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Introduction: SARS-CoV-2 viral load has been related to COVID-19 severity. The main aim of this study was to evaluate the relationship between SARS-CoV-2 viremia and SNPs in genes previously studied by our group as predictors of COVID-19 severity. Materials and methods: Retrospective observational study including 340 patients hospitalized for COVID-19 in the University Hospital La Princesa between March 2020 and December 2021, with at least one viremia determination. Positive viremia was considered when viral load was above the quantifiable threshold (20 copies/ml). A total of 38 SNPs were genotyped. To study their association with viremia a multivariate logistic regression was performed. Results: The mean age of the studied population was 64.5 years (SD 16.6), 60.9% patients were male and 79.4% white non-Hispanic. Only 126 patients (37.1%) had at least one positive viremia. After adjustment by confounders, the presence of the minor alleles of rs2071746 (HMOX1; T/T genotype OR 9.9 p < 0.0001), rs78958998 (probably associated with SERPING1 expression; A/T genotype OR 2.3, p = 0.04 and T/T genotype OR 12.9, p < 0.0001), and rs713400 (eQTL for TMPRSS2; C/T + T/T genotype OR 1.86, p = 0.10) were associated with higher risk of viremia, whereas the minor alleles of rs11052877 (CD69; A/G genotype OR 0.5, p = 0.04 and G/G genotype OR 0.3, p = 0.01), rs2660 (OAS1; A/G genotype OR 0.6, p = 0.08), rs896 (VIPR1; T/T genotype OR 0.4, p = 0.02) and rs33980500 (TRAF3IP2; C/T + T/T genotype OR 0.3, p = 0.01) were associated with lower risk of viremia. Conclusion: Genetic variants in HMOX1 (rs2071746), SERPING1 (rs78958998), TMPRSS2 (rs713400), CD69 (rs11052877), TRAF3IP2 (rs33980500), OAS1 (rs2660) and VIPR1 (rs896) could explain heterogeneity in SARS-CoV-2 viremia in our population.
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BACKGROUND: Around 15 million premature babies are born annually, requiring specialized care. Incubators are vital for maintaining their body temperature, which is crucial for their well-being. Ensuring optimal conditions in incubators, including constant temperature, oxygen control, and comfort, is essential for improving the care and survival rates of these infants. METHODS: To address this, an IoT-based monitoring system was developed in a hospital setting. The system comprised hardware components such as sensors and a microcontroller, along with software components including a database and a web application. The microcontroller collected data from the sensors, which was then transmitted to a broker via WiFi using the MQTT protocol. The broker validated and stored the data in the database, while the web application provided real-time access, alerts, and event recording. RESULTS: Two certified devices were created, employing high quality components. The system was successfully implemented and tested in both the biomedical engineering laboratory and the neonatology service of the hospital. The results of the pilot test supported the concept of IoT-based technology, demonstrating satisfactory responses in temperature, humidity, and sound variables within the incubators. CONCLUSIONS: The monitoring system facilitated efficient record traceability, allowing access to data over various timeframes. It also captured event records (alerts) related to variable problems, providing information on duration, date, hour, and minutes. Overall, the system offered valuable insights and enhanced monitoring capabilities for neonatal care.
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Internet das Coisas , Neonatologia , Recém-Nascido , Lactente , Humanos , Monitorização Fisiológica , Incubadoras , HospitaisRESUMO
BACKGROUND: Childhood tuberculosis continues to be a major public health problem. Although the visibility of the epidemic in this population group has increased, further research is needed. OBJECTIVE: To design, implement and evaluate an integrated care strategy for children under five years old who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients in Medellín and the Metropolitan Area. METHODS: A quasi-experimental study in which approximately 300 children who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients from Medellín and the Metropolitan Area will be evaluated and recruited over one year. A subgroup of these children, estimated at 85, who require treatment for latent tuberculosis, will receive an integrated care strategy that includes: some modifications of the current standardized scheme in Colombia, with rifampicin treatment daily for four months, follow-up under the project scheme with nursing personnel, general practitioners, specialists, professionals from other disciplines such as social work, psychology, and nutritionist. Additionally, transportation and food assistance will be provided to encourage treatment compliance. This strategy will be compared with isoniazid treatment received by a cohort of children between 2015 and 2018 following the standardized scheme in the country. The study was approved by the CIB Research Ethics Committee and UPB. CLINICALTRIALS: gov identifier NCT04331262. DISCUSSION: This study is expected to contribute to the development of integrated care strategies for the treatment of latent tuberculosis in children. The results will have a direct impact on the management of childhood tuberculosis contributing to achieving the goals proposed by the World Health Organization's End TB Strategy. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT04331262 . Implementation of an Integrated Care Strategy for Children Contacts of Patients with Tuberculosis. Registered 2 April 2020.
