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1.
Pain Manag Nurs ; 25(1): 46-55, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37495473

RESUMO

BACKGROUND: The term "nature-based sensory stimuli" refers to the sensory information produced by biotic and abiotic agents from natural environments. The literature has reported the beneficial effects of these agents on various pain dimensions in non-clinical populations. AIMS: To evaluate the potential analgesic effects of nature-based multisensory stimulation in women with fibromyalgia syndrome. METHODS: A randomized, double-blind, placebo-controlled, parallel-group trial with a 1:1 allocation ratio was conducted. Forty-two women with fibromyalgia syndrome interacted with either different plant species with flowers, stones, and soil organic matter or their synthetic imitations for 30 minutes. Outcome measurements were performed before and after the intervention, including clinical pain intensity using the Numeric Rating Scale, cold pain thresholds using the Cold Pressor Test, mechanical hyperalgesia and wind-up using a monofilament, and pressure pain thresholds using a pressure algometer. RESULTS: Analyses revealed group × time interactions for clinical pain intensity (F = 7.915, p = .008), cold-water immersion time (F = 7.271, p = .010), mechanical hyperalgesia (F = 4.701, p = .036), and pressure pain threshold (p ≤ .017). Between-group differences were found in clinical pain intensity (p = .012), cold pain thresholds (p = .002), and pressure pain thresholds (p < .05). The experimental group exhibited reduced clinical pain intensity (p = .001) and increased pressure pain thresholds (p ≤ .034). CONCLUSIONS: Women with fibromyalgia syndrome may benefit from multisensory stimulation using biotic and abiotic agents from natural environments for 30 minutes. Interacting with flowering plants and soil components appears to induce analgesic effects.


Assuntos
Fibromialgia , Feminino , Humanos , Analgésicos/farmacologia , Método Duplo-Cego , Fibromialgia/complicações , Fibromialgia/terapia , Hiperalgesia , Dor/tratamento farmacológico , Limiar da Dor/fisiologia , Solo
2.
Nutrients ; 16(1)2023 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-38201870

RESUMO

(Background) Esophagectomy (EPG) presents high morbidity and mortality. Omega-3 fatty acids (ω-3FA) are a pharmaconutrient with benefits for postoperative morbidity. Studies of ω-3FA administered parenterally after esophagectomy are scarce. This study proposes to investigate the effect of combining fish oil lipid emulsions (LE) administered parenterally with enteral nutrition support. (Methods) Randomization was 1:1:1 in three groups: Group A received a LE mixture of 0.4 g/kg/day of fish oil and 0.4 g/kg/day of LCT/MCT 50:50, Group B received 0.8 g/kg/day of fish oil LE, and Group C received 0.8 g/kg/day of LCT/MCT 50:50. Variables were measured at recruitment time and day +1, +3, and +5. Inflammatory variables studied were Interlukin-6, C-reactive protein (CRP), tumoral necrosis factor-α (TNF-α), IL-10, IL-8 and CD25s. Safety, nutritional parameters and complications were analyzed. (Results) Administration of ω-3LE in the immediate postoperative period did not modulate the earlier inflammatory response. Statistically significant differences were found in IL-6 and CRP overall temporal evolution but were not found when studying the type of LE administered or in patients needing critical care. Administration of ω-3 resulted in safe and improved hypertriglyceridemia, depending on the dose. (Conclusions) ω-3FA has no impact on the early inflammatory postoperative response assessed for a short period but was safe. More studies for longer periods are needed.


Assuntos
Ácidos Graxos Ômega-3 , Óleos de Peixe , Humanos , Emulsões , Esofagectomia/efeitos adversos , Proteína C-Reativa , Suplementos Nutricionais
3.
J Med Syst ; 47(1): 4, 2022 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-36585480

RESUMO

Delays beyond recommended wait times, especially for specialist services, are associated with adverse health outcomes. The Alberta Surgical Initiative aims to improve the referral wait time-the time between a referral is received at the central intake to the time a specialist sees the patient. Using the discrete event simulation modelling approach, we evaluated and compared the impact of four referral distribution policies in a central intake system on three system performance measures (number of consultations, referral wait time and surgeon utilization). The model was co-designed with clinicians and clinic staff to represent the flow of patients through the system. We used data from the Facilitated Access to Surgical Treatment (FAST) centralized intake referral program for General Surgery to parameterize the model. Four distribution policies were evaluated - next-available-surgeon, sequential, "blackjack," and "kanban." A sequential distribution of referrals for surgical consultation among the surgeons resulted in the worst performance in terms of the number of consultations, referral wait time and surgeon utilization. The three other distribution policies are comparable in performance. The "next available surgeon" model provided the most efficient and robust model, with approximately 1,000 more consultations, 100 days shorter referral time and a 14% increase in surgeon utilization. Discrete event simulation (DES) modelling can be an effective tool to illustrate and communicate the impact of the referral distribution policy on system performance in terms of the number of consultations, referral wait time and surgeon utilization.


