Gastro-Esophageal Reflux in Children

Gastro-esophageal reflux (GER) is common in infants and children and has a varied clinical presentation: from infants with innocent regurgitation to infants and children with severe esophageal and extra-esophageal complications that define pathological gastro-esophageal reflux disease (GERD). Although the pathophysiology is similar to that of adults, symptoms of GERD in infants and children are often distinct from classic ones such as heartburn. The passage of gastric contents into the esophagus is a normal phenomenon occurring many times a day both in adults and children, but, in infants, several factors contribute to exacerbate this phenomenon, including a liquid milk-based diet, recumbent position and both structural and functional immaturity of the gastro-esophageal junction. This article focuses on the presentation, diagnosis and treatment of GERD that occurs in infants and children, based on available and current guidelines

Quantitative assessment of disease resistance by real-time PCR

Dissertação de Mestrado Integrado em Arquitectura, apresentada ao Departamento de Arquitectura da Faculdade de Ciências e Tecnologia da Universidade de Coimbra, sob a orientação do Prof. Doutor Rui Lobo.O centro histórico de Coimbra, como muitos outros, sofre as consequências do grave problema da desocupação. A gravidade deste problema nota-se ao olhar para o estado de degradação e ruína dos edifícios, mas também, e principalmente, ao percorrer o espaço no período noturno, altura em que o comércio fecha deixando a área totalmente sem vida e consequentemente pouco convidativa e perigosa. A quem cabe a função de animar este espaço? Ao comércio? O prolongar o seu horário de funcionamento ou o manter as luzes das montras acesas durante a noite acarretam custos e alteração de dinâmicas que são dificilmente compensados. Aos turistas? Estes têm um caráter transitório. Então cabe a quem? Tem de caber á população residente na área. Mas, se o espaço está desabitado, quem o vai dinamizar? A reabilitação tem de passar pela criação de condições para que se recupere e desenvolva a função habitacional. Como proliferar a função habitacional em edifícios que não respondem às exigências mínimas de habitabilidade dos dias de hoje? Já lá vai o tempo em que se demolia para construir de novo. Hoje, mais do que nunca, o valor patrimonial do legado arquitetónico é valorizado (e bem!) pois é parte essencial da identidade da cidade e da nossa identidade. Num espaço como o centro histórico a reabilitação da casa corrente deve promover as melhorias das condições de habitabilidade e ao mesmo tempo o seu valor enquanto parte constituinte de um conjunto com identidade própria. A questão fundamental a que esta tese se propõe tentar responder é: ‘Como reabilitar?’The historical center of Coimbra, like many others, suffers from serious problems of emptiness. The severity of this problem is noticed when looking at the state of degradation and ruin of buildings, but also, and especially, at night, when the shops close leaving the area lifeless and consequently uninviting and dangerous. Who has the function of animating this space? The shops? To extend their opening hours or to keep the shop lights lit at night entail costs and changing dynamics that are rarely compensated. The tourists? These have a temporary character. So it’s up to who? It must fit to the resident population in the area. However, if space is uninhabited, who will animate it? Rehabilitation has to go through the creation of conditions to recover and develop the housing function. How can we proliferate housing function in buildings that do not have the minimum habitability requirements of today? Gone are the days of demolishion to build again. Today, more than ever, the asset value of the architectural heritage is considered (and well!) because it is an essential part of the city’s identity. In an area as the historical center the rehabilitation of the ‘current house’ must promote improvements on living conditions and at the same time its value as a constituent part of a set with its own identity. The key question this thesis will try to answer is: ‘How to rehabilitate?

Дослідження впливу густого екстракту квасолі та лікарських препаратів на його основі на стан коагуляційного гемостазу у щурів із експериментальним цукровим діабетом 2-го типу

On the basis of the conducted studies we have found that during the use in the treatment of the rats with diabetes type 2 the thick extract beans, pills "Hlifasonorm" and capsules "Hlifasolin", in a comparative aspect with acetylsalicylic acid and quercetin, have confirmed the presence of a coherent action in capsules "Hlifasolin" on time blood clotting, blood plasma recalcification time, prothrombin index and quantity of fibrinogen. Thus, the use of pills “Hlifasonorm" and caps" Hlifasolin "in the treatment of diabetes type 2 will make it possible to prevent imbalance prothrombotic and fibrinolytic properties of blood.На основании проведенных исследований установлено, что использование в лечении животных с СД 2-го типа густого экстракта фасоли,  таблеток «Глифасонорм» и капсул «Глифасолин» в сравнительном аспекте с ацетилсалициловой кислотой и кверцетином подтвердило наличие более выраженного действия у капсул «Глифасолин» на время свертывания крови, время рекальцификации плазмы крови, протромбиновый индекс и количество фибриногена. Таким образом, использование таблеток «Глифасонорм» и капсул «Глифасолин» при лечении СД 2-го типа даст возможность предупредить нарушения равновесия протромботических и фибринолитеческих свойств крови.На підставі проведених досліджень встановлено, що використання у лікуванні щурів із ЦД 2-го типу густого екстракту квасолі, таблеток «Гліфасонорм» і капсул «Гліфасолін» у порівняльному аспекті з ацетилсаліциловою кислотою і кверцетином підтвердило наявність більш виразної дії у капсул «Гліфасолін» на час згортання крові, час рекальцифікації плазми крові, протромбіновий індекс та кількість фібриногену. Таким чином, використання таблеток «Гліфасонорм» і капсул «Гліфасолін» в лікуванні ЦД 2-го типу дасть можливість попередити порушення рівноваги протромботичної і фібринолітичної властивостей крові.

Activity of the Lactate Dehydrogenase Inhibitor Oxamic Acid against the Fermentative Bacterium \u3ci\u3eStreptococcus mitis/oralis\u3c/i\u3e: Bactericidal Effects and Prevention of Daptomycin Resistance In Vitro and in an Ex Vivo Model

Streptococcus mitis/oralis is a fermentative bacterium that relies on lactate dehydrogenase to balance its redox poise and keep glycolysis active. Metabolomic analysis of an in vitro– derived daptomycin-resistant (DAP-R) S. mitis/oralis strain (351-D10) revealed differences in glucose catabolism relative to its DAP-susceptible (DAP-S) parental strain, 351. Metabolic changes associated with the transition to this DAP-R phenotype suggested that inhibiting glycolysis could alter DAP susceptibility. In addition, the strong reliance of S. mitis/oralis on glycolysis for energy and biosynthetic intermediates suggested that inhibiting glycolysis would adversely affect growth and biomass accumulation. To test these hypotheses, we used the lactate dehydrogenase inhibitor oxamic acid (OXA) to assess its efficacy against DAP-S S. mitis/oralis strain 351 during DAP exposures in vitro and ex vivo. As expected, OXA was growth inhibitory to S. mitis/oralis in a dose-dependent manner in vitro; however, it did not alter in vitro DAP susceptibility profiles. In contrast, OXA did prevent the emergence of DAP-R in an ex vivo model of simulated endocardial vegetations. These data suggest that metabolic inhibitors directed against this fermentative bacterium with limited metabolic capabilities could enhance killing and potentially forestall the emergence of DAP resistance

Xenopus laevis and Emerging Amphibian Pathogens in Chile

Amphibians face an extinction crisis with no precedence. Two emerging infectious diseases, ranaviral disease caused by viruses within the genus Ranavirus and chytridiomycosis due to Batrachochytrium dendrobatidis (Bd), have been linked with amphibian mass mortalities and population declines in many regions of the globe. The African clawed frog (Xenopus laevis) has been indicated as a vector for the spread of these pathogens. Since the 1970s, this species has been invasive in central Chile. We collected X. laevis and dead native amphibians in Chile between 2011 and 2013. We conducted post-mortem examinations and molecular tests for Ranavirus and Bd. Eight of 187 individuals (4.3 %) tested positive for Ranavirus: seven X. laevis and a giant Chilean frog (Calyptocephallela gayi). All positive cases were from the original area of X. laevis invasion. Bd was found to be more prevalent (14.4 %) and widespread than Ranavirus, and all X. laevis Bd-positive animals presented low to moderate levels of infection. Sequencing of a partial Ranavirus gene revealed 100 % sequence identity with Frog Virus 3. This is the first report of Ranavirus in Chile, and these preliminary results are consistent with a role for X. laevis as an infection reservoir for both Ranavirus and Bd

Enhancing the utility of antroduodenal manometry in pediatric intestinal pseudo-obstruction

BACKGROUND: Antroduodenal manometry (ADM) and histopathology are currently employed to aid the diagnosis of pediatric intestinal pseudo-obstruction (PIPO). Limited data are available on the reliability of ADM analysis and its correlation with histopathology. We aimed to develop a protocol for enhanced analysis of ADM contractile patterns, including a scoring system, and explore whether this provided better correlation with histopathology. METHODS: Children referred with suspected PIPO between April 2012-December 2019 who underwent both ADM and full-thickness biopsies were included. ADM tracings were analyzed using both standard (conventional ADM) and novel (enhanced ADM) motility parameters. A novel ADM score (GLASS score) was generated based on the enhanced ADM analysis. Conventional and enhanced ADM analyses were then correlated with histopathology. RESULTS: Forty patients were included. Using conventional clinical criteria, 29 of these were diagnosed with PIPO and the other 11 with non-PIPO diagnoses. Twenty-three of the PIPO patients had abnormal histopathology: 6 myopathy, 4 neuropathy, 3 neuro-myopathy, and 10 non-specific changes. No agreement in diagnosis was found between conventional ADM analysis and histopathology (ϰ = 0.068; p = 0.197), whereas the latter significantly correlated with enhanced ADM analysis (ϰ = 0.191; p = 0.003). The enhanced ADM score was significantly higher in PIPO versus non-PIPO (16.0 vs. 8.0; p < 0.001). CONCLUSIONS: As opposed to conventional analysis protocols, the newly developed enhanced ADM analysis and associated score is not only able to discriminate between PIPO and non-PIPO patients, but also between distinct histopathological pathologies. Further studies are required to assess the utility of enhanced ADM analysis in larger populations

Глобальные гляциологические модели: новый этап в развитии методов прогнозирования эволюции ледников. Часть 1. Общий подход и архитектура моделей

For several decades, mathematical models of mountain glaciers and ice sheets have been used to study the dynamics of the cryosphere. In recent years, a new step in glaciological modeling has made possible to recon- struct processes in mountain-glacial systems both regionally and globally. The proposed review analyses rea- sons to use this possibility for global glaciological models, key assumptions and methods, general approaches and differences between individual models. Global glacier modeling is a rapidly developing field. This became possible only after the data on all glaciers of the world appeared in the Randolph Glacier Inventory in 2012. The ice thickness inversion procedures discussed in this review made it possible to calculate the initial volume and geometry of glaciers. Methods of varying complexity were used to regionalize global climate data and cal- culate glacier mass balance. Modeling the dynamics of glaciers required the adaptation of simplified schemes to represent the fluidity of ice (or the flow of ice). To date, only two global glacier models contain ice dynamics calculations based on Glenn's law and the diffusion equation: OGGM and GloGEMflow. Simulation results are subject to uncertainties due to input errors, climate predictions, model approximations, and calibration proce- dures. A new stage in the development of methods opens up opportunities to use a number of new directions in the study of the mechanisms that control the evolution of glaciation, depending on the implementation of a particular climatic scenario. Global glacier models make possible to build glaciological projections, calculate potential changes in the regime of glacial runoff, as well as assess risks and predict the occurrence of dangerous processes caused by changes in glaciation parameters, such as mudflows, landslides, and glacial lake outbursts.В обзоре рассмотрены предпосылки возникновения глобальных гляциологических моделей, ключевые допущения и методы, общие подходы и различия между отдельными моделями. Глобальные модели ледников позволяют строить гляциологические проекции, рассчитывать потенциальные изменения в режиме ледникового стока, а также оценивать риски и прогнозировать возникновение опасных процессов (сели, оползни, прорывы ледниковых озер), обусловленных изменениями параметров оледенения

Clinical Outcomes in Patients with Heterogeneous Vancomycin-Intermediate Staphylococcus aureus Bloodstream Infection

The prevalence of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) infections varies in the literature, a problem complicated by the lack of routine screening procedures; however, limited data suggest that hVISA has been associated with persistent bloodstream infections (BSI) and vancomycin failure, yet these studies have been confounded by design issues. We conducted this study to compare the characteristics of patients with BSI caused by hVISA with those with vancomycin-susceptible Staphylococcus aureus (VSSA) treated with vancomycin. This retrospective, multicenter matched (1:1) cohort study compared the clinical characteristics and outcomes of hVISA and VSSA. Patients with hVISA methicillin-resistant Staphylococcus aureus (MRSA) BSI from 2004 to 2012 were matched to VSSA-MRSA BSI patients. The primary outcome was failure of vancomycin treatment, defined as a composite of persistent bacteremia (≥7 days), persistent signs and symptoms, change of MRSA antibiotic, recurrent BSI, or MRSA-related mortality. We identified 122 matched cases. The overall vancomycin failure rate was 57% (82% hVISA versus 33% VSSA; P \u3c 0.001). The individual components of failure in hVISA versus VSSA were persistent bacteremia, 59% versus 21% (P \u3c 0.001); change in MRSA therapy, 54% versus 25% (P = 0.001); MRSA-related mortality, 21% versus 10% (P = 0.081); and recurrence of BSI, 26% versus 2% (P \u3c 0.001). Using logistic regression analysis and adjusting for covariates, hVISA (adjusted odds ratio [aOR], 11.1; 95% confidence interval [CI], 4.3 to 28.7) and intensive care unit (ICU) admission (aOR, 4.5; 95% CI, 1.8 to 11.6) were still independently associated with vancomycin failure. Relative to VSSA BSI, patients with hVISA were more likely to experience failure of vancomycin treatment, including persistent bacteremia and recurrence. Our results indicate that hVISA was responsible for considerable morbidity

Comparative Analysis of Super-Kamiokande and SNO Solar-Neutrino Data and the Photospheric Magnetic Field

We analyze Super-Kamiokande, SNO, and photospheric magnetic-field data for the common time interval, namely the SNO D2O phase. Concerning rotational modulation, the magnetic-field power spectrum shows the strongest peaks at the second and sixth harmonics of the solar synodic rotation frequency [3 nu(rot) and 7 nu(rot)]. The restricted Super-Kamiokande dataset shows strong modulation at the second harmonic. The SNO D2O dataset shows weak modulation at that frequency, but strong modulation in the sixth-harmonic frequency band. We estimate the significance level of the correspondence of the Super-Kamiokande second-harmonic peak with the corresponding magnetic-field peak to be 0.0004, and the significance level of the correspondence of the SNO D2O sixth-harmonic peak with the corresponding magnetic-field peak to be 0.009. By estimating the amplitude of the modulation of the solar neutrino flux at the second harmonic from the restricted Super-Kamiokande dataset, we find that the weak power at that frequency in the SNO D2O power spectrum is not particularly surprising. Concerning 9.43 yr-1, we find no peak at this frequency in the power spectrum formed from the restricted Super-Kamiokande dataset, so it is no surprise that this peak does not show up in the SNO D2O dataset, either.Comment: 32 pages, 8 tables, 16 figure