RESUMO
OBJECTIVE: Type-III selective intrauterine growth restriction (sIUGR) is associated with a high and unpredictable risk of fetal death and fetal brain injury. The objective of this study was to describe the prospective risk of fetal death and the risk of adverse neonatal outcome in a cohort of twin pregnancies complicated by Type-III sIUGR and treated according to up-to-date guidelines. METHODS: We reviewed retrospectively all monochorionic diamniotic twin pregnancies complicated by Type-III sIUGR managed at nine fetal centers over a 12-year period. Higher-order multiple gestations and pregnancies with major fetal anomalies or other monochorionicity-related complications at initial presentation were excluded. Data on fetal and neonatal outcomes were collected and management strategies reviewed. Composite adverse neonatal outcome was defined as neonatal death, invasive ventilation beyond the resuscitation period, culture-proven sepsis, necrotizing enterocolitis requiring treatment, intraventricular hemorrhage Grade > I, retinopathy of prematurity Stage > II or cystic periventricular leukomalacia. The prospective risk of intrauterine death (IUD) and the risk of neonatal complications according to gestational age were evaluated. RESULTS: We collected data on 328 pregnancies (656 fetuses). After exclusion of pregnancies that underwent selective reduction (n = 18 (5.5%)), there were 51/620 (8.2%) non-iatrogenic IUDs in 35/310 (11.3%) pregnancies. Single IUD occurred in 19/328 (5.8%) pregnancies and double IUD in 16/328 (4.9%). The prospective risk of non-iatrogenic IUD per fetus declined from 8.1% (95% CI, 5.95-10.26%) at 16 weeks, to less than 2% (95% CI, 0.59-2.79%) after 28.4 weeks and to less than 1% (95% CI, -0.30 to 1.89%) beyond 32.6 weeks. In otherwise uncomplicated pregnancies with Type-III sIUGR, delivery was generally planned at 32 weeks, at which time the risk of composite adverse neonatal outcome was 29.0% (31/107 neonates). In twin pregnancies that continued to 34 weeks, there was a very low risk of IUD (0.7%) and a low risk of composite adverse neonatal outcome (11%). CONCLUSIONS: In this cohort of twin pregnancies complicated by Type-III sIUGR and treated at several tertiary fetal centers, the risk of fetal death was lower than that reported previously. Further efforts should be directed at identifying predictors of fetal death and optimal antenatal surveillance strategies to select a cohort of pregnancies that can continue safely beyond 33 weeks' gestation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Assuntos
Retardo do Crescimento Fetal/mortalidade , Resultado da Gravidez/epidemiologia , Gravidez de Gêmeos , Adulto , Feminino , Morte Fetal , Retardo do Crescimento Fetal/terapia , Idade Gestacional , Humanos , Recém-Nascido , Estudos Longitudinais , Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-Natal , Artérias Umbilicais/diagnóstico por imagemRESUMO
The role of psychosocial factors (PSF) in increased risk of stroke is a novel public health challenge, but unclear definitions for PSF and the multiple stroke subtypes have led to inconsistent reports. A review of this issue is therefore warranted. METHODS: Several databases were used for this narrative systematic review (Medline, Embase and Cochrane Library). Two independent reviewers evaluated articles from between 2001 and 2018 on the themes of PSF and stroke/transient ischemic attack (TIA). PSF criteria were job strain, psychological interpersonal and behavioral stress, and social deprivation. Ischemic and hemorrhagic stroke and TIA subtypes were also identified. RESULTS: Forty-five cohorts, five case-control studies and two meta-analyses were included. Despite mixed results, PSF were associated with an increased risk of ischemic and hemorrhagic stroke in populations of all ages, and more predominantly in women. CONCLUSION: This broad review shows that the presence of PSF is associated with an increased risk stroke and TIA. As such, PSF must figure in both public health policy and stroke prevention programs, similar to other established metabolic and environmental factors.