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Prestação Integrada de Cuidados de Saúde , Tuberculose Latente , Tuberculose Pulmonar , Tuberculose , Humanos , Criança , Pré-Escolar , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Tuberculose Pulmonar/tratamento farmacológico , IsoniazidaRESUMO
The educational framework-Conceive, Design, Implement, and Operate-is part of an international proposal to improve education in the field of engineering, emphasizing how to teach engineering comprehensively, which allows the standardization of skills in professionals as a model for teaching engineering. Moreover, problem-based learning allows students to experiment with challenging situations through cases that simulate natural contexts with their profession. The integration of these two education strategies applied to the Internet of Things (IoT) Education for Industry 4.0 has promoted the generation of teaching challenges. Our education strategy proposes the synergy between laboratory guides and the classroom with the following actions: the content of the topic is presented, followed by the presentation of an issue focused into a realistic context, with practical exercises integrating software and hardware for the deployment of the solution to be reported as a final project. Moreover, undergraduate students in the biomedical engineering area acquired new knowledge about IoT, but at the same time, they may develop skills in the field of programming and structuring different architectures to solve real-world problems. Finally, traditional models of education require new teaching initiatives in the field of biomedical engineering concerning the current challenges and needs of the labor market.
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Engenharia , Aprendizagem Baseada em Problemas , Humanos , Aprendizagem Baseada em Problemas/métodos , Engenharia/educação , Engenharia Biomédica , Estudantes , InternetRESUMO
BACKGROUND: The French PRODIGE 7 trial, published on January 2021, has raised doubts about the specific survival benefit provided by HIPEC with oxaliplatin 460 mg/m2 (30 minutes) for the treatment of peritoneal metastases from colorectal cancer. However, several methodological flaws have been identified in PRODIGE 7, specially the HIPEC protocol or the choice of overall survival as the main endpoint, so its results have not been assumed as definitive, emphasizing the need for further research on HIPEC. It seems that the HIPEC protocol with high-dose mytomicin-C (35 mg/m2) is the preferred regime to evaluate in future clinical studies. METHODS: GECOP-MMC is a prospective, open-label, randomized, multicenter phase IV clinical trial that aims to evaluate the effectiveness of HIPEC with high-dose mytomicin-C in preventing the development of peritoneal recurrence in patients with limited peritoneal metastasis from colon cancer (not rectal), after complete surgical cytoreduction. This study will be performed in 31 Spanish HIPEC centres, starting in March 2022. Additional international recruiting centres are under consideration. Two hundred sixteen patients with PCI ≤ 20, in which complete cytoreduction (CCS 0) has been obtained, will be randomized intraoperatively to arm 1 (with HIPEC) or arm 2 (without HIPEC). We will stratified randomization by surgical PCI (1-10; 11-15; 16-20). Patients in both arms will be treated with personalized systemic chemotherapy. Primary endpoint is peritoneal recurrence-free survival at 3 years. An ancillary study will evaluate the correlation between surgical and pathological PCI, comparing their respective prognostic values. DISCUSSION: HIPEC with high-dose mytomicin-C, in patients with limited (PCI ≤ 20) and completely resected (CCS 0) peritoneal metastases, is assumed to reduce the expected risk of peritoneal recurrence from 50 to 30% at 3 years. TRIAL REGISTRATION: EudraCT number: 2019-004679-37; Clinicaltrials.gov: NCT05250648 (registration date 02/22/2022, ).
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Neoplasias do Colo , Neoplasias Colorretais , Hipertermia Induzida , Intervenção Coronária Percutânea , Neoplasias Peritoneais , Neoplasias Retais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/cirurgia , Neoplasias Colorretais/patologia , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução , Humanos , Hipertermia Induzida/métodos , Quimioterapia Intraperitoneal Hipertérmica , Mitomicina/uso terapêutico , Neoplasias Peritoneais/secundário , Estudos Prospectivos , Neoplasias Retais/terapia , Taxa de SobrevidaRESUMO
The adverse environmental conditions found in the periodontium during periodontitis pathogenesis stimulate local autophagy responses, mainly due to a continuous inflammatory response against the dysbiotic subgingival microbiome. The junctional epithelium represents the main site of the initial interaction between the host and the dysbiotic biofilm. Here, we investigated the role of autophagy in junctional epithelium keratinocytes (JEKs) in response to Aggregatibacter actinomycetemcomitans or its purified lipopolysaccharides (LPS). Immunofluorescence confocal analysis revealed an extensive nuclear translocation of transcription factor EB (TFEB) and consequently, an increase in autophagy markers and LC3-turnover assessed by immunoblotting and qRT-PCR. Correspondingly, challenged JEKs showed a punctuate cytosolic profile of LC3 protein contrasting with the diffuse distribution observed in untreated controls. Three-dimensional reconstructions of confocal images displayed a close association between intracellular bacteria and LC3-positive vesicles. Similarly, a close association between autophagic vesicles and the protein p62 was observed in challenged JEKs, indicating that p62 is the main adapter protein recruited during A. actinomycetemcomitans infection. Finally, the pharmacological inhibition of autophagy significantly increased the number of bacteria-infected cells as well as their death, similar to treatment with LPS. Our results indicate that A. actinomycetemcomitans infection induces autophagy in JEKs, and this homeostatic process has a cytoprotective effect on the host cells during the early stages of infection.
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Aggregatibacter actinomycetemcomitans/fisiologia , Autofagia , Inserção Epitelial/patologia , Queratinócitos/microbiologia , Queratinócitos/patologia , Fatores de Transcrição de Zíper de Leucina e Hélice-Alça-Hélix Básicos/metabolismo , Biomarcadores/metabolismo , Contagem de Células , Linhagem Celular , Núcleo Celular/metabolismo , Sobrevivência Celular , Humanos , Imageamento Tridimensional , Lipopolissacarídeos/isolamento & purificação , Modelos Biológicos , Transporte Proteico , Proteína Sequestossoma-1/metabolismoRESUMO
Background: Drug-induced esophagitis is an uncommon diagnosis in the pediatric population. The following is a report of six adolescents with L-arginine-induced esophagitis. Case reports: All patients were under treatment with L-arginine for short stature. After using the prescribed medication for 1-3 months, all cases started with severe retrosternal pain, odynophagia, and dysphagia. The upper gastrointestinal endoscopies showed ulcers located in the mid esophageal mucosa. Conclusions: In the presence of acute severe odynophagia, dysphagia, and retrosternal pain, drug-induced esophagitis should be considered as a possible diagnosis. Treatment includes liquid diet, pain control, sucralfate, omeprazole, and interruption of L-arginine. In addition, the physician should explain preventive measures focused on patient and family education on the drug side effects and precise instructions on how to take medications, as well as a careful balance of risk and benefits of any medication. At present, there are no clinical trials that support the use of L-arginine in treatment of short stature.
Introducción: La esofagitis inducida por medicamentos es un diagnóstico poco frecuente en pacientes pediátricos. A continuación, se describe una serie de seis casos de pacientes menores de 15 años con esofagitis inducida por L-arginina. Casos clínicos: Los seis casos se encontraban en tratamiento con L-arginina por talla baja e iniciaron con dolor retroesternal, odinofagia y disfagia de rápida instalación. Cuatro de ellos acudieron al servicio de urgencias por la intensidad de los síntomas. Los hallazgos en la endoscopia del tubo digestivo alto fueron úlceras en la mucosa del esófago a la altura del tercio medio, zona de estrechez natural por la compresión del bronquio izquierdo. Conclusiones: En presencia de odinofagia, disfagia, dolor retroesternal y el antecedente de la ingesta de L-arginina, la esofagitis inducida por fármacos debe considerarse como una posibilidad diagnóstica. El tratamiento está basado en el manejo del dolor, sucralfato, omeprazol, así como la suspensión del medicamento y medidas preventivas centradas en la educación del paciente y los familiares sobre los riesgos y beneficios de un medicamento y la forma correcta de administrarlo.
