Hemorrhagic shock and encephalopathy syndrome – the markers for an early HSES diagnosis

<p>Abstract</p> <p>Background</p> <p>The hemorrhagic shock and encephalopathy syndrome (HSES) is a devastating disease that affects young children. The outcomes of HSES patients are often fatal or manifesting severe neurological sequelae. We reviewed the markers for an early diagnosis of HSES.</p> <p>Methods</p> <p>We examined the clinical, biological and radiological findings of 8 patients (4 months to 9 years old) who met the HSES criteria.</p> <p>Results</p> <p>Although cerebral edema, disseminated intravascular coagulopathy (DIC), and multiple organ failure were seen in all 8 cases during their clinical courses, brain computed tomography (CT) scans showed normal or only slight edema in 5 patients upon admission. All 8 patients had normal platelet counts, and none were in shock. However, they all had severe metabolic acidosis, which persisted even after 3 hours (median base excess (BE), -7.6 mmol/L). And at 6 hours after admission (BE, -5.7 mmol/L) they required mechanical ventilation. Within 12 hours after admission, fluid resuscitation and vasopressor infusion for hypotension was required. Seven of the patients had elevated liver enzymes and creatine kinase (CK) upon admission. Twenty-four hours after admission, all 8 patients needed vasopressor infusion to maintain blood pressure.</p> <p>Conclusion</p> <p>CT scan, platelet count, hemoglobin level and renal function upon admission are not useful for an early diagnosis of HSES. However, the elevated liver enzymes and CK upon admission, hypotension in the early stage after admission with refractory acid-base disturbance to fluid resuscitation and vasopressor infusion are useful markers for an early HSES diagnosis and helpful to indicate starting intensive neurological treatment.</p

Symptomatic asymmetry in the first six months of life: differential diagnosis

Asymmetry in infancy is a clinical condition with a wide variation in appearances (shape, posture, and movement), etiology, localization, and severity. The prevalence of an asymmetric positional preference is 12% of all newborns during the first six months of life. The asymmetry is either idiopathic or symptomatic. Pediatricians and physiotherapists have to distinguish symptomatic asymmetry (SA) from idiopathic asymmetry (IA) when examining young infants with a positional preference to determine the prognosis and the intervention strategy. The majority of cases will be idiopathic, but the initial presentation of a positional preference might be a symptom of a more serious underlying disorder. The purpose of this review is to synthesize the current information on the incidence of SA, as well as the possible causes and the accompanying signs that differentiate SA from IA. This review presents an overview of the nine most prevalent disorders in infants in their first six months of life leading to SA. We have discovered that the literature does not provide a comprehensive analysis of the incidence, characteristics, signs, and symptoms of SA. Knowledge of the presented clues is important in the clinical decision making with regard to young infants with asymmetry. We recommend to design a valid and useful screening instrument

Worldwide trends in population-based survival for children, adolescents, and young adults diagnosed with leukaemia, by subtype, during 2000–14 (CONCORD-3) : analysis of individual data from 258 cancer registries in 61 countries

Background Leukaemias comprise a heterogenous group of haematological malignancies. In CONCORD-3, we analysed data for children (aged 0–14 years) and adults (aged 15–99 years) diagnosed with a haematological malignancy during 2000–14 in 61 countries. Here, we aimed to examine worldwide trends in survival from leukaemia, by age and morphology, in young patients (aged 0–24 years). Methods We analysed data from 258 population-based cancer registries in 61 countries participating in CONCORD-3 that submitted data on patients diagnosed with leukaemia. We grouped patients by age as children (0–14 years), adolescents (15–19 years), and young adults (20–24 years). We categorised leukaemia subtypes according to the International Classification of Childhood Cancer (ICCC-3), updated with International Classification of Diseases for Oncology, third edition (ICD-O-3) codes. We estimated 5-year net survival by age and morphology, with 95% CIs, using the non-parametric Pohar-Perme estimator. To control for background mortality, we used life tables by country or region, single year of age, single calendar year and sex, and, where possible, by race or ethnicity. All-age survival estimates were standardised to the marginal distribution of young people with leukaemia included in the analysis. Findings 164563 young people were included in this analysis: 121328 (73·7%) children, 22963 (14·0%) adolescents, and 20272 (12·3%) young adults. In 2010–14, the most common subtypes were lymphoid leukaemia (28205 [68·2%] patients) and acute myeloid leukaemia (7863 [19·0%] patients). Age-standardised 5-year net survival in children, adolescents, and young adults for all leukaemias combined during 2010–14 varied widely, ranging from 46% in Mexico to more than 85% in Canada, Cyprus, Belgium, Denmark, Finland, and Australia. Individuals with lymphoid leukaemia had better age-standardised survival (from 43% in Ecuador to ≥80% in parts of Europe, North America, Oceania, and Asia) than those with acute myeloid leukaemia (from 32% in Peru to ≥70% in most high-income countries in Europe, North America, and Oceania). Throughout 2000–14, survival from all leukaemias combined remained consistently higher for children than adolescents and young adults, and minimal improvement was seen for adolescents and young adults in most countries. Interpretation This study offers the first worldwide picture of population-based survival from leukaemia in children, adolescents, and young adults. Adolescents and young adults diagnosed with leukaemia continue to have lower survival than children. Trends in survival from leukaemia for adolescents and young adults are important indicators of the quality of cancer management in this age group.peer-reviewe

Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000–2014 (CONCORD-3)

Background: Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology. Methods: We analyzed individual data for adults (15–99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000–2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator. Results: The study included 556,237 adults. In 2010–2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%–38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000–2004 and 2005–2009. These improvements were more noticeable among adults diagnosed aged 40–70 years than among younger adults. Conclusions: To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines

El discurso social sobre la desigualdad social y la educación pública en Costa Rica 2006-2020

En el marc dels canvis històrics esdevinguts a Costa Rica, he pres la perspectiva d’estudi sobre la desigualtat social i la desigualtat educativa com a part de les principals amenaces a la cohesió social i al respecte social. Per mitjà d’un estudi discursiu, específicament sota la categoria de discurs social, he abordat la reconstrucció de la desigualtat social i també la desigualtat educativa costa-riquenya a partir de l’any 2006 i fins al 2020, moment de finalització de la investigació. La pregunta que articula la tesi és: ¿com s’ha construït el discurs social a Costa Rica sobre la desigualtat social i l’educació pública des de les narratives de l’elit de govern, l’oposició parlamentària, i els sindicats, sota els períodes de govern de el Partit Liberación Nacional (PLN: 2006-2014) i el Partit Acción Ciudadana (PAC: 2014-2022)? He estudiat el govern, l’oposició i els sindicats com a grups narratius, els quals tenen especificitats en la forma de valorar i produir una lectura del que passa al país, sobretot, pel que fa a la desigualtat social i l’educació pública. He fet una anàlisi qualitativa de cadascun tot creant categories que capten els principals punts d’acord sobre la desigualtat social ieducativa durant quatre períodes de govern que han dirigit el país en aquest interval de temps. Les categories centrals de l’anàlisi han estat la redistribució i el reconeixement (Fraser, 2006). Per a cada període he pres una política econòmica i una política educativa com a principal eix de reconstrucció i anàlisi. Alhora, he analitzat de quina manera cada grup narragiu elabora una narració, planteja arguments i defensa els seus interessos. He arribat a les següents conclusions sobre el discurs social amb què les elits del país han interpretat la desigualtat social a Costa Rica. En primer lloc, l’elit de govern ha variat la seva narració des d’una “elit visionària” cap a una lògica de “elit inclusiva”, tot seguint la via ded progressisme multicultural que es troba més a prop del liberalisme i del neoliberalisme. En segon lloc, aquesta variació ha provocat problemes de desplaçament (Fraser, 2006), perquè ha situat la injustícia i la desigualtat en el pla merament identitari, i ha deixat de banda l’estructura socioeconòmica que remarquen les reflexions crítiques sobre el capitalisme. En tercer lloc, des de 2006 l’oposició parlamentària s’ha anat fragmentant fins a deixar veure una nova faceta molt més conservadora / religiosa que ha creat un front contrari a aquest progressisme. Això ha impregnat el discurs social de reïficació (Fraser, 2006) en la mesura que s’han estès discursos amb lògiques cap a dins que no connecten amb altres grups. En quart lloc, el grup narratiu sindical també ha desembocat en la reïficació. Malgrat la seva força històrica, ara es pateix una forta deslegitimació, acompanyada de saturació i demandes professionals (sobretot les i els treballadors de sector docència, principalment a primària i secundària), la qual cosa els exposa a una greu culpabilització social i victimització a causa de la mateixa desigualtat social.En el marco de los cambios históricos que se vienen dando en Costa Rica, se ha tomado la perspectiva de estudio sobre la desigualdad social y la desigualdad educativa como parte de las principales amenazas a la cohesión social y respeto social. Por medio de un estudio discursivo, específicamente bajo la categoría de discurso social se aborda la reconstrucción de la desigualdad social y también la desigualdad educativa costarricense a partir del año 2006 y hasta el 2020 momento de finalización de la investigación. La pregunta que articula la tesis es: ¿Cómo se ha construido el discurso social en Costa Rica sobre la desigualdad social y la educación pública costarricense desde las narrativas de la élite de gobierno, la oposición parlamentaria, y los sindicatos, bajo los períodos de gobierno del Partido Liberación Nacional (PLN: 2006-2014) y el Partido Acción Ciudadana (PAC: 2014-2022)? A partir de dicha categoría -discurso social- se establecen lo que se denominan grupos narrativos, como grupos que tienen especificidades en su forma de valorar y producir su propia lectura de lo que acontece en el país según su conexión con la desigualdad social y la situación con la educación pública. Los tres grupos narrativos seleccionados son la élite de gobierno, la oposición parlamentaria y los sindicatos. Cada grupo narrativo es estudiado por medio de la metodología cualitativa, en donde se han creado categorías para poder captar lo que se articula de acuerdo a la desigualdad social y desigualdad educativa, por cada período de gobierno, que son cuatro. Las categorías centrales de esta fase son: Redistribución y Reconocimiento (Fraser, 2006). Para cada período se tomó dos políticas de gobierno central (una para política económica y otra para política educativa), que orientara la discusión y tener un eje del cual partir en el proceso de reconstrucción y análisis. Y a su vez, paralelamente otro grupo categorial relacionado con el