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1.
Int J Environ Health Res ; : 1-21, 2024 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-39206834

RESUMO

The present review aimed to evaluate the current situation of pesticide residues detected in shrimp (commercial species) on the Mexican coasts. The organochlorine pesticides (OC), α-endosulfan (210.01 ng g-1), endosulfan sulfate (127.5 ng g-1), heptachlor (126.04 ng g-1 and γ-HCH (121.04 ng g-1) are identified as the most common pesticides in shrimp tissues, with the Northwest area reporting the highest concentrations of these OC. Given that there is an under-evaluation of pesticide residue levels, there was a greater contribution of studies directed at the Northwest of the country considering that there are states that are among the main shrimp-producing and consumers entities. The concentrations and types of pesticides banned nationally and globally, due to their toxic effects on the population, were reported. Therefore, since the most current information is 19 years out of date, it is necessary to perform recent evaluations with sensible and precise methods.

2.
Eur J Med Chem ; 258: 115573, 2023 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-37379675

RESUMO

Zika and dengue viruses cause mosquito-borne diseases of high epidemic relevance. The viral NS2B-NS3 proteases play crucial roles in the pathogen replication cycle and are validated drug targets. They can adopt at least two conformations depending on the position of the NS2B cofactor. Recently, we reported ligand-induced conformational changes of dengue virus NS2B-NS3 protease by single-molecule Förster resonance energy transfer (smFRET). Here, we investigated the conformational dynamics of the homologous Zika virus protease through an integrated methodological approach combining smFRET, thermal shift assays (DSF and nanoDSF) and 19F NMR spectroscopy. Our results show that allosteric inhibitors favor the open conformation and competitive inhibitors stabilize the closed conformation of the Zika virus protease.


Assuntos
Infecção por Zika virus , Zika virus , Animais , Peptídeo Hidrolases , Transferência Ressonante de Energia de Fluorescência , Serina Endopeptidases/metabolismo , Proteínas não Estruturais Virais , Conformação Proteica , Espectroscopia de Ressonância Magnética , Inibidores de Proteases/farmacologia , Inibidores de Proteases/química
3.
Clin Res Cardiol ; 2023 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-37341769

RESUMO

AIMS: Heart failure (HF) guidelines recommend treating all patients with HF and reduced ejection fraction (HFrEF) with quadruple therapy, although they do not establish how to start it. This study aimed to evaluate the implementation of these recommendations, analyzing the efficacy and safety of the different therapeutic schedules. METHODS AND RESULTS: Prospective, observational, and multicenter registry that evaluated the treatment initiated in patients with newly diagnosed HFrEF and its evolution at 3 months. Clinical and analytical data were collected, as well as adverse reactions and events during follow-up. Five hundred and thirty-three patients were included, selecting four hundred and ninety-seven, aged 65.5 ± 12.9 years (72% male). The most frequent etiologies were ischemic (25.5%) and idiopathic (21.1%), with a left ventricular ejection fraction of 28.7 ± 7.4%. Quadruple therapy was started in 314 (63.2%) patients, triple in 120 (24.1%), and double in 63 (12.7%). Follow-up was 112 days [IQI 91; 154], with 10 (2%) patients dying. At 3 months, 78.5% had quadruple therapy (p < 0.001). There were no differences in achieving maximum doses or reducing or withdrawing drugs (< 6%) depending on the starting scheme. Twenty-seven (5.7%) patients had any emergency room visits or admission for HF, less frequent in those with quadruple therapy (p = 0.02). CONCLUSION: It is possible to achieve quadruple therapy in patients with newly diagnosed HFrEF early. This strategy makes it possible to reduce admissions and visits to the emergency room for HF without associating a more significant reduction or withdrawal of drugs or significant difficulty in achieving the target doses.

