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1.
Int J Cancer ; 152(7): 1314-1319, 2023 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-36541784

RESUMO

Cancer is one of the most burdening global health challenges. Indigenous communities are at high risk for worse healthcare outcomes because of inequalities in the incidence, prevalence, and mortality of oncological diseases, that arise from socioeconomic, racial, cultural, religious beliefs, and ethnic factors. Their perception about themselves is closely related to what affects their territory, making them possess a profound rooted feeling with their surroundings, and intense spiritual believes. Consequently, the disease process is linked to physical and emotional imbalances and alterations in their territory. Researchers from the United States, Canada, New Zealand, and Australia have worked diligently to learn about barriers to cancer management among these populations. Unfortunately, robust cancer data is lacking for most of the world's Indigenous, leading to obstacles in information systems and consequently, inequities in healthcare with the perpetuation of the problem. Therefore, a better understanding of cancer as a global health problem is required. Our study aims to propose a holistic and culturally adapted framework to improve cancer health services and outcomes among Indigenous peoples in Colombia.

2.
Microsc Res Tech ; 2022 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-36314569

RESUMO

The ectopic calcifications of non-mineralized tissues can occur in several forms throughout life, such as pulpal calcification. The presence of pulp stones is a challenge in endodontic treatment because they partially or fully obliterate the pulp chamber hindering access to root canals and their subsequent shaping. This study aimed to determine their crystallographic properties and evaluate the capacity of citric acid (CA) and ethylenediaminetetraacetic acid (EDTA) to promote the demineralization of pulp calcifications. The samples were obtained from patients with indications of endodontic treatment, and the radiographic examination was suggestive of pulp stone in at least one permanent tooth. The samples were isolated and analyzed by scanning electron microscopy/energy-dispersive x-ray spectroscopy (SEM/EDX). The Fourier Transform by high resolution-transmission electron microscopy, Raman microscopy, and X-ray diffraction (XRD) were used to identify the mineral phase and crystallographic characteristics. To evaluate the effect of CA and EDTA on the crystallinity of calcifications, they were submerged into these two individual solutions and the changes were assessed in situ by Raman spectroscopy. The SEM images obtained from calcifications demonstrated irregular morphologies. EDX of sample surfaces shows a high presence of oxygen, carbon, calcium, and phosphorous, however, other elements such as sodium, magnesium, nitrogen, chlorine, potassium, sulfur, and zinc were identified in less quantity. According to Raman, XRD, and high-resolution transmission electron microscopy, the predominant mineral phase identified in the pulpal calcification was a poor crystallinity apatite. According to in situ analyses, the effect of CA and EDTA was observed on the signals of PO4 3- and CH2 groups corresponding to inorganic and organic components. The changes with CA were evident at 7 min while the effect of EDTA was observed until 15 min of treatment. All results indicate that pulp stones have a heterogeneous composition principally composed of apatite with low crystallinity. The solubility of these pathological minerals is adequate using solutions such as EDTA or CA; however, the effectivity depends on the mineralization grade of calcifications, time, and concentration of exposition to this chemical.

3.
Rev Bras Ginecol Obstet ; 44(9): 838-844, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36067797

RESUMO

OBJECTIVE: The immediate referral of patients with risk factors for placenta accreta spectrum (PAS) to specialized centers is recommended, thus favoring an early diagnosis and an interdisciplinary management. However, diagnostic errors are frequent, even in referral centers (RCs). We sought to evaluate the performance of the prenatal diagnosis for PAS in a Latin American hospital. METHODS: A retrospective descriptive study including patients referred due to the suspicion of PAS was conducted. Data from the prenatal imaging studies were compared with the final diagnoses (intraoperative and/or histological). RESULTS: A total of 162 patients were included in the present study. The median gestational age at the time of the first PAS suspicious ultrasound was 29 weeks, but patients arrived at the PAS RC at 34 weeks. The frequency of false-positive results at referring hospitals was 68.5%. Sixty-nine patients underwent surgery based on the suspicion of PAS at 35 weeks, and there was a 28.9% false-positive rate at the RC. In 93 patients, the diagnosis of PAS was ruled out at the RC, with a 2.1% false-negative frequency. CONCLUSION: The prenatal diagnosis of PAS is better at the RC. However, even in these centers, false-positive results are common; therefore, the intraoperative confirmation of the diagnosis of PAS is essential.


