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Healthcare advocacy is the duty and privilege of all healthcare providers, but especially for those who care for children. Intersex and gender diverse youth face significant barriers across many aspects of life, with access to competent gender affirming healthcare chief among them. Understanding the importance of both institutional and individual efforts in healthcare advocacy is paramount to improving healthcare access and outcomes for this population.
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Defesa do Paciente , Pessoas Transgênero , Humanos , Feminino , Masculino , Criança , Acessibilidade aos Serviços de Saúde , Adolescente , Assistência à Saúde Afirmativa de GêneroRESUMO
Background: While the short-term prognosis of cardiac arrest patients - nearly 250,000 new cases per year in Europe - has been extensively studied, less is known regarding the mid and long-term outcome of survivors. Objective: The aim of the DESAC study is to describe mid- and long-term survival rate and functional status of cardiac arrest survivors, and to assess the influence of pre and intra hospital therapeutic strategies on these two outcomes. Methods: Between Jul 2015 and Oct 2018, adult patients over 18 years who were discharged alive from any intensive care units (public and private hospitals) in the Ile-de-France area (Paris and suburbs, France) after a non-traumatic cardiac arrest were screened for participation in this multicentric study. Survivors were included after they signed (or the proxies) an informed consent before discharge during initial hospitalisation. We calculated that including 600 patients in total would allow an 80% power to demonstrate a 2 years survival rate difference of 10% between patients who did and those who did not receive therapeutic hypothermia after resuscitation. Pre- and in-hospital data related to the circumstances surrounding the event and to the therapeutic interventions (such as cardio-pulmonary resuscitation, defibrillation, emergent coronary revascularization, neuroprotective therapeutics) were collected. After discharge, patients were interviewed at 3 months, 6 months and every year thereafter for a minimum follow-up of 26 months and a maximum follow-up of 48 months. Information on vital status, occurrence of cardiovascular events, medications and a comprehensive assessment of the functional status (qualitive of life as assessed by the Short-Form General Health Survey (SF36) scale, activities of daily living (ADL) scale, neurological Cerebral Performance Categories (CPC) and Overall Performance Categories (OPC) scales, socio-professional activities) were collected at follow-up interviews. Discussion: The DESAC study should provide important information regarding several dimensions of the mid and long-term prognosis of cardiac arrest survivors and on the benefit (and potentially harm) of early therapeutic strategies.
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Meckel's diverticulum is a congenital anomaly leading to the formation of a true diverticulum in the distal small intestine. Though most are asymptomatic and discovered incidentally, Meckel's diverticuli can give rise to a wide range of symptoms. Rarely, this can be a malignancy, most commonly a carcinoid tumor. Other cancers have also been reported, with adenocarcinomas being particularly rare. Here, we report the case of a 62-year-old man presenting to the emergency room with vague gastrointestinal symptoms. Subsequent workup revealed a 3 cm mass in the distal jejunum/proximal ileum, which was located within a previously undiagnosed Meckel's diverticulum. The mass was sent to pathology, who confirmed an adenocarcinoma arising from a small bowel diverticulum. This case serves as an important reminder of the malignant potential of a Meckel's diverticulum and adds to the ongoing discussion regarding whether prophylactic diverticulectomy should be recommended to patients with a known Meckel's diverticulum.