Assuntos
Encaminhamento e Consulta , Listas de Espera , Humanos , Alberta , Fatores de Tempo , Acessibilidade aos Serviços de Saúde
4.
Neonatology ; 119(5): 558-566, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35793660

RESUMO

INTRODUCTION: The lung ultrasound score (LUS) has been suggested to predict moderate-severe bronchopulmonary dysplasia (msBPD) in preterm infants. We aimed to assess LUS evolution after birth in preterm infants and the effect of gestational age. METHODS: This multicentre prospective observational study was performed with newborns born before 33 weeks of gestation. We created two groups: group 1 (23-27 weeks) and group 2 (28-32 weeks). We compared LUSs between the groups from birth until 36 weeks of postmenstrual age, and we estimated the LUS evolution in each group with a linear multilevel mixed-effects regression model. The effects of the need for surfactant or an msBPD diagnosis were also studied. RESULTS: We included 339 patients: 122 (36%) in group 1 and 217 (64%) in group 2. The infants in group 1 showed a steady progression in the LUS from birth until 4 weeks of age and a subsequent decrease; the infants in group 2 showed a progressive decrease in the LUS throughout the study. This progression varied significantly in the first weeks of life in infants who required surfactant at birth and after the first week of life in the patients diagnosed with msBPD. DISCUSSION/CONCLUSIONS: Extremely preterm infants showed persistently high LUSs during the first weeks of life, regardless of the progression to msBPD. In this group, the infants who did not require surfactant at birth exhibited an increase in their LUSs after the first week until their values were equal to the remaining infants in their group.


Assuntos
Displasia Broncopulmonar , Surfactantes Pulmonares , Displasia Broncopulmonar/diagnóstico por imagem , Feminino , Retardo do Crescimento Fetal , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Pulmão/diagnóstico por imagem , Estudos Prospectivos , Tensoativos
5.
Cir Esp (Engl Ed) ; 100(7): 410-415, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35550447

RESUMO

OBJECTIVE: To describe the experience of the robotic approach for achalasia surgery in a tertiary center. MATERIAL AND METHODS: Patients with achalasia who underwent robotic surgery between May 2010 and April 2019 were analyzed. The study variables were collected in a prospective database and a descriptive analysis was performed. RESULTS: 45 patients (55.6% male) with a mean age of 44 years were included. The main symptom at diagnosis was dysphagia. 19 patients (42.2%) received endoscopic treatment prior to surgery, mostly pneumatic dilation (84.2%). Heller's myotomy associated with Toupet fundoplication was the surgical technique of choice, with a mean operative time of 211 min. The average stay was 5 days. There were 2 postoperative perforations (4.4%). Perioperative mortality was 0%. The mean follow-up was 64 months. At 3 and 5 years, a significant decrease in the Eckardt score was observed and the manometric study showed a decrease in the lower esophageal sphincter pressure at rest of 58% and 70%, respectively, with persistence of hypomotility of the esophageal body. Pathological gastroesophageal reflux was diagnosed in two patients (5.4%) and 4 (10.8%) presented recurrence of symptoms, requiring endoscopic pneumatic dilations. In 2 cases, the dilations were not effective, so an endoscopic myotomy was considered. CONCLUSIONS: In our experience, robotic surgery is a safe and effective procedure for the treatment of achalasia.


Assuntos
Acalasia Esofágica , Miotomia de Heller , Miotomia , Procedimentos Cirúrgicos Robóticos , Adulto , Acalasia Esofágica/cirurgia , Feminino , Fundoplicatura/métodos , Miotomia de Heller/métodos , Humanos , Masculino
6.
J Invest Dermatol ; 142(2): 382-389, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34536484

RESUMO

Expression-based systematic drug repositioning has been explored to predict novel treatments for a number of skin disorders. In this study, we utilize this approach to identify, to our knowledge, previously unreported therapies for epidermolysis bullosa simplex (EBS). RNA sequencing analysis was performed on skin biopsies of acute blisters (<1 week old) (n = 9) and nonblistered epidermis (n = 11) obtained from 11 patients with EBS. Transcriptomic analysis of blistered epidermis in patients with EBS revealed a set of 1,276 genes dysregulated in EBS blisters. The IL-6, IL-8, and IL-10 pathways were upregulated in the epidermis from EBS. Consistent with this, predicted upstream regulators included TNF-α, IL-1ß, IL-2, IL-6, phosphatidylinositol 3-kinase, and mTOR. The 1,276 gene EBS blister signature was integrated with molecular signatures from cell lines treated with 2,423 drugs using the Connectivity Map CLUE platform. The mTOR inhibitors and phosphatidylinositol 3-kinase inhibitors most opposed the EBS signature. To determine whether mTOR inhibitors could be used clinically in EBS, we conducted an independent pilot study of two patients with EBS treated with topical sirolimus for painful plantar keratoderma due to chronic blistering. Both individuals experienced marked clinical improvement and a notable reduction of keratoderma. In summary, a computational drug repositioning analysis successfully identified, to our knowledge, previously unreported targets in the treatment of EBS.


Assuntos
Reposicionamento de Medicamentos , Epidermólise Bolhosa Simples/tratamento farmacológico , Inibidores de MTOR/uso terapêutico , Sirolimo/uso terapêutico , Administração Cutânea , Adolescente , Adulto , Biópsia , Criança , Pré-Escolar , Biologia Computacional , Epiderme/efeitos dos fármacos , Epiderme/metabolismo , Epiderme/patologia , Epidermólise Bolhosa Simples/genética , Epidermólise Bolhosa Simples/patologia , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Queratinócitos/efeitos dos fármacos , Queratinócitos/metabolismo , Queratinócitos/patologia , Inibidores de MTOR/farmacologia , Masculino , Pessoa de Meia-Idade , Fosfatidilinositol 3-Quinases/metabolismo , Inibidores de Fosfoinositídeo-3 Quinase/farmacologia , Inibidores de Fosfoinositídeo-3 Quinase/uso terapêutico , Projetos Piloto , RNA-Seq , Sirolimo/farmacologia , Serina-Treonina Quinases TOR/antagonistas & inibidores , Serina-Treonina Quinases TOR/metabolismo , Resultado do Tratamento , Adulto Jovem
7.
Rev. cuba. invest. bioméd ; 41: e2423, 2022. ilus
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1408610

RESUMO

Las cardiopatías complican alrededor del 4 por ciento de los embarazos; y representan la principal causa no obstétrica de muerte materna. Las lesiones valvulares tienen una alta prevalencia, siendo la estenosis mitral la de peor pronóstico durante el embarazo. El presente artículo tiene como objetivo exponer las recomendaciones del Servicio Nacional de Cardiopatía y Embarazo para el manejo de la estenosis mitral durante la gestación. Resulta crucial la evaluación de la anatomía valvular y la severidad de la enfermedad. Lesiones moderadas a severas deben ser tratadas con betabloqueadores cardioselectivos y comisurotomía percutánea electiva, si la anatomía es favorable. Si hay retención de volumen están indicados los diuréticos. Entre las drogas de uso obstétrico están contraindicadas las prostaglandinas, el nifedipino y el fenoterol. El momento de terminación del embarazo depende de la edad gestacional y de la aparición de signos de descompensación materna o fetal, en cuyo caso tienen indicación de cesárea(AU)


Heart disease complicates about 4 percent of pregnancies; and represent the leading non-obstetric cause of maternal death. Valvular lesions have a high prevalence, being mitral stenosis the one with the worst prognosis during pregnancy. This article aims to present the recommendations of the National Heart Disease and Pregnancy Service for the management of mitral stenosis during pregnancy. Evaluation of valve anatomy and disease severity is crucial. Moderate to severe injuries should be treated with cardioselective beta-blockers and elective percutaneous commissurotomy, if the anatomy is favorable. If there is volume retention, diuretics are indicated. Among the drugs for obstetric use, prostaglandins, nifedipine and fenoterol are contraindicated. The time of termination of pregnancy depends on the gestational age and the appearance of signs of maternal or fetal decompensation, in which case they have an indication for cesarean section(AU)


Assuntos
Humanos , Gravidez , Fatores de Risco de Doenças Cardíacas , Cardiopatias/complicações , Hemodinâmica , Estenose da Valva Mitral , Comportamentos Relacionados com a Saúde
8.
Surg Neurol Int ; 12: 394, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34513160

RESUMO

BACKGROUND: Hemangioblastomas are vascular tumors, of benign behavior, that originate in the central nervous system. Supratentorial hemangioblastomas are extremely rare and are generally associated with Von Hippel-Lindau disease (VHL). The involvement of structures by contiguity, such as blood vessels or meninges, is something exceptional. There are few references in the literature of supratentorial hemangioblastomas with meningeal involvement and most of them are described in reports or small case series. METHODS: We performed a systematic review of the literature to observe the characteristics of patients with supratentorial hemangioblastomas with meningeal involvement. In addition, we present the case of a 43-year-old male patient with a sporadic supratentorial hemangioblastoma with both, meningeal and vascular involvement that recurred years after treatment. RESULTS: The patients presented supratentorial tumors with meningeal involvement, we had a 1.2:1 ratio male-female distribution. The mean age was 50 years. Most tumors were located in the cerebral hemispheres, the lobe affected most frequently was the frontal lobe. About 67% of the cases were sporadic and only 21% were related to VHL disease. There were three cases of recurrence after surgery. CONCLUSION: Supratentorial hemangioblastomas are extremely rare lesions. It is rare for supratentorial hemangioblastomas to invade adjacent structures such as blood vessels or meninges, however, when this happens, it is recommended a preoperative vascular imaging study, especially in parasagittal hemangioblastomas where superior longitudinal sinus may be involved. In these cases, en bloc surgical resection is difficult and the probability of recurrence is higher. Although clinical trials and studies with a greater casuistry are necessary to establish guidelines for the management of supratentorial hemangioblastomas, nowadays, contribution of new cases is useful for understanding this pathology.

9.
Medicine (Baltimore) ; 100(25): e26426, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160431

RESUMO

INTRODUCTION: Esophagectomy is a major surgery with a high degree of catabolic and post-surgical inflammatory response accompanied by high morbidity and significant mortality. Post-surgical nutritional support via enteral administration of ω-3 fatty acids has been seen to be effective although its bad tolerance. There are few clinical trials with parenteral ω-3 fatty acids in these patients. We propose to investigate the effect of combining a parenteral fish oil lipid emulsion with the standard enteral nutrition (EN) support. MATERIALS AND METHODS: Prospective, single-center, randomized, double-blind study in esophagectomized patients, and treated after surgery with parenteral lipid emulsions of ω-3 fatty acids or a mixture of ω-6 long-chain triglycerides/short-chain triglycerides 50%. These emulsions will be added to the standard nutritional support in continuous infusion until 5 days of treatment have been completed. Patients will be randomized 1:1:1 in Group A receiving 0.4 g/kg/d of fish-oil lipid emulsion and 0.4 g/kg/d of a lipid emulsion mixture of ω-6 long-chain fatty acids (LCT) plus medium-chain fatty acids (MCT) (total dose of 0.8 g/kg/d of lipid emulsion); Group B receiving 0.8 g/kg/d of fish oil lipid emulsion and Group C receiving 0.8 g/kg/d of LCT/MCT emulsion.The main objective is to determine whether 5 days administration of intravenous ω-3 fatty acid lipid emulsion is effective in normalizing interleukin-6 levels compared with LCT/MCT emulsions, and whether a 0.8 g/kg/d dose is more effective than 0.4 g/kg/d. Secondary outcomes include other inflammatory markers such as C-reactive protein, tumor necrosis factor alpha and interleukin-10, and parameters of morbidity, safety, nutrition and mortality.Samples will be collected at the time when surgery is indicated and on days 0, 1, 3, 5 and 21 to determine inflammatory, nutritional, hepatic and safety parameters. In addition, clinical follow-up will be continued throughout the hospital admision and up to 1 year after surgery. DISCUSSION: Studies of ω-3 fatty acids administered parenterally in esophagectomized patients are scarce. This study proposes to investigate the effect of combining fish-oil lipid emulsions administered parenterally with EN support. Potential benefits include fast incorporation of lipids to the cellular membranes and to the inflammatory cascade, and the use of only 1 pharmaconutrient. TRIAL REGISTRATION: FAR-NP-2017-01 EudraCT number: 2016-004978-17.https://reec.aemps.es/reec/public/detail.html searching the EudraCT number. VERSION IDENTIFIER: Version 2, 08/06/2017.


Assuntos
Esofagectomia/reabilitação , Emulsões Gordurosas Intravenosas/administração & dosagem , Óleos de Peixe/administração & dosagem , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/terapia , Adulto , Terapia Combinada/métodos , Método Duplo-Cego , Nutrição Enteral , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Feminino , Humanos , Interleucina-6/sangue , Interleucina-6/imunologia , Masculino , Nutrição Parenteral/métodos , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/imunologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
10.
Cir Esp (Engl Ed) ; 2021 May 28.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34059311

RESUMO

OBJECTIVE: To describe the experience of the robotic approach for achalasia surgery in a tertiary center. MATERIAL AND METHODS: Patients with achalasia who underwent robotic surgery between May 2010 and April 2019 were analyzed. The study variables were collected in a prospective database and a descriptive analysis was performed. RESULTS: 45 patients (55.6% male) with a mean age of 44 years were included. The main symptom at diagnosis was dysphagia. 19 patients (42.2%) received endoscopic treatment prior to surgery, mostly pneumatic dilation (84.2%). Heller's myotomy associated with Toupet fundoplication was the surgical technique of choice, with a mean operative time of 211minutes. The average stay was 5 days. There were 2 postoperative perforations (4.4%). Perioperative mortality was 0%. The mean follow-up was 64 months. At 3 and 5 years, a significant decrease in the Eckardt score was observed and the manometric study showed a decrease in the lower esophageal sphincter pressure at rest of 58% and 70%, respectively, with persistence of hypomotility of the esophageal body. Pathological gastroesophageal reflux was diagnosed in two patients (5.4%) and 4 (10.8%) presented recurrence of symptoms, requiring endoscopic pneumatic dilations. In 2 cases, the dilations were not effective, so an endoscopic myotomy was considered. CONCLUSIONS: In our experience, robotic surgery is a safe and effective procedure for the treatment of achalasia.

11.
Eur J Trauma Emerg Surg ; 47(3): 683-692, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33742223

RESUMO

PURPOSE: To analyse acute cholecystitis (AC) management during the first pandemic outbreak after the recommendations given by the surgical societies estimating: morbidity, length of hospital stay, mortality and hospital-acquired SARS-CoV-2 infection rate. METHODS: Multicentre-combined (retrospective-prospective) cohort study with AC patients in the Community of Madrid between 1st March and 30th May 2020. 257 AC patients were involved in 16 public hospital. Multivariant binomial logistic regression (MBLR) was applied to mortality. RESULTS: Of COVID-19 patients, 30 were diagnosed at admission and 12 patients were diagnosed during de admission or 30 days after discharge. In non-COVID-19 patients, antibiotic therapy was received in 61.3% of grade I AC and 40.6% of grade II AC. 52.4% of grade III AC were treated with percutaneous drainage (PD). Median hospital stay was 5 [3-8] days, which was higher in the non-surgical treatment group with 7.51 days (p < 0.001) and a 3.25% of mortality rate (p < 0.21). 93.3% of patients with SARS-CoV-2 infection at admission were treated with non-surgical treatment (p = 0.03), median hospital stay was 11.0 [7.5-27.5] days (p < 0.001) with a 7.5% of mortality rate (p > 0.05). In patients with hospital-acquired SARS-CoV-2 infection, 91.7% of grade I-II AC were treated with non-surgical treatment (p = 0.037), with a median hospital stay of 16 [4-21] days and a 18.2% mortality rate (p > 0.05). Hospital-acquired infection risk when hospital stay is > 7 days is OR 4.7, CI 95% (1.3-16.6), p = 0.009. COVID-19 mortality rate was 11.9%, AC severity adjusted OR 5.64 (CI 95% 1.417-22.64). In MBLR analysis, age (OR 1.15, CI 95% 1.02-1.31), SARS-CoV-2 infection (OR 14.49, CI 95% 1.33-157.81), conservative treatment failure (OR 8.2, CI 95% 1.34-50.49) and AC severity were associated with an increased odd of mortality. CONCLUSION: In our population, during COVID-19 pandemic, there was an increase of non-surgical treatment which was accompanied by an increase of conservative treatment failure, morbidity and hospital stay length which may have led to an increased risk hospital-acquired SARS-CoV-2 infection. Age, SARS-CoV-2 infection, AC severity and conservative treatment failure were mortality risk factors.


