Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 96
Filtrar
1.
BMJ Case Rep ; 13(5)2020 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-32385121

RESUMEN

The eight-and-a-half syndrome (EHS)-defined by the combination of a seventh cranial nerve palsy and an ipsilateral one-and-a-half syndrome-is a rare brainstem syndrome, which localises to the caudal tegmental region of the pons. We present a case of the EHS secondary to an inflammatory lesion on a previously healthy 26-year-old woman, with a literature review emphasising the relevance of aetiological assessment.

2.
Surg Endosc ; 2020 May 19.
Artículo en Inglés | MEDLINE | ID: mdl-32430527

RESUMEN

BACKGROUND: Approximately 10% of patients receiving anti-reflux procedures present with shortened esophagus. Collis gastroplasty (CG) is the current gold standard for esophageal lengthening, but mediastinal esophageal mobilization without gastroplasty may be an alternative approach. This study assesses preoperative and intraoperative hernia characteristics and mediastinal dissection impact in patients with large hiatal hernia repair (HHR). METHODS: A single-institution, prospectively collected database was reviewed for adults who underwent laparoscopic HHR with mesh and anti-reflux surgery between 2005 and 2016, hernia ≥ 5 cm. Preoperative hernia and follow-up were assessed using upper endoscopy and barium swallow. Intraoperative hernia characteristics were collected from the operative note. Esophageal symptom scores were collected pre- and postoperatively. Analyses were conducted using SPSS v26.0. RESULTS: Among 662 patients who had anti-reflux surgery in this period, a total of 205 patients who underwent HHR with mesh met the inclusion criteria and were included in study. Mean age was 61.7 ± 13.6 years, and majority of patients were female and Caucasian. Mean BMI was 29.9 ± 6.0 kg/m2. Median hernia size was 6.5 cm [5.0-12.0 cm], and intra-thoracic stomach had a prevalence of 21.9%. Analysis of preoperative barium swallow revealed an average of elevated gastroesophageal junction above the diaphragm of 4.10 ± 1.67 cm. Radiographically, average hernia size was 6.34 ± 1.93 cm and 6.38 ± 1.92 cm in the anterior-posterior and obliquus view, respectively. Median follow-up time was 2.7 years [1-9 years]. Esophageal symptoms improved in all patients (p < 0.05). 45% of patients had radiographic recurrence, but only four presented symptomatic or were on PPI. CONCLUSIONS: CG has been the standard for ensuring adequate esophageal length prior to anti-reflux surgery. Our results support that CG is unnecessary in the majority of cases, and extensive mediastinal dissection was successfully used instead of CG with durable, long-term outcomes. Extended mediastinal dissection may mitigate CG risks in patients requiring additional intra-abdominal esophagus.

3.
J BUON ; 25(1): 543-548, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32277681

RESUMEN

PURPOSE: To compare the antitumor effect of adenoviruses that express mutant variants of the protein E7 from HPV-16 fused to calreticulin. METHODS: Recombinant adenoviruses were generated to express calreticulin fused to mutant versions of E7 (CRT/E7m and CRT/E7dm). Western blot and immunofluorescence assays were made to demonstrate protein expression. Antitumor assays were performed in C57BL6 mice injected with TC-1 cell line. RESULTS: When HEK293 cells were infected with these adenoviruses, we detected that all the recombinant proteins were expressed at endoplasmic reticulum, as expected. Next, the antitumor effect was tested on a murine tumor model established by inoculation of TC-1 cell line. We detected that both Ad CRT/E7m and Ad CRT/E7dm were capable of reducing the antitumor volume when compared to Ad LacZ, which was used as negative control. No significant difference was observed when compared to Ad CRT/E7, a positive control. CONCLUSIONS: Here we demonstrated that the mutant versions of E7 HPV-16 fused to calreticulin generate similar antitumor effect than the wild type version.

