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Background: Retinoblastoma is the most common intraocular tumor in the pediatric population. Its main therapeutic objectives are to avoid fatal outcomes and preserve vision as much as possible. Intra-arterial chemotherapy (IAC) improves drug delivery and reduces possible systemic adverse effects. This modality allows direct administration of chemotherapeutic agents to intraocular malignancies via the ophthalmic artery (OA), proving to be a feasible and effective method for globe salvage. Most side effects of IAC are local, including eyelash loss of the nasal portion of the eyelid. Summary: We performed a comprehensive review to analyze data regarding ciliary madarosis in patients diagnosed with retinoblastoma treated with IAC. We describe 9 studies with a total of 637 eyes with retinoblastoma that underwent IAC, of which 45 cases presented madarosis. In chemotherapy-induced alopecia, there is hair shaft thinning and breakage. On trichoscopy, the remaining end of the fractured hair will be observed as black dots. Differential diagnoses must include alopecia areata and trichotillomania. Key Messages: Ciliary madarosis secondary to IAC, although transitional, may cause discomfort in patients and family members. Physical examination, as well as a trichoscopic evaluation of the affected area, can help in reaching a prompt diagnosis and prognosis for this particular alopecia.
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Stridor is a symptom of upper airway obstruction and may result from congenital or acquired causes. The diagnosis is usually clinical. If further investigation is necessary for differential diagnosis, endoscopy is the method of choice in most cases. Imaging studies are complementary to endoscopy. They allow evaluation of laryngeal and tracheobronchial pathology and extrinsic airway compressions due to tumors or vascular malformations and define a lesion's location, extent, and characteristics. They are helpful in cases of diagnostic doubt and when endoscopy is unavailable. It is essential to understand the anatomy and pathophysiology of the respiratory tract and to be aware of the indications and limitations of complementary examinations for proper diagnosis. The different imaging modalities available to evaluate stridor in pediatrics are described, and their advantages are discussed.
El estridor es un síntoma de obstrucción de la vía aérea superior y puede ser resultado de causas congénitas o adquiridas. El diagnóstico suele ser clínico. Si es necesaria una investigación adicional para el diagnóstico diferencial, la endoscopia es el método de elección en la mayoría de los casos. Los estudios por imágenes son complementarios a la endoscopia. Permiten evaluar la patología laríngea y traqueobronquial, las compresiones extrínsecas de la vía aérea por tumores o malformaciones vasculares y definir la localización, extensión y características de una lesión. Son útiles en casos de duda diagnóstica y cuando la endoscopia no está disponible. Es fundamental comprender la anatomía y fisiopatología del tracto respiratorio, y ser conscientes de las indicaciones y limitaciones de los exámenes complementarios para el diagnóstico adecuado. Se describen las diferentes modalidades de imágenes disponibles para evaluar el estridor en pediatría y se discuten sus ventajas.
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Sons Respiratórios , Humanos , Sons Respiratórios/etiologia , Criança , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/diagnóstico , Diagnóstico por Imagem/métodosRESUMO
Background/purpose: Translucent monolithic zirconia restorations have recently introduced. The purpose of this study was to evaluate the clinical behavior and the survival rate of the posterior third-generation monolithic zirconia crowns (MZCs) during three years of clinical service. Materials and methods: Twenty-four patients who needed thirty crowns were enrolled in this study. Digital impressions were made, and the crowns were milled and cemented with a resin cement. The crowns outcomes were assessed using the California Dental Association's (CDA) criteria. Gingival index (GI), plaque index (PI), and periodontal probing depth (PPD) for MZCs and contralateral natural teeth (control) were assessed. Margin index (MI) for MZCs was also assessed. Data analysis was conducted using the Wilcoxon signed-rank and the Friedman tests. Results: The 3-year survival rate was 100%. All MZCs were rated as satisfactory throughout the follow-up period, and no biological or mechanical complications were observed. No differences were recorded when GI, PI and PPD at 3-year of follow-up were compared to baseline. No differences were recorded between crowned and control teeth. The MI remained stable throughout the study period. Conclusion: The third-generation monolithic zirconia appears to be a good treatment option for the rehabilitation of posterior single teeth.
