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1.
Psychiatr Psychol Law ; 31(1): 47-56, 2024.
Article En | MEDLINE | ID: mdl-38455270

The high prevalence of psychiatric symptoms among juvenile delinquents is a well-replicated international finding. This study aimed to find the prevalence of mood disorders and their relationship with serious criminal acts in a population of adolescents in conflict with the law and in custody. A total of 123 male inmates aged 14 to 17 years were interviewed and assessed. Mood disorders were diagnosed in 15% of the sample for current episode and 31% for lifetime, making them third most prevalent after dependence disorders and disruptive disorders. The psychopathological profile of the adolescents who had committed violent crimes corroborates other studies reporting a high prevalence of mood disorders in this population. Several factors have been found to influence the formation of juvenile delinquency, including absence of family structure, social inequality, lack of quality school education, alcohol and drug abuse/addiction and disruptive disorders. The present results confirm mood disorders as another such factor.

2.
Heliyon ; 10(3): e25194, 2024 Feb 15.
Article En | MEDLINE | ID: mdl-38317954

Biodegradable biopolymers from species of the animal kingdom or their byproducts are sustainable as ecological materials due to their abundant supply and compatibility with the environment. The research aims to obtain a biodegradable active material from chitosan, gelatin, and collagen from bocachico scales (Prochilodus magdalenae). Regarding the methodology, films were developed from gelatin, chitosan, and collagen from bocachico scales (Prochilodus magdalenae) at different concentrations using glycerol as a plasticizer and citric acid as a cross-linker. The films were obtained with the hydrated mass processed by compression molding and characterized according to humidity, water solubility, contact angle, mechanical properties, and structural properties. The results of the films showed a hydrophobic characteristic. First, the chitosan-collagen (CS/CO) films showed a yellowish color, while the gelatin-collagen (Gel/CO) films were transparent and less soluble than the gelatin-collagen (Gel/CO) films. Concerning mechanical properties, gelatin films showed higher stiffness and tensile strength than chitosan films. Furthermore, in the morphological analysis, more homogeneous chitosan films were obtained by increasing the concentration of citric acid. In general, chitosan, gelatin, and collagen extracted from the scales of the bocachico (Prochilodus magdalenae) are an alternative in the application of films in the food industry.

3.
Sci Rep ; 14(1): 2395, 2024 01 29.
Article En | MEDLINE | ID: mdl-38287072

Recently, the tiger-cat species complex was split into Leopardus tigrinus and Leopardus guttulus, along with other proposed schemes. We performed a detailed analysis integrating ecological modeling, biogeography, and phenotype of the four originally recognized subspecies-tigrinus, oncilla, pardinoides, guttulus-and presented a new multidimensional niche depiction of the species. Species distribution models used > 1400 records from museums and photographs, all checked for species accuracy. Morphological data were obtained from institutional/personal archives. Spotting patterns were established by integrating museum and photographic/camera-trap records. Principal component analysis showed three clearly distinct groups, with the Central American specimens (oncilla) clustering entirely within those of the Andes, namely the pardinoides group of the cloud forests of the southern Central-American and Andean mountain chains (clouded tiger-cat); the tigrinus group of the savannas of the Guiana Shield and central/northeastern Brazil (savanna tiger-cat); and the guttulus group in the lowland forests of the Atlantic Forest domain (Atlantic Forest tiger-cat). This scheme is supported by recent genetic analyses. All species displayed different spotting patterns, with some significant differences in body measurements/proportions. The new distribution presented alarming reductions from the historic range of - 50.4% to - 68.2%. This multidimensional approach revealed a new species of the elusive and threatened tiger-cat complex.


