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1.
Blood Cancer J ; 14(1): 74, 2024 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-38684670

RESUMO

Smoldering multiple myeloma (SMM) precedes multiple myeloma (MM). The risk of progression of SMM patients is not uniform, thus different progression-risk models have been developed, although they are mainly based on clinical parameters. Recently, genomic predictors of progression have been defined for untreated SMM. However, the usefulness of such markers in the context of clinical trials evaluating upfront treatment in high-risk SMM (HR SMM) has not been explored yet, precluding the identification of baseline genomic alterations leading to drug resistance. For this reason, we carried out next-generation sequencing and fluorescent in-situ hybridization studies on 57 HR and ultra-high risk (UHR) SMM patients treated in the phase II GEM-CESAR clinical trial (NCT02415413). DIS3, FAM46C, and FGFR3 mutations, as well as t(4;14) and 1q alterations, were enriched in HR SMM. TRAF3 mutations were specifically associated with UHR SMM but identified cases with improved outcomes. Importantly, novel potential predictors of treatment resistance were identified: NRAS mutations and the co-occurrence of t(4;14) plus FGFR3 mutations were associated with an increased risk of biological progression. In conclusion, we have carried out for the first time a molecular characterization of HR SMM patients treated with an intensive regimen, identifying genomic predictors of poor outcomes in this setting.


Assuntos
Biomarcadores Tumorais , Progressão da Doença , Resistencia a Medicamentos Antineoplásicos , Mutação , Mieloma Múltiplo Latente , Humanos , Masculino , Resistencia a Medicamentos Antineoplásicos/genética , Feminino , Mieloma Múltiplo Latente/genética , Biomarcadores Tumorais/genética , Pessoa de Meia-Idade , Idoso , Sequenciamento de Nucleotídeos em Larga Escala , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
3.
Actas Dermosifiliogr ; 115(3): T237-T245, 2024 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-38242435

RESUMO

BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.


Assuntos
Dermatologia , Humanos , Espanha , Estudos Transversais
4.
Oncol Lett ; 27(3): 89, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38268779

RESUMO

Differentially methylated regions (DMRs) can be used as head and neck squamous cell carcinoma (HNSCC) diagnostic, prognostic and therapeutic targets in precision medicine workflows. DNA from 21 HNSCC and 10 healthy oral tissue samples was hybridized to a genome-wide tiling array to identify DMRs in a discovery cohort. Downstream analyses identified differences in promoter DNA methylation patterns in oral, laryngeal and oropharyngeal anatomical regions associated with tumor differentiation, nodal involvement and survival. Genome-wide DMR analysis showed 2,565 DMRs common to the three subsites. A total of 738 DMRs were unique to laryngeal cancer (n=7), 889 DMRs were unique to oral cavity cancer (n=10) and 363 DMRs were unique to pharyngeal cancer (n=6). Based on the genome-wide analysis and a Gene Ontology analysis, 10 candidate genes were selected to test for prognostic value and association with clinicopathological features. TIMP3 was associated with tumor differentiation in oral cavity cancer (P=0.039), DAPK1 was associated with nodal involvement in pharyngeal cancer (P=0.017) and PAX1 was associated with tumor differentiation in laryngeal cancer (P=0.040). A total of five candidate genes were selected, DAPK1, CDH1, PAX1, CALCA and TIMP3, for a prevalence study in a larger validation cohort: Oral cavity cancer samples (n=42), pharyngeal cancer tissues (n=25) and laryngeal cancer samples (n=52). PAX1 hypermethylation differed across HNSCC anatomic subsites (P=0.029), and was predominantly detected in laryngeal cancer. Kaplan-Meier survival analysis (P=0.043) and Cox regression analysis of overall survival (P=0.001) showed that DAPK1 methylation is associated with better prognosis in HNSCC. The findings of the present study showed that the HNSCC subsites oral cavity, pharynx and larynx display substantial differences in aberrant DNA methylation patterns, which may serve as prognostic biomarkers and therapeutic targets.

5.
Actas Dermosifiliogr ; 115(3): 237-245, 2024 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-37890617

RESUMO

BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.


Assuntos
Dermatologia , Humanos , Espanha , Estudos Transversais
7.
Prensa méd. argent ; 109(4): 133-135, 20230000. fig
Artigo em Espanhol | BINACIS, LILACS | ID: biblio-1512144

RESUMO

Introducción: Desde su introducción en la década de 1930, las colangiografías intraoperatorias se han utilizado para comprender la anatomía biliar y sus variantes, para detectar coledocolitiasis y lesiones quirúrgicas del conducto biliar principal (LQVBP). Métodos: Las colangiografías intraoperatorias aleatorias se analizaron retrospectivamente durante el período de julio de 2019 a enero de 2023 en el hospital Nacional de Clínica. Resultados: El tiempo promedio de las colangiografías intraoperatorias fue de 16 minutos (2´ - 30´). Discusión. La colangiografía intraoperatoria es un procedimiento seguro, con una morbilidad de 0.66% en la serie. Conclusión: Las colangiografías intraoperatorias son un método intraoperatorio seguro y efectivo que no tiene implicaciones negativas para la evolución del paciente


Introduction. Since its introduction in the 1930s, the intraoperative cholangiographies has been used to understand the biliary anatomy and its variants, to detect choledocholithiasis and surgical lesions of the main bile duct (LQVBP). Methods. Random intraoperative cholangiographies were retrospectively analyzed during the period from July 2019 to January 2023 at the Hospital Nacional de Clínicas. Results. The average time of the intraoperative cholangiographies was 16 minutes (2´ - 30´). Discussion. Intraoperative cholangiography is a safe procedure, with a morbidity of 0.66% in the series. Conclusión. intraoperative cholangiographies is a safe, effective intraoperative method that does not have negative implications for the evolution of the patient.


Assuntos
Humanos , Masculino , Feminino , Colangiografia/métodos , Coledocolitíase/cirurgia
8.
AIDS ; 37(13): 1987-1995, 2023 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-37418541

RESUMO

OBJECTIVES: Chemokine receptor CCR5 is the principal co-receptor for entry of M-tropic HIV virus into immune cells. It is expressed in the central nervous system and may contribute to neuro-inflammation. The CCR5 antagonist maraviroc (MVC) has been suggested to improve HIV-associated neurocognitive impairment (NCI). DESIGN: A double-blind, placebo-controlled, 48-week, randomized study of MVC vs. placebo in people with HIV (PWH) on stable antiretroviral therapy (ART) for more than one year in Hawaii and Puerto Rico with plasma HIV RNA less than 50 copies/ml and at least mild NCI defined as an overall or domain-specific neuropsychological z (NPZ) score less than -0.5. METHODS: Study participants were randomized 2 : 1 to intensification of ART with MVC vs. placebo. The primary endpoint was change in global and domain-specific NPZ modeled from study entry to week 48. Covariate adjusted treatment comparisons of average changes in cognitive outcome were performed using winsorized NPZ data. Monocyte subset frequencies and chemokine expression as well as plasma biomarker levels were assessed. RESULTS: Forty-nine participants were enrolled with 32 individuals randomized to MVC intensification and 17 to placebo. At baseline, worse NPZ scores were seen in the MVC arm. Comparison of 48-week NPZ change by arm revealed no differences except for a modest improvement in the Learning and Memory domain in the MVC arm, which did not survive multiplicity correction. No significant changes between arms were seen in immunologic parameters. CONCLUSION: This randomized controlled study found no definitive evidence in favor of MVC intensification among PWH with mild cognitive difficulties.


Assuntos
Infecções por HIV , Humanos , Maraviroc , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Cicloexanos , Triazóis/uso terapêutico , Terapia Antirretroviral de Alta Atividade
9.
Brain ; 146(8): 3162-3171, 2023 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-37043503

RESUMO

ATP1A3 encodes the α3 subunit of the sodium-potassium ATPase, one of two isoforms responsible for powering electrochemical gradients in neurons. Heterozygous pathogenic ATP1A3 variants produce several distinct neurological syndromes, yet the molecular basis for phenotypic variability is unclear. We report a novel recurrent variant, ATP1A3(NM_152296.5):c.2324C>T; p.(Pro775Leu), in nine individuals associated with the primary clinical features of progressive or non-progressive spasticity and developmental delay/intellectual disability. No patients fulfil diagnostic criteria for ATP1A3-associated syndromes, including alternating hemiplegia of childhood, rapid-onset dystonia-parkinsonism or cerebellar ataxia-areflexia-pes cavus-optic atrophy-sensorineural hearing loss (CAPOS), and none were suspected of having an ATP1A3-related disorder. Uniquely among known ATP1A3 variants, P775L causes leakage of sodium ions and protons into the cell, associated with impaired sodium binding/occlusion kinetics favouring states with fewer bound ions. These phenotypic and electrophysiologic studies demonstrate that ATP1A3:c.2324C>T; p.(Pro775Leu) results in mild ATP1A3-related phenotypes resembling complex hereditary spastic paraplegia or idiopathic spastic cerebral palsy. Cation leak provides a molecular explanation for this genotype-phenotype correlation, adding another mechanism to further explain phenotypic variability and highlighting the importance of biophysical properties beyond ion transport rate in ion transport diseases.