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Arginina/efeitos adversos , Mucosa Esofágica/efeitos dos fármacos , Esofagite/induzido quimicamente , Adolescente , Arginina/administração & dosagem , Dor no Peito/etiologia , Criança , Transtornos de Deglutição/etiologia , Mucosa Esofágica/patologia , Esofagite/diagnóstico , Esofagite/terapia , Feminino , Humanos , Masculino , Omeprazol/administração & dosagem , Sucralfato/administração & dosagem , Úlcera/etiologiaRESUMO
Abstract Background: Drug-induced esophagitis is an uncommon diagnosis in the pediatric population. The following is a report of six adolescents with L-arginine-induced esophagitis. Case reports: All patients were under treatment with L-arginine for short stature. After using the prescribed medication for 1-3 months, all cases started with severe retrosternal pain, odynophagia, and dysphagia. The upper gastrointestinal endoscopies showed ulcers located in the mid esophageal mucosa. Conclusions: In the presence of acute severe odynophagia, dysphagia, and retrosternal pain, drug-induced esophagitis should be considered as a possible diagnosis. Treatment includes liquid diet, pain control, sucralfate, omeprazole, and interruption of L-arginine. In addition, the physician should explain preventive measures focused on patient and family education on the drug side effects and precise instructions on how to take medications, as well as a careful balance of risk and benefits of any medication. At present, there are no clinical trials that support the use of L-arginine in treatment of short stature.
Resumen Introducción: La esofagitis inducida por medicamentos es un diagnóstico poco frecuente en pacientes pediátricos. A continuación, se describe una serie de seis casos de pacientes menores de 15 años con esofagitis inducida por L-arginina. Casos clínicos: Los seis casos se encontraban en tratamiento con L-arginina por talla baja e iniciaron con dolor retroesternal, odinofagia y disfagia de rápida instalación. Cuatro de ellos acudieron al servicio de urgencias por la intensidad de los síntomas. Los hallazgos en la endoscopia del tubo digestivo alto fueron úlceras en la mucosa del esófago a la altura del tercio medio, zona de estrechez natural por la compresión del bronquio izquierdo. Conclusiones: En presencia de odinofagia, disfagia, dolor retroesternal y el antecedente de la ingesta de L-arginina, la esofagitis inducida por fármacos debe considerarse como una posibilidad diagnóstica. El tratamiento está basado en el manejo del dolor, sucralfato, omeprazol, así como la suspensión del medicamento y medidas preventivas centradas en la educación del paciente y los familiares sobre los riesgos y beneficios de un medicamento y la forma correcta de administrarlo.
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Adolescente , Criança , Feminino , Humanos , Masculino , Arginina/efeitos adversos , Esofagite/induzido quimicamente , Mucosa Esofágica/efeitos dos fármacos , Arginina/administração & dosagem , Úlcera/etiologia , Dor no Peito/etiologia , Omeprazol/administração & dosagem , Sucralfato/administração & dosagem , Transtornos de Deglutição/etiologia , Esofagite/diagnóstico , Esofagite/terapia , Mucosa Esofágica/patologiaRESUMO
BACKGROUND AND OBJECTIVES: To validate and analyze the results of intralesional photodynamic therapy in the treatment of complex anal fistula. STUDY DESIGN/MATERIALS AND METHODS: This prospective multicentric observational study enrolled patients treated for complex anal fistula who underwent intralesional photodynamic therapy (i-PDT). The included patients were treated from January 2016 to December 2018 with a minimum follow-up of 1 year to evaluate recurrence, continence and postoperative morbidity. Intralesional 5-aminolevulinic acid (ALA) gel (2%) was injected directly into the fistula. The internal and external orifices were closed. After an incubation period of 2 hours, the fistula was irradiated using an optical fiber connected to a red laser (Multidiode 630 PDT) operating at 1 W/cm for 3 minutes (180 J). RESULTS: In total, 49 patients were included (61.2% male). The mean age was 48 years, and the mean duration of fistula was 13 months. Of the fistulas included, 75.5% were medium transphincteric, and 24.5% were high transphincteric. The median fistula length was 4 ± 1,14 cm (range: 3-5). A total of 41 patients (83.7%) had a previous history of fistula surgery. Preoperatively, some degree of anal incontinence was found in 5 patients (10.2%). No center reported any other procedure-related complications intraoperatively. Phototoxicity was found in one patient. In the first 48 hours after the procedure, fever was reported in 2 patients (4%). At the end of follow-up, total healing was observed in 32/49 patients (65.3%). No patient reported new incontinence postoperatively. CONCLUSION: i-PDT could be considered a good choice in patients with complex anal fistulas to avoid surgery and its complications. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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Ácido Aminolevulínico/administração & dosagem , Fotoquimioterapia , Fármacos Fotossensibilizantes/administração & dosagem , Fístula Retal/tratamento farmacológico , Fístula Retal/cirurgia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fístula Retal/patologia , Reprodutibilidade dos Testes , Técnicas de Sutura , Resultado do Tratamento , Adulto JovemRESUMO
Las neuropatías agrupan un gran número de patologías de nervio periférico; estas pueden ser adquiridas o hereditarias, de origen sistémico o restringidas a un número de nervios. Las neuropatías son causa de dolor e incapacidad y requieren un manejo multidisciplinar para mejorar la calidad de vida de los pacientes. Dentro de ellas tenemos la neuropatía motora multifocal (NMM), también denominada 'neuropatía motora multifocal con bloqueo de conducción' (NMMCB), la cual es una neuropatía adquirida, inflamatoria, poco frecuente, caracterizada por debilidad en las extremidades, sin pérdida sensorial, progresiva y asimétrica. Se presenta además un bloqueo persistente de la conducción nerviosa que afecta las fibras motoras de forma selectiva.
Neuropathies group a large number of peripheral nerve pathologies; these can be acquired or hereditary, of systemic origin or restricted to a number of nerves. Neuropathies cause pain and disability and require multidisciplinary management to improve the quality of life of patients. Among them we have multifocal motor neuropathy (MMN), also called 'multifocal motor neuropathy with conduction block' (MMPNB), which is an acquired, inflammatory, rare neuropathy, characterized by weakness in the extremities, without sensory loss, progressive and asymmetric. There is also a persistent nerve conduction block that selectively affects motor fibers.
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Humanos , Masculino , Adulto , Neuropatia Hereditária Motora e Sensorial , Malformações do Sistema NervosoRESUMO
La infección por el nuevo coronavirus (Covid-19), descrita desde diciembre de 2019, ha ocasionado una pandemia de gran magnitud con consecuencias devastadoras a nivel mundial e implicaciones en la salud de las personas que la padecen y presentan síntomas, lo cual genera complicaciones a corto y a largo plazo, éstas últimas aún desconocidas en su totalidad. Se han descrito complicaciones cardiovasculares secundarias a la infección por Covid -19 entre las que se cuenta la aparición de arritmias, infarto agudo del miocardio, miocarditis y eventos trombótico. Sin embargo, las complicaciones a largo plazo aún no se dilucidan en su totalidad teniendo en cuenta el corto periodo de evolución de la enfermedad. A pesar de esto, es clara la asociación que existe entre las enfermedades cardiovasculares previas y la coinfección por Covid-19, lo cual favorece la aparición de enfermedades severas y peores desenlaces en las personas que las presentan. Teniendo en cuenta esta asociación, es importante crear o fortalecer programas de rehabilitación cardiaca que utilicen herramientas tecnológicas para favorecer la telerrehablitación y así mejorar la calidad de vida de las personas, favoreciendo su independencia.
The infection by the new coronavirus (Covid-19), described since December 2019, has caused a pandemic of great magnitude with devastating consequences worldwide and implications in the health of people who suffer from it and present symptoms, which generates short and long term complications, the latter still unknown in its entirety. Cardiovascular complications secondary to Covid-19 infection have been described, including arrhythmias, acute myocardial infarction, myocarditis and thrombotic events. However, long-term complications are not yet fully elucidated considering the short evolution period of the disease. Despite this, there is a clear association between previous cardiovascular disease and Covid-19 coinfection, which favors the onset of severe disease and worse outcomes in those who present it. Taking this association into account, it is important to create or strengthen cardiac rehabilitation programs that use technological tools to favor telerehablitation and thus improve the quality of life of people, favoring their independence.
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Humanos , TelerreabilitaçãoRESUMO
The genus Bannoa consists of four described species associated with dead leaves in southwestern Japan. In this study, we describe three new species, Bannoa guamensis, B. rosea, and B. tropicalis, from the South Pacific island of Guam and Guyana in South America. Isolates were obtained from surfaces of diseased and healthy leaves of plants in the Euphorbiaceae, Asteraceae, and Poaceae. DNA sequences from four gene regions, including nuc rDNA internal transcribed spacer ITS1-5.8S-ITS2 (ITS), D1-D2 domains of nuc 28S rDNA (28S), nuc 18S rDNA (18S), and a portion of tef1, which encodes translation elongation factor 1-alpha, were produced for phylogenetic analysis. Intercompatibility tests were performed, and subsequent development of clamp connections and basidia were documented for B. tropicalis. Potential life history strategies and association with diseased leaves, including rust-infected leaves, were evaluated across the genus. This is the first report of a species of Bannoa from South America.
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Basidiomycota/classificação , Filogenia , Folhas de Planta/microbiologia , Clima Tropical , Basidiomycota/isolamento & purificação , DNA Espaçador Ribossômico/genética , Guiana , Hifas , RNA Ribossômico 28S/genética , RNA Ribossômico 5,8S/genética , Análise de Sequência de DNARESUMO
Purpose: The purpose of this study is to answer two research questions: (1) What is the clinical evidence for the reported outcomes in studies on electronic pillboxes for older adults? and (2) What is the technology readiness level (TRL) of the electronic pillboxes used, or intended to be used, for older adults?Methods: The scholarly literature was systematically searched and analyzed. Articles were included if they reported results about electronic pillboxes that were used or intended to be used for older adults' medication.Results: Clinical studies used commercially well-established electronic pillboxes with a high TRL. New electronic pillboxes in development had a low TRL. The discovered outcome was mainly adherence to medication. The overall mean adherence to medication regimens for all the studies using an electronic pillbox was higher than the gold standard of a good adherence level cut-off point (mean adherence 88.8%>80%). However, we found a large variation in this variable (SD = 10.7). With regard to an older adult population's adherence to medication regimens, for the outcome variable of those who had undergone a kidney transplant, the clinical evidence that electronic pillboxes have a positive impact was strong (1b); for those with a chronic hepatitis C medical condition, the clinical evidence was medium (3), and for those with arterial hypertension and multiple chronic (diabetes and hypertension) medical conditions, the clinical evidence was weak (5).Conclusion: More research is needed in this area using designs that provide greater validity.Implications for RehabilitationElectronic pillboxes with multiple reminders such as the "voice of a friend" or relative, which implies that electronic pillboxes which adopt "a social role" are advisable.An unequal level of clinical evidence that electronic pillboxes have a positive impact on the adherence outcome variable was found.For new electronic pillboxes still in development that specifically take into account older adults' needs, the TRL is still low; as a result, they could not be tested in real settings.
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Monitoramento de Medicamentos/instrumentação , Eletrônica , Adesão à Medicação , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-IdadeRESUMO
Resumen Introducción: la enfermedad cardiovascular es la principal causa de muerte en Colombia. Se han demostrado peores resultados clínicos en las mujeres a pesar de ser más prevalente en hombres. Objetivo: describir las diferencias angiográficas y epidemiológicas entre género de pacientes con síndrome coronario agudo. Métodos: se hizo un estudio descriptivo retrospectivo entre 2013-2014, en el que se incluyeron pacientes con síndrome coronario agudo que fueron separados por género. Se describieron factores de riesgo cardiovascular, biomarcadores de isquemia, angiografía coronaria y mortalidad intrahospitalaria. Los datos se analizaron en SPSS 20.0 Resultados: se estudiaron 148 pacientes; 35% tenían infarto con elevación del ST, 42,9% sin elevación del ST y 21% angina inestable. La prevalencia de enfermedad renal crónica para hombres y mujeres fue de 18,9 vs. 4,1% (p = 0,004); ataque cerebrovascular 2,7% vs. 14,9% (p = 0,009), de predominio femenino, este último. El valor de troponina fue mayor en hombres, 71,6 vs. 56,8% (p = 0,043). Las mujeres requirieron mayor implante de stent, 72,6 vs. 58,1% (p = 0,002); sin embargo, en el género masculino la prevalencia de enfermedad multivaso con indicación de revascularización coronaria fue mayor, 25,7 vs. 6,8% (p = 0,002). La afectación simultánea de las arterias descendente anterior proximal y circunfleja como criterio de severidad, fue mayor en hombres, 5,4 vs. 16,4%, con diferencias significativas (p = 0,032). Conclusiones: este estudio plantea la posibilidad de que en nuestra población pueden existir diferencias clínicas y fisiopatológicas entre género, constituyéndose en un factor fundamental para posibles cambios en su diagnóstico e intervención.
Abstract Introduction: Cardiovascular disease is the primary cause of death in Colombia. Poorer results have been shown in women, despite it being more prevalent in males. Objective: To describe the between-gender angiographic and epidemiological differences in patients with acute coronary syndrome. Methods: Between the years 2013 and 2014, a retrospective descriptive study was performed on patients with acute coronary syndrome that were grouped according to gender. An analysis was made of cardiovascular risk factors, ischaemia biomarkers, coronary angiography, and hospital mortality. The data were analysed using the SPSS 20.0 statistics package. Results: Of the 148 patients studied, 35% had an infarction with an ST elevation, 42.9% an infarction with no ST elevation, and 21% with unstable angina. The prevalence of chronic kidney disease for men and women was 18.9% vs. 4.1% (P=.004), and stroke 2.7% vs. 14.9% (P=.009), with the latter predominantly female. The Troponin value was higher in males, 71.6% vs. 56.8% (P=.043). The women required more stent implants, 72.6% vs. 58.1% (P=.002). However, the prevalence of multivessel disease with a coronary re-vascularisation indication was higher in males, 25.7% vs. 6.8% (P=.002). The simultaneous involvement of the proximal anterior descending and circumflex arteries as a criterion of severity was higher in males, 16.4% vs. 5.4%, with significant differences (P=.032). Conclusions: This study establishes the possibility that there can be between-gender clinical and pathophysiological differences, which may be a fundamental factor for possible changes in its diagnosis and intervention.
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Humanos , Identidade de Gênero , Síndrome Coronariana AgudaRESUMO
The authors aimed to compare surrogate markers of atherosclerosis (pulse wave velocity, intima-media thickness) between adults with and without Down syndrome (DS) and to assess the impact of parathyroid hormone levels and classic cardiovascular risk factors on arterial stiffness. After comparing 51 adults with DS and 51 healthy adults (siblings of DS individuals), the authors found that adults with DS seem to have lower arterial stiffness, as a result of chronic hypotension. Subclinical atherosclerosis parameters do not correlate with traditional cardiovascular risk factors in adults with DS, thus raising the hypothesis that classic predictive models for cardiovascular disease are not valid in this population. Hyperparathyroidism could play an important role in arterial damage in these individuals. The lower than expected prevalence of obesity and dyslipidemia could be explained by better eating habits, with this study being the first to address the anthropometric and clinical profile of a Mediterranean cohort of adults with DS.
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Aterosclerose/diagnóstico , Síndrome de Down/complicações , Adulto , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , Estudos Transversais , Síndrome de Down/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Adulto JovemRESUMO
El síndrome de Brugada (SB) es una enfermedad arritmogénica caracterizada por un patrón electrocardiográfico en el que hay una elevación del segmento ST en las derivaciones V1 a V3, y un patrón de bloqueo de la rama derecha. Es una patología poco frecuente en nuestro medio, con mayor prevalencia en países como: el Japón y en el suroeste de Asia. Su etiología es multifactorial y aún es tema de debate. Los diagnósticos diferenciales abarcan: el síndrome coronario agudo, el bloqueo de rama derecha y la pericarditis. A continuación se describe el caso con un patrón electrocardiográfico típico que se manifiesta con síncope y fibrilación auricular.
Brugada syndrome (BS) is an arrhythmogenic condition characterised by an electrocardiographic pattern where there is an elevation of the ST segment in leads V1 to V3, and a right bundle branch block. It is an uncommon condition in our environment, being more prevalent in other areas such as Japan and southwest Asia. Its aetiology is multifactorial and is still under discussion. Differential diagnoses cover acute coronary syndrome, right bundle branch block and pericarditis. We describe a case with a typical electrocardiographic pattern manifesting with syncope and atrial fibrillation.
Assuntos
Humanos , Fibrilação Atrial , SíncopeRESUMO
This study assessed bioremediation of acid rock drainage in simulated permeable reactive barriers (PRB) using algae, Chlorella sorokiniana, as the sole electron donor for sulfate-reducing bacteria. Lipid extracted algae (LEA), the residues of biodiesel production, were compared with whole cell algae (WCA) as an electron donor to promote sulfate-reducing activity. Inoculated columns containing anaerobic granular sludge were fed a synthetic medium containing H2SO4 and Cu(2+). Sulfate, sulfide, Cu(2+) and pH were monitored throughout the experiment of 123d. Cu recovered in the column packing at the end of the experiment was evaluated using sequential extraction. Both WCA and LEA promoted 80% of sulfate removal (12.7mg SO4(2-) d(-1)) enabling near complete Cu removal (>99.5%) and alkalinity generation raising the effluent pH to 6.5. No noteworthy sulfate reduction, alkalinity formation and Cu(2+) removal were observed in the endogenous control. In algae amended-columns, Cu(2+) was precipitated with biogenic H2S produced by sulfate reduction. Formation of CuS was evidenced by sequential extraction and X-ray diffraction. LEA and WCA provided similar levels of electron donor based on the COD balance. The results demonstrate an innovative passive remediation system using residual algae biomass from the biodiesel industry.
Assuntos
Chlorella/química , Cobre/análise , Sulfatos/química , Bactérias Redutoras de Enxofre/metabolismo , Poluentes Químicos da Água/análise , Purificação da Água/métodos , Biodegradação Ambiental , Análise da Demanda Biológica de Oxigênio , Reatores Biológicos , Chlorella/metabolismo , Elétrons , Concentração de Íons de Hidrogênio , Modelos Teóricos , Oxirredução , Sulfatos/metabolismo , Sulfetos/químicaRESUMO
This study assessed the bioremediation of acid rock drainage (ARD) in flow-through columns testing zero-valent iron (ZVI) for the first time as the sole exogenous electron donor to drive sulfate-reducing bacteria in permeable reactive barriers. Columns containing ZVI, limestone or a mixture of both materials were inoculated with an anaerobic mixed culture and fed a synthetic ARD containing sulfuric acid and heavy metals (initially copper, and later also cadmium and lead). ZVI significantly enhanced sulfate reduction and the heavy metals were extensively removed (>99.7%). Solid-phase analyses showed that heavy metals were precipitated with biogenic sulfide in the columns packed with ZVI. Excess sulfide was sequestered by iron, preventing the discharge of dissolved sulfide. In the absence of ZVI, heavy metals were also significantly removed (>99.8%) due to precipitation with hydroxide and carbonate ions released from the limestone. Vertical-profiles of heavy metals in the columns packing, at the end of the experiment, demonstrated that the ZVI columns still had excess capacity to remove heavy metals, while the capacity of the limestone control column was approaching saturation. The ZVI provided conditions that enhanced sulfate reduction and generated alkalinity. Collectively, the results demonstrate an innovative passive ARD remediation process using ZVI as sole electron-donor.