RESUMEN

BACKGROUND: Late-relapsing hepatitis after yellow fever (LHep-YF) during the convalescent phase of the disease has been described during recent yellow fever (YF) outbreaks in Brazil. LHep-YF is marked by a rebound in liver enzymes and nonspecific clinical manifestations around 46-60 days after YF symptom onset. METHODS: Here we have characterized the clinical course and risk factors for LHep-YF using data from a representative cohort of patients who survived YF in Brazil, 2017-2018. A total of 221 YF-positive patients were discharged from the infectious disease reference hospital in Minas Gerais and were followed up at 30, 45, and 60 days post-symptom onset. RESULTS: From 46 to 60 days post-symptom onset, 16% of YF patients (n = 36/221) exhibited a rebound of aminotransferases (aspartate aminotransferase or alanine aminotransferase >500 IU/L), alkaline phosphatase, and total bilirubin levels. Other etiologies of liver inflammation such as infectious hepatitis, autoimmune hepatitis, and metabolic liver disease were ruled out. Jaundice, fatigue, headache, and low platelet levels were associated with LHep-YF. Demographic factors, clinical manifestations, laboratory tests, ultrasound findings, and viral load during the acute phase of YF were not associated with the occurrence of LHep-YF. CONCLUSIONS: These findings provide new data on the clinical course of Late-relapsing hepatitis during the convalescent phase of YF and highlight the need for extended patient follow-up after acute YF.

Asunto(s)

RESUMEN

People at risk of suicide tend to be isolated and cannot share their thoughts. For this reason, suicidal ideation monitoring becomes a hard task. Therefore, people at risk of suicide need to be monitored in a manner capable of identifying if and when they have a suicidal ideation, enabling professionals to perform timely interventions. This study aimed to develop the Boamente tool, a solution that collects textual data from users' smartphones and identifies the existence of suicidal ideation. The solution has a virtual keyboard mobile application that passively collects user texts and sends them to a web platform to be processed. The platform classifies texts using natural language processing and a deep learning model to recognize suicidal ideation, and the results are presented to mental health professionals in dashboards. Text classification for sentiment analysis was implemented with different machine/deep learning algorithms. A validation study was conducted to identify the model with the best performance results. The BERTimbau Large model performed better, reaching a recall of 0.953 (accuracy: 0.955; precision: 0.961; F-score: 0.954; AUC: 0.954). The proposed tool demonstrated an ability to identify suicidal ideation from user texts, which enabled it to be experimented with in studies with professionals and their patients.

RESUMEN

Objectives: Cutaneous leishmaniasis is a neglected disease, associated with high morbidity, which is partially due to the toxicity of available therapies. The pentavalent antimonial derivatives intralesional infiltration has proven to be as effective as the intravenous drug-based therapy, however, there is a lack of robust safety data.Methods: Phase II, uncontrolled, unicenter clinical trial to assess the safety profile of a standardized meglumine antimionate intralesional therapy, based on weekly infiltrations.Results: Fifty-three patients were studied, predominantly men (60%) and young adults (43.7 ± 17.1 years). Overall, 86.9% of the patients had at least one clinical adverse event. Local events were the most frequent (83%), followed by systemic ones (47.3%). Fourteen participants (26%) presented biochemical abnormalities. In all cases, laboratorial alterations were classified as mild and treatment discontinuation was not required. Differently, the two hypersensitivity (3.8%) reactions observed led to permanent treatment interruption. QTc interval prolongation was recorded in 14 patients (25.5%). The following risk associations to adverse events were identified in the multiple analysis: hypertension with systemic clinical events and smoking with QT interval prolongation.Expert commentary: In general, MA-IL was well tolerated and although associated with local and systemic adverse events, there was a low risk of high intensity or severe complications.

Asunto(s)

RESUMEN

RESUMEN Introducción: El tromboembolismo de pulmón agudo (TEP) representa la tercera causa de mortalidad cardiovascular. Sin embargo, existen pocos datos de esta patología en nuestro país. Nuestro objetivo fue describir las características basales, evolución y tratamiento implementado en pacientes con tromboembolismo de pulmón agudo en Argentina. Material y métodos: Se trata de un registro multicéntrico prospectivo que incorporó pacientes con diagnóstico de tromboembolismo de pulmón agudo internados en centros con residencia de cardiología desde octubre de 2016 a noviembre de 2017. Se realizó un análisis convencional para estadística descriptiva y comparativa. Se consideró significativo un valor de p < 0,05. Se realizó una auditoría cruzada al 20% de los centros participantes. Resultados: Se incluyeron 684 pacientes consecutivos de 75 centros, con un promedio de edad de 63,8 años; 388 (57%) eran de sexo femenino. El TEP fue el motivo de internación en 484 (71%) de los casos. Los factores predisponentes más frecuentes fueron obesidad, hospitalización reciente, reposo transitorio y cáncer activo. Se indicó anticoagulación durante la internación en 661 (97%) pacientes y terapia de reperfusión en 91 (13%). Sin embargo, solo 50 de los 102 pacientes que se presentaron con inestabilidad hemodinámica recibieron alguna terapia de reperfusión (49%). La mortalidad hospitalaria fue del 12%, principalmente relacionada con el tromboembolismo de pulmón agudo (51%). Conclusiones: El tromboembolismo de pulmón agudo en nuestro medio constituye una patología con elevada mortalidad en la internación atribuible principalmente al evento embólico. Se observó una baja utilización de terapias de reperfusión en pacientes con inestabilidad hemodinámica.

ABSTRACT Background: Acute pulmonary embolism (PE) represents the third cause of cardiovascular mortality. However, there is lack of information about this entity in our country. Our aim was to describe baseline characteristics, clinical evolution and treatment of patients with acute PE in Argentina. Methods: This was a prospective multicenter registry including patients with acute PE hospitalized in centers with cardiology residency from October 2016 to November 2017. Conventional analysis was performed for descriptive and comparative statistics. A value of p<0.05 was considered significant. Cross audit was performed to 20% of participating centers. Results: We included 684 consecutive patients from 75 centers with an average age of 63.8 years and 388 (57%) women. Hospital admission was due to PE in 484 (71%) cases. The most frequent predisposing factors were obesity, recent hospitalization, transient rest and active cancer. Anticoagulation was indicated in 661 patients (97%) and reperfusion therapy was performed in 91 (13%). However, only 50 of the 102 patients who presented with hemodynamic instability received reperfusion therapy (49%). Global in-hospital mortality was 12%, mainly associated with acute PE (51%). Conclusions: Acute pulmonary embolism presents with high in-hospital mortality in our setting, mainly related to the embolic event. We observed a low use of reperfusion therapies in patients with hemodynamic instability.