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1.
J Pharm Sci ; 113(3): 772-784, 2024 03.
Artículo en Inglés | MEDLINE | ID: mdl-38043682

RESUMEN

The main objective of the experiment is to develop and evaluate hydrogel-bearing nanostructured lipid carriers (NLCs) loaded with ketoconazole (KTZ) for the effective treatment of candidiasis. The eugenol was used as a liquid lipid (excipient) for the development of KTZ-loaded NLCs and was explored for anti-fungal effect. The production of NLCs involves high energy processes to generate spherical, uniform particles, having a higher percentage of entrapment efficiency (%EE) for KTZ with 89.83 ± 2.31 %. The data from differential scanning calorimeter (DSC), powder x-ray diffraction (PXRD), and attenuated total reflectance (ATR) demonstrated the KTZ dispersion in NLCs. The NLCs loaded hydrogel possessed optimum spreadability and exhibited shear thinning behavior, indicating the ease of application of the final formulation. The 6.41-fold higher transdermal flux (Jss) was governed for KTZ from KTZ-NLC than coarse-KTZ, which explains the usefulness of NLCs. The KTZ-NLCs exhibited significant 2.58 and 6.35-fold higher retention in the stratum corneum and viable epidermis of the skin. The cell cytotoxicity studies using human dermal fibroblast cell (HDFS) lines depicted the usefulness of NLCs in reducing cell toxicities for KTZ. The KTZ-NLCs were found to inhibit planktonic growth and hyphal transition and showed a larger zone of inhibition against C. albicans strains with a MIC-50 value of 0.39 µg/mL. The antibiofilm activity of KTZ-NLCs at lower concentrations, in contrast to plain KTZ, explained the interaction of developed NLCs with fungal membranes. The overall results depicted the effectiveness of the loading KTZ in the lipid matrix to achieve antifungal activity against C. albicans.


Asunto(s)
Candida albicans , Nanoestructuras , Humanos , Eugenol/farmacología , Portadores de Fármacos/farmacología , Hidrogeles/farmacología , Lípidos/farmacología , Tamaño de la Partícula
2.
Children (Basel) ; 10(12)2023 Nov 29.
Artículo en Inglés | MEDLINE | ID: mdl-38136073

RESUMEN

A Pediatric Endocrine Society (PES) Drugs and Therapeutics Committee workgroup sought to determine the prescribing practices of pediatric endocrinologists when treating children <10 years of age with congenital adrenal hyperplasia (CAH). Our workgroup administered a 32-question online survey to PES members. There were 187 respondents (88.9% attending physicians), mostly from university-affiliated clinics (~80%). Ninety-eight percent of respondents prescribed the short-acting glucocorticoid hydrocortisone to treat young children, as per the Endocrine Society CAH Guidelines, although respondents also prescribed long-acting glucocorticoids such as prednisolone suspension (12%), prednisone tablets (9%), and prednisone suspension (6%). Ninety-seven percent of respondents indicated that they were likely/very likely to prescribe hydrocortisone in a thrice-daily regimen, as per CAH Guidelines, although 19% were also likely to follow a twice-daily regimen. To achieve smaller doses, using a pill-cutter was the most frequent method recommended by providers to manipulate tablets (87.2%), followed by dissolving tablets in water (25.7%) to create a daily batch (43.7%) and/or dissolving a tablet for each dose (64.6%). Thirty-one percent of providers use pharmacy-compounded hydrocortisone suspension to achieve doses of <2.5 mg. Our survey shows that practices among providers in the dosing of young children with CAH vary greatly and sometimes fall outside of the CAH Guidelines-specifically when attempting to deliver lower, age-appropriate hydrocortisone doses.

3.
3 Biotech ; 13(12): 400, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37982082

RESUMEN

The current study presents an overview of heavy metals bioremediation from halo-alkaline conditions by using extremophilic microorganisms. Heavy metal remediation from the extreme environment with high pH and elevated salt concentration is a challenge as mesophilic microorganisms are unable to thrive under these polyextremophilic conditions. Thus, for effective bioremediation of extreme systems, specialized microbes (extremophiles) are projected as potential bioremediating agents, that not only thrive under such extreme conditions but are also capable of remediating heavy metals from these environments. The physiological versatility of extremophiles especially halophiles and alkaliphiles and their enzymes (extremozymes) could conveniently be harnessed to remediate and detoxify heavy metals from the high alkaline saline environment. Bibliometric analysis has shown that research in this direction has found pace in recent years and thus this review is a timely attempt to highlight the importance of halo-alkaliphiles for effective contaminant removal in extreme conditions. Also, this review systematically presents insights on adaptive measures utilized by extremophiles to cope with harsh environments and outlines the role of extremophilic microbes in industrial wastewater treatment and recovery of metals from waste with relevant examples. Further, the major challenges and way forward for the effective applicability of halo-alkaliphilic microbes in heavy metals bioremediation from extremophilic conditions are also highlighted.

