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The long-term stability in real and accelerated time for galenic oils based on full-spectrum cannabis has been studied, using sesame oil as a dilutant. Sesame oil is one of the most used vehicles in the cannabis pharmaceutical industry due to the costs and increased oral bioavailability of cannabinoids. The real-time assays conducted at 25 °C over twelve months demonstrated high stability and showed no significant changes in the composition of cannabinoids, total polyphenols, flavonoids, or antioxidant capacity. In these studies, it was observed that there was no development of microorganisms compromising the stability of the oils over a year. The three oil varieties exhibited a high bactericidal capacity against E. coli, S. aureus, and P. larvae.
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Antibacterianos , Antioxidantes , Cannabis , Escherichia coli , Óleos de Plantas , Cannabis/química , Antibacterianos/farmacologia , Antibacterianos/química , Óleos de Plantas/farmacologia , Óleos de Plantas/química , Animais , Antioxidantes/farmacologia , Antioxidantes/química , Escherichia coli/efeitos dos fármacos , Staphylococcus aureus/efeitos dos fármacos , Estabilidade de Medicamentos , Óleo de Gergelim/química , Óleo de Gergelim/farmacologia , Canabinoides/farmacologia , Canabinoides/química , Larva/efeitos dos fármacos , Polifenóis/farmacologia , Polifenóis/química , Flavonoides/farmacologia , Flavonoides/químicaRESUMO
Primary health care (PHC) has increased in global relevance as it has been demonstrated to be a useful strategy to promote community access to health services. Multilateral organizations and national governments have reached a consensus regarding the basic principles of PHC, but the application of these varies from country to country due to the particularities of local health systems.This article aims to review and summarize PHC strategies and the configuration of health networks in Latin American and Caribbean countries.The review was carried out using keywords in at least 9 databases. Papers in languages other than English, Portuguese, and Spanish were excluded, while non-refereed articles and regional gray literature were incorporated. As a result, 1,146 papers were identified. After three instances of analysis, 142 articles were selected for this investigation. Data were analyzed according to an analysis by theme.The evidence collected on health reforms in the region reflects the need to intensify care strategies supported by PHC and care networks. These must be resilient to changes in the population's needs and must be able to adapt to contexts of epidemiological accumulation.
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Atenção Primária à Saúde , Humanos , América Latina , Região do Caribe , Equidade em Saúde , Acessibilidade aos Serviços de Saúde , Reforma dos Serviços de SaúdeRESUMO
BACKGROUND: Adherence to Helicobacter pylori (H. pylori) eradication treatment is a cornerstone for achieving adequate treatment efficacy. OBJECTIVE: To determine which factors influence compliance with treatment. METHODS: A systematic prospective non-interventional registry (Hp-EuReg) of the clinical practice of European gastroenterologists. Compliance was considered adequate if ≥90% drug intake. Data were collected until September 2021 using the AEG-REDCap e-CRF and were subjected to quality control. Modified intention-to-treat analyses were performed. Multivariate analysis carried out the factors associated with the effectiveness of treatment and compliance. RESULTS: Compliance was inadequate in 646 (1.7%) of 38,698 patients. The non-compliance rate was higher in patients prescribed longer regimens (10-, 14-days) and rescue treatments, patients with uninvestigated dyspepsia/functional dyspepsia, and patients reporting adverse effects. Prevalence of non-adherence was lower for first-line treatment than for rescue treatment (1.5% vs. 2.2%; p < 0.001). Differences in non-adherence in the three most frequent first-line treatments were shown: 1.1% with proton pump inhibitor + clarithromycin + amoxicillin; 2.3% with proton pump inhibitor clarithromycin amoxicillin metronidazole; and 1.8% with bismuth quadruple therapy. These treatments were significantly more effective in compliant than in non-compliant patients: 86% versus 44%, 90% versus 71%, and 93% versus 64%, respectively (p < 0.001). In the multivariate analysis, the variable most significantly associated with higher effectiveness was adequate compliance (odds ratio, 6.3 [95%CI, 5.2-7.7]; p < 0.001). CONCLUSIONS: Compliance with Helicobacter pylori eradication treatment is very good. Factors associated with poor compliance include uninvestigated/functional dyspepsia, rescue-treatment, prolonged treatment regimens, the presence of adverse events, and the use of non-bismuth sequential and concomitant treatment. Adequate treatment compliance was the variable most closely associated with successful eradication.