OBJETIVO: Recomenda-se o encaminhamento imediato de pacientes com fatores de risco para espectro placentário acreta (PAS, na sigla em inglês) para centros especializados, favorecendo assim o diagnóstico precoce e o manejo interdisciplinar. No entanto, erros diagnósticos são frequentes, mesmo em centros de referência (CRs). Buscou-se avaliar o desempenho do diagnóstico pré-natal para PAS em um hospital latino-americano. MéTODOS: Um estudo descritivo retrospectivo incluindo pacientes encaminhados por suspeita de SAP foi realizado. Os dados dos exames de imagem do pré-natal foram comparados com os diagnósticos finais (intraoperatórios e/ou histológicos). RESULTADOS: Foram incluídos 162 pacientes no presente estudo. A idade gestacional mediana no momento da primeira ultrassonografia suspeita de PAS foi de 29 semanas, mas as pacientes chegaram ao CR de PAS com 34 semanas. A frequência de resultados falso-positivos nos hospitais de referência foi de 68,5%. Sessenta e nove pacientes foram operadas com base na suspeita de PAS com 35 semanas e houve 28,9% de falso-positivos no CR. Em 93 pacientes, o diagnóstico de PAS foi descartado no CR, com frequência de falso-negativos de 2,1%. CONCLUSãO: O diagnóstico pré-natal de PAS é melhor no CR. Entretanto, mesmo nestes centros, resultados falso-positivos são comuns; portanto, a confirmação intraoperatória do diagnóstico de SAP é essencial.


Assuntos
Placenta Acreta , Feminino , Idade Gestacional , Humanos , Lactente , Placenta , Placenta Acreta/diagnóstico por imagem , Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos , Ultrassonografia Pré-Natal
4.
Rev Bras Ginecol Obstet ; 44(10): 925-929, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36067798

RESUMO

OBJECTIVE: Placenta accreta spectrum (PAS) is a cause of massive obstetric hemorrhage and maternal mortality. The application of family-centered delivery techniques (FCDTs) during surgery to treat this disease is infrequent. We evaluate the implementation of FCDTs during PAS surgeries. METHODS: This was a prospective, descriptive study that included PAS patients undergoing surgical management over a 12-month period. The patients were divided according to whether FCDTs were applied (group 1) or not (group 2), and the clinical outcomes were measured. In addition, hospital anesthesiologists were surveyed to evaluate their opinions regarding the implementation of FCDTs during the surgical management of PAS. RESULTS: Thirteen patients with PAS were included. The implementation of FCDTs during birth was possible in 53.8% of the patients. The presence of a companion during surgery and skin-to-skin contact did not hinder interdisciplinary management in any case. CONCLUSION: Implementation of FCDTs during PAS care is possible in selected patients at centers with experience in managing this disease.


OBJETIVO: O espectro da placenta acreta (do inglês placenta accreta spectrum - PAS) é causa de hemorragia obstétrica maciça e mortalidade materna. A aplicação de técnicas de parto centrado na família (do inglês family-centered delivery techniques - FCDTs) durante a cirurgia para tratar esta doença é pouco frequente. Avaliamos a implementação das FCDTs durante as cirurgias do PAS. MéTODOS: Estudo prospectivo e descritivo que incluiu pacientes com PAS submetidos a tratamento cirúrgico durante um período de 12 meses. Os pacientes foram divididos de acordo com a aplicação de FCDTs (grupo 1) ou não (grupo 2), e os resultados clínicos foram medidos. Além disso, anestesiologistas hospitalares foram entrevistados para avaliar suas opiniões sobre a implementação das FCDTs durante o manejo cirúrgico do PAS. RESULTADOS: Foram incluídos 13 pacientes com PAS. A implementação de FCDTs durante o parto foi possível em 53,8% das pacientes. A presença do acompanhante durante a cirurgia e o contato pele a pele não prejudicou o manejo interdisciplinar em nenhum caso. CONCLUSãO: A implementação de FCDTs durante o atendimento do PAS é possível em pacientes selecionados em centros com experiência no manejo dessa doença.