Assuntos
Ataxia Cerebelar , Deficiência Intelectual , Humanos , Mutação/genética , Síndrome , Deficiência Intelectual/genética , Ataxia Cerebelar/genética , Fenótipo , Espasticidade Muscular/genética , Cátions , ATPase Trocadora de Sódio-Potássio/genética
10.
Prostate ; 83(8): 765-772, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36895160

RESUMO

INTRODUCTION: Active surveillance (AS) is considered a suitable management practice for those patients with low-risk prostate cancer (PCa). At present, however, the role of multiparametric magnetic resonance imaging (mpMRI) in AS protocols has not yet been clearly established. OUTCOMES: To determine the role of mpMRI and its ability to detect significant prostate cancer (SigPCa) in PCa patients enrolled in AS protocols. MATERIALS AND METHODS: There were 229 patients enrolled in an AS protocol between 2011 and 2020 at Reina Sofía University Hospital. MRI interpretation was based on PIRADS v.1 or v.2/2.1 classification. Demographics, clinical, and analytical data were collected and analyzed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for mpMRI in different scenarios. We defined SigPCa and reclassification/progression as a Gleason score (GS) ≥ 3 + 4, a clinical stage ≥T2b, or an increase in PCa volume. Kaplan-Meier and log-rank tests were used to estimate progression-free survival time. RESULTS: Median age was 69.02 (±7.73) at diagnosis, with a 0.15 (±0.08) PSA density (PSAD). Eighty-six patients were reclassified after confirmatory biopsy, with a suspicious mpMRI an indication for a clear reclassification and risk-predictor factor in disease progression (p < 0.05). During follow-up, 46 patients were changed from AS to active treatment mainly due to disease progression. Ninety patients underwent ≥2mpMRI during follow-up, with a median follow-up of 29 (15-49) months. Thirty-four patients had a baseline suspicious mpMRI (at diagnostic or confirmatory biopsy): 14 patients with a PIRADS 3 and 20 patients with ≥PIRADS 4. From 14 patients with a PIRADS 3 baseline mpMRI, 29% progressed radiologically, with a 50% progression rate versus 10% (1/10 patients) for those with similar or decreased mpMRI risk. Of the 56 patients with a non-suspicious baseline mpMRI (PIRADS < 2), 14 patients (25%) had an increased degree of radiological suspicion, with a detection rate of SigPCa of 29%. The mpMRI NPV during follow-up was 0.91. CONCLUSION: A suspicious mpMRI increases the reclassification and disease progression risk during follow-up and plays an important role in monitoring biopsies. In addition, a high NPV at mpMRI follow-up can help to decrease the need to monitor biopsies during AS.


Assuntos
Neoplasias da Próstata , Conduta Expectante , Masculino , Humanos , Idoso , Próstata/patologia , Neoplasias da Próstata/patologia , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética , Progressão da Doença , Biópsia Guiada por Imagem/métodos
11.
Biointerphases ; 18(2): 021001, 2023 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-36898958

RESUMO

Tumor invasion is likely driven by the product of intrinsic and extrinsic stresses, reduced intercellular adhesion, and reciprocal interactions between the cancer cells and the extracellular matrix (ECM). The ECM is a dynamic material system that is continuously evolving with the tumor microenvironment. Although it is widely reported that cancer cells degrade the ECM to create paths for migration using membrane-bound and soluble enzymes, other nonenzymatic mechanisms of invasion are less studied and not clearly understood. To explore tumor invasion that is independent of enzymatic degradation, we have created an open three-dimensional (3D) microchannel network using a novel bioconjugated liquid-like solid (LLS) medium to mimic both the tortuosity and the permeability of a loose capillary-like network. The LLS is made from an ensemble of soft granular microgels, which provides an accessible platform to investigate the 3D invasion of glioblastoma (GBM) tumor spheroids using in situ scanning confocal microscopy. The surface conjugation of the LLS microgels with type 1 collagen (COL1-LLS) enables cell adhesion and migration. In this model, invasive fronts of the GBM microtumor protruded into the proximal interstitial space and may have locally reorganized the surrounding COL1-LLS. Characterization of the invasive paths revealed a super-diffusive behavior of these fronts. Numerical simulations suggest that the interstitial space guided tumor invasion by restricting available paths, and this physical restriction is responsible for the super-diffusive behavior. This study also presents evidence that cancer cells utilize anchorage-dependent migration to explore their surroundings, and geometrical cues guide 3D tumor invasion along the accessible paths independent of proteolytic ability.


Assuntos
Microgéis , Humanos , Movimento Celular , Invasividade Neoplásica/patologia , Matriz Extracelular/metabolismo , Colágeno Tipo I , Linhagem Celular Tumoral , Microambiente Tumoral
13.
Cuad. Hosp. Clín ; 63(1): 34-38, jun. 2022.
Artigo em Espanhol | LILACS | ID: biblio-1399673

RESUMO

INTRODUCCIÓN: los sistemas sanguíneos continúan siendo de gran importancia en múltiples disciplinas como la medicina transfusional, genética poblacional, medicina forense, trasplante de órganos entre otras, estas se basan en la determinación de los grupos sanguíneos ABO y Rh. El siguiente trabajo analiza la fenotipificación eritrocitaria en un grupo de estudiantes de la carrera de Bioquímica y Farmacia de 5to, 6to y 7mo semestre, Universidad Franz Tamayo (UNIFRANZ) sede El Alto - Bolivia. MATERIALES Y MÉTODOS: se realizó un estudio descriptivo de serie de casos, determinando los sistemas ABO y RhD, para las pruebas directa e indirecta a fin de evitar discrepancias; utilizando como soporte la técnica de microplaca, regida a controles de calidad en Inmunohematología. RESULTADOS: los resultados mostraron que el 86% eran mujeres, el grupo etario dominante esta entre 18 a 25 años de edad. El sistema ABO determinó el mayor porcentaje al grupo O con un 93%, destacando que no se encontró el grupo AB en el grupo de estudio. El sistema RhD, tuvo 100% de positivos, no encontrándose fenotipos RhD negativo ni variantes ni parciales. CONCLUSIÓN: la fenotipificación de grupos sanguíneos tanto directa e indirecta, a través de la plataforma de microplaca ayuda a evitar errores y discrepancias, tal como lo recomienda el Manual de Inmunohematología en servicios de sangre en Bolivia.


INTRODUCTION Blood systems continue to be of great importance in multiple disciplines such as transfusion medicine, population genetics, forensic medicine and organ transplantation, which are based on the determination of ABO and Rh blood groups. The following work analyzes the erythrocyte phenotyping in a group of students of Biochemistry and Pharmacy of 5th, 6th and 7th semesters, UNIFRANZ, El Alto. MATERIALS AND METHODS A descriptive case series study was carried out, determining the ABO and RhD systems for direct and indirect tests in order to avoid discrepancies; using the microplate technique as support, according to quality controls in Immunohematology. RESULTS The results showed that 86% were women, the dominant age group was between 18 and 25 years of age. The ABO system determined the highest percentage of group O with 93%, highlighting that the AB group was not found in the study group. The RhD system was 100% positive, with no RhD negative phenotypes, neither variant nor partial. CONCLUSION The phenotyping of blood groups, both direct and indirect, through the microplate platform helps to avoid errors and discrepancies, as recommended by the Manual of Immunohematology in blood services in Bolivia.


