[Heart ischemia and psychosomatics: the role of stressful events and lifestyles].

Objective: the aim of our study was to evaluate the role of stressful events, lifestyles and various socio-environmental factors in the beginning of ischemic cardiac diseases, together with cardiovascular factors. Materials and methods: 64 patients with recent cardiac ischemia and 64 controls matched 1:1, according to their sex and age, have been evaluated. The study required the filling in of clinico-anamnestic reports and the evaluation of stressful events, using the Holmes Rahe scale. Results: in the 44% of the patients who had a heart ischemia, an emotional striking event occurred few days before, with a 28% incidence of work and family problems. The mean score of the Holmes Rahe Social Readjustment Rating Scale was statistically significantly higher among cases (p<0,05). The percentage of the subjects who experienced a stressful event during the last year was significantly higher among those with an ischemic event even though the heart disease factors were similar in the 2 groups of cases and controls. Conclusions: although the known heart risk factors predispose to ischemic event, our results suggest that stressful and emotional factors play a fundamental role in increasing the risk

Characteristics of a hepatitis C patient cohort at a specialized tertiary care facility: Identifying criteria to improve the allocation of public health resources

OBJECTIVES: Our objective was to analyze, in a population treated for hepatitis C infection at a tertiary care treatment unit, the prevalence of comorbidities and extrahepatic manifestations, the range and degree of the clinical complexity and the associations between advanced liver disease and clinical variables. METHODS: Medical records from chronically infected hepatitis C patients seen at a dedicated treatment facility for complex cases in the Infectious Diseases Division of Hospital das Clı´nicas in Brazil were analyzed. Clinical complexity was defined as the presence of one or more of the following conditions: advanced liver disease (Metavir score F3 or F4 and/or clinical manifestations or ultrasound/endoscopy findings consistent with cirrhosis) or hepatocellular carcinoma and/or 3 or more extrahepatic manifestations and/or comorbidities concomitantly. RESULTS: Among the 1574 patients analyzed, only 41% met the definition of being clinically complex. Cirrhosis or hepatocarcinoma was identified in 22.2% and 1.8% of patients, respectively. According to multiple logistic regression analysis, male sex (p=0.007), age440 years (po0.001) and the presence of metabolic syndrome (p=0.008) were independently associated with advanced liver disease. CONCLUSION: The majority of patients did not meet the criteria for admittance to this specialized tertiary service, reinforcing the need to reevaluate public health policies. Enhanced utilization of existing basic and intermediate complexity units for the management of less complex hepatitis C cases could improve care and lower costs

Diagnóstico y tratamiento de hemorragia digestiva en síndrome de Bean (Blue Rubber-Bleb Nevus Syndrome)

El síndrome de Bean (Blue Rubber-Bleb Nevus Syndrome BRBNS) es un raro trastorno que se caracteriza por la presencia de malformaciones vasculares cutáneas y viscerales. Si bien el compromiso suele ser multiorgánico, el tracto gastrointestinal es la afectación más frecuente, siendo causa de hemorragia digestiva y anemia crónica. Presentamos una paciente de sexo femenino de 8 años de edad, derivada por lesiones vasculares cutáneas, anemia y hemorragia digestiva. Las lesiones cutáneas fueron compatibles con BRBNS. El compromiso gastrointestinal se confirmó por endoscopia alta y baja, con tratamiento endoscópico posterior. Se efectuaron 2 ligaduras en el estómago, esclerosis en 1 lesión duodenal, y a nivel de colon fueron necesarias 6 ligaduras y 3 resecciones con ansa de polipectomía. Por medio de enteroscopía intraoperatoria (EIO) con asistencia laparoscópica se inspeccionó intestino delgado desde válvula ileocecal hasta ángulo de Treitz, observando 18 lesiones. Fueron resecadas 8 lesiones de aspecto polipoide con ansa de polipectomía y 8 lesiones con compromiso transmural (las de mayor tamaño) recibieron resección quirúrgica con anastomosis parcial. Solo una lesión requirió anastomosis término-terminal. Consideramos que el tratamiento endoscópico y la EIO con asistencia laparoscópica son opciones seguras y eficaces para el control de la hemorragia digestiva en el BRBNS

A concept for integrated care pathways for atopic dermatitis-A GA 2 LEN ADCARE initiative

The integrated care pathways for atopic dermatitis (AD-ICPs) aim to bridge the gap between existing AD treatment evidence-based guidelines and expert opinion based on daily practice by offering a structured multidisciplinary plan for patient management of AD. ICPs have the potential to enhance guideline recommendations by combining interventions and aspects from different guidelines, integrating quality assurance, and describing co-ordination of care. Most importantly, patients can enter the ICPs at any level depending on AD severity, resources available in their country, and economic factors such as differences in insurance reimbursement systems. The GA 2 LEN ADCARE network and partners as well as all stakeholders, abbreviated as the AD-ICPs working group, were involved in the discussion and preparation of the AD ICPs during a series of subgroup workshops and meetings in years 2020 and 2021, after which the document was circulated within all GAL 2 EN ADCARE centres. The AD-ICPs outline the diagnostic procedures, possible co-morbidities, different available treatment options including differential approaches for the pediatric population, and the role of the pharmacists and other stakeholders, as well as remaining unmet needs in the management of AD. The AD-ICPs provide a multidisciplinary plan for improved diagnosis, treatment, and patient feedback in AD management, as well as addressing critical unmet needs, including improved access to care, training specialists, implementation of educational programs, assessment on the impact of climate change, and fostering a personalised treatment approach. By focusing on these key areas, the initiative aims to pave the way for a brighter future in the management of AD