Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 195
Filtrar
1.
Obes Surg ; 34(10): 3790-3795, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39264552

RESUMO

BACKGROUND: The global prevalence of obesity is increasing and represents a major public health challenge. However, there is a paucity of data regarding Helicobacter pylori (H pylori) eradication in people with obesity. The aim of the study is to examine the influence of obesity degree on H. pylori eradication in patients undergoing bariatric and metabolic surgery. METHODS: A post hoc analysis was conducted in a cohort of 204 adults patients (129 individuals diagnosed with obesity, 75 normal weight) H. pylori positive, included in two multicenter, prospective studies. Patients underwent a 14-day quadruple concomitant treatment, and H. pylori eradication was assessed using the 13C-urea breath test. The cohort was stratified according to body mass index (BMI), and statistical analyses were performed using chi-squared test, Kruskal-Wallis test, and logistic regression. RESULTS: Eradication rates were significantly lower in patients with obesity compared with normal weight individuals (68.2% vs. 88.0%, OR 0.29, 95% CI 0.13-0.63, p < 0.01). Furthermore, within the population diagnosed with obesity, the degree of obesity correlated with decreased eradication rates, with class 3 (BMI 40.0-49.9) and class 4 (BMI ≥ 50.0) obesity showing the lowest rates (67% and 51%, with an OR 0.28 and 0.15 respectively, p < 0.01). CONCLUSIONS: Our results indicate that obesity may influence H. pylori eradication, especially among severe obesity patients undergoing bariatric surgery, which could have implications for the development of ulcers and gastritis as well as the risk of gastric cancer. Tailored eradication strategies may be necessary to improve treatment efficacy in this population.


Assuntos
Antibacterianos , Cirurgia Bariátrica , Infecções por Helicobacter , Helicobacter pylori , Obesidade Mórbida , Humanos , Infecções por Helicobacter/tratamento farmacológico , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Estudos Prospectivos , Obesidade Mórbida/cirurgia , Obesidade Mórbida/complicações , Antibacterianos/uso terapêutico , Índice de Massa Corporal , Testes Respiratórios , Resultado do Tratamento , Inibidores da Bomba de Prótons/uso terapêutico , Quimioterapia Combinada
2.
Work ; 78(1): 55-72, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38701166

RESUMO

BACKGROUND: The sculpting craft must adopt awkward postures that lead to musculoskeletal disorders (MSDs). OBJECTIVE: This study investigated the prevalence of musculoskeletal discomfort (MD) and its associations with postural risk factors, demographics, and work characteristics among sculptors. They were determined the differences between MDs during the weeks of the study. METHODS: A longitudinal study was conducted; MD was investigated using the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ). Posture was assessed using the Rapid Upper Limb Assessment method (RULA). Multivariate logistic regression (MLR) models analyzed associations with different factors. ANOVA was used to test for differences in MD prevalence. RESULTS: The analysis included 585 responses by body region. The prevalence of MD was high in the lower and upper limbs among sculptors (67.6%), with the lower back, upper arm, neck, and knees being the four most affected regions. Gender (female) (OR = 2.15), marital status (married) (OR = 1.80), health risk (obesity), the dual of a secondary job (OR = 1.94), job stress (OR = 2.10), duration of work (OR = 2.01), and difficulty keeping up with work (OR = 2.00) were significant predictors contributing to the occurrence of MD in different body regions. Only shoulder MD prevalence showed significant differences between study weeks. CONCLUSIONS: Sculptors suffer from MD. Demographic and work characteristic factors influence MD prevalence. Postural training, improved adaptation of work organization, and intervention guidance on ergonomic risks may reduce the prevalence of MD and the risk of MSDs in this population.


Assuntos
Doenças Musculoesqueléticas , Humanos , Masculino , Feminino , Fatores de Risco , Adulto , México/epidemiologia , Doenças Musculoesqueléticas/epidemiologia , Doenças Musculoesqueléticas/etiologia , Prevalência , Pessoa de Meia-Idade , Estudos Longitudinais , Inquéritos e Questionários , Postura/fisiologia , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Modelos Logísticos
3.
Clin Transl Oncol ; 26(8): 2060-2069, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38653928

RESUMO

PURPOSE: This study aimed to investigate the current therapeutic management of patients with early-stage HER2-positive (HER2+) breast cancer in Spain, while also exploring the perceptions surrounding HER2DX in terms of its credibility, clinical relevance, and impact on therapeutic decision-making. Understanding these aspects is crucial for optimizing treatment strategies and enhancing patient outcomes in the context of HER2+ breast cancer. METHODS: An online questionnaire was conducted by an independent third-party between April and May 2022 across 70 medical oncologists highly specialized in breast cancer management in Spain. The survey included 37 questions regarding treatment decision making in HER2+ early breast cancer. RESULTS: The management of patients with HER2+ early breast cancer exhibited a high degree of heterogeneity. Among the interviewed oncologists, 53% would recommend upfront surgery for node negative tumors measuring 1 cm or less. Interestingly, 69% and 56% of interviewers were open to deescalate the duration of adjuvant trastuzumab in pT1a and pT1b N0 tumors, respectively. Certain clinicopathological characteristics, such as high grade, high Ki-67, and young age, influenced the decision to prescribe neoadjuvant treatment for patients with clinical stage 1 disease. In cases where neoadjuvant treatment was prescribed for cT1-2 N0 tumors, there was a wide variation in the choice of chemotherapeutic and anti-HER2 regimens. Regarding the use of adjuvant trastuzumab emtansine (T-DM1) in patients with residual disease after neoadjuvant therapy, there was diversity in practice, and a common concern emerged that T-DM1 might be overtreating some patients. HER2DX, as a diagnostic tool, was deemed trustworthy, and the reported scores were considered clinically useful. However, 86% of interviewees believed that a prospective trial was necessary before fully integrating the test into routine clinical practice. CONCLUSION: In the context of early-stage HER2+ breast cancer in Spain, a notable diversity in therapeutic approaches was observed. The majority of interviewed medical oncologists acknowledged HER2DX as a clinically valuable test for specific patients, in line with the 2022 SEOM-GEICAM-SOLTI clinical guidelines for early-stage breast cancer. To facilitate the full integration of HER2DX into clinical guidelines, conducting prospective studies to further validate its efficacy and utility was recommended.