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BACKGROUND: Isolated perforations of hollow viscus (HV) represent less than 1% of injuries in blunt abdominal trauma (BAT). When they do present, they are generally due to high-impact mechanisms in the segments of the intestine that are fixed. The aim of this study is to determine the incidence of major HV injuries in BAT at the "Dr. Domingo Luciani" General Hospital (HDL), and address the literature gap regarding updated HV perforations following BAT, especially in low-income settings. METHODS: A retrospective review was conducted on the medical records of patients admitted to our trauma center with a diagnosis of complicated BAT with HV perforation over 14 years. RESULTS AND DISCUSSION: Seven hundred sixty-one patients were admitted under the diagnosis of BAT. Of them, 36.79% underwent emergency surgical resolution, and 6.04% had HV perforation as an operative finding. Almost half (44.44%) of these cases presented as a single isolated injury, while the remaining were associated with other intra-abdominal organ injuries. The most common lesions were Grade II-III jejunum and Grade I transverse colon, affecting an equal proportion of patients at 13.33%. In recent years, an increased incidence of HV injuries secondary to BAT has been observed. Despite this, in many cases, the diagnosis is delayed, so even in the presence of negative diagnostic studies, the surgical approach based on the trauma mechanism, hemodynamic status, and systematic reevaluation of the polytraumatized patient should prevail.
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Traumatismos Abdominais , Perfuração Intestinal , Ferimentos não Penetrantes , Humanos , Centros de Traumatologia , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/cirurgia , Ferimentos não Penetrantes/complicações , Traumatismos Abdominais/epidemiologia , Traumatismos Abdominais/cirurgia , Traumatismos Abdominais/complicações , Jejuno , Perfuração Intestinal/cirurgia , Estudos RetrospectivosRESUMO
Several studies have shown that chronic exposure to the herbicide atrazine (ATR) causes alterations in locomotor activity and markers of the dopaminergic systems of male rats. However, few studies have evaluated the sex-dependent effects of atrazine exposure. The aim of the present study was to evaluate whether chronic ATR exposure causes alterations in behavioral performance and dopaminergic systems of female rats. At weaning, two groups of rats were exposed to 1 or 10 mg ATR/kg body weight daily thorough the food, while the control group received food without ATR for 14 months. Spontaneous locomotor activity was evaluated monthly for 12 months, while anxiety, egocentric and spatial memory, motor coordination, and olfactory function tasks were evaluated between 13 and 14 months of ATR exposure. Tyrosine hydroxylase (TH) and monoamine content in brain tissue were assessed at the end of ATR treatment. Female rats treated with 1 or 10 mg ATR showed vertical hypoactivity compared to the control group only in the first month of ATR exposure. Impairments in olfactory functions were found due to ATR exposure. Nevertheless, no alterations in anxiety, spatial and egocentric memory, or motor coordination tasks were observed, while the levels of TH and dopamine and its metabolites in brain tissue were similar among groups. These results suggest that female rats could present greater sensitivity to the neurotoxic effects of ATR on spontaneous locomotor activity in the early stages of development. However, they are unaffected by chronic ATR exposure later in life compared to male rats. More studies are necessary to unravel the sex-related differences observed after chronic ATR exposure.
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Atrazina , Herbicidas , Ratos , Masculino , Feminino , Animais , Atrazina/toxicidade , Ratos Sprague-Dawley , Herbicidas/toxicidade , Dopamina/metabolismo , LocomoçãoRESUMO
El Toxoplasma gondii es un parásito que se encuentra, aproximadamente, en el 30 % de la población humana. Durante los últimos años se ha evidenciado que la infección latente puede ser un factor de riesgo para el desarrollo de trastornos mentales; particularmente para la esquizofrenia, ansiedad, trastornos bipolares y trastornos de conducta. La asociación con los trastornos neuropsiquiátricos pueden explicarse por la influencia que tiene el parásito sobre la expresión de múltiples neurotransmisores; entre ellos la dopamina. Se realizó una búsqueda en las bases de datos PubMed y SciELO de 2015 a 2023, se seleccionaron artículos originales y de revisión de revistas científicas internacionales, en idiomas inglés y español con el objetivo de describir la relación entre la seroprevalencia de T. gondii y el desarrollo de trastornos mentales en población adulta. Existe relación entre los trastornos mentales en la población adulta con la infección por Toxoplasma gondii y este aumenta la posibilidad de desarrollar esquizofrenia y depresión en individuos sin historial previo, y que podría exacerbar cuadros psiquiátricos previos con dificultad en el tratamiento. Sin embargo, no todos los datos estadísticos establecen una relación directa, algunos estudios demuestran una asociación, ciertos datos son discordantes, lo que abre una puerta para futuras investigaciones.