Tigers , Animals , Phylogeny , Forests , Brazil
4.
Gen Comp Endocrinol ; 347: 114427, 2024 Feb 01.
Article En | MEDLINE | ID: mdl-38141858

The guanaco, a wild South American camelid, is renowned for its remarkable resilience to extreme conditions. Despite this, little is known about how reproductive hormones in female camelids are influenced during their seasonal breeding period, which occurs during long photoperiod. To explore this, the study investigated the response of the hypothalamic-pituitary-gonadal axis in female guanacos during short days (10L:14D; July) and long days (16L:8D; December) in the Mediterranean ecosystem (33°38'28″S, 70°34'27″W). Blood samples from 14 adult animals were collected, and measurements of melatonin, 17ß-estradiol, FSH, and LH concentrations were taken. The results showed that melatonin concentration was lower (P < 0.05) during long days than short days, whereas 17ß-estradiol, FSH, and LH concentrations were higher (P < 0.05) during long days compared to short days. Furthermore, the study detected the expression of the melatonin receptor 1A and kisspeptin in the hypothalamus and pituitary, suggesting that the pineal gland of female guanacos is sensitive to seasonal changes in day length. These findings also indicate a seasonal variation in the concentration of reproductive hormones, likely linked to the distinct modulation of the hypothalamic-pituitary-gonadal axis of female guanacos during short and long days.


Camelids, New World , Melatonin , Animals , Female , Camelids, New World/metabolism , Melatonin/metabolism , Photoperiod , Hypothalamic-Pituitary-Gonadal Axis , Ecosystem , Estradiol , Follicle Stimulating Hormone
5.
Einstein (Sao Paulo) ; 21: eRC0544, 2023.
Article En | MEDLINE | ID: mdl-37970955

Tailgut cysts are rare congenital lesions that are remnants of the embryonic hindgut. This abnormality presents with non-specific symptoms or no symptoms; therefore, misdiagnosis is common. Here, we present four cases of tailgut cysts that were successfully removed using a robotic surgical approach. A 42-year-old woman with tenesmus, pain in the right gluteal region, and discomfort in the rectal region during evacuation was referred to our medical center. Another patient was a 28-year-old woman who presented with the same symptoms to our general practitioner. Both patients underwent upper abdominal and pelvic magnetic resonance imaging that revealed a tailgut cyst. Further, a 36-year-old woman was referred with coccyx and hypogastric pain. Magnetic resonance imaging revealed two pararectal cystic formations. She underwent robot-assisted surgery, and after analysis by a pathologist, the conclusion was that the tailgut cyst was associated with scarring fibrosis. A 55-year-old woman with posterior epigastric pelvic pain associated with heartburn underwent robot-assisted surgery to resect a retroperitoneal tumor. These cases highlighted the importance of tailgut cysts in the differential diagnosis of rectal lesions. Surgical treatment is preferred because malignant transformations can occur. The difference between laparoscopic and robotic approaches is the better visualization and stability of the latter, inducing less tissue damage. Robotic resection is a safe procedure, especially in patients with a narrow pelvis, because it reduces tissue damage.


Cysts , Rectal Diseases , Robotic Surgical Procedures , Female , Humans , Adult , Middle Aged , Brazil , Rectal Diseases/diagnostic imaging , Rectal Diseases/surgery , Cysts/diagnostic imaging , Cysts/surgery , Pelvic Pain/etiology , Pelvic Pain/surgery , Abdominal Pain
6.
Health Qual Life Outcomes ; 21(1): 88, 2023 Aug 14.
Article En | MEDLINE | ID: mdl-37580739

BACKGROUND: Distorted thoughts are common in Major Depressive Disorder (MDD), and can impact patients' perceptions of depression severity, and predict chronicity and treatment response. This study aimed to investigate whether distorted thoughts mediate depressive symptoms in MDD over a 6-month period. METHOD: These are secondary results from a study that followed 119 patients diagnosed with moderate to severe MDD for 6 months. Diagnoses were confirmed by the Structured Interview for DSM-IV (SCID-CV). The analysis was composed of results from the Hamilton Depression Rating Scale (HAMD-17), the Montgomery-Asberg Depression Rating Scale (MADRS), the second edition of the Beck Depression Inventory (BDI-II), and the Depression Thoughts Scale (DTS) collected at weeks 1, 8, 12 and 24. RESULTS: Results showed that the DTS mediated the relationship between depressive symptoms experienced approximately 3 months after starting antidepressant treatment. CONCLUSION: Cognitive distortions were linked as a mediator to depressive symptoms, highlighting the importance of early psychological interventions in patients with MDD who exhibit these distortions. TRIAL REGISTRATION: NCT02268487.


