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1.
Artigo em Inglês | MEDLINE | ID: mdl-39045030

RESUMO

A 73-year-old male patient was referred to us with a long Barrett's esophagus (BE). He had a history of pulmonary embolism under anticoagulant therapy. Esophagogastroduodenoscopy showed a C8M9 BE with no macroscopic lesions. Random biopsies from the BE revealed multifocal high-grade dysplasia. The case was discussed in a multidisciplinary team conference and the decision for full resection of BE with endoscopic submucosal dissection (ESD) was made. Considering the large ESD resection and the high risk of stricture, we developed a novel preventive technique: the "steroid lifting method" for submucosal injection during ESD. Complete circumferential ESD with en bloc resection was performed using the "steroid lifting method", without adverse events. Oral liquids were initiated on day 1 and the patient was discharged on day 4. Oral prednisolone (30 mg per day) was started and tapered for a total of 6 weeks. The pathological examination confirmed multifocal high-grade dysplasia, with radical and curative resection. The patient had neither stricture, dysphagia nor recurrence of Barrett's mucosa at the 2, 6, 12, and 24-month follow-up. International guidelines recommend oral prednisolone and triamcinolone injection to prevent stricture formation in large ESD of esophageal squamous cell carcinoma. However, there is no solid data on BE ESD. The risk factors for stricture formation and the optimal preventive management after large BE ESD is not known. The "steroid lifting method" might be an option in this context. Large prospective studies addressing stricture formation and preventive measures on BE ESD are necessary.

2.
Kidney Int Rep ; 9(9): 2667-2676, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39291188

RESUMO

Introduction: Among individuals with high-risk APOL1 genotypes, the lifetime risk of developing kidney failure is ∼15%, indicating that other genetic variants or nongenetic modifiers likely contribute substantially to an individual patient's risk of progressive kidney disease. Here, we estimate the prevalence and distribution of Mendelian kidney diseases among patients with high-risk APOL1 genotypes undergoing commercial genetic testing in the United States. Methods: We analyzed clinical exome sequencing data from 15,181 individuals undergoing commercial genetic testing for Mendelian kidney disease in the United States from 2020 to 2021. We identified patients with high-risk APOL1 genotypes by the presence of G1/G1, G1/G2, or G2/G2 alleles. Patients carrying single risk APOL1 alleles were identified as G1/G0, G2/G0; the remainder of patients were G0/G0. We estimated the prevalence and distribution of Mendelian kidney disease stratified by APOL1 genotype and genetically predicted ancestry. Results: Of 15,181 patients, 3119 had genetic testing results consistent with a molecular diagnosis of Mendelian kidney disease (20.5%). Of 15,181 patients, 1035 (6.8%) had high-risk APOL1 genotypes. Among patients with recent genomic African ancestry, the prevalence of Mendelian kidney diseases was lower in those with high-risk APOL1 genotypes (9.6%; n = 91/944) compared with single risk APOL1 allele carriers (13.6%; n = 198/1453) and those with G0/G0 APOL1 genotypes (16.6%; n = 213/1281). Among patients with Mendelian kidney disease and recent genomic African ancestry, we observed differences in the prevalence of pathogenic/likely pathogenic variants in PKD1 (19.8% in high-risk vs. 30.2% in low-risk genotypes), and COL4A4 (24.2% in high-risk vs. 10.5% in low-risk genotypes). Conclusion: In this selected population of patients undergoing clinical genetic testing, we found evidence of Mendelian kidney disease in ∼10% patients with high-risk APOL1 genotypes.

3.
Metabolism ; 161: 156028, 2024 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-39270816

RESUMO

Metabolic dysfunction-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD), has become the leading cause of chronic liver disease worldwide. Optimal dietary intervention strategies for MAFLD are not standardized. This study aimed to achieve consensus on prevention of MAFLD through dietary modification. A multidisciplinary panel of 55 international experts, including specialists in hepatology, gastroenterology, dietetics, endocrinology and other medical specialties from six continents collaborated in a Delphi-based consensus development process. The consensus statements covered aspects ranging from epidemiology to mechanisms, management, and dietary recommendations for MAFLD. The recommended dietary strategies emphasize adherence to a balanced diet with controlled energy intake and personalized nutritional interventions, such as calorie restriction, high-protein, or low-carbohydrate diets. Specific dietary advice encouraged increasing the consumption of whole grains, plant-based proteins, fish, seafood, low-fat or fat-free dairy products, liquid plant oils, and deeply colored fruits and vegetables. Concurrently, it advised reducing the intake of red and processed meats, saturated and trans fats, ultra-processed foods, added sugars, and alcohol. Additionally, maintaining the Mediterranean or DASH diet, minimizing sedentary behavior, and engaging in regular physical activity are recommended. These consensus statements lay the foundation for customized dietary guidelines and proposing avenues for further research on nutrition and MAFLD.

4.
PLoS One ; 19(9): e0305610, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39292688

RESUMO

The aim of the present research was to evaluate the efficiency of different vegetation indices (VI) obtained from satellites with varying spatial resolutions in discriminating the phenological stages of soybean crops. The experiment was carried out in a soybean cultivation area irrigated by central pivot, in Balsas, MA, Brazil, where weekly assessments of phenology and leaf area index were carried out. Throughout the crop cycle, spectral data from the study area were collected from sensors, onboard the Sentinel-2 and Amazônia-1 satellites. The images obtained were processed to obtain the VI based on NIR (NDVI, NDWI and SAVI) and RGB (VARI, IV GREEN and GLI), for the different phenological stages of the crop. The efficiency in identifying phenological stages by VI was determined through discriminant analysis and the Algorithm Neural Network-ANN, where the best classifications presented an Apparent Error Rate (APER) equal to zero. The APER for the discriminant analysis varied between 53.4% and 70.4% while, for the ANN, it was between 47.4% and 73.9%, making it not possible to identify which of the two analysis techniques is more appropriate. The study results demonstrated that the difference in sensors spatial resolution is not a determining factor in the correct identification of soybean phenological stages. Although no VI, obtained from the Amazônia-1 and Sentinel-2 sensor systems, was 100% effective in identifying all phenological stages, specific indices can be used to identify some key phenological stages of soybean crops, such as: flowering (R1 and R2); pod development (R4); grain development (R5.1); and plant physiological maturity (R8). Therefore, VI obtained from orbital sensors are effective in identifying soybean phenological stages quickly and cheaply.


Assuntos
Glycine max , Glycine max/crescimento & desenvolvimento , Redes Neurais de Computação , Brasil , Produtos Agrícolas/crescimento & desenvolvimento , Folhas de Planta/crescimento & desenvolvimento , Algoritmos , Análise Discriminante
5.
Planta Med ; 2024 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-39227040

RESUMO

Monoterpenes and sesquiterpenes are classes of organic compounds found in various natural products, such as the essential oil of Hyptis crenata (EOHc). The therapeutic potential of these terpenes present in EOHc is evidenced by their effect on smooth muscle and potential clinical applications. Among the highlighted monoterpenes, such as sabinene, α-pinene, and ß-pinene, a relaxing effect on rat intestinal smooth muscles is observed, attributed to interaction with calcium channels. Furthermore, monoterpenoids like borneol, cineole, and linalool also demonstrate vasorelaxant properties, suggesting potential in the treatment of cardiovascular conditions. Sesquiterpenes, such as caryophyllene and aromadendrenes, exhibit relaxing effects in various smooth muscle tissues, such as rat uterus and guinea pig ileum, indicating pharmacological potential in these areas. The translational exploration of targets, such as calcium channels and G protein-coupled receptors, highlights the importance of these compounds in discovering new therapies based on natural products for treating various medical conditions.

6.
Monogr Oral Sci ; 32: 43-55, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39321779

RESUMO

Molar incisor hypomineralisation (MIH) is a qualitative type of enamel defect, which occurs due to a failure in the biomineralisation process of the enamel organic matrix during amelogenesis. The tooth enamel affected by MIH shows changes in its chemical, structural, and mechanical properties, leading to different clinical repercussions. The color of MIH opacities varies from opaque white to yellow/brown, and elemental analyses of these lesions show a lower calcium and phosphate content, minerals that are more abundant in sound enamel. Furthermore, the incorporation of other molecules occurs, such as carbonate, a component that provides a greater degree of solubility, thus making hypomineralised enamel more susceptible to posteruptive fractures. At a structural level, the layer of hydroxyapatite crystals appears to be disorganized, with morphological changes, implying a greater degree of porosity in the structure. The increase in porosity of the structure may be associated with dental hypersensitivity, a common clinical repercussion among patients with MIH. Among the mechanical properties, a decrease in hardness and modulus of elasticity occurs, and this also makes the enamel more fragile. Deficiency in biomineralisation can be caused by changes in the function of ameloblasts or by failures at the intercellular junction that result in lower activity of proteases such as MMP-20 and KLK4. The increase in proteins in the organic matrix of enamel impairs the growth and incorporation of minerals into the hydroxyapatite crystals, so that the enamel becomes hypomineralised and has larger organic content, thus having an impact on its properties. These changes present in the enamel with MIH help to explain the clinical repercussions caused by this condition.


Assuntos
Hipoplasia do Esmalte Dentário , Esmalte Dentário , Humanos , Esmalte Dentário/patologia , Esmalte Dentário/ultraestrutura , Hipoplasia do Esmalte Dentário/patologia , Durapatita , Desmineralização do Dente/patologia , Dureza
8.
Chem Biodivers ; : e202401073, 2024 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-39258811

RESUMO

This work describes the evaluation the potentiating activity of antibiotics by campesterol (1) and its derivatives (2-11) against multiresistant strains of Staphylococcusaureus 10, Escherichia coli 06 and Pseudomonas aeruginosa 24 employing the microdilution test. When subjected to the in vitro potentiating activity bioassay, all compounds showed a potentiating effect associated with norfloxacin against E. coli and P. aeruginosa with a reduction in the MIC of the antibiotic of up to 75%. These compounds also reduced the MIC of gentamicin by 37% to 87% in S. aureus and E. coli. Additionally, molecular docking studies were conducted to gain a deeper understanding of the interactions between the appropriate proteins and the most effective compounds (2, 4, 9, and 10 against E. coli; 1, 2, 3, 5, 8, and 9 against S. aureus), including antibiotics. This paper registers for the first time the in vitro and in silico studies on the action of compounds 1-11 in antibiotic potentiation.

9.
Artigo em Inglês | MEDLINE | ID: mdl-39171600

RESUMO

Amyotrophic Lateral Sclerosis (ALS) is a rare, progressive, and incurable disease. Sporadic (sALS) accounts for ninety percent of ALS cases, while familial ALS (fALS) accounts for around fifteen percent. Reports have identified over 30 different forms of familial ALS. Multiple types of fALS exhibit comparable symptoms with mutations in different genes and possibly with different predominant metabolic signals. Clinical diagnosis takes into account patient history but not genetic mutations, misfolded proteins, or metabolic signaling. As research on genetics and metabolic pathways advances, it is expected that the intricate complexity of ALS will compound further. Clinicians discuss whether a gene's presence is a cause of the disease or just an association or consequence. They believe that a mutant gene alone is insufficient to diagnose ALS. ALS, often perceived as a single disease, appears to be a complex collection of diseases with similar symptoms. This review highlights gene mutations, metabolic pathways, and muscle-neuron interactions.

10.
J Transl Med ; 22(1): 721, 2024 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-39103851
11.
Cureus ; 16(7): e65658, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-39205730

RESUMO

BACKGROUND: Artificial intelligence (AI) can be a tool in the diagnosis and acquisition of knowledge, particularly in dentistry, sparking debates on its application in clinical decision-making. OBJECTIVE: This study aims to evaluate the accuracy, completeness, and reliability of the responses generated by Chatbot Generative Pre-Trained Transformer (ChatGPT) 3.5 in dentistry using expert-formulated questions. MATERIALS AND METHODS: Experts were invited to create three questions, answers, and respective references according to specialized fields of activity. The Likert scale was used to evaluate agreement levels between experts and ChatGPT responses. Statistical analysis compared descriptive and binary question groups in terms of accuracy and completeness. Questions with low accuracy underwent re-evaluation, and subsequent responses were compared for improvement. The Wilcoxon test was utilized (α = 0.05). RESULTS: Ten experts across six dental specialties generated 30 binary and descriptive dental questions and references. The accuracy score had a median of 5.50 and a mean of 4.17. For completeness, the median was 2.00 and the mean was 2.07. No difference was observed between descriptive and binary responses for accuracy and completeness. However, re-evaluated responses showed a significant improvement with a significant difference in accuracy (median 5.50 vs. 6.00; mean 4.17 vs. 4.80; p=0.042) and completeness (median 2.0 vs. 2.0; mean 2.07 vs. 2.30; p=0.011). References were more incorrect than correct, with no differences between descriptive and binary questions. CONCLUSIONS: ChatGPT initially demonstrated good accuracy and completeness, which was further improved with machine learning (ML) over time. However, some inaccurate answers and references persisted. Human critical discernment continues to be essential to facing complex clinical cases and advancing theoretical knowledge and evidence-based practice.

12.
J Surg Case Rep ; 2024(8): rjae556, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39211367

RESUMO

Transverse colonic volvulus is exceptionally rare and is the rarest compared to sigmoid or cecal volvulus. This case report summarizes the care of a young 19-year-old woman who presented with transverse colonic volvulus. This woman came to the emergency room with abdominal pain, nausea, and vomiting, and she had no risk factors for a volvulus. This case report has the goal of raising awareness among those taking care of anyone coming in for abdominal pain. Volvulus is a serious issue and can be life threatening if not treated appropriately.

13.
Int J Mol Sci ; 25(15)2024 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-39125701

RESUMO

Anethole is a terpenoid with antioxidant, anti-inflammatory, and neuronal blockade effects, and the present work was undertaken to study the neuroprotective activity of anethole against diabetes mellitus (DM)-induced neuropathy. Streptozotocin-induced DM rats were used to investigate the effects of anethole treatment on morphological, electrophysiological, and biochemical alterations of the sciatic nerve (SN). Anethole partially prevented the mechanical hyposensitivity caused by DM and fully prevented the DM-induced decrease in the cross-sectional area of the SN. In relation to electrophysiological properties of SN fibers, DM reduced the frequency of occurrence of the 3rd component of the compound action potential (CAP) by 15%. It also significantly reduced the conduction velocity of the 1st and 2nd CAP components from 104.6 ± 3.47 and 39.8 ± 1.02 to 89.9 ± 3.03 and 35.4 ± 1.56 m/s, respectively, and increased the duration of the 2nd CAP component from 0.66 ± 0.04 to 0.82 ± 0.09 ms. DM also increases oxidative stress in the SN, altering values related to thiol, TBARS, SOD, and CAT activities. Anethole was capable of fully preventing all these DM electrophysiological and biochemical alterations in the nerve. Thus, the magnitude of the DM-induced neural effects seen in this work, and the prevention afforded by anethole treatment, place this compound in a very favorable position as a potential therapeutic agent for treating diabetic peripheral neuropathy.


Assuntos
Derivados de Alilbenzenos , Anisóis , Diabetes Mellitus Experimental , Estresse Oxidativo , Nervo Isquiático , Animais , Derivados de Alilbenzenos/farmacologia , Nervo Isquiático/efeitos dos fármacos , Diabetes Mellitus Experimental/tratamento farmacológico , Ratos , Anisóis/farmacologia , Anisóis/uso terapêutico , Masculino , Estresse Oxidativo/efeitos dos fármacos , Ratos Wistar , Neuropatias Diabéticas/tratamento farmacológico , Neuropatias Diabéticas/prevenção & controle , Neuropatias Diabéticas/metabolismo , Potenciais de Ação/efeitos dos fármacos , Antioxidantes/farmacologia , Fármacos Neuroprotetores/farmacologia , Fármacos Neuroprotetores/uso terapêutico
14.
Astrobiology ; 24(7): 721-733, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38985734

RESUMO

Understanding the nature and preservation of microbial traces in extreme environments is crucial for reconstructing Earth's early biosphere and for the search for life on other planets or moons. At Rio Tinto, southwestern Spain, ferric oxide and sulfate deposits similar to those discovered at Meridiani Planum, Mars, entomb a diversity of fossilized organisms, despite chemical conditions commonly thought to be challenging for life and fossil preservation. Investigating this unique fossil microbiota can elucidate ancient extremophile communities and the preservation of biosignatures in acidic environments on Earth and, potentially, Mars. In this study, we use an innovative multiscale approach that combines the state-of-the-art synchrotron X-ray nanoimaging methods of ptychographic X-ray computed laminography and nano-X-ray fluorescence to reveal Rio Tinto's microfossils at subcellular resolution. The unprecedented nanoscale views of several different specimens within their geological and geochemical contexts reveal novel intricacies of preserved microbial communities. Different morphotypes, ecological interactions, and possible taxonomic affinities were inferred based on qualitative and quantitative 3D ultrastructural information, whereas diagenetic processes and metabolic affinities were inferred from complementary chemical information. Our integrated nano-to-microscale analytical approach revealed previously invisible microbial and mineral interactions, which complemented and filled a gap of spatial resolution in conventional methods. Ultimately, this study contributes to the challenge of deciphering the faint chemical and morphological biosignatures that can indicate life's presence on the early Earth and on distant worlds.


Assuntos
Fósseis , Espanha , Microbiota , Exobiologia/métodos , Compostos Férricos/química , Bactérias/ultraestrutura , Marte , Síncrotrons
15.
Diabetologia ; 67(9): 1877-1896, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38864887

RESUMO

AIMS/HYPOTHESIS: Insulitis, a hallmark of inflammation preceding autoimmune type 1 diabetes, leads to the eventual loss of functional beta cells. However, functional beta cells can persist even in the face of continuous insulitis. Despite advances in immunosuppressive treatments, maintaining functional beta cells to prevent insulitis progression and hyperglycaemia remains a challenge. The cannabinoid type 1 receptor (CB1R), present in immune cells and beta cells, regulates inflammation and beta cell function. Here, we pioneer an ex vivo model mirroring human insulitis to investigate the role of CB1R in this process. METHODS: CD4+ T lymphocytes were isolated from peripheral blood mononuclear cells (PBMCs) from male and female individuals at the onset of type 1 diabetes and from non-diabetic individuals, RNA was extracted and mRNA expression was analysed by real-time PCR. Single beta cell expression from donors with type 1 diabetes was obtained from data mining. Patient-derived human islets from male and female cadaveric donors were 3D-cultured in solubilised extracellular matrix gel in co-culture with the same donor PBMCs, and incubated with cytokines (IL-1ß, TNF-α, IFN-γ) for 24-48 h in the presence of vehicle or increasing concentrations of the CB1R blocker JD-5037. Expression of CNR1 (encoding for CB1R) was ablated using CRISPR/Cas9 technology. Viability, intracellular stress and signalling were assayed by live-cell probing and real-time PCR. The islet function measured as glucose-stimulated insulin secretion was determined in a perifusion system. Infiltration of immune cells into the islets was monitored by microscopy. Non-obese diabetic mice aged 7 weeks were treated for 1 week with JD-5037, then euthanised. Profiling of immune cells infiltrated in the islets was performed by flow cytometry. RESULTS: CNR1 expression was upregulated in circulating CD4+ T cells from individuals at type 1 diabetes onset (6.9-fold higher vs healthy individuals) and in sorted islet beta cells from donors with type 1 diabetes (3.6-fold higher vs healthy counterparts). The peripherally restricted CB1R inverse agonist JD-5037 arrested the initiation of insulitis in humans and mice. Mechanistically, CB1R blockade prevented islet NO production and ameliorated the ATF6 arm of the unfolded protein response. Consequently, cyto/chemokine expression decreased in human islets, leading to sustained islet cell viability and function. CONCLUSIONS/INTERPRETATION: These results suggest that CB1R could be an interesting target for type 1 diabetes while highlighting the regulatory mechanisms of insulitis. Moreover, these findings may apply to type 2 diabetes where islet inflammation is also a pathophysiological factor. DATA AVAILABILITY: Transcriptomic analysis of sorted human beta cells are from Gene Expression Omnibus database, accession no. GSE121863, available at https://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSM3448161 .


Assuntos
Diabetes Mellitus Tipo 1 , Células Secretoras de Insulina , Ilhotas Pancreáticas , Receptor CB1 de Canabinoide , Humanos , Feminino , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 1/imunologia , Masculino , Receptor CB1 de Canabinoide/metabolismo , Camundongos , Células Secretoras de Insulina/metabolismo , Células Secretoras de Insulina/efeitos dos fármacos , Animais , Ilhotas Pancreáticas/metabolismo , Ilhotas Pancreáticas/efeitos dos fármacos , Linfócitos T CD4-Positivos/metabolismo , Linfócitos T CD4-Positivos/imunologia , Adulto , Leucócitos Mononucleares/metabolismo , Leucócitos Mononucleares/efeitos dos fármacos , Camundongos Endogâmicos NOD
16.
Chemosphere ; 361: 142481, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38823428

RESUMO

The study presents the successful development of a new electrochemical sensor with low cost and disposability for application in nitrofurazone detection in environmental and pharmaceutical samples. The sensors were fabricated using materials obtained from local storage and conductive carbon ink. The modification of the screen-printed electrodes with the hybrid nanomaterial based on silver nanoparticles, carbon quantum dots, and carbon nanotubes showed synergistic contributions in the nitrofurazone electrooxidation, as observed in the wide linear range (0.008 at 15.051 µM), with a sensitivity of 0.650 µA/µM. The limit of detection obtained was 4.6 nM. Differential pulse voltammetry, cyclic voltammetry, X-ray photoelectron spectroscopy, X-ray diffraction analysis, and high-resolution transmission electron microscopy were used to evaluate the electrochemical and structural characteristics. Studies of possible interferences were considered with nitrofurazone in the presence of the ions and organic molecules. The results were satisfactory, with a variation of 93.3% ± 4.39% at 100% ± 2.40%. The low volume used in the analyses (50 µL), disposability, high sensibility, selectivity, and low limit of detection are advantages that make the proposed sensor an electrochemical tool of high viability for the NFZ detection in environmental matrices and pharmaceutical formulations.


Assuntos
Antibacterianos , Técnicas Eletroquímicas , Nanopartículas Metálicas , Nanotubos de Carbono , Nitrofurazona , Nitrofurazona/análise , Nitrofurazona/química , Técnicas Eletroquímicas/métodos , Nanotubos de Carbono/química , Nanopartículas Metálicas/química , Antibacterianos/análise , Limite de Detecção , Prata/química , Eletrodos , Pontos Quânticos/química
17.
Rev Gaucha Enferm ; 45: e20230102, 2024.
Artigo em Inglês, Português | MEDLINE | ID: mdl-38922230

RESUMO

OBJECTIVE: To analyze the relationship between the emotional intelligence of healthcare workers in a hospital environment and their perception of the safety climate in the COVID-19 pandemic. METHOD: Cross-sectional, analytical study, carried out with 81 health workers who worked in hospitals during the pandemic, between September and November 2021. Data collection was carried out using an electronic form, which included a sociodemographic/occupational questionnaire and the Brazilian versions of the Safety Attitudes Questionnaire and the Schutte Self Test. Spearman's correlation test and simple and multiple linear regression analyses were applied. RESULTS: An increase of 1 point in emotional intelligence levels resulted in an increase of 0.487 points in the perception of the safety climate. The most significant predictor of this perception was the ability to manage other people's emotions (ß=0.334; p=0.003; R2=0.168). CONCLUSION: A higher level of emotional intelligence in hospital healthcare workers was related to a greater perception of the safety climate during the COVID-19 pandemic.


Assuntos
COVID-19 , Inteligência Emocional , Recursos Humanos em Hospital , Humanos , COVID-19/psicologia , COVID-19/epidemiologia , Estudos Transversais , Masculino , Feminino , Adulto , Brasil/epidemiologia , Recursos Humanos em Hospital/psicologia , Pessoa de Meia-Idade , Inquéritos e Questionários , Pandemias , Atitude do Pessoal de Saúde , Gestão da Segurança , Pessoal de Saúde/psicologia , Hospitais
18.
Front Public Health ; 12: 1389057, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38846606

RESUMO

Vertical integration models aim for the integration of services from different levels of care (e.g., primary, and secondary care) with the objective of increasing coordination and continuity of care as well as improving efficiency, quality, and access outcomes. This paper provides a view of the Portuguese National Health Service (NHS) healthcare providers' vertical integration, operationalized by the Portuguese NHS Executive Board during 2023 and 2024. This paper also aims to contribute to the discussion regarding the opportunities and constraints posed by public healthcare organizations vertical integration reforms. The Portuguese NHS operationalized the development and generalization of Local Health Units management model throughout the country. The same institutions are now responsible for both the primary care and the hospital care provided by public services in each geographic area, in an integrated manner. This 2024 reform also changed the NHS organic and organizational structures, opening paths to streamline the continuum of care. However, it will be important to ensure adequate monitoring and support, with the participation of healthcare services as well as community structures and other stakeholders, to promote an effective integration of care.


Assuntos
Prestação Integrada de Cuidados de Saúde , Reforma dos Serviços de Saúde , Programas Nacionais de Saúde , Portugal , Humanos , Programas Nacionais de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Medicina Estatal/organização & administração , Atenção Primária à Saúde/organização & administração , Continuidade da Assistência ao Paciente
19.
Int J Hematol Oncol Stem Cell Res ; 18(2): 192-201, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38868805

RESUMO

The myelodysplastic syndrome (MDS) is a heterogeneous group of clonal disorders of hematopoietic progenitor cells related to ineffective hematopoiesis and an increased risk of transformation to acute myelogenous leukemia. MDS is divided into categories, namely lineage dysplasia (MDS-SLD), MDS with ring sideroblasts (MDS-RS), MDS with multilineage dysplasia (MDS-MLD), MDS with excess blasts (MDS-EB). The International Prognostic Classification System (IPSS) ranks the patients as very low, low, intermediate, high, and very high based on disease evolution and survival rates. Evidence points to toll-like receptor (TLR) abnormal signaling as an underlying mechanism of this disease, providing a link between MDS and immune dysfunction. Microbial signals, such as lipopolysaccharides from gram-negative bacteria, can activate or suppress TLRs. Therefore, we hypothesized that MDS patients present gut microbiota alterations associated with disease subtypes and prognosis. To test this hypothesis, we sequenced the 16S rRNA gene from fecal samples of 30 MDS patients and 16 healthy elderly controls. We observed a negative correlation between Prevotella spp. and Akkermansia spp. in MDS patients compared with the control group. High-risk patients presented a significant increase in the genus Prevotella spp. compared to the other risk categories. There was a significant reduction in the abundance of the genus Akkermansia spp. in high-risk patients compared with low- and intermediate-risk. There was a significant decrease in the genus Ruminococcus spp. in MDS-EB patients compared with controls. Our findings show a new association between gut dysbiosis and higher-risk MDS, with a predominance of gram-negative bacteria.

20.
Materials (Basel) ; 17(12)2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38930197

RESUMO

Changing the morphology is an excellent option for altering the textural parameters of SBA-15 materials. This study provides a guide on how the properties of mesoporous structures behave according to their morphology and their contribution to thermal stability. The objective of this work was to synthesize different morphologies (spherical, hexagonal prisms, rice-like grains, rods, and fibers) of SBA-15 materials and evaluate the existing textural changes. The materials were synthesized by varying the temperature of the synthesis gel from 25 °C to 55 °C, with stirring at 300 or 500 rpm. The results of X-ray diffraction, Fourier transform infrared spectroscopy, N2 adsorption and desorption, and scanning electron microscopy were evaluated. Thermal stability tests were also conducted in an inert atmosphere. The materials were successfully synthesized, and it was observed that they all exhibited different characteristics, such as their ordering, interplanar distance, mesoporous parameter, specific surface area, micropore and mesopore volumes, external mesoporous area, and wall thickness. They also presented different thermal stabilities. The rice grain morphology had the highest specific surface area (908.8 cm2/g) and the best thermal stability, while the rod morphology had the best pore diameter (7.7 nm) and microporous volume (0.078 cm3/g).

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