Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 59
Filtrar
1.
J Prosthet Dent ; 2024 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-38972799

RESUMO

Computer-aided design and computer-aided manufacturing (CAD-CAM) technologies have been integrated into the dental digital workflow. However, pretreatment virtual veneer preparations and the digital design and manufacturing of guided preparation and cementation templates has not yet been incorporated into the clinical routine. This article presents a novel protocol for digitally guided veneer rehabilitation by following the esthetic integration area concept, facilitating precise control over tooth structure removal and obviating the need for interim restorations.

2.
Transplant Direct ; 10(6): e1649, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38817627

RESUMO

Background: Uncontrolled donation after circulatory death (uDCD) increases organ availability for kidney transplantation (KT) at the expense of a higher risk of primary graft nonfunction (PNF). At least half of the cases of PNF are secondary to graft venous thrombosis. The potential benefit from prophylactic anticoagulation in this scenario remains unclear. Methods: In this single-center retrospective study we compared 2 consecutive cohorts of KT from uDCD with increased (≥0.8) renal resistive index (RRI) in the Doppler ultrasound examination performed within the first 24-72 h after transplantation: 36 patients did not receive anticoagulation ("nonanticoagulation group") and 71 patients underwent prophylactic anticoagulation until normalization of RRI in follow-up Doppler examinations ("anticoagulation group"). Results: Anticoagulation was initiated at a median of 2 d (interquartile range, 2-3) after transplantation and maintained for a median of 12 d (interquartile range, 7-18). In 4 patients (5.6%), anticoagulation had to be prematurely stopped because of the development of a hemorrhagic complication. In comparison with the nonanticoagulation group, recipients in the anticoagulation group had a lower 2-wk cumulative incidence of graft venous thrombosis (19.4% versus 0.0%; P < 0.001) and PNF (19.4% versus 2.8%; P = 0.006). The competing risk analysis with nonthrombotic causes of PNF as the competitive event confirmed the higher risk of graft thrombosis in the nonanticoagulation group (P = 0.0001). The anticoagulation group had a higher incidence of macroscopic hematuria (21.1% versus 5.6%; P = 0.049) and blood transfusion requirements (39.4% versus 19.4%; P = 0.050) compared with the nonanticoagulation group. No graft losses or deaths were attributable to complications potentially associated with anticoagulation. Conclusions: Early initiation of prophylactic anticoagulation in selected KT recipients from uDCD with an early Doppler ultrasound RRI of ≥0.8 within the first 24-72 h may reduce the incidence of graft venous thrombosis as a cause of PNF.

3.
Rev. urug. cardiol ; 39(1): e201, 2024. tab
Artigo em Espanhol | LILACS, BNUY, UY-BNMED | ID: biblio-1565799

RESUMO

Introducción: la falla aguda del ventrículo derecho (VD) en el posoperatorio de cirugía cardíaca (POCC) constituye un desafío clínico por su importante morbimortalidad. El reconocimiento de la importancia de la función del VD en el POCC es un hecho reciente, lo que puede evidenciarse por la ausencia de parámetros de función ventricular derecha en los scores de estratificación del riesgo quirúrgico. Su definición varía según diferentes autores; es difícil conocer su prevalencia y los factores asociados a su desarrollo. Objetivo: analizar la prevalencia, las características clínicas, ecocardiográficas y el pronóstico de los pacientes con falla del VD en el POCC valvular intervenidos en el Instituto Nacional de Cirugía Cardíaca (INCC) en el año 2021 y establecer una comparación con los pacientes intervenidos en el mismo período que no desarrollaron dicha complicación. Método: estudio observacional retrospectivo, analítico. Se incluyeron los pacientes sometidos a cirugía cardíaca valvular en el INCC durante el 2021 que no presentaban ciertos criterios de exclusión preestablecidos. Se consideró la falla aguda del VD en el POCC como la evidencia ecocardiográfica de disfunción ventricular derecha definida cualitativamente en el ecocardiograma posoperatorio. El análisis estadístico se realizó con el software SPSS versión 26.0. Resultados: se incluyeron en el estudio 45 pacientes, de los cuales 7 (15,6%) desarrollaron falla del VD en el POCC. No hubo diferencias entre las características basales. El grupo que desarrolló falla del VD en el POCC presentó una fracción de eyección del ventrículo izquierdo (FEVI) significativamente menor en el ecocardiograma preoperatorio (p = 0,010). No se objetivaron diferencias en las variables intraoperatorias. Respecto al pronóstico, falleció un paciente de cada grupo en el POCC inmediato. Conclusiones: la FEVI preoperatoria podría cumplir un rol predictor de falla aguda del VD en el POCC valvular, hallazgo para comprobar en estudios prospectivos. El impacto de la falla del VD en la mortalidad no pudo definirse, dado el limitado número de pacientes.


Introduction. acute right ventricle (RV) failure in the postoperative period of cardiac surgery (POCC) constitutes a clinical challenge due to its significant morbidity and mortality. Recognition of the RV function importance in POCC is a recent fact, which can be evidenced by the absence of right ventricular function parameters in surgical risk stratification scores. Its definition varies according to different authors, it is difficult to know its prevalence and the factors associated with its development. Objective: to analyze the prevalence, clinical and echocardiographic characteristics, and prognosis of patients with RV failure in valvular POCC operated at the National Institute of Cardiac Surgery (INCC) in 2021 and to establish a comparison with patients operated on in the same period who did not develop this complication. Method: retrospective analytical observational study. Patients undergoing heart valve surgery in the INCC during 2021 were included. Acute RV failure in the POCC was considered as echocardiographic evidence of qualitatively defined right ventricular dysfunction in the postoperative echocardiogram. Statistical analysis was performed using SPSS version 26.0 software. Results: forty-five patients were included in the study, of which 7 (15.6%) developed RV failure in the POCC. There were no differences between baseline characteristics. The group that developed RV failure in POCC had a significantly lower left ventricular ejection fraction (LVEF) on preoperative echocardiography (p = 0.010). No differences were observed in the intraoperative variables. Regarding the prognosis, one patient from each group died in the immediate POCC. Conclusions: preoperative LVEF could play a role in predicting acute RV failure in valvular POCC, a finding to be verified in prospective studies. The impact of RV failure on mortality could not be defined given the limited number of patients.


Introdução: a insuficiência aguda do ventrículo direito (VD) no pós-operatório de cirurgia cardíaca (CCPO) constitui um desafio clínico devido à sua significativa morbidade e mortalidade. O reconhecimento da importância da função do VD no CCPO é fato recente, o que pode ser evidenciado pela ausência de parâmetros de função ventricular direita nos escores de estratificação de risco cirúrgico. Sua definição varia de acordo com diferentes autores, é difícil conhecer sua prevalência e os fatores associados ao seu desenvolvimento. Meta: analisar a prevalência, as características clínicas e ecocardiográficas e o prognóstico dos pacientes com insuficiência de VD em POCC valvular operados no Instituto Nacional de Cirurgia Cardíaca (INCC) em 2021 e estabelecer uma comparação com pacientes operados no mesmo período que não desenvolveram essa complicação. Método: estudo observacional analítico retrospectivo. Foram incluídos pacientes submetidos à cirurgia valvar no INCC durante o ano de 2021. Insuficiência aguda do VD no POCC foi considerada como evidência ecocardiográfica de disfunção ventricular direita qualitativamente definida no ecocardiograma pós-operatório. A análise estatística foi realizada com o software SPSS versão 26.0. Resultados: quarenta e cinco pacientes foram incluídos no estudo, dos quais 7 (15,6%) desenvolveram falência do VD no POCC. Não houve diferenças entre as características basais. O grupo que evoluiu com falência do VD no POCC apresentou fração de ejeção do ventrículo esquerdo (FEVE) significativamente menor no ecocardiograma pré-operatório (p = 0,010). Não foram observadas diferenças nas variáveis intraoperatórias. Quanto ao prognóstico, um paciente de cada grupo faleceu no POCC imediato. Conclusões: a FEVE pré-operatória poderia desempenhar um papel na predição de insuficiência aguda do VD no CCPO valvular, achado para ser verificado em estudos prospectivos. O impacto da falência do VD na mortalidade não pôde ser definido devido ao número limitado de pacientes.


Assuntos
Humanos , Complicações Pós-Operatórias , Disfunção Ventricular Direita/epidemiologia , Disfunção Ventricular Direita/diagnóstico por imagem , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Prognóstico , Prevalência , Estudos Retrospectivos
4.
Environ Mol Mutagen ; 64(8-9): 466-472, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37984337

RESUMO

The aim of this study was twofold: (1) evaluate the effect of benzo[a]pyrene (BaP) on expression levels of AQP3 and Notch1 genes in HaCaT cells exposed "in vitro" and (2) investigate the possible biological role of assessed genes by bioinformatics methods. Cells were exposed to increasing concentrations of BaP (0.0-4.0 µM) for 1-4 days. After treatments, cell viability and expression levels of AhR, CYP1A1, AQP3, and Notch1 genes were evaluated. The possible biological role of assessed genes was evaluated using bioinformatics tools. Low cytotoxicity in HaCaT cells dosed with BaP was detected. A significant overexpression (p < .05) of CYP1A1, AQP3, and Notch1 was found in exposed HaCaT cells. The gene expression upregulation was dependent on AhR activation. The bioinformatics analysis showed that these genes were enriched in related cancer signaling pathways. The findings suggest that AQP3 and Notch1 are upregulated by AhR activation in HaCaT cells exposed to BaP.


Assuntos
Benzo(a)pireno , Citocromo P-450 CYP1A1 , Humanos , Citocromo P-450 CYP1A1/genética , Citocromo P-450 CYP1A1/metabolismo , Benzo(a)pireno/metabolismo , Células HaCaT , Receptores de Hidrocarboneto Arílico/genética , Receptores de Hidrocarboneto Arílico/metabolismo , Regulação para Cima
6.
Int J Environ Health Res ; : 1-11, 2023 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-37930997

RESUMO

Emerging scientific studies have supported the hypothesis that exposure to environmental chemicals increases the incidence of diverse human metabolic disorders. Therefore, this study aimed to evaluate the association between fluoride exposure and metabolic syndrome (MetS) prevalence in people from the Central Region of Mexico. This research included 575 adult individuals. Urinary fluoride concentrations were determined using a potentiometric method. Anthropometric measurements and blood pressure were also acquired. Serum fasting glucose and lipid levels were quantified. For the MetS screening, we used the International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. The mean urinary fluoride levels were 3.50 ± 2.50 mg/L. The prevalence of MetS was approximately 27 and 25% according to NCEP ATP III and IDF criteria, respectively. A multivariate logistic regression analysis showed significant associations (p < 0.05) between urinary fluoride concentrations and MetS occurrence using NCEP ATP III criteria (OR = 1.60; 95% CI 1.05-2.10) and IDF criteria (OR = 1.35; 95% CI 0.95-1.45). These findings emphasize the need to discover the underlying mechanisms that fluoride exposure has on MetS pathogenesis.

7.
Cir Esp (Engl Ed) ; 101 Suppl 4: S3-S7, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37979938

RESUMO

Gastroesophageal reflux disease (GERD) is a complex entity and one of the most frequents in general population. Association of GERD with obesity is clearly defined from an epidemiological point of view, where up to 40% of patients with overweight and obesity present reflux. Most of the risk factors associated to GERD are shared and especially frequent in patients with obesity. The pathophysiology that explain this correlation is complex and multifactorial, and includes both aspects related to physiology of motility, and anatomic changes. The malfunction of the lower esophageal sphincter, the greater transdiaphragmatic pressure gradient, pathological accumulation of fat and the high rate of hiatal hernia that comes with overweight will be the main factors that explain this correlation. Other factor like pathological eating habits or obesity related diseases have also an important role. In summary, it is the sum of the factors more than just one of them what would explain the pathophysiology of GERD in obese population.