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Doenças das Cartilagens , Embolia , Doenças da Medula Espinal , Doenças das Cartilagens/complicações , Doenças das Cartilagens/diagnóstico por imagem , Embolia/complicações , Embolia/diagnóstico por imagem , Humanos , Infarto/diagnóstico por imagem , Infarto/etiologia , Medula Espinal/diagnóstico por imagemAssuntos
Anticorpos Antibacterianos/imunologia , Imunoglobulina G/imunologia , Polissacarídeos Bacterianos/imunologia , Doenças da Imunodeficiência Primária/diagnóstico , Vacinas Tíficas-Paratíficas/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doadores de Tecidos , Adulto JovemRESUMO
Resumen Introducción: Para analizar cuál es la mejor alternativa para la recuperación del paciente comatoso tras la lesión cerebral traumática grave en su contexto agudo, entre 1-6 semanas tras el evento traumático, se realizó una búsqueda bibliográfica sistemática. Metodología: La búsqueda empleó las principales bases de datos (Pubmed, Embase, Ovid y Cochrane) con la finalidad de discernir qué terapias son las más propicias para una correcta mejora neurocognitiva del enfermo. Se profundizará en la estimulación sensorial, las diversas instrucciones que se han recopilado sobre su aplicación clínica, el por qué de su efectividad, cuáles son los mejores tipos de estimulación y el fenómeno de habituación. Resultados: Este campo será el de la estimulación sensorial multimodal: por un lado, el uso de la estimulación sensorial que surge de los familiares y que se muestra ciertamente efectiva; y por otro lado, la realización de sesiones en las que intervenga personal del hospital y que estimule los diferentes sentidos. A partir de ciertos estudios se deducirá y comprobará que habrá un efecto positivo significativo al combinar ambas terapias. Esta unión sinérgica terapéutica será la que se pueda protocolizar y llevar a cabo en cualquier hospital. Conclusiones: Por tanto, se presenta el tratamiento terapéutico definitivo para pacientes clínicamente estables que han sufrido una LCT grave en un contexto agudo. Se debe destacar que el principal objetivo de la propuesta es aportar indicaciones a partir de la experiencia clínica sobre cómo se tienen que hacer los diferentes tipos de estimulación para obtener un resultado favorable.
Introduction: To analyze which is the best alternative for the recovery of the comatose patient after severe traumatic brain injury in its acute context, between 1-6 weeks after the traumatic event, a systematic bibliographic search was carried out. Methodology: The search used the main databases (Pubmed, Embase, Ovid and Cochrane) in order to discern which therapies are most conducive to a correct neurocognitive improvement of the patient. The sensory stimulation will be deepened, the various instructions that have been compiled about its clinical application, the why of its effectiveness, which are the best types of stimulation and the habituation phenomenon. Results: This field will be that of multimodal sensory stimulation: on the one hand, the use of sensory stimulation that emerges from the relatives and that is certainly effective; and on the other hand, the realization of sessions in which hospital personnel intervene and stimulate the different senses. From certain studies it will be deduced and verified that there will be a significant positive effect when combining both therapies. This synergistic therapeutic union will be the one that can be protocolized and carried out in any hospital. Conclusions: Therefore, definitive therapeutic treatment is presented for clinically stable patients who have suffered a severe TBI in an acute context. It should be noted that the main objective of the proposal is to provide indications based on clinical experience on how different types of stimulation have to be done in order to obtain a favorable result.
