Return visits to the Paediatric Emergency Department: first analysis in Italy

Return visits to the emergency room have come under scrutiny with a view to identifying the reasons for these events. The aim of the study was to estimate the incidence of return visits to emer- gency room and to compare this with data from other countries, with a view to proposing a method of monitoring this parameter nationwide. Ours is the first Italian study to report the incidence of return visits to the ER and to analyse the factors correlated with this phenomenon. The incidence of return visits within 72 hours of the first visit proved to be 2.5%. Statistical analysis revealed a significant difference in the number of return visits between patients under 1 year of age and those older than 1 year. Our future objective is to re-analyse recent case-records on the basis of the indicators identified, with a view to assessing the quality of the service

Assessment of the Triage System in a Pediatric Emergency Department. A pilot study on critical code

Introduction. In Italy, triage involves assigning a priority color code to patients arriving at the hospital Emergency Department: red (very critical), yellow (moderately critical), green (not very critical), and white (not critical). Methods. This study was aimed at assessing the triage system in the Emergency Department of ?Giannina Gaslini? Children? s Hospital in Genoa, Italy. The authors examined 130 triage forms assigning a yellow code in 2003, in order to determine whether they had been correctly filled in with regard to the detection of vital parameters, identification of main symptoms and color code assignment. Results. Results showed that vital signs were recorded in 94% of patients, main symptoms were identified in 97%, and a yel- low code was assigned according to hospital guidelines in 84%. The percentage of underestimation (3.2%) was higher than that reported in the literature (2%). Conclusions. The study shows the need to improve compliance with the guidelines and to evaluate green and white codes

Active Evasion of CTL Mediated Killing and Low Quality Responding CD8+ T Cells Contribute to Persistence of Brucellosis

Brucellosis is a common zoonotic disease that remains endemic in many parts of the world. Dissecting the host immune response during this disease provides insight as to why brucellosis is often difficult to resolve. We used a Brucella epitope specific in vivo killing assay to investigate the ability of CD8+ T cells to kill targets treated with purified pathogenic protein. Importantly, we found the pathogenic protein TcpB to be a novel effector of adaptive immune evasion by inhibiting CD8+ T cell killing of Brucella epitope specific target cells in mice. Further, BALB/c mice show active Brucella melitensis infection beyond one year, many with previously unreported focal infection of the urogenital area. A fraction of CD8+ T cells show a CD8+ Tmem phenotype of LFA-1hi, CD127hi, KLRG-1lo during the course of chronic brucellosis, while the CD8+ T cell pool as a whole had a very weak polyfunctional cytokine response with diminished co-expression of IFN-γ with TNFα and/or IL-2, a hallmark of exhaustion. When investigating the expression of these 3 cytokines individually, we observed significant IFN-γ expression at 90 and 180 days post-infection. TNFα expression did not significantly exceed or fall below background levels at any time. IL-2 expression did not significantly exceeded background, but, interestingly, did fall significantly below that of uninfected mice at 180 days post-infection. Brucella melitensis evades and blunts adaptive immunity during acute infection and our findings provide potential mechanisms for the deficit observed in responding CD8+ T cells during chronic brucellosis

MOTOR PERFORMANCE AND HEALTH OF THE PARTICIPANTS OF THE PROGRAM SPORT AND LEISURE IN CITY (PSLC)

The Health Sciences College at Trairi (FACISA), Specialized Unit of Rio Grande do Norte Federal University (UFRN), was invited to take part at a health extension action iwith the idealizers of the Sport and Leisure in City Program (PELC in Portuguese), implanted in Santa Cruz/RN by the Federal Institute of Education, Science and Technology of  Rio Grande of Norte State (IFRN). The proposal was to make leisure possible all over the community, creating centers for children, adolescents and adults. The objective was to evaluate the neuromotor performance, the tolerance to the submaximum efforts, anticipatory balance, and anthropometry of PSLC adult participants, in order to stimulate a healthy life style, and to offer a greater knowledge about their health condition. The sample was composed by 18 PELC participants, all of them female, more than 60 years old and favorable cardiologic evaluation for the practice of physical activity. The strength of lower limbs ( seating and to standing test) and flexibility of lower limbs (seating and reaching test) were evaluated; body mass index (BMI) and waist-to-hip ratio (anthropometric measures); evaluation of the tolerance to the submaximum efforts (6 minutes walking test - TC6); antecipatory balance (test of functional reach); and blood pressure (indirect method). It was observed that the women studied in this research presented significant aging characteristics, such as: tolerance to the submaximum efforts lower than expected (n=13); obesity (n=8); elevated deposition of abdominal fat (n=17); hypertension (n=12); moderate risk for falls (n=9). Thre was negative statistical significant correlation between the following variables: age x flexibility (r=-0.59, p=0.01); age x TC6 (r=-0.61, p=0.007); and sistolic blood pressure X anticipatory balance (r=0,47, p=0,05). A significant positive correlation between systolic blood pressure and relation C/Q (r=0.49, p=0.04), and flexibility and TC6 (r=0.51, p=0.03) was found. This extension action allowed greater knowledge about the health of PELC participants

RENDIMIENTO MOTOR Y SALUD DE LOS PARTICIPANTES DEL PROGRAMA DE DEPORTE Y RECREACIÓN EN LA CIUDAD (PELC)

A Faculdade de Ciências da Saúde do Trairi (FACISA), Unidade Acadêmica Especializada da Universidade Federal do Rio Grande do Norte (UFRN), foi convidada para participar de uma ação extensionista em saúde em parceria com os idealizadores do Projeto Esporte e Lazer na Cidade (PELC), implantado em Santa Cruz (RN), pelo Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Norte (IFRN), com a proposta de viabilizar o lazer em toda a comunidade, criando núcleos para crianças, adolescentes e adultos. O objetivo de ação foi avaliar o desempenho neuromotor, a tolerância aos esforços submáximos, equilíbrio antecipatório e antropometria dos participantes adultos do PELC, a fim de estimular a adoção de um estilo de vida saudável e oferecer um maior conhecimento acerca de suas condições de saúde. A amostra foi composta por 18 participantes do PELC, sendo que todos eram do gênero feminino, idade acima de 60 anos e avaliação cardiológica favorável para a prática de atividade física. Foram avaliados força de membros inferiores (teste sentar e levantar) e flexibilidade de membros inferiores (teste de sentar e alcançar); índice de massa corporal (IMC) e relação cintura/quadril (avaliação antropométrica); avaliação da tolerância aos esforços submáximos (teste de caminhada de 6 minutos – TC6); equilíbrio antecipatório (teste de alcance funcional); e pressão arterial sistólica (PAS) e diastólica (esfigmomanometria indireta). Ao final da coleta destes dados, as participantes receberam informações sobre o resultado da avaliação e orientações em saúde. Observou-se que as mulheres estudadas na presente ação de extensão apresentaram várias características marcantes do envelhecimento, tais como: tolerância aos esforços submáximos abaixo do esperado (n=13); obesidade (n=8), elevada deposição de gordura abdominal (n=17); hipertensão arterial (n=12); e risco moderado para quedas (n=9). Houve correlação negativa, estatisticamente significativa, entre as seguintes variáveis: idade x flexibilidade (r=-0.59, p=0.01); idade x teste de caminhada de 6 minutos (r=-0.61, p=0.007); e pressão arterial sistólica e equilíbrio (r=- 0,47, p=0,05). Foi encontrada uma significante correlação positiva entre PAS e relação cintura/quadril (r=0.49, p=0.04); e flexibilidade e TC6 (r=0.51, p=0.03). Esta ação extensionista permitiu o maior conhecimento acerca da saúde das participantes do PELC.The Health Sciences College at Trairi (FACISA), Specialized Unit of Rio Grande do Norte Federal University (UFRN), was invited to take part at a health extension action iwith the idealizers of the Sport and Leisure in City Program (PELC in Portuguese), implanted in Santa Cruz/RN by the Federal Institute of Education, Science and Technology of Rio Grande of Norte State (IFRN). The proposal was to make leisure possible all over the community, creating centers for children, adolescents and adults. The objective was to evaluate the neuromotor performance, the tolerance to the submaximum efforts, anticipatory balance, and anthropometry of PSLC adult participants, in order to stimulate a healthy life style, and to offer a greater knowledge about their health condition. The sample was composed by 18 PELC participants, all of them female, more than 60 years old and favorable cardiologic evaluation for the practice of physical activity. The strength of lower limbs ( seating and to standing test) and flexibility of lower limbs (seating and reaching test) were evaluated; body mass index (BMI) and waist-to-hip ratio (anthropometric measures); evaluation of the tolerance to the submaximum efforts (6 minutes walking test - TC6); antecipatory balance (test of functional reach); and blood pressure (indirect method). It was observed that the women studied in this research presented significant aging characteristics, such as: tolerance to the submaximum efforts lower than expected (n=13); obesity (n=8); elevated deposition of abdominal fat (n=17); hypertension (n=12); moderate risk for falls (n=9). Thre was negative statistical significant correlation between the following variables: age x flexibility (r=-0.59, p=0.01); age x TC6 (r=-0.61, p=0.007); and sistolic blood pressure X anticipatory balance (r=0,47, p=0,05). A significant positive correlation between systolic blood pressure and relation C/Q (r=0.49, p=0.04), and flexibility and TC6 (r=0.51, p=0.03) was found. This extension action allowed greater knowledge about the health of PELC participants.La Facultad de Ciencias de la Salud del Trairi (FACISA), Unidad Especializada de la Universidad Federal de Rio Grande do Norte (UFRN), fue invitada a participar en una acción de extensión de salud de los trabajadores, idealizado por los creadores del Proyecto de Deporte y Lazer de la Ciudad (PELC), que se llevó a cabo poe el Instituto Federal de Educación, Ciencia y Tecnología de Rio Grande do Norte (IFRN) con la propuesta de permitir el ocio en toda la comunidad, la creación de núcleos para los niños, adolescentes y adultos. El objetivo de la acción fue evaluar el desempeño neuromotor, la tolerancia al esfuerzo submáximo, el equilibrio anticipatorio y la antropometría de los participantes adultos del PELC, con el fin de estimular la adopción de un estilo de vida saludable y proporcionar un mayor conocimiento acerca de su salud. La muestra estuvo compuesta por participantes de PELC, todos los cuales eran mujeres, mayores de 60 años y de evaluación cardiaca favorable para la actividad física. Se evaluó la fuerza de las extremidades inferiores (prueba de sentado y de pie) y una menor flexibilidad de las extremidades (sentarse y llegar a la prueba), índice de masa corporal (IMC) y la relación cintura/cadera (medidas antropométricas), la evaluación de la tolerancia al esfuerzo submáximo (prueba de caminata de 6 minutos), el equilibrio de anticipación (prueba de alcance funcional), y la presión arterial sistólica y diastólica (esfigmomanometría indirectos). Al final de esta recogida de datos, los participantes recibieron información de la evaluación y orientación de la salud. Se observó que las mujeres estudiadas en esta acción de extensión tenían varias características sorprendentes del envejecimiento, tales como: la tolerancia a los esfuerzos submáximos menor de lo esperado (n = 13), obesidad (n = 8), la alta acumulación de grasa abdominal (n = 17), hipertensión (n = 12) y un riesgo moderado de caídas (n = 9). Correlación negativa estadísticamente significativa entre las siguientes variables: edad x flexibilidad (r =- 0.59, p = 0,01), edad x prueba de caminada de 6 minutos (r =- 0.61, p = 0,007) y presión arterial sistólica (PAS) X equilibrio de anticipación (r=-0,47, p=0,05). Se observó una correlación positiva significativa entre PAS y relación C/Q (r = 0,49, p = 0,04) y la flexibilidad y la prueba de caminada de 6 minutos (r = 0,51, p = 0,03). Esta acción de extensión permitió el mayor conocimiento de la salud de los participantes del PELC

Avaliação antioxidante e mutagênica do extrato aquoso de cupuaçu em animais expostos a ciclofosfamida

O cupuaçu (Theobroma grandiflorum S.) é um fruto comestível e originário da região Amazônica brasileira, sendo hoje encontrado em várias partes do mundo. A polpa, bem como a semente, apresenta em sua composição compostos que possuem influência sobre fatores biológicos e consequentemente, podem apresentar efeitos preventivos contra algumas doenças. O estudo teve como objetivo avaliar o efeito protetor do cupuaçu como antioxidante nos tecidos (fígado e cérebro) e na medula óssea de camundongos machos Swiss, através da inibição da mutagenicidade induzida pelo agente alquilante ciclofosfamida (CPA). O extrato aquoso in natura do cupuaçu (EAC) foi usado para os testes in vivo de biomarcadores de estresse oxidativo (superóxido dismutase, catalase, glutationa-S-transferase, glutationa reduzida, ácido ascórbico e carbonilação de proteínas) e do micronúcleo  para a avaliação do potencial antimutagênico/mutagênico . Os animais (n= 6 /grupo) foram tratados por 15 dias consecutivos com EAC (via gavagem) e no 15º dia receberam intraperitonealmente NaCl (0,9%) ou CPA (25 mg/Kg), sendo sacrificados 24 horas após o tratamento para avaliação dos parâmetros acima citados e da frequência de eritrócitos policromáticos micronucleados (MNPCE). Os resultados mostraram que o pré-tratamento por 15 dias com o EAC somente aumentou a atividade da superóxido dismutase cerebral e na presença da CPA houve redução desta atividade no fígado. Esta dose de CPA não promoveu alterações per se no status redox, porém o extrato não reduziu a frequência de MNPCE induzida pela CPA, quando comparado com o grupo controle positivo. Ainda, o grupo tratado somente com a polpa não mostrou efeito mutagênico. Diante dos resultados foi possível verificar que o cupuaçu não apresentou atividade antimutagênica/mutagênica e ainda que o processo de congelamento das amostras pode ter interferido nas respostas frente aos parâmetros bioquímicos do status redox avaliados

Near Normalization of Metabolic and Functional Features of the Central Nervous System in Type 1 Diabetic Patients With End-Stage Renal Disease After Kidney-Pancreas Transplantation

OBJECTIVE The pathogenesis of brain disorders in type 1 diabetes (T1D) is multifactorial and involves the adverse effects of chronic hyperglycemia and of recurrent hypoglycemia. Kidney-pancreas (KP), but not kidney alone (KD), transplantation is associated with sustained normoglycemia, improvement in quality of life, and reduction of morbidity/mortality in diabetic patients with end-stage renal disease (ESRD). RESEARCH DESIGN AND METHODS The aim of our study was to evaluate with magnetic resonance imaging and nuclear magnetic resonance spectroscopy (1H MRS) the cerebral morphology and metabolism of 15 ESRD plus T1D patients, 23 patients with ESRD plus T1D after KD (n = 9) and KP (n = 14) transplantation, and 8 age-matched control subjects. RESULTS Magnetic resonance imaging showed a higher prevalence of cerebrovascular disease in ESRD plus T1D patients (53% [95% CI 36–69]) compared with healthy subjects (25% [3–6], P = 0.04). Brain 1H MRS showed lower levels of N-acetyl aspartate (NAA)-to-choline ratio in ESRD plus T1D, KD, and KP patients compared with control subjects (control subjects vs. all, P < 0.05) and of NAA-to-creatine ratio in ESRD plus T1D compared with KP and control subjects (ESRD plus T1D vs. control and KP subjects, P ≤ 0.01). The evaluation of the most common scores of psychological and neuropsychological function showed a generally better intellectual profile in control and KP subjects compared with ESRD plus T1D and KD patients. CONCLUSIONS Diabetes and ESRD are associated with a precocious form of brain impairment, chronic cerebrovascular disease, and cognitive decline. In KP-transplanted patients, most of these features appeared to be near normalized after a 5-year follow-up period of sustained normoglycemia

New Insights into Osteogenic and Chondrogenic Differentiation of Human Bone Marrow Mesenchymal Stem Cells and Their Potential Clinical Applications for Bone Regeneration in Pediatric Orthopaedics

Human mesenchymal stem cells (hMSCs) are pluripotent adult stem cells capable of being differentiated into osteoblasts, adipocytes, and chondrocytes. The osteogenic differentiation of hMSCs is regulated either by systemic hormones or by local growth factors able to induce specific intracellular signal pathways that modify the expression and activity of several transcription factors. Runt-related transcription factor 2 (Runx2) and Wnt signaling-related molecules are the major factors critically involved in the osteogenic differentiation process by hMSCs, and SRY-related high-mobility-group (HMG) box transcription factor 9 (SOX9) is involved in the chondrogenic one. hMSCs have generated a great interest in the field of regenerative medicine, particularly in bone regeneration. In this paper, we focused our attention on the molecular mechanisms involved in osteogenic and chondrogenic differentiation of hMSC, and the potential clinical use of hMSCs in osteoarticular pediatric disease characterized by fracture nonunion and pseudarthrosis