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Amoxicilina , Antibacterianos , Quimioterapia Combinada , Infecções por Helicobacter , Helicobacter pylori , Adesão à Medicação , Inibidores da Bomba de Prótons , Sistema de Registros , Humanos , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Masculino , Adesão à Medicação/estatística & dados numéricos , Feminino , Inibidores da Bomba de Prótons/uso terapêutico , Inibidores da Bomba de Prótons/administração & dosagem , Pessoa de Meia-Idade , Estudos Prospectivos , Antibacterianos/uso terapêutico , Antibacterianos/efeitos adversos , Europa (Continente) , Adulto , Amoxicilina/uso terapêutico , Amoxicilina/administração & dosagem , Resultado do Tratamento , Claritromicina/uso terapêutico , Idoso , Dispepsia/tratamento farmacológico , Dispepsia/microbiologia , Metronidazol/uso terapêutico , Metronidazol/administração & dosagem , Bismuto/uso terapêutico , Bismuto/administração & dosagem , Bismuto/efeitos adversosRESUMO
The advancement of public services, including the increased accessibility of health services, has led to a rise in life expectancy globally. As a result, aging populations are becoming more prevalent, raising concerns about cognitive decline. Fortunately, non-pharmacological methods, such as physical exercise, have been shown to mitigate the effects of aging on the brain. In this perspective article, we examined meta-analyses on the impact of physical exercise on cognition in older adults. The results indicate that combined exercise (i.e., aerobic plus strength training), has a significant positive effect on overall cognition and executive function. However, we found a lack of scientific studies on this topic in Latin American and Caribbean countries. Therefore, there is a pressing need for research to identify the feasibility of physical exercise interventions to improve cognitive skills in older adults from these regions.
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The growing use of Cannabis sativa as a complementary therapy to allopathic medicine has brought about the modification of laws for its use worldwide. This entails the need to harmonize the methods of galenic preparations in pharmacies and cannabis-specialized non-governmental organizations as well as for self-provision as contemplated in some current legislation, such as that of Argentina. Thus, this work aimed to study simple and efficient methods to produce medicinal cannabis oils that require low-cost equipment and few handling steps. The final formulas allowed the obtaining of preparations of known concentrations of neutral cannabinoids, total polyphenol content, total flavonoid content, and antioxidant capacity. These methods allow for the selection of convenient vehicles and access to safe medicinal products of standardized quality. Our results show that cannabis extraction can be efficiently performed by directly using long-chain lipidic vehicles as extractants, resulting in a formulation with maximized oxidizing capacity and potentially extending its durability.
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Canabinoides , Cannabis , Maconha Medicinal , Cannabis/química , Extratos Vegetais/química , Canabinoides/química , Flavonoides/química , LipídeosRESUMO
Environmental factors such as diet and lifestyle have been shown to influence the development of some intestinal mucosal lesions that may be precursors of colorectal cancer (CRC). The presence of these alterations seems to be associated with misbalanced immunological parameter levels. However, it is still unclear as to which immunological parameters are altered in each phase of CRC development. In this work, we aimed to study the potential relationships of immunological and metabolic parameters with diet in a CRC-related lesion context. Dietary information was obtained using an annual semi-quantitative food-frequency questionnaire (FFQ) from 93 volunteers classified via colonoscopy examination according to the presence of intestinal polyps or adenocarcinoma. Cytokines, chemokines, and adipokines were determined from serum samples. We observed a reduction in adiponectin according to the damage to the mucosa, accompanied by an increase and decrease in C-X-C motif chemokine ligand 10 (CXCL10) and resistin, respectively, in CRC cases. The presence of aberrant crypt foci (ACF) in the polyp group was associated with higher tumor necrosis factor-alpha (TNF-α) concentrations. Vegetables were directly correlated with adiponectin and resistin levels, while the opposite occurred with red meat. A bioactive compound, soluble pectin, showed a negative association with TNF-α. Future dietary strategies could be developed to modulate specific immunological parameters in the context of CRC.
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Neoplasias Colorretais , Resistina , Humanos , Adulto , Neoplasias Colorretais/metabolismo , Adiponectina , Fator de Necrose Tumoral alfa , Dieta , Mucosa Intestinal/metabolismoRESUMO
La bacteriemia por Staphylococcus aureus se define como el aislamiento de dicho germen en al menos un cultivo de sangre. Las metástasis infecciosas se originan por diseminación hematógena y su posterior localización en un sitio distinto al órgano en donde se originó el proceso infeccioso. La prevalencia en la presentación de estos focos infecciosos secundarios es baja en la edad pediátrica, por lo que representa un desafío diagnóstico. Se presenta el caso de un paciente pediátrico con una celulitis facial por Staphylococcus aureus, con metástasis infecciosas y evolución tórpida.
