Transient reactivation of occult hepatitis B virus infection despite lamivudine prophylaxis in a patient treated for non-Hodgkin lymphoma

A female patient with non-Hodgkin lymphoma who tested positive for surface antigen of the hepatitis B virus and negative for hepatitis B core antibody experienced a reactivation of occult HBV infection 20 months after rituximab discontinuation despite lamivudine prophylaxis covering the 4 months of rituximab administration and the subsequent 12 months.     

Patients with New York Heart Association class III heart failure may benefit with high flow nasal cannula supportive therapy : High flow nasal cannula in heart failure

Purpose

High flow nasal cannula (HFNC) may decrease preload being associated with beneficial hemodynamic and respiratory effects in adults with heart failure.

Methods

This is a sequential intervention prospective study including 10 adults with New York Heart Association (NYHA) class III and left ventricle ejection fraction 45% or less. High flow gas was administered (fraction of inspired oxygen, 0.21) through nasal cannula (Optiflow^TM; Fisher & Paykel, Auckland, New Zealand). Sequential echocardiographies were performed at baseline, using HFNC with 20 lpm and 40 lpm and post-HFNC. A reduction greater than 20% in the estimated inspiratory collapse of the inferior vena cava (IVC) from baseline was considered clinically significant.

Results

Ten patients were included, with median age of 57 (44-65) years; 6 (60%) were female, and 8 (80%) had dilated cardiomyopathy. Median IVC inspiratory significantly (P < .05) decreased from baseline (37%) to HFNC with 20 lpm (28%) and HFNC with 40 lpm (21%), representing mean attributable reductions of 20% (95% confidence interval, 6-55) and 53% (95% confidence interval, 36-67) from baseline. Changes in the IVC inspiratory collapse were reversible after HFNC withdrawal. Respiratory rate was significantly reduced from 23 breaths per minute at baseline to 17 breaths per minute at HFNC with 20 lpm and 13 breaths per minute at HFNC with 40 lpm. In contrast, no significant changes in other echocardiographic or clinical variables were documented.

Conclusion

These findings suggest that patients with NYHA class III heart failure may benefit with HFNC supportive therapy.     

Advocacy care on HIV disclosure to children

Children with HIV are dependent on taking continuous medication and care, and family preparation is required when disclosing HIV. This study aimed to unveil families’ experiences with HIV disclosure to children under 13 years old. Eight family members who have disclosed HIV to seropositive children were interviewed in‐depth and individually. The fieldwork took place at a public paediatric outpatient hospital in Rio de Janeiro. The results showed that the family members’ discourse highlighted two ways of knowing their own condition and disclosing the condition of the children with HIV. First, they needed to address the communication of bad news and discover their own HIV status through their children's disease. Second, the disclosure was a process constituted by four stages: preparing for disclosure, identifying the time, deciding how and where to tell, and instilling silence after disclosure. They also recognized that nurses had a role in the process as part of an interprofessional team. Nurses can develop advocacy care and empower family members in the preparation of safe HIV disclosure. By systematizing and institutionalizing the care advocacy process, nurses may enable caretakers and children to participate in their therapeutic management, improving adherence to the treatment and self‐care with autonomy.     

Delay from Diagnosis to Surgery in Transferred Type A Aortic Dissection

Objectives

The purpose of this research is to analyze factors associated with delays to surgical management of Type A acute aortic dissection patients.

Small erosion of adjustable gastric band: endoscopic removal through incision in gastric wall

The erosion of a laparoscopic adjustable gastric band (LAGB) can cause pain that is not controlled by analgesics. In such cases, early endoscopic removal may be indicated, but only when gastric penetration is greater than 50%. We report the case of a patient with severe shoulder pain due to a small area of LAGB erosion, which was treated with early endoscopic removal through an incision in the gastric wall. The pain worsened after eating and gastroscopy revealed slight gastric erosion of the band under the cardia. The gastric wall covering the LAGB was incised using an endoscopic needle knife. In a second upper endoscopy performed 7 days later at the endoscopy suite, endoscopic scissors were used to cut the thread and part of the band lock. The open band was then removed orally. This novel endoscopic incision in the gastric wall hastened band erosion and avoided abdominal reoperation.     

Genetic education,knowledge and experiences between nurses and physicians in primary care in Brazil: A cross‐sectional study

Recent advances in genomics and related technologies have the potential to improve health care throughout the world. In this cross‐sectional study, we examine genetics education, knowledge, and genetics‐related experiences among the nurses and physicians who provide primary care in a Brazilian city. Fifty‐four healthcare professionals from family health units participated in the study (response rate: 90%). Data were collected using a structured 36‐item questionnaire divided into five axes: sociodemographic data and academic background; genetics education; genetics knowledge; genetics‐related experiences in family practice; and knowledge regarding the National Policy for Comprehensive Care in Clinical Genetics in the Unified Health System. Although most participants (85.2%) acknowledged receiving some genetic content during their undergraduate education, the majority (77.8%) advised that they did not feel prepared to deliver genomics‐based health care in primary care. The results suggest that nurses and physicians often lack the knowledge to provide genomics‐based health care in primary care. Therefore, continuing education in genetics/genomics should be provided to primary healthcare professionals in order to enhance family practice and compliance with national policies.     

Microspectroscopy of red blood cells

Spectroscopic techniques have been widely employed to analyze properties of macromolecules and dynamics of intracellular events on bulk preparations of cells. The development of computer controlled microspectrophotometers has made possible the study of the same events in single cells, often providing significant and unexpected results. This paper briefly reviews experimental works carried out in our laboratories on single red blood cells. Microspectrophotometric techniques were applied which make use of the fact that ligand binding to intracellular haemoglobin is associated with optical changes. Information on the relative abundance of different haemoglobin components inside single erythrocytes of trout blood was obtained from spectra of air equilibrated samples, taking advantage of the extreme pH sensitivity of one of the four haemoglobin components. The kinetics of oxygen and carbon monoxide binding to haemoglobin has been followed and demonstrated to correspond to a zero order process, with a rate much slower than that characteristic for haemoglobin in solution. These results demonstrate that the process is diffusion limited; computer simulations suggest that ligand uptake is limited by the time required for the diffusion from the extracellular space of enough ligand molecules for total saturation of intraerythrocytic haemoglobin. Finally, oxygen dissociation curves in single red blood cells can be obtained by means of particular flow cell, with promising results for the study of physiological and pathological processes (namely red cell sickling in drepanocytosis).     

Changes in fatty acid composition in myelin lipids after 2,4-dichlorophenoxyacetic butyl ester treatment

Previous studies have shown that 2,4-Dichlorophenoxyacetic butyl ester (2,4-D b.e.) causes hypomyelination in chicks born from eggs externally treated and alters the myelin chemical composition. In this paper the effect of 2,4-D b.e. on myelin phospholipid and fatty acid composition has been examined. The results of our investigations show significant variations in the phospholipid composition, with the phosphatidyl inositol content increased and sphingomyelin and phosphatidyl ethanolamine contents diminished. The fatty acid pattern of the individual myelin lipids is also significantly altered, with an important reduction of long chain fatty acids and an increase of saturated fatty acids. The observed changes in the chemical composition implicate alterations in the intrinsic properties of this membrane.