RESUMO
BACKGROUND & AIMS: Liver failure is characterized by endothelial dysfunction, which results in hemodynamic disturbances leading to renal failure. Albumin infusion improves hemodynamics and prevents renal dysfunction in advance liver failure. These effects are only partly explained by the oncotic properties of albumin. This study was designed to test the hypothesis that albumin exerts its beneficial effects by stabilising endothelial function. METHODS: In vivo: systemic hemodynamics, renal function, markers of endothelial dysfunction (ADMA) and inflammation were studied in analbuminaemic and Sprague-Dawley rats, 6-weeks after sham/bile duct ligation surgery. In vitro: human umbilical vein endothelial cells were stimulated with LPS with or without albumin. We studied protein expression and gene expression of adhesion molecules, intracellular reactive oxygen species, and cell stress markers. RESULTS: Compared to controls, analbuminaemic rats had significantly greater hemodynamic deterioration after bile duct ligation, resulting in worse renal function and shorter survival. This was associated with significantly greater plasma renin activity, worse endothelial function, and disturbed inflammatory response. In vitro studies showed that albumin was actively taken up by endothelial cells. Incubation of albumin pre-treated endothelial cells with LPS was associated with significantly less activation compared with untreated cells, decreased intracellular reactive oxygen species, and markers of cell stress. CONCLUSIONS: These results show, for the first time, that absence of albumin is characterised by worse systemic hemodynamics, renal function and higher mortality in a rodent model of chronic liver failure and illustrates the important non-oncotic properties of albumin in protecting against endothelial dysfunction.
Assuntos
Albuminas , Arginina/análogos & derivados , Doença Hepática Terminal/metabolismo , Endotélio Vascular , Inflamação/metabolismo , Albuminas/metabolismo , Albuminas/farmacologia , Animais , Arginina/metabolismo , Modelos Animais de Doenças , Doença Hepática Terminal/fisiopatologia , Endotélio Vascular/metabolismo , Endotélio Vascular/fisiopatologia , Hemodinâmica/efeitos dos fármacos , Hemodinâmica/fisiologia , Humanos , Óxido Nítrico Sintase/metabolismo , Estresse Oxidativo , Ratos , Ratos Sprague-Dawley , Espécies Reativas de Oxigênio/metabolismo , Fator de von Willebrand/metabolismoRESUMO
BACKGROUND & AIM: This study assessed the involvement of metabolic factors (anthropometric indices, insulin resistance (IR) and adipocytokines) in the prediction of portal hypertension, esophageal varices and risk of variceal bleeding in cirrhotic patients. MATERIAL AND METHODS: Two prospective and retrospective cohorts of cirrhotic patients were selected (n = 357). The first prospective cohort (n = 280) enrolled consecutively in three centers, underwent upper gastrointestinal endoscopy, seeking evidence of esophageal varices. Clinical, anthropometric, liver function tests, ultrasonographic, and metabolic features were recorded at the time of endoscopy, patients were followed-up every 6 months until death, liver transplantation or variceal bleeding. The second retrospective cohort (n = 48 patients) had measurements of the hepatic venous pressure gradient (HVPG). Statistical analyses of the data were with the SPSS package. RESULTS: The presence of esophageal varices was independently associated with lower platelet count, raised HOMA index and adiponectin levels. This relationship extended to subset analysis in patients with Child A cirrhosis. HOMA index and adiponectin levels significantly correlated with HVPG. Beside Child-Pugh class, variceal size and glucagonemia, HOMA index but not adiponectin and leptin plasma levels were associated with higher risk of variceal bleeding. CONCLUSION: In patients with cirrhosis, HOMA score correlates with HVPG and independently predict clinical outcomes. Three simple markers i.e. platelet count, IR assessed by HOMA-IR and adiponectin significantly predict the presence of esophageal varices in cirrhotic patients.
Assuntos
Adiponectina/sangue , Glicemia/análise , Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/etiologia , Hipertensão Portal/etiologia , Insulina/sangue , Cirrose Hepática/complicações , Adulto , Idoso , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Egito , Endoscopia Gastrointestinal , Varizes Esofágicas e Gástricas/sangue , Varizes Esofágicas e Gástricas/diagnóstico , Feminino , Hemorragia Gastrointestinal/sangue , Hemorragia Gastrointestinal/diagnóstico , Humanos , Hipertensão Portal/sangue , Hipertensão Portal/diagnóstico , Hipertensão Portal/fisiopatologia , Resistência à Insulina , Estimativa de Kaplan-Meier , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Testes de Função Hepática , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Contagem de Plaquetas , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Espanha , Pressão VenosaRESUMO
BACKGROUND: Hepatic encephalopathy is a major complication of cirrhosis and is associated with a poor prognosis. OBJECTIVE: To identify mutations in the gene sequence for glutaminase in humans that could be responsible for the development of hepatic encephalopathy in patients with cirrhosis. DESIGN: Cohort study. SETTING: Outpatient clinics in 6 Spanish hospitals. PATIENTS: 109 consecutive patients with cirrhosis in the estimation cohort, 177 patients in the validation cohort, and 107 healthy control participants. MEASUREMENTS: Patients were followed every 3 or 6 months until the development of hepatic encephalopathy or liver transplantation, death, or the end of the study. RESULTS: The genetic analyses showed that glutaminase TACC and CACC haplotypes were linked to the risk for overt hepatic encephalopathy. Mutation scanning of the glutaminase gene identified a section in the promoter region where base pairs were repeated (a microsatellite). Over a mean follow-up of 29.6 months, hepatic encephalopathy occurred in 28 patients (25.7%) in the estimation cohort. Multivariable Cox models were used to determine the following independent predictors: Child-Turcotte-Pugh stage (hazard ratio [HR], 1.6 [95% CI, 1.29 to 1.98]; P = 0.001), minimal hepatic encephalopathy (HR, 3.17 [CI, 1.42 to 7.09]; P = 0.006), and having 2 long alleles of the microsatellite (HR, 3.12 [CI, 1.39 to 7.02]; P = 0.006). The association between 2 long alleles of the microsatellite and overt hepatic encephalopathy was confirmed in a validation cohort (HR, 2.1 [CI, 1.17 to 3.79]; P = 0.012). Functional studies showed higher luciferase activity in cells transfected with the long form of the microsatellite, which suggests that the long microsatellite enhances glutaminase transcriptional activity. LIMITATION: Other genes and allelic variants might be involved in the clinical expression of hepatic encephalopathy. CONCLUSION: This study identifies a genetic factor that is associated with development of hepatic encephalopathy in patients with cirrhosis. PRIMARY FUNDING SOURCE: Instituto de Salud Carlos III, Spanish Ministry of Health.
Assuntos
Glutaminase/genética , Encefalopatia Hepática/genética , Cirrose Hepática/enzimologia , Cirrose Hepática/genética , Mutação , Regiões Promotoras Genéticas/genética , Idoso , Feminino , Encefalopatia Hepática/etiologia , Humanos , Cirrose Hepática/complicações , Masculino , Repetições de Microssatélites/genética , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Minimal hepatic encephalopathy (MHE) reduces quality of life of cirrhotic patients, predicts overt hepatic encephalopathy, and is associated with poor prognosis. We hypothesized that MHE arises once metabolic alterations derived from the liver reach a particular threshold. Our aim was to assess whether metabolic profiling of serum samples by high-field (1)H-nuclear magnetic resonance spectroscopy ((1)H NMR) and subsequent multivariate analyses would be useful to characterize metabolic perturbations associated with MHE and to identify potential metabolic biomarkers. Metabolic serum profiles from controls (n = 69) and cirrhotic patients without MHE (n = 62) and with MHE (n = 39) were acquired using high field NMR. Supervised modeling of the data provided perfect discrimination between healthy controls and cirrhotic patients and allowed the generation of a predictive model displaying strong discrimination between patients with and without MHE (R(2)Y = 0.68, Q(2)Y = 0.63). MHE patients displayed increased serum concentrations of glucose, lactate, methionine, TMAO, and glycerol, as well as decreased levels of choline, branch amino acids, alanine, glycine, acetoacetate, NAC, and lipid moieties. Serum metabonomics by (1)H NMR offers a useful approach for characterizing underlying metabolic differences between patients with and without MHE. This procedure shows great potential as a diagnostic tool of MHE as it objectively reflects measurable biochemical differences between the patient groups and may facilitate monitoring of both disease progression and effects of therapeutic treatments.
Assuntos
Encefalopatia Hepática/metabolismo , Espectroscopia de Ressonância Magnética/métodos , Metaboloma , Metabolômica/métodos , Adulto , Idoso , Aminoácidos/sangue , Glicemia/metabolismo , Feminino , Encefalopatia Hepática/sangue , Encefalopatia Hepática/complicações , Humanos , Lactatos/sangue , Cirrose Hepática/sangue , Cirrose Hepática/complicações , Cirrose Hepática/metabolismo , Masculino , Pessoa de Meia-Idade , Análise Multivariada , PrognósticoRESUMO
OBJECTIVES: To determine the volume of health professionals who suffered distress due to their care of patients with COVID-19 and to analyse the direction in which the response capacity of the professionals to face future waves of COVID-19 is evolving. DESIGN: A cross-sectional study. SETTING: Primary care and hospitals in Spain. PARTICIPANTS: A non-randomised sample of 685 professionals (physicians, nurses and other health staff). PRIMARY AND SECONDARY OUTCOME MEASURES: Frequency and intensity of stress responses measured by the Acute Stress of Health Professionals Caring COVID-19 Scale (EASE). Variation of stress responses according to the number of deaths per day per territory and the evolutionary stage of the COVID-19 outbreak measured by the Kruskal-Wallis and the Mann-Whitney U tests. RESULTS: The average score on the EASE Scale was 11.1 (SD 6.7) out of 30. Among the participants, 44.2% presented a good emotional adjustment, 27.4% a tolerable level of distress, 23.9% medium-high emotional load and 4.5% extreme acute stress. The stress responses were more intense in the most affected territories (12.1 vs 9.3, p=0.003) and during the disillusionment phase (12.7 vs 8.5 impact, 10.2 heroic and 9.8 honeymoon, p=0.000). CONCLUSIONS: The pandemic has affected the mental health of a significant proportion of health professionals which may reduce their resilience in the face of future waves of COVID-19. The institutional approaches to support the psychological needs of health professionals are essential to ensure optimal care considering these results.
Assuntos
COVID-19/epidemiologia , Pessoal de Saúde/psicologia , Saúde Mental , Pandemias , SARS-CoV-2 , Estresse Psicológico/etiologia , Recursos Humanos , Doença Aguda , Adulto , COVID-19/complicações , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Espanha/epidemiologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologiaRESUMO
Introducción: La Organización Mundial de la Salud reconoce la demencia como una prioridad de salud pública. Afecta a 50 millones de personas en todo el mundo y se registran alrededor de 10 millones de nuevos casos cada año. Objetivo: Aplicar los criterios diagnósticos a los pacientes con demencia de acuerdo al Manual Diagnóstico y Estadístico de los Trastornos Mentales-V y la Clasificación Internacional de Enfermedades-10, en el Hospital Psiquiátrico Universitario René Vallejo Ortiz entre junio de 2016 y diciembre de 2022. Métodos: Se realizó un estudio observacional, descriptivo de corte transversal. El universo estuvo compuesto por todos los pacientes ingresados en la mencionada institución. La muestra no probabilística y a criterio de los autores la integraron 66 pacientes adultos, con el diagnóstico en el periodo de estudio señalado. Se utilizó estadística descriptiva e inferencial. Los datos se presentaron en tablas y gráficos. Resultados: De los 66 pacientes investigados el 33,3 % presentaban entre 60 y 69. El sexo femenino representó el 57,6 %. De acuerdo al Manual Diagnóstico y Estadístico de los Trastornos Mentales- V, 24 pacientes para un 36,4 % se encontraban dentro de los A9, mientras que 12 (18,2 %) en los A10. Sin embargo, según la Clasificación Internacional de Enfermedades-10 el 93,9 % cumplen los criterios de demencia. Conclusiones: Las principales manifestaciones clínicas fueron la desorientación y la hipomnesia con asociación al deterioro cognitivo leve. En la asociación de las clasificaciones se constató que solo la mitad de los estudiados cumplían los criterios diagnósticos de forma unánime.
Introduction: The World Health Organization recognizes dementia as a public health priority. It affects 50 million people worldwide, with around 10 million new cases reported each year. Objective: To apply the diagnostic criteria to patients with dementia according to the Diagnostic and Statistical Manual of Mental Disorders-V and the International Classification of Diseases-10 at the René Vallejo Ortiz University Psychiatric Hospital between June of 2016 and December 2022. Methods: An observational, descriptive, cross-sectional study was carried out. The universe was made up of all patients admitted to the aforementioned institution. The non-probabilistic sample and at the discretion of the authors was made up of 66 adult patients with the diagnosis in the indicated study period. Descriptive and inferential statistics were used. The data was presented in tables and graphs. Results: Of the 66 patients investigated, 33.3% were between 60 and 69. The female sex represented 57.6%. According to the DSM-V, 24 patients, 36.4%, were within A9, while 12 (18.2%) were within A10. However, according to ICD -10, 93.9% meet the criteria for dementia. Conclusions: The main clinical manifestations were disorientation and hypomnesia associated with mild cognitive impairment. In the association of the classifications, it was found that only half of those studied unanimously met the diagnostic criteria.
RESUMO
AIM: To assess whether portacaval anastomosis (PCA) in rats affects the protein expression and/or activity of glutaminase in kidneys, intestines and in three brain areas of cortex, basal ganglia and cerebellum and to explain the neurological alterations found in hepatic encephalopathy (HE). METHODS: Sixteen male Wistar rats weighing 250-350 g were grouped into sham-operation control (n=8) or portacaval shunt (n=8). Twenty-eight days after the procedure, the animals were sacrificed. The duodenum, kidney and brain were removed, homogenised and mitochondria were isolated. Ammonia was measured in brain and blood. Phosphate-activated glutaminase (PAG) activity was determined by measuring ammonia production following incubation for one hour at 37 celsius degree with O-phthalaldehyde (OPA) and specific activity expressed in units per gram of protein (mukat/g of protein). Protein expression was measured by immunoblotting. RESULTS: Duodenal and kidney PAG activities together with protein content were significantly higher in PCA group than in control or sham-operated rats (duodenum PAG activity was 976.95+/-268.87 mukat/g of protein in PCA rats vs 429.19+/-126.92mukat/g of protein in sham-operated rats; kidneys PAG activity was 1259.18+/-228.79 mukat/g protein in PCA rats vs 669.67+/-400.8 mukat/g of protein in controls, P<0.05; duodenal protein content: 173% in PCA vs sham-operated rats; in kidneys the content of protein was 152% in PCA vs sham-operated rats). PAG activity and protein expression in PCA rats were higher in cortex and basal ganglia than those in sham-operated rats (cortex: 6646.6+/-1870.4 mukat/g of protein vs 3573.8+/-2037.4 mukat/g of protein in control rats, P<0.01; basal ganglia, PAG activity was 3657.3+/-1469.6 mukat/g of protein in PCA rats vs 2271.2+/-384 mukat/g of protein in sham operated rats, P<0.05; In the cerebellum, the PAG activity was 2471.6+/-701.4 mukat/g of protein vs 1452.9+/-567.8 mukat/g of protein in the PCA and sham rats, respectively, P<0.05; content of protein: cerebral cortex: 162%+/-40% vs 100%+/-26%, P<0.009; and basal ganglia: 140%+/-39% vs 100%+/-14%, P<0.05; but not in cerebellum: 100%+/-25% vs 100%+/-16%, P=ns). CONCLUSION: Increased PAG activity in kidney and duodenum could contribute significantly to the hyperammonaemia in PCA rats, animal model of encephalopathy. PAG is increased in non-synaptic mitochondria from the cortex and basal ganglia and could be implicated in the pathogenesis of hepatic encephalopathy. Therefore, PAG could be a possible target for the treatment of HE or liver dysfunction.
Assuntos
Glutaminase/metabolismo , Derivação Portocava Cirúrgica/efeitos adversos , Amônia/metabolismo , Animais , Gânglios da Base/enzimologia , Córtex Cerebral/enzimologia , Córtex Cerebral/metabolismo , Modelos Animais de Doenças , Duodeno/enzimologia , Encefalopatia Hepática/enzimologia , Encefalopatia Hepática/etiologia , Humanos , Rim/enzimologia , Masculino , Ratos , Ratos WistarRESUMO
Antioxidant activities of lipophilic hydroxytyrosyl acetate, palmitate, oleate, and linoleate were compared with those of hydroxytyrosol, alpha-tocopherol, and butylhydroxytoluene (BHT) in both glyceridic matrix and biological systems. Aliquots of a glyceridic matrix spiked with various concentrations of antioxidant were subjected to accelerated oxidation in a Rancimat apparatus operated at 90 degrees C. The relationships between induction time (IT) and antioxidant concentration (mmol/kg) presented by hydroxytyrosol and hydroxytyrosyl acetate, palmitate, oleate, and linoleate were similar. Hydroxytyrosol and its esters showed greater antioxidant activity than alpha-tocopherol or BHT. We also evaluated the capacity of hydroxytyrosyl esters to protect proteins and lipids against oxidation caused by peroxyl radicals, using a brain homogenate as an ex vivo model. All tested compounds showed a protective effect in these systems, which was greater in preventing the generation of carbonyl groups in protein than of malondialdehyde in lipid. Inclusion of a lipophilic chain in the hydroxytyrosol molecule enhanced its antioxidant capacities in this biological model.
Assuntos
Antioxidantes/farmacologia , Ésteres/farmacologia , Álcool Feniletílico/análogos & derivados , Acetatos/farmacologia , Animais , Encéfalo/metabolismo , Hidroxitolueno Butilado/farmacologia , Ácido Linoleico/farmacologia , Peroxidação de Lipídeos/efeitos dos fármacos , Ácido Oleico/farmacologia , Palmitatos/farmacologia , Álcool Feniletílico/farmacologia , Proteínas/metabolismo , Ratos , Ratos Wistar , alfa-Tocoferol/farmacologiaAssuntos
Encefalopatia Hepática/patologia , Animais , Ductos Biliares/fisiologia , Intoxicação por Tetracloreto de Carbono/patologia , Doença Hepática Induzida por Substâncias e Drogas/patologia , Modelos Animais de Doenças , Cães , Humanos , Ligadura , Fígado/patologia , Cirrose Hepática/induzido quimicamente , Derivação Portocava Cirúrgica , RatosRESUMO
The frequent affectations to the mental health of the health personnel involved in the response to the COVID-19 pandemic demands the use of an instrument capable of integrating, in its evaluation, the most vulnerable psychological areas in accordance with the actions of Primary Prevention of the Psychological Safety Management Protocol. The objective is to describe the mental health vulnerability of the health personnel before working directly with patients affected by COVID-19. A descriptive, transversal study was carried out with 108 subjects. The psychological vulnerability screening instrument developed as part of the Psychological Safety Management Protocol was applied, in the Hospital for attention to suspected and positive patients of COVID-19. The mental health vulnerability of the sanitary personnel prevailed. The most vulnerable groups were the one from 23 to 40 years old, the feminine sex and the nursing personnel. The most affected areas were the cognitive and the affective ones; expressing more intensity in the symptoms related to difficulties to concentrate, sadness and anxiety. The existence of a greater vulnerability in the mental health of the health personnel before starting to work with patients who are suspected and positive to COVID-19, expresses the need to maintain the Primary Prevention stage as part of the Psychological Safety Management Protocol.(AU)
Os frequentes efeitos sobre a saúde mental dos profissionais de saúde envolvidos na resposta à pandemia COVID-19 exigem a utilização de um instrumento capaz de integrar, na sua avaliação, as áreas psicológicas mais vulneráveis de acordo com as ações de Prevenção Primária declaradas no Protocolo da Gestão de Segurança Psicológica. O objetivo é descrever a vulnerabilidade na saúde mental do pessoal de saúde antes de desenvolver um trabalho direto com pacientes afetados pelo COVID-19. Foi desenvolvido um estudo descritivo e transversal com 108 trabalhadores/as da saúde da instituição a partir do uso do instrumento de rastreamento da vulnerabilidade psicológica. No Hospital para atenção a pacientes suspeitos e positivos de COVID-19. O estudo confirma: um predomínio da vulnerabilidade na saúde mental dos profissionais de saúde; enfermeiras, entre 23 e 40 anos, constituíam o grupo mais vulnerável; as áreas mais afetadas foram cognitivas e afetivas, projetadas em intensos sintomas de desconcentração, tristeza e ansiedade. A existência de maior vulnerabilidade na saúde mental do pessoal de saúde antes de começar a trabalhar diretamente com pacientes suspeitos e positivos para COVID-19, expressa a necessidade de manter a etapa de Prevenção Primária como parte do Protocolo de Gestão da Segurança Psicológica.(AU)
Las frecuentes afectaciones a la salud mental del personal sanitario involucrado en la respuesta a la pandemia de la COVID-19 demanda el uso de un instrumento capaz de integrar, en su evaluación, las áreas psicológicas más vulnerables de acuerdo con las acciones de Prevención Primaria del Protocolo de Gestión de Seguridad Psicológica. El objetivo es describir la vulnerabilidad en la salud mental del personal sanitario antes del trabajo directo con pacientes afectados de COVID-19. Se realizó un estudio descriptivo, transversal con 108 sujetos. Se aplicó el instrumento de cribado de vulnerabilidad psicológica desarrollado en el Protocolo de Gestión de Seguridad Psicológica, en el Hospital de atención a pacientes sospechosos y positivos de COVID-19. Predominó la vulnerabilidad en la salud mental del personal sanitario; el grupo más vulnerable fue el de 23 a 40 años, del sexo femenino y el personal de enfermería. Las áreas con mayor afectación resultaron la cognitiva y la afectiva; expresándose más intensidad en los síntomas relacionados con las dificultades para concentrarse, la tristeza y ansiedad. La existencia de una mayor vulnerabilidad en la salud mental del personal sanitario antes de comenzar a trabajar con pacientes sospechosos y positivos a la COVID-19, expresa la necesidad de mantener la etapa de Prevención Primaria como parte del Protocolo de Gestión de Seguridad Psicológica.(AU)
Assuntos
Saúde Mental , Pessoal de Saúde , COVID-19 , Grupos de Risco , Gestão da SegurançaRESUMO
INTRODUCTION. A foetal or prenatal cerebrovascular accident (CVA) is defined as an ischaemic, thrombotic or arterial or venous haemorrhagic event that occurs between the 14th week of gestation and the onset of labour. PATIENTS AND METHODS. We report a retrospective study of a series of 10 patients suffering from a, presumably foetal, stroke that went unnoticed during the pregnancy and was diagnosed in the early infant stage. The symptoms and the age at which they were identified are highlighted. RESULTS. None of the 10 patients studied presented any relevant events in the mothers' medical history, but there were four threats of a preterm birth that were solved using the usual means and without the occurrence of any alterations that later affected the foetus. The studies that led to the diagnosis were carried out between the sixth and ninth months of life, and the reason for visiting was reported by the family as being a lower degree of mobility on one side of the body with respect to the other. Two patients presented thrombophilia. With a mean follow-up time of six years, all the patients have an associated infantile cerebral palsy, a third of them have epilepsy and 75% have learning difficulties or intellectual disability. CONCLUSIONS. When CVA are not detected in the prenatal period, it is important in primary care to look for and detect the warning signs of the psychomotor development of the infant at an early stage in order to begin a study of the case and to undertake rehabilitation as early as possible.
TITLE: Accidentes cerebrovasculares prenatales diagnosticados en la etapa de lactante: serie de 10 pacientes.Introduccion. El accidente cerebrovascular (ACV) fetal o prenatal se define como un suceso isquemico, trombotico o hemorragico arterial o venoso que acontece entre las 14 semanas de gestacion y el inicio del parto. Pacientes y metodos. Estudio retrospectivo de una serie de 10 pacientes afectos de un ictus, presumiblemente fetal, desapercibido durante el embarazo y diagnosticado en la etapa de lactante; se destacan cuales han sido los sintomas y la edad en que se han identificado. Resultados. De los 10 pacientes estudiados, ninguno presentaba antecedentes maternos relevantes, pero se detectaron cuatro amenazas de parto pretermino que se resolvieron con las medidas habituales y sin hallazgos de alteracion fetal posterior. Entre el segundo y tercer trimestre de vida es cuando se han realizado los estudios que han llevado al diagnostico, y se ha indicado por la familia una menor movilidad de un hemicuerpo respecto al contralateral como motivo de consulta. Dos pacientes presentaban una trombofilia. Con una media de seguimiento de seis años, todos asocian una paralisis cerebral infantil, la tercera parte una epilepsia y el 75% tiene dificultades de aprendizaje o discapacidad intelectual. Conclusion. Cuando los ACV no se detectan prenatalmente, es importante que en la atencion primaria se busquen y detecten los signos de alarma del desarrollo psicomotor del lactante de forma precoz para iniciar su estudio y procurar una rehabilitacion lo mas pronto posible.
Assuntos
Dano Encefálico Crônico/etiologia , Doenças Fetais/diagnóstico , Acidente Vascular Cerebral/embriologia , Adulto , Encéfalo/patologia , Dano Encefálico Crônico/congênito , Paralisia Cerebral/etiologia , Epilepsia/congênito , Epilepsia/etiologia , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Deficiências da Aprendizagem/etiologia , Imageamento por Ressonância Magnética , Masculino , Idade Materna , Paresia/congênito , Paresia/etiologia , Gravidez , Complicações na Gravidez , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Avaliação de Sintomas , Trombofilia/complicações , Trombofilia/embriologia , Adulto JovemRESUMO
a magnitud de la población de 65 años y más en situación de dependencia de la Argentina sería de más de un millón de personas. Dada la gran heterogeneidad en el tipo y en la intensidad de las ayudas que requieren las personas en situación de dependencia, resulta esencial establecer criterios de clasificación para identificar grupos homogéneos en términos de severidad.Objetivo: el trabajo busca establecer una metodología y unos criterios objetivos que permitan identificar grupos homogéneos de personas en situación de dependencia sobre la base de información secundaria (y limitada).Métodos: el método utilizado se basa en el Baremo de Valoración de la Situación de Dependencia (BVD) vigente en España y en la aplicación de la metodología de Arboles de Clasificación, bajo la función rpart del programa R. Las principales fuentes de información son la Encuesta sobre Discapacidad, Autonomía personal y Situaciones de Dependencia de España (EDAD, 2008) y la Encuesta Nacional sobre Calidad de Vida de los Adultos Mayores de la Argentina (ENCaViAM, 2012).Resultados: el modelo seleccionado arroja un elevado grado de ajuste sugiriendo que es posible estimar la distribución de la población mayor en situación de dependencia según grado de severidad de manera razonable a partir de un grupo reducido de variables.Conclusiones: si bien la prevalencia de la dependencia de las personas mayores sería mayor en la Argentina respecto a lo obervado en España, la importancia relativa de los grupos con mayor severidad sería menor en el primer país (en Argentina).
he magnitude of the population 65 years and over in dependency status (ie, people with long-term care need) in Argentina would be more than one million people. Given the great heterogeneity in the type and intensity of the aid required by individuals with long-term care need, it is essential to establish some criteria to classify those in homogeneous groups in terms of severity.Objective: This work aims to establish a methodology and objective criteria that allow the identification of homogeneous groups of people in dependency status on the basis of secondary (and limited) information.Methods: The method used is based on the Valuation Scale of Dependency Situation from Spain and on the application of the Classification Trees method under the rpart function of the R program. The main sources of information are the Survey on Disability, Personal Autonomy and Dependency Situations from Spain (EDAD, 2008) and the National Survey on Quality of Life of the Elderly from Argentina (ENCaViAM, 2012).Results: the model selected shows a high degree of adjustment suggesting that it is possible to estimate the distribution of the elderly population in dependency status according to their severity level in a reasonable way from a reduced group of variables.Conclusions: although the prevalence of dependency among the elderly would be higher in Argentina than in Spain, the relative importance of groups with greater severity would be lower in the first country (in Argentina).
RESUMO
OBJECTIVE: To analyze how news items about clinical errors are treated by the press in Spain and their influence on patients. METHODS: We performed a quantitative and qualitative study. Firstly, news items published between April and November 2007 in six newspapers were analyzed. Secondly, 829 patients from five hospitals in four autonomous regions were surveyed. RESULTS: We analyzed 90 cases generating 128 news items, representing a mean of 16 items per month. In 91 news items (71.1%) the source was checked. In 78 items (60.9%) the author could be identified. The impact of these news items was -4.86 points (95% confidence interval [95%CI]: -4.15-5.57). In 59 cases (57%) the error was attributed to the system, in 27 (21.3%) to health professionals, and in 41 (32.3%) to both. Neither the number of columns (p=0.702), nor the inclusion of a sub-header (p=0.195), nor a complementary image (p=0.9) were found to be related to the effect of the error on safety perceptions. Of the 829 patients, 515 (62.1%; 95%CI: 58.8-65.4%) claimed to have recently seen or heard news about clinical errors in the press, on the radio or on television. The perception of safety decreased when the same person was worried about being the victim of a clinical error and had seen a recent news item about such adverse events (chi(2)=15.17; p=0.001). CONCLUSIONS: Every week news items about clinical errors are published or broadcast. The way in which newspapers report legal claims over alleged medical errors is similar to the way they report judicial sentences for negligence causing irreparable damage or harm. News about errors generates insecurity in patients. It is advisable to create interfaces between journalists and health professionals.
Assuntos
Pacientes Internados/psicologia , Jornalismo , Erros Médicos/psicologia , Jornais como Assunto/estatística & dados numéricos , Segurança , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Ansiedade/etiologia , Medo , Feminino , Hospitais , Humanos , Jornalismo/ética , Jornalismo/normas , Masculino , Imperícia , Meios de Comunicação de Massa , Pessoa de Meia-Idade , Opinião Pública , Espanha/epidemiologia , Adulto JovemRESUMO
Systemic hyperammonemia has been largely found in patients with cirrhosis and hepatic encephalopathy, and ammonia plays a major role in the pathogenesis of hepatic encephalopathy. However, controversial points remain: a) the correlation between plasma ammonia levels and neurophysiological impairment. The lack of correlation between ammonia levels and grade of hepatic encephalopathy in some cases has been considered a weakness of the ammonia hypothesis, but new methods for ammonia measurements and the implication of systemic inflammation in the modulation of ammonia neurotoxicity could explain this gap; b) the source of ammonia production. Hyperammonemia has been considered as derived from urea breakdown by intestinal bacteria and the majority of treatments were targeted against bacteria-derived ammonia from the colon. However, some data suggest an important role for small intestine ammonia production: 1) the hyperammonemia after porto-caval shunted rats has been found similar in germ-free than in non-germ-free animals. 2) In cirrhotic patients the greatest hyperammonemia was found in portal drained viscera and derived mainly from glutamine deamination. 3) The amount of time required to increase of ammonia (less than one hour) after oral glutamine challenge supports a small intestine origin of the hyperammonemia. As the main source of ammonia in cirrhotics derives from portal drained viscera owing to glutamine deamidation, increased glutaminase activity in the intestine seems to be responsible for systemic hyperammonemia. Lastly, some genetic alterations in the glutaminase gene such as the haplotype TACC could modulate intestinal ammonia production and the risk of overt hepatic encephalopathy in cirrhotics.
Assuntos
Amônia/metabolismo , Encefalopatia Hepática/metabolismo , Hiperamonemia/metabolismo , Intestino Delgado/metabolismo , Falência Hepática Aguda/metabolismo , Animais , Predisposição Genética para Doença/genética , Glutaminase/genética , Glutaminase/metabolismo , Glutamina/metabolismo , Encefalopatia Hepática/fisiopatologia , Humanos , Hiperamonemia/genética , Hiperamonemia/fisiopatologia , Intestino Delgado/fisiopatologia , Circulação Hepática/fisiologia , Falência Hepática Aguda/fisiopatologia , Mutação/genéticaRESUMO
BACKGROUND: Terminal cancer-associated cachexia, characterized by a marked weight loss, anorexia, asthenia and anemia, is usually associated with a malnutrition status. AIM OF THE STUDY: To investigate whether a diet formulated with a crayfish enzymatic extract, enriched in essential amino acids, omega-3 fatty acids, and astaxanthin, would be effective for the treatment of cancer-associated cachexias, by decreasing mortality and morbidity rates in cachectic rats and/or improving survival. METHODS: Two types of diet were used: a standard diet and one formulated with crayfish enzymatic extract. Rats were divided into two groups (24 animals per group): one without tumor (T-) and the other with tumor (T+) (AH-130 Yoshida ascites hepatoma). Each group was further divided into two subgroups (12 animals per subgroup). Two subgroups (T-(standard) and T+(standard)) were fed the standard diet and the other two (T-(CFEE) and T+(CFEE)) the crayfish enzymatic extract one for four weeks, after which different tissue and plasma parameters were studied. RESULTS: The implantation of the tumor resulted in a considerable loss of muscle and adipose tissue mass in both groups, but the loss of muscle and fat was lower in the group fed the crayfish enzymatic extract diet. There was also a concomitant increase in the plasma concentration of TNF-alpha, although the increase was smaller in the crayfish enzymatic extract-treated group. CONCLUSION: This study shows that although the treatment of cachetic rats with the crayfish enzymatic extract diet did not revert the cachexia, it increased survival (57.1% vs. 25.9% in the group treated with crayfish enzymatic extract and standard diets, respectively) and meliorated the cachexia symptoms--anorexia and body mass loss (muscle and adipose tissue).
Assuntos
Astacoidea/enzimologia , Caquexia/tratamento farmacológico , Ácidos Graxos Ômega-3/uso terapêutico , Sobrevida , Redução de Peso/efeitos dos fármacos , Animais , Anorexia/tratamento farmacológico , Anorexia/etiologia , Anorexia/mortalidade , Composição Corporal/efeitos dos fármacos , Caquexia/etiologia , Caquexia/mortalidade , Suplementos Nutricionais , Masculino , Neoplasias/complicações , Estado Nutricional , Distribuição Aleatória , Ratos , Ratos Wistar , Fatores de Tempo , Xantofilas/uso terapêuticoRESUMO
Posidonia oceanica is an endemic Mediterranean seagrass species that has often been assumed to contain low levels of genetic diversity. Random amplified polymorfic DNA (RAPD) markers were used to assess genetic diversity among five populations from three geographical regions (north, central, and south) of the western Mediterranean Sea. Stranded germinating seeds from one of the central populations were also included in the analysis. Forty-one putative genets were identified among 76 ramets based on 28 RAPD markers. Genotypic diversity strongly depended on the spatial structure, age, and maturity of the meadows. The lowest clonal diversity was found in the less structured and youngest prairies. Conversely, a high genotypic diversity was found in the highly structured meadows. The genotypic diversity in these meadows was at the same level as in P. australis and higher than previously reported data for P. oceanica populations in the Tyrrhenian Sea near the coast of Italy.
RESUMO
BACKGROUND: The antioxidant capacity of rice bran (RB) (due mainly to its gamma-oryzanol content) is very well known. We have recently developed a water-soluble oryzanol enzymatic extract (WSOEE), which shows a greatly increased functionality. AIM OF THE STUDY: The aim of our study is the evaluation of the antioxidant potential of WSOEE in an ex vivo model to compare its protective capacity against oxidative damage by active-oxygen substances and free radicals (mainly the peroxyl radical) to biomolecules (such as proteins and lipids) with that of antioxidants, such as Trolox (a water-soluble derivative of vitamin E), melatonin, and folic acid. METHODS: WSOEE gamma-oryzanol content and composition were determined by HPLC. Free-radical-scavenging capacity was evaluated using the assay based on phycoerythrin fluorescence. Antioxidant capacity against hydroperoxide-caused oxidative injury to proteins and lipids was evaluated using an ex vivo model: a rat brain homogenate. The effectiveness was determined by assessing protein damage (measured as carbonyl group content by Western blot immunoassay) and lipid peroxidation (measured as malondialdehyde content). RESULTS: The WSOEE gamma-oryzanol composition profile was similar to that of RB (cycloartenyl, 24-methylene cycloartenyl, campesteryl, and sitosteryl ferulates), but with two major differences: WSOEE gamma-oryzanol concentration was five times higher than that of RB, and WSOEE was water soluble. WSOEE total antioxidant capacity to trap the peroxyl radical was high, and similar to that of Trolox. The capacity to inhibit lipid peroxidation induced by cumene hydroperoxide in rat brain homogenate yielded a protection similar to that of Trolox. WSOEE also showed the capacity to protect protein from oxidation phenomena in rat brain homogenate, with a behavior similar to that of melatonin. This is of particular importance, since the loss of protein function caused by oxidative modification may affect the activity of enzymes, receptors, and membrane transporters, among other functions. CONCLUSION: WSOEE is a new potential antioxidant agent from rice bran that shows a high free-radical-scavenging capacity and prevents protein oxidation and lipid peroxidation when cells ex vivo are exposed to free radicals.