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1.
Am J Cardiol ; 2022 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-35382925

RESUMEN

This study aimed to understand the long-term outcomes of patients with heart failure with recovered ejection fraction, identify predictors of adverse events, and develop a risk stratification model. From an academic healthcare system, we retrospectively identified 133 patients (median age 66, 38% female, 30% ischemic etiology) who had an improvement in left ventricular ejection fraction (LVEF) from <40% to ≥53%. Significant predictors of all-cause mortality, hospitalization, and future reduction in LVEF were identified through Cox regression analysis. Kaplan-Meier survival was 70% at 5 years. Freedom from hospitalization was 58% at 1 year, and the risk of future LVEF reduction to <40% was 28% at 3 years. Diuretic dose and B-type natriuretic peptide (BNP) at the time of LVEF recovery were the strongest predictors of mortality and hospitalization in multivariate-adjusted analysis (BNP hazard ratio 1.13 per 100 pg/ml increase [p <0.01]; furosemide-equivalent dose hazard ratio 1.19 per 40 mg increase [p = 0.02]). An all-cause mortality Cox proportional hazard risk model incorporating New York Heart Association functional class, BNP and diuretic dose at the time of recovery showed excellent risk discrimination (c-statistic 0.79) and calibration. In conclusion, patients with heart failure with recovered ejection fraction have heterogenous clinical outcomes and are not "cured." A risk model using New York Heart Association functional class, BNP, and diuretic dose can accurately stratify mortality risk.

2.
J Mol Cell Cardiol ; 163: 20-32, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34624332

RESUMEN

Understanding the spatial gene expression and regulation in the heart is key to uncovering its developmental and physiological processes, during homeostasis and disease. Numerous techniques exist to gain gene expression and regulation information in organs such as the heart, but few utilize intuitive true-to-life three-dimensional representations to analyze and visualise results. Here we combined transcriptomics with 3D-modelling to interrogate spatial gene expression in the mammalian heart. For this, we microdissected and sequenced transcriptome-wide 18 anatomical sections of the adult mouse heart. Our study has unveiled known and novel genes that display complex spatial expression in the heart sub-compartments. We have also created 3D-cardiomics, an interface for spatial transcriptome analysis and visualization that allows the easy exploration of these data in a 3D model of the heart. 3D-cardiomics is accessible from http://3d-cardiomics.erc.monash.edu/.

3.
Heart ; 108(9): 710-716, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-34493546

RESUMEN

OBJECTIVE: Patients with non-ischaemic dilated cardiomyopathy (NICM) may experience a normalisation in left ventricular ejection fraction (LVEF). Although this correlates with improved prognosis, it does not correspond to a normalisation in the risk of death during follow-up. Currently, there are no tools to risk stratify this population. We tested the hypothesis that absolute global longitudinal strain (aGLS) is associated with mortality in patients with NICM and recovered ejection fraction (LVEF). METHODS: We designed a retrospective, international, longitudinal cohort study enrolling patients with NICM with LVEF <40% improved to the normal range (>50%). We studied the relationship between aGLS measured at the time of the first recording of a normalised LVEF and all-cause mortality during follow-up. We considered aGLS >18% as normal and aGLS ≥16% as of potential prognostic value. RESULTS: 206 patients met inclusion criteria. Median age was 53.5 years (IQR 44.3-62.8) and 56.6% were males. LVEF at diagnosis was 32.0% (IQR 24.0-38.8). LVEF at the time of recovery was 55.0% (IQR 51.7-60.0). aGLS at the time of LVEF recovery was 13.6%±3.9%. 166 (80%) and 141 (68%) patients had aGLS ≤18% and <16%, respectively. During a follow-up of 5.5±2.8 years, 35 patients (17%) died. aGLS at the time of first recording of a recovered LVEF correlated with mortality during follow-up (HR 0.90, 95% CI 0.91 to 0.99, p=0.048 in adjusted Cox model). No deaths were observed in patients with normal aGLS (>18%). In unadjusted Kaplan-Meier survival analysis, aGLS <16% was associated with higher mortality during follow-up (31 deaths (22%) in patients with GLS <16% vs 4 deaths (6.2%) in patients with GLS ≥16%, HR 3.2, 95% CI 1.1 to 9, p=0.03). CONCLUSIONS: In patients with NICM and normalised LVEF, an impaired aGLS at the time of LVEF recovery is frequent and associated with worse outcomes.