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Humanos , Pacientes , Coma , Guias como Assunto , Instruções , Lesões Encefálicas TraumáticasRESUMO
BACKGROUND: The 1,8-Naphthalimides constitute an important class of biologically active, DNAbinding compounds. There are no available data on the synthesis of 1,8-naphthalimide derivatives with nonprotein amino acids and their biological activity. The aim of this paper was to determine the synthesis, structural characterization and cytotoxic activity of new 1-(1,3-dioxo-1H-benzo[de]isoquinolin-2(3H)-yl)cycloalkane-1- carboxylic acids with 5-, 6-, 7-, 8- and 12-membered rings as well as 2-(1,3-dioxo-1H-benzo[de]isoquinolin-2(3H)- yl)adamantane-2-carboxylic acid and 1-(1,3-dioxo-1H-benzo[de]isoquinolin-2(3H)-yl)-1,2,3,4-tetrahydronaphthalene- 1-carboxylic acid. METHODS: The target compounds were obtained by an interaction of 1,8-naphthalic anhydride with a series of non-protein amino acids. The optimized geometry and harmonic vibrational frequencies have been calculated by DFT employing B3LYP functional using 6-31G(d,p) basis set. An ab initio (MP2 and Hartee-Fock) and DFT (different functionals) using several basis sets have been applied for NMR calculations. The cytotoxic effects of the synthesized compounds are assessed against two human tumor cell lines, namely K-562 (chronic myeloid leukemia) and HUT-78 (cutaneous T-cell lymphoma) after 72 h exposure, using the MTT-dye reduction assay. The apoptogenic effects and the ability to modulate the NFκB-signaling pathways were determined using commercially available ELISA kits. RESULTS: All compounds inhibited the growth of malignant cells at micromolar concentrations whereby compound 4b (1-(1,3-dioxo-1H-benzo[de]isoquinolin-2(3H)-yl)cyclohexane-1-carboxylic acid) demonstrated superior activity in both cell lines with IC50 values comparable to those of the reference anticancer drug melphalan. CONCLUSION: New 1,8-naphthalimide derivatives with non-protein amino acids were successfully synthesized. Quantum-chemical calculations were performed to elucidate the structure of the newly synthesized compounds. There is a proper alignment between theoretical and experimental results. The cytotoxicity of the synthesized products against two human tumor cell lines, namely K-562 and HUT-78 was evaluated. All compounds inhibited the growth of malignant cells at micromolar concentrations. The pharmacodynamics evaluation of compound 4b showed that its cytotoxicity is mediated by induction of apoptosis and inhibition of NFκB-signaling.
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Aminoácidos/química , Antineoplásicos/síntese química , Naftalimidas/síntese química , Naftalimidas/farmacologia , Antineoplásicos/farmacologia , Linhagem Celular Tumoral , Teoria da Densidade Funcional , Humanos , Modelos Moleculares , Estrutura MolecularRESUMO
We have designed a systemic model to understand the effect of Photodynamic Therapy (PDT) on long time scales. The model takes into account cell necrosis due to oxygen reactive species, cell apoptosis through the caspase pathway and the competition between healthy and tumor cells. We attempted to describe the system using state of the art computational techniques (necrosis and apoptosis) and simple models that allow a deeper understanding of the long time scale processes involved (healing and tumor growth). We analyzed the influence of the surface and tumor depth on the effectiveness of different treatment plans and we proposed, for the set of parameters used in this work, an optimum timing between sessions of PDT.
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Simulação por Computador , Fotoquimioterapia , Animais , Apoptose , Caspases/metabolismo , Humanos , Necrose , Neoplasias/patologia , Neoplasias/terapia , Espécies Reativas de Oxigênio/metabolismo , Fatores de TempoRESUMO
OBJECTIVE: To determine the association between dental hygiene, gingivitis and overweight or the risk of overweight according to body mass index (BMI). METHODS: A cross-sectional study was performed with 1527 preschoolers. The children were divided into 4 groups: (i) absence of visible plaque and normal weight; (ii) absence of visible plaque and risk of overweight or overweight; (iii) presence of visible plaque and normal weight; and (iv) presence of visible plaque and risk of overweight or overweight. The clinical parameters evaluated were as follows: body mass index, degree of urban marginalization, dental caries, the simplified oral hygiene index and gingival status. Bivariate analysis and multivariate binary logistic regression models were used to identify associations between variables. RESULTS: The highest mean of gingivitis (0.28) was observed in the groups with visible plaque with normal weight and with overweight and risk of overweight. The presence of visible plaque and risk of overweight or overweight were positively associated (P = .0001) with the mean of gingivitis (OR = 8.28, 95% CI = 3.30-19.8). The absence of visible plaque and risk of overweight or overweight (P = .0001) were also positively associated with the presence of gingivitis (OR = 2.44, 95% CI = 0.68-8.06). This is after both models were adjusted by gender and degree of marginalization. CONCLUSIONS: The professionals should develop interdisciplinary approaches to (i) propose appropriate interventions to improve oral health in overweight preschoolers; and (ii) propose interventions to decrease the overweight with the possibility of also reducing its association with gingivitis.
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Placa Dentária/complicações , Gengivite/etiologia , Higiene Bucal , Sobrepeso/complicações , Índice de Massa Corporal , Pré-Escolar , Estudos Transversais , Feminino , Gengivite/prevenção & controle , Humanos , Masculino , México , Índice de Higiene Oral , Sobrepeso/prevenção & controle , Dente DecíduoRESUMO
RESUMEN La endometriosis corresponde a la presencia de glándulas endometriales o estroma en sitios distintos a la cavidad uterina. Afecta del 5 al 15% de las mujeres en edad reproductiva y se asocia a importante sintomatología. La teoría de la menstruación retrógrada propuesta por Sampson es la más aceptada para explicar su etiología. Varios estudios han asociado esta enfermedad a un riesgo aumentado de neoplasia, ésta entidad, denominada endometriosis asociada a malignidad, se localiza en sitios extra gonadales en un 20% de los casos, donde la pared abdominal no alcanza más de 30 casos reportados. Si bien no existe un tratamiento estándar, la mayoría de los autores han adaptado el protocolo de tratamiento para el cáncer de ovario asociado a endometriosis.
ABSTRACT Endometriosis corresponds to the presence of endometrial glands or stroma at sites other than the uterine cavity. It affects 5 to 15% of women of reproductive age and is associated with a significant symptomatology. The theory of retrograde menstruation proposed by Sampson is the most accepted to explain its etiology. Several studies have associated this disease with an increase in neoplasia, the entity, called endometriosis associated with malignancy, is located in extra gonadal sites in 20% of cases, where the abdominal wall does not reach more than 30 reported cases. Although there is no standard treatment, most authors have adapted the treatment for ovarian cancer associated with endometriosis.
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Humanos , Gravidez , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/patologia , Adenocarcinoma de Células Claras/diagnóstico , Endometriose/diagnóstico , Endometriose/epidemiologia , Cuidados Paliativos , Tumores do Estroma Gonadal e dos Cordões Sexuais/patologia , Diagnóstico Diferencial , Tratamento FarmacológicoRESUMO
OBJECTIVE: To determine the clinical characteristics and management of hypertensive patients with nonvalvular atrial fibrillation (AF) treated with direct oral anticoagulants (DOACs) according to blood pressure (BP) control. METHODS: For this purpose, data from two observational, cross-sectional and multicenter studies were combined. In both studies, patients on chronic treatment with anticoagulants and that were on current treatment with DOACs at least for 3 months were included. Adequate BP was defined as a systolic BP<140mmHg and a diastolic BP<90mmHg (<140/85mmHg if diabetes). RESULTS: Overall, 1036 patients were included. Of these, 881 (85%) had hypertension that were finally analyzed. The presence of other risk factors and cardiovascular disease was common. Mean BP was 132.6±14.3/75.2±9.2mmHg and 70.5% of patients achieved BP goals. Those patients with a poor BP control had more frequently diabetes, and a history of prior labile INR. Patients had a high thromboembolic risk, but without significant differences according to BP control. By contrast, more patients with a poor BP control had a higher bleeding risk (HAS-BLED ≥3: 24.0% vs 35.4%; P<0.001). HAS-BLED score was an independent predictor of poor BP control (odds ratio 1.435; 95% confidence interval 1.216-1.693; P<0.001). Satisfaction with anticoagulant treatment was independent of BP control. CONCLUSIONS: More than two thirds of our patients with hypertension and AF anticoagulated with DOACs achieve BP targets, what is clearly superior to that reported in the general hypertensive population.
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Fibrilação Atrial/complicações , Pressão Sanguínea/efeitos dos fármacos , Inibidores do Fator Xa/uso terapêutico , Hipertensão/complicações , Trombofilia/tratamento farmacológico , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/fisiopatologia , Estudos Transversais , Complicações do Diabetes/fisiopatologia , Gerenciamento Clínico , Dislipidemias/complicações , Inibidores do Fator Xa/farmacologia , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Estudos Multicêntricos como Assunto/estatística & dados numéricos , Estudos Observacionais como Assunto/estatística & dados numéricos , Satisfação do Paciente , Acidente Vascular Cerebral/prevenção & controle , Trombofilia/etiologiaRESUMO
OBJECTIVES: To determine the clinical characteristics and management of patients with non-valvular atrial fibrillation (NVAF) treated with direct oral anticoagulants (DOAC) according to who initiates their prescription, the Primary Care (PC) physician or referring the patient to a specialist. MATERIAL AND METHODS: Two observational, cross-sectional and multicentre studies were compared for this purpose. The SILVER-AP study was performed in those autonomous communities in which the PC physician can prescribe DOAC directly, and the BRONCE-AP study in those autonomous communities in which the PC physician has to refer the patient to the specialist to start treatment with DOAC. Patients on chronic treatment with anticoagulants, in whom therapy was changed, and those that were on current treatment with DOAC for at least 3months, were included. RESULTS: A total of 1,036 patients (790 from SILVER-AP study and 246 from BRONCE-AP study) were included. Compared with the BRONCE-AP study, those patients included in SILVER-AP were older and had more comorbidities, as well as a higher thromboembolic and haemorrhagic risk (CHA2DS2-VASc 4.3±1.6 vs. 3.8±1.8; P<.001; HAS-BLED 2.1±0.8 vs. 1.8±1.0; P<.001). Therapeutic adherence and satisfaction with treatment were high. Low doses of DOAC were frequently prescribed, particularly with dabigatran. CONCLUSIONS: Those patients in whom the PC physician can prescribe DOAC directly have a worse clinical profile, as well as a higher thromboembolic and haemorrhagic risk than those patients in whom the PC physician has to refer to the specialist.
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Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Atenção Primária à Saúde/estatística & dados numéricos , Especialização/estatística & dados numéricos , Administração Oral , Adulto , Estudos Transversais , Relação Dose-Resposta a Droga , Feminino , Hemorragia/epidemiologia , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta , Tromboembolia/epidemiologiaRESUMO
Photodynamic therapy (PDT) is an emergent technique used for the treatment of several diseases. After PDT, cells die by necrosis, apoptosis or autophagy. Necrosis is produced immediately during photodynamic therapy by high concentration of reactive oxygen species, apoptosis and autophagy are triggered by mild or low doses of light and photosensitizer. In this work we model the cell response to low doses of PDT assuming a bi-dimensional matrix of interacting cells. For each cell of the matrix we simulate in detail, with the help of the Gillespie's algorithm, the two main chemical pathways leading to apoptosis. We unveil the role of both pathways in the cell death rate of the tumor, as well as the relevance of several molecules in the process. Our model suggests values of concentrations for several species of molecules to enhance the effectiveness of PDT.
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Apoptose , Simulação por Computador , Modelos Biológicos , Fotoquimioterapia , Apoptose/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Humanos , Fármacos Fotossensibilizantes/farmacologia , Fatores de TempoRESUMO
TITLE: Lesiones agudas simetricas de ganglios basales en el contexto de una uremia.
