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1.
J Wrist Surg ; 13(1): 86-95, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38264129

RESUMO

Background Wrist arthroscopy has become a commonly used tool for the management of adults with distal radius fractures (DRFs), although its implementation requires technical competence. This systematic review and meta-analysis appraised the available evidence concerning the contribution of wrist arthroscopy to the functional and radiological outcomes of patients with DRFs operated with arthroscopic assistance. Methods Randomized control trials were identified through five principal electronic databases on May 31, 2022: Web of Science, Scopus, EBSCO, Embase, and PubMed. Two authors independently performed the search and data extraction and assessed risk of bias (RoB) using the Cochrane RoB tool. Results A total of 1,780 relevant abstracts and citations were extracted in the preliminary search, which yielded 6 trials that met the eligibility criteria, and 3 studies were included in the quantitative synthesis. The overall pooled mean difference (MD) estimate showed no significant difference in the Disabilities of the Arm, Shoulder, and Hand scores between surgical groups with and without arthroscopic assistance (MD = 0.77 points, 95% confidence interval = -6.58 to 5.03, p = 0.79), with substantial heterogeneity (I 2 = 85%). Conclusion There was low-quality evidence that wrist arthroscopy conveyed not clinically or statistically significant difference to functional outcomes of patients with DRFs. However, our findings are limited by the numbers of studies included and lack of long-term follow-up, although they do provide a good starting point for future quality research.

2.
Rev. peru. med. exp. salud publica ; 40(2): 179-188, abr.-jun. 2023. tab, graf
Artigo em Espanhol | LILACS, INS-PERU | ID: biblio-1509032

RESUMO

RESUMEN Objetivos. Explorar la frecuencia e impacto de la violencia contra los trabajadores de salud de Argentina y compararlo con el resto de sus pares de Latinoamérica en el contexto de la pandemia por COVID-19. Materiales y métodos. Estudio de corte transversal a través de una encuesta electrónica al personal médico y no médico de Latinoamérica que desempeño tareas asistenciales desde marzo de 2020. Se utilizó una regresión de Poisson para estimar las Razones de Prevalencia crudas (RP) y ajustadas (RPa) con sus respectivos intervalos de confianza al 95%. Resultados. Un total de 3544 participantes de 19 países respondieron la encuesta; 1992 (56,0%) residían en Argentina. Entre los mismos, el 62,9% padeció al menos un hecho de violencia: 97,7% refirió violencia verbal y 11,8% violencia física. El 41,5% de los agredidos padecieron situaciones de violencia al menos una vez por semana. El personal de salud de Argentina vivenció más frecuentemente violencia que los de otros países (62,9% vs. 54,6%, p<0,001), siendo estos eventos más habituales y estresantes (p<0,05). Además, refirieron más frecuentemente haber considerado cambiar sus tareas asistenciales y/o deseos de abandonar su profesión (p<0,001). En la regresión de Poisson, los participantes de Argentina tuvieron una prevalencia de violencia mayor que los trabajadores de salud de la región (14,6%; p<0,001). Conclusiones. Existió una elevada prevalencia de violencia contra el personal de salud de Argentina durante la pandemia por COVID-19. Estos hechos tuvieron un alto impacto negativo entre quienes los padecieron. Nuestros datos sugieren que, esto podría haber sido más frecuente en Argentina respecto de otras regiones del continente.


ABSTRACT Objectives. To explore the frequency and impact of violence against healthcare workers in Argentina and to compare it with the rest of their Latin American peers during the COVID-19 pandemic. Materials and methods. A cross-sectional study was conducted by applying an electronic survey on Latin American medical and non-medical personnel who carried out health care tasks since March 2020. We used Poisson regression to estimate crude (PR) and adjusted (aPR) Prevalence Ratios with their respective 95% confidence intervals. Results. A total of 3544 participants from 19 countries answered the survey; 1992 (56.0%) resided in Argentina. Of these, 62.9% experienced at least one act of violence; 97.7% reported verbal violence and 11.8% physical violence. Of those who were assaulted, 41.5% experienced violence at least once a week. Health personnel from Argentina experienced violence more frequently than those from other countries (62.9% vs. 54.6%, p<0.001), and these events were more frequent and stressful (p<0.05). In addition, Argentinean health personnel reported having considered changing their healthcare tasks and/or desired to leave their profession more frequently (p<0.001). In the Poisson regression, we found that participants from Argentina had a higher prevalence of violence than health workers from the region (14.6%; p<0.001). Conclusions. There was a high prevalence of violence against health personnel in Argentina during the COVID-19 pandemic. These events had a strong negative impact on those who suffered them. Our data suggest that violence against health personnel may have been more frequent in Argentina than in other regions of the continent.