Assuntos
Placenta Acreta , Gravidez , Feminino , Humanos , Placenta Acreta/cirurgia , Estudos Prospectivos , Histerectomia/métodos , Cesárea/métodos , Mortalidade Materna , Estudos Retrospectivos , Placenta
5.
Rev. bras. ginecol. obstet ; 44(5): 467-474, May 2022. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1387917

RESUMO

Abstract Objective Placenta accreta spectrum (PAS) is a serious diseases, and the recommendation is that the treatment is conducted in centers of excellence. Such hospitals are not easy to find in low- and middle-income countries. We seek to describe the process of prenatal diagnosis, surgical management, and postnatal histological analysis in a low-income country referral hospital with limited resources. Methods A descriptive, retrospective study was carried out including patients with a pre- or intraoperative diagnosis of PAS. The clinical results of the patients were studied as well as the results of the prenatal ultrasound and the correlation with the postnatal pathological diagnosis. Results In total, 129 patients were included. Forty-eight of them had a prenatal PAS ultrasound diagnosis (37.2%). In the remaining 81 (62.8%), the diagnosis was intraoperative. Although hysterectomy was performed in all cases, one-third of the patients (31%) did not have a histological study of the uterus. In 40% of the patients who had a histological study, PAS was not reported by the pathologist. Conclusion The frequency of prenatal diagnosis and the availability of postnatal histological studies were very low in the studied population. Surgical skill, favored by a high flow of patients, is an important factor to avoid complications in settings with limited resources.


Resumo Objetivo O espectro da placenta accreta é uma patologia grave, cujo tratamento é recomendado emcentros de excelência. Esses hospitais não são fáceis de encontrar em países de baixa e média renda. Procuramos descrever o processo de diagnóstico prénatal, tratamento cirúrgico, e análise histológica pós-natal em um hospital de referência de baixa renda com recursos limitados. Métodos Foi realizado um estudo descritivo, retrospectivo, incluindo pacientes com diagnóstico pré ou intraoperatório de espectro da placenta accreta. Foram estudados os resultados clínicos das pacientes, bem como os resultados da ultrassonografia prénatal e a correlação com o diagnóstico patológico pós-natal. Resultados No total, 129 pacientes foram incluídas. Quarenta e oito delas tiveramum diagnóstico de ultrassom do espectro da placenta accreta pré-natal (37,2%). Nos 81 (62,8%) restantes, o diagnóstico foi intraoperatório. Embora a histerectomia tenha sido realizada em todos os casos, um terço deles (31%) não tinha estudo histológico do útero. Em 40% dos pacientes que tiveram estudo histológico, o espectro da placenta accreta não foi relatado pelo patologista. Conclusão A frequência do diagnóstico pré-natal e a disponibilidade de estudos histológicos pós-natais foram muito baixas na população estudada. A habilidade cirúrgica, favorecida por um alto fluxo de pacientes, é um fator importante para evitar complicações em ambientes com recursos limitados.

