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1.
Pediatr Blood Cancer ; 71(6): e30973, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38556746

RESUMEN

BACKGROUND: Latin American countries are improving childhood cancer care, showing strong commitment to implement the Global Initiative for Childhood Cancer, but there are scant publications of the situation at a continental level. METHODS: As part of the International Society of Paediatric Oncology Global Mapping project, delegates of each country participating in the Latin American Society of Pediatric Oncology (SLAOP) and chairs of national pediatric oncology societies and cooperative groups were invited to provide information regarding availability of national pediatric cancer control programs (NPCCP), pediatric oncology laws, pediatric oncology tumor registries, and training programs and support to diagnosis and treatment. RESULTS: Nineteen of the 20 countries participating in SLAOP responded. National delegates reported nine countries with NPCCP and four of them were launched in the past 5 years. National pediatric tumor registries are available in eight countries, and three provided published survival results. Fellowship programs for training pediatric oncologists are available in 12 countries. National delegates reported that eight countries provide support to most essential diagnosis and treatments and 11 provide partial or minimal support that is supplemented by civil society organizations. Seven countries have a pediatric oncology law. There are three international cooperative groups and four national societies for pediatric oncology. CONCLUSION: Despite many challenges, there were dramatic advances in survivorship, access to treatment, and availability of NPCCP in Latin America. Countries with highest social development scores in general provide more complete support and are more likely to have NPCCP, training programs, and reported survival results.

2.
Environ Res ; 247: 118204, 2024 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-38224938

RESUMEN

The synthesis of CuAu-based monometallic (MNPs) and bimetallic nanoparticles (BNPs) supported on chitosan-based hydrogels for their application as catalysts is presented. The hydrogels consisted of chitosan chains cross-linked with tripolyphosphate (TPP) in the form of beads with an approximate average diameter of 1.81 mm. The MNPs and BNPs were obtained by the adsorption of metallic ions and their subsequent reduction with hydrazine, achieving a metallic loading of 0.297 mmol per gram of dry sample, with average nanoparticle sizes that were found between 2.6 and 4.4 nm. Both processes, metal adsorption and the stabilization of the nanoparticles, are mainly attributed to the participation of chitosan hydroxyl, amine and amide functional groups. The materials revealed important absorption bands in the visible region of the light spectra, specifically between 520 and 590 nm, mainly attributed to LSPR given the nature of the MNPs and BNPs inside the hydrogels. Subsequently, the hydrogels were evaluated as catalysts against the reduction of 4-nitrophenol (4NP) into 4-aminophenol (4AP), followed by UV-visible spectroscopy. The kinetic advance of the reaction revealed important improvements in the catalytic activity of the materials by synergistic effect of BNPs and plasmonic enhancement under visible light irradiation, given the combination of metals and the light harvesting properties of the nanocomposites. Finally, the catalytic performance of hydrogels containing BNPs CuAu 3:1 showed an important selectivity, recyclability and reusability performance, due to the relevant interaction of the BNPs with the chitosan matrix, highlighting the potential of this nanocomposite as an effective catalyst, with a potential environmental application.


Asunto(s)
Quitosano , Nanopartículas del Metal , Hidrogeles/química , Quitosano/química , Nanopartículas del Metal/química , Plata/química , Catálisis
3.
Actas Esp Psiquiatr ; 52(3): 221-229, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38863050

RESUMEN

INTRODUCTION: Addiction behaviors are primary contributors to mental health issues among adolescents, often utilized as coping mechanisms or emotional regulation tools. This study aimed to establish the content validity of the Penn Alcohol Craving Scale (PACS) for Colombian adolescents, recognized for its representation of the cognitive-emotional aspects of craving. METHODOLOGY: This quantitative research focused on instrument validation. Seven subject matter experts evaluated the scale in terms of pertinence, relevance, usefulness, sufficiency, clarity, and appearance. Data analysis was conducted using SPSS version 22, calculating internal consistency and the Content Validity Index. Qualitative feedback from experts was compiled in an Excel matrix, facilitating grammatical and semantic adjustments to the instrument. RESULTS: Cronbach's Alpha values for each item and the scale exceeded 0.8. Content Validity Index scores exceeded 0.7 in four out of five evaluated criteria. These results supported retaining all scale items in the Colombian version. CONCLUSIONS: The content validation process yielded an instrument that satisfied expert opinion regarding conceptual constructs and explanatory power for the Colombian adolescent population.


Asunto(s)
Ansia , Humanos , Adolescente , Colombia , Masculino , Femenino , Reproducibilidad de los Resultados , Conducta Adictiva/psicología , Conducta Adictiva/diagnóstico
4.
J Antimicrob Chemother ; 78(10): 2462-2470, 2023 10 03.
Artículo en Inglés | MEDLINE | ID: mdl-37583091

RESUMEN

BACKGROUND: Risk factors for carbapenem resistance in Enterobacterales bloodstream infections among children with cancer or post-HSCT have not been thoroughly explored. METHODS: All children with cancer or post-HSCT who developed Enterobacterales bloodstream infections in two cancer referral centres in major Colombian cities between 2012 and 2021 were retrospectively examined. When the infection episode occurred, carbapenem resistance mechanisms were evaluated according to the available methods. Data were divided in a training set (80%) and a test set (20%). Three internally validated carbapenem-resistant Enterobacterales (CRE) prediction models were created: a multivariate logistic regression model, and two data mining techniques. Model performances were evaluated by calculating the average of the AUC, sensitivity, specificity and predictive values. RESULTS: A total of 285 Enterobacterales bloodstream infection episodes (229 carbapenem susceptible and 56 carbapenem resistant) occurred [median (IQR) age, 9 (3.5-14) years; 57% male]. The risk of CRE was 2.1 times higher when the infection was caused by Klebsiella spp. and 5.8 times higher when a carbapenem had been used for ≥3 days in the previous month. A model including these two predictive variables had a discriminatory performance of 77% in predicting carbapenem resistance. The model had a specificity of 97% and a negative predictive value of 81%, with low sensitivity and positive predictive value. CONCLUSIONS: Even in settings with high CRE prevalence, these two variables can help early identification of patients in whom CRE-active agents are unnecessary and highlight the importance of strengthening antibiotic stewardship strategies directed at preventing carbapenem overuse.


Asunto(s)
Gammaproteobacteria , Trasplante de Células Madre Hematopoyéticas , Neoplasias , Sepsis , Humanos , Niño , Masculino , Adolescente , Femenino , Estudios Retrospectivos , Carbapenémicos/farmacología , Carbapenémicos/uso terapéutico , Antibacterianos/farmacología , Antibacterianos/uso terapéutico
5.
J Shoulder Elbow Surg ; 32(2): 310-317, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35998779

RESUMEN

BACKGROUND: Glenoid inclination must be assessed precisely during preoperative planning for reverse shoulder arthroplasty (RSA) to position the glenoid baseplate correctly. We hypothesized that a more dynamic measurement method would better match the diversity of glenoid heights in the population and the variety of commercialized glenoid baseplates. Our purpose was to describe a new method to measure the RSA angle accounting for the baseplate size. METHODS: Computed tomography scans of 50 shoulders that underwent RSA for primary osteoarthritis or cuff tear arthropathy between June 2019 and February 2020 were included (mean age, 76 years). Three variants of the RSA angle were measured: the RSA angle as originally described by Boileau et al, the relative RSA 25 angle (which simulates the implantation of a 25-mm baseplate), and the relative RSA 29 angle (which simulates the implantation of a 29-mm baseplate). Measurements in the 2-dimensional true reformatted scapular plane were made by 3 independent operators. RESULTS: The mean R-S distance (ie, distance between point R [intersection of supraspinatus fossa line with glenoid surface] and point S [inferior border of glenoid]) was 24.2 ± 4.0 mm. The mean RSA angle was 20.3° ± 8.4°, whereas the mean relative RSA 25 angle was 19.3° ± 7.8° and the mean relative RSA 29 angle was 15.6° ± 7.6°. The mean difference between the RSA angle and the relative RSA 25 angle was 1.0° ± 4.1° (P = .16). The mean difference between the RSA angle and the relative RSA 29 angle was 4.7° ± 3.8° (P < .0001). In half of the shoulders in our series, the difference between the RSA angle and the RSA 29 angle exceeded 5°. CONCLUSION: The RSA angle is a reproducible measure of the inclination of the inferior part of the glenoid that is reliable in most cases for glenoid baseplates of 24-25 mm in height. However, surgeons should be aware that the RSA angle may overestimate the superior orientation of the inferior glenoid for baseplates of different sizes or for small- or large-stature patients. In these cases, the relative RSA angle adapted to the size of the baseplate more accurately evaluates the inclination of the inferior glenoid.


