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BACKGROUND: Direct common carotid artery puncture (DCP) is conventionally used as a bailout technique in stroke patients. However, little is known about the relevant anatomy. OBJECTIVE: Examine the relationship of the common carotid artery (CCA) to surrounding structures based on different DCP trajectories passing through the artery's center. METHODS: Fifty randomly selected head/neck CTAs were analyzed. The trajectory of DCP and relationship to the internal jugular vein (IJV) and thyroid were analyzed at 1 cm intervals above the clavicle on 7 axial sections. Using the trans-carotid sagittal plane (TCSP) as the 0° trajectory, we plotted 3 additional trajectories at 30° intervals and the relationship with the IJV and thyroid proximity was graded as following: 0 = absent, 1 = adjacent, and 2 = crossing. The CCA tortuosity index (TI) was also analyzed for each vessel. RESULTS: Analysis of 2800 trajectories across 100 CCAs showed that the IJV and thyroid were least encountered on the axial sections 2 cm above the clavicle, at 0° on the right (9 thyroids and 6 IJV), and at 90° on the left (0 Thyroids and 14 IJVs). The TI of the CCA was significantly lower above the clavicle than its entire length (p<0.001). CONCLUSION: DCP performed 2 cm above the clavicle at 0° on the right, and 90° on the left appears to minimize encounters with the IJV and thyroid gland, reducing potential complications. However, despite these findings, ultrasound guidance remains vital for DCP safety. Further focus on endovascular device safety in DCP is needed.
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In Mexico, the economically active population aged over 50 years has been increasing in recent years. Due to their age, these workers may experience health deterioration and require some form of care. However, only formal employment is associated with better access to health services and pensions. At the same time, these workers may also need to care for children, sick partners or dependent older adults, which limits their time available for employment. This study examined the association between disability, receiving and providing care and access to health services, and economic activity among adults aged 50 to 69 in Mexico in 2015 and 2018. Multilevel modeling was conducted using data from the Mexican Health and Aging Study (MHAS). The MHAS is a longitudinal panel study of adults aged 50 years and older. The study sample included data from 8,831 observations from 2015 and 10,445 observations from 2018. Those living with some degree of disability and receiving care were found to be less likely to be economically active than those living with disability and not receiving care. Similarly, individuals who care for someone were also found to be less likely to be employed. Furthermore, the data suggested that individuals without access to health services were more likely to be economically active. For individuals aged 50 to 69 years, health and care issues were factors that limited economic activity status. In family-oriented societies with weak welfare states, the right to health is partial for the population and care is traditionally the responsibility of women, which exacerbates gender inequalities and has a differential impact on paid work for men and women.
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Cuidadores , Personas con Discapacidad , Accesibilidad a los Servicios de Salud , Factores Socioeconómicos , Humanos , México , Masculino , Femenino , Anciano , Persona de Mediana Edad , Personas con Discapacidad/estadística & datos numéricos , Cuidadores/economía , Cuidadores/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Estudios Longitudinales , Empleo/estadística & datos numéricos , Estado de Salud , Factores SociodemográficosRESUMEN
INTRODUCTION: Advances in endoscopic endonasal transsphenoidal surgery have led to improved postoperative outcomes after pituitary adenoma resection, including reduced length of stay, complications and readmission rates, without compromising safety and satisfaction. METHODS: Our team implemented a perioperative protocol in January 2021 for patients undergoing endoscopic, transsphenoidal pituitary surgery. This study compares preoperative characteristics and postoperative outcomes in 279 patients between 2016 and 2022 (128 preprotocol and 151 postprotocol). Our protocol includes interdisciplinary preoperative evaluations, unified communication, cortisol thresholds for postoperative glucocorticoid replacement, and fluid restriction to prevent delayed hyponatremia. RESULTS: Median age was 54 ± 17 years with 50.8% female patients. There were 229 (82.1%) macroadenomas (>1 cm) and 50 (17.9%) microadenomas/cysts (<1 cm). Mean diameter was 18 (transverse), 18 (craniocaudal), 16 (anteroposterior) mm. Tumor types included 125 (44.8%) gonadotroph, 46 (16.4%) adrenocorticotroph, 40 (14.3%) lactotroph, 26 (9.3%) Rathke cysts, 19 (6.8%) somatotroph, 13 (4.6%) nondiagnostic, 3 (1%) somatotroph-lactotroph, 3 (1%) mammosomatotroph, 2 (0.71%) null cell, and 2 (0.7%) thyrotroph adenomas. Postprotocol, 74.2% of patients were discharged on postoperative day 1 compared with 46.1% preprotocol (P < 0.0001). Transient arginine vasopressin deficiency decreased from 10.4% (preprotocol) to 4.6% postprotocol (P = 0.101). Hyponatremia occurred in 13.3% pre-protocol and 4.6% postprotocol. Emergency department visits dropped from 9.4% to 3.9%, and readmissions decreased from 7.8% to 2.6%. Persistent arginine vasopressin deficiency affected 2.3% preprotocol and 1.3% postprotocol patients. Cerebrospinal fluid leaks occurred in 8.5% preprotocol and 7.3% postprotocol. CONCLUSIONS: Implementing an interdisciplinary, perioperative protocol for transsphenoidal endoscopic pituitary surgery improves length of stay while minimizing readmissions and surgery-related complications.
