Clinics
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lIn 2009, the influenza A (H1N1) virus spread rapidly around the world, causing the first pandemic of the 21st Century. In 2010, there was a vaccination campaign against this new virus subtype to reduce the morbidity and mortality of the disease in some countries, including Brazil. Herein, we describe the clinical and epidemiological characteristics of patients under 19 years of age who were hospitalized with confirmed influenza A (H1N1) infection in 2009 and 2010. ⋯ The median length of hospitalization was five days; 27% of the patients required intensive care, and two died. In 2010, two patients were hospitalized with influenza A (H1N1): one infant with adenovirus co-infection who had received one previous H1N1 vaccine dose and presented with respiratory sequelae and a 2-month-old infant who had a hospital-acquired infection. An impressive reduction in hospital admissions was observed in 2010 when the vaccination campaign took place in Brazil.
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Celiac disease is a permanent enteropathy caused by the ingestion of gluten, which leads to an immunemediated inflammation of the small intestine mucosa. The prevalence of celiac disease varies among different nations and ethnic backgrounds, and its diversity is determined by genetic and environmental factors. São Paulo city is one of the largest cities in the world, with a vast population and an important history of internal migratory flow from other Brazilian regions, as well as immigration from other, primarily European, countries, resulting in significant miscegenation. The aim of the present study was to estimate the prevalence of adults with undiagnosed celiac disease among blood donors of São Paulo by collecting information on the ancestry of the population studied. ⋯ The prevalence of celiac disease is at least 1:286 among supposedly healthy blood bank volunteers in São Paulo, Brazil.
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A number of complications exist with invasive mechanical ventilation and with the use of and withdrawal from prolonged ventilator support. The use of protocols that enable the systematic identification of patients eligible for an interruption in mechanical ventilation can significantly reduce the number of complications. This study describes the application of a weaning protocol and its results. ⋯ The use of a specific weaning protocol resulted in a lower mechanical ventilation time and an acceptable reintubation rate. This protocol can be used as a comparative index in hospitals to improve the weaning system, its monitoring and the informative reporting of patient outcomes and may represent a future tool and source of quality markers for patient care.
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Sorafenib is an oral multikinase inhibitor that has been proven effective as a single-agent therapy in hepatocellular carcinoma, and there is a strong rationale for investigating its use in combination with other agents. Vitamin K2 is nearly non-toxic to humans and has been shown to inhibit the growth of hepatocellular carcinoma. In this study, we evaluated the effects of a combination of sorafenib and vitamin K2 on the growth of hepatocellular carcinoma cells. ⋯ Our results determined that combined treatment with sorafenib and vitamin K2 can work synergistically to inhibit the growth of hepatocellular carcinoma cells. This finding raises the possibility that this combined treatment strategy might be promising as a new therapy against hepatocellular carcinoma, especially for patients with poor liver tolerance.
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Randomized Controlled Trial
Hyperventilation accelerates the rise of arterial blood concentrations of desflurane in gynecologic patients.
Under a constant inspired concentration, the uptake of a volatile anesthetic into the arterial blood should mainly be governed by alveolar ventilation, according to the assumption that the patient's cardiac output remains stable during anesthesia. We investigated whether ventilation volume affects the rate of desflurane uptake by examining arterial blood concentrations. ⋯ Hyperventilation accelerated the rate of the rise in Ades following desflurane administration, which was time-dependent with respect to different alveolar ventilations levels.