discurso social, que son narración, argumento e intereses. Entre las más destacadas conclusiones está que el discurso social de la desigualdad social de Costa Rica según la élite de gobierno está variando su narración desde una &#8220;élite visionaria&#8221; hacia una lógica de &#8220;élite inclusiva&#8221;, eso en primer lugar; tomando un sendero de progresismo multicultural que se encuentra más cerca con el liberalismo y también con el neoliberalismo. En segundo lugar, que parece que está decantando en problemas de desplazamiento (Fraser, 2006), esto es, ubicar el problema de la injusticia y la desigualdad en el plano meramente identitario, y no abordando el problema de la estructura socio-económica propias de las reflexiones críticas sobre el capitalismo. Tercero, la oposición parlamentaria en los casi 15 años de estudio, desde 2006, ha ido fragmentándose hasta dejar ver una nueva faceta mucho más conservadora/religiosa que ha creado un frente contrario a dicho progresismo, que ha generado problemas de reificación (Fraser, 2006). Es decir, lógicas hacia dentro que no conectan con otros grupos. Y, cuarto, también con un grupo sindical -los trabajadores públicos principalmente- que, pese a su fuerza histórica, ahora se ven asediados por problemas de deslegitimación, saturación y demandas profesionales (sobre todo las y los trabajadores del sector docencia, principalmente en primaria y secundaria). Y, también, culpabilización social de los trabajadores y victimización debido a la misma desigualdad social.Historical changes that are taking place in Costa Rica. From a perspective on social inequality and educational inequality this study takes the stand point of threats to social cohesion and social respect. Using discursive studies, specifically under the category of social discourse, the reconstruction of social inequality and also Costa Rican educational inequality is addressed from 2006 to 2020, when the research ends. The question that articulates the thesis is: How has the social discourse in Costa Rica on social inequality and public education been constructed from the narratives of the governing elite, the parliamentary opposition, and the unions, under the periods of government of the Liberación Nacional party (PLN: 2006-2014) y Acción Ciudadana party (PAC: 2014-2022)? From this category -social discourse- narrative groups are established. Groups that have specificities in their way of evaluating and producing their own perspective of what happens in the country according to their connection with social inequality and the situation with public education. The three selected narrative groups are: the government elite, the parliamentary opposition, and the unions. Each narrative group is studied over time, through a qualitative methodology, where categories have been created to capture what is articulated according to social inequality and educational inequality (for each period of government, which are four). The central categories of this phase are: Redistribution and Recognition (Fraser, 2006). For each period, two central government policies were adopted (one for economic policy and other for educational policy), which would guide the discussion and have an axis from which generate the reconstruction and analysis process. And, parallel to that, another categorial scheme related to social discourse, which are: narration, arguments and interests. Among the most outstanding conclusions is that, in the first place, the social discourse of social inequality in Costa Rica is that according with government elite, the narrative is changing from a "visionary elite" to a logic of "inclusive elite". Taking a path of multicultural progressivism which is closer to liberalism and also to liberalism. Second, it seems that it is decanting in displacement problems (Fraser, 2006), this is: to locate the problem of injustice and inequality on the purely identity plane, and not addressing the problem of the socio-economic structure typical of critical reflections on the capitalism. Third, the parliamentary opposition in the almost 15 years of study -since 2006-, has been fragmenting until it shows a new, much more conservative/religious facet that has created a front contrary to progressivism, which has generated reification problems (Fraser, 2006) that is, inward logic that does not connect with other groups. And lastly, also with a union group -mainly public workers- that, despite their historical strength, are now besieged by problems of delegitimization, saturation and professional demands (especially teaching workers, mainly in primary and secondary). And, also social blaming of workers and victimization due to the same social inequality.Universitat Autònoma de Barcelona. Programa de Doctorat en Sociologi

Análisis mediático de la conflictividad social y comunicación política en Costa Rica. El papel de los medios de comunicación: La Nación, La Extra y el Semanario Universidad Respecto al primer año de gobierno del Partido Acción Ciudadana (PAC).

En el presente avance de investigación se recoge una serie de análisis iniciales sobre un primer acercamiento cuantitativo del abordaje mediático de tres conflictos durante el primer gobierno del Partido Acción Ciudadana (PAC), en la figura del presidente Luis Guillermo Solís Rivera. Se analiza la presentación de tres medios de comunicación escritos, con características diferentes para plantear comparaciones y algunas conclusiones con posible carácter de generalización que evidencien la óptica de dichos medios, sus prioridades e intencionalidades siempre tomando en cuenta la coyuntura del primer gobierno de un partido hasta hace poco tiempo emergente y con un discurso importante que intentó ofrecer un factor diferenciador claro frente a lo que llamaron la “política tradicional”.