Assuntos
Antibacterianos/uso terapêutico , COVID-19 , Colecistectomia/estatística & dados numéricos , Colecistite Aguda , Tratamento Conservador , Infecção Hospitalar , Controle de Infecções , COVID-19/diagnóstico , COVID-19/mortalidade , COVID-19/prevenção & controle , Colecistite Aguda/diagnóstico , Colecistite Aguda/epidemiologia , Colecistite Aguda/terapia , Estudos de Coortes , Comorbidade , Tratamento Conservador/métodos , Tratamento Conservador/estatística & dados numéricos , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/virologia , Drenagem/métodos , Drenagem/estatística & dados numéricos , Feminino , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Medição de Risco , SARS-CoV-2 , Espanha/epidemiologia
12.
Chest ; 160(3): 1006-1016, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33689782

RESUMO

BACKGROUND: Different lung ultrasound (LUS) scanning protocols have been used, and the results in terms of diagnostic accuracy are heterogeneous. RESEARCH QUESTIONS: What is the diagnostic accuracy of the LUS score to predict moderate to severe bronchopulmonary dysplasia (msBPD)? Does scanning of posterior lung fields improve the diagnostic accuracy? STUDY DESIGN AND METHODS: This was a multicenter prospective, observational study in six centers. Two LUS aeration scores, one involving only anterolateral lung fields and the other adding the posterior fields were obtained at birth, on the third day of life (DOL), on the seventh DOL, on the 14th DOL, and on the 21st DOL. The diagnostic accuracy of both scores to predict msBPD was assessed at each time point. RESULTS: Eight hundred thirty-two LUS examinations in 298 infants were included. Both LUS score using anterolateral and posterior fields and LUS score using only anterolateral fields showed a similar moderate diagnostic accuracy to predict msBPD on the third DOL (area under the receiver operating characteristic curve [AUC] 95% CI, 0.68-0.85 vs 0.68-0.85; P = .97), seventh DOL (AUC 95% CI, 0.74-0.85 vs 0.74-0.84; P = .26), and 21st DOL (AUC 95% CI, 0.72-0.86 vs 0.74-0.88; P = .17). The LUS score using anterolateral and posterior fields was slightly more accurate at 14th DOL (AUC 95% CI, 0.69-0.83 vs 0.66-0.80; P = .01). A cutoff of 8 points in the LUS score using only anterolateral fields on the seventh DOL provided a sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 70%, 79%, 3.3, and 0.38, respectively, to predict msBPD. Adding gestational age (GA) and sex improved the discriminative value without significant differences compared with a predictive model based on multiple clinical variables: AUC 95% CI, 0.77-0.88 vs 0.80-0.91 (P = .52). INTERPRETATION: The LUS score is able to predict msBPD from the third DOL with a moderate diagnostic accuracy. Scanning posterior lung fields slightly improved diagnostic accuracy only at the 14th DOL. Adding GA and sex improves the diagnostic accuracy of the LUS scores. The LUS score is useful to stratify BPD risk early after birth.


Assuntos
Displasia Broncopulmonar/diagnóstico , Pulmão/diagnóstico por imagem , Ultrassonografia , Confiabilidade dos Dados , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Valor Preditivo dos Testes , Melhoria de Qualidade , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Ultrassonografia/métodos , Ultrassonografia/normas
13.
Virchows Arch ; 479(1): 57-67, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33447899

RESUMO

Clear cytoplasm is a major characteristic feature of most malignant renal neoplasms. Benign clear cells in the renal parenchyma, usually histiocytes, can occasionally be found, but they are infrequently of an epithelial nature. We report histological, immunohistochemical, ultrastructural, and cytogenomic features of clear epithelial cell clusters incidentally found in four kidney specimens. Multiple microscopic clear cell clusters were present in the cortex, often in subcapsular location. They were composed of large epithelial cells with strikingly clear cytoplasm, without nuclear atypia, arranged in solid nests, and some tubules with narrow lumina. Immunohistochemically, they were positive for AE1AE3, PAX 8, EMA, kidney-specific cadherin, cytokeratin 7, E cadherin, and CD117, with focal immunoreactivity for CD10. Carbonic anhydrase IX, vimentin, and markers related to apoptosis and proliferation were negative. Ultrastructurally, the cytoplasms were enlarged and poor in organelles, showing ballooning degeneration. Array comparative genomic hybridization showed no chromosomal gains or losses. Clear cell clusters constitute a rare finding in the kidney and must be differentiated from benign lesions (ectopic adrenal tissue, osmotic tubulopathy, histiocytic clusters, renal adenomas) and renal cell carcinomas. Clear cell clusters appear to be generated from "endocrine-type" atrophic tubules whose cells are enlarged due to intracellular oedema. Immunohistochemistry shows a distal nephron phenotype with a limited expression of a proximal marker, CD10. Coexisting chronic renal disease or ischemic conditions seem to be related to the development of clear cell clusters. Pathological, ultrastructural, and cytogenomic features do not support a preneoplastic nature of this lesion, at least in the cases studied here.


Assuntos
Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Rim/patologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Carcinoma de Células Renais/química , Carcinoma de Células Renais/ultraestrutura , Hibridização Genômica Comparativa , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Humanos , Imuno-Histoquímica , Rim/química , Rim/ultraestrutura , Neoplasias Renais/química , Neoplasias Renais/ultraestrutura , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade , Fenótipo , Valor Preditivo dos Testes
14.
Histopathology ; 78(5): 759-771, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33113154

RESUMO

AIMS: Although rare, malignant sarcomatoid breast tumours without evidence of epithelial differentiation comprise a diagnostic challenge with management implications. Earlier studies have generally considered these to be primary breast sarcomas; however, supporting evidence is lacking and management remains variable. This study aimed to provide an evidence-based approach to improve the consistency of diagnosis and management for such cases. METHODS AND RESULTS: A large series (n = 140) of metaplastic breast carcinoma (MBC) diagnosed in Nottingham over 18 years was analysed. Only cases with available data on immunohistochemical expression of cytokeratins (CKs) were included. The prevalence and pattern of expression for various CKs were assessed and details of tumours negative for CKs were collected. A diagnostic approach based on our experience is provided. Forty-seven cases (34%) showed foci of conventional type invasive breast carcinoma or ductal carcinoma in situ (DCIS), while 93 cases (66%) were diagnosed as MBC based on morphology and/or CK expression. Ninety-seven cases (69%) were negative for one or more CKs, with 18 cases (13%) negative for five or more CKs. Eight cases (6%) lacked expression of all CKs tested. Further examination showed evidence of carcinomatous nature in five cases, and three were diagnosed as MBC following extensive diagnostic work-up and based on our experience. CONCLUSION: This study suggests that MBC represents a spectrum of neoplasms, with some lacking CK expression. Sarcomatoid neoplasms of the breast lacking evidence of carcinomatous morphology and CK expression may represent an extreme end of differentiation that can be considered as carcinomas rather than sarcomas for management purposes (following extensive work-up).


Assuntos
Neoplasias da Mama , Adulto , Biomarcadores Tumorais/análise , Mama/patologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/diagnóstico , Carcinoma Intraductal não Infiltrante/patologia , Estudos de Coortes , Diagnóstico Diferencial , Epitélio/patologia , Feminino , Humanos , Imuno-Histoquímica , Queratinas/análise , Pessoa de Meia-Idade , Estudos Retrospectivos , Sarcoma/diagnóstico , Sarcoma/patologia
15.
World Neurosurg ; 144: 250-255, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32781144

RESUMO

BACKGROUND: Cystic lesions in the sellar region include a variety of entities, such as craniopharyngioma, Rathke cleft cyst (RCC), intrasellar arachnoid cyst, cystic pituitary adenomas, cholesterol granulomas (CGs), and xanthogranulomas (XGs). The distinction among them remains a preoperative challenge due to similarities in their clinical and radiologic findings. CASE DESCRIPTION: We describe 3 cases with cystic sellar lesions. The first patient is a woman who presented with headache and hormonal disturbances, including high levels of prolactin, with a sellar and suprasellar cystic lesion discovered on magnetic resonance imaging. She was initially treated with dopamine agonists with normalization of prolactin levels but no changes on the size of the lesion. She underwent an endoscopic endonasal resection and the histology resulted in a CG/XG. The second patient is a woman who consulted for an incidentally discovered sellar cyst. During the follow-up, the lesion demonstrated enlargement with compression of the optic chiasm. With a preoperative diagnosis of RCC, the lesion was removed through an endoscopic endonasal transsellar approach. Final pathologic diagnosis was consistent with CG/XG. The third case was that of a man who presented with refractory headaches and vision loss, with a sellar/suprasellar cystic lesion on magnetic resonance imaging. He underwent endoscopic endonasal transsellar surgery for resection of what preoperatively was thought to be a giant RCC; final pathology again was consistent with CG/XG. CONCLUSIONS: CG/XG is an uncommon pathology with unspecific clinical and radiologic features. However, this pathology should be considered in the differential diagnosis of mixed cystic/solid lesions in the sellar region.


Assuntos
Colesterol , Cistos/diagnóstico , Granuloma/diagnóstico , Doenças da Hipófise/diagnóstico , Adulto , Cistos/cirurgia , Diagnóstico Diferencial , Procedimentos Endovasculares/métodos , Feminino , Granuloma/etiologia , Granuloma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Procedimentos Neurocirúrgicos/métodos , Doenças da Hipófise/cirurgia , Sela Túrcica , Resultado do Tratamento
16.
Proc Natl Acad Sci U S A ; 117(6): 3114-3122, 2020 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-31988134

RESUMO

Plasmodium falciparum vaccine RTS,S/AS01 is based on the major NPNA repeat and the C-terminal region of the circumsporozoite protein (CSP). RTS,S-induced NPNA-specific antibody titer and avidity have been associated with high-level protection in naïve subjects, but efficacy and longevity in target populations is relatively low. In an effort to improve upon RTS,S, a minimal repeat-only, epitope-focused, protective, malaria vaccine was designed. Repeat antigen copy number and flexibility was optimized using the tobacco mosaic virus (TMV) display platform. Comparing antigenicity of TMV displaying 3 to 20 copies of NPNA revealed that low copy number can reduce the abundance of low-affinity monoclonal antibody (mAb) epitopes while retaining high-affinity mAb epitopes. TMV presentation improved titer and avidity of repeat-specific Abs compared to a nearly full-length protein vaccine (FL-CSP). NPNAx5 antigen displayed as a loop on the TMV particle was found to be most optimal and its efficacy could be further augmented by combination with a human-use adjuvant ALFQ that contains immune-stimulators. These data were confirmed in rhesus macaques where a low dose of TMV-NPNAx5 elicited Abs that persisted at functional levels for up to 11 mo. We show here a complex association between NPNA copy number, flexibility, antigenicity, immunogenicity, and efficacy of CSP-based vaccines. We hypothesize that designing minimal epitope CSP vaccines could confer better and more durable protection against malaria. Preclinical data presented here supports the evaluation of TMV-NPNAx5/ALFQ in human trials.


Assuntos
Anticorpos Antiprotozoários/imunologia , Vacinas Antimaláricas , Malária Falciparum/imunologia , Plasmodium falciparum , Proteínas de Protozoários , Vírus do Mosaico do Tabaco/genética , Animais , Células HEK293 , Humanos , Imunogenicidade da Vacina , Macaca mulatta , Vacinas Antimaláricas/química , Vacinas Antimaláricas/genética , Vacinas Antimaláricas/imunologia , Camundongos , Camundongos Endogâmicos C57BL , Modelos Moleculares , Plasmodium falciparum/genética , Plasmodium falciparum/imunologia , Engenharia de Proteínas , Proteínas de Protozoários/química , Proteínas de Protozoários/genética , Proteínas de Protozoários/imunologia , Proteínas Recombinantes de Fusão/química , Proteínas Recombinantes de Fusão/genética , Proteínas Recombinantes de Fusão/imunologia
17.
Cir Esp (Engl Ed) ; 97(8): 451-458, 2019 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31047649

RESUMO

Minimally invasive surgery provides for the treatment of esophagogastric junction tumors under safe conditions, reducing respiratory and abdominal wall complications. Recovery is improved, while maintaining the oncological principles of surgery to obtain an optimal long-term outcome. It is important to have a sufficient volume of activity to progress along the learning curve with close expert supervision in order to guarantee R0 resection and adequate lymphadenectomy. Minimal invasiveness ought not become an objective in itself. Should total gastrectomy be performed, the risk of a positive proximal margin makes intraoperative biopsy compulsory, without ruling out a primary open approach. Meanwhile, minimally invasive esophagectomy has been gaining ground. Its main difficulty, the intrathoracic anastomosis, can be safely carried out either with a mechanical side-to-side suture or a robot-assisted manual suture, thanks to the 3-D vision and versatility of the instruments.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Junção Esofagogástrica/cirurgia , Gastrectomia/métodos , Procedimentos Cirúrgicos Robóticos , Neoplasias Gástricas/cirurgia , Anastomose Cirúrgica/métodos , Esôfago de Barrett/patologia , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/diagnóstico por imagem , Junção Esofagogástrica/patologia , Esofagoscopia , Humanos , Laparoscopia , Excisão de Linfonodo/métodos , Invasividade Neoplásica , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Complicações Pós-Operatórias/prevenção & controle , Neoplasias Gástricas/patologia
18.
Educ. med. super ; 33(1): e1463, ene.-mar. 2019. tab, fig
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1089875

RESUMO

Introducción: A través de los estudios de seguimiento a graduados se pueden obtener las incompatibilidades e insuficiencias de las competencias disponibles en relación con las competencias necesarias para concretar la estrategia corporativa. Objetivo: Evaluar el perfil profesional y necesidades de formación de los egresados de la Carrera de Enfermería de la Universidad Técnica de Ambato. Métodos: Se realizó un estudio observacional, descriptivo y retrospectivo como parte del seguimiento a graduados de la Carrera de Enfermería. El universo estuvo representado por los 698 graduados de la carrera desde enero del año 2002 hasta diciembre de 2017, no se seleccionó muestra. Resultados: Se evidenció una tendencia ascendente no significativa del número de graduados (r=0,024 IC95 por ciento : 32,81 a 54,94). La mayoría de los graduados se desempeñaron en el área de salud pública (44,4 por ciento) y como empleados públicos (73,7 por ciento). Señalaron como principales asignaturas en su formación la enfermería médico-quirúrgica (35,4 por ciento) y la enfermería gineco-obstétrica (24,6 por ciento), a la vez que demandaron con mayor frecuencia la formación de posgrado en las áreas de emergencias y atención en salud familiar. Conclusiones: A pesar del discreto incremento en el número de graduados, la Carrera de Enfermería de la Universidad Técnica de Ambato ha respondido a su encargo social en cuanto a la formación de talento humano que en mayor medida se ha desempeñado en el sector público(AU)


Introduction: Through follow-up studies of graduates, the incompatibilities and inadequacies of available competences can be obtained in association with the competences necessary to concretize the corporate strategy. Objective: To evaluate the professional profile and the training needs of the Nursing major graduates from Technical University of Ambato. Methods: An observational, descriptive and retrospective study was carried out as part of the follow-up of the Nursing major graduates. The population was represented by the 698 graduates from January 2002 to December 2017. No sample was selected. Results: There was a non-significant trend towards an increase in the number of graduates (r=0.024; 95 percent confidence interval, 32.81 to 54.94). The majority of the graduates worked in the area of public health (44.4 percent) and as public employees (73.7 percent). They mentioned that the main subjects in their training were Medical-Surgical Nursing (35.4 percent) and Gynecological-Obstetric Nursing (24.6 percent), while demanding more frequent postgraduate training in the emergency and family healthcare areas. Conclusions: Despite the discreet increase in the number of graduates, the Nursing major of Technical University of Ambato has responded to its social assignment as to the training of human talent, a personal that has significantly worked in the public sector(AU)


Assuntos
Humanos , Masculino , Feminino , Estudos Retrospectivos , Enfermagem , Categorias de Trabalhadores
19.
Rev. Fac. Med. (Bogotá) ; 67(1): 57-62, Jan.-Mar. 2019. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1013200

RESUMO

Resumen Introducción. La mortalidad materna (MM) es uno de los indicadores sanitarios que evidencia con mayor claridad la inequidad de género para la toma de decisiones y la exclusión social, esto toda vez que demanda una intervención médica urgente encaminada a prevenir una muerte. Objetivo. Exponer la magnitud y la tendencia de la MM en el cantón Ambato entre los años 2005 y 2014. Materiales y métodos. Estudio observacional, descriptivo, retrospectivo y transversal de las muertes maternas ocurridas en Ambato entre los años 2005 y 2014. El universo de estudio estuvo conformado por las 46 muertes maternas ocurridas y 51 947 nacidos vivos. Resultados. Se evidenció un ascenso significativo de la natalidad (r=0.652, p=0.041) y en el número de nacidos vivos con asistencia profesional (r=0.894, p=0.000); la razón de MM acumulada en el periodo fue de 88.6, con una tendencia al descenso no significativa (r=0.12 p=0.743). La enfermedad hipertensiva del embarazo fue la primera causa directa de MM (n=17, 41.5%). Conclusiones. La natalidad ha ido en ascenso y la tendencia de la MM a lo largo de 10 años no ha mostrado cambios significativos. La enfermedad hipertensiva del embarazo ha sido la principal causa de MM.


Abstract Introduction: Maternal mortality (MM) is one of the health indicators that most clearly demonstrates gender inequality in decision-making and social exclusion, since it demands urgent medical intervention aimed at preventing death. Objective: To expose the magnitude and trend of MM in Ambato between 2005 and 2014. Materials and methods: Observational, descriptive, retrospective and cross-sectional study of maternal deaths in Ambato between 2005 and 2014. The study universe consisted of 46 maternal deaths and 51 947 live births. Results: There was a significant increase in the birth rate (r=0.652, p=0.041) and in the number of live births with professional assistance (r=0.894, p=0.000). The cumulative MM ratio in the period was 88.6, with a non-significant downward trend (r=0.12 p=0.743). Hypertensive disease of pregnancy was the first direct cause of MM (n=17, 41.5%). Conclusions: Birth rates have been on the rise and the trend of MM over 10 years has not shown significant changes. Hypertensive disease of pregnancy remains the main cause of MM.

20.
Dev Psychol ; 55(1): 170-183, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30359055

RESUMO

The present study examines the influence of economic and family stress processes on change in drug and alcohol use in a cohort of 478 Mexican American youth (50.8% female) followed longitudinally beginning in Grade 5 when the youth averaged 10.4 years of age. Adolescents, their mothers (median age 36 at Grade 5), and their fathers (median age 39 at Grade 5) were assessed on economic hardship (Grades 5 through 7), family stress processes (Grades 5 through 9), and adolescent substance use (Grades 7 through 9). Hypotheses were derived from a culturally informed family stress model (FSM), which proposes that economic hardship initiates a sequential cascade of problems involving parents' emotional distress, interparental conflict, disruptions in parenting and increased risk for adolescent substance use. Structural equation modeling was used to test these hypothesized linkages and the findings were consistent with predictions derived from the FSM. The results also demonstrated that parents' familism moderated the association between parent distress and interparental conflict, acting as a source of resilience in this family stress process. Findings suggest that prevention and intervention efforts focused on reducing caregiver distress and interparental conflict and enhancing parenting practices, as well as policies that reduce the level of economic hardship experienced by families, may aid in the reduction of adolescent substance use. Additionally, interventions focused on facilitating the cultural value of familism may promote more positive interactions between Mexican American parents which, in turn, may promote more effective parenting practices that help to reduce the risk for adolescent substance use. (PsycINFO Database Record (c) 2018 APA, all rights reserved).


Assuntos
Fumar Cigarros/etnologia , Conflito Familiar/etnologia , Uso da Maconha/etnologia , Americanos Mexicanos , Relações Pais-Filho/etnologia , Poder Familiar/etnologia , Estresse Psicológico/etnologia , Consumo de Álcool por Menores/etnologia , Adolescente , Adulto , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
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