Assuntos
Neoplasias da Mama , Receptor ErbB-2 , Humanos , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/metabolismo , Feminino , Espanha , Receptor ErbB-2/metabolismo , Inquéritos e Questionários , Padrões de Prática Médica/estatística & dados numéricos , Trastuzumab/uso terapêutico , Atitude do Pessoal de Saúde , Tomada de Decisão Clínica , Estadiamento de Neoplasias , Pessoa de Meia-Idade , Quimioterapia Adjuvante , Antineoplásicos Imunológicos/uso terapêutico , Ado-Trastuzumab Emtansina/uso terapêutico , Adulto
4.
Environ Sci Pollut Res Int ; 31(20): 30009-30025, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38598159

RESUMO

In this work, we present the water quality assessment of an urban river, the San Luis River, located in San Luis Province, Argentina. The San Luis River flows through two developing cities; hence, urban anthropic activities affect its water quality. The river was sampled spatially and temporally, evaluating ten physicochemical variables on each water sample. These data were used to calculate a Simplified Index of Water Quality in order to estimate river water quality and infer possible contamination sources. Data were statistically analyzed with the opensource software R, 4.1.0 version. Principal component analysis, cluster analysis, correlation matrices, and heatmap analysis were performed. Results indicated that water quality decreases in areas where anthropogenic activities take place. Robust inferential statistical analysis was performed, employing an alternative of multivariate analysis of variance (MANOVA), MANOVA.wide function. The most statistically relevant physicochemical variables associated with water quality decrease were used to develop a multiple linear regression model to estimate organic matter, reducing the variables necessary for continuous monitoring of the river and, hence, reducing costs. Given the limited information available in the region about the characteristics and recovery of this specific river category, the model developed is of vital importance since it can quickly detect anthropic alterations and contribute to the environmental management of the rivers. This model was also used to estimate organic matter at sites located in other similar rivers, obtaining satisfactory results.


Assuntos
Monitoramento Ambiental , Rios , Qualidade da Água , Rios/química , Argentina , Monitoramento Ambiental/métodos , Análise Multivariada , Cidades , Poluentes Químicos da Água/análise , Análise de Componente Principal
5.
Diagnostics (Basel) ; 13(15)2023 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-37568921

RESUMO

Patent ductus arteriosus (PDA) is frequent in preterm newborns, and its incidence is inversely associated with the degree of prematurity. The first choice of pharmacological treatment is ibuprofen. Several genes, including EPAS1, have been proposed as probable markers associated with a genetic predisposition for the development of PDA in preterm infants. EPAS 1 NG_016000.1:g.84131C>G or rs7557402 has been reported to be probably benign and associated with familial erythrocytosis by the Illumina Clinical Services Laboratory. Other variants of EPAS1 have been previously reported to be benign for familial erythrocytosis because they decrease gene function and are positive for familial erythrocytosis because the overexpression of EPAS1 is a key factor in uncontrolled erythrocyte proliferation. However, this could be inconvenient for ductal closure, since for this process to occur, cell proliferation, migration, and differentiation should take place, and a decrease in EPAS1 gene activity would negatively affect these processes. Single-nucleotide polymorphisms (SNPs) in EPAS1 and TFAP2B genes were searched with high-resolution melting and Sanger sequencing in blood samples of preterm infants with hemodynamically significant PDA treated with ibuprofen at the National Institute of Perinatology. The variant rs7557402, present in the EPAS1 gene eighth intron, was associated with a decreased response to treatment (p = 0.007, OR = 3.53). The SNP rs7557402 was associated with an increased risk of pharmacological treatment failure. A probable mechanism involved could be the decreased activity of the product of the EPAS1 gene.

6.
Interv Cardiol ; 18: e15, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37398876

RESUMO

Glycoprotein IIb/IIIa inhibitors are an adjuvant therapy for the treatment of patients with acute coronary syndromes. The main adverse reactions are bleeding and thrombocytopenia in 1-2% of cases. A 66-year-old woman arrived at the emergency department with ST-elevation MI. The catheterisation lab was busy, so she received thrombolytic therapy. Coronary angiography revealed a 90% stenosis in the middle segment of the left anterior descending artery and Thrombolysis in MI 2 flow. Subsequent percutaneous coronary intervention showed abundant thrombus and a coronary dissection and it was necessary to insert five drug-eluting stents. Non-fractionated heparin and a tirofiban infusion were used. After the percutaneous coronary intervention, she developed severe thrombocytopenia, haematuria and gingivorrhagia, for which infusion of tirofiban was suspended. In follow-up, no major bleeding or subsequent haemorrhagic complications were identified. It is crucial to distinguish between heparin-induced thrombocytopenia and thrombocytopenia caused by other drugs. A high level of suspicion should be employed in these cases.