4.
J Virol Methods ; 322: 114824, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37778538

RESUMEN

Primary infection or reactivation of latent human cytomegalovirus (HCMV) or herpes simplex viruses (HSV) 1 or 2 during pregnancy can transmit the virus in utero or during natural childbirth to the fetus. The majority of these infections are asymptomatic at birth but may present later with potentially lethal disseminated infection or meningitis (HSV), or long-term neurodevelopmental sequelae including sensorineural hearing loss or neurodevelopmental impairments (HCMV). Unfortunately, early signs and symptoms of disseminated viral infections may be misdiagnosed as bacterial sepsis. Therefore, immediate testing for viral etiologies may not be ordered or even considered by skilled clinicians. In asymptomatic HCMV infections, early detection is necessary to monitor for and treat future neurologic sequelae. In acutely ill-appearing infants, specific detection of viruses against other disease-causing agents is vital to inform correct patient management, including early administration of the correct antimicrobial(s). An ideal test should be rapid, inexpensive, require low sample volumes, and demonstrate efficacy in multiple tissue matrices to aid in timely clinical decision-making for neonatal infections. This work discusses the development of a rapid probe-free qPCR assay for HSV and HCMV that enables early and specific detection of these viruses in neonates. The assay's probe free chemistry would allow easier extension to a broad-based multiplexed pathogenic panel as compared to assays utilizing sequence-specific probes or nested PCR.


Asunto(s)
Herpes Simple , Infecciones por Herpesviridae , Herpesvirus Humano 1 , Recién Nacido , Lactante , Embarazo , Femenino , Humanos , Citomegalovirus/genética
5.
Expert Rev Med Devices ; 20(9): 779-789, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37466357

RESUMEN

INTRODUCTION: The study evaluates the technology of fluoroscopy-based hip navigation that has shown to improve implant positioning in total hip arthroplasty (THA). METHODS: Premier Healthcare data for patients undergoing manual THA or fluoroscopy-based hip navigation THA between 1 January 2016-30 September 2021, were analyzed 90- and 365-day post-THA. The primary outcome was inpatient readmission. Secondary outcomes were operating room (OR) time, length of stay, discharge status, and hospital costs. Baseline covariate differences were balanced using fine stratification and analyzed using generalized linear models. RESULTS: Among 4,080 fluoroscopy-based hip navigation THA and 429,533 manual THA balanced patients, hip-related readmission rates were statistically significantly lower for the fluoroscopy-based hip navigation THA cohort vs. manual THA for both 90-day (odd ratio [95% CI]: 0.69 [0.52 to 0.91] and 365-day (0.63 [0.49 to 0.81] follow-up. OR time was higher with fluoroscopy-based hip navigation THA vs. manual THA (134.65 vs. 132.04 minutes); however, fluoroscopy-based hip navigation THA patients were more likely to be discharged to home (93.73% vs. 90.11%) vs. manual THA. Hospital costs were not different between cohorts at 90- and 365-day post-operative. CONCLUSIONS: Fluoroscopy-based hip navigation THA resulted in fewer readmissions, greater discharge to home, and similar hospital costs compared to manual THA.


Computer-assisted solutions are becoming more ubiquitous in surgical procedures. However, most of the current research is limited to small sample size and limited economic endpoints. The current study utilizes hospital billing data and fine stratification methodology to address the issue around sample size and covariate balancing. Hospital billing data provide a large sample across the US along with hospital costs that can be broken into different categories. Fine stratification methodology allows for covariate balancing while keeping all the samples. It is particularly advantageous when the treated or exposed group represents less than 5% of the entire cohort for a given study, as was observed in this study. Covariate balancing was done on patient, provider (hospital) and surgeon characteristics to minimize confounding. Furthermore, a generalized linear model was utilized to minimize any residual confounding. The study evaluated both short term (3-month) and long term (1-year) outcomes. Study suggested clinical benefits in using computer-assisted fluoroscopy-based hip navigation system in THA compared to manual THA as well as showed cost parity between computer-assisted fluoroscopy-based hip navigation system in THA and manual THA.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Humanos , Readmisión del Paciente , Tiempo de Internación , Complicaciones Posoperatorias , Factores de Riesgo , Aceptación de la Atención de Salud , Fluoroscopía , Computadores , Estudios Retrospectivos
6.
Expert Rev Med Devices ; 20(4): 303-311, 2023 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-36852695

