Evaluation of right ventricular function performed by 3d-echocardiography in scleroderma patients

The impairment of the right ventricle (RV) in systemic sclerosis (SSc) is usually related to pulmonary arterial hypertension (PAH). New echocardiographic techniques, such as 3-dimensional echocardiography (3DE) and 2-dimensional speckle tracking (2DSTE), allow an accurate evaluation of the RV function. The aim of this study was to evaluate the RV function using 3DE and 2DSTE in SSc patients with no history of heart disease and no PAH. Forty-five SSc patients, 42 females and 3 males, 28 with limited cutaneous SSc (lcSSc) and 17 with diffuse cutaneous SSc (dcSSc), were studied. Forty-three age- and gender-matched healthy subjects were enrolled as controls. All of them underwent a 3DE and 2DSTE ecocardiographic evaluation of the RV function. Systolic pulmonary arterial pressure (sPAP) and total pulmonary vascular resistance (tPVR) were also estimated by power doppler. RV echocardiographic parameters were compared in the different subsets of SSc patients. A statistical analysis was performed by t-test, ANOVA and multiple logistic regression. RV areas in 2DSTE and volumes in 3DE were higher and RV function parameters were reduced in SSc patients compared with controls. Also sPAP and tVPR were higher, but they did not reach pathological values. Echocardiographic alterations were more pronounced in patients with lcSSc. 3DE and 2DSTE echocardiography allowed us to detect morphological and functional alterations of the RV in a group of SSc patients with no clinical signs of heart disease and no PAH. These patients had significantly higher sPAP and tPVR than healthy controls without reporting values compatible with PAH. These data suggest that RV alterations are related to a pressure overload rather than to an intrinsic myocardial involvement in SSc

Estrategias de afrontamiento frente a la violencia y acoso laboral en Enfermería que implementa el nivel jerárquico : Estudio cuantitativo, descriptivo, transversal a realizarse en el Hospital Córdoba en el período Octubre - Diciembre del año 2020

En los últimos años se ha pretendido lograr un consenso mundial sobre la importancia de la defensa de los derechos humanos, por este motivo muchas conductas que antes eran consideradas aceptables o inevitables ya no lo son; en este marco, se utiliza el término violencia para representar cualquier acción o amenaza intencional que realice una persona hacia otra o hacia sí misma que atente contra la integridad física o psicológica. La violencia laboral oculta, silenciada y silenciosa, muchas veces invisibilizada y naturalizada, deja vulnerables a quienes son víctimas. Provoca un daño directo a la integridad de las personas, afectando su salud física y mental, su vida laboral y social. De ahí la importancia de desarrollar políticas de intervención para su abordaje integral. Dentro de los sectores afectados, el personal que trabaja en instituciones de salud es uno de los más vulnerables. Siendo una paradoja que estas instituciones fueron creadas, entre otros, con el objeto de “cuidar la salud” de los individuos y las poblaciones, lo que hace más inaceptable aún, que la violencia atente contra la salud de las personas que trabajan en ellas. En la práctica diaria es muy frecuente observar comportamientos ofensivos, abusivos, intimidantes o insultantes, abusos de poder, sanciones injustas, actitudes que provocan malentendidos y luchas internas perjudicando en gran manera el desempeño laboral de los agentes, la comunicación entre pares e interdisciplinaria. Si bien esta situación es observable en todos los estamentos de la institución es particularmente preocupante en el nivel del personal de enfermería, dado que son las más vulnerables de sufrirlas. En este contexto el presente trabajo busca conocer las estrategias de afrontamiento frente a la violencia y acoso laboral en enfermería que implementa el nivel jerárquico del Hospital Córdoba de esta ciudad, indagando si existen en la institución protocolos de actuación como estrategias de prevención, mediante acciones de difusión, capacitación, identificación de situaciones de violencia; y estrategias de intervención a través de entrevistas personales, asistencia y acompañamiento a la víctima, abordaje interdisciplinario y registros estadísticos. Este proyecto pretende, con los resultados obtenidos, promover la participación comprometida de los actores para su reflexión y, a partir de allí, optimizar y maximizar intervenciones y políticas que permitan el mejor abordaje de la problemática desde la institución. El trabajo está organizado en dos capítulos: Capítulo I: El problema de investigación, contiene el planteo y definición del problema, justificación del estudio y marco teórico; que incluye la definición conceptual de la variable, el objetivo general y específicos. Capítulo II: Diseño metodológico, abordará un estudio de tipo cuantitativo, descriptivo, de corte transversal, que indagará sobre la variable Estrategias de Afrontamiento Frente a la Violencia y Acoso Laboral en Enfermería que Implementa el Nivel Jerárquico del Hospital Córdoba y sus dimensiones, que incluyen Estrategias de Prevención y Estrategias de Intervención. Los datos serán recolectados a través de un cuestionario autoadministrado, con preguntas semiestructuradas y abiertas a una población que comprende 24 Licenciados en Enfermería del nivel jerárquico del Hospital Córdoba. Para el análisis se utilizará la estadística descriptiva y los resultados serán organizados y presentados en tablas y gráficos. A su vez incluirá cronograma de actividades, presupuesto y referencia bibliográfica según normas APA; un apartado para Anexo con notas de autorización destinadas a las autoridades, consentimiento informado, instrumento de recolección de datos y tabla matriz por cada variable.Fil: Funes, María Mercedes. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Escuela de Enfermería; Argentina.Fil: Polito, Pamela Lujan del Valle. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Escuela de Enfermería; Argentina

An Open clinical trial assessing a novel training program for social cognitive impairment in schizophrenia

Objective: Social cognition is profoundly impaired in patients with schizophrenia. This study describes 'Mental-State Reasoning Training for Social Cognitive Impairment' (SoCog-MSRT), a 5-week program developed to improve social cognition in patients with schizophrenia. We aimed to investigate the feasibility of implementing SoCog-MSRT in a rehabilitation setting and to evaluate whether our training methods produced improvements. Method: The feasibility and benefits of SoCog-MSRT were evaluated in an open clinical trial with 14 participants with schizophrenia or schizoaffective disorder. Training comprised 10 twice-weekly sessions, for 5 weeks, with a pre- and post-training assessment. Results: There were significant improvements on: (a) a classic false-belief test of Theory of Mind (ToM); (b) inferring complex mental states from the eyes; and (c) a self-reported measure of social understanding. Some of these improvements were associated with baseline levels of working memory and premorbid Intelligence Quotient (IQ). Conclusions: SoCog-MSRT can improve ToM abilities and social understanding, but individuals with poorer working memory and lower premorbid IQ may be less able to benefit from this type of training.5 page(s

Rituximab-associated hypogammaglobulinaemia in ANCA-associated vasculitis and connective tissue diseases: a longitudinal observational study

The burden of hypogammaglobulinaemia following rituximab (RTX) treatment in rheumatic diseases has not been fully elucidated yet. Our aim was to evaluate the frequency and predictors of hypogammaglobulinaemia in patients affected by ANCA-associated vasculitis (AAV) and connective tissue diseases (CTD)

A quasi-randomized feasibility pilot study of specific treatments to improve emotion recognition and mental-state reasoning impairments in schizophrenia

Abstract Background Impaired ability to make inferences about what another person might think or feel (i.e., social cognition impairment) is recognised as a core feature of schizophrenia and a key determinant of the poor social functioning that characterizes this illness. The development of treatments to target social cognitive impairments as a causal factor of impaired functioning in schizophrenia is of high priority. In this study, we investigated the acceptability, feasibility, and limited efficacy of 2 programs targeted at specific domains of social cognition in schizophrenia: “SoCog” Mental-State Reasoning Training (SoCog-MSRT) and “SoCog” Emotion Recognition Training (SoCog-ERT). Method Thirty-one participants with schizophrenia or schizoaffective disorder were allocated to either SoCog-MSRT (n = 19) or SoCog-ERT (n = 12). Treatment comprised 12 twice-weekly sessions for 6 weeks. Participants underwent assessments of social cognition, neurocognition and symptoms at baseline, post-training and 3-months after completing training. Results Attendance at training sessions was high with an average of 89.29 % attendance in the SoCog-MSRT groups and 85.42 % in the SoCog-ERT groups. Participants also reported the 2 programs as enjoyable and beneficial. Both SoCog-MSRT and SoCog-ERT groups showed increased scores on a false belief reasoning task and the Reading the Mind in the Eyes test. The SoCog-MSRT group also showed reduced personalising attributional biases in a small number of participants, while the SoCog-ERT group showed improved emotion recognition. Conclusions The results are promising and support the feasibility and acceptability of the 2 SoCog programs as well as limited efficacy to improve social cognitive abilities in schizophrenia. There is also some evidence that skills for the recognition of basic facial expressions need specific training. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613000978763 . Retrospectively registered 3/09/2013

How I treat patients with systemic sclerosis in clinical practice

Systemic sclerosis (SSc) or scleroderma is a disorder of the connective tissue affecting the skin, and it is often associated with visceral involvement. The predominant pathological features of SSc are autoimmunity, vasculopathy, and fibrosis. Progressive fibrosis is associated with changes in the microcirculation of the involved organs. Here, we review the clinical features of systemic sclerosis and describe the best practice approaches for its management, reviewing available guidelines and recommendations and providing experts' insights

The Development of the Mental-State Reasoning Training (MSR) program : phase I and II

Social cognition, the cognitive operation that underlies social interactions and the understanding of the intention of others, is profoundly impaired in schizophrenia. Thus, improving social disability in schizophrenia is now a high priority in schizophrenia research. This study describes a group-based program designed to improve general understanding of other people's thoughts and feelings (mental state reasoning training; MSRT). This is a manual-based program developed around videos, computer games, and group games and is delivered in ten sessions over five to seven weeks, twice-weekly.2 page(s

Skin ulcers in systemic sclerosis: correlation with clinical phenotype in a monocentric cohort from the north-east of Italy

To evaluate the prevalence of skin ulcers (SUs) and their association with clinical phenotype in a monocentric cohort of patients affected with systemic sclerosis (SSc)

Plasma-exchange as a "rescue therapy" for dermato/polymyositis in acute phase. Experience in three young patients

There are few data in the literature supporting the efficacy of plasma-exchange in dermato/polymyositis. The authors report three cases of patients with acute disease phase showing severe pharyngo-esophageal muscle weakness unresponsive to conventional therapy (corticosteroids and immunosuppressant agents) who were treated with plasma-exchange. As the patients were at high risk of "aspiration pneumonia", tracheostomy and PEG tubes were placed. The patients underwent a series of plasma-exchange for a mean of 15 weeks, during which time they progressively recovered muscle strength, their serum muscle enzyme values returned to normal levels, and MRI showed resolution of muscle edema. The tracheostomy and PEG tubes could be removed. Our findings suggest that plasma-exchange in association with immunosuppressant agents could play a relevant role in the management of dermato/polymyositis in acute phase

Pulmonary arterial hypertension in connective tissue disorders: Pathophysiology and treatment

Our article focuses on the pathogenesis and treatment of CTD-PAH. In the latest ESC/ESR guidelines for PAH, the authors underline that although CTD-PAH should follow the same treatment protocol as idiopathic PAH, the therapeutic approach is more complex and difficult in the former. This review throws light on several peculiar aspects of CTD-PAH and the latest findings in the pathogenesis, namely, the role of inflammation in the maladaptive right ventricle remodeling in SSc-PAH where immunosuppressants are classically believed to be ineffective. Furthermore, we discuss the major critical points in the therapy of CTD-PAH which is one of the strengths of our article. To the best of our knowledge, there are no other reviews that exclusively focus on the pathogenesis and treatment of CTD-PAH patients, with an emphasis on the more critical issues. Thus, it is our contention that our work would be of interest to the readers