE (Nov-Apr) and for maximum SWE, as well as a significantly earlier occurrence of the maximum SWE and earlier disappearance of the continuous snow cover. The anomalies of mean SWE revealed that the series of low-snow winters since the 1990s is unprecedented since the beginning of measurements. Increased melting during the accumulation period below 2000 m a.s.l is also observed–especially in the most recent years–as well as slower melt rates in spring, and higher day-to-day variability. For these trends no regional differences were found despite the climatological variability of the investigated stations. This indicates that the results are transferable to other regions of the Alps.

La sociedad Norteamericana de Gastroen terología, Nutrición y Hepatología Pediátrica (NASPGHAN) y la Sociedad Europea de Gastroenterología, Nutrición y Hepatología Pediátrica (ESPGHAN) definen como reflujo gastroesofágico (RGE) al paso del contenido gástrico hacia el esófago, con o sin regurgitación y con o sin vómito; el RGE se convierte en enfermedad por reflujo gastroesofágico (ERGE) cuando el reflujo ocasiona síntomas de alarma y/o complicaciones1.

Abstract Dermatobia hominis is a parasite widely distributed in neotropical regions. The parasitic phase of the cycle is characterized by the formation of a subcutaneous nodule in the host, which can promote infestation by other dipterans and skin infections. The aim of this report is to register parasitism by D. hominis in free-ranging Panthera onca captured in the Brazilian wetland and to determine significant biological and meteorological factors that are likely to influence the presence of larval parasitism in captured wild jaguars. Between 2011 to 2020, 34 jaguars were captured and examined manually by searching for lesions characteristic of myiasis. By manual compression in the subcutaneous nodules, larvae morphologically identified as D. hominis (first and third instars) were collected from 13 jaguars. A multinomial logistic regression showed that adult jaguars had 16.49-fold higher odds of being parasitized than subadults. Thus, jaguars captured in the season of July–September have 34.01- and 11.42-fold higher odds of being parasitized compared to the seasons of October–December and April–June, respectively, which is associated with high total monthly precipitation in the previous season. The present study is the first to describe parasitism by D. hominis larvae in jaguars.

Introduction Health personnel, including physicians, are a fundamental part of the first line of defense against the SARS-CoV-2 pandemic. Objective To characterize the clinical manifestations and course of the first cases of contagion by SARS-CoV-2 in doctors of Peru. Methodology We present a series of six cases of doctors infected by SARS-CoV-2, with confirmed positivity for COVID-19, showing the daily evolution from the diagnosis of the disease, its main signs and symptoms, evolution, and until the outcome in each case. Results Five were men. The median age was 28 years (interquartile range: 27 to 33). In three cases the physician worked more than 12 hours a day in emergency and hospitalization services and not wear a mask at all times. The most frequent symptoms were axillary temperature above 38°C, malaise, dry cough, and odynophagia (the latter in three of the cases). The diagnosis was made at a median of 3 days (interquartile range: 3 to 4 days). The symptoms that persisted the most were dry cough (present during ten days in four doctors). Dysgeusia was the only symptom with the most extended duration (15 days in only one doctor). In the six cases, the course was favorable. However, these doctors found it difficult to return to functions in their hospital centers adequately. Discussion Despite a small number of cases, it is the first report detailing the evolution of symptoms day by day, which can help for occupational health and even for case surveillance and monitoring.

Latar belakang. Di distrik Sumba Barat pada tahun 2004 dilaporkan malaria merupakan penyakit terbanyak. Era transportasi yang tinggi menyebabkan kemungkinan kejadian malaria kongenital di Lembata dan Flores (Maumere) juga tinggi Tujuan. Memberikan gambaran mengenai malaria kongenital di RSUD dr. TC. Hillers, Maumere. Metode: Penelitian deskriptif dilakukan mulai Desember 2012 – Desember 2013. Spesimen darah diambil dari neonatus dan ibunya, dikirim dengan dry ice ke Fakultas Kedokteran Universitas Brawijaya dan dilakukan pemeriksaan hapusan darah dan nested PCR. Hasil. Angka kejadian malaria kongenital di RSUD dr. TC. Hillers Maumere selama 1 tahun penelitian 7,78%. Dari 39 subjek yang terinfeksi malaria kongenital, 74,4% terinfeksi P. vivax. Gejala neonatus yang terinfeksi antara lain, anemia (46,2%), sepsis like (28,2%), prematur (38,5%), ikterus (5,5%), dan asimtomatis (48,7%). Kesimpulan. Angka kejadian malaria kongenital di RSUD dr. TC. Hillers Maumere cukup tinggi dan dapat memberikan manifestasi klinis pada bayi yang dilahirkan.

Ecosystem entropy production is predicted to increase along ecological succession and approach a state of maximum entropy production, but few studies have bridged the gap between theory and data. Here, we explore radiative entropy production in terrestrial ecosystems using measurements from 64 Free/Fair-Use sites in the FLUXNET database, including a successional chronosequence in the Duke Forest in the southeastern United States. Ecosystem radiative entropy production increased then decreased as succession progressed in the Duke Forest ecosystems, and did not exceed 95% of the calculated empirical maximum entropy production in the FLUXNET study sites. Forest vegetation, especially evergreen needleleaf forests characterized by low shortwave albedo and close coupling to the atmosphere, had a significantly higher ratio of radiative entropy production to the empirical maximum entropy production than did croplands and grasslands. Our results demonstrate that ecosystems approach, but do not reach, maximum entropy production and that the relationship between succession and entropy production depends on vegetation characteristics. Future studies should investigate how natural disturbances and anthropogenic management—especially the tendency to shift vegetation to an earlier successional state—alter energy flux and entropy production at the surface-atmosphere interface.

OBJETIVO: Traduzir, adaptar e validar uma versão em português (do Brasil) da Childhood Autism Rating Scale (CARS). MÉTODOS: Após processo de tradução, a versão foi aplicada em 60 pacientes com diagnóstico de autismo infantil, de 3 a 17 anos de idade, selecionados consecutivamente de um ambulatório especializado a fim de analisar as propriedades psicométricas da nova versão (CARS-BR) (consistência interna, validade e confiabilidade). RESULTADOS: A consistência interna foi elevada, com valor de alfa de Cronbach de 0,82; a validade convergente (comparada com a Escala de Avaliação de Traços Autístícos) alcançou um coeficiente de correlação de Pearson de r = 0,89. Ao ser correlacionada à Escala de Avaliação Global de Funcionamento (para determinação da validade discriminante), a CARS-BR apresentou um coeficiente de correlação de Pearson de r = -0,75. A confiabilidade teste-reteste foi 0,90. CONCLUSÃO: A metodologia utilizada e os cuidados no processo de tradução permitem concluir que esse é um instrumento válido e confiável para avaliação da gravidade do autismo no Brasil.OBJECTIVE: To translate the Childhood Autism Rating Scale into Brazilian Portuguese and to determine the initial psychometric properties of the resulting version (CARS-BR). METHODS: The methodology used to produce an adequate version included translation, backtranslation and evaluation of semantic equivalence. In order to determine its psychometric properties (internal consistency, validity and reliability), the CARS-BR was administered to 60 consecutive patients with autism, aged between 3 and 17 years and seen at a university hospital. RESULTS: Internal consistency was high, with a Cronbach's alpha of 0.82. Convergent validity, in comparison with the Autistic Traits Assessment Scale, exhibited a Pearson's correlation coefficient of r = 0.89. When correlated with the Global Assessment of Functioning Scale in order to evaluate discriminant validity, the CARS-BR exhibited a Pearson's coefficient of r = -0.75. Test-retest reliability exhibited a kappa coefficient of 0.90. CONCLUSION: These results suggest that the CARS-BR is a valid and reliable instrument for evaluating autism severity in Brazil.

Summary: The aim of this study is to describe a novel approach to revise maladaptive soft-tissue contour around an ileostomy. A patient with permanent ileostomy suffered from significant defects in soft-tissue contour due to scarring and wound contraction. He underwent autologous fat grafting to achieve sealing of his stoma appliance and improve cosmesis. Due to numerous surgeries, the stoma appliance would not seal and required daily appliance changes. The patient received autologous fat grafting to augment the contour around stoma. A complete fitting of stoma was achieved. The patient is satisfied with stoma sealing and is changing his stoma appliance every 5–7 days without skin excoriation. Autologous fat transfer is an effective approach to treat a subset of stoma patients with complex subcutaneous defects.

To evaluate the effect of two exogenous enzymatic complex (EEC) in diets with soybean meal with different protein solubility on the performance of broilers, 990 Cobb chickens from 8 to 42 days were assigned in a completely randomly design with factorial arrangement 3x2, to diets with soybean meal with 73, 80 and 86% of KOH solubility, and the on top addition (Soy73E, Soy80E and Soy86E) or not (Soy73, Soy80 and Soy86) of a proteolytic (Allzyme VegPro®) and fibrolytic (Allzyme SSF®) EEC. The EEC did not affect (P>0.05) live weight variation (58.9 ± 1.2 g/anim/d), feed conversion (1.95 ± 0.04), viscosity (1.35 ± 0.07 cps) neither intestinal pH (6.5 ± 0.1), increasing the intake on Soy 86 in 3.5 and 2.8% for finishing and total cycle. EEC increased the crypts depth (P=0.052) on 7.1%, and intestinal lesions were lower on Soy73. The EEC addition increased the feed intake when soybean meal had the lower thermal processing, and increased the crypts depth in intestinal villi, without variations in live weight, feed conversion, pH neither intestinal viscosity.

La función esencial del médico de la familia es la prevención de las enfermedades y la promoción de estilos de vida saludables mediante la divulgación de información sobre conductas de riesgo destinadas a transformar las condiciones generales de vida de la población, ampliar conocimientos y mejorar la salud. Objetivos: El presente estudio se propuso elevar el nivel de conocimiento de los familiares de 41 niños asmáticos sobre el asma bronquial, y por esa vía tratar de modificar el estilo de vida de los niños para lograr un mejor control de esta enfermedad.

El artículo analiza cómo la venganza surge como una de las manifestaciones de la persecución en el duelo y se impide o detiene con la liquidación de éste. Lo social participa en este proceso, tanto en la codicia que en ella despierta el objeto de la venganza, como en la posibilidad de operar como soporte indispensable para que quienes están de duelo lo finalicen y pongan límite a la persecución vengativa.

En un recorrido por las novelas más familiares de los colombianos hemos ubicado los tesoros que funcionan como señuelo del objeto y que operan como causa aparente tanto de las aventuras de sus héroes como de la violencia más descarnada en las sociedades y