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1.
Small ; 16(6): e1905192, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31971354

RESUMO

Nanocomposite materials benefit from the diverse physicochemical properties featured by nanoparticles, and the presence of nanoparticle concentration gradients can lend functions to macroscopic materials beyond the realm of classical nanocomposites. It is shown here that linearity and time-shift invariance obtained via the synergism of two independent physical phenomena-translational self-diffusion and shear-driven dispersion-may give access to an exceptionally high degree of flexibility in the design of scalable and programmable long-range concentration gradients of nanoparticles in solidifiable liquid matrices.

2.
Anal Chem ; 92(1): 561-566, 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31815450

RESUMO

Taylor dispersion is a microfluidic analytical technique with a high dynamic range and therefore is suited well to measuring the hydrodynamic radius of small molecules, proteins, supramolecular complexes, macromolecules, nanoparticles and their self-assembly. Here we calculate an unaddressed yet fundamental property: the limit of resolution, which is defined as the smallest change in the hydrodynamic radius that Taylor dispersion can resolve accurately and precisely. Using concepts of probability theory and inferential statistics, we present a comprehensive theoretical approach, addressing uniform and polydisperise particle systems, which involve either model-based or numerical analyses. We find a straightforward scaling relationship in which the resolution limit is linearly proportional to the optical-extinction-weighted average hydrodynamic radius of the particle systems.

3.
Nanomaterials (Basel) ; 9(12)2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31835823

RESUMO

The overt hazard of carbon nanotubes (CNTs) is often assessed using in vitro methods, but determining a dose-response relationship is still a challenge due to the analytical difficulty of quantifying the dose delivered to cells. An approach to accurately quantify CNT doses for submerged in vitro adherent cell culture systems using UV-VIS-near-infrared (NIR) spectroscopy is provided here. Two types of multi-walled CNTs (MWCNTs), Mitsui-7 and Nanocyl, which are dispersed in protein rich cell culture media, are studied as tested materials. Post 48 h of CNT incubation, the cellular fractions are subjected to microwave-assisted acid digestion/oxidation treatment, which eliminates biological matrix interference and improves CNT colloidal stability. The retrieved oxidized CNTs are analyzed and quantified using UV-VIS-NIR spectroscopy. In vitro imaging and quantification data in the presence of human lung epithelial cells (A549) confirm that up to 85% of Mitsui-7 and 48% for Nanocyl sediment interact (either through internalization or adherence) with cells during the 48 h of incubation. This finding is further confirmed using a sedimentation approach to estimate the delivered dose by measuring the depletion profile of the CNTs.

4.
ACS Nano ; 13(7): 7759-7770, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31276366

RESUMO

The long-term fate of biomedically relevant nanoparticles (NPs) at the single cell level after uptake is not fully understood yet. We report that lysosomal exocytosis of NPs is not a mechanism to reduce the particle load. Biopersistent NPs such as nonporous silica and gold remain in cells for a prolonged time. The only reduction of the intracellular NP number is observed via cell division, e.g., mitosis. Additionally, NP distribution after cell division is observed to be asymmetrical, likely due to the inhomogeneous location and distribution of the NP-loaded intracellular vesicles in the mother cells. These findings are important for biomedical and hazard studies as the NP load per cell can vary significantly. Furthermore, we highlight the possibility of biopersistent NP accumulation over time within the mononuclear phagocyte system.

5.
Anal Chem ; 91(15): 9946-9951, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31246027

RESUMO

Taylor dispersion is capable of measuring accurately the hydrodynamic radius over several orders of magnitude. Accordingly, it is now a highly competitive technique dedicated to characterizing small molecules, proteins, macromolecules, nanoparticles, and their self-assembly. Regardless, an in-depth analysis addressing the precision of the technique, being a key indicator of reproducibility, is not available. Benefiting from analytical modeling and statistical analysis, we address error propagation and present a comprehensive theoretical study of the precision of Taylor dispersion. Theory is then compared against experiment, and we find full consistency. Our results are most helpful when the design, objectives, or control of analytical quality is in focus.

6.
J Colloid Interface Sci ; 544: 217-229, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-30849619

RESUMO

Poly(ethylene oxide)-poly(propylene oxide)-poly(ethylene oxide) (PEO-PPO-PEO) (F127) hydrogels have been used to deliver nitric oxide (NO) topically in biomedical applications. Here, the effect of F127 microenvironments on the photochemical NO release from S-nitrosoglutathione (GSNO) was investigated in F127 solutions 7.6 wt% 15 wt% and 22.5 wt% at 15 °C and 37 °C. Small-angle X-ray Scattering (SAXS) and Differential Scanning Calorimetry (DSC) measurements, along with proton Nuclear Magnetic Resonance (1H NMR) spectral shifts and T2 relaxation data at six different concentration-temperature conditions, allowed identifying F127 microphases characterized by: a sol phase of unimers; micelles in non-defined periodic order, and a gel phase of cubic packed micelles. Kinetic measurements showed that GSNO photodecompositon proceeds faster in micellized F127 where GSNO is segregated to the intermicellar microenvironment. Real time kinetic monitoring of NO release and T2 relaxation profiles showed that NO is preferentially partitioned into the hydrophobic PPO cores of the F127 micelles, with the consequent decrease in its rate of release to the gas phase. These results show that F127 microphases affect both the kinetics of GSNO photodecomposition and the rate of NO escape and can be used to modulate the photochemical NO delivery from F127/GSNO solutions.