Toxoplasma gondii is a parasite that is found in approximately 30 % of the human population. In recent years, it has been shown that latent infection can be a risk factor for the development of mental disorders; particularly schizophrenia, anxiety, bipolar disorders, and conduct disorders. The association with neuropsychiatric disorders can be explained by the influence of the parasite on the expression of multiple neurotransmitters; among them, dopamine has received the most attention. A narrative bibliographic review article was done with the search of original and review articles in international scientific journals, in English and Spanish listing the relationship between the seroprevalence of T. gondii and the development of mental disorders in the adult population. The relationship between mental disorders in the adult population with Toxoplasma gondii infection is present and increases the possibility of developing schizophrenia and depression in individuals with no previous history, including the ability to worsen previous psychiatric conditions, making it difficult for standard management. Not all statistical data establish a direct relationship, some studies show an association and certain data are discordant, which opens a door for future research.
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Adulto , El SalvadorRESUMO
PURPOSE: To evaluate the diagnostic performance of a novel deep learning attenuation correction software (DLACS) for myocardial perfusion imaging (MPI) using a cadmium-zinc-telluride (CZT) cardio dedicated camera with invasive coronary angiography (ICA) correlation for the diagnosis of coronary artery disease (CAD) in a high-risk population. METHODS: Retrospective study of 300 patients (196 males [65%], mean age 68 years) from September 2014 to October 2019 undergoing MPI, followed by ICA and evaluated by means of quantitative angiography software, within six months after the MPI. The mean pre-test probability score for coronary disease according to the European Society of Cardiology criteria was 37% for the whole cohort. The MPI was performed in a dedicated CZT cardio camera (D-SPECT Spectrum Dynamics) with a two-day protocol, according to the European Association of Nuclear Medicine guidelines. MPI was retrospectively evaluated with and without the DLACS. RESULTS: The overall diagnostic accuracy of MPI without DLACS to identify patients with any obstructive CAD at ICA was 87%, sensitivity 94%, specificity 57%, Positive Predictive Value 91% and Negative Predictive Value 64%. Using DLACS the overall diagnostic accuracy was 90%, sensitivity 91%, specificity 86%, Positive Predictive Value 97% and Negative Predictive Value 66%. CONCLUSION: Use of the novel DLACS enhances performance of the MPI using the CZT D-SPECT camera and achieves improved results, especially avoiding artefacts and reducing the number of false positive results.
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Cádmio , Doença da Artéria Coronariana , Aprendizado Profundo , Imagem de Perfusão do Miocárdio , Telúrio , Zinco , Masculino , Humanos , Idoso , Estudos Retrospectivos , Angiografia Coronária/métodos , Imagem de Perfusão do Miocárdio/métodos , Doença da Artéria Coronariana/diagnóstico por imagemRESUMO
BACKGROUND: Vesicourethral anastomosis stenosis (VUAS) refers to the diameter narrowing of a vesicourethral anastomosis (VUA). It is a known complication after radical prostatectomy that nowadays presents in less than 1% of these cases. When the lumen narrows sufficiently to impede urine flow, obstructive symptoms arise. While the incidence of VUAS used to be notably higher prior to the widespread use of the robotic approach, traditional procedures still fail in up to 42% of cases. Initial management typically involves endoscopic procedures, such as dilation, incision, or resection. If these approaches prove ineffective, VUA reconstruction is warranted. Following the resection of the unhealthy urethra, a potential drawback is the insufficient length of the healthy proximal urethral to reach the bladder without tension. In such cases, urinary diversion with an ileal conduit is an option. However, when the patient prefers to maintain an orthotopic urinary tract configuration, there is limited guidance in the literature regarding surgical techniques. OBJECTIVE: To outline the indications, describe the step-by-step technique, and evaluate the outcomes of transperineal urethral advancement to facilitate a tension-free VUA. MATERIALS: We first discuss the indications to identify which patients are candidates for this procedure. Then, a step-by-step description of the robotic VUA revision assisted by transperineal urethral mobilization is presented. Detailed steps and helpful hints are included. Finally, we outline the postoperative pathway and expected outcomes. RESULTS: This technique allows patients with VUAS to preserve the orthotopic configuration of the urinary tract when a tension-free anastomosis proves challenging. Although urinary incontinence is expected, an artificial urinary sphincter could be placed in the following months. CONCLUSION: The robotic management of complex vesicourethral anastomosis stenosis with transperineal urethral advancement is a feasible and safe procedure that requires the interdisciplinary management of robotic and reconstructive urologists.
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Procedimentos Cirúrgicos Robóticos , Uretra , Masculino , Humanos , Uretra/cirurgia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Procedimentos Cirúrgicos Urogenitais , Anastomose CirúrgicaRESUMO
Purpose To evaluate and compare the survival, success rates, and biological and technical complications of three-unit posterior monolithic and veneered zirconia and metal-ceramic (MC) posterior fixed partial dentures (FPDs) fabricated using a digital workflow and computer-aided design and computer-aided manufacturing (CAD/CAM) over a 5-year follow-up.Methods Ninety patients in need of three-unit posterior FPDs were randomized to receive monolithic zirconia (MZ), veneered zirconia (VZ), and MC restorations (n = 30 each). Teeth preparations were scanned using an intraoral scanner, and restorations were milled and cemented with resin cement. Clinical performance and periodontal parameters were assessed at baseline and yearly up to 5 years after insertion. Data analysis was performed using the Kaplan-Meier method, Friedman test, and Wilcoxon signed-rank test with Bonferroni correction and Mann-Whitney U test.Results The 5-year survival rates of the MZ, VZ, and MC FPDs were 87%, 97%, and 100%, respectively (P = 0.04). Most complications were biological in nature. Only one MZ FPD fractured 58 months after placement. All the restorations were assessed as satisfactory at each recall. Differences were found in the gingival index score over time in the VZ and MC groups. The margin index remained stable throughout the follow-up period in both zirconia groups.Conclusions The results of this study suggest that using a digital workflow to fabricate posterior FPDs is an adequate treatment option and that monolithic zirconia could be a viable alternative to metal-ceramic or veneered zirconia. However, further long-term studies are necessary to provide stronger evidence in patients with bruxism.
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Falha de Restauração Dentária , Planejamento de Dentadura , Humanos , Estudos Prospectivos , Fluxo de Trabalho , Cerâmica , Zircônio , Prótese Parcial Fixa , Desenho Assistido por Computador , Porcelana DentáriaRESUMO
OBJECTIVE: To describe near-infrared fluorescence (NIRF) for assessment of gastric viability and describe NIRF's influence on the surgeon's operative strategy in dogs with gastric dilatation and volvulus (GDV). STUDY DESIGN: Prospective clinical trial. ANIMALS: Twenty dogs with GDV and 20 systemically healthy dogs. METHODS: Following gastric derotation, the surgeon's subjective assessment of gastric viability was recorded prior to near-infrared imaging. Changes in the surgeon's initial assessment of viability based on the visual pattern of gastric fluorescence was recorded. If nonviable (lack of defined vessels), a partial gastrectomy was performed and submitted for histopathology. The stapled gastrectomy line was imaged. Viable (defined vessels) and nonviable fluorescence intensities were compared with healthy dogs undergoing surgery for nongastrointestinal disease. RESULTS: Subjective assessment diagnosed 17 viable and three nonviable GDVs (2 fundi; 1 cardia). Near-infrared imaging demonstrated nonviable gastric fluorescence in 4 dogs (3 fundi/cardia; 1 fundus). The surgeon's margins for resection were altered in 3/20 dogs. Fluorescence intensity (cardia, fundus, body, pylorus) was lower in GDV viable (30.59%, p = .04; 38.17%, p < .01; 51.18%, p < .01; 44.12%, p= .01) and nonviable (11.00%, p < .01; 4.33%, p < .01; 57.67%, p = .22; 54.33%, p = .72) dogs compared to healthy controls (44.7%, 70.05%, 84.00%, 63.95%). Fundic fluorescence was less in nonviable gastric tissue in comparison with viable gastric tissue (p = .03). Fluorescence of the gastrectomy staple line approximated that of viable tissue. CONCLUSION: Near-infrared fluorescence can identify histologically confirmed nonviable gastric tissue. CLINICAL SIGNIFICANCE: These results provide enough evidence to support the implementation of NIRF as an adjunct to gross examination of the gastric wall in dogs with GDV.
