Management of uncomplicatted accute appendicitis in children

Purpose: To review the existing evidence in 2017-2018 and spreading the information, with solid scientific basis, regarding the use of no operative treatment for children with uncomplicated acute appendicitis. Methods: A literature search for the years 2017/2018 was performed using the following descriptors: uncomplicated acute appendicitis, children, paediatric appendicitis, pediatric appendicitis, management, medical treatment, clinical treatment, antibiotics treatment, no operative treatment and surgical treatment, appendectomy. Randomized controlled trials were considered the best source of information. Results: On the reviewed literature, one can say that the no operative approach for uncomplicated acute appendicitis in children presents similar outcome, hospital length of stay, antibiotic days, reduced degree and duration of pain, and overall perioperative complication rates, but there may be more inpatient readmissions and missing other diseases when compared with surgical treatment. However, this new approach reduces negative appendectomy rate, shorter days of sick leave and care leave, expedited return for the child go back to school and other normal activities, decreased hospital charge and less long term complications. Conclusion: Antibiotics treatment alone appears to be a safe first-line therapy in selected children with uncomplicated acute appendicitis and deserves a randomized controlled trial in tertiary hospitals in Brazil. Those patients who require future appendectomy do not experience significant complications. A multicenter Brazilian trial comparing antibiotics-first to appendectomy, including outpatient management, is feasible to evaluate efficacy and safety of this new approach

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Padrão mioelétrico do cólon esquerdo no reflexo gastrocólico

O objetivo deste estudo foi determinar o padrão eletromiográfico do reflexo gastrocólico no cólon esquerdo (sigmóide), através da avaliação da atividade elétrica de controle (AEC), atividade elétrica de resposta (AER) e complexo motor migrante (CMM). Foram avaliadas 15 pacientes, do sexo feminino, submetidas à histerectomia, sem alteração clínica do trato gastrointestinal. A idade média foi de 40,2 anos. As pacientes foram controles de si próprias, tendo sido comparado o período pré com o per e pósprandial. Eletrodos bipolares cobertos por Téflon foram implantados a nível da tênia anterior do cólon esquerdo. Após a recuperação do íleo paralítico, realizou-se a coleta dos dados. Foi utilizado um sistema de aquisição de dados (DATA Q Série 200), que captou frequência entre 0,02 a 10 Hz e um software de análise de dados, (WINDAQ 200) que funcionou no ambiente Windows. Os resultados obtidos evidenciaram que a AEC e AER de curta duração (n/h) não apresentaram diferença estatística. A AER de longa duração (n/h, apresentou uma diminuição estatisticamente significativa. O CMM apresentou aumento estatístico. A conclusão do estudo foi que houve diminuição da atividade elétrica de resposta colônica de longa duração e um aumento da atividade motora do cólon esquerdc após a alimentação