Assuntos
Humanos , Masculino , Feminino , COVID-19 , Pandemias
3.
MHSalud ; 19(2)dic. 2022.
Artigo em Espanhol | LILACS, SaludCR | ID: biblio-1405527

RESUMO

Resumen El estudio tiene como propósito analizar la fiabilidad de la prueba de 8 lanzamientos de 3 diferentes variantes de lanzamientos de balonmano en estudiantado universitario. 33 varones, 20 ±1,9 años; peso 72,39±8,9 kg; altura 176,75 ±6,07 cm; IMC 23,14±2,3. Los sujetos participantes fueron evaluados en 2 sesiones separadas entre sí por un lapso de una semana. Ejecutaron lanzamientos hasta quedar registrados 8 mediciones en cada una de las pruebas, lanzamientos inespecíficos, en apoyo y en carrera con 3 pasos, se registró la velocidad de lanzamiento con un radar posterior a la portería. La fiabilidad del promedio de las puntuaciones del test de 8 medidas entre la primera sesión y la segunda con una prueba test-retest, se obtuvieron los siguientes resultados: en el lanzamiento inespecífico se obtuvo un ICC= (0,86) entre el 95% de confianza, un de CV= (7,43%) y un ES= (0,08). Para el lanzamiento con apoyo se obtuvo un ICC= (0,94) al 95 % de confianza, un de CV= (4,71 %) y un ES= (-0,09). Para el lanzamiento con carrera se obtuvo un ICC= (0,96) al 95 % de confianza, un de CV= (4,00 %) y un ES= (0,05). Este estudio ha demostrado que la prueba de 8 lanzamientos y las 3 variantes es una medida de rendimiento confiable y estable para estudiantes de nivel universitario sin experiencia en el balonmano, en relación con las variables del lanzamiento, las 3 fueron fiables, solo la variable inespecífica fue menor en comparación al lanzamiento con apoyo y con carrera.


Abstract This study aims to analyze the reliability of the test of 8 throws of 3 different variants of handball throws in university students. The participants were 33 males, 20 ± 1.9 years; weight 72.39 ± 8.9 kg; height 176.75 ± 6.07 cm; BMI 23.14 ± 2.3. They were evaluated in 2 sessions separated from each other by a period of one week. The participants executed throws until 8 measurements were recorded in each of the tests, unspecific throws, in support and in the race with 3 steps; the launch speed was recorded with a radar behind the goal. The reliability of the average of the test scores of 8 measurements between the first session and the second was measured with a test-retest test. The following results were obtained: in the nonspecific launch, an ICC= (0.86) was obtained between 95% of confidence, one of CV= (7.43%) and one ES = (0.08). For the toss with support, an ICC = (0.94) was obtained at 95% confidence, one of CV = (4.71%) and an ES = (-0.09). For the running throw, an ICC = (0.96) was obtained at 95% confidence, one of CV = (4.00%) and one ES = (0.05). This study has shown that the test of 8 throws and the 3 variants is a reliable and stable performance measure for university-level students without experience in handball; in relation to the throw variables, all 3 were reliable. Only the nonspecific variable was lower compared to the supported and running pitch.


Resumo O estudo tem como objetivo analisar a confiabilidade do teste de 8 arremessos de 3 variantes diferentes de arremessos de handebol em estudantes universitários. 33 homens, 20 ±1,9 anos; peso 72,39±8,9 kg; altura 176,75 ±6,07 cm; IMC 23,14±2,3. Os participantes foram testados em 2 sessões separadas por um lapso de 1 semana. Os participantes executaram arremessos até poder registrar 8 medições em cada um dos testes, arremessos não específicos, com apoio e correndo com 3 passos. A velocidade de arremesso foi registrada com um radar pós-gol. A confiabilidade da média dos resultados dos testes de 8 medições entre a primeira sessão e a segunda com um teste de retorno, deu os seguintes resultados: no teste de lançamento não específico, foi obtido um ICC= (0,86) com 95% de confiança, um CV= (7,43%) e um ES= (0,08). Para o lançamento apoiado obtivemos um ICC= (0,94) a 95% de confiança, um CV= (4,71%) e um ES= (-0,09). Para o arremesso de corrida obtivemos um ICC= (0,96) a 95% de confiança, um CV= (4,00%) e um ES= (0,05). Este estudo mostrou que o teste de 8 lances e as 3 variantes é uma medida de desempenho confiável e estável para estudantes universitários sem experiência em handebol. Em relação às variáveis de arremesso, todas as 3 foram confiáveis, apenas a variável não específica foi menor em comparação com o arremesso com suporte e com corrida.