Asunto(s)
Artroplastía de Reemplazo de Hombro , Cavidad Glenoidea , Articulación del Hombro , Humanos , Anciano , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/cirugía , Artroplastía de Reemplazo de Hombro/métodos , Cavidad Glenoidea/diagnóstico por imagen , Cavidad Glenoidea/cirugía , Escápula/cirugía , Tomografía Computarizada por Rayos X/métodos
6.
Int J Mol Sci ; 24(14)2023 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-37511264

RESUMEN

Cellular mitochondrial function can be assessed using high-resolution respirometry that measures the O2 consumption rate (OCR) across a number of cells. However, a direct measurement of cellular mitochondrial function provides valuable information and physiological insight. In the present study, we used a quantitative histochemical technique to measure the activity of succinate dehydrogenase (SDH), a key enzyme located in the inner mitochondrial membrane, which participates in both the tricarboxylic acid (TCA) cycle and electron transport chain (ETC) as Complex II. In this study, we determine the maximum velocity of the SDH reaction (SDHmax) in individual human airway smooth muscle (hASM) cells. To measure SDHmax, hASM cells were exposed to a solution containing 80 mM succinate and 1.5 mM nitroblue tetrazolium (NBT, reaction indicator). As the reaction proceeded, the change in optical density (OD) due to the reduction of NBT to its diformazan (peak absorbance wavelength of 570 nm) was measured using a confocal microscope with the pathlength for light absorbance tightly controlled. SDHmax was determined during the linear period of the SDH reaction and expressed as mmol fumarate/liter of cell/min. We determine that this technique is rigorous and reproducible, and reliable for the measurement of mitochondrial function in individual cells.


Asunto(s)
Ciclo del Ácido Cítrico , Mitocondrias , Humanos , Mitocondrias/metabolismo , Miocitos del Músculo Liso
7.
Exp Dermatol ; 31(9): 1431-1442, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-35620886

RESUMEN

Recessive dystrophic epidermolysis bullosa (RDEB) patients develop poorly healing skin wounds that are frequently colonized with microbiota. Because T cells play an important role in clearing such pathogens, we aimed to define the status of adaptive T cell-mediated immunity in RDEB wounds. Using a non-invasive approach for sampling of wound-associated constituents, we evaluated microbial contaminants in cellular fraction and exudates obtained from RDED wounds. Infectivity and intracellular trafficking of inactivated Staphylococcus aureus was accessed in RDEB keratinocytes. S. aureus and microbial antigen-specific activation of RDEB wound-derived T cells were investigated by fluorescence-activated cell sorting-based immune-phenotyping and T-cell functional assays. We found that RDEB wounds and epithelial cells are most frequently infected with Staphylococcus sp. and Pseudomonas sp. and that S. aureus essentially infects more RDEB keratinocytes and RDEB-derived squamous cell carcinoma cells than keratinocytes from healthy donors. The RDEB wound-associated T cells contain populations of CD4+ and CD8+ peripheral memory T cells that respond to soluble microbial antigens by proliferating and secreting interferon gamma (IFNγ). Moreover, CD8+ cytotoxic T lymphocytes recognize S. aureus-infected RDEB keratinocytes and respond by producing interleukin-2 (IL-2) and IFNγ and degranulating and cytotoxically killing infected cells. Prolonged exposure of RDEB-derived T cells to microbial antigens in vitro does not trigger PD-1-mediated T-cell exhaustion but induces differentiation of the CD4high population into CD4high CD25+ FoxP3+ regulatory T cells. Our data demonstrated that adaptive T cell-mediated immunity could clear infected cells from wound sites, but these effects might be inhibited by PD-1/Treg-mediated immuno-suppression in RDEB.


Asunto(s)
Infecciones Bacterianas , Epidermólisis Ampollosa Distrófica , Linfocitos T , Antígenos , Colágeno Tipo VII , Epidermólisis Ampollosa Distrófica/patología , Humanos , Queratinocitos/patología , Activación de Linfocitos , Receptor de Muerte Celular Programada 1 , Staphylococcus aureus , Linfocitos T/inmunología
8.
Gac Med Mex ; 158(M3): M1-M48, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35350063

RESUMEN

Acute myeloid leukemia (AML) comprises a heterogeneous group of hematopoietic cell neoplasms of myeloid lineage that arise from the clonal expansion of their precursors in the bone marrow, interfering with cell differentiation, leading to a syndrome of bone marrow failure. AML is a consequence of genetic and epigenetic changes (point mutations, gene rearrangements, deletions, amplifications, and arrangements in epigenetic changes that influence gene expression) in hematopoietic precursor cells, which create a clone of abnormal cells that are capable of proliferating but cannot differentiate into mature hematopoietic cells or undergo programmed cell death. The diagnosis requires more than 20% myeloid blasts in the bone marrow and certain cytogenic abnormalities. Treatment will depend on age, comorbidities, and cytogenetic risk among the most frequent.


La leucemia mieloide aguda (LMA) comprende un grupo heterogéneo de neoplasias de células hematopoyéticas de linaje mieloide que surgen de la expansión clonal de sus precursores en la médula ósea, interfiriendo con la diferenciación celular, lo que conlleva a un síndrome de falla medular. La LMA es una consecuencia de cambios genéticos y epigenéticos (mutaciones puntuales, rearreglos de genes, deleciones, amplificaciones y arreglos en cambios epigenéticos que influyen en la expression del gen) en las células hematopoyéticas precursoras, la cual crea una clona de células anormales que son capaces de proliferar, pero no se pueden diferenciar en células hematopoyéticas maduras ni sufrir una muerte celular programada. El diagnostic requiere más del 20% de blastos mieloides en médula ósea y ciertas anormalidades citogénicas. El tratamiento dependerá de la edad, comorbilidades, riesgo citogenético entre las más frecuentes.


Asunto(s)
Leucemia Mieloide Aguda , Diferenciación Celular , Consenso , Humanos , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/terapia , México
9.
Am J Med Genet A ; 185(11): 3390-3400, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34435747

RESUMEN

Recessive dystrophic epidermolysis bullosa (RDEB) is a rare genodermatosis caused by mutations in the gene coding for type VII collagen (COL7A1). More than 800 different pathogenic mutations in COL7A1 have been described to date; however, the ancestral origins of many of these mutations have not been precisely identified. In this study, 32 RDEB patient samples from the Southwestern United States, Mexico, Chile, and Colombia carrying common mutations in the COL7A1 gene were investigated to determine the origins of these mutations and the extent to which shared ancestry contributes to disease prevalence. The results demonstrate both shared European and American origins of RDEB mutations in distinct populations in the Americas and suggest the influence of Sephardic ancestry in at least some RDEB mutations of European origins. Knowledge of ancestry and relatedness among RDEB patient populations will be crucial for the development of future clinical trials and the advancement of novel therapeutics.


Asunto(s)
Colágeno Tipo VII/genética , Epidermólisis Ampollosa Distrófica/genética , Hispánicos o Latinos/genética , Judíos/genética , Chile/epidemiología , Colombia/epidemiología , Epidermólisis Ampollosa Distrófica/epidemiología , Femenino , Genes Recesivos/genética , Humanos , Masculino , México/epidemiología , Fenotipo , Estados Unidos/epidemiología
10.
Transpl Infect Dis ; 23(2): e13498, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33119920

RESUMEN

OBJECTIVE: There is a relative lack of information about infections occurring in children following allogeneic hematopoietic stem cell transplants (allo-HSCT) in developing countries. Herein, we describe the incidence rates of different infections according to the transplant period and baseline condition in Colombia. METHODS: In a retrospective cohort study of all children who underwent allo-HSCTs from 2012 to 2017 in a hospital in Cali, Colombia, we reviewed medical records from the first post-transplant day until day + 365 to describe microbiologically confirmed incidence rates of infections and deaths during three post-transplant periods and according to baseline condition. RESULTS: Most allo-HSCT (n = 144, 96%) were followed by infections over the following year, mostly due to bacteria and cytomegalovirus (4.3 and 3.3 per 1000 patient-days, respectively). Children were at the highest risk for infection in the first 30 days post-HSTC, but mortality was highest after 100 days. Overall, high mortality (n = 44, 31.7%) was associated with infections, especially from extensively drug-resistant bacteria, adenovirus, and aspergillosis. Infection rates were similar independent of the baseline condition. CONCLUSION: Almost all children in this cohort developed infections post allo-HSCT. Describing the distribution of infections throughout the first post allo-HSCT year allows clinicians to narrow the differential diagnosis of infections according to the post-transplant period. This is especially useful when prioritizing interventions in children receiving HSCT in stringent healthcare systems in developing countries.


Asunto(s)
Trasplante de Médula Ósea , Trasplante de Células Madre Hematopoyéticas , Niño , Colombia , Humanos , Estudios Retrospectivos , Trasplante Homólogo
11.
J Asthma ; 58(11): 1488-1494, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-32715830

RESUMEN

OBJECTIVE: Although the assessment of a bronchodilator response (BDR) is a routine and important procedure when performing lung function tests, comparisons between spirometric and oscillometric BDRs in asthmatic children living at high altitude have not been previously reported. The aim of the present study was to compare spirometric and oscillometric BDRs in children living at high altitude, and to identify independent predictors of spirometric and oscillometric BDRs. METHODS: Between January and December, 2015, asthmatic children aged between 5 and 17 years old performed impulse oscillometry (IOS) and spirometry during the same visit before and after albuterol administration. The data were analyzed, and children were classified into those positive for oscillometric BDR only, those positive for spirometric BDR only, those positive for both BDRs, and those negative for both BDRs. RESULTS: Ninety-three asthmatic children (56 boys, 37 girls), with a median (IQR) age of 11 (8-13) years, made up the study population. Among the total of 93 participants, 13 (14.0%), 4 (4.3%), 0 (0%), and 76 (81.7%) were positive for spirometric BDR only, positive for oscillometric BDR only, positive for both BDRs, and negative for both BDRs, respectively. Age and baseline lung function were identified as significant predictors of positive spirometric BDR. CONCLUSIONS: The present study shows poor concordance between positive spirometric and oscillometric BDRs, with a greater proportion of patients with a spirometric BDR when compared to those with positive oscillometric BDR. Additionally, age and baseline lung function are useful for predicting spirometric BDR results.


Asunto(s)
Albuterol/uso terapéutico , Altitud , Asma/tratamiento farmacológico , Asma/fisiopatología , Broncodilatadores/uso terapéutico , Oscilometría , Espirometría , Adolescente , Niño , Femenino , Humanos , Masculino , Resultado del Tratamiento
12.
Pediatr Nephrol ; 36(6): 1525-1532, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33415483

RESUMEN

BACKGROUND: Pediatric nephrologists use kidney length and kidney volume z-scores to longitudinally assess normal nephron endowment. However, most radiologists only report kidney length. Agreement between kidney length and kidney volume z-scores in children has been understudied. This study aims to assess agreement between kidney length and kidney volume z-scores in children. METHODS: This novel cross-sectional cohort study prospectively followed prematurely born babies from a large specialized prematurity follow-up center. A healthy control group matched the cases by age and sex and was recruited from schools. Children were assessed for kidney length and kidney volumes at age 5 by three independent ultrasonographers. All measurements were performed in triplicate. Detailed anthropometry, blood pressure, and kidney function were also obtained. Age-independent z-scores were calculated for all parameters according to Scholbach and Weitzel and compared using descriptive statistics. RESULTS: We studied 89 premature patients (median 32 weeks gestational age) and 33 healthy controls (median 38 weeks gestational age). There were 732 determinations of kidney length, width, and thickness. The mean z-score of the right kidney length was 0.65 ± 0.08 (SEM) compared with 0.88 ± 0.08 of the left kidney length (p = 0.0003, two-sided paired t test). The squared correlation coefficient for kidney volume to kidney length was 0.32 (p < 0.0001). Bland and Altman analysis revealed considerable bias with - 1.36 ± 0.76 standard deviations and 95% limits of agreement from - 2.83 to - 0.16. CONCLUSION: Reporting only kidney length results in significant overestimation of age-independent z-scores. Based on our findings, consideration to measuring all kidney dimensions may be more appropriate.


Asunto(s)
Antropometría , Recién Nacido de Bajo Peso , Riñón , Estudios de Casos y Controles , Preescolar , Estudios Transversales , Edad Gestacional , Humanos , Riñón/diagnóstico por imagen , Tamaño de los Órganos
13.
Nucleic Acids Res ; 47(2): 970-980, 2019 01 25.
Artículo en Inglés | MEDLINE | ID: mdl-30462273

RESUMEN

Cancer-associated mutations of the core splicing factor 3 B1 (SF3B1) result in selection of novel 3' splice sites (3'SS), but precise molecular mechanisms of oncogenesis remain unclear. SF3B1 stabilizes the interaction between U2 snRNP and branch point (BP) on the pre-mRNA. It has hence been speculated that a change in BP selection is the basis for novel 3'SS selection. Direct quantitative determination of BP utilization is however technically challenging. To define BP utilization by SF3B1-mutant spliceosomes, we used an overexpression approach in human cells as well as a complementary strategy using isogenic murine embryonic stem cells with monoallelic K700E mutations constructed via CRISPR/Cas9-based genome editing and a dual vector homology-directed repair methodology. A synthetic minigene library with degenerate regions in 3' intronic regions (3.4 million individual minigenes) was used to compare BP usage of SF3B1K700E and SF3B1WT. Using this model, we show that SF3B1K700E spliceosomes utilize non-canonical sequence variants (at position -1 relative to BP adenosine) more frequently than wild-type spliceosomes. These predictions were confirmed using minigene splicing assays. Our results suggest a model of BP utilization by mutant SF3B1 wherein it is able to utilize non-consensus alternative BP sequences by stabilizing weaker U2-BP interactions.


Asunto(s)
Factores de Empalme de ARN/metabolismo , Animales , Emparejamiento Base , Células Cultivadas , Células Madre Embrionarias/metabolismo , Biblioteca de Genes , Células HEK293 , Humanos , Ratones , Mutación , Motivos de Nucleótidos , Fosfoproteínas/genética , Sitios de Empalme de ARN , Factores de Empalme de ARN/genética , ARN Mensajero/metabolismo
14.
Int J Sports Med ; 42(9): 825-832, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33126281

RESUMEN

Throwing velocity is one of the most important factors for scoring goals in handball. This study aimed to identify the type of throw and procedure for selecting the final test outcome that provide throwing velocity with the greatest reliability. Fifteen experienced handball players and 33 non-experienced participants were tested in two sessions. Each session consisted of 4 trials of 3 different throwing tests (unspecific, 7-meters, and 3-steps). The maximum value of 4 trials, average value of 4 trials, and average value of the 3 best trials were considered. Throwing velocity was highly reliable (coefficient of variation [CV]≤3.3%, intraclass correlation coefficient≥0.89) with the exception of the unspecific throw for the non-experienced group (CV≥5.9%, intraclass correlation coefficient≤0.56). The 3-steps throw (CV=1.7%) was more reliable than the 7-meters throw (CV=2.1%) (CVratio=1.19) and unspecific throw (CV = 3.8%) (CVratio=2.18), the 3 procedures provided a comparable reliability (CV range=2.4-2.6%; CVratio≤1.07), and the experienced group (CV=1.0%) presented a higher reliability than the non-experienced group (CV=4.0%) (CVratio=3.83). These results support the 3-steps throw to maximise the reliability of throwing velocity performance.


Asunto(s)
Rendimiento Atlético , Fuerza Muscular , Extremidad Superior/fisiología , Adulto , Humanos , Masculino , Reproducibilidad de los Resultados , Deportes , Adulto Joven
15.
JAMA ; 325(14): 1426-1435, 2021 04 13.
Artículo en Inglés | MEDLINE | ID: mdl-33662102

RESUMEN

Importance: Ivermectin is widely prescribed as a potential treatment for COVID-19 despite uncertainty about its clinical benefit. Objective: To determine whether ivermectin is an efficacious treatment for mild COVID-19. Design, Setting, and Participants: Double-blind, randomized trial conducted at a single site in Cali, Colombia. Potential study participants were identified by simple random sampling from the state's health department electronic database of patients with symptomatic, laboratory-confirmed COVID-19 during the study period. A total of 476 adult patients with mild disease and symptoms for 7 days or fewer (at home or hospitalized) were enrolled between July 15 and November 30, 2020, and followed up through December 21, 2020. Intervention: Patients were randomized to receive ivermectin, 300 µg/kg of body weight per day for 5 days (n = 200) or placebo (n = 200). Main Outcomes and Measures: Primary outcome was time to resolution of symptoms within a 21-day follow-up period. Solicited adverse events and serious adverse events were also collected. Results: Among 400 patients who were randomized in the primary analysis population (median age, 37 years [interquartile range {IQR}, 29-48]; 231 women [58%]), 398 (99.5%) completed the trial. The median time to resolution of symptoms was 10 days (IQR, 9-13) in the ivermectin group compared with 12 days (IQR, 9-13) in the placebo group (hazard ratio for resolution of symptoms, 1.07 [95% CI, 0.87 to 1.32]; P = .53 by log-rank test). By day 21, 82% in the ivermectin group and 79% in the placebo group had resolved symptoms. The most common solicited adverse event was headache, reported by 104 patients (52%) given ivermectin and 111 (56%) who received placebo. The most common serious adverse event was multiorgan failure, occurring in 4 patients (2 in each group). Conclusion and Relevance: Among adults with mild COVID-19, a 5-day course of ivermectin, compared with placebo, did not significantly improve the time to resolution of symptoms. The findings do not support the use of ivermectin for treatment of mild COVID-19, although larger trials may be needed to understand the effects of ivermectin on other clinically relevant outcomes. Trial Registration: ClinicalTrials.gov Identifier: NCT04405843.


Asunto(s)
Tratamiento Farmacológico de COVID-19 , Ivermectina/uso terapéutico , Adulto , Anciano , Antiinfecciosos/efectos adversos , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Ivermectina/efectos adversos , Masculino , Persona de Mediana Edad , Gravedad del Paciente , SARS-CoV-2/aislamiento & purificación , Factores de Tiempo , Insuficiencia del Tratamiento
16.
Lancet Oncol ; 21(9): e444-e451, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32888473

RESUMEN

Population-based cancer registries (PBCRs) generate measures of cancer incidence and survival that are essential for cancer surveillance, research, and cancer control strategies. In 2014, the Toronto Paediatric Cancer Stage Guidelines were developed to standardise how PBCRs collect data on the stage at diagnosis for childhood cancer cases. These guidelines have been implemented in multiple jurisdictions worldwide to facilitate international comparative studies of incidence and outcome. Robust stratification by risk also requires data on key non-stage prognosticators (NSPs). Key experts and stakeholders used a modified Delphi approach to establish principles guiding paediatric cancer NSP data collection. With the use of these principles, recommendations were made on which NSPs should be collected for the major malignancies in children. The 2014 Toronto Stage Guidelines were also reviewed and updated where necessary. Wide adoption of the resultant Paediatric NSP Guidelines and updated Toronto Stage Guidelines will enhance the harmonisation and use of childhood cancer data provided by PBCRs.


Asunto(s)
Guías como Asunto/normas , Neoplasias/terapia , Pediatría/tendencias , Pronóstico , Niño , Atención a la Salud , Humanos , Estadificación de Neoplasias , Neoplasias/epidemiología , Sistema de Registros
17.
Lancet Oncol ; 21(4): e185-e224, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32240612

RESUMEN

We estimate that there will be 13·7 million new cases of childhood cancer globally between 2020 and 2050. At current levels of health system performance (including access and referral), 6·1 million (44·9%) of these children will be undiagnosed. Between 2020 and 2050, 11·1 million children will die from cancer if no additional investments are made to improve access to health-care services or childhood cancer treatment. Of this total, 9·3 million children (84·1%) will be in low-income and lower-middle-income countries. This burden could be vastly reduced with new funding to scale up cost-effective interventions. Simultaneous comprehensive scale-up of interventions could avert 6·2 million deaths in children with cancer in this period, more than half (56·1%) of the total number of deaths otherwise projected. Taking excess mortality risk into consideration, this reduction in the number of deaths is projected to produce a gain of 318 million life-years. In addition, the global lifetime productivity gains of US$2580 billion in 2020-50 would be four times greater than the cumulative treatment costs of $594 billion, producing a net benefit of $1986 billion on the global investment: a net return of $3 for every $1 invested. In sum, the burden of childhood cancer, which has been grossly underestimated in the past, can be effectively diminished to realise massive health and economic benefits and to avert millions of needless deaths.


Asunto(s)
Países en Desarrollo , Costos de la Atención en Salud , Accesibilidad a los Servicios de Salud/organización & administración , Neoplasias/epidemiología , Neoplasias/terapia , Niño , Costo de Enfermedad , Humanos
18.
Nature ; 507(7491): 225-8, 2014 Mar 13.
Artículo en Inglés | MEDLINE | ID: mdl-24463515

RESUMEN

Ancient genomic sequences have started to reveal the origin and the demographic impact of farmers from the Neolithic period spreading into Europe. The adoption of farming, stock breeding and sedentary societies during the Neolithic may have resulted in adaptive changes in genes associated with immunity and diet. However, the limited data available from earlier hunter-gatherers preclude an understanding of the selective processes associated with this crucial transition to agriculture in recent human evolution. Here we sequence an approximately 7,000-year-old Mesolithic skeleton discovered at the La Braña-Arintero site in León, Spain, to retrieve a complete pre-agricultural European human genome. Analysis of this genome in the context of other ancient samples suggests the existence of a common ancient genomic signature across western and central Eurasia from the Upper Paleolithic to the Mesolithic. The La Braña individual carries ancestral alleles in several skin pigmentation genes, suggesting that the light skin of modern Europeans was not yet ubiquitous in Mesolithic times. Moreover, we provide evidence that a significant number of derived, putatively adaptive variants associated with pathogen resistance in modern Europeans were already present in this hunter-gatherer.


Asunto(s)
Alelos , Fósiles , Inmunidad/genética , Pigmentación/genética , Población Blanca/genética , Agricultura/historia , Evolución Biológica , Cuevas , Color del Ojo/genética , Genoma Humano/genética , Genómica , Historia Antigua , Humanos , Intolerancia a la Lactosa/genética , Masculino , Polimorfismo de Nucleótido Simple/genética , Análisis de Componente Principal , Esqueleto , Pigmentación de la Piel/genética , España/etnología
19.
Genome Res ; 26(2): 163-73, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26680994

RESUMEN

The gray wolf (Canis lupus) is a widely distributed top predator and ancestor of the domestic dog. To address questions about wolf relationships to each other and dogs, we assembled and analyzed a data set of 34 canine genomes. The divergence between New and Old World wolves is the earliest branching event and is followed by the divergence of Old World wolves and dogs, confirming that the dog was domesticated in the Old World. However, no single wolf population is more closely related to dogs, supporting the hypothesis that dogs were derived from an extinct wolf population. All extant wolves have a surprisingly recent common ancestry and experienced a dramatic population decline beginning at least ∼30 thousand years ago (kya). We suggest this crisis was related to the colonization of Eurasia by modern human hunter-gatherers, who competed with wolves for limited prey but also domesticated them, leading to a compensatory population expansion of dogs. We found extensive admixture between dogs and wolves, with up to 25% of Eurasian wolf genomes showing signs of dog ancestry. Dogs have influenced the recent history of wolves through admixture and vice versa, potentially enhancing adaptation. Simple scenarios of dog domestication are confounded by admixture, and studies that do not take admixture into account with specific demographic models are problematic.


Asunto(s)
Perros/genética , Lobos/genética , Animales , Teorema de Bayes , ADN Mitocondrial/genética , Femenino , Genoma , Hibridación Genética , Masculino , Cadenas de Markov , Modelos Genéticos , Filogenia , Polimorfismo de Nucleótido Simple , Análisis de Componente Principal , Análisis de Secuencia de ADN
20.
Proc Natl Acad Sci U S A ; 113(1): 152-7, 2016 01 05.
Artículo en Inglés | MEDLINE | ID: mdl-26699508

RESUMEN

Population bottlenecks, inbreeding, and artificial selection can all, in principle, influence levels of deleterious genetic variation. However, the relative importance of each of these effects on genome-wide patterns of deleterious variation remains controversial. Domestic and wild canids offer a powerful system to address the role of these factors in influencing deleterious variation because their history is dominated by known bottlenecks and intense artificial selection. Here, we assess genome-wide patterns of deleterious variation in 90 whole-genome sequences from breed dogs, village dogs, and gray wolves. We find that the ratio of amino acid changing heterozygosity to silent heterozygosity is higher in dogs than in wolves and, on average, dogs have 2-3% higher genetic load than gray wolves. Multiple lines of evidence indicate this pattern is driven by less efficient natural selection due to bottlenecks associated with domestication and breed formation, rather than recent inbreeding. Further, we find regions of the genome implicated in selective sweeps are enriched for amino acid changing variants and Mendelian disease genes. To our knowledge, these results provide the first quantitative estimates of the increased burden of deleterious variants directly associated with domestication and have important implications for selective breeding programs and the conservation of rare and endangered species. Specifically, they highlight the costs associated with selective breeding and question the practice favoring the breeding of individuals that best fit breed standards. Our results also suggest that maintaining a large population size, rather than just avoiding inbreeding, is a critical factor for preventing the accumulation of deleterious variants.


Asunto(s)
Animales Domésticos/genética , Conjuntos de Datos como Asunto , Enfermedades de los Perros/genética , Perros/genética , Variación Genética , Selección Artificial/genética , Animales , Especies en Peligro de Extinción , Genoma/genética , Heterocigoto , Endogamia , Densidad de Población , Selección Genética , Lobos/genética
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