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1.
Expert Rev Gastroenterol Hepatol ; 16(7): 689-697, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35708303

RESUMEN

BACKGROUND: In this study, we evaluate the clinical impact of psychiatric illnesses (PI) on the hospital outcomes of patients admitted with alcoholic liver disease (ALD). METHODS: From the National Inpatient Sample from 2012-2017, patients with alcoholic cirrhosis or alcoholic hepatitis were selected and stratified using the presence/absence of PI (which was a composite of psychiatric conditions). The cases were propensity score-matched to PI-absent controls and were compared to the following endpoints: mortality, death due to suicide, length of stay (LOS), hospitalization charges, and hepatic complications. RESULTS: After matching, there were 122,907 PI with and 122,907 without PI. Those with PI were younger (51.8 vs. 51.9 years p = 0.02) and more likely to be female (39.2 vs. 38.7% p = 0.01); however, there was no difference in race. Patients with PI had lower rates of alcoholic cirrhosis but higher rates of alcoholic hepatitis/alcoholic hepatic steatosis. In multivariate, patients with PI had lower rates of all-cause mortality (aOR 0.51 95%CI 0.49-0.54); however, they experienced higher rates of deaths due to suicide (aOR 3.00 95%CI 1.56-5.78) and had longer LOS (aOR 1.02 95%CI 1.01-1.02). CONCLUSION: Presence of PI in ALD patients is associated with prolonged hospital stay and higher rates deaths due to suicide.


Asunto(s)
Hepatitis Alcohólica , Hepatopatías Alcohólicas , Trastornos Mentales , Femenino , Hepatitis Alcohólica/diagnóstico , Hepatitis Alcohólica/epidemiología , Hospitales , Humanos , Cirrosis Hepática Alcohólica/diagnóstico , Cirrosis Hepática Alcohólica/epidemiología , Hepatopatías Alcohólicas/complicaciones , Hepatopatías Alcohólicas/epidemiología , Masculino , Trastornos Mentales/complicaciones , Estudios Retrospectivos
3.
Physician Leadersh J ; 4(1): 32-34, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30571892

RESUMEN

The transition from excellent clinician to excellent leader is a big one - with a bin change of failure. It's important to recognize the differences and similarities between these two roles, and create a pathway for success.


Asunto(s)
Adaptación Psicológica , Administradores de Instituciones de Salud/psicología , Liderazgo , Médicos/psicología , Rol Profesional/psicología , Adulto , Selección de Profesión , Femenino , Humanos , Masculino , Persona de Mediana Edad
5.
J Cell Biochem ; 111(5): 1179-87, 2010 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-20717918

RESUMEN

Microgravity (µXg) leads to a 10-15% loss of bone mass in astronauts during space flight. Osteoclast (OCL) is the multinucleated bone-resorbing cell. In this study, we used the NASA developed ground-based rotating wall vessel bioreactor (RWV), rotary cell culture system (RCCS) to simulate µXg conditions and demonstrated a significant increase (2-fold) in osteoclastogenesis compared to normal gravity control (Xg). Gene expression profiling of RAW 264.7 OCL progenitor cells in modelled µXg by Agilent microarray analysis revealed significantly increased expression of critical molecules such as cytokines/growth factors, proteases and signalling proteins, which play an important role in enhanced OCL differentiation/function. Transcription factors such as c-Jun, MITF and CREB implicated in OCL differentiation are upregulated; however no significant change in the levels of NFATc1 expression in preosteoclast cells subjected to modelled µXg. We also identified high-level expression of calcium-binding protein, S100A8 (calcium-binding protein molecule A8/calgranulin A) in preosteoclast cells under µXg. Furthermore, modelled µXg stimulated RAW 264.7 cells showed elevated cytosolic calcium (Ca(2+)) levels/oscillations compared to Xg cells. siRNA knock-down of S100A8 expression in RAW 264.7 cells resulted in a significant decrease in modelled µXg stimulated OCL differentiation. We also identified elevated levels of phospho-CREB in preosteoclast cells subjected to modelled µXg compared to Xg. Thus, modelled µXg regulated gene expression profiling in preosteoclast cells provide new insights into molecular mechanisms and therapeutic targets of enhanced OCL differentiation/activation to prevent bone loss and fracture risk in astronauts during space flight missions.


Asunto(s)
Diferenciación Celular/genética , Perfilación de la Expresión Génica , Osteoclastos/citología , Ingravidez/efectos adversos , Animales , Astronautas , Resorción Ósea/etiología , Resorción Ósea/genética , Resorción Ósea/prevención & control , Línea Celular , Fracturas Óseas/etiología , Fracturas Óseas/genética , Fracturas Óseas/prevención & control , Macrófagos/citología , Ratones , Modelos Biológicos , Análisis de Secuencia por Matrices de Oligonucleótidos , Vuelo Espacial
6.
Mil Med ; 167(8): 701-4, 2002 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-12188246

RESUMEN

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare cutaneous diseases marked by substantial epidermal denudation and are often complicated by sepsis and multiple organ failure. They are most commonly caused by drug therapy. Patients afflicted with these diseases require care that may exhaust the capabilities of medicine wards and medical intensive care units alike; however, their mortality is reduced when treated at burn centers, which are better equipped to treat extensive skin denudation. We report a case of TEN and propose an algorithm to provide guidance for making the critical decision to transfer patients with SJS and TEN to burn units.


Asunto(s)
Algoritmos , Síndrome de Stevens-Johnson , Quimioterapia Combinada , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad , Transferencia de Pacientes , Síndrome de Stevens-Johnson/inducido químicamente , Síndrome de Stevens-Johnson/etiología , Síndrome de Stevens-Johnson/patología , Síndrome de Stevens-Johnson/terapia
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