RESUMEN

INTRODUCTION: The impact of robotic-assisted total knee arthroplasty (rTKA) vs. traditional, manual TKA (mTKA) on hospital costs is not well documented and is analyzed herein. RESEARCH DESIGN AND METHODS: Patients in the Premier billing Healthcare Database undergoing elective rTKA or mTKA ("index') in the in- or outpatient setting for knee osteoarthritis between Oct 1st, 2015, to September 30th, 2021, were identified. Variables included patient demographics and comorbidities and hospital characteristics. Matched rTKA vs. mTKA cohorts were created using direct (on provider characteristics, age, gender, race and Elixhauser index) and propensity score matching (fixation type, comorbidities). Index and 90-day inflation-adjusted costs and healthcare utilization (HCU) were analyzed for both cohorts, using generalized linear models. RESULTS: 16,714 rTKA patients were matched to 51,199 mTKA patients. Average 90-day hospital cost reached $17,932 and were equivalent for both cohorts (rTKA vs. mTKA: $132 (95% confidence interval; -$19 to $284). There was a 2.7% (95%CI: 2.2%-3.3%) increase in home or home health discharge, and a 0.4% (95%CI: 0%-0.8%) decrease in 90-day hospital knee related re-visit in the rTKA vs. mTKA group. CONCLUSIONS: Cost-neutrality of rTKA vs. mTKA was observed, with a potential for lowered immediate post-operative HCU in the rTKA vs. mTKA cohorts.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Procedimientos Quirúrgicos Robotizados , Humanos , Aceptación de la Atención de Salud , Hospitales , Articulación de la Rodilla
7.
J Clin Endocrinol Metab ; 108(7): 1797-1805, 2023 06 16.
Artículo en Inglés | MEDLINE | ID: mdl-36630291

RESUMEN

Adrenal crisis continues to be an important cause of death despite being a preventable condition. Significant deficits in patient education in the prevention of adrenal crisis have been identified as a contributor to adrenal crisis risk, despite the importance of patient education being highlighted in international guidelines. Deficits in clinician education have also been identified as risk factors for adrenal crisis although they have not been addressed. We use 3 clinical cases to highlight the role of both patient and clinician education in the prevention of adrenal crisis, review what is known about education related to adrenal insufficiency and provide a possible approach to addressing education deficits with the aim of reducing the risk of adrenal crisis through both patient and clinician education.


Asunto(s)
Insuficiencia Suprarrenal , Humanos , Insuficiencia Suprarrenal/diagnóstico , Insuficiencia Suprarrenal/etiología , Insuficiencia Suprarrenal/prevención & control , Enfermedad Aguda , Escolaridad , Factores de Riesgo
8.
Biochem Biophys Res Commun ; 643: 16-23, 2023 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-36584588

RESUMEN

Understanding GPER biology in breast cancer is rather limited in compassion to the classic estrogen receptors. Mitochondrial dynamics play a critical role in determining cell survival and death under various microenvironmental conditions. We present evidence that GPER-induce mitochondrial fission in breast cancer cells. GPER mediated mitochondrial fission through activating Drp1 by phosphorylating S616 residue and down-regulates fusion proteins Mfn1 and Mfn2 levels. GPER-induced Drp1 activation mediated by p44/42 MAPK and inhibition of this signalling axis completely reverse the mitochondrial fission induced by GPER. Further, mitochondrial fission is required for GPER-induced cell death in breast cancer cells. To conclude, GPER induces mitochondrial fission through p44/42 MAPK - Drp1 signalling, and mitochondrial fission is critical for GPER-induced cell death in breast cancer cells. GENERAL SIGNIFICANCE: First time we report GPER's role in mitochondrial dynamics in cancer cells. Mitochondrial dynamics play a critical role in cancer progression including tamoxifen resistance. Exploring a detailed mechanistic understanding of GPER signalling may help to design new therapy for advanced cancers.


Asunto(s)
Neoplasias de la Mama , Dinaminas , Humanos , Femenino , Dinaminas/metabolismo , GTP Fosfohidrolasas/metabolismo , Neoplasias de la Mama/metabolismo , Dinámicas Mitocondriales/fisiología , Receptores de Estrógenos , Proteínas Mitocondriales/metabolismo
9.
10.
Cureus ; 14(9): e29200, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36258972

RESUMEN

Background and objective The antiemetic drug is one of the most common armamentariums in an anaesthesiologist's pharmacopoeia to prevent postoperative nausea and vomiting (PONV). PONV is one of the usual side effects after general anaesthesia, especially in female patients (21%) and after laparoscopic surgery (60%). This study aimed to compare the efficacy of ondansetron with ramosetron. Methodology After institutional ethical clearance and informed written consent, one hundred female patients scheduled for laparoscopic gynaecological surgeries were selected for this prospective, double-blinded, randomised interventional study. These patients were further subdivided into two equal groups (50 in groups R and O). Group R received ramosteron 0.3mg, and group O received ondansetron 8mg 30 minutes before the end of surgery. Patients were assessed between 0-2, 2-6, 6-12 and 12-24 hrs in the postoperative period. The primary objective of this study was to compare the effect of a single dose of ramosetron (0.3mg) with a single dose of ondansetron (8mg) for the prevention of PONV after general anaesthesia in laparoscopic surgeries. The secondary goal was to record the time of occurrence of the first episode of PONV, the need for rescue antiemetics, patient satisfaction scores, and to look for any side effects. Results This study shows no significant difference in the reduction of PONV incidence between group O and group R in the first 24 hours of the postoperative period. The overall incidence of PONV was significantly higher in the early postoperative (0-6 hrs) than in the late postoperative period (6-24 hrs), i.e., 51% and 13%, respectively. The requirement of rescue antiemetic was higher in group O than in group R but not statistically significant. In our study, both groups had similar patient satisfaction scores. Headache was the most common side effect and was noted in 9% of the patient population. Conclusion We conclude that ramosetron is as effective as ondansetron in preventing the incidence and severity of PONV up to 24 hours postoperatively.

11.
J Coll Physicians Surg Pak ; 32(8): 1086-1088, 2022 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-35932142

RESUMEN

Opsoclonus-myoclonus syndrome (OMS) or the dancing eye syndrome, is a rare inflammatory neurological disorder often with paraneoplastic aetiology. It has an incidence of 1 in 1000,000 population worldwide. Opsoclonus-myoclonus syndrome is associated with 2-3% of patients having neuroblastoma. The authors present 5 cases of OMS in children who had neuroblastoma and underwent surgical resection. The median age was 26 (14-36) months. Male: female ratio was 1:1.5. All the patients had moderate to severe symptoms. Duration of symptoms at presentation varied from 3 days to one and half years. The possibility of OMS should be considered in all children presenting with probable neurological symptoms. Pharmacological therapy combined with surgery results in a good outcome. Balanced anaesthesia with the most commonly used drugs can be safely administered in the patients with opsoclonus-myoclonus syndrome. Key Words: Opsoclonus, Myoclonus, Neuroblastoma, Child, Anaesthesia.


Asunto(s)
Anestésicos , Neuroblastoma , Síndrome de Opsoclonía-Mioclonía , Adulto , Autoanticuerpos , Niño , Femenino , Humanos , Masculino , Neuroblastoma/complicaciones , Neuroblastoma/cirugía , Síndrome de Opsoclonía-Mioclonía/diagnóstico , Síndrome de Opsoclonía-Mioclonía/tratamiento farmacológico , Síndrome de Opsoclonía-Mioclonía/etiología
12.
J Clin Endocrinol Metab ; 107(10): 2716-2728, 2022 09 28.
Artículo en Inglés | MEDLINE | ID: mdl-35932277

RESUMEN

CONTEXT: Pediatric obesity is a serious health problem in the United States. While lifestyle modification therapy with dietary changes and increased physical activity are integral for the prevention and treatment of mild to moderate obesity in youth, only a modest effect on sustained weight reduction is observed in children and young adults with severe obesity. This underscores the need for additional evidence-based interventions for children and adolescents with severe obesity, including pharmacotherapy, before considering invasive procedures such as bariatric surgery. EVIDENCE ACQUISITION: This publication focuses on recent advances in pharmacotherapy of obesity with an emphasis on medications approved for common and rarer monogenic forms of pediatric obesity. EVIDENCE SYNTHESIS: We review medications currently available in the United States, both those approved for weight reduction in children and "off-label" medications that have a broad safety margin. CONCLUSION: It is intended that this review will provide guidance for practicing clinicians and will encourage future exploration for successful pharmacotherapy and other interventions for obesity in youth.


Asunto(s)
Fármacos Antiobesidad , Cirugía Bariátrica , Obesidad Mórbida , Obesidad Infantil , Adolescente , Fármacos Antiobesidad/uso terapéutico , Niño , Humanos , Obesidad Infantil/tratamiento farmacológico , Estados Unidos , Pérdida de Peso
13.
J Family Med Prim Care ; 11(5): 2207-2210, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35800579

RESUMEN

Mucinous ovarian carcinoma is a less-prevalent subtype of epithelial tumors. We present a case of giant mucinous ovarian carcinoma weighing 41.1 kg in a 24-year-old Indian girl. Benign mucinous tumors have the potential to reach an enormous size but such a huge malignant mucinous tumor is very rare in literature and its occurrence in a young female is even rarer.

14.
Environ Sci Pollut Res Int ; 29(60): 90580-90600, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-35871193

RESUMEN

The Najafgarh drain is the first major drain that joins the Yamuna River at Wazirabad in Delhi, India, and is known to contribute to the maximum pollution load to this river. The drain is originally an extension of the Sahibi River and was intentionally constructed as a canal to carry stormwater, but presently, it is carrying more of sewage, agricultural, and industrial effluents received through various small and large secondary drains. The present study has analyzed the water quality status of this interconnected system, i.e., the Najafgarh drain, its associated secondary drains, and the Yamuna River for physicochemical parameters (n = 16), microbiological parameter (n = 1), and heavy metal concentrations (n = 8). The analysis of the surface water samples collected during pre- and post-monsoon seasons showed that secondary drain discharges significantly impacted the water quality of the Najafgarh drain, which in turn affected the Yamuna River. Out of the eight selected secondary drains for this study, the Goyla dairy outlet came out as the most polluted site in terms of organic pollutants while the Basaidarapur drain was loaded with heavy metal contaminants. Statistical tools comprising hierarchical cluster analysis (HCA), Pearson's correlation, and principal component analysis (PCA) were further implemented on the water quality dataset for a better understanding of the possible sources of contamination for organic and inorganic pollutants in the selected sampling sites. The present study, thus, might help in providing key highlights to the policymakers for effective regulation and management of the point source discharges in Najafgarh drain, which will ultimately restrict its pollution loadings in Yamuna River, Delhi, and also help in the restoration of this important water body.


Asunto(s)
Metales Pesados , Contaminantes del Agua , Calidad del Agua , India
15.
Cureus ; 14(3): e23309, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35464558

RESUMEN

BACKGROUND: Minor gynaecological procedures are usually done in outpatient settings. Early discharge with minimal haemodynamic compromise is an essential requirement of these procedures. Many sedative drugs are being used for outpatient surgeries. Of the sedative agents available, dexmedetomidine, which has sedative and analgesic sparing effects, has the best safety profile in the cardiorespiratory system. Therefore, we evaluated the optimum dexmedetomidine dose for providing better procedural sedation. METHODOLOGY: This randomized, double-blinded study included 120 ASA grade I and II patients aged 18-45 years who were undergoing short gynaecological procedures in a tertiary care hospital. Patients were randomly allocated into three groups of 40 each. After a loading dose of 1 µg/kg over 10 min, group A received dexmedetomidine infusion at a rate of 0.2 µg/kg/hr, group B at a rate of 0.4 µg/kg/hr, and group C at a rate of 0.6 µg/kg/hr. Perioperative hemodynamic changes, intraoperative adjuvant drug requirements, and postoperative recovery were also compared in the three different dexmedetomidine groups. RESULTS: Heart rate, blood pressure, oxygen saturation, and respiratory rate remained within the normal physiological range in all three groups at most perioperative time points. The time to achieve the Modified Aldrete Score and the post-anesthetic discharge scoring system was maximum in group C and minimum in group A. Ketamine had to be supplemented in almost half of the patients in group A and less than a quarter of the patients in group B. In group C, surgery was completed without any drug supplementation. Two patients in group B and four patients in group C had an episode of bradycardia. Oxygen saturation decreased in one patient in group C, necessitating oxygen supplementation. CONCLUSIONS: Dexmedetomidine, at a dose of 0.4 µg/kg/hr with ketamine supplementation, provides the most appropriate procedural sedation and analgesia (PSA) without any significant hemodynamic compromise.

16.
Adv Mater ; 34(9): e2106481, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34961972

RESUMEN

Long after the heady days of high-temperature superconductivity, the oxides came back into the limelight in 2004 with the discovery of the 2D electron gas (2DEG) in SrTiO3 (STO) and several heterostructures based on it. Not only do these materials exhibit interesting physics, but they have also opened up new vistas in oxide electronics and spintronics. However, much of the attention has recently shifted to KTaO3 (KTO), a material with all the "good" properties of STO (simple cubic structure, high mobility, etc.) but with the additional advantage of a much larger spin-orbit coupling. In this state-of-the-art review of the fascinating world of KTO, it is attempted to cover the remarkable progress made, particularly in the last five years. Certain unsolved issues are also indicated, while suggesting future research directions as well as potential applications. The range of physical phenomena associated with the 2DEG trapped at the interfaces of KTO-based heterostructures include spin polarization, superconductivity, quantum oscillations in the magnetoresistance, spin-polarized electron transport, persistent photocurrent, Rashba effect, topological Hall effect, and inverse Edelstein Effect. It is aimed to discuss, on a single platform, the various fabrication techniques, the exciting physical properties and future application possibilities of this family of materials.

17.
Environ Sci Pollut Res Int ; 28(48): 68025-68052, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34648156

RESUMEN

The increased production and consumption scale of plastic items has led to the generation of microplastics (MPs), an emerging class of contaminants, in our environment. MPs are plastic particles less than 5 mm in size and could originate due to primary and secondary sources. The primary ones are generated as such in the MP size range while the secondary MPs are a result of fragmentation of larger plastic particles which eventually enters the aquatic, terrestrial and atmospheric environments. The increasing concern of MP pollution in every compartment of our environment is being globally explored, with relatively fewer studies in India. Among the total studies published on MP prevalence in the Indian environments, marine systems have received significantly higher attention compared to the other compartments like freshwater, atmosphere, terrestrial and human consumables. This review article is an effort to present current understanding of MP pollution in aquatic systems, terrestrial systems, atmosphere and human consumables of India by reviewing available scientific literature. Along with this, the review also focuses on identification of the gap areas in current knowledge and highlights way forward for future research. This would further help in meeting the goals of this emergent pollutant management.


Asunto(s)
Microplásticos , Contaminantes Químicos del Agua , Monitoreo del Ambiente , Contaminación Ambiental/análisis , Humanos , Plásticos , Contaminantes Químicos del Agua/análisis
18.
J Clin Endocrinol Metab ; 106(12): 3605-3620, 2021 11 19.
Artículo en Inglés | MEDLINE | ID: mdl-34363474

RESUMEN

CONTEXT: Identification of modifiable risk factors, including genetic and acquired disorders of lipid and lipoprotein metabolism, is increasingly recognized as an opportunity to prevent premature cardiovascular disease (CVD) in at-risk youth. Pediatric endocrinologists are at the forefront of this emerging public health concern and can be instrumental in beginning early interventions to prevent premature CVD-related events during adulthood. AIM: In this article, we use informative case presentations to provide practical approaches to the management of pediatric dyslipidemia. CASES: We present 3 scenarios that are commonly encountered in clinical practice: isolated elevation of low-density lipoprotein cholesterol (LDL-C), combined dyslipidemia, and severe hypertriglyceridemia. Treatment with statin is indicated when the LDL-C is ≥190 mg/dL (4.9 mmol/L) in children ≥10 years of age. For LDL-C levels between 130 and 189 mg/dL (3.4-4.89 mmol/L) despite dietary and lifestyle changes, the presence of additional risk factors and comorbid conditions would favor statin therapy. In the case of combined dyslipidemia, the primary treatment target is LDL-C ≤130 mg/dL (3.4 mmol/L) and the secondary target non-high-density lipoprotein cholesterol <145 mg/dL (3.7 mmol/L). If the triglyceride is ≥400 mg/dL (4.5 mmol/L), prescription omega-3 fatty acids and fibrates are considered. In the case of triglyceride >1000 mg/dL (11.3 mmol/L), dietary fat restriction remains the cornerstone of therapy, even though the landscape of medications is changing. CONCLUSION: Gene variants, acquired conditions, or both are responsible for dyslipidemia during childhood. Extreme elevations of triglycerides can lead to pancreatitis. Early identification and management of dyslipidemia and cardiovascular risk factors is extremely important.


Asunto(s)
LDL-Colesterol/metabolismo , Predisposición Genética a la Enfermedad , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipertrigliceridemia/tratamiento farmacológico , Trastornos del Metabolismo de los Lípidos/tratamiento farmacológico , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Hipertrigliceridemia/genética , Hipertrigliceridemia/metabolismo , Hipertrigliceridemia/patología , Trastornos del Metabolismo de los Lípidos/genética , Trastornos del Metabolismo de los Lípidos/metabolismo , Trastornos del Metabolismo de los Lípidos/patología , Lípidos/análisis , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo
19.
Endocrinol Diabetes Metab ; 4(3): e00262, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34268455

RESUMEN

Background: Coronavirus-19 (COVID-19) is a disease caused by the SARS-CoV-2 virus, the seventh coronavirus identified as causing disease in humans. The SARS-CoV-2 virus has multiple potential pathophysiologic interconnections with endocrine systems, potentially causing disturbances in glucose metabolism, hypothalamic and pituitary function, adrenal function and mineral metabolism. A growing body of data is revealing both the effects of underlying endocrine disorders on COVID-19 disease outcome and the effects of the SARS-CoV-2 virus on endocrine systems. However, comprehensive assessment of the relationship to endocrine disorders in children has been lacking. Content: In this review, we present the effects of SARS-CoV-2 infection on endocrine systems and review the current literature on complications of COVID-19 disease in underlying paediatric endocrine disorders. We provide recommendations on management of endocrinopathies related to SARS-CoV-2 infection in this population. Summary and outlook: With the surge in COVID-19 cases worldwide, it is important for paediatric endocrinologists to be aware of the interaction of SARS-CoV-2 with the endocrine system and management considerations for patients with underlying disorders who develop COVID-19 disease. While children and adults share some risk factors that influence risk of complications in SARS-CoV-2 infection, it is becoming clear that responses in the paediatric population are distinct and outcomes from adult studies cannot be extrapolated. Evidence emerging from paediatric studies provides some guidance but highlights the need for more research in this area.


Asunto(s)
COVID-19/complicaciones , Enfermedades del Sistema Endocrino/complicaciones , Niño , Manejo de la Enfermedad , Humanos
20.
J Environ Manage ; 293: 112860, 2021 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-34089959

RESUMEN

Microplastics (MPs) are emerging as a severe threat in our environment. Their diverse existence in marine environments is being researched globally and thus a widely known fact; however, their presence in the freshwater counterpart has gained attention lately only. Riverine systems, the most critical freshwater resources serve as an essential link between terrestrial and marine environments and their contamination with MPs is going to create severe environmental issues. Because of their small size and unique morphology, these polymers can exhibit variable toxicity to the interacting biota and alter their habitat properties; thus, causing serious impacts on the environment and health of living beings, including humans. These microplastics can also interact with pollutants like heavy metals and organic pollutants, which further augment their harming potential. Inefficient and poor plastic waste disposal practices play an important role in the generation of microplastic pollutants. In the present COVID 19 pandemics, the excessive use of plastic to contain the spread of infection has further added the plastic load in the environment which will eventually lead to the generation of microplastic particles. Also, a significant amount of microplastic pollutants in riverine systems are delivered through wastewater treatment plant effluents. These trade-offs create a distress situation in the environment. The present study connects these key issues for a better understanding of the diverse existence of microplastic pollutants, their sources, and fate, with a special emphasis on riverine systems. A critical appraisal of the knowledge gaps and proposal of suitable solutions through this review might open up avenues for further research and effective management of the microplastics in aquatic environments.


Asunto(s)
COVID-19 , Contaminantes Químicos del Agua , Monitoreo del Ambiente , Humanos , Microplásticos , Plásticos , SARS-CoV-2 , Contaminantes Químicos del Agua/análisis
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