RESUMEN
BACKGROUND: Marmosets (Callithrix sp.), including black-tuffed marmosets (C. penicillata), are neotropical primates that can be highly adapted to urban environments, especially parks and forested areas near cities. Staphylococcus spp. are part of the microbiota of many different hosts and lead to opportunistic severe infection. Isolates from wild animals can be resistant to antimicrobial drugs. However, there are a few studies that evaluated Staphylococcus spp. in neotropical primates. The goal of this study was to evaluate Staphylococcus spp. isolated from free-ranging black-tuffed marmosets. METHODS: Marmosets were captured in six urban parks. After sedation, skin and rectal swabs and feces were sampled. Staphylococcus spp. isolates were identified by MALDI-ToF and their antimicrobial susceptibility was determined. RESULTS: Over 30% of captured individuals were positive for Staphylococcus spp., and S. aureus was the most isolated species followed by Mammaliicoccus (Staphylococcus) sciuri. With the exception of the marmoset subjected to necropsy, none of the other had lesions, which supports that notion that Staphylococcus spp. are members of the microbiota, but also opportunistic pathogens. Most isolates were susceptible to all antimicrobials tested; however, one isolate of S. epidermidis was resistant to multiple antimicrobials (penicillin, cefoxitin, ciprofloxacin, clindamycin, and erythromycin). We considered S. aureus as the main staphylococci to colonize black-tuffed marmosets. CONCLUSIONS: Black-tuffed marmosets can be colonized by several Staphylococcus species, most frequently by S. aureus, and the majority of isolates were sensible to the antimicrobials tested. One S. epidermidis isolate was considered multidrug resistant.
Asunto(s)
Antibacterianos , Callithrix , Enfermedades de los Monos , Infecciones Estafilocócicas , Staphylococcus , Animales , Callithrix/microbiología , Staphylococcus/efectos de los fármacos , Staphylococcus/aislamiento & purificación , Enfermedades de los Monos/microbiología , Enfermedades de los Monos/epidemiología , Infecciones Estafilocócicas/veterinaria , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/epidemiología , Antibacterianos/farmacología , Femenino , Farmacorresistencia Bacteriana , Masculino , Microbiota/efectos de los fármacos , Ciudades , Brasil/epidemiología , Heces/microbiologíaRESUMEN
PURPOSE: This study aimed to map the use of hyaluronic acid (HA) in preventing and controlling radiotoxicity in women with gynecological cancer undergoing radiotherapy. METHODS: We conducted a scoping review of eight electronic databases: CINAHL, Cochrane CENTRAL, LILACS, PubMed, Scopus, Embase, LIVIVO, and the Web of Science Core Collection. In addition, a grey literature search was performed using Google Scholar and ProQuest Dissertations & Theses Global. A manual search was also identified additional references. The search was conducted on May 18, 2023. We included primary studies, reviews, and guidelines that discussed the use of HA to prevent and manage the toxicities resulting from gynecological radiotherapy. RESULTS: Eighteen studies were included in this scoping review, published between 2009 and 2022. There was heterogeneity in the use of HA, particularly in the method of application (moisturizing gel, vaginal ovules, spacer gel, and bladder instillations). Furthermore, the radiotoxicities varied among studies, encompassing, among others, vaginal atrophy, dryness, dyspareunia, telangiectasis, adhesions, vaginal stenosis, bleeding, hematuria, and bladder issues. Most studies addressed the potential benefits of HA in managing the signs and symptoms resulting from radiotherapy. CONCLUSION: HA has been utilized in clinical practice, in various formulations, for managing signs and symptoms in patients with gynecological cancer undergoing radiotherapy. However, further studies are necessary to thoroughly investigate the most effective method of HA application and its effectiveness in managing radiotoxicity.
Asunto(s)
Neoplasias de los Genitales Femeninos , Ácido Hialurónico , Traumatismos por Radiación , Humanos , Ácido Hialurónico/administración & dosificación , Femenino , Neoplasias de los Genitales Femeninos/radioterapia , Traumatismos por Radiación/etiologíaRESUMEN
Thrombotic microangiopathy is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and end-organ injury. Pregnancy-associated thrombotic microangiopathy is a severe disorder with a high risk of maternal mortality and poor fetal outcomes. Preeclampsia/eclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome are the most common causes, and hemolytic uremic syndrome or thrombotic thrombocytopenic purpura are rare causes. Due to overlapping clinical findings, the differential diagnosis is challenging and should be managed by a multidisciplinary team. We present a case of a 38-year-old woman at 40 weeks of second gestation, admitted with thrombotic microangiopathy being the final diagnosis not immediately clear.
Asunto(s)
Síndrome Hemolítico-Urémico , Púrpura Trombocitopénica Trombótica , Microangiopatías Trombóticas , Embarazo , Femenino , Humanos , Adulto , Microangiopatías Trombóticas/diagnóstico , Microangiopatías Trombóticas/etiología , Microangiopatías Trombóticas/terapia , Púrpura Trombocitopénica Trombótica/diagnóstico , Púrpura Trombocitopénica Trombótica/terapia , Púrpura Trombocitopénica Trombótica/etiología , Síndrome Hemolítico-Urémico/complicaciones , Síndrome Hemolítico-Urémico/diagnóstico , Hemólisis , Diagnóstico DiferencialRESUMEN
One outstanding challenge for machine learning in diagnostic biomedical imaging is algorithm interpretability. A key application is the identification of subtle epileptogenic focal cortical dysplasias (FCDs) from structural MRI. FCDs are difficult to visualize on structural MRI but are often amenable to surgical resection. We aimed to develop an open-source, interpretable, surface-based machine-learning algorithm to automatically identify FCDs on heterogeneous structural MRI data from epilepsy surgery centres worldwide. The Multi-centre Epilepsy Lesion Detection (MELD) Project collated and harmonized a retrospective MRI cohort of 1015 participants, 618 patients with focal FCD-related epilepsy and 397 controls, from 22 epilepsy centres worldwide. We created a neural network for FCD detection based on 33 surface-based features. The network was trained and cross-validated on 50% of the total cohort and tested on the remaining 50% as well as on 2 independent test sites. Multidimensional feature analysis and integrated gradient saliencies were used to interrogate network performance. Our pipeline outputs individual patient reports, which identify the location of predicted lesions, alongside their imaging features and relative saliency to the classifier. On a restricted 'gold-standard' subcohort of seizure-free patients with FCD type IIB who had T1 and fluid-attenuated inversion recovery MRI data, the MELD FCD surface-based algorithm had a sensitivity of 85%. Across the entire withheld test cohort the sensitivity was 59% and specificity was 54%. After including a border zone around lesions, to account for uncertainty around the borders of manually delineated lesion masks, the sensitivity was 67%. This multicentre, multinational study with open access protocols and code has developed a robust and interpretable machine-learning algorithm for automated detection of focal cortical dysplasias, giving physicians greater confidence in the identification of subtle MRI lesions in individuals with epilepsy.
Asunto(s)
Epilepsias Parciales , Epilepsia , Malformaciones del Desarrollo Cortical , Humanos , Estudios Retrospectivos , Malformaciones del Desarrollo Cortical/complicaciones , Malformaciones del Desarrollo Cortical/diagnóstico por imagen , Epilepsia/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Aprendizaje Automático , Epilepsias Parciales/diagnóstico por imagenRESUMEN
OBJECTIVES: To assess the prevalence of burnout, anxiety and depression symptoms, and posttraumatic stress disorder (PTSD) in PICU workers in Brazil during the first peak of the COVID-19 pandemic. To compare the results of subgroups stratified by age, gender, professional category, health system, and previous mental health disorders. DESIGN: Multicenter, cross-sectional study using an electronic survey. SETTING: Twenty-nine public and private Brazilian PICUs. SUBJECTS: Multidisciplinary PICU workers. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Self-reported questionnaires were used to measure burnout (Maslach Burnout Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), and PTSD (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [PCL-5]) in 1,084 respondents. Subjects were mainly young (37.1 ± 8.4 yr old) and females (85%), with a median workload of 50 hours per week. The prevalence of anxiety and depression was 33% and 19%, respectively, whereas PTSD was 13%. The overall median burnout scores were high in the emotional exhaustion and personal accomplishment dimensions (16 [interquartile range (IQR), 8-24] and 40 [IQR, 33-44], respectively) whereas low in the depersonalization one (2 [IQR, 0-5]), suggesting a profile of overextended professionals, with a burnout prevalence of 24%. Professionals reporting prior mental health disorders had higher prevalence of burnout (30% vs 22%; p = 0.02), anxiety (51% vs 29%; p < 0.001), and depression symptoms (32.5% vs 15%; p < 0.001), with superior PCL-5 scores for PTSD ( p < 0.001). Public hospital workers presented more burnout (29% vs 18.6%, p < 0.001) and more PTSD levels (14.8% vs 10%, p = 0.03). Younger professionals were also more burned out ( p < 0.05 in all three dimensions). CONCLUSIONS: The prevalence of mental health disorders in Brazilian PICU workers during the first 2020 peak of COVID-19 was as high as those described in adult ICU workers. Some subgroups, particularly those reporting previous mental disorders and younger professionals, should receive special attention to prevent future crises.
Asunto(s)
Agotamiento Profesional , COVID-19 , Femenino , Humanos , Niño , Salud Mental , COVID-19/epidemiología , Pandemias , Prevalencia , Estudios Transversales , Agotamiento Profesional/epidemiología , Agotamiento Profesional/psicología , Unidades de Cuidado Intensivo Pediátrico , Personal de Salud/psicologíaRESUMEN
In 2015, the failure of the Fundão dam in Mariana, Brazil released ~43 million m3 of iron mining tailings into the environment. Despite restoration initiatives in the following years, few studies-and most focused on revegetation-have evaluated the effectiveness of the restoration process in areas impacted by the disaster. We aimed to evaluate the responses of the arthropod community in areas impacted by iron mining tailings deposition from the Fundão dam that is in the restoration process. We defined sampling units in the riparian zone of the Gualaxo do Norte River, which is under restoration, and in a native not impacted riparian zone. We collected soil arthropods using pitfall traps and sampled environmental variables in the same sites. We used generalize least squares models (GLS) to test if the restored areas already presented values of arthropod diversity and functional group abundance similar to the reference area and to test which environmental variables are influencing arthropod diversity. We also tested how large the differences of arthropod community composition between the study areas and used the index of indicator species (IndVal) to verify which species could be used as an indicator of reference or restoration areas. The diversity of arthropods and the functional groups of detritivores and omnivores were higher in the native riparian zone. Understory density, soil density, organic matter content, and microbial biomass carbon were the environmental variables that significantly explained the diversity and species composition of arthropods. We show that restoration areas still have different soil arthropod diversity values and community composition when compared to reference areas. Evaluating the response of the arthropod community to the restoration process and long-term monitoring are essential to achieve a satisfactory result in this process and achieve a self-sustaining ecosystem.
Asunto(s)
Artrópodos , Animales , Ecosistema , Suelo , Monitoreo del Ambiente , Minería , Hierro , Brasil , RíosRESUMEN
BACKGROUND: Brain structure abnormalities throughout the course of Parkinson's disease have yet to be fully elucidated. OBJECTIVE: Using a multicenter approach and harmonized analysis methods, we aimed to shed light on Parkinson's disease stage-specific profiles of pathology, as suggested by in vivo neuroimaging. METHODS: Individual brain MRI and clinical data from 2357 Parkinson's disease patients and 1182 healthy controls were collected from 19 sources. We analyzed regional cortical thickness, cortical surface area, and subcortical volume using mixed-effects models. Patients grouped according to Hoehn and Yahr stage were compared with age- and sex-matched controls. Within the patient sample, we investigated associations with Montreal Cognitive Assessment score. RESULTS: Overall, patients showed a thinner cortex in 38 of 68 regions compared with controls (dmax = -0.20, dmin = -0.09). The bilateral putamen (dleft = -0.14, dright = -0.14) and left amygdala (d = -0.13) were smaller in patients, whereas the left thalamus was larger (d = 0.13). Analysis of staging demonstrated an initial presentation of thinner occipital, parietal, and temporal cortices, extending toward rostrally located cortical regions with increased disease severity. From stage 2 and onward, the bilateral putamen and amygdala were consistently smaller with larger differences denoting each increment. Poorer cognition was associated with widespread cortical thinning and lower volumes of core limbic structures. CONCLUSIONS: Our findings offer robust and novel imaging signatures that are generally incremental across but in certain regions specific to disease stages. Our findings highlight the importance of adequately powered multicenter collaborations. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Asunto(s)
Enfermedad de Parkinson , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Humanos , Imagen por Resonancia Magnética , Neuroimagen , Enfermedad de Parkinson/complicaciones , Tálamo/patologíaRESUMEN
Chestnut coat color in horses is determined by a missense mutation within the MC1R gene. However, the intensity of the chestnut color can vary widely within individuals possessing this genotype. Here, we investigated this variation using standardized photographs of 96 horses. Each horse was ranked lightest to darkest within the cohort for phenotype by 3 blinded observers. A genome-wide association study utilizing the relative shade ranking as the phenotype and using 268 487 single-nucleotide polymorphisms (SNPs) genotyped using the Affymetrix Equine 670k array identified a single significantly associated region on chromosome 3 (P = 2.934 × 10-8). Analysis of whole-genome sequences for horses spanning the diverse range of chestnut color identified candidate SNPs within the coding sequence of the only gene in the region: SALL1. The function of SALL1 is largely unknown, though it is predicted to interact with the Hermansky-Pudlak Syndrome type 1 (HPS1) protein, which causes partial albinism in humans. However, with only one study suggesting a circumstantial influence of the SALL1 protein on pigmentation, additional work is needed to confirm this new coat color locus in larger populations and investigate the function of this protein for impacts on equine health.
Asunto(s)
Estudio de Asociación del Genoma Completo , Pigmentación , Animales , Genoma , Genotipo , Caballos/genética , Fenotipo , Pigmentación/genéticaRESUMEN
Hygienic and sanitary measures and social distancing policies implemented during the new coronavirus disease - COVID-19 - pandemic have altered the care and follow-up provided by healthcare professionals for patients with chronic diseases, including patients with epilepsy (PWEs). Telemedicine has become a solution for the healthcare of PWEs in many developed countries. In this short communication, we trace a particular perspective for the application of telemedicine for PWEs undergoing ketogenic diet (KD) treatment, considering the social and economic difficulties faced by healthcare teams in resource-poor countries, such as Brazil. During the pandemic, financial strain was the main impediment to following KD. The pandemic increased socioeconomic insecurity and access to KD-related products, as well as increasing anxiety in 71% of PWE, impacting their KD treatment follow-up. The challenges of telemedicine in Brazil include not only social and economic issues but also access to food, healthcare services, and education for the population, in addition to digital inclusion.
Asunto(s)
COVID-19/epidemiología , Dieta Cetogénica/tendencias , Epilepsia Refractaria/dietoterapia , Epilepsia Refractaria/epidemiología , Programas Nacionales de Salud/tendencias , Telemedicina/tendencias , Adulto , Brasil/epidemiología , Dieta Cetogénica/métodos , Femenino , Humanos , Masculino , Pandemias , Telemedicina/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Police officers experience a high degree of chronic stress. Policing ranks among the highest professions in terms of disease and accident rates. Mental health is particularly impacted, evidenced by elevated rates of burnout, anxiety and depression, and poorer quality of life than the general public. Mindfulness training has been shown to reduce stress, anxiety, burnout and promote quality of life in a variety of settings, although its efficacy in this context has yet to be systematically evaluated. Therefore, this trial will investigate the efficacy of a mindfulness-based intervention versus a waitlist control in improving quality of life and reducing negative mental health symptoms in police officers. METHODS: This multicenter randomized controlled trial has three assessment points: baseline, post-intervention, and six-month follow-up. Active police officers (n = 160) will be randomized to Mindfulness-Based Health Promotion (MBHP) or waitlist control group at two Brazilian major cities: Porto Alegre and São Paulo. The primary outcomes are burnout symptoms and quality of life. Consistent with the MBHP conceptual model, assessed secondary outcomes include perceived stress, anxiety and depression symptoms, and the potential mechanisms of resilience, mindfulness, decentering, self-compassion, spirituality, and religiosity. DISCUSSION: Findings from this study will inform and guide future research, practice, and policy regarding police offer health and quality of life in Brazil and globally. TRIAL REGISTRATION: ClinicalTrials.gov NCT03114605 . Retrospectively registered on March 21, 2017.
Asunto(s)
Ansiedad , Agotamiento Profesional , Agotamiento Psicológico , Depresión , Atención Plena/métodos , Policia/psicología , Calidad de Vida , Adulto , Ansiedad/diagnóstico , Ansiedad/etiología , Ansiedad/terapia , Brasil , Agotamiento Profesional/psicología , Agotamiento Profesional/terapia , Agotamiento Psicológico/etiología , Agotamiento Psicológico/terapia , Depresión/diagnóstico , Depresión/etiología , Depresión/terapia , Empatía , Femenino , Humanos , Masculino , Salud MentalRESUMEN
Hereditary hemolytic anemias are a group of disorders with a variety of causes, including red cell membrane defects, red blood cell enzyme disorders, congenital dyserythropoietic anemias, thalassemia syndromes and hemoglobinopathies. As damaged red blood cells passing through the red pulp of the spleen are removed by splenic macrophages, splenectomy is one possible therapeutic approach to the management of severely affected patients. However, except for hereditary spherocytosis for which the effectiveness of splenectomy has been well documented, the efficacy of splenectomy in other anemias within this group has yet to be determined and there are concerns regarding short- and long-term infectious and thrombotic complications. In light of the priorities identified by the European Hematology Association Roadmap we generated specific recommendations for each disorder, except thalassemia syndromes for which there are other, recent guidelines. Our recommendations are intended to enable clinicians to achieve better informed decisions on disease management by splenectomy, on the type of splenectomy and the possible consequences. As no randomized clinical trials, case control or cohort studies regarding splenectomy in these disorders were found in the literature, recommendations for each disease were based on expert opinion and were subsequently critically revised and modified by the Splenectomy in Rare Anemias Study Group, which includes hematologists caring for both adults and children.
Asunto(s)
Anemia Hemolítica Congénita/cirugía , Guías como Asunto/normas , Esplenectomía/normas , Humanos , Esplenectomía/efectos adversos , Esplenectomía/métodos , Trombosis/etiologíaAsunto(s)
Proteínas de Fusión bcr-abl/sangre , Glucuronidasa/sangre , Leucemia Mielógena Crónica BCR-ABL Positiva/sangre , Proteínas Proto-Oncogénicas c-abl/sangre , ARN Mensajero/sangre , ARN Neoplásico/sangre , Inducción de Remisión , Femenino , Proteínas de Fusión bcr-abl/genética , Glucuronidasa/genética , Humanos , Leucemia Mielógena Crónica BCR-ABL Positiva/genética , Leucemia Mielógena Crónica BCR-ABL Positiva/terapia , Masculino , Neoplasia Residual , Proteínas Proto-Oncogénicas c-abl/genética , ARN Mensajero/genética , ARN Neoplásico/genéticaRESUMEN
BACKGROUND: Muscle strength is essential for healthy ageing. Handgrip strength (HGS) has been recommended by expert bodies as the preferred measure of muscle strength, in addition to being considered a strong predictor of overall health. Cross-sectional studies have shown several potential factors associated with HGS, but a systematic review of factors predicting HGS over time has not previously been conducted. The aim of this study is to systematically review the literature on the factors associated with adult HGS [at follow-up(s) or its rate of change] across the life course. METHODS: Searches were performed in MEDLINE via Ebsco, Embase and SPORTDiscus databases. Longitudinal studies assessing potential factors impacting adult HGS over time were included in the analyses. Based on previously established definitions of consistency of results, a semiquantitative analysis was conducted using the proportions of studies supporting correlations with HGS. RESULTS: A total of 117 articles were included in this review. Factors associated with HGS were grouped into 11 domains: demographic, socioeconomic, genetic, early life, body composition, health markers/biomarkers, health conditions, psychosocial, lifestyle, reproductive and environmental determinants. Overall, 103 factors were identified, of which 10 showed consistent associations with HGS over time (i.e., in at least four studies with ≥60% agreement in the direction of association). Factors associated with greater declines in HGS included increasing age, male sex, higher levels of inflammatory markers and the presence of cardiovascular diseases. Education level, medication use, and self-rated health were not associated with the rate of change in HGS. Increased birth weight was associated with a stronger HGS over time, whereas depressive symptoms were linked to a weaker HGS, and smoking habits showed null associations. CONCLUSIONS: Comparison between studies and estimation of effect sizes were limited due to the heterogeneity in methods. Although sex and age may be the main drivers of HGS decline, it is crucial to prioritize modifiable factors such as inflammation and cardiovascular diseases in health interventions to prevent greater losses. Interventions to improve birth weight and mental health are also likely to produce positive effects on muscle strength. Our results point to the complexity of processes involving muscle strength and suggest that the need to better understand the determinants of HGS remains.
RESUMEN
Apis mellifera L. (Hymenoptera: Apidae) is fundamental in the production chain, ensuring food diversity through the ecosystem service of pollination. The aim of this work was to evaluate the impact of imidacloprid, orally, topically, and by contact, on A. mellifera workers and to verify the presence of this active ingredient in honey. Toxicity levels were verified by bioassays. In bioassay 1, the levels correspond to the percentages of 100, 10, 1, 0.1, and 0.01% of the recommended concentration for field application of the commercial product Nortox® (active ingredient imidacloprid), with which we obtained the mean lethal concentration (LC50) in 48 h for A. mellifera, determining the concentration ranges to be used in the subsequent bioassays. Bioassays 2 and 3 followed the guidelines of the Organization for Economic Cooperation and Development, which specify the LC50 (48 h). In bioassay 4, the LC50 (48 h) and the survival rate of bees for a period of 120 h were determined by contact with a surface contaminated with imidacloprid, and in bioassay 5, the interference of the insecticide with the flight behavior of bees was evaluated. Honey samples were collected in agroecological and conventional georeferenced apiaries and traces of the imidacloprid were detected by means of high-performance liquid chromatography (HPLC-UV) with extraction by SPE C18. Bee survival was directly affected by the concentration and exposure time, as well behavioral performance, demonstrating the residual effect of imidacloprid on A. mellifera workers. Honey samples from a conventional apiary showed detection above the maximum residue limits (MRL) allowed by the European Union (0.05 µg mL-1), but samples from other apiaries showed no traces of this insecticide. Imidacloprid affects the survival rate and behavior of Africanized A. mellifera and honey quality.
Asunto(s)
Miel , Himenópteros , Insecticidas , Abejas , Animales , Insecticidas/toxicidad , Ecosistema , Neonicotinoides/toxicidad , Nitrocompuestos/toxicidadRESUMEN
There are a few studies on diseases of anteaters, but reports on reproductive lesions and neoplasms of these animals are scarce. This is the first report of a case of metastatic Sertoli cell tumour in a giant anteater (Myrmecophaga tridactyla). The animal had renal lesions associated with impaired renal function as indicated by serum biochemistry. Histopathological and immunohistochemical examinations provided a conclusive diagnosis of Sertoli cell tumour with metastasis to the liver, kidneys and lymph nodes.
Asunto(s)
Tumor de Células de Sertoli , Neoplasias Testiculares , Xenarthra , Masculino , Animales , Vermilingua , Tumor de Células de Sertoli/veterinaria , Animales de Zoológico , Neoplasias Testiculares/veterinariaRESUMEN
Reliable and accurate epidemiological data is a prerequisite for a cost effective screening program for inherited disorders, which however, is lacking in a number of developing countries. Here we report the first detailed population study in the Republic of Guinea, a sub-Saharan West African country, designed to assess the frequency of glucose-6-phosphate dehydrogenase (G6PD) deficiency and hemoglobinopathies, including screening for thalassemia. Peripheral blood samples from 187 Guinean adults were screened for hemoglobin (Hb) variants by standard hematological methods. One hundred and ten samples from males were screened for G6PD deficiency by the fluorescent spot test. Molecular analysis was performed for the most common α-thalassemia (α-thal) deletions, ß-globin gene mutations, G6PD variants B (376A), A (376G), A- (376G/202A) and Betica (376G/968C), using polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP) or sequencing. Of the 187 subjects screened, 36 were heterozygous for Hb S [ß6(A3)GluâVal, GAG>GTG] (allele frequency 9.62%). Sixty-four subjects were heterozygous and seven were homozygous for the -α(3.7) kb deletion (allele frequency 20.85%). ß-Thalassemia alleles were detected in five subjects, four with the -29 (A>G) mutation (allele frequency 1.07%) and one with codon 15 (TGG>TAG) (allele frequency 0.96%). The G6PD A- and G6PD Betica deficient variants were highly prevalent with a frequency of 5.7 and 3.3%, respectively. While we did not test for ferritin levels or α(0)-thal, four females (5.2%) had red cell indices strongly suggestive of iron deficient anemia: Hb <9.7 g/dL; MCH <19.3 pg; MCV <68.2; MCHC <31.6 g/dl; RDW >19.8%. Our results are consistent with high frequency of alleles such as Hb S, α-thal and G6PD deficient alleles associated with malaria resistance. Finding a 9.6% Hb S allele frequency supports the notion for a proficient neonatal screening to identify the sickle cell patients, who might benefit from early prophylactic treatment for infections. The incidence of significant iron deficient anemia in women is lower than expected in an under developed country.
Asunto(s)
Deficiencia de Glucosafosfato Deshidrogenasa/genética , Glucosafosfato Deshidrogenasa/genética , Hemoglobinopatías/genética , Globinas alfa/genética , Globinas beta/genética , Adulto , Femenino , Frecuencia de los Genes , Pruebas Genéticas/métodos , Genotipo , Deficiencia de Glucosafosfato Deshidrogenasa/epidemiología , Guinea/epidemiología , Haplotipos , Hemoglobinopatías/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Mutación , Reacción en Cadena de la Polimerasa , Polimorfismo Genético , Polimorfismo de Longitud del Fragmento de Restricción , Prevalencia , Talasemia/epidemiología , Talasemia/genética , Adulto JovenRESUMEN
CONTEXT: Epilepsy is a chronic neurological disorder that has social, cognitive, and psychological consequences to the patient. OBJECTIVE: The effects of the ketogenic diet (KD) in children and adults with pharmacoresistant epilepsy on cognitive function were evaluated in this systematic review. DATA SOURCES: The MEDLINE, Cochrane Library, Scopus, Web of Science, and LILACS databases were searched up to February 2021. STUDY SELECTION AND DATA EXTRACTION: From the 2973 records initially identified, 24 studies were included in the systematic review. These records were screened via PICO criteria, focusing on studies that evaluated the effects of KD on cognitive function of patients with pharmacoresistant epilepsy. RESULTS: Nineteen studies described improvements in cognitive function attributed to KD; improvements were not observed in 2 studies, but neither was aggravation. Contradictory results were reported in 3 studies, depending on the method used to assess cognition. At first glance, cognitive function appears to be associated with the number of seizures, diet effectiveness, amount of carbohydrate ingested, and antiseizure medication used. However, due to the diversity of methods used to assess cognitive function, especially self-perception of cognitive improvement by the patient, it was not possible to confirm this hypothesis. CONCLUSION: It was not possible to confirm if KD itself promotes improvements in cognitive function in patients with pharmacoresistant epilepsy. Certainly, more studies are needed with better methodological quality, larger and more homogeneous samples in relation to epileptic syndrome and clinical aspects of the disease, more rigid monitoring of adherence to the diet, and use of standardized tests for neuropsychological assessment. Systematic Review Registration: PROSPERO registration no. CRD42019129236.
Asunto(s)
Dieta Cetogénica , Epilepsia , Adulto , Niño , Cognición , Dieta Cetogénica/efectos adversos , Dieta Cetogénica/métodos , Humanos , ConvulsionesRESUMEN
Sepsis continues to be one of the leading causes of admission to the Pediatric Intensive Care Unit, representing a great challenge for researchers and healthcare staff. This mini review aims to assess research on pediatric sepsis over the years. Of the 2,698 articles retrieved from the Scopus database, the 100 most cited were selected (50 published since 2000 and 50 published since 2016). The most cited studies, published in the 21st century, are highlighted, with their main findings and perspectives.
RESUMEN
The treatment of breast cancer is often complicated by lymphedema of the upper limbs. Standard lymphedema evaluation methodologies are not able to measure tissue fibrosis. The ultrasound aspects related to tissue microstructures of lymphedema are neglected in clinical evaluations. The objective of this study was to identify and measure the degree of impairment, topography, and biophysical alterations of subcutaneous lymphedema tissue secondary to the treatment of breast cancer by ultrasonography. Forty-two women at a mean age of 58 (±9.7) years, with unilateral lymphedema due to breast cancer treatment, were evaluated. The upper limbs were divided into affected (affected by lymphedema) and control (contralateral limb). Each limb was subdivided into seven areas, defined by perimetry, evaluated in pairs. The biophysical characteristics thickness, entropy, and echogenicity were evaluated by ultrasonography. The results showed a significant difference in the echogenicity and thickness variables between the affected and unaffected upper limb, in all the extent of the upper limb, while entropy showed no significant difference. The findings indicate that the data presented were consistent both in identifying and measuring the degree of impairment and biophysical changes in the subcutaneous tissue of lymphedema secondary to the treatment of breast cancer.