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1.
Int J Infect Dis ; 143: 107041, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38583824

RESUMO

OBJECTIVES: The objective of this study was to explore the factors and outcomes associated with gestational syphilis in Peru. METHODS: Women from the miscarriage, vaginal delivery, and C-section wards from a large maternity hospital in Lima with or without syphilis diagnosis were enrolled and their pregnancy outcomes compared. Maternal syphilis status using maternal blood and child serostatus using cord blood were determined by rapid plasma reagin (RPR) and rapid syphilis tests. The newborns' clinical records were used to determine congenital syphilis. RESULTS: A total of 340 women were enrolled, 197 were positive and 143 were negative for RPR/rapid syphilis tests. Antibody titers in sera from cord and maternal blood were comparable with RPR titers and were highly correlated (rho = 0.82, P <0.001). Young age (P = 0.009) and lower birth weight (P = 0.029) were associated with gestational syphilis. Of the women with gestational syphilis, 76% had received proper treatment. Mothers of all newborns with congenital syphilis also received appropriate treatment. Treatment of their sexual partners was not documented. CONCLUSIONS: Syphilis during pregnancy remains a major cause of the fetal loss and devastating effects of congenital syphilis in newborns.


Assuntos
Complicações Infecciosas na Gravidez , Sífilis Congênita , Sífilis , Humanos , Feminino , Gravidez , Peru/epidemiologia , Sífilis Congênita/epidemiologia , Sífilis Congênita/diagnóstico , Adulto , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Estudos Prospectivos , Recém-Nascido , Sífilis/epidemiologia , Sífilis/diagnóstico , Adulto Jovem , Resultado da Gravidez/epidemiologia , Transmissão Vertical de Doenças Infecciosas , Sorodiagnóstico da Sífilis , Adolescente , Sangue Fetal
2.
J Consult Clin Psychol ; 91(12): 694-707, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38032621

RESUMO

OBJECTIVE: Untreated mental disorders are important among low- and middle-income country (LMIC) university students in Latin America, where barriers to treatment are high. Scalable interventions are needed. This study compared transdiagnostic self-guided and guided internet-delivered cognitive behavioral therapy (i-CBT) with treatment as usual (TAU) for clinically significant anxiety and depression among undergraduates in Colombia and Mexico. METHOD: 1,319 anxious, as determined by the Generalized Anxiety Disorder-7 (GAD-7) = 10+ and/or depressed, as determined by the Patient Health Questionnaire-9 (PHQ-9) = 10+, undergraduates (mean [SD] age = 21.4 [3.2]); 78.7% female; 55.9% first-generation university student) from seven universities in Colombia and Mexico were randomized to culturally adapted versions of self-guided i-CBT (n = 439), guided i-CBT (n = 445), or treatment as usual (TAU; n = 435). All randomized participants were reassessed 3 months after randomization. The primary outcome was remission of both anxiety (GAD-7 = 0-4) and depression (PHQ-9 = 0-4). We hypothesized that remission would be higher with guided i-CBT than with the other interventions. RESULTS: Intent-to-treat analysis found significantly higher adjusted (for university and loss to follow-up) remission rates (ARD) among participants randomized to guided i-CBT than either self-guided i-CBT (ARD = 13.1%, χ12 = 10.4, p = .001) or TAU (ARD = 11.2%, χ12 = 8.4, p = .004), but no significant difference between self-guided i-CBT and TAU (ARD = -1.9%, χ12 = 0.2, p = .63). Per-protocol sensitivity analyses and analyses of dimensional outcomes yielded similar results. CONCLUSIONS: Significant reductions in anxiety and depression among LMIC university students could be achieved with guided i-CBT, although further research is needed to determine which students would most likely benefit from this intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Assuntos
Ansiedade , Terapia Cognitivo-Comportamental , Depressão , Internet , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Ansiedade/terapia , Depressão/terapia , América Latina , Universidades , Estudantes
3.
BMC Psychol ; 11(1): 301, 2023 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-37777804

RESUMO

BACKGROUND: Self-efficacy alludes to personal competence in an individual's effectiveness when facing stressful situations. This construct has been related to different domains of the health field, finding that high levels of self-efficacy benefit human functioning and enhance well-being. METHODS: The present study aimed to determine the psychometric properties of the self-efficacy scale for managing chronic diseases (SEMCD-S) by assessing factorial, convergent and divergent validity, reliability, and measurement invariance. Likewise, the comparison of self-efficacy according to socio-demographic characteristics was proposed by contrasting latent factors. An instrumental, transactional, descriptive, and non-experimental design study was carried out with the participation of 325 Colombian senior citizens. RESULTS: The findings suggest that the scale has appropriate psychometric properties. The one-factor structure exhibited a satisfactory fit, the mean-variance extracted reported acceptable figures and the correlation analysis with other constructs supported this instrument's convergent and discriminant validity. Likewise, it was invariant to the different socio-demographic aspects examined, while the internal consistency figures were high. Differences in the means of the latent factors were only detected in the academic grade. In this case, older adults with a primary school level attained higher self-efficacy values than those who had completed high school or university studies. CONCLUSIONS: It is concluded that the self-efficacy scale for chronic disease management is a valid and reliable instrument that can be used in the Colombian context to measure and compare this construct.


Assuntos
Gerenciamento Clínico , Autoeficácia , Humanos , Idoso , Psicometria , Reprodutibilidade dos Testes , Colômbia , Doença Crônica , Inquéritos e Questionários
4.
J Behav Cogn Ther ; 33(2): 67-80, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37680902

RESUMO

This study examined descriptions of suicidal thoughts and behavior (STB) to identify risk and protective factors that may present in clinical settings among university students from Latin America. Our focus was on answering the following key questions: How are suicidal thoughts and behavior described? What are reasons for wanting to die and for living? What impact do STBs have on motivations to seek or avoid psychological treatment? To this end, 55 qualitative interviews were completed with university students from Colombia and Mexico who recently endorsed emotional difficulties in the World Mental Health International College Student (WMH-ICS) surveys. Interviews were coded to identify themes specific to STBs. Findings revealed insight on symptom presentations and consequences of STBs. Participants described uncontrollable somatic symptoms during periods of high suicide risk, which serves as a relevant clinical marker for health providers. An important reason for living was to avoid suffering for family, which was protective against suicide and motivates familial involvement in treatment planning. Participants sought solutions to emotional problems after experiencing STBs, including psychological treatment. Cultural stigma of mental illness induced feelings of shame and burden, which led to avolition, avoidance, and nondisclosure of symptom severity. This study provides insight into the utility of evaluating cultural context in (a) detecting antecedents to STBs frequently reported as somatic symptoms, (b) identifying protective factors against suicide, and (c) recognizing how stigma of mental illness and suicide, shame avoidance, and familism might influence personal motivations to seek or avoid help for emotional distress.

5.
Front Psychol ; 14: 1040110, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37292504

RESUMO

The content, management, and implementation of social skills have been developed since the end of the 20th century as a model of capabilities. Thus, as human beings develop and train their basic cognitive and perceptual-motor functions, they increase their ability to solve and cope with difficulties. This article aims to present a bibliometric and systematic review of social skills, using query sources in databases such as Web of Science (WoS) and Scopus between the years 2000 and 2022, with platforms such as Bibliometrix and Gephi. This search yielded a total of 233 records in WoS and 250 records in Scopus that were merged and, after eliminating 143 duplicate data, were consolidated into 340 records that enclose the academic production of 20 years. Through scientific mapping, the main authors, journals, and countries in this field were determined; similarly, the most relevant studies were classified into three categories, namely, classic, structural, and perspectives, which were represented by means of the metaphor of the tree of science. In addition, a program for further studies was planned, such as in-depth qualitative research measuring observationally and directly taking into account emotional expressiveness, emotional understanding, emotion regulation, and behavior, and the impact of social skills training on social problem-solving. Finally, another important aspect to mention is that this research work is useful for the scientific academic community in many areas of knowledge such as psychology, education, and managers of educational institutions.

6.
JAMA Psychiatry ; 80(8): 768-777, 2023 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-37285133

RESUMO

Importance: Guided internet-delivered cognitive behavioral therapy (i-CBT) is a low-cost way to address high unmet need for anxiety and depression treatment. Scalability could be increased if some patients were helped as much by self-guided i-CBT as guided i-CBT. Objective: To develop an individualized treatment rule using machine learning methods for guided i-CBT vs self-guided i-CBT based on a rich set of baseline predictors. Design, Setting, and Participants: This prespecified secondary analysis of an assessor-blinded, multisite randomized clinical trial of guided i-CBT, self-guided i-CBT, and treatment as usual included students in Colombia and Mexico who were seeking treatment for anxiety (defined as a 7-item Generalized Anxiety Disorder [GAD-7] score of ≥10) and/or depression (defined as a 9-item Patient Health Questionnaire [PHQ-9] score of ≥10). Study recruitment was from March 1 to October 26, 2021. Initial data analysis was conducted from May 23 to October 26, 2022. Interventions: Participants were randomized to a culturally adapted transdiagnostic i-CBT that was guided (n = 445), self-guided (n = 439), or treatment as usual (n = 435). Main Outcomes and Measures: Remission of anxiety (GAD-7 scores of ≤4) and depression (PHQ-9 scores of ≤4) 3 months after baseline. Results: The study included 1319 participants (mean [SD] age, 21.4 [3.2] years; 1038 women [78.7%]; 725 participants [55.0%] came from Mexico). A total of 1210 participants (91.7%) had significantly higher mean (SE) probabilities of joint remission of anxiety and depression with guided i-CBT (51.8% [3.0%]) than with self-guided i-CBT (37.8% [3.0%]; P = .003) or treatment as usual (40.0% [2.7%]; P = .001). The remaining 109 participants (8.3%) had low mean (SE) probabilities of joint remission of anxiety and depression across all groups (guided i-CBT: 24.5% [9.1%]; P = .007; self-guided i-CBT: 25.4% [8.8%]; P = .004; treatment as usual: 31.0% [9.4%]; P = .001). All participants with baseline anxiety had nonsignificantly higher mean (SE) probabilities of anxiety remission with guided i-CBT (62.7% [5.9%]) than the other 2 groups (self-guided i-CBT: 50.2% [6.2%]; P = .14; treatment as usual: 53.0% [6.0%]; P = .25). A total of 841 of 1177 participants (71.5%) with baseline depression had significantly higher mean (SE) probabilities of depression remission with guided i-CBT (61.5% [3.6%]) than the other 2 groups (self-guided i-CBT: 44.3% [3.7%]; P = .001; treatment as usual: 41.8% [3.2%]; P < .001). The other 336 participants (28.5%) with baseline depression had nonsignificantly higher mean (SE) probabilities of depression remission with self-guided i-CBT (54.4% [6.0%]) than guided i-CBT (39.8% [5.4%]; P = .07). Conclusions and Relevance: Guided i-CBT yielded the highest probabilities of remission of anxiety and depression for most participants; however, these differences were nonsignificant for anxiety. Some participants had the highest probabilities of remission of depression with self-guided i-CBT. Information about this variation could be used to optimize allocation of guided and self-guided i-CBT in resource-constrained settings. Trial Registration: ClinicalTrials.gov Identifier: NCT04780542.


Assuntos
Terapia Cognitivo-Comportamental , Depressão , Humanos , Feminino , Adulto Jovem , Adulto , Depressão/terapia , Universidades , Ansiedade/terapia , Transtornos de Ansiedade/terapia , Transtornos de Ansiedade/psicologia , Terapia Cognitivo-Comportamental/métodos , Resultado do Tratamento , Internet
7.
Heliyon ; 9(5): e16020, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37153411

RESUMO

Purpose: To correlate the chest computed tomography severity score (CT-SS) with the need for mechanical ventilation and mortality in hospitalized patients with COVID-19. Materials and methods: The chest CT images of 224 inpatients with COVID-19, confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR), were retrospectively reviewed from April 1 to 25, 2020, in a tertiary health care center. We calculated the CT-SS (dividing each lung into 20 segments and assigning scores of 0, 1, and 2 due to opacification involving 0%, <50%, and ≥50% of each region for a global range of 0-40 points, including both lungs), and collected clinical data. The receiver operating characteristic curve and Youden Index analysis was performed to calculate the CT-SS threshold and accuracy for classification for risk of mortality or MV requirement. Results: 136 men and 88 women were recruited, with an age range of 23-91 years and a mean of 50.17 years; 79 met the MV criteria, and 53 were nonsurvivors. The optimal threshold was >27.5 points for mortality (area under ROC curve >0.96), with a sensitivity of 93% and specificity of 87%, and >25.5 points for the need for MV (area under ROC curve >0.94), with a sensitivity of 90% and specificity of 89%. The Kaplan-Meier curves show a significant difference in mortality by the CT-SS threshold (Log Rank p < 0.001). Conclusions: In our cohort of hospitalized patients with COVID-19, the CT-SS accurately discriminates the need for MV and mortality risk. In conjunction with clinical status and laboratory data, the CT-SS may be a useful imaging tool that could be included in establishing a prognosis for this population.

8.
Front Psychol ; 14: 1106563, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37089743

RESUMO

The purpose of the present study was to establish the association between self-efficacy, perception of disease, emotional regulation, and fatigue and the health-related quality of life in older adults living in the departments of Cesar and Atlántico in Colombia and who have been diagnosed with a chronic disease. The participants were 325 older adults of both sexes, with literacy and no presence of cognitive impairment in the Mini-Mental State Examination (MMSE); A non-probabilistic sampling was carried out. We used the MOS-SF-36 questionnaire, the Brief Illness Perception Questionnaire scale for measuring the perception of disease, the Stanford Patient Education Research Center's Chronic Disease Self self-efficacy questionnaire for chronic patients, the Difficulties in Emotional Regulation Scale, and the Fatigue Severity Questionnaire as measurement instruments. The design was non-experimental cross-sectional with a correlational scope. The results indicate that self-efficacy, disease perception, emotional regulation and severity of fatigue are variables that could impact the physical function of quality of life, confirming that self-efficacy would work as a factor that decreases the probability that a participant score low on this dimension of quality of life. On the other hand, both the perception of the disease and the severity of fatigue were identified as factors that probably negatively influence quality of life.

10.
Curr Pharm Des ; 28(33): 2725-2741, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36321314

RESUMO

BACKGROUND: Parkinson's disease (PD) is the second most common neurodegenerative disorder worldwide. The symptoms of PD are characterized not only by motor alterations but also by a spectrum of nonmotor symptoms. Some of these are psychiatric manifestations such as sleep disorders; depression; cognitive difficulties that can evolve into dementia; and symptoms of psychosis, which include hallucinations, illusions, and delusions. Parkinson's disease psychosis (PDP) occurs in 18-50% of patients with PD. Treating PDP is challenging because antipsychotic drugs tend to be inefficient or may even worsen the disease's motor symptoms. OBJECTIVE: This review aims to summarize the current understanding of the molecular mechanisms involved in PDP and recent innovative alternatives for its treatment. METHODS: This is a narrative review in which an extensive literature search was performed on the Scopus, EMBASE, PubMed, ISI Web of Science, and Google Scholar databases from inception to August 2021. The terms "Parkinson's disease psychosis", "Parkinson psychosis," "neurodegenerative psychosis", and "dopamine psychosis" were among the keywords used in the search. RESULTS: Recently, views on the etiology of hallucinations and illusions have evolved remarkably. PDP has been cemented as a multifactorial entity dependent on extrinsic and novel intrinsic mechanisms, including genetic factors, neurostructural alterations, functional disruptions, visual processing disturbances, and sleep disorders. Consequently, innovative pharmacological and biological treatments have been proposed. Pimavanserin, a selective 5-HT2A inverse agonist, stands out after its approval to treat PDP-associated hallucinations and illusions. CONCLUSION: Future results from upcoming clinical trials should further characterize the role of this drug in the management of PDP as well as other treatment options with novel mechanisms of action, such as saracatinib, SEP-363856, cannabidiol, electroconvulsive therapy, and transcranial magnetic stimulation.


Assuntos
Antipsicóticos , Ilusões , Doença de Parkinson , Transtornos Psicóticos , Transtornos do Sono-Vigília , Humanos , Doença de Parkinson/tratamento farmacológico , Dopamina , Transtornos Psicóticos/tratamento farmacológico , Alucinações/induzido quimicamente , Alucinações/tratamento farmacológico , Antipsicóticos/uso terapêutico , Ureia/farmacologia , Ureia/uso terapêutico , Transtornos do Sono-Vigília/induzido quimicamente
11.
Rev. chil. nutr ; 49(5)oct. 2022.
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1407834

RESUMO

ABSTRACT The objective was to determine the relationship between various factors and food insecurity, using a cross-sectional analytical study of 400 older adults living in rural and urban areas of the Azuay province in Southern Ecuador. Food security was measured using the Latin American and Caribbean Food Security Scale (ELCSA). The data was analyzed using version 15 of the Statistical Package for the Social Sciences (SPSS) program, and the odds ratio with 95% confidence interval (CI) was used to determine statistical association. The incidence of food insecurity was higher in older adults who live in households comprised only of members above the age of 18 (43.7%) and in rural zones (65%). Food insecurity is high in older adults, especially in individuals who live in rural areas and who have low levels of education and low socioeconomic levels. It is necessary to implement public policy and preventative strategies to mitigate the risk of food insecurity in older adults.


RESUMEN El objetivo fue determinar la relación entre diversos factores y la inseguridad alimentaria, con un estudio analítico transversal en 400 adultos mayores que viven en zonas rurales y urbanas de la provincia de Azuay en el sur de Ecuador. La seguridad alimentaria se midió utilizando la Escala de Seguridad Alimentaria de América Latina y el Caribe (ELCSA). Los datos fueron analizados en la versión 15 del programa Statistical Package for the Social Sciences (SPSS), y se utilizó el Odds Ratio con IC 95% para determinar la asociación estadística. La incidencia de la inseguridad alimentaria fue mayor en los adultos mayores que viven en hogares compuestos únicamente por miembros mayores de 18 años (43,7%) y en las zonas rurales (65%). La inseguridad alimentaria es alta en los adultos mayores, especialmente en individuos que viven en zonas rurales y que tienen bajos niveles educativos y niveles socioeconómicos bajos. Es necesario implementar políticas públicas y estrategias preventivas para mitigar el riesgo de inseguridad alimentaria en los adultos mayores.

12.
Int J Mol Sci ; 23(13)2022 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-35805923

RESUMO

Electroconvulsive therapy (ECT) is based on conducting an electrical current through the brain to stimulate it and trigger generalized convulsion activity with therapeutic ends. Due to the efficient use of ECT during the last years, interest in the molecular bases involved in its mechanism of action has increased. Therefore, different hypotheses have emerged. In this context, the goal of this review is to describe the neurobiological, endocrine, and immune mechanisms involved in ECT and to detail its clinical efficacy in different psychiatric pathologies. This is a narrative review in which an extensive literature search was performed on the Scopus, Embase, PubMed, ISI Web of Science, and Google Scholar databases from inception to February 2022. The terms "electroconvulsive therapy", "neurobiological effects of electroconvulsive therapy", "molecular mechanisms in electroconvulsive therapy", and "psychiatric disorders" were among the keywords used in the search. The mechanisms of action of ECT include neurobiological function modifications and endocrine and immune changes that take place after ECT. Among these, the decrease in neural network hyperconnectivity, neuroinflammation reduction, neurogenesis promotion, modulation of different monoaminergic systems, and hypothalamus-hypophysis-adrenal and hypothalamus-hypophysis-thyroid axes normalization have been described. The majority of these elements are physiopathological components and therapeutic targets in different mental illnesses. Likewise, the use of ECT has recently expanded, with evidence of its use for other pathologies, such as Parkinson's disease psychosis, malignant neuroleptic syndrome, post-traumatic stress disorder, and obsessive-compulsive disorder. In conclusion, there is sufficient evidence to support the efficacy of ECT in the treatment of different psychiatric disorders, potentially through immune, endocrine, and neurobiological systems.


Assuntos
Eletroconvulsoterapia , Transtorno Obsessivo-Compulsivo , Transtornos Psicóticos , Humanos , Sistemas Neurossecretores , Transtornos Psicóticos/psicologia , Resultado do Tratamento
13.
Artigo em Inglês | MEDLINE | ID: mdl-35564865

RESUMO

While life expectancy is increasing due to scientific advancement, quality of life in aging depends, among other factors, on the nutritional status and socioeconomic status of older adults. To determine socioeconomic status and its association with nutritional status as a predictor of food insecurity among older adults in southern Ecuador, a cross-sectional study of 188 older adults in urban areas and 212 in rural areas was conducted. Nutritional status, food insecurity, and socioeconomic status were measured. Data were analyzed using SPSS v 15.0 for descriptive statistics and bivariate analysis. Of the older participants, 59% had malnutrition, the majority women, and 24.7% were in poverty. Underweight was associated with low socioeconomic status for adults between 65 and 74 years old (OR = 7.710; CI 95% = 1.691-35.147), while obesity was associated with low socioeconomic status and non-manual labor (OR = 3.048; CI 95% = 1.268-7.326). Over 80% of older adults living in homes without children younger than 18 and at low socioeconomic status had food insecurity. The prevalence of underweight, overweight, and obesity points to widespread nutritional problems, especially in rural areas, that are significantly associated with low socioeconomic status. This demonstrates the need for multidisciplinary programs and government policies that can contribute to reducing food insecurity among the highly vulnerable older population.


Assuntos
Estado Nutricional , Magreza , Idoso , Criança , Estudos Transversais , Equador/epidemiologia , Feminino , Insegurança Alimentar , Abastecimento de Alimentos , Humanos , Obesidade/epidemiologia , Prevalência , Qualidade de Vida , Classe Social , Fatores Socioeconômicos , Magreza/epidemiologia
14.
Bol. latinoam. Caribe plantas med. aromát ; 21(2): 242-255, mar. 2022. tab, ilus
Artigo em Inglês | LILACS | ID: biblio-1395298

RESUMO

The species Lippia integrifolia is an aromatic, sub-woody shrub, distributed from Northwest and Central Argentina to Bolivia. It is among the most important native aromatic species. It presents medicinal properties, some of which have been scientifically proven. As an alternative to harvesting, the process of domestication of the species was initiated. The objective of this work was to assess the phenotypic variability based on botanical-taxonomic and morpho-agronomic descriptors and the use of indicators to evaluate its natural situation in the west-center of Argentina. We worked in five wild populations, registering morphological variables, phenology, natural regeneration, herbivory and presence of diseases. L. integrifoliapresents a wide morphological variability, which can be explained with three morphological descriptors. Natural regeneration ́s rate is very low to zero, in four of the sites. The results obtained are of importance to make decisions related to the sustainable use in situ, and to begin a program of domestication of the species.


La especie Lippia integrifolia es un arbusto aromático, sub-leñoso, distribuido desde el noroeste y centro de Argentina hasta Bolivia. Es una de las especies aromáticas nativas más importantes. Presenta propiedades medicinales, algunas de las cuales han sido científicamente probadas. Como alternativa a la cosecha, se inició el proceso de domesticación de la especie. El objetivo de este trabajo fue evaluar la variabilidad fenotípica basada en descriptores botánico-taxonómicos y morfo-agronómicos y el uso de indicadores para evaluar su situación natural en el centro-oeste de Argentina. Trabajamos en cinco poblaciones silvestres, registrando variables morfológicas, fenología, regeneración natural, herviboría y presencia de enfermedades. L. integrifolia presenta una amplia variabilidad morfológica, que puede explicarse con tres descriptores morfológicos. La tasa de regeneración natural es muy baja a cero, en cuatro de los sitios. Los resultados obtenidos son importantes para tomar decisiones relacionadas con el uso sostenible in situ y para comenzar un programa de domesticación de la especie.


Assuntos
Lippia/anatomia & histologia , Fenótipo , Argentina , Plantas Medicinais/anatomia & histologia , Produção Agrícola , Verbenaceae/anatomia & histologia , Variação Biológica da População
15.
Hematol., Transfus. Cell Ther. (Impr.) ; 43(4): 476-481, Oct.-Dec. 2021. tab, ilus
Artigo em Inglês | LILACS | ID: biblio-1350816

RESUMO

ABSTRACT Introduction: We performed cost-effectiveness and cost-utility analyses of the modified International Consortium on Acute Promyelocytic Leukemia protocol in Mexico for the treatment of acute promyelocytic leukemia Acute Promyelocytic Leukemia. Methods: We performed a three-state Markov analysis: stable disease (first line complete response [CR]), disease event (relapse, second line response and CR) and death. The modified IC-APL protocol is composed of three phases: induction, consolidation and maintenance. Cost and outcomes were used to calculate incremental cost-effectiveness ratios (ICERs); quality-adjusted life-years were used to calculate incremental cost-utility ratios (ICURs). Results: The CR was achieved in 18 patients (90%), treated with the IC-APL protocol as the first-line option; one patient (5%) died in induction, another one never achieved CR (5%); of the 18 patients that achieved CR, 1 relapsed (5.5%). The median treatment cost of the IC-APL protocol was $21,523 USD. The average life-year in our study was 7.8 years, while the average quality-adjusted life-year (QALY) was 6.1 years. When comparing the ICER between the IC-APL and the all-trans retinoic acid (ATRA) plus arsenic trioxide (ATO) protocols, we found the different costs of $6497, $19,133 and $17,123 USD in Italy, the USA and Canada, respectively. In relation to the ICUR, we found the different costs to be $13,955 and $11,979 USD in the USA and Canada, respectively. Conclusion: Taking into account the similar response rates, lower cost and easy access to the modified IC-APL regimen, we consider it a cost-effective and cost-utility protocol, deeming it the treatment of choice for our population.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Leucemia Promielocítica Aguda/diagnóstico , Leucemia Promielocítica Aguda/tratamento farmacológico , Tretinoína/uso terapêutico , Protocolos Clínicos , Análise Custo-Benefício
16.
Int J Mol Sci ; 22(19)2021 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-34638711

RESUMO

Chronic pain (CP) is a severe clinical entity with devastating physical and emotional consequences for patients, which can occur in a myriad of diseases. Often, conventional treatment approaches appear to be insufficient for its management. Moreover, considering the adverse effects of traditional analgesic treatments, specialized pro-resolving lipid mediators (SPMs) have emerged as a promising alternative for CP. These include various bioactive molecules such as resolvins, maresins, and protectins, derived from ω-3 polyunsaturated fatty acids (PUFAs); and lipoxins, produced from ω-6 PUFAs. Indeed, SPMs have been demonstrated to play a central role in the regulation and resolution of the inflammation associated with CP. Furthermore, these molecules can modulate neuroinflammation and thus inhibit central and peripheral sensitizations, as well as long-term potentiation, via immunomodulation and regulation of nociceptor activity and neuronal pathways. In this context, preclinical and clinical studies have evidenced that the use of SPMs is beneficial in CP-related disorders, including rheumatic diseases, migraine, neuropathies, and others. This review integrates current preclinical and clinical knowledge on the role of SPMs as a potential therapeutic tool for the management of patients with CP.


Assuntos
Dor Crônica/metabolismo , Dor Crônica/terapia , Ácidos Graxos Ômega-3/metabolismo , Ácidos Graxos Ômega-6/metabolismo , Mediadores da Inflamação/metabolismo , Manejo da Dor , Animais , Humanos
17.
Med Mycol Case Rep ; 33: 32-37, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34307008

RESUMO

We describe two fatal cases of COVID-19 in which Rhizopus microsporus and Lichtheimia corymbifera were cultured from endotracheal aspirate samples. Both patients had no underlying comorbidities other than obesity. Despite antifungal therapy, both cases developed septic shock and progressive refractory hypoxemia without evidence of other underlying infections. It is unclear whether isolation of these fungal organisms represents invasive disease or corresponds to an epiphenomenon of critical illness. Yet, patients suffering from COVID-19 may be at risk of superinfection from a broader range of fungal organisms than previously thought.

18.
Hematol Transfus Cell Ther ; 43(4): 476-481, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33077397

RESUMO

INTRODUCTION: We performed cost-effectiveness and cost-utility analyses of the modified International Consortium on Acute Promyelocytic Leukemia protocol in Mexico for the treatment of acute promyelocytic leukemia Acute Promyelocytic Leukemia. METHODS: We performed a three-state Markov analysis: stable disease (first line complete response [CR]), disease event (relapse, second line response and CR) and death. The modified IC-APL protocol is composed of three phases: induction, consolidation and maintenance. Cost and outcomes were used to calculate incremental cost-effectiveness ratios (ICERs); quality-adjusted life-years were used to calculate incremental cost-utility ratios (ICURs). RESULTS: The CR was achieved in 18 patients (90%), treated with the IC-APL protocol as the first-line option; one patient (5%) died in induction, another one never achieved CR (5%); of the 18 patients that achieved CR, 1 relapsed (5.5%). The median treatment cost of the IC-APL protocol was $21,523 USD. The average life-year in our study was 7.8 years, while the average quality-adjusted life-year (QALY) was 6.1 years. When comparing the ICER between the IC-APL and the all-trans retinoic acid (ATRA) plus arsenic trioxide (ATO) protocols, we found the different costs of $6497, $19,133 and $17,123 USD in Italy, the USA and Canada, respectively. In relation to the ICUR, we found the different costs to be $13,955 and $11,979 USD in the USA and Canada, respectively. CONCLUSION: Taking into account the similar response rates, lower cost and easy access to the modified IC-APL regimen, we consider it a cost-effective and cost-utility protocol, deeming it the treatment of choice for our population.

19.
Clin Infect Dis ; 73(1): e199-e205, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32986118

RESUMO

BACKGROUND: We evaluated the risk of death for health-care workers (HCW) with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Mexico City during the coronavirus disease 2019 (COVID-19) pandemic, and describe the associated factors in hospitalized HCW, compared with non-HCW. METHODS: We analyzed data from laboratory-confirmed SARS-CoV-2 cases registered from 27 February-31 August 2020 in Mexico City's public database. Individuals were classified as non-HCW or HCW (subcategorized as physicians, nurses, and other HCW). In hospitalized individuals, a multivariate logistic regression model was used to analyze the potential factors associated with death and compare mortality risks among groups. RESULTS: A total of 125 665 patients were included. Of these, 13.1% were HCW (28% physicians, 38% nurses, and 34% other HCW). Compared with non-HCW, HCW were more frequently female, were younger, and had fewer comorbidities. Overall, 25 771 (20.5%) were treated as inpatients and 11 182 (8.9%) deaths were reported. Deaths in the total population (9.9% vs 1.9%, respectively; P < .001) and in hospitalized patients (39.6% vs 19.3%, respectively; P < .001) were significantly higher in non-HCW than in HCW. In hospitalized patients, using a multivariate model, the risk of death was lower in HCW in general (odds ratio [OR], 0.53) than in non-HCW, and the risks were also lower by specific occupation (OR for physicians, 0.60; OR for nurses, 0.29; OR for other HCW 0.61). CONCLUSIONS: HCW represent an important proportion of individuals with SARS-CoV-2 infection in Mexico City. While the mortality risk is lower in HCW compared to non-HCW, a high mortality rate in hospitalized patients was observed in this study. Among HCW, nurses had a lower risk of death compared to physicians and other HCW.


Assuntos
COVID-19 , SARS-CoV-2 , Feminino , Pessoal de Saúde , Humanos , México , Pandemias
20.
Cult. cuid ; 24(58): 207-216, sept.-dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-200399

RESUMO

OBJETIVO: Conocer y comprender las nociones y estrategias de bienestar presentes en adolescentes con altos y bajos niveles de riesgo suicida. METODOLOGÍA: Este estudio exploratorio con enfoque cualitativo mediante el cual se analizaron las diferencias entre las nociones de bienestar y las estrategias recurrentes en 40 adolescentes con puntuaciones alta y bajas de riesgo suicida. RESULTADOS: Indican la existencia de nociones asociadas a la salud, a la visión integradora y a una perspectiva subjetiva. En cuanto a las estrategias usadas por los adolescentes para promover su propio bienestar las categorías que emergieron se centraron en la interacción social, el hedonismo, el control, la redefinición y proyección subjetiva positiva, y la orientación al cambio. CONCLUSIÓN: Se discuten los resultados sobre la orientación de estrategias de intervención en adolescentes con alto riesgo suicida basados en sus propias nociones


OBJECTIVE: To know and understand the notions and strategies of well-being present in adolescents with high and low levels of suicidal risk. METHODOLOGY: This exploratory study with qualitative approach, which explored the differences between notions of well-being and recurrent strategies in 40 adolescents with high and low suicide risk scores.Results. Indicate the existence of notions associated with health, the integrating vision and a subjective perspective. Regarding the strategies used by adolescents to promote their own well-being, the categories that emerged focused on social interaction, hedonism, control, redefinition and positive subjective projection, and orientation towards change. CONCLUSION: Results on the orientation of intervention strategies in adolescents with high suicide risk based on their own notions are discussed


OBJETIVO: Conhecer e compreender as noções e estratégias de bem-estar presentes em adolescentes com alto e baixo risco de suicídio. METODOLOGIA: Estudo exploratório com abordagem qualitativa, que explorou as diferenças entre noções de bem-estar e estratégias recorrentes em 40 adolescentes com escores de alto e baixo risco de suicídio. RESULTADOS: Indicar a existência de noções associadas à saúde, a visão integradora e uma perspectiva subjetiva. Em relação às estratégias utilizadas pelos adolescentes para promover seu próprio bem-estar, as categorias que emergiram enfocaram a interação social, o hedonismo, o controle, a redefinição e a projeção subjetiva positiva e a orientação para a mudança. CONCLUSÃO: Os resultados sobre a orientação das estratégias de intervenção em adolescentes com alto risco de suicídio com base em suas próprias noções são discutido


Assuntos
Humanos , Masculino , Feminino , Adolescente , Ideação Suicida , Comportamento do Adolescente/psicologia , Saúde do Adolescente , Fatores de Risco , Medição de Risco , Entrevistas como Assunto , Satisfação Pessoal , Pesquisa Qualitativa
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