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Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/psicologia , Bases de Dados Factuais , Humanos , Ataque Isquêmico Transitório/epidemiologia , Ataque Isquêmico Transitório/etiologia , Ataque Isquêmico Transitório/psicologia , Psicologia , Saúde Pública/tendências , Fatores de Risco , Fatores SocioeconômicosRESUMO
Evidence from epidemiological studies has demonstrated that outdoor air pollution is now a well-known major problem of public health, mainly in low and middle income countries. Contrasting with myocardial infarction, there are few data on the association of air pollution and stroke. METHODS: We propose a narrative literature review of the effects and the underlying biological mechanisms of short- and long-term exposure to air pollutants on stroke risk and mortality, using the following key-words: stroke, cerebrovascular events, ischemic and haemorrhage stroke, transient ischaemic attack, mortality, air pollution and air pollutants. RESULTS: Twenty-one papers were selected. Air pollution, of which whose small particulate matter are the most toxic, contributes to about one-third of the global burden of stroke. We can identify vulnerable patients with classical neuro-vascular risk factors or a prior history of stroke or transient ischemic attack or persons living in low-income countries. Biological mechanisms of this new morbid association are discussed. CONCLUSION: Air pollution should be recognized as a silent killer inducing stroke whose mortality rates remain elevated by its role as a new modifiable neurovascular risk factor, needing public health policies.
Assuntos
Poluição do Ar/efeitos adversos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Poluição do Ar/estatística & dados numéricos , Comorbidade , Modificador do Efeito Epidemiológico , Humanos , Exposição por Inalação/efeitos adversos , Exposição por Inalação/estatística & dados numéricos , Ataque Isquêmico Transitório/epidemiologia , Ataque Isquêmico Transitório/etiologia , Ataque Isquêmico Transitório/mortalidade , Material Particulado/toxicidade , Fatores de Risco , Acidente Vascular Cerebral/mortalidadeRESUMO
Introduction: Despite the fact, that symptom-triggered alcohol withdrawal treatment is recommended by German guidelines on alcoholism, many hospitals continue to use fixed-schedule protocols, as they have been successfully applied for many years. Methods: This retrospective study compared all patients' records of alcohol withdrawal treatment from October 2010 to November 2011 at Magdeburg's University Department of Psychiatry (n=120). A symptom-triggered protocol with clomethiazole (AESB, n=46) was used in parallel with the existing fixed-schedule protocol with diazepam (n=74). Results: The symptom-triggered group showed less need of pharmacological treatment duration (p<0.001) and cumulative dosage of medication compared to the fixed-schedule protocol (p<0.006). No difference was observed regarding the need of clonidine or haloperidol (to treat blood pressure derailment or delirium) and the incidence of epileptic seizures. Discussion: Based on the shorter treatment duration and a similar rate of complications our department has switched to the symptom-triggered protocol to improve the quality of patient care.
Assuntos
Transtornos Induzidos por Álcool/tratamento farmacológico , Transtornos Induzidos por Álcool/prevenção & controle , Clormetiazol/uso terapêutico , Diazepam/uso terapêutico , Moduladores GABAérgicos/uso terapêutico , Adulto , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Estudos RetrospectivosRESUMO
OBJECTIVES: There is evidence that psychiatrists are rarely aware of how religion may intervene in their patient's life. That is particularly obvious concerning patients with psychosis. Yet, even for patients featuring delusions with religious content, religious activities and spiritual coping may have a favourable influence. Indeed, patients with psychosis can use religion to cope with life difficulties related to their psychotic condition, in a social perspective but also in order to gain meaning in their lives. Also, religion may be part of explanatory models about their disorder with, in some cases, a significant influence on treatment adhesion. PATIENTS AND METHODS: This paper describes a prospective randomized study about a spiritual assessment performed by the psychiatrists of patients with schizophrenia. The outpatient clinics in which the sample was collected are affiliated with the department of psychiatry at the university hospitals of Geneva. Eighty-four outpatients with psychosis were randomized into two groups: an experimental group receiving both traditional treatment and spiritual assessment with their psychiatrist and a control group of patients receiving only their usual treatment. Psychiatrists were supervised by a clinician (PH) and a psychologist of religions (PYB) for each patient in the spiritual assessment group. Data were collected from both groups before and after 3 months of clinical follow-up. RESULTS: Spiritual assessment was well-tolerated by all patients. Moreover, their wish to discuss religious matters with their psychiatrist persisted following the spiritual assessment. Even though clinicians acknowledged the usefulness of the supervision for some patients, especially when religion was of importance for clinical care, they reported being moderately interested in applying spiritual assessments in clinical settings. Compared to the control group, there were no differences observed in the 3 months' outcome in terms of primary outcome measures for satisfaction with care, yet the attendance at the appointments was significantly increased in the group with spiritual assessment. The same result was found when restricting analyses to patients for whom an intervention was suggested or patients who invested more in religion. Areas of potential intervention were frequent both in a psychiatric and psychotherapeutical perspective. CONCLUSIONS: Spiritual assessment appears to be useful for patients with psychosis. This is in accordance with the recommendations of the World Psychiatric Association which promotes considering the whole person in clinical care. Spiritual assessment is quite simple to perform, providing that clinicians do not prescribe or promote religion, and that no critical comments are made concerning religious issues. Clinicians do not need to know in depth the religious domains of each of their patients, as it appears that each patient accommodates his/her religious background his/her own way.