Bacteremia due to Staphylococcus aureus is defined as the isolation of this microorganism in at least one blood culture. A metastatic infection is caused by the hematogenous dissemination and subsequent location of the microorganism in a site other than the one where the infection started. The prevalence of these secondary sources of infection is low in the pediatric population, which is a diagnostic challenge. Here we describe the case of a pediatric patient with facial cellulitis due to Staphylococcus aureus, with metastatic infection and torpid course.
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Humanos , Masculino , Criança , Infecções Estafilocócicas/epidemiologia , Bacteriemia/epidemiologia , Staphylococcus aureus , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/etiologiaRESUMO
Measurement of HIV-1 viral load (VL) is essential for monitoring antiretroviral treatment (ART) efficacy. The preferred specimen type for VL is plasma, but in remote settings where collection and preservation of plasma many not be possible, dried blood spots (DBS) are often used instead. A new specimen collection matrix, the cobas plasma separation card (PSC, Roche Diagnostics Solutions), enables specimen preparation from a finger prick or venous blood, using a multi-layer absorption and filtration design that results in a specimen similar to dried plasma. We sought to confirm the correlation between VL results obtained using PSC prepared from venous blood to those from plasma or DBS, as well as PSC prepared with capillary blood from a finger prick. PSC, DBS and plasma were prepared with blood from HIV-1 infected persons attending a primary care clinic in Kampala, Uganda. VL in PSC and plasma was measured using cobas HIV-1 (Roche Diagnostics), while VL in DBS was measured with RealTime HIV-1 (Abbott Diagnostics). The correlation between VL from plasma and PSC made from capillary or venous blood was high (regression coefficient of determination r2 between 0.87 and 0.91), and there was good agreement based on mean bias (-0.14 to 0.24 log10 copies/mL) and classification of VL above or below 1000 copies/mL (91.4% agreement). In contrast, VL from DBS was lower than plasma or PSC (mean bias 0.51 to 0.63 log10 copies/mL) and not as well correlated (r2 0.78 to 0.81, 75.1-80.5% agreement). These results confirm the utility of PSC as an alternative specimen type for HIV-1 viral load measurement in areas where preparation and optimal storage or shipment of plasma is an obstacle to provision of treatment and care of HIV-1 infected people.
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Background and study aims Rates of new dysplastic lesions or cancer progression after first dye chromoendoscopy in the era of high-definition endoscopy have yet to be determined. Patients and methods A multicenter, population-based, retrospective cohort study was performed in seven hospitals in Spain. Patients with inflammatory bowel disease and fully resected (R0) dysplastic colon lesions under surveillance with high-definition dye-based chromoendoscopy were sequentially enrolled between February 2011 and June 2017, with a minimum endoscopic follow-up of 36 months. The aim was to assess the incidence of developing more advanced metachronous neoplasia by analyzing possible associated risk factors. Results The study sample included 99 patients and 148 index lesions (145 low-grade dysplasia lesions and three high-grade dysplasia [HGD] lesions with a mean follow-up of 48.76 months [IQR: 36.34-67.15]). The overall incidence of new dysplastic lesions was 0.23 per 100 patient-years, 1.15 per 100 patients at 5 years and 2.29 per 100 patients at 10 years. A history of dysplasia was associated with a higher risk of developing any grade of dysplasia during follow-up ( P â=â0.025), whereas left colon lesions were associated with a lower risk ( P â=â0.043). The incidence of more advanced lesions at 1 year and 10 years was 1â% and 14â% respectively, with lesion sizeâ>â1âcm being a risk factor ( P â=â0.041). One of the eight patients (13â%) with HGD lesions developed colorectal cancer during follow-up. Conclusions The risk of dysplasia progressing to advanced neoplasia and, specifically, the risk of new neoplastic lesions after endoscopic resection of colitis-associated dysplasia, are both very low.
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OBJECTIVE: To determine the potential risk factors associated with having COVID-19 among unvaccinated pregnant and non-pregnant women. DESIGN: A multicentre prospective cohort study among eligible women in Metro Manila, Philippines, from 2020 to 2022. SETTING: Five national and local hospital research sites altogether recruited and screened 500 consenting eligible individuals. PARTICIPANTS: Pregnant and non-pregnant participants meeting the eligibility criteria were admitted for a reverse-transcription PCR determination of SARS-CoV-2, pregnancy testing and ultrasound, and an interview with an administered questionnaire. EXPOSURES: Primary exposure was pregnancy; secondary exposures involve sociodemographic, lifestyle and obstetric-gynaecologic factors. OUTCOME MEASURE: Outcome being measured was COVID-19 status. RESULTS: The significant COVID-19 risk factors were: pregnancy (PR=1.184, 95% CI 1.096, 1.279), having a white-collar job (PR=1.123, 95% CI 1.02, 1.235), travelling abroad (PR=1.369, 95% CI 1.083, 1.173) and being infected by at least one vaccine-preventable disease (VPD) (PR=1.208, 95% CI 1.113, 1.310). Protective factors included having graduate-level education (PR=0.787, 95% CI 0.649, 0.954), immunisation against a VPD (PR=0.795, 95% CI 0.733, 0.862) and practising contraception (PR=0.889, 95% CI 0.824, 0.960). CONCLUSION: This study is the first in the country to determine the risks influencing COVID-19 infection among unvaccinated pregnant and non-pregnant women. Pregnancy is a significant risk for COVID-19 among women in Metro Manila. Educational attainment and positive health behaviours seem to confer protection. Occupations and activities that increase the frequency of interactions, as well as history of communicable diseases may predispose women to COVID-19. Further studies are needed to elucidate the development of the disease in pregnant women, including the maternal and neonatal effects of COVID-19 via potential vertical mechanisms of transmission.
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COVID-19 , Complicações Infecciosas na Gravidez , Gravidez , Recém-Nascido , Feminino , Humanos , COVID-19/epidemiologia , SARS-CoV-2 , Estudos Prospectivos , Filipinas/epidemiologia , Estudos Longitudinais , Complicações Infecciosas na Gravidez/epidemiologiaRESUMO
Bacteremia due to Staphylococcus aureus is defined as the isolation of this microorganism in at least one blood culture. A metastatic infection is caused by the hematogenous dissemination and subsequent location of the microorganism in a site other than the one where the infection started. The prevalence of these secondary sources of infection is low in the pediatric population, which is a diagnostic challenge. Here we describe the case of a pediatric patient with facial cellulitis due to Staphylococcus aureus, with metastatic infection and torpid course.
La bacteriemia por Staphylococcus aureus se define como el aislamiento de dicho germen en al menos un cultivo de sangre. Las metástasis infecciosas se originan por diseminación hematógena y su poste- rior localización en un sitio distinto al órgano en donde se originó el proceso infeccioso. La prevalencia en la presentación de estos focos infecciosos secundarios es baja en la edad pediátrica, por lo que re- presenta un desafío diagnóstico. Se presenta el caso de un paciente pediátrico con una celulitis facial por Staphylococcus aureus, con metástasis infecciosas y evolución tórpida.
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Bacteriemia , Infecções Estafilocócicas , Humanos , Criança , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/etiologia , Staphylococcus aureus , Infecções Estafilocócicas/epidemiologia , Bacteriemia/epidemiologiaRESUMO
High-intensity interval training (HIIT) is an exercise modality acknowledged to maintain physical fitness with more engagement in an active lifestyle compared with other traditional exercise models. Nevertheless, its effects on cardiac control and physical performance in an online-guided setting are not yet clarified. The present work assessed physical fitness and heart rate variability (HRV) before and after an online, home-based HIIT program in college-age students while pandemic lockdowns were in effect. Twenty university students (age: 21.9 ± 2.4 years.) that were solely enrolled in online classes were distributed into three groups: control-CON-(n = 6), 14 min of HIIT-HIIT-14-(n = 8), and 21 min of HIIT-HIIT-21-(n = 6). A maximal push-up test was employed to assess muscular endurance and performance, and resting HRV signals were collected with wireless heart rate monitors and were processed in Kubios HRV Std. (Kubios Oy, Finland). There was an increase in total push-up capacity compared to CON (p < 0.05 HIIT-21 vs. CON; p < 0.001 HIIT-14 vs. CON) after 8 weeks. A significant interaction was observed in high-frequency and low-frequency spectra ratios after the HIIT-21 intervention (p < 0.05). The current work demonstrated that either short- or mid-volume online, whole-body HIIT improves muscle strength, whereas mid-volume HIIT (HIIT-21) was the only intervention that developed a sympathovagal adaptation. This study showed promising results on muscular endurance and cardiac autonomic modulation through whole-body HIIT practice at home.
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Treinamento Intervalado de Alta Intensidade , Humanos , Adulto Jovem , Adulto , Treinamento Intervalado de Alta Intensidade/métodos , Sistema Nervoso Autônomo , Composição Corporal/fisiologia , Aptidão Física , Exercício Físico/fisiologiaRESUMO
BACKGROUND/OBJECTIVE: The quarantine caused by the COVID-19 pandemic increased sedentary behavior, psychological stress, and sleep disturbances in the population favoring the installation of alterations in the cardiovascular system. In this sense, physical exercise has widely been suggested as an efficient treatment to improve health. The current study determined the impact of short-term high-intensity circuit training (HICT) on resting heart rate variability (HRV) in adults. METHODS: Nine healthy participants (age: 31.9 ± 4.4 yr.) performed 36 HICT sessions (3 times per day; 3 days per week) and four participants (age: 29.5 ± 1.7 yr.) were assigned to a control group. The HICT consisted of 12 min of whole-body exercises performed during a workout. Twenty-four hours before and after the exercise program, HRV parameters were recorded. RESULTS: The heart rate exercise during the last session trended to be lower when compared with the first HICT session (p = 0.07, d = 0.39, 95% CI = -13.50, 0.72). The interval training did not modify the HRV time (Mean NN, SDNN, RMSSD, NN50, pNN50) and frequency (LF, HF, LF/HF ratio, total power) domain parameters. CONCLUSION: Thirty-six HICT sessions did not provide enough stimuli to modify the resting HRV in adults during social isolation elicited by the COVID-19 pandemic. However, the data suggested that exercise protocol did not induce cardio-vagal adaptations.
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COVID-19 , Exercícios em Circuitos , Adulto , Exercício Físico/fisiologia , Frequência Cardíaca/fisiologia , Humanos , PandemiasRESUMO
Resumen La estomatitis aftosa recurrente (EAR) es una patología ulcerativa crónica idiopática, que, aunque no llega a comprometer la vida de los pacientes, si puede desmejorar su calidad de vida. Presenta una alta incidencia en la población con un alto porcentaje de recurrencia. Atendiendo a su importancia, el objetivo de esta revisión es brindar una actualización respecto a las terapias farmacológicas y con láser para el manejo de la estomatitis aftosa recurrente. Se realizó una búsqueda bibliográfica en las bases de datos PubMed, Science Direct, EBSCO HOST y LILACS desde enero de 2010 a octubre de 2020, identificando publicaciones en inglés y español. Los artículos que fueron incluidos debían estar relacionadas con la estomatitis aftosa y su tratamiento, enfocándose en el manejo farmacológico o con láser. La estrategia de búsqueda arrojó 4536 citas bibliográficas, de las cuales fueron incluidas 19 en esta presente revisión. La mayoría de los estudios fueron ensayos clínicos aleatorizados donde la población objeto fueron adultos que demostraron el uso de antiinflamatorios, inmunomoduladores, anticuerpos monoclonales, antisépticos, anestésicos, entre otros, para el manejo de la estomatitis aftosa recurrente. De los artículos analizados se pudo concluir que la terapia farmacológica debe ser instaurada de manera particular, de acuerdo a la clínica y antecedentes del paciente. Los fármacos de primera elección son de uso tópico, reservando los de uso sistémico para casos moderados o severos y para pacientes con tratamiento refractarios, asimismo, las recomendaciones coadyuvantes como alimentación e higiene pueden ayudar a la resolución de la enfermedad. La terapia láser surge como alternativa de tratamiento con bajo riesgo y buenos resultados para la EAR.
Abstract Recurrent Aphthous Stomatitis (RAS) is an idiopathic chronic ulcerative pathology. Although it does not compromise the life of the patients, it can impair their quality of life. It presents a high incidence in the population and a high percentage of recurrence. In view of its importance, the aim of this review is to provide an update on pharmacological and laser therapies that are being implemented for the management of RAS. A bibliographic search of literature that was published between January 2010 and October 2020 was performed in PubMed, Science Direct, EBSCOhost, and LILACS databases, identifying publications in English and Spanish languages. The articles that were included had to be related to aphthous stomatitis and its treatment, focusing on pharmacological or laser management. 4536 bibliographic citations were found and 19 of them were included in this review. Most of the studies were randomized clinical trials in which the target population were adults that reported the use of anti-inflammatory drugs, immunomodulators, monoclonal antibodies, antiseptics, anesthetics, among others for the treatment of recurrent aphthous stomatitis. From the articles analyzed, it was possible to conclude that pharmacological therapy should be established in a particular way according to the patient's symptoms and medical record. The first-choice drugs are of topical use, reserving those of systemic use for moderate or severe cases and for patients with refractory treatment. Likewise, adjuvant recommendations such as nutrition and hygiene can help in the resolution of the disease. Laser therapy emerges as an alternative treatment with low risk and positive results for recurrent aphthous stomatitis.
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Since 2020, the world has been suffering from a pandemic that has affected thousands of people regardless of socio-economic conditions, forcing the population to adopt different strategies to prevent and control the advance of the disease, one of which is social distancing. Even though social distancing is a safe strategy to reduce the spread of COVID-19, it is also the cause of a rising sedentary behavior. This behavior develops an excess of fat tissue that leads to metabolic and inflammatory disruption related to chronic diseases and mental health disorders, such as anxiety, depression, and sleep issues. Furthermore, the adoption of dietary patterns involving the consumption of ultra-processed foods, higher in fats and sugars, and the reduction of fresh and healthy foods may play a role in the progress of the disease. In this perspective, we will discuss how an unhealthy diet can affect brain function and, consequently, be a risk factor for mental health diseases.
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Background: Human brain function declines with aging. In this sense, exercise-based interventions has a promising effect on brain plasticity for older adults. Serum brain-derived neurotrophic factor (BDNF) is a positive biomarker for brain neuroplasticity in healthy older adults also modified by exercise training. Selected features of the exercise prescription for improving brain health are missing; therefore, the aim of this study was to determine the effects of concurrent exercise training frequency on serum BDNF levels in healthy older adults. Methods: Nineteen volunteers (age: 65 ± 4 year; body mass index: 28.0 ± 4.5 kg/m2) completed either a three times/week (3-t/w) (n = 8) or five times/week (5-t/w) (n = 11) concurrent exercise program. The exercise program lasted 11 weeks and all exercise sessions were performed for 50 min at moderate intensity. Serum BDNF, body composition, cardiovascular, and physical fitness variables were assessed before and after the exercise training program. Results: Regardless of the group, the serum BDNF increased following the intervention (p < 0.001), and there were no significant group (p = 0.827) or interaction (p = 0.063) effects. The maximal oxygen consumption (VO2max) increased regardless of the group (p = 0.007), with a non-significant group (p = 0.722) or interaction (p = 0.223) effects. Upper- and lower-body strength increased in both groups (p = 0.003); however, there was no effect of the training frequency (p = 0.53). For the skeletal muscle mass, there was a trend in the interaction effect (p = 0.053). Finally, the body fat percentage was unchanged. Conclusion: Eleven weeks of combined exercise training increased serum BDNF levels in healthy older adults, a response independent of the training frequency. The overall fitness level improved similarly in both exercise groups. These data reveal that a minimal dosage of concurrent exercise enhance functional capacity and a brain health biomarker in older adults.
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The detection of dysplasia in patients with inflammatory bowel disease (IBD) continues to be important given the increased risk of colorectal cancer in this population. Therefore, in 2017, we performed a review and update of the recommendations for the management and follow-up of patients with IBD based on the clinical practice guidelines of various scientific societies. The present manuscript focuses on new aspects of the detection, follow-up, and management of dysplasia according to the latest studies and recommendations. While chromoendoscopy with targeted biopsy continues to be the technique of choice for the screening and detection of dysplasia in IBD, the associated difficulties mean that it is now being compared with other techniques (virtual chromoendoscopy), which yield similar results with less technical difficulties. Furthermore, the emergence of new endoscopy techniques that are still being researched but seem promising (e.g., confocal laser endomicroscopy and full-spectrum endoscopy), together with the development of devices that improve endoscopic visualization (e.g., Endocuff Vision), lead us to believe that these approaches can revolutionize the screening and follow-up of dysplasia in patients with IBD. Nevertheless, further studies are warranted to define the optimal follow-up strategy in this patient population.
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Neoplasias Colorretais , Doenças Inflamatórias Intestinais , Colite/complicações , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/etiologia , Detecção Precoce de Câncer/métodos , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/patologiaRESUMO
As the COVID-19 pandemic unfolds, manually enhanced ad-hoc solutions have helped the physical space designers and decision makers to cope with the dynamic nature of space planning. Due to the unpredictable nature by which the pandemic is unfolding, the standard operating procedures also change, and the protocols for physical interaction require continuous reconsideration. Consequently, the development of an appropriate technological solution to address the current challenge of reconfiguring common physical environments with prescribed physical distancing measures is much needed. To do this, we propose a design optimization methodology which takes the dimensions, as well as the constraints and other necessary requirements of a given physical space to yield optimal redesign solutions on the go. The methodology we propose here utilizes the solution to the well-known mathematical circle packing problem, which we define as a constrained mathematical optimization problem. The resulting optimization problem is solved subject to a given set of parameters and constraints - corresponding to the requirements on the social distancing criteria between people and the imposed constraints on the physical spaces such as the position of doors, windows, walkways and the variables related to the indoor airflow pattern. Thus, given the dimensions of a physical space and other essential requirements, the solution resulting from the automated optimization algorithm can suggest an optimal set of redesign solutions from which a user can pick the most feasible option. We demonstrate our automated optimal design methodology by way of a number of practical examples, and we discuss how this framework can be further taken forward as a design platform that can be implemented practically.
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BACKGROUND: Most children and youth develop mild or asymptomatic disease during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, a very small number of patients suffer severe Coronavirus induced disease 2019 (COVID-19). The reasons underlying these different outcomes remain unknown. METHODS: We analyzed three different cohorts: children with acute infection (n=550), convalescent children (n=138), and MIS-C (multisystem inflammatory syndrome in children, n=42). IgG and IgM antibodies to the spike protein of SARS-CoV-2, serum-neutralizing activity, plasma cytokine levels, and the frequency of circulating Follicular T helper cells (cTfh) and plasmablasts were analyzed by conventional methods. FINDINGS: Fifty-eight percent of the children in the acute phase of infection had no detectable antibodies at the time of sampling while a seronegative status was found in 25% and 12% of convalescent and MIS-C children, respectively. When children in the acute phase of the infection were stratified according disease severity, we found that contrasting with the response of children with asymptomatic, mild and moderate disease, children with severe COVID-19 did not develop any detectable response. A defective antibody response was also observed in the convalescent cohort for children with severe disease at the time of admission. This poor antibody response was associated to both, a low frequency of cTfh and a high plasma concentration of inflammatory cytokines. INTERPRETATION: A weak and delayed kinetic of antibody response to SARS-CoV-2 together with a systemic pro-inflammatory profile characterize pediatric severe COVID-19. Because comorbidities are highly prevalent in children with severe COVID-19, further studies are needed to clarify their contribution in the weak antibody response observed in severe disease. FUNDING: National Agency for Scientific and Technological Promotion from Argentina (IP-COVID-19-0277 and PMO-BID-PICT2018-2548).
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Anticorpos Antivirais/sangue , Formação de Anticorpos , COVID-19/complicações , COVID-19/imunologia , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Síndrome de Resposta Inflamatória Sistêmica/imunologia , Argentina , COVID-19/sangue , Criança , Pré-Escolar , Citocinas/sangue , Feminino , Humanos , Lactente , Masculino , SARS-CoV-2/imunologia , Síndrome de Resposta Inflamatória Sistêmica/sangueRESUMO
Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to date has viewed resilience as an outcome that can be measured through performance outcomes, as an ability of complex adaptive systems that is derived from dynamic behaviour and interactions, or as both. However, there is little congruence on the theory and the existing frameworks have not been widely used, which as diluted the research applications for health system resilience. A global group of health system researchers were convened in March 2021 to discuss and identify priorities for health system resilience research and implementation based on lessons from COVID-19 and other health emergencies. Five research priority areas were identified: (1) measuring and managing systems dynamic performance, (2) the linkages between societal resilience and health system resilience, (3) the effect of governance on the capacity for resilience, (4) creating legitimacy and (5) the influence of the private sector on health system resilience. A key to filling these research gaps will be longitudinal and comparative case studies that use cocreation and coproduction approaches that go beyond researchers to include policy-makers, practitioners and the public.