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1.
Dig Dis Sci ; 69(3): 749-765, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38217680

RESUMEN

BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) that contributes in part to irreversible bowel damage and long-term complications, reduced quality of life, invalidity, and economic burden. Suboptimal control of IBD is associated with higher healthcare resource utilization (HCRU), impaired quality of life (QoL), and reduced work productivity. AIMS: The IBD-PODCAST study aimed to assess the proportion of IBD patients with suboptimal control and its associated impact. METHODS: IBD-PODCAST is a cross-sectional, multicenter study that aimed to characterize the CD and UC population with optimal or suboptimal control according to the STRIDE-II criteria and patient- and physician-reported measures. Here we present the results of the Spanish cohort (n = 396). RESULTS: A total of 104/196 (53.1%) CD and 83/200 (41.5%) UC patients were found to have suboptimal disease control. Long-term treatment targets according to STRIDE-II were applied in 172 (87.8%) CD and 181 (90.5%) UC patients. 125 of 172 (72.7%) CD and 74 of 181 (40.9%) UC patients were currently treated with targeted immunomodulators. Patients with CD and UC and suboptimal disease control showed impaired QoL, higher HCRU and direct costs, and also loss of work productivity compared to those with optimal control. CONCLUSION: Despite a high rate of targeted immunomodulator therapy, a substantial proportion of IBD patients show suboptimal disease control according to the STRIDE II criteria. Those patients with suboptimal disease control exhibit impaired QoL, less work productivity, and higher HCRU, suggesting that there is considerable need for better treatment approaches in IBD.


Asunto(s)
Colitis Ulcerosa , Enfermedad de Crohn , Enfermedades Inflamatorias del Intestino , Humanos , Calidad de Vida , España/epidemiología , Estudios Transversales , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Enfermedades Inflamatorias del Intestino/epidemiología , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/tratamiento farmacológico , Colitis Ulcerosa/diagnóstico , Colitis Ulcerosa/tratamiento farmacológico , Factores Inmunológicos/uso terapéutico
2.
J Hum Genet ; 65(10): 895-902, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32488064

RESUMEN

Ataxias are one of the most frequent complaints in Neurogenetics units worldwide. Currently, more than 50 subtypes of spinocerebellar ataxias and more than 60 recessive ataxias are recognized. We conducted an 11-year prospective, observational, analytical study in order to estimate the frequency of pediatric and adult genetic ataxias in Argentina, to describe the phenotypes of this cohort and evaluate the diagnostic yield of the algorithm used in our unit. We included 334 ataxic patients. Our diagnostic approach was successful in one-third of the cohort. A final molecular diagnosis was reached in 113 subjects. This rate is significantly higher in the subgroup of patients with a positive family history, where the diagnostic yield increased to 55%. The most prevalent dominant and recessive ataxias in Argentina were SCA-2 (36% of dominant ataxias) and FA (62% of recessive ataxias), respectively. Next generation sequencing-based assays were diagnostic in the 65% of the patients requiring these tests. These results provide relevant epidemiological information, bringing a comprehensive knowledge of the most prevalent subtypes of genetic ataxias and their phenotypes in our territory and laying the groundwork for rationally implementing genetic diagnostic programs for these disorders in our country.


Asunto(s)
Algoritmos , Ataxia Cerebelosa/genética , Heterogeneidad Genética , Técnicas de Diagnóstico Molecular/métodos , Adolescente , Adulto , Edad de Inicio , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Ataxia Cerebelosa/clasificación , Ataxia Cerebelosa/diagnóstico , Ataxia Cerebelosa/epidemiología , Niño , Preescolar , Enfermedad Crónica , Progresión de la Enfermedad , Genes Dominantes , Genes Recesivos , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Persona de Mediana Edad , Nistagmo Patológico/genética , Estudios Prospectivos , Adulto Joven
3.
Skin Res Technol ; 23(2): 243-248, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-27796065