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Transtornos Psicóticos/psicologia , Transtornos Psicóticos/terapia , Religião , Espiritualidade , Adaptação Psicológica , Adulto , Idoso , Delusões/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Psiquiatria , Psicologia , Fatores SocioeconômicosRESUMO
In its recent guidance document on tiered risk assessment for plant protection products for aquatic organisms, the European Food Safety Authority (EFSA) proposed to use Glyceria maxima as monocotyledonous grass species for the testing of special herbicide groups. However, published toxicity data for this species is very limited and there is no test guideline for Glyceria sp. For this reason a microcosm study was conducted in order to gain experience on the degree of sensitivity of G. maxima to the herbicidal substances clodinafop-propargyl (grass herbicide) and fluroxypyr (auxin) in comparison to the already established test organism water milfoil Myriophyllum spicatum and the duckweed species Landoltia punctata. Five concentrations without replicates were tested for each test substance using 10 microcosms and three microcosms served as controls. The experiment was run for 8 weeks. Morphological endpoints were used to determine growth and EC50 values. The results show that M. spicatum was most sensitive to fluroxypyr (37 days EC50 for roots: 62 µg/L) and G. maxima most sensitive to clodinafop-propargyl (22 days EC50 for total shoot length: 48 µg/L) whereas the duckweed species was considerable less sensitive. Hence, G. maxima turns out to be a good candidate for testing grass specific herbicides, supporting its inclusion as an additional macrophyte test for the risk assessment of herbicides as proposed by the EFSA.
Assuntos
Acetatos/toxicidade , Herbicidas/toxicidade , Poaceae/efeitos dos fármacos , Propionatos/toxicidade , Piridinas/toxicidade , Poluentes do Solo/toxicidade , Poluentes Químicos da Água/toxicidade , União Europeia , Sedimentos Geológicos/química , Alemanha , Medição de Risco/legislação & jurisprudênciaRESUMO
Most clinicians avoid discussing sexuality with patients with severe mental disorders. Sexual disturbances can be related to medication, to psychological issues such as self-stigma and anhedonia, and to the social context. We studied desire and sexual practices in women suffering from schizophrenia, in comparison with healthy women. Contrary to previous research, women with schizophrenia featured dyadic and individual desire similar to women of comparable age. Yet, only half of women with psychosis had sexual practice, either alone or with a partner. They were less satisfied with their activity, both in terms of function and psychological issues such as sexual self-esteem. This finding underscores the stigmatization these women suffer from, which prevents the opportunity of a possible improvement in this important interpersonal domain.
