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1.
Surg Endosc ; 38(6): 3288-3295, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38658391

RESUMEN

INTRODUCTION: Surgery is currently the only effective treatment for retroperitoneal tumors that do not involve any specific organ. The use of robots for removing both benign and malignant retroperitoneal tumors is considered safe and feasible. However, there is insufficient evidence to determine whether robotic retroperitoneal tumor resection (RMBRs) is superior to open retroperitoneal malignant resection (OMBRs). This study compares the short-term outcomes of robotic excision of benign and malignant retroperitoneal tumors with open excision of the same-sized tumors. METHODS: The study compared demographics and outcomes of patients who underwent robotic resection (n = 54) vs open resection (n = 54) of retroperitoneal tumors between March 2018 and December 2022. A 1:1 matching analysis was conducted to ensure a fair comparison. RESULTS: The study found that RBMRs resulted in reduced operative time (OT), estimated blood loss (EBM), and postoperative hospital stay (PSH) when compared to OBMRs. Additionally, RBMRs reduced EBL, PHS, and OT for patients with malignant tumor involvement in major vessels. No significant differences were found in tumor size, blood transfusion rate, and morbidity rate between the RBMRs and OBMRs groups. CONCLUSION: When comparing RMBRs to OMBRs, it was observed that RMBR was associated with lower (EBL), shorter postoperative hospital stays (PHS), and reduced operative time (OT) in a specific group of patients with both benign and malignant tumors.


Asunto(s)
Aorta Abdominal , Tiempo de Internación , Tempo Operativo , Neoplasias Retroperitoneales , Procedimientos Quirúrgicos Robotizados , Vena Cava Inferior , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Vena Cava Inferior/cirugía , Vena Cava Inferior/patología , Masculino , Femenino , Neoplasias Retroperitoneales/cirugía , Neoplasias Retroperitoneales/patología , Persona de Mediana Edad , Aorta Abdominal/cirugía , Tiempo de Internación/estadística & datos numéricos , Anciano , Estudios Retrospectivos , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Adulto , Resultado del Tratamiento , Riñón/cirugía , Riñón/patología
2.
BMC Geriatr ; 24(1): 314, 2024 Apr 04.
Artículo en Inglés | MEDLINE | ID: mdl-38575871

RESUMEN

BACKGROUND AND OBJECTIVES: It is known that difficulty sleeping after a fracture can have negative effects on both mental and physical health and may prolong the recovery process. The objective of this study is to explore how sleep quality and psychological health are linked in patients with pelvic and acetabulum fractures. METHODS: A study was conducted on 265 patients between 2018 and 2022 who had suffered pelvic and acetabulum fractures. The study examined various factors, including age, gender, cause of injury, post-operative complications, and injury severity. The study employed ordinal logistic regression to examine the relationship between various pelvic fractures and seven subscales of the Majeed Pelvic Score (MPS), as well as the Sleep Disorder Questionnaire (SDQ) and Beck Depression Inventory (BDI). The study focused on the postoperative outcome one year after surgery, and each patient was assessed at the one-year mark after surgical intervention. Additionally, the study evaluated the functional outcome, sleep quality, and psychological disorders of the patients. RESULTS: From 2018 to 2022, a total of 216 patients suffered from pelvic and acetabulum fractures. Among them, 6.6% experienced borderline clinical depression, and 45.2% reported mild mood disturbances. Anxiety was found to be mild to moderate in 46% of Tile C and posterior acetabulum wall fracture patients. About 24.8% of patients reported insomnia, while 23.1% reported sleep movement disorders. However, no significant correlation was found between fracture types and sleep disorders. The mean Majeed pelvic score (MPS) was 89.68. CONCLUSIONS: Patients with pelvic and acetabular fractures typically experience functional improvement, but may also be at increased risk for insomnia and sleep movement disorders, particularly for certain types of fractures. Psychological well-being varies between fracture groups, with signs of borderline clinical depression observed in some cases. However, anxiety levels do not appear to be significantly correlated with pelvic and acetabular fractures.