RESUMEN

BACKGROUND/PURPOSE: Facial lipoatrophy in HIV patients, secondary to antiretroviral therapy (ART) with thymidine analogs, has been related to important psychosocial alterations and poor adherence to treatment. Polyacrylamide gel (PAAG) is a filler that has been used for treating facial lipoatrophy in HIV patients. The aim was to assess the clinical and sonographic anatomical changes after injection of PAAG in HIV patients with facial lipoatrophy secondary to ART. METHODS: HIV patients receiving ART and suffering from severe facial lipoatrophy were recruited and underwent clinical and color Doppler ultrasound evaluation prior to PAAG application (AQUAMID® ) and sonographically monitored at 18 months and clinically followed up for 36 months after the procedure. Adverse effects were recorded based on occurrence and complexity. RESULTS: A total of 33 patients were evaluated, 30 men (91%) and 3 women (9%) with an average age of 49.6 years (±8.4). Clinical improvement assessed by a dermatologist had an average score of 5.9 (±0.7) on a scale of 1-7. On color Doppler ultrasound there was a significant increase of the thickness of the subcutaneous tissue (SCT) in both nasofold lines when comparing before and after PAAG injection (P < 0.01) and no signs of inflammation (hypervascularity). User satisfaction was qualified as excellent or good in all cases. Only two patients experienced adverse effects (hematoma and puncture site infection), which was successfully managed without consequences. CONCLUSION: Treatment of facial lipoatrophy with PAAG seems to be effective in HIV patients and no signs of complications were observed in the monitoring at 36 months after injection. Color Doppler ultrasound can identify the filler deposits and the anatomical changes of the SCT non-invasively.


Asunto(s)
Resinas Acrílicas/administración & dosificación , Antirretrovirales/efectos adversos , Dermatosis Facial/diagnóstico por imagen , Dermatosis Facial/terapia , Síndrome de Lipodistrofia Asociada a VIH/diagnóstico por imagen , Síndrome de Lipodistrofia Asociada a VIH/terapia , Ultrasonografía Doppler en Color/métodos , Adulto , Rellenos Dérmicos/administración & dosificación , Dermatosis Facial/inducido químicamente , Femenino , Síndrome de Lipodistrofia Asociada a VIH/inducido químicamente , Humanos , Masculino , Resultado del Tratamiento
4.
Eur J Clin Microbiol Infect Dis ; 35(2): 261-8, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26676855

RESUMEN

The aim of this study was to identify patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with low risk of infective endocarditis (IE) who might not require routine trans-esophageal echocardiography (TEE). We retrospectively evaluated 398 patients presenting with MRSA bacteremia for the presence of the following clinical criteria: intravenous drug abuse (IVDA), long-term catheter, prolonged bacteremia, intra-cardiac device, prosthetic valve, hemodialysis dependency, vertebral/nonvertebral osteomyelitis, cardio-structural abnormality. IE was diagnosed using the modified Duke criteria. Of 398 patients with MRSA bacteremia, 26.4 % of cases were community-acquired, 56.3 % were health-care-associated, and 17.3 % were hospital-acquired. Of the group, 44 patients had definite IE, 119 had possible IE, and 235 had a rejected diagnosis. Out of 398 patients, 231 were evaluated with transthoracic echocardiography (TTE) or TEE. All 44 patients with definite IE fulfilled at least one criterion (sensitivity 100 %). Finally, a receiver operator characteristic (ROC) curve was obtained to evaluate the total risk score of our proposed criteria as a predictor of the presence of IE, and this was compared to the ROC curve of a previously proposed criteria. The area under the ROC curve for our criteria was 0.710, while the area under the ROC curve for the criteria previously proposed was 0.537 (p < 0.001). The p-value for comparing those 2 areas was less than 0.001, indicating statistical significance. Patients with MRSA bacteremia without any of our proposed clinical criteria have very low risk of developing IE and may not require routine TEE.