Assuntos
Antígenos de Grupos Sanguíneos , Fenótipo , Estudantes , Gestão da Qualidade Total
14.
Arch Esp Urol ; 75(2): 156-164, 2022 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-35332885

RESUMO

PSA is the most widely used diagnosticand prognostic biomarker in prostate cancer (PCa).However, its lack of specificity has generated the needto search for new complementary markers. In thisscenario, blood plasma constitutes one of the sourcesof search for new markers, which have been tried tobe combined with PSA and other clinical variables inorder to develop tests that increase their diagnosticspecificity.This narrative review of the literature provides anoverview of commercially available plasma biomarkers and tests for use in different clinical settingsfor PCa. The most studied markers to help select theappropriate patients for initial and / or repeat biopsyhave been: PHI, 4K, STHLM3. These markers havebeen oriented towards the diagnosis of the so-calledclinically signifi cant PCa, trying to validate and calibratetheir algorithms in different populations. Giventhe development and evolution in the diagnosis of PCa,there is still a lack of evidence of the impact of magneticresonance imaging (MRI) when used in combinationwith these new markers, as well as its possiblerole in the screening of the disease and not only in theearly diagnosis process. Furthermore, there are only asmall number of studies that have directly comparedthese tests with each other and with PSA, so there isnot enough evidence to know which test has the bestproperties in each clinical scenario. In order to clarifythe true diagnostic role of these new biomarkers, newprospective, comparative studies in different populationsare absolutely necessary to evaluate their clinicalutility in combination with MRI and fusion biopsy.


El PSA es el biomarcador diagnóstico ypronóstico más ampliamente utilizado en cáncer deprostata (CaP). Sin embargo, su falta de especificidadha generado la necesidad de buscar nuevos marcadorescomplementarios. En este escenario, el plasmasanguíneo constituye una de las fuentes de búsquedade nuevos marcadores, los cuales han tratado decombinarse con el PSA y otras variables clínicas conel objeto de desarrollar tests que aumentaran su especificidaddiagnóstica.En esta revisión narrativa de la literatura se proporcionauna descripción general de los biomarcadoresplasmáticos y tests disponibles comercialmentepara ser utilizados en diferentes contextos clínicosdel CaP. Los test más estudiados para ayudar a seleccionarlos pacientes adecuados para la biopsia inicialy / o repetida han sido: PHI, 4K, STHLM3. Estos testse han orientado hacia el diagnóstico del denominadoCaP clínicamente significativo, intentando validary calibrar sus algoritmos en diferentes poblaciones.Dado el desarrollo y evolución en el diagnóstico deCaP, aún existe una falta de evidencia del impacto de la resonancia magnética (RM) al ser empleada encombinación con estos nuevos marcadores, así comosu posible papel en el screening de la enfermedad yno solo en el proceso de diagnóstico precoz. Además,solo se dispone de una pequeña cantidad de estudiosque hayan comparado directamente estos test entreellos y con el PSA, de modo que no existe evidenciasuficiente para saber qué test tiene mejores propiedadesen cada escenario clínico. En el escenarioactual, para poder aclarar el verdadero papel diagnósticode estos nuevos biomarcadores, son absolutamentenecesarios nuevos estudios prospectivos,comparativos y en diferentes poblaciones, que evalúensu utilidad clínica en combinación con la RM yla biopsia fusión.


Assuntos
Antígeno Prostático Específico , Neoplasias da Próstata , Biomarcadores Tumorais , Humanos , Masculino , Neoplasias da Próstata/diagnóstico
15.
J Clin Monit Comput ; 36(6): 1667-1677, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35061147

RESUMO

Reference values for non-invasive blood pressure (NIBP) are available for children undergoing general anesthesia, but have not been analyzed by type of anesthetic. This study establishes age-specific pediatric NIBP reference values, stratified by anesthetic type: inhalational anesthesia (IHA), total intravenous anesthesia (TIVA), and mostly intravenous anesthesia (MIVA, an inhalational induction followed by intravenous maintenance of anesthesia). NIBP measurements were extracted from a de-identified vital signs database for children < 19 years undergoing anesthesia between Jan/2013-Dec/2016, excluding cardiac surgery. We automatically rejected artifacts and randomly sampled 20 NIBP values per case. Anesthetic phase (induction/maintenance) was identified using operating room booking times for procedure start, and anesthetic types were identified based on intraoperative minimum alveolar concentration values in the different phases of the anesthetic. From 36,347 cases in our operating room booking system, we matched 24,457 cases with available vital signs. Of these, 20,613 (84%) had valid NIBP data and could be assigned to one anesthetic type: TIVA 11,819 [57%], IHA 4,752 [23%], and MIVA 4,042 [20%]. Mean NIBP during anesthesia increased with age, from median values of 48 mmHg (TIVA), 45 mmHg (IHA), and 41 mmHg (MIVA) in neonates, to 70 mmHg (TIVA), 68 mmHg (IHA), and 64 mmHg (MIVA) in 18-year-olds, respectively. In children < 1 year, mean NIBP values were 4 mmHg higher with TIVA than IHA (p < 0.001). These pediatric NIBP reference values contribute to ongoing debate about alarm limits based on age and anesthetic type, and may motivate prospective studies into the effects of different anesthesia regimes on vital signs.