Asunto(s)
Fracturas Óseas , Fracturas de Cadera , Trastornos del Movimiento , Huesos Pélvicos , Trastornos del Inicio y del Mantenimiento del Sueño , Fracturas de la Columna Vertebral , Humanos , Acetábulo/lesiones , Estudios Transversales , Calidad del Sueño , Fracturas Óseas/complicaciones , Fracturas Óseas/epidemiología , Fracturas Óseas/cirugía , Huesos Pélvicos/cirugía , Huesos Pélvicos/lesiones , Estudios Retrospectivos
3.
J Pak Med Assoc ; 73(4): 892-895, 2023 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-37052009

RESUMEN

Renal transplantation is considered to be the treatment of choice for patients with end-stage kidney failure. While transplantation has a high success rate, there are a number of associated challenges which include those related to the primary disease, transplant procedure as well as medications that are necessary to take after transplantation. Steroids, for instance, have been reported to lead to ocular complications in patients who have undergone renal transplantation in other parts of the world. This retrospective case series reports the pattern of ocular complications among patients who underwent renal transplant since the inception of ophthalmology clinic at a dialysis and transplant centre in Karachi, Pakistan. The case series corroborates the findings of other similar studies from around the world, with cataract being the most common occurrence in this cohort. A unique finding in Pakistani setup includes the high prevalence of night blindness, which requires investigation in a larger cohort prospectively.


Asunto(s)
Catarata , Fallo Renal Crónico , Trasplante de Riñón , Humanos , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/métodos , Estudios Retrospectivos , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/cirugía , Fallo Renal Crónico/complicaciones , Diálisis Renal/métodos , Catarata/complicaciones
4.
Acta Orthop Belg ; 89(2): 354-361, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-37924554

RESUMEN

The posterolateral tibial plateau fracture is an uncommon intra-articular injury and mostly needed surgery. However, its surgical approach remains controversial. This manuscript describes an anterolateral approach to treat posterolateral tibial plateau fractures and evaluates the patient's functional outcomes. From June 2018 to July 2021 seventeen patients with posterolateral tibial plateau fractures were surgically treated through an anterolateral approach. The intraoperative and postoperative follow-up indicators were recorded. The reduction quality of fractures was assessed using Rasmussen radiological score, and postsurgical functional recovery was estimated using Rasmussen clinical score and Lysholm score. The mean follow-up interval was 28.71 ± 9.61 months (range 18-44). The surgery time and blood loss were 111.06 ± 15.62 min (range 85-140) and 118.12 ± 38.45 mL (range 80-250) separately. Postoperatively, the Rasmussen radiological score was 16.24 ± 2.33 (range 12-18). The average time of bone union was 14.29 ± 1.53 weeks (range 12-18). At the final follow-up, the average PTS and MPTA were 9.71 ± 2.76° (range 5-14°) and 86.82 ± 2.04° (range 84-90°) separately. A satisfactory articular reduction was achieved in 16 patients (94.1%). The final ROM was 123.29 ± 19.70° (range 60-142°). The Rasmussen clinical score and Lysholm score were 25.71 ± 5.74 (range 10-30) and 91.47 ± 6.50 (range 75-98) separately. Anterolateral approach has minimal risk of intraoperative neurovascular injuries in the popliteal fossa with satisfactory results. The hardware removal was also facilitated. This approach is feasible, safe and efficient.


Asunto(s)
Fracturas de la Tibia , Fracturas de la Meseta Tibial , Humanos , Resultado del Tratamiento , Fijación Interna de Fracturas/métodos , Curación de Fractura , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/cirugía , Estudios Retrospectivos , Placas Óseas
5.
Philos Trans A Math Phys Eng Sci ; 380(2236): 20210352, 2022 Nov 14.
Artículo en Inglés | MEDLINE | ID: mdl-36154473

RESUMEN

Numerous applied models used in the study of optimal control problems, inverse problems, shape optimization, machine learning, fractional programming, neural networks, image registration and so on lead to stochastic optimization problems in Hilbert spaces. Under a suitable convexity assumption on the objective function, a necessary and sufficient optimality condition for stochastic optimization problems is a stochastic variational inequality. This article presents a new stochastic regularized second-order iterative scheme for solving a variational inequality in a stochastic environment where the primary operator is accessed by employing sampling techniques. The proposed iterative scheme, which fits within the general framework of the stochastic approximation approach, has its almost-sure convergence analysis given in a Hilbert space. We test the feasibility and the efficacy of the proposed stochastic approximation approach for a stochastic optimal control problem and a stochastic inverse problem, both associated with a second-order stochastic partial differential equation. This article is part of the theme issue 'Non-smooth variational problems and applications'.

6.
J Econ Entomol ; 109(1): 78-83, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26578626

RESUMEN

Aphis pomi De Geer, the green apple aphid, is an economic pest of apple and other rosaceae throughout the world. In the present study, functional responses of the syrphids Episyrphus balteatus De Geer, Eristalis tenax(L.), Eristalis interruptus (Poda), and Sphaerophoria scripta (L.), to A. pomi were studied under laboratory conditions to determine their relative predatory potential. The second- and third-instar larvae of the predators were exposed to increasing densities of similar-sized A. pomi nymphs in Petri dishes. Ep. balteatus was found to possess the highest consumption rate followed by Er. tenax, Er. interruptus, and S. scripta. All predator species and stages exhibited a Type II functional response. The coefficients of attack rate and handling time showed an insignificant variation between species and preying stages, suggesting equal potential of the four syrphid species to regulate A. pomi colonies.