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Babesiosis is a growing concern due to the increased prevalence of this infectious disease caused by Babesia protozoan parasites, affecting various animals and humans. With rising worries over medication side effects and emerging drug resistance, there is a notable shift towards researching babesiacidal agents. Antimicrobial peptides, specifically cathelicidins known for their broad-spectrum activity and immunomodulatory functions, have emerged as potential candidates. Aquiluscidin, a cathelicidin from Crotalus aquilus, and its derivative Vcn-23, have been of interest due to their previously observed antibacterial effects and non-hemolytic activity. This work aimed to characterize the effect of these peptides against three Babesia species. Results showed Aquiluscidin's significant antimicrobial effects on Babesia species, reducing the B. bigemina growth rate and exhibiting IC50 values of 14.48 and 20.70 µM against B. ovata and B. bovis, respectively. However, its efficacy was impacted by serum presence in culture, and it showed no inhibition against a B. bovis strain grown in serum-supplemented medium. Conversely, Vcn-23 did not demonstrate babesiacidal activity. In conclusion, Aquiluscidin shows antibabesia activity in vitro and its efficacy is affected by the presence of serum in the culture medium. Nevertheless, this peptide represents a candidate for further investigation of its antiparasitic properties and provides insights into potential alternatives for the treatment of babesiosis.
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INTRODUCTION: The prevalence of intracranial aneurysms (IA) in patients with acute ischemic stroke (AIS) requiring mechanical thrombectomy (MT) is unclear. OBJECTIVE: To describe the prevalence of IA in patients with AIS and their influence on MT. MATERIALS & METHODS: This is a retrospective cohort study on all patients admitted with a diagnosis of AIS from January 2008 to March 2022 at a tertiary academic center. The records were reviewed for demographic, clinical, imaging, and outcomes data. Only patients who had CTA at admission were included in this analysis. RESULTS: Among 2265 patients admitted with AIS, this diagnosis was confirmed in 2113 patients (93.3 %). We included 1111 patients (52.6 %) who had head CTA and 321 (28.9 %) who underwent MT. The observed prevalence of aneurysms on CTA was 4.5 % (50/1111 patients), and 8 (16 %) had multiple aneurysms. MT was performed in 7 patients harboring IAs: 6 ipsilateral (5 proximal and 1 distal to the occlusion)and 1 contralateral aneurysm.. The patient with a contralateral aneurysm had a TICI 2B score In patients with ipsilateral aneurysms, TICI 2B or 3 was achieved in 3 cases (50 %), which is significantly lower than historical control of MT (91.6 %) without IA (p = 0.01). No aneurysms ruptured during MT. The aneurysm noted distal to the occlusion was mycotic. CONCLUSION: In this analysis, the observed prevalence of IA in patients with AIS was 4.5%. Ipsilateral aneurysms (proximal or distal to the occlusion site) deserve particular attention, given the potential risk of rupture during MT. Aneurysms located distal to the occlusion were mycotic and the rate of recanization in patients with ipsilateral aneurysms was low compared to historical controls. Further studies are needed to improve the outcomes in patients with IA requiring MT.
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Aneurisma Intracraneal , Accidente Cerebrovascular Isquémico , Centros de Atención Terciaria , Trombectomía , Humanos , Aneurisma Intracraneal/epidemiología , Aneurisma Intracraneal/cirugía , Aneurisma Intracraneal/complicaciones , Masculino , Femenino , Accidente Cerebrovascular Isquémico/epidemiología , Accidente Cerebrovascular Isquémico/cirugía , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Prevalencia , Trombectomía/métodos , Anciano de 80 o más AñosRESUMEN
In this work, we introduce variational umbrella seeding, a novel technique for computing nucleation barriers. This new method, a refinement of the original seeding approach, is far less sensitive to the choice of order parameter for measuring the size of a nucleus. Consequently, it surpasses seeding in accuracy and umbrella sampling in computational speed. We test the method extensively and demonstrate excellent accuracy for crystal nucleation of nearly hard spheres and two distinct models of water: mW and TIP4P/ICE. This method can easily be extended to calculate nucleation barriers for homogeneous melting, condensation, and cavitation.
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OBJECTIVE: Chordomas are rare tumors of the skull base and spine believed to arise from the vestiges of the embryonic notochord. These tumors are locally aggressive and frequently recur following resection and adjuvant radiotherapy. Proton therapy has been introduced as a tissue-sparing option because of the higher level of precision that proton-beam techniques offer compared with traditional photon radiotherapy. This study aimed to compare recurrence in patients with chordomas receiving proton versus photon radiotherapy following resection by applying tree-based machine learning models. METHODS: The clinical records of all patients treated with resection followed by adjuvant proton or photon radiotherapy for chordoma at Mayo Clinic were reviewed. Patient demographics, type of surgery and radiotherapy, tumor recurrence, and other variables were extracted. Decision tree classifiers were trained and tested to predict long-term recurrence based on unseen data using an 80/20 split. RESULTS: Fifty-three patients with a mean ± SD age of 55.2 ± 13.4 years receiving surgery and adjuvant proton or photon therapy to treat chordoma were identified; most patients were male. Gross-total resection was achieved in 54.7% of cases. Proton therapy was the most common adjuvant radiotherapy (84.9%), followed by conventional or external-beam radiation therapy (9.4%) and stereotactic radiosurgery (5.7%). Patients receiving proton therapy exhibited a 40% likelihood of having recurrence, significantly lower than the 88% likelihood observed in those treated with nonproton therapy. This was confirmed on logistic regression analysis adjusted for extent of tumor resection and tumor location, which revealed that proton adjuvant radiotherapy was associated with a decreased risk of recurrence (OR 0.1, 95% CI 0.01-0.71; p = 0.047) compared with photon therapy. The decision tree algorithm predicted recurrence with an accuracy of 90% (95% CI 55.5%-99.8%), with the lowest risk of recurrence observed in patients receiving gross-total resection with adjuvant proton therapy (23%). CONCLUSIONS: Following resection, adjuvant proton therapy was associated with a lower risk of chordoma recurrence compared with photon therapy. The described machine learning models were able to predict tumor progression based on the extent of tumor resection and adjuvant radiotherapy modality used.
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Cordoma , Recurrencia Local de Neoplasia , Fotones , Terapia de Protones , Neoplasias de la Columna Vertebral , Humanos , Cordoma/radioterapia , Cordoma/cirugía , Masculino , Femenino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/radioterapia , Terapia de Protones/métodos , Radioterapia Adyuvante/métodos , Adulto , Anciano , Neoplasias de la Columna Vertebral/radioterapia , Neoplasias de la Columna Vertebral/cirugía , Fotones/uso terapéutico , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Non-polarizable force fields fail to accurately predict free energies of aqueous electrolytes without compromising the predictive ability for densities and transport properties. A new approach is presented in which (1) TIP4P/2005 water and scaled charge force fields are used to describe the interactions in the liquid phase and (2) an additional Effective Charge Surface (ECS) is used to compute free energies at zero additional computational expense. The ECS is obtained using a single temperature-independent charge scaling parameter per species. Thereby, the chemical potential of water and the free energies of hydration of various aqueous salts (e.g., NaCl and LiCl) are accurately described (deviations less than 5% from experiments), in sharp contrast to calculations where the ECS is omitted (deviations larger than 20%). This approach enables accurate predictions of free energies of aqueous electrolyte solutions using non-polarizable force fields, without compromising liquid-phase properties.
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Curation of biomedical knowledge into systems biology diagrammatic or computational models is essential for studying complex biological processes. However, systems-level curation is a laborious manual process, especially when facing ever-increasing growth of domain literature. New findings demonstrating elaborate relationships between multiple molecules, pathways and cells have to be represented in a format suitable for systems biology applications. Importantly, curation should capture the complexity of molecular interactions in such a format together with annotations of the involved elements and support stable identifiers and versioning. This challenge calls for novel collaborative tools and platforms allowing to improve the quality and the output of the curation process. In particular, community-based curation, an important source of curated knowledge, requires support in role management, reviewing features and versioning. Here, we present Biological Knowledge Curation (BioKC), a web-based collaborative platform for the curation and annotation of biomedical knowledge following the standard data model from Systems Biology Markup Language (SBML). BioKC offers a graphical user interface for curation of complex molecular interactions and their annotation with stable identifiers and supporting sentences. With the support of collaborative curation and review, it allows to construct building blocks for systems biology diagrams and computational models. These building blocks can be published under stable identifiers and versioned and used as annotations, supporting knowledge building for modelling activities.
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Programas Informáticos , Biología de Sistemas , Curaduría de DatosRESUMEN
Mastocytosis is a group of disorders characterized by the pathologic accumulation of mast cells in various tissues. One example of mastocytosis is urticaria pigmentosa, which presents with mastocytomas that can cause hives and, when irritated, pruritus. To our knowledge, we are describing the first case of urticaria pigmentosa without pruritus. The patient had a positive Darier's sign, stated that they never felt itchy, and denied ever using a topical steroid or antihistamine. Although our patient declined additional testing, patients like this may benefit from a detailed evaluation of their sensory system through both quantitative sensory testing and genetic analysis. J Drugs Dermatol. 2024;23(3): doi:10.36849/JDD.7558e.
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Urticaria Pigmentosa , Urticaria , Humanos , Urticaria Pigmentosa/diagnóstico , Prurito/diagnóstico , Prurito/etiología , Urticaria/diagnóstico , Mastocitos , EmocionesRESUMEN
BACKGROUND: Flow diversion using the pipeline embolization device (PED) has been a paradigm shift for anterior circulation (AC) aneurysms. However, only a few studies report the long-term (≥1 year) angiographic and clinical outcomes for posterior circulation (PC) aneurysms. This study aims to compare the long-term safety and efficacy of treatment of AC and PC aneurysms with PED. METHODS: The databases included Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane, and Scopus. Studies with at least 10 patients and 1-year follow-up were included. Twenty-four studies met our inclusion criteria. A random effect meta-analysis was performed to estimate the ischemic and hemorrhagic complications. A meta-analysis of proportions was performed to estimate the pooled rates of long-term complete aneurysmal occlusion, symptomatic stroke, aneurysmal rupture, and intracranial hemorrhage. RESULTS: There were 1952 aneurysms, of which 1547 (79.25%) were in the AC and 405 (20.75%) in the PC. The 1-year occlusion rate was 78% in AC compared to 73% in PC aneurysms (P < 0.01). The symptomatic infarct rate was 5% in AC compared to 13% in PC (P < 0.01). While the rupture rate was 1% in AC compared to 4% in PC (P = 0.01), the rate of intracranial hemorrhage was 2% for both (P = 0.99). CONCLUSIONS: The long-term occlusion rate after PED was higher in AC aneurysms, and the cumulative incidence of stroke and aneurysm rupture was higher in PC aneurysms.
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Embolización Terapéutica , Aneurisma Intracraneal , Humanos , Embolización Terapéutica/métodos , Embolización Terapéutica/instrumentación , Embolización Terapéutica/efectos adversos , Aneurisma Intracraneal/terapia , Resultado del Tratamiento , Aneurisma Roto/terapiaRESUMEN
BACKGROUND: With continuously aging societies, an increase in the number of people with cognitive decline is to be expected. Aside from the development of causative treatments, the successful implementation of prevention strategies is of utmost importance to reduce the high societal burden caused by neurodegenerative diseases leading to dementia among which the most common cause is Alzheimer's disease. OBJECTIVE: The aim of the Luxembourgish "programme dementia prevention (pdp)" is to prevent or at least delay dementia in an at-risk population through personalized multi-domain lifestyle interventions. The current work aims to provide a detailed overview of the methodology and presents initial results regarding the cohort characteristics and the implementation process. METHODS: In the frame of the pdp, an extensive neuropsychological evaluation and risk factor assessment are conducted for each participant. Based on the results, individualized multi-domain lifestyle interventions are suggested. RESULTS: A total number of 450 participants (Mean ageâ=â69.5 years; SDâ=â10.8) have been screened at different recruitment sites throughout the country, among whom 425 participants (94.4%) met the selection criteria. CONCLUSIONS: We provide evidence supporting the feasibility of implementing a nationwide dementia prevention program and achieving successful recruitment of the target population by establishing a network of different healthcare providers.
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Enfermedad de Alzheimer , Disfunción Cognitiva , Humanos , Anciano , Luxemburgo/epidemiología , Disfunción Cognitiva/terapia , Enfermedad de Alzheimer/epidemiología , Enfermedad de Alzheimer/prevención & control , Estilo de Vida , Selección de PacienteRESUMEN
INTRODUCTION: Skull-base chordomas are aggressive tumors with a propensity for recurrence/progression. Even with standard of care (SoC), 5-year recurrence rates are variable (19%-54%). This high recurrence/progression rate correlates with increased morbidity and mortality. We sought to analyze a multicenter cohort of skull base chordomas to identify predictors of progression in patients receiving SoC. METHODS: The [Blinded]-Neurosurgery data registry was queried for skull base chordomas treated from 2008-2020. Patients with the histopathologic diagnosis of chordoma were included. The cohort was composed of patients with preoperative and postoperative magnetic resonance imaging. Tumor volume and radiologic characteristics were obtained from axial T2 sequences using a Digital Imaging and Communications in Medicine viewer. Survival analysis was performed using Kaplan-Meier method, and time-to-event multivariate regression was performed to identify independent predictors of progression. RESULTS: The cohort included 195 patients, of which 66 patients met inclusion criteria; median age was 44, and 28 (42%) were females. Fifty-four (82%) received SoC, 7 (11%) resection only, and 5 (8%) radiotherapy only. Median preoperative and postoperative tumor volumes were 11.55 cm3 (0.33-54.89) and 0.34 cm3 (0-42.52), respectively. Recurrence rate with SoC was 37%. Postoperative tumor volume (P = 0.010) correlated with progression. A postoperative volume of >4.9 cm3 (P = 0.044), ≤81.3% of tumor resection (P = 0.02), and lower-clivus location (P < 0.005) correlated with decreased time to progression. CONCLUSIONS: Skull base chordomas can be challenging to resect. Even though maximal resection and radiotherapy improve rate of tumor progression, many of these lesions eventually recur. We have identified a postoperative tumor volume of ≥4.9 cm3 and extent of resection of ≤81.3% in this cohort as predictors of progression in patients receiving SoC.
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Cordoma , Neoplasias de la Base del Cráneo , Femenino , Humanos , Masculino , Cordoma/diagnóstico por imagen , Cordoma/cirugía , Cordoma/patología , Estudios de Seguimiento , Imagen por Resonancia Magnética/métodos , Estudios Retrospectivos , Base del Cráneo/patología , Neoplasias de la Base del Cráneo/diagnóstico por imagen , Neoplasias de la Base del Cráneo/cirugía , Neoplasias de la Base del Cráneo/patología , Análisis de Supervivencia , Resultado del Tratamiento , AdultoRESUMEN
Oncolytic viral therapy is quickly emerging as a promising subset of immunotherapy, which theoretically can target tumor cells while sparing surrounding healthy cells by harnessing the replication machinery of viruses with tropism for tumor cells, resulting in direct oncolysis, and by transforming immunologically "cold" tumor into areas that elicit the host's immune response. This review provides an overview of oncolytic viral therapy until the present day, starting with the original concept in 1912. The general mechanism of oncolytic viruses (OVs) depends on selectively integrating them into tumor cells based on genetic engineering of viral genomic material, inducing oncolysis and eliciting the host's innate immune response. Moreover, a major component of oncolytic viral therapy has been herpes simplex virus, with talimogene laherparepvec being the only FDA-approved oncolytic viral therapy for the treatment of melanomas. This review explores the characteristics, advantages, disadvantages, and therapeutic uses of several DNA and RNA viral families. A snapshot of the oncolytic viral treatments used in the most recent and advanced clinical trials is also provided. Lastly, the challenges of implementing oncolytic viral therapy are explored, both at a molecular and clinical level, with a highlight of promising future directions. In particular, the lack of an optimal delivery method based on tumor type for oncolytic viral therapy poses a significant obstacle, even in clinical studies. Intrathecal continuous delivery of OVs is a promising prospect, potentially by adapting the novel continuous irrigation and drainage IRRAflow catheter. Further exploration and testing of the IRRAflow catheter should be undertaken.
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Melanoma , Neoplasias , Viroterapia Oncolítica , Virus Oncolíticos , Humanos , Viroterapia Oncolítica/métodos , Melanoma/patología , Virus Oncolíticos/genética , Neoplasias/terapia , Inmunoterapia/métodosRESUMEN
Rickettsia species are obligate intracellular bacteria that can cause mild to severe human disease. Based on phylogeny, clinical symptoms, and antigenic properties, rickettsiae are classified into four groups. Infections by these agents are characterized by clinical symptoms ranging from self-limited to severe and even fatal febrile illnesses, depending on the Rickettsia spp. involved, the patient's predisposition, and timely medical care. The present study aimed to characterize rickettsial diseases in Yucatan according to clinical and laboratory features appearing in medical records corresponding to 427 samples taken between 2015 and 2018. A study was conducted over the period 2015-2018 on 427 samples. Clinical and laboratory features were documented from the patients' medical records. For molecular diagnosis, blood was collected in 3.8 % sodium citrate as anticoagulant, and DNA was extracted. Single-step and nested PCR amplification was performed using genus-specific primers for the rickettsial 17kDa and ompB genes. The amplicons obtained were purified and sequenced. A total of 22.7 % (97/427) positive cases of Rickettsia spp. were identified by PCR from 14.15 % (15/106) of the municipalities in Yucatan. 75.2 % (73/97) of the cases were from the city of Merida during the autumn (September-December). The age groups with the highest frequency of confirmed cases were pediatric (5-14 years) (57.7 %) and adults (25-49 years) (42.2 %). There were six fatal cases in children, one associated with R. typhi and five with R. rickettsii. In non-fatal cases, 32.9 % (32/97) corresponded to the spotted fever group (SFG), and 60.8 % (59/97) to the typhus group (TG). Significant differences in signs, and laboratory data, were observed between the pediatric and adult populations. For the treatment of patients, oral and intravenous doxycycline was used in severe hospitalized cases. Typhus group and spotted fever group Rickettsiae are endemic pathological agents found in urban and rural areas of our region. Molecular identification allows for greater diagnostic accuracy and timely treatment and consequently a better prognosis. It is necessary to implement or reinforce measures focused on the dissemination of knowledge regarding rickettsial diseases and their prevention.
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Infecciones por Rickettsia , Rickettsia , Rickettsiosis Exantemáticas , Tifus Epidémico Transmitido por Piojos , Adulto , Humanos , Niño , Preescolar , Adolescente , México/epidemiología , Infecciones por Rickettsia/diagnóstico , Infecciones por Rickettsia/epidemiología , Infecciones por Rickettsia/microbiología , Rickettsiosis Exantemáticas/epidemiologíaRESUMEN
Abstract: In Mexico, the economically active population aged over 50 years has been increasing in recent years. Due to their age, these workers may experience health deterioration and require some form of care. However, only formal employment is associated with better access to health services and pensions. At the same time, these workers may also need to care for children, sick partners or dependent older adults, which limits their time available for employment. This study examined the association between disability, receiving and providing care and access to health services, and economic activity among adults aged 50 to 69 in Mexico in 2015 and 2018. Multilevel modeling was conducted using data from the Mexican Health and Aging Study (MHAS). The MHAS is a longitudinal panel study of adults aged 50 years and older. The study sample included data from 8,831 observations from 2015 and 10,445 observations from 2018. Those living with some degree of disability and receiving care were found to be less likely to be economically active than those living with disability and not receiving care. Similarly, individuals who care for someone were also found to be less likely to be employed. Furthermore, the data suggested that individuals without access to health services were more likely to be economically active. For individuals aged 50 to 69 years, health and care issues were factors that limited economic activity status. In family-oriented societies with weak welfare states, the right to health is partial for the population and care is traditionally the responsibility of women, which exacerbates gender inequalities and has a differential impact on paid work for men and women.
Resumen: La población de México económicamente activa mayor de 50 años de edad se ha incrementado en los últimos años. Estos trabajadores en esta edad pueden sentir empeorar su salud y requerir algún tipo de atención. Sin embargo, solamente el empleo formal dio un mejor acceso a los servicios sanitarios y las pensiones. Al mismo tiempo, esta población también puede necesitar cuidar a niños, a la pareja enferma o a una persona mayor dependiente, lo que limita su tiempo disponible para trabajar. Este estudio evaluó la asociación entre la discapacidad, recibir y brindar asistencia y acceso a los servicios sanitarios, y la actividad económica de adultos de entre 50 y 69 años en México en el período de 2015 y 2018. Se trata de un enfoque de modelado multinivel que utiliza datos del Estudio Nacional de Salud y Envejecimiento en México (ENASEM). ENASEM es un estudio longitudinal con adultos de 50 años o más. La muestra del estudio estuvo conformada por 8.831 observaciones en 2015 y 10.445 en 2018. Las personas que viven con algún grado de discapacidad y reciben atención tienen menos probabilidades de ser económicamente activas en comparación con las que viven con discapacidades y no reciben atención. Del mismo modo, las personas que brindan atención también tienen menos probabilidades de tener un trabajo. Además, los datos destacan que las personas sin acceso a los servicios sanitarios tienen más probabilidades de ser económicamente activas. En las personas de entre 50 y 69 años, los problemas de salud y la atención son factores que restringen la condición de la actividad económica. En las sociedades orientadas a la familia con estados de bienestar débiles, el derecho a la salud es parcial a la población y el cuidado es tradicionalmente realizado por las mujeres, lo que empeora las desigualdades de género y tiene un impacto diferencial en el trabajo remunerado para hombres y mujeres.
Resumo: No México, a população economicamente ativa com mais de 50 anos tem crescido nos últimos anos. Devido à idade, estes trabalhadores podem apresentar piora da saúde e necessitar de algum tipo de cuidado. No entanto, apenas o emprego formal está atrelado a um melhor acesso aos serviços de saúde e aposentadorias. Ao mesmo tempo, indivíduos dessa população também podem precisar cuidar de crianças, um companheiro doente ou idoso dependente, o que limita seu tempo disponível para o trabalho. Este estudo examinou a associação entre deficiência, receber e fornecer cuidados e acesso a serviços de saúde e a atividade econômica entre adultos de 50 a 69 anos no México em 2015 e 2018. Trata-se de uma abordagem com modelagem multinível utilizando dados do Estudo Nacional sobre Saúde e Envelhecimento no México (ENASEM). O ENASEM é um estudo longitudinal painel com adultos com 50 anos ou mais. A amostra do estudo incluiu dados de 8.831 observações em 2015 e 10.445 em 2018. Aqueles que vivem com algum grau de incapacidade e recebem cuidados têm menor probabilidade de serem economicamente ativos em comparação com aqueles que vivem com incapacidades e não recebem cuidados. Da mesma forma, os indivíduos que prestam cuidados também são menos propensos a terem um emprego. Além disso, os dados sugerem que indivíduos sem acesso a serviços de saúde têm maior probabilidade de serem economicamente ativos. Em indivíduos na faixa etária de 50 a 69 anos, problemas de saúde e cuidados são fatores que restringem a condição de atividade econômica. Em sociedades orientadas para a família com estados de bem-estar social fracos, o direito à saúde é parcial para a população e o cuidado é tradicionalmente assumido pelas mulheres, o que agrava as desigualdades de gênero e tem um impacto diferencial no trabalho remunerado para homens e mulheres.
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The importance of nitrate and ammonium salts both in the environment and in biological processes cannot be questioned. In this work, using the TIP4P/2005 water model, aqueous solutions of nitrate and ammonium electrolytes are parametrized using scaled charges while keeping a rigid structure and nonpolarizable charge distributions. The models are optimized by systematically testing a set of properties for twelve electrolytes-eight nitrate and four ammonium salts-thus, enlarging the number of potential chemical species encompassed within the Madrid-2019 force field for ions. The capacity of the force field for predicting densities, ion-ion and ion-solvent structures, and transport properties of the solutions comprised by the trial batch of salts was tested and discussed. Both the dependence of the densities with the salt concentration and the solution structure were nicely reproduced by the models in the whole concentration range without any trace of precipitating events and with improved accuracy in comparison with recently reported models, while the agreement of the simulated transport properties with experimental data ranges from good to reasonable, depending on the ion/counterion pair. These scaled charge models might be considered as force fields embodying a reasonable compromise between exactness and general applicability and also as an important step in the development of accurate models for polyatomic ions.
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Objective: To describe the safety and feasibility of a fast-track pathway for neurosurgical craniotomy patients receiving care in a neurosciences progressive care unit (NPCU). Patients and Methods: Traditionally, most craniotomy patients are admitted to the neurosciences intensive care unit (NSICU) for postoperative follow-up. Decreased availability of NSICU beds during the coronavirus disease-2019 delta surge led our team to establish a de-novo NPCU to preserve capacity for patients requiring high level of care and would bypass routine NSICU admissions. Patients were selected a priori by treating neurosurgeons on the basis of the potential need for high-level ICU services. After operation, selected patients were transferred to the postoperative care unit, where suitability for NPCU transfer was reassessed with checklist-criteria. This process was continued after the delta surge. Results: From July 1, 2021 to September 30, 2022, 57 patients followed the NPCU protocol. Thirty-four (59.6%) were women, and the mean age was 56 years. Fifty-seven craniotomies for 34 intra-axial and 23 extra-axial lesions were performed. After assessment and application of the checklist-criteria, 55 (96.5%) were transferred to NPCU, and only 2 (3.5%) were transferred to ICU. All 55 patients followed in NPCU had good safety outcomes without requiring NSICU transfer. This saved $143,000 and led to 55 additional ICU beds for emergent admissions. Conclusion: This fast-track craniotomy protocol provides early experience that a surgeon-selected group of patients may be suitably monitored outside the traditional NSICU. This system has the potential to reduce overall health care expenses, increase capacity for NSICU bed availability, and change the paradigm of NSICU admission.
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Flow diversion with the pipeline embolization device (PED) is increasingly used to treat intracranial aneurysms with high obliteration rates and low morbidity. However, long-term (≥ 1 year) angiographic and clinical outcomes still require further investigation. The aim of this study was to compare the occlusion and complication rates for small (< 10 mm) versus large (10-25 mm) aneurysms at long-term following treatment with PED. A systematic review and meta-analysis were performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We conducted a comprehensive search of English language databases including Ovid MEDLINE and Epub Ahead of Print, In-Process, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Our studies included a minimum of 10 patients treated with PED for small vs. large aneurysms and with at least 12 months of follow-up. The primary safety endpoint was the rate of clinical complications measured by the occurrence of symptomatic stroke (confirmed clinically and radiographically), intracranial hemorrhage, or aneurysmal rupture. The primary efficacy endpoint was the complete aneurysm occlusion rate. Our analysis included 19 studies with 1277 patients and 1493 aneurysms. Of those, 1378 aneurysms met our inclusion criteria. The mean age was 53.9 years, and most aneurysms were small (89.75%; N = 1340) in women (79.1%; N = 1010). The long-term occlusion rate was 73% (95%, CI 65 to 80%) in small compared to 84% (95%, CI 76 to 90%) in large aneurysms (p < 0.01). The symptomatic thromboembolic complication rate was 5% (95%, CI 3 to 9%) in small compared to 7% (95%, CI 4 to 13%) in large aneurysms (p = 0.01). The rupture rate was 2% vs. 4% (p = 0.92), and the rate of intracranial hemorrhage was 2% vs. 4% (p = 0.96) for small vs. large aneurysms, respectively; however, these differences were not statistically significant. The long-term occlusion rate after PED treatment is higher in large vs. small aneurysms. Symptomatic thromboembolic rates with stroke are also higher in large vs. small aneurysms. The difference in the rates of aneurysm rupture and intracranial hemorrhage was insignificant. Although the PED seems a safe and effective treatment for small and large aneurysms, further studies are required to clarify how occlusion rate and morbidity are affected by aneurysm size.
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Aneurisma Roto , Aneurisma Intracraneal , Accidente Cerebrovascular , Humanos , Femenino , Persona de Mediana Edad , Aneurisma Roto/cirugía , Aneurisma Intracraneal/cirugía , Hemorragias Intracraneales , AngiografíaRESUMEN
Resumen La preeclampsia es una patología con alta morbimortalidad a nivel mundial. En esta enfermedad la placenta es un órgano de choque donde la inflamación y la respuesta inmunológica generan el daño que se traduce en el cuadro clínico característico. La tríada clásica en preeclampsia está integrada por hipertensión, edema y proteinuria, por lo que se piensa que el endotelio debe estar afectado por la actividad inflamatoria-inmunológica. El sistema inmunológico actúa en el desarrollo del embarazo y lo hace a diferentes tiempos y regulando de manera fisiológica. Tanto componentes celulares como humorales de la respuesta innata y adquirida han sido estudiados en pacientes con preeclampsia y se ha determinado que su participación es decisiva en la fisiopatología de esta enfermedad. La participación del sistema inmunológico en la fisiopatología de la preeclampsia alcanza un alto nivel de complejidad pues interacciona con otros sistemas (coagulación, renal, cardiovascular y endocrinológico entre otros) favoreciendo así la enfermedad. Es por esto que el tratamiento debe ser integral, con una visión holística del padecimiento y que requiere de un equipo multidisciplinario, que actué armónicamente para así alcanzar el mayor éxito terapéutico con la menor frecuencia de secuelas para el binomio madre-feto o madre-recién nacido. En la gestación se desarrolla la denominada "tolerancia inmunológica del embarazo", en ese estado de tolerancia inmunológica las células B y T pueden reconocer antígenos específicos (por ejemplo, los paternos) y posteriormente activarse y generar la respuesta inmunológica, por lo que la preeclampsia podría ser considerada como una patología autoinmune, donde la perdida de la tolerancia inmunológica sería la piedra angular en la fisiopatología, conocer como limitar o regular esta activación celular anómala podría servir para proponer nuevos acercamientos terapéuticos y controlar así esta enfermedad.
Abstract Preeclampsia is a pathology with high morbidity and mortality worldwide. In this disease, the placenta is an organ of shock where inflammation and the immune response generate the damage that results in the characteristic clinical scenario. The classic triad in preeclampsia is made up of hypertension, edema, and proteinuria, so it is thought that the endothelium must be affected by inflammatory-immunological activity. The immune system acts in the development of pregnancy and does so at different times and regulating physiologically. Both, cellular and humoral components of the innate and acquired response have been studied in patients with preeclampsia and it has been determined that their participation is decisive in the pathophysiology of this disease. The involvement of the immune system in the pathophysiology of preeclampsia reaches a high level of complexity since it interacts with other systems (coagulation, renal, cardiovascular and endocrinological among others) thus favoring the disease. For this reason, treatment must be comprehensive, with a holistic vision of the condition and requires a multidisciplinary team that acts harmoniously to achieve the greatest therapeutic success with the least frequency of sequelae for the mother-fetus or mother-newborn dyads. During pregnancy, the so-called "immunological tolerance of pregnancy" develops, in this state of immunological tolerance the B and T cells can recognize specific antigens (for example, the paternal ones) and later activate and generate the immune response, which is why preeclampsia could being considered an autoimmune pathology, where the loss of immunological tolerance would be the cornerstone of pathophysiology, knowing how to limit or regulate this abnormal cell activation could help to propose new therapeutic approaches and thus control this disease.