Depressive Disorder, Major , Humans , Antidepressive Agents/therapeutic use , Depression , Depressive Disorder, Major/diagnosis , Longitudinal Studies , Psychiatric Status Rating Scales , Quality of Life
7.
Nutr. clín. diet. hosp ; 43(3): 57-62, Juli 26, 2023. graf, tab
Article Es | IBECS | ID: ibc-223599

Introducción. Los universitarios representan un sector de riesgo por las modificaciones en sus hábitos alimentarios y estilo de vida. Objetivo. Evaluar la presencia de obesidad central en estudiantes masculinos de la Licenciatura Pedagogía de la Actividad Física y el Deporte de la Universidad Laica Eloy Alfaro de Manabí, Ecuador Materiales y métodos. Investigación observacional descriptiva sobre 165 estudiantes. Se les tomaron medidas antropométricas siguiendo el protocolo ISAK, con cálculo del índice de masa corporal, la determinación del riesgo cardiometabólico, por ciento de grasa, índice de conicidad y área de grasa intraabdominal. Resultados Los sujetos en estudio presentaron una edad media de 22,68±4,56 años con valores promedio de talla 1,68±0,08 m y peso 70,17±12,03 kg, la media de la circunferencia abdominal no indicó un estado de riesgo cardiometabólico. El IMC alcanzó un promedio de 24,67±3,48; de acuerdo al %GC los valores de mayor prevalencia se encuentran en la condición óptima con un 58,8% y ligero sobrepeso con un 33,9%. La aplicación de la curva ROC(AUC) al índice de conicidad arrojó un valor de área bajo la curva de 0,537 e intervalo de 45,5% a 61,6%. Discusión. Se presenta sobrepeso y obesidad central como consecuencia de la distribución de la grasa corporal según el modelo andrógino. Los valores obtenidos del IMC y %GC muestran contradicciones, y tendencia a la obesidad de peso normal. El IC no constituye un modelo para una discriminación de sujetos con riesgo cardiometabólico. Conclusiones. Entre los estudiantes se presenta exceso ponderal y obesidad central, y tendencia a la obesidad de peso normal, en ellos índice de conicidad no permite realizar la discriminación de sujetos con riesgo cardiometabólico según obesidad abdominal.(AU)


Introduction: University students represent a risk sectordue to changes in their eating habits and lifestyle. Objective: To evaluate the presence of central obesity instudents of the Pedagogy of Physical Activity and SportsDegree at the Laica Eloy Alfaro University of Manabí, Ecuador. Methods: Descriptive observational research on 211 students. Anthropometric measurements were taken followingthe ISAK protocol, with calculation of body mass index, determination of cardiometabolic risk, percent fat, taper index,and intraabdominal fat area. Results: Women exceed men both in age and in area of intraabdominal fat, but not in weight, height, waist circumference, BMI and conicity index, higher in men, with significant statistical differences. The BMI showed a mean of 25.02± 3.88. The values of prevalence by %GC was in the optimalcondition was 58.3%, while in slightly overweight it was 30%.When relating the classifications of % BG and nutritional status, he explained that the normal weight condition (BMI) is included in the categories of thinness, optimal and slightly overweight of the % BG, while the condition of overweight (BMI)is present in all categories of the %GC. The application of theReceiver Operating Characteristic Curve to the conicity indexrevealed an area under the ROC(AUC) curve value of 0.537(95% CI 0.457 – 0.616). Discussion: Overweight and central obesity occur particularly in men as a consequence of the distribution of body fataccording to the androgynous model compared to the gynoidmodel. The values obtained from the BMI with respect to the%GC show contradictions that indicate a tendency to obesityof normal weight. The area of intraabdominal fat is muchsmaller than the 130 cm2 tomography standard and only represents a risk state. The CI does not constitute a model fordiscriminating subjects with cardiometabolic risk according tothe percentage of the area under the ROC curve...(AU)


Humans , Male , Adolescent , Young Adult , Students , Healthy Lifestyle , Life Style , Feeding Behavior , Obesity , Overweight , Ecuador , 52503 , Epidemiology, Descriptive , Anthropometry , Intra-Abdominal Fat
8.
J Biomech Eng ; 145(10)2023 Oct 01.
Article En | MEDLINE | ID: mdl-37382599

Everyday, we interact with screens, sensors, and many other devices through contact with the skin. Experimental efforts have increased our knowledge of skin tribology but are challenged by the fact that skin has a complex structure, undergoes finite deformations, has nonlinear material response, and has properties that vary with anatomical location, age, sex, and environmental conditions. Computational models are powerful tools to dissect the individual contribution of these variables to the overall frictional response. Here, we present a three-dimensional high-fidelity multilayer skin computational model including a detailed surface topography or skin microrelief. Four variables are explored: local coefficient of friction (COF), indenter size, mechanical properties of the stratum corneum, and displacement direction. The results indicate that the global COF depends nonlinearly on the local COF, implying a role for skin deformation on the friction response. The global COF is also influenced by the ratio of the indenter size to the microrelief features, with larger indenters smoothing out the role of skin topography. Changes in stiffness of the uppermost layer of skin associated with humidity have a substantial effect on both the contact area and the reaction forces, but the overall changes in the COF are small. Finally, for the microrelief tested, the response can be considered isotropic. We anticipate that this model and results will enable the design of materials and devices for a desired interaction against skin.


Skin , Humans , Anisotropy , Skin/chemistry , Friction
9.
Eur J Med Chem ; 257: 115511, 2023 Sep 05.
Article En | MEDLINE | ID: mdl-37247505

Selective and brain-permeable protein kinase inhibitors are in preclinical development for treating neurodegenerative diseases. Among them, MLK3 inhibitors, with a potent neuroprotective biological action have emerged as valuable agents for the treatment of pathologies such as Alzheimer's, Parkinson's disease and amyotrophic lateral sclerosis. In fact, one MLK3 inhibitor, CEP-1347, reached clinical trials for Parkinson's disease. Additionally, another compound called prostetin/12k, a potent and rather selective MLK3 inhibitor has started clinical development for ALS based on its motor neuron protection in both in vitro and in vivo models. In this review, we will focus on the role of MLK3 in neuron-related cell death processes, neurodegenerative diseases, and the potential advantages of targeting this kinase through pharmacological modulation for neuroprotective treatment.


Neurodegenerative Diseases , Parkinson Disease , Humans , Neurodegenerative Diseases/drug therapy , Parkinson Disease/drug therapy , MAP Kinase Kinase Kinases , Cell Death , Mitogen-Activated Protein Kinase Kinase Kinase 11
10.
JAMA Neurol ; 80(5): 474-483, 2023 05 01.
Article En | MEDLINE | ID: mdl-37010829

Importance: General anesthesia and procedural sedation are common practice for mechanical thrombectomy in acute ischemic stroke. However, risks and benefits of each strategy are unclear. Objective: To determine whether general anesthesia or procedural sedation for anterior circulation large-vessel occlusion acute ischemic stroke thrombectomy are associated with a difference in periprocedural complications and 3-month functional outcome. Design, Setting, and Participants: This open-label, blinded end point randomized clinical trial was conducted between August 2017 and February 2020, with final follow-up in May 2020, at 10 centers in France. Adults with occlusion of the intracranial internal carotid artery and/or the proximal middle cerebral artery treated with thrombectomy were enrolled. Interventions: Patients were assigned to receive general anesthesia with tracheal intubation (n = 135) or procedural sedation (n = 138). Main Outcomes and Measures: The prespecified primary composite outcome was functional independence (a score of 0 to 2 on the modified Rankin Scale, which ranges from 0 [no neurologic disability] to 6 [death]) at 90 days and absence of major periprocedural complications (procedure-related serious adverse events, pneumonia, myocardial infarction, cardiogenic acute pulmonary edema, or malignant stroke) at 7 days. Results: Among 273 patients evaluable for the primary outcome in the modified intention-to-treat population, 142 (52.0%) were women, and the mean (SD) age was 71.6 (13.8) years. The primary outcome occurred in 38 of 135 patients (28.2%) assigned to general anesthesia and in 50 of 138 patients (36.2%) assigned to procedural sedation (absolute difference, 8.1 percentage points; 95% CI, -2.3 to 19.1; P = .15). At 90 days, the rate of patients achieving functional independence was 33.3% (45 of 135) with general anesthesia and 39.1% (54 of 138) with procedural sedation (relative risk, 1.18; 95% CI, 0.86-1.61; P = .32). The rate of patients without major periprocedural complications at 7 days was 65.9% (89 of 135) with general anesthesia and 67.4% (93 of 138) with procedural sedation (relative risk, 1.02; 95% CI, 0.86-1.21; P = .80). Conclusions and Relevance: In patients treated with mechanical thrombectomy for anterior circulation acute ischemic stroke, general anesthesia and procedural sedation were associated with similar rates of functional independence and major periprocedural complications. Trial Registration: ClinicalTrials.gov Identifier: NCT03229148.