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Libido/fisiologia , Transtornos Psicóticos , Comportamento Sexual , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/psicologia , Comportamento Sexual/psicologia , Disfunções Sexuais Psicogênicas/psicologia , Sexualidade/psicologia , Adulto JovemRESUMO
At the international workshop Aquatic Macrophyte Risk Assessment for Pesticides (AMRAP), it was noted that the EU risk assessment under the directive 91/414/EEC for herbicides, based only on algae and the monocotyledonous duckweed species Lemna sp., offers no certain protection against some growth regulating auxins. Therefore, AMRAP members proposed the introduction of the dicotyledonous water milfoil Myriophyllum as additional test species. This study was aimed to compare toxicity results from three test systems (TS) with varying complexity, namely Water TS, Sediment TS and Microcosm TS using Myriophyllum spicatum as test organism. As test substances, the photosynthesis inhibiting herbicide isoproturon, the growth regulating auxins fluroxypyr and 2,4-dichlorophenoxyacetic acid (2,4-D), and the non-specific acting toxicant 3,5-dichlorophenol (3,5-DCP) were chosen. It was assessed if and why the sensitivity of M. spicatum towards the four toxicants varied in the different test systems and if the addition of sucrose to the medium used in the Water TS had an effect on the sensitivity of Myriophyllum. All TS were suitable for detecting negative effects of toxicants with different modes of action on M. spicatum. The lowest variability of endpoints was found in the Water TS with lowest experimental complexity. For auxins, the endpoint weight did not result in robust EC50 values in all TS, whereas root related endpoints, which are also ecologically relevant, turned out to be very sensitive with low variance. Sucrose in the medium of the Water TS did not seem to influence the sensitivity of M. spicatum towards isoproturon and 3,5-DCP but may have increased the sensitivity of M. spicatum roots when exposed to 2,4-D. However, the findings of all TS resulted in similar risk estimations if root endpoints were not considered.
Assuntos
Magnoliopsida/efeitos dos fármacos , Compostos Orgânicos/toxicidade , Testes de Toxicidade/normas , Herbicidas/toxicidade , Magnoliopsida/crescimento & desenvolvimento , Praguicidas/toxicidade , Raízes de Plantas/efeitos dos fármacos , Sacarose/farmacologia , Poluentes Químicos da Água/toxicidadeRESUMO
BACKGROUND: Laryngeal mask insertion (LMI) represents a fundamental skill for anesthesiologists in routine management as well as in difficult airway situations. This study aimed to evaluate the time needed by first year anesthesiology residents to perform 40 LMIs and assessed the associated success rates and the number of attempts needed for successful LMI. METHODS: This prospective single center study evaluated the number of work days, the success rate and the attempts needed for successful LMI (LMA ProSeal™) in consecutive blocks of five LMI procedures and the related difficulties and complications. RESULTS: From 2007 to 2010 a total of 10 anesthesiology resident physicians were evaluated consecutively. These residents needed a mean of 18.3 ± 4.1 (mean ± standard deviation) working days to successfully perform 40 LMIs. The LMI success rate after the first 5 LMIs increased steadily up to the results after 40 LMIs per resident (LMI success rate within 1 attempt 72 versus 86 %, p = 0.09, LMI success rate within all LMI attempts 74 versus 96 %, p = 0.001). The mean number of attempts required until successful LMI decreased from 1.45 ± 0.82 after the first 5 LMIs to 1.16 ± 0.37 after 40 LMIs (p = 0.03). The most common difficulties associated with unsuccessful LMI by residents that led to handing over to an experienced colleague were small oral aperture (9.8 %), short thick neck, large tongue, blood/mucus in the mouth or throat (each 7.3 %) and retrognathy (4.9 %). CONCLUSIONS: The increasing LMI success rate and the decreasing rate of LMI attempts for successful airway management correlated to a learning curve and development of LMI dexterity over time.
Assuntos
Anestesiologia/educação , Competência Clínica , Máscaras Laríngeas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Manuseio das Vias Aéreas , Serviço Hospitalar de Anestesia , Criança , Pré-Escolar , Feminino , Alemanha , Humanos , Internato e Residência , Intubação Intratraqueal/métodos , Aprendizagem , Masculino , Pessoa de Meia-Idade , Pacientes , Estudos Prospectivos , Traqueia/anatomia & histologia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: In Germany about one million patients suffer from neurogenic lower urinary tract dysfunction (NLUTD). If left untreated, various forms of NLUTD can lead to secondary damage of the lower and upper urinary tract. Thus, the guideline was developed for the drug therapy of patients with NLUTD, who frequently require lifelong care and aftercare. METHODS: The guideline was developed in a consensus process with several meetings and online reviews, and final recommendations were decided on in online consensus meetings. Ballots were sent to elected officials of the contributing professional societies. Level of consensus was given for each coordinated recommendation ( https://www.awmf.org/leitlinien/detail/ll/043-053.html ). RESULTS/MOST IMPORTANT RECOMMENDATIONS: (Video)urodynamic classification of the NLUTD should be conducted before the use of antimuscarinic drugs (84.2%). Approved oral antimuscarinics should be used as first choice. Contraindications must be respected (100%). If oral treatment is ineffective or in the case of adverse drug reaction (ADRs) alternatively instillation of oxybutynin solution intravesically (83%) or onabotulinumneurotoxine (OBoNT) injection should be offered (89.5%). In case of failure or ADRs of antimuscarinics, ß3 sympathomimetic mirabegron can be used to treat neurogenic detrusor overactivity (NDO) (off-label use) (100%). In case of paraplegia below C8 or multiple sclerosis with an expanded disability status scale (EDSS) ofâ¯≤ 6.5, OBoNT injection can be offered as an alternative (89.5%). Drug therapy for NDO should be started early in newborns/young children (84.2%). Conservative, nondrug therapy should be considered in frail elderly (94.7%). No parasympathomimetic therapy should be used to treat neurogenic detrusor underactivity (94.7%). CONCLUSION: Precise knowledge of the neurological underlying disease/sequence of trauma and the exact classification of the NLUTD are required for development of individualized therapy.
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Doenças do Sistema Nervoso Autônomo , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Bexiga Urinaria Neurogênica , Bexiga Urinária Hiperativa , Sistema Urinário , Recém-Nascido , Criança , Humanos , Pré-Escolar , Idoso , Bexiga Urinaria Neurogênica/tratamento farmacológico , Antagonistas Muscarínicos/uso terapêutico , Bexiga Urinária , Bexiga Urinária Hiperativa/tratamento farmacológicoRESUMO
AIMS/HYPOTHESIS: Low serum 25-hydroxyvitamin D [25(OH)D] concentration may increase risk of insulin-requiring diabetes. METHODS: A nested case-control study was performed using serum collected during 2002-2008 from military service members. One thousand subjects subsequently developed insulin-requiring diabetes. A healthy control was individually matched to each case on blood-draw date (±2 days), age (±3 months), length of service (±30 days) and sex. The median elapsed time between serum collection and first diagnosis of diabetes was 1 year (range 1 month to 10 years). Statistical analysis used matched pairs and conditional logistic regression. RESULTS: ORs for insulin-requiring diabetes by quintile of serum 25(OH)D, from lowest to highest, were 3.5 (95% CI 2.0, 6.0), 2.5 (1.5, 4.2), 0.8 (0.4, 1.4), 1.1 (0.6, 2.8) and 1.0 (reference) (p (trend) <0.001). The quintiles (based on fifths using serum 25(OH)D concentration in the controls) of serum 25(OH)D in nmol/l, were <43 (median 28), 43-59 (median 52), 60-77 (median 70), 78-99 (median 88) and ≥100 (median 128). CONCLUSIONS/INTERPRETATION: Individuals with lower serum 25(OH)D concentrations had higher risk of insulin-requiring diabetes than those with higher concentrations. A 3.5-fold lower risk was associated with a serum 25(OH)D concentration ≥60 nmol/l.
Assuntos
Diabetes Mellitus Tipo 1/diagnóstico , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Deficiência de Vitamina D/diagnóstico , Vitamina D/análogos & derivados , Adolescente , Adulto , Estudos de Casos e Controles , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/epidemiologia , Suplementos Nutricionais , Relação Dose-Resposta a Droga , Feminino , Humanos , Incidência , Masculino , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicaçõesRESUMO
This study investigated the IGF-1-influence on oncological relevant genes in pleomorphic adenomas. Therefore A64-tumor cells were stimulated by recombinant IGF-1. After RNA-extraction, transcript levels of hBD-1, hBD-2, hBD-3, DEFA1/3, DEFA4, S100A4, Psoriasin, DOC-1, EGF, EGFR, and IGFR were analyzed by qRT-PCR at t = 0, 4, 8, 24, 48, and 72 hr. The gene-products were visualized by immunostaining. A64-tumor-cells were deficient for hBD-1 and IGF-1. IGF-1 downregulates hBD-2 and hBD-3 without influencing hBD-1-expression. IGF-1 only slightly affects DEFA1/3-, DEFA4-, S100A4-, Psoriasin-, DOC-1-, EGF-, EGFR-, and IGFR-gene-expression. IGF-1-deficiency combined with low basic hBD-2-gene-expression and hBD-3-gene-expression might counteract, whereas hBD-1-deficiency promotes malignant transformation in pleomorphic adenomas.
Assuntos
Adenoma Pleomorfo/genética , Transformação Celular Neoplásica/genética , Fator de Crescimento Insulin-Like I/deficiência , Neoplasias das Glândulas Salivares/genética , beta-Defensinas/genética , Adenoma Pleomorfo/metabolismo , Processos de Crescimento Celular/fisiologia , Linhagem Celular Tumoral , Transformação Celular Neoplásica/metabolismo , Expressão Gênica , Humanos , Imuno-Histoquímica , Fator de Crescimento Insulin-Like I/genética , Fator de Crescimento Insulin-Like I/metabolismo , Fator de Crescimento Insulin-Like I/farmacologia , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes/farmacologia , Neoplasias das Glândulas Salivares/metabolismo , beta-Defensinas/biossíntese , beta-Defensinas/metabolismoRESUMO
BACKGROUND: Securing the airway by means of endotracheal intubation (ETI) represents a fundamental skill for anaesthesiologists in emergency situations. This study aimed to evaluate the time needed by first-year anaesthesiology residents to perform 200 ETIs and assessed the associated success rates and number of attempts until successful ETI. METHODS: This prospective single centre study evaluated the number of working days, the success rate, the attempts needed until successful ETI in consecutive blocks of 25 ETI procedures and the related difficulties and complications. RESULTS: From 2007 to 2010, 21 residents were evaluated consecutively. These residents needed a mean (mean ± standard deviation) of 15.6 ± 3.0 days for 25 ETIs. Out of all residents 52% reached the target value of 200 ETIs after 50.2 ± 14.8 weeks of total working time. The ETI success rate after the first 25 ETIs increased steadily to the results after 200 ETIs (ETI success rate within one ETI attempt: 67% vs. 83%, P = 0.0001; ETI success rate within all ETI attempts: 82% vs. 92%, P = 0.0001). The number of attempts required until successful ETI decreased from 1.6 ± 0.8 after the first 25 ETIs to 1.3 ± 0.6 after 200 ETIs (P = 0.0001). CONCLUSION: The increasing rate of relative ETI success and the decreasing rate of necessary attempts for successful airway management suggest a steadily increasing gain in ETI experience. The complications that developed during the first 200 ETI procedures justify supervision by a specialist in the field or a senior physician. Moreover, these results may influence the minimum requirement for qualification in anaesthesiology and emergency medicine.
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Competência Clínica , Medicina de Emergência/educação , Intubação Intratraqueal/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesiologia/educação , Criança , Pré-Escolar , Serviços Médicos de Emergência , Feminino , Humanos , Lactente , Internato e Residência , Intubação Intratraqueal/efeitos adversos , Laringe/anatomia & histologia , Masculino , Pessoa de Meia-Idade , Garantia da Qualidade dos Cuidados de Saúde , Falha de Tratamento , Prega Vocal/anatomia & histologia , Adulto JovemRESUMO
Laboratory toxicity test designs are far from reality and therefore extrapolations to field situations may be more difficult. In laboratory experiments with the amphipod Gammarus roeseli exposed to the insecticide imidacloprid it was investigated if test conditions closer to reality influences its sensitivity and if it is possible to extrapolate results from these laboratory tests to results from a stream mesocosm study. Experiments were run by varying medium, temperature, size, and seasonal origin of gammarids. Age and seasonal aspects had strongest effects with juveniles and animals taken from a spring population being most sensitive with an EC50 (96 h) of 14.2 µg L⻹ imidacloprid. The test designs closest to the conditions in the stream mesocosms reflected best the results in mesocosms study on basis of LOEC values. However, the EC(x) extrapolation failed to predict the effects of short term imidacloprid pulses in the field.