4.
Updates Surg ; 72(1): 179-184, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32141046

RESUMEN

Little is known about how robot technology is employed by surgeons in minimally invasive surgery (MIS). We evaluated the needs of established robotic surgeons and of those who are new to this technology. A survey was designed and sent electronically to MIS surgeons. Questions included fellowship training, area of expertise, experience with robotic simulation and in clinical use, mentorship, likelihood of switching to a different approach, and expectations for the robot. Descriptive analysis was conducted using STATA/MP 15.1. 189 interviewees self-identified as hernia surgeons. 73.8% had additional fellowship, with majority practicing for 3-6 years (54%). Nearly 40% were MIS surgeons (N = 73), followed by general surgery (34.4%), and bariatrics (13.8%). 146 interviewees (77.7%) have used the daVinci® in clinical scenarios. Among robotic surgeons, majority were performing less than ten robotic cases per month. Inguinal hernia repairs were the leading procedures (49%), followed by foregut-related (19.5%), and colorectal-related surgeries (17.5%). Nearly 40% of surgeons stated inguinal hernia repairs to be the most often performed procedure using the robot. Nearly 40% of open and laparoscopic hernia surgeons are willing to adopt robotic-assisted procedures for their inguinal hernia repairs. Level 1 evidence (47.9%) and cost (24.1%) were the most pressing needs for robotic research. Majority of interviewees have used the daVinci® in clinical settings. Hernia repair remains the primary application of the robot in general surgery, among specialized surgeons. Over 40% of hernia surgeons are interested in switching to robotic technology over its open or laparoscopic counterparts.


Asunto(s)
Hernia Inguinal/cirugía , Herniorrafia/estadística & datos numéricos , Procedimientos Quirúrgicos Mínimamente Invasivos/estadística & datos numéricos , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Cirujanos/estadística & datos numéricos , Herniorrafia/métodos , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Encuestas y Cuestionarios
5.
Genes (Basel) ; 11(3)2020 03 16.
Artículo en Inglés | MEDLINE | ID: mdl-32188171

RESUMEN

The order Mucorales is a group of ancient fungi with limited tools for gene manipulation. The main consequence of this manipulation unwillingness is the limited knowledge about its biology compared to other fungal groups. However, the emerging of mucormycosis, a fungal infection caused by Mucorales, is attracting the medical spotlight in recent years because the treatments available are not efficient in reducing the high mortality associated with this disease. The result of this renewed interest in Mucorales and mucormycosis is an extraordinarily productive effort to unveil their secrets during the last decade. In this review, we describe the most compelling advances related to the genetic study of virulence factors, pathways, and molecular mechanisms developed in these years. The use of a few genetic study models has allowed the characterization of virulence factors in Mucorales that were previously described in other pathogens, such as the uptake iron systems, the mechanisms of dimorphism, and azole resistances. More importantly, recent studies are identifying new genes and mechanisms controlling the pathogenic potential of Mucorales and their interactions with the host, offering new alternatives to develop specific strategies against mucormycosis.

6.
Surg Endosc ; 2020 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-32040632

RESUMEN

BACKGROUND: We aimed to examine the outcomes and utilization of different hiatal hernia repair (HHR) approaches in elective and emergent/urgent settings. METHODS: Vizient 2015-2017 database was queried for adult patients who underwent HHR. Patients were grouped into open (OHHR), laparoscopic (LHHR), or robotic-assisted (RHHR), and further stratified by elective or urgent status and severity of illness at admission. Surgical outcomes and costs were compared across all groups. Statistical analysis were done using SPSS v.25.0. RESULTS: 9171 adults were included (OHHR N = 1534;LHHR N = 6796;RHHR N = 841). LHHR was the most utilized approach (74.1%), followed by OHRR (16.7%) and RHHR (9.2%). OHHR was employed three times as frequently in U settings, compared to elective. Overall, OHHR had longer mean length of stay (LOS; 9.41 vs. < 4 days) and higher postoperative complication rates (8.8% vs < 3.8%), mortality (2.7% vs < 0.5%) and mean direct cost ($27,842 vs < $10,407), when compared to both LHHR and RHHR, all p < 0.05. Analysis of mild to severely ill elective cases demonstrated LHHR and RHHR to be better than OHHR regarding complications (p < 0.05), cost (p < 0.001) and LOS (p < 0.013); there were insufficient extremely ill elective patients for meaningful analysis. In the urgent setting, minimally invasive approaches predominate, overtaken by OHHR only for the extremely ill. Despite the urgent setting, for mild-moderately ill patients, OHHR was statistically inferior to both LHHR and RHHR for LOS (p = 0.002, p < 0.0001) and cost (p = 0.0133, p < 0.001). In severe-extremely ill patients, despite being more utilized, OHHR was not superior to LHHR; in fact, complication, cost, and mortality trends (all p > 0.05) favored LHHR. CONCLUSION: Our analysis demonstrated LHHR to currently be the most employed approach overall. LHHR and RHHR were associated with lower cost, decreased LOS, complications, and mortality compared to OHHR, in all but the sickest of patients. Patients should be offered minimally invasive HHR, even in urgent/emergent settings, if technically feasible.