4.
Int J Mol Sci ; 24(6)2023 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-36982434

RESUMO

Organophosphate pesticides (OPs) have greatly facilitated food production worldwide, and their use is not limited to agriculture and the control of pests and disease vectors. However, these substances can directly affect the immune response of non-target organisms. In this sense, exposure to OPs can have negative effects on innate and adaptive immunity, promoting deregulation in humoral and cellular processes such as phagocytosis, cytokine expression, antibody production, cell proliferation, and differentiation, which are crucial mechanisms for host defense against external agents. This review focuses on the scientific evidence of exposure to OPs and their toxic effects on the immune system of non-target organisms (invertebrates and vertebrates) from a descriptive perspective of the immuno-toxic mechanisms associated with susceptibility to the development of bacterial, viral, and fungal infectious diseases. During the exhaustive review, we found that there is an important gap in the study of non-target organisms, examples of which are echinoderms and chondrichthyans. It is therefore important to increase the number of studies on other species directly or indirectly affected by Ops, to assess the degree of impact at the individual level and how this affects higher levels, such as populations and ecosystems.


Assuntos
Inseticidas , Praguicidas , Animais , Ecossistema , Invertebrados , Vertebrados , Compostos Organofosforados , Imunidade , Organofosfatos , Praguicidas/toxicidade
5.
Exp Hematol ; 119-120: 21-27, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36623718

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a global health problem; this has caused thousands of deaths around the world. This infection induces hematologic alterations, and it is necessary to recognize predictive biomarkers to address the need for hospitalization or the severity of the disease. This study aimed to analyze different parameters in outpatients and hospitalized patients infected with SARS-CoV-2 and determine whether hematic biometry can be used for prognosis rapidly. We analyzed 689 patients, of whom 355 were outpatients (162 women and 193 men) and 334 required hospitalization (197 men and 137 women). The average age of the hospitalized patients was 46 years (men, 49 years; women, 52 years), whereas the average age of the outpatients was 49 years (men, 51 years; women, 44 years). Hematologic parameters were analyzed and compared between the outpatients and hospitalized patients. The patients were divided into groups by age and sex. We found that in the hospitalized patients, the erythrocyte, hematocrit, and hemoglobin levels decreased, whereas the outpatients did not experience changes in the erythroid series. In leukocytes, these increased significantly, as they did in neutrophils; however, lymphocytopenia was observed. In the outpatients, we observed normal levels of neutrophils and lymphopenia. We can conclude that hematic biometry can be used as a biomarker, and the relation between neutrophils and lymphocytes is indicated for understanding the development and prognosis of the disease.


Assuntos
COVID-19 , SARS-CoV-2 , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Prognóstico , Hospitalização
6.
Nicotine Tob Res ; 25(6): 1184-1193, 2023 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-36069915

RESUMO

INTRODUCTION: Available evidence is mixed concerning associations between smoking status and COVID-19 clinical outcomes. Effects of nicotine replacement therapy (NRT) and vaccination status on COVID-19 outcomes in smokers are unknown. METHODS: Electronic health record data from 104 590 COVID-19 patients hospitalized February 1, 2020 to September 30, 2021 in 21 U.S. health systems were analyzed to assess associations of smoking status, in-hospital NRT prescription, and vaccination status with in-hospital death and ICU admission. RESULTS: Current (n = 7764) and never smokers (n = 57 454) did not differ on outcomes after adjustment for age, sex, race, ethnicity, insurance, body mass index, and comorbidities. Former (vs never) smokers (n = 33 101) had higher adjusted odds of death (aOR, 1.11; 95% CI, 1.06-1.17) and ICU admission (aOR, 1.07; 95% CI, 1.04-1.11). Among current smokers, NRT prescription was associated with reduced mortality (aOR, 0.64; 95% CI, 0.50-0.82). Vaccination effects were significantly moderated by smoking status; vaccination was more strongly associated with reduced mortality among current (aOR, 0.29; 95% CI, 0.16-0.66) and former smokers (aOR, 0.47; 95% CI, 0.39-0.57) than for never smokers (aOR, 0.67; 95% CI, 0.57, 0.79). Vaccination was associated with reduced ICU admission more strongly among former (aOR, 0.74; 95% CI, 0.66-0.83) than never smokers (aOR, 0.87; 95% CI, 0.79-0.97). CONCLUSIONS: Former but not current smokers hospitalized with COVID-19 are at higher risk for severe outcomes. SARS-CoV-2 vaccination is associated with better hospital outcomes in COVID-19 patients, especially current and former smokers. NRT during COVID-19 hospitalization may reduce mortality for current smokers. IMPLICATIONS: Prior findings regarding associations between smoking and severe COVID-19 disease outcomes have been inconsistent. This large cohort study suggests potential beneficial effects of nicotine replacement therapy on COVID-19 outcomes in current smokers and outsized benefits of SARS-CoV-2 vaccination in current and former smokers. Such findings may influence clinical practice and prevention efforts and motivate additional research that explores mechanisms for these effects.


Assuntos
COVID-19 , Abandono do Hábito de Fumar , Humanos , Nicotina/uso terapêutico , Estudos de Coortes , Mortalidade Hospitalar , Vacinas contra COVID-19/uso terapêutico , Universidades , Wisconsin , COVID-19/epidemiologia , COVID-19/prevenção & controle , SARS-CoV-2 , Dispositivos para o Abandono do Uso de Tabaco , Fumar/epidemiologia , Hospitais
7.
Cancer Epidemiol Biomarkers Prev ; 32(1): 12-21, 2023 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-35965473

RESUMO

BACKGROUND: There is mixed evidence about the relations of current versus past cancer with severe COVID-19 outcomes and how they vary by patient and cancer characteristics. METHODS: Electronic health record data of 104,590 adult hospitalized patients with COVID-19 were obtained from 21 United States health systems from February 2020 through September 2021. In-hospital mortality and ICU admission were predicted from current and past cancer diagnoses. Moderation by patient characteristics, vaccination status, cancer type, and year of the pandemic was examined. RESULTS: 6.8% of the patients had current (n = 7,141) and 6.5% had past (n = 6,749) cancer diagnoses. Current cancer predicted both severe outcomes but past cancer did not; adjusted odds ratios (aOR) for mortality were 1.58 [95% confidence interval (CI), 1.46-1.70] and 1.04 (95% CI, 0.96-1.13), respectively. Mortality rates decreased over the pandemic but the incremental risk of current cancer persisted, with the increment being larger among younger vs. older patients. Prior COVID-19 vaccination reduced mortality generally and among those with current cancer (aOR, 0.69; 95% CI, 0.53-0.90). CONCLUSIONS: Current cancer, especially among younger patients, posed a substantially increased risk for death and ICU admission among patients with COVID-19; prior COVID-19 vaccination mitigated the risk associated with current cancer. Past history of cancer was not associated with higher risks for severe COVID-19 outcomes for most cancer types. IMPACT: This study clarifies the characteristics that modify the risk associated with cancer on severe COVID-19 outcomes across the first 20 months of the COVID-19 pandemic. See related commentary by Egan et al., p. 3.


Assuntos
COVID-19 , Neoplasias , Adulto , Humanos , Vacinas contra COVID-19 , Pandemias , Universidades , Wisconsin , COVID-19/epidemiologia , Neoplasias/epidemiologia , Neoplasias/terapia , Hospitalização
8.
PLoS One ; 17(9): e0274571, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36170336

RESUMO

MAIN OBJECTIVE: There is limited information on how patient outcomes have changed during the COVID-19 pandemic. This study characterizes changes in mortality, intubation, and ICU admission rates during the first 20 months of the pandemic. STUDY DESIGN AND METHODS: University of Wisconsin researchers collected and harmonized electronic health record data from 1.1 million COVID-19 patients across 21 United States health systems from February 2020 through September 2021. The analysis comprised data from 104,590 adult hospitalized COVID-19 patients. Inclusion criteria for the analysis were: (1) age 18 years or older; (2) COVID-19 ICD-10 diagnosis during hospitalization and/or a positive COVID-19 PCR test in a 14-day window (+/- 7 days of hospital admission); and (3) health system contact prior to COVID-19 hospitalization. Outcomes assessed were: (1) mortality (primary), (2) endotracheal intubation, and (3) ICU admission. RESULTS AND SIGNIFICANCE: The 104,590 hospitalized participants had a mean age of 61.7 years and were 50.4% female, 24% Black, and 56.8% White. Overall risk-standardized mortality (adjusted for age, sex, race, ethnicity, body mass index, insurance status and medical comorbidities) declined from 16% of hospitalized COVID-19 patients (95% CI: 16% to 17%) early in the pandemic (February-April 2020) to 9% (CI: 9% to 10%) later (July-September 2021). Among subpopulations, males (vs. females), those on Medicare (vs. those on commercial insurance), the severely obese (vs. normal weight), and those aged 60 and older (vs. younger individuals) had especially high mortality rates both early and late in the pandemic. ICU admission and intubation rates also declined across these 20 months. CONCLUSIONS: Mortality, intubation, and ICU admission rates improved markedly over the first 20 months of the pandemic among adult hospitalized COVID-19 patients although gains varied by subpopulation. These data provide important information on the course of COVID-19 and identify hospitalized patient groups at heightened risk for negative outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04506528 (https://clinicaltrials.gov/ct2/show/NCT04506528).


Assuntos
COVID-19 , Unidades de Terapia Intensiva , Adulto , Idoso , COVID-19/mortalidade , COVID-19/terapia , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Intubação Intratraqueal , Masculino , Medicare , Pessoa de Meia-Idade , Pandemias , Estados Unidos/epidemiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-35565114

RESUMO

Governments have implemented measures to minimize SARS-CoV-2 spread. However, these measures were relaxed, and the appearance of new variants has prompted periods of high contagion known as waves. In Mexico, four waves distributed between July and August 2020, January and February 2021, August and September 2021, and January and February 2022 have appeared. Current health policies discourage mass sampling, preferring to focus on the corrective treatment of severe cases. Outpatients are only advised to undergo brief voluntary confinement and symptomatic treatment, with no follow-up. Therefore, the present study aimed to analyze sex, age, and viral load in outpatients during the four waves in a medium-sized city in Mexico. For each wave, the date of peak contagion was identified, and data were collected within ±15 days. In this regard, data from 916 patients (434 men and 482 women) were analyzed. The age range of positive patients (37-45 years) presented a higher frequency during the first and third waves, while 28-36 years was the most frequent age range during the second and fourth waves, while the viral load values were significantly higher, for both sexes, during the fourth wave. Obtained data of COVID-19 prevalence in population segments can be used for decision-making in the design of effective public health policies.


Assuntos
COVID-19 , SARS-CoV-2 , Adulto , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Testes Sorológicos , Carga Viral
10.
Artigo em Inglês | MEDLINE | ID: mdl-35409524

RESUMO

The COVID-19 pandemic highlighted health systems vulnerabilities, as well as thoughtlessness by governments and society. Due to the nature of this contingency, the use of geographic information systems (GIS) is essential to understand the SARS-CoV-2 distribution dynamics within a defined geographic area. This work was performed in Tepic, a medium-sized city in Mexico. The residence of 834 COVID-19 infected individuals was georeferenced and categorized by viral load (Ct). The analysis took place during the maximum contagion of the first four waves of COVID-19 in Mexico, analyzing 158, 254, 143, and 279 cases in each wave respectively. Then heatmaps were built and categorized into five areas ranging from very low to very high risk of contagion, finding that the second wave exhibited a greater number of cases with a high viral load. Additionally, a spatial analysis was performed to measure urban areas with a higher risk of contagion, during this wave this area had 19,203.08 km2 (36.11% of the city). Therefore, a kernel density spatial model integrated by meaningful variables such as the number of infected subjects, viral load, and place of residence in cities, to establish geographic zones with different degrees of infection risk, could be useful for decision-making in future epidemic events.


Assuntos
COVID-19 , SARS-CoV-2 , COVID-19/epidemiologia , Sistemas de Informação Geográfica , Humanos , México/epidemiologia , Pandemias , Carga Viral
11.
Biomol NMR Assign ; 16(1): 81-86, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34988902

RESUMO

ATP binding cassette (ABC) proteins are present in all phyla of life and form one of the largest protein families. The Bacillus subtilis ABC transporter BmrA is a functional homodimer that can extrude many different harmful compounds out of the cell. Each BmrA monomer is composed of a transmembrane domain (TMD) and a nucleotide binding domain (NBD). While the TMDs of ABC transporters are sequentially diverse, the highly conserved NBDs harbor distinctive conserved motifs that enable nucleotide binding and hydrolysis, interdomain communication and that mark a protein as a member of the ABC superfamily. In the catalytic cycle of an ABC transporter, the NBDs function as the molecular motor that fuels substrate translocation across the membrane via the TMDs and are thus pivotal for the entire transport process. For a better understanding of the structural and dynamic consequences of nucleotide interactions within the NBD at atomic resolution, we determined the 1H, 13C and 15N backbone chemical shift assignments of the 259 amino acid wildtype BmrA-NBD in its post-hydrolytic, ADP-bound state.


Assuntos
Transportadores de Cassetes de Ligação de ATP , Bacillus , Bacillus/metabolismo , Bacillus subtilis/metabolismo , Hidrólise , Ressonância Magnética Nuclear Biomolecular , Nucleotídeos/metabolismo
12.
Emergencias ; 28(2): 121-123, 2016.
Artigo em Espanhol | MEDLINE | ID: mdl-29105435

RESUMO

EN: We report 3 cases of left iliac vein thrombosis whose underlying cause was right iliac artery compression syndrome, also known as May-Thurner syndrome. Endovascular treatment with anatomical correction (stent placement) was applied in 2 of the cases; anticoagulant therapy was maintained given the presence of associated hypercoagulability. A thorough understanding of this diagnosis is important so that an attempt at anatomical correction can be proposed to complement anticoagulant therapy in the interest of improving prognosis.


ES: Se presentan 3 casos de trombosis de la vena ilíaca izquierda que como causa subyacente presentaban una compresión por parte de la arteria ilíaca derecha, lo cual es conocido como síndrome de May-Thurner. Se procedió en 2 de ellos a tratamiento endovascular con corrección anatómica mediante colocación de un stent, manteniendo la anticoagulación por presentar trombofilia asociada. Es importante conocer esta entidad, para además de aplicar la anticoagulación, intentar realizar una corrección anatómica que mejore el pronóstico del enfermo.

14.
Health Aff (Millwood) ; 33(11): 1985-92, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25367994

RESUMO

The Washington Heights-Inwood section of Manhattan is a predominantly poor Hispanic community with disproportionately high rates of chronic disease, including asthma, diabetes, and congestive heart failure. In October 2010, NewYork-Presbyterian Hospital, in association with the Columbia University Medical Center, launched an integrated network of patient-centered medical homes that were linked to other providers and community-based resources and formed a "medical village." Three years later, a study of 5,852 patients who had some combination of diabetes, asthma, and congestive heart failure found that emergency department visits and hospitalizations had been reduced by 29.7 percent and 28.5 percent, respectively, compared to the year before implementation of the network. Thirty-day readmissions and average length-of-stay declined by 36.7 percent and 4.9 percent, respectively. Patient satisfaction scores improved across all measures. Financially, NewYork-Presbyterian experienced a short-term return on investment of 11 percent. Some of the gain was a result of increased reimbursements from New York State. Nonetheless, these findings demonstrate that academic medical centers can improve outcomes for poor communities by building regional care models centering on medical homes that incorporate patient-centered processes and are linked through information systems and service collaborations to hospitals, specialty practices, and community-based providers and organizations.


Assuntos
Relações Comunidade-Instituição , Comportamento Cooperativo , Assistência Centrada no Paciente/organização & administração , Programas Médicos Regionais/organização & administração , Hospitais Urbanos , Humanos , Área Carente de Assistência Médica , Cidade de Nova Iorque , Estudos de Casos Organizacionais , Áreas de Pobreza , Avaliação de Programas e Projetos de Saúde
15.
Rev Med Inst Mex Seguro Soc ; 52(5): 598-9, 2014.
Artigo em Espanhol | MEDLINE | ID: mdl-25301136

RESUMO

BACKGROUND: Penoscrotal lymphedema (scrotal elephantiasis) is a condition that has been described in areas in which filariasis is endemic. CASE REPORT: This paper presents a case of a 45-year-old man with idiopathic lymphedema isolated to the scrotum. After acquired causes of lymphedema were ruled out, the patient was treated with scrotectomy and penoscrotal reconstruction. Currently, the patient is receiving follow-up care without evidence of recurrence. CONCLUSIONS: Penoscrotal lymphedema may cause symptoms of weakness, immobility and emotional disturbance. Surgery procedure provides a satisfactory cosmetical and functional outcome.


Introducción: el linfedema penoescrotal (también conocido como elefantiasis penoescrotal) es una condición que históricamente se ha descrito en áreas en las que la filariasis es endémica. Caso clínico: presentamos el caso de un hombre de 45 años de edad con linfedema escrotal. Después de descartar las causas adquiridas de linfedema, el paciente fue sometido a escrotectomía, prepuciectomía y reconstrucción escrotal y peneana. Actualmente el paciente se encuentra en seguimiento, sin datos de recidiva. Conclusión: el linfedema penoescrotal puede causar síntomas de debilidad e inmovilidad, así como problemas psicológicos. La cirugía otorga resultados cosméticos y funcionales aceptables.


Assuntos
Elefantíase , Doenças dos Genitais Masculinos , Escroto , Elefantíase/diagnóstico , Elefantíase/cirurgia , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
16.
Rev Med Inst Mex Seguro Soc ; 52(2): 224-7, 2014.
Artigo em Espanhol | MEDLINE | ID: mdl-24758864

RESUMO

BACKGROUND: Adrenal gland involvement is a very rare extranodal presentation of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease). Its pathogenesis still remains unknown with many theories about its probable cause. Symptoms and signs of adrenal involvement presentation are uncertain. Although, it is a disease with a good prognosis and a favorable clinical course in most cases, the low index of suspicion and difficulty in radiological differential diagnosis lead to radical treatment. CLINICAL CASE: We present a case of Rosai-Dorfman disease with right adrenal plus left infrahiliar nodal involvement. It was treated with adrenalectomy and node exeresis. The infrahilial involvement evolution was appropriate. CONCLUSIONS: Rosai-Dorfman disease is a rare disease and the extra-nodal presentation is even more rare. The incidence and evolution of this disease in the adrenal gland is unknown. The presence of this pathology should be considered if the patient shows adrenal gland affected and lymph node growth, in order to consider the individualized treatment, which may vary (treatment with corticosteroids, chemotherapy and/or radiotherapy).


INTRODUCCIÓN: la afectación extranodal de la glándula suprarrenal es una forma infrecuente de la histiocitosis sinusal con linfadenopatía masiva o enfermedad de Rosai-Dorfman. Aún se desconoce la etiopatogenia de esta enfermedad. Los síntomas y signos de presentación en la afectación adrenal son inciertos. Aunque es una enfermedad de buen pronóstico y curso clínico favorable, el bajo índice de sospecha y el difícil diagnóstico radiológico diferencial llevan a tratamiento radical en la mayoría de los casos. CASO CLÍNICO: se describe el caso de una paciente con enfermedad de Rosai-Dorfman en quien se identificó tumor adrenal derecho de 97 × 99 × 68 mm y tumor nodal infrahiliar izquierdo de 61 × 58 × 57 mm. El tratamiento incluyó adrenalectomía y vigilancia activa del tumor infrahilial mediante tomografía y gammagrama renal. La evolución de la paciente fue adecuada. CONCLUSIONES: la enfermedad de Rosai-Dorfman es una patología poco común y su presentación extranodal es todavía más extraña. La incidencia y evolución de la enfermedad en glándula suprarrenal se desconocen. Esta patología debe ser considerada en glándula suprarrenal cuando hay afección adrenal y crecimiento nodal, para plantear el tratamiento individualizado que puede variar entre vigilancia activa, tratamiento con corticosteroides, quimioterapia y radioterapia.


Assuntos
Doenças das Glândulas Suprarrenais/etiologia , Histiocitose Sinusal/complicações , Feminino , Histiocitose Sinusal/diagnóstico , Humanos , Pessoa de Meia-Idade
17.
Diabetes Care ; 36(4): 1006-11, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23193212

RESUMO

OBJECTIVE: Oxidized lipoproteins and antioxidized LDL antibodies (antioxLDL abs) have been detected in human plasma and atherosclerotic lesions. The principle aim of this study was to analyze the possible relationship between IgG and IgM antioxLDL abs and factors involved in different metabolic pathways (inflammation, lipid metabolism, apoptosis, and cell cycle arrest profile) in the occluded popliteal artery (OPA) compared with the femoral vein (FV). RESEARCH DESIGN AND METHODS: Fifteen patients with advanced atherosclerosis and type 2 diabetes undergoing lower limb amputation participated in this study. Each patient had OPA and FV biopsy specimens and peripheral arterial occlusive disease. By real-time PCR, gene expression was analyzed from the OPA and FV specimens, and antioxLDL ab levels were measured by specific enzyme-linked immunosorbent assay. RESULTS: The OPA and FV showed a positive correlation between only IgM antioxLDL ab levels and the expression of genes involved in different metabolic pathways, including inflammation (TFPI), apoptosis (BAX, caspase 3, AKT1), plaque disruption (MMP2 and MMP10), lipid metabolism (SCARB1, PPARg), and cell turnover (CDKN1A), and genes for transcription and growth factors (NFkB and VEGFA, respectively). CONCLUSIONS: The results show that gene expression in the metabolic pathways (apoptosis, lipid metabolism, and inflammation) in the OPA and FV are directly related to the levels of IgM antioxLDL abs.


Assuntos
Anticorpos/imunologia , Diabetes Mellitus Tipo 2/imunologia , Diabetes Mellitus Tipo 2/metabolismo , Placa Aterosclerótica/imunologia , Placa Aterosclerótica/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Veia Femoral/imunologia , Veia Femoral/metabolismo , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Lipoproteínas LDL/imunologia , Masculino , Redes e Vias Metabólicas/imunologia , Redes e Vias Metabólicas/fisiologia , Pessoa de Meia-Idade , Artéria Poplítea/imunologia , Artéria Poplítea/metabolismo , Reação em Cadeia da Polimerase em Tempo Real , Adulto Jovem
18.
Health Aff (Millwood) ; 30(10): 1955-64, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21976340

RESUMO

Communities of poor, low-income immigrants with limited English proficiency and disproportionate health burdens pose unique challenges to health providers and policy makers. NewYork-Presbyterian Hospital developed the Regional Health Collaborative, a population-based health care model to improve the health of the residents of Washington Heights-Inwood. This area is a predominantly Hispanic community in New York City with high rates of asthma, diabetes, heart disease, and depression. NewYork-Presbyterian created an integrated network of patient-centered medical homes to form a "medical village" linked to other providers and community-based resources. The initiative set out to document the priority health needs of the community, target high-prevalence conditions, improve cultural competence among providers, and introduce integrated information systems across care sites. The first six months of the program demonstrated a significant 9.2 percent decline in emergency department visits for ambulatory care-sensitive conditions and a 5.8 percent decrease in hospitalizations that was not statistically significant. This initiative offers a model for other urban academic medical centers to better serve populations facing social and cultural barriers to care.