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Imidazóis/toxicidade , Inseticidas/toxicidade , Nitrocompostos/toxicidade , Testes de Toxicidade/métodos , Poluentes Químicos da Água/toxicidade , Anfípodes , Animais , Feminino , Masculino , Neonicotinoides , Rios/químicaRESUMO
Intracerebral hemorrhage accounts for approximately 15% of the 115,000 strokes occurring each year in France. Although therapeutic strategies are more limited than for ischemic stroke, major points in the management of intracerebral hemorrhage can reduce short term morbidity and mortality by limiting the expansion of the hematoma and the occurrence of early complications, and long term patients' outcome by reducing the risk of recurrence. This article aims to update the key elements that contribute to improve of the prognosis of intracerebral hemorrhage patients.
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Hemorragia Cerebral , Acidente Vascular Cerebral , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/terapia , França , Hematoma/diagnóstico , Hematoma/etiologia , Hematoma/terapia , Humanos , PrognósticoRESUMO
Ischemic stroke accounts for 80% of overall stroke, and is one of the leading causes of death, disability and dementia in worldwide. Management of patients with acute ischemic stroke dramatically improved over time with the implementation of intensive care stroke units, the development of acute recanalization strategies, the optimization of the management of post-stroke complications, and the prevention of early stroke recurrence. The objective of this article is to provide a general overview of the current management of patients with acute ischemic stroke aiming at improving post-stroke outcome.
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AVC Isquêmico , Acidente Vascular Cerebral , Humanos , Unidades de Terapia Intensiva , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Resultado do TratamentoRESUMO
BACKGROUND/AIMS: Spirituality and religiousness have been shown to be highly prevalent in patients with psychosis. Yet the influence of religious denomination as it affects coping methods and/or as an explanatory model for illness and treatment remains to be determined. This study aims (1) to investigate if religious denomination is associated with explanatory models, (2) to assess the evolution over time of these explanatory models, and (3) to examine the relationship between these explanatory models and the spiritual vision of treatment and adhesion to such treatment. SAMPLING AND METHODS: Of an initial cohort of 115 outpatients, 80% (n = 92) participated in a 3-year follow-up study. The evolution of their religious explanatory models was assessed in order to evaluate if religious denomination, as a meaning-making coping tool, is associated with the patients' explanatory models. Finally, we examined the relationship between these representations and the patients' spiritual visions of treatment and treatment adhesion. RESULTS: A spiritual vision of the illness (as part of an explanatory model) was more frequent in patients with psychosis for whom the subjective dimension of religion was important. However, there was no association between the patients' religious denomination and their spiritual vision of the illness. The analyses showed that the various contents of spiritual visions of illness were not positive or negative per se; instead, they depended on how this religious vision was integrated into the person's experience. Examining longitudinal aspects of coping showed that the spiritual vision sometimes changed, but was not associated with clinical or social outcome. CONCLUSIONS: For patients with psychosis, explanatory models frequently involve a religious component which is independent of denomination and likely to change over time. Clinicians should address this issue on a regular basis, by asking patients about their explanatory model before trying to build a bridge with the medical model.
Assuntos
Adaptação Psicológica , Transtornos Psicóticos/psicologia , Religião e Psicologia , Psicologia do Esquizofrênico , Adulto , Distribuição de Qui-Quadrado , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Componente Principal , Qualidade de Vida/psicologia , Autoimagem , Inquéritos e QuestionáriosRESUMO
AIMS/HYPOTHESIS: The aim of the study was to determine age- and race-related, and overall incidence rates of insulin-requiring diabetes in adults in the US military. METHODS: Electronic records for admissions to US military and Tricare hospitals during 1990-2005 and visits to military clinics during 2000-2005 were identified using the Career History Archival Medical and Personnel System at the Naval Health Research Center, San Diego, CA, USA. Population data were obtained from the Defense Manpower Data Center and Defense Medical Epidemiology Database. RESULTS: In men there were 2,918 new cases of insulin-requiring diabetes in 20,427,038 person-years at ages 18-44 years (median age 28 years) for a total age-adjusted incidence rate of 17.5 per 100,000 person-years (95% CI 16.4-18.6). Incidence rates were twice as high in black men as in white men (31.5 vs 14.5 per 100,000, p < 0.001). In women there were 414 new cases in 3,285,000 person-years at ages 18-44 years (median age 27 years), for a total age-adjusted incidence rate of 13.6 per 100,000 (95% CI 12.4-14.9). Incidence rates were twice as high in black women as in white women (21.8 vs 9.7 per 100,000, p < 0.001). In a regression model, incidence of insulin-requiring diabetes peaked annually in the winter-spring season (OR 1.46, p < 0.01). Race and seasonal differences persisted in the multivariate analysis. CONCLUSIONS/INTERPRETATION: Differences in incidence rates by race and season suggest a need for further research into possible reasons, including the possibility of a contribution from vitamin D deficiency. Cohort studies using prediagnostic serum 25-hydroxyvitamin D should be conducted to further evaluate this relationship.
Assuntos
Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Militares , Adulto , Fatores Etários , População Negra , Diabetes Mellitus/etnologia , Feminino , Humanos , Masculino , Fatores Sexuais , Estados Unidos , População Branca , Adulto JovemRESUMO
Comparative analysis of predicted protein sequences encoded by the genomes of Caenorhabditis elegans and Saccharomyces cerevisiae suggests that most of the core biological functions are carried out by orthologous proteins (proteins of different species that can be traced back to a common ancestor) that occur in comparable numbers. The specialized processes of signal transduction and regulatory control that are unique to the multicellular worm appear to use novel proteins, many of which re-use conserved domains. Major expansion of the number of some of these domains seen in the worm may have contributed to the advent of multicellularity. The proteins conserved in yeast and worm are likely to have orthologs throughout eukaryotes; in contrast, the proteins unique to the worm may well define metazoans.
Assuntos
Caenorhabditis elegans/química , Proteínas Fúngicas/química , Proteínas de Helminto/química , Saccharomyces cerevisiae/química , Animais , Caenorhabditis elegans/genética , Caenorhabditis elegans/fisiologia , Evolução Molecular , Proteínas Fúngicas/genética , Proteínas Fúngicas/fisiologia , Regulação da Expressão Gênica , Genes Fúngicos , Genes de Helmintos , Proteínas de Helminto/genética , Proteínas de Helminto/fisiologia , Saccharomyces cerevisiae/genética , Saccharomyces cerevisiae/fisiologia , Homologia de Sequência de Aminoácidos , Transdução de SinaisRESUMO
BACKGROUND: Individuals with psychosis are known to have a lower self-esteem compared to the general population, in part because of social stigma, paternalistic care, long periods of institutionalization and negative family interactions. This study aimed at assessing the efficacy of a self-esteem enhancement program for individuals with severe mental illness and at analyzing the results in their European context. METHOD: A randomized cross-over study including 54 outpatients with a diagnosis of schizophrenia from Geneva, Switzerland, was conducted. Twenty-four were recruited from an outpatient facility receiving traditional psychiatric care whereas 30 came from an outpatient facility with case-management care. Psychosocial, diagnostic and symptom measures were taken for all the subjects before treatment, after treatment, and at 3-months' follow-up. RESULTS: Results indicated significant positive self-esteem module effects on self-esteem, self-assertion, active coping strategies and symptom for the participants receiving case-management care. Results were not significant for those receiving traditional care. However, 71% of all participants expressed satisfaction with the module. CONCLUSION: Individuals with schizophrenia appear to be benefit from the effects of the self-esteem module, particularly when they are involved in a rehabilitation program and followed by a case manager who liaises with the other partners of the multidisciplinary team. This encourages reconsidering the interventions' format and setting in order to ensure lasting effects on the environment and in turn on coping, self-esteem and overall empowerment.