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1.
Int J Soc Determinants Health Health Serv ; : 27551938241245675, 2024 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-38646663

RESUMO

Mexican President Andrés Manuel López Obrador's historic election victory in 2018 marked a sharp break from past decades of neoliberal socioeconomic policies. López Obrador campaigned on the promise of deep reform, with health care high on his agenda. The public health care sector had been decimated by decades of budget cuts, eroding workers' morale and patients' confidence, and crippling all aspects of the system. This article looks back to the creation of the nation's public health care system in the early twentieth century during the administration of President Lázaro Cárdenas (1934-1940). This "universal" system was designed to implement a central social justice goal of the Mexican Revolution of health care for all. The program rested on two pillars: providing care to the nation's vast, impoverished rural population and actively engaging communities in their own health care. Our objective is to critically assess the two presidents' health care initiatives within the distinct historical contexts of their administrations.

2.
Can J Aging ; : 1-15, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38297497

RESUMO

Worldwide, over 55-million people have dementia, and the number will triple by 2050. Persons living with dementia are exposed to risks secondary to cognitive challenges including getting lost. The adverse outcomes of going missing include injuries, death, and premature institutionalization. In this scoping review, we investigate risk factors associated with going missing among persons living with dementia. We searched and screened studies from four electronic databases (Medline, CINAHL, Embase, and Scopus), and extracted relevant data. We identified 3,376 articles, of which 73 met the inclusion criteria. Most studies used quantitative research methods. We identified 27 variables grouped into three risk factor domains: (a) demographics and personal characteristics, (b) health conditions and symptoms, and (c) environmental and contextual antecedents. Identification of risk factors associated with getting lost helps to anticipate missing incidents. Risk factors can be paired with proactive strategies to prevent incidents and inform policies to create safer communities.

3.
J Addict Med ; 18(2): 174-179, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38270205

RESUMO

OBJECTIVES: In a longitudinal cohort of patients with HIV and chronic pain, we sought to (1) identify trajectories of opioid misuse and opioid use disorder (OUD) symptoms, and to (2) determine whether prescription opioid dose was associated with symptom trajectories. METHODS: We leveraged an existing 12-month longitudinal observational study, Project PIMENTO, of persons living with HIV and chronic pain who received care at a hospital system in the Bronx, New York. A quota sampling strategy was used to ensure variability of prescribed opioid use in the recruited sample. Research interviews occurred quarterly and assessed opioid behaviors and criteria for OUD. To describe symptom trajectories, we conducted 2 separate longitudinal latent class analyses to group participants into (1) opioid misuse and (2) OUD trajectories. Finally, we used multinomial logistic regression models to examine the relationship between baseline prescription opioid dose and symptom trajectories. RESULTS: Of 148 total participants, at baseline 63 (42.6%) had an active opioid prescription, 69 (46.6%) met the criteria for current opioid misuse, and 44 (29.7%) met the criteria for current OUD. We found 3 opioid misuse and 3 OUD symptom trajectories, none of which showed worsened symptoms over time. In addition, we found that higher prescription opioid dose at baseline was associated with a greater OUD symptom trajectory. CONCLUSIONS: Opioid misuse and OUD were common but stable or decreasing over time. Although these results are reassuring, our findings also support prior studies that high-dose opioid therapy is associated with greater OUD symptoms.


Assuntos
Dor Crônica , Infecções por HIV , Transtornos Relacionados ao Uso de Opioides , Adulto , Humanos , Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estudos Longitudinais , Infecções por HIV/tratamento farmacológico
4.
PLoS One ; 19(1): e0296924, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38277365

RESUMO

OBJECTIVE: To estimate the incidence rate of tuberculosis (TB) in the Highlands (Tsotsil-Tseltal) region of Chiapas and to analyze sociodemographic factors that might influence the success of anti-TB treatment from the period of January 2019 to June 2022. METHODS: Retrospective study in which the TB databases of the National Epidemiological Surveillance System (SINAVE) were analyzed. TB incidence rates were calculated based on the number of registered TB cases and estimated annual populations. The success-failure of anti-TB treatment was analyzed according to sociodemographic indicators, degree of concentration of indigenous population of the municipality of residence and admission to SINAVE. RESULTS: Two hundred thirty-three cases were analyzed. The variables associated to a lower success rate of treatment against TB were: living in a municipality with high-very high concentration of indigenous population, being indigenous, having a primary school education or lower, and agricultural occupation. The number of TB diagnosed from 2020-2022 and the incidence rates from 2020-2021 decreased significantly compared to 2019. CONCLUSIONS: It is necessary to strengthen the follow-up of TB cases in the region, mainly in areas with high-very high indigenous concentration, in people with low levels of education and engaged in agricultural work.


Assuntos
Fatores Sociodemográficos , Tuberculose , Humanos , México/epidemiologia , Estudos Retrospectivos , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Incidência , Antituberculosos/uso terapêutico
5.
Neurosci Lett ; 820: 137597, 2024 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-38110146

RESUMO

According to the opponent-process theory of drug addiction, the intake of an addictive substance initiates two processes: a rapid primary process that results in the drug's rewarding effects, and a slower opponent process that leads to the aversive motivational state of drug aftereffects. This aversive state is integral in the desire, pursuit, and maintenance of drug use, potentially leading to dependence and addiction. However, current observational and experimental evidence suggests that the administration of a 5-hydroxytryptamine receptors-type 2A (5-HT2A) agonist, while capable of inducing a positive mental state in humans, may not generate the behavioral patterns typically associated with drugs of abuse. In this study, we found that administering the 5-HT2A agonist 4-Acetoxy-N,N-dimethyltryptamine fumarate (4-AcO-DMT) did not result in place preference in male rats compared to control saline administration 24 h later, after the drug has been cleared from the organism. However, in a modified place preference test where only the acute motivational effects of the drug were evaluated (excluding withdrawal), 4-AcO-DMT was found to be rewarding. Furthermore, in another modified place preference test where only the motivational effects of drug withdrawal were evaluated (excluding the acute effects of drug administration), the 24-hour aftereffect of 5-HT2A agonist administration also resulted in a robust place preference. Therefore, while 4-AcO-DMT administration was able to induce place preference, its 24-hour aftereffect also produced a strong reward. In the counterbalanced test, this reward from the aftereffect effectively overshadowed its acute rewarding properties, which could potentially create a false impression that 4-AcO-DMT lacks motivational properties. This suggests that 5-HT2A agonist administration follows a different dynamic than that proposed by the opponent-process theory of motivation and implies that the administration of 5-HT2A agonists may lead to behavioral patterns less typical of drugs associated with addiction.


Assuntos
Alucinógenos , Transtornos Relacionados ao Uso de Substâncias , Humanos , Ratos , Masculino , Animais , Alucinógenos/farmacologia , Agonistas do Receptor 5-HT2 de Serotonina/farmacologia , N,N-Dimetiltriptamina , Recompensa
6.
Rev Esp Salud Publica ; 972023 Sep 29.
Artigo em Espanhol | MEDLINE | ID: mdl-37921404

RESUMO

OBJECTIVE: The most common cause of shoulder pain is clinical pictures related to rotator cuff problems. One of the most common treatments is arthroscopic surgery. The objective was to describe the clinical and epidemiological characteristics of patients undergoing this type of surgery in Spain. METHODS: A descriptive, observational and cross-sectional study with ninety participants was carried out. Data on age, sex, performance of work activity with overuse of upper limbs, body mass index (BMI), smoking habit, diagnosis of diabetes, performance of physical-sports activity and history of pre-surgical treatments were collected. Finally, a descriptive analysis of the variables and an analysis of correlations were carried out, using the Pearson and Spearman statistical test according to the type of variable. RESULTS: The mean age was 57.21 years with a standard deviation (SD) of 8.5 (95% CI, 55.41-59.00). Regarding their BMI, the mean was 28.49 with a SD of 4.9 (95% CI, 27.49-29.53), with 35.6% being obese (BMI greater than 30). The medical diagnosis of the subjects was 51.1% total rotator cuff tear. On the other hand, the intensity of physical activity was one hour or less per week in 87.8% of the sample. Finally, in relation to the previous physiotherapy treatment, 69.7% of the subjects had received some type of intervention. CONCLUSIONS: The demographic and clinical characteristics found are consistent with those of other previously studied populations, and the association factors between them endorse the previously mentioned risk factors, with advanced age gaining special importance.


OBJETIVO: La causa más común de dolor de hombro son los cuadros clínicos relacionados con problemas del manguito rotador. Uno de los tratamientos más habituales es la cirugía artroscópica. El objetivo del estudio fue describir las características clínicas y epidemiológicas de los pacientes sometidos a este tipo de cirugías en España. METODOS: Se realizó un estudio de tipo descriptivo, observacional y de corte transversal con noventa participantes. Se recogieron los datos de edad, sexo, realización de actividad laboral con sobreuso de miembros superiores (MMSS), índice de masa corporal (IMC), consumo de tabaco, diagnóstico de diabetes, realización de actividad física-deportiva y antecedentes de tratamientos prequirúrgicos. Finalmente, se realizó un análisis descriptivo de las variables y un análisis de correlaciones, mediante la prueba estadística de Pearson y Spearman según el tipo de variable. RESULTADOS: La media de edad fue de 57,21 años con una desviación estándar (DE) de 8,5 (Intervalo de Confianza [IC] del 95%, 55,41-59,00). En cuanto a su IMC, la media fue de 28,49 con una DE de 4,9 (IC del 95%, 27,49-29,53), siendo el 35,6% personas con obesidad (IMC mayor de 30). El diagnóstico médico de los sujetos fue en un 51,1% de rotura total del manguito rotador. Por otro lado, la intensidad de realización de actividad física fue de una hora o menos a la semana en el 87,8% de la muestra. Por último, en relación con el tratamiento previo de fisioterapia, el 69,7% de los sujetos habían recibido algún tipo de intervención. CONCLUSIONES: Las características demográficas y clínicas encontradas están en consonancia con las de otras poblaciones estudiadas previamente, y los factores de asociación entre ellas refrendan los factores de riesgo ya señalados previamente (edad, obesidad, sobreuso de MMSS), cobrando especial importancia la edad avanzada.


Assuntos
Estudos Retrospectivos , Humanos , Pessoa de Meia-Idade , Estudos Transversais , Fatores de Risco , Espanha/epidemiologia
7.
Orthop J Sports Med ; 11(11): 23259671231212856, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38021298

RESUMO

Background: Previous biomechanical studies of the meniscotibial ligament have determined that it contributes to meniscal stability. An injury to it can cause the meniscus to extrude, and reconstruction of that ligament significantly reduces extrusion. Purpose: To assess the biomechanical effects of sectioning the lateral meniscotibial ligament (LMTL) and the meniscofibular ligament (MFL) with respect to the radial mobility of the lateral meniscus and to evaluate the biomechanical effects of the capsulodesis and centralization techniques. Study Design: Controlled laboratory study. Methods: The lateral meniscus of 22 porcine knees was evaluated. They were mounted on a testing apparatus to apply muscle and ground-reaction forces. The meniscus was evaluated at 30° and 60° of knee flexion using 2 markers placed on the posterior cruciate ligament and the lateral meniscus after applying an axial compression of 200 N to the knee joint. Measurements were recorded under 5 conditions: intact lateral meniscus, injury of the LMTL, subsequent injury of the MFL, the use of the open capsulodesis technique, and the reconstruction of the LMTL and the MFL with the centralization technique. Results: The distance between the 2 markers was significantly greater in the extrusion group (combined lesion of the LMTL and MFL) than in the intact or reconstruction groups (capsulodesis and centralization techniques; P < .001 in all cases). In the cases of load application, no significant differences were observed between the control group (intact meniscus) and the groups on which the reconstruction techniques were performed. There were also no differences when comparing the results obtained between both reconstruction techniques. In all settings, the distance between the 2 markers increased with the increase in the knee flexion angle. Conclusion: In a porcine model, the LMTL and the MFL participated as restrictors of the radial mobility of the lateral meniscus during loading. Their injury caused a significant increase in lateral meniscal extrusion, and the centralization and the capsulodesis procedures were able to reduce extrusion. Clinical Relevance: This study demonstrates the capacity of the LMTL and the MFL to restrict the radial mobility of the lateral meniscus during loading and how it is affected when they are injured.

8.
Radiol Case Rep ; 18(12): 4345-4350, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37789921

RESUMO

Osteosarcoma (OS) of the head and neck is a rare and aggressive disease characterized by the formation of osteoid by malignant osteoblasts. The mandible or maxilla are the most common sites of presentation. Radiologically, these tumors show considerable, destructive growth with periosteal reaction, which can suggest the diagnosis of OS. 3D printing, as an emerging technology, can play a role in orthopedic oncology by providing patient-specific 3D printed models to improve surgical planning and facilitate patient understanding. We present the case of a male in his early 30s with a final histological diagnosis of recurrent osteosarcoma of the left maxilla, where a 3D printed model was helpful for the diagnostic workup, surgical planning, and the procedure.

9.
Front Neurol ; 14: 1165155, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37681010

RESUMO

Hemorrhage secondary to rupture of a brain arteriovenous malformations (AVM) is one of the initial manifestations, and the main cause of, morbidity and mortality in patients with this condition. Current treatment strategies include endovascular embolization with the goal of AVM obliteration and neurological preservation. In the transvenous endovascular embolization procedure, adenosine is the preferred agent to induce temporary hypotension and allow adequate AVM embolization. We describe the intraoperative management of an adenosine-resistant 38 year-old male who underwent a successful intracranial AVM embolization after concomitant administration of gradually increasing doses of nitroglycerin. This report suggests that nitroglycerin infusion can be combined with adenosine boluses to create a pronounced and dose-dependent hypotension in patients partially unresponsive to adenosine alone.

10.
Rev. esp. salud pública ; 97: e202309080, Sept. 2023. graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-226218

RESUMO

Fundamentos: La causa más común de dolor de hombro son los cuadros clínicos relacionados con problemas del manguitorotador. Uno de los tratamientos más habituales es la cirugía artroscópica. El objetivo del estudio fue describir las característicasclínicas y epidemiológicas de los pacientes sometidos a este tipo de cirugías en España. Métodos: Se realizó un estudio de tipo descriptivo, observacional y de corte transversal con noventa participantes. Se recogieronlos datos de edad, sexo, realización de actividad laboral con sobreuso de miembros superiores (MMSS), índice de masa corporal (IMC),consumo de tabaco, diagnóstico de diabetes, realización de actividad física-deportiva y antecedentes de tratamientos prequirúrgicos.Finalmente, se realizó un análisis descriptivo de las variables y un análisis de correlaciones, mediante la prueba estadística de Pearson y Spearman según el tipo de variable.Resultados: La media de edad fue de 57,21 años con una desviación estándar (DE) de 8,5 (Intervalo de Confianza [IC] del 95%,55,41-59,00). En cuanto a su IMC, la media fue de 28,49 con una DE de 4,9 (IC del 95%, 27,49-29,53), siendo el 35,6% personas conobesidad (IMC mayor de 30). El diagnóstico médico de los sujetos fue en un 51,1% de rotura total del manguito rotador. Por otro lado,la intensidad de realización de actividad física fue de una hora o menos a la semana en el 87,8% de la muestra. Por último, en relacióncon el tratamiento previo de fisioterapia, el 69,7% de los sujetos habían recibido algún tipo de intervención. Conclusiones: Las características demográficas y clínicas encontradas están en consonancia con las de otras poblacionesestudiadas previamente, y los factores de asociación entre ellas refrendan los factores de riesgo ya señalados previamente (edad,obesidad, sobreuso de MMSS), cobrando especial importancia la edad avanzada.(AU)


Background: The most common cause of shoulder pain is clinical pictures related to rotator cuff problems. One of the mostcommon treatments is arthroscopic surgery. The objective was to describe the clinical and epidemiological characteristics of patientsundergoing this type of surgery in Spain. Methods: A descriptive, observational and cross-sectional study with ninety participants was carried out. Data on age, sex, perfor-mance of work activity with overuse of upper limbs, body mass index (BMI), smoking habit, diagnosis of diabetes, performance of physi-cal-sports activity and history of pre-surgical treatments were collected. Finally, a descriptive analysis of the variables and an analysis ofcorrelations were carried out, using the Pearson and Spearman statistical test according to the type of variable.Results: The mean age was 57.21 years with a standard deviation (SD) of 8.5 (95% CI, 55.41-59.00). Regarding their BMI, the meanwas 28.49 with a SD of 4.9 (95% CI, 27.49-29.53), with 35.6% being obese (BMI greater than 30). The medical diagnosis of the subjectswas 51.1% total rotator cuff tear. On the other hand, the intensity of physical activity was one hour or less per week in 87.8% of thesample. Finally, in relation to the previous physiotherapy treatment, 69.7% of the subjects had received some type of intervention. Conclusions: The demographic and clinical characteristics found are consistent with those of other previously studied populations,and the association factors between them endorse the previously mentioned risk factors, with advanced age gaining special importance.(AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Manguito Rotador , Artropatia de Ruptura do Manguito Rotador , Lesões do Manguito Rotador , Lesões do Ombro , Manejo da Dor , Ombro/cirurgia , Dor , Cirurgia Geral , Demografia , Epidemiologia Descritiva , Estudos Transversais , Especialidade de Fisioterapia , Reabilitação , Dor de Ombro/reabilitação , Dor de Ombro/terapia , Índice de Massa Corporal , Terapia por Exercício
11.
Rev. chil. obstet. ginecol. (En línea) ; 88(4): 205-214, ago. 2023. tab
Artigo em Espanhol | LILACS | ID: biblio-1515211

RESUMO

Introducción: La interrupción del embarazo mediando principalmente la voluntad de la mujer, es decir, cuando una mujer desea abortar para terminar su embarazo por cualquier razón, es un procedimiento controversial. Las actitudes individuales de los profesionales de la salud hacia este procedimiento influirían sobre la aceptación o el rechazo de realizarlo y, por ende, afectarían su acceso en el sistema de salud. Objetivo: Relacionar actitudes hacia la interrupción del embarazo con características sociodemográficas y académicas de estudiantes chilenos de enfermería, medicina y obstetricia y puericultura. Método: Estudio cuantitativo con diseño observacional, transversal y descriptivo. Reclutamos estudiantes universitarios con un muestreo no probabilístico. Recolectamos datos mediante cuestionarios virtuales autoadministrados. Preguntamos por la intención de realizar o asistir un aborto médico o quirúrgico frente a 15 escenarios distintos y creamos un índice con estas respuestas. Calculamos estadísticas descriptivas básicas y creamos modelos de regresión lineal. Consideramos significancia estadística si p < 0,05. Resultados: Participaron 229, 306 y 233 estudiantes de enfermería, medicina y obstetricia y puericultura, respectivamente (en total, 768). En el modelo de regresión lineal múltiple, declararse cristiano (β = −0,248) y afirmar que la religión es muy o totalmente importante en la vida (β = −0,269) se asociaron más fuertemente y de manera inversa y significativa con el índice de intención de realizar o asistir un aborto médico o quirúrgico. Conclusiones: La religión es un factor que influiría decisivamente sobre las actitudes hacia la interrupción del embarazo. Los escenarios más positivamente valorados podrían explicarse considerando que las leyes reflejarían los valores predominantes de una sociedad.


Introduction: Termination of pregnancy mediated primarily by the womans will, i.e., when a woman wishes to have an abortion to terminate her pregnancy for any reason, is a controversial procedure. The individual attitudes of health professionals towards this procedure would affect the degree of acceptance or rejection of performing this procedure and, therefore, would affect its accessibility in the health system. Objective: To relate attitudes towards abortion with sociodemographic and academic characteristics of Chilean nursing, medicine and midwifery students. Method: Quantitative study with observational, cross-sectional and descriptive design. We recruited university students with non-probabilistic sampling. We collected data through self-administered virtual questionnaires. We asked about the intention to perform an abortion in 15 different scenarios and created an index with these responses. We calculated basic descriptive statistics and created linear regression models. We considered statistical significance if p < 0.05. Results: 229, 306 and 233 students from nursing, medicine and midwifery participated, respectively (total: 768). In the multiple linear regression model, declaring oneself a Christian (β = −0.248) and stating that religion is very or totally important in life (β = −0.269) were inversely and significantly associated with the index of intention to perform an abortion. Conclusions: Religion is a factor that would decisively influence attitudes toward termination of pregnancy. The more positively valued scenarios could be explained by considering that laws would reflect the predominant values of a society.


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Estudantes de Ciências da Saúde/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Aborto , Fatores Socioeconômicos , Modelos Lineares , Chile , Estudos Transversais , Inquéritos e Questionários , Intenção
12.
Polymers (Basel) ; 15(13)2023 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-37447436

RESUMO

Understanding the mechanics of fiber attrition during the extrusion process is highly important in predicting the strength of long fiber-reinforced thermoplastic composites. However, little work has been done to investigate the mechanics of fiber dispersion and its effects on fiber attrition. This study aims at investigating fiber dispersion in simple shear flows for long fiber-reinforced thermoplastic pellets. Depending on the fabrication process, fiber bundles display distinct levels of compaction within the pellets. Studies have shown that morphological differences can lead to differences in dispersion mechanics; therefore, using a Couette rheometer and a sliding plate rheometer, coated and pultruded pellets were subjected to simple shear deformation, and the amount of dispersion was quantified. Additionally, a new image-based analysis method is presented in this study to measure fiber dispersion for a multi-pellet-filled system. Results from the single-pellet dispersion study showed a small amount of correlation between the dimensionless morphological parameter and the dispersion measurement. Pultruded and coated pellets were both found to have similar dispersion rates in a multi-pellet system. However, pultruded pellets were found to have a higher dispersion value at all levels when compared with coated pellets in both dispersion studies.

13.
Cureus ; 15(6): e40363, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37456380

RESUMO

There are no established guidelines regarding anesthesia with a peripheral nerve block (PNB) in the young adult population with von Willebrand disease (vWD) type I. We present a case of a successful PNB outcome in a 20-year-old male patient with vWD type I, osteogenesis imperfecta (OI), and rheumatoid arthritis (RA) who underwent an intramedullary nailing surgery after suffering a left distal femur fracture secondary to a sports injury. Before the procedure, the patient was treated with HUMATE-P® [antihemophilic factor and von Willebrand factor (human)], ALPHANATE® (antihemophilic factor/von Willebrand factor complex), and aminocaproic acid for hematologic control. Left femoral and popliteal nerve blocks were performed for postoperative pain control. The patient was discharged home uneventfully three days after the surgery. In this case, PNB proved to be a safe and effective alternative in the management of a vWD type I young adult patient with comorbidities. Given the lack of established guidelines, a multidisciplinary team should be involved in the pre and perioperative management of these patients due to the risk of delayed bleeding.

14.
Clin Genitourin Cancer ; 21(6): 712.e1-712.e8, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37258359

RESUMO

Radical treatments and active surveillance are valid therapeutic approaches for low-risk prostate cancer. The oncologic effectiveness and morbidity of Radical Prostatectomy (RP) and radiotherapy have been broadly validated. Focal therapies pursue to reduce the morbidity observed after radical treatments, while preserving the oncologic effectiveness. This study aims to review the state-of-the-art about principles, oncologic effectiveness, morbidity, and side-effects associated with leading focal therapies. We review and summarize articles related with Cryotherapy, High-Intensity Focal Ultrasound (HIFU), Photodynamic Therapy (PDT), and Irreversible Electroporating (IRE) published in MEDLINE from 2000 to 2022. There is a wide heterogeneity in terms of the measurement of effectiveness and morbidity. Hence, comparing different energies, strategies and protocols seem to be unprecise and controversial. Cryosurgery and HIFU have reported more clinical experience than PDT and IRE. Biochemical recurrence rate after the first session varied from 4.5% to 23%, and up to 20% of patients underwent a salvage radical treatment. The reported incidence of erectile disfunction and urinary incontinence ranges from 3% to 50% and 0% to 34%, respectively. None randomized clinical trial comparing any focal therapy to any radical treatment has been published. We conclude that the expansion of focal therapies requires the consolidation of MRI-guided fusion biopsies in everyday clinical practice. Short-term oncologic effectiveness has been proved and supports their usefulness in low-risk patients unfit for surgical treatment. However, long-term effects and the clinical experience in intermediate and high-risk patients remains limited. Currently none of the focal therapies can be considered the Gold Standard for low-risk patients.


Assuntos
Criocirurgia , Neoplasias da Próstata , Masculino , Humanos , Neoplasias da Próstata/patologia , Antígeno Prostático Específico , Crioterapia/efeitos adversos , Crioterapia/métodos , Próstata/patologia , Terapia de Salvação/métodos , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Emerg Microbes Infect ; 12(1): 2202281, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37039029

RESUMO

ABSTRACTThe emergence of the Omicron SARS-CoV-2 variant of concern has changed the COVID-19 scenario as this variant is characterized by high transmissibility and immune evasion ability. To evaluate the impact of this variant on the Canary Islands (Spain) population, we determined the reinfection rates and disease severity associated with the Omicron sublineages and the previously circulating variants of concern. We performed a retrospective observational study on 21,745 SARS-CoV-2 viral genomes collected from December 2020 to July 2022 in the Canary Islands (Spain). We compared the reinfection rates between lineages using pairwise proportion and Fisher's exact tests. To assess disease severity, we studied the association of Alpha, Delta, BA.1, BA.2, BA.5, and other risk factors on 28-day hospital mortality using logistic regression and Cox proportional hazard models. We observed 127 bona fide reinfection cases throughout the study period. We found that BA.5 had the highest reinfection rate compared to other lineages (vs. Delta p = 2.89 × 10-25; vs. BA.1 p = 5.17 × 10-11; vs. BA.2 p = 0.002). Among the 1,094 hospitalized patients, multivariate logistic regression showed that Alpha (Odds Ratio [OR] = 0.45, 95% Confidence Interval [CI] = 0.23-0.87, p = 0.02), BA.2 (OR = 0.38, 95% CI = 0.22-0.63, p = 1.91 × 10-4), and BA.5 (OR = 0.30, 95% CI = 0.16-0.55, p = 1.05 × 10-4) had lower 28-day hospital mortality compared to Delta. These results were confirmed by using Cox proportional hazard models. Omicron lineages, and in particular BA.5, were associated with higher reinfection rates and lower disease severity (28-day hospital mortality) than previously circulating variants of concern.


Assuntos
COVID-19 , SARS-CoV-2 , Humanos , Espanha , Reinfecção , Gravidade do Paciente
16.
Comput Struct Biotechnol J ; 21: 2197-2203, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36968018

RESUMO

On July 23, 2022, monkeypox disease (mpox) was declared a Public Emergency of International Concern (PHEIC) by the World Health Organization (WHO) due to a multicountry outbreak. In Europe, several cases of mpox virus (MPXV) infection related to this outbreak were detected in the Canary Islands (Spain). Here we describe the combination of viral DNA sequencing and bioinformatic approaches, including methods for de novo genome assembly and short- and long-read technologies, used to reconstruct the first MPXV genome isolated in the Canary Islands on the 31st of May 2022 from a male adult patient with mild symptoms. The same sequencing and bioinformatic approaches were then validated with three other positive cases of MPXV infection from the same mpox outbreak. We obtained the best results using a reference-based approach with short reads, evidencing 46-79 nucleotide variants against viral sequences from the 2018-2019 mpox outbreak and placing the viral sequences in the new B.1 sublineage of clade IIb of the MPXV classification. This study of MPXV demonstrates the potential of metagenomics sequencing for rapid and precise pathogen identification.

17.
Heliyon ; 9(2): e13153, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36755598

RESUMO

The Peruvian Amazon is a geographical area with great biodiversity, where the main economic activities are agricultural crops and grazing animals. The evaluation of sustainability in production systems is based on the analysis of economic, environmental and social components, which are variable between production units or livestock farms. The classification of livestock farms based on their characteristics of similarity and differences can contribute to the most appropriate assessment of their level of sustainability. The objective of this research was to determine the level of sustainability of livestock farms in the district of Moyobamba, San Martín, Peru, based on environmental, economic and social criteria. The research was carried out from November 2018 to February 2019 with a survey of a sample of 60 livestock farms out of a population of 2220. A survey-type form and data collection in the field were applied, adapting a methodology that proposes inferring on 33 indicators grouped into six criteria: three environmental criteria (soil quality, pasture health and animal quality), two economic criteria (farm system and farm economy), and a social criterion of the farm. A scale from 1 to 10 was used to assess the condition of each indicator. The typification of farms was carried out through a Conglomerate Analysis. To analyze the level of sustainability, Amoeba graphs were constructed for each defined farm group. Qualitative variables were analyzed with contingency tables and quantitative variables using the T test (p < 0.05). Three types of livestock farms were identified, differentiated by level of education, farm size, years in cattle raising and number of cattle heads (p < 0.05), where Group 1 is less experienced, Group 1 has more area and cattle, and Group 3 only have older years in livestock. There were significant differences between the evaluated criteria and the sustainability index. From the typification of livestock farms, Group 2 (13 farms) presented a higher level of sustainability as did Group 3 (16 farms), while Group 1 (31 farms) presented unsustainable conditions. The environmental indicators based on animal quality and farm system show unsustainability in all farms the District of Moyobamba, as they fail to exceed the threshold of sustainability (5).

18.
Health Aff (Millwood) ; 42(1): 63-73, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36623219

RESUMO

The US physician workforce does not reflect the racial and ethnic makeup of the country's population, despite efforts to promote diversity. Becoming a physician requires significant time and financial investment, and populations that are underrepresented in medicine have also been excluded from building wealth. Understanding the differential burden of debt by race and ethnicity may inform strategies to improve workforce diversity. We used 2014-19 data on postgraduate resident trainees from the Association of American Medical Colleges to examine the association between race and ethnicity and debt independent of other demographics and residency characteristics. Black trainees were significantly more likely to have every type of debt than the overall sample and all other racial and ethnic groups (96 percent of Black trainees had any debt versus 83 percent overall; 60 percent had premedical education loans versus 35 percent overall, and 50 percent had consumer debt versus 25 percent overall). American Indian/Alaska Native, Hispanic, and Native Hawaiian/Pacific Islander trainees were more likely to have debt compared with White and Asian trainees. Overall, debt prevalence decreased over time and varied by specialty; however, for Black trainees, debt decreased minimally over time and was stable across specialties. Scholarships, debt relief, and financial guidance should be explored to improve diversity and inclusion in medicine across specialties.


Assuntos
Etnicidade , Internato e Residência , Humanos , Asiático , Hispânico ou Latino , Grupos Minoritários , Estados Unidos , Negro ou Afro-Americano , Indígena Americano ou Nativo do Alasca , Havaiano Nativo ou Outro Ilhéu do Pacífico
19.
J Psychoactive Drugs ; 55(1): 62-72, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-35114904

RESUMO

Aberrant glutamatergic signaling has been closely related to several pathologies of the central nervous system. Glutamatergic activity can induce an increase in neural plasticity mediated by brain-derived neurotrophic factor (BDNF) in the ventral tegmental area (VTA), a nodal point in the mesolimbic dopamine system. Recent studies have related BDNF dependent plasticity in the VTA with the modulation of aversive motivation to deal with noxious environmental stimuli. The disarray of these learning mechanisms would produce an abnormal augmentation in the representation of the emotional information related to aversion, sometimes even in the absence of external environmental trigger, inducing pathologies linked to mood disorders such as depression and drug addiction. Recent studies point out that serotonin (5-hydroxytryptamine, 5-HT) receptors, especially the 2a (5-HT2a) subtype, play an important role in BDNF-related neural plasticity in the VTA. It has been observed that a single administration of a 5HT2a agonist can both revert an animal to a nondependent state from a drug-dependent state (produced by the chronic administration of a substance of abuse). The 5HT2a agonist also reverted the BDNF-induced neural plasticity in the VTA, suggesting that the administration of 5-HT2a agonists could be used as effective therapeutic agents to treat drug addiction. These findings could explain the neurobiological correlate of the therapeutic use of 5HT2a agonists, which can be found in animals, plants and fungi during traditional medicine ceremonies and rituals to treat mood related disorders.


Assuntos
Síndrome de Abstinência a Substâncias , Transtornos Relacionados ao Uso de Substâncias , Animais , Humanos , Área Tegmentar Ventral/metabolismo , Área Tegmentar Ventral/patologia , Fator Neurotrófico Derivado do Encéfalo , Motivação , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Plasticidade Neuronal
20.
J Voice ; 37(4): 616-620, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34053823

RESUMO

OBJECTIVES: To determine the prevalence of separate and combined voice and swallowing impairments before and after total thyroidectomy and to delineate risk factors for these symptoms. METHODS: Retrospective review of 592 consecutive patients who underwent total thyroidectomy from July 2003 to August 2015. RESULTS: Combined voice and swallowing problems occurred preoperatively in 4.7% (11/234), 3.3% (3/92), and 6.0% (16/266) of patients with malignancy, hyperthyroidism, and benign euthyroid disease, respectively. Postoperatively, prevalence was 5.1%, 2.2%, and 1.9%, respectively. Benign euthyroid disease (20.7%) had the greatest risk of preoperative dysphagia (P = 0.003) and the largest glands (P < 0.001). Comparing before and after surgery, the cancer and benign euthyroid groups had decreased dysphagia (cancer: 11.5% vs. 6.0%, P = 0.034; benign: 20.7% vs. 3.8%, P < 0.001) but increased dysphonia (cancer: 19.2% vs. 28.6%, P = 0.017; benign: 15.8% vs. 27.1%, P = 0.002). Overall, 23/592 (3.9%) developed new dysphagia and 122/592 (20.6%) developed new dysphonia after surgery. Intraoperative recurrent laryngeal nerve transection occurred in 12 cases (2.0%). CONCLUSIONS: Total thyroidectomy resolved dysphagia but increased dysphonia in benign and malignant euthyroid patients. Voice and swallowing problems following thyroidectomy occurred more frequently than intraoperative recurrent laryngeal nerve transection, confirming symptoms often occur in the absence of suspected nerve injury.


Assuntos
Transtornos de Deglutição , Disfonia , Traumatismos do Nervo Laríngeo Recorrente , Humanos , Disfonia/diagnóstico , Disfonia/epidemiologia , Disfonia/etiologia , Traumatismos do Nervo Laríngeo Recorrente/diagnóstico , Traumatismos do Nervo Laríngeo Recorrente/epidemiologia , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Glândula Tireoide , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Incidência , Tireoidectomia/efeitos adversos , Nervo Laríngeo Recorrente
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