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Doenças do Cão , Volvo Gástrico , Animais , Cães , Doenças do Cão/cirurgia , Doenças do Cão/diagnóstico por imagem , Volvo Gástrico/veterinária , Volvo Gástrico/cirurgia , Volvo Gástrico/diagnóstico por imagem , Feminino , Estudos de Casos e Controles , Masculino , Gastrectomia/veterinária , Gastrectomia/métodos , Estudos Prospectivos , Espectroscopia de Luz Próxima ao Infravermelho/veterinária , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Dilatação Gástrica/veterinária , Dilatação Gástrica/cirurgia , Dilatação Gástrica/diagnóstico por imagem , Imagem Óptica/veterinária , Imagem Óptica/métodos , Estômago/diagnóstico por imagem , Estômago/cirurgia , FluorescênciaRESUMO
Introduction: We have previously shown that Environmental Enrichment (EE), a multi-modal psychosocial intervention consisting of increased social interaction, novelty, and open spaces, improved disease presentation, anxiety, and immune-related disturbances in the rat model of endometriosis. However, there is a knowledge gap regarding the effects of EE interventions in patients with this painful, inflammatory chronic disease. Aim: To adapt and test the efficacy of an EE intervention on pelvic pain, mental health, perceived stress, quality of life, and systemic inflammation in endometriosis patients through a randomized clinical trial (RCT). Materials and methods: A multidisciplinary team with expertise in physiology, neuroscience, psychology, and women's health adapted and implemented a two-arm RCT comparing an EE intervention with a wait-list control group. Six EE modules administered on alternate weeks were provided to patients in the intervention (N = 29); controls received education only. Survey data and biospecimens were collected at baseline, end-of-study, and 3-months post-intervention to assess pain (Brief Pain Inventory, BPI), endometriosis-related quality of life-QoL (Endometriosis Health Profile-30, EHP30), anxiety (Generalized Anxiety Disorder 7, GAD7), depression (Patient Health Questionnaire for Depression 8, PHQ8), pain catastrophizing (Pain Catastrophizing Score, PCS), stress (Perceived Stress Scale-14, PSS14), and saliva cortisol levels (AM, PM). Results: Compared to the wait-list controls, participants in the EE intervention showed significantly decreased GAD-7 scores at the end of the intervention and 3-month follow-up. Depression, perceived stress, and QoL improved at the 3-month follow-up compared to baseline. While pain levels did not improve, they significantly correlated with anxiety, depression, QoL and pain catastrophizing scores. Conclusion: This pilot RCT demonstrated significant improvements in anxiety and depressive symptoms, QoL, and perceived stress, supporting enriched environments as an integrative psychosocial intervention to be used as adjuvant to the standard of care for endometriosis pain.
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RATIONALE AND OBJECTIVES: Despite significant scientific advances in cancer treatment in recent decades, Black Americans still face marked inequities in cancer screening, diagnosis, and treatment. Redressing these persistent inequities will require innovative strategies for community engagement. Radiologists, as experts in cancer screening and diagnosis for multiple malignancies, including breast, lung, and colon, are ideally suited to lead and implement community-based strategies to address local cancer disparities. MATERIALS AND METHODS: Through an established academic-community partnership in West Philadelphia built over the course of multiple prior community healthcare events, the authors piloted a novel radiology-led multidisciplinary approach to improve access to cancer screening for the predominantly Black, medically-underserved residents. Using a "one-stop-shop" framework to provide a comprehensive suite of screening and ancillary services in the heart of the community, the authors sought to remove as many impediments to screening as possible. RESULTS: Approximately 350 participants attended the health fair, and a total of 232 screening tests or assessments were completed. Data from this event suggest that this inclusive approach, as well as the use of a health fair "passport" to incentivize engagement, can successfully improve access to screening and follow-up in an underserved community. CONCLUSION: This "one-stop-shop" community approach can be replicated by radiology-led teams in other settings as a high-value, scalable opportunity to reduce disparities in access to cancer screening.
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Detecção Precoce de Câncer , Neoplasias , Humanos , Neoplasias/diagnóstico por imagemRESUMO
The development and progression of prostate cancer (PCa) depends on complex interactions between genetic, environmental and dietary factors that modulate the carcinogenesis process. Interactions between chemical exposures and genetic polymorphisms in genes encoding xenobiotic metabolizing enzymes (XME), antioxidant enzymes and DNA repair enzymes have been reported as the main drivers of cancer. Thus, a better understanding of the causal risk factors for PCa will provide avenues to identify men at increased risk and will contribute to develop effective detection and prevention methods. We performed a meta-analysis on 17,518 cases and 42,507 controls obtained from 42 studies to determine whether seven SNPs and one CNV pertaining to oxidative stress, xenobiotic detoxification and DNA repair enzymes are associated with the risk of PCa (GPX1 (rs1050450), XRCC1 (rs25487), PON1 (rs662), SOD2 (rs4880), CAT (rs1001179), GSTP1 (rs1695) and CNV GSTM1). A significant increased risk of PCa was found for SOD2 (rs4880) ORGG+GA vs. AA 1.08; 95%CI 1.01-1.15, CAT (rs1001179) ORTT vs. TC+CC 1.39; 95%CI 1.17-1.66, PON1 (rs662) ORCT vs. CC+TT 1.17; 95%CI 1.01-1.35, GSTP1 (rs1695) ORGG vs. GA+AA 1.20; 95%CI 1.05-1.38 and GSTM1 (dual null vs. functional genotype) ORN vs. NN1+NN2 1.34; 95%CI 1.10-1.64. The meta-analysis showed that the CNV GSTM1, and the SNPs GSTP1 (rs1695) and CAT (rs1001179) are strongly associated with a greater risk of PCa and, to a lesser extent, the genetic variants SOD2 (rs4880) and PON1 (rs662). Although several antioxidant enzymes and XME play an important role in the PCa development, other risk factors such as chemical exposures should also be considered to gain insight on PCa risk. The functional in silico analysis showed that the genetic variants studied had no clinical implication regarding malignancy, except for GPX1 (rs1050450) SNP.
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Antioxidantes , Neoplasias da Próstata , Masculino , Humanos , Xenobióticos , Glutationa S-Transferase pi/genética , Genótipo , Neoplasias da Próstata/genética , Polimorfismo de Nucleotídeo Único , Predisposição Genética para Doença , Estudos de Casos e Controles , Proteína 1 Complementadora Cruzada de Reparo de Raio-X/genética , Arildialquilfosfatase/genéticaRESUMO
BACKGROUND: The use of molecular biomarkers for COVID-19 remains unconclusive. The application of a molecular biomarker in combination with clinical ones that could help classifying aggressive patients in first steps of the disease could help clinician and sanitary system a better management of the disease. Here we characterize the role of ACE2, AR, MX1, ERG, ETV5 and TMPRSS2 for trying a better classification of COVID-19 through knowledge of the disease mechanisms. METHODS: A total of 329 blood samples were genotyped in ACE2, MX1 and TMPRSS2. RNA analyses were also performed from 258 available samples using quantitative polymerase chain reaction for genes: ERG, ETV5, AR, MX1, ACE2, and TMPRSS2. Moreover, in silico analysis variant effect predictor, ClinVar, IPA, DAVID, GTEx, STRING and miRDB database was also performed. Clinical and demographic data were recruited from all participants following WHO classification criteria. RESULTS: We confirm the use of ferritin (p < 0.001), D-dimer (p < 0.010), CRP (p < 0.001) and LDH (p < 0.001) as markers for distinguishing mild and severe cohorts. Expression studies showed that MX1 and AR are significantly higher expressed in mild vs severe patients (p < 0.05). ACE2 and TMPRSS2 are involved in the same molecular process of membrane fusion (p = 4.4 × 10-3), acting as proteases (p = 0.047). CONCLUSIONS: In addition to the key role of TMPSRSS2, we reported for the first time that higher expression levels of AR are related with a decreased risk of severe COVID-19 disease in females. Moreover, functional analysis demonstrates that ACE2, MX1 and TMPRSS2 are relevant markers in this disease.