Assuntos
Refluxo Gastroesofágico , Hérnia Hiatal , Humanos , Sobrepeso/complicações , Refluxo Gastroesofágico/complicações , Esfíncter Esofágico Inferior , Hérnia Hiatal/complicações , Obesidade/complicações , Obesidade/epidemiologia
9.
Resuscitation ; 189: 109863, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37302687

RESUMO

AIM: To analyse the association between donor capnometry data and the short-term evolution of kidney grafts in cases of uncontrolled donation after circulatory death (uDCD). METHOD: We used an ambispective observational study design, conducted in the Community of Madrid between January and December 2019, inclusive. Patients who suffered out-of-hospital cardiac arrest (CA) with no response to advanced cardiopulmonary resuscitation (CPR) were selected as potential donors. Donor capnometry levels were measured at the start, midpoint and transfer to hospital then compared with indicators of renal graft evolution. RESULTS: The initial selection included 34 possible donors, of which 12 (35.2%) were viable donors from whom 22 (32.3%) kidneys were recovered. There was a correlation between the highest capnometry values and less need for post-transplant dialysis (≥24 mmHg, p < 0.017), fewer dialysis sessions and fewer days to recover correct renal function (Rho -0.47, p < 0.044). There was a significant inverse correlation between the capnometry values at transfer and 1-month post-transplant creatinine levels (Rho -0.62, p < 0.033). There were no significant differences between the capnometry values at transfer and primary nonfunction (PNF) or warm ischaemia time. One-year patient survival was 100% for patient receiving organ donation, while graft survival was 95%. CONCLUSIONS: Capnometry levels at transfer are a useful predictor of the short-term function and viability of kidney transplants from uncontrolled donations after circulatory death.


Assuntos
Transplante de Rim , Transplante de Órgãos , Obtenção de Tecidos e Órgãos , Humanos , Rim , Doadores de Tecidos , Sobrevivência de Enxerto , Morte
10.
Plants (Basel) ; 12(12)2023 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-37375988

RESUMO

Blueberry is a highly demanded and consumed fruit due to its beneficial effects on human health, because of its bioactive compounds with a high antioxidant capacity. The interest in increasing the yield and quality of blueberries has led to the application of some innovative techniques such as biostimulation. The objective of this research was to assess the effect of the exogenous application of glutamic acid (GLU) and 6-benzylaminopurine (6-BAP) as biostimulants on flower bud sprouting, fruit quality, and antioxidant compounds in blueberry cv. Biloxi. The application of GLU and 6-BAP positively affected bud sprouting, fruit quality, and antioxidant content. The application of 500 and 10 mg L-1 GLU and 6-BAP, respectively, increased the number of flower buds, while 500 and 20 mg L-1 generated fruits with higher content of flavonoids, vitamin C, and anthocyanins and higher enzymatic activity of catalase and ascorbate peroxidase enzymes. Hence, the application of these biostimulants is an effective way to enhance the yield and fruit quality of blueberries.

11.
Opt Lett ; 48(8): 2178-2181, 2023 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-37058671

RESUMO

We introduce and demonstrate the concept of a multipixel detector integrated at the tip of an individual multicore fiber. A pixel consists here of an aluminum-coated polymer microtip incorporating a scintillating powder. Upon irradiation, the luminescence released by the scintillators is efficiently transferred into the fiber cores owing to the specifically elongated metal-coated tips that ensure efficient luminescence matching to the fiber modes. With each pixel being selectively coupled to one of the cores of the multicore optical fiber, the resulting fiber-integrated x ray detection process is totally free from inter-pixel cross talk. Our approach holds promise for fiber-integrated probes and cameras for remote x and gamma ray analysis and imaging in hard-to-reach environments.

14.
Environ Toxicol Pharmacol ; 97: 104032, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36473620

RESUMO

Recent studies have demonstrated that dichlorodiphenyldichloroethylene (DDE) induced a pro-inflammatory condition in peripheral blood mononuclear cells (PBMC). However, the molecular mechanisms implicated in this condition are poorly understood. Therefore, this study aimed to evaluate miR-155, miR-126, and miR-21 expression levels in PBMC exposed "in vitro" to DDE. PBMC were dosed with increasing concentrations of DDE (10-80 µg mL-1) at different treatment times (0-24 h). The results showed an up-regulation in the expression levels of assessed miRNAs (miR-155, miR-146, and miR-21) after PBMCs were exposed to DDE. Besides, bioinformatic analysis was performed to understand the biological roles of assessed miRNAs. The bioinformatic analysis shows that assessed miRNAs are associated with regulating signaling pathways involved in cancer, apoptosis, cell cycle, inflammation, metabolism, etc. These findings offer new insights into the molecular mechanisms related to the inflammatory processes and their regulation induced by DDE in PBMC exposed "in vitro".


Assuntos
Leucócitos Mononucleares , MicroRNAs , Humanos , Leucócitos Mononucleares/metabolismo , Apoptose , Regulação para Cima , Inflamação/induzido quimicamente , Inflamação/metabolismo
15.
Int J Mol Sci ; 25(1)2023 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-38203684

RESUMO

Ovarian cancer (OC) incidence and mortality peaks at post-menopause while OC risk is either reduced by parity or increased by nulliparity during fertile life. The long-term effect of nulliparity on ovarian gene expression is largely unknown. In this study, we describe a bioinformatic/data-mining analysis of 112 coding genes upregulated in the aged nulliparous (NP) mouse ovary compared to the aged multiparous one as reference. Canonical gene ontology and pathway analyses indicated a pro-oxidant, xenobiotic-like state accompanied by increased metabolism of inflammatory lipid mediators. Up-regulation of typical epithelial cell markers in the aged NP ovary was consistent with synchronized overexpression of Cldn3, Ezr, Krt7, Krt8 and Krt18 during the pre-neoplastic phase of mOSE cell cultures in a former transcriptome study. In addition, 61/112 genes were upregulated in knockout mice for Fshr and for three other tumor suppressor genes (Pten, Cdh1 and Smad3) known to regulate follicular homeostasis in the mammalian ovary. We conclude that the aged NP ovary displays a multifaceted stress state resulting from oxidative imbalance and pro-inflammatory lipid signaling. The enriched epithelial cell content might be linked to follicle depletion and is consistent with abundant clefts and cysts observed in aged human and mouse ovaries. It also suggests a mesenchymal-to-epithelial transition in the mOSE of the aged NP ovary. Our analysis suggests that in the long term, nulliparity worsens a variety of deleterious effects of aging and senescence thereby increasing susceptibility to cancer initiation in the ovary.


Assuntos
Perfilação da Expressão Gênica , Morfolinas , Compostos Organosselênicos , Neoplasias Ovarianas , Humanos , Animais , Camundongos , Feminino , Gravidez , Idoso , Paridade , Lipídeos , Mamíferos
16.
Mol Psychiatry ; 27(9): 3708-3718, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35705634

RESUMO

Schizophrenia (SZ) is a complex neuropsychiatric disorder, affecting 1% of the world population. Long-standing clinical observations and molecular data have pointed to a possible vascular deficiency that could be acting synergistically with neuronal dysfunction in SZ. As SZ is a neurodevelopmental disease, the use of human-induced pluripotent stem cells (hiPSC) allows disease biology modeling while retaining the patient's unique genetic signature. Previously, we reported a VEGFA signaling impairment in SZ-hiPSC-derived neural lineages leading to decreased angiogenesis. Here, we present a functional characterization of SZ-derived brain microvascular endothelial-like cells (BEC), the counterpart of the neurovascular crosstalk, revealing an intrinsically defective blood-brain barrier (BBB) phenotype. Transcriptomic assessment of genes related to endothelial function among three control (Ctrl BEC) and five schizophrenia patients derived BEC (SZP BEC), revealed that SZP BEC have a distinctive expression pattern of angiogenic and BBB-associated genes. Functionally, SZP BEC showed a decreased angiogenic response in vitro and higher transpermeability than Ctrl BEC. Immunofluorescence staining revealed less expression and altered distribution of tight junction proteins in SZP BEC. Moreover, SZP BEC's conditioned media reduced barrier capacities in the brain microvascular endothelial cell line HCMEC/D3 and in an in vivo permeability assay in mice. Overall, our results describe an intrinsic failure of SZP BEC for proper barrier function. These findings are consistent with the hypothesis tracing schizophrenia origins to brain development and BBB dysfunction.


Assuntos
Células-Tronco Pluripotentes Induzidas , Esquizofrenia , Humanos , Animais , Camundongos , Células-Tronco Pluripotentes Induzidas/metabolismo , Barreira Hematoencefálica/metabolismo , Esquizofrenia/metabolismo , Encéfalo , Linhagem Celular
17.
Rev. urug. cardiol ; 37(1): e701, jun. 2022. ilus
Artigo em Espanhol | LILACS, UY-BNMED, BNUY | ID: biblio-1390036

RESUMO

La endocarditis infecciosa es una patología heterogénea con una alta mortalidad y requiere tratamiento quirúrgico en al menos la mitad de los casos. Cuando asienta en posición mitral, la reparación valvular en lugar de su sustitución, si bien representa un desafío técnico, ha ido ganando terreno en los últimos años. Describimos el caso de un paciente que se presentó con una endocarditis sobre válvula nativa mitral en quien se realizó una plastia valvular exitosa. Revisaremos la evidencia acerca de su beneficio.


Infective endocarditis is a heterogeneous disease with a high mortality and that requires surgical treatment in at least half of cases. When seated in mitral position, valve repair rather than replacement, while technically challenging, has been gaining popularity in recent years. We describe the case of a patient who presented with a mitral valve endocarditis in whom a successful valve repair was performed. Evidence supporting its use will be reviewed.


A endocardite infecciosa é uma doença heterogênea com alta mortalidade que requer tratamento cirúrgico em pelo menos metade dos casos. Quando sentado na posição mitral, o reparo da válvula, em vez da substituição da válvula, embora seja um desafio técnico, tem ganhado espaço nos últimos anos. Descrevemos o caso de um paciente que apresentou endocardite valvar mitral nativa, no qual foi realizada plastia valvar com sucesso. Vamos revisar as evidências sobre o seu benefício.


Assuntos
Humanos , Masculino , Adulto , Infecções Estafilocócicas/cirurgia , Endocardite Bacteriana/cirurgia , Insuficiência da Valva Mitral/cirurgia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Cefazolina/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/diagnóstico por imagem , Antibacterianos/uso terapêutico , Insuficiência da Valva Mitral/microbiologia , Insuficiência da Valva Mitral/tratamento farmacológico , Insuficiência da Valva Mitral/diagnóstico por imagem
18.
Rev. urug. cardiol ; 37(1): e402, jun. 2022. ilus, tab
Artigo em Espanhol | LILACS, UY-BNMED, BNUY | ID: biblio-1390040

RESUMO

Introducción: la hipertensión pulmonar asociada a cardiopatías congénitas del adulto implica un amplio espectro de situaciones clínicas complejas de difícil manejo para el cardiólogo clínico. Revisión: se repasarán los principales aspectos fisiopatológicos relacionados con el desarrollo de hipertensión pulmonar en los diferentes grupos de cardiopatías congénitas, así como los criterios para establecer el diagnóstico. Se discutirá el tratamiento guiado por perfil de riesgo y los grupos farmacológicos disponibles en nuestro medio. Por último, se discutirán grupos especiales, como el síndrome de Eisenmenger y la embarazada con cardiopatía e hipertensión pulmonar. Conclusión: es importante tener presente de todas formas que la hipertensión pulmonar en este escenario puede tener un mal pronóstico (como en el síndrome de Eisenmenger), por lo cual se deben realizar los mayores esfuerzos para hacer un diagnóstico precoz y tratamiento oportuno de estos pacientes.


Introduction: pulmonary hypertension associated with congenital heart disease in adults involves a wide spectrum of complex clinical situations that are difficult to manage for the clinical cardiologist. Review: the main pathophysiological aspects related to the development of pulmonary hypertension in the different groups of congenital heart disease will be reviewed, as well as the criteria to establish the diagnosis. Treatment guided by risk profile and the pharmacological groups available in our setting will be discussed. Finally, special groups such as Eisenmenger syndrome and pregnant women with heart disease and pulmonary hypertension will be discussed. Conclusion: it is important to keep in mind, however, that pulmonary hypertension in this scenario could have a poor prognosis (for example in Eisenmenger syndrome), which is why every effort should be made to make an early diagnosis and timely treatment of these patients.


Introdução: a hipertensão pulmonar associada à cardiopatia congênita em adultos envolve um amplo espectro de situações clínicas complexas e de difícil manejo para o cardiologista clínico. Revisão: serão revistos os principais aspectos fisiopatológicos relacionados ao desenvolvimento da hipertensão pulmonar nos diferentes grupos de cardiopatias congênitas, bem como os critérios para estabelecer o diagnóstico. Serão discutidos o tratamento guiado pelo perfil de risco e os grupos farmacológicos disponíveis em nosso meio. Por fim, serão discutidos grupos especiais como síndrome de Eisenmenger e gestantes com cardiopatia e hipertensão pulmonar. Conclusão: de qualquer forma, é importante ter em mente que a hipertensão pulmonar nesse cenário pode ter um prognóstico ruim (como na síndrome de Eisenmenger), razão pela qual todo esforço deve ser feito para o diagnóstico precoce e tratamento oportuno desses pacientes.


Assuntos
Humanos , Adulto , Cardiopatias Congênitas/complicações , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia
19.
Infect Genet Evol ; 101: 105288, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35489699

RESUMO

Drug resistant tuberculosis (DR-TB) is an important public health issue in different parts of the world. Mycobacterium tuberculosis complex variants (MTBC vars) preferentially infect certain hosts, limiting their distribution to different ecosystems. However, MTBC vars can infect other hosts beyond their preferred target potentially contributing to persistence of drug resistance (DR) in other niches. Here, we performed a comprehensive intra-host genetic analysis for the identification of DR-related mutations among all MTBC minor vars whole genome sequences (8,095 strains) publicly available worldwide. High confidence drug-resistance mutations in katG (isoniazid), rpsL (streptomycin), pncA (pyrazinamide), rpoB (rifampicin) and gyrA (fluoroquinolones) genes were identified among intrahost minor sub-populations in 197 different strains (2.43%) belonging to vars africanum, bovis, caprae, microti, orygis and pinnipedii. In addition, a three-dimensional structure modeling analysis to assess the role of novel mutations was also performed. Our findings highlight the importance of detecting discrete intra-host populations carrying DR mutations.


Assuntos
Mycobacterium tuberculosis , Tuberculose Resistente a Múltiplos Medicamentos , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Resistência a Medicamentos , Ecossistema , Humanos , Testes de Sensibilidade Microbiana , Mutação , Mycobacterium tuberculosis/genética , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia
20.
Obes Surg ; 32(3): 704-711, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34981326

RESUMO

PURPOSE: Cholelithiasis is an issue in bariatric surgery patients. The incidence of cholelithiasis is increased in morbidly obese patients. After bariatric surgery, the management maybe sometimes challenging. There is no consensus about how to deal with cholelithiasis prior to bariatric surgery. MATERIALS AND METHODS: A retrospective review from our prospectively collected bariatric surgery database. Primary bariatric procedures from 2009 to 2020 were included. Prevalence of cholelithiasis and its management prior to bariatric surgery and the incidence and management of postoperative biliary events were analyzed. RESULTS: Over 1445 patients analyzed, preoperatively cholelithiasis was found in 153 (10.58%), and 68 out of them (44.44%) were symptomatic. Seventy-six patients had a concomitant cholecystectomy. In those cases, the bariatric procedure did not show increased operative time, length of stay, morbidity, or mortality compared to the rest of primary bariatric procedures. Twelve patients (15.58%) with previous cholelithiasis and no concomitant cholecystectomy presented any kind of biliary event and required cholecystectomy. De novo cholelithiasis rate requiring cholecystectomy was 3.86%. Postoperative biliary events both in de novo and persistent cholelithiasis population did not show any difference between the type of surgery, weight loss, and other characteristics. CONCLUSIONS: Cholelithiasis was present in 10.58% of our primary bariatric surgery population. Concomitant cholecystectomy was safe in our series. Non-surgical management of asymptomatic cholelithiasis did not lead to a higher risk of postoperative biliary events. The global postoperative cholecystectomy rate was equivalent to the general population.


Assuntos
Cirurgia Bariátrica , Colelitíase , Obesidade Mórbida , Cirurgia Bariátrica/métodos , Colecistectomia/métodos , Colelitíase/epidemiologia , Colelitíase/etiologia , Colelitíase/cirurgia , Humanos , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA