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A variety of aminoisoquinoline-5,8-quinones bearing α-amino acids moieties were synthesized from 3-methyl-4-methoxycarbonylisoquinoline-5,8-quinone and diverse l- and d-α-amino acid methyl esters. The members of the series were evaluated for their cytotoxic activity against normal and cancer cell lines by using the (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) (MTT) assay. From the current investigation, structure-activity relationships demonstrate that the location and structure of the amino acid fragment plays a significant role in the cytotoxic effects. Moderate to high cytotoxic activity was observed and four members, derived from l-alanine, l-leucine, l-phenylalanine, and d-phenylalanine, were selected as promising compounds by their IC50 ranging from 0.5 to 6.25 µM and also by their good selectivity indexes (≥2.24).
Assuntos
Aminoácidos , Antineoplásicos , Citotoxinas , Neoplasias/tratamento farmacológico , Quinolonas , Aminoácidos/síntese química , Aminoácidos/química , Aminoácidos/farmacologia , Antineoplásicos/síntese química , Antineoplásicos/química , Antineoplásicos/farmacologia , Linhagem Celular Tumoral , Citotoxinas/síntese química , Citotoxinas/química , Citotoxinas/farmacologia , Ensaios de Seleção de Medicamentos Antitumorais , Humanos , Neoplasias/metabolismo , Neoplasias/patologia , Quinolonas/síntese química , Quinolonas/química , Quinolonas/farmacologiaRESUMO
Right atrial aneurysm is a rare congenital heart condition defined as a dilation of the right atrium in the absence of an underlying cause [1]. The clinical presentation varies; most patients are asymptomatic, while others may experience arrhythmias or intracavitary thrombi [1, 2]. We report a case.
Assuntos
Apêndice Atrial , Aneurisma Cardíaco , Cardiopatias Congênitas , Humanos , Valor Preditivo dos Testes , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/cirurgia , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgiaRESUMO
Introducción. El trauma cardíaco penetrante es una patología con alta mortalidad, que alcanza hasta el 94 % en el ámbito prehospitalario y el 58 % en el intrahospitalario. El algoritmo internacional para los pacientes que ingresan con herida precordial, hemodinámicamente estables, es la realización de un FAST subxifoideo o una ventana pericárdica, según la disponibilidad del centro, y de ser positivo se procede con una toracotomía o esternotomía. Métodos. Se hizo una búsqueda bibliográfica en las bases de datos Medline, Pubmed, Science Direct y UpTodate, usando las palabras claves: "taponamiento cardíaco", "herida precordial" y "manejo no operatorio". Se tomaron los datos de la historia clínica y las imágenes, previa autorización del paciente. Caso clínico. Paciente masculino ingresó con herida en área precordial, estable hemodinámicamente, sin signos de sangrado activo, con FAST subxifoidea "dudosa". Se procedió a realizar ventana pericárdica, la cual fue positiva para hemopericardio de 150 ml; se evacuaron los coágulos del saco pericárdico, se introdujo sonda Nelaton 10 Fr para lavado con solución salina 500 ml, hasta obtener retorno de líquido claro. Frente al cese del sangrado y estabilidad del paciente se decidió optar por un manejo conservador, sin toracotomía. Conclusiones. No todos los casos de hemopericardio traumático por herida por arma cortopunzante requieren toracotomía. El manejo conservador con ventana pericárdica, drenaje de hemopericardio más lavado y dren es una opción en aquellos pacientes que se encuentran estables hemodinámicamente y no se evidencia sangrado activo posterior al drenaje del hemopericardio.
Introduction. Penetrating cardiac trauma is a pathology with high mortality, reaching up to 94% in the prehospital and 58% in the hospital settings. The international algorithm for patients who are admitted to the hospital with a precordial wound and who are hemodynamically stable is to perform a subxiphoid FAST echo or a pericardial window according to the availability of the center and, if positive, proceed to perform thoracotomy or sternotomy. Methods. A literature search was made in the Medline, Pubmed, ScienceDirect, and UpTodate biomedical databases, using the keywords "cardiac tamponade", "precordial wound" and "non-operative management". The data was taken from the clinical history, the images and the surgical procedure. Clinical case. Male patient who was admitted to the emergency room due to a wound in the precordial area, hemodynamically stable without signs of active bleeding, with subxiphoid FAST that is reported as "doubtful". We proceeded to perform a pericardial window which is positive for 150 ml hemopericardium, evacuation of clots from the pericardial sac, inserted a 10 Fr Nelaton catheter and washed with 500 ml saline solution until the return of clear fluid was obtained. In view of the cessation of bleeding and the stability of the patient, it was decided to opt for a conservative management and not to perform a thoracotomy. Conclusions. Not all cases of traumatic hemopericardium from a sharp injury require thoracotomy. Conservative management with pericardial window drainage of the hemopericardium plus lavage and drain is an option in those patients who are hemodynamically stable and there is no evidence of active bleeding after drainage of the hemopericardium.
Assuntos
Humanos , Derrame Pericárdico , Pericárdio , Técnicas de Janela Pericárdica , Ferimentos e Lesões , Técnicas e Procedimentos Diagnósticos , Tratamento ConservadorRESUMO
Introducción. El manejo de la herida cardiaca penetrante es un reto dado que requiere un rápido manejo quirúrgico para evitar que su desenlace sea fatal. Múltiples factores pronósticos han sido descritos, sin embargo, no ha sido documentada la relación entre el tiempo de llegada a quirófano y el uso de pledgets con la mortalidad. Métodos. Se realizó un estudio observacional retrospectivo de corte transversal, desde el año 2011 hasta el año 2018, en un hospital universitario de la ciudad de Medellín. Se evaluaron los registros de los pacientes con herida cardiaca penetrante confirmada y se realizó análisis univariado, bivariado y multivariado, así como curvas de supervivencia. Resultados. Los pacientes inestables o con taponamiento cardiaco que llegan al quirófano después del minuto 4 de haber ingresado a urgencias tienen cuatro veces más posibilidades de morir que los que llegan a quirófano antes (RR 4,1 IC95% 1,4312,07). El uso de pledgets en el reparo de la herida cardiaca, corresponde a un factor protector para los pacientes, con un OR ajustado de 2,5 (IC95% 1,124-5,641). El tipo de traumatismo, la arritmia intraoperatoria y el índice de choque al ingreso también fueron factores pronósticos. Discusión. Se documenta el efecto del tiempo de llegada a quirófano sobre la mortalidad, lo cual permitirá en un futuro generar cambios en el manejo de estos pacientes en función de estos tiempos. La evidencia encontrada sugiere mejores desenlaces con el uso rutinario de pledgets
Introduction. The management of penetrating cardiac injury is challenging since it requires rapid surgical ma-nagement to avoid a fatal outcome. Multiple prognostic factors have been described, however, the relationship between the time of arrival to the operating room and the use of pledgets with mortality has not been documented.Methods. A cross-sectional retrospective observational study was conducted from 2011 to 2018 in a university hospital in the city of Medellín. Records of patients with confirmed penetrating cardiac injury were evaluated, and univariate, bivariate, and multivariate analyzes were performed, as well as survival curves.Results. Unstable patients or patients with cardiac tamponade who arrive to the operating room after 4 minutes after being admitted to the emergency room are four times more likely to die than those who arrive to the operating room earlier (RR 4.1 95% CI 1.4312.07). The use of pledgets in the repair of the cardiac wound corresponds to a protective factor for patients, with an adjusted OR of 2.5 (95% CI 1.124-5.641). The type of trauma, intraoperative arrhythmia and the shock index on admission were also prognostic factors. Discussion. The effect of the time of arrival to the operating room on mortality is documented, which will allow in the future to generate changes in the management of these patients based on these times. The evidence found suggests better outcomes with the routine use of pledgets
Assuntos
Humanos , Ferimentos Penetrantes , Emergências , Tempo para o Tratamento , Procedimentos Cirúrgicos Operatórios , Mortalidade , Traumatismos CardíacosRESUMO
RESUMEN Objetivo: Analizar los factores de riesgo de evolución desfavorable (ED) en niños con insuficiencia mitral (IM) sometidos a plástica mitral (PM). Métodos: Se analizaron pacientes con IM sometidos a PM entre los años 2004 y 2014. Se definió ED como la reoperación o la IM significativa (3+, moderada a grave, o 4+, grave) durante el seguimiento. Las variables se expresaron como mediana. Se realizó el análisis univariado y el de regresión logística multivariado de los factores predictores de ED. Resultados: Se sometieron a PM 65 pacientes con IM 3+ e IM 4+. La etiología incluyó displasia (44,6%), endocarditis infecciosa (13,8%), fiebre reumática (18,4%), anomalía coronaria (7,7%) y otras (13,8%). La mediana del tiempo de seguimiento fue 26,5 meses (52 pacientes se encuentran aún en seguimiento). El 44,6% presentó disfunción ventricular y el 46,1% hipertensión pulmonar. La cantidad de pacientes con ED fue de 15: 9 fueron reoperados (7 reemplazos valvulares y 2 replástica). El análisis univariado demostró asociación significativa entre ED y las siguientes condiciones: fiebre reumática (p = 0,005), anillo mitral preoperatorio ≥+5 DS (p = 0,002), diámetro sistólico del ventrículo izquierdo (DSVI) ≥ +4 DS (p = 0,022), hipertensión pulmonar (p = 0,024) e IM residual posoperatoria inmediata ≥ moderada (p = 0,021). El análisis multivariado demostró como variables independientes de ED el diámetro del anillo mitral (p = 0,012), la fiebre reumática (p = 0,026) y la IM residual temprana (p = 0,042). No se produjo mortalidad. Conclusiones: La plástica mitral en niños con IM grave demostró resultados favorables a mediano plazo. La fiebre reumática, el diámetro del anillo mitral ≥ +5 DS y la IM residual ≥ 2+ fueron factores predictores de ED. No se hallaron diferencias estadísticamente significativas durante el seguimiento en relación con la edad ni con la presencia de disfunción ventricular.
ABSTRACT Objective: The aim of this study was to analyze risk factors of unfavorable outcome (UO) in patients with mitral regurgitation (MR) undergoing mitral valve repair (MVR). Methods: Patients with MR who had undergone MVR from 2004 to 2014 were retrospectively analyzed. Unfavorable outcome was defined as reoperation or significant MR [moderate to severe (3+) or severe MR (4+)] during follow-up. Variables were expressed as median. Univariate and multivariate logistic regression analyses were performed to identify predictive factors of UO. Results: Sixty five patients with MR3+ and MR4+ underwent MVR. Etiology was dysplasia in 44.6% of cases, infective endocarditis in 13.8%, rheumatic fever in 18.4%, abnormal coronary origin in 7.7% and other disorders in 13.8%. Median follow-up time was 26.5 months (52 patients are still being followed-up).Ventricular dysfunction was documented in 44.6% of cases and 46.1% had pulmonary hypertension. Fifteen patients presented UO and 9 were reoperated (7 valve replacements and 2 re-repairs). Univariate analysis demonstrated a significant association between UO and the following conditions: rheumatic fever (p=0.005), preoperative mitral annulus ≥+5 SD (p=0.002), left ventricular end-systolic diameter ≥+4 SD (p=0.022), pulmonary hypertension (p=0.024) and immediate postoperative residual MR ≥ moderate (p=0.021). Multivariate analysis demonstrated mitral annulus diameter (p=0.012), rheumatic fever (p=0.026) and early residual MR (p=0.042) as independent variables of UO. No deaths occurred in this series. Conclusions: Mitral valve repair in children with severe MR demonstrated mid-term favourable results. Rheumatic fever, mitral annulus diameter ≥+5 SD and immediate postoperative residual MR ≥2+ were predictive factors of UO. Neither age at surgery nor ventricular dysfunction showed statistically significant differences during follow-up.
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Objetivo: Analizar información bibliográfica sobre el uso de medidas alternativas y convencionales para el manejo de las ulceras venosas. Metodología: Se realizó una revisión de tipo documental, durante los meses de Junio y Julio de 2015, en varias fuentes bibliográficas, bases de datos y revistas indexadas nacionales e internacionales como: ScieLO, Proquest, Bireme, Elsevier, Biblioteca Virtual en Salud, Enfermería Global, Aquichan, Pubmed, Revista Mexicana, Guías de Práctica Clínica, Universidad Nacional de Colombia, Revista Cubana de Medicina General Integral, Instituto Nacional de Angiología y Cirugía Vascular. Se buscaron artículos originales de diferentes profesionales del área de la salud, publicados entre los años 2009 y 2015. Resultados: Se encontró que los métodos convencionales son: manejo con escleroterapia, presión negativa, plasma rico en plaquetas, larva terapia, bota de Unna, pasta de óxido de zinc, protocolos de cuidado de pie diabético, sellantes de fibrina, ácido ascórbico, vendajes compresivos, película de barrera no irritante, apósito de espuma polimérica y laser de baja potencia; los alternativos son: acupuntura, miel, aceite ozonizado, miel de Ulmo. Conclusiones: Pese a que cada institución tiene un protocolo diferente para el manejo de las úlceras venosas, la revisión bibliográfica demostró la similitud en muchas de las técnicas empleadas para el mismo fin: llegar rápidamente a la cicatrización de las heridas. En muchas instituciones consideran el uso de terapias alternativas como un método para reducir costos, pero queda claro que aunque pueden tener un valor económico inferior, el tiempo para la curación de las heridas es más prolongado, lo que implica la utilización de una mayor cantidad de materiales
Objective: Analyze bibliographic information on the use of alternative and conventional for the management of venous ulcers measures Methodology: A review of documentary by different professionals was conducted during the months of June and July 2015, the search was conducted in various literature sources, databases and national and international indexed journals as ScieLO, Proquest, Bireme, Elsevier, BVS, Global Nursing, Aquichan, Pubmed, Mexican journal, Clinical Practice Guidelines, National University of Colombia, Cuban Journal of General Medicine, National Institute of Angiology and Vascular Surgery. Results: It was found that conventional methods are: sclerotherapy, negative pressure, platelet rich plasma, larvae therapy, Unna boot, zinc oxide paste, fibrin sealants, ascorbic acid, bandage, non-irritating barrier film, polymeric foam dressing and Laser low power; alternative forms are: acupuncture, honey, ozonated oil, honey Ulmo. Conclusions: Although each institution has a different protocol for the management of venous ulcers, the literature review showed the similarity in many of the techniques used for the same purpose: to quickly get wound healing. In many institutions consider the use of alternative therapies as a method to reduce costs, but it is clear that although they may have a lowwer economic value, the time for wound healing is longer, involving the use of a greater amount of materials
Objetivo: analisar informação bibliográfica sobre o uso de medidas alternativas e convencionais para o manejo das úlceras venosas. Metodologia: foi realizada revisão documental nos meses de junho e julho de 2015, em várias fontes bibliográficas, bases de dados e revistas indexadas nacionais e internacionais como: ScieLO, Proquest, Bireme, Elsevier, Biblioteca Virtual em Saúde, Enfermería Global, Aquichan, Pubmed, Revista Mexicana, Guías de Práctica Clínica, Universidad Nacional de Colombia, Revista Cubana de Medicina General Integral, Instituto Nacional de Angiología y Cirugía Vascular. Foram pesquisados artigos originais de diversos profissionais da área de saúde, publicados entre 2009 e 2015. Resultados: encontrou que os métodos convencionais são: manejo com escleroterapia, pressão negativa, plasma rico em plaquetas, terapia larval, bota de Unna, pasta de óxido de zinco, protocolos de cuidado do pé diabético, selantes de fibrina, ácido ascórbico, curativos compressivos com gaze, filme de barreira não irritante, curativo de espuma de poliuretano e laser de baixa potência; os alternativos são: acupuntura, mel, óleo ozonizado, mel de Ulmo. Conclusões: apesar de que cada instituição tem um protocolo diferente para o manejo das úlceras venosas, a revisão bibliográfica demonstrou a semelhança de muitas das técnicas empregadas para o mesmo fim: chegar rapidamente à cicatrização das feridas. Em muitas instituições consideram o uso de terapias alternativas como um método para reduzir custos, mas é evidente que, embora tenham um valor econômico inferior, o tempo para a ferida se curar é mais longo, e implica em utilização de maior quantidade de materiais
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Humanos , Úlcera Varicosa , Cicatrização , Qualidade de Vida , Terapias ComplementaresRESUMO
All children who enter foster care have experienced disruptions in their relationships with caregivers, and many have experienced maltreatment. Studying the effects of these adverse early experiences can inform developmental theory. In particular, insight can be provided regarding sensitive periods in the development of attachment and self-regulatory capabilities. The quality of surrogate caregivers varies as a function of both the intervention services provided and foster parent characteristics. Studying the effects of foster parent quality can suggest which aspects of child functioning are more or less canalized at various developmental periods. This paper considers salient developmental issues of infancy, preschool years, middle childhood, and adolescence and examines ways in which these issues may present special difficulties for foster children. Across development, foster care is associated with difficulties regulating behaviors, emotions, and physiology. Thus, conditions associated with foster care placement (e.g., disruptions in care, maltreatment) appear to affect very basic and fundamental regulatory processes. Interventions have been designed that target developmentally specific manifestations of regulatory difficulties. Although the literature regarding evidence-based interventions for foster parents is quite limited, preliminary findings provide some evidence that nurturing, responsive care can serve to partially remediate early deficits. These findings suggest that stable and nonfrightening care is essential for normal development. Nonetheless, even in the case of quite adverse early experience that results in problematic child outcomes, there is some evidence that the development of many systems remains relatively plastic.
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Cuidados no Lar de Adoção , Pais/psicologia , Teoria Psicológica , Adolescente , Criança , Transtornos do Comportamento Infantil/psicologia , Transtornos do Comportamento Infantil/terapia , Pré-Escolar , Humanos , Apego ao Objeto , Relações Pais-FilhoRESUMO
Introducción: La neurocisticercosis (NCC), es la parasitosis más frecuente del sistema nervioso central. La epilepsia, las disfunciones del tracto piramidal, el incremento de la presión intracraneana y el deterioro intelectual son las manifestaciones clínicas más usuales en esta entidad. Materiales y métodos: Se revisan cinco casos de neurocisticercosis de localización frontal comprobados por estudios de neuroimágenes; los pacientes presentaron como síntomas déficit de atención y en cuatro de ellos crisis epilépticas focales. A todos se les realizó electroencefalograma, ELISA en sangre y a cuatro en líquido cefalorraquídeo. Todos se trataron con albendazol y carbamazepina. Además, se les prescribió metilfenidato como manejo farmacológico para el déficit de atención. Resultados: En todos los pacientes se encontró al examen físico inquietud, gran distracción e impulsividad. La tomografía cerebral detectó en la mayoría de los casos la lesión (80%) y en un caso fueron necesarios estudios de resonancia magnética cerebral para comprobarla. Sólo en un caso el electroencefalograma fue anormal, pues se observaron ondas lentas focales temporo-occipitales. En cuatro pacientes la tomografía cerebral de control mostró lesiones calcificantes de localizaciones frontales después del manejo antiparasitario. Con ninguno de los medicamentos se observaron efectos nocivos. Conclusión: Los pacientes con NCC frontal pueden presentar trastornos de déficit de atención e hiperactividad; esto se explicaría por la disfunción frontoestriatal, como sucede en el síndrome de trastorno de déficit de atención e hiperactividad (TDAH). En zonas endémicas de NCC como las de Colombia es prudente considerar esta entidad en niños con sintomatología TDAH, sobre todo si no hay ningún antecedente neuroconductual previo, pues los niños con trastornos neurológicos estructurales pueden presentar síntomas de TDAH.
Introduction: Neurocysticercosis (NCC) is the most common parasitic disease of the central nervous system. Epilepsy, pyramidal tract dysfunction, increased intracranial pressure and intellectual deterioration are the most frequently recognized clinical manifestations of NCC. Materials and methods: A total of five cases of frontal neurocysticercosis with diagnosis made by neuro-imaging studies are discussed. Symptoms as focal seizures associated to attention deficit were found. To all of them EEG, ELISA in blood and to four in LCR were carried out. Patients were treated with albendazol and carbamazepine. Methylphenidate as a pharmacologic treatment for attention deficit was also prescribed. Results: All of the patients had restlessness to the physical examination, they were impulsive and had inattention. The cerebral computed tomography detected in most of the cases injury (80%) and in one case it was necessary to make additional magnetic resonance imaging to verify it. Only in one case the electroencephalogram was abnormal, with slow temporo-occipital waves observed. CT showed frontal calcificated injuries, after medical treatment. There were no side effects to medication. Conclusion: Patients with frontal NCC may display upheavals of attention deficit and hyperactivity, that could be explained by the dysfunction frontostriatal theory, as it happens in the attention deficit and hyperactivity disorder (ADHD). In endemic zones of NCC like Colombia, it is necessary to consider this condition in children presenting symptoms of ADHD, especially in pediatric patients without any previous conduct disorder, since there are children with structural neurological upheavals with ADHD symptoms.