Assuntos
Hidrogéis/química , Óxido Nítrico/química , Poloxâmero/química , Polietilenoglicóis/química , Polímeros/química , Propilenoglicóis/química , S-Nitrosoglutationa/química , Portadores de Fármacos/química , Liberação Controlada de Fármacos , Cinética , Micelas , Processos Fotoquímicos , Temperatura Ambiente
7.
Rev. argent. cardiol ; 87(1): 16-20, feb. 2019. graf
Artigo em Espanhol | LILACS-Express | ID: biblio-1003244

RESUMO

RESUMEN Objetivos: Comparar pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) incluidos en centros participantes de dos registros argentinos. Material y métodos: Se compararon pacientes con IAMCEST incluidos en 54 centros que participaron tanto en el registro SCAR (2011) como en el ARGEN-IAM-ST (2015). Resultados: Se analizaron 676 pacientes con IAMCEST; 222 del SCAR y 454 del ARGEN-IAM-ST No hubo cambios significativos en la edad y el género. Se observó una reducción significativa en el uso de fibrinolíticos, con un incremento de la angioplastia primaria. El shock cardiogénico se redujo a la mitad. No hubo diferencias en la mortalidad y de reinfarto durante la hospitalización. Conclusiones: Se observó una mayor indicación de angioplastia primaria y una disminución en el uso de fibrinolíticos. El shock cardiogénico se redujo significativamente en los últimos 5 años, sin cambios significativos en la mortalidad hospitalaria.


ABSTRACT Objectives: The aim of this study was to compare patientis with ST-segment elevation myocardial infarction (STEMI) included in centers participating of two registries in Argentina. Methods: STEMI patientis included in the 54 centers participating in the SCAR (2011) registry and in the ARGEN-IAM-ST (2015) registry were compared. Resultis: A total of 676 STEMI patientis were analyzed: 222 in the SCAR registry and 454 in the ARGEN-IAM-ST registry. There were no significant differences in age and sex. The use of fibrinolytic agentis was significantly lower and the use of primary percutaneous coronary intervention was significantly increased. The incidence of cardiogenic shock was 50% lower. There were no differences in mortality and reinfarction during hospitalization. Conclusions: The indication of primary percutaneous coronary intervention increased and the use of fibrinolytic agentis decreased. Cardiogenic shock decreased significantly in the last 5 years without significant changes in in-hospital mortality.

8.
Sci Rep ; 8(1): 2440, 2018 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-29402918

RESUMO

The synthesis of anisotropic metallic nanoparticles (NPs) has been a field of intense and challenging research in the past decade. In this communication, we report on the reproducible and highly controllable synthesis of monodisperse branched gold nanoparticles in a droplet-based microfluidics platform. The process has been automated by adapting two different bulk synthetic strategies to microdroplets, acting as microreactors, for NP synthesis: a surfactant-free synthesis and a surfactant-assisted synthesis. Microdroplets were generated in two different microfluidic devices designed to accommodate the requirements of both bulk syntheses. The epitaxial growth of AuNSTs inside the microdroplets allowed for a fine control of reagent mixing and local concentrations during particle formation. This is the first time branched gold NPs have been synthesised in a microfluidics platform. The monodispersity of the product was comparable to the synthesis in bulk, proving the potential of this technology for the continuous synthesis of high quality anisotropic NPs with improved reproducibility.

9.
Rev. argent. cardiol ; 85(2): 1-11, abr. 2017. ilus
Artigo em Espanhol | LILACS-Express | ID: biblio-957756

RESUMO

Introducción: En los últimos años ha surgido con fuerza el concepto outcome-based education, que enfatiza la conveniencia de establecer con claridad las competencias profesionales a lograr. En la normativa vigente se especifica la habilidad para interpretar los resultados de la investigación y hacer una lectura crítica de las publicaciones científicas como una de las competencias del médico cardiólogo. Objetivo: Indagar la capacidad de los residentes para interpretar las pruebas estadísticas más frecuentemente utilizadas en los trabajos de investigación. Material y métodos: Cuestionario de 17 preguntas de selección múltiple, desarrollado y validado por Pizarro y colaboradores. Puntaje máximo posible: 17 puntos. Se establecieron cuatro niveles de dominio de la habilidad para la lectura crítica según cantidad de respuestas correctas: ninguna (menos de 5 puntos), insuficiente (entre 5 y 9 puntos), bueno (entre 10 y 14 puntos) y muy bueno (15 y más). Resultados: En mayo de 2016, 169 residentes de cardiología respondieron el cuestionario de forma anónima y voluntaria. El 29% menciona formación previa en el tema, el 88% dice que en la residencia se realizan regularmente ateneos bibliográficos. - Rango de respuestas correctas: 0-15. - Promedio: 7,56 ± 1,66. - Mediana: 7 (intervalo intercuartil 4-8,5). - Cronbach: 0,81. En promedio, se respondió correctamente el 44% del cuestionario, sin diferencias significativas entre hombres y mujeres (45% vs. 43%; p = 0,34) ni entre los que tenían y los que no tenían formación previa en estadística (45% vs. 43%; p = 0,39). Se encontró diferencia significativa entre egresados de universidad argentina y de extranjera (45% vs. 36%; p < 0,045). Conclusiones: El 73% de los residentes mostraron un nivel insuficiente de los conocimientos necesarios para interpretar los trabajos de investigación. Los resultados son similares a los de otros estudios publicados. Sería interesante revisar las estrategias de enseñanza y analizar su grado de eficacia.

