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1.
Am Surg ; : 31348241257470, 2024 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-38789105

RESUMO

Introduction: The American College of Surgeons (ACS) recommends that special considerations be made during triage of trauma patients aged ≥55 due to an observed increase in morbidity and mortality in this population. The geriatric population aged ≥65 represents 30% of all trauma patients. Our objective was to assess which pre-existing conditions (PECs) are associated with worse outcomes in trauma patients aged ≥55. Methods: Study population was selected from the local trauma registry (2020-22). Bi-variate analysis compared PEC status with outcomes controlling for each Injury Severity Score (ISS) category. Injury Severity Score was defined as mild (1-8), moderate (9-15), severe (16-24), and critical (≥25). Results: A total of 5,168 patients were identified (54.9% female, 56.7% age ≥75, 49.1% mild injury). Patients who had chronic renal failure (CRF) were at increased odds of mortality after adjusting for mild (adjusted odds ratio [aOR]: 2.63), moderate (aOR: 2.97), severe (aOR: 2.84), and critical (aOR: 2.62) injuries. Patients who had cirrhosis or congestive heart failure (CHF) were at increased odds of mortality after adjusting for mild (aOR: 3.03, 1.61), moderate (aOR: 3.63, 2.14), and severe (aOR: 3.46, 1.93) injuries, respectively. In addition, there was a relationship between having chronic obstructive pulmonary disease (COPD), dementia, anticoagulant therapy, or diabetes with unplanned intensive care unit (ICU) admission and development of acute kidney injury (AKI). Discussion: There is an association between certain pre-exiting conditions and worse outcomes. Early identification of these factors could provide a foundation for better interdisciplinary management, prevention of complications and associated mortality.

2.
Am Surg ; : 31348241248783, 2024 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-38655840

RESUMO

BACKGROUND: Patients with emergency surgical conditions (ESCs) experience higher complication rates than those without emergency conditions. Our purpose was to improve time-based key performance indicators (KPIs) of care for ESC patients, including diagnostic workup, empiric stabilization, and referral to definitive care. METHODS: A rapid response program (ESTAT) was developed to screen for and coordinate optimal, timely care for a spectrum of high-risk ESCs, from the patient's index clinical encounter up to definitive care. The Mann-Whitney test assessed whether any differences in KPIs were statistically significant (P < .05) before compared to after the implementation of ESTAT. RESULTS: 98 patients were identified: 44 in ESTAT group (70% age ≥55, 57% male); 54 in control group (57% age ≥55, 44% male). There were significant decreases from time of index clinical encounter to resuscitation (5 min. vs 34 min., P < .001), to diagnostic imaging (52 min. vs 1 hr. 19 min., P = .004), and to definitive care (2 hr. 17 min. vs 3 hr. 51 min., P = .007) in the ESTAT group compared to the control group, respectively. DISCUSSION: Improving time-based KPIs for delivery of clinical services is a common goal of medical emergency response systems (MERS) in numerous specialties. Implementation of an ESTAT program provides a screening tool for at-risk patients and reduces time to stabilize, diagnose and triage to definitive surgical intervention. These time benefits may ultimately translate to reduced complication rates for ESC patients. ESTAT may also represent a patient onboarding mechanism for surgical specialty verification programs promoted by quality improvement committees of various professional societies.

3.
medRxiv ; 2024 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-38645094

RESUMO

Around 60% of individuals with neurodevelopmental disorders (NDD) remain undiagnosed after comprehensive genetic testing, primarily of protein-coding genes1. Increasingly, large genome-sequenced cohorts are improving our ability to discover new diagnoses in the non-coding genome. Here, we identify the non-coding RNA RNU4-2 as a novel syndromic NDD gene. RNU4-2 encodes the U4 small nuclear RNA (snRNA), which is a critical component of the U4/U6.U5 tri-snRNP complex of the major spliceosome2. We identify an 18 bp region of RNU4-2 mapping to two structural elements in the U4/U6 snRNA duplex (the T-loop and Stem III) that is severely depleted of variation in the general population, but in which we identify heterozygous variants in 119 individuals with NDD. The vast majority of individuals (77.3%) have the same highly recurrent single base-pair insertion (n.64_65insT). We estimate that variants in this region explain 0.41% of individuals with NDD. We demonstrate that RNU4-2 is highly expressed in the developing human brain, in contrast to its contiguous counterpart RNU4-1 and other U4 homologs, supporting RNU4-2's role as the primary U4 transcript in the brain. Overall, this work underscores the importance of non-coding genes in rare disorders. It will provide a diagnosis to thousands of individuals with NDD worldwide and pave the way for the development of effective treatments for these individuals.

4.
In Vivo ; 34(5): 2419-2421, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32871767

RESUMO

BACKGROUND/AIM: L-Asparaginase (L-ASNase) is used as a tumor-inhibitory drug on paediatric acute lymphoblastic leukemia (ALL). ERW-ASNase is commercialised as a lyophilized powder stable only for 8 hours once reconstituted and, consequently, the leftover is usually discarded. The aim of this study will be to analyse the stability of the reconstituted lyophilised ERW-ASNase. MATERIALS AND METHODS: In the present study, we analysed the enzymatic stability of reconstituted ERW-ASNase after conservation in three different temperature conditions for 2 and 5 days. RESULTS: Our results show that ERW-ASNase is stable at 4°C, -20°C and -80°C for up to 5 days, retaining 95% of the initial enzymatic activity in all three storage temperatures tested. CONCLUSION: It is feasible to reuse the remaining content of ERW-ASNase vial after reconstitution, which allows the optimization of the content of ERW-ASNase vials use and reduces the cost of this formulation usage, making it more accessible.


Assuntos
Antineoplásicos , Erwinia , Leucemia-Linfoma Linfoblástico de Células Precursoras , Antineoplásicos/uso terapêutico , Asparaginase/uso terapêutico , Criança , Humanos , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Temperatura
6.
Rev. odontol. mex ; 19(2): 121-126, abr.-jun. 2015. ilus, tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: lil-748840

RESUMO

Se presenta en la Clínica de Endodoncia de la División de Estudios de Postgrado e Investigación (DEPeI) de la Facultad de Odontología (UNAM) una paciente diagnosticada con mucormicosis rinocerebral; en este artículo se presentan las variaciones en el manejo clínico de esta paciente y la importancia de mantener el mayor número de órganos dentales en boca para una mejor estabilidad del obturador palatino, tanto para las funciones de fonación como de masticación adecuadas.


A patient previously diagnosed with cerebral mucormycosis attended the Endodontics Clinic of the Graduate and Research School, National School of Dentistry, National University of Mexico (UNAM). This article presents variations in the clinical handling of the patient; stress is made on the importance of preserving the greatest number of teeth in the mouth to thus achieve better stability of the palatal obturator and establish suitable phonation and mastication functions.

7.
Rev. chil. neuropsicol. (En línea) ; 8(1): 1-5, jul. 2013. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-722768

RESUMO

El objetivo del estudio fue describir la relación entre las respuestas del MMN, obtenidas mediante pares de palabras del idioma español con diferente contenido en frecuencia, y las características del lenguaje en niños preescolares mexicanos. Se evaluaron 12 niños preescolares hablantes del español entre 5 años 2 meses y6 años 3 meses de edad, diestros, de nivel socioeconómico medio-bajo, provenientes de escuelas públicas de Xalapa, Veracruz, México. Por la articulación de su lenguaje, se crearon dos grupos: uno sin dificultades de articulación, y otro con dificultades de articulación, a su vez, clasificadas como leves, moderadas y severas. Para obtener el MMN se utilizó un paradigma oddball, con un par mínimo de palabras: /ajos/-/ojos/, presentado biauralmente a una intensidad de 90dB.El 83 por ciento de los niños presentó un MMN esperado y el 17 por ciento un MMN temprano. De los siete niños sin dificultades de lenguaje, seis niños presentaron potencial esperado (150-350 ms.) y uno temprano (100-150 ms.); de los cinco niños con dificultades cuatro niños presentaron MMN esperado y uno temprano. La respuesta de MMN puede usarse como una herramienta para explorar el procesamiento de las diferencias acústicas del lenguaje, que son la base de la percepción de éste.


The aim of the study was to describe the relationship between MMN responses, obtained by pairs of words in the Spanish language with different frequency content, and language features in Mexican preschoolers. We evaluated 12 Spanish speaking preschoolers ranging from 5 years 2 months to 6 years 3 months,right handed, of medium-low socioeconomic level, and from public schools in the city of Xalapa, Veracruz, Mexico. We created two groups based on their capacity for articulation in language: one without difficulties in articulation, and one with difficulties in articulation, further divided into mild, moderate and severe categories. To elicite the MMN, an oddball paradigm was used, with the Word pair: /ajos/-/ojos/ applied binaurally at an intensity of 90 dB. 83 percent of the children presented an expected MMN and 17 percent presented an early MMN. Of the seven children without language difficulties, two presented an expected MMN (150-350 ms.) and one presented an early MMN (100-150 ms.), of the five children with difficulties, one presented an early. The MMN response elicited by a word pair can be used as a tool to explore differences in acoustic language processing, which is the basis of language perception.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Potenciais Evocados Auditivos , Percepção da Fala , Transtornos da Linguagem/diagnóstico , Transtornos da Linguagem/fisiopatologia , Percepção Auditiva , Idioma , Modelos Logísticos , México , Testes Neuropsicológicos , Tempo de Reação , Fatores Socioeconômicos
8.
P. R. health sci. j ; 13(2): 125-8, jun. 1994.
Artigo em Inglês | LILACS | ID: lil-176778

RESUMO

Twelve patients with ischemic heart disease had complete left and right catheterization before and after sublingual captopril. Hemodynamic measurements were ten (10) minutes apart and were monitored for thirty (30) minutes. The heart rate increased from 70 +/- 13 to 76 +/- 11 beats/minute (P = .04). There was no change in the arterial blood pressure, although the systemic vascular resistance decreased from 1500 +/- 400 to 1026 +/- 480 dynes-sec-cm-5 (P < .0001). The pulmonary artery pressure was increased 15 +/- 6 to 25 +/- 5mmHg (P = .005) and the pulmonary vascular resistance increased from 288 + 160 to 376 + 160 dynes-sec-cm-5 (P < .0001). The wedge pressure increased from 7 +/- 2 to 14 +/- 3 mmHg (P = .05). The cardiac output (CO) increased from 5.06 +/- 1.06 to 578 +/- 1.58 Lt/min. (P.05 =. The left ventricular end diastolic volume (LVEDV) increased from 128 +/- 40 to 145 +/- 37cc)P = .002), without change in the end systolic volume (ESV). The ejection fraction (EF) increased from 56 +/- 3 to 61 +/- 4 per cent (P = .02). These pressure changes appeared at two (2) minutes and disappeared after thirty (30) minutes. The study shows that, sublingual captopril produces a transient elevation of the pulmonary artery pressure and resistance


Assuntos
Humanos , Pessoa de Meia-Idade , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Isquemia Miocárdica/fisiopatologia , Pressão Arterial/efeitos dos fármacos , Artéria Pulmonar/fisiopatologia , Administração Sublingual , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Captopril/administração & dosagem , Captopril/farmacologia , Cateterismo Cardíaco , Hemodinâmica , Resistência Vascular/efeitos dos fármacos
9.
Bol. Asoc. Méd. P. R ; 83(1): 19-21, ene. 1991. ilus
Artigo em Inglês | LILACS | ID: lil-97783

RESUMO

Un hombre de 32 años presentó con queja de palpitaciones y nivels elevados de hierro sérico. Evaluación posterior reveló elevación de la ferritina en suero, y una biopsia de hígado confirmó el diagnóstico de hemocromatosis. La evaluación cardiovascular fue normal excepto por bradicardia sinusal alternando con taquicardia sinusal en un Holter de 24 horas. El paciente se comenzó en tratamiento con flebotomías semanales y la familia se esta evaluando para detectar tempranamente cualquier otro caso. Las manifestaciones, evaluación diagnóstica e importancia del diagnóstico temprano son enfatizadas


Assuntos
Humanos , Adulto , Masculino , Arritmias Cardíacas/diagnóstico , Hemocromatose/diagnóstico , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/terapia , Biópsia por Agulha , Fígado/patologia , Hemocromatose/complicações , Hemocromatose/terapia , Ferro/sangue , Flebotomia
10.
Rev. mex. angiol ; 26(1): 17-21, ene.-mar. 1998. tab, ilus
Artigo em Espanhol | LILACS | ID: lil-248398

RESUMO

Se presentan 12 casos en los cuales coinciden procesos de trombosis o flebitis de miembros pélvico con el uso oral de medicación derivada de imidazoles: para tratamiento de patología digestiva, dermatológica o ginecológica. Ocho casos presentaban factores de riesgo como: tromboflebitis previas, uso de estrógenos o derivados, infecciones severas, traumatismos. Llaman la atención tres casos de flebotrombosis poplítea derecha en varones sitio sin otro aparente factor de riesgo. Se hace mención de un caso de trombosis u obstrucción arterial distal. Se hace una revisión de las complicaciones habituales reportadas con estos medicamentos y su interacción con los anticoagulantes orales. Sugerimos para ratificar o rectificar tal observación, incluir en el interrogatorio de pacientes con trombosis o flebitis de etiología no identificada, la investigación del uso de imidazoles y derivados


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Flebite/induzido quimicamente , Trombose/induzido quimicamente , Fatores de Risco , Imidazóis/efeitos adversos
11.
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