6.
Rev Bras Ginecol Obstet ; 44(5): 467-474, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35472821

RESUMO

OBJECTIVE: Placenta accreta spectrum (PAS) is a serious diseases, and the recommendation is that the treatment is conducted in centers of excellence. Such hospitals are not easy to find in low- and middle-income countries. We seek to describe the process of prenatal diagnosis, surgical management, and postnatal histological analysis in a low-income country referral hospital with limited resources. METHODS: A descriptive, retrospective study was carried out including patients with a pre- or intraoperative diagnosis of PAS. The clinical results of the patients were studied as well as the results of the prenatal ultrasound and the correlation with the postnatal pathological diagnosis. RESULTS: In total, 129 patients were included. Forty-eight of them had a prenatal PAS ultrasound diagnosis (37.2%). In the remaining 81 (62.8%), the diagnosis was intraoperative.Although hysterectomy was performed in all cases, one-third of the patients (31%) did not have a histological study of the uterus. In 40% of the patients who had a histological study, PAS was not reported by the pathologist. CONCLUSION: The frequency of prenatal diagnosis and the availability of postnatal histological studies were very low in the studied population. Surgical skill, favored by a high flow of patients, is an important factor to avoid complications in settings with limited resources.


OBJETIVO: O espectro da placenta accreta é uma patologia grave, cujo tratamento é recomendado em centros de excelência. Esses hospitais não são fáceis de encontrar em países de baixa e média renda. Procuramos descrever o processo de diagnóstico pré-natal, tratamento cirúrgico, e análise histológica pós-natal em um hospital de referência de baixa renda com recursos limitados. MéTODOS: Foi realizado um estudo descritivo, retrospectivo, incluindo pacientes com diagnóstico pré ou intraoperatório de espectro da placenta accreta. Foram estudados os resultados clínicos das pacientes, bem como os resultados da ultrassonografia pré-natal e a correlação com o diagnóstico patológico pós-natal. RESULTADOS: No total, 129 pacientes foram incluídas. Quarenta e oito delas tiveram um diagnóstico de ultrassom do espectro da placenta accreta pré-natal (37,2%). Nos 81 (62,8%) restantes, o diagnóstico foi intraoperatório.Embora a histerectomia tenha sido realizada em todos os casos, um terço deles (31%) não tinha estudo histológico do útero. Em 40% dos pacientes que tiveram estudo histológico, o espectro da placenta accreta não foi relatado pelo patologista. CONCLUSãO: A frequência do diagnóstico pré-natal e a disponibilidade de estudos histológicos pós-natais foram muito baixas na população estudada. A habilidade cirúrgica, favorecida por um alto fluxo de pacientes, é um fator importante para evitar complicações em ambientes com recursos limitados.


Assuntos
Placenta Acreta , Feminino , Hospitais , Humanos , Histerectomia/métodos , Placenta/patologia , Placenta Acreta/diagnóstico , Placenta Acreta/cirurgia , Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-Natal
7.
AMA J Ethics ; 24(4): E296-304, 2022 04 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-35405056

RESUMO

Latinx individuals represent a linguistically and racially diverse, growing US patient population. Raciolinguistics considers intersections of language and race, prioritizes lived experiences of non-English speakers, and can help clinicians more deftly conceptualize heterogeneity and complexity in Latinx health experiences. This article discusses how raciolinguistic hierarchies (ie, practices of attaching social value to some languages but not others) can undermine the quality of Latinx patients' health experiences. This article also offers language-appropriate clinical and educational strategies for promoting health equity.


Las personas latinx representan una creciente población estadounidense diversa de pacientes desde el punto de vista lingüístico y racial. La raciolingüística considera las interrelaciones del idioma y la raza, prioriza las experiencias vividas de personas que no hablan inglés y puede ayudar a los médicos a conceptualizar de manera más hábil la heterogeneidad y la complejidad en las experiencias de salud de latinx. Este artículo analiza cómo las jerarquías raciolingüísticas (es decir, las prácticas de otorgar valor social a algunos idiomas, pero no a otros) pueden socavar la calidad de la experiencia sanitaria de los pacientes latinx. Este artículo también ofrece estrategias clínicas y educativas adecuadas al lenguaje para promover la equidad sanitaria.


Assuntos
Equidade em Saúde , Humanos , Idioma
8.
J Matern Fetal Neonatal Med ; 35(25): 9299-9302, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35057705

RESUMO

INTRODUCTION: Placenta accreta spectrum (PAS) is a potentially fatal disease. A quarter of PAS cases are not detected during prenatal evaluations, so obstetricians without experience with this disease may encounter complex cases without having the necessary resources. We report a series of PAS intraoperative finding (IOF) cases and analyze useful strategies to improve patient outcomes. CASE SERIES: Four cases of PAS IOF are reported. These patients were women with previous pregnancies terminated by cesarean section, with placenta previa/anterior, and whose prenatal ultrasound did not detect PAS. Three patients were candidates for the postponement of cesarean section and/or hysterectomy. One case had active vaginal bleeding, so it was not feasible to delay surgery. Patients who benefited from delaying surgery or seeking additional help through telesupport had better clinical outcomes. CONCLUSION: Decisions about which interventions to conduct and which to delay in cases of PAS intraoperative finding can determine the clinical outcome.


Assuntos
Placenta Acreta , Placenta Prévia , Humanos , Feminino , Gravidez , Masculino , Placenta Acreta/diagnóstico , Placenta Acreta/cirurgia , Cesárea , Estudos Retrospectivos , Placenta Prévia/cirurgia , Histerectomia , Placenta
9.
J Matern Fetal Neonatal Med ; 35(25): 5031-5034, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33455510

RESUMO

INTRODUCTION: Placenta accreta spectrum (PAS) disorder is a serious condition that frequently requires special care in specialized centers. Migrant pregnant women face economic and social disadvantages that place them in situations of pervasive health disparities and, thus, poorer pregnancy outcomes can be expected. PURPOSE: Describe the care of migrants without health insurance, affected by PAS and treated in a reference center for PAS. METHODS AND RESULTS: The institutional registry of PAS in a private Latin American center was reviewed in search of migrant patients, identifying three patients without health insurance, with PAS, referred outside the traditional administrative channels, in the context of an inter-institutional collaboration program. CONCLUSION: Migration imposes additional difficulties in the management of complex obstetric pathologies such as PAS. We recommend interinstitutional collaboration as a strategy to bring patients affected by PAS to experienced hospitals.


Assuntos
Placenta Acreta , Refugiados , Humanos , Feminino , Gravidez , Placenta Acreta/terapia , Populações Vulneráveis , Custos e Análise de Custo , Atenção à Saúde
10.
J Matern Fetal Neonatal Med ; 35(25): 6104-6111, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33843408

RESUMO

INTRODUCTION: Placenta accreta spectrum (PAS) causes severe morbidity and can result in maternal death. It must be managed in specialized centers with interdisciplinary groups, but few publications have described the usual management within a specific geographic region. We intend to describe the usual approach for PAS in reference centers in Latin America. METHODOLOGY: This was an observational, multicenter, cross-sectional study conducted in Latin American PAS reference centers. A standardized survey was implemented and applied to obstetric service coordinators and leaders of interdisciplinary groups with experience in PAS between September and November 2020. RESULTS: One hundred fifty-four hospitals were included. Most of them (64.3%) handle approximately one case of PAS every two months, and almost all centers (89.6%) believe that their performance could be improved. CONCLUSIONS: Most of the reference centers for PAS in Latin America attend to a small number of cases each year, and almost all of these hospitals identify opportunities to improve the management or approach for PAS in women.


Assuntos
Placenta Acreta , Gravidez , Humanos , Feminino , Placenta Acreta/epidemiologia , Placenta Acreta/terapia , América Latina/epidemiologia , Estudos Transversais , Estudos Retrospectivos , Hospitais , Placenta
11.
Front Immunol ; 12: 808799, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-35095895

RESUMO

During an inflammatory process, shift in the cellular metabolism associated with an increase in extracellular acidification are well-known features. This pH drop in the inflamed tissue is largely attributed to the presence of lactate by an increase in glycolysis. In recent years, evidence has accumulated describing the role of lactate in inflammatory processes; however, there are differences as to whether lactate can currently be considered a pro- or anti-inflammatory mediator. Herein, we review these recent advances on the pleiotropic effects of lactate on the inflammatory process. Taken together, the evidence suggests that lactate could exert differential effects depending on the metabolic status, cell type in which the effects of lactate are studied, and the pathological process analyzed. Additionally, various targets, including post-translational modifications, G-protein coupled receptor and transcription factor activation such as NF-κB and HIF-1, allow lactate to modulate signaling pathways that control the expression of cytokines, chemokines, adhesion molecules, and several enzymes associated with immune response and metabolism. Altogether, this would explain its varied effects on inflammatory processes beyond its well-known role as a waste product of metabolism.


Assuntos
Inflamação/etiologia , Inflamação/metabolismo , Ácido Láctico/metabolismo , Animais , Transporte Biológico , Biomarcadores , Citocinas/metabolismo , Suscetibilidade a Doenças/imunologia , Metabolismo Energético , Humanos , Imunomodulação , Mediadores da Inflamação/metabolismo , Redes e Vias Metabólicas , Especificidade de Órgãos/imunologia , Receptores Acoplados a Proteínas G/metabolismo
12.
Endodoncia (Madr.) ; 38(3): 6-15, dic. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-200308

RESUMO

OBJETIVO: Comparar, en un estudio experimental in vitro, el porcentaje de áreas no obturadas entre la técnica de compactación lateral en frío (TCL) y la técnica de compactación lateral con ultrasonido (TCLU). MATERIALES Y MÉTODOS: El estudio fue realizado en una muestra de 68 dientes humanos extraídos. Se asignaron de manera aleatoria en dos grupos de 34 dientes cada uno. Todos los dientes se cortaron a 16±1 mm de longitud desde el ápice hacia la corona, se instrumentaron con el sistema rotatorio Protaper Next (Dentsply) y se realizó protocolo de irrigación final con NaOCl al 2.5% y EDTA al 17% neutralizados con suero fisiológico entre ellos. El Grupo I se obturó con TCL y el Grupo II con TCLU. En ambos grupos se utilizó Sealapex como cemento. Los dientes fueron seccionados horizontalmente a 2, 4, 6 y 8 mm desde el ápice; cada corte se observó con un microscopio estereoscópico (56X) y se tomaron fotografías. Se calculó el porcentaje de área obturada con gutapercha, cemento y de áreas no obturadas, utilizando el programa ImageJ. El análisis de los resultados se llevó acabo mediante la suma de rangos de Wilcoxon. RESULTADOS: El grupo TCLU presentó un mayor porcentaje de gutapercha en el conducto radicular en comparación con el grupo TCL (94.4% y 87.4% respectivamente), menor porcentaje de áreas no obturadas (1.3% y 4.2%), y menor porcentaje de áreas ocupadas con cemento (3.8% y 7.2%). Las diferencias fueron estadísticamente significativas (P<0.05).CONCLUSIÓN: Los resultados de este estudio muestran que la modificación de la técnica de compactación lateral con ultrasonido descrita en esta investigación presenta resultados in vitro superiores a TCL


AIM: To compare, in an Experimental in vitro study, the percentage of non-filled areas between cold lateral compaction technique (CLT) and lateral compaction with ultrasonic technique (LUT). METHODS: The study was made on in a sample of 68 extracted human teeth. They were randomized into two groups of 34 teeth each. All teeth were cut 16±1 mm from the apex and instrumented with the Protaper Next rotary system (Dentsply) and a final irrigation protocol was performed with NaOCl 2.5% and EDTA 17% neutralized with normal saline solution between them. Group I was filled with CLT and