10.
Rev. Soc. Argent. Diabetes ; 50(3): 117-128, Diciembre 2016. graf
Artigo em Espanhol | LILACS | ID: biblio-882237

RESUMO

En los últimos años el aumento de la prevalencia de obesidad y diabetes mellitus tipo 2 (DM2), la aparición a edades más tempranas de DM2, así como el desplazamiento del embarazo a edades mayores conllevan a un aumento de casos de diabetes (DM) en el embarazo. En algunas pacientes la diabetes no se diagnostica y obviamente no se trata. Este hecho puede complicar un embarazo, especialmente en el período embriogénico. La aplicación de nuevos criterios de diagnóstico para la diabetes gestacional, la controversia en el uso y la seguridad de los antidiabéticos orales durante el embarazo, así como el uso de determinados análogos de insulina hacen indispensable que Latinoamérica, a través del Grupo de Trabajo de Diabetes y Embarazo de la Asociación Latinoamericana de Diabetes (ALAD), actualice sus recomendaciones. El desarrollo de las mismas se realizó en varias reuniones y trabajo conjunto del grupo. Se tuvo en cuenta el grado de nivel de evidencia, la experiencia de los referentes y la adaptación cultural según las regiones donde se implementarán las recomendaciones descriptas


Assuntos
Diabetes Gestacional , Glucose , Teste de Tolerância a Glucose , Gravidez
11.
Anal Chem ; 88(6): 3115-20, 2016 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-26892256

RESUMO

S-Nitrosothiols (RSNOs) are carriers of nitric oxide (NO) and have important biological activities. We propose here the use of gold nanoparticles (AuNPs) and NO-selective amperometric microsensor for the detection and quantification of S-nitrosoglutathione (GSNO) as a step toward the determination of plasma RSNOs. AuNPs were used to decompose RSNOs with the quantitative release of free NO which was selectively detected with a NO microsensor. The optimal [GSNO]/[AuNPs] ratio was determined, corresponding to an excess of AuNP surface relative to the molar GSNO amount. Moreover, the influence of free plasma thiols on this method was investigated and a protocol based on the blocking of free thiols with iodoacetic acid, forming the carboxymethyl derivative of the cysteine residues, is proposed.


Assuntos
Técnicas Eletroquímicas/métodos , Ouro/química , Nanopartículas Metálicas , S-Nitrosoglutationa/análise , S-Nitrosotióis/sangue , Humanos
12.
BMJ Open ; 5(11): e008554, 2015 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-26603243

RESUMO

OBJECTIVES: We aimed to assess the association between long-term use of inhaled corticosteroids (ICS) and bone adverse effects in patients with asthma. DESIGN: Systematic review and meta-analysis of fracture risk and changes in bone mineral density with long-term ICS use in asthma. METHODS: We initially searched MEDLINE and EMBASE in July 2013, and performed an updated PubMed search in December 2014. We selected randomised controlled trials (RCTs) and controlled observational studies of any ICS (duration at least 12 months) compared to non-ICS use in patients with asthma. We conducted meta-analysis of ORs for fractures, and mean differences in bone mineral density. Heterogeneity was assessed using the I(2) statistic. RESULTS: We included 18 studies (7 RCTs and 11 observational studies) in the systematic review. Meta-analysis of observational studies did not demonstrate any significant association between ICS and fractures in children (pooled OR 1.02, 95% CI 0.94 to 1.10, two studies), or adults (pooled OR 1.09, 95% CI 0.45 to 2.62, four studies). Three RCTs and three observational studies in children reported on bone mineral density at the lumbar spine, and our meta-analysis did not show significant reductions with ICS use. Three RCTs and four observational studies in adults reported on ICS use and bone mineral density at the lumbar spine and femur, with no significant reductions found in the meta-analysis compared to control. CONCLUSIONS: ICS use for ≥12 months in adults or children with asthma was not significantly associated with harmful effects on fractures or bone mineral density.


Assuntos
Corticosteroides/efeitos adversos , Antiasmáticos/efeitos adversos , Asma/tratamento farmacológico , Densidade Óssea/efeitos dos fármacos , Fraturas Ósseas/etiologia , Administração por Inalação , Corticosteroides/uso terapêutico , Adulto , Antiasmáticos/uso terapêutico , Criança , Humanos , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco
13.
Cochrane Database Syst Rev ; (10): CD010984, 2015 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-26505729

RESUMO

BACKGROUND: Platelet transfusions are used in modern clinical practice to prevent and treat bleeding in people who are thrombocytopenic due to bone marrow failure. Although considerable advances have been made in platelet transfusion therapy in the last 40 years, some areas continue to provoke debate, especially concerning the use of prophylactic platelet transfusions for the prevention of thrombocytopenic bleeding.This is an update of a Cochrane review first published in 2004, and updated in 2012 that addressed four separate questions: prophylactic versus therapeutic-only platelet transfusion policy; prophylactic platelet transfusion threshold; prophylactic platelet transfusion dose; and platelet transfusions compared to alternative treatments. This review has now been split into four smaller reviews; this review compares different platelet transfusion doses. OBJECTIVES: To determine whether different doses of prophylactic platelet transfusions (platelet transfusions given to prevent bleeding) affect their efficacy and safety in preventing bleeding in people with haematological disorders undergoing myelosuppressive chemotherapy with or without haematopoietic stem cell transplantation (HSCT). SEARCH METHODS: We searched for randomised controlled trials in the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library 2015, Issue 6), MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1937), the Transfusion Evidence Library (from 1950), and ongoing trial databases to 23 July 2015. SELECTION CRITERIA: Randomised controlled trials involving transfusions of platelet concentrates, prepared either from individual units of whole blood or by apheresis, and given to prevent bleeding in people with malignant haematological disorders or undergoing HSCT that compared different platelet component doses (low dose 1.1 x 10(11)/m(2) ± 25%, standard dose 2.2 x 10(11)/m(2) ± 25%, high dose 4.4 x 10(11)/m(2) ± 25%). DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS: We included seven trials (1814 participants) in this review; six were conducted during one course of treatment (chemotherapy or HSCT).Overall the methodological quality of studies was low to moderate across different outcomes according to GRADE methodology. None of the included studies were at low risk of bias in every domain, and all the included studies had some threats to validity.Five studies reported the number of participants with at least one clinically significant bleeding episode within 30 days from the start of the study. There was no difference in the number of participants with a clinically significant bleeding episode between the low-dose and standard-dose groups (four studies; 1170 participants; risk ratio (RR) 1.04, 95% confidence interval (CI) 0.95 to 1.13; moderate-quality evidence); low-dose and high-dose groups (one study; 849 participants; RR 1.02, 95% CI 0.93 to 1.11; moderate-quality evidence); or high-dose and standard-dose groups (two studies; 951 participants; RR 1.02, 95% CI 0.93 to 1.11; moderate-quality evidence).Three studies reported the number of days with a clinically significant bleeding event per participant. There was no difference in the number of days of bleeding per participant between the low-dose and standard-dose groups (two studies; 230 participants; mean difference -0.17, 95% CI -0.51 to 0.17; low quality evidence). One study (855 participants) showed no difference in the number of days of bleeding per participant between high-dose and standard-dose groups, or between low-dose and high-dose groups (849 participants).Three studies reported the number of participants with severe or life-threatening bleeding. There was no difference in the number of participants with severe or life-threatening bleeding between a low-dose and a standard-dose platelet transfusion policy (three studies; 1059 participants; RR 1.33, 95% CI 0.91 to 1.92; low-quality evidence); low-dose and high-dose groups (one study; 849 participants; RR 1.20, 95% CI 0.82 to 1.77; low-quality evidence); or high-dose and standard-dose groups (one study; 855 participants; RR 1.11, 95% CI 0.73 to 1.68; low-quality evidence).Two studies reported the time to first bleeding episodes; we were unable to perform a meta-analysis. Both studies (959 participants) individually found that the time to first bleeding episode was either the same, or longer, in the low-dose group compared to the standard-dose group. One study (855 participants) found that the time to the first bleeding episode was the same in the high-dose group compared to the standard-dose group.Three studies reported all-cause mortality within 30 days from the start of the study. There was no difference in all-cause mortality between treatment arms (low-dose versus standard-dose: three studies; 1070 participants; RR 2.04, 95% CI 0.70 to 5.93; low-quality evidence; low-dose versus high-dose: one study; 849 participants; RR 1.33, 95% CI 0.50 to 3.54; low-quality evidence; and high-dose versus standard-dose: one study; 855 participants; RR 1.71, 95% CI 0.51 to 5.81; low-quality evidence).Six studies reported the number of platelet transfusions; we were unable to perform a meta-analysis. Two studies (959 participants) out of three (1070 participants) found that a low-dose transfusion strategy led to more transfusion episodes than a standard-dose. One study (849 participants) found that a low-dose transfusion strategy led to more transfusion episodes than a high-dose strategy. One study (855 participants) out of three (1007 participants) found no difference in the number of platelet transfusions between the high-dose and standard-dose groups.One study reported on transfusion reactions. This study's authors suggested that a high-dose platelet transfusion strategy may lead to a higher rate of transfusion-related adverse events.None of the studies reported quality-of-life. AUTHORS' CONCLUSIONS: In haematology patients who are thrombocytopenic due to myelosuppressive chemotherapy or HSCT, we found no evidence to suggest that a low-dose platelet transfusion policy is associated with an increased bleeding risk compared to a standard-dose or high-dose policy, or that a high-dose platelet transfusion policy is associated with a decreased risk of bleeding when compared to a standard-dose policy.A low-dose platelet transfusion strategy leads to an increased number of transfusion episodes compared to a standard-dose strategy. A high-dose platelet transfusion strategy does not decrease the number of transfusion episodes per participant compared to a standard-dose regimen, and it may increase the number of transfusion-related adverse events.Findings from this review would suggest a change from current practice, with low-dose platelet transfusions used for people receiving in-patient treatment for their haematological disorder and high-dose platelet transfusion strategies not being used routinely.


Assuntos
Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hemorragia/prevenção & controle , Transfusão de Plaquetas/métodos , Transplante de Células-Tronco/efeitos adversos , Trombocitopenia/complicações , Adulto , Causas de Morte , Criança , Hemorragia/etiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Trombocitopenia/induzido quimicamente , Trombocitopenia/terapia , Fatores de Tempo
14.
Rev. argent. cardiol ; 83(5): 406-411, oct. 2015. graf, tab
Artigo em Espanhol | LILACS-Express | ID: biblio-957653

RESUMO

Introducción: El registro sobre Síndromes Coronarios Agudos en Argentina (SCAR) analizó la evolución intrahospitalaria del infarto de miocardio en nuestro país en pacientes que contaban con diferentes coberturas del sistema de salud, lo cual ha llevado al presente subanálisis derivado del registro SCAR. Objetivo: Determinar la influencia de la cobertura médica en el pronóstico intrahospitalario del infarto de miocardio. Material y métodos: El registro SCAR fue un estudio transversal, prospectivo y multicéntrico, que incluyó 476 pacientes con diagnóstico de infarto agudo de miocardio con supradesnivel del segmento ST (IAMST). La cobertura médica se diferenció en prepaga, obra social, PAMI y sin cobertura (solo estatal). Resultados: El 80% de los IAMST recibieron reperfusión, el 75% por angioplastia transluminal coronaria primaria (ATCP). La ATCP fue más frecuente en quienes tenían prepaga [OR 5,5 (2,5-12,4); p < 0,001] y los pacientes con PAMI [OR 0,47 (0,24-087); p = 0,02] o sin cobertura recibieron menos ATCP [OR 0,34 (0,2-0,6); p < 0,001]. El 13% fueron derivados a otro centro, más frecuentemente si tenían PAMI (p = 0,002). El tiempo hasta la ATCP fue mayor en pacientes con PAMI [240 (88-370) min; p = 0,0005] y menor si tenían prepaga [80 (42-120) min; p < 0,001]. La mortalidad intrahospitalaria del IAMST fue del 8%, 2,8% con prepaga, 4,3% con cobertura estatal, 6,88% con obra social y 25% con PAMI (ANOVA < 0,001). Tener prepaga se asoció con una mortalidad menor [OR 0,27 (0,08-0,91); p = 0,035] y tener PAMI se asoció con una mortalidad mayor, aun ajustado por sexo, edad y comorbilidades [OR 2,40 (1,1-5,8); p = 0,05]. Conclusión: El tratamiento y la mortalidad del IAMST fueron diferentes según la cobertura médica.


Background: The Acute Coronary Syndromes in Argentina (SCAR) registry analyzed in-hospital myocardial infarction out-come in patients with different medical coverage provided by the healthcare system; this has led to the present subanalysis derived from the SCAR registry. Objective: The aim of this study was to determine the influence of medical coverage on myocardial infarction in-hospital prognosis. Methods: The SCAR registry was a cross-sectional, prospective, multicenter study including 476 patients with ST-segment elevation acute myocardial infarction (STEMI). Medical coverage was classified in prepaid health insurance, social security insurance, PAMI and without medical coverage (except public coverage). Results: Eighty percent of STEMI patients received reperfusion therapy, 75% by primary transluminal coronary angioplasty (PTCA). PTCA was more frequent in those with prepaid health insurance [OR 5.5 (2.5-12.4); p<0.001] and less frequent in PAMI patients [OR 0.47 (0.24-0.87), p=0.02] or in those without any medical coverage [OR=0.34 (0.2-0.6), p<0.001]. Thirteen percent of patients were transferred to another hospital, more frequently if they were PAMI patients (p=0.002). Time to PTCA was longer in patients with PAMI [240 (88-370) min, p=0.0005] and shorter in patients with prepaid health insurance [80 (42-120) min, p<0.001]. Overall in-hospital STEMI mortality was 8%, 2.8% in patients with prepaid health insurance, 4.3% in patients with public medical coverage, 6.88% in patients with social security insurance and 25% in patients covered by PAMI (ANOVA <0.001). Mortality was significantly lower in patients with prepaid health insurance [OR=0.27 (0.08-0.91), p=0.035] and higher in patients with PAMI, even after adjusting by sex, age and comorbidities [OR 2.40 (1.1-5.8), p=0.05]. Conclusion: STEMI treatment and mortality were different according to the type of medical coverage.