Brain Ischemia , Endovascular Procedures , Ischemic Stroke , Stroke , Adult , Humans , Female , Aged , Male , Ischemic Stroke/etiology , Brain Ischemia/complications , Conscious Sedation , Stroke/drug therapy , Anesthesia, General , Thrombectomy/adverse effects , Endovascular Procedures/adverse effects , Treatment Outcome
11.
J Neurointerv Surg ; 15(e2): e248-e254, 2023 Nov.
Article En | MEDLINE | ID: mdl-36357169

BACKGROUND: Patients treated with acute carotid stenting (CAS) may have higher odds of a favorable outcome than those treated without CAS during thrombectomy in tandem occlusions. Antiplatelet therapy is associated with CAS to avoid stent thrombosis, which occurs in around 20% of patients and negatively impacts outcomes. In this study we compared two antiplatelet strategies in tandem occlusion strokes treated with CAS and intracranial thrombectomy in clinical practice. METHODS: The Endovascular Treatment in Ischemic Stroke Registry is an ongoing prospective observational study involving 21 comprehensive stroke centers performing thrombectomy in France. We analyzed patients with atherosclerotic tandem occlusions treated with acute CAS and intracranial thrombectomy who received at least one antiplatelet agent. Aggressive antiplatelet therapy included oral or intravenous glycoprotein (GP) IIb/IIIa or P2Y12 inhibitors. The primary outcome was cervical carotid artery patency at day 1 imaging follow-up. RESULTS: Among the 187 included patients, 124 (66.3%) received aspirin alone and 63 (33.7%) received aggressive antiplatelet therapy. There was no significant difference regarding safety outcomes, especially in symptomatic intracerebral hemorrhage, parenchymal hematoma, and procedural complications. There was a significantly higher rate of carotid stent patency at day 1 in the aggressive antiplatelet therapy group (81.7% vs 97.1%, aOR 17.49, 95% CI 1.10 to 277.2, p=0.042). Odds of favorable functional outcome (90-day modified Rankin Scale score 0-2) were similar between the groups (OR 3.04, 95% CI 0.64 to 14.25, p=0.158). CONCLUSIONS: In tandem occlusions treated with CAS plus thrombectomy, an aggressive antiplatelet regimen was associated with an increased rate of carotid stent patency at day 1 without safety concerns. Randomized trials are warranted to confirm these findings.


Carotid Stenosis , Endovascular Procedures , Ischemic Stroke , Stroke , Humans , Platelet Aggregation Inhibitors/therapeutic use , Aspirin , Treatment Outcome , Stroke/diagnostic imaging , Stroke/drug therapy , Stroke/surgery , Thrombectomy/methods , Endovascular Procedures/methods , Ischemic Stroke/etiology , Stents/adverse effects , Registries , Retrospective Studies , Carotid Stenosis/complications
12.
J Neurointerv Surg ; 15(e2): e289-e297, 2023 Nov.
Article En | MEDLINE | ID: mdl-36460462