Asunto(s)
Áfidos/fisiología , Dípteros/fisiología , Control Biológico de Vectores , Conducta Predatoria , Animales , Áfidos/crecimiento & desarrollo , Agentes de Control Biológico , Dípteros/crecimiento & desarrollo , Larva/crecimiento & desarrollo , Larva/fisiología , Ninfa/crecimiento & desarrollo , Ninfa/fisiología
7.
HPB (Oxford) ; 18(1): 88-97, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26776856

RESUMEN

OBJECTIVES: We report single center experience on the outcome and toxicity of SBRT alone or in combination with surgery for inoperable primary and metastatic liver tumors between 2007 and 2014. PATIENTS AND METHODS: Patients with 1-4 hepatic lesions and tumor diameter ≤9 cm received SBRT at 46.8Gy ± 3.7 in 4-6 fractions. The primary end point was local control with at least 6 months of radiographic followup, and secondary end points were toxicity and survival. RESULTS: Eighty-seven assessable patients (114 lesions) completed liver SBRT for hepatoma (39) or isolated metastases (48) with a median followup of 20.3 months (range 1.9-64.1). Fourteen patients underwent liver transplant with SBRT as a bridging treatment or for tumor downsizing. Eight patients completed hepatic resections in combination with planned SBRT for unresectable tumors. Two-year local control was 96% for hepatoma and 93.8% for metastases; it was 100% for lesions ≤4 cm. Two-year overall survival was 82.3% (hepatoma) and 64.3% (metastases). No incidence of grade >2 treatment toxicity was observed. CONCLUSION: In this retrospective analysis we demonstrate that liver SBRT alone or in combination with surgery is safe and effective for the treatment of isolated inoperable hepatic malignancies and provides excellent local control rates.


Asunto(s)
Carcinoma Hepatocelular/radioterapia , Carcinoma Hepatocelular/cirugía , Hepatectomía , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/cirugía , Trasplante de Hígado , Terapia Neoadyuvante , Radiocirugia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/patología , Fraccionamiento de la Dosis de Radiación , Femenino , Hepatectomía/efectos adversos , Hepatectomía/mortalidad , Humanos , Estimación de Kaplan-Meier , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/mortalidad , Masculino , Persona de Mediana Edad , Imagen Multimodal/métodos , Terapia Neoadyuvante/efectos adversos , Terapia Neoadyuvante/mortalidad , Pennsylvania , Radiocirugia/efectos adversos , Radiocirugia/mortalidad , Planificación de la Radioterapia Asistida por Computador , Radioterapia Adyuvante , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Carga Tumoral
8.
Crit Care Med ; 43(6): 1291-325, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25978154

RESUMEN

This document was developed through the collaborative efforts of the Society of Critical Care Medicine, the American College of Chest Physicians, and the Association of Organ Procurement Organizations. Under the auspices of these societies, a multidisciplinary, multi-institutional task force was convened, incorporating expertise in critical care medicine, organ donor management, and transplantation. Members of the task force were divided into 13 subcommittees, each focused on one of the following general or organ-specific areas: death determination using neurologic criteria, donation after circulatory death determination, authorization process, general contraindications to donation, hemodynamic management, endocrine dysfunction and hormone replacement therapy, pediatric donor management, cardiac donation, lung donation, liver donation, kidney donation, small bowel donation, and pancreas donation. Subcommittees were charged with generating a series of management-related questions related to their topic. For each question, subcommittees provided a summary of relevant literature and specific recommendations. The specific recommendations were approved by all members of the task force and then assembled into a complete document. Because the available literature was overwhelmingly comprised of observational studies and case series, representing low-quality evidence, a decision was made that the document would assume the form of a consensus statement rather than a formally graded guideline. The goal of this document is to provide critical care practitioners with essential information and practical recommendations related to management of the potential organ donor, based on the available literature and expert consensus.


Asunto(s)
Unidades de Cuidados Intensivos/organización & administración , Guías de Práctica Clínica como Asunto , Donantes de Tejidos , Obtención de Tejidos y Órganos/organización & administración , Muerte , Humanos , Unidades de Cuidados Intensivos/normas , Derechos del Paciente , Sociedades Médicas , Obtención de Tejidos y Órganos/normas , Estados Unidos
9.
Arch Virol ; 159(5): 1199-205, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24287711

RESUMEN

Okra leaf curl disease (OLCD) is an important viral disease of okra in tropical and subtropical areas. The disease is caused by begomovirus-satellite complexes. A begomovirus and associated betasatellite and alphasatellite were identified in symptomatic okra plants from Barka, in the Al-Batinah region of Oman. Analysis of the begomovirus sequences showed them to represent a new begomovirus most closely related to cotton leaf curl Gezira virus (CLCuGeV), a begomovirus of African origin. The sequences showed less than 85 % nucleotide sequence identity to CLCuGeV isolates. The name okra leaf curl Oman virus (OLCOMV) is proposed for the new virus. Further analysis revealed that the OLCOMV is a recombinant begomovirus that evolved by the recombination of CLCuGeV isolates with tomato yellow leaf curl virus-Oman (TYLCV-OM). An alpha- and a betasatellite were also identified from the same plant sample, which were also unique when compared to sequences available in the databases. However, although the betasatellite appeared to be of African origin, the alphasatellite was most closely related to alphasatellites originating from South Asia. This is the first report of a begomovirus-satellite complex infecting okra in Oman.


Asunto(s)
Abelmoschus/virología , Begomovirus/fisiología , Enfermedades de las Plantas/virología , Virus Satélites/fisiología , Begomovirus/genética , Genoma Viral , Omán , Filogenia
10.
Arch Virol ; 159(3): 445-55, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24052149

RESUMEN

For last two decades, begomoviruses (family Geminiviridae) have been a major constraint for tomato production in Oman, particularly in the Al-Batinah region, the major agricultural area of Oman. Farms in the Al-Batinah region were surveyed during January-March and November-December in 2012 and January-February in 2013. Leaf samples of tomato plants showing typical leaf curl disease symptoms were collected and analyzed for begomoviruses. Out of fifteen begomovirus clones sequenced, seven were shown to be tomato yellow leaf curl virus strain Oman (TYLCV-OM); three, chili leaf curl virus strain Oman (ChLCV-OM); and one, tomato leaf curl Oman virus (ToLCOMV) - viruses that have previously been shown to occur in Oman. Four sequences were shown to have relatively low percent identity values to known begomoviruses, with the highest (86 %) to isolates of pepper leaf curl Lahore virus, indicating that these should be included in a new species, for which the name "Tomato leaf curl Al Batinah virus" (ToLCABV) is proposed. Although the betasatellite tomato leaf curl betasatellite (ToLCB; 7 full-length sequences isolated) was identified with some isolates of ChLCV-OM, TYLCV-OM and ToLCOMV, it was not identified in association with any of the ToLCABV isolates. Analysis of the sequences of the TYLCV-OM and ToLCOMV isolates characterized here did not show them to differ significantly from previously characterized isolates of these viruses. The three isolates of ChLCV-OM characterized were shown to have a recombination pattern distinct from earlier characterized isolates. ToLCABV was shown to have resulted from recombination between ChLCV-OM and ToLCOMV. A clone of ToLCABV was infectious by Agrobacterium-mediated inoculation to Nicotiana benthamiana and tomato, inducing symptoms typical of those seen in tomato in the field. Additionally, ToLCABV was shown to be able to interact in planta with ToLCB, resulting in a change in symptom phenotype, although the betasatellite did not appear to affect viral DNA levels.


Asunto(s)
Begomovirus/clasificación , Begomovirus/genética , Evolución Molecular , Enfermedades de las Plantas/virología , Polimorfismo Genético , Solanum lycopersicum/virología , Agrobacterium/genética , Begomovirus/aislamiento & purificación , Análisis por Conglomerados , ADN Viral/química , ADN Viral/genética , Datos de Secuencia Molecular , Omán , Filogenia , Recombinación Genética , Análisis de Secuencia de ADN , Homología de Secuencia , Nicotiana/virología , Transformación Genética
11.
J Insect Sci ; 14: 72, 2014 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-25373219

RESUMEN

The suitability of two prey species, Aphis pomi De Geer (Hemiptera: Aphididae) and Brevicoryne brassicae (L.), for two generalist aphidophagous coccinellids, Adalia tetraspilota (Hope) (Coleoptera: Coccinellidae) and Hippodamia variegata (Goeze), at various abundance levels was investigated under laboratory conditions. While both A. pomi and B. brassicae were found to be suitable, the predators performed better when feeding upon B. brassicae. The prey densities affected the developmental parameters of the two predators appreciably. Optimal growth and development was noted in the prey density range of 40-80 aphids per day per predator. Both species and abundance levels of prey significantly affected the larval period of the two predators. Appreciable variation in survivorship of larvae, prepupal and pupal period, and adult weight was noted by varying the prey species and prey abundance. Longer reproductive period (oviposition period) and shorter non-reproductive periods (preoviposition and postoviposition periods) were noted for females that fed on B. brassicae as compared to those that fed on A. pomi. Reproductive output was appreciably higher for females that fed on B. brassicae, and the fecundity decreased drastically under food shortage.


Asunto(s)
Áfidos , Escarabajos/crecimiento & desarrollo , Cadena Alimentaria , Animales , Brassicaceae , Femenino , Longevidad , Masculino , Conducta Predatoria , Reproducción
12.
Virus Genes ; 46(1): 195-8, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23085885

RESUMEN

Cassava mosaic disease (CMD) is the most devastating disease of the subsistence crop cassava (Manihot esculenta) across Africa and the Indian subcontinent. The disease is caused by viruses of the genus Begomovirus (family Geminiviridae)-seven species have been identified so far. The Sultanate of Oman is unusual among countries in Arabia in growing cassava on a small scale for local consumption. During a recent survey in A'Seeb wilayat of Muscat governorate, Oman, cassava plants were identified with symptoms typical of CMD. A begomovirus, East African cassava mosaic Zanzibar virus (EACMZV), was isolated from symptomatic plants. This virus was previously only known to occur in Zanzibar and Kenya. During the 19th Century, Zanzibar was governed by Oman and was so important that the Sultan of Oman moved his capital there from Muscat. After a period of colonial rule, the governing Arab elite was overthrown, following independence in the 1960s, and many expatriate Omanis returned to their homeland. Having gained a liking for the local Zanzibar cuisine, it appears that returning Omanis did not wish to do without dishes made from one particular favorite, cassava. Consequently, they carried planting material back to Oman for cultivation in their kitchen gardens. The evidence suggests that this material harbored EACMZV. Recently, Oman has been shown to be a nexus for geminiviruses and their associated satellites from diverse geographic origins. With their propensity to recombine, a major mechanism for evolution of geminiviruses, and the fact that Oman (and several other Arabian countries) is a major hub for trade and travel by air and sea, the possibility of onward spread is worrying.


Asunto(s)
Begomovirus/aislamiento & purificación , Manihot/virología , Enfermedades de las Plantas/virología , Secuencia de Bases , Análisis por Conglomerados , ADN Viral/genética , Datos de Secuencia Molecular , Omán , Filogenia , Alineación de Secuencia , Análisis de Secuencia de ADN
13.
J Orthop Surg Res ; 18(1): 654, 2023 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-37667295

RESUMEN

BACKGROUND AND OBJECTIVES: Local anesthetics (LAs) are widely used to infiltrate into surgical wounds for postoperative analgesia. Different adjuvants like dexamethasone and dexmedetomidine, when added to LA agents, could improve and prolong analgesia. The aim of this trial was to evaluate the analgesic efficacy and opioid-sparing properties of dexamethasone and dexmedetomidine when added to ropivacaine for wound infiltration in transforaminal lumbar interbody fusion (TLIF). METHODS: We conducted a controlled study among 68 adult patients undergoing TLIF, which was prospective, randomized and double-blind in nature. The participants were divided into four equal groups at random. Group R was given 150 mg of 1% ropivacaine (15 mL) and 15 mL of normal saline. Group R + DXM received 150 mg of 1% ropivacaine (15 mL) and 10 mg of dexamethasone (15 mL). Group R + DEX received 150 mg of 1% ropivacaine (15 mL) and 1 µg/kg of dexmedetomidine (15 mL). Lastly, group R + DXM + DEX was given 150 mg of 1% ropivacaine (15 mL), 10 mg of dexamethasone and 1 µg/kg of dexmedetomidine (15 mL). The primary focus was on the length of pain relief provided. Additionally, secondary evaluations included the amount of hydromorphone taken after surgery, the numerical rating scale and safety assessments within 48 h after the operation. RESULTS: Based on the p value (P > 0.05), there was no significant variance in the duration of pain relief or the total usage of hydromorphone after surgery across the four groups. Similarly, the numerical rating scale scores at rest and during activity at 6-, 12-, 24- and 48-h post-surgery for all four groups showed no difference (P > 0.05). However, the incidence of delayed anesthesia recovery was slightly higher in group R + DEX and group R + DXM + DEX when compared to group R or group R + DXM. Furthermore, there were no significant differences between the four groups in terms of vomiting, nausea, dizziness or delayed anesthesia recovery. CONCLUSION: For wound infiltration in TLIF, the addition of dexamethasone and dexmedetomidine to ropivacaine did not result in any clinically significant reduction in pain or opioid consumption and could prompt some side effects.


Asunto(s)
Adyuvantes Anestésicos , Analgesia , Dexametasona , Dexmedetomidina , Fusión Vertebral , Adulto , Humanos , Analgesia/métodos , Analgésicos Opioides , Dexametasona/administración & dosificación , Dexmedetomidina/administración & dosificación , Hidromorfona , Vértebras Lumbares/cirugía , Dolor , Estudios Prospectivos , Ropivacaína/administración & dosificación , Fusión Vertebral/efectos adversos , Adyuvantes Anestésicos/administración & dosificación , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Anestesia Local/métodos
14.
Clin Nephrol ; 77(3): 246-53, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22377258

RESUMEN

Antibody-mediated rejection (AMR) following renal transplantation is less responsive to conventional anti-rejection therapies. Plasmapheresis (PP), intravenous immunoglobulin (IVIg), rabbit antithymocyte globulin (rATG) and rituximab deplete immature B-cells but not mature plasma cells. The proteasome inhibitor bortezomib has activity against mature plasma cell, the source of damaging donor-specific antibody (DSA).We present the successful use of bortezomib in 2 patients who developed AMR following kidney transplantation. The first patient was a 54-year-old white female who received living-unrelated kidney transplantation from her husband. She developed severe AMR early after transplantation with rising DSA titers consistent with an anamnestic immune response by memory cells to the donor antigens. Renal function deteriorated despite treatment with pulse methylprednisolone (MP), PP and IVIg. After initiation of therapy with bortezomib, DSA titers became negative and serum creatinine returned to baseline with histological resolution of AMR. The second patient was a 19-year-old white male who received deceased donor kidney transplantation and developed AMR within 2 weeks, refractory to therapy with pulse MP, PP and IVIg with rising DSA. Bortezomib use resulted in disappearance of DSA and renal function improvement. Both patients tolerated the treatment well with stable renal function at last follow-up. The novel mechanisms of action and preliminary results with bortezomib are encouraging, but require larger studies and longer follow-up.


Asunto(s)
Ácidos Borónicos/uso terapéutico , Rechazo de Injerto/tratamiento farmacológico , Isoanticuerpos/sangre , Fallo Renal Crónico/cirugía , Trasplante de Riñón/inmunología , Inhibidores de Proteasas/uso terapéutico , Inhibidores de Proteasoma , Pirazinas/uso terapéutico , Adulto , Biopsia , Bortezomib , Femenino , Rechazo de Injerto/enzimología , Rechazo de Injerto/inmunología , Rechazo de Injerto/patología , Humanos , Masculino , Persona de Mediana Edad , Complejo de la Endopetidasa Proteasomal/metabolismo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
15.
Scientifica (Cairo) ; 2022: 5831832, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35979342

RESUMEN

Agriculture is the economic backbone of Pakistan. 67% of country's population resides in rural areas and primarily depends on agriculture. Pakistan's soils are poor in OM and have a low C : N ratio, and the overall fertility status is insufficient to support increased crop yields. Compost is an excellent alternative solution for improving soil OM content. However, this excellent alternative supply in Pakistan has yet to be used. Mass volumes of leaves, grass clippings, plant stalks, vines, weeds, twigs, and branches are burned daily. In this study, different compost piles (P1, P2, and P3) of compost were made using different agricultural and animal waste combinations to assess temperature, pH, and NPK. Results revealed that P3 demonstrated the most successful composting procedure. The temperature and pH levels throughout the composting process were determined in a specified range of 42-45oC and 6.1-8.3, respectively. Total nitrogen content ranged from 81.5 to 2175 ppm in farm compost. Total phosphorus concentrations range from 1.33 to 13.98 ppm, and potassium levels, on the other hand, range from 91.53 to 640 ppm in farm compost. The overall nitrogen concentration grew progressively between each pile at the end of a week. The varied concentrations revealed that adding various forms of agricultural waste would result in a variation in the quantity of NPK owing to microbial activity. On-farm composting has emerged as an effective technique for the sustainability of agricultural activities, capable of resolving crucial problems like crop residues and livestock waste disposal. Based on this study's results, the pile (P3) combination shows the best NPK value performance and is recommended for agricultural uses to overcome the OM deficiency.

16.
Clin Transplant ; 25(1): E32-7, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-20636411

RESUMEN

Immunosuppression management in post-transplant malignancy is challenging because of a lack of objective immunologic assessment tools. The ImmuKnow assay measures the ATP level from CD4 T cells, quantifying cell-mediated immunity and providing an insight into the immune status of transplant recipients. Its potential use in patients with post-transplant de novo malignancy was evaluated. Thirteen adult transplant patients with de novo malignancy were divided into survivors (n = 9) and non-survivors (n = 4) after malignancy treatment. Tacrolimus and the ImmuKnow levels were monitored before, during, and after malignancy treatment. The ImmuKnow level in non-survivors group was significantly lower before and after malignancy treatment compared to survivors group (p = 0.013 and 0.0014 respectively). In survivor group, the ImmuKnow level was significantly decreased during malignancy treatment (p = 0.019) but recovered to the initial level after the treatment. However, in non-survivor group, the ImmuKnow level remained suppressed throughout the observed period despite a reduction in immunosuppressive drug levels. The ImmuKnow assay can be an objective means evaluating immune status of patients with de novo malignancy. The ImmuKnow assay can express the degree of immune suppression induced by chemotherapeutic or radiation therapy and may be a useful tool in optimizing the timing of re-introduction of immunosuppression after malignancy treatment.


Asunto(s)
Carcinoma de Células Escamosas/tratamiento farmacológico , Rechazo de Injerto/inmunología , Inmunosupresores/uso terapéutico , Complicaciones Posoperatorias , Tacrolimus/uso terapéutico , Neoplasias de la Lengua/tratamiento farmacológico , Adenosina Trifosfato/metabolismo , Adulto , Anciano , Linfocitos T CD4-Positivos/inmunología , Carcinoma de Células Escamosas/etiología , Monitoreo de Drogas , Femenino , Estudios de Seguimiento , Humanos , Inmunidad Celular , Pruebas Inmunológicas , Trasplante de Riñón , Trasplante de Hígado , Masculino , Persona de Mediana Edad , Trasplante de Páncreas , Estudios Prospectivos , Tasa de Supervivencia , Neoplasias de la Lengua/etiología , Resultado del Tratamiento , Adulto Joven
17.
Transpl Int ; 24(7): 640-50, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-21429047

RESUMEN

In addition to standard corticosteroid induction, anti-thymocyte globulin (ATG) or daclizumab as induction immunosuppression has been reported for liver transplantation. However, the effects and long-term outcomes of antibody induction therapy are not well known, especially for hepatitis C (HCV). The United Network for Organ Sharing (UNOS) database was utilized to analyze 16, 898 adult primary liver transplant patients who received ATG alone (n = 452), ATG and steroids (ATG + S) (n = 1758), daclizumab alone (n = 683), or steroid alone (n = 14, 005), listed as induction immunosuppression. Graft and patient survival, and donor and recipient factors for survival were analyzed for HCV and all liver diseases. For patients with HCV, ATG + S had significantly inferior graft survival compared with daclizumab (P = 0.01) and steroids (P = 0.03). The Cox proportional hazards model also showed that ATG + S was a marginal risk factor for graft failure (P = 0.05). On the other hand, for patients with all the liver diseases, graft and patient survival were not significantly different between induction regimens. ATG induction appeared to be preferentially used in patients with renal dysfunction, with improvement in renal function after liver transplantation. Thus, ATG induction can be used for patients with renal dysfunction in non-HCV diseases. Daclizumab induction achieved satisfactory short-term and long-term outcomes of liver transplantation in all the liver diseases including HCV disease.


Asunto(s)
Corticoesteroides/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Suero Antilinfocítico/uso terapéutico , Inmunoglobulina G/uso terapéutico , Terapia de Inmunosupresión/métodos , Trasplante de Hígado/métodos , Corticoesteroides/administración & dosificación , Adulto , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales Humanizados , Suero Antilinfocítico/administración & dosificación , Daclizumab , Femenino , Rechazo de Injerto , Supervivencia de Injerto/efectos de los fármacos , Hepatitis C/epidemiología , Hepatitis C/prevención & control , Humanos , Inmunoglobulina G/administración & dosificación , Trasplante de Hígado/mortalidad , Masculino , Persona de Mediana Edad , Sistema de Registros , Insuficiencia Renal/prevención & control , Prevención Secundaria
18.
Int J Mech Sci ; 2112021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37720357

RESUMEN

The mechanical response of an advanced high strength and corrosion resistant 10 % Cr nanocomposite steel (ASTM A1035CS Grade 120) is measured under uniaxial tension and compression at the strain rates of 10-4 s-1, 10-2 s-1, 100 s-1, 700 s-1, and 3000 s-1. The experiments are performed at 22 °C as well as 80 °C to investigate the material behavior at the expected temperature rise due to adiabatic deformation at 15 % strain. Additionally, different compression-shear hat-shaped specimens are tested at quasi-static and dynamic strain rates to investigate the localization behavior of this material. The material exhibits small strain rate sensitivity (SRS) during quasi-static loading, but a pronounced SRS between quasi-static and dynamic strain rates. Tension-compression asymmetry is also observed at both temperatures. Experiments at 80 °C reveal a decrease in flow stress in both tension and compression indicating the material is sensitive to thermal softening due to adiabatic heating. Load-Unload-Reload (LUR) and strain rate jump experiments are performed to investigate the reasoning behind the approximate rate insensitivity of ASTM A1035CS steel during quasi-static strain rates. A new constitutive model is also developed using a novel rate dependent material model with a modified Hockett-Sherby (MHS) hardening model and incorporating Lode angle dependence to capture the tension-compression asymmetry. The model is also used to predict the LUR and strain rate jump experiments. Finally, reasoning behind the unique rate dependent thermo-mechanical behavior of ASTM A1035CS steel is discussed in regards to adiabatic heating, strain-partitioning, and phase transformation.

19.
Int J Plast ; 1302020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34135544

RESUMEN

The thermo-mechanical behavior and texture evolution of two overaged Al 7056 alloy plates, in T761 and T721 tempers, are measured over a wide range of strain rates (10‒4 - 3 × 103 s‒1) and temperatures (22-300 °C) under uniaxial tension and compression along the thickness direction, i.e. normal to the plate surface. A detailed study of the initial microstructure reveals an increase in precipitate size and decrease in density of precipitates, as the alloy is aged from the T761 to T721 temper; which in turn affects the flow stress and strain hardening behavior. Differences in flow strength and strain hardening rate, as well as tension-compression asymmetry in the two tempers, are apparent at the lower temperatures (22 °C & 100 °C) and decrease significantly at the higher temperatures (200 °C & 300 °C). Furthermore, initial texture measurements show a strong texture gradient along the normal direction (ND) of the plate. This texture gradient affects the ultimate stress insignificantly. However, it does have a considerable effect on the failure strains of specimens taken from different locations through the thickness. A transition from shear fracture at and below 200 °C to cup and cone fracture mode above 200 °C is observed in tension. Both tempers exhibit a positive strain rate sensitivity (SRS) that is dependent on temperature and strain rate. A sharp decrease in flow stress is found at 300 °C. The Khan-Liu (KL) model is modified to correlate with the measured thermo-mechanical responses of the two tempers over the studied, wide range of strain rates and temperatures. There is a close correlation between simulated and observed results.

20.
J Pak Med Assoc ; 59(12): 847-50, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-20201179

RESUMEN

OBJECTIVE: To asses the effects of Rocuronium pretreatment on Succinylcholine induced Fasciculations and postoperative Myalgias. METHODS: A randomized double blind case control study was conducted in Department of Anaesthesia and Surgical Intensive Care Unit, Liaquat National Hospital, Karachi from October 2003 - April 2004. Sixty adults ASA I or II patients who presented for elective general surgical procedures were included in the study. The patients were divided in two groups of thirty each by a simple lottery method. Group "A" received placebo and group "B" received Rocuronium 0.1 mg/kg, one minute prior to induction with Pentothal Sodium 5 mg/kg, Suxamethonium, 1.5 mg/kg and Nalbuphine 10 mg / 70 kg. Fasciculations and intubation condition was assessed immediately after the induction of anaesthesia while post operative myalgias were assessed 6, 12 and 24 hours after surgery. RESULTS: Fasciculations were noticed in group "A" as 100% (mild to severe) and in group "B" 13.3% (mild). Post operative myalgias at 6 and 12 hours after surgery were 76.66 % in group "A" and 16.66 in groups "B". After 24 hours in group "A' post operative myalgias were 93.33% and group "B" 23.33%. CONCLUSION: It is concluded that pretreatment with Rocuronium reduced the incidence of myalgias, fasciculations and produced rapid precurarization in one minute thereby saving time on busy operating lists. They also allowed the early ambulation of patients in minor surgeries.


Asunto(s)
Androstanoles/uso terapéutico , Fasciculación/prevención & control , Enfermedades Musculares/prevención & control , Fármacos Neuromusculares Despolarizantes/efectos adversos , Fármacos Neuromusculares no Despolarizantes/uso terapéutico , Succinilcolina/efectos adversos , Adolescente , Adulto , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/prevención & control , Rocuronio , Adulto Joven
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