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Respiratory illnesses is the most common manifestation of Coronavirus disease 2019 (COVID-19); however, myocardial injury has recently emerged as a frequent complication.
An observational, longitudinal, prospective, and multicenter study of hospitalized Mexican patients was made. We assessed the prevalence of myocardial injury and its relationship with complications and mortality.
254 COVID-19 patients were included. Their average age was 53.8years old, 167 (65.7%) were male and 87 (34.3%) female. According to troponin levels, two populations were generated, those with and without myocardial injury. There was no difference in gender or age between both groups. However, there was a greater proportion of obesity and hypertension in myocardial injury group. Multivariate logistic regression analysis revealed that obesity (OR 2.029, 95% CI 1.039-3.961; p=0.038), arterial oxygen saturation <90% (OR 2.250, 95% CI 1.216-3.560; p=0.025), and systolic blood pressure <90mmHg (OR 2.636, 95% CI 1.530-4.343; p=0.042), were directly related to higher levels of troponins. Multivariate cox proportional hazards analysis showed that primary endpoint (mortality) was determined by overweight/obesity (OR 1.290, 95% CI 0.115-0.730; p=0.009), ferritin levels (OR 1.001, 95% CI 1.000-1.001; p<0.001), myocardial injury (OR 3.764, 95% CI 1.307-10.838; p=0.014), septic shock (OR 4.104, 95% CI 1.142-14.132; p=0.024), acute respiratory distress syndrome (OR 3.001, 95% CI 1.008-10.165; p=0.040), and treatment with Hydroxychloroquine/Azithromycin (OR 0.357, 95% IC 0.133-0.955; p=0.040). Secondary endpoint (Mechanical ventilation risk) was associated to the same factors.
Myocardial injury represents an increased risk of complications and death in Mexican hospitalized patients with COVID-19.
Myocardial injury represents an increased risk of complications and death in Mexican hospitalized patients with COVID-19.
SARS-CoV-2 infection has caused a global pandemic. Many of the medications identified to treat COVID-19 could be connected with QTc prolongation and its consequences.
Non-ICU hospitalized patients of the three centres involved in the study from the 19th of March to the 1st of May were included in this retrospective multicentre study. Relevant clinical data were digitally collected. The primary outcome was the incidence of QTc prolongation≥500ms, the main secondary outcomes were the Tisdale score ability to predict QTc prolongation and the incidence of ventricular arrhythmias and sudden deaths.
196 patients were analysed. 20 patients (10.2%) reached a QTc≥500ms. Patients with QTc≥500ms were significantly older (66.7±14.65 vs 76.6±8.77years p 0.004), with higher Tisdale score (low 56 (31.8%) vs 0; intermediate 95 (54.0%) vs 14 (70.0%); high 25 (14.2%) vs 6 (30.0%); p 0.007) and with higher prognostic lab values (d-dimer 1819±2815 vs 11486±38554ng/ml p 0.010; BNP 212.5±288.4 vs 951.3±816.7pg/ml p<0.001; procalcitonin 0.27±0.74 vs 1.33±4.04ng/ml p 0.003). After a multivariate analysis the Tisdale score was able to predict a QTc prolongation≥500ms (OR 1,358 95% CI 1,076-1,714p 0,010). 27 patients died because of COVID-19 (13.7%), none experienced ventricular arrhythmias, and 2 (1.02%) patients with concomitant cardiovascular condition died of sudden death.
In our population, a QTc prolongation≥500ms was observed in a minority of patients, no suspected fatal arrhythmias have been observed. Tisdale score can help in predicting QTc prolongation.
In our population, a QTc prolongation ≥ 500 ms was observed in a minority of patients, no suspected fatal arrhythmias have been observed. Tisdale score can help in predicting QTc prolongation.Structural determinants of health like neighborhood are often overlooked in the context of understanding public awareness of health topics and health information seeking behaviors. Seeking health information is particularly relevant given that some communities have higher prevalence of disease than others. Using the Structural Influence Model of Health Communication (SIMHC), this paper examines how both individual and neighborhood level characteristics contribute to health communication outcomes such as being aware of health topics like cancer, obesity, and HIV, and whether or not individual seeking health-related information or coming across information in the course of their general media use. Respondents to the Southeastern Pennsylvania Household Health Survey (SEPa HHS), a county-stratified random sample of adults ages 18-75 years old, who completed the survey in 2015, were recontacted for participation in 2017. Over one-thousand respondents (n=1,005) completed the survey, and the final sample size for this analysis was 887. Individual level correlates included demographic factors and relevant lifestyle behaviors (e.g., smoking); neighborhood level variables- determined by ZIP Code- included such socioeconomic status (SES) measures as percent unemployed, percent with a high school education, and percent living in poverty. Multilevel modeling was used to determine whether there were random effects on the health communication outcomes of interest. Analyses showed our outcomes of interest did not vary across neighborhoods, whether they were treated as random or fixed effects. Different characterizations of neighborhood (e.g., census block group) and different indicators of neighborhood media environments may be more likely to demonstrate macro level effects on health communication outcomes.
Studies relating childhood cognitive development to poor linear growth seldom take adequate account of social conditions related to both, leading to a focus on nutrition interventions. We aimed to assess the roles of both biological and social conditions in determining early childhood cognition, mediated by birthweight and early linear growth.
After exploratory structural equation modelling to identify determining factors, we tested direct and indirect paths to cognitive performance through birthweight and child height-for-age at 2 years, assessed between 4 and 8.5 years of age among 2448 children in four birth cohort studies in low-and-middle-income countries (Brazil, Guatemala, Philippines and South Africa). Determinants were compared across the cohorts.
Three factors yielded excellent fit, comprising birth endowment (primarily maternal age and birth order), household resources (crowding, dependency) and parental capacity (parental education). We estimated their strength together with maternal height rces than by birth weight and early linear growth. Improving children's cognitive functioning requires multi-sectoral interventions to improve parental education and enhance their economic wellbeing, interventions that are known to improve also early childhood growth.
Across four low- and middle-income contexts, cognition in childhood is influenced more by the parental capacity of families and their economic resources than by birth weight and early linear growth. Improving children's cognitive functioning requires multi-sectoral interventions to improve parental education and enhance their economic wellbeing, interventions that are known to improve also early childhood growth.•Superficial myofibroblastoma of the Labia Majora.•Differential diagnosis between vulvar superficial myofibroblastoma and cyst/hydrocele of Nuck duct.•Differential diagnosis between vulvar superficial myofibroblastoma and inguinal/crural hernia.Low-grade endometrial stromal sarcoma (LG-ESS) is a rare uterine tumor that sometimes recurs and advances. Hormonal treatment, especially high-dose progestins and aromatase inhibitors (AIs), has demonstrated efficacy against these tumors. Because the standard treatment period is uncertain and hormonal treatment is effective, hormonal agents are likely to be used long-term, especially when a residual tumor is present. However, the long-term use of high-dose progestins and AIs may cause thromboembolism, as well as musculoskeletal stiffness and pain. Dienogest, a relatively new progestin, has demonstrated safety after long-term administration; it also appears to have a more favorable long-term safety profile compared with other progestins and AIs. We encountered a young patient with recurrent LG-ESS that metastasized to the liver and exhibited resistance to high-dose medroxyprogesterone acetate (MPA). The patient was successfully treated with dienogest monotherapy. This is the first report describing the efficacy of dienogest against recurrent and metastatic LG-ESS that is resistant to MPA and other agents.•MPNST arising from a gynaecological origin is rare.•It poses a diagnostic challenge with symptoms and imaging - histology is essential.•Current mainstay of treatment involves radical surgery with clear margins.•The benefits of chemotherapy and radiotherapy are not well established.Submicron particles (~800 nm) of paclitaxel (SPP) contain 1-2 billion molecules of pure drug that release tumoricidal levels of paclitaxel over many weeks. This study compared two dose-levels of SPP instilled into the peritoneal cavity (IP) in 200 ml of saline post-cytoreductive surgery. Eligible patients with primary (n = 6) or recurrent (n = 4) epithelial ovarian cancer who underwent complete cytoreductive surgery were enrolled to receive a single instillation of IP SPP followed by standard IV carboplatin and paclitaxel. Endpoints were PFS and evaluation of treatment emergent adverse events. Clinical response was determined by symptoms, physical exams, CT scans, and serum CA-125 measurements. Of the 24 subjects screened, 10 were enrolled and received treatment seven patients received 100 mg/m2 and three received 200 mg/m2. Seven subjects completed the 12-month follow-up period. Six patients were evaluable due to one subject who had unevaluable scans throughout the follow-up period and was thus excluded from PFS determination. Upon completion of planned chemotherapy post-SPP instillation, the PFS at 6 months was 66% (4/6) and at 12-months 66% (4/6) using RECIST 1.1. One subject had a complete response at the end of IV treatment but died (unrelated to study treatment) before PFS evaluation. There was one case of incision dehiscence and one case of vaginal cuff leakage after surgery. This pilot study supports further evaluation of IP SPP to treat peritoneal carcinomas.Serous ovarian cancers are typically high grade and recur within a short interval. The currently available therapeutic options provide a relatively low response rate and the progress-free survival are short-lived. There is emerging data that CDK4/6 may be effective in metastatic ovarian cancer. This case describes the use of palbociclib after multiple lines of cytotoxic chemotherapy and hormonal therapy. At 30 months upon commencement of palbociclib and letrozole, this patient continues to respond to the treatment radiologically and in the suppression of CA125.This data article describes raw statistics on occupational health and safety strategies influencing the reduction of coronavirus in South Africa. The purpose of this research was to investigate factors that could potentially influence the reduction of the spread of COVID-19 in a municipality setting. The following independent constructs are explored physical wellness, psychological wellness, Intellectual wellness, intellectual wellness, emotional wellness and social wellness. In addition to the individual dependent variables, the influence of these constructs on the reduction of COVID-19 transmission and employee performance at a selected municipality was tested. click here Hypotheses emerged from the proposed influence of each of these constructs on reduction of COVID-19 transmission at a municipality. Smart PLS was used to measure the impact of the proposed hypotheses of the research. In order to describe data on the respondents' characteristics, SPSS and SMART PLS was used to generate the relevant statistics. The data generated for this research could potentially advise on how healthy and safety strategies could contribute to lowering the transmission of COVID-19 at a municipality.
