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1.
BMC Neurol ; 24(1): 161, 2024 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-38745275

RESUMO

INTRODUCTION: Postural balance impairment can affect the quality of life of patients with Parkinson's disease. Previous studies have described connections of the vestibular system with postural functions, suggesting a potential participation of the basal ganglia in receiving vestibular stimuli. This systematic review aims to summarize the evidence on the effectiveness of vestibular rehabilitation on postural balance in patients with Parkinson's disease. METHODS: A systematic review was conducted using the electronic databases: PubMed, Embase, Scopus and PEDro. The study selection was independently conducted by two reviewers, and disagreements were evaluated by a third reviewer. The included studies had no restrictions on publication dates or languages and the last update occurred in July 2023. RESULTS: From the 485 studies found in the searches, only 3 studies were deemed eligible for the systematic review involving a total of 130 participants. The Berg Balance Scale was described as the tool for evaluation of postural balance in all studies. The meta-analysis showed statistically significant results in favor of vestibular rehabilitation (MD = 5.35; 95% CI = 2.39, 8.31; P < 0.001), regardless of the stage of Parkinson's disease. Although the effect size was suggested as a useful functional gain, the analysis was done with caution, as it only included 3 randomized controlled trials. The risk of bias using the RoB-2 was considered as being of "some concern" in all studies. Furthermore, the quality of the evidence based on the Grading of Recommendations Assessment Development and Evaluation system, produced by pooling the included studies was considered very low. CONCLUSION: Compared to other interventions, vestibular rehabilitation has potential to assist the postural balance of patients with Parkinson's disease. However, the very low quality of the evidence demonstrates uncertainty about the impact of this clinical practice. More robust studies are needed to confirm the benefits of this therapy in patients with Parkinson's disease. This study was prospectively registered in PROSPERO: CRD42020210185.


Assuntos
Doença de Parkinson , Equilíbrio Postural , Ensaios Clínicos Controlados Aleatórios como Assunto , Equilíbrio Postural/fisiologia , Humanos , Doença de Parkinson/reabilitação , Doença de Parkinson/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Doenças Vestibulares/reabilitação , Doenças Vestibulares/fisiopatologia , Resultado do Tratamento , Vestíbulo do Labirinto/fisiopatologia , Reabilitação Neurológica/métodos
2.
Telemed J E Health ; 30(4): 994-1005, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37930716

RESUMO

Introduction: Image quality and acquisition protocol adherence assessment is a neglected area in teledermatology. We examine if it is feasible to use deep learning methods to automate the assessment of the adherence of examinations to image acquisition protocols. In this study, we focused on the quality criteria of two image acquisition protocols: (1) approximation image and (2) panoramic image, as these are present in all teledermatology examination protocols currently used by the Santa Catarina State Integrated Telemedicine and Telehealth System (STT/SC). Methods: We use a data set of 36,102 teledermatological examinations performed at the STT/SC during 2021. As our validation process, we adopted standard machine learning metrics and an inter-rater agreement (IRA) study with 11 dermatologists. For the approximation image protocol, we used the Mask-Region based Convolutional Neural Network (RCNN) Object Detection Deep Learning (DL) architecture to identify the presence of a lesion identification tag and a ruler used to provide a frame reference of the lesion. For the panoramic image protocol, we used DensePose, a pose estimation DL, architecture to assess the presence of a whole patient body and its orientation. A combination of the two approaches was additionally validated through an IRA study between specialists. Results: Mask-RCNN achieved a score of 96% mean average precision (mAP), while DensePose presented 75% mAP. IRA achieved a level of agreement of 96.68% with the Krippendorff alpha score. Conclusions: Our results show the feasibility of using deep learning to automate the image quality and protocol adherence assessment in teledermatology, before the specialist's manual analysis of the examination.


Assuntos
Redes Neurais de Computação , Telemedicina , Humanos , Telemedicina/métodos , Exame Físico , Processamento de Imagem Assistida por Computador/métodos , Brasil
3.
J Pediatr Hematol Oncol ; 45(7): e817-e822, 2023 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-37526408

RESUMO

The therapeutic approach to Wilms tumor (WT) is multidisciplinary and leads to significant patient impairment, increasing the risk of nutritional compromise and malnutrition. Children with cancer are vulnerable to sarcopenia which has been recognized as a negative impact of anticancer therapy. Recent studies have highlighted the reduction in the total psoas muscle area (TPMA) to be associated with a poor prognosis in many pediatric diseases, including cancer. This study aims to evaluate changes in the TPMA compartment during the treatment of children with WT. An observational, longitudinal, and retrospective study was undertaken in a single institution evaluating children (1 to 14 y, n=38) with WT between 2014 and 2020. TPMA was assessed by the analysis of previously collected, electronically stored computed tomography images of the abdomen obtained at 3 time points: diagnosis, preoperatively, and 1 year after surgery. For all patients, TPMA/age were calculated with a specific online calculator. Our data show a high incidence of sarcopenia (55.3%) at diagnosis which increased after 4 to 6 weeks of neoadjuvant chemotherapy (73.7%) and remained high (78.9%) 1 year after the surgical procedure. Using TPMA/age Z-score curves we have found significant and rapid muscle loss in children with WT, with little or no recovery in the study period.


Assuntos
Neoplasias Renais , Desnutrição , Sarcopenia , Tumor de Wilms , Criança , Humanos , Neoplasias Renais/complicações , Desnutrição/complicações , Prognóstico , Estudos Retrospectivos , Sarcopenia/diagnóstico , Sarcopenia/etiologia , Tumor de Wilms/complicações , Tumor de Wilms/terapia , Estudos Longitudinais
4.
Curr Issues Mol Biol ; 44(11): 5498-5515, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36354684

RESUMO

The WD repeat containing antisense to TP53 (WRAP53) gene codifies an antisense transcript for tumor protein p53 (TP53), stabilization (WRAP53α), and a functional protein (WRAP53ß, WDR79, or TCAB1). The WRAP53ß protein functions as a scaffolding protein that is important for telomerase localization, telomere assembly, Cajal body integrity, and DNA double-strand break repair. WRAP53ß is one of many proteins known for containing WD40 domains, which are responsible for mediating a variety of cell interactions. Currently, WRAP53 overexpression is considered a biomarker for a diverse subset of cancer types, and in this study, we describe what is known about WRAP53ß's multiple interactions in cell protein trafficking, Cajal body formation, and DNA double-strand break repair and its current perspectives as a biomarker for cancer.

5.
Aging Clin Exp Res ; 34(12): 2963-2976, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36306110

RESUMO

With the increase in life expectancy, the incidence of neurodegenerative disorders and their impact worldwide has been increasing in recent years. Neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease, and Huntington's disease, have complex and varied mechanisms of pathogenesis. Importantly, they share the common feature of disrupted circadian rhythms. This hallmark is believed to underlie the symptoms of such diseases and even potentially contribute to their onset. In addition, the association of physical frailty with dementia and neurodegenerative disorders has been demonstrated. In fact, frail persons are 8 times more likely to have some form of dementia and population studies report a significant prevalence for frailty in older patients with AD and PD. SIRT1 regulates the acetylation status of clock components and controls circadian amplitude of clock genes. However, the mechanisms responsible for this circadian clock control have been the subject of contradictory findings. Importantly, the activation of SIRT1 has been shown to have very relevant therapeutic potential against neurodegeneration. Nevertheless, few studies have attempted to connect the therapeutic reestablishing of SIRT1 as an approach against circadian disruption in neurodegenerative diseases. In this review, we address: circadian rhythms as an important early biomarker of neurodegenerative disorders; mechanisms for SIRT1 activation and the novel sirtuin-activating compounds (STACs); SIRT1 circadian paradox and subsequent studies in an unprecedented way in the literature; the beneficial role of SIRT1 activation in neurodegeneration; innovative proposals of how circadian-based interventions (e.g., SIRT1 activators) may become an important therapeutic approach against neurodegenerative disorders and how non-pharmacologic interventions (e.g., Mediterranean-style diet) might help in the prevention and/or treatment of these high-burden disorders, while tackling frailty and enhancing robustness.


Assuntos
Doença de Alzheimer , Relógios Circadianos , Fragilidade , Doenças Neurodegenerativas , Humanos , Idoso , Relógios Circadianos/genética , Sirtuína 1/genética , Ritmo Circadiano
6.
Int J Mol Sci ; 23(10)2022 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-35628297

RESUMO

Human T cell leukemia virus type 1 (HTLV-1) was identified as the first pathogenic human retrovirus and is estimated to infect 5 to 10 million individuals worldwide. Unlike other retroviruses, there is no effective therapy to prevent the onset of the most alarming diseases caused by HTLV-1, and the more severe cases manifest as the malignant phenotype of adult T cell leukemia (ATL). MicroRNA (miRNA) dysfunction is a common feature of leukemogenesis, and it is no different in ATL cases. Therefore, we sought to analyze studies that reported deregulated miRNA expression in HTLV-1 infected cells and patients' samples to understand how this deregulation could induce malignancy. Through in silico analysis, we identified 12 miRNAs that stood out in the prediction of targets, and we performed functional annotation of the genes linked to these 12 miRNAs that appeared to have a major biological interaction. A total of 90 genes were enriched in 14 KEGG pathways with significant values, including TP53, WNT, MAPK, TGF-ß, and Ras signaling pathways. These miRNAs and gene interactions are discussed in further detail for elucidation of how they may act as probable drivers for ATL onset, and while our data provide solid starting points for comprehension of miRNAs' roles in HTLV-1 infection, continuous effort in oncologic research is still needed to improve our understanding of HTLV-1 induced leukemia.


Assuntos
Infecções por HTLV-I , Leucemia-Linfoma de Células T do Adulto , MicroRNAs , Biologia Computacional , Infecções por HTLV-I/genética , Vírus Linfotrópico T Tipo 1 Humano , Humanos , Leucemia-Linfoma de Células T do Adulto/genética , Leucemia-Linfoma de Células T do Adulto/virologia , MicroRNAs/genética
7.
Int J Mol Sci ; 23(15)2022 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-35897788

RESUMO

The circadian clock (CC) is a daily system that regulates the oscillations of physiological processes and can respond to the external environment in order to maintain internal homeostasis. For the functioning of the CC, the clock genes (CG) act in different metabolic pathways through the clock-controlled genes (CCG), providing cellular regulation. The CC's interruption can result in the development of different diseases, such as neurodegenerative and metabolic disorders, as well as cancer. Leukemias correspond to a group of malignancies of the blood and bone marrow that occur when alterations in normal cellular regulatory processes cause the uncontrolled proliferation of hematopoietic stem cells. This review aimed to associate a deregulated CC with the manifestation of leukemia, looking for possible pathways involving CG and their possible role as leukemic biomarkers.


Assuntos
Transtornos Cronobiológicos , Relógios Circadianos , Leucemia , Neoplasias , Biomarcadores , Relógios Circadianos/genética , Ritmo Circadiano/genética , Humanos , Leucemia/genética
8.
Int J Mol Sci ; 23(7)2022 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-35409190

RESUMO

The increasing numbers of cancer cases worldwide and the exceedingly high mortality rates of some tumor subtypes raise the question about if the current protocols for cancer management are effective and what has been done to improve upon oncologic patients' prognoses. The traditional chemo-immunotherapy options for cancer treatment focus on the use of cytotoxic agents that are able to overcome neoplastic clones' survival mechanisms and induce apoptosis, as well as on the ability to capacitate the host's immune system to hinder the continuous growth of malignant cells. The need to avert the highly toxic profiles of conventional chemo-immunotherapy and to overcome the emerging cases of tumor multidrug resistance has fueled a growing interest in the field of precision medicine and targeted molecular therapies in the last couple of decades, although relatively new alternatives in oncologic practices, the increased specificity, and the positive clinical outcomes achieved through targeted molecular therapies have already consolidated them as promising prospects for the future of cancer management. In recent years, the development and application of targeted drugs as tyrosine kinase inhibitors have enabled cancer treatment to enter the era of specificity. In addition, the combined use of targeted therapy, immunotherapy, and traditional chemotherapy has innovated the standard treatment for many malignancies, bringing new light to patients with recurrent tumors. This article comprises a series of clinical trials that, in the past 5 years, utilized kinase inhibitors (KIs) as a monotherapy or in combination with other cytotoxic agents to treat patients afflicted with solid tumors. The results, with varying degrees of efficacy, are reported.


Assuntos
Neoplasias , Citotoxinas/uso terapêutico , Sistemas de Liberação de Medicamentos , Humanos , Fatores Imunológicos/uso terapêutico , Imunoterapia/métodos , Terapia de Alvo Molecular , Neoplasias/tratamento farmacológico , Neoplasias/patologia
9.
J Craniofac Surg ; 31(4): e326-e329, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32049921

RESUMO

Myoepithelioma is a rare benign tumor of the salivary glands, in which the vast majority of neoplastic cells are myoepithelial. A rare microscopic finding in salivary gland tumors, including myoepitheliomas, is the presence of psammoma bodies (PBs), whose etiology and role in the tumors are uncertain. The objective of this study is to describe the unusual histopathologic findings, such as psammomas, of a large myopephelioma on the palate and the prosthetic restorative treatment performed after resection of the tumor. A 52-year-old woman was referred for evaluation of a tumor-like lesion, of smooth surface and normal mucosal color, measuring approximately 5 cm, on the left side hard palate, which had been identified 4 years earlier. The diagnostic hypothesis was a pleomorphic adenoma (PA), and an incisional biopsy was performed. After histopathologic analysis, a PA was suggested, and surgical resection of the tumor was performed. The histopathologic findings were compatible with myoepithelioma showing numerous calcified basophilic structures compatible with PB. Sixteen months after resection of the tumor, a removable maxillary obturator prosthesis was made because of the communication into oral and nasal cavity due from the surgical procedure. The treatment of choice for myoepithelioma is surgical excision with a nonlesional area margin. In the present report, the authors achieve good postoperative results without recurrences. After installation of the prosthesis, the patient had an excellent adaptation and acceptance, thus restoring her function and psychologic condition.


Assuntos
Adenoma Pleomorfo/cirurgia , Mioepitelioma/cirurgia , Neoplasias das Glândulas Salivares/cirurgia , Biópsia , Feminino , Humanos , Pessoa de Meia-Idade , Cavidade Nasal/patologia , Neoplasias das Glândulas Salivares/patologia
10.
J Craniofac Surg ; 31(5): e509-e511, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32541271

RESUMO

Lingual lateral canal is a rare variation in the trajectory of the mandibular canal, and is usually detected as an incidental finding on radiographic exams, especially on cone-beam computed tomography. Due to its radiographic characteristics, this anatomical variation might be confused with a mandible fracture. Therefore, the knowledge of its presence is essential not only to differentiate it from a fracture, but also for the success of surgical procedures performed in the mandible, making it easier to avoid clinical complications such as swelling, bruising, bleeding, and neurovascular disorders. This report shows the case of a lingual lateral canal mimicking a fracture on the mandibular body.


Assuntos
Diagnóstico Diferencial , Fraturas Mandibulares/diagnóstico por imagem , Língua/diagnóstico por imagem , Idoso , Variação Anatômica , Tomografia Computadorizada de Feixe Cônico/métodos , Humanos , Masculino
11.
Crit Care Med ; 47(1): e44-e51, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30303842

RESUMO

OBJECTIVES: To systematically review the literature and synthesize evidence concerning the effects of vasopressin and its analogs compared with other vasopressors in distributive shock, focusing on renal outcomes. DATA SOURCES: We performed a systematic review in MEDLINE, Embase, Cochrane Central, and Clinicaltrials.gov databases. STUDY SELECTION: Randomized clinical trials that compared vasopressin and its analogs with other vasopressors and reported renal outcomes in adult patients with distributive shock. DATA EXTRACTION: Paired reviewers independently screened citations, conducted data extraction and assessed risk of bias. Three prespecified subgroup analyses were conducted. Three main outcomes related to acute renal failure were analyzed: the need for renal replacement therapy, acute kidney injury incidence, and acute kidney injury-free days. I test was used to evaluate heterogeneity between studies. Substantial heterogeneity was defined as I greater than 50%. A random-effects model with Mantel-Haenszel weighting was used for all analyses. Heterogeneity was explored using subgroup analysis. The quality of evidence for intervention effects was summarized using Grading of Recommendations Assessment, Development, and Evaluation methodology. This study was registered in the PROSPERO database (CRD42017054324). DATA SYNTHESIS: Three-thousand twenty-six potentially relevant studies were identified, and 30 articles were reviewed in full. Seventeen studies met the inclusion criteria, including a total of 2,833 individuals. Of these, 11 studies (2,691 individuals) were suitable for quantitative meta-analysis. Overall, the evidence was of low to moderate quality. Patients who received vasopressin and its analogs had a reduced need for renal replacement therapy (odds ratio, 0.59 [0.37-0.92]; p = 0.02; I = 49%) and a lower acute kidney injury incidence (odds ratio, 0.58 [0.37-0.92]; p = 0.02; I = 63%). These results should be interpreted with caution, due to excessive heterogeneity. Acute kidney injury-free data was not pooled, since the small number of studies and extreme heterogeneity. CONCLUSIONS: In patients with distributive shock, vasopressin and its analogs use is associated with a reduced need for renal replacement therapy and lower acute kidney injury incidence. These results are supported by high risk of bias evidence.


Assuntos
Choque/tratamento farmacológico , Vasoconstritores/uso terapêutico , Vasopressinas/uso terapêutico , Injúria Renal Aguda/etiologia , Humanos , Incidência , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia de Substituição Renal/estatística & dados numéricos , Choque/complicações , Terlipressina/uso terapêutico
12.
Hematol Oncol ; 37(1): 62-74, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30129104

RESUMO

Autologous transplantation continues to be the cornerstone of younger and fit multiple myeloma patients. It is known that frontline induction therapy before transplantation can influence post-transplant results. Therefore, best frontline treatment for transplant-eligible patients should be based on best available evidence to guide therapy. Furthermore, until now due to data scarcity, it was not possible to thoroughly compare lenalidomide to other regimens in this setting. We performed a systematic review and network (mixed treatment comparison) meta-analysis of 21 clinical trial publications, enrolling 6474 patients and comparing 11 different treatment frontline setting regimens regarding survival, response, and safety outcomes. OS analysis showed superiority of CRD (cyclophosphamide-lenalidomide-dexamethasone) over TD-based (thalidomide-dexamethasone, HR = 0.76,0.62-0.90), VAD-based (HR = 0.71,0.52-0.90), and Z-Dex (idarubicin-dexamethasone, HR = 0.37,0.17-0.76) regimens. Concerning PFS, VTD (bortezomib-thalidomide-dexametasone) showed superior results when compared with TD-based (HR = 0.66,0.51-0.84), VAD-based (HR = 0.61,0.46-0.82), Z-Dex (HR = 0.42,0.22-0.78), and high dose dexamethasone (Dex, HR = 0.62,0.41-0.90) regimens. Bortezomib/thalidomide regimens were not superior to lenalidomide, considering these outcomes. Also, concerning complete and overall response, VTD ranked first among other regimens, showing clear superiority over thalidomide-only containing protocols. Safety outcome evaluated infectious, cardiac, gastrointestinal, neurological, thrombotic, and hematological grade 3 to 4 adverse events. Risk of thrombotic events was higher with TAD (thalidomide-doxorubicin-dexamethasone), neurological with PAD (bortezomib-doxorubicin-dexamethasone), infectious with Dex, hematological with Z-Dex, gastrointestinal with VTD, and cardiac with PAD regimens. Our study endorses current recommendations on combined immunomodulatory drugs and proteasome inhibitors frontline regimens (in triplets) in transplant-eligible multiple myeloma patients, but also formally demonstrates the favorable performance of lenalidomide in overall and progression-free survival, when compared with bortezomib/thalidomide protocols.


Assuntos
Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada , Gerenciamento Clínico , Feminino , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Masculino , Mieloma Múltiplo/mortalidade , Análise de Sobrevida , Resultado do Tratamento
13.
Pharmacol Res ; 147: 104395, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31412272

RESUMO

Anxiety disorders are highly prevalent in modern societies, and are ranked the sixth most important contributor of non-fatal negative health outcomes. L-theanine is an amino acid naturally found in green tea (Camellia sinensis) and some other plant extracts, and recent clinical studies have proposed promising adjuvant effects of L-theanine for the negative impact of anxiety and psychological stress on health. In this integrative narrative review, we aimed to appraise and further discuss the effects of L-theanine administration on anxiety disorders and psychological stress. Published data suggests that L-theanine administered at daily doses ranging from 200 to 400 mg for up to 8 weeks are safe and induce anxiolytic and anti-stress effects in acute and chronic conditions. L-theanine at doses lower and higher than these may also show promising therapeutic potential; however, a more thorough investigation through randomized double-blind placebo-controlled crossover clinical trials are necessary to elucidate its effects for longer periods, providing further insights for meta-analyses and the development of recommendation guidelines. Additionally, animal studies investigating a higher dosage, its combination with other pharmacological compounds and associated metabolic comorbidities are recommended, as cases of hepatotoxicity associated with the consumption of green tea extract have been reported.


Assuntos
Anti-Hipertensivos/uso terapêutico , Glutamatos/uso terapêutico , Psicotrópicos/uso terapêutico , Medicamentos Indutores do Sono/uso terapêutico , Animais , Ansiedade/tratamento farmacológico , Pressão Sanguínea/efeitos dos fármacos , Transtorno Depressivo Maior/tratamento farmacológico , Humanos , Esquizofrenia/tratamento farmacológico , Estresse Psicológico/tratamento farmacológico
14.
Int J Mol Sci ; 20(24)2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31817604

RESUMO

Hybrid and antimicrobial nanoparticles (NPs) of poly (methyl methacrylate) (PMMA) in the presence of poly (diallyl dimethyl ammonium) chloride (PDDA) were previously obtained by emulsion polymerization in absence of surfactant with low conversion. In the presence of amphiphiles such as cetyl trimethyl ammonium bromide (CTAB), dioctadecyl dimethyl ammonium bromide (DODAB) or soybean lecithin, we found that conversion increased substantially. In this work, the effect of the amphiphiles on the NPs core-shell structure and on the antimicrobial activity of the NPs was evaluated. NPs dispersions casted on silicon wafers, glass coverslips or polystyrene substrates were also used to obtain antimicrobial coatings. Methods for characterizing the dispersions and coatings were based on scanning electron microscopy, dynamic light scattering, determination of thickness, rugosity, and wettability for the coatings and determination of colony-forming unities (log CFU/mL) of microbia after 1 h interaction with the coatings or dispersions. The amphiphiles used during PMMA/PDDA/amphiphile NPs synthesis reduced the thickness of the NPs PDDA shell surrounding each particle. The antimicrobial activity of the dispersions and coatings were due to PDDA-the amphiphiles were either washed out by dialysis or remained in the PMMA polymeric core of the NPs. The most active NPs and coatings were those of PMMA/PDDA/CTAB-the corresponding coatings showed the highest rugosity and total surface area to interact with the microbes. The dispersions and coatings obtained by casting of the NPs dispersions onto silicon wafers were hydrophilic and exhibited microbicidal activity against Escherichia coli, Staphylococcus aureus, and Candida albicans. In addition, a major effect of reduction in particle size revealed the suitability of nanometric and cationic NPs (sizes below 100 nm) represented by PMMA/PDDA/CTAB NPs to yield maximal microbicidal activity from films and dispersions against all microbia tested. The reduction of cell viability by coatings and dispersions amounted to 6-8 logs from [PDDA] ≥ minimal microbicidal concentration.


Assuntos
Compostos Alílicos/química , Antibacterianos/química , Anti-Infecciosos/química , Lipídeos/química , Nanopartículas/química , Polímeros/química , Polimetil Metacrilato/química , Compostos de Amônio Quaternário/química , Tensoativos/química , Antibacterianos/farmacologia , Testes de Sensibilidade Microbiana , Staphylococcus aureus/efeitos dos fármacos
15.
Int J Health Care Qual Assur ; 32(2): 474-487, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-31017060

RESUMO

PURPOSE: The purpose of this paper is to identify and describe hospital quality indicators, classifying them according to Donabedian's structure, process and outcome model and in specific domains (quality, safety, infection and mortality) in two care divisions: inpatient and emergency services. DESIGN/METHODOLOGY/APPROACH: A systematic review identified hospital clinical indicators. Two independent investigators evaluated 70 articles/documents located in electronic databases and nine documents from the grey literature, 35 were included in the systematic review. FINDINGS: In total, 248 hospital-based indicators were classified as infection, safety, quality and mortality domains. Only 10.2 percent were identified in more than one article/document and 47 percent showed how they were calculated/obtained. Although there are scientific papers on developing, validating and hospital indicator assessment, most indicators were obtained from technical reports, government publications or health professional associations. RESEARCH LIMITATIONS/IMPLICATIONS: This review identified several hospital structure, process and outcome quality indicators, which are used by different national and international groups in both research and clinical practice. Comparing performance between healthcare organizations was difficult. Common clinical care standard indicators used by different networks, programs and institutions are essential to hospital quality benchmarking. ORIGINALITY/VALUE: To the authors' knowledge, this is the first systematic review to identify and describe hospital quality indicators after a comprehensive search in MEDLINE/PubMed, etc., and the grey literature, aiming to identify as many indicators as possible. Few studies evaluate the indicators, and most are found only in the grey literature, and have been published mostly by government agencies. Documents published in scientific journals usually refer to a specific indicator or to constructing an indicator. However, indicators most commonly found are not supported by reliability or validity studies.


Assuntos
Infecção Hospitalar/prevenção & controle , Mortalidade Hospitalar , Segurança do Paciente/normas , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Estatura Cabeça-Cóccix , Humanos , Admissão e Escalonamento de Pessoal/normas , Qualidade da Assistência à Saúde/normas
16.
Br J Clin Pharmacol ; 84(10): 2415-2421, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29959798

RESUMO

AIMS: The present study evaluated the placental transfer and amniotic fluid distribution of bupivacaine enantiomers in health pregnant women and in human immunodeficiency virus (HIV)-infected pregnant women receiving epidural anaesthesia for caesarean section. METHODS: Twelve HIV-infected pregnant women (HIV group) were treated long-term (at least 8 weeks) with lopinavir/ritonavir (400/100 mg twice daily), and 12 healthy pregnant women (Control group) who submitted to epidural anaesthesia with racemic bupivacaine (75 mg) during caesarean section were investigated. At delivery, samples of maternal and fetal blood and amniotic fluid were collected (10-20 min after drug administration). RESULTS: The placental transfer ratio of bupivacaine enantiomers was significantly higher among the pregnant women from the HIV group when compared with those from the Control group (Mann-Whitney test, P ≤ 0.05). Placental transfer ratios (median and 25th - 75th percentiles) for (+)-(R)-bupivacaine were 0.58 (0.38-0.82) in the HIV group vs. 0.25 (0.18-0.33) in the Control group, and for (-)-(S)-bupivacaine, they were 0.54 (0.34-0.69) in the HIV group vs. 0.25 (0.19-0.29) in the Control group. The transplacental distribution of bupivacaine was stereoselective only in the HIV group. The umbilical artery/umbilical vein ratio and amniotic fluid/maternal vein ratio were low and nonstereoselective, and no statistically significant differences were observed between the groups. CONCLUSIONS: This study supports that the placental transfer of both bupivacaine enantiomers was 100% higher in HIV-pregnant women treated with lopinavir/ritonavir when compared with that in healthy pregnant women receiving epidural anaesthesia for caesarean section.


Assuntos
Anestésicos Locais/farmacocinética , Bupivacaína/farmacocinética , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/efeitos adversos , Lopinavir/efeitos adversos , Complicações Infecciosas na Gravidez/tratamento farmacológico , Ritonavir/efeitos adversos , Adulto , Líquido Amniótico/química , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/métodos , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Estudos de Casos e Controles , Cesárea/efeitos adversos , Combinação de Medicamentos , Feminino , Sangue Fetal/química , Humanos , Troca Materno-Fetal/efeitos dos fármacos , Permeabilidade , Placenta/efeitos dos fármacos , Placenta/metabolismo , Gravidez
17.
Ecotoxicol Environ Saf ; 163: 521-527, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30077148

RESUMO

The main purpose of this work was to evaluate the performance of a commercial reverse osmosis (RO) membrane regarding selectivity (rejection) and productivity (permeate flux) of the treatment of quaternary ammonium compounds (QAC) after electro-Fenton (EF) treatment. Pollutants treated after the EF process should be investigated for ecotoxicity, since excess ions and high conductivity are harmful to aquatic and terrestrial biota. The use of the membrane system after EF treatment acts as final polishing since some electro-oxidative treatments leave the sample with high conductivity. In this study, RO was operated with a constant flow of 1 L min-1 and feed pressures of 1 MPa, 2 MPa and 3 MPa to reject ions (sodium and iron) and to decrease the level of toxicity using representative species from different taxonomic groups: freshwater algae (Pseudokirchneriella subcapitata), microcrustaceans (Daphnia similis) and lettuce seeds (Lactuca sativa). Experiments carried out at different pressures showed that increased pressure caused a rise in rejection and permeate flux. At the applied pressure of 3 MPa, after 180 min, conductivity removal efficiency of 83% was obtained, 85% for sodium and 99% for iron at a flow of 13.87 L/h m2. In all bioassays, the use of the membrane was efficient to decrease the toxicity by rejecting the ions. The microcrustacean tested was the most sensitive organism, while alga was the most tolerant organism. The germination of lettuce seeds and the relative growth rate of the radicle after the combined EF+RO process was satisfactory.


Assuntos
Poluentes Ambientais/toxicidade , Osmose , Tensoativos/toxicidade , Animais , Clorófitas/efeitos dos fármacos , Daphnia/efeitos dos fármacos , Poluentes Ambientais/análise , Poluentes Ambientais/química , Filtração , Germinação/efeitos dos fármacos , Lactuca/efeitos dos fármacos , Membranas Artificiais , Estresse Oxidativo , Polônia , Testes de Toxicidade Aguda , Testes de Toxicidade Crônica
18.
Int J Mol Sci ; 19(10)2018 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-30274201

RESUMO

Hybrid nanoparticles of poly(methylmethacrylate) synthesized in the presence of poly (diallyldimethyl ammonium) chloride by emulsion polymerization exhibited good colloidal stability, physical properties, and antimicrobial activity but their synthesis yielded poor conversion. Here we create antimicrobial coatings from casting and drying of the nanoparticles dispersions onto model surfaces such as those of silicon wafers, glass coverslips, or polystyrene sheets and optimize conversion using additional stabilizers such as cetyltrimethyl ammonium bromide, dioctadecyldimethyl ammonium bromide, or soybean lecithin during nanoparticles synthesis. Methodology included dynamic light scattering, determination of wettability, ellipsometry of spin-coated films, scanning electron microscopy, and determination of colony forming unities (log CFU/mL) of bacteria after 1 h interaction with the coatings. The additional lipids and surfactants indeed improved nanoparticle synthesis, substantially increasing the conversion rates by stabilizing the monomer droplets in dispersion during the polymerization. The coatings obtained by spin-coating or casting of the nanoparticles dispersions onto silicon wafers were hydrophilic with contact angles increasing with the amount of the cationic polymer in the nanoparticles. Against Escherichia coli and Staphylococcus aureus, bacteria cell counts were reduced by approximately 7 logs upon interaction with the coatings, revealing their potential for several biotechnological and biomedical applications.


Assuntos
Antibacterianos/farmacologia , Materiais Revestidos Biocompatíveis/farmacologia , Nanopartículas/química , Polímeros/farmacologia , Coloides , Escherichia coli/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Nanopartículas/ultraestrutura , Polietilenos/farmacologia , Polimetil Metacrilato/farmacologia , Compostos de Amônio Quaternário/farmacologia , Solventes , Staphylococcus aureus/efeitos dos fármacos , Tensoativos/farmacologia
19.
Tumour Biol ; 39(4): 1010428317694552, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28378638

RESUMO

Astrocytomas are the most common primary brain tumors. They are very resistant to therapies and usually progress rapidly to high-grade lesions. Here, we investigated the potential role of DNA repair genes in astrocytoma progression and resistance. To this aim, we performed a polymerase chain reaction array-based analysis focused on DNA repair genes and searched for correlations between expression patters and survival prognoses. We found 19 genes significantly altered. Combining these genes in all possible arrangements, we found 421 expression signatures strongly associated with poor survival. Importantly, five genes (DDB2, EXO1, NEIL3, BRCA2, and BRIP1) were independently correlated with worse prognoses, revealing single-gene signatures. Moreover, silencing of EXO1, which is remarkably overexpressed, promoted faster restoration of double-strand breaks, while NEIL3 knockdown, also highly overexpressed, caused an increment in DNA damage and cell death after irradiation of glioblastoma cells. These results disclose the importance of DNA repair pathways for the maintenance of genomic stability of high-grade astrocytomas and suggest that EXO1 and NEIL3 overexpression confers more efficiency for double-strand break repair and resistance to reactive oxygen species, respectively. Thereby, we highlight these two genes as potentially related with tumor aggressiveness and promising candidates as novel therapeutic targets.


Assuntos
Astrocitoma/mortalidade , Neoplasias Encefálicas/mortalidade , Reparo do DNA , Apoptose , Astrocitoma/genética , Astrocitoma/metabolismo , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/metabolismo , Ciclo Celular , Linhagem Celular Tumoral , Enzimas Reparadoras do DNA/genética , Enzimas Reparadoras do DNA/metabolismo , Exodesoxirribonucleases/genética , Exodesoxirribonucleases/metabolismo , Expressão Gênica , Humanos , Estimativa de Kaplan-Meier , N-Glicosil Hidrolases/genética , N-Glicosil Hidrolases/metabolismo , Prognóstico
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