7.
Rev. chil. infectol ; Rev. chil. infectol;40(3): 313-314, jun. 2023.
Artigo em Espanhol | LILACS | ID: biblio-1515124

RESUMO

Microascus spp, teleomorfo de Scopulariopsis, es un hongo saprofito encontrado normalmente en suelo, alimentos, vegetales e incluso en ambientes interiores. Considerado un contaminante ambiental, se caracteriza por la resistencia intrínseca a los antifúngicos disponibles. Existen escasas referencias de infecciones por Microascus gracilis, asociándose como causa de eumicetoma o enfermedad diseminada en pacientes sometidos a trasplante pulmonar. Presentamos un caso de otomicosis por M. gracilis con el fin de considerar la búsqueda de hongos en los cultivos óticos y poner de relevancia el poder patógeno y colonizador de este agente.


Microascus spp, a teleomorph of Scopulariopsis, is a saprophytic fungus normally found in soil, food, vegetables, and even indoors. Considered an environmental pollutant, it is characterized by its intrinsic resistance to available antifungals. There are few references to infections by Microascus gracilis, associating it as a cause of eumycetoma or disseminated disease in lung transplant recipients. We present a case of otomycosis caused by M. gracilis, to consider the search for fungi in ear cultures and highlight the pathogenic and colonizing power of this agent.


Assuntos
Humanos , Feminino , Idoso , Ascomicetos/isolamento & purificação , Otomicose/diagnóstico , Otomicose/microbiologia , Scopulariopsis
8.
Behav Sci (Basel) ; 13(2)2023 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-36829358

RESUMO

Procrastination is a phenomenon that affects university students and consists of not finishing a task or finishing it late, which has a direct impact on their academic performance. This is relevant because, in a context of high competition, higher education institutions and their decision-makers need to be aware of the factors that influence university students' procrastination in order to implement actions that favor student attraction and retention. Based on the above, this research aims to propose a theoretical model of procrastination in university students, based on the literature review and content validation assessment through a semi-structured questionnaire. The proposed model is made up of nine dimensions: Psychological, Physiological, Social, Academic, Leisure, Time Management, Resources, Labor, and Environmental. Dimensions were obtained based on adequate levels of content validity provided by the literature and the questionnaire. In the future, the research proposes to study the way in which these dimensions are present in procrastination and design a scale that allows for their measurement.

9.
Arch. argent. pediatr ; 121(1): e202102550, feb. 2023. tab
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1412904

RESUMO

Introducción. En las unidades de cuidados intensivos pediátricos, se utiliza gran cantidad de medicamentos, muchos prescritos fuera de las condiciones establecidas en su ficha técnica (prescripciones off-label y unlicensed). El objetivo de este estudio fue describir el uso de medicamentos y estimar la prevalencia de fármacos off-label y unlicensed en una unidad de cuidados intensivos pediátricos de un hospital de tercer nivel español. Población y métodos. Estudio transversal, observacional, de una cohorte de niños ingresados en una unidad de cuidados intensivos pediátricos. El estudio se llevó a cabo en 2017. Se revisó cada fármaco prescrito, sus condiciones de uso y administración. Además, se analizaron las fichas técnicas de los fármacos implicados con la finalidad de identificar si el uso de los medicamentos se realizaba según sus condiciones de autorización, o bien se hacía fuera de prospecto (off-label) o como unlicensed. Resultados. La muestra fue de 97 pacientes. El 74,2 % (n = 72) de los pacientes recibieron algún fármaco off-label o unlicensed. El 23,8 % (n = 243) de las prescripciones fueron off-label y el 8,7 % (n = 89), unlicensed. El subanálisis realizado por grupos de edad mostró que el grupo de edad que recibió mayor número de prescripciones totales (n = 611) y el mayor porcentaje de fármacos prescritos en condiciones off-label y/o unlicensed (38,4 %) fue el de menores de 2 años. Conclusiones. La prescripción de fármacos off-label y/o unlicensed es una práctica habitual en la unidad de cuidados intensivos pediátricos. Este estudio permite documentar la complejidad de la terapéutica en niños.


Introduction. In pediatric intensive care units, a large number of drugs are used, many of which are prescribed for condition beyond those established in their summary of product characteristics (off-label and unlicensed drug prescriptions). The objective of this study was to describe drug use and estimate the prevalence of off-label and unlicensed drugs in a pediatric intensive care unit of a tertiary care Spanish hospital. Population and methods. Cross-sectional, observational study with a single cohort of children admitted to a pediatric intensive care unit. The study was conducted in 2017. Each drug prescription, its conditions of use and administration were reviewed. In addition, the summary of product characteristics of drugs used were analyzed in order to identify whether they were used according to their conditions of authorization, or whether they were used in an off-label or unlicensed manner. Results. The sample included 97 patients. At least one off-label or unlicensed drug was administered to 74.2% (n = 72) of patients; 23.8% (n = 243) corresponded to off-label prescriptions and 8.7% (n = 89), unlicensed prescriptions. A sub-analysis by age group showed that the age group that received a higher number of total prescriptions (n = 611) and a higher percentage of off-label and/or unlicensed drug prescriptions (38.4%) was under 2 years of age. Conclusions. Off-label and/or unlicensed drug prescription is a common practice in the pediatric intensive care unit. This study allowed us to document the complexity of therapeutics in children.


