2012—2022年常州市武进区猩红热流行特征及时间序列分析

目的 了解2012—2022年江苏省常州市武进区猩红热病例的流行病学特征及发病趋势,为做好猩红热防控工作提供依据。方法 以描述流行病学方法分析2012—2022年武进区猩红热流行特征,采用2012—2021年猩红热病例的月报告数构建季节自回归综合移动平均模型(SARIMA模型)并预测2022年的发病数。结果 2012—2022年武进区共报告猩红热病例557例,年均报告发病率为3.55/10万,2014年报告发病率最高达5.07/10万,之后发病率总体呈下降趋势(趋势χ²=14.256,P<0.001)。每年3—6月和11月至次年1月为发病高峰;病例男女性别比为1.64∶1,以4～8岁儿童为主、占病例总数的76.66%。通过检验的最优模型为SARIMA(1,0,0)(1,0,1)12,参数估计有统计学意义,Ljung-Box检验残差为白噪声序列(P=0.799);用该模型预测2022年猩红热月发病数,实际值均在预测值的95%可信区间。结论2014年起武进区猩红热报告发病率总体呈下降趋势,SARIMA模型可短期预测猩红热发病,为疫情防控提供参考;应加强幼儿园和小...     

2009—2013年克拉玛依市手足口病流行状况分析

目的掌握2009—2013年克拉玛依市手足口病流行特征,为防控提供科学依据。方法以描述流行病学方法分析2009—2013年克拉玛依市手足口病疫情。结果 2009—2013年克拉玛依市分别报告手足口病病例243例、319例、226例、437例和188例,发病率分别为81.34/10万、106.71/10万、58.06/10万、111.33/10万和48.09/10万;发病高峰在每年的5—8月,6月达全年最高峰,2013年呈现3个发病高峰;各年龄组发病数男性均高于女性,3岁左右幼托儿童和散居儿童是手足口病最主要的发病群体;不同年份EV71(χ2=36.97)、CA16(χ2=51.85)病原阳性率差异有统计学意义(均P0.01),2011年和2013年,手足口病病原以EV71为主,2010年和2012年以CA16为主。结论 2010年和2012年较其他年份手足口病报告病例数、发病率均有所上升,2010—2013年流行优势毒株发生转变;3岁左右幼托儿童和散居儿童是手足口病防控重点人群,应加强防病宣传。     

2014-2018年甘肃省猩红热流行特征及空间聚集性分析

目的分析2014—2018年甘肃省猩红热流行特征及空间聚集性,探索高发聚集区域,为猩红热防控提供理论依据。方法开展2014—2018年甘肃省猩红热发病情况描述流行病学分析,利用趋势面分析猩红热的空间分布趋势,采用空间扫描分析猩红热的聚集区域。结果2014—2018年甘肃省猩红热发病呈缓慢的上升趋势(趋势χ²=195.285,P=0.000),共报告猩红热病例6624例,年平均报告发病率5.08/10万,97.95%的病例发生在15岁以下儿童及青少年,高峰期集中在5—7月和10月—次年1月;三维趋势分析显示,猩红热报告发病总体分布由北向南显著降低,由西向东显著降低;空间扫描结果显示,猩红热报告发病存在空间聚集性,聚集区域为西部和中部的部分县(区),2016年开始聚集区域由中部地区向西部地区转移。结论2014—2018年甘肃省猩红热报告发病有明显的空间聚集性;应将聚集区作为重点防控地区,有针对性地制定相应的防控措施。     

2010-2019 年吉林省猩红热流行特征分析

目的 分析吉林省猩红热发病趋势和流行特征,为制订有效的防控策略提供科学依据。方法 收集中国疾病预防控制信息系统中2010-2019 年吉林省报告的猩红热病例信息,采用描述性流行病学方法对吉林省猩红热三间分布特征进行分析。结果 2010-2019 年吉林省累计报告猩红热病例26 614 例,年平均发病率为9. 71/ 10 万。一年四季均有病例发生,存在明显的季节性,发病高峰出现在5-6 月和10-12 月。在各个市(州)均有发病,年平均发病率居前3 位的市(州)为延边朝鲜族自治州(23. 12 / 10 万) 、吉林市(16. 68/ 10 万)和松原市(10. 84/ 10 万),不同地区之间发病率差异具有统计学意义(P<0. 05)。男性报告病例数明显高于女性,男女性别比为1. 44 ∶ 1;男性发病率为11. 30/ 10 万,女性发病率为8. 08/ 10 万,两者之间差异有统计学意义(P<0. 05)。发病患者年龄集中在15 岁以下(占97. 87%),以5~6 岁报告发病率最高,报告发病率为230. 01/ 10 万。职业分布主要为学生(占41. 88%)、托幼儿童(占40. 67%)和散居儿童(占15. 96%)。 结论 吉林省猩红热发病呈周期性波动,学生和托幼儿童是发病的高危人群,冬春季是猩红热高发季节,应加强冬春季学校和托幼机构以及高发病地区猩红热疫情防控工作,有效控制猩红热的发生和蔓延。     

1951～2007年新疆猩红热流行特征分析

目的掌握新疆猩红热的流行状况,为制定防制策略和预测疫情趋势提供依据。方法对1951—2007年新疆猩红热的疫情进行描述分析并了解发病水平和流行特征。结果57年问新疆猩红热疫情呈现波动起伏状态,具有一定的周期性,有过2次大的流行;全年均有病例发生;发病集中于学生、幼托儿童和散居儿童;北疆地区发病高于南疆地区;1994年之后全疆发病水平呈现相对较低状态,2002年起猩红热疫情呈上升趋势。结论3～14岁年龄组为新疆猩红热发病的高危人群,应加强全疆中、小学校和托幼机构疫情监测,提高医疗机构的诊疗水平,防止暴发流行。     

2009-2013年四川省大竹县手足口病流行病学特征分析

目的了解四川省大竹县手足口病的流行特征及其变化。方法采用描述流行病学方法对2009-2013年大竹县手足口病疫情监测资料进行分析。结果 2009-2013年大竹县共报告手足口病893例,年均发病率为19.81/10万,死亡1例,不同年份间发病率差异有统计学意义(χ2=845.07,P0.01),以2013年发病率最高。全县50个乡镇均有病例报告,以竹阳镇为主。发病呈双峰型,主要集中在4-7月和10-12月。年龄以5岁以下儿童为主,男性多于女性。患者主要是散居儿童和幼托儿童。病原体以柯萨奇病毒A组16型(Cox A16)和肠道病毒71型(EV71)并存。结论大竹县手足口病的发生存在明显的季节、年龄、性别、地区差异。     

新疆精河县流行性腮腺炎疫情调查

目的分析2010—2014年新疆精河县流行性腮腺炎疫情,了解并掌握其发病水平和流行特征,为制定防控措施提供科学依据。方法运用中国疾病预防控制信息系统统计数据,采用描述流行病学方法分析2010—2014年精河县流行性腮腺炎的流行特征及其时间、性别、年龄、职业和地区的分布情况。结果 2010—2014年精河县共报告流行性腮腺炎病例619例,无死亡病例,年均报告发病率84.65/10万,不同年份发病率差异有统计学意义(χ2=547.45,P0.001);男女发病比1.44∶1,不同性别发病率差异有统计学意义(χ2=14.50,P0.001);5月为发病高峰,占发病总数的18.90%;发病主要年龄组为0~14岁儿童,占发病总数的92.89%;以学生、托幼儿童居多,分别占病例总数的58.97%和25.36%;精河县7个乡(镇)均有病例报告,发病居前三位的地区依次为精河镇、大河沿子镇、茫丁乡,分别占报告病例总数的32.79%、23.91%和19.71%。结论精河县应提高疫苗免疫覆盖率,进一步做好常规疫苗查漏补种及入学查验预防接种证工作;在重要地区针对重点人群加强流行性腮腺炎疫情的监测和预警分析;加大健康教育力度,对学校和托幼机构暴发的疫情及时发现、及早处置。     

2011—2020年泉州市洛江区手足口病流行病学特征分析

目的 分析泉州市洛江区手足口病流行病学特征,为探讨和制定洛江区手足口病防控措施提供科学依据。方法 根据“中国疾病预防控制信息系统”传染病报告数据,收集2011年1月1日—2020年12月31日洛江区手足口病资料,应用描述性统计方法分析病例的时间、地区、人群等流行分布特征。结果 2011—2020年洛江区报告手足口病病例7 319例,重症病例1例,无死亡病例,发病率为25.00/10万~493.27/10万,年均发病率为324.14/10万,发病率呈现逐年降低趋势(χ^(2)_(趋势)=118.98,P<0.05);病例高峰主要出现在春夏季,秋季次之。各街道(乡镇)均有病例报告,其中万安街道(26.55%,1 943/7 319)、马甲镇(25.55%,1 870/7 319)、双阳街道(18.66%,1 366/7 319)病例分布较多,占总病例数的70.76%。男性病例4 721例,女性2 598例,性别比为1.82∶1;发病人群主要为散居儿童(69.95%,5 210/7 319),其次是幼托儿童(27.18%,1 989/7 319);5岁以下年龄组报告病例较多,占总病例数的91.57%。结论 洛江区手足口病疫情具有周期性、季节性变化特征,5岁以下儿童为高发人群,要加强对儿童手足口病防控力度。     

2014—2018年高台县水痘疫情流行特征分析

目的了解甘肃省高台县水痘发病情况和流行特征,为制定科学的防控措施提供依据。方法从中国疾病预防控制信息系统中,按发病日期导出2014—2018年高台县水痘疫情资料,采用描述流行病学方法分析数据。结果2014—2018年高台县水痘共报告发病453例,无死亡病例,年平均报告发病率为57.34/10万,发病率呈逐年上升趋势;9个镇均有发病,发病率城关镇最高(115.63/10万)、占发病总数的33.55%;全年各月均有发病,发病高峰5—6月、9月—次年1月,各月报告发病率差异有统计学意义(χ~2=143.335,P<0.05);发病主要集中在3～15岁(383例、占84.55%),男性发病率高于女性,男女性别比为1.29∶1;以托幼儿童(34.44%)和学生为主要发病人群(48.34%)。结论加强部门协调沟通,重点加强托幼机构和学校水痘疫情监测,提高疫情处置有效性,针对性地开展健康教育,提高水痘疫苗二剂接种率,是高台县减少水痘发病的主要措施。     

2015-2019年绵阳市涪城区手足口病流行特征分析

目的了解2015-2019年绵阳市涪城区手足口病流行及病原特征,为手足口病防治措施提供科学依据。方法采用描述流行病学方法,结合实验室RT-PCR检测结果,对2015-2019年绵阳市涪城区手足口病疫情资料进行统计分析,率的比较采用χ²检验。结果2015-2019年共报告手足口病病例6702例,实验室诊断2706例,无暴发疫情和死亡病例报告,重症14例,报告发病率为242.98/10万,重症率0.21%,不同年度发病差异有统计学意义(χ²=531.46,P<0.001)。时间分布以4-7月为主,发病3119例(46.54%),10-12月次之,发病2120例(31.63%);1~4岁发病5581例(占83.27%),发病率为5670.65/10万,不同年龄组发病率差异有统计学意义(χ²=147426.94,P<0.001);散居儿童发病3994例(59.59%),幼托儿童发病2448例(36.53%)。男性发病3954例(59.00%),发病率为287.09/10万,女性发病2748例(41.00%),发病率为198.99/10万,男性发病率高于女性(χ²=220.80,P<0.001);城区发病4504例,发病率为223.38/10万,乡村发病2198例,发病率为296.26/10万,乡镇发病率高于城区(χ²=110.84,P<0.001)。结论绵阳市涪城区手足口病发病年龄以5岁以下为主,散居儿童发病明显多于托幼儿童,男童发病率高于女童,建议涪城区继续加强手足口病的预防与控制工作,重视手足口病疫苗的接种。     

Effects of inspiratory muscle training in patients with heart failure

Aim

To investigate the effects of inspiratory muscle training (IMT) on functional capacity and balance, respiratory and peripheral muscle strength, pulmonary function, dyspnea, fatigue, depression, and quality of life in heart failure patients.

Methods

A prospective, randomized controlled, double-blinded study. Thirty patients with heart failure (NYHA II-III, LVEF<40%) were included. Sixteen patients received IMT at 40% of maximal inspiratory pressure (MIP), and 14 patients received sham therapy (15% of MIP) for 6 weeks. Functional capacity and balance, respiratory muscle strength, quadriceps femoris muscle strength, pulmonary function, dyspnea, fatigue, quality of life, and depression were evaluated.