Asunto(s)
Bacteriemia/microbiología , Ecocardiografía Transesofágica/métodos , Endocarditis Bacteriana/microbiología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/diagnóstico , Adulto , Bacteriemia/diagnóstico , Catéteres de Permanencia , Desfibriladores Implantables , Femenino , Humanos , Masculino , Persona de Mediana Edad , Curva ROC , Estudios Retrospectivos , Riesgo , Infecciones Estafilocócicas/mortalidad , Abuso de Sustancias por Vía Intravenosa
5.
Neurologia ; 31(3): 143-8, 2016 Apr.
Artículo en Inglés, Español | MEDLINE | ID: mdl-26394912

RESUMEN

BACKGROUND: Intravenous thrombolysis with alteplase is an effective treatment for ischaemic stroke when applied during the first 4.5 hours, but less than 15% of patients have access to this technique. Mechanical thrombectomy is more frequently able to recanalise proximal occlusions in large vessels, but the infrastructure it requires makes it even less available. METHODS: We describe the implementation of code stroke in Asturias, as well as the process of adapting various existing resources for urgent stroke care in the region. By considering these resources, and the demographic and geographic circumstances of our region, we examine ways of reorganising the code stroke protocol that would optimise treatment times and provide the most appropriate treatment for each patient. RESULTS: We distributed the 8 health districts in Asturias so as to permit referral of candidates for reperfusion therapies to either of the 2 hospitals with 24-hour stroke units and on-call neurologists and providing IV fibrinolysis. Hospitals were assigned according to proximity and stroke severity; the most severe cases were immediately referred to the hospital with on-call interventional neurology care. Patient triage was provided by pre-hospital emergency services according to the NIHSS score. CONCLUSIONS: Modifications to code stroke in Asturias have allowed us to apply reperfusion therapies with good results, while emphasising equitable care and managing the severity-time ratio to offer the best and safest treatment for each patient as soon as possible.


Asunto(s)
Accidente Cerebrovascular/clasificación , Accidente Cerebrovascular/terapia , Trombectomía/estadística & datos numéricos , Terapia Trombolítica/estadística & datos numéricos , Isquemia Encefálica/epidemiología , Isquemia Encefálica/terapia , Servicios Médicos de Urgencia , Fibrinolíticos/uso terapéutico , Humanos , Reperfusión , España/epidemiología , Accidente Cerebrovascular/epidemiología , Resultado del Tratamiento
7.
Colorectal Dis ; 16(8): O273-82, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24456168

RESUMEN

AIM: The diagnostic accuracy of the faecal immunochemical test (FIT) at a 100 ng/ml threshold for colorectal cancer (CRC) was compared with National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) referral criteria. METHOD: A multicentre, prospective, blind study of diagnostic tests was carried out in two Spanish health areas. In 787 symptomatic patients referred for a diagnostic colonoscopy, we determined whether patients met NICE and SIGN referral criteria. All patients performed one FIT determination (OCsensor(™) ). The sensitivity and specificity for CRC detection were determined with McNemar's test. The diagnostic odds ratio as well as the number needed to scope (NNS) to detect a CRC were calculated. RESULTS: We detected CRC in 97 (12.3%) patients; 241 (30.6%) had an FIT ≥ 100 ng/ml and 300 (38.1%) and 473 (60.1%) met NICE and SIGN referral criteria. The FIT had a higher sensitivity for CRC detection than NICE criteria (87.6%, 61.9%; P < 0.001) and SIGN criteria (82.5%; P = 0.4). The specificity of FIT was also higher than NICE and SIGN criteria (77.4%, 65.2%, 42.7%; P < 0.001). The odds ratios of FIT, NICE and SIGN criteria for the diagnosis of CRC were 24.24 (95% CI 12.91-45.53), 3.04 (95% CI 1.96-4.71) and 3.51 (95% CI 2.03-6.06). The NNS to detect a CRC in individuals with an FIT ≥ 100 ng/ml was 2.83 (95% CI 2.4-3.41) and in individuals who met NICE and SIGN criteria it was 5 (95% CI 3.98-6.37) and 5.95 (95% CI 4.85-7.35). CONCLUSION: Our study suggests that FIT is more accurate for the detection of CRC than the current NICE and SIGN referral criteria in symptomatic patients referred for colonoscopy.


Asunto(s)
Biomarcadores de Tumor/análisis , Neoplasias Colorrectales/diagnóstico , Pruebas Diagnósticas de Rutina/métodos , Heces/química , Adulto , Anciano , Anciano de 80 o más Años , Colonoscopía , Detección Precoz del Cáncer , Femenino , Humanos , Inmunoquímica , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Valor Predictivo de las Pruebas , Estudios Prospectivos , Derivación y Consulta , Sensibilidad y Especificidad , Método Simple Ciego , España
8.
Rev Med Chil ; 142(4): 481-93, 2014 Apr.
Artículo en Español | MEDLINE | ID: mdl-25117039

RESUMEN

Delirium (acute confusional state) is a common and disabling complication among surgical older people. It is often underdiagnosed and undertreated. Its incidence varies by type of intervention and it is associated with several complications such as functional impairment, cognitive dysfunction, prolonged hospitalization and institutionalization. These increase hospitalization costs and the risk of death. There are precipitating and predisposing risk factors, which increase the susceptibility for postoperative delirium. This condition should be considered as a syndrome of epidemiological importance, which needs to be prevented or treated in a timely manner through a multidisciplinary intervention. The perioperative care of elderly patients involves different medical specialties and is a subject of general knowledge.


Asunto(s)
Delirio/etiología , Complicaciones Posoperatorias , Anciano , Delirio/diagnóstico , Delirio/tratamiento farmacológico , Humanos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/tratamiento farmacológico , Factores de Riesgo
9.
J Fr Ophtalmol ; 47(3): 104022, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37951743

RESUMEN

PURPOSE: To evaluate reproducibility of endothelial cell density (ECD) measurements using the Konan Cell Check D in donor corneas by two different ophthalmologists and to compare the two automated cell count methods (center and flex-center) available in the software of this specular microscope. METHODS: ECD values were quantified in 54 donor corneas by two independent investigators using the Cell Check D (Konan Medical USA Inc) with both automated cell count methods. In the center method, at least 30 contiguous cells are marked. For the flex-center method, an area is delineated and only the cells within the designated area are counted. RESULTS: The mean ECD was 2473.81±378.22 cells/mm2. Good ECD intergrader reproducibility for the center (ICC=0.821) and the flex-center method (ICC=0.784) were noted. Poor reliability was observed for coefficient of variation and hexagonality (ICC≤0.265). When both methods for ECD analysis were compared, a moderate correlation for the two independent graders using the two manual (center and flex-center) methods was detected (correlation coefficient of 0.678 and 0.745 for each of the investigators). Comparison between methods yielded significantly higher ECD with the flex-center method (P=0.013). When corneas were divided by ECD, those under 2200 cells/mm2 and those between 2200 and 2700 cells/mm2 also had significantly higher ECD with the flex-center method (P<0.022). CONCLUSIONS: ECD values are reproducible with both methods, although the flex-center method ECDs tend to be higher, particularly in cases of low ECD. Eye banks and surgeons should exercise caution in making decisions based only on small differences in ECD.


Asunto(s)
Endotelio Corneal , Bancos de Ojos , Humanos , Reproducibilidad de los Resultados , Córnea , Microscopía/métodos
10.
Clin Neuroradiol ; 33(3): 701-708, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36856786

RESUMEN

INTRODUCTION: Combined stent-retriever/large-bore distal aspiration catheter (LB-DAC) thrombectomy was recently introduced to treat large-vessel occlusion; however, it is unclear whether larger inner diameters improve outcomes. We compared angiographic and clinical outcomes in patients with occlusions of the M1 segment of the middle cerebral artery treated with mechanical thrombectomy using extra-LB-DAC versus LB-DAC in combination with stent-retrievers. METHODS: We analyzed consecutive patients with M1 occlusion included in the ROSSETTI registry treated with non-balloon guide catheter combined LB-DAC/stent-retriever thrombectomy between June 2019 and April 2022. We compared demographics, baseline clinical variables, procedural variables, angiographic outcomes, and clinical outcomes [National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) and modified Rankin scale score at 3 months] between patients treated with extra-LB-DAC (Sofia Plus, MIVI Q6, Catalyst7; inner diameter, 0.068″-0.070″) versus LB-DAC (Sofia 5F, MIVI Q5, Catalyst 6; inner diameter, 0.055″-0.064″). Primary outcome was the first-pass effect (FPE) rate, defined as near-complete/complete reperfusion (mTICI 2c-3) after a single pass of the device. RESULTS: We included 324 patients (extra-LB-DAC, 185, 57.1% patients). Demographics, clinical data, and clinical outcomes were similar between the two groups; however, there was a trend towards improvement in National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) in the cohort treated with extra-LB-DAC 9 points (IQR 4;16 points) vs. 12 points (IQR 4;18 points, P = 0.083). Patients treated with extra-LB-DAC had higher FPE rate (47% vs. 30.9%; P = 0.003) and higher modified FPE (mTICI ≥ 2b after a single pass) rate (65.9% vs 46.8%; P = 0.001). The use of extra-LB-DAC was an independent factor in predicting FPE (odds ratio 1.982, 95% confidence interval 1.250-3.143, P = 0.004). CONCLUSION: Our results suggest that in combined LB-DAC/stent-retriever thrombectomy, a larger aspiration catheter inner diameter is associated with higher rates of FPE and mFPE.


Asunto(s)
Isquemia Encefálica , Procedimientos Endovasculares , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Isquemia Encefálica/terapia , Procedimientos Endovasculares/métodos , Resultado del Tratamiento , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/cirugía , Trombectomía/métodos , Accidente Cerebrovascular Isquémico/etiología , Catéteres , Angiografía Cerebral , Stents/efectos adversos , Estudios Retrospectivos
11.
Neurologia (Engl Ed) ; 37(1): 38-44, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35074187

RESUMEN

OBJECTIVE: The symptoms of minor stroke and transient ischemic attack (TIA) are temporary and mild. Despite the transient nature of the focal symptoms and the absence of visible brain lesions in some patients, many experience persistent cognitive problems subsequently. We aimed to establish the discriminant capacity of the Montreal Cognitive Assessment (MoCA) in screening for cognitive impairment (CI) within 90 days of TIA. METHODS: A total of 50 patients with minor stroke or TIA were recruited. Patients were administered the MoCA test and a formal neuropsychological test battery. CI was defined clinically according to neuropsychological test findings. RESULTS: The average age of recruited patients was 57.7±8.0 years; 70.0% were men; all patients had completed at least primary education. Thirty-seven patients (74.0%) presented CI. Receiver operating characteristic curve analysis obtained an optimal MoCA cut-off point of 25 for discriminating between patients with CI and those without, with an area under the curve of 0.835 (95% confidence interval [CI], 0.720-0.949), sensitivity of 78.4% (95% CI, 62.8%-88.6%), specificity of 76.9% (95% CI, 49.7%-91.8%), positive predictive value of 90.6% (95% CI, 81.0%-95.6%), and negative predictive value of 55.6% (95% CI, 39.5%-70.4%). CONCLUSIONS: More than half of the patients presented CI as determined by the formal battery of neuropsychological tests. A MoCA cut-off point of 25 is sufficiently sensitive and specific for detecting CI after minor stroke or TIA, and may be implemented as a screening technique in routine clinical practice.


Asunto(s)
Disfunción Cognitiva , Ataque Isquémico Transitorio , Accidente Cerebrovascular , Anciano , Disfunción Cognitiva/diagnóstico , Humanos , Ataque Isquémico Transitorio/diagnóstico , Masculino , Pruebas de Estado Mental y Demencia , Persona de Mediana Edad , Pruebas Neuropsicológicas , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico
12.
Neurologia (Engl Ed) ; 37(1): 38-44, 2022.
Artículo en Inglés, Español | MEDLINE | ID: mdl-30737125

RESUMEN

OBJECTIVE: The symptoms of minor stroke and transient ischemic attack (TIA) are temporary and mild. Despite the transient nature of the focal symptoms and the absence of visible brain lesions in some patients, many experience persistent cognitive problems subsequently. We aimed to establish the discriminant capacity of the Montreal Cognitive Assessment (MoCA) in screening for cognitive impairment (CI) within 90 days of TIA. METHOD: A total of 50 patients with minor stroke or TIA were recruited. Patients were administered the MoCA test and a formal neuropsychological test battery. CI was defined clinically according to neuropsychological test findings. RESULTS: The average age of recruited patients was 57.7±8.0 years; 70.0% were men; all patients had completed at least primary education. Thirty-seven patients (74.0%) presented CI. Receiver operating characteristic curve analysis obtained an optimal MoCA cut-off point of 25 for discriminating between patients with CI and those without, with an area under the curve of 0.835 (95% confidence interval [95% CI] 0.720-0.949), sensitivity of 78.4% (95% CI 62.8-88.6%), specificity of 76.9% (95% CI 49.7-91.8%), positive predictive value of 90.6% (95% CI 81.0-95.6%), and negative predictive value of 55.6% (95% CI 39.5-70.4%). CONCLUSIONS: More than half of the patients presented CI as determined by the formal battery of neuropsychological tests. A MoCA cut-off point of 25 is sufficiently sensitive and specific for detecting CI after minor stroke or TIA, and may be implemented as a screening technique in routine clinical practice.

13.
Rev Esp Quimioter ; 35 Suppl 3: 54-62, 2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-36285860

RESUMEN

SARS-CoV-2 infection has had a major impact on donation and transplantation. Since the cessation of activity two years ago, the international medical community has rapidly generated evidence capable of sustaining and increasing this neccesary activity. This paper analyses the epidemiology and burden of COVID-19 in donation and transplantation, the pathogenesis of the infection and its relationship with graft-mediated transmission, the impact of vaccination on donation and transplantation, the evolution of donation in Spain throughout the pandemic, some lessons learned in SARS-CoV-2 infected donor recipients with positive PCR and the applicability of the main therapeutic tools recently approved for treatment among transplant recipients.


Asunto(s)
COVID-19 , Trasplante de Órganos , Humanos , SARS-CoV-2 , Pandemias , Donantes de Tejidos
14.
Case Rep Dent ; 2021: 5593973, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33854802

RESUMEN

Ameloblastomas are benign but locally invasive odontogenic tumors most frequently located in the mandible. The gold standard of treatment is the surgical resection of the tumor with safety margins. Postsurgical defects generate a significant morbidity that needs reconstruction and oral rehabilitation to restore the oral functions. This case report describes the prosthetic rehabilitation of a 42-year-old male after resection of a mandibular ameloblastoma. Excision of the lesion by segmental mandibulectomy and mandibular reconstruction by microvascularized fibula flap was performed. After placement of 6 dental implants, the patient was rehabilitated with a lower hybrid prosthesis fabricated using computer-aided design-computer-aided manufacturing. During a 7-year and 5-month follow-up, some clinical complications were observed.

15.
Dermatol Res Pract ; 2020: 2485401, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32411190

RESUMEN

INTRODUCTION: Previous research suggests the presence of a spouse may considerably affect melanoma detection rates through more frequent examinations, better access to healthcare, and improved social support. Yet, the role of marital status on melanoma survival is currently unknown. The aim of this study is to assess whether marital status is associated with survival following melanoma diagnosis. METHODS: We performed secondary analysis of data from all participants of the Florida Cancer Data System (FCDS) and included adult melanoma patients diagnosed between 2001 and 2009 with follow-up information available until 2015. Marital status was categorized as single, married, divorced, or widowed. The primary outcome was survival interval after melanoma diagnosis, which was assessed according to the time from the date of diagnosis to the time of death or last contact. Cox proportional hazard models were used to assess the independent association between marital status and survival. RESULTS: We assessed data from 36,578 melanoma patients. Married patients were significantly more likely to survive than single patients (Hazard ratio (HR) = 0.65; 99% Confidence Interval (CI): 0.57-0.74; P < 0.001) after adjusting for age, sex, race, ethnicity, geographic location, insurance status, tobacco use, primary site, stage, and histology. There was no evidence of effect modification by gender (P=0.189). CONCLUSIONS: Married patients, including both men and women, had a 35% reduction in the risk of death after melanoma diagnosis compared with single patients, and mechanisms independent of earlier detection, such as social support, may play a role in survival in patients with melanoma.

16.
Neurologia (Engl Ed) ; 35(8): 556-562, 2020 Oct.
Artículo en Inglés, Español | MEDLINE | ID: mdl-29277523

RESUMEN

INTRODUCTION: Stroke has a complex aetiopathogenesis influenced by numerous risk factors. There is growing interest in the study of the pathophysiological changes associated with stress and their potential relationship with cerebrovascular disease. The purpose of this paper is to assess the strength of association between exposure to stress and stroke. METHODS: We conducted a case-control study (1:1) to compare exposure to stress in a group of patients with a history of a first transient ischaemic attack (TIA) or minor stroke and in a control group. Participants were asked a subjective question about their perception of stress in the previous months and completed the standardised Effort-Reward Imbalance (ERI) questionnaire. Logistic regression models were used for data analysis. RESULTS: The study included data on 50 cases and 50 controls. There were no significant differences in demographic variables and economic, social, and employment status between cases and controls. Fifty percent of the cases reported moderate to severe stress, compared to 30% of controls (OR: 2.33; 95% CI: 1.02-5.30; P=.041). ERI questionnaire results found that greater effort at work (OR: 1.48; 95% CI: 1.19-1.83) and greater commitment is associated with stroke (OR: 1.34; 95% CI: 1.17-1.54), while higher reward constitutes a protective factor against the disease (OR: 0.71; 95% CI: 0.61-0.82). CONCLUSIONS: There is a strong association between self-perceived psychological stress and TIA. The imbalance between effort and reward at work is also clearly related to TIA.


Asunto(s)
Ataque Isquémico Transitorio/etiología , Estrés Psicológico/complicaciones , Accidente Cerebrovascular/etiología , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Autoimagen , Encuestas y Cuestionarios
17.
Anal Bioanal Chem ; 394(1): 373-82, 2009 May.
Artículo en Inglés | MEDLINE | ID: mdl-19259646

RESUMEN

A compact magnetically boosted radiofrequency glow discharge (GD) has been designed, constructed and its analytical potential evaluated by its coupling to a mass spectrometer (MS). Simple modifications to the original source configuration permitted the insertion of permanent magnets. Small cylindrical Nd-Fe-B magnets (diameter = 4 mm, h = 10 mm) were placed in an in-house-modified GD holder disc that allows easy and fast exchange of the magnets. The different processes taking place within the GD plasma under the influence of a magnetic field, such as sputtering, ionisation processes and ion transport into the MS, were studied using different GD operating conditions. Changes to the ionisation and ion transport efficiency caused by the magnetic field were studied using an rf-GD-TOFMS setup. A magnetic field of 60-75 gauss (G) was found not to affect the sputtering rates but to enhance the analyte ion signal intensities while decreasing the Ar species ion signals. Moreover, magnetic fields in this range were shown not to modify the crater shapes, enabling the fast and sensitive high depth resolved analysis of relatively thick coated samples (micrometre) by using the designed compact magnetically boosted rf-GD-TOFMS.

18.
An Pediatr (Barc) ; 71(6): 510-3, 2009 Dec.
Artículo en Español | MEDLINE | ID: mdl-19811957

RESUMEN

Progressive familial intrahepatic cholestasis (PFIC) is a heterogeneous group of autosomic-recessive inherited cholestatic disorders that begin in the neonatal period or in the first years of life. There are three types of PFIC defined by different mutations located in the gene responsible for the bile flow through the intrahepatic canalicular transporter system. These disorders usually present in children or young adults and the main clinical manifestations are cholestasis, jaundice and pruritus, and they progress slowly towards liver fibrosis in adult life. PFIC diagnosis is based on clinical suspicion, biochemical findings (that include normal gamma-glutamyl transpeptidase in type 1 and 2, but increased levels in type 3), image techniques that rule-out other disorders, and histological confirmation. Initial treatment consists of symptomatic relief of cholestatic symptoms with choleretic agents (urso-deoxycholic acid). Partial biliary derivation and ileal bypass are intermediate therapeutic options. In case of no response to these treatments, liver transplantation is indicated. We report the case of a neonate with PFIC type 2 presenting as a liver failure.


Asunto(s)
Colestasis Intrahepática/complicaciones , Fallo Hepático/etiología , Colestasis Intrahepática/genética , Progresión de la Enfermedad , Humanos , Recién Nacido , Masculino
19.
Ann Vasc Surg ; 22(3): 465-8, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18466823

RESUMEN

Most patients with symptomatic internal carotid artery occlusion have a single minor or major hemispheric stroke. A minority of patients have ipsilateral retinal ischemia, recurrent strokes, or transient ischemic attacks. Whereas spontaneous carotid recanalization is rare, acute surgical recanalization has been attempted, with mixed results. Recently, acute endovascular recanalization has been performed and described as feasible and relatively safe. We describe a patient with symptom recurrence related to hemodynamic factors after occlusion of the carotid artery who was successfully treated 14 days after symptom onset.


Asunto(s)
Arteria Carótida Interna/diagnóstico por imagen , Estenosis Carotídea/terapia , Trastornos Cerebrovasculares/etiología , Hemodinámica , Radiografía Intervencional/métodos , Reperfusión/métodos , Tomografía Computarizada por Rayos X , Velocidad del Flujo Sanguíneo , Arteria Carótida Interna/fisiopatología , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/fisiopatología , Circulación Cerebrovascular , Trastornos Cerebrovasculares/diagnóstico por imagen , Trastornos Cerebrovasculares/terapia , Humanos , Masculino , Persona de Mediana Edad , Arteria Oftálmica/diagnóstico por imagen , Arteria Oftálmica/fisiopatología , Recurrencia , Reperfusión/instrumentación , Stents , Resultado del Tratamiento
20.
J Food Prot ; 71(11): 2217-22, 2008 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-19044264

RESUMEN

A study was conducted in 2006 to determine the prevalence of Salmonella on three cantaloupe farms in Matamoros, Coahuila, Mexico, and on one farm that cultivates chile peppers var. Bell in Culiacán, Sinaloa, Mexico. Samples from cantaloupe farms consisted of cantaloupe rinses, irrigation water, water from furrows in the field, and workers' hands. Samples from the chile pepper farm consisted of rinses of chile peppers obtained at the field, pepper rinses obtained at the packing house, and irrigation water from the field. A total of 55 samples were obtained from both production systems. Twelve and 10 samples from the cantaloupe and chile pepper production systems, respectively, tested positive for Salmonella according to a traditional culture method. The difference between the proportion of Salmonella-positive samples from the cantaloupe production system (12 of 28 = 0.43) and the chile pepper production system (10 of 27 = 0.37) was not statistically significant (P > 0.05). A PCR-restriction fragment length polymorphism (RFLP) method based on the fliC gene was used to determine the serotype of the isolates. Salmonella Typhimurium was the only serotype found associated with the cantaloupe production system, whereas both Salmonella Typhimurium and Enteritidis serotypes were found associated with the chile pepper production system. Results showed that 91% (20 of 22) and 9% (2 of 22) of the isolates from both agricultural systems matched with the Salmonella Typhimurium and Salmonella Enteritidis reference strain restriction profiles, respectively. This study demonstrates the utility of the PCR-RFLP technique for determining the serotypes of Salmonella isolates obtained from cantaloupe and chile pepper production systems.


Asunto(s)
Capsicum/microbiología , Cucumis melo/microbiología , ADN Bacteriano/análisis , Contaminación de Alimentos/análisis , Polimorfismo de Longitud del Fragmento de Restricción , Salmonella/aislamiento & purificación , Técnicas de Tipificación Bacteriana , Recuento de Colonia Microbiana , Seguridad de Productos para el Consumidor , Manipulación de Alimentos/métodos , Microbiología de Alimentos , Embalaje de Alimentos/métodos , México , Reacción en Cadena de la Polimerasa/métodos , Salmonella/clasificación , Salmonella/genética , Salmonella enteritidis/clasificación , Salmonella enteritidis/genética , Salmonella enteritidis/aislamiento & purificación , Salmonella typhimurium/clasificación , Salmonella typhimurium/genética , Salmonella typhimurium/aislamiento & purificación , Sensibilidad y Especificidad , Serotipificación , Microbiología del Agua
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