15.
Rev. argent. cardiol ; 83(4): 300-304, ago. 2015. graf, tab
Artigo em Espanhol | LILACS-Express | ID: biblio-957630

RESUMO

Introducción: En nuestro medio se desconoce cuál ha sido la influencia de la evidencia clínica sobre las estrategias implementadas en el tratamiento de los síndromes coronarios agudos sin elevación del segmento ST (SCASEST). Objetivos: Evaluar la variación de las características clínicas, las estrategias adoptadas, las conductas terapéuticas y los eventos hospitalarios de los SCASEST en centros que participaron en dos registros realizados en la Argentina. Material y métodos: Se compararon pacientes incluidos en centros que participaron en los registros STRATEG-SIA (1999) y SCAR (Síndromes Coronarios Agudos en Argentina - 2011). Resultados: Se analizaron 238 pacientes del registro STRATEG-SIA y 452 del SCAR incluidos en 36 centros. La mayoría eran de género masculino y menores de 65 años (SCAR 57%, STRATEG-SIA 54%; p = ns). El grupo SCAR presentó mayor prevalencia de hipertensión arterial (75% vs. 60%; p = 0,001), dislipidemia (63% vs. 51%; p = 0,003), insuficiencia cardíaca crónica (10,5% vs. 4,6%; p = 0,02) y revascularización coronaria previa (30% vs. 17%; p = 0,001). Con una proporción mayor de puntaje TIMI de riesgo moderado y alto (3-4: 48% vs. 37%; 5-7: 18% vs. 8%; p = 0,0001), la coronariografía fue más frecuente en el SCAR (71% vs. 50%; p = 0,0001), duplicándose la angioplastia coronaria y reduciéndose a la mitad las cirugías de revascularización miocárdica. No hubo diferencias significativas en la tasa intrahospitalaria de muerte e infarto (7,2% vs. 5,9%; p = ns). Conclusiones: Los pacientes del registro SCAR (2011) representan un grupo de mayor riesgo. Las diferencias en las tasas de eventos hospitalarios no fueron estadísticamente significativas.


Background: The influence of clinical evidence on strategies implemented in the treatment of non-ST-segment elevation acute coronary syndromes (NSTEACS) is not known in our setting. Objectives: The aim of this study was to evaluate the differences in clinical characteristics, strategies adopted, therapeutic management and in-hospital events of NSTEACS in participating centers from two registries in Argentina. Methods: Patients included in participating centers of the STRATEG-SIA registry (1999) and SCAR registry (Síndromes Coronarios Agudos en Argentina - 2011) were compared. Results: We analyzed 238 patients of the STRATEG-SIA registry and 452 of the SCAR registry in 36 centers. Most patients were men and <65 years (SCAR 57%, STRATEG-SIA 54%; p=ns). The SCAR group presented higher prevalence of hypertension (75% vs. 60%; p=0.001), dyslipidemia (63% vs. 51%; p=0.003), chronic heart failure (10.5% vs. 4.6%; p=0.02) and history of myocardial revascularization (30% vs. 17%; p=0.001). In the SCAR registry, the proportion of moderate and high-risk patients (TIMI risk score 3-4: 48% vs. 37%; 5-7: 18% vs. 8%; p=0.0001) was higher and coronary angiography was more frequent (71% vs. 50%; p=0.0001), with a twofold increase in the proportion of percutaneous coronary interventions and 50% reduction in the number of myocardial revascularization surgeries. There were no significant differences in the rate of mortality and myocardial infarction during hospitalization (7.2% vs. 5.9%; p=ns). Conclusions: Patients of the SCAR (2011) registry represent a group at higher risk. The differences in the rates of in-hospital events were not statistically significant.

16.
PLoS One ; 10(7): e0133428, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26191797

RESUMO

BACKGROUND: Long-term inhaled corticosteroids (ICS) may reduce growth velocity and final height of children with asthma. We aimed to evaluate the association between ICS use of >12 months and growth. METHODS: We initially searched MEDLINE and EMBASE in July 2013, followed by a PubMed search updated to December 2014. We selected RCTs and controlled observational studies of ICS use in patients with asthma. We conducted random effects meta-analysis of mean differences in growth velocity (cm/year) or final height (cm) between groups. Heterogeneity was assessed using the I2 statistic. RESULTS: We found 23 relevant studies (twenty RCTs and three observational studies) after screening 1882 hits. Meta-analysis of 16 RCTs showed that ICS use significantly reduced growth velocity at one year follow-up (mean difference -0.48 cm/year (95% CI -0.66 to -0.29)). There was evidence of a dose-response effect in three RCTs. Final adult height showed a mean reduction of -1.20 cm (95% CI -1.90 cm to -0.50 cm) with budesonide versus placebo in a high quality RCT. Meta-analysis of two lower quality observational studies revealed uncertainty in the association between ICS use and final adult height, pooled mean difference -0.85 cm (95% CI -3.35 to 1.65). CONCLUSION: Use of ICS for >12 months in children with asthma has a limited impact on annual growth velocity. In ICS users, there is a slight reduction of about a centimeter in final adult height, which when interpreted in the context of average adult height in England (175 cm for men and 161 cm for women), represents a 0.7% reduction compared to non-ICS users.


Assuntos
Corticosteroides/administração & dosagem , Antiasmáticos/administração & dosagem , Asma/tratamento farmacológico , Estatura/efeitos dos fármacos , Desenvolvimento Infantil/efeitos dos fármacos , Administração por Inalação , Adolescente , Corticosteroides/uso terapêutico , Antiasmáticos/uso terapêutico , Budesonida/uso terapêutico , Criança , Pré-Escolar , Humanos
18.
Cochrane Database Syst Rev ; (6): CD005341, 2015 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-26118415

RESUMO

BACKGROUND: Despite modern antimicrobials and supportive therapy, bacterial and fungal infections are still major complications in people with prolonged disease-related or therapy-related neutropenia. Since the late 1990s there has been increasing demand for donated granulocyte transfusions to treat or prevent severe infections in people who lack their own functional granulocytes. This is an update of a Cochrane review first published in 2009. OBJECTIVES: To determine the effectiveness and safety of prophylactic granulocyte transfusions compared with a control population not receiving this intervention for preventing all-cause mortality, mortality due to infection, and evidence of infection due to infection or due to any other cause in people with neutropenia or disorders of neutrophil function. SEARCH METHODS: We searched for randomised controlled trials (RCTs) and quasi-RCTs in the Cochrane Central Register of Controlled Trials (Cochrane Library 2015, Issue 3), MEDLINE (from 1946), EMBASE (from 1974), CINAHL (from 1937), theTransfusion Evidence Library (from 1980) and ongoing trial databases to April 20 2015. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs comparing people receiving granulocyte transfusions to prevent the development of infection with a control group receiving no granulocyte transfusions. Neonates are the subject of another Cochrane review and were excluded from this review. There was no restriction by outcomes examined, but this review focuses on mortality, mortality due to infection and adverse events. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS: Twelve trials met the inclusion criteria. One trial is still ongoing, leaving a total of 11 trials eligible involving 653 participants. These trials were conducted between 1978 and 2006 and enrolled participants from fairly comparable patient populations. None of the studies included people with neutrophil dysfunction. Ten studies included only adults, and two studies included children and adults. Ten of these studies contained separate data for each arm and were able to be critically appraised. One study re-randomised people and therefore quantitative analysis was unable to be performed.Overall, the quality of the evidence was very low to low across different outcomes according to GRADE methodology. This was due to many of the studies being at high risk of bias, and many of the outcome estimates being imprecise.All-cause mortality was reported for nine studies (609 participants). There was no difference in all-cause mortality over 30 days between people receiving prophylactic granulocyte transfusions and those that did not (seven studies; 437 participants; RR 0.92, 95% CI 0.63 to 1.36, very low-quality evidence).Mortality due to infection was reported for seven studies (398 participants). There was no difference in mortality due to infection over 30 days between people receiving prophylactic granulocyte transfusions and those that did not (six studies; 286 participants; RR 0.69, 95% CI 0.33 to 1.44, very low-quality evidence).The number of people with localised or systemic bacterial or fungal infections was reported for nine studies (609 participants). There were differences between the granulocyte dose subgroups (test for subgroup differences P = 0.01). There was no difference in the number of people with infections over 30 days between people receiving prophylactic granulocyte transfusions and those that did not in the low-dose granulocyte group (< 1.0 x 10(10) granulocytes per day) (four studies, 204 participants; RR 0.84, 95% CI 0.58 to 1.20; very low-quality evidence). There was a decreased number of people with infections over 30 days in the people receiving prophylactic granulocyte transfusions in the intermediate-dose granulocyte group (1.0 x 10(10) to 4.0 x 10(10) granulocytes per day) (4 studies; 293 participants; RR 0.40, 95% CI 0.26 to 0.63, low-quality evidence).There was a decreased number of participants with bacteraemia and fungaemia in the participants receiving prophylactic granulocyte transfusions (nine studies; 609 participants; RR 0.45, 95% CI 0.30 to 0.65, low-quality evidence).There was no difference in the number of participants with localised bacterial or fungal infection in the participants receiving prophylactic granulocyte transfusions (six studies; 296 participants; RR 0.75, 95% CI 0.50 to 1.14; very low-quality evidence).Serious adverse events were only reported for participants receiving granulocyte transfusions and donors of granulocyte transfusions. AUTHORS' CONCLUSIONS: In people who are neutropenic due to myelosuppressive chemotherapy or a haematopoietic stem cell transplant, there is low-grade evidence that prophylactic granulocyte transfusions decrease the risk of bacteraemia or fungaemia. There is low-grade evidence that the effect of prophylactic granulocyte transfusions may be dose-dependent, a dose of at least 10 x 10(10) per day being more effective at decreasing the risk of infection. There is insufficient evidence to determine any difference in mortality rates due to infection, all-cause mortality, or serious adverse events.


Assuntos
Infecções Bacterianas/prevenção & controle , Granulócitos/transplante , Transfusão de Leucócitos/métodos , Micoses/prevenção & controle , Neutropenia/terapia , Adulto , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Causas de Morte , Criança , Glucocorticoides/uso terapêutico , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Humanos , Transtornos Leucocíticos/complicações , Transtornos Leucocíticos/terapia , Transfusão de Leucócitos/efeitos adversos , Neutropenia/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Molecules ; 20(3): 4109-23, 2015 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-25749680

RESUMO

Nitric oxide (NO)-mediated vasodilation plays a key role in gastric mucosal defense, and NO-donor drugs may protect against diseases associated with gastric mucosal blood flow (GMBF) deficiencies. In this study, we used the ex vivo gastric chamber method and Laser Doppler Flowmetry to characterize the effects of luminal aqueous NO-donor drug S-nitroso-N-acetylcysteine (SNAC) solution administration compared to aqueous NaNO2 and NaNO3 solutions (pH 7.4) on GMBF in Sprague-Dawley rats. SNAC solutions (600 µM and 12 mM) led to a rapid threefold increase in GMBF, which was maintained during the incubation of the solutions with the gastric mucosa, while NaNO2 or NaNO3 solutions (12 mM) did not affect GMBF. SNAC solutions (600 µM and 12 mM) spontaneously released NO at 37 °C at a constant rate of 0.3 or 14 nmol·mL-1·min-1, respectively, while NaNO2 (12 mM) released NO at a rate of 0.06 nmol·mL-1·min-1 and NaNO3 (12 mM) did not release NO. These results suggest that the SNAC-induced GMBF increase is due to their higher rates of spontaneous NO release compared to equimolar NaNO2 solutions. Taken together, our data indicate that oral SNAC administration is a potential approach for gastric acid-peptic disorder prevention and treatment.


Assuntos
Acetilcisteína/análogos & derivados , Mucosa Gástrica/irrigação sanguínea , Óxido Nítrico/metabolismo , Fluxo Sanguíneo Regional/efeitos dos fármacos , Acetilcisteína/farmacologia , Animais , Fluxometria por Laser-Doppler , Medições Luminescentes , Masculino , Nitratos/farmacologia , Nitrogênio/farmacologia , Ratos , Ratos Sprague-Dawley
20.
Rev. argent. cardiol ; 82(6): 500-505, dic. 2014. tab
Artigo em Espanhol | LILACS-Express | ID: lil-750558

RESUMO

Introducción: Se conoce que la leucocitosis y la hiperglucemia se correlacionan a corto plazo con peor pronóstico en pacientes con síndrome coronario agudo, pero su novel relación, denominada índice leucoglucémico (ILG), se ha evaluado escasamente. Objetivos: Analizar el valor pronóstico del ILG en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) y su valor agregado a los puntajes de riesgo clásicos. Material y métodos: Se analizaron los pacientes con diagnóstico de IAMCEST del Registro Multicéntrico SCAR (Síndromes Coronarios Agudos en Argentina). El punto final analizado fue la muerte o Killip Kimball 3-4 (KK 3-4) en el período hospitalario. Se analizó el ILG tanto como variable continua como en cuartiles según los valores de los percentiles 25, 50 y 75. Resultados: Se analizaron 405 de 476 pacientes con diagnóstico final de IAMCEST. La presencia del punto final fue significativamente creciente por cuartiles de ILG: 0%, 7,60%, 9,30% y 30,60% (p < 0,0001). El área bajo la curva ROC del ILG para el punto final combinado fue de 0,77 [(IC 95% 0,71-0,88); p = 0,0001]; el mejor valor de corte pronóstico fue de 1.000. La presencia de muerte o KK 3-4 fue del 0% y del 13% en los IAMCEST con ILG menor o mayor de 1.000, respectivamente. En un modelo de regresión logística multivariado, el ILG se asoció independientemente con muerte o KK 3-4. El área bajo la curva ROC del puntaje TIMI para IAMCEST fue de 0,58. El agregado del ILG incrementó su capacidad discriminatoria a 0,66 (p = 0,001). Conclusiones: El ILG demostró que es un predictor independiente de mala evolución en el IAMCEST (muerte o KK 3-4), con valor aditivo al puntaje TIMI.


Background: Leukocytosis and hyperglycemia correlate with worse short-term prognosis in patients with acute coronary syndrome, but their new relationship, called leuko-glycemic index (LGI), has been scarcely evaluated. Objectives: The aim of this study was to analyze the prognostic value of LGI in patients with ST-segment-elevation acute myocardial infarction (STEMI) and its added value to classical risk scores. Methods: Patients diagnosed with STEMI from the SCAR (Acute Coronary Syndromes in Argentina) Multicenter Registry were analyzed. The final endpoint was death or in-hospital Killip-Kimball 3-4 (KK 3-4). The LGI was analyzed as a continu-ous variable and in quartiles according to 25, 50 and 75 percentile values. Results: The study evaluated 405 out of 476 patients with final STEMI diagnosis. Presence of the primary endpoint significantly increased per LGI quartile: 0%, 7.60%, 9.30% and 30.60% (p < 0.0001). The LGI area under the ROC curve for the composite endpoint was 0.77 [(95% CI 0.71-0.88); p = 0.0001]; the best prognostic cut-off value was 1000. Presence of death or KK 3-4 was 0% and 13% in STEMI patients with LGI below or above 1000, respectively In a multivariate logistic regression model, LGI was independently associated with death or KK 3-4. The area under the ROC curve of the TIMI risk score for STEMI was 0.58. The addition of LGI increased its discriminatory capacity to 0.66 (p = 0.001). Conclusions: The LGI was an independent predictor of adverse outcome in STEMI patients (death or KK 3-4), adding prognostic value to the TIMI risk score.

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