Results

Functional capacity and balance, respiratory and peripheral muscle strength, dyspnea, depression were significantly improved in the treatment group compared with controls; quality of life and fatigue were similarly improved within groups (p < 0.05). Functional capacity (418.59 ± 123.32 to 478.56 ± 131.58 m, p < 0.001), respiratory (MIP = 62.00 ± 33.57 to 97.13 ± 32.63 cmH₂O, p < 0.001) and quadriceps femoris muscle strength (240.91 ± 106.08 to 301.82 ± 111.86 N, p < 0.001), FEV₁%, FVC% and PEF%, functional balance (52.73 ± 3.15 to 54.25 ± 2.34, p < 0.001), functional dyspnea (2.27 ± 0.88 to 1.07 ± 0.79, p < 0.001), depression (11.47 ± 7.50 to 3.20 ± 4.09, p < 0.001), quality of life, fatigue (42.73 ± 11.75 to 29.07 ± 13.96, p < 0.001) were significantly improved in the treatment group. Respiratory muscle strength (MIP = 78.64 ± 35.95 to 90.86 ± 30.23 cmH₂O, p = 0.001), FVC%, depression (14.36 ± 9.04 to 9.50 ± 10.42, p = 0.011), quality of life and fatigue (42.86 ± 12.67 to 32.93 ± 15.87, p = 0.008) were significantly improved in the control group.

Conclusion

The IMT improves functional capacity and balance, respiratory and peripheral muscle strength; decreases depression and dyspnea perception in patients with heart failure. IMT should be included effectively in pulmonary rehabilitation programs.     

Cardiac arrhythmias and sudden cardiac death in women

Zusammenfassung. Hintergrund: Geschlechtsspezifische Unterschiede bei Herzrhythmusstörungen sind seit Jahrzehnten bekannt. Einflüsse von Sexualsteroiden auf das autonome Nervensystem und die zelluläre Elektrophysiologie des Erregungsbildungs- und -leitungssystems werden ebenso diskutiert wie direkte genetische Dispositionen auf zellulärer, funktioneller oder metabolischer Ebene. Zudem gilt es, die alters- und geschlechtsspezifischen Unterschiede im Hinblick auf unterschiedliche kardiale Grunderkrankungen zu berücksichtigen, die ihrerseits Häufigkeit, Form und Schwere maßgeblich mitbestimmen. Herzrhythmusstörungen bei Frauen: Eine im Vergleich zu Männern höhere Ruhefrequenz und ein längeres QTc-Intervall, beginnend nach der Pubertät, sind die auffälligsten EKG-Veränderungen bei Frauen und weisen eine enge Beziehung zu konstitutionellen und hormonellen Einflüssen auf. Supraventrikuläre Herzrhythmusstörungen, bei Frauen prädestiniert Sinus- und AV-Knoten-Reentry-Tachykardien, seltener Wolff-Parkinson-White-Tachykardien, können zyklusabhängigen Häufigkeitsschwankungen unterliegen. Vorhofflimmern ist bei Frauen ebenfalls häufiger als bei Männern, meist typischerweise symptomatisch, und die Therapie erweist sich als problematischer. Ventrikuläre Herzrhythmusstörungen, in der gesunden Allgemeinbevölkerung gleich häufig, weisen bei Männern eine enge und prognostisch bedeutsame Beziehung zur KHK auf, während diese bei Frauen weniger ausgeprägt ist und arrhythmogene Kofaktoren eine größere Rolle spielen. Frauen leiden häufiger an erworbenem und kongenitalem Long-QT-Syndrom, in deren Folge häufiger Torsade de pointes-Tachykardien auftreten (u. a. durch ausgeprägtere medikamentös induzierte QT-Verlängerung, häufigere Kurz-Lang-Sequenzen, Unterschiede der Ikr-Sensitivität), die allerdings seltener als bei Männern in Kammerflimmern degenerieren. Frauen sind von einem plötzlichen Herztod etwa dreimal seltener betroffen. Er ereignet sich etwa zehn Jahre später; die zugrunde liegende Ursache ist deutlich heterogener als bei Männern, und die Prognose, ein solches Ereignis zu überleben, ist deutlich schlechter. Frauen sind in Studien zu Primär- und Sekundärprävention deutlich unterrepräsentiert, wenngleich der Nutzen dieser Therapie sogar den bei Männern zu übersteigen scheint. Schlussfolgerungen: Auch wenn die Genese der geschlechtsspezifischen Unterschiede von kardialen Arrhythmien in einer Reihe von Punkten noch offen ist, implizieren die dargestellten Befunde die besondere Notwendigkeit eines entsprechend ausgerichteten Forschungsansatzes, da sich nur so geschlechtsspezifische Risikostratifikations- und Therapieansätze für die Zukunft entwickeln lassen.     