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COVID-19 , Feminino , Humanos , COVID-19/genética , Enzima de Conversão de Angiotensina 2/genética , SARS-CoV-2/genética , Marcadores Genéticos , Bases de Dados Factuais , Serina Endopeptidases/genética , Proteínas de Resistência a MyxovirusRESUMO
Maritime transport is a vital sector for global trade and the world economy. Particularly for islands, there is also an important social dimension of this sector, since island communities strongly rely on it for a connection with the mainland and the transportation of goods and passengers. Furthermore, islands are exceptionally vulnerable to climate change, as the rising sea level and extreme events are expected to induce severe impacts. Such hazards are anticipated to also affect the operations of the maritime transport sector by affecting either the port infrastructure or ships en route. The present study is an effort to better comprehend and assess the future risk of maritime transport disruption in six European islands and archipelagos, and it aims at supporting regional to local policy and decision-making. We employ state-of-the-art regional climate datasets and the widely used impact chain approach to identify the different components that might drive such risks. Larger islands (e.g., Corsica, Cyprus and Crete) are found to be more resilient to the impacts of climate change on maritime operations. Our findings also highlight the importance of adopting a low-emission pathway, since this will keep the risk of maritime transport disruption similar to present levels or even slightly decreased for some islands because of an enhanced adaptation capacity and advantageous demographic changes. Supplementary Information: The online version contains supplementary material available at 10.1007/s41207-023-00370-6.
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In recent years, the functionalization of mesoporous silica nanoparticles (MSNs) with different types of responsive pore gatekeepers have shown great potential for the formulation of drug delivery systems (DDS) with minimal premature leakage and site-specific controlled release. New nanotechnological approaches have been developed with the objective of utilizing natural biopolymers as smart materials in drug delivery applications. Natural biopolymers are sensitive to various physicochemical and biological stimuli and are endowed with intrinsic biodegradability, biocompatibility, and low immunogenicity. Their use as biocompatible smart coatings has extensively been investigated in the last few years. This review summarizes the MSNs coating procedures with natural polysaccharides and protein-based biopolymers, focusing on their application as responsive materials to endogenous stimuli. Biopolymer-coated MSNs, which conjugate the nanocarrier features of mesoporous silica with the biocompatibility and controlled delivery provided by natural coatings, have shown promising therapeutic outcomes and the potential to emerge as valuable candidates for the selective treatment of various diseases.
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PURPOSE: To evaluate the diagnostic performance of three different cardiac stress protocols for myocardial perfusion imaging (MPI) using a cadmium-zinc-telluride (CZT) camera with invasive coronary angiography (ICA) correlation for the diagnosis of coronary artery disease in a high risk population. METHODS: Retrospective study of 263 patients (96 women and 167 males, mean age 68 years) from which 119 patients performed a bicycle stress test (BST), 113 pharmacological stress test (PST) and 31 a combination of the two (CST) between September 2014 and December 2018. The patients then underwent myocardial perfusion imaging (MPI), followed by ICA and evaluated by means of quantitative angiography software, within six months after the MPI. The mean pre-test probability score for coronary disease according to the European Society of Cardiology criteria was 36% for the whole population. The MPI was performed in a dedicated CZT cardio camera (D-SPECT Spectrum Dynamics) with a two-day protocol, according to the European Association of Nuclear Medicine guidelines. RESULTS: No significant difference was observed between the three stress protocols in terms of diagnostic accuracy (BST 85%, PST 88%, CST 84%). The overall diagnostic accuracy of MPI to identify patients with any obstructive CAD at ICA was 86%, Sensitivity 93%, Specificity 54%, PPV 90% and NPV 63%. CONCLUSION: The CZT D-SPECT camera achieves overall satisfactory results in the diagnosis of CAD, observing no significant differences in the diagnostic performance when the stress test was performed as a BST, PST or CST.
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BACKGROUND: In 2008, the Chilean National Nursing Examination Commission, COENENF, developed a national nursing exam (ENENF). Since 2013, COENENF has implemented a validated opinion survey at the time of the national examination to strengthen the quality of the exam and facilitate its continuous improvement. AIM: To determine the perception of nursing students about general aspects, specific areas, representativeness, mastery and usefulness of the 2018 ENENF. MATERIAL AND METHODS: A descriptive, cross-sectional study, using a self-administered Likert-type survey, was administered in 2018 to 2949 last-year nursing students from 29 nursing schools who took the ENENF. The survey comprised three areas: representativeness of the questions, student mastery of each area, and the usefulness of the exam. RESULTS: Students had a positive perception of the Chilean ENENF and its application. Theoretical knowledge is effectively assessed and close to half of the sample agreed that the ENENF is useful. The results also suggest areas that should be improved. CONCLUSIONS: Nursing students had a positive perception of the ENENF.
Assuntos
Humanos , Masculino , Feminino , Estudantes de Enfermagem/psicologia , Percepção , Chile , Estudos Transversais , Inquéritos e QuestionáriosRESUMO
Introducción: La discapacidad se considera un problema de salud a nivel mundial. Las personas con discapacidad física son susceptibles de padecer distintos problemas de salud. A pesar de ser un grupo priorizado, el acceso a los servicios de salud es menor que el de la población en general, debido a barreras de distintos tipos. Objetivo: Describir las barreras y facilitadores de acceso a la atención primaria de salud en personas con discapacidad física. Métodos: Se realizó una revisión bibliográfica cuya metodología estuvo basada en la búsqueda, selección, revisión, interpretación y síntesis de la evidencia científica relacionada con el problema de investigación. Se utilizó como fuente de literatura científica primaria la publicada en las bases de datos Scielo, Redalyc, Latindex y PudMed en los últimos 5 años, con los términos de búsqueda MeSH en idoma español, inglés y portugués. Desarrollo: Se identificó un total de 67 documentos de los cuales se empleó 46 en la investigación realizada. Los restantes 21 manuscritos fueron excluidos por presentar deficiencias metodológicas que limitaban su utilización. Las principales barreras son las condiciones físicas de las unidades de salud; el funcionamiento del Sistema de Salud; el acceso de las personas con discapacidad a la atención primaria de salud; y las características del paciente y su entorno familiar. El principal facilitador es el relacionado con el Sistema de Salud. Conclusiones: El acceso de las personas con discapacidad física a los servicios de salud está condicionado por situaciones que se interpretan como barreras o facilitadores. En este sentido los factores relacionados con el sistema de salud nacional y con las características y el entorno de la persona con discapacidad pueden comportarse como barrera o como facilitador, en dependencia de su expresión(AU)
Introduction: Disability is considered a health problem worldwide. People with physical disabilities are susceptible to different health problems. Despite being a prioritized group, access to health services is lower than that of the general population, conditioned by the presence of different types of barriers. Objective: To describe the barriers and facilitators of access to primary health care in people with physical disabilities. Methods: A bibliographic review was carried out whose methodology was based on the search, selection, review, interpretation and synthesis of the scientific evidence related to the research problem. It was used as a source of primary scientific literature published in the databases Scielo, Redalyc, Latindex and PudMed in the last 5 years, with the MeSH search terms in Spanish, English and Portuguese. Results: A total of 67 documents were identified, of which 46 were used in the research carried out. The remaining 21 manuscripts were excluded due to methodological deficiencies that limited their use. Conclusions: The access of people with physical disabilities to health services is conditioned by situations that are interpreted as barriers or facilitators. In this sense, the factors related to the national health system and the characteristics and environment of the person with a disability can act as a barrier or as a facilitator, depending on their expression(AU)