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1.
Scand J Med Sci Sports ; 33(1): 64-71, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36251531

RESUMEN

The objective of the research was to investigate the effects of the learning tasks and leadership profile of the coach on the subjective perception of decision-making. In total, 910 Brazilian adolescents (14.00 ± 1.8 years) and 57 Brazilian coaches (45.57 ± 7.25 years) were included in the study, participants of a sports program in 37 public schools in the city of Curitiba in the state of Paraná. Ordinal logistic regression was used to verify the independent associations between the variables and the tertiles of the scores for each decision-making characteristic. The small-sized game learning tasks were positively associated with commitment to decision-making learning (CR = 1.21, 95% CI = 1.01-1.49). Positive associations were also found between the coaches' leadership profile and decision-making competence.


Asunto(s)
Percepción , Instituciones Académicas , Humanos , Adolescente , Brasil
2.
J Stroke Cerebrovasc Dis ; 31(4): 106313, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35093627

RESUMEN

BACKGROUND AND PURPOSE: Contrary to anterior circulation, the legitimacy of endovascular treatment in posterior circulation stroke is still being questioned. Finding reliable prognostic factors and determining how patient selection should be done has become top priority. METHODS: Observational and retrospective study from two Portuguese hospitals, including all consecutive patients with posterior circulation occlusions who underwent thrombectomy between January 1st 2015 and December 31st 2019. RESULTS: Out of a total of 126 patients, the median age was 74 (IQR 61-80) and 39.7% were female. A good clinical outcome (mRS ≤2) was associated with a lower incidence of coma (24,2% vs 66,7%, p < 0,001) and of sudden onset coma (3% vs 18%,=0,04), a lower NIHSS at admission (14 vs 19, p < 0,001), a higher pc-ASPECTS at admission (10 vs 9, p < 0,001) and at 24 h (8 vs 6, p < 0,001) and a higher BATMAN score (7 vs 6, p = 0,017). Differences in the times of symptom-onset-to-recanalization (496 vs 536, p = 0,19) and symptom-onset-to-coma (130 vs 195, p = 0,52) were not remarkable. When excluding NIHSS and pc-ASPECTS at 24 h, coma (p = 0,003; OR=0,22; 95% CI: 0,08-0,59) and the pc-ASPECTS at admission (p = 0,037; OR=1,63; 95% CI: 1,03-2,57) become independent predictors of good outcome. CONCLUSIONS: In strokes from the posterior circulation, coma, more than time, appears to be an important prognostic factor. The BATMAN and the pc-ASPECTS scores were also associated with clinical outcome and coma.


Asunto(s)
Procedimientos Endovasculares , Accidente Cerebrovascular , Anciano , Encéfalo , Coma/diagnóstico , Coma/terapia , Femenino , Humanos , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapia , Trombectomía , Resultado del Tratamiento
3.
J Sports Sci Med ; 20(1): 9-16, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33707981

RESUMEN

In a time of instability caused by adolescence, sport may represent a resource to prevent future individual and social problems. Within the complex relationships developed in social sports contexts, the figure of the coach can be fundamental for the development of a beneficial environment. The objective of the research was to investigate the relationship between the teaching methods and leadership profile of the coach and outcomes on the perception of positive development of young people participating in an after school sports program. In total participated, 910 adolescents (14.0 ± 1.8 years) and 57 coaches (45.57 ± 7.25 years) in 37 public schools in the city of Curitiba, in the state of Paraná-Brazil. Ordinal logistic regression was used to verify the independent associations between the variables sex, category, sport, trainer methodology, perception of the coaches, and perception of the athletes with the tertiles of the scores of each developmental characteristic of the young athletes (personal and social skills, cognitive skills, goal setting, and initiative). Odds ratios (OR) were obtained with a 95% confidence interval (95%CI), adopting p < 0.05. The small sized games method were positively associated with cognitive skills and goal setting. Positive associations were also found between athletes' perceptions of the leadership profile of coaches with: personal and social skills (instructor, democratic behaviour, social support, and positive feedback), cognitive skills (instructor, democratic behaviour, and social support), goal setting (instructor, social support, and positive feedback), and initiative (instructor and positive feedback). In addition, the athletes' perception of the coaches' autocratic behaviour was inversely associated with personal and social skills and goal setting. For the evaluated program, the results suggest the choice, on the part of the coaches, of small sized games, combined with a democratic, affective, motivating leadership profile that provides instructions on technical skills and game strategies. The combination of the designated psych-pedagogical aspects is correlated to the positive development of young people through team sports.


Asunto(s)
Desarrollo del Adolescente , Liderazgo , Enseñanza/psicología , Deportes de Equipo , Adolescente , Brasil , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
6.
J Clin Neurosci ; 119: 205-211, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38141436

RESUMEN

INTRODUCTION: Headache after cerebral venous thrombosis (post-CVT headache [PCH]) is a common complaint during follow-up. Risk factors and their pathophysiology are not well known. We studied PCH prevalence in CVT patients, its pathophysiology, and possible risk factors. MATERIALS AND METHODS: We performed a retrospective observational study of patients admitted to a tertiary hospital between 2006 and 2019 with CVT and at least one follow-up appointment. We diagnosed PCH when patients reported headaches during the follow-up visit. Recanalization was retrospectively assessed by two neuroradiologists using the first available follow-up MRI/ MRV, and the PRIORITy-CVT study classification. RESULTS: Of 131 patients, sixty (60/131, 45.8 %) reported PCH at the 3-month follow-up. Of these PCH, 9 had previous migraine (9/60, 5.0 %) and 13 previous tension-type headaches (13/60, 21.6 %), before CVT. Forty-four (44/60, 73.3 %) PCH patients had de novo headache: 21 (21/60, 35.0 %) de novo tension-type headaches; 6 (6/60, 10.0 %) de novo migraine; 6 [(6/60, 10.0 %) secondary headache disorders: 3 due to dural arteriovenous fistula, 2 due to intracranial hypertension, and 1 recurrent CVT], and 11 other headache types. Most patients had at least partial recanalization, with no difference in PCH frequency amongst recanalization subgroups (p = 0.598). Premorbid depression (p = 0.009, OR 7.9, 95 % CI 1.6-31.4) increased the odds ratio of PCH, while superior sagittal sinus thrombosis (p = 0.005, OR 0.15, 95 % CI 0.03-0.56) decreased it. DISCUSSION: Our study shows that PCH is a common finding after CVT and elucidates potential risk factors. PCH is common in patients with previous or de novo primary headache. In PCH patients without previous headache, secondary causes of headache, namely related to CVT complications, should be excluded. PCH is also increased in patients with premorbid depression. There was no statistically significant difference in PCH amongst the PRIORITy-CVT recanalization subgroups, but most patients had at least partial recanalization.


Asunto(s)
Trombosis Intracraneal , Trastornos Migrañosos , Trombosis de los Senos Intracraneales , Cefalea de Tipo Tensional , Trombosis de la Vena , Humanos , Estudios Retrospectivos , Prevalencia , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/epidemiología , Factores de Riesgo , Cefalea/epidemiología , Cefalea/etiología , Cefalea/diagnóstico , Trombosis Intracraneal/complicaciones , Trombosis Intracraneal/diagnóstico por imagen , Trombosis Intracraneal/epidemiología , Trombosis de los Senos Intracraneales/complicaciones , Trombosis de los Senos Intracraneales/epidemiología
7.
Clin Neurol Neurosurg ; 236: 108090, 2024 01.
Artículo en Inglés | MEDLINE | ID: mdl-38160657

RESUMEN

BACKGROUND: We aimed to assess the usefulness of the falx cerebri and the corpus callosum measurements as imaging markers of the evaluation of patients with bilateral subdural hematomas. METHODS: The anterior-posterior and craniocaudal distances between the falx cerebri (FC) and the corpus callosum (CC) were retrospectively measured in 88 head CT scans from 2018 to 2022 from patients with bilateral subdural hematomas and associated with quantitative data and clinical outcomes. Statistical analysis was performed using multivariate regression and receiver operating characteristic curves. RESULTS: Of the 88 patients included, 77.3% were male and the median age of 76.0 years (interquartile range 14.0). The mean craniocaudal and anterior-posterior FC-CC distances were 27.6 ± 6.2 mm and 25.1 ± 6.9 mm, respectively, and showed a positive correlation with hematoma thickness and volume. Both anterior-posterior and craniocaudal FC-CC distances exhibited moderate to good inter-rater reliability. After adjusting for confounders, the craniocaudal FC-CC distance was associated with an increased risk of altered consciousness at admission (OR=1.013; 95% CI 1.001-1.024; p = 0.031), downward displacement of the third ventricle (OR=1.019; 95% CI 1.001-1.038; p = 0.035), and a reduced time to surgery (ß = 0.057; 95% CI 0.007-0.107; p = 0.027). CONCLUSION: This study emphasizes that increased FC-CC distances in patients with bilateral subdural hematomas may aid clinical decision-making and are associated with larger hematoma volumes, evidence of descending transtentorial herniation on imaging, and a heightened risk of altered consciousness at admission.


Asunto(s)
Cuerpo Calloso , Hematoma Subdural , Humanos , Masculino , Anciano , Femenino , Cuerpo Calloso/diagnóstico por imagen , Estudios Retrospectivos , Reproducibilidad de los Resultados , Hematoma Subdural/diagnóstico por imagen , Hematoma Subdural/cirugía , Hematoma Subdural/etiología , Gravedad del Paciente , Duramadre/cirugía
8.
J Neurointerv Surg ; 2024 Mar 07.
Artículo en Inglés | MEDLINE | ID: mdl-38453462

RESUMEN

BACKGROUND: Accurate prediction of functional outcomes is crucial in stroke management, but this remains challenging. OBJECTIVE: To evaluate the performance of the generative language model ChatGPT in predicting the functional outcome of patients with acute ischemic stroke (AIS) 3 months after mechanical thrombectomy (MT) in order to assess whether ChatGPT can used to be accurately predict the modified Rankin Scale (mRS) score at 3 months post-thrombectomy. METHODS: We conducted a retrospective analysis of clinical, neuroimaging, and procedure-related data from 163 patients with AIS undergoing MT. The agreement between ChatGPT's exact and dichotomized predictions and actual mRS scores was assessed using Cohen's κ. The added value of ChatGPT was measured by evaluating the agreement of predicted dichotomized outcomes using an existing validated score, the MT-DRAGON. RESULTS: ChatGPT demonstrated fair (κ=0.354, 95% CI 0.260 to 0.448) and good (κ=0.727, 95% CI 0.620 to 0.833) agreement with the true exact and dichotomized mRS scores at 3 months, respectively, outperforming MT-DRAGON in overall and subgroup predictions. ChatGPT agreement was higher for patients with shorter last-time-seen-well-to-door delay, distal occlusions, and better modified Thrombolysis in Cerebral Infarction scores. CONCLUSIONS: ChatGPT adequately predicted short-term functional outcomes in post-thrombectomy patients with AIS and was better than the existing risk score. Integrating AI models into clinical practice holds promise for patient care, yet refining these models is crucial for enhanced accuracy in stroke management.

9.
J Funct Biomater ; 15(3)2024 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-38535244

RESUMEN

Zinc oxide nanoparticles (ZnO NPs) are metal oxide nanomaterials, which are important for several applications: antibacterial, anthelmintic, antiprotozoal and antitumoral, among others. These applications are mainly related to the ability to spontaneously produce and induce the production of reactive oxygen species that are important components for the destruction of pathogens and tumor cells. While trying to potentiate ZnO NPs, studies have associated these NPs with silver oxide (AgO) or silver (Ag) NPs. It has already been reported that this combination (Ag-ZnO/AgO NPs) is able to enhance the microbicidal potential. Although possessing much potential for several purposes, it is important to evaluate whether this association also poses the risk of toxicity to cells and experimental models. Therefore, this work aimed to evaluate the toxicity of various Ag-ZnO/AgO NP nanocomposites, in vitro and in vivo. Accordingly, ZnO nanocrystals and nanocomposites with various concentrations of AgO (ZnO:5Ag, ZnO:9Ag or ZnO:11Ag) were used in different cytotoxicity models: Galleria mellonella (G. mellonella), cell lines (VERO and RAW 264.7) and C57BL/6 mice. In the G. mellonella model, four concentrations were used in a single dose, with subsequent evaluation of mortality. In the case of cells, serial concentrations starting at 125 µg/mL were used, with subsequent cytotoxicity assessment. Based on the safe doses obtained in G. mellonella and cell models, the best doses were used in mice, with subsequent evaluations of weight, biochemistry as also renal and liver histopathology. It was observed that the toxicity, although low, of the nanocomposites was dependent upon the concentration of AgO used in association with ZnO NPs, both in vitro and in vivo.

10.
Crit Care Sci ; 35(1): 11-18, 2023 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-37712725

RESUMEN

OBJECTIVE: To explain the rationale and protocol of the methods and analyses to be used in the LIVER-PAM randomized clinical trial, which seeks to understand whether a higher mean arterial pressure is capable of reducing the incidence of renal dysfunction postoperatively after liver transplantation. METHODS: LIVER-PAM is an open-label, randomized, controlled, singlecenter clinical trial. Patients randomized to the intervention group will have a mean arterial pressure of 85 - 90mmHg in the initial 24 hours of postoperative management, while patients in the control group will have a mean arterial pressure of 65 - 70mmHg in the same period. A sample of 174 patients will be required to demonstrate a 20% reduction in the absolute incidence of renal dysfunction, with a power of 80% and an alpha of 0.05. CONCLUSION: If a 20% reduction in the absolute incidence of renal dysfunction in the postoperative period of liver transplantation is achieved with higher target mean arterial pressure in the first 24 hours, this would represent an inexpensive and simple therapy for improving current outcomes in the management of liver transplant patients.ClinicalTrials.gov Registry: NCT05068713.


Asunto(s)
Hipotensión , Enfermedades Renales , Trasplante de Hígado , Humanos , Presión Arterial , Trasplante de Hígado/efectos adversos , Grupos Control , Ensayos Clínicos Controlados Aleatorios como Asunto
11.
Neurology ; 100(7): e739-e750, 2023 02 14.
Artículo en Inglés | MEDLINE | ID: mdl-36351814

RESUMEN

BACKGROUND AND OBJECTIVES: COVID-19-related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19. METHODS: This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS: Of a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour mortality (OR 2.47; 95% CI 1.58-3.86), and 3-month mortality (OR 1.88; 95% CI 1.52-2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION: Patients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring, and establishing prognosis. TRIAL REGISTRATION INFORMATION: The study was registered under ClinicalTrials.gov identifier NCT04895462.


Asunto(s)
Isquemia Encefálica , COVID-19 , Procedimientos Endovasculares , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Accidente Cerebrovascular Isquémico/epidemiología , Accidente Cerebrovascular Isquémico/cirugía , Fibrinolíticos/uso terapéutico , Isquemia Encefálica/complicaciones , Isquemia Encefálica/epidemiología , Isquemia Encefálica/cirugía , Estudios de Cohortes , Terapia Trombolítica/efectos adversos , Resultado del Tratamiento , COVID-19/complicaciones , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/terapia , Accidente Cerebrovascular/diagnóstico , Hemorragias Intracraneales/etiología , Hemorragia Cerebral/complicaciones , Procedimientos Endovasculares/efectos adversos , Sistema de Registros
12.
Antimicrob Agents Chemother ; 56(2): 1042-6, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22083476

RESUMEN

The clinical Klebsiella pneumoniae INSRA6884 strain exhibited nonsusceptibility to all penicillins tested (MICs of 64 to >2,048 µg/ml). The MICs of penicillins were weakly reduced by clavulanate (from 2,048 to 512 µg/ml), and tazobactam restored piperacillin susceptibility. Molecular characterization identified the genes bla(GES-7) and a new ß-lactamase gene, bla(SHV-107), which encoded an enzyme that differed from SHV-1 by the amino acid substitutions Leu35Gln and Thr235Ala. The SHV-107-producing Escherichia coli strain exhibited only a ß-lactam resistance phenotype with respect to amoxicillin, ticarcillin, and amoxicillin-clavulanate combination. The kinetic parameters of the purified SHV-107 enzyme revealed a high affinity for penicillins. However, catalytic efficiency for these antibiotics was lower for SHV-107 than for SHV-1. No hydrolysis was detected against oxyimino-ß-lactams. The 50% inhibitory concentration (IC(50)) for clavulanic acid was 9-fold higher for SHV-107 than for SHV-1, but the inhibitory effects of tazobactam were unchanged. Molecular dynamics simulation suggested that the Thr235Ala substitution affects the accommodation of clavulanate in the binding site and therefore its inhibitory activity.


Asunto(s)
Ácido Clavulánico/farmacología , Inhibidores Enzimáticos/farmacología , Klebsiella pneumoniae/efectos de los fármacos , Resistencia betalactámica/genética , Inhibidores de beta-Lactamasas , beta-Lactamasas/metabolismo , Anciano de 80 o más Años , Sustitución de Aminoácidos , Antibacterianos/farmacología , Sitios de Unión , Femenino , Humanos , Cinética , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/enzimología , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Modelos Moleculares , Neumonía Bacteriana/microbiología , Portugal , Esputo/microbiología , beta-Lactamasas/química , beta-Lactamasas/genética
13.
World J Gastroenterol ; 13(41): 5471-5, 2007 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-17907290

RESUMEN

AIM: To investigate the systemic hemodynamic effects of two surgical procedures largely employed for treatment of schistosomal portal hypertension. METHODS: Thirty-six patients undergoing elective surgical treatment of portal hypertension due to hepatosplenic mansonic schistosomiasis were prospectively evaluated. All patients were subjected to preoperative pulmonary artery catheterization; 17 were submitted to esophagogastric devascularization and splenectomy (EGDS) and 19 to distal splenorenal shunt (DSRS). The systemic hemodynamic assessment was repeated 4 d after the surgical procedure. RESULTS: Preoperative evaluation revealed (mean +/- SD) an increased cardiac index (4.78 +/- 1.13 L/min per m(2)), associated with a reduction in systemic vascular resistance index (1457 +/- 380.7 dynes.s/cm(5).m(2)). The mean pulmonary artery pressure (18 +/- 5.1 mmHg) as well as the right atrial pressure (7.9 +/- 2.5 mmHg) were increased, while the pulmonary vascular resistance index (133 +/- 62 dynes x s/cm(5) x m(2)) was decreased. Four days after EGDS, a significant reduction in cardiac index (3.80 +/- 0.4 L/min per m(2), P < 0.001) and increase in systemic vascular resistance index (1901.4 +/- 330.2 dynes x s/cm(5) x m(2), P < 0.001) toward normal levels were observed. There was also a significant reduction in pulmonary artery pressure (12.65 +/- 4.7 mmHg, P < 0.001) and no significant changes in the pulmonary vascular resistance index (141.6 +/- 102.9 dynes x s/cm(5) x m(2)). Four days after DSRS, a non-significant increase in cardiac index (5.2 +/- 0.76 L/min per m(2)) and systemic vascular resistance index (1389 +/- 311 dynes x s/cm(5) x m(2)) was observed. There was also a non-significant increase in pulmonary artery pressure (19.84 +/- 5.2 mmHg), right cardiac work index (1.38 +/- 0.4 kg x m/m(2)) and right ventricular systolic work index (16.3 +/- 6.3 g x m/m(2)), without significant changes in the pulmonary vascular resistance index (139.7 +/- 67.8 dynes xs/cm(5) x m(2)). CONCLUSION: The hyperdynamic circulatory state observed in mansonic schistosomiasis was corrected by EGDS, but was maintained in patients who underwent DSRS. Similarly, the elevated mean pulmonary artery pressure was corrected after EGDS and maintained after DSRS. EGDS seems to be the most physiologic surgery for patients with schistosomal portal hypertension.


Asunto(s)
Várices Esofágicas y Gástricas/cirugía , Esófago/cirugía , Hipertensión Portal/cirugía , Esquistosomiasis mansoni/complicaciones , Esplenectomía , Derivación Esplenorrenal Quirúrgica , Estómago/cirugía , Procedimientos Quirúrgicos Vasculares , Adulto , Presión Sanguínea , Gasto Cardíaco , Várices Esofágicas y Gástricas/fisiopatología , Esófago/irrigación sanguínea , Femenino , Humanos , Hipertensión Portal/parasitología , Hipertensión Portal/fisiopatología , Ligadura , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Arteria Pulmonar/fisiopatología , Esquistosomiasis mansoni/fisiopatología , Esquistosomiasis mansoni/cirugía , Arteria Esplénica/cirugía , Estómago/irrigación sanguínea , Factores de Tiempo , Resultado del Tratamiento , Resistencia Vascular , Función Ventricular Izquierda , Función Ventricular Derecha
14.
Am J Case Rep ; 18: 1086-1089, 2017 Oct 11.
Artículo en Inglés | MEDLINE | ID: mdl-29018183

RESUMEN

BACKGROUND Adequate portal venous flow is required for successful liver transplantation. Reduced venous flow and blood flow 'steal' by collateral vessels are a concern, and when there is a prominent splenorenal shunt present, ligation of the left renal vein has been recommended to improve portal venous blood flow. CASE REPORT A 51-year-old man who had undergone right nephrectomy in childhood required liver transplantation for liver cirrhosis and hepatocellular carcinoma due to hepatitis C virus (HCV) infection. The patient had no other comorbidity and no history of hepatorenal syndrome. At transplantation surgery, portal venous flow was poor and did not improve with ligation of shunt veins, but ligation of the left renal vein improved portal venous flow. On the first and fifth postoperative days, the patient was treated with basiliximab, a chimeric monoclonal antibody to the IL-2 receptor, and methylprednisolone. The calcineurin inhibitor, tacrolimus, was introduced on the fifth postoperative day. On the sixteenth postoperative day, renal color Doppler ultrasound showed normal left renal parenchyma; hepatic Doppler ultrasound showed good portal vein flow and preserved hepatic parenchyma in the liver transplant. CONCLUSIONS This case report has shown that in a patient with a single left kidney, left renal vein ligation is feasible and safe in a patient with no other risk factors for renal impairment following liver transplantation. Modification of postoperative immunosuppression to avoid calcineurin inhibitors in the very early postoperative phase may be important in promoting good recovery of renal function and to avoid the need for postoperative renal dialysis.


Asunto(s)
Ligadura , Trasplante de Hígado , Hígado/irrigación sanguínea , Vena Porta , Venas Renales/cirugía , Humanos , Masculino , Persona de Mediana Edad , Vena Porta/diagnóstico por imagen , Venas Renales/anomalías , Riñón Único , Vena Esplénica/anomalías
16.
Transplantation ; 100(5): 1066-72, 2016 05.
Artículo en Inglés | MEDLINE | ID: mdl-27014791

RESUMEN

BACKGROUND: Hepatic artery thrombosis (HAT) increases morbidity and mortality after liver transplantation (LT). The identification of risk factors for HAT may aid transplant teams in the development of strategies aimed at reducing HAT. This article describes the risk factors for HAT and outcomes after LT. METHODS: This report describes a retrospective study (1995 to 2015) of primary pediatric living donor LT (LDLT). Pretransplant and technical variables were included in the study. Binary logistic regression was used for data analysis. RESULTS: This study included 656 primary LDLT. The median age, body weight, and pediatric end-stage liver disease score at the time of transplant were 13 months, 8.4 kg and 15, respectively. Twenty-one (3.2%) patients developed HAT. Intraoperative HAT (odds ratio, 62.63; 95% confidence interval, 12.64-310.19; P < 0.001) and the use of liver grafts with a graft-to-recipient weight ratio less than 1.1% (odds ratio, 24.46; 95% confidence interval, 4.55-131.56; P < 0.001) retained statistical significance in the multivariate model. Patient and graft survivals were significantly worse in cases with HAT. The overtime trend analysis revealed a decrease in the incidence of HAT (P = 0.008) and an increase in the use of 2-arterial anastomosis (P < 0.001). CONCLUSIONS: A graft-to-recipient weight ratio of 1.1% or less and intraoperative HAT were independently associated with HAT. Trend analysis further revealed a significant reduction in the incidence of HAT over time, as well as the increased use of 2 hepatic arteries for anastomosis during graft implantation. The double artery anastomosis may represent an extra protection to pediatric recipients undergoing LDLT.


Asunto(s)
Arteria Hepática/cirugía , Trasplante de Hígado/métodos , Donadores Vivos , Trombosis/patología , Adolescente , Adulto , Anastomosis Quirúrgica , Anticoagulantes/química , Peso Corporal , Niño , Preescolar , Selección de Donante , Femenino , Supervivencia de Injerto , Humanos , Lactante , Estimación de Kaplan-Meier , Hígado/cirugía , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/métodos , Adulto Joven
18.
J Gastrointest Surg ; 9(6): 853-9, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-15985244

RESUMEN

Hemangioma is the most common primary tumor of the liver and its diagnosis has become increasingly prevalent. Most of these lesions are asymptomatic and are managed conservatively. Large hemangiomas are often symptomatic and reports of surgical intervention are becoming increasingly frequent. We present our experience, over the last 14 years, with diagnosis and management of 249 liver hemangiomas, with special attention to a conservative strategy. Clinical presentation, diagnosis, treatment, and long-term outcome are analyzed. Of 249 patients, 77 (30.9%) were symptomatic, usually with right abdominal upper quadrant pain. Diagnosis was based on a radiologic algorithm according to the size and characteristics of the tumor; diagnosis by this method was not possible in only one case (0.4 %). Giant hemangiomas (>4 cm) were found in 68 patients (27.3%) and in 16 were larger than 10 cm. Eight patients (3.2%) underwent surgical treatment; indications were incapacitating pain in 6, diagnostic doubt in 1, and stomach compression in 1. No postoperative complications or mortality were observed in this series. Patients who did not undergo surgery (n = 241) did not present any complication related to the hemangioma during long-term follow-up (mean = 78 months). Hemangioma is a benign course disease with easy diagnosis and management. We propose a conservative approach for these lesions. Resection, which can be safely performed, should be reserved for the rare situations such as untreatable pain, diagnostic uncertainty, or compression of adjacent organs.


Asunto(s)
Hemangioma/patología , Hemangioma/cirugía , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Adulto , Anciano , Biopsia con Aguja , Femenino , Estudios de Seguimiento , Hemangioma/mortalidad , Hepatectomía/métodos , Humanos , Inmunohistoquímica , Neoplasias Hepáticas/mortalidad , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Prospectivos , Medición de Riesgo , Análisis de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía Doppler
19.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 261-268, May-June 2019. tab
Artículo en Inglés | LILACS | ID: biblio-1002231

RESUMEN

Smoking is the most important risk factor for coronary heart disease (CHD) and ischemic events; alcohol consumption, on the other hand, appears to have a protective role. Objective: Assess the association between smoking and alcohol consumption with the severity of coronary artery injuries in patients with acute myocardial infarction (AMI). Methods: Cross-sectional study, performed in Santa Catarina. Variables were evaluated using the Chi-squared T/Fisher's exact test, Kendall's correlation coefficient, Student's t test or Mann-Whitney U test. Values of p < 0.05 were considered significant. Results: Between August 2016 to June 2017, 226 patients were evaluated with first episode of AMI. There was a difference in sex distribution, showing that 59.7% of men and 85.4% of women were not alcoholic (p < 0.001). There was a higher prevalence of non-hypertensive patients who consumed alcohol than hypertensive ones (40.7% vs. 24.4% and p = 0.010) and patients without diabetes who had drinking habits than those diabetic (36.4% vs. 12.0% and p = 0.001). There was also a higher prevalence of non-diabetic patients who smoked than diabetic ones (38.1% vs. 22.0% and p = 0.035). A weak and negative correlation was found between the number of cigarettes per day and the pack-year with the TIMI frame count (r = -0.174 and p = 0.041 and r = -0.192 and p = 0.027, respectively). The other associations did not show statistical significance. Conclusion: The study showed that the number of cigarettes consumed per day and the pack-year is related to a smaller TIMI frame count, i.e., to a better coronary flow, which may be related to the Smoker's Paradox. There was no correlation between the beverage type and quantity with the SYNTAX score, Ejection fraction and TIMI frame count


Asunto(s)
Humanos , Masculino , Femenino , Tabaquismo/complicaciones , Enfermedad de la Arteria Coronaria/mortalidad , Consumo de Bebidas Alcohólicas/efectos adversos , Infarto del Miocardio , Volumen Sistólico , Enfermedades Cardiovasculares/mortalidad , Factores Sexuales , Prevalencia , Estudios Transversales , Factores de Riesgo , Diabetes Mellitus , Hospitales Públicos
20.
Vet Parasitol ; 178(3-4): 379-82, 2011 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-21292402

RESUMEN

Nowadays, insect control is usually carried out using chemical insecticides, but insect resistance and other negative side effects have prompted the search for alternatives. Biopesticides provide a positive alternative to synthetic pesticides because they have low impact on the environmental, low toxicity to humans and low costs among other advantages. This research was carried out to evaluate the activity of Parahancornia amapa (Huber) Ducke (Apocynaceae) lyophilized latex on the post embryonic development of Chrysomya megacephala (F.) (Diptera: Calliphoridae). Larvae treated with 1.0% latex showed a shorter post embryonic development period (larval, pupal and newly hatched larvae to adult); whereas larvae treated with 3.0% latex provoked a prolongation of these periods. Viability (53%) was also very low at the newly hatched larvae to adult period for larvae treated with 3.0% latex, indicating that latex from P. amapa at high concentrations could change C. megacephala post embryonic development.


Asunto(s)
Apocynaceae/química , Dípteros/crecimiento & desarrollo , Látex , Control Biológico de Vectores/métodos , Animales , Bioensayo/métodos , Larva/efectos de los fármacos
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