Asunto(s)
Cardiomiopatía Dilatada , Cardiomiopatía Dilatada/diagnóstico , Ecocardiografía , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Volumen Sistólico , Función Ventricular Izquierda
4.
PLoS One ; 16(3): e0247785, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33705434

RESUMEN

In response to the health threats posed by toxic lead to humans, scavenging wildlife and the environment, there is currently a focus on transitioning from lead-based to lead-free bullets for shooting of wild animals. We compared efficiency metrics and terminal ballistic performance for lead-based and lead-free (non-lead) bullets for aerial shooting of wild pigs (Sus scrofa) in eastern Australia. Ballistic testing revealed that lead-based and lead-free bullets achieved similar performance in precision and muzzle kinetic energy (E0) levels (3337.2 J and 3345.7 J, respectively). An aerial shooting trial was conducted with wild pigs shot with one type of lead-based and one type of lead-free bullets under identical conditions. Observations were made from 859 shooting events (n = 430 and 429 respectively), with a sub-set of pigs examined via gross post-mortem (n = 100 and 108 respectively), and a further sub-set examined via radiography (n = 94 and 101 respectively). The mean number of bullets fired per pig killed did not differ greatly between lead-based and lead-free bullets respectively (4.09 vs 3.91), nor did the mean number of bullet wound tracts in each animal via post-mortem inspection (3.29 vs 2.98). However, radiography revealed a higher average number of fragments per animal (median >300 vs median = 55) and a broader distribution of fragments with lead-based bullets. Our results suggest that lead-based and lead-free bullets are similarly effective for aerial shooting of wild pigs, but that the bullet types behave differently, with lead-based bullets displaying a higher degree of fragmentation. These results suggest that aerial shooting may be a particularly important contributor to scavenging wildlife being exposed to lead and that investigation of lead-free bullets for this use should continue.


Asunto(s)
Animales Salvajes , Exposición a Riesgos Ambientales , Armas de Fuego , Plomo/toxicidad , Sus scrofa , Animales , Autopsia/veterinaria , Humanos
5.
J Am Heart Assoc ; 10(7): e020252, 2021 04 06.
Artículo en Inglés | MEDLINE | ID: mdl-33787311

RESUMEN

Background The optimal threshold of left ventricular ejection fraction (LVEF) that should prompt aortic valve replacement (AVR) in asymptomatic patients with high-gradient severe aortic stenosis (AS) is controversial. The aim of this study was to assess the relationship between LVEF and mortality benefit in comparing early AVR versus watchful waiting in asymptomatic patients with severe AS. Methods and Results MEDLINE, Embase, Web of Science, and Google Scholar were searched for observational studies and randomized controlled trials on adults with asymptomatic severe AS. Severe AS was defined by a peak aortic velocity ≥4 m/s and/or mean aortic valve gradient ≥40 mm Hg and/or calculated aortic valve area <1.0 cm2 or an indexed valve area <0.6 cm2. Studies comparing AVR with conservative management were included and meta-analysis on all-cause mortality was performed. Ten eligible studies were identified with a total of 3332 patients. In 5 observational studies comparing early AVR versus watchful waiting, our meta-analysis showed early AVR was associated with lower mortality with a hazard ratio (HR) of 0.41 (CI, 0.23-0.71; P<0.01). In 4 observational studies comparing AVR versus no AVR, our meta-analysis showed AVR was associated with lower mortality with a HR of 0.31 (CI, 0.17-0.58; P<0.001). In a meta-regression analysis pooling all 10 studies, there was no statistically significant correlation between study mean LVEF and the size of mortality benefit of AVR (P=0.83). Conclusions Among asymptomatic patients with high-gradient severe AS, AVR was associated with a mortality benefit across the spectrum of LVEF. Our study calls into question the need of an LVEF threshold for recommending AVR in this patient population.


Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Enfermedades Asintomáticas , Ecocardiografía/métodos , Prótesis Valvulares Cardíacas , Medición de Riesgo/métodos , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/fisiopatología , Salud Global , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Incidencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Tasa de Supervivencia/tendencias
6.
PLoS One ; 16(3): e0248317, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33735249

RESUMEN

BACKGROUND: Patients with heart failure (HF) with recovered ejection fraction (HFrecEF) are a recently identified cohort that are phenotypically and biologically different from HFrEF and HFpEF patients. Whether there are unique phenotypes among HFrecEF patients is not known. METHODS: We studied all patients at a large medical center, who had an improvement in LVEF from ≤ 35% to ≥ 50% (LVrecEF) between January 1, 2005 and December 31, 2013. We identified a set of 11 clinical variables and then performed unsupervised clustering analyses to identify unique clinical phenotypes among patients with LVrecEF, followed by a Kaplan-Meier analysis to identify differences in survival and the proportion of LVrecEF patients who maintained an LVEF ≥ 50% during the study period. RESULTS: We identified 889 patients with LVrecEF who clustered into 7 unique phenotypes ranging in size from 37 to 420 patients. Kaplan-Meier analysis demonstrated significant differences in mortality across clusters (logrank p<0.0001), with survival ranging from 14% to 87% at 1000 days, as well as significant differences in the proportion of LVrecEF patients who maintained an LVEF ≥ 50%. CONCLUSION: There is significant clinical heterogeneity among patients with LVrecEF. Clinical outcomes are distinct across phenotype clusters as defined by clinical cardiac characteristics and co-morbidities. Clustering algorithms may identify patients who are at high risk for recurrent HF, and thus be useful for guiding treatment strategies for patients with LVrecEF.


Asunto(s)
Insuficiencia Cardíaca/terapia , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología , Anciano , Anciano de 80 o más Años , Análisis por Conglomerados , Femenino , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Resultado del Tratamiento
7.
Open Heart ; 8(1)2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33723015

RESUMEN

OBJECTIVE: In patients with non-ischaemic cardiomyopathy and reduced left ventricular ejection fraction (LVEF), normalisation of LVEF is associated with improved outcomes. However, data on patients with ischaemic cardiomyopathy and recovered LVEF are lacking. The goal of this study was to assess the prognostic significance of normalisation of the LVEF in patients with ischaemic cardiomyopathy. METHODS/RESULTS: We performed a non-prespecified post hoc analysis of the Surgical Treatment for Ischaemic Heart Failure (STICH) trial to determine the association between normalisation of LVEF (>50%) and mortality during follow-up. Of the 1212 patients with LVEF <35% enroled in the STICH trial, 932 underwent assessment of LVEF at 4 months and/or 2 years after enrolment. Among them, 18 patients experienced normalisation in LVEF at 4-month follow-up and 35 patients experienced recovery in LVEF at 2 years. Recovery of LVEF at 4 months and recovery of LVEF at 2 years were not correlated. Recovery of LVEF at 4 months was not associated with reduced all-cause mortality in unadjusted analysis (log-rank test p=0.54) or in Cox proportional hazards analysis (HR: 0.93; 95% CI: 0.48 to 1.80; p=0.82). Ejection fraction recovery at 2 years was associated with a reduction in all-cause mortality, both in unadjusted analysis (log-rank test p=0.004) and in the Cox proportional hazard model (HR: 0.41; 95% CI: 0.21 to 0.80; p=0.009). CONCLUSIONS: In patients with ischaemic cardiomyopathy, delayed normalisation of LVEF is associated with reduced mortality, whereas early recovery of LVEF is not. Further studies are needed to confirm these findings.


Asunto(s)
Cardiomiopatías/fisiopatología , Isquemia Miocárdica/fisiopatología , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología , Cardiomiopatías/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/mortalidad , Tasa de Supervivencia/tendencias , Factores de Tiempo , Estados Unidos/epidemiología
8.
Heart ; 2020 Aug 25.
Artículo en Inglés | MEDLINE | ID: mdl-32843496

RESUMEN

OBJECTIVE: The frequency and predictors of improvement in left ventricular ejection fraction (LVEF) in ischaemic cardiomyopathy and its association with mortality is poorly understood. We sought to assess the predictors of LVEF improvement ≥10% and its effect on mortality. METHODS: We compared characteristics of patients enrolled in The Surgical Treatment for Ischaemic Heart Failure (STICH) trial with and without improvement of LVEF ≥10% at 24 months. A logistic regression model was constructed to determine the independent predictors of LVEF improvement. A Cox proportional hazards model was created to assess the independent association of improvement in LVEF ≥10% with mortality. RESULTS: Of the 1212 patients enrolled in STICH, 618 underwent echocardiographic assessment of LVEF at baseline and 24 months. Of the patients randomised to medical therapy plus coronary artery bypass graft surgery (CABG), 58 (19%) had an improvement in LVEF >10% compared with 51 (16%) patients assigned to medical therapy alone (p=0.30). Independent predictors of LVEF improvement >10% included prior myocardial infarction (OR 0.44, 95% CI: 0.28 to 0.71, p=0.001) and lower baseline LVEF (OR 0.94, 95% CI: 0.91 to 0.97, p<0.001). Improvement in LVEF >10% (HR 0.61, 95% CI: 0.44 to 0.84, p=0.004) and randomisation to CABG (HR 0.72, 95% CI: 0.57 to 0.90, p=0.004) were independently associated with a reduced hazard of mortality. CONCLUSIONS: Improvement of LVEF ≥10% at 24 months was uncommon in patients with ischaemic cardiomyopathy, did not differ between patients assigned to CABG and medical therapy or medical therapy alone and was independently associated with reduced mortality. TRIAL REGISTRATION NUMBER: NCT00023595.

9.
Clin Neuropsychiatry ; 17(2): 59-62, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-34908968

RESUMEN

Coronavirus Disease 2019 (COVID-19) has disrupted virtually every aspect of daily living, engendering forced isolation and social distance, economic hardship, fears of contracting a potentially lethal illness and feelings of helplessness and hopelessness. Unfortunately, there is no formula or operating manual for how to cope with the current global pandemic. Previous research has documented an array of responses to mass crises or disasters, including chronic anxiety and posttraumatic stress as well as resilience and recovery. Much can be learned from this research about how people have coped in the past in order to identify strategies that may be particularly effective in managing distress and cultivating resilience during these perilous times. We delineate multiple coping strategies (e.g., behavioral activation, acceptance-based coping, mindfulness practice, loving-kindness practices) geared to decrease stress and promote resilience and recovery. These strategies may be especially effective because they help individuals make meaning, build distress tolerance, increase social support, foster a view of our deep human interconnectedness, and take goal-directed value-driven actions in midst of the COVID-19 pandemic.

10.
Oral Maxillofac Surg Clin North Am ; 31(4): 549-559, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31481290

RESUMEN

This article reviews evolving and lesser known technologies for tissue cutting and their application in oral and maxillofacial surgery.


Asunto(s)
Electrocirugia/métodos , Espectrometría de Masa por Ionización de Electrospray , Procedimientos Quirúrgicos Ultrasónicos/métodos , Humanos , Espectrometría de Masa por Ionización de Electrospray/métodos
11.
Diagn Progn Res ; 3: 3, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31093573

RESUMEN

Background: Current American College of Cardiology/American Heart Association (ACC/AHA) guidelines provide a class I recommendation for patients with type 2 diabetes mellitus and multivessel coronary artery disease (CAD) to be treated with coronary artery bypass graft surgery (CABG). However, these patients are heterogeneous in terms of the risks and benefits associated with CABG. We sought to develop a risk score to identify low-risk patients with diabetes and multivessel CAD in whom CABG can be safely deferred. Methods: Patients in the CABG strata randomized to intensive medical therapy (IMT) in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial who experienced death, myocardial infarction (MI), or stroke were compared with those who did not. We developed a risk score for death, MI, or stroke using a Cox proportional hazards model that included the following variables: age, history of heart failure, history of hypercholesterolemia, history of stroke, transient ischemic attack, serum creatinine, insulin use, myocardial jeopardy index, and HbA1c. Results: Among patients with a risk score less than the median, those randomized to IMT or prompt CABG experienced similar rates of event-free survival at 5 years (77.8% vs. 83.2%, logrank P = 0.24). Among patients with a risk score greater than the median, those randomized to IMT experienced worse rates of event-free survival at 5 years than those randomized to prompt CABG (60.3% vs 73.2%, logrank P = 0.01). Conclusions: A novel risk score identifies low-risk patients with diabetes and stable, symptomatic multivessel CAD in whom CABG can be safely deferred.

12.
Can J Surg ; 62(1): E19-E21, 2019 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30694037

RESUMEN

Summary: Phyllodes breast tumours are fairly uncommon, and they can be benign, borderline or malignant. General surgeons usually encounter them following the surgical excision of a breast lump that had the appearance of a fibroepithelial lesion. The surgeon is then faced with the question of what to do to establish an acceptable treatment margin. In this discussion, we recommend a plan for the management of Phyllodes tumours based on a review of the recent literature, confirmed by a retrospective review of the results from our centre. A negative margin is acceptable treatment following a lumpectomy for Phyllodes tumours. Only patients with a positive margin should undergo a revision.


Asunto(s)
Neoplasias de la Mama/cirugía , Márgenes de Escisión , Mastectomía Segmentaria/métodos , Recurrencia Local de Neoplasia/epidemiología , Tumor Filoide/cirugía , Adulto , Neoplasias de la Mama/patología , Estudios de Cohortes , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Tumor Filoide/patología , Pronóstico , Enfermedades Raras , Estudios Retrospectivos , Medición de Riesgo , Resultado del Tratamiento
13.
J Feline Med Surg ; 21(4): 322-328, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-29792378

RESUMEN

OBJECTIVES: The aim of this retrospective study was to describe the location and distribution of craniomaxillofacial (CMF) fractures in 45 cats presented to a veterinary referral centre between 2012 and 2017. METHODS: Cats with a history of head trauma, one or more CMF fractures and a pretreatment CT scan of the CMF region were included in this study. For the purpose of the study, the CMF skeleton was divided into 15 functional anatomical regions and the fracture sites were allocated to one of these functional regions. Statistical analysis was performed using R. RESULTS: Skull fractures were evident in 80.0% of cats, and mandibular fractures in 86.7% of cats in this study. The median number of anatomical functional regions affected was eight and there was evidence of moderate or strong correlation between fractures of different regions of the mid-face. Where fractures were recorded in the nasopharynx and orbit they were bilateral in 93.5% and 89.7%, respectively. Twenty-six (57.8%) of the cats had fractures affecting one or both temporomandibular joints, which included fractures of the mandibular fossa, condylar neck and condyle. Twenty-nine cats (64.4%) had tooth fractures and seven cats (15.6%) had significant eye injuries. CONCLUSIONS AND RELEVANCE: Cats presenting with a single symphyseal separation or parasymphyseal fracture are very likely to have further fractures at other locations. Fractures in the nasopharynx, orbit, nose, upper jaw, intermaxillary suture and zygomatic arch regions (the 'mid-face') are likely to occur together. The pattern of distribution of mandibular fractures is not as predictable as that for maxillary fractures. CT imaging is required to achieve a complete diagnosis of the location and distribution of skull fractures in cats after head trauma.


Asunto(s)
Enfermedades de los Gatos , Traumatismos Faciales , Fracturas Maxilares , Animales , Enfermedades de los Gatos/epidemiología , Enfermedades de los Gatos/patología , Gatos , Traumatismos Faciales/epidemiología , Traumatismos Faciales/patología , Traumatismos Faciales/veterinaria , Fracturas Maxilares/epidemiología , Fracturas Maxilares/patología , Fracturas Maxilares/veterinaria
14.
World J Urol ; 37(6): 1095-1101, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30151598

RESUMEN

OBJECTIVE: To evaluate factors associated with use of patient navigation in a prostate cancer population and identify whether navigation is associated with prolonged time to care. Cancer patient navigation has been shown to improve access to cancer screening, diagnosis, and treatment, but little is known about patient navigation in prostate cancer care. METHODS: All men diagnosed with localized prostate cancer between 2009 and 2015 were abstracted from the MaineHealth multi-specialty tumor registry. Regression analyses controlling for patient-, disease-, and system-level factors evaluated characteristics associated with navigation utilization. The association between navigation utilization, barriers to care, and longer time to treatment was assessed with Cox proportional hazards regression. RESULTS: Of the patient population (n = 1587), 85% of men were navigated. Navigation use was associated with earlier year of diagnosis, treatment by a high-volume urologist, and lower risk disease (p < 0.05). Treatment delay was associated with low-risk disease (vs: intermediate OR 0.62, 95% CI 0.46-0.85 and high OR 0.16, 95% CI 0.1-0.25) and receipt of navigation services (OR 1.65, 95% CI 1.12-2.45) but not distance to care, insurance, or treatment choice. CONCLUSIONS: We observed that patients with low-risk prostate cancer were more likely to utilize navigation, but traditional barriers to care were not associated with utilization. Navigation was associated with longer time to treatment, which likely reflects clinically appropriate delays associated with greater shared decision making. Time to treatment may not be the ideal metric for evaluating navigation in prostate cancer; shared decision making, patient satisfaction, and psychosocial outcomes may be more appropriate.


Asunto(s)
Navegación de Pacientes/estadística & datos numéricos , Neoplasias de la Próstata/terapia , Tiempo de Tratamiento/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros
16.
Public Health Nutr ; 21(3): 627-631, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29143691

RESUMEN

OBJECTIVE: We sought to describe front-of-package marketing strategies and nutritional quality of child-oriented beverages in Guatemala. DESIGN: We purchased all child-oriented ready-to-drink fruit drinks, milks and carbonated beverages in three convenience stores and one supermarket in Guatemala City. Front-of-package marketing was defined as the presence of spokes-characters, cartoons, celebrities, or health-related images, words, claims or endorsements on beverage packaging. We used the UK Nutrition Profiling Model (NPM) to classify beverages as healthy or less healthy. SETTING: Guatemala City, Guatemala. RESULTS: We purchased eighty-nine beverages; most were fruit drinks (n 52, 58 %), milk (15, 17 %), carbonated beverages (5, 17 %), rice/soya products (5, 6·0 %), water (1, 1 %) and energy drinks (1, 1 %). Two-thirds (57, 64 %) had health claims. Of those with a nutrition facts label (85, 96 %), nearly all (76, 89 %) were classified as less healthy. No association between the presence of health claims and NPM score (P=0·26) was found. Eight beverages had health-related endorsements. However, only one beverage was classified as healthy. CONCLUSIONS: In this sample of beverages in Guatemala City, health claims and health-related endorsements are used to promote beverages with poor nutritional quality. Our data support evidence-based policies to regulate the use of front-of-package health claims and endorsements based on nutritional quality.


Asunto(s)
Bebidas , Industria de Alimentos/métodos , Etiquetado de Alimentos , Mercadotecnía , Valor Nutritivo , Animales , Bebidas Gaseosas , Niño , Comportamiento del Consumidor , Dieta , Bebidas Energéticas , Embalaje de Alimentos , Frutas , Guatemala , Humanos , Leche , Oryza , Soja , Agua
17.
Air Med J ; 36(6): 311-314, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29132594

RESUMEN

OBJECTIVE: The aim of this study was to determine the prevalence, safety (as measured by the incidence of adverse events), and effectiveness (as measured by the incidence of intubations) of ketamine sedation in patients with acute behavioral disturbance (ABD) during air medical retrieval. METHODS: This was a retrospective observational study. Eligible patients were identified by searching the electronic databases of 2 air medical retrieval services in Queensland, Australia, for adult patients with ABD transported between January 1, 2015, and June 30, 2016. Data abstraction was performed as per standard chart review criteria. The incidences of intubations and adverse reactions were the main outcomes. RESULTS: One hundred twenty-two patients met the inclusion criteria. Thirty-one (25.4%) patients were intubated, 21 (17.2%) for airway protection/respiratory depression and 10 (8.1%) for persistent ABD. Twenty-one (17.2%) patients received ketamine, 3 of whom (14.3%) were intubated for persistent ABD. Nine (42.9%) patients developed hypertension after ketamine, 2 of whom needed intervention. One patient developed hypoxia after ketamine that resolved without intervention, and 1 patient developed increased secretions. No patients developed nausea, vomiting, emergence phenomena, apnea, or laryngospasm. CONCLUSION: Our study suggests that ketamine is a safe and effective agent for sedating patients with ABD during air medical retrieval.


Asunto(s)
Anestésicos Disociativos/uso terapéutico , Sedación Consciente , Ketamina/uso terapéutico , Problema de Conducta , Adulto , Ambulancias Aéreas , Anestésicos Disociativos/efectos adversos , Femenino , Humanos , Hipoxia/inducido químicamente , Intubación Intratraqueal , Ketamina/efectos adversos , Masculino , Persona de Mediana Edad , Agitación Psicomotora/tratamiento farmacológico , Estudios Retrospectivos , Adulto Joven
18.
J Biol Chem ; 292(38): 15670-15680, 2017 09 22.
Artículo en Inglés | MEDLINE | ID: mdl-28778927

RESUMEN

To prolong residence on their hosts, ticks secrete many salivary factors that target host defense molecules. In particular, the tick Rhipicephalus sanguineus has been shown to produce three salivary glycoproteins named "evasins," which bind to host chemokines, thereby inhibiting the recruitment of leukocytes to the location of the tick bite. Using sequence similarity searches, we have identified 257 new putative evasin sequences encoded by the genomes or salivary or visceral transcriptomes of numerous hard ticks, spanning the genera Rhipicephalus, Amblyomma, and Ixodes of the Ixodidae family. Nine representative sequences were successfully expressed in Escherichia coli, and eight of the nine candidates exhibited high-affinity binding to human chemokines. Sequence alignments enabled classification of the evasins into two subfamilies: C8 evasins share a conserved set of eight Cys residues (four disulfide bonds), whereas C6 evasins have only three of these disulfide bonds. Most of the identified sequences contain predicted secretion leader sequences, N-linked glycosylation sites, and a putative site of tyrosine sulfation. We conclude that chemokine-binding evasin proteins are widely expressed among tick species of the Ixodidae family, are likely to play important roles in subverting host defenses, and constitute a valuable pool of anti-inflammatory proteins for potential future therapeutic applications.


Asunto(s)
Quimiocinas/antagonistas & inhibidores , Ixodidae/genética , Receptores de Quimiocina/metabolismo , Secuencia de Aminoácidos , Animales , Secuencia Conservada , Bases de Datos Genéticas , Escherichia coli/genética , Evolución Molecular , Genómica , Ixodidae/clasificación , ARN Mensajero/genética , ARN Mensajero/metabolismo , Receptores de Quimiocina/química , Receptores de Quimiocina/genética , Alineación de Secuencia
19.
Circ Heart Fail ; 10(6)2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28559418

RESUMEN

BACKGROUND: Patients with recovery of left ventricular ejection fraction (LVEF) remain at risk for future deterioration of LVEF. However, there are no tools to risk stratify these patients. We hypothesized that global longitudinal strain (GLS) could predict sustained recovery within this population. METHODS AND RESULTS: We retrospectively identified 96 patients with a reduced LVEF <50% (screening echocardiogram), whose LVEF had increased by at least 10% and normalized (>50%) on evidence-based medical therapies (baseline echocardiogram). We examined absolute GLS on the baseline echocardiogram in relation to changes in LVEF on a follow-up echocardiogram. Patients with recovered LVEF had a wide range of GLS. The GLS on the baseline study correlated with the LVEF at the time of follow-up (r=0.33; P<0.001). The likelihood of having an LVEF >50% on follow-up increased by 24% for each point increase in absolute GLS on the baseline study (odds ratio, 1.24; P=0.001). An abnormal GLS (≤16%) at baseline had a sensitivity of 88%, a specificity of 46%, and an accuracy of 0.67 (P<0.001) as a predictor of a decrease in LVEF >5% during follow-up. A normal GLS (>16%) on the baseline study had a sensitivity of 47%, a specificity of 83%, and an accuracy of 0.65 (P=0.002) for predicting a stable LVEF (-5% to 5%) on follow-up. CONCLUSIONS: In patients with a recovered LVEF, an abnormal GLS predicts the likelihood of having a decreased LVEF during follow-up, whereas a normal GLS predicts the likelihood of stable LVEF during recovery.


Asunto(s)
Ecocardiografía/métodos , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos/fisiopatología , Recuperación de la Función , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/diagnóstico , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Tiempo
20.
BMJ ; 356: j498, 2017 01 30.
Artículo en Inglés | MEDLINE | ID: mdl-28137925
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