Assuntos
Anestésicos Inalatórios , Nomogramas , Recém-Nascido , Humanos , Criança , Pressão Sanguínea , Estudos Retrospectivos , Estudos Prospectivos , Anestesia por Inalação , Anestesia Geral
16.
Am J Obstet Gynecol MFM ; 4(2): 100533, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34808403

RESUMO

BACKGROUND: In randomized trials, antepartum intravenous iron sucrose is effective at improving predelivery hemoglobin in iron deficiency anemia. Yet, there is a gap between this knowledge and its implementation into care. OBJECTIVE: We aimed to determine if the implementation of a standardized protocol for the management of antepartum anemia outside of a clinical trial improves intravenous iron sucrose utilization and clinical outcomes. STUDY DESIGN: We performed a prospective cohort study evaluating the incorporation of an anemia protocol into routine clinical care for women with antepartum hemoglobin <11.0 g/dL. Our protocol, developed with multidisciplinary stakeholders, included (1) serial third trimester hemoglobin assessment, (2) oral iron supplementation for antepartum hemoglobin 9.5-11 g/dL, and (3) antepartum intravenous iron sucrose use (300 mg weekly for 3 weeks) for hemoglobin <9.5 g/dL. We compared 6-months preimplementation (January 2018 to June 2018) to 6-months postimplementation (January 2019 to June 2019). The outcomes evaluated were antepartum intravenous iron sucrose utilization, the number of intravenous iron sucrose dosages, predelivery hemoglobin, and blood transfusion. RESULTS: A total of 1423 women were included (pre=778; post=645) without significant baseline differences. The antepartum hemoglobin nadir was no different between the groups (pre: 10.2; interquartile range [9.6-10.6] vs post: 10.2; interquartile range [9.6-10.6]; P=.77). The implementation of a standardized protocol for the management of antepartum anemia was associated with 80% increased odds of receiving intravenous iron sucrose than the preimplementation group (pre: 4.8% vs post: 8.2%, P=.008; odds ratio, 1.79; 95% confidence interval, [1.16-2.77]). The implementation of a standardized protocol for the management of antepartum iron deficiency anemia was also associated with higher hemoglobin at admission for delivery (pre: 10.9; interquartile range [10.1-11.6] vs post: 11.0; interquartile range [10.3-11.7], P=.048). There were no significant differences between the groups in blood product transfusion (pre: 7.1% vs post: 5.1%, P=.13). CONCLUSION: Implementation of a standardized antepartum anemia protocol is associated with increased intravenous iron sucrose utilization and improvement in predelivery hemoglobin.


Assuntos
Anemia Ferropriva , Anemia , Hematínicos , Deficiências de Ferro , Transtornos Puerperais , Anemia/diagnóstico , Anemia/tratamento farmacológico , Anemia/epidemiologia , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/tratamento farmacológico , Anemia Ferropriva/epidemiologia , Feminino , Compostos Férricos/uso terapêutico , Óxido de Ferro Sacarado/uso terapêutico , Hematínicos/uso terapêutico , Hemoglobinas/análise , Hemoglobinas/metabolismo , Hemoglobinas/uso terapêutico , Humanos , Masculino , Estudos Prospectivos , Transtornos Puerperais/tratamento farmacológico , Resultado do Tratamento
17.
Braz. j. biol ; 82: 1-9, 2022. map, tab, graf
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1468487