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Doenças dos Gânglios da Base/diagnóstico por imagem , Doenças dos Gânglios da Base/etiologia , Gânglios da Base/diagnóstico por imagem , Uremia/complicações , Doença Aguda , Idoso , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
BACKGROUND: The causal role of childhood trauma for psychosis is well established, but the mechanisms that link trauma to psychosis are largely unknown. Since childhood trauma is known to cause difficulties in emotion regulation (ER) and patients with psychosis show impaired ER, we hypothesize that impaired ER explains why people with a background of trauma are prone to psychotic experiences. METHODS: The study used a longitudinal cohort design based on a community sample (N=562) from Germany, Indonesia, and the United States. Childhood trauma was assessed at baseline. ER and psychotic experiences (defined as positive symptom frequency and related distress) were measured repeatedly at a 4-, 8-, and 12-month follow-up. Cross-lagged panel and longitudinal mediation analyses with structural equation modeling were used to test the predictive value of ER on psychotic experiences and its mediating role in the association of childhood trauma and psychotic experiences. RESULTS: The cross-lagged paths from impaired ER to symptom distress (but not frequency) were significant. However, there was also evidence for the reverse causation from symptom frequency and distress to impaired ER. ER partially mediated the significant prospective paths from childhood trauma to symptom distress. CONCLUSION: The findings demonstrate that ER plays a role in translating childhood trauma into distressing psychotic experiences in later life. Moreover, the findings point to a maintenance mechanism in which difficulties in ER and symptom distress exacerbate each other. Thus, ER could be a promising target for interventions aimed at prevention of psychosis.
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Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/psicologia , Transtornos Psicóticos/epidemiologia , Estresse Psicológico/epidemiologia , Adulto , Sobreviventes Adultos de Maus-Tratos Infantis/estatística & dados numéricos , Criança , Maus-Tratos Infantis/estatística & dados numéricos , Emoções , Feminino , Alemanha , Humanos , Masculino , Estudos Prospectivos , Transtornos Psicóticos/psicologia , Fatores de Risco , Estresse Psicológico/psicologiaRESUMO
ntroduction. Enamel microabrasion is a procedure used for removing a superficial layer of enamel that has some alteration of color and/or texture caused by dental fluorosis. The purpose of this study was to compare the microhardness and micromorphology of the fluorotic enamel surface after microabrasion with 6.6% hydrochloric acid and silica or 18% hydrochloric acid and evaluate the effect of desensitizing agent exposure on the treated enamel. Materials and Methods. Twenty anterior teeth with moderate fluorosis were divided into two groups: 1) Perla-Dent® group and 2) Opalustre® group. Each buccal surface of incisors was sectioned to obtain samples 3x3 mm. The samples were then mounted in acrylic blocks. The enamel surface of the blocks was polished, after the microabrasion materials and desensitizing agent were applied according to the manufacturer's instructions. All samples were analyzed by Vickers microhardness tester and scanning electron microscopy (SEM). Results. Both experimental groups presented a decrease in the microhardness values, with statistically significant differences (p<0.0001) when comparing the baseline and after treatments values. To compare the microhardness values after both microabrasion and desensitizing treatment in the study groups, it was observed that the Perla-Dent® group obtained lower values than the Opalescence® group with a statistically significant difference (p<0.0001). The representative images of study groups in SEM showed the enamel surface morphology after Perla-Dent® treatment more irregular and a very marked relief than that observed in enamel surface morphology after Opalustre® treatment. Conclusion. The surface of the enamel was more affected with Perla-Dent® treatment than with Opalustre® treatment and the placement of UltraEz® agent does not recover its baseline microhardness.
ntroducción. La microabrasión del esmalte es un procedimiento usado para remover la capa superficial de esmalte que tiene alguna alteración de color y / o textura causada por la fluorosis dental. El objetivo de este estudio fue comparar la microdureza y micromorfología de la superficie del esmalte fluorado después de microabrasión con ácido clorhídrico al 6,6% y sílice ó 18% de ácido clorhídrico y evaluar el efecto de la exposición del agente desensibilizante sobre el esmalte tratado. Materiales y métodos. 20 dientes anteriores con fluorosis moderada se dividieron en dos grupos: 1) grupo PerlaDent® y 2) grupo Opalustre®. La superficie bucal se seccionó para obtener muestras de 3x3 mm. Las muestras se montaron luego en bloques acrílicos. La superficie del esmalte de los bloques fue pulida, y posteriormente los materiales de microabrasión y el agente desensibilizante se aplicaron de acuerdo con las instrucciones del fabricante. Todas las muestras fueron analizadas por medio de microdureza Vickers y Microscopía electrónica de barrido (MEB). Resultados. Ambos grupos experimentales presentaron disminución de los valores de microdureza con diferencias estadísticamente significativas (p<0.0001) al comparar los valores de antes y después de los tratamientos. Al comparar los valores de microdureza después del tratamiento de microabrasión y desensibilizante en los grupos de estudio, se observó que el grupo Perla-Dent® obtuvo valores más bajos que el grupo Opalustre® con diferencia estadísticamente significativa (p<0.0001). Las imágenes representativas de los grupos de estudio en MEB mostraron la morfología de la superficie del esmalte después del tratamiento con Perla-Dent® más irregular y con un relieve más marcado que el observado en la superficie del esmalte después del tratamiento con Opalustre®. Conclusión. La superficie del esmalte se presentó más afectada posterior al tratamiento con Perla-Dent® que con Opalustre® y la colocación del agente UltraEz® no logró recuperar el grado de microdureza basal.