7.
Am J Phys Med Rehabil ; 99(4): 338-347, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31688009

RESUMEN

In the United States, the number of people with Hispanic backgrounds is rapidly increasing. This growth, along with other factors, may put them at increased risk for healthcare disparities. Thus, physical medicine and rehabilitation should evaluate disparities in health services through the lens of the evidence base. To our knowledge, this is the first review describing the literature on healthcare disparities for Hispanic patients in the field of physical medicine and rehabilitation. This review explores healthcare utilization, risk factors, access, and health conditions specific to Hispanic populations. Articles used in this narrative review were collected for a 10-yr span (2009-2018) from online databases.Our findings highlight disparities across common conditions and injuries in the physical medicine and rehabilitation literature, including poststroke rehabilitation, hip fracture treatment and rehabilitation, spinal cord injury, and traumatic brain injury. Our review suggests that Hispanic patients may be at risk for worse outcomes after these conditions, because of low access to rehabilitation services and disparities in the referral process. Similar results are reported for pain management and Parkinson disease. As we strive to provide optimal care to an increasingly diverse patient population, researchers and clinicians must consider effects of race and ethnicity on access to and utilization of rehabilitation services.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Hispanoamericanos/estadística & datos numéricos , Medicina Física y Rehabilitación/estadística & datos numéricos , Humanos , Estados Unidos
10.
Surg Obes Relat Dis ; 15(12): 2060-2065, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31668944

RESUMEN

BACKGROUND: Intragastric balloon (IGB) placement can provide a mean percent total weight loss (%TWL) of 10.2% at 6-month follow-up. OBJECTIVES: We aimed to evaluate 30-day outcomes and safety of patients undergoing IGB placement. SETTING: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. METHODS: The 2016 to 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program was queried for adult patients who underwent primary IGB placement. Demographic characteristics and preoperative risk factors were collected. Postoperative outcomes included %TWL, percent excess weight loss, and complications rates and causes. Subset analysis was done for outcomes comparison between surgeons or gastroenterologists performing the procedure. Statistical analysis was performed using SPSS 25.0. RESULTS: A total of 1221 patients were included. The majority was female (81.9%), Caucasian (81.2%), with a mean age of 48 ± 11.3 years and a mean preoperative body mass index of 34.9 ± 11.2 kg/m2. Of patients, 98.8% were discharged within 24 hours of the procedure. Two patients were admitted to the intensive care unit, and 7.2% received postoperative treatment for dehydration. Reoperation and readmission rates were 1.1% and 7.2%, respectively, mainly due to nausea, vomiting, and poor nutritional status (n = 22). The intervention rate was 6.2%. Patients in this cohort achieved a mean %TWL of 6.2% (standard deviation, 5.52%) and mean TWL of 6.8 kg within 30 days postoperatively (n = 147; 24-30 d). CONCLUSIONS: Our data show patients met approximately 50% of their target weight loss 30 days after IGB placement. Nausea, vomiting, and poor nutrition status were the most common complications within 30 days of the procedure. Long-term follow-up is necessary to determine if these patients are able to sustain their weight loss and for how long.

11.
Obes Surg ; 29(12): 4077-4083, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31641982

RESUMEN

Obesity is a worldwide epidemic with rates nearly doubling over the last 30 years. Despite increasing prevalence, the multifactorial pathogenesis of obesity continues to be widely misunderstood. Investigating genetic drivers in the development of obesity is an important area of focus, as genetics move to the forefront of medicine and personalized treatment evolves. Thus, this narrative review focused on four genes which have genome-wide association study-documented links to obesity and obesity syndromes. We explored their involvement in the predisposition, progression, and prognosis of obesity. Leptin, leptin receptor, pro-opiomelanocortin, and melanocortin 4 receptor are our four genes of interest, and herein we elaborated on the current literature, pathogenesis, and available treatments for patients with these specific genetic mutations.

12.
Am J Surg ; 218(6): 1213-1218, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31500796

RESUMEN

BACKGROUND: This study sought to evaluate surgical outcomes, cost, and opiate utilization of patients who underwent laparoscopic (LC) or robotic cholecystectomy (RC). METHODS: The Vizient database was queried for patients admitted with mild to moderate severity of illness (SOI) scores who underwent LC or RC from January 2015 through December 2017. Rates of overall complications, postoperative infection, mortality, LOS, cost, and opiate utilization were compared between groups using IBM SPSS v.25.0, α = 0.05. RESULTS: 91,849 patients (LC:N = 89,878; RC:N = 1,971) met the inclusion criteria. Robotic approach was associated with more complications (LC:0.9%, RC:1.7%; p < 0.001), postoperative infections (LC:0.2%, RC:0.4%; p = 0.033) and a higher direct cost (LC:$6782 ±â€¯3421, RC:$9354 ±â€¯5497; p < 0.001). Opiates were prescribed more frequently in the laparoscopic group (LC:98.3%, RC:97.2%; p = 0.002). CONCLUSION: The direct cost of RC is significantly higher than LC with no added benefit. Routine use of the robotic platform for cholecystectomy should be discouraged until costs are reduced.


Asunto(s)
Colecistectomía/economía , Procedimientos Quirúrgicos Robotizados/economía , Adolescente , Adulto , Anciano , Analgésicos Opioides/uso terapéutico , Colecistectomía Laparoscópica/economía , Bases de Datos Factuales , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Complicaciones Posoperatorias/economía , Índice de Severidad de la Enfermedad , Estados Unidos
13.
J Craniofac Surg ; 30(7): 2014-2017, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31449228

RESUMEN

BACKGROUND: Bleeding is the most common adverse event in patients undergoing cranial vault reconstruction. The authors compare the transfusion rates against a national sample to determine whether the patients experience lower transfusion rates. METHODS: The authors queried the Pediatric National Surgical Quality Improvement Program (Peds-NSQIP) for patients who underwent cranial vault reconstruction (CPT 61559) and compared them to patients who underwent cranial vault reconstruction for sagittal craniosynostosis at Children's Hospital and Medical Center (CHMC) in Omaha, Nebraska. Patients over the age of 24 months were excluded. Binary logistic regression analysis was performed using IBM-SPSS v24.0 to determine factors associated with transfusion at CHMC. RESULTS: Patient demographics, preoperative hematocrit and platelet counts, readmission rates, and reoperation rates did not differ between CHMC (N = 54) and Peds-NSQIP (N = 1320) cohorts. Patients in the CHMC cohort had shorter preincision anesthesia times (47 versus 80 minutes, P < 0.001), shorter operative times (108 versus 175 minutes, P < 0.001), lower transfusion rates (50% versus 73%, P < 0.001), and smaller mean transfusion volumes (16 versus 33 mL/kg, P < 0.001); however mean length of stay was longer (4.1 versus 3.6 days, P < 0.001). Factors independently associated with transfusion at CHMC included preoperative hematocrit (odds ratio [OR] 0.423, P = 0.002), administration of an antifibrinolytic agent (OR 0.004, P = 0.001) and temperature at the time of incision (OR 0.020, P = 0.043). CONCLUSION: Patients at CHMC require less transfused blood and experience low transfusion rates. Preoperative hematocrit, administration of antifibrinolytic agents, and temperature at the time of incision are all modifiable factors associated with perioperative transfusion.


Asunto(s)
Transfusión Sanguínea , Cráneo/cirugía , Antifibrinolíticos/uso terapéutico , Pérdida de Sangre Quirúrgica , Preescolar , Estudios de Cohortes , Craneosinostosis/cirugía , Femenino , Hematócrito , Humanos , Lactante , Masculino , Tempo Operativo , Atención Perioperativa , Procedimientos Quirúrgicos Reconstructivos , Reoperación
14.
J Surg Oncol ; 120(4): 661-669, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31292967

RESUMEN

BACKGROUND: Anastomotic leak is the most common major complication after esophagectomy. We investigated the 2016 American College of Surgeons National Surgical Quality Improvement Program esophagectomy targeted database to identify risk factors for anastomotic leak. METHODS: Patients who underwent esophagectomy for cancer were included. Patients experiencing an anstomotic leak were identified, and univariate and multivariable logistic regression was performed to identify variables independently associated with anastomotic leak. RESULTS: Of 915 patients included, 83% were male and the median age was 64 years. Patients with anastomotic leak more frequently had additional complications (87% vs 36%, P < .001). Rates of reoperation (64% vs 11%, P < .001) and mortality (8% vs 2%, P = .001) were higher in patients with anastomotic leak. After adjusting for patient and procedure characteristics, prolonged operative time (for each additional 30-minutes; adjusted odds ratios (AOR) 1.068, 95% CI, 1.022-1.115, P = .003), increased preoperative WBC count (for each 3000/µL increase; AOR 1.323, 95% CI, 1.048-1.670, P = .019), pre-existing diabetes (AOR 1.601, 95% CI, 1.012-2.534, P = .045), and perioperative transfusion (AOR 1.777, 95% CI, 1.064-2.965, P = .028) were independently associated with anastomotic leak. CONCLUSION: Both patient and procedure-related factors are associated with anastomotic leak. Though frequently non-modifiable, these findings could facilitate risk stratification and early detection of anastomotic leak to reduce associated morbidity.


Asunto(s)
Adenocarcinoma/cirugía , Fuga Anastomótica/etiología , Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Medición de Riesgo/métodos , Adenocarcinoma/patología , Anciano , Fuga Anastomótica/patología , Carcinoma de Células Escamosas/patología , Neoplasias Esofágicas/patología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico
15.
Biogerontology ; 20(5): 583-603, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31187283

RESUMEN

Humans and other organisms show age-related signs of deterioration, which makes aging an interesting process to study. In the present work, we review the anti-aging evidence of several of the most promising natural compounds. Quercetin, rapamycin, resveratrol, spermidine, curcumin or sulforaphane administration increase longevity and stress resistance in model organisms such as yeasts, nematodes, flies and mice. Even more, rapamycin, resveratrol, and curcumin are currently in preclinical tests on the Interventions Testing Program of the National Institute on Aging due to their encouraging results in model organisms. The potential mechanisms underlying the beneficial effects of these compounds are briefly described.


Asunto(s)
Adaptación Fisiológica/efectos de los fármacos , Envejecimiento , Productos Biológicos , Longevidad , Transducción de Señal/efectos de los fármacos , Adaptación Fisiológica/fisiología , Envejecimiento/efectos de los fármacos , Envejecimiento/fisiología , Animales , Productos Biológicos/metabolismo , Productos Biológicos/farmacología , Humanos , Longevidad/efectos de los fármacos , Longevidad/fisiología , Modelos Biológicos , Transducción de Señal/fisiología
16.
Rev. salud pública Parag ; 9(1): [P9-P18], jun. 2019.
Artículo en Español | LILACS, BDNPAR | ID: biblio-1047012

RESUMEN

Dentro del Proyecto CONACYT "Construyendo estándares socioambientales y de salud pública con el sector primario para incremento de la competitividad en los mercados PIN15-1103. CONACYT/ALTER VIDA" se aplicó un Cuestionario de Monitoreo Comunitario para la exposición y posibles impactos a la salud por el uso de plaguicidas; el objetivo de este artículo es validar el cuestionario de monitoreo comunitario y presentar los datos del trabajo de campo. El diseño del estudio fue observacional y descriptivo, se tomaron dos comunidades dedicadas a la producción agrícola, una en Caaguazú y otra en San Pedro. El muestro fue no probabilístico por bola de nieve comprendiendo a aquellos expuestos a plaguicidas en ambos distritos seleccionados, con una distancia máxima 1 kilómetro a los cultivos o plantaciones. Las variables analizadas incluyeron datos de filiación, uso y exposición de los agroquímicos, uso de equipos de protección individual, gestión de los residuos de plaguicidas, capacitación, salud. También se aplicó el alfa de Cronbach para estudiar la confiabilidad del instrumento. Todos los análisis fueron hechos con SPSS 25. Como conclusión, se ha detectado que la gestión en el uso de los agroquímicos en la población analizada debe ser reforzada en varios ejes, desde la capacitación, gestión en el uso, la disposición final, entre otras. El instrumento tiene buena consistencia y fiabilidad interna. Palabras clave: exposición ocupacional a agroquímicos, impactos a la salud, Paraguay.


Within the CONACYT Project "Building socio-environmental and public health standards with the primary sector to increase competitiveness in the markets PIN15-1103.CONACYT/ALTER VIDA" a Community Monitoring Questionnaire was applied for the exhibition and possible impacts on health for the use of pesticides, the objective of this article is to validate the community monitoring questionnaire and present the data of the field work. The design of the study was observational and descriptive, taking two communities dedicated to agricultural production, one in Caaguazú and the other in San Pedro. The sampling was not probabilistic by snowball comprising those exposed to pesticides in both selected districts, with a maximum distance of 1 kilometre to crops or plantations. The variables analyzed include filiation's data, use and exposure of agrochemicals, use of personal protection equipment, and management of pesticide residues, training, and health. Cronbach's alpha was also applied to study the reliability of the instrument. All analyzes were done with SPSS 25. In conclusion, it has been detected that the management in the use of agrochemicals in the analyzed population must be reinforced in several areas, from training, management in use, final disposal, among others. The instrument has good internal consistency. Key words: occupational exposure to agrochemicals; health impacts; Paraguay


Asunto(s)
Humanos , Masculino , Femenino , Monitoreo del Ambiente , Agroquímicos , Grupos de Riesgo , Participación de la Comunidad
17.
Rev. salud pública Parag ; 9(1): [P19-P32], jun. 2019.
Artículo en Español | LILACS, BDNPAR | ID: biblio-1047014

RESUMEN

Introducción: Paraguay, con alto desarrollo de agricultura extensiva, es potencialmente vulnerable a situaciones relacionadas con manejo inadecuado, falta de prevención y riesgos para la salud individual, comunitaria y ambiental, por incumplimiento de buenas prácticas en la selección, manipulación y gestión de plaguicidas. Objetivo: Diseñar e implementar un método de vigilancia con carga de datos del sistema público para detectar, jerarquizar y mapear eventos relacionados al manejo inadecuado de plaguicidas; establecer posibles asociaciones con causas de morbilidad y mortalidad; y seguimiento para evaluar riesgos relativos. Métodos: Con la creación del Sistema de Información Georreferenciado de Evaluación de Casos de afecciones a la Salud (SIGEC), método web que recolecta información del monitoreo comunitario de manejo y posibles efectos de plaguicidas en pequeños productores y empresas agrícolas, y de parcelas de plantaciones en el territorio nacional, se realizó un estudio de vigilancia epidemiológica sobre condiciones de vida, variables ambientales y riesgo de exposición a plaguicidas. Resultados: Al relacionar datos del egreso hospitalario de enfermedades trazadoras (EH) 2011 - 2015, en mapas por Departamentos, Regiones del Estudio Piloto y por Distritos, se observó una concentración de las mismas en 3 a 4 regiones relacionadas al uso de plaguicidas, repitiéndose dicha situación en patologías con concentraciones altas (color rojo) o intermedias (color amarillo), con posible asociación casual o causal. Los demás distritos de estas regiones observadas que se encuentran coloreadas de verde, no implica ausencia de casos registrados, sino que se encuentran en el tercio inferior del total registrado (tabla a la izquierda de los mapas). La poligonización valora el grado de exposición de personas en riesgo y brinda georreferenciamiento de las variables del Monitoreo Comunitario, además permite seguimiento mediante gráficos de puntos, útiles para los tomadores de decisiones en salud. Las herramientas propuestas son amigables y similares a las del Censo Comunitario realizado por estadígrafos regionales en las USF. Conclusiones: La vigilancia epidemiológica basada en el SIGEC complementa la visión parcial de los actuales sistemas de seguimiento del MSP y BS mediante la información en gráficos georreferenciados, visualiza datos del problema de salud planteado, en un territorio específico, utiliza variables ambientales y laborales con posible relación a exposición de plaguicidas, en formato de lectura fácil, convirtiéndola en herramienta útil para el posterior seguimiento a través de investigaciones con diseño pertinente, utilizando modelos estadísticos apropiados, para la posterior aplicación de políticas públicas. Palabras-clave: Exposición a plaguicidas; vigilancia del ambiente del trabajo; monitoreo epidemiológico; programas informáticos


Introduction: Paraguay, with high development of extensive agriculture, is potentially vulnerable to situations related to inadequate management, lack of prevention and risks to individual, community and environmental health, due to non-compliance with good practices in the selection, handling and management of pesticides. Objective: Design and implement a surveillance method with data loading of the public system to detect, prioritize and map events related to the inadequate handling of pesticides; establish possible associations with causes of morbidity and mortality; and monitoring to assess relative risks. Methods: With the creation of the Georeferenced Information System for the Evaluation of Cases of Health Conditions (SIGEC), a web method that collects information on community monitoring of management and possible effects of pesticides on small producers and agricultural companies, and on plantation plots In the national territory, an epidemiological surveillance study was conducted on life conditions, environmental variables and risk of exposure to pesticides. Results: When relating hospital discharge data of tracer diseases (EH) 2011 - 2015, in maps by Departments, Regions of the Pilot Study and by Districts, a concentration of them was observed in 3 to 4 regions related to the use of pesticides, repeating this situation in pathologies with high concentrations (red color) or intermediate (yellow color), with possible causal or casual association. The other districts of these observed regions that are colored green, does not imply absence of registered cases, but they are in the lower third of the total registered (table on the left of the maps). Poligonization assesses the degree of exposure of people at risk and provides georeferencing of the Community Monitoring variables, and also allows monitoring through point charts, useful for health decision-makers. The proposed tools are friendly and similar to those of the Community Census conducted by regional statisticians at the USF. Conclusions: The epidemiological surveillance based on the SIGEC complements the partial vision of the current monitoring systems of the MSP and BS through the information in georeferenced graphs, visualizes data of the health problem raised, in a specific territory, uses environmental and labor variables with possible relation to exposure of pesticides, in easy reading format, making it a useful tool for subsequent monitoring through relevant design investigations, using appropriate statistical models, for the subsequent application of public policies. Key words: Exposure to pesticides; monitoring of the work environment; epidemiological monitoring; Software


Asunto(s)
Vigilancia Sanitaria Ambiental , Tecnología de la Información , Plaguicidas , Ambiente de Trabajo , Ambiente Controlado
18.
Cell Biol Int ; 43(7): 809-819, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31050073

RESUMEN

Our research group has developed a cell-penetrating peptide-based delivery system that includes the Asn194Lys mutation in the rabies virus glycoprotein-9R peptide (mRVG-9R). This system has the capacity to deliver DNA in astrocytes and SH-SY5Y cells. The aim of this study was to evaluate the ability of the mRVG-9R peptide to deliver DNA molecules to murine brain cells. The mRVG-9R peptide, a karyophilic peptide (KP) and a plasmid encoding green fluorescent protein (GFP) were bound by electrostatic charges to form the mRVG-9R complex. mRVG-9R complex was injected into the cerebral cortex, striatum and hippocampus of C57BL/6 mice by stereotactic surgery. After 2, 4, and 20 days, the animals were sacrificed and their brains were prepared for quantitative reverse-transcription polymerase chain reaction and histological analysis. We detected the GFP expression in neurons and glial cells in the cerebral cortex, striatum, and hippocampus of the murine brain. The results suggest that the mRVG-9R peptide has the ability to deliver DNA molecules to murine brain cells. Also, the expression of the reporter gene is maintained at least up to 20 days after injection in neurons, astrocytes, oligodendrocytes, and microglia cells. Thus, the in vivo transfection ability of the mRVG-9R peptide, makes it a promising candidate as a therapeutic gene delivery vector to the central nervous system cells.


Asunto(s)
Péptidos de Penetración Celular/farmacología , Cuerpo Estriado/efectos de los fármacos , Portadores de Fármacos/farmacología , Glicoproteínas/farmacología , Proteínas Fluorescentes Verdes/metabolismo , Hipocampo/efectos de los fármacos , Fragmentos de Péptidos/farmacología , Proteínas Virales/farmacología , Animales , Astrocitos/citología , Astrocitos/efectos de los fármacos , Cuerpo Estriado/citología , Genes Reporteros , Vectores Genéticos/uso terapéutico , Proteínas Fluorescentes Verdes/genética , Hipocampo/citología , Ratones , Ratones Endogámicos C57BL , Microglía/citología , Neuronas/citología , Neuronas/efectos de los fármacos , Oligodendroglía/citología , Oligodendroglía/efectos de los fármacos , Transfección/métodos
19.
Case Rep Oncol ; 12(1): 139-146, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31043952

RESUMEN

Background: Pituitary tumors typically remain silent unless interaction with nearby structures occurs. Rare subsets of pituitary tumors display aggressive phenotypes: highly mitotic, locally invasive, metastatic, chemotherapy and radiation resistant, etc. Disease progression and response to therapy is ill-defined in these subtypes, and their true prognostic potential is debated. Thus, identifying tumor characteristics with prognostic value and efficacious treatment options remains a challenge in aggressive pituitary tumors. Case Presentation: A 45-year-old female presented with a nonfunctioning corticotropic pituitary macroadenoma with biomarkers suggestive of an "atypical" subtype: Ki-67 of 8-12%, increased mitosis, and locally invasive. Despite resections and radiation, growth continued, eventually affecting her vision. Although histologically ACTH positive, the patient remained clinically asymptomatic. Twelve months later, an episode of Cushing's disease-induced psychosis prompted a PET-CT scan, identifying sites of metastasis. Temozolomide was added to her medical regimen, and her metastatic liver lesions and boney metastases were treated with radiofrequency ablation and stereotactic body radiation therapy, respectively. Systemic treatment resulted in a drop in her ACTH levels, with her most recent scans/labs at 12 months following RFA suggesting remission. Conclusions: This is a unique presentation of a pituitary tumor, displaying characteristics of both clinically silent corticotropic and "atypical" macroadenoma subtypes. Although initially ACTH positive while clinically silent, the patient's disease ultimately recurred metastatically with manifestations of Cushing's disease and psychosis. With the addition of temozolomide to her treatment plan, her primary and metastatic sites have responded favorably to radiation therapy. Thus, the addition of temozolomide may be beneficial in the treatment of aggressive pituitary tumors.

20.
Sci Total Environ ; 659: 1567-1576, 2019 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-31096366

RESUMEN

A Life Cycle Assessment was carried out in order to assess the environmental performance of constructed wetland systems for winery wastewater treatment. In particular, six scenarios which included the most common winery wastewater treatment and management options in South-Western Europe, namely third-party management and activated sludge systems, were compared. Results showed that the constructed wetland scenarios were the most environmentally friendly alternatives, while the third-party management was the worst scenario followed by the activated sludge systems. Specifically, the potential environmental impacts of the constructed wetlands scenarios were 1.5-180 and 1-10 times lower compared to those generated by the third-party and activated sludge scenarios, respectively. Thus, under the considered circumstances, constructed wetlands showed to be an environmentally friendly technology which helps reducing environmental impacts associated with winery wastewater treatment by treating winery waste on-site with low energy and chemicals consumption.


Asunto(s)
Monitoreo del Ambiente , Eliminación de Residuos Líquidos/métodos , Humedales , Eliminación de Residuos Líquidos/estadística & datos numéricos , Aguas Residuales/química , Aguas Residuales/estadística & datos numéricos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA