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1.
Braz. j. biol ; 83: e250373, 2023. tab, graf
Artigo em Inglês | LILACS-Express | MEDLINE, LILACSEXPRESS | ID: biblio-1339376

RESUMO

Abstract Honey is a suitable matrix for the evaluation of environmental contaminants including organochlorine insecticides. The present study was conducted to evaluate residues of fifteen organochlorine insecticides in honey samples of unifloral and multifloral origins from Dir, Pakistan. Honey samples (5 g each) were extracted with GC grade organic solvents and then subjected to Rotary Evaporator till dryness. The extracts were then mixed with n-Hexane (5 ml) and purified through Column Chromatography. Purified extracts (1μl each) were processed through Gas Chromatograph coupled with Electron Capture Detector (GC-ECD) for identification and quantification of the insecticides. Of the 15 insecticides tested, 46.7% were detected while 53.3% were not detected in the honey samples. Heptachlor was the most prevalent insecticide with a mean level of 0.0018 mg/kg detected in 80% of the samples followed by β-HCH with a mean level of 0.0016 mg/kg detected in 71.4% of the honey samples. Honey samples from Acacia modesta Wall. were 100% positive for Heptachlor with a mean level of 0.0048 mg/kg followed by β-HCH with a mean level of 0.003 mg/kg and frequency of 83.3%. Minimum levels of the tested insecticides were detected in the unifloral honey from Ziziphus jujuba Mill. Methoxychlor, Endosulfan, Endrin and metabolites of DDT were not detected in the studied honey samples. Some of the tested insecticides are banned in Pakistan but are still detected in honey samples indicating their use in the study area. The detected levels of all insecticides were below the Maximum Residue Levels (MRLs) and safe for consumers. However, the levels detected can cause mortality in insect fauna. The use of banned insecticides is one of the main factors responsible for the declining populations of important insect pollinators including honeybees.


Resumo O mel é uma matriz adequada para a avaliação de contaminantes ambientais, incluindo inseticidas organoclorados. O presente estudo foi conduzido para avaliar resíduos de 15 inseticidas organoclorados em amostras de mel de origem unifloral e multifloral de Dir, Paquistão. Amostras de mel (5 g cada) foram extraídas com solventes orgânicos de grau GC e, em seguida, submetidas ao evaporador rotativo até a secura. Os extratos foram então misturados com n-hexano (5 ml) e purificados por cromatografia em coluna. Os extratos purificados (1μl cada) foram processados através de cromatógrafo gasoso acoplado a detector de captura de elétrons (GC-ECD) para identificação e quantificação dos inseticidas. Dos 15 inseticidas testados, 46,7% foram detectados enquanto 53,3% não foram detectados nas amostras de mel. O heptacloro foi o inseticida mais prevalente com um nível médio de 0,0018 mg / kg detectado em 80% das amostras, seguido por β-HCH com um nível médio de 0,0016 mg / kg detectado em 71,4% das amostras de mel. Amostras de mel da parede de Acacia modesta foram 100% positivos para heptacloro com um nível médio de 0,0048 mg / kg seguido por β-HCH com um nível médio de 0,003 mg / kg e frequência de 83,3%. Níveis mínimos dos inseticidas testados foram detectados no mel unifloral de Ziziphus jujuba da usina. Metoxicloro, Endosulfan, Endrin e metabólitos do DDT não foram detectados nas amostras de mel estudadas. Alguns dos inseticidas testados são proibidos no Paquistão, mas ainda são detectados em amostras de mel, indicando seu uso na área de estudo. Os níveis detectados de todos os inseticidas estavam abaixo dos Níveis Máximos de Resíduos (MRLs) e seguros para os consumidores. No entanto, os níveis detectados podem causar mortalidade na fauna de insetos. O uso de inseticidas proibidos é um dos principais fatores responsáveis pelo declínio das populações de importantes insetos polinizadores, incluindo as abelhas.

2.
Med Biol Eng Comput ; 2022 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-35023073

RESUMO

Investigating gender differences based on emotional changes using electroencephalogram (EEG) is essential to understand various human behavior in the individual situation in our daily life. However, gender differences based on EEG and emotional states are not thoroughly investigated. The main novelty of this paper is twofold. First, it aims to propose an automated gender recognition system through the investigation of five entropies which were integrated as a set of entropy domain descriptors (EDDs) to illustrate the changes in the complexity of EEGs. Second, the combination EDD set was used to develop a customized EEG framework by estimating the entropy-spatial descriptors (ESDs) set for identifying gender from emotional-based EEGs. The proposed methods were validated on EEGs of 30 participants who examined short emotional video clips with four audio-visual stimuli (anger, happiness, sadness, and neutral). The individual performance of computed entropies was statistically examined using analysis of variance (ANOVA) to identify a gender role in the brain emotions. Finally, the proposed ESD framework performance was evaluated using three classifiers: support vector machine (SVM), k-nearest neighbors (kNN) and random forest (RF), and long short-term memory (LSTM) deep learning model. The results illustrated the effect of individual EDD features as remarkable indices for investigating gender while studying the relationship between EEG brain activity and emotional state changes. Moreover, the proposed ESD achieved significant enhancement in classification accuracy with SVM indicating that ESD may offer a helpful path for reliable improvement of the gender detection from emotional-based EEGs.

3.
Artigo em Inglês | MEDLINE | ID: mdl-35000070

RESUMO

PURPOSE: Colorectal cancer (CRC) is the third most common cancer in the world, with enhancing morbidity and mortality each year. Due to the drug resistance against CRC, the use of novel compounds besides chemotherapy is required. Natural seafood contains large amounts of biologically active substances with new chemical structures and new medicinal activities. The aim of this study was to evaluate the effects of hydroalcoholic extract of Sargassum oligocystom algae on SW742, HT-29, WiDr, and CT-26 CRC cell lines, and to evaluate the expression of P53 and APC genes using quantitative real-time PCR (RT-qPCR). METHODS: The cytotoxicity of S. oligocystom hydroalcoholic extract was determined by MTT and trypan blue methods in six different concentrations including 0.1, 0.2, 0.5, 1, 2, and 4 mg/mL on various CRC cell lines and a control group. The expression of P53 and APC genes in exposure to 2 mg/mL of the extract was also evaluated using RT-qPCR. RESULTS: The LD50 and LD90 of S. oligocystom included 0.5-1 and > 2 mg/mL, respectively mostly affecting SW742 and CT-26 cells. In the trypan blue test, 90% viability and death of cells were observed at 0.1 and 4 mg/mL of extract, respectively. The 2 mg/mL was a safe cytotoxic concentration. A significant viability decrease was observed at concentrations ≥ 1 mg/mL (p < 0.001). Sargassum oligocystom extract at 2 mg/mL significantly increased the expression of APC ranging 1.98-2.2-fold (p < 0.001) but not P53 gene which ranged 0.5-0.68-fold (p = 0.323) after 24 h. CONCLUSION: These results indicated that the brown algae S. oligocystom extract had significant antitumor effects against the SW742, HT-29, WiDr, and CT-26 CRC cell lines and especially CT-26, suggesting that it may be a potential candidate for further studies and therefore designing drugs of natural anticancer origin. The S. oligocystom had an anticancer effect via an increase in the APC gene expression.

4.
Eur Radiol ; 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-35031841

RESUMO

PURPOSE: To compare the diagnostic performance and inter-observer agreement of five different CT chest severity scoring systems for COVID-19 to find the most precise one with the least interpretation time. METHODS AND MATERIALS: This retrospective study included 85 patients (54 male and 31 female) with PCR-confirmed COVID-19. They underwent CT to assess the severity of pulmonary involvement. Three readers were asked to assess the pulmonary abnormalities and score the severity using five different systems, including chest CT severity score (CT-SS), chest CT score, total severity score (TSS), modified total severity score (m-TSS), and 3-level chest CT severity score. Time consumption on reporting of each system was calculated. RESULTS: Two hundred fifty-five observations were reported for each system. There was a statistically significant inter-observer agreement in assessing qualitative lung involvement using the m-TSS and the other four quantitative systems. The ROC curves revealed excellent and very good diagnostic accuracy for all systems when cutoff values for detection severe cases were > 22, > 17, > 12, and > 26 for CT-SS, chest CT score, TSS, and 3-level CT severity score. The AUC was very good (0.86), excellent (0.90), very good (0.89), and very good (0.86), respectively. Chest CT score showed the highest specificity (95.2%) in discrimination of severe cases. Time consumption on reporting was significantly different (< 0.001): CT-SS > 3L-CT-SS > chest CT score > TSS. CONCLUSION: All chest CT severity scoring systems in this study demonstrated excellent inter-observer agreement and reasonable performance to assess COVID-19 in relation to the clinical severity. CT-SS and TSS had the highest specificity and least time for interpretation. KEY POINTS: • All chest CT severity scoring systems discussed in this study revealed excellent inter-observer agreement and reasonable performance to assess COVID-19 in relation to the clinical severity. • Chest CT scoring system and TSS had the highest specificity. • Both TSS and m-TSS consumed the least time compared to the other three scoring systems.

5.
BMC Pregnancy Childbirth ; 22(1): 5, 2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34979990

RESUMO

BACKGROUND: The Salud Mesoamérica Initiative (SMI) is a public-private collaboration aimed to improve maternal and child health conditions in the poorest populations of Mesoamerica through a results-based aid mechanism. We assess the impact of SMI on the staffing and availability of equipment and supplies for delivery care, the proportion of institutional deliveries, and the proportion of women who choose a facility other than the one closest to their locality of residence for delivery. METHODS: We used a quasi-experimental design, including baseline and follow-up measurements between 2013 and 2018 in intervention and comparison areas of Guatemala, Nicaragua, and Honduras. We collected information on 8754 births linked to the health facility closest to the mother's locality of residence and the facility where the delivery took place (if attended in a health facility). We fit difference-in-difference models, adjusting for women's characteristics (age, parity, education), household characteristics, exposure to health promotion interventions, health facility level, and country. RESULTS: Equipment, inputs, and staffing of facilities improved after the Initiative in both intervention and comparison areas. After adjustment for covariates, institutional delivery increased between baseline and follow-up by 3.1 percentage points (ß = 0.031, 95% CI -0.03, 0.09) more in intervention areas than in comparison areas. The proportion of women in intervention areas who chose a facility other than their closest one to attend the delivery decreased between baseline and follow-up by 13 percentage points (ß = - 0.130, 95% CI -0.23, - 0.03) more than in the comparison group. CONCLUSIONS: Results indicate that women in intervention areas of SMI are more likely to go to their closest facility to attend delivery after the Initiative has improved facilities' capacity, suggesting that results-based aid initiatives targeting poor populations, like SMI, can increase the use of facilities closest to the place of residence for delivery care services. This should be considered in the design of interventions after the COVID-19 pandemic may have changed health and social conditions.


Assuntos
Parto Obstétrico , Promoção da Saúde , Acesso aos Serviços de Saúde , Serviços de Saúde Materna , Cuidado Pré-Natal , Adolescente , Adulto , Feminino , Guatemala , Instalações de Saúde , Honduras , Humanos , Pessoa de Meia-Idade , Nicarágua , Gravidez , Resultado da Gravidez , Adulto Jovem
6.
Hum Mutat ; 2022 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-34989426

RESUMO

Developmental and epileptic encephalopathy 35 (DEE 35) is a severe neurological condition caused by biallelic variants in ITPA, encoding inosine triphosphate pyrophosphatase, an essential enzyme in purine metabolism. We delineate the genotypic and phenotypic spectrum of DEE 35, analyzing possible predictors for adverse clinical outcomes. We investigated a cohort of 28 new patients and reviewed previously described cases, providing a comprehensive characterization of 40 subjects. Exome sequencing was performed to identify underlying ITPA pathogenic variants. Brain MRI (magnetic resonance imaging) scans were systematically analyzed to delineate the neuroradiological spectrum. Survival curves according to the Kaplan-Meier method and log-rank test were used to investigate outcome predictors in different subgroups of patients. We identified 18 distinct ITPA pathogenic variants, including 14 novel variants, and two deletions. All subjects showed profound developmental delay, microcephaly, and refractory epilepsy followed by neurodevelopmental regression. Brain MRI revision revealed a recurrent pattern of delayed myelination and restricted diffusion of early myelinating structures. Congenital microcephaly and cardiac involvement were statistically significant novel clinical predictors of adverse outcomes. We refined the molecular, clinical, and neuroradiological characterization of ITPase deficiency, and identified new clinical predictors which may have a potentially important impact on diagnosis, counseling, and follow-up of affected individuals.

7.
Signal Processing ; 194: 108426, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34898764

RESUMO

This work focuses on the development of a new family of decision-making algorithms for adaptation and learning, which are specifically tailored to decision problems and are constructed by building up on first principles from decision theory. A key observation is that estimation and decision problems are structurally different and, therefore, algorithms that have proven successful for the former need not perform well when adjusted for the latter. Exploiting classical tools from quickest detection, we propose a tailored version of Page's test, referred to as BLLR (barrier log-likelihood ratio) test, and demonstrate its applicability to real-data from the COVID-19 pandemic in Italy. The results illustrate the ability of the design tool to track the different phases of the outbreak.

8.
Magn Reson Imaging Clin N Am ; 30(1): 199-213, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34802579

RESUMO

Soft tissue vascular anomalies show a wide heterogeneity of clinical manifestations and imaging features. MR imaging has an important role in the diagnosis and management of vascular lesions of the head and neck. MR angiography is mandatory in cases of arteriovenous and combined malformations to assess the high-flow nature/component of the lesions and plan therapy. Infantile hemangiomas can be differentiated from congenital hemangiomas by clinical course. Reactive vascular tumors have nonspecific features similar to infantile hemangiomas. Locally malignant and malignant vascular tumors have irregular borders, infiltration of different tissue planes, and lower apparent diffusion coefficient values than benign vascular tumors.


Assuntos
Hemangioma , Malformações Vasculares , Cabeça , Hemangioma/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Pescoço , Malformações Vasculares/diagnóstico por imagem
9.
J Mol Graph Model ; 110: 108062, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34775218

RESUMO

Based on the linear combination of atomic orbital-molecular orbital by the natural bond orbitals (NBO) theory, the attractive donor-acceptor superposition interaction between filled (Lewis-type) and vacant (non-Lewis-type) orbitals provide a general mechanism for quantal energy lowering. This interaction has a direct impact on the quantity of the second-order stabilization energy. Therefore, the valence non-Lewis density (VNLD) index, the electron density of unoccupied valence nonbonding and antibonding orbitals, is introduced as an approach to describe and measure aromaticity. This index is based on the frontier orbital concept. To investigate the validity of the proposed aromaticity index, we selected several test sets of organic and inorganic molecules such as different ring sizes in cyclic and heterocyclic hydrocarbons, and all-metal and semimetal clusters, and compared our findings with previous aromaticity analysis. According to the results, VNLD values are well correlated and anticipated the order of aromaticity with the formerly introduced criteria. Furthermore, VNLD reveals that the rings with π-sextet electrons localized in a ring are more aromatic than the other rings, thus, it is in line with Clar's rule. Our proposed aromaticity index has advantages such as, easy to obtain from NBO analysis, and does not require reference molecules which made it more applicable for realizing the aromaticity order in many organic and inorganic compounds.


Assuntos
Elétrons , Teoria Quântica
10.
Meta Gene ; 31: 100989, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34729360

RESUMO

Coronavirus disease 19 (COVID-19) is a highly contagious respiratory viral infection. Dysregulated immune response is an important feature of disease, and cytokines are among the most important mediators of dysregulated immunity. Interleukin-37 (IL-37) is one such cytokine and studies have indicated its role in pathogenesis of COVID-19. However, IL37 gene polymorphisms have not been identified in patients with COVID-19. Therefore, this case-control study (100 patients and 100 controls) was performed to understand the role six single nucleotide polymorphisms of IL37 gene (SNPs: rs3811042, rs3811043, rs2466449, rs3811045, rs3811046 and rs3811047) in susceptibility to COVID-19 among cases with severe disease. These polymorphisms were identified by Sanger DNA sequencing. Results revealed that TG genotype of rs3811046 showed a significantly increased frequency in patients compared to controls (61.0 vs. 38.0%; odds ratio [OR] = 2.55; 95% confidence interval [CI] = 1.45-4.50; probability [p] = 0.002; corrected p [pc] = 0.01). GA genotype of rs3811047 also showed an increased frequency in patients but the pc-value was not significant (39.0 vs. 24.0%; OR = 2.02; 95% CI = 1.10-3.71; p = 0.033; pc = 0.165). Haplotype analysis revealed a significantly increased frequency of the haplotype G-C-A-T-T-A (in the order: rs3811042, rs3811043, rs2466449, rs3811045, rs3811046 and rs3811047) in COVID-19 patients compared to controls (0.055 vs. 0.006; OR = 10.23; 95% CI = 1.53-68.14; p = 0.003; pc = 0.03). In conclusion, the study indicated that two variants of IL37 gene (rs3811046 and rs3811047) may be associated with susceptibility to COVID-19 among Iraqi population.

11.
Spectrochim Acta A Mol Biomol Spectrosc ; 264: 120253, 2022 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-34391992

RESUMO

Globally, the environmental pollution is one of the major issues causing toxicity towards human and aquatic life. We have developed a facile and innovative sensing approach for detection of sulphide ions (S2-) present in the aqueous media using Ag0 decorated Cr2S3 NPs embedded on PVP matrix (Ag/Cr2S3-PVP). Based on the SPR phenomena, the detection of S2- ions was established. The nanohybrid was characterized using various techniques such as UV-vis spectrophotometer, High-Resolution Transmission Electron Microscopy (HR-TEM), Thermal Gravimetric Analysis (TGA), X-ray diffraction analysis(XRD), Energy-dispersive X-ray spectroscopy (EDS), Fourier-transform infrared spectroscopy (FT-IR), Scanning Electron Microscopy (SEM), and X-ray photoelectron spectroscopy (XPS). The yellowish colour of Ag/Cr2S3-PVP nanohybrid turned to brown colour in presence of S2- ions. The selectivity and sensitivity of the prepared probe was studied against the other interfering metal ions. In addition, the effect of different concentration of S2- ions in the nanohybrid solution was investigated and the Limit of detection (LOD) was found to be 6.6 nM. The good linearity was found over the range of 10 nM to 100 µM with R2 value of 0.981. The paper strip based probe was developed for rapid onsite monitoring of S2- ions. The proposed method is found to be cost-effective, rapid, and simple. We have validated the practical applicability of the prepared probe for determining the concentration of S2- ions in real water samples.


Assuntos
Colorimetria , Nanopartículas Metálicas , Humanos , Limite de Detecção , Espectroscopia de Infravermelho com Transformada de Fourier , Sulfetos , Água
12.
Spectrochim Acta A Mol Biomol Spectrosc ; 265: 120356, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34536896

RESUMO

A selective and sensitive detection of L-cysteine (Cys) is an important tool for various biological studies. Here, Au nanoparticles (NPs) were prepared by chemical reduction technique. The probe was developed to detect and quantify Cys in the presence of Cr3+ ions which acts as a cross linker. The citrate capped Au NPs probe was analyzed by UV-visible spectrophotometry, TEM, EDAX, FTIR, DLS, XPS and zetasize. The zeta potential and effective size of Au NPs were -41.22 mV and 12 nm, respectively. The Cys interaction with Au NPs showed drastic colour variation from red to purple and colourless with rapid response time of 1 min. The limit of detection (LOD) of Au NPs probe was as low as 0.012 nM. The TEM image of Au NPs after Cys interaction verified the aggregation that resulted in colour change. The XPS core level scans of Au 4f showed 0.3 eV red shift when Cyswas interacted. The Au NPs sensor is highly selective for Cys with excellent reproducibility. Acidic pH slightly favored Cys detection. Further, the probe was applied to estimate Cys quantity from milk, urine, blood and environmental augmented samples in the presence of other amino acids . The study suggests that the proposed Au NPs could detect Cys with high accuracy from various biological samples.


Assuntos
Ouro , Nanopartículas Metálicas , Colorimetria , Cisteína , Reprodutibilidade dos Testes , Ressonância de Plasmônio de Superfície
13.
Clin Exp Allergy ; 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34854146

RESUMO

BACKGROUND: Eczema is a common inflammatory skin disease with varying developmental trajectories/patterns that are influenced by different risk factors. The aim of this study was to investigate eczema development from infancy to early adulthood by identifying distinct developmental trajectories that describe disease patterns over time and evaluate the role of prenatal and early life risk factors. METHODS: The Isle of Wight Birth Cohort (n=1,456) was prospectively assessed at birth, 1, 2, 4, 10, 18, and 26 years. In all assessments, eczema was defined as chronic or chronically relapsing itchy dermatitis lasting >6 weeks with characteristic morphology and distribution in the past 12 months. Developmental trajectories of eczema between 1-or-2 and 26 years were identified separately for males and females by applying semiparametric mixture models. Associations were assessed by applying a modified Poisson regression to estimate adjusted risk ratios (aRR) and 95% confidence intervals (CI). RESULTS: In both males and females, the following eczema developmental trajectories were identified: unaffected/transient (males: 77.7% vs. females: 73.0%), mid-onset late-resolving (males: 7.8% vs. females: 4.4%), late-onset (males: 5.2% vs. females: 9.5%), and early-onset persistent (males: 9.3% vs. females: 5.4%). In females, an additional trajectory was identified: early-onset early-resolving (7.7%). Among males, filaggrin gene (FLG) variants (aRR = 2.45, 95% CI: 1.34-4.46) and paternal eczema (2.66, 1.39-5.08) were associated with the early-onset persistent trajectory. Among females, maternal eczema (2.84, 1.42-5.70) and high birthweight (2.25, 1.08-4.69) were associated with the early-onset persistent trajectory. CONCLUSIONS: Four and five trajectories represented eczema development among males and females, respectively, with different predisposing risk factors. Our results indicate that males and females may experience a different course of eczema.

14.
Int J Nanomedicine ; 16: 7711-7726, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34848956

RESUMO

Introduction: Protein-derived biogenic syntheses of inorganic nanoparticles have gained immense attention because of their broad spectrum of applications. Proteins offer a reducing environment to enable the synthesis of nanoparticles and encapsulate synthesized nanoparticles and provide them temporal stability in addition to biocompatibility. Methods: In the present study, Benincasa hispida fruit proteins were used to synthesize silver nanoparticles (AgNPs) at 37 °C over five days of incubation. The synthesis of AgNPs was confirmed by UV-Vis spectroscopy, TEM, zeta potential, and DLS analyses. Further, these NPs depicted antibacterial and antibiofilm effects. Additionally, the anticancer activities of nanoparticles were also tested against the lung cancer cell line (A549) with respect to the normal cell line (NRK) using MTT assay. Further, the estimation of ROS generation through DCFH-DA staining along with a reduction in mitochondrial membrane potential by Mito Tracker Red CMX staining was carried out. Moreover, nuclear degradation in the AgNPs treated cells was cross-checked by DAPI staining. Results: The average size of AgNPs was detected to be 27 ±1 nm by TEM analysis, whereas surface encapsulation by protein was determined by FTIR spectroscopy. These NPs were effective against bacterial pathogens such as Escherichia coli, Staphylococcus aureus, Salmonella enteric, and Staphylococcus epidermis with MICs of 148.12 µg/mL, 165.63 µg/mL, 162.77 µg/mL, and 124.88 µg/mL, respectively. Furthermore, these nanoparticles inhibit the formation of biofilms of E. coli, S. aureus, S. enteric, and S. epidermis by 71.14%, 73.89%, 66.66%, and 64.81%, respectively. Similarly, these nanoparticles were also found to inhibit (IC50 = 57.11 µM) the lung cancer cell line (A549). At the same time, they were non-toxic against NRK cells up to a concentration of 200 µM. Discussion: We successfully synthesized potentially potent antibacterial, antibiofilm and anticancer biogenic AgNPs.

15.
Artigo em Inglês | MEDLINE | ID: mdl-34851861

RESUMO

INTRODUCTION: As rates of primary total joint arthroplasty continue to rise, so do rates of revision. Revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) are more frequently done at larger centers, are associated with higher morbidity, and may have different patient satisfaction outcomes. This study compares the survey results of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) between patients who underwent primary versus revision THA or TKA. METHODS: All adult patients who underwent inpatient, elective, primary, and revision THA or TKA at a single institution were selected for retrospective analysis. Patient demographics, comorbidities, functional status, surgical variables, 30-day outcomes, and HCAHPS scores were assessed. Univariate and multivariate analyses were done to determine correlations between the aforementioned variables and top-box HCAHPS survey scores for primary versus revision THA and TKA. RESULTS: Of 2,707 patients who met the inclusion criteria and had returned the HCAHPS survey, primary THA was documented in 1,075 patients (39.71%), revision THA in 75 (2.77%), primary TKA in 1,497 (55.30%), and revision TKA in 60 (2.22%). Revision THA patients were more functionally dependent, and TKA patients had higher American Society of Anesthesiologists score than their primary comparators. Revisions had longer hospital length of stay for both procedures. For THA, revision THA patients demonstrated lower total top-box rates compared withprimary THA patients (71.64% versus 75.67% top-box, P < 0.001) and lower scores on the care from doctors subsection (76.26% versus 85.34%, P < 0.001) of the HCAHPS survey. Similarly, for TKA, revision TKA patients demonstrated lower total top-box rates (76.13% versus 79.22%, P < 0.013) and lower scores on the care from doctors subsection (66.28% versus 83.65%, P < 0.001) of the HCAHPS survey. DISCUSSION: For both THA and TKA, revision procedures were associated with lower total HCAHPS scores and rated care from doctors. This suggests that HCAHPS scores may be biased by factors outside the surgeon's control, such as the complexity associated with revision procedures. LEVEL OF EVIDENCE: Level III.

16.
BMC Pediatr ; 21(1): 534, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34852795

RESUMO

BACKGROUND: Intrapartum-related hypoxic events, or birth asphyxia, causes one-fourth of neonatal deaths globally and in Mesoamerica. Multidimensional care for asphyxia must be implemented to ensure timely and effective care of newborns. Salud Mesoamérica Initiative (SMI) is a performance-based program seeking to improve maternal and child health for low-income areas of Central America. Our objective was to assess the impact of SMI on neonatal asphyxia care in health centers and hospitals in the region. METHODS: A pre-post design. Two hundred forty-eight cases of asphyxia were randomly selected from medical records at baseline (2011-2013) and at second-phase follow-up (2017-2018) in Mexico (state of Chiapas), Honduras, Nicaragua, and Guatemala as part of the SMI Initiative evaluation. A facility survey was conducted to assess quality of health care and the management of asphyxia. The primary outcome was coverage of multidimensional care for the management of asphyxia, consisting of a skilled provider presence at birth, immediate assessment, initial stabilization, and appropriate resuscitation measures of the newborn. Data were analyzed using multivariable logistic regression. RESULTS: Management of asphyxia improved significantly after SMI. Proper care of asphyxia in intervention areas was better (OR = 2.4; 95% CI = 1.3-4.6) compared to baseline. Additionally, multidimensional care was significantly higher in Honduras (OR = 4.0; 95% CI = 1.4-12.0) than in Mexico. Of the four multidimensional care components, resuscitation showed the greatest progress by follow-up (65.7%) compared to baseline (38.7%). CONCLUSION: SMI improved the care for neonatal asphyxia management across all levels of health care in all countries. Our findings show that proper training and adequate supplies can improve health outcomes in low-income communities. SMI provides a model for improving health care in other settings.

17.
Front Pharmacol ; 12: 743059, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34867349

RESUMO

Microglia, the resident phagocytes of the central nervous system and one of the key modulators of the innate immune system, have been shown to play a major role in brain insults. Upon activation in response to neuroinflammation, microglia promote the release of inflammatory mediators as well as promote phagocytosis. Plasma prekallikrein (PKall) has been recently implicated as a mediator of neuroinflammation; nevertheless, its role in mediating microglial activation has not been investigated yet. In the current study, we evaluate the mechanisms through which PKall contributes to microglial activation and release of inflammatory cytokines assessing PKall-related receptors and their dynamics. Murine N9-microglial cells were exposed to PKall (2.5 ng/ml), lipopolysaccharide (100 ng/ml), bradykinin (BK, 0.1 µM), and neuronal cell debris (16.5 µg protein/ml). Gene expression of bradykinin 2 receptor (B2KR), protease-activated receptor 2 (PAR-2), along with cytokines and fibrotic mediators were studied. Bioinformatic analysis was conducted to correlate altered protein changes with microglial activation. To assess receptor dynamics, HOE-140 (1 µM) and GB-83 (2 µM) were used to antagonize the B2KR and PAR-2 receptors, respectively. Also, the role of autophagy in modulating microglial response was evaluated. Data from our work indicate that PKall, LPS, BK, and neuronal cell debris resulted in the activation of microglia and enhanced expression/secretion of inflammatory mediators. Elevated increase in inflammatory mediators was attenuated in the presence of HOE-140 and GB-83, implicating the engagement of these receptors in the activation process coupled with an increase in the expression of B2KR and PAR-2. Finally, the inhibition of autophagy significantly enhanced the release of the cytokine IL-6 which were validated via bioinformatics analysis demonstrating the role of PKall in systematic and brain inflammatory processes. Taken together, we demonstrated that PKall can modulate microglial activation via the engagement of PAR-2 and B2KR where PKall acts as a neuromodulator of inflammatory processes.

18.
Nat Rev Immunol ; 2021 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-34873279

RESUMO

The germinal centre (GC) response is critical for the generation of affinity-matured plasma cells and memory B cells capable of mediating long-term protective immunity. Understanding whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or vaccination elicits a GC response has profound implications for the capacity of responding B cells to contribute to protection against infection. However, direct assessment of the GC response in humans remains a major challenge. Here we summarize emerging evidence for the importance of the GC response in the establishment of durable and broad immunity against SARS-CoV-2 and discuss new approaches to modulate the GC response to better protect against newly emerging SARS-CoV-2 variants. We also discuss new findings showing that the GC B cell response persists in the draining lymph nodes for at least 6 months in some individuals following vaccination with SARS-CoV-2 mRNA-based vaccines.

19.
Neurologist ; 2021 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-34855662

RESUMO

INTRODUCTION: Progressive multifocal leukoencephalopathy (PML) is a rare infection of the central nervous system due to the reactivation of the John Cunningham polyomavirus. It is commonly a progressive fatal disease with worldwide distribution. CASE REPORT: We describe a rare case of PML, which was misdiagnosed as neuropsychiatric systemic lupus erythematosus (SLE) with a catastrophic outcome due to delay in diagnosis with superadded cyclophosphamide therapy. CONCLUSION: There are several lessons taught from our case. Firstly, in patients with autoimmune disorders who are strongly immunosuppressed, the new onset of cognitive impairment and seizures should alert the treating physician to look carefully for PML. Secondly, in cases of SLE where the diagnosis of the cause of cognitive impairment and seizures is not clear, we suggest that immunosuppression should not be intensified until PML has clearly been ruled out. Lastly, multidisciplinary care in patients with suspected neuropsychiatric SLE including a neurologist, an infectious diseases consultant, a neuroradiologist, and a rheumatologist is needed.

20.
J Family Med Prim Care ; 10(10): 3851-3856, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34934691

RESUMO

Background: Alopecia is a common health condition that can be associated with social and psychological consequences. Aims: This study aims to estimate the prevalence of hair loss and its associated risk factors among primary healthcare center (PHC) attendees in the Jazan region. Methods: This investigation was a cross-sectional study conducted in the Jazan region of southwest Saudi Arabia. A total of 23 PHCs were randomly selected from five governorates in the region. Data were collected via interviewing PHCs attendees and were asked about their demographic characteristics, presence of hair loss, and among attendees who confirmed having hair loss, they were further asked about associated clinical features, healthcare-seeking behavior, and factors that might contribute to the development of their condition. Results: A total of 729 participants consented to be involved in this study. The number of respondents who reported having hair loss was 483, representing 66.3% of the whole sample. Gender appears to have the highest level of variability, with the majority of participants reporting hair loss being female (P < 0.001). The most frequently reported type of hair loss was telogen effluvium, followed by androgenic alopecia. A total of 185 respondents reported taking medications to treat their hair loss, of whom 108 (58.3%) did not seek any medical advice to identify the cause of their condition. Limitations: The main weakness of this investigation is related to relying on a reported presence of hair loss without having it confirmed with a clinical diagnosis. Conclusion: A minority of participants who reported suffering from hair loss were further evaluated by healthcare professionals to learn the cause of their hair loss. This may indicate the presence of poor hair care and the probability of a higher risk of hair loss requiring the development of suitable preventive strategies.

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