Gut microbiota changes in patients with hypertension: A systematic review and meta-analysis

Hypertension is a major public health issue worldwide. The imbalance of gut microbiota is thought to play an important role in the pathogenesis of hypertension. The authors conducted the systematic review and meta-analysis to clarify the relationship between gut microbiota and hypertension through conducting an electronic search in six databases. Our meta-analysis included 19 studies and the results showed that compared with healthy controls, Shannon significantly decreased in hypertension [SMD = −0.13, 95%CI (−0.22, −0.04), p = .007]; however, Simpson [SMD = −0.01, 95%CI (−0.14, 0.12), p = .87], ACE [SMD = 0.18, 95%CI (−0.06, 0.43), p = .14], and Chao1 [SMD = 0.11, 95%CI (−0.01, 0.23), p = .08] did not differ significantly between hypertension and healthy controls. The F/B ratio significantly increased in hypertension [SMD = 0.84, 95%CI (0.10, 1.58), p = .03]. In addition, Shannon index was negatively correlated with hypertension [r = −0.12, 95%CI (−0.19, −0.05)], but had no significant correlation with SBP [r = 0.10, 95%CI (−0.19, 0.37)] and DBP [r = −0.39, 95%CI (−0.73, 0.12)]. At the phylum level, the relative abundance of Firmicutes [SMD = −0.01, 95%CI (−0.37, 0.34), p = .94], Bacteroidetes [SMD = −0.15, 95%CI (−0.44, 0.14), p = .30], Proteobacteria [SMD = 0.25, 95%CI (−0.01, 0.51), p = .06], and Actinobacteria [SMD = 0.21, 95%CI (−0.11, 0.53), p = .21] did not differ significantly between hypertension and healthy controls. At the genus level, compared with healthy controls, the relative abundance of Faecalibacterium decreased significantly [SMD = −0.16, 95%CI (−0.28, −0.04), p = .01], while the Streptococcus [SMD = 0.20, 95%CI (0.08, 0.32), p = .001] and Enterococcus [SMD = 0.20, 95%CI (0.08, 0.33), p = .002] significantly increased in hypertension. Available evidence suggests that hypertensive patients may have an imbalance of gut microbiota. However, it still needs further validation by large sample size studies of high quality.     

Arterial blood pressure and serum lipids in a population of children and adolescents from Southern Italy: The Calabrian Sierras Community Study (CSCS)

Background

Lipid standards in Italy are lacking in children and adolescents whereas those for blood pressure (BP) were derived from US surveys.

Methods

In a 14-town community in Southern Italy 1657 (64%) of 2594 children aged 6–14 years were enrolled and anthropometric, BP, lipid and glucose serum levels were obtained.

Results

Average systolic BP was 101 ± 11 (60–150) mm Hg and cholesterol (CholT) level was 156 ± 28 (57–264) mg/dl. There were positive (p < 0.00001) age-trends for systolic BP and body mass index (BMI) in both genders whereas age-trends for CholT and heart rate were negative (p < 0.00001). A negative age-trend in both genders was also seen for non-HDL cholesterol (p < 0.03). Based on 95% percentile gender and age distributions, there were 177 (10.68%) hypertensive (HT) and 82 (4.94%) hypercholesterolemic (HC) children or adolescents. Univariately, HT had higher (p < 0.00001) height, weight, BMI, arm circumference, hips, waist, diastolic BP and waist/height, whereas HC had higher LDL-, HDL and non-HDL-cholesterol and triglycerides (p < 0.01). Systolic BP was predicted (r² = 0.2810, p = 0.00001) by age (t = 2.319, p < 0.0205), male gender (t = 3.179, p < 0.0015), glucose (t = 2.357, p < 0.0186), height (t = 2.473, p < 0.0135), arm circumference (t = 3.313, p < 0.0009) and heart rate (t = 4.161, p < 0.00001). CholT was related inversely (r² = 0.1399, p = 0.00001) to height (t = − 3.928, p < 0.0001), weight (t = − 3.922, p < 0.0001) and waist/height (t = − 4.797, p < 0.00001) and directly to BMI (t = 3.064, p < 0.0022), waist (t = 5.149, p < 0.0000), triglycerides (t = 11.332, p < 0.00001) and female gender (t = − 2.041, p < 0.0414).

Conclusion

In these Southern Italian children and adolescents systolic BP and CholT are related with anthropometric and other variables, not confined to height. BP is lower than previously reported.     

Quality of life in young fibromyalgia patients and effect of depression

Aim: The purpose of this study was to compare the depression and quality of life (QOL) scores of fibromyalgia (FM) patients and control subjects. We also aimed to detect relationships between different QOL scales, depression and clinical symptoms. Method: Ninety‐eight fibromyalgia patients and 48 healthy volunteers were included in the study. Depression was evaluated by a psychiatrist according to the Hamilton Depression Rating Scale and Diagnostic and Statistical Manual for Mental Disorders Edition 4 (DSM‐IV) criteria. QOL of the FM patients was assessed according to the Nottingham Health Profile (NHP), Health Assessment Questionnaire (HAQ), and Fibromyalgia Impact Questionnaire (FIQ). Results: We found significantly higher scores of depression, NHP, FIQ and HAQ in FM patients compared with controls (P < 0.000). Pain, tender point count (TPC), pain intensity, skinfold tenderness, FIQ, HAQ, and NHP scores were higher in patients with depression than in those without depression. Depression scores correlated with FIQ (r = 0.39, P < 0.01), HAQ (r = 0.35, P < 0.01), NHP (r = 0.55, P < 0.01) scores, TPC (r = 0.34, P < 0.01) and duration of disease (r = 0.21, P < 0.05). Fibromyalgia Impact Questionnaire scores correlated with HAQ scores (r = 0.45, P < 0.01), NHP scores (r = 0.49, P < 0.01) and TPC (r = 0.21, P < 0.05). HAQ scores correlated with NHP scores (r = 0.40, P < 0.01) and TPC (r = 0.29, P < 0.05). Nottingham Health Profile scores correlated with TPC (r = 0.43, P < 0.01) and duration of disease (r = 0.22, P < 0.05). Conclusion: We found higher scores of TPC, pain intensity, skinfold tenderness, NHP, FIQ, and HAQ in depressive FM patients as compared with non‐depressive FM patients. Our study indicates that there is an important relationship between pain, depression and QOL scales in young FM patients. Therefore; these patients should be managed using a multidisciplinary approach including psychiatric support.     

Diabetes and pregnancy

Summary Pregnancy raises insulin requirement, lowers the renal threshold for glucose, increases the tendency to infection of the urinary tract and to renal insufficiency. Diabetic women are more prone to hydramnios, toxemia, stillbirths and neonatal deaths. Their infants, in contrast to their appearance (macrosomia), are immature and of low vitality. Congenital abnormalities, hyaline membrane disease, cardiac dilatation, hyperbilirubinemia, hypocalcemic tetany make their adaptation to extrauterine life difficult during the first few days. Good cooperation between internist, obstetrician, anesthesiologist and pediatrician considerably improves the prognosis of diabetic pregnancies.

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Zusammenfassung Schwangerschaft erhöht den Insulinbedarf, senkt die Nierenschwelle für Traubenzucker, steigert die Neigung zu Infektionen der Harnwege und zu Niereninsuffizienz. Diabetikerinnen neigen zu Hydramnion, Spättoxikose, Totgeburt und Neugeborenen-Todesfällen. Die Kinder zuckerkranker Mütter sind trotz ihrer Makrosomie unreif und lebensschwach. Missbildungen, hyaline Membranen, Herzerweiterung, Hyperbilirubinämie, hypokalzämische Tetanie erschweren während der ersten Tage die Anpassung an das extrauterine Leben. Gute Zusammenarbeit von Internist, Geburtshelfer, Narkosearzt und Pädiater verbessern die Prognose der Schwangerschaft bei zuckerkranken Frauen in wesentlichem Masse.

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Resumen El embarazo aumenta la necesidad de insulina, disminuye el dintel renal de la glucosa, aumenta la tendencia a las infecciones de las vias urinarias y a la insuficiencia renal. En las mujeres diabéticas son más frecuentes el hidramnios, la toxiemia, la natimortalidad y las muertes neonatales. Los recién nacidos de madre diabética, contrariamente a su aspecto (macrosomia), son inmaturos y escasamente vitales. Su adaptación a la vida extrauterina en los primeros días de vida se hace difícil a causa de anomalías congénitas, membranas hialinas, dilatación cardiaca, hiperbilirrubinemia y tetania hipocalcémica. Una buena collaboración entre internista, obstétrico, anestesista y pediatra mejora considerablemente el pronóstico de los embarazos diabéticos.

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Résumé La grossesse augmente le besoin en insuline, descend le seuil rénal pour glucose et agrandit la tendance à l'infection des voies urinaires et à l'insuffisance rénale. Chez les femmes diabétiques l'hydramnie est fréquente; elles sont disposées à la toxémie, aux mort-nés et à une mortalité exagérée des nouveau-nés. Les nouveau-nés des mères diabétiques sont immatures et de vitalité réduite malgré leur apparence macrosomique. Des malformations congénitales, des membranes hyalines, une dilatation aiguë du coeur, l'hyperbilirubinémie, une tétanie hypocalcémique rendent difficile l'adaptation à la vie extrautérine, surtout pendant les premiers jours. Une étroite coopération entre interniste, accoucheur, narcotiseur et pédiatre améliore considérablement le pronostic de la grossesse des diabétiques.