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Unidades de Terapia Intensiva Pediátrica , Uso Off-Label , Atenção Terciária à Saúde , Preparações Farmacêuticas , Estudos Transversais , Estudos Prospectivos , Hospitais
10.
Mol Cytogenet ; 16(1): 2, 2023 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-36631885

RESUMO

BACKGROUND: The human genome presents variation at distinct levels, copy number variants (CNVs) are DNA segments of variable lengths that range from several base pairs to megabases and are present at a variable number of copies in human genomes. Common CNVs have no apparent influence on the phenotype; however, some rare CNVs have been associated with phenotypic traits, depending on their size and gene content. CNVs are detected by microarrays of different densities and are generally visualized, and their frequencies analysed using the HapMap as default reference population. Nevertheless, this default reference is inadequate when the samples analysed are from people from Mexico, since population with a Hispanic genetic background are minimally represented. In this work, we describe the variation in the frequencies of four common CNVs in Mexican-Mestizo individuals. RESULTS: In a cohort of 147 unrelated Mexican-Mestizo individuals, we found that the common CNVs 2p11.2 (99.6%), 8p11.22 (54.5%), 14q32.33 (100%), and 15q11.2 (71.1%) appeared with unexpectedly high frequencies when contrasted with the HapMap reference (ChAS). Yet, while when comparing to an ethnically related reference population, these differences were significantly reduced or even disappeared. CONCLUSION: The findings in this work contribute to (1) a better description of the CNVs characteristics of the Mexican Mestizo population and enhance the knowledge of genome variation in different ethnic groups. (2) emphasize the importance of contrasting CNVs identified in studied individuals against a reference group that-as best as possible-share the same ethnicity while keeping this relevant information in mind when conducting CNV studies at the population or clinical level.

11.
Arch Argent Pediatr ; 121(1): e202102550, 2023 02 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-36194689

RESUMO

Introduction. In pediatric intensive care units, a large number of drugs are used, many of which are prescribed for condition beyond those established in their summary of product characteristics (off-label and unlicensed drug prescriptions). The objective of this study was to describe drug use and estimate the prevalence of off-label and unlicensed drugs in a pediatric intensive care unit of a tertiary care Spanish hospital. Population and methods. Cross-sectional, observational study with a single cohort of children admitted to a pediatric intensive care unit. The study was conducted in 2017. Each drug prescription, its conditions of use and administration were reviewed. In addition, the summary of product characteristics of drugs used were analyzed in order to identify whether they were used according to their conditions of authorization, or whether they were used in an off-label or unlicensed manner. Results. The sample included 97 patients. At least one off-label or unlicensed drug was administered to 74.2% (n = 72) of patients; 23.8% (n = 243) corresponded to off-label prescriptions and 8.7% (n = 89), unlicensed prescriptions. A sub-analysis by age group showed that the age group that received a higher number of total prescriptions (n = 611) and a higher percentage of off-label and/or unlicensed drug prescriptions (38.4%) was under 2 years of age. Conclusions. Off-label and/or unlicensed drug prescription is a common practice in the pediatric intensive care unit. This study allowed us to document the complexity of therapeutics in children.


Introducción. En las unidades de cuidados intensivos pediátricos, se utiliza gran cantidad de medicamentos, muchos prescritos fuera de las condiciones establecidas en su ficha técnica (prescripciones off-label y unlicensed). El objetivo de este estudio fue describir el uso de medicamentos y estimar la prevalencia de fármacos off-label y unlicensed en una unidad de cuidados intensivos pediátricos de un hospital de tercer nivel español. Población y métodos. Estudio transversal, observacional, de una cohorte de niños ingresados en una unidad de cuidados intensivos pediátricos. El estudio se llevó a cabo en 2017. Se revisó cada fármaco prescrito, sus condiciones de uso y administración. Además, se analizaron las fichas técnicas de los fármacos implicados con la finalidad de identificar si el uso de los medicamentos se realizaba según sus condiciones de autorización, o bien se hacía fuera de prospecto (off-label) o como unlicensed. Resultados. La muestra fue de 97 pacientes. El 74,2 % (n = 72) de los pacientes recibieron algún fármaco off-label o unlicensed. El 23,8 % (n = 243) de las prescripciones fueron off-label y el 8,7 % (n = 89), unlicensed. El subanálisis realizado por grupos de edad mostró que el grupo de edad que recibió mayor número de prescripciones totales (n = 611) y el mayor porcentaje de fármacos prescritos en condiciones off-label y/o unlicensed (38,4 %) fue el de menores de 2 años. Conclusiones. La prescripción de fármacos off-label y/o unlicensed es una práctica habitual en la unidad de cuidados intensivos pediátricos. Este estudio permite documentar la complejidad de la terapéutica en niños.


Assuntos
Unidades de Terapia Intensiva Pediátrica , Uso Off-Label , Criança , Humanos , Lactente , Pré-Escolar , Estudos Transversais , Atenção Terciária à Saúde , Estudos Prospectivos , Preparações Farmacêuticas , Hospitais
12.
Rev Med Chil ; 151(12): 1623-1630, 2023 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-39270084

RESUMO

Lithium is a mood stabilizer recommended by most clinical guidelines as the gold standard to prevent relapses in the treatment of Bipolar Affective Disorder. It is highly effective, but unfortunately, it causes adverse effects at several levels, including the skin. AIM: To review the frequency, presentation, evolution, and management of adverse dermatologic effects caused by this drug. METHODS: We performed a narrative review using Scielo, Web of Science (WoS), and Google Scholar search engines, using keywords in Spanish and English. RESULTS: The skin presentations that appear most frequently are the progression of previously existing or newly diagnosed psoriasis, alopecia, acne, follicular inflammation, and maculopapular eruptions. CONCLUSIONS: Lithium produces and/or exacerbates a series of dermatological conditions of different severity, even at therapeutic levels, which are not usually severe but, even so, should not be underestimated since it can affect adherence to the drug.


Assuntos
Transtorno Bipolar , Humanos , Transtorno Bipolar/tratamento farmacológico , Compostos de Lítio/efeitos adversos , Antimaníacos/efeitos adversos , Antimaníacos/uso terapêutico , Toxidermias/etiologia , Dermatopatias/induzido quimicamente
13.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1523938

RESUMO

Objetivos: Revisar las cirugías de prótesis totales de cadera realizadas en nuestro hospital, determinar el origen de la artrosis e identificar cuántas se colocaron por coxartrosis secundarias a enfermedad de Legg-Calvé-Perthes. Materiales y Métodos: Se realizó un estudio retrospectivo en el que se revisaron todas las cirugías de prótesis totales de cadera desde 2008 hasta diciembre de 2021. Se evaluaron las radiografías prequirúrgicas para determinar la etiología de la artrosis, y se consideraron variables, como lateralidad, sexo y edad en el momento de la intervención. Resultados: Se revisaron 1103 caderas en 935 pacientes. El 81% correspondía a coxartrosis primaria. En 11 caderas de 10 pacientes (1%), se detectó coxartrosis secundaria a la enfermedad de Legg-Calvé-Perthes. La media de la edad de estos pacientes era de 61 años. Conclusiones: Hay evidencia de que las alteraciones del crecimiento de la fisis femoral proximal o el sobrecrecimiento del trocánter mayor, propias de la enfermedad de Legg-Calvé-Perthes, pueden contribuir a la aparición de un choque femoroacetabular, con su consiguiente coxartrosis precoz. Es posible que algunas "mal clasificadas" coxartrosis primarias fueran identificadas así porque no existía otro dato sugerente de coxartrosis secundarias, y escondieran otra etiología evolucionada. Asimismo, proponemos el seguimiento del paciente joven con enfermedad de Legg-Calvé-Perthes, más allá del final del crecimiento, para identificar el choque femoroacetabular en sus inicios y poder ofrecer opciones terapéuticas artroscópicas. Nivel de Evidencia: III


Objectives: To review the number of total hip replacements (THA) performed in our hospital, determine their aetiology and identify how many of them were performed for hip osteoarthritis secondary to Legg-Calvé-Perthes disease (LCPD). Materials and Methods: We conducted a retrospective study reviewing all THA surgeries from 2008 to December 2021. We studied the pre-operative radiographs, determining the aetiology of the osteoarthritis, laterality, sex and age of the patient at the time of surgery. Results: We reviewed a total of 1103 hips in 935 patients. Primary hip osteoarthritis accounted for 81% of the cases. We gathered a total of 11 hips from 10 individuals (1%), with a mean age of 61 years, for hip osteoarthritis secondary to LCPD. Conclusions:There is evidence that femoro-acetabular impingement (FAI), which results in early secondary hip osteoarthritis, may be influenced by changes in the growth of the proximal femoral physis or overgrowth of the greater trochanter, which are characteristics of LCPD. We believe that certain cases of "misclassified" primary hip osteoarthritis may have been incorrectly identified since no additional information was found to support the diagnosis of secondary hip osteoarthritis, hiding the potential of an alternate, evolved aetiology. Furthermore, we suggest monitoring young patients with LCPD after their growth is complete in order to detect early FAI and provide arthroscopic therapeutic options. Level of Evidence: III


Assuntos
Adulto , Osteoartrite do Quadril , Impacto Femoroacetabular , Prótese de Quadril , Doença de Legg-Calve-Perthes
14.
J Clin Med ; 11(24)2022 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-36555880

RESUMO

Chagas cardiomyopathy (CC), caused by the protozoan Trypanosoma cruzi, is an important cause of cardiovascular morbidity and mortality in developing countries. It is estimated that 6 to 7 million people worldwide are infected, and it is predicted that it will be responsible for 200,000 deaths by 2025. The World Health Organization (WHO) considers Chagas disease (CD) as a Neglected Tropical Disease (NTD), which must be acknowledged and detected in time, as it remains a clinical and diagnostic challenge in both endemic and non-endemic regions and at different levels of care. The literature on CC was analyzed by searching different databases (Medline, Cochrane Central, EMBASE, PubMed, Google Scholar, EBSCO) from 1968 until October 2022. Multicenter and bioinformatics trials, systematic and bibliographic reviews, international guidelines, and clinical cases were included. The reference lists of the included papers were checked. No linguistic restrictions or study designs were applied. This review is intended to address the current incidence and prevalence of CD and to identify the main pathogenic mechanisms, clinical presentation, and diagnosis of CC.

15.
Artigo em Inglês | MEDLINE | ID: mdl-36505946

RESUMO

Objective: To describe antimicrobial resistance before and after the COVID-19 pandemic in the Dominican Republic. Design: Retrospective study. Setting: The study included 49 outpatient laboratory sites located in 13 cities nationwide. Participants: Patients seeking ambulatory microbiology testing for urine and bodily fluids. Methods: We reviewed antimicrobial susceptibility reports for Escherichia coli isolates from urine and Pseudomonas aeruginosa (PSAR) from bodily fluids between January 1, 2018, to December 31, 2021, from deidentified susceptibility data extracted from final culture results. Results: In total, 27,718 urine cultures with E. coli and 2,111 bodily fluid cultures with PSAR were included in the analysis. On average, resistance to ceftriaxone was present in 25.19% of E. coli isolated from urine each year. The carbapenem resistance rates were 0.15% for E. coli and 3.08% for PSAR annually. The average rates of E. coli with phenotypic resistance consistent with possible extended-spectrum ß-lactamase (ESBL) in urine were 25.63% and 24.75%, respectively, before and after the COVID-19 pandemic. The carbapenem resistance rates in urine were 0.11% and 0.20%, respectively, a 200% increase. The average rates of PSAR with carbapenem resistance in bodily fluid were 2.33% and 3.84% before and after the COVID-19 pandemic, respectively, a 130% percent increase. Conclusions: Resistance to carbapenems in PSAR and E. coli after the COVID-19 pandemic is rising. These resistance patterns suggest that ESBL is common in the Dominican Republic. Carbapenem resistance was uncommon but increased after the COVID-19 pandemic.

16.
Salud Publica Mex ; 64(5, sept-oct): 530-538, 2022 Aug 26.
Artigo em Espanhol | MEDLINE | ID: mdl-36130340

RESUMO

OBJETIVO: Proporcionar recomendaciones para la detección temprana de pacientes con alto riesgo de desarrollar cáncer de pulmón (CP) en el primer nivel de atención y su referencia oportuna. Material y métodos. Se realizó una búsqueda detallada de la evidencia científica disponible para responder las preguntas de investigación clínica y se utilizó el Panel Delphi modificado para lograr un consenso entre expertos. RESULTADOS: Se generaron 14 recomendaciones siguiendo los estándares de una GPC. Conclusión. El CP representa un problema de salud pública en México; por ello, esta guía establece recomendaciones que apoyan la toma de decisiones sobre la detección precoz y la referencia de pacientes con sospecha de CP en el primer nivel de atención.


Assuntos
Detecção Precoce de Câncer , Neoplasias Pulmonares , Humanos , México , Encaminhamento e Consulta , Estudos Retrospectivos
17.
Artigo em Espanhol | PAHO-IRIS | ID: phr-55365

RESUMO

[RESUMEN]. En este artículo se expone la evidencia sobre la implementación de políticas públicas en salud mental, con el objetivo de describir los avances y los desafíos para poner en marcha el modelo biopsicosocial y comunitario principalmente en Latinoamérica. Se realizó una revisión teórica de artículos indexados en Web Of Science, Scopus, PubMed y SciELO. Se incorporaron informes y programas gubernamentales. Los determinantes sociales impactan a la salud mental, la pobreza aumenta significativamente el riesgo de desarrollar una psicopatología. Por ello, la Organización Mundial de la Salud insiste en la necesidad de adoptar un paradigma biopsicosocial para enfrentar los desafíos de salud mental. Alrededor de un tercio de los países, todavía no cuenta con una política nacional de salud mental y existen grandes disparidades de financiamiento y cobertura para la población entre países de ingresos altos y bajos. Particularmente de Latinoamérica, los resultados ilustran un avance en países de ingresos medios y bajos, en elaborar programas de salud mental desde un enfoque comunitario y biopsicosocial. Sin embargo, presentan desafíos en su operacionalización, financiamiento y adaptación a sus realidades socioculturales. La evidencia indica que para avanzar desde un paradigma biomédico hacia uno que incorpore los determinantes sociales de la salud, no se deberían mantener idénticas estrategias en comunidades distintas, puesto que las necesidades de países de ingresos bajos y medios difieren a las de países de ingresos altos. Por ello, resulta fundamental aumentar la investigación local para generar evidencia que refleje las necesidades nacionales en materia de políticas públicas en salud mental.


[ABSTRACT]. This article presents evidence on the implementation of public policies on mental health, and describes the advances and challenges to implementing the biopsychosocial and community model, mainly in Latin America. A theoretical review was conducted of articles indexed in Web of Science, Scopus, PubMed and SciELO. Government reports and programs were included. Social determinants impact mental health. In particular, poverty significantly increases the risk of developing a mental disorder. Accordingly, the World Health Organization insists on the need to adopt a biopsychosocial paradigm to address mental health challenges. About a third of countries still do not have a national mental health policy and there are large disparities in funding and population coverage between high- and low-income countries. Particularly in Latin America, the results illustrate progress in low- and middle-income countries in terms of developing mental health programs with a community and biopsychosocial approach. However, there are challenges in their operationalization, financing, and adaptation to socio-cultural realities. The evidence indicates that in order to move from a biomedical paradigm to one that incorporates the social determinants of health, identical strategies should not be employed in all communities, since the needs of low- and middle-income countries differ from those of high-income countries. Therefore, it is essential to increase local research to generate evidence that reflects national needs with regard to public policies on mental health.


[RESUMO]. Este artigo apresenta evidências sobre a implementação de políticas públicas de saúde mental, com o objetivo de descrever os avanços e desafios para a implementação do modelo biopsicossocial e comunitário, principalmente na América Latina. Foi realizada uma revisão teórica de artigos indexados nas plataformas Web of Science, Scopus, PubMed e SciELO e foram incluídos relatórios e programas governamentais. Os determinantes sociais afetam a saúde mental, e a pobreza aumenta significativamente o risco de desenvolvimento de psicopatologias. Por essa razão, a Organização Mundial da Saúde insiste na necessidade de se adotar um paradigma biopsicossocial para enfrentar os desafios da saúde mental. Aproximadamente um terço dos países ainda não conta com uma política nacional de saúde mental e existem grandes disparidades de financiamento e cobertura para a população entre países de alta e baixa renda. Particularmente na América Latina, os resultados mostram um avanço em países de baixa e média renda na elaboração de programas de saúde mental a partir de um enfoque comunitário e biopsicossocial. No entanto, apresentam desafios na operacionalização, financiamento e adaptação a suas realidades socioculturais. As evidências indicam que, para passar de um paradigma biomédico a outro que inclua os determinantes sociais da saúde, não deveriam ser mantidas as mesmas estratégias em comunidades distintas, uma vez que as necessidades dos países de baixa e média renda diferem das dos de alta renda. Portanto, é fundamental ampliar a pesquisa local para gerar evidências que reflitam as necessidades nacionais de políticas públicas de saúde mental.


Assuntos
Saúde Mental , Modelos Biopsicossociais , Política de Saúde , Determinantes Sociais da Saúde , Saúde Mental , Modelos Biopsicossociais , Política de Saúde , Determinantes Sociais da Saúde , Saúde Mental , Modelos Biopsicossociais , Política de Saúde , Determinantes Sociais da Saúde
18.
Rev. cuba. med. trop ; 73(2): e577, 2021. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1347481

RESUMO

Introducción: Las cepas de Escherichia coli productoras de β-lactamasas de espectro extendido son patógenos multirresistentes y una de las bacterias que más contribuyen con la resistencia antibiótica bacteriana en la clínica. Sin embargo, se aíslan cada vez con más frecuencia de ambientes naturales, tales como los ecosistemas acuáticos en los cuales se emplea como un indicador de contaminación fecal. Objetivo: Evaluar la susceptibilidad a los antibióticos y la producción de enzimas ß-lactamasas de espectro extendido de aislados de Escherichia coli procedentes de ecosistemas dulceacuícolas de La Habana. Métodos: Se analizaron 43 aislados de E. coli provenientes de los ríos Almendares, Quibú y Luyanó de La Habana. Se determinó la susceptibilidad a 18 antibióticos y la producción fenotípica de ß-lactamasas de espectro extendido según las normas del Instituto de Estándares para el Laboratorio Clínico. La detección molecular de las enzimas se realizó mediante reacción en cadena de la polimerasa. Se calculó el índice de multirresistencia a los antibióticos y los patrones de resistencia de cada aislado de E. coli- ß-lactamasas de espectro extendido. Resultados: El 65 por ciento de los aislados de E. coli fueron resistentes al menos a un antibiótico y el 35 por ciento fueron sensibles a todos los antibióticos. El fenotipo ß-lactamasas de espectro extendido fue detectado en siete aislados; de estos, cuatro fueron portadores del gen bla CTX-M-1 y tres presentaron bla TEM. El 37 por ciento de los aislados de E. coli mostraron valores de índices de multirresistencia a los antibióticos menores que 0,22; el 16 por ciento de 0,22; el 9,3 por ciento mayor que 0,5; y el 5 por ciento mayor que 0,7. Los aislados de E. coli-BLEE mostraron corresistencia a las familias de las tetraciclinas, quinolonas, aminoglucósidos y macrólidos. Conclusiones: La presencia de aislados ambientales multirresistentes de E. coli productores de ß-lactamasas de espectro extendido en ecosistemas dulceacuícolas de La Habana destaca la necesidad de implementar estrategias de control para prevenir la diseminación de estos aislados en los ambientes naturales(AU)


Introduction: Extended-spectrum β-lactamase-producing Escherichia coli strains are multiresistant pathogens and one of the bacteria contributing most greatly to bacterial antibiotic resistance in clinical practice. However, they are increasingly isolated from natural environments, such as aquatic ecosystems, where they are used as fecal pollution indicators. Objective: Evaluate antibiotic susceptibility and extended-spectrum ß-lactamase enzyme production in Escherichia coli isolates from freshwater ecosystems in Havana. Methods: An analysis was conducted of 43 E. coli isolates from the rivers Almendares, Quibú and Luyanó in Havana. Determination was made of susceptibility to 18 antibiotics and phenotypic production of extended-spectrum ß-lactamases according to standards from the Clinical and Laboratory Standards Institute. Molecular detection of the enzymes was performed by polymerase chain reaction. Estimation was carried out of the antibiotic multiresistance index and the resistance patterns of each extended-spectrum E. coli ß-lactamase isolate. Results: Of the E. coli isolates studied, 65 percent were resistant to at least one antibiotic, whereas 35 percent were sensitive to all antibiotics. The extended-spectrum ß-lactamase phenotype was detected in seven isolates, of which four were carriers of the gene bla CTX-M-1 and three contained bla TEM. 37 percent of the E. coli isolates displayed antibiotic multiresistance index values below 0.22, 16 percent of 0.22, 9.3 percent above 0.5 and 5 percent above 0.7. ESBL E. coli isolates displayed co-resistance to the families tetracyclines, quinolones, aminoglycosides and macrolides. Conclusions: The presence of multiresistant extended-spectrum ß-lactamase-producing environmental E. coli isolates in Havana freshwater ecosystems highlights the need to implement control strategies aimed at preventing the spread of these isolates in natural environments(AU)


Assuntos
Humanos , Resistência Microbiana a Medicamentos , Reação em Cadeia da Polimerase , Ecossistema , Suscetibilidade a Doenças , Poluição Ambiental , Escherichia coli , Água Doce , Padrões de Referência , Indicadores de Contaminação
19.
Taiwan J Obstet Gynecol ; 60(3): 526-529, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33966741

RESUMO

OBJECTIVE: Sex chromosome mosaicism remains challenging in the study of disorders of sex development (DSD). Aneuploid cells in the developing gonad play a major role in sex determination. Therefore, it is necessary acknowledge their presence by different methods. Our aim was to stand out the utility of urothelial cells for unravelling complex and hidden cell lines in DSD patients. CASE REPORT: Herein we report on a 19-year-old female with primary amenorrhea, short stature without ambiguous external genitalia. She had a 45,X/46, XY karyotype in leukocytes. Interphase FISH revealed hidden 45,X/47,XYY/47,XXY/46,XY/46, XX mosaicism in leukocytes and urothelial cells. CONCLUSION: These findings highlight the importance of investigating sex chromosome mosaicism in other tissues. Of particular interest in cases of DSD are the cells from the urinary epithelium, which may reflect the cell composition of the urogenital ridge, the analysis of these cells should be considered within the clinical assessment of DSD patients.


Assuntos
Amenorreia/congênito , Transtornos do Desenvolvimento Sexual/diagnóstico , Mosaicismo , Aberrações dos Cromossomos Sexuais , Cromossomos Sexuais/genética , Análise Citogenética , Transtornos do Desenvolvimento Sexual/genética , Feminino , Humanos , Hibridização in Situ Fluorescente , Cariótipo , Cariotipagem , Leucócitos/citologia , Urotélio/citologia , Adulto Jovem
20.
Rev. enferm. Inst. Mex. Seguro Soc ; 29(2): 57-64, 01-abr-2021. graf, tab
Artigo em Espanhol | LILACS, BDENF - Enfermagem | ID: biblio-1354786

RESUMO

Introducción: actualmente es posible evaluar el desarrollo infantil y, con ello, proporcionar señales de las posibles alteraciones que pueden existir en los niños menores de 5 años. Objetivo: evaluar el desarrollo infantil e identificar las áreas del desarrollo afectadas en los niños de 2 a 4 años en el primer nivel de atención. Metodología: estudio transversal descriptivo en 69 niños de ambos sexos de 2 a 4 años y 11 meses de edad, a quienes se les aplicó en el consultorio la prueba Evaluación del Desarrollo Infantil. Los datos se expresaron como media ± desviación estándar, porcentajes y prueba de ji al cuadrado, considerando como significancia estadística p < 0.05. Resultados: se incluyeron 44 (63.7%) niños y 25 (36.3%) niñas, con una edad media de 2.57 ± 0.63. El desarrollo infantil fue normal en 49 niños (71%), se observó rezago en el desarrollo en 9 niños (13%) y riesgo de retraso en 11 niños (16%). Las áreas que más afectaron el resultado global fueron motor grueso (p = 0.001), motor fino (p = 0.00) y lenguaje (p = 0.00). Conclusiones: es importante evaluar el desarrollo infantil en los niños menores de 5 años, ya que el riesgo de retraso en el desarrollo se sigue detectando en una proporción considerable, lo que a futuro puede aumentar el costo de su atención.


Introduction: Currently it is possible to evaluate child development and with it, provide signs of the possible alterations that may exist in children under 5 years of age. Objective: To evaluate child development and identify affected areas of development in children from 2 to 4 years of age who attended UMF. Method: Descriptive study, we included 69 patients, both sexes from 2 to 4 years 11 months of age who agreed to participate. The Child Development Assessment test was used. The data were expressed + SD, and percentages, Chi square, significance p < 0.05. Results: 44 (63.7%) men and 25 (36.2%) women were included, mean age 2.57 + 0.63; child development was normal in 49 children (71%), developmental delay in 9 children (13%) and risk of delay in 11 children (16%); The areas that most affected the overall result were: gross motor (p = 0.001), fine motor (p = 0.00) and language (p = 0.00). Conclusions: It is important to carry out the Evaluation of Child Development in children under 5 years of age, since the risk of delay in development continues to be detected in a considerable proportion, which in the future may increase the cost of their care.


Assuntos
Humanos , Pré-Escolar , Criança , Atenção Primária à Saúde , Desenvolvimento Infantil , Saúde da Criança , Menores de Idade , Avaliação em Saúde , Pré-Escolar , Estudos Transversais , Estudo de Avaliação
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA