Feasibility of performing the 3-minute step test with remote supervision in children and adolescents with cystic fibrosis: A comparative study

Importance:The 3-min step test is a simple option to monitor submaximal exercise capacity,although its use via remote video monitoring has not been investigated in children with cystic fibrosis(CF).Objective:This study aimed to assess the feasibility and reproducibility of performing the 3-min step test with remote supervision.Methods:A cross-sectional study including CF patients(6-18 years)from two CF services were performed.Demographic,anthropometric,clinical,and lung function data were collected and two 3-min step tests were performed:(i)in-person supervision,and(ii)remotely supervised by video monitoring.Before and after the tests,heart rate(HR),oxygen saturation(SpO_(2)),and the Borg score for dyspnea and lower limb fatigue were monitored.Results:Twenty-three patients(10.7±3.7 years)with a mean FEV1 of 89.5%±23.2%were included.There were no significant differences between tests,with mean differences(95%confidence intervals)in final HR of-3.3(-8.9,2.4),change in HR of-1.9(-6.1,2.1),final SpO_(2) of 0.3(-0.4,1.0),and final dyspnea of 0.1(-0.8,0.9).The intraclass correlation coefficient was 0.852(final HR),0.762(final SpO_(2)),and 0.775(final lower limb fatigue).Significant and moderate correlations were found between tests for final HR(r=0.75),change in HR(r=0.61),and final SpO_(2)(r=0.61).The Bland-Altman analysis showed a mean difference in final SpO_(2) between tests of 0.3%(limit of agreement-3.0%,3.5%).Interpretation:Physiological responses between tests were similar,indicating it was feasible to perform the 3-min step test with remote supervision in CF children.

Dabigatran in the Treatment of Extensive Cerebral Venous Thrombosis:A Case Report

Background: Cerebral venous thrombosis (CVT) is a rare type of cerebrovascular disease associated with a 15% rate of death or function dependence. The mainstay of treatment for CVT is systemic anticoagulation, despite venous hemorrhagic infarction. Vitamin K antagonists have long been the only available option for anticoagulation;however, the past few years have brought the development of many new target-specific drugs, collectively called non-vitamin K antagonist oral anticoagulants (NOACs). Although emerging evidence suggests NOACs have an acceptable safety and tolerability profile in CVT, there are limited data available and no randomized controlled trials have been performed to date. Case Presentation: This describes the case of a patient with CVT occurring during an infection who was successfully treated with a NOAC, dabigatran, after a difficult time on warfarin. Conclusions: A case of extensive and deep CVT was identified. Dabigatran 150 mg treatment twice daily in this patient resulted in no additional damage to the brain. This case study illustrates that the use of NOACs such as dabigatran can be safe and effective in patients with CVT.

Is the Distribution of Microorganisms and Peritonitis Affected by Seasonality in Peritoneal Dialysis?

Introduction: Peritonitis continues to be the main complication for patients on peritoneal dialysis (PD). Objective: To determine the frequency of peritonitis according to the disease-causing microorganism and its distribution throughout the year, linking to seasonality. Methods: A retrospective study conducted in the Dialysis Unit of the Hospital S&atildeo Lucas, PUCRS (HSL-PUCRS). Patients undergoing PD between January 1984 and September 2013 were included. Descriptive statistics were used and Fisher’s exact test with Monte Carlo simulation for comparison between the categorical variables. Results: Of 415 evaluated patients, 66% had at least one episode of peritonitis with an incidence rate of 0.68 episode/year. There were 601 peritonitis episodes in total. The most common microorganism was coagulase-negative Staphylococcus (26.6%, n = 160), followed by Staphylococcus aureus (16.3%, n = 98), with 16.3% of the sample being negative culture. Most episodes occurred in the months of January (10.3%, n = 62) and May (10.1%, n = 61), while June had the lowest occurrence (5.2%, n = 31). The number of episodes observed in January and May were significantly higher when compared to June

Phase angle and non-alcoholic fatty liver disease before and after bariatric surgery

BACKGROUND Obesity is a global health problem that is continuing to increase in the young population.In Brazil,the frequency of obesity in 2018 was 19.8%.Several comorbidities are directly associated with obesity,such as non-alcoholic fatty liver disease(NAFLD),which is considered the most common liver disorder in Western countries and affects up to 46%of adults.Bariatric surgery is effective in treating obesity and can improve NAFLD;however,the effect of bariatric surgery on body composition,phase angle(PA),and improving NAFLD needs to be further studied.AIM To analyze the PA in the postoperative period of bariatric surgery and to correlate it with changes in body composition and liver disease.METHODS This study is a retrospective cohort study of the analysis of the medical records of patients undergoing bariatric surgery in a reference center of a teaching hospital in Porto Alegre over a 2-year period.Patients older than 18 years whose record contained all information relevant to the study were included.The data analyzed were body composition and PA through electrical bioimpedance and NAFLD through liver biopsy in the pre-and postoperative period.The level of significance adopted for the statistical analyses was 5%.RESULTS We evaluated 379 patients with preoperative data.Regarding PA,169 patients were analyzed,and 33 patients had liver biopsy pre-and postoperatively with NAFLD information.In total,79.4%were female,with a mean age of 39.1±10.6 years.The average body mass index(BMI)was 45.9±7.5 kg/m².The PA showed a mean of 5.8±0.62°in the preoperative period and a significant reduction in the postoperative period.A postoperative reduction in body composition data(skeletal muscle mass,fat percentage,fat mass,body cell mass,BMI and visceral fat area)was shown as well.Regarding liver disease,all patients presented a reduction in the degrees and stages of liver disease in the postoperative period,and some had no degree of liver disease at all.CONCLUSION PA decreased after bariatric surgery,with a direct correlation with weight loss and changes in body composition.The decrease in PA was not correlated with the improvement in NAFLD.

Expression Grade Sirtuin-1 （SIRT-1） in Tumor Tissue in Women with Breast Cancer： A New Biomarker Prognosis？

Breast cancer is a complex and heterogeneous disease with different clinical outcomes. The investigations of new biomolecular markers are essential to know the prognosis and improve the clinical management of patients. The SIRT-1 （sirtuin- 1） is a histone deacetylase implicated in various epigenetic critical functions for the cells and the maintenance of genomic stability. The objective of this study is to investigate the grade of expression of the SIRT-I （sirtuin-1） and the prognostic value in overall survival of women with breast cancer. Retrospective cohort of 457 women with breast cancer has been researched, undergoing treatment in Erechim-RS from 2003 to 2013 and followed until July 2015. The degree of SIRT-1 expression was investigated by immunohistochemistry in 123 patients （26.9%） of the cohort. The OS （overall survival） from specific disease and risk of death from breast cancer were estimated by Kaplan-Meier and Cox＇s proportional risks. The median age of 57.4 years cohort with OS of 79.6% in 5 years and 69.1% at 10 years, with follow-up time of 61.9 months are revealed in this work. The SIRT-1 overexpression was found in 6.5% of cases and characterized a subgroup of women with shorter survival and increased risk of death from breast cancer （HR = 2.66; 95% CI 1.03 to 6.86; p = 0.043） and adjusted by age （HR = 2.86; 95% CI 1.11 to 7.38; p = 0.030）, histology （HR = 2.79; 95% CI 1.07 to 7.28; p = 0.036）, lymph nodes （HR = 2.73; 95% CI 1.06 to 7.04; p = 0.037）, Her-2 （HR = 2.82; 95% CI 1.07 to 7.44; p = 0.036）; chemotherapy （HR = 2.90; 95% CI 1.11 to 7.60; p = 0.030） and radiotherapy （HR = 2.71; 95% CI 1.05 to 7.01; p = 0.040）. In regressive multivariate models adjusted for age, status of axillary lymph nodes, Her-2 expression and proliferation index （Ki-67）, the grade of expression of the SIRT-1 maintained association with poor prognosis. From the study, it can be concluded that the assessment of the SIRT-1 expression is an independent prognostic biomarker in breast cancer.