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Riassunto La gravidanza accresce il fabbisogno insulinico, abbassa la soglia renale per il glucosio, aumenta la disposizione alle infezioni delle vie urinarie e all'insufficienza renale. Nelle donne diabetiche sono più frequenti l'idramnios, la tossiemia, la natimortalità e le morti neonatali. I neonati di madre diabetica, contrariamente al loro aspetto (macrosomia), sono immaturi e scarsamente vitali. Il loro adattamento alla vita extrauterina nei primi giorni di vita è reso difficile da anomalie congenite, membrane ialine, dilatazione cardiaca, iperbilirubinemia e tetania ipocalcemica. Una buona cooperazione tra internista, ostetrico, anestesista e pediatra migliora considerevolmente la prognosi delle gravidanze diabetiche.

     

Predictive Factors of Severe Behçet's disease: A Longitudinal,Prospective Cohort Followed Between 1981–2020

IntroductionBehçet's disease (BD) is a systemic vasculitis of unknown cause. The spectrum of the disease ranges from mucocutaneous manifestations to other organ diseases with relevant morbidity. Associations between disease severity and male sex, earlier age at onset, and the presence of erythema nodosum have been described.ObjectivesTo evaluate clinical factors associated with manifestations of severe disease in a single-center cohort.MethodsA longitudinal, prospective, unicentric cohort study with patients followed in a specialized outpatient clinic between 1981 and 2020. Severe BD was defined as a Krause total clinical severity score >4 points.ResultsWe included 243 patients, of whom 31% were male, with an average follow-up time of 14.6 years. Regarding organ manifestations, all patients had mucous manifestations (N = 243, 100%), 133 (55%) skin, 104 (43%) joint, 71 (29%) ocular, 48 (20%) vascular, 47 (19%) neurological, 22 (9%) gastrointestinal and 1 (0.4%) cardiac involvement by BD. One hundred fifty-six (64%) patients were classified as having severe BD. Severe BD was more frequent in men (OR = 2.004, p = 0.024), increasing with age (OR = 1.021 per year, p = 0.037), in the presence of skin manifestations (OR = 4.711, p < 0.001), specifically erythema nodosum (OR = 8.381, p < 0.001), and pseudofolliculitis (OR = 2.910, p < 0.001).In the multivariate model, variables independently associated with severe BD were male gender (Adjusted OR = 1.961, p = 0.047), erythema nodosum (Adjusted OR = 8.561, p < 0.001) and pseudofolliculitis (Adjusted OR = 2.372, p = 0.007).DiscussionMale gender, erythema nodosum, and pseudofolliculitis were independently associated with severe BD forms and therefore should serve as warning signs to the clinician.     

Doppler parameters of ophthalmic artery in women with preeclampsia: A meta-analysis

Preeclampsia is a progressive and severe cardiovascular disorder in pregnant women. To determine the potential significance of ophthalmic Doppler parameters in preeclamptic women and to provide evidence-based hints for clinical practice and scientific investigation. We searched PubMed, Embase, Web of Science, and the Cochrane Library till July 31, 2022. Pooled standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated using the random effects model. Heterogeneity across included studies was evaluated utilizing the Q test and I² statistic. We identified 8 observational studies that met the inclusion criteria. The pooled SMD for peak systolic velocities (PSV) was .12 (95% CI: −.82, 1.06, p = .8071; I² = 94%, p < .0001). The overall SMD for time-averaged mean peak velocities (MV) was 1.79 (95% CI: .87, 2.71, p = .0001; I² = 60%, p = .1152). Regarding the pulsatility index (PI), the pooled SMD was −2.05 (95% CI: −3.12, −.98, p = .0002; I² = 92%, p < .0001). Overall SMD for end-diastolic velocities (EDV) was 1.11 (95% CI: .23, 1.98, p = .0136; I² = 92%, p < .0001). The pooled SMDs for resistance index (RI) and peak ratio (PR) was −.18 (95% CI: −1.90, 1.53, p = .8333; I² = 96%, p < .0001) and 1.46 (95% CI: −1.30, 4.22, p = .2994; I² = 99%, p < .0001), respectively. Publication bias was not identified. MV, PI, and EDV showed significant differences between patients with preeclampsia and non-hypertensive pregnant participants. Studies on the predictive performance of ophthalmic artery Doppler parameters are warranted.     

