Síndrome inflamatorio multisistémico de tipo Kawasaki asociado a COVID-19 en un adulto

Recently, few reports have described a serious condition linked to SARS-CoV-2 that mimics Kawasaki disease called Multisystem inflammatory syndrome, especially in children (MIS-C) and young adults. In this work, we report on a severe form of MIS in a young female adult previously infected by SARS-CoV-2. She was treated by plasmapheresis with albumin and steroids, however outcome was fatal. We discuss the pathogenesis of this rare and life threatening entity and suggest some therapeutic regimen. This syndrome should not be misdiagnosed with an infectious or a drug induced cutaneous rash in the current context of COVID-19 pandemic.     

Evaluation of the Chinese Adult Strabismus-20 （CAS-20） questionnaire using Rasch analysis

ObjectiveTo further refine the Chinese Adult Strabismus-20 （CAS-20） health-related quality of life（HRQOL） questionnaire using Rasch analysis. MethodsIn this cross-sectional study, the CAS-20 questionnaire was independently completed by 246 adult strabismus patients. Based on the score for each item, Rasch analysis was performed on the original CAS-20 using the following aspects： dimensionality, response order, local dependence, infit and outfit analysis, differential item function, subject targeting and confirmatory dimensionality. ResultsThe original CAS-20 was divided into 4 subscales, which were labeled ″self-perception″, ″interaction″, ″reading function″, and ″general function″. Response ordering was appropriate for all of the 4 subscales. As a result of infit and outfit analysis, 3 items were removed, one each from ″self-perception″, ″reading function″, and ″general function″. No significant differential item function was found for sex or age. Compared with the ability of the patients and item difficulty, the 3 subscales matched well except for ″reading function″. ConclusionThe original CAS-20 was reduced to 17 items, and divided into 4 subscales, which were ″self-perception″, ″interaction″, ″reading function″, and ″general function″. Subject response choices saved 5 test options. The refined CAS-20 may prove to be more responsive to HRQOL changes in adult strabismus patients.     

Implementing Adolescent Screening,Brief Intervention,and Referral to Treatment (SBIRT) Education in a Pediatric Residency Curriculum

Background: Screening, brief intervention, and referral to treatment (SBIRT) is recommended as part of routine health care for adolescents as well as adults. In an effort to promote universal SBIRT, the Substance Abuse and Mental Health Services Administration awarded funding to residency programs to develop and implement SBIRT education and training. Our project focused on creating scientifically based, developmentally appropriate strategies and teaching materials for the adolescent age range. This paper describes curriculum development and implementation and presents evaluation data. Methods: Pediatric and child psychiatry residents were trained. The training consisted of 4 activities: (1) case-based teaching modules, (2) role-play of motivational interviewing and brief interventions, (3) mock interviews with trained adolescents, and (4) supervised “hands-on” screening and brief interventions. Main outcome measures included trainee satisfaction, and SBIRT knowledge, perceived self-efficacy, and self- and observer report of use of the SBIRT algorithm. Results: Among 150 total participants completing the SBIRT training modules, nearly all (92.3%) were satisfied/very satisfied with the training modules. Knowledge accuracy immediately post training was high, but declined significantly by the end of the first residency year, with little change across subsequent years of residency. Confidence ratings also declined over time. Use of the SBIRT algorithm during the Adolescent Medicine rotation was high according to trainee self- and faculty observer report. Conclusions: We found evidence of training satisfaction, increased confidence in talking to adolescents about substance use, and widespread use of recommended practices immediately following training. Use of a highly structured algorithm to guide practice, and simple, highly structured brief interventions was a successful training approach, as residents self-reported accurate use of the SBIRT algorithm immediately after training. Knowledge and self-confidence declined over time. It is possible that “booster” sessions and ongoing opportunities to review materials could help residents retain knowledge and skills.     

HA-1A in septic patients with ARDS: Results from the pivotal trial

Objective To evaluate the effects of HA-1A, a human monoclonal antiendotoxin antibody, in septic patients with ARDS.Design Substudy of a multicenter, double-blinded, placebo-controlled trial of HA-1A in septic patients.Patients 63 septic patients with ARDS at the time of study entry.Intervention A single intravenous injection of HA-1A (100 mg) or placebo.Results A quantitative radiographic score, the PaO₂/FIO₂ ratio and an index of the severity of ARDS did not show a significant difference between the treatment and placebo groups at 3, 5 and 7 days after treatment. The duration of endotracheal intubation did not differ between the two groups. 15 of 30 HA-1A treated patients (50%) and 23 of 33 placebo-treated patients (69.7%) died within 28 days. The daily mortality was always lower in the HA-1A group, but this difference was not statistically significant at 28 days. The 28-day survival curves for the two treatment groups adjusted by covariate analysis were not significantly different (p=0.07). Using logistic regression, a significant independent effect of HA-1A treatment was detected upon the early survival rate at 7 days (p=0.03) but not at 14 and 28 days.Conclusion A single injection of HA-1A in septic patients with ARDS did not reverse acute respiratory failure or improve long-term survival.This study was supported by a grant from Centocor Inc., Malvern, PA, USA     

Sustained IL-1β expression impairs adult hippocampal neurogenesis independent of IL-1 signaling in nestin+ neural precursor cells

Alterations in adult hippocampal neurogenesis have been observed in numerous neurological diseases that contain a neuroinflammatory component. Interleukin-1β (IL-1β) is a pro-inflammatory cytokine that contributes to neuroinflammation in many CNS disorders. Our previous results reveal a severe reduction in adult hippocampal neurogenesis due to focal and chronic expression of IL-1β in a transgenic mouse model, IL-1β^XAT, that evokes a complex neuroinflammatory response. Other investigators have shown that IL-1β can bind directly to neural precursors to cause cell cycle arrest in vitro. In order to observe if IL-1 signaling is necessary in vivo, we conditionally knocked out MyD88, an adapter protein essential for IL-1 signaling, in nestin⁺ neural precursor cells (NPCs) in the presence of IL-1β-dependent inflammation. Our results show that conditional knockout of MyD88 does not prevent IL-1β-induced reduction in neuroblasts using a genetic fate mapping model. Interestingly, MyD88 deficiency in nestin⁺ NPCs causes an increase in the number of astrocytes in the presence of IL-1β, suggesting that MyD88-dependent signaling is important in limiting astroglial differentiation due to inflammation. MyD88 deficiency does not alter the fate of NPCs in the absence of inflammation. Furthermore, the inflammatory milieu due to IL-1β is not affected by the absence of MyD88 in nestin⁺ NPCs. These results show that sustained IL-1β causes a reduction in adult hippocampal neurogenesis that is independent of MyD88-dependent signaling in nestin⁺ NPCs, suggesting an indirect negative effect of IL-1β on neurogenesis.     

Prospective evaluation of thracic-duct drainage in the treatment of respiratory failure complicating severe acute pancreatitis

Thoracic duct drainage (TDD) may be of value for removing toxic substances released by the inflamed pancreas and which are responsible for lung damage. We have prospectively assessed the efficacy of TDD in improving pulmonary gas exchange in 12 patients with severe acute pancreatitis (SAP) complicated by persistent respiratory failure despite standard conservative treatment including peritoneal dialysis in 8 patients. In group A were 6 patients (mean Ranson score=7.3) with adult respiratory distress syndrome (ARDS) and in group B were 6 hypoxemic patients (mean Ranson score=6.6) judged to be at risk of developing ARDS. The duration of TDD ranged from 3 to 10 days and the total amount of drained lymph (L) varied from 770 to 15 600 ml. Immunoreactive trypsin levels were significantly higher in L when compared to blood in both groups. Leukocyte myeloperoxidases in L (normal value < than 332±82 ng/ml in plasma) were increased in 5 of 5 group A patients (830±317 ng/ml) and in 3 of 6 patients in group B (671±467 ng/ml). After TDD pulmonary gas exchange as measured by median PaO₂/FiO₂ (mmHg) improved from 148±60 to 285±42 in group A and from 192±37 to 330±42 in group B (p<0.05). All patients were weaned after ventilation for a mean of 8 days in group A and 4 days in group B. All patients survived apart from 1 group B patient who died of sepsis on day 34. These data suggest that TDD, by allowing removal of potential mediators of lung injury is of major therapeutic value in ARDS complicating SAP. This approach may also prevent further respiratory impairment in susceptible patients.     

不同经济水平农村居民原发性高血压危险因素分析

目的 了解不同经济水平农村居民高血压危险因素有无不同.方法 采用自编问卷对河北省冀州市不同经济水平的≥35岁的农村居民中的469名新发高血压患者和2799名对照进行了原发性高血压危险因素调查,并进行了多因素Logistic回归分析.结果 经济水平较好组高血压危险因素(以OR值大小为序)依次为家族史、体质量指数、盐腌食品、每天吃鸡蛋、年龄,它们的OR分别为2.863、1.286、1.263、1.200、1.052;经济水平较差组高血压危险因素(以OR值大小为序)依次为家族史、吸烟、每天吃鸡蛋、饮酒、文化程度、性别、喜吃肥肉、体质量指数、年龄,它们的OR分别为3.990、1.767、 1.753、1.728、1.532、1.448、 1.276、 1.205、1.068,每天吃新鲜水果和家庭年人均收入高是高血压的保护因素,它们的OR为0.708和0.788.结论 经济水平不同高血压危险因素不完全相同.     

生命历程中饮酒暴露与农村居民高血压患病关系

目的 探讨生命历程中饮酒暴露与农村居民高血压患病关系,为高血压的预防控制提供依据。方法 采用分层整群抽样方法,于2011年7月对在山东省5个乡镇抽取的7370名 ≥15岁农村居民进行面对面问卷调查,并以生命历程风险暴露测量标尺记录其15岁至当前年龄的饮酒历程。结果 山东省 ≥15岁农村居民高血压总患病率为14.91%,男性高血压患病率(13.62%)低于女性(15.71%)(χ²=5.987,P<0.05),且男、女性居民高血压患病率均随年龄增长呈上升趋势(均P<0.001);山东省 ≥15岁农村居民总饮酒率为19.63%,男性饮酒率(46.83%)高于女性(2.79%)(χ²=2139.17,P<0.001),且男、女性居民饮酒率均随年龄增长呈上升趋势(均P<0.001);饮酒者高血压患病率为17.07%,高于非饮酒者的14.38%(χ²=6.608,P=0.010);起始饮酒年龄越大、平均每日饮酒量越多,高血压患病率越高(均P<0.01);不同饮酒类型、饮酒频率和饮酒年限居民高血压患病率比较,饮酒种类为啤酒者、饮酒频率为1~4次/月者和饮酒年限为5~14年者高血压患病率较低,差异均有统计学意义(均P<0.01)。结论 饮酒居民高血压患病率高于非饮酒居民,起始饮酒年龄、饮酒年限、饮酒频率、饮酒种类和饮酒量均与高血压患病有关。     

Case report: Asymptomatic bronchopulmonary sequestration in an adult with dual celiac and aortic supply

A rare congenital malformation of the respiratory tract, bronchopulmonary sequestration generally presents in childhood and adolescence with recurrent pneumonia or in adulthood as an incidental finding on thoracic imaging. Manifesting as intrapulmonary or extrapulmonary types, bronchopulmonary sequestration characteristically receives blood supply from the systemic rather than pulmonary circulation. We present a 45-year-old male patient who received a provisional diagnosis of bronchopulmonary sequestration following an incidental finding on routine imaging. This case describes the way in which a provisional diagnosis may be made based upon imaging as well as underscoring the importance of alleviating the burden of additional imaging studies.