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1.
AIDS Res Ther ; 21(1): 21, 2024 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-38609992

RESUMO

BACKGROUND: Maintaining people living with HIV (PLWHIV) in clinical care is a global priority. In the Metro Detroit area of Michigan, approximately 30% of PLWHIV are out of care. To re-engage lost-to-follow-up patients, Wayne Health Infectious Disease clinic launched an innovative Homecare program in 2017. In addition to home healthcare delivery, the program included links to community resources and quarterly community meetings. We aimed to evaluate Homecare's impact on participants' ability to stay engaged in HIV care and reach viral suppression. We included data from PLWHIV and their healthcare workers. METHODS: We used a convergent mixed-methods design, including first year program record review, semi-structured interviews, and a validated Likert scale questionnaire rating illness perception before and after Homecare. Interview data were collected from 15 PLWHIV in Metro Detroit and two healthcare workers responsible for program delivery. Semi-structured interviews focused on obstacles to clinic-based care, support networks, and illness perceptions. Interview data were transcribed and analyzed using a thematic approach. A fully coded analysis was used to create a conceptual framework of factors contributing to Homecare's success. Means in eight categories of the Brief Illness Perception (IPQ) were compared using paired T-tests. RESULTS: In the first year of Homecare, 28 of 34 participants (82%) became virally suppressed at least once. The program offered (1) social support and stigma reduction through strong relationships with healthcare workers, (2) removal of physical and resource barriers such as transportation, and (3) positive changes in illness perceptions. PLWHIV worked towards functional coping strategies, including improvements in emotional regulation, acceptance of their diagnosis, and more positive perspectives of control. Brief-IPQ showed significant changes in six domains before and after Homecare. CONCLUSION: Homecare offers an innovative system for successfully re-engaging and maintaining lost-to-follow-up PLWHIV in care. These findings have implications for HIV control efforts and could inform the development of future programs for difficult to reach populations.


Assuntos
Infecções por HIV , Humanos , Michigan , Seguimentos , Infecções por HIV/terapia , Instituições de Assistência Ambulatorial , Capacidades de Enfrentamento
2.
J Cell Mol Med ; 27(22): 3423-3430, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37882471

RESUMO

Monocytes and neutrophils play key roles in the cytokine storm triggered by SARS-CoV-2 infection, which changes their conformation and function. These changes are detectable at the cellular and molecular level and may be different to what is observed in other respiratory infections. Here, we applied machine learning (ML) to develop and validate an algorithm to diagnose COVID-19 using blood parameters. In this retrospective single-center study, 49 hemogram parameters from 12,321 patients with clinical suspicion of COVID-19 and tested by RT-PCR (4239 positive and 8082 negative) were analysed. The dataset was randomly divided into training and validation sets. Blood cell parameters and patient age were used to construct the predictive model with the support vector machine (SVM) tool. The model constructed from the training set (5936 patients) achieved an accuracy for diagnosis of SARS-CoV-2 infection of 0.952 (95% CI: 0.875-0.892). Test sensitivity and specificity was 0.868 and 0.899, respectively, with a positive (PPV) and negative (NPV) predictive value of 0.896 and 0.872, respectively (prevalence 0.50). The validation set model (4964 patients) achieved an accuracy of 0.894 (95% CI: 0.883-0.903). Test sensitivity and specificity was 0.8922 and 0.8951, respectively, with a positive (PPV) and negative (NPV) predictive value of 0.817 and 0.94, respectively (prevalence 0.34). The area under the receiver operating characteristic curve was 0.952 for the algorithm performance. This algorithm may allow to rule out COVID-19 diagnosis with 94% of probability. This represents a great advance for early diagnostic orientation and guiding clinical decisions.


