A randomized trial of nebulized 3% hypertonic saline with salbutamol in the treatment of acute bronchiolitis in hospitalized infants

OBJECTIVE: Acute bronchiolitis is a common disorder of infants that often results in hospitalization. Apart from supportive care, no therapy has been shown to influence the course of the disease, except for a possible effect of nebulized hypertonic saline (HS). To determine whether this does have beneficial effects on length of stay in hospital or on severity scores, we undertook a double-blind, randomized, controlled trial in a pediatric department of a Portuguese hospital. METHODS: Previously healthy infants, younger than 12 months, hospitalized with mild-to-moderate acute viral bronchiolitis were randomized to receive either nebulized 3% (hypertonic, HS) or 0.9% (normal, NS) saline during their entire hospital stay. Primary endpoints were: length of hospital stay and severity scores on each day of hospitalization. Need for supplemental oxygen, further add-on medications and adverse effects were also analyzed. RESULTS: Sixty-eight patients completed the study (HS: 33; NS: 35). The median length of hospital stay did not differ between groups: HS: 5.6 ± 2.3 days; NS: 5.4 ± 2.1 days (P = 0.747). We found no difference between groups in severity scores from day 1 to day 4. There were no differences in need for supplemental oxygen or add-on medications. Patients in HS group had significantly more cough (46% vs. 20%, P = 0.025) and rhinorrhoe (58% vs. 31%, P = 0.30). CONCLUSION: This study does not support the use of nebulized HS over NS in therapy of hospitalized children with mild-to-moderate acute viral bronchioliti

Portuguese Children's Sleep Habits Questionnaire - validation and cross-cultural comparison

OBJECTIVE: to validate the Portuguese version of the Children's Sleep Habits Questionnaire (CSHQ-PT) and compare it to the versions from other countries. METHODS: the questionnaire was previously adapted to the Portuguese language according to international guidelines. 500 questionnaires were delivered to the parents of a Portuguese community sample of children aged 2 to 10 years old. 370 (74%) valid questionnaires were obtained, 55 children met exclusion criteria and 315 entered in the validation study. RESULTS: the CSHQ-PT internal consistency (Cronbach's α) was 0.78 for the total scale and ranged from 0.44 to 0.74 for subscales. The test-retest reliability for subscales (Pearson's correlations, n=58) ranged from 0.59 to 0.85. Our data did not adjust to the original 8 domains structure in Confirmatory Factor Analysis but the Exploratory Factor Analysis extracted 5 factors that have correspondence to CSHQ subscales. CONCLUSION: the CSHQ-PT evidenced psychometric properties that are comparable to the versions from other countries and adequate for the screening of sleep disturbances in children from 2 to 10 years old

Determinants of tuberculosis transmission and treatment abandonment in Fortaleza, Brazil

BACKGROUND: Tuberculosis (TB) remains a public health problem, despite recent achievements in reducing incidence and mortality rates. In Brazil, these achievements were above the worldwide average, but marked by large regional heterogeneities. In Fortaleza (5th largest city in Brazil), the tuberculosis cure rate has been declining and treatment abandonment has been increasing in the past decade, despite a reduction in incidence and an increase in directly observed therapy (DOT). These trends put efforts to eliminate tuberculosis at risk. We therefore sought to determine social and programmatic determinants of tuberculosis incidence and treatment abandonment in Fortaleza. METHODS: We analyzed sociodemographic and clinical data for all new tuberculosis cases notified in the Notifiable Diseases Information System (SINAN) from Fortaleza between 2007 and 2014. We calculated incidence rates for 117 neighborhoods in Fortaleza, assessed their spatial clustering, and used spatial regression models to quantify associations between neighborhood-level covariates and incidence rates. We used hierarchical logistic regression models to evaluate how individual- and neighborhood-level covariates predicted tuberculosis treatment abandonment. RESULTS: There were 12,338 new cases reported during the study period. Case rates across neighborhoods were significantly positively clustered in two low-income areas close to the city center. In an adjusted model, tuberculosis rates were significantly higher in neighborhoods with lower literacy, higher sewerage access and homicide rates, and a greater proportion of self-reported black residents. Treatment was abandoned in 1901 cases (15.4%), a rate that rose by 71% between 2007 and 2014. Abandonment was significantly associated with many individual sociodemographic and clinical factors. Notably, being recommended for DOT was protective for those who completed DOT, but associated with abandonment for those who did not. CONCLUSION: Low socioeconomic status areas have higher tuberculosis rates, and low socioeconomic individuals have higher risk of treatment abandonment, in Fortaleza. Treatment abandonment rates are growing despite the advent of universal DOT recommendations in Brazil. Proactive social policies, and active contact tracing to find missed cases, may help reduce the tuberculosis burden in this setting

Perinatal Stroke: 11 Cases

Introdução: Os acidentes vasculares cerebrais (AVC) são causa de epilepsia e perturbações do neurodesenvolvimento. Têm tido uma incidencia crescente atribuível em parte à melhoria das tecnicas de imagens cerebrais. Alguns diagnósticos são efectuados retrospectivamente após o periodo neonatal. O objectivo da presente serie de casos clínicos foi identificar factores comuns que possam facilitar o diagnóstico no período neonatal. Material e métodos: Estudo retrospectivo efectuado com base na consulta dos processos clinicos dos recém-nascidos, com diagnóstico de AVC entre um de Janeiro de 2003 e 31 de Dezembro de 2013. Resultados: Foram identificados onze casos de AVC perinatal, num total 28382 nados-vivos. Dois casos foram diagnosticados no periodo fetal e nove no periodo neonatal. As convulsões foram a manifestação clinica mais frequente (8 em 11 casos). A mediana da idade de diagnóstico foi um dia e variou entre um e nove dias. A ecografia transfontanelar mostrou alterações em sete casos. A ressonancia magnetica nuclear cranio-encefalica mostrou alterações em todos os casos. Cinco AVC foram arteriais isquemicos, quatro hemorragicos e dois tromboses dos seios venosos. Em seis casos foram identificadas possiveis causas. Foram observadas complicações e sequelas em quatro dos casos. Discussão: As convulsões foram a manifestação clinica mais frequentemente encontrada.Em recém-nascidos de termo com convulsões sem historia de asfixia intraparto o AVC perinatal deverá ser diagnóstico de exclusão, mesmo na ausencia de alterações na ecografia transfontanelar

Effects of chronic exercise on severity, quality of life and functionality in an elderly Parkinson’s disease patient: case report

Exercise produces potential influences on physical and mental capacity in patients with neuropsychiatric disor- ders, and can be made a viable form of therapy to treat Parkinson’s disease (PD). We report the chronic effects of a regu- lar physical exercise protocol on cognitive and motor functions, functional capacity, and symptoms in an elderly PD pa- tient without dementia. The patient participated of a program composed of proprioceptive, aerobic and flexibility exer- cises, during 1 hour, three days a week, for nine months. Patient used 600 mg of L-DOPA daily, and 1 hour prior to each exercise session. Assessment was conducted in three stages, 0-3, 3-6 and 6 to 9 months, using percentual variation to the scales Hoehn and Yahr, Mini-Mental State Examination (MMSE), Parkinson Activity Scale (PAS), Beck Depression In- ventory (BDI), and Unified Parkinson's Disease Rating Scale (UPDRS-III). Reassessment showed clear changes in clini- cal parameters for Hoehn and Yahr (4 to 2.5), MMSE (14 to 22), PAS (13 to 29), BDI (9 to 7) and UPDRS-III (39 to 27) at the end of 9 months. According to our data, exercise seems to be effective in promoting the functional capacity and the maintenance of cognitive and motor functions of PD patients. Regular exercise protocols can be implemented as an ad- junctive treatment for reducing the severity of PD

Electronic Spin Transport in Dual-Gated Bilayer Graphene

The elimination of extrinsic sources of spin relaxation is key in realizing the exceptional intrinsic spin transport performance of graphene. Towards this, we study charge and spin transport in bilayer graphene-based spin valve devices fabricated in a new device architecture which allows us to make a comparative study by separately investigating the roles of substrate and polymer residues on spin relaxation. First, the comparison between spin valves fabricated on SiO2 and BN substrates suggests that substrate-related charged impurities, phonons and roughness do not limit the spin transport in current devices. Next, the observation of a 5-fold enhancement in spin relaxation time in the encapsulated device highlights the significance of polymer residues on spin relaxation. We observe a spin relaxation length of ~ 10 um in the encapsulated bilayer with a charge mobility of 24000 cm2/Vs. The carrier density dependence of spin relaxation time has two distinct regimes; n<4 x 1012 cm-2, where spin relaxation time decreases monotonically as carrier concentration increases, and n>4 x 1012 cm-2, where spin relaxation time exhibits a sudden increase. The sudden increase in the spin relaxation time with no corresponding signature in the charge transport suggests the presence of a magnetic resonance close to the charge neutrality point. We also demonstrate, for the first time, spin transport across bipolar p-n junctions in our dual-gated device architecture that fully integrates a sequence of encapsulated regions in its design. At low temperatures, strong suppression of the spin signal was observed while a transport gap was induced, which is interpreted as a novel manifestation of impedance mismatch within the spin channel

Transport Spectroscopy of Symmetry-Broken Insulating States in Bilayer Graphene

The flat bands in bilayer graphene(BLG) are sensitive to electric fields E\bot directed between the layers, and magnify the electron-electron interaction effects, thus making BLG an attractive platform for new two-dimensional (2D) electron physics[1-5]. Theories[6-16] have suggested the possibility of a variety of interesting broken symmetry states, some characterized by spontaneous mass gaps, when the electron-density is at the carrier neutrality point (CNP). The theoretically proposed gaps[6,7,10] in bilayer graphene are analogous[17,18] to the masses generated by broken symmetries in particle physics and give rise to large momentum-space Berry curvatures[8,19] accompanied by spontaneous quantum Hall effects[7-9]. Though recent experiments[20-23] have provided convincing evidence of strong electronic correlations near the CNP in BLG, the presence of gaps is difficult to establish because of the lack of direct spectroscopic measurements. Here we present transport measurements in ultra-clean double-gated BLG, using source-drain bias as a spectroscopic tool to resolve a gap of ~2 meV at the CNP. The gap can be closed by an electric field E\bot \sim13 mV/nm but increases monotonically with a magnetic field B, with an apparent particle-hole asymmetry above the gap, thus providing the first mapping of the ground states in BLG.Comment: 4 figure

Strain-induced Evolution of Electronic Band Structures in a Twisted Graphene Bilayer

Here we study the evolution of local electronic properties of a twisted graphene bilayer induced by a strain and a high curvature. The strain and curvature strongly affect the local band structures of the twisted graphene bilayer; the energy difference of the two low-energy van Hove singularities decreases with increasing the lattice deformations and the states condensed into well-defined pseudo-Landau levels, which mimic the quantization of massive Dirac fermions in a magnetic field of about 100 T, along a graphene wrinkle. The joint effect of strain and out-of-plane distortion in the graphene wrinkle also results in a valley polarization with a significant gap, i.e., the eight-fold degenerate Landau level at the charge neutrality point is splitted into two four-fold degenerate quartets polarized on each layer. These results suggest that strained graphene bilayer could be an ideal platform to realize the high-temperature zero-field quantum valley Hall effect.Comment: 4 figure

Neck and supraclavicular lymphadenopathy secondary to 9-valent human papillomavirus vaccination

We present two clinical cases of lymphadenopathy after vaccination with the human papillomavirus (HPV) 9-valent vaccine: an asymptomatic 11-year-old boy with inferior cervical and supraclavicular lymphadenopathy, and a 13-year-old girl who presented with lymphadenopathy. In both cases, medical history was unremarkable and there was no recent infection, or other clinical findings. Both adolescents had received the HPV 9-valent vaccine in the previous week. In the first case, blood tests, ultrasonography and biopsy were performed, while in the second, a watchful waiting strategy was adopted. In both cases, the lymphadenopathy resolved spontaneously. The boy received the second dose of the vaccine 6 months later and lymphadenopathy reappeared. The Naranjo scale was applied, classifying the events as definite (in the case of the boy) and probable (girl) adverse drug reactions. The vaccine is safe, but recognising this minor adverse event is important to prevent unnecessary investigation and reduce patient and parental anxiety.info:eu-repo/semantics/publishedVersio

Large tunable valley splitting in edge-free graphene quantum dots on boron nitride

Coherent manipulation of binary degrees of freedom is at the heart of modern quantum technologies. Graphene offers two binary degrees: the electron spin and the valley. Efficient spin control has been demonstrated in many solid state systems, while exploitation of the valley has only recently been started, yet without control on the single electron level. Here, we show that van-der Waals stacking of graphene onto hexagonal boron nitride offers a natural platform for valley control. We use a graphene quantum dot induced by the tip of a scanning tunneling microscope and demonstrate valley splitting that is tunable from -5 to +10 meV (including valley inversion) by sub-10-nm displacements of the quantum dot position. This boosts the range of controlled valley splitting by about one order of magnitude. The tunable inversion of spin and valley states should enable coherent superposition of these degrees of freedom as a first step towards graphene-based qubits