Assuntos
Humanos , Masculino , Adulto , Esportes , Atletismo , Estabilidade Central
4.
Medicina (B.Aires) ; 82(supl.4): 1-56, nov. 2022. graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1405761

RESUMO

Resumen El accidente cerebrovascular (ACV) constituye la principal causa de discapacidad de origen neuro- lógico en los adultos mayores a 40 años y la cuarta causa de muerte en Argentina. En los últimos diez años las publicaciones indexadas relacionadas al tratamiento del ACV isquémico fueron más numerosas que las de ACV hemorrágico. El objetivo de este material es proporcionar recomendaciones locales y actualiza- das del abordaje de pacientes con hematoma intraparenquimatoso espontáneo durante la internación. Para la redacción de este manuscrito se convocó a especialistas en esta enfermedad que conformaron grupos de trabajo. Se plantearon 10 tópicos centrales expresados como epidemiologia, atención inicial, imágenes, tratamiento de la presión arterial, reversión de antitrombóticos, indicación de cirugía, profilaxis anticonvulsivante, pronóstico, prevención de complicaciones y reinicio de antitrombóticos. De cada tópico se plantearon mediante preguntas PICO los interrogantes más frecuentes de la práctica diaria. Luego de una revisión sistemática de la literatura, se generaron recomendaciones evaluadas mediante sistema GRADE y consensuadas entre autores y pacientes.


Abstract Stroke is the leading cause of neurological disability in people over 40 years of age and the fourth leading cause of death in Argentina. In the last ten years, the indexed publications related to the treatment of ischemic stroke were more numerous than those of hemorrhagic stroke. The objective of this material is to provide local and updated recommendations for the management of patients with spontaneous intracere- bral hemorrhage during hospitalization. For the writing of this manuscript, diferent specialists were convened to form working groups. Ten central topics expressed as epidemiology, initial care, imaging, blood pressure treatment, reversal of antithrombotics, indication for surgery, seizure prophylaxis, prognosis, prevention of complications and resumption of antithrombotics were raised. For each topic, the most frequent questions of daily practice were raised through PICO questions. After a systematic review of the literature, recommendations were generated, evaluated using the GRADE system and agreed between authors and patients.

5.
Medicina (B Aires) ; 82 Suppl 4: 1-56, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-36269297

RESUMO

Stroke is the leading cause of neurological disability in people over 40 years of age and the fourth leading cause of death in Argentina. In the last ten years, the indexed publications related to the treatment of ischemic stroke were more numerous than those of hemorrhagic stroke. The objective of this material is to provide local and updated recommendations for the management of patients with spontaneous intracerebral hemorrhage during hospitalization. For the writing of this manuscript, diferent specialists were convened to form working groups. Ten central topics expressed as epidemiology, initial care, imaging, blood pressure treatment, reversal of antithrombotics, indication for surgery, seizure prophylaxis, prognosis, prevention of complications and resumption of antithrombotics were raised. For each topic, the most frequent questions of daily practice were raised through PICO questions. After a systematic review of the literature, recommendations were generated, evaluated using the GRADE system and agreed between authors and patients.


El accidente cerebrovascular (ACV) constituye la principal causa de discapacidad de origen neurológico en los adultos mayores a 40 años y la cuarta causa de muerte en Argentina. En los últimos diez años las publicaciones indexadas relacionadas al tratamiento del ACV isquémico fueron más numerosas que las de ACV hemorrágico. El objetivo de este material es proporcionar recomendaciones locales y actualizadas del abordaje de pacientes con hematoma intraparenquimatoso espontáneo durante la internación. Para la redacción de este manuscrito se convocó a especialistas en esta enfermedad que conformaron grupos de trabajo. Se plantearon 10 tópicos centrales expresados como epidemiologia, atención inicial, imágenes, tratamiento de la presión arterial, reversión de antitrombóticos, indicación de cirugía, profilaxis anticonvulsivante, pronóstico, prevención de complicaciones y reinicio de antitrombóticos. De cada tópico se plantearon mediante preguntas PICO los interrogantes más frecuentes de la práctica diaria. Luego de una revisión sistemática de la literatura, se generaron recomendaciones evaluadas mediante sistema GRADE y consensuadas entre autores y pacientes.


Assuntos
Fibrinolíticos , Acidente Vascular Cerebral , Humanos , Adulto , Pessoa de Meia-Idade , Fibrinolíticos/uso terapêutico , Hemorragia Cerebral/terapia , Acidente Vascular Cerebral/etiologia , Pressão Sanguínea/fisiologia , Hospitalização
6.
J Nanobiotechnology ; 20(1): 352, 2022 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-35907835

RESUMO

BACKGROUND: Coronaviruses usually cause mild respiratory disease in humans but as seen recently, some human coronaviruses can cause more severe diseases, such as the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the global spread of which has resulted in the ongoing coronavirus pandemic. RESULTS: In this study we analyzed the potential of using iron oxide nanoparticles (IONPs) coated with biocompatible molecules like dimercaptosuccinic acid (DMSA), 3-aminopropyl triethoxysilane (APS) or carboxydextran (FeraSpin™ R), as well as iron oxyhydroxide nanoparticles (IOHNPs) coated with sucrose (Venofer®), or iron salts (ferric ammonium citrate -FAC), to treat and/or prevent SARS-CoV-2 infection. At non-cytotoxic doses, IONPs and IOHNPs impaired virus replication and transcription, and the production of infectious viruses in vitro, either when the cells were treated prior to or after infection, although with different efficiencies. Moreover, our data suggest that SARS-CoV-2 infection affects the expression of genes involved in cellular iron metabolism. Furthermore, the treatment of cells with IONPs and IOHNPs affects oxidative stress and iron metabolism to different extents, likely influencing virus replication and production. Interestingly, some of the nanoparticles used in this work have already been approved for their use in humans as anti-anemic treatments, such as the IOHNP Venofer®, and as contrast agents for magnetic resonance imaging in small animals like mice, such as the FeraSpin™ R IONP. CONCLUSIONS: Therefore, our results suggest that IONPs and IOHNPs may be repurposed to be used as prophylactic or therapeutic treatments in order to combat SARS-CoV-2 infection.


Assuntos
Tratamento Farmacológico da COVID-19 , Nanopartículas , Animais , Células Cultivadas , Compostos Férricos , Óxido de Ferro Sacarado , Humanos , Ferro , Camundongos , SARS-CoV-2
7.
Artigo em Inglês | MEDLINE | ID: mdl-35162826

RESUMO

BACKGROUND: The purpose of this systematic review was to determine the effect of antioxidant consumption on markers of oxidative stress and muscle damage after performing a muscle strength exercise. METHODS: The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statements were followed. Four databases were used: Scopus, PubMed, WOS and SportDiscus. Methodological quality was assessed using the PEDro scale. RESULTS: A total of 1709 articles were retrieved and following duplicate removal and application of exclusion criteria seven articles were reviewed. Supplementation with pomegranate juice alleviates oxidative stress, taurine reduces muscle damage, melatonin protects the skeletal muscles, blueberries decrease oxidation and oats mitigate muscle damage. CONCLUSIONS: Acute administration of antioxidants immediately before or during an exercise session can have beneficial effects, such as delay of fatigue and a reduction in the recovery period. Administration of antioxidant susbtances may reduce muscle damage and oxidative stress markers.


Assuntos
Antioxidantes , Suplementos Nutricionais , Antioxidantes/metabolismo , Exercício Físico/fisiologia , Força Muscular , Músculo Esquelético/fisiologia , Estresse Oxidativo
8.
Int J Mol Sci ; 22(7)2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33810326

RESUMO

Musashi-1 (MSI1) is an RNA-binding protein that regulates progenitor cells in adult and developing organisms to maintain self-renewal capacities. The role of musashi-1 in the bone healing environment and its relation with other osteogenic factors is unknown. In the current study, we analyze the expression of MSI1 in an experimental model of rat femoral bone fractures. We also analyze the relation between MSI1 expression and the expression of two osteogenic markers: periostin (POSTN) and runt-related transcription factor 2 (RUNX2). We use histological, immunohistochemical, and qPCR techniques to evaluate bone healing and the expression of MSI1, POSTN, and RUNX2 over time (4, 7, and 14 days). We compare our findings with non-fractured controls. We find that in bone calluses, the number of cells expressing MSI1 and RUNX2 increase over time and the intensity of POSTN expression decreases over time. Within bone calluses, we find the presence of MSI1 expression in mesenchymal stromal cells, osteoblasts, and osteocytes but not in hypertrophic chondrocytes. After 14 days, the expression of MSI1, POSTN, and RUNX2 was significantly correlated. Thus, we conclude that musashi-1 potentially serves in the osteogenic differentiation of mesenchymal stromal cells and bone healing. Therefore, further studies are needed to determine the possibility of musashi-1's role as a clinical biomarker of bone healing and therapeutic agent for bone regeneration.


Assuntos
Consolidação da Fratura , Proteínas do Tecido Nervoso/metabolismo , Osteogênese , Proteínas de Ligação a RNA/metabolismo , Animais , Calo Ósseo/citologia , Calo Ósseo/metabolismo , Calo Ósseo/fisiologia , Moléculas de Adesão Celular/genética , Moléculas de Adesão Celular/metabolismo , Condrócitos/metabolismo , Subunidade alfa 1 de Fator de Ligação ao Core/genética , Subunidade alfa 1 de Fator de Ligação ao Core/metabolismo , Masculino , Células-Tronco Mesenquimais/metabolismo , Proteínas do Tecido Nervoso/genética , Osteoblastos/metabolismo , Osteócitos/metabolismo , Proteínas de Ligação a RNA/genética , Ratos , Ratos Wistar
9.
Rev. bras. med. esporte ; 27(1): 60-64, Jan.-Mar. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1156109

RESUMO

ABSTRACT Introduction The squat is an exercise that is widely used for the development of strength in sports. However, considering that not all sports gestures are vertical, it is important to investigate the effectiveness of propulsive force stimuli applied in different planes. Objective The main purpose of this study was to determine the influence of maximum isometric force (MIF) exerted on starting blocks over performance in 5, 10 and 20-meter sprints. Methods Seven high-level male sprinters (mean age ± SD = 28 ± 5.77 years) participated in this study. The variables were: a) MIF in squats and on starting blocks (measured using a functional electromechanical dynamometer [FEMD]), b) time in 5, 10 and 20-m sprints and c) jump height (measured by the squat jump test). For data analysis, a Pearson correlation was performed between the different variables. The criteria for interpreting the strength of the r coefficients were as follows: trivial (<0.1), small (0.1−0.3), moderate (0.3−0.5), high (0.5−0.7), very high (0.7−0.9), or practically perfect (>0.9). The level of significance was p < 0.05. Results There was very high correlation between MIF exerted on starting blocks and performance in the first meters of the sprint (5-m: r = -0.84, p = 0.01). However, there was small correlation between MIF in squats and performance in the first meters of the sprint (5-m: r = -0.22, p < 0.62). Conclusion The MIF applied on starting blocks correlates very high with time in the first meters of the sprint in high-level athletes. In addition, the use of the FEMD provides a wide range of possibilities for evaluation and development of strength with a controlled natural movement. Level of evidence IV; Prognostic Studies - Case series.


RESUMO Introdução O agachamento é um exercício amplamente utilizado para o desenvolvimento de força nos esportes. No entanto, considerando que nem todos os gestos esportivos são verticais, é importante investigar a eficácia dos estímulos de força propulsiva em diferentes planos. Objetivo O principal objetivo deste estudo foi determinar a influência da força isométrica máxima (FIM) exercida em os blocos de largada sobre o desempenho em sprints de 5, 10 e 20 metros. Métodos Sete velocistas de alto nível do sexo masculino (média ± DP = 28,0 ± 5,77 anos) fizeram parte deste estudo. As variáveis foram: a) FIM no agachamento e nos blocos de largada (avaliados com um dinamômetro eletromecânico funcional (DEF)), b) tempo de sprints de 5, 10 e 20 metros e c) altura do salto (medida pelo teste de squat jump). Para análise dos dados, foi usada a correlação de Pearson entre as diferentes variáveis. Os critérios para interpretar o coeficiente r foi: nulo (< 0,1), pequeno (0,1 a 0,3), moderado (0,3 a 0,5), alto (0,5 a 0,7), muito alto (0,7 a 0,9) ou praticamente perfeito (> 0,9). O nível de significância foi p < 0,05. Resultados Houve correlação muito alta entre a FIM exercida nos blocos de largada e o desempenho nos primeiros metros do sprint (5-m: r = -0,84, p = 0,01). No entanto, a correlação entre o agachamento da FIM e os primeiros metros de sprint foi pequena (5-m: r = -0,22, p < 0,62). Conclusão A FIM aplicada aos blocos de largada teve uma correlação muito alto com o tempo nos primeiros metros de sprint em atletas de alto nível. Além disso, o uso de um DEF oferece uma ampla gama de possibilidades para avaliar e desenvolver força com um movimento natural controlado. Nível de evidência IV; Estudos Prognósticos - Série de casos.


RESUMEN Introducción La sentadilla es un ejercicio ampliamente usado para el desarrollo de fuerza en los deportes. Sin embargo, considerando que no todos los gestos deportivos son verticales, es importante investigar la eficacia de los estímulos de fuerza propulsiva en diferentes planos. Objetivo El principal objetivo de este estudio fue determinar la influencia de la fuerza isométrica máxima (FIM) ejercida en los bloques de salida sobre el rendimiento en sprints de 5, 10 y 20 metros. Métodos Siete velocistas de alto nivel del sexo masculino (promedio ± SD = 28,0 ± 5,7 años) formaron parte de este estudio. Las variables fueron: a) FIM en la sentadilla y en los bloques de salida (evaluados con un dinamómetro electromecánico funcional [DEF]) b) tiempo de sprints de 5, 10 y 20-metros y c) altura del salto (medida a través del test de squat jump). Para el análisis de los datos se usó la correlación de Pearson entre las diferentes variables. Los criterios para interpretar el coeficiente r fueron: nulo (<0,1), pequeño (0,1 a 0,3), moderado (0,3 a 0,5), alto (0,5 a 0,7), muy alto (0,7 a 0,9) o prácticamente perfecto (>0,9). El nivel de significancia fue p < 0,05. Resultados Hubo correlación muy alta entre la FIM ejercida en los bloques de salida y el rendimiento en los primeros metros del sprint (5-m: r = -0,84, p = 0,01). Sin embargo, la correlación entre la FIM en sentadilla y los primeros metros de sprint fue pequeña (5-m: r = -0,22, p < 0,62). Conclusión La FIM aplicada a los bloques de salida tuvo una correlación muy alta con el tiempo en los primeros metros de sprint en atletas de alto nivel. Además, el uso de un DEF ofrece una amplia gama de posibilidades para evaluar y desarrollar fuerza con un movimiento natural controlado. Nivel de evidencia IV; Estudios pronósticos: Serie de casos.


Assuntos
Humanos , Masculino , Adulto , Adulto Jovem , Atletismo , Músculo Esquelético/fisiologia , Força Muscular/fisiologia , Desempenho Atlético/fisiologia
10.
Rev. argent. salud publica ; 12(Suplemento Covid-19): 1-8, 23 de Julio 2020.
Artigo em Espanhol | LILACS, ARGMSAL, BINACIS, BRISA/RedTESA | ID: biblio-1140653

RESUMO

INTRODUCCIÓN: la publicación reciente de los resultados preliminares de un ensayo aleatorizado multicéntrico, que informan sobre la efectividad del tratamiento con dexametasona en pacientes con infección grave por SARS-CoV-2, plantea la necesidad de hacer una revisión de la literatura e identificar y valorar de manera crítica la evidencia sobre la efectividad y seguridad de esta intervención. METODOS: se realizó una búsqueda amplia, no sistemática. Se utilizó la metodología GRADE para la evaluación de la certeza en la evidencia incluida. Se conformó un equipo multidisciplinario para elaborar un informe de evaluación de tecnología sanitaria. RESULTADOS: el uso de glucocorticoides (dexametasona en dosis de 6 mg/día por 10 días) en pacientes con neumonía por SARS-CoV-2 mostró reducir la mortalidad global a los 28 días (riesgo relativo [RR]: 0,83; intervalo de confianza del 95% [IC95%]: 0,75-0,93), con un número necesario a tratar (NNT) de 33 (confianza alta). En pacientes con neumonía grave con requerimientos de asistencia ventilatoria mecánica (AVM) se observó una disminución de la mortalidad (RR: 0,64; IC95%: 0,51-0,81; NNT: 8,5) (confianza moderada). En pacientes con neumonía grave con requerimientos de oxígeno sin AVM también se informa una reducción de la mortalidad (RR: 0,82; IC95%: 0,72-0,94) (confianza moderada). En pacientes con neumonía sin requerimientos de oxígeno (RR: 1,19; IC95%: 0,91-1,55) no se evidenció beneficio con el uso de esta intervención (confianza baja). No se describieron efectos adversos en los pacientes críticos con el uso de corticoides en las dosis utilizadas. DISCUSIÓN: se recomienda la administración de dexametasona en dosis de 6 mg/día (dosis bajas) durante 10 días en los pacientes con neumonía grave por SARS-CoV-2 y requerimientos de oxigenoterapia o AVM.


INTRODUCTION: The recent publication of the preliminary results of a multicenter randomized trial reporting the effectiveness of dexamethasone treatment in patients with severe SARS-CoV-2 infection; raises the need to conduct a literature review, identify and critically assess the evidence on the effectiveness and safety of this intervention. METHODS: a broad, non-systematic search was carried out. The GRADE methodology was used to assess the certainty of the included evidence. A multidisciplinary team was formed to carry out a Health Technology Assessment report. RESULTS: the use of glucocorticoids (dexamethasone 6 mg / day for 10 days) in patients with COVID-19 pneumonia will reduce global mortality at 28 days, (RR 0.83, 95% CI 0.75 to 0.93), with a number necessary to treat (NNT) of 33, (High confidence). In patients with severe pneumonia requiring mechanical ventilation (MV), a decrease in mortality was reported (RR, 0.64; 95% CI, 0.51 to 0.81, NNT 8.5) (Moderate confidence). In patients with severe pneumonia with oxygen requirements without MV, it reports a reduction in mortality (RR, 0.82; 95% CI, 0.72 to 0.94), (Moderate confidence). The adverse effects of corticosteroids in critically ill patients have not been described with these doses used. DISCUSSION: the administration of dexamethasone 6 mg / day (low doses) for 10 days is recommended in patients with SARS-CoV-2 associated severe pneumonia and oxygen or mechanical ventilation requirements.


Assuntos
Humanos , Avaliação da Tecnologia Biomédica , Dexametasona , Infecções por Coronavirus , Argentina
11.
Rev. Hosp. El Cruce ; (24): 19-34, 18/07/2019.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1006630

RESUMO

OBJETIVO: Se describe la segunda parte de la revisión que comprende el pronóstico y el tratamiento actualizado de la embolia pulmonar en el servicio de emergencias. Se trata de describir, desarrollar el pronóstico y el tratamiento actual de la embolia de pulmón. MÉTODO: Revisión de evidencias científicas. CONCLUSIÓN: El enfoque diagnóstico de la embolia de pulmón en el Servicio de Emergencias representa un verdadero desafío, donde debemos tener un alto grado de sospecha dada la inespecificidad de los síntomas y que puede estar enmascarada por otras patologías.


OBJECTIVE: The second part of the review that includes the prognosis and the updated treatment of pulmonary embolism in the emergency service is described. It is about describing, developing the prognosis and the current treatment of lung embolism. METHODS: Review of scientific evidence. CONCLUSION: The diagnostic approach of pulmonary embolism in the Emergency Department represents a real challenge, where we must have a high degree of suspicion given the non-specificity of the symptoms and that may be masked by other pathologies.


Assuntos
Embolia Pulmonar , Epidemiologia , Técnicas de Apoio para a Decisão , Cuidados Críticos
12.
Int J Mol Sci ; 20(9)2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31052494

RESUMO

BACKGROUND: Musashi-1 (MSI1) is a negative regulator of mesenchymal stromal cell (MSC) differentiation which in turn favors cell proliferation. However, little is known about its expression by MSC from the oral cavity and in the context of osteogenic differentiation. AIM: The aim of this study was to analyze the expression of MSI1 in the context of osteogenic differentiation of MSC derived from the oral cavity. MATERIAL/METHODS: For this in vitro study, MSC were isolated from six different origins of the oral cavity. They were extensively characterized in terms of proliferative and clonogenicity potential, expression of stemness genes (MYC, NANOG, POU5F1, and SOX2), expression of surface markers (CD73, CD90, CD105, CD14, CD31, CD34, and CD45) and adipo-, chondro- and osteogenic differentiation potential. Then, osteogenic differentiation was induced and the expression of MSI1 mRNA and other relevant markers of osteogenic differentiation, including RUNX2 and Periostin, were also evaluated. RESULTS: Cell populations from the alveolar bone (pristine or previously grafted with xenograft), dental follicle, dental germ, dental pulp, and periodontal ligament were obtained. The analysis of proliferative and clonogenicity potential, expression of the stemness genes, expression of surface markers, and differentiation potential showed similar characteristics to those of previously published MSC from the umbilical cord. Under osteogenic differentiation conditions, all MSC populations formed calcium deposits and expressed higher SPARC. Over time, the expression of MSI1 followed different patterns for the different MSC populations. It was not significantly different than the expression of RUNX2. In contrast, the expression of MSI1 and POSTN and RUNX2 were statistically different in most MSC populations. CONCLUSION: In the current study, a similar expression pattern of MSI1 and RUNX2 during in vitro osteogenic differentiation was identified.


Assuntos
Diferenciação Celular , Células-Tronco Mesenquimais/citologia , Boca/citologia , Proteínas do Tecido Nervoso/genética , Osteogênese , Proteínas de Ligação a RNA/genética , Células Cultivadas , Subunidade alfa 1 de Fator de Ligação ao Core/genética , Regulação da Expressão Gênica , Humanos , Células-Tronco Mesenquimais/metabolismo , Boca/metabolismo , RNA Mensageiro/genética
13.
Rev. Hosp. El Cruce ; (22): 14-27, 20180613. tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-914936

RESUMO

En la presente entrega se describe la primera parte de la revisión sobre embolia pulmonar en el servicio de emergencias del Hospital El Cruce. Es una patología que representa un verdadero desafío en los Servicios de Emergencias (SE), desde su enfoque de diagnóstico complejo, dada la inespecificidad de los síntomas, ya que puede estar enmascarada por otras patologías, como también ser una causa de mortalidad en la fase aguda y puede conducir a una enfermedad cardiopulmonar crónica e incapacitante.


This is a description of the first part of the review on pulmonary embolism in the emergency service atEl CruceHospital. This pathology poses a true challenge to Emergency Services (ES) for its complex diagnosis, given their non-specific symptoms, since it can be masked by other pathologies, and can also cause death in its acute phase and lead to a disabling chronic cardiopulmonary disease.


Assuntos
Cuidados Críticos , Técnicas de Apoio para a Decisão , Epidemiologia , Embolia Pulmonar
14.
Int J Radiat Oncol Biol Phys ; 76(4): 1085-91, 2010 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-19577864

RESUMO

PURPOSE: To evaluate the efficacy and safety profile of vinorelbine and estramustine in combination with three-dimensional conformational radiotherapy (3D-CRT) in patients with localized high-risk prostate cancer. METHODS AND MATERIALS: Fifty patients received estramustine, 600 mg/m(2) daily, and vinorelbine, 25 mg/m(2), on days 1 and 8 of a 21-day cycle for three cycles in combination with 8 weeks of 3D-CRT (total dose of 70.2 gray [Gy] at 1.8-Gy fractions or 70 Gy at 2.0-Gy fractions). Additionally, patients received luteinizing hormone-releasing hormone analogs for 3 years. RESULTS: All patients were evaluated for response and toxicity. Progression-free survival at 5 years was 72% (95% confidence interval [CI]: 52-86). All patients who relapsed had only biochemical relapse. The most frequent severe toxicities were cystitis (16% of patients), leucopenia (10% of patients), diarrhea (10% of patients), neutropenia (8% of patients), and proctitis (8% of patients). Six patients (12%) did not complete study treatment due to the patient's decision (n = 1) and to adverse events such as hepatotoxicity, proctitis, paralytic ileus, and acute myocardial infarction. CONCLUSIONS: Vinorelbine and estramustine in combination with 3D-CRT is a safe and effective regimen for patients with localized high-risk prostate cancer. A randomized trial is needed to determine whether the results of this regimen are an improvement over the results obtained with radiotherapy and androgen ablation.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Radioterapia Conformacional , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Terapia Combinada/métodos , Cistite/etiologia , Diarreia/etiologia , Esquema de Medicação , Estramustina/administração & dosagem , Estramustina/efeitos adversos , Humanos , Leucopenia/etiologia , Masculino , Pessoa de Meia-Idade , Neutropenia/etiologia , Proctite/etiologia , Estudos Prospectivos , Neoplasias da Próstata/patologia , Radioterapia Conformacional/efeitos adversos , Indução de Remissão , Espanha , Vimblastina/administração & dosagem , Vimblastina/efeitos adversos , Vimblastina/análogos & derivados , Vinorelbina
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