Assuntos
COVID-19 , Humanos , COVID-19/diagnóstico , Teste para COVID-19 , SARS-CoV-2 , Estudos Retrospectivos , Técnicas de Laboratório Clínico , Sensibilidade e Especificidade , Aprendizado de Máquina
3.
Invest New Drugs ; 37(1): 17-26, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29721755

RESUMO

The substance P/neurokinin-1 receptor system has been implicated in tumor cell proliferation. Neurokinin-1 receptor has been identified in different solid tumors but not frequently in hematopoietic malignant cells. We investigated the presence of the Neurokinin-1 receptor in acute myeloid leukemia cell lines (KG-1 and HL-60), demonstrating that acute myeloid leukemia cell lines overexpress the truncated Neurokinin-1 receptor isoform compared with lymphocytes from healthy donors. Using the MTS (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) method, we demonstrated that substance P induced cell proliferation in both acute myeloid leukemia cell lines. We also observed that four different Neurokinin-1 receptor antagonists (L-733,060, L-732,138, CP 96-345 and aprepitant) elicited inhibition of acute myeloid leukemia cell growth lines in a concentration-dependent manner, while growth inhibition was only marginal in lymphocytes; the specific antitumor action of Neurokinin-1 receptor antagonists occurs via the Neurokinin-1 receptor, and leukemia cell death is due to apoptosis. Finally, administration of high doses of daily intraperitoneal fosaprepitant to NOD scid gamma mice previously xenografted with the HL60 cell line increased the median survival from 4 days (control group) to 7 days (treated group) (p = 0.059). Taken together, these findings suggest that Neurokinin-1 receptor antagonists suppress leukemic cell growth and may be considered to be potential antitumor drugs for the treatment of human acute myeloid leukemia.


Assuntos
Leucemia Mieloide Aguda/tratamento farmacológico , Antagonistas dos Receptores de Neurocinina-1/farmacologia , Receptores da Neurocinina-1/química , Animais , Apoptose , Proliferação de Células , Humanos , Leucemia Mieloide Aguda/metabolismo , Leucemia Mieloide Aguda/patologia , Camundongos , Camundongos Endogâmicos NOD , Camundongos SCID , Receptores da Neurocinina-1/metabolismo , Células Tumorais Cultivadas , Ensaios Antitumorais Modelo de Xenoenxerto
4.
Osteoporos Int ; 30(7): 1339-1351, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31037362

RESUMO

INTRODUCTION: To examine prognostic factors that influence complications after hip fracture surgery. To summarize proposed underlying mechanisms for their influence. METHODS: We reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Scoping Review extension. We searched MEDLINE, Embase, CINAHL, AgeLine, Cochrane Library, and reference lists of retrieved studies for studies of prognostic factor/s of postoperative in-hospital medical complication/s among patients 50 years and older treated surgically for non-pathological closed hip fracture, published in English on January 2008-January 2018. We excluded studies of surgery type or in-hospital medications. Screening was duplicated by two independent reviewers. One reviewer completed the extraction with accuracy checks by the second reviewer. We summarized the extent, nature, and proposed underlying mechanisms for the prognostic factors of complications narratively and in a dependency graph. RESULTS: We identified 44 prognostic factors of in-hospital complications after hip fracture surgery from 56 studies. Of these, we identified 7 patient factors-dehydration, anemia, hypotension, heart rate variability, pressure risk, nutrition, and indwelling catheter use; and 7 process factors-time to surgery, anesthetic type, transfusion strategy, orthopedic versus geriatric/co-managed care, multidisciplinary care pathway, and potentially modifiable during index hospitalization. We identified underlying mechanisms for 15 of 44 factors. The reported association between 12 prognostic factors and complications was inconsistent across studies. CONCLUSIONS: Most factors were reported by one study with no proposed underlying mechanism for their influence. Where reported by more than one study, there was inconsistency in reported associations and the conceptualization of complications differed, limiting comparison across studies. It is therefore not possible to be certain whether intervening on these factors would reduce the rate of complications after hip fracture surgery.


Assuntos
Fixação de Fratura/efeitos adversos , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/etiologia , Hospitalização , Humanos , Prognóstico , Fatores de Risco
5.
J Microsc ; 273(1): 81-88, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30417387

RESUMO

The influence of the neighbouring atomic-columns in determining the composition at atomic column scale of quaternary semiconductor compounds, using simulated HAADF-STEM images is evaluated. The InAlAsSb alloy, a promising material in the photovoltaic field, is considered. We find that the so called 'crosstalk' effect plays an important role for the aimed compositional determination. The intensity transfer is larger from neighbouring atomic columns with higher average Z, and towards atomic columns with smaller Z. Our results show that in order to obtain precise information on the column composition, the HAADF-STEM intensities of both columns need to be taken into account simultaneously.

6.
Microsc Microanal ; 25(6): 1297-1303, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31407642

RESUMO

From simple averaging to more sophisticated registration and restoration strategies, such as super-resolution (SR), there exist different computational techniques that use a series of images of the same object to generate enhanced images where noise and other distortions have been reduced. In this work, we provide qualitative and quantitative measurements of this enhancement for high-angle annular dark-field scanning transmission electron microscopy imaging. These images are compared in two ways, qualitatively through visual inspection in real and reciprocal space, and quantitatively, through the calculation of objective measurements, such as signal-to-noise ratio and atom column roundness. Results show that these techniques improve the quality of the images. In this paper, we use an SR methodology that allows us to take advantage of the information present in the image frames and to reliably facilitate the analysis of more difficult regions of interest in experimental images, such as surfaces and interfaces. By acquiring a series of cross-sectional experimental images of magnetite (Fe3O4) thin films (111), we have generated interpolated images using averaging and SR, and reconstructed the atomic structure of the very top surface layer that consists of a full monolayer of Fe, with topmost Fe atoms in tetrahedrally coordinated sites.

7.
Inflammopharmacology ; 2018 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-30209762

RESUMO

OBJECTIVES: To evaluate the utility of elevated serum P-glycoprotein (P-gp) as a risk marker of therapeutic response failure in rheumatoid arthritis (RA) patients treated with disease-modifying antirheumatic drugs (DMARDs). METHODS: A cross-sectional study was conducted in 151 RA patients. Patients were classified into two groups according to the response achieved in terms of the disease activity score (DAS)28 after ≥ 6 months: (1) patients with a therapeutic response to DMARDs, with DAS28 < 3.2; and (2) patients without a response to DMARDs, with persistent DAS28 ≥ 3.2. We explored a wide group of clinical factors associated with therapeutic resistance. Serum P-gp levels were measured by ELISA. The risk of P-gp elevation as a marker of failure to achieve a therapeutic response to DMARDs was computed using multivariate logistic regression. RESULTS: Serum P-gp levels were significantly higher in RA patients (n = 151) than in the controls (n = 30) (158.70 ± 182.71 ng/mL vs. 14.12 ± 8.97 ng/mL, p < 0.001). The P-gp level was correlated with the DAS28 score (r = 0.39, p < 0.001). RA patients with DMARD failure had higher serum P-gp levels than patients with a therapeutic response (206 ± 21.47 ng/mL vs 120.60 ± 15.70 ng/mL; p = 0.001). High P-gp levels increased the risk of DMARD failure (OR 3.36, 95% CI 1.54-7.27, p = 0.001). After adjusting for confounding variables, elevated P-gp remained associated with DMARD failure (OR 2.64, 95% CI 1.29-5.40, p = 0.01). CONCLUSION: Elevated serum P-gp is associated with DMARD failure. The P-gp level can be considered a clinical tool for evaluating the risk of DMARD failure in patients; however, future prospective studies should be performed to evaluate the utility of this marker in predicting long-term responses.

8.
J Microsc ; 262(1): 50-8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26501744

RESUMO

Super-resolution (SR) software-based techniques aim at generating a final image by combining several noisy frames with lower resolution from the same scene. A comparative study on high-resolution high-angle annular dark field images of InAs/GaAs QDs has been carried out in order to evaluate the performance of the SR technique. The obtained SR images present enhanced resolution and higher signal-to-noise (SNR) ratio and sharpness regarding the experimental images. In addition, SR is also applied in the field of strain analysis using digital image processing applications such as geometrical phase analysis and peak pairs analysis. The precision of the strain mappings can be improved when SR methodologies are applied to experimental images.

9.
Br J Nutr ; 115(9): 1623-31, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26961225

RESUMO

I deficiency is still a worldwide public health problem, with children being especially vulnerable. No nationwide study had been conducted to assess the I status of Spanish children, and thus an observational, multicentre and cross-sectional study was conducted in Spain to assess the I status and thyroid function in schoolchildren aged 6-7 years. The median urinary I (UI) and thyroid-stimulating hormone (TSH) levels in whole blood were used to assess the I status and thyroid function, respectively. A FFQ was used to determine the consumption of I-rich foods. A total of 1981 schoolchildren (52 % male) were included. The median UI was 173 µg/l, and 17·9 % of children showed UI<100 µg/l. The median UI was higher in males (180·8 v. 153·6 µg/l; P<0·001). Iodised salt (IS) intake at home was 69·8 %. IS consumption and intakes of ≥2 glasses of milk or 1 cup of yogurt/d were associated with significantly higher median UI. Median TSH was 0·90 mU/l and was higher in females (0·98 v. 0·83; P<0·001). In total, 0·5 % of children had known hypothyroidism (derived from the questionnaire) and 7·6 % had TSH levels above reference values. Median TSH was higher in schoolchildren with family history of hypothyroidism. I intake was adequate in Spanish schoolchildren. However, no correlation was found between TSH and median UI in any geographical area. The prevalence of TSH above reference values was high and its association with thyroid autoimmunity should be determined. Further assessment of thyroid autoimmunity in Spanish schoolchildren is desirable.


Assuntos
Deficiências Nutricionais/epidemiologia , Doença de Hashimoto/epidemiologia , Hipotireoidismo/epidemiologia , Iodo/deficiência , Estado Nutricional , Glândula Tireoide , Tireotropina/sangue , Estudos Transversais , Laticínios , Deficiências Nutricionais/urina , Dieta , Inquéritos sobre Dietas , Família , Feminino , Doença de Hashimoto/sangue , Humanos , Hipotireoidismo/sangue , Iodo/administração & dosagem , Iodo/urina , Masculino , Prevalência , Fatores Sexuais , Cloreto de Sódio na Dieta/administração & dosagem , Espanha/epidemiologia
10.
Rev Esp Quimioter ; 37(1): 93-96, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37925628

RESUMO

OBJECTIVE: Non-albicans Candida species, such as Candida kefyr, are emerging pathogens. Chromogenic media are highly useful for the diagnosis of urinary tract infections (UTIs). The aim was to describe the behavior of this specie on a non-specific chromogenic medium. METHODS: A retrospective study of cases of candiduria detected in the Microbiology laboratory of the Virgen de las Nieves Hospital in Granada (Spain) between 2016 and 2021 (N=2,130). Urine samples were quantitatively seeded on non-selective UriSelect™4 chromogenic agar. RESULTS: Between 2016 and 2021, C. kefyr was the seventh most frequent Candida species responsible for candiduria in our setting (n=15). The macroscopic appearance of C. kefyr colonies, punctiform and bluish, allowed the direct identification of these microorganisms. CONCLUSIONS: This study provides the first description of the specific behavior of C. kefyr on UriSelect™4 agar, which differentiates it from other Candida species based on its enzymatic characteristics.


Assuntos
Candidíase , Kluyveromyces , Infecções Urinárias , Humanos , Ágar , Meios de Cultura , Estudos Retrospectivos , Candida , Candidíase/diagnóstico , Candidíase/microbiologia , Infecções Urinárias/microbiologia
11.
Plant Dis ; 97(12): 1662, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30716848

RESUMO

Tomato plants exhibiting typical symptoms of begomovirus infection, including leaf deformation, curling, and yellowing, were collected from cultivated fields in Lavalle Department, Corrientes, Argentina, in 2010. Although the number of affected plants was only 2% within a farm, the finding is of considerable importance since the white fly Bemisia tabaci is widely spread within the country, even in other southernmost areas such as the cinturón hortícola de Buenos Aires (horticultural belt around Buenos Aires). DNA isolated from infected tomato leaves collected from three symptomatic tomato plants was amplified by PCR with specific primers designed to amplify a region of component A and B of the Begomovirus genome (3). The amplified DNA fragment was sequenced and a new set of primers were designed based on the obtained sequences. A DNA fragment of about 1,300 bp was amplified and later the complete genome, which was 2,683 bp long. No fragments were obtained when template DNA was from non-infected leaf samples. The 2,683-bp fragment was annotated at the NCBI under Accession No. KC132844. Analysis by NCBI BLAST showed that it was highly homologous to DNA-A component of Begomovirus. Furthermore, the genome organization was typical of DNA-A component of bipartite New World begomovirus. The sequence had one open reading frame (ORF) on the viral-sense strand (AV1/CP) and four ORFs on the complementary-sense strand (AC1/Rep, AC2/TrAp, AC3/REn, and AC4). In order to confirm this finding, the viral genome was amplified by rolling circle amplification (RCA, TempliPhi 100 Amplification Kit, Amersham Biosciences) as described by the manufacturer instructions. The RCA full-length product was digested with XhoI generating a 2,700-bp DNA fragment, suggesting the presence of only one restriction site, in agreement with the bioinformatics analysis of the KC132844 sequence. This PCR product was used as template in PCR reactions with specific primers to DNA-A or DNA-B components. While the DNA-A primers generated the expected 1,300-bp fragment, those homologous to the DNA-B component did not generate amplifications. These results confirmed the identity of the DNA-A component of the isolate MT8. The full sequence of the DNA-A component was 94% homologous to the DNA-A sequence of the Uruguayan begomovirus Tomato Rugose Yellow Leaf Curl Virus-[U4.1] (JN381823.1). Therefore, considering our results and the criteria proposed by Fauquet (1), isolate MT8 is a new species of begomovirus described recently (2). This is the first report of TRYLCV in one of the main areas of tomato production in Argentina. This virus might be accompanying another begomovirus TYVSV that provoked yellow veins symptoms in tomato plants cultivated in the same area of Corrientes. These viruses appeared recently and concomitantly with the introduction of the white fly Bemisia spp. in the area, which is one of the main production areas of tomato and provides fresh tomatoes to the whole country, and in wintertime to the city of Buenos Aires, when the horticultural belt around Buenos Aires is not under production. References: (1) C. M. Fauquet et al. Arch Virol 153:783, 2008. (2) B. Márquez-Martín et al. Arch Virol 157:1137, 2012. (3) M. R. Rojas et al. Plant Dis. 77:340, 1993.

12.
Rev Esp Quimioter ; 36(3): 282-290, 2023 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-36942425

RESUMO

OBJECTIVE: In the bacterial etiology of severe acute infectious diarrhea, except that caused by Clostridioides difficile, most of them have an invasive character and antibiotic treatment will be necessary in specific situations. Shigella is a classic pathogen, in which it is crucial to know the sensitivity to different classic and alternative antimicrobials. The objective of this work was to analyze the presence of shigellosis and the rate of antibiotic resistance. METHODS: A descriptive-retrospective study of the reports of shigellosis of stool cultures issued between January 2016 and April 2022 was conducted. RESULTS: A total of 34 episodes (16 -47.1%- by Shigella sonnei) were observed, as of 2018. There were only 2 pediatric cases. The overall resistance rate to azithromycin, trimethoprim-sulfamethoxazole and ciprofloxacin was 52.9%, 64.7% and 44.1%, respectively. 26.5% were resistant to the 3 groups of antibiotics. There was a higher rate of resistance for S. sonnei. The emergence of resistance to cephalosporins in recent years stands out. Episodes of multidrug-resistant shigellosis were detected between 2020 (1 by S. flexneri) and 2022 (4 by S. sonnei). CONCLUSIONS: The episodes of shigellosis are emerging in our environment with a higher rate of multi-resistance. In this context, current empirical treatments for acute enteroinvasive enteritis are at risk of failure, if necessary.


Assuntos
Disenteria Bacilar , Criança , Humanos , Disenteria Bacilar/tratamento farmacológico , Disenteria Bacilar/epidemiologia , Disenteria Bacilar/microbiologia , Estudos Retrospectivos , Espanha/epidemiologia , Farmacorresistência Bacteriana , Testes de Sensibilidade Microbiana , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Diarreia/tratamento farmacológico , Diarreia/epidemiologia , Serviço Hospitalar de Emergência
15.
Appl Environ Microbiol ; 77(18): 6703-5, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21803893

RESUMO

We describe a method for production of recombinant human hemoglobin by Escherichia coli grown in a bioreactor. E. coli BL21(DE3) transformed with a plasmid containing hemoglobin genes and Plesiomonas shigelloides heme transport genes reached a cell dry weight of 83.64 g/liter and produced 11.92 g/liter of hemoglobin in clarified lysates.


Assuntos
Vias Biossintéticas/genética , Biotecnologia/métodos , Escherichia coli/metabolismo , Hemoglobinas/biossíntese , Plasmídeos , Plesiomonas/genética , Reatores Biológicos , Escherichia coli/genética , Heme/metabolismo , Hemoglobinas/genética , Humanos , Proteínas Recombinantes/biossíntese , Proteínas Recombinantes/genética
16.
Anal Bioanal Chem ; 401(9): 2881-9, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21898154

RESUMO

An approach based on IUPAC methodology to estimate the limit of detection of bulk optode-based analytical methods for anions has been developed. The traditional IUPAC methodology for calculating the detection limit was modified to be adapted to particular cases where the calibration curves have a sigmoidal profile. Starting from the different full theoretical models for every co-extraction mechanism of the analyte in the membrane in bulk optodes, several particular simplified models at low analyte concentration were obtained and validated. The slope of the calibration curve at low analyte concentration was calculated from the first derivative of the simplified equation and, subsequently, the detection limit was estimated. This fitted-for-purpose estimation strategy was applied to anion quantification for in-house bulk optode-based analytical methods, and the estimated limits of detection were compared with those obtained by applying classical geometrical methodology. This way of establishing the detection limit yields values that maintain their true statistical and probabilistic aspects. It can be easily applied to any analytical system which yields non-linear calibration curves at low analyte concentration.


Assuntos
Ânions/análise , Técnicas de Química Analítica/métodos , Guias de Prática Clínica como Assunto/normas , Calibragem , Técnicas de Química Analítica/normas , Técnicas de Química Analítica/estatística & dados numéricos , Humanos , Cinética , Limite de Detecção , Modelos Estatísticos , Dispositivos Ópticos , Análise de Regressão
17.
Rev Clin Esp ; 211(5): 251-6, 2011 May.
Artigo em Espanhol | MEDLINE | ID: mdl-21459373

RESUMO

The evaluation of the research quality of individuals and institutions is essential for the appropriate use of resources, hiring of staff or the awarding of prizes and recognitions. Bibliometric indicators are especially used for this purpose. The most widely used among them is the impact factor. A new indicator has been introduced recently, the so-called h-index, which is growing in popularity for the evaluation of the quantity and quality of research using a single digit. However, although the h-index is useful, it has its limitations. In this paper, we refer specifically to these limits, stressing that, in our opinion, it is not completely suitable to assess the research quality of professionals who compete in any area. In this respect, we are proposing a new bibliographical index, which we have called the global index. Since it uses information from six bibliometric indicators, we consider that this index is more suitable for comparing the scientific quality of the researchers.


Assuntos
Bibliometria , Editoração/estatística & dados numéricos
18.
Actas Urol Esp (Engl Ed) ; 45(4): 264-272, 2021 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33637375

RESUMO

INTRODUCTION: Renal angiomyolipoma is a frequent manifestation of Tuberous Sclerosis Complex (TSC), for which everolimus therapy has been recently established as a novel non-invasive therapeutic option. As there are limited real life and long-term data, the analysis of our experience provides added value in terms of safety and efficacy. MATERIAL AND METHODS: Descriptive analysis of our experience in patients with giant bilateral renal angiomyolipomas, in the context of TSC, treated with 10 mg oral everolimus daily, during a median of 71.5 months. We evaluated the following parameters: response rate and duration, reduction of kidney size and lesions, prevention of complications and presentation of toxicity and its cause. RESULTS: We confirm the effectiveness of treatment in 4 young patients, with multiple, bilateral angiomyolipomas of a median of 12 (5-19) cm maximum diameter, from June 2013 to date, after continuous reduction in lesion size, a decrease of 30% of the volume in 75% at six months and 50% in half of the subjects at two years, still showing drug response. Absence of complications such as bleeding or glomerular filtration rate decline in the long term, with a favorable safety profile, without interruptions and with mild-moderate, non-cumulative adverse effects, mostly within the first year of treatment. CONCLUSION: Everolimus is a safe and effective therapeutic option for renal angiomyolipoma and various manifestations of TSC, which has been reproduced in real life with six years of follow-up.


Assuntos
Angiomiolipoma , Neoplasias Renais , Lipoma , Esclerose Tuberosa , Angiomiolipoma/tratamento farmacológico , Everolimo/efeitos adversos , Humanos , Neoplasias Renais/tratamento farmacológico , Esclerose Tuberosa/tratamento farmacológico
19.
JDR Clin Trans Res ; 6(1): 87-95, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32040925

RESUMO

OBJECTIVE: This evaluation captures the perspectives of multiple stakeholders within a salaried dental care delivery organization (dentists, dental assistants, dental hygienists, and dental management) on the implementation of a pit-and-fissure sealant guideline in the Kaiser Permanente Dental Program. Also assessed is the role of formal processes and structures in providing a framework for guideline implementation. METHODS: We collected qualitative data through field observations, stakeholder interviews (n = 6), and focus groups (30 participants in 5 focus groups). Field observation notes captured summaries of conversations and other activities. Interviews and focus groups were recorded and transcribed. We analyzed transcripts and field notes using a template analysis with NVivo 12 software to identify themes related to the existing implementation process of clinical guidelines and stakeholder perspectives on the strengths and weaknesses of this process. RESULTS: Stakeholders perceived 2 main barriers for achieving implementation of the pit-and-fissure sealant guideline: 1) shortcomings in the implementation infrastructure resulting in lack of clarity about the roles and responsibilities in the guideline implementation process and lack of effective mechanisms to disseminate guideline content and 2) resource constraints, such as limited human, space, and material resources. Perceived opportunities for the dissemination and implementation of guidelines included recognition of the importance of guidelines in dental practice and well-functioning workflows within dental specialties. CONCLUSION: Our research points to the importance of developing and maintaining an infrastructure to ensure standardized, predictable mechanisms for implementation of guidelines and thereby promoting practice change. While addressing resource constraints may not be possible in all circumstances, an important step for improving guideline implementation-wherever feasible-would be the development of a robust implementation infrastructure that captures and delineates roles and responsibilities of different clinical actors in the guideline implementation process. KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by health care leadership and administrators to understand possible reasons for a lack of guideline implementation and provide suggestions for establishing sustainable infrastructure to promote the adoption of clinical guidelines in salaried dental clinics.


Assuntos
Cárie Dentária , Prática Odontológica de Grupo , Humanos , Selantes de Fossas e Fissuras
20.
Neurologia (Engl Ed) ; 36(9): 681-691, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34752346

RESUMO

INTRODUCTION: Alzheimer disease risk polymorphisms have been studied in patients with dementia, but have not yet been explored in mild cognitive impairment (MCI) in our population; nor have they been addressed in relation to cognitive variables, which can be predictive biomarkers of disease. OBJECTIVE: To evaluate cognitive performance and presence of polymorphisms of the genes SORL1(rs11218304), PVRL2(rs6859), CR1(rs6656401), TOMM40(rs2075650), APOE (isoforms ε2, ε3, ε4), PICALM(rs3851179), GWAS_14q(rs11622883), BIN1(rs744373), and CLU(rs227959 and rs11136000) in patients with MCI and healthy individuals. METHODOLOGY: We performed a cross-sectional, exploratory, descriptive study of a prospective cohort of participants selected by non-probabilistic sampling, evaluated with neurological, neuropsychological, and genetic testing, and classified as cognitively healthy individuals and patients with MCI. Cognition was evaluated with the Neuronorma battery and analysed in relation to the polymorphic variants by means of measures of central tendency, confidence intervals, and nonparametric statistics. RESULTS: We found differences in performance in language and memory tasks between carriers and non-carriers of BIN1, CLU, and CR1 variants and a trend towards poor cognitive performance for PICALM, GWAS_14q, SORL1, and PVRL2 variants; the APOE and TOMM40 variants were not associated with poor cognitive performance. DISCUSSION: Differences in cognitive performance associated with these polymorphic variants may suggest that the mechanisms regulating these genes could have an effect on cognition in the absence of dementia; however, this study was exploratory and hypotheses based on these results must be explored in larger samples.


Assuntos
Disfunção Cognitiva , Proteínas Monoméricas de Montagem de Clatrina , Proteínas Adaptadoras de Transdução de Sinal , Apolipoproteínas E/genética , Clusterina/genética , Cognição , Disfunção Cognitiva/genética , Estudos Transversais , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Humanos , Proteínas Relacionadas a Receptor de LDL , Proteínas de Membrana Transportadoras/genética , Proteínas do Complexo de Importação de Proteína Precursora Mitocondrial , Proteínas Monoméricas de Montagem de Clatrina/genética , Proteínas Nucleares , Polimorfismo de Nucleotídeo Único , Estudos Prospectivos , Receptores de Complemento 3b/genética , Proteínas Supressoras de Tumor
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