Inpatientvs. outpatient bowel preparation for elective colorectal surgery

BACKGROUND: Recent pressures to decrease the cost of medical care have mandated preoperative outpatient bowel preparation (OBP) for elective colorectal surgery without any data documenting equivalent quality of care. This study examined the safety and efficacy of OBP compared with inpatient bowel preparation (IBP). METHODS: Records of all patients who underwent OBP for elective colorectal resection since the inception of the OBP program from July 1993 to June 1994 were compared with records of all patients who received IBP for elective procedures from January to June 1993. RESULTS: The two groups, 90 patients who underwent OBP and 98 patient who had IBP, were well matched for age, sex, diagnosis, and operations performed. The OBP group had a shorter length of hospital stay (median, 7 vs. 9 days; P < 0.0001; chi-squared analysis), whereas the complication rate was similar (19 percent in the OBP group vs. 18 percent in the IBP group), including infectious complications (10 percent in the OBP group vs. 7 percent in the IBP group). Although operating time was similar (mean, 199 vs. 213 minutes) and estimated blood loss (mean, 528 vs. 536 ml), the OBP group had significantly higher perioperative fluid requirements: intraoperative fluids (median, 4300 vs. 3700 ml; P < 0.05; Student's t-test), intraoperative colloid administration (48 vs. 29 percent; P < 0.0002; chi-squared), 24-hour postoperative fluids (3224 vs. 2700 ml; P < 0.0001; Student's t-test), and postoperative fluid challenges (50 vs. 20 percent; P <0.0001; chi-squared analysis). CONCLUSION: Outpatient bowel preparation for elective colorectal surgery is safe and effective. It offers shorter hospital stay, and, therefore, potentially reduces medical care cost. Patients with multiple medical problems may not tolerate extensive fluid shifts; therefore, other preoperative arrangements, such as inpatient or outpatient intravenous fluid therapy, need to be considered to minimize complications that may outweigh potential cost savings.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Montreal, Quebec, Canada, May 7 to 12, 1995.     

Effects of yoga on cardiovascular disease risk factors: A systematic review and meta-analysis

Background

The aim of this review was to systematically assess and meta-analyze the effects of yoga on modifiable biological cardiovascular disease risk factors in the general population and in high-risk disease groups.

Methods

MEDLINE/PubMed, Scopus, the Cochrane Library, and IndMED were screened through August 2013 for randomized controlled trials (RCTs) on yoga for predefined cardiovascular risk factors in healthy participants, non-diabetic participants with high risk for cardiovascular disease, or participants with type 2 diabetes mellitus. Risk of bias was assessed using the Cochrane risk of bias tool.

Results

Forty-four RCTs with a total of 3168 participants were included. Risk of bias was high or unclear for most RCTs. Relative to usual care or no intervention, yoga improved systolic (mean difference (MD) = − 5.85 mm Hg; 95% confidence interval (CI) = − 8.81, − 2.89) and diastolic blood pressure (MD = − 4.12 mm Hg; 95%CI = − 6.55, − 1.69), heart rate (MD = − 6.59 bpm; 95%CI = − 12.89, − 0.28), respiratory rate (MD = − 0.93 breaths/min; 95%CI = − 1.70, − 0.15), waist circumference (MD = − 1.95 cm; 95%CI = − 3.01, − 0.89), waist/hip ratio (MD = − 0.02; 95%CI = − 0.03, − 0.00), total cholesterol (MD = − 13.09 mg/dl; 95%CI = − 19.60, − 6.59), HDL (MD = 2.94 mg/dl; 95%CI = 0.57, 5.31), VLDL (MD = − 5.70 mg/dl; 95%CI = − 7.36, − 4.03), triglycerides (MD = − 20.97 mg/dl; 95%CI = − 28.61, − 13.32), HbA1c (MD = − 0.45%; 95%CI = − 0.87, − 0.02), and insulin resistance (MD = − 0.19; 95%CI = − 0.30, − 0.08). Relative to exercise, yoga improved HDL (MD = 3.70 mg/dl; 95%CI = 1.14, 6.26).

Conclusions

This meta-analysis revealed evidence for clinically important effects of yoga on most biological cardiovascular disease risk factors. Despite methodological drawbacks of the included studies, yoga can be considered as an ancillary intervention for the general population and for patients with increased risk of cardiovascular disease.