Assuntos
Relações Comunidade-Instituição , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Hispânico ou Latino , Assistência Centrada no Paciente/organização & administração , Serviços Urbanos de Saúde/organização & administração , Centros Médicos Acadêmicos , Comportamento Cooperativo , Necessidades e Demandas de Serviços de Saúde , Humanos , Avaliação das Necessidades , Cidade de Nova Iorque , Desenvolvimento de Programas , Protestantismo , Fatores Socioeconômicos , População Urbana
19.
J Health Care Poor Underserved ; 22(2): 562-75, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21551934

RESUMO

The impact of social and economic determinants of health status and the existence of racial and ethnic health care access disparities have been well-documented. This paper describes a model, the Health Care Access Barriers Model (HCAB), which provides a taxonomy and practical framework for the classification, analysis and reporting of those modifiable health care access barriers that are associated with health care disparities. The model describes three categories of modifiable health care access barriers: financial, structural, and cognitive. The three types of barriers are reciprocally reinforcing and affect health care access individually or in concert. These barriers are associated with screening, late presentation to care, and lack of treatment, which in turn result in poor health outcomes and health disparities. By targeting those barriers that are measurable and modifiable the model facilitates root-cause analysis and intervention design.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Disparidades em Assistência à Saúde/etnologia , Modelos Organizacionais , Prática Clínica Baseada em Evidências , Disparidades nos Níveis de Saúde , Humanos , Programas de Rastreamento , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Fatores Socioeconômicos
20.
Interciencia ; 32(9): 601-609, sept. 2007. tab, graf
Artigo em Espanhol | LILACS | ID: lil-502734

RESUMO

Se realizó una Evaluación Ecológica Rápida de la ictiofauna en cinco áreas (áreas piloto, AP) del delta del río Orinoco que incluyeron al delta superior (AP1), medio (AP2 y AP5) e inferior (AP3 y AP4), todas ubicadas, a excepción de AP1, dentro de la Reserva de Biosfera Delta del Orinoco (RBDO). Se realizaron tres campañas del campo desde set/2002 a may/2003. Se evaluaron entre 14 y 16 estaciones que incluyeron caños principales, secundarios y lagunas. La colecta de peces se realizó con redes de ahorque experimentales en horas diurnas (8:00-18:30) con un esfuerzo neto total de pesca de 23,2 y 37,6h para la primera y segunda campaña de colecta, respectivamente. Se capturaron 80 especies, 7 de las cuales son nuevos registros para el delta, el cual posee 394 especies, de las que 50 por ciento están presentes en la RBDO. En AP1 se obtuvo la mayor riqueza, diversidad y equidad de especies; allí existe una serie de ambientes lagunares únicos en el delta y probablemente representa una fuente importante de reclutas para otras áreas del mismo. Los invertebrados bénticos, el necton y la materia orgánica de origen terrestre fueron las tres grandes fuentes alimenticias de la ictiofauna deltaica evaluada y su importancia relativa varió espacial y temporalmente. Este estudio amplía la distribución espacial del cíclido foráneo Caquetaia Kraussii. La alteración antrópica sobre la ictiofauna del delta del Orinico puede considerarse baja hasta ahora y la mayor presión tiene lugar en el delta Superior, sin evidencia de acciones que la reviertan.


Assuntos
Animais , Fauna Aquática , Rios , Ecossistema Tropical , Ecologia , Venezuela
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