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Resumen Introducción : Las características clínicas y evolutivas de los pacientes con diagnóstico de COVID-19 pueden diferir entre las distintas olas de la pandemia. El objetivo de este estudio fue comparar las características clínicas, evolución y mortalidad de pacientes hospitalizados por COVID-19 durante la primera y segunda ola en Argentina. Métodos : Registro multicéntrico y prospectivo de pacientes ≥ 18 años con diagnóstico confirmado de COVID-19 internados en 18 hospitales de Argentina durante la primera (marzo a octubre 2020) y la segunda ola (marzo a julio 2021) de la pandemia. Se compararon variables demográficas, características clínicas, y evolu ción a 30 días. Resultados : Se incluyeron un total de 1691 pacien tes (primera ola n = 809, segunda ola n = 882). Los pa cientes hospitalizados durante la segunda ola tenían mayor edad (mediana 53 años vs. 61 años, p < 0.001), comorbilidades (71% vs. 77%, p = 0.007) y requerimiento de oxígeno (21% vs. 62%, p < 0.001). Durante la hospi talización, los pacientes de la segunda ola requirieron más oxigenoterapia (49% vs. 85%, p < 0.001), asistencia mecánica respiratoria (12% vs. 22%, p <0,001) y presen taron mayor mortalidad (11% vs. 26%, p < 0.001). Compa rando únicamente a los que requirieron oxigenoterapia durante la hospitalización, la mortalidad a los 30 días fue de 20% y 30% p < 0.001 en la primera y segunda ola respectivamente. Conclusión : Comparados con los pacientes interna dos durante la primera ola, los internados durante la segunda ola de SARS-CoV-2 en Argentina presentaron mayor gravedad y mortalidad.
Abstract Introduction : Clinical features and outcomes of SARS-CoV-2 infections may change between different waves of the pandemic. The objective of this study was to compare clinical characteristics and outcomes between two cohorts of patients hospitalized for COVID-19 during the first and second waves in Argentina. Methods : Multicenter and prospective registry of patients ≥18 years old with a confirmed diagnosis of COVID-19 admitted to 18 hospitals in Argentina during the first wave (March to October 2020) and second wave (March to July 2021) of the pandemic. Demographics, clinical characteristics, and outcomes of these patients were compared. Results : A total of 1691 patients were included (first wave n = 809, second wave n = 882). Hospitalized pa tients during the second wave were older (median 53 years vs. 61 years, p < 0.001), had more comorbidities (71% vs. 77%, p=0.007) and required more supplemental oxygen at admission (21% vs 62%, p < 0.001). During hos pitalization, patients of the second wave required more supplemental oxygen (49% vs. 85%, p < 0.001), invasive ventilation (12% vs. 22%, p < 0.001) and had higher 30- day mortality (11% vs. 26%, p < 0.001). Comparing only patients who required supplemental oxygen during hos pitalization, 30-day mortality was 20% and 30% p < 0.001 for the first and second wave, respectively. Conclusion : Compared to patients admitted during the first wave, patients admitted with SARS-CoV2 dur ing the second wave in Argentina were more seriously ill and had a higher mortality.
ABSTRACT
ABSTRACT The aim of this study was to evaluate changes in periodontal status and maxillary buccal bone by considering clinical and tomographic parameters during the first year of orthodontic expansion with Invisalign® aligners. Upper first (1PM) and upper second (2PM) premolars of 19 patients with orthodontic expansion requirement treated with Invisalign® aligners were evaluated. Plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL) and cone beam tomographic (CBCT) records were collected at 76 sites before starting treatment (T0) and at 12 months (T1). Bone height was measured from cementoenamel junction (CEJ) to the crest cortical bone (CC). Bone thickness was measured at two levels: 4 mm (CEJ+4) and 6 mm (CEJ+6) apical to the CEJ. A descriptive analysis was made of the variations of bone thickness and height in a series of cases. The average expansion was 1.93 mm for 1PM and 167 mm for 2PM. Arithmetic mean of distance CEJ-CC in 1PM was 3.05 mm at T0, and remained at 3.05 mm at T1. Arithmetic mean of distance CEJ-CC in 2PM was 2.06 mm at T0 and 2.31 at T1. Post-expansion, most of the analyzed sites (86%) exhibited a bone thickness of ≥0.5 mm. The greatest variations between T0 and T1 were observed at the level of 1PM CEJ+ 4 and 2PM CEJ+ 6. The minimal changes in the clinical records (GI, PI, PPD and CAL) between T0 and T1 were compatible with the maintenance of gingivalperiodontal health. Invisalign® for expansion movements did not produce substantial changes in the evaluated periodontal clinical parameters or in the bone measurements. Removable appliances reduce plaque retentive factors and favor adequate oral hygiene.
RESUMEN El objetivo de este estudio fue evaluar los cambios en el estado periodontal y hueso facial maxilar a través de parámetros clínicos y tomográficos durante la expansión ortodóncica con alineadores Invisalign® en el primer año de tratamiento. Se evaluaron los primeros (1PM) y segundos (2PM) premolares superiores pertenecientes a 19 pacientes con requerimiento de expansión ortodóncica tratados con alineadores Invisalign®. Se registraron los índices de placa (IP), índice gingival (IG), profundidad al sondaje (PS) y nivel de inserción (NI) y registros tomográficos de haz cónico (CBCT) en 76 sitios antes de comenzar el tratamiento (T0) y a los 12 meses (T1). Se midió la altura ósea desde el límite amelocementario (LAC) hasta la cortical de la cresta (CC) y el espesor en dos niveles; a 4 mm (LAC+4) y a 6 mm (LAC+6) hacia apical del LAC. Se realizó un análisis descriptivo de las variaciones de la altura y espesor óseo en una serie de casos. La expansión promedio para 1PM fue de 1,93 mm y para 2PM fue de 1,67 mm. La media aritmética de LAC-CC en primeros premolares fue de 3,05 mm en T0 y se mantuvo el valor de 3,05 mm en T1. La media aritmética de LAC-CC en segundos premolares fue de 2,06 mm en T0 y 2,31 en T1. Post expansión, la mayoría de los sitios (86%) analizados exhibieron un espesor óseo ≥0,5 mm. Las mayores variaciones entre T0 y T1 se observaron a nivel de 1PM CEJ+4 y 2PM CEJ+6. Los registros clínicos (PI, GI, PPD y CAL) evidenciaron mínimos cambios entre T0 y T1, compatibles con el mantenimiento de la salud gíngivo-periodontal. El uso de Invisalign ® para movimientos de expansión no produjo cambios sustanciales en los parámetros clínicos periodontales evaluados ni en las mediciones óseas. La aparatología removible reduce los factores retentivos de placa bacteriana y facilita una adecuada higiene oral.
Subject(s)
Humans , Orthodontic Appliances, Removable/adverse effects , Tooth Movement Techniques/adverse effects , Oral Health , Dental Plaque/etiology , Malocclusion/therapy , Maxilla/diagnostic imaging , Tooth Movement Techniques/instrumentation , Dental Plaque Index , Health Status , Dental Plaque/microbiology , Cone-Beam Computed TomographyABSTRACT
BACKGROUND: Latest tissue engineering strategies for musculoskeletal tissues regeneration focus on creating a biomimetic microenvironment closely resembling the natural topology of extracellular matrix. This paper presents a novel musculoskeletal tissue scaffold fabricated by hybrid additive manufacturing method. METHODS: The skeleton of the scaffold was 3D printed by fused deposition modeling, and a layer of random or aligned polycaprolactone nanofibers were embedded between two frames. A parametric study was performed to investigate the effects of process parameters on nanofiber morphology. A compression test was performed to study the mechanical properties of the scaffold. Human fibroblast cells were cultured in the scaffold for 7 days to evaluate the effect of scaffold microstructure on cell growth. RESULTS: The tip-to-collector distance showed a positive correlation with the fiber alignment, and the electrospinning time showed a negative correlation with the fiber density. With reinforced nanofibers, the hybrid scaffold demonstrated superior compression strength compared to conventional 3D-printed scaffold. The hybrid scaffold with aligned nanofibers led to higher cell attachment and proliferation rates, and a directional cell organization. In addition, there was a nonlinear relationship between the fiber diameter/density and the cell actinfilament density. CONCLUSION: This hybrid biofabrication process can be established as a highly efficient and scalable platform to fabricate biomimetic scaffolds with patterned fibrous microstructure, and will facilitate future development of clinical solutions for musculoskeletal tissue regeneration.
Subject(s)
Humans , Biomimetics , Extracellular Matrix , Fibroblasts , Methods , Microtechnology , Nanofibers , Printing, Three-Dimensional , Regeneration , Skeleton , Tissue Engineering , Tissue ScaffoldsABSTRACT
A 22-year-old woman was diagnosed with intermediate risk stage II Hodgkin lymphoma and treated with three cycles of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by involved-field radiation therapy. A complete metabolic remission was achieved after two cycles of ABVD, which was maintained until three years after completion of treatment. Follow-up FDG-PET/CT four years after completion of treatment, however, showed a new FDG-avid (Deauville score of 4) lesion in the right scapula, suggesting relapsed disease. Computer tomography (CT)-guided biopsy of this lesion was performed and subsequent histological examination revealed a radiation-induced giant cell granuloma.
Subject(s)
Female , Humans , Young Adult , Biopsy , Bleomycin , Dacarbazine , Doxorubicin , Follow-Up Studies , Giant Cells , Granuloma, Giant Cell , Hodgkin Disease , Scapula , VinblastineABSTRACT
El objetivo de este estudio fue evaluar la capacidad de desarrollo in vitro de ovocitos bovinos de vacas mestizas B. taurus y B. indicus. Los ovocitos fueron recuperados de ovarios de hembras bovinas provenientes de un matadero comercial. Para la obtención de los complejos cumulus-ovocitos (CCO) se realizó la técnica de slicing, seleccionando los ovocitos que tenían al menos una capa de células del cumulus y un citoplasma homogéneo. Los ovocitos seleccionados fueron madurados y fecundados in vitro (MIV-FIV). Se utilizó semen de un toro Brahman puro (B. indicus). Para la evaluación de la MIV y FIV todos los ovocitos se fijaron por al menos 24 h a 4°C en solución metanol-ácido acético (3:1) y teñidos con aceto-orceína al 1,1%. La tasa de maduración de ovocitos de vacas con predominancia fenotípica B. indicus fue del 66,17% mientras que las vacas con predominancia fenotípica B. taurus alcanzaron un 50,94% (P>0,05). En cuanto a la tasa de fecundación se obtuvo un 14,28 y 35,72% de ovocitos penetrados normalmente y anormales, respectivamente, para el grupo de ovocitos con predominancia fenotípica B. indicus. Mientras que para vacas con predominancia fenotípica B. taurus, un 10,22% correspondió a ovocitos penetrados normales y 19,31% de ovocitos penetrados anormales, sin encontrar diferencias estadísticamente significativas en ambos grupos. Los presentes resultados, tanto para la progresión meiótica como para las tasas de fecundación, indican que los ovocitos de vacas mestizas con predominancia fenotípica B. indicus son más competentes en las primeras etapas de desarrollo in vitro que los ovocitos de vacas mestizas con predominancia fenotípica B. taurus.
The aim of this study was to evaluate the in vitro development capacity of bovine oocytes from crossbred B. taurus and B. indicus cows. Oocytes from bovine cows were collected from commercial slaughterhouse. The cumulus-oocyte complex (COC) ovaries were obtained by Slicing technique, selecting those oocytes that had 2 to 3 layers of cumulus cells and homogeneous cytoplasm. After selection oocytes proceed with maturation (IVM) and fertilization in vitro (IVF). It used semen from a pure Brahman bull (B. indicus). For the assessment of IVM as for IVF oocytes were fixed for about 24 hours at 4°C in methanol-acetic acid (3:1) solution and stained with 1.1% aceto-orcein. The maturation rate of oocytes from cows with B. indicus phenotypic predominance was 66.17%, whereas cows with B. taurus phenotypic predominance 50.94% (P>0.05). Fertilization rate obtained in B. indicus phenotypic predominance group was 14.28% of oocytes normal penetrated and abnormal penetrated 35.72%, for cows with a phenotypic predominance B. taurus oocytes normal penetrated were 10.22% and 19.31% of abnormal oocytes penetrated. In conclusion, the present results indicate that oocytes from cows with phenotypic predominance B. indicus are more competent in the early stages of development in vitro than oocytes from cows with phenotypic predominance B. taurus.
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Background. Rural areas in all countries suffer from a shortage of health care professionals. In South Africa; the shortage is particularly marked; some rural areas have a doctor-topopulation ratio of 5.5:100 000. Similar patterns apply to other health professionals. Increasing the proportion of rural-origin students in faculties of health sciences has been shown to be one way of addressing such shortages; as the students are more likely to work in rural areas after graduating. Objective. To determine the proportion of rural- origin students at all medical schools in South Africa. Design. A retrospective descriptive study was conducted in 2003. Lists of undergraduate students admitted from 1999 to 2002 for medicine; dentistry; physiotherapy and occupational therapy were obtained from 9 health science faculties. Origins of students were classified as city; town and rural by means of postal codes. The proportion of rural-origin students was determined and compared with the percentage of rural people in South Africa (46.3). Results. Of the 7 358 students; 4 341 (59) were from cities; 1 107 (15) from towns and 1 910 (26) from rural areas. The proportion of rural-origin students in the different courses nationally were: medicine - 27.4; physiotherapy - 22.4; occupational therapy - 26.7; and dentistry - 24.8. Conclusion. The proportion of rural-origin students in South Africa was considerably lower than the national rural population ratio. Strategies are needed to increase the number of rural-origin students in universities via preferential admission to alleviate the shortage of health professionals in rural areas
Subject(s)
Medically Underserved Area , Rural Health Services , Students/educationABSTRACT
Photons participate in many atomic and molecular interactions and processes. Recent biophysical research has discovered an ultraweak radiation in biological tissues. It is now recognized that plants, animal and human cells emit this very weak biophotonic emission which can be readily measured with a sensitive photomultiplier system. UVA laser induced biophotonic emission of cultured cells was used in this report with the intention to detect biophysical changes between young and adult fibroblasts as well as between fibroblasts and keratinocytes. With suspension densities ranging from 1-8 x 106 cells/ml, it was evident that an increase of the UVA-laser-light induced photon emission intensity could be observed in young as well as adult fibroblastic cells. By the use of this method to determine ultraweak light emission, photons in cell suspensions in low volumes (100 microl) could be detected, in contrast to previous procedures using quantities up to 10 ml. Moreover, the analysis has been further refined by turning off the photomultiplier system electronically during irradiation leading to the first measurements of induced light emission in the cells after less than 10 micros instead of more than 100 milliseconds. These significant changes lead to an improvement factor up to 106 in comparison to classical detection procedures. In addition, different skin cells as fibroblasts and keratinocytes stemming from the same donor were measured using this new highly sensitive method in order to find new biophysical insight of light pathways. This is important in view to develop new strategies in biophotonics especially for use in alternative therapies.
Subject(s)
Biophysics/methods , Cell Line , Cells, Cultured , Cryopreservation , Equipment Design , Fibroblasts/cytology , Humans , Keratinocytes/cytology , Lasers , Light , Photons , Skin/metabolism , Time Factors , Ultraviolet RaysABSTRACT
O sucesso no uso de Trichogramma como agente de controle biológico depende de sua produção em laboratório que é etapa fundamental, entre outras, em qualquer programa de controle biológico. Este trabalho investigou a capacidade de parasitismo de Trichogramma pratissolii Querino & Zuchi, uma nova espécie encontrada, parasitando ovos de Anagasta kuehniella (Zeller) e Corcyra cephalonica (Stainton) (Lepidoptera: Pyralidae) submetidos a 15, 18, 21, 24, 27, 30 e 33°C. Ovos desses hospedeiros foram oferecidos para fêmeas recém-emergidas por 24h. Esse procedimento foi repetido para cada fêmea e temperatura até a morte das fêmeas do parasitóide, para estimar o parasitismo diário, acumulado e a longevidade das fêmeas. Em ambos hospedeiros, o parasitismo diário decresceu em função da idade da fêmea. Em todas as temperaturas estudadas e ambos hospedeiros, o maior parasitismo ocorreu durante as primeiras 24h e, atingiu 80 por cento do total no quarto e terceiro dias quando parasitou A. kuehniella e C. cephalonica, respectivamente. Para ambos os hospedeiros os maiores índices de parasitismo foram observados entre 21°C e 27°C. A longevidade média de fêmeas de T. pratissolii sem alimento e provenientes de ovos de A. kuehniella e C. cephalonica sobreviveram de 1,0 a 8,9 dias, quando criadas a 15°C e 33°C, respectivamente. Os resultados encontrados indicam que ovos de A. kuehniella e C. cephalonica e temperaturas de 21°C a 27°C foram apropriados para criação de T. pratissolii.
The successful use of Trichogramma as biocontrol agent depends on its mass production in laboratory, a fundamental step for any biological control program among other factors. This work investigated the parasitism capacity of Trichogramma pratissolii Querino & Zuchi (Hymenoptera: Trichogrammatidae), a new recorded Trichogramma species, parasitizing eggs of Anagasta kuehniella (Zeller) and Corcyra cephalonica (Stainton) (Lepidoptera: Pyralidae) under the temperatures of 15, 18, 21, 24, 27, 30 and 33°C. Eggs of these hosts were offered to newly emerged females during 24h. This procedure was repeated daily for each female and each temperature up to female death, in order to estimate daily and accumulated parasitism, and female longevity. On both hosts, the daily parasitism decreased as function of the female age. Under all temperatures studied and both hosts the highest rate of parasitism was observed during the first 24h of host exposure, and reached 80 percent of total parasitism in the 4th and 3rd days when parasitizing A. kuehniella and C. cephalonica, respectively. On both hosts, the highest parasitism rate was observed under temperatures from 21°C to 27°C. Average longevities of T. pratissolii females deprived of food emerging from A. kuehniella and C. cephalonica lived for 1.0 and 8.9 days when reared at 15°C e 33°C, respectively. The results indicate that eggs of A. kuehniella and C. cephalonica and temperatures from 21°C to 27°C were appropriate to rear T. pratissolii.
Subject(s)
Animals , Hymenoptera/physiology , Lepidoptera/parasitology , Temperature , LongevityABSTRACT
Este artigo tem por objetivo propor uma metodologia de aprendizagem integrando os conceitos entre redes neurais qrtificiais (RNAs) e a teoria dos conjuntos difusos (TCDs). O maior interesse da pesquisa é examinar a aplicabilidade das operações aritméticas t-normas e t-conormas, implementadas através de dois tipos de neurônios difusos. Os resultados mostram que a operação aritmética Soma/Produto de Einstein E/OU implementado com o neurônio difuso proposto por Kwan-Cai obteve os melhores índices de acertos do SND. Os resultados foram analisados considerando os indicadores quantitativos de modelagem. A área de domínio, utilizada para provar a validade da metodologia, é no diagnóstico de eventos paroxístico (EPs), envolvendo os eventos epilépticos (EEs) e os eventos não epilépticos (ENEs).
Subject(s)
Learning , Nerve Net , MethodsABSTRACT
Inseticidas químicos são amplamente usados para o controle da traça-das-crucíferas, Plutella xylostella (L.). Esta é considerada a principal praga das crucíferas em todo o mundo e o surgimento de resistência de P. xylostella tem sido freqüentemente relatado. Este trabalho investigou as diferentes interações dos fungos Metarhizium anisopliae (Metsch.) Sorok. e Beauveria bassiana (Bals.) Vuill. com o parasitóide de larva-pupa Oomyzus sokolowskii (Kurdjumov) sobre larvas de P. xylostella. O experimento foi conduzido à temperatura de 26 ± 1°C, UR de 75 ± 5 por cento e fotofase de 12h, empregando-se delineamento inteiramente casualizado, constando de oito tratamentos com seis repetições cada. Foram utilizados os isolados E9 de M. anisopliae e ESALQ 447 de B. bassiana, na concentração de 10(7) conídios ml-1. Os resultados mostram que M. anisopliae e B. bassiana reduziram o parasitismo de P. xylostella por O. sokolowskii . Por outro lado, efeitos aditivos no controle de P. xylostella foram evidenciados nas diferentes combinações dos fungos com o parasitóide, exceto para B. bassiana quando pulverizado 24h antes da exposição a O. sokolowskii. Os fungos M. anisopliae e B. bassiana foram mais eficientes quando aplicados após a exposição das larvas ao parasitóide, e a eficiência de O. sokolowskii foi influenciada negativamente pela presença dos fungos independente da combinação. A associação dos fungos com o parasitóide apresentam potencial para serem testados em campo, objetivando o controle de P. xylostella bem como favorecer economicamente o sistema produtivo das brássicas.
Subject(s)
Animals , Beauveria/physiology , Hymenoptera/physiology , Lepidoptera/microbiology , Lepidoptera/parasitology , Metarhizium/physiology , Pest Control, Biological/methods , Host-Parasite Interactions , Larva/microbiology , Larva/parasitologyABSTRACT
Background: The development of registrar training as part of the newly created speciality of family medicine in South Africa requires the development of a national consensus on the clinical procedural skills outcomes that should be expected of training programmes.Methods This study utilized a Delphi technique to establish a national consensus between 35 experts from training institutions; those already in family practice and managers who might be employing family physicians in both private and public sector contexts. Results: Consensus was reached on 214 core skills at different levels of desired competency and 23 elective skills. The core skills were divided into 58 that should be taught by family physicians; 101 that should be performed independently and 55 that should be performed during training under supervision. The panel were unable to reach consensus on a further 21 skills.ConclusionThis is the first study that has proposed a set of essential clinical procedural skills for the training of family physicians in South Africa. The findings will act as a benchmark for programmes in South Africa and through the new initiative of `FaMEC in Africa' may influence curriculum development in other African countries. They may be used as a guide for curriculum planning; as a way of monitoring skills development and as an indication to registrars of the skills they need to achieve for assessment purposes. The findings may also inform the planning of training programmes for the proposed mid-level health worker (clinical associate) in South Africa as their skills will be a sub-set of these skills and will be taught by family physicians within district hospitals. Training programmes for undergraduates and interns in family medicine may also want to position themselves as stepping stones in line with these final outcomes of postgraduate training
Subject(s)
Clinical Competence , Delphi TechniqueABSTRACT
Background: The development of registrar training as part of the newly created speciality. Methods: This study utilized a Delphi technique to establish a national consensus between 35 experts from training institutions; those already in family practice and managers who might be employing family physicians in both private and public sector contexts of family medicine in South Africa requires the development of a national consensus on the clinical procedural skills outcomes that should be expected of training programmes.Results: Consensus was reached on 214 core skills at different levels of desired competency and 23 elective skills. The core skills were divided into 58 that should be taught by family physicians; 101 that should be performed independently and 55 that should be performed during training under supervision. The panel were unable to reach consensus on a further 21 skills.Conclusion: This is the first study that has proposed a set of essential clinical procedural skills for the training of family physicians in South Africa. The findings will act as a benchmark for programmes in South Africa and through the new initiative of 'FaMEC in Africa' may influence curriculum development in other African countries. They may be used as a guide for curriculum planning; as a way of monitoring skills development and as an indication to registrars of the skills they need to achieve for assessment purposes. The findings may also inform the planning of training programmes for the proposed mid-level health worker (clinical associate) in South Africa as their skills will be a sub-set of these skills and will be taught by family physicians within district hospitals. Training programmes for undergraduates and interns in family medicine may also want to position themselves as stepping stones in line with these final outcomes of postgraduate training
Subject(s)
Clinical Competence , Delphi Technique , Family Practice , Reference StandardsABSTRACT
Background: The primary healthcare system was adopted as the vehicle of healthcare delivery and a means of reaching the larger part of the population in South Africa in 1994. One of the strategies employed in providing a comprehensive service is the incorporation of visits to clinics by doctors in support of other members of the primary healthcare team; particularly nurses. A successful collaboration at this level brings benefit to everyone involved; particularly patients. Clear expectations and a confusion of roles leads to lack of teamwork; thus it is important to have clearly established models for such involvement. Doctors working in district hospitals mostly visit clinics; but their workload; staff shortages and transport often interfere with these visits. As a form of private-public partnership; local GPs are sometimes contracted to visit the clinics. Very little is known about this practice and problems are reported; including the perception that GPs do not spend as much time in the clinics as they are paid for10.Understanding the practice better may provide answers on how to improve the quality of primary care in the district health system. The aim of this study was to describe the experiences of local GPs visiting public clinics regularly over a long period of time. Methods A case study was undertaken in the Odi district of the North West Province in three primary care clinics visited by GPs. The experiences of the doctors; clinic nurses; district managers and patients regarding the GP's visits were elicited through in-depth interviews. Details of the visits with regard to patient numbers; lengths of the visits; remuneration and preferences were also sought. The data were analysed using different methods to highlight important themes. Results: The visits by the GPs to the clinics were viewed as beneficial by the patients and clinic staff. The GPs were often preferred to government doctors because of their skills; patience and availability. The visits were also seen as a gesture of patriotism by the GPs. There were constraints; such as a shortage of medicines and equipment; which reduce the success of these visits. Conclusion: The involvement of GPs in primary care clinics is beneficial and desirable. It enhances equity in terms of access to services. Addressing the constraints can optimise the public-private partnership at this level
Subject(s)
Delivery of Health Care , Primary Health CareABSTRACT
Background: The primary healthcare system was adopted as the vehicle of healthcare delivery and a means of reaching the larger part of the population in South Africa in 1994. One of the strategies employed in providing a comprehensive service is the incorporation of visits to clinics by doctors in support of other members of the primary healthcare team; particularly nurses. A successful collaboration at this level brings benefit to everyone involved; particularly patients. Clear expectations and a confusion of roles leads to lack of teamwork; thus it is important to have clearly established models for such involvement. Doctors working in district hospitals mostly visit clinics; but their workload; staff shortages and transport often interfere with these visits. As a form of private-public partnership; local GPs are sometimes contracted to visit the clinics. Very little is known about this practice and problems are reported; including the perception that GPs do not spend as much time in the clinics as they are paid for10.Understanding the practice better may provide answers on how to improve the quality of primary care in the district health system. The aim of this study was to describe the experiences of local GPs visiting public clinics regularly over a long period of time.Methods: A case study was undertaken in the Odi district of the North West Province in three primary care clinics visited by GPs. The experiences of the doctors; clinic nurses; district managers and patients regarding the GP's visits were elicited through in-depth interviews. Details of the visits with regard to patient numbers; lengths of the visits; remuneration and preferences were also sought. The data were analysed using different methods to highlight important themes.Results: The visits by the GPs to the clinics were viewed as beneficial by the patients and clinic staff. The GPs were often preferred to government doctors because of their skills; patience and availability. The visits were also seen as a gesture of patriotism by the GPs. There were constraints; such as a shortage of medicines and equipment; which reduce the success of these visits.Conclusion: The involvement of GPs in primary care clinics is beneficial and desirable. It enhances equity in terms of access to services. Addressing the constraints can optimise the public-private partnership at this level
Subject(s)
Community Health Workers , Cooperative Behavior , Family , Hospitals , Physicians , Primary Health Care , Private Sector , Public SectorABSTRACT
INTRODUÇAO: Em nosso meio, os carcinomas gástricos ainda são neoplasias bastante freqüentes e responsáveis por altas taxas de mortalidade. Recentemente, têm-se demonstrado a expressão de p53 e a amplificacão do gene c-erb-B2 nos carcinomas gástricos. A relevância e o significado biológico destas alteracões ainda não foram totalmente estabelecidos. OBJETIVO: Estudar as expressões imuno-histoquímicas de p53 e c-erb-B2 em 482 casos de carcinomas gástricos. MATERIAL E MÉTODOS: Foram construídos três blocos de tissue microarray (TMA) utilizando-se duplicatas de 482 casos de carcinomas gástricos. Os cortes foram corados por hematoxilina e eosina (HE), tendo sido feita pesquisa para p53 e c-erb-B2. Foram considerados positivos para p53 os casos com marcacão nuclear em mais de 10 por cento das células tumorais. Para o c-erb-B2 foram considerados positivos os casos com marcacão de membrana completa em mais de 10 por cento das células tumorais. RESULTADOS: A expressão de p53 e c-erb-B2 foi observada em 30 por cento e 12 por cento dos casos, respectivamente. Em relacão aos tipos histológicos observou-se correlacão entre os carcinomas do tipo intestinal e a expressão de c-erb-B2 (p < 0,001). A expressão de p53 foi mais freqüente nos carcinomas com mais de 5cm de diâmetro (p = 0,036). Não foram observadas alteracões nas curvas de sobrevida dos pacientes em relacão às expressões desses marcadores. CONCLUSAO: Em nosso meio, carcinomas gástricos do tipo intestinal são mais freqüentemente positivos para c-erb-B2 nos tipos intestinais do que nos difusos. A expressão de p53 está associada ao tamanho tumoral. A técnica do TMA é válida e eficiente para o estudo de marcadores imuno-histoquímicos, com forte correlacão com os cortes tradicionais de representacão do tumor.
Subject(s)
Humans , Carcinoma/genetics , Carcinoma/pathology , Immunohistochemistry , Stomach Neoplasms/genetics , Stomach Neoplasms/pathology , /biosynthesis , /biosynthesis , Gene Expression Regulation, Neoplastic/geneticsABSTRACT
Este trabalho foi realizado com o objetivo de identificar a espécie de mosca-branca presente em mamoeiro (Carica papaya L.) em Petrolina, PE e avaliar a influência de genótipos de mameiro sobre a infestação do inseto. Para isso, foram realizadas quatro avaliações mensais, estimando-se o número de ovos e ninfas em dezoito genótipos de mamoeiro. Em cada avaliação, foram retiradas duas folhas de uma única planta de cada genótipo, classificadas como folha nova e folha velha. A espécie de mosca-branca encontrada foi Trialeurodes variabilis (Quaintance). O maior número de ovos ocorreu nas regiões apical e mediana de folhas novas. Em folhas velhas, a maior parte dos ovos foi encontrada na região basal e as ninfas ocorreram com maior freqüência na região mediana. Os maiores valores para número de ovos nas folhas novas foram observados em CMF-012, CMF-022, CMF-023 e CMF-047, diferindo significativamente daqueles registrados nos demais genótipos. Nas folhas velhas, CMF-022, CMF-023 e CMF-047 apresentaram as maiores infestações de ninfas, diferindo significativamente de CMF-012, CMF-020, CMF-021 e CMF-034, os quais foram moderadamente infestados, em relação aos demais genótipos, nos quais se registrou baixa população de ninfas. Os genótipos Sunrise Solo e Tainung n°1 apresentaram baixa população de ovos e ninfas de T. variabilis. No presente trabalho, observou-se que os genótipos de mamoeiro afetaram diferencialmente a infestação da mosca-branca e que a estrutura populacional da praga variou de acordo com a idade da folha.
This work aimed at identifying the whitefly species attacking papaya (Carica papaya L.) plants in Petrolina, Pernambuco State, Brazil, and at evaluating the influence of papaya genotypes on insect infestation. Four monthly evaluations were done to estimate the number of eggs and nymphs on eighteen papaya genotypes. Two leaves per genotype, a new leaf and an old one, were removed at each evaluation. The whitefly species was identified as Trialeurodes variabilis (Quaintance). Eggs were found mostly on the terminal and median sections of the new leaves. On the old leaves, eggs and nymphs were mainly present on the proximal and median sections, respectively. The egg numbers were statistically higher on the new leaves of the genotypes CMF-012, CMF-022, CMF-023 and CMF-047. On the old leaves the nymph numbers were the highest on CMF-022, CMF-023 and CMF-047, differing significantly from CMF-012, CMF-020, CMF-021 and CMF-034. In these, infestations were moderate comparing to the remaining genotypes studied, which presented low nymph populations. Sunrise Solo and Tainung n°1 presented low populations of eggs and nymphs of T. variabilis. In synthesis, papaya genotypes influenced differently the whitefly infestation, and the structure of the pest population varied according to leaf age.
ABSTRACT
Esta pesquisa tem como objetivo a análise de modelos de aprendizagem utilizando diferentes operações aritméticas aplicadas em um Sistema Neuro-Difuso (SND). A pesquisa integra os conceitos entre as Redes Neurais Artificiais (RNAs) e a Teoria dos Conjuntos Difusos (TCDs). Descreve diferentes combinações de operações aritméticas para compor as regras difusas utilizando expressões de entrada lingüísticas e numéricas. Para avaliar a validade da proposta, um SND é proposto para diagnosticar Eventos Paroxísticos envolvendo os Eventos Epilépticos(EEs) e os Eventos não Epilépticos (ENEs). Após uma simulação realizada constatou-se que as operações aritméticas Produto/Soma Algébrica e Produto/Soma de Hamacher apresentaram um valor final mais próximo em relação ao valor fornecido pelo especialista de domínio.
Subject(s)
Humans , Artificial Intelligence , Diagnosis, Differential , Fuzzy Logic , Models, Neurological , Neural Networks, Computer , SeizuresABSTRACT
Objetivos: a) Realizar una revisión del tratamiento médico empleado en el infarto agudo de miocardio con elevación del segmento ST. b) Determinar la letalidad intrahospitalaria. Metodología: estudio retrospectivo-descriptivo y análitico, basados en la revisión de fichas clínicas de pacientes internados con diagnóstico de infarto agudo de miocardio con elevación del ST en el servicio de Unidad Coronaria del HCIPS en el periodo comprendido entre el 16-01-02 y el 26-12-02. Resultados: Se incluyeron 44 pacientes, la edad media fue de 67,5 años (35-86 años), sexo masculino 36(59%), 16 pacientes fueron diabeticos, 25 (56,8%) hipertensos; 11 (25%) dislipidemico; 18 (40,9%) fumadores, 5 (11,36%) tenía historia previa de infarto de miocardio . El infarto de cara anterolateral fue el mas frecuente16 pacientes (36,36%), seguido de anterior extenso 10 (22,72%), anteroseptal 6 (13.63%), con inferolateral 6(13,63%), inferior 4 (9,09%) e inferoposterior 2 (4,54%). Ingresaron con Killip Kimbal (kk) I:18 pacientes (40,90%), KK II:17 (38.63%), KK III:5 (11,36%), KK IV (p,09%). De los 44 pacientes 21 (47,72%) recibieron tromboliticos, 36 (81,8%) inhibidores de la enzima convertidora de angiotensina, 39 (88,6%) aspirina, 25 (56,8%) betabloqueantes, 22 (50%) estatinas, 8 (18,18%) clopidrogel, 32 (72,72%) nitratos, 6 (13,6%) morfina, 15 (34,08%) dopamina, 14 (31,81) dobutamina, 5 11,36%) lidocainas, 5 (11,36%) amiodarona, 41 (93,18%) heparina. La mortalidad fue del 29,5%. El shock cardiogénico fue la causa más frecuente del obito 61,5%. Conclusión: A) Las medicaciones más utilizadas fueron la heparina, la aspirina, los inhibidores de la enzima convertora de angiontensina y los nitratos. Los betabloqueantes, las estatinas y los tromboliticos fueron los menos utilizados. B) La mortalidad intrahospitalaria fue superior a la encontrada en la literatura.