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1.
Transbound Emerg Dis ; 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32053252

RESUMO

Vampire bats became the main reservoir of rabies in Latin America, where the disease remains one of the most important viral zoonoses affecting humans and livestock. In Peru, the most affected livestock are cattle. The official data of 1,729 cases of bovine rabies were evaluated between 2003 and 2017 through a descriptive analysis, decomposition of the time series and spatiotemporal analyses. Although the cases did not present a defined seasonality, the trend seemed to increase for several years. The bovine rabies cases are more frequent in the inter-Andean valleys than in other regions of the Amazon plains. The highest case density was observed in the regions of Ayacucho, Cuzco and Apurímac, all located in the Andes. It is necessary to review the current national program for the prevention and control of rabies in livestock, incorporating concepts of the ecology of vampire bats, as well as the prediction of the infection waves geographic and temporal spread. These approaches could improve the efficiency of other current prevention measures that have not shown the expected control effects, such as indiscriminate culling of vampire bats.

2.
Biochim Biophys Acta Biomembr ; 1862(2): 183133, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31785236

RESUMO

Food polyphenols in fruits juices, tea, coffee, wine and beer confer sensory properties such as colour, astringency and bitterness. The development of functional healthy drinks without the unpleasant sensory feeling is boosting research for a clearer understanding on the interactions of polyphenols within the oral mucosa. In this study we investigated the interaction of astringent polyphenols, namely ECG, EGCG, procyanidin B4 and PGG, with lipids in model membranes by spectroscopic techniques. The membrane model was built varying the cholesterol content to mimic mouth regions and experiments were conducted at pH 5 to mimic the pH drop at the moment of beverage (e.g. green tea, red wine) intake. Fluorescence quenching results conducted on LUVs with cholesterol molar fractions ranging between 0.34 < χchol < 0.74 and similar size distributions (122.9 ± 3.7 nm) showed that interaction of polyphenols is structure- and concentration-dependent. Also, the decrease of partition constants (Kp) with increasing cholesterol content (χchol) suggest that the affinity of polyphenols is weaker in cholesterol-rich liposomes. STD results revealed that the interaction of EGCG and PGG with membrane lipids involved mainly galloyl residues. Overall, spectroscopic data show that polyphenols interact to higher extent with more polar regions found in buccal, flour of the mouth and gingiva regions than with more hydrophobic regions located in the palate and tongue supporting that lipid microenvironments play a role in oral sensory perception.

3.
Prev Vet Med ; 174: 104809, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31756671

RESUMO

The importance of the common vampire bat Desmodus rotundus for the transmission of the rabies virus does not lie solely in its ability to transmit this disease to other mammals, but also in its capacity to adapt to environmental and climatic changes, granting them a wide geographical distribution. Control of this disease is currently based on culling of the vampire bat and vaccination of the livestock. A transmission model incorporating geographic and behavioral determinants of the vampire bat was proposed to direct and optimize the epidemiological surveillance and control of livestock rabies. This model was built using a bimodal network connecting 260 vampire bat roosts among themselves (roost-roost-network) and with 1557 farms (roost-farm network) in eastern Sao Paulo State, Brazil. These roosts were grouped in 9 communities, some very interconnected, and some not and the farms were grouped in 14 communities. From 2013 to 2017, 44 livestock rabies outbreaks occurred in the area, circulating among the farm communities during the entire period, with possible introductions from neighboring areas. Based on the network and environment parameters, it was possible to reasonably predict both the roosts' occupation type (harem, bachelor, overnight and empty) and livestock rabies outbreak occurrence. The network approach brings light to the importance of phylogenetic studies of bats and rabies virus. Finally, the understanding of the interactions between bats and their feeding sources, influenced by the environment, allows to establish more precise surveillance and control measures and, ultimately, with a lower cost-benefit ratio of these actions.

4.
J Oral Rehabil ; 47(2): 221-228, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31705804

RESUMO

PURPOSE: In the definition of an occlusal scheme, clinicians should choose between conventional and computerised methods based on a careful appraise of the advantages and limitations. This study aims to assess the correlation between the two approaches in a clinical setting. METHODS: Twenty-four patients were included to compare different methods of occlusal contacts assessment on the posterior surfaces of flat mandibular appliances. In supine position, they were asked to clench with maximum strength, in the maximum intercuspation position with a 24 µm articulating paper positioned between the teeth and the appliance surface. An extra-oral photograph of the marks was taken (total N = 2082). They were visually classified based on a pre-defined scale (ie, conventional assessment) and with ImageJ analysis software (ie, photographic software assessment). Additionally, a computerised occlusal analysis was performed (ie, computerised assessment). Correlation analysis of the data achieved with conventional, photographic and computerised assessments was performed. RESULTS: Correlation between conventional and computerised assessments was weak (r = .265), whilst it was moderate between conventional and photographic assessments (r = .633), as well as between photographic and computerised assessments (r = .476). CONCLUSIONS: This investigation showed a weak-to-moderate correlation between different methods (ie, conventional, photographic and computerised) to assess occlusal marks. None of the three can actually be considered the standard of reference, but based on their specific features, it can bet suggested that the conventional method may be enough for most clinical purposes, unless otherwise proven.


Assuntos
Mandíbula , Software , Humanos
5.
Prenat Diagn ; 39(13): 1254-1261, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31691307

RESUMO

OBJECTIVES: To explore the association between timing of diagnosis of common autosomal trisomies, maternal age, and socio-economic status (SES). DESIGN: Retrospective study of cytogenetic diagnoses of trisomy 21 (T21), trisomy 18 (T18), and trisomy 13 (T13) in Victoria, Australia, in 2015 to 2016, stratified by timing (prenatal less than 17 weeks gestation, prenatal including or greater than or 17 weeks gestation, and postnatal before 12 months of age), maternal age, and SES region. Utilisation of prenatal testing following a live-born T21 infant was ascertained via record linkage. RESULTS: Among 160 230 total births were 571 diagnoses of T21 and 246 of T18/T13. The overall and live birth prevalences of T21 were 3.56 and 0.47 per 1000 births, respectively. Compared with women from disadvantaged SES regions, women from high SES regions were more likely to have a prenatal diagnosis of a trisomy before 17 weeks than after (P < .01) and less likely to have a live-born T21 infant than a prenatal diagnosis (P < .01). There was a significant trend to higher live birth rates of T21 with lower SES (P = .004). The majority (68.5%) of women who gave birth to a live infant with T21 did not utilise prenatal testing. CONCLUSION: There is a significant relationship between lower SES, later prenatal diagnosis of trisomy, and higher live birth rate of T21 in Victoria.

6.
Fetal Diagn Ther ; : 1-11, 2019 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-31593968

RESUMO

Although relatively uncommon, the incidence of fetal echogenic lung lesions - a heterogeneous group of anomalies that includes congenital pulmonary airway malformations (CPAM) and bronchopulmonary sequestrations (BPS) - has increased recently. Two decades ago, the CPAM-volume ratio (CVR) was first described as a tool to predict the development of hydrops, with this outcome found to be unlikely in fetuses with CVRs of ≤1.6 cm2. Since then, no clear international consensus has evolved as to the optimal CVR thresholds for the prediction of fetal/neonatal outcomes. This systematic review aimed to assess all original research studies that reported on the predictive utility of the CVR. Potentially relevant papers were identified through searching for citations of the paper that originally described the CVR, in addition to keyword searches of electronic databases. Fifty-two original research papers were included in the final review. Of these, 34 used the CVR for descriptive purposes only, 5 assessed the validity of established thresholds in different populations, and 13 proposed new thresholds. The evidence identified in this review would suggest that a threshold much lower than 1.6 cm2 is likely to be of greater utility in most populations for many outcomes of perinatal relevance. For neonatal outcomes (mostly respiratory compromise at birth), a CVR on the initial ultrasound scan ranging from 0.5 to 1.0 cm2 appears to have the greatest predictive value. Although a number of studies concurred that 1.6 cm2 was a useful threshold for the prediction of hydrops, many others were unable to assess this due to the rarity of this complication. For this reason, thresholds as low as 0.4 cm2 may be more useful for the prediction of a broader range of fetal concerns, including mediastinal shift and fluid collections. Further large-scale studies are required to determine the true utility of this well-established index.

7.
PLoS One ; 14(10): e0223838, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31603935

RESUMO

BACKGROUND: Heart failure is associated with exercise intolerance and sleep- disordered breathing; however, studies in patients with chronic constrictive pericarditis are scarce. The purpose of our study was to assess exercise capacity and sleep in patients with chronic constrictive pericarditis (CCP) undergoing a pericardiectomy. METHODS: We studied consecutive patients scheduled for pericardiectomy due to symptomatic CCP. Were performed quality of life (Minnesota Living with Heart Failure Questionnaire-MLHFQ) and sleep questionnaires (Epworth, Pittsburgh Sleep Quality Index-PSQI), serum B-type natriuretic peptide (BNP), serum C-reactive protein, transthoracic echocardiography, cardiopulmonary exercise test and overnight polysomnography immediately before and six months after pericardiectomy. RESULTS: Twenty-five patients (76% males, age: 45.5±13.8 years, body mass index: 24.9±3.7 kg/m2, left ventricular ejection fraction: 60±6%) with CCP (76% idiopathic, 12% tuberculosis) were studied. As compared to the preoperative period, pericardiectomy resulted in reduction in BNP (143 (83.5-209.5) vs 76 (40-117.5) pg/mL, p = 0.011), improvement in VO2 peak (18.7±5.6 vs. 25.2±6.3 mL/kg/min, p<0.001), quality of life (MLHFQ score 62 (43,5-77,5) vs. 18 (8,5-22), p<0,001) and sleep (PSQI score 7.8±4.1 vs. 4.7±3.7, p<0.001) and no significant change in sleep disordered breathing (apnea hypopnea index-AHI 15.6 (8.3-31.7) vs. 14.6 (5.75-29.9) events/h, p = 0.253). CONCLUSION: Patients with symptomatic CCP showed reduced exercise capacity and sleep-disordered breathing. After pericardiectomy, there was improvement in exercise capacity and neutral effect on sleep-disordered breathing.

8.
Artigo em Inglês | MEDLINE | ID: mdl-31625225

RESUMO

OBJECTIVES: Women's choices of prenatal screening and diagnostic pathways have increased in complexity since the introduction of cell-free DNA (cfDNA) screening and chromosomal microarrays. We performed individual record-linkage of women undergoing screening with cfDNA, combined first trimester screening (CFTS), second trimester serum screening (STSS), and/or prenatal and postnatal cytogenetic testing to (i) obtain population-based estimates on women's utilization of screening and diagnosis, (ii) analyse the performance of different screening strategies, and (iii) report the residual risks of any major chromosome abnormality following a low risk aneuploidy screen. METHODS: Retrospective study of women resident in Victoria, Australia, undergoing screening or prenatal diagnosis in 2015. Patient-funded cfDNA referrals from multiple providers were merged with state-wide results for government-subsidized CFTS, STSS and invasive diagnostic procedures. Postnatal cytogenetic results from products of conception and infants up to 12 months of age were obtained to ascertain cases of false negative screening results and atypical chromosome abnormalities. Individual record-linkage was performed with LinkageWizTM and statistical analyses with STATA v14.0. RESULTS: There were 79,140 births during the study period; 66,166 women (83.4%) underwent at least one form of aneuploidy screening. Linkage data were complete for 92.4% of women undergoing screening (n=61,911) and of these, 73.1% (n=45,275) used CFTS alone, 20.2% (n=12,520) used cfDNA alone; 5.3% (n=3268) used STSS alone, 1.3% (n=813) used both CFTS and cfDNA, and < 0.1% (n=35) used both STSS and cfDNA. CFTS had a combined sensitivity for trisomies 21, 13 and 18 of 89.57% (95%CI 82.64-93.93) for a screen positive rate (SPR) of 2.94%. There were 12 false negative results in the CFTS pathway (10 trisomy 21, 1 trisomy 18 and 1 trisomy 13). CfDNA had a combined sensitivity of 100% (95% CI 95.0-100.0) for trisomies 21, 13 and 18 for a 1.21% screen positive rate. When high risk cfDNA results for any chromosome, including the sex chromosomes, and failed cfDNA tests were treated as screen positives, the cfDNA SPR increased to 2.42%. The risk of any major chromosome abnormality (including atypical abnormalities) detected on prenatal or postnatal diagnostic testing after a low risk screening result was 1 in 1188 for CFTS (n=37) and 1 in 762 for cfDNA (n=16) (p= 0.13). The range of chromosome abnormalities detected after low risk cfDNA included pathogenic CNVs (n=6), triploidy (n=3), rare autosomal trisomies (n=3) and monosomy X (n=2). CONCLUSIONS: Our state-wide linkage analysis delineated the utilization and clinical performance of the multitude of screening pathways available to pregnant women. The sensitivity of cfDNA for trisomies 21, 13 and 18 was clearly superior to CFTS. While there was no statistically significant difference in the residual risk of any major chromosome abnormality after low risk CFTS or cfDNA result, there were fewer live infants diagnosed with a major chromosome abnormality in the cfDNA cohort. These data provide valuable population-based evidence to inform practice recommendations and health policy. This article is protected by copyright. All rights reserved.

9.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(4): 356-361, out.-dez. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1047212

RESUMO

O desenvolvimento das salas cirúrgicas híbridas permitiu que operações de abordagem cirúrgica convencional pudessem ser realizadas e complementadas com a abordagem percutânea e endovascular, criando uma nova forma de tratar os pacientes por meio de cirurgias híbridas. Os procedimentos híbridos permitem que cirurgiões e cardiologistas intervencionistas possam associar suas expertises para tratar, da melhor forma possível, os pacientes com doenças cada vez mais complexas e avançadas, com melhores resultados, reduzindo a morbidade e mortalidade perioperatória e permitindo recuperação mais rápida


The development of hybrid operating rooms allowed that conventional surgical approach operations could be performed and complemented with the percutaneous and endovascular approach, creating a new way of treating patients through hybrid surgeries. Hybrid procedures allow surgeons and interventional cardiologists to combine their expertise to best treat patients with increasingly complex and advanced diseases, with better outcomes, reducing perioperative morbidity and mortality and allowing faster recovery


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Revascularização Miocárdica/métodos , Salas Cirúrgicas , Aorta Torácica , Próteses e Implantes , Aortografia/métodos , Ponte de Artéria Coronária/métodos , Stents Farmacológicos , Intervenção Coronária Percutânea/métodos
10.
J Card Surg ; 34(9): 796-802, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31269267

RESUMO

OBJECTIVE: The purpose of this study was to analyze the learning curve effect on hospital mortality, postoperative outcomes, freedom from reintervention in the aorta and long-term survival after frozen elephant trunk (FET) operation. METHODS: From July 2009 to June 2018, 79 patients underwent surgery with the FET technique. They had type A aortic dissection (acute 7.6%, chronic 33%), type B aortic dissection (acute 1.26%, chronic 34.2%), and complex thoracic aortic aneurysm (24%). 27.8% were reoperations and 43% received concomitant cardiac procedures. To compare the results, the sample was divided into group 1 (G1) (first half of the sample - operations from 2009 to 2014) and group 2 (G2) (first half of the sample - operations from 2015 to 2018). RESULTS: The in-hospital mortality was 20.25%, 30.7% for G1 and 10% for G2 (P = .02). The mean cardiopulmonary bypass time, myocardial ischemia time, and selective cerebral perfusion at 25°C time were 154 ± 31, 118 ± 32, and 59 ± 12 minutes, respectively, similar for both groups. Stroke and spinal cord injury occurred in four and two patients, with no difference between groups (P = .61 and P = .24). The necessity for secondary intervention on the downstream aorta for both groups was also similar (P = .136). Five of sixty-three surviving patients died during the follow-up period and the estimated survival rate was different between groups 49% vs 88% (P = .007). CONCLUSION: The learning curve with the FET procedure had a significant impact on hospital mortality and midterm survival over the follow-up period, albeit did not influence the freedom from reintervention on the downstream aorta.

11.
Food Chem ; 299: 125051, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31284245

RESUMO

This study aims to exploit the molecular and cellular mechanisms concerning the functionality of dietary polyphenols (catechin, procyanidin B3, procyanidin C2, epigallocatechin and epigallocatechin gallate) in a nutritional context to prevent Celiac Disease (CD). In that sense, the interaction between the main CD bioactive peptide (32-mer peptide) and some polyphenols was fully characterized at the intestinal level under near physiological conditions by means of different spectroscopic techniques and dynamic simulations. Accordingly, it is proposed that the primarily polyphenol-binding sites on the 32-mer peptide correspond to leucine, tyrosine and phenylalanine containing domains being this interaction entropy-driven. Although procyanidin B3 and trimer C2 had a similar low-affinity constant at 310 K, both procyanidins were able to reduce the 32-mer peptide apical-to-basolateral translocation in in vitro simulated intestinal epithelial barrier thus prospecting the occurrence of additional and still unexplored regulatory mechanisms by which dietary polyphenols might modulate the transepithelial transport of CD bioactive peptides.


Assuntos
Alimentos , Glutens/química , Fragmentos de Peptídeos/química , Polifenóis/química , Análise Espectral , Glutens/metabolismo , Mucosa Intestinal/metabolismo , Fragmentos de Peptídeos/metabolismo , Ligação Proteica , Transporte Proteico
12.
Cranio ; : 1-6, 2019 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-30907703

RESUMO

OBJECTIVE: To assess the association between self-reported awake bruxism (AB) and the chronotype profile among Brazilian, Portuguese, and Italian dental students. METHODS: A cross-sectional study involving 205 dental students was developed. Self-reported AB as well as information on sleep characteristics were collected from a questionnaire. The Morningness-Eveningness Questionnaire (MEQ) was used to measure the chronotype profile. Descriptive statistical analysis, the chi-square test, and univariate analysis were used to evaluate the factors associated with AB. RESULTS: The prevalence of AB in all groups was 33.7%. The intermediate chronotype profile was the most prevalent (60.4%), and only 16.7% of the participants had the morning profile. The univariate analysis showed that older dental students (OR = 2.640, 95% CI 1.388-5.021) and those with the eveningness chronotype profile (OR = 3.370, 95% CI 1.302-8.725) are associated with AB. DISCUSSION: Students over the age of 22 and those with the eveningness chronotype profile were prone to AB.

13.
Fetal Diagn Ther ; 46(3): 193-199, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30763938

RESUMO

BACKGROUND: Detection of a single yolk sac on early first trimester ultrasound was previously thought to be a reliable diagnostic feature of monochorionic monoamniotic (MCMA) twin pregnancies. OBJECTIVES: To determine the frequency of two yolk sacs in MCMA twin pregnancies and the association of yolk sac number with pregnancy outcomes. METHODS: A retrospective cohort analysis of MCMA twins managed at a tertiary obstetric centre from January 2003 until February 2017. All MCMA twin pregnancies were diagnosed on tertiary centre ultrasound and, where possible, placental histopathology postnatally. All MCMA twin pregnancies, including conjoined twins, with available first trimester ultrasounds from 5 to 11 weeks' gestation were included in the analysis. MCMA pregnancies without available first trimester ultrasounds and triplet pregnancies which included a MCMA pair were excluded from the study. RESULTS: Sixty-seven MCMA cases were identified over 14 years. Thirty-eight cases were included in the analysis. There was one yolk sac identified in 26 cases (68%) and two yolk sacs in 12 cases (32%). Two yolk sacs were associated with a higher proportion of male fetuses (33%, 4 out of 12, vs. 8%, 2 out of 26; p = 0.01). There were no other significant differences between one and two yolk sacs for maternal or neonatal outcomes. CONCLUSIONS: Two yolk sacs are present in up to a third of all MCMA twin pregnancies, dispelling the original concept that a single yolk sac is diagnostic of MCMA pregnancies. Yolk sac number should not be used to determine amnionicity. The presence of two yolk sacs on first trimester ultrasound is associated with an increased rate of male fetuses. The number of yolk sacs has no other significant impact on perinatal outcomes.

14.
Exp Appl Acarol ; 77(2): 215-228, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30805817

RESUMO

The genetic structure of populations of the tick Amblyomma ovale from five distinct areas of the Brazilian Atlantic rainforest was evaluated via DNA sequencing and associated with the presence of domestic dogs acting as hosts at the edge of forest fragments. Ticks were collected from domestic dogs and from the environment between 2015 and 2017. Four collection areas were located in the surroundings and within the Serra do Mar State Park, São Paulo State (23°37'21"S, 45°24'43"W), where dogs were bimonthly monitored along 2 years using camera traps and GSM trackers. To determine the spatial limits of genetic structure, ticks collected upon dogs living near the Serra do Baturié, Ceará State (4°15'40"S, 38°55'54"W) were included as well. A total of 39 haplotypes of 16S rRNA and Cox 1 mitochondrial genes sequences were observed, with 27 of them coming from areas within the Serra do Mar State Park. No haplotype was shared between the Serra do Mar and the Serra do Baturié indicating isolation of tick populations at the scale of 2000 km. Although three different haplotype lineages of A. ovale occurred within the Serra do Mar State Park, no genetic structure was found across the study sites within this park, suggesting high tick gene flow across a range of 45 km. Monitoring data from domestic dogs and wild carnivores showed that these species share the same habitats at the forest edge, with dogs playing a likely limited role in tick dispersal. Our findings have important implications for understanding the genetic structure of wide spread A. ovale along Brazilian rainforest remnants, which can further be associated to tick-borne infectious agents, such as Rickettsia parkeri, and used for predicting future patterns of tick diversity in the Brazilian Atlantic rainforest.


Assuntos
Doenças do Cão/transmissão , Fluxo Gênico , Ixodidae/genética , Infestações por Carrapato/veterinária , Animais , Brasil , Doenças do Cão/parasitologia , Cães , Complexo IV da Cadeia de Transporte de Elétrons/análise , Feminino , Genes Mitocondriais , Masculino , RNA Bacteriano/análise , RNA Ribossômico 16S/análise , Floresta Úmida , Infestações por Carrapato/parasitologia , Infestações por Carrapato/transmissão
15.
Ticks Tick Borne Dis ; 10(2): 442-453, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30611725

RESUMO

This study evaluated the species richness and seasonal dynamics of ticks and rickettsial agents infecting ticks in the largest natural Reserve of the Cerrado biome of Brazil, the Grande Sertão Veredas National Park. During 2012-2014, a total of 9531 host-seeking ticks were collected by dry ice traps and dragging, whereas 1563 ticks were collected from small mammals, and 1186 ticks from domestic animals. Overall, the following 12 tick species were identified: Amblyomma auricularium, Amblyomma dubitatum, Amblyomma naponense, Amblyomma ovale, Amblyomma parvum, Amblyomma sculptum, Amblyomma tigrinum, Amblyomma triste, Dermacentor nitens, Rhipicephalus microplus, Rhipicephalus sanguineus sensu lato, and Ornithodoros mimon. The three most abundant tick species, A. sculptum, A. parvum, and A. triste, are likely to develop one generation per year, with adults predominating between spring and autumn, and immature ticks during autumn-winter. Small mammals seem to be important hosts for immature stages of A. parvum, and A. triste, but not for A. sculptum. Molecular analyses revealed the presence of the human pathogen Rickettsia parkeri in 10% of the A. triste ticks, whereas two agents of unknown pathogenicity, Rickettsia bellii and 'Candidatus Rickettsia andeanae' were found in 7 and 5%, respectively, of the A. parvum ticks. A fourth rickettsial agent, Rickettsia amblyommatis, was found in a single A. sculptum tick. Several Vero cell-established isolates of R. parkeri and R. bellii were obtained from A. triste and A. parvum, respectively. Serological analyses of small mammals suggest that they have been infected by R. parkeri and R. bellii, possibly via natural infestations by A. triste and A. parvum, respectively. Because the Park has suffered low anthropic alterations, our results should provide baseline data that shall be used for future comparisons with other Cerrado areas with higher degree of anthropic changes.


Assuntos
Infecções por Rickettsia/veterinária , Estações do Ano , Infestações por Carrapato/veterinária , Carrapatos/microbiologia , Animais , Animais Domésticos/microbiologia , Animais Domésticos/parasitologia , Animais Selvagens/microbiologia , Animais Selvagens/parasitologia , Brasil/epidemiologia , Bovinos , Cães , Ecossistema , Cavalos , Larva/microbiologia , Mamíferos/parasitologia , Ninfa/microbiologia , Parques Recreativos , Rickettsia/isolamento & purificação , Infecções por Rickettsia/epidemiologia , Infestações por Carrapato/epidemiologia
16.
Prenat Diagn ; 39(2): 116-123, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30578730

RESUMO

OBJECTIVES: To compare the frequency of abnormal genetic diagnoses spanning a period before and after the availability of chromosomal microarray analysis (CMA). We hypothesised that microarray would provide additional clinically relevant information in cases of isolated hypoplastic nasal bone. METHOD: Fetuses with ultrasound-detected hypoplastic nasal bone (absent or <2.5th percentile in length) between 16 and 37 weeks' gestation over a 10-year period were analysed retrospectively. RESULTS: A total of 118 cases of hypoplastic nasal bone met the inclusion criteria. A pathogenic or potentially pathogenic karyotype was detected more frequently in the era where CMA was available (31/60, 52% vs 19/58, 33%). Of these, 25 cases (42%) had common aneuploidies, and six cases (10%) had clinically relevant copy number variants (CNVs). A clinically relevant CNV was detected in two fetuses that presented with isolated hypoplastic nasal bone on initial ultrasound. CONCLUSION: In addition to its known association with trisomy 21, a hypoplastic nasal bone may be an objective marker of facial dysmorphism associated with clinically relevant CNVs. Our results support consideration of invasive testing with microarray for pregnancies in which a hypoplastic nasal bone has been diagnosed on ultrasound irrespective of a low-risk screening result for common chromosomal abnormalities.


Assuntos
Aberrações Cromossômicas/embriologia , Anormalidades Craniofaciais/diagnóstico , Variações do Número de Cópias de DNA , Análise em Microsséries , Osso Nasal/anormalidades , Adulto , Transtornos Cromossômicos/diagnóstico , Transtornos Cromossômicos/embriologia , Variações do Número de Cópias de DNA/genética , Feminino , Testes Genéticos/métodos , Idade Gestacional , Humanos , Osso Nasal/diagnóstico por imagem , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Diagnóstico Pré-Natal/métodos , Estudos Retrospectivos , Trissomia/diagnóstico , Trissomia/genética , Ultrassonografia Pré-Natal
17.
J Matern Fetal Neonatal Med ; 32(5): 703-709, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28974162

RESUMO

INTRODUCTION: Fetal echogenic lung lesions (ELL) are the commonest pulmonary pathology diagnosed on antenatal sonography, and include congenital pulmonary airway malformations (CPAMs) and bronchopulmonary sequestrations. This study aimed to evaluate the predictive utility of the CPAM volume ratio (CVR) at presentation in a series of fetuses with ELLs at a tertiary Australian referral hospital. MATERIAL AND METHODS: Retrospective cohort study of all pregnancies with a prenatal diagnosis of an isolated fetal echogenic lung lesion managed at the Royal Women's Hospital, Victoria, Australia, between 2005 and 2015. Data were obtained from electronic ultrasound image databases and medical records. RESULTS: Sixty-five cases were included in the final analysis. The mean gestation at presentation was 22 weeks and 6 d, and the mean CVR was 0.66. Hydrops was evident in four cases at presentation, and did not develop subsequently in any other case. Significant perinatal concerns - fetal/neonatal demise, hydrops, requirement for neonatal intubation/ventilation, or surgery in the first year of life - did not occur with or following a CVR at presentation of <0.45. The survival rate at 1 year was 95%. DISCUSSION: The CVR is a potentially useful tool to assess all fetal ELLs, and not just those presumed to be CPAMs. A CVR at presentation of <0.45 was associated with favourable outcomes.


Assuntos
Brônquios/anormalidades , Anormalidades do Sistema Respiratório/diagnóstico por imagem , Adulto , Brônquios/diagnóstico por imagem , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária , Ultrassonografia Pré-Natal , Adulto Jovem
18.
J Minim Invasive Gynecol ; 26(5): 919-927, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30243684

RESUMO

STUDY OBJECTIVE: To describe the incidence, management, and complications of cesarean scar pregnancy (CSP) and define risk factors for conversion from medical to surgical treatment of CSP. DESIGN: Retrospective clinical study (Canadian Task Force classification II-3). SETTING: Tertiary medical center. PATIENTS: All patients who were admitted and treated for CSP between 2008 and 2016. INTERVENTIONS: The cohort was divided according to management, and demographic, clinical, and sonographic data were collected. Rates of conversion were compared between groups, and risk factors necessitating conversion were sought. MEASUREMENTS AND MAIN RESULTS: Forty-six cases of CSP were identified. The incidence of CSP has increased from 0.05% to 0.09% of all deliveries. A regression model for absolute numbers of CSP predicted an additional 0.47 CSP each year (p = .03). The most common treatment modalities were systemic treatment with methotrexate (28.2%) and ultrasound-guided intrasac injection of KCl with systemic treatment of methotrexate (58.7%). The mean sac diameter (MSD) of cases that were converted was 11.2 mm larger than in cases that were not converted (p < .001). No patients with an MSD <10 mm or a trophoblastic mass <20 mm3 were converted to surgical management. Maximal levels of beta human chorionic gonadotropin (ß-hCG) were significantly associated with the risk of conversion. Only 6.3% of patients with a ß-hCG level <10,000 IU at presentation were converted from medical to surgical management. There was no significant association between fetal cardiac activity and conversion from medical to surgical management. CONCLUSIONS: CSP has emerged as an important phenomenon in modern obstetrics and gynecology, and its frequency appears to be on the rise. The preferred method of treatment remains unclear; however, it is possible that a large MSD and trophoblastic mass at presentation should prompt surgical treatment.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/etiologia , Gravidez Ectópica/cirurgia , Adulto , Austrália/epidemiologia , Cesárea/estatística & dados numéricos , Cicatriz/epidemiologia , Cicatriz/patologia , Cicatriz/cirurgia , Feminino , Humanos , Incidência , Metotrexato/uso terapêutico , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Complicações na Gravidez/cirurgia , Gravidez Ectópica/tratamento farmacológico , Retratamento , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Ultrassonografia
19.
Braz J Cardiovasc Surg ; 33(5): 490-495, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30517258

RESUMO

INTRODUCTION: Three-dimensional (3D) printing has become an affordable tool for assisting heart surgeons in the aorta endovascular field, both in surgical planning, education and training of residents and students. This technique permits the construction of physical prototypes from conventional medical images by converting the anatomical information into computer aided design (CAD) files. OBJECTIVE: To present the 3D printing feature on developing prototypes leading to improved aortic endovascular surgical planning, as well as transcatheter aortic valve implantation, and mainly enabling training of the surgical procedure to be performed on patient's specific condition. METHODS: Six 3D printed real scale prototypes were built representing different aortic diseases, taken from real patients, to simulate the correction of the disease with endoprosthesis deployment. RESULTS: In the hybrid room, the 3D prototypes were examined under fluoroscopy, making it possible to obtain images that clearly delimited the walls of the aorta and its details. The endovascular simulation was then able to be performed, by correctly positioning the endoprosthesis, followed by its deployment. CONCLUSION: The 3D printing allowed the construction of aortic diseases realistic prototypes, offering a 3D view from the two-dimensional image of computed tomography (CT) angiography, allowing better surgical planning and surgeon training in the specific case beforehand.


Assuntos
Doenças da Aorta/cirurgia , Procedimentos Endovasculares , Modelagem Computacional Específica para o Paciente , Cuidados Pré-Operatórios/métodos , Impressão Tridimensional , Idoso , Doenças da Aorta/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Resultado do Tratamento
20.
Rev. bras. cir. cardiovasc ; 33(6): 618-625, Nov.-Dec. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-977465

RESUMO

Abstract Currently there is a progressive increase in the prevalence of diabetes in a referred for cardiovascular surgery. Benefits of glycemic management (< 180 mg/dL) in diabetic patients compared to patients without diabetes in perioperative cardiac surgery. The purpose of this study is to present recommendations based on international evidence and adapted to our clinical practice for the perioperative management of hyperglycemia in adult patients with and without diabetes undergoing cardiovascular surgery. This update is based on the latest current literature derived from articles and guidelines regarding perioperative management of diabetic patients to cardiovascular surgery.

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