Two-year history of lymphadenopathy and fever caused by Bartonella henselae in a child

We report the case of a 6-year-old boy that presented with enlarged lymph nodes on his neck. He complained of tiredness and discouragement, which worsened during feverish periods. There were no relevant laboratory test abnormalities and serological tests were not reactive. Bartonella henselae DNA was detected by species-specific nested polymerase chain reaction. After treatment, the patient progressed with no fever or lymphadenopathy. Bartonellosis is a group of infectious diseases caused by bacteria of the genus Bartonella. This case report is a useful reminder to clinicians that long-term fever of unknown origin can be related to B. henselae infection, even if the specific serology is not reactive

Práticas Integrativas e Complementares no Plano Municipal de Saúde de Fortaleza

Complementary and integrative health practices (CIPs) integrated are recommended by the World Health Organization (WHO) and are inserted in the Brazilian public health system from the implementation of the National Policy on Integrative and Complementary Practices of the Unified Health System (PNPIC - SUS). In Fortaleza, are present in the Health Municipal Plan and Fortaleza, are present in the Plan. This article aims to research the inconsistencies or deficiencies of the PICS provided for in the Municipal Health Plan of Fortaleza in comparison with the Alma-Ata Declaration of the WHO and Ordinance N. 971 of the Ministry of Health. For this purpose, was utilized a qualitative approach, through documentary research. We conclude that the Municipal Health Plan of Fortaleza is inferior to the guidelines adopted by the PNPIC, in addition to having a poor expansion proposal, demonstrating that it is not a priority for the three-year period under study.As Práticas Integrativas e Complementares em Saúde (PICS) são recomendadas pela Organização Mundial da Saúde e se inserem na rede pública de saúde brasileira a partir da implementação da Política Nacional de Práticas Integrativas e Complementares (PNPIC). Em Fortaleza, estão presentes no Plano Municipal de Saúde (PMS) - 2018/2021. O artigo ora apresentado visa pesquisar as inconsistências ou deficiências das PICS previstas no PMS de Fortaleza em comparação com a Declaração de Alma-Ata da OMS e a Portaria nº 971 do Ministério da Saúde. Para tanto, utilizou-se a abordagem qualitativa, através de pesquisa documental. Concluímos que o PMS está aquém das orientações adotadas pela PNPIC, além de conter uma proposta de ampliação inconsistente, demonstrando não ser prioridade para o triênio em estudo

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

pengambilang keputusan yang efektif

xv, 205 hlm.; 20 x 16 cm

Power creating it using it : cara merebut dan mempertahankan kekuasaan

xviii, 249 hlm ,; 20,5 x 14,5 c

Pengambilan keputusan yang efektif= Effective decision making: Petunjuk praktis dan komprehensif untuk manajemen

Bibliografi hlm. 205-217; Judul asli, Effective decision makingxxiv, 217 hlm.; 21 cm

Pengambilan keputusan yang efektif: petunjuk praktis dan komprehensif untuk manajemen/ Drummond

xxiv, 217 hal.; 21 cm