BACKGROUND: Intravenous thrombolysis (IVT) for patients treated with mechanical thrombectomy (MT) for proximal occlusions has recently been questioned through randomized trials. However, few patients with M2 occlusions were included. We investigated the influence of prior IVT for patients presenting M2 occlusions treated with MT in comparison with MT alone. METHODS: We conducted a retrospective analysis of the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a multicenter observational study. Data from consecutive patients treated with MT for M2 occlusions between January 2015 and January 2022 at 26 comprehensive stroke centers were analyzed. The primary endpoint was 90-day modified Rankin Scale score of 0-2. Outcomes were compared using propensity score approaches. We also performed sensitivity analysis in relevant subgroups of patients. RESULTS: Among 1132 patients with M2 occlusions treated with MT, 570 received prior IVT. The two groups were comparable after propensity analysis. The rate of favorable functional outcome was significantly higher in the IVT+MT group compared with the MT alone group (59.8% vs 44.7%; adjusted OR 1.38, 95% CI 1.10 to 1.75, P=0.008). Hemorrhagic and procedural complications were similar in both groups. In sensitivity analysis excluding patients with anticoagulation treatment, favorable recanalization was more frequent in the IVT+MT group (OR 1.37, 95% CI 1.11 to 1.70, P=0.004). CONCLUSIONS: In cases of M2 occlusions, prior IVT combined with MT resulted in better functional outcome than MT alone, without increasing the rate of hemorrhagic or procedural complications. These results suggest the benefit of IVT in patients undergoing MT for M2 occlusions.


Brain Ischemia , Ischemic Stroke , Mechanical Thrombolysis , Stroke , Humans , Fibrinolytic Agents/therapeutic use , Thrombolytic Therapy/methods , Ischemic Stroke/drug therapy , Ischemic Stroke/surgery , Thrombectomy/methods , Retrospective Studies , Treatment Outcome , Stroke/drug therapy , Stroke/surgery , Mechanical Thrombolysis/methods , Registries , Brain Ischemia/drug therapy , Brain Ischemia/surgery
13.
WIREs Mech Dis ; 15(2): e1589, 2023 03.
Article En | MEDLINE | ID: mdl-36493758

The mammalian acrosome is a secretory vesicle attached to the sperm nucleus whose fusion with the overlying plasma membrane is required to achieve fertilization. Acrosome biogenesis starts during meiosis, but it lasts through the entire process of haploid cell differentiation (spermiogenesis). Acrosome biogenesis is a stepwise process that involves membrane traffic from the Golgi apparatus, but it also seems that the lysosome/endosome system participates in this process. Defective sperm head morphology is accompanied by defective acrosome shape and function, and patients with these characteristics are infertile or subfertile. The most extreme case of acrosome biogenesis failure is globozoospermia syndrome, which is primarily characterized by the presence of round-headed spermatozoa without acrosomes with cytoskeleton defects around the nucleus and infertility. Several genes participating in acrosome biogenesis have been uncovered using genetic deletions in mice, but only a few of them have been found to be deleted or modified in patients with globozoospermia. Understanding acrosome biogenesis is crucial to uncovering the molecular basis of male infertility and developing new diagnostic tools and assisted reproductive technologies that may help infertile patients through more effective treatment techniques. This article is categorized under: Reproductive System Diseases > Environmental Factors Infectious Diseases > Stem Cells and Development Reproductive System Diseases > Molecular and Cellular Physiology.


Acrosome , Teratozoospermia , Humans , Male , Mice , Animals , Acrosome/metabolism , Spermatozoa/metabolism , Teratozoospermia/genetics , Semen/metabolism , Spermatogenesis/genetics , Mammals
14.
Anat Histol Embryol ; 52(2): 336-340, 2023 Mar.
Article En | MEDLINE | ID: mdl-36345659

This is the first morpho-histological comparison of guanaco ovaries between reproductive (long-days) and non-reproductive (short-days) seasons, and oestrogen receptor-alpha (ERα) and beta (ERß) detection. Different stages of follicle development were found in the cortical area, but no corpus luteum was detected. The size and frequency of antral follicles and large atretic follicles were higher in long-day ovaries than short-days, consistent with ovarian activity in this season. Differential expression of ERα and ERß was observed in follicles at different stages of development between short and long days. These data reveal histological and molecular differences between reproductive and non-reproductive seasons of guanaco ovaries.


Camelids, New World , Ovary , Female , Animals , Ovary/anatomy & histology , Estrogen Receptor alpha , Estrogen Receptor beta , Ovarian Follicle
15.
J Neurointerv Surg ; 15(4): 402-407, 2023 Apr.
Article En | MEDLINE | ID: mdl-35347058

BACKGROUND: Neurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional procedures in France. METHODS: In April 2021, French neurointerventional surgery centers were invited to participate in a nationwide 51-question survey disseminated through an active trainee-led research collaborative network (the JENI-RC). RESULTS: All 40 centers answered the survey. Fifty-one percent of centers reported using ticagrelor and 43% used clopidogrel as premedication before intracranial stenting. For flow diversion treatment, dual antiplatelet therapy was maintained for 3 or 6 months in 39% and 53% of centers, respectively, and aspirin was prescribed for 12 months or more than 12 months in 63% and 26% of centers, respectively. For unruptured aneurysms, the most common heparin bolus dose was 50 IU/kg (59%), and only 35% of centers monitored heparin activity for dose adjustment. Tirofiban was used in 64% of centers to treat thromboembolic complications. Fifteen percent of these comprehensive stroke centers reported using tenecteplase to treat acute ischemic strokes. Cangrelor appeared as an emergent drug in specific indications. CONCLUSION: This nationwide survey highlights the important heterogeneity in clinical practices across centers. There is a pressing need for trials and guidelines to further evaluate and harmonize antithrombotic regimens in the neurointerventional field.


Fibrinolytic Agents , Stroke , Humans , Fibrinolytic Agents/therapeutic use , Cross-Sectional Studies , Aspirin , Stroke/drug therapy , Stroke/surgery , Stroke/etiology , Heparin/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use
16.
Einstein (Säo Paulo) ; 21: eRC0544, 2023. tab, graf
Article En | LILACS-Express | LILACS | ID: biblio-1520846

ABSTRACT Tailgut cysts are rare congenital lesions that are remnants of the embryonic hindgut. This abnormality presents with non-specific symptoms or no symptoms; therefore, misdiagnosis is common. Here, we present four cases of tailgut cysts that were successfully removed using a robotic surgical approach. A 42-year-old woman with tenesmus, pain in the right gluteal region, and discomfort in the rectal region during evacuation was referred to our medical center. Another patient was a 28-year-old woman who presented with the same symptoms to our general practitioner. Both patients underwent upper abdominal and pelvic magnetic resonance imaging that revealed a tailgut cyst. Further, a 36-year-old woman was referred with coccyx and hypogastric pain. Magnetic resonance imaging revealed two pararectal cystic formations. She underwent robot-assisted surgery, and after analysis by a pathologist, the conclusion was that the tailgut cyst was associated with scarring fibrosis. A 55-year-old woman with posterior epigastric pelvic pain associated with heartburn underwent robot-assisted surgery to resect a retroperitoneal tumor. These cases highlighted the importance of tailgut cysts in the differential diagnosis of rectal lesions. Surgical treatment is preferred because malignant transformations can occur. The difference between laparoscopic and robotic approaches is the better visualization and stability of the latter, inducing less tissue damage. Robotic resection is a safe procedure, especially in patients with a narrow pelvis, because it reduces tissue damage.

17.
Article En | MEDLINE | ID: mdl-38592432

Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD, and available treatment pathways for the management of TRD vary across the Latin American region, highlighting the need for a uniform definition and treatment principles to optimize the management of TRD in Latin America. METHODS: Following a thematic literature review and pre-meeting survey, a Latin America expert panel comprising 14 psychiatrists with clinical experience in managing patients with TRD convened and utilized the RAND/UCLA appropriateness method to develop consensus-based recommendations on the appropriate definition of TRD and principles for its management. RESULTS: The expert panel agreed that 'treatment-resistant depression' (TRD) is defined as 'failure of two drug treatments of adequate doses, for 4-8 weeks duration with adequate adherence, during a major depressive episode'. A stepwise treatment approach should be employed for the management of TRD - treatment strategies can include maximizing dose, switching to a different class, and augmenting or combining treatments. Nonpharmacological treatments, such as electroconvulsive therapy, are also appropriate options for patients with TRD. CONCLUSION: These consensus recommendations on the operational definition of TRD and approved treatments for its management can be adapted to local contexts in the Latin American countries but should not replace clinical judgement. Individual circumstances and benefit-risk balance should be carefully considered while determining the most appropriate treatment option for patients with TRD.

18.
Sensors (Basel) ; 22(24)2022 Dec 10.
Article En | MEDLINE | ID: mdl-36560056

The surface condition of roadways has direct consequences on a wide range of processes related to the transportation technology, quality of road facilities, road safety, and traffic noise emissions. Methods developed for detection of road surface condition are crucial for maintenance and rehabilitation plans, also relevant for driving environment detection for autonomous transportation systems and e-mobility solutions. In this paper, the clustering of the tire-road noise emission features is proposed to detect the condition of the wheel tracks regions during naturalistic driving events. This acoustic-based methodology was applied in urban areas under nonstop real-life traffic conditions. Using the proposed method, it was possible to identify at least two groups of surface status on the inspected routes over the wheel-path interaction zone. The detection rate on urban zone reaches 75% for renewed lanes and 72% for distressed lanes.


Automobile Driving , Noise, Transportation , Transportation , Acoustics
19.
Braz J Psychiatry ; 44(6): 576-583, 2022 Sep 19.
Article En | MEDLINE | ID: mdl-36580584

OBJECTIVE: To explore whether there is an association between distractibility, anxiety, irritability, and agitation (DAIA) symptoms and the severity of depressive and manic symptoms. METHODS: Patients with unipolar and bipolar disorder (I and II) and mixed depression were evaluated. DAIA symptoms were assessed using previously described definitions. RESULTS: The full analysis set comprised 100 patients. The severity of depressive symptoms in mixed depression, assessed by Montgomery-Åsberg Depression Rating Scale (MADRS), was significantly associated with the presence of two or more DAIA symptoms in the bipolar sample, influenced mainly by anxiety. The severity of manic symptoms in mixed depression, assessed by Young Mania Rating Scale (YMRS), was significantly associated with the presence of two or more DAIA symptoms in the bipolar sample and three or four DAIA symptoms in the unipolar sample. CONCLUSION: DAIA symptoms were associated with greater severity of manic symptoms in mixed depression. DAIA symptoms must be evaluated in all patients with mixed features and are associated with the severity of depressive and manic symptoms in mixed depression.


Bipolar Disorder , Depression , Humans , Depression/diagnosis , Bipolar Disorder/diagnosis , Anxiety/diagnosis , Irritable Mood , Psychomotor Agitation
20.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 44(6): 576-583, Nov.-Dec. 2022. tab, graf
Article En | LILACS-Express | LILACS | ID: biblio-1420530

Objective: To explore whether there is an association between distractibility, anxiety, irritability, and agitation (DAIA) symptoms and the severity of depressive and manic symptoms. Methods: Patients with unipolar and bipolar disorder (I and II) and mixed depression were evaluated. DAIA symptoms were assessed using previously described definitions. Results: The full analysis set comprised 100 patients. The severity of depressive symptoms in mixed depression, assessed by Montgomery-Åsberg Depression Rating Scale (MADRS), was significantly associated with the presence of two or more DAIA symptoms in the bipolar sample, influenced mainly by anxiety. The severity of manic symptoms in mixed depression, assessed by Young Mania Rating Scale (YMRS), was significantly associated with the presence of two or more DAIA symptoms in the bipolar sample and three or four DAIA symptoms in the unipolar sample. Conclusion: DAIA symptoms were associated with greater severity of manic symptoms in mixed depression. DAIA symptoms must be evaluated in all patients with mixed features and are associated with the severity of depressive and manic symptoms in mixed depression. Clinical trial registration: ClinicalTrials.gov (NCT04123301).

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