Inhibitors against spontaneously acquired coagulation factors: Acquired hemophilia B

Los inhibidores adquiridos del factor IX son extremadamente raros. Un hombre de 70 años presentó sangrado profuso continuo luego de una cirugía ortopédica. Su PTT activado inicial fue 77.4 segundos (intervalo normal, 25-36) y su PT fue normal. La corrección del PTT activado expandido, resulta a favor del déficit del factor IX, confirmando el nivel de dicho factor 52%, con niveles normales de factor VIII. Esto fue realizado con plasma fresco congelado. Se presenta una revisión exhaustiva del tema. [Sossa Cl, Jiménez SI, Rodríguez P. Inhibidores contra los factores de la coagulación adquiridos espontáneamente: Hemofilia B adquirida.Acquired factor IX inhibitors are extremely rare. A 70-year-old man presented with continuous profuse bleeding after orthopedic surgery. His initial activated PTT was 77.4 seconds (normal range, 25-36) and his PT was normal. The correction of the expanded activated PTT results in favor of the factor IX deficiency, confirming the level of said factor 52%, with normal levels of factor VIII. This was performed with fresh frozen plasma. An exhaustive review of the topic is presented. [Sossa Cl, Jiménez SI, Rodríguez P. Inhibitors against spontaneously acquired coagulation factors: Acquired hemophilia B

¿Es la obesidad un factor de riesgo para el trastorno de déficit de atención con hiperactividad (TDAH)?

lteraciones en el desarrollo de la atencióny la organización conductual puedenconfigurar cuadros clínicos comoel trastorno déficit de atención (TDA) que puede estaracompañado o no de hiperactividad (TDAH), este últimoparece tener una relación directa con otros diagnósticosde tipo endocrino como la obesidad. El objetivo del estudioes analizar la relación que existe entre el TDAH y laobesidad. Es por ello que se realiza una revisión sistemáticade estudios científicos revelando relaciones y diferenciasentre ambos trastornos desde una mirada fisiológica,cognoscitiva y comportamental. Se concluye que la relaciónentre el TDAH y la obesidad se da por factores genéticos,por variaciones dopaminérgicas, cambios en patronesde sueño, desajustes emocionales y por alteraciones en laregulación de la conducta; igualmente influyen factoressociales relacionados con el cuidado en el embarazo y laalimentación de las mujeres antes y durante la gestación

Anemia hemolítica autoinmune postinfección por virus de la hepatitis A. Informe de caso

La anemia hemolítica autoinmune se asocia con una variedad de virus hepatotrópicos, en particular citomegalovirus (CMV), virus del Epstein-Barr y de la hepatitis B. No es frecuente dentro de la historia natural de la hepatitis A, la aparición de anemia hemolítica, y cuando se presenta, generalmente se asocia a deficiencia de glucosa-6-fosfato deshidrogenasa. Presentamos el caso de un paciente de sexo masculino sin hemólisis previa, con astenia e ictericia de dos meses de evolución y hepatomegalia 14 cm por debajo del reborde costal derecho. Los hallazgos en los exámenes de laboratorios mostraron anemia hemolítica con Coombs directo positivo, anticuerpos tipo inmunoglobulina M contra el virus de la hepatitis A positivos, niveles de bilirrubinas 20 veces y aminotrasferasas cuatro veces por arriba del rango normal; con estos datos el paciente fue diagnosticado como hepatitis A complicada con anemia hemolítica y probable hepatitis autoinmune asociada, por lo que se inició manejo con corticoides, alcanzándose mejoría clínica. Resaltamos la importancia de descartar la infección por el virus de la hepatitis A como posible etiología de anemia hemolítica autoinmune. &nbsp

Autoimmune haemolytic anaemia associated to hepatitis A. Case report

La anemia hemolÍtica autoinmune se asocia con una variedad de virus hepatotrópicos, en particular citomegalovirus (CMV), virus del Epstein-Barr y de la hepatitis B. No es frecuente dentro de la historia natural de la hepatitis A, la aparición de anemia hemolÍtica, y cuando se presenta, generalmente se asocia a deficiencia de glucosa-6-fosfato deshidrogenasa. Presentamos el caso de un paciente de sexo masculino sin hemólisis previa, con astenia e ictericia de dos meses de evolución y hepatomegalia 14 cm por debajo del reborde costal derecho. Los hallazgos en los exámenes de laboratorios mostraron anemia hemolÍtica con Coombs directo positivo, anticuerpos tipo inmunoglobulina M contra el virus de la hepatitis A positivos, niveles de bilirrubinas 20 veces y aminotrasferasas cuatro veces por arriba del rango normal; con estos datos el paciente fue diagnosticado como hepatitis A complicada con anemia hemolÍtica y probable hepatitis autoinmune asociada, por lo que se inició manejo con corticoides, alcanzándose mejorÍa clÍnica. Resaltamos la importancia de descartar la infección por el virus de la hepatitis A como posible etiologÍa de anemia hemolÍtica autoinmune.Autoimmune hemolytic anemia is associated with a variety of hepatotropic viruses, in particular cytomegalovirus (CMV), Epstein-Barr virus and hepatitis B. It is not frequent within the natural history of hepatitis A, the appearance of hemolytic anemia, and when it occurs, it is generally associated with glucose-6-phosphate dehydrogenase deficiency. We present the case of a male patient without previous hemolysis, with asthenia and jaundice for two months and hepatomegaly 14 cm below the right costal margin. Laboratory examination findings showed direct positive Coombs hemolytic anemia, positive immunoglobulin M antibodies against hepatitis A virus, bilirubin levels 20 times and aminotrases four times above the normal range; With these data, the patient was diagnosed as complicated hepatitis A with hemolytic anemia and probable associated autoimmune hepatitis, for which management with corticosteroids was initiated, achieving clinical improvement. We highlight the importance of ruling out hepatitis A virus infection as a possible etiology of autoimmune hemolytic anemia

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Is obesity a risk factor for Attention-Deficit Hyperactivity Disorder (ADHD)?

Alteraciones en el desarrollo de la atención y la organización conductual pueden configurar cuadros clínicos como el trastorno déficit de atención (TDA) que puede estar acompañado o no de hiperactividad (TDAH), este último parece tener una relación directa con otros diagnósticos de tipo endocrino como la obesidad. El objetivo del estudio es analizar la relación que existe entre el TDAH y la obesidad. Es por ello que se realiza una revisión sistemática de estudios científicos revelando relaciones y diferencias entre ambos trastornos desde una mirada fisiológica, cognoscitiva y comportamental. Se concluye que la relación entre el TDAH y la obesidad se da por factores genéticos, por variaciones dopaminérgicas, cambios en patrones de sueño, desajustes emocionales y por alteraciones en la regulación de la conducta; igualmente influyen factores sociales relacionados con el cuidado en el embarazo y la alimentación de las mujeres antes y durante la gestación.Alterations in the development of attention and behavioral organization can configure clinical diagnoses such as attention deficit disorder (ADD) that may not be accompanied by hyperactivity (ADHD), the latter seems to have a direct relationship with other endocrine diagnoses such as the obesity. The aim of the study is to analyze the relationship between ADHD and obesity. That is why a systematic review of scientific studies is carried out revealing relationships between both disorders from a physiological, cognitive and behavioral perspective. It is concluded that the relationship between ADHD and obesity is given by genetic factors, by dopaminergic variations, changes in sleep patterns, emotional imbalances and by alterations in the regulation of behavior; likewise, social factors related to pregnancy care and the feeding of women before and during pregnancy influence it

Anemia hemolítica autoinmune postinfección por virus de la hepatitis A. Informe de caso; Autoimmune haemolytic anaemia associated to hepatitis A. Case report

La anemia hemolítica autoinmune se asocia con una variedad de virus hepatotrópicos, en particular citomegalovirus (CMV), virus del Epstein-Barr y de la hepatitis B. No es frecuente dentro de la historia natural de la hepatitis A, la aparición de anemia hemolítica, y cuando se presenta, generalmente se asocia a deficiencia de glucosa-6-fosfato deshidrogenasa. Presentamos el caso de un paciente de sexo masculino sin hemólisis previa, con astenia e ictericia de dos meses de evolución y hepatomegalia 14 cm por debajo del reborde costal derecho. Los hallazgos en los exámenes de laboratorios mostraron anemia hemolítica con Coombs directo positivo, anticuerpos tipo inmunoglobulina M contra el virus de la hepatitis A positivos, niveles de bilirrubinas 20 veces y aminotrasferasas cuatro veces por arriba del rango normal; con estos datos el paciente fue diagnosticado como hepatitis A complicada con anemia hemolítica y probable hepatitis autoinmune asociada, por lo que se inició manejo con corticoides, alcanzándose mejoría clínica. Resaltamos la importancia de descartar la infección por el virus de la hepatitis A como posible etiología de anemia hemolítica autoinmune.______________________________________________________________________ Acute auto inmune haemolytic anaemia is associated with a variety of hepatotropic viruses, in particular cytomegalovirus, Epstein Barr virus and hepatitis B. The typical course of hepatitis A is rarely complicated with glucose-6-phosphate dehydrogenase deficiency. Wepresent the case of a man without previous haemolysis, he had been unwell for two months with fatigue and jaundice, the liver edge was palpable and tender 14 cm below the costal margin. Clinical chemistry showed haemolytic anaemia with positive direct coombs test, immunoglobulin M antibodies to hepatitis A virus were detected, the total bilirrubin concentration 20 times the upper and transaminase 4 times upper limit for normal levels; with this finds the case was diagnosed hepatitis A complicated by haemolytic anaemia and associated with probable autoimmune hepatitis, therefore was started treatment with corticosteroids, over the following week he gradually improved clinically. We described the importance rule out hepatitis A viral infection as possible etiology for haemolytic anaemia

Eating for Two? Protocol of an Exploratory Survey and Experimental Study on Social Norms and Norm-Based Messages Influencing European Pregnant and Non-pregnant Women’s Eating Behavior

The social context is an important factor underlying unhealthy eating behavior and the development of inappropriate weight gain. Evidence is accumulating that powerful social influences can also be used as a tool to impact people’s eating behavior in a positive manner. Social norm-based messages have potential to steer people in making healthier food choices. The research field on nutritional social norms is still emerging and more research is needed to gain insights into why some people adhere to social norms whereas others do not. There are indications stemming from empirical studies on social eating behavior that this may be due to ingratiation purposes and uncertainty reduction. That is, people match their eating behavior to that of the norm set by their eating companion(s) in order to blend in and be part of the group. In this project, we explore nutritional social norms among pregnant women. This population is particularly interesting because they are often subject to unsolicited advice and experience social pressure from their environment. In addition, their pregnancy affects their body composition, eating pattern, and psychosocial status. Pregnancy provides an important window of opportunity to impact health of pregnant women and their child. Nevertheless, the field of nutritional social norms among pregnant women is understudied and more knowledge is needed on whether pregnant women use guidelines from their social environment for their own eating behavior. In this project we aim to fill this research gap by means of an exploratory survey (Study 1) assessing information about social expectations, (mis)perceived social norms and the role of different reference groups such as other pregnant women, family, and friends. In addition, we conduct an online experiment (Study 2) testing to what extent pregnant women are susceptible to social norm-based messages compared to non-pregnant women. Moreover, possible moderators are explored which might impact women’s susceptibility to social norms as well as cultural aspects that co-determine which social norms and guidelines exist. The project’s findings could help design effective intervention messages in promoting healthy eating behavior specifically targeted to European pregnant women.© 2018 Bevelander, Herte, Kakoulakis, Sanguino, Tebbe and Tünt

The general fault in our fault lines

Pervading global narratives suggest that political polarization is increasing, yet the accuracy of such group meta-perceptions has been drawn into question. A recent US study suggests that these beliefs are inaccurate and drive polarized beliefs about out-groups. However, it also found that informing people of inaccuracies reduces those negative beliefs. In this work, we explore whether these results generalize to other countries. To achieve this, we replicate two of the original experiments with 10,207 participants across 26 countries. We focus on local group divisions, which we refer to as fault lines. We find broad generalizability for both inaccurate meta-perceptions and reduced negative motive attribution through a simple disclosure intervention. We conclude that inaccurate and negative group meta-perceptions are exhibited in myriad contexts and that informing individuals of their misperceptions can yield positive benefits for intergroup relations. Such generalizability highlights a robust phenomenon with implications for political discourse worldwide