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Doenças da Coroide/diagnóstico por imagem , Neovascularização de Coroide/diagnóstico por imagem , Angiofluoresceinografia , Imagem Multimodal , Pólipos/diagnóstico por imagem , Doenças da Coroide/etiologia , Neovascularização de Coroide/complicações , Feminino , Corantes Fluorescentes , Humanos , Verde de Indocianina , Pessoa de Meia-Idade , Pólipos/etiologiaRESUMO
OBJECTIVE: To present the clinical relevance of the anatomical classification of the neovascular form of Age-Related Macular Degeneration (AMD). METHODS: Critical analysis of the current situation in the management of patients with neovascular AMD, by reviewing the available scientific evidence with regards to the classification of the types of neovascular lesion by angiography and optical coherence tomography (OCT). RESULTS: The classification of the neovascular lesion type secondary to AMD by OCT in type 1 lesions (under the pigment epithelium), type 2 (subretinal), and type 3 (retinal angiomatous proliferation), provides an added value in allowing to establish a long-term visual prognosis, an estimate of the number of treatments that a certain case may require, and a stratification of the risk for secondary geographic atrophy. CONCLUSIONS: Incorporating OCT to the initial qualitative analysis of cases with neovascular AMD offers an added value superior to that provided by the angiography, with the relevant clinical implications.
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Neovascularização de Coroide/classificação , Angiofluoresceinografia , Degeneração Macular/complicações , Tomografia de Coerência Óptica , Neovascularização de Coroide/diagnóstico por imagem , Neovascularização de Coroide/etiologia , Gerenciamento Clínico , Atrofia Geográfica/epidemiologia , Atrofia Geográfica/etiologia , Humanos , Degeneração Macular/diagnóstico por imagem , Prognóstico , Medição de RiscoRESUMO
Agroecosystem management commonly involves the use of pesticides. As a result, a heterogeneous landscape is created, in which suitable and unsuitable spaces are defined by the absence/presence of pesticides. In this study, we explored how foragers of the honey bee, Apis mellifera L., adapt to such context. We specifically evaluated the effect of GF-120, a spinosad-based fruit fly toxic bait, on the allocation of foragers between food sources under the hypothesis that foragers will move from food sources with GF-120 to food sources without it. We thus carried out three experiments: in experiment 1, a group of foragers was trained to collect honey solution from a feeder; next, this feeder offered a GF-120/honey solution. A minority of foragers continued collecting the GF-120/honey solution. In experiment 2, we trained two groups of foragers from a colony to two food sources equally rewarding. Next, GF-120 was added to one of the food sources. We found that the majority of foragers moved from the GF-120-treated feeder to the feeder without GF-120 and that the minority that continued visiting the GF-120-treated feeder did not collect the GF-120/honey solution. In a third experiment, we wanted to know if foragers in an experimental setup as in experiment 1 would perform waggle dances: none of the foragers that collected GF-120/honey were observed dancing. Our results emphasize the importance of "food refuges" for non-target species, since they minimize the impact of agrochemicals upon them.