RESUMO

Cladocera represent an important zooplankton group because of their seasonal prominence in terms of abundance and their contribution in controlling primary production (phytoplankton). On a global scale, there are few studies on Cladocera in hypersaline environments. The present work aims to evaluate the spatio-temporal variation of the Cladocera assemblage across a salinity gradient in the habitats of the Araruama Lagoon. Samples were collected in random months over a period of four years at 12 fixed stations in the Araruama Lagoon using a WP2 plankton net equipped with a flow meter. Our results do not reveal significant influence of the tide and seasonal variation as factors affecting the Cladocera assemblage. Five Cladocera species were found in the Araruama Lagoon, only in stations 11 and 12 where they reached an average of 1,799 ± 3,103 ind. m-³. The mean of the Shannon Diversity Index was 0.45 ± 0.2. The species that stood out in terms of frequency and abundance were: Penilia avirostris (frequency of occurrence: 71%), followed by Pseudevadne tergestina (41%). The same species also stood out in terms of relative abundance, Penilia avirostris (87%) and Pseudevadne tergestina (11%). The absence of Cladocera in the innermost parts of the lagoon suggests that their entrance to these locations is possibly inhibited by the salinity and temperature gradient of the lagoon, being the main factors influencing the dynamics of the Cladocera assemblages.


Os cladóceros representam um importante grupo de zooplâncton, devido ao seu destaque sazonal em termos de abundância e à sua contribuição no controlo da produção primária (fitoplâncton). Em escala global, há poucos estudos com Cladocera em ambientes hipersalinos. O presente trabalho tem como objetivo avaliar a variação espaço-temporal da assembleia de Cladocera em um gradiente de salinidades da Lagoa de Araruama. As amostras foram coletadas em meses aleatórios, durante um período de quatro anos, em 12 estações fixas na Lagoa de Araruama, utilizando uma rede de plâncton WP2 equipada com um fluxômetro. Os nossos resultados não revelam uma influência significativa da maré e da variação sazonal como fatores que afetam a assembleia de Cladocera. Cinco espécies de Cladocera foram encontradas na Lagoa de Araruama. A assembleia apresentou maior densidade absoluta estações 12 e 11, atingindo uma a média de 1.799 ± 3.103 inds-³. A média do Índice de Diversidade de Shannon foi de 0,45 ± 0,2. As espécies que se destacaram em termos de frequência e abundância foram: Penilia avirostris (frequência de ocorrência: 71%), seguida de Pseudevadne tergestina (41%). As mesmas espécies também se destacaram em termos de abundância relativa Penilia avirostris (87%) e Pseudevadne tergestina (11%). A ausência de Cladocera nas partes mais interiores da lagoa sugere que a sua entrada nestes locais é possivelmente inibida pela salinidade e gradiente de temperatura da lagoa, sendo os principais fatores que influenciam a dinâmica da assembleia de Cladocera.


Assuntos
Animais , Cladocera/crescimento & desenvolvimento , Água do Mar , Análise Espaço-Temporal
18.
Braz. j. biol ; 822022.
Artigo em Inglês | LILACS-Express | LILACS, VETINDEX | ID: biblio-1468674

RESUMO

Abstract Cladocera represent an important zooplankton group because of their seasonal prominence in terms of abundance and their contribution in controlling primary production (phytoplankton). On a global scale, there are few studies on Cladocera in hypersaline environments. The present work aims to evaluate the spatio-temporal variation of the Cladocera assemblage across a salinity gradient in the habitats of the Araruama Lagoon. Samples were collected in random months over a period of four years at 12 fixed stations in the Araruama Lagoon using a WP2 plankton net equipped with a flow meter. Our results do not reveal significant influence of the tide and seasonal variation as factors affecting the Cladocera assemblage. Five Cladocera species were found in the Araruama Lagoon, only in stations 11 and 12 where they reached an average of 1,799 ± 3,103 ind. m-3. The mean of the Shannon Diversity Index was 0.45 ± 0.2. The species that stood out in terms of frequency and abundance were: Penilia avirostris (frequency of occurrence: 71%), followed by Pseudevadne tergestina (41%). The same species also stood out in terms of relative abundance, Penilia avirostris (87%) and Pseudevadne tergestina (11%). The absence of Cladocera in the innermost parts of the lagoon suggests that their entrance to these locations is possibly inhibited by the salinity and temperature gradient of the lagoon, being the main factors influencing the dynamics of the Cladocera assemblages.


Resumo Os cladóceros representam um importante grupo de zooplâncton, devido ao seu destaque sazonal em termos de abundância e à sua contribuição no controlo da produção primária (fitoplâncton). Em escala global, há poucos estudos com Cladocera em ambientes hipersalinos. O presente trabalho tem como objetivo avaliar a variação espaço-temporal da assembleia de Cladocera em um gradiente de salinidades da Lagoa de Araruama. As amostras foram coletadas em meses aleatórios, durante um período de quatro anos, em 12 estações fixas na Lagoa de Araruama, utilizando uma rede de plâncton WP2 equipada com um fluxômetro. Os nossos resultados não revelam uma influência significativa da maré e da variação sazonal como fatores que afetam a assembleia de Cladocera. Cinco espécies de Cladocera foram encontradas na Lagoa de Araruama. A assembleia apresentou maior densidade absoluta estações 12 e 11, atingindo uma a média de 1.799 ± 3.103 inds-3. A média do Índice de Diversidade de Shannon foi de 0,45 ± 0,2. As espécies que se destacaram em termos de frequência e abundância foram: Penilia avirostris (frequência de ocorrência: 71%), seguida de Pseudevadne tergestina (41%). As mesmas espécies também se destacaram em termos de abundância relativa Penilia avirostris (87%) e Pseudevadne tergestina (11%). A ausência de Cladocera nas partes mais interiores da lagoa sugere que a sua entrada nestes locais é possivelmente inibida pela salinidade e gradiente de temperatura da lagoa, sendo os principais fatores que influenciam a dinâmica da assembleia de Cladocera.

19.
Braz. j. biol ; 82: e236354, 2022. tab, graf
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1249288

RESUMO

Cladocera represent an important zooplankton group because of their seasonal prominence in terms of abundance and their contribution in controlling primary production (phytoplankton). On a global scale, there are few studies on Cladocera in hypersaline environments. The present work aims to evaluate the spatio-temporal variation of the Cladocera assemblage across a salinity gradient in the habitats of the Araruama Lagoon. Samples were collected in random months over a period of four years at 12 fixed stations in the Araruama Lagoon using a WP2 plankton net equipped with a flow meter. Our results do not reveal significant influence of the tide and seasonal variation as factors affecting the Cladocera assemblage. Five Cladocera species were found in the Araruama Lagoon, only in stations 11 and 12 where they reached an average of 1,799 ± 3,103 ind. m-3. The mean of the Shannon Diversity Index was 0.45 ± 0.2. The species that stood out in terms of frequency and abundance were: Penilia avirostris (frequency of occurrence: 71%), followed by Pseudevadne tergestina (41%). The same species also stood out in terms of relative abundance, Penilia avirostris (87%) and Pseudevadne tergestina (11%). The absence of Cladocera in the innermost parts of the lagoon suggests that their entrance to these locations is possibly inhibited by the salinity and temperature gradient of the lagoon, being the main factors influencing the dynamics of the Cladocera assemblages.


Os cladóceros representam um importante grupo de zooplâncton, devido ao seu destaque sazonal em termos de abundância e à sua contribuição no controlo da produção primária (fitoplâncton). Em escala global, há poucos estudos com Cladocera em ambientes hipersalinos. O presente trabalho tem como objetivo avaliar a variação espaço-temporal da assembleia de Cladocera em um gradiente de salinidades da Lagoa de Araruama. As amostras foram coletadas em meses aleatórios, durante um período de quatro anos, em 12 estações fixas na Lagoa de Araruama, utilizando uma rede de plâncton WP2 equipada com um fluxômetro. Os nossos resultados não revelam uma influência significativa da maré e da variação sazonal como fatores que afetam a assembleia de Cladocera. Cinco espécies de Cladocera foram encontradas na Lagoa de Araruama. A assembleia apresentou maior densidade absoluta estações 12 e 11, atingindo uma a média de 1.799 ± 3.103 inds-3. A média do Índice de Diversidade de Shannon foi de 0,45 ± 0,2. As espécies que se destacaram em termos de frequência e abundância foram: Penilia avirostris (frequência de ocorrência: 71%), seguida de Pseudevadne tergestina (41%). As mesmas espécies também se destacaram em termos de abundância relativa Penilia avirostris (87%) e Pseudevadne tergestina (11%). A ausência de Cladocera nas partes mais interiores da lagoa sugere que a sua entrada nestes locais é possivelmente inibida pela salinidade e gradiente de temperatura da lagoa, sendo os principais fatores que influenciam a dinâmica da assembleia de Cladocera.


Assuntos
Animais , Cladocera , Fitoplâncton , Plâncton , Estações do Ano , Zooplâncton
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