Influenza A não H1N1 associada à insuficiência respiratória e à insuficiência renal aguda em paciente com fibrose cística previamente vacinado

In the 2014 - 2015 season, most influenza infections were due to A (H3N2) viruses. More than two-thirds of circulating A (H3N2) viruses are antigenically and genetically different (drifted) from the A (H3N2) vaccine component of 2014 - 2015 northern and southern Hemisphere seasonal influenza vaccines. The purpose of this paper is to report a case of seasonal influenza A non-H1N1 infection that occurred in June 2015 in an adult cystic fibrosis patient with severe lung disease previously vaccinated with the anti-flu trivalent vaccine. The patient evolved to respiratory and renal failure (without rhabdomyolysis) and was placed under mechanical ventilation and hemodialysis. The clinical outcome was positive after 39 days of hospital stay. In addition, the patient was clinically stable after 18 months of follow-up. With the recent advances in critical care medicine and in cystic fibrosis treatment, survival with advanced pulmonary disease in cystic fibrosis presents new questions and potential problems, which are still being formulated.No período sazonal compreendido entre 2014 e 2015, a maior parte das infecções por influenza decorreu do vírus influenza A H3N2. Mais de dois terços dos vírus influenza A H3N2 circulante eram antigênica e geneticamente diferentes (drift) do componente A H3N2 da vacina da influenza sazonal 2014 - 2015 para os hemisférios norte e sul. O objetivo deste trabalho foi relatar um caso de infecção por influenza A sazonal não H1N1 ocorrido em junho de 2015 em um paciente adulto com fibrose cística com doença pulmonar grave, previamente vacinado com a vacina antigripal trivalente. O paciente evoluiu com insuficiências respiratória e renal (sem rabdomiólise), sendo submetido à ventilação mecânica e à hemodiálise. A evolução clínica foi positiva após 39 dias de permanência hospitalar. Ainda, o paciente permaneceu clinicamente estável após seguimento de 18 meses. Com os avanços recentes na medicina intensiva e no tratamento, a sobrevivência com uma doença pulmonar avançada na fibrose cística apresenta novas questões e problemas potenciais, que ainda estão sendo formulados

DSM-5 insomnia disorder in pregnancy: associations with depression, suicidal ideation, and cognitive and somatic arousal, and identifying clinical cutoffs for detection

STUDY OBJECTIVES: The study had three primary goals. First, we estimated survey-assessed DSM-5 insomnia disorder rates in pregnancy, and described associated sociodemographics, and sleep-wake and mental health symptoms. Second, we derived cutoffs for detecting DSM-5 insomnia disorder using common self-report measures of sleep symptoms. Third, we identified clinically relevant cut-points on measures of nocturnal cognitive and somatic arousal. METHODS: Ninety-nine women (85.9% in the 2nd trimester) completed online surveys including DSM-5 insomnia disorder criteria, the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Presleep Arousal Scale’s Cognitive (PSASC) and Somatic (PSASS) factors, and Edinburgh Postnatal Depression Scale. RESULTS: DSM-5 insomnia disorder rate was 19.2%. Insomnia was associated with depression, suicidality, nocturnal cognitive and somatic arousal, and daytime sleepiness. An ISI scoring method that aligns with DSM-5 criteria yielded excellent metrics for detecting insomnia disorder and good sleep. Regarding quantitative cutoffs, ISI ≥ 10 and ISI ≥ 11 (but not ISI ≥ 15) were supported for detecting DSM-5 insomnia, whereas ISI ≤ 7 and ISI ≤ 9 performed well for detecting good sleep. PSQI cutoff of 5 was supported for detecting insomnia and good sleep. The optimal cutoff for nocturnal cognitive arousal was PSASC ≥ 18, whereas the optimal cutoff for somatic arousal was PSASS ≥ 13. CONCLUSIONS: Insomnia disorder affects a large segment of pregnant women. Empirically derived cutoffs for insomnia, good sleep, cognitive arousal, and somatic arousal may inform case identification and future perinatal sleep research methodology

Fabrication of a monolithic lab-on-a-chip platform with integrated hydrogel waveguides for chemical sensing

Hydrogel waveguides have found increased use for variety of applications where biocompatibility and flexibility are important. In this work, we demonstrate the use of polyethylene glycol diacrylate (PEGDA) waveguides to realize a monolithic lab-on-a-chip device. We performed a comprehensive study on the swelling and optical properties for different chain lengths and concentrations in order to realize an integrated biocompatible waveguide in a microfluidic device for chemical sensing. Waveguiding properties of PEGDA hydrogel were used to guide excitation light into a microfluidic channel to measure the fluorescence emission profile of rhodamine 6G as well as collect the fluorescence signal from the same device. Overall, this work shows the potential of hydrogel waveguides to facilitate delivery and collection of optical signals for potential use in wearable and implantable lab-on-a-chip devices

FAKTOR-FAKTOR YANG MEMPENGARUHI TINGGINYA ANGKA SUSPEK TUBERKULOSIS DI PUSKESMAS PERAWATAN RATU AGUNG

Ber ba ga i c ar a tel ah di lak uk an untuk m enangg ul ang i T B, s alah s atun ya de nga n pen er ap an s tr at egi DO T S ( Dir ec tly O bs er v ed T r eatm ent Sh or tc our s e ) hing ga k e pel a ya na n k es ehatan pr im er . Ber das ar k an la por a n tah u nan Pus k esm as Per awa ta n Ratu Ag ung tah un 2 01 0 dik etahu i b ah wa s epanj an g t ahu n a ngk a s us pek T B m as ih ting gi, n am un a ngk a tem uan BT A po s itif s er ta a ngk a T B par u BT A neg atif r el atif r en dah. Pe ne lit ian in i b er tuj ua n unt uk m engur aik an f ak tor - f ak tor yan g d id uga ber hu bun gan d eng an ti n ggi n ya angk a s us pek T B di P us k esm as Per awatan Ra tu A gun g; m ener angk an s ebar an r es ponde n ber d as ar k an k arak ter is tik data dem ogr af is, antr opom etr i, da n k ar ak ter is tik tem pat tingg a l; s er ta m ener angk an hub unga n ant ar a k ar ak ter is tik res ponde n den gan k ec ur igaan a tau k ej adian T B. D es ai n p ene it ian ya ng d i gunak an ada lah c r os s - s ec tiona l. Sam pel t er dir i dar i du a k elom pok , yai tu k elom pok pas ien da n k elom pok tenaga k es ehatan di Pu sk esm as Per a wat an Ratu A gu ng. Da ta dar i k elom pok pas ien dik um pulk an den gan m enggu nak an p eng is ian k ues io ner , daf tar til ik k unj ungan r um ah, da n pe nguk ur an ber at bada n da n tin gg i ba dan. Data dar i k elom pok tena ga k es ehatan dik um pulk an denga n pr os es wa wa nc ar a. Se ban yak 33 r es po nden dar i k elom pok pas ie n ber has il d ik um pulk an, de nga n r es pond en ter ban yak untuk m as ing- m asing var ia be l ber a da pada r en tan g us ia 50 54 tahu n, ti ngk at pen did ik an SMA/s e der aj at, s tatus gi zi c uk up, ber pe ngh as il an c uk up, dan ber tem pat tin gga l di r um ah k ategor i ba ik . Has il uj i k om par atif m enunj uk k an ada n ya h ub unga n k em ak naan ant ar a var iab el us i a d an t in gk at pen di dik an d eng an var i abe l d ia gnos is T B par u. W awanc ar a di l ak uk an ter had ap d ok ter , petu gas Pr ogr am Pen ang gu lan gan T B, d an p etug as lab or ator ium dan di k etahui ba h wa f ak tor yang dapa t m en yeba bk an ting gi n ya angk a s us pek T B par u di P us k esm as Per awatan Ra tu A gun g ada la h k em ungk inan pr os es penj ar i nga n s us pek T B ya n g ter l al u lon ggar ; f ak tor -f ak tor ya ng da pat m en yeba bk an r en dah n ya a ngk a tem uan BT A pos it if adal a h tid ak 100 % - n ya s us pe k yang di per ik s a s putum , penc at atan id ent itas s us pek di la bor at or ium yan g ti dak len gk ap s ehin gga m en yu litk an p el ac ak an pad a s us pek yan g t idak m en ye les a ik an pem er ik s aan S PS, pen ggu naa n ant i biot ik ya ng ti dak tepat s e bel um pem er ik s aan BT A, da n k ooper at iv itas p as ien ya ng m as ih b el um baik ; dan f ak tor - f ak tor yan g dapa t m en yeb abk an r enda hn ya an gk a tem uan k as us T B par u BT A neg atif adal ah t idak s elur uh s us pek dengan BT A nega tif ya ng d ip er ik s a Ron tgen par u, gam bar an T B yang t idak k has , dan ti dak s em ua pas ie n yan g dip er ik s a Rontge n k em bali lag i k e Pus k esm as

Teaching and Learning Under COVID-19 Public Health Edicts: The Role of Household Lockdowns and Prior Technology Usage

Public health edicts necessitated by COVID-19 prompted a rapid pivot to remote online teaching and learning. Two major consequences followed: households became students\u27 main learning space, and technology became the sole medium of instructional delivery. We use the ideas of digital disconnect and digital divide to examine, for students and faculty, their prior experience with, and proficiency in using, learning technology. We also explore, for students, how household lockdowns and digital capacity impacted learning. Our findings are drawn from 3806 students and 283 faculty instructors from nine higher education institutions across Asia, Australia, Europe, and North America. For instructors, we find little evidence of a digital divide but some evidence of a digital disconnect. However, neither made a difference to self-reported success in transitioning courses. Faculty instructors were impacted in a myriad of diverse ways. For students, we show that closure and confinement measures which created difficult living situations were associated with lower levels of confidence in learning. The digital divide that did exist among students was less influential than were household lockdown measures in undermining student learning

The impact of large terrestrial carnivores on Pleistocene ecosystems

Large mammalian terrestrial herbivores, such as elephants, have dramatic effects on the ecosystems they inhabit and at high population densities their environmental impacts can be devastating. Pleistocene terrestrial ecosystems included a much greater diversity of megaherbivores (e.g., mammoths, mastodons, giant ground sloths) and thus a greater potential for widespread habitat degradation if population sizes were not limited. Nevertheless, based on modern observations, it is generally believed that populations of megaherbivores (>800 kg) are largely immune to the effects of predation and this perception has been extended into the Pleistocene. However, as shown here, the species richness of big carnivores was greater in the Pleistocene and many of them were significantly larger than their modern counterparts. Fossil evidence suggests that interspecific competition among carnivores was relatively intense and reveals that some individuals specialized in consuming megaherbivores. To estimate the potential impact of Pleistocene large carnivores, we use both historic and modern data on predator–prey body mass relationships to predict size ranges of their typical and maximum prey when hunting as individuals and in groups. These prey size ranges are then compared with estimates of juvenile and subadult proboscidean body sizes derived from extant elephant growth data. Young proboscideans at their most vulnerable age fall within the predicted prey size ranges of many of the Pleistocene carnivores. Predation on juveniles can have a greater impact on megaherbivores because of their long interbirth intervals, and consequently, we argue that Pleistocene carnivores had the capacity to, and likely did, limit megaherbivore population sizes.National Science Foundation provided funding from EAR 1237928.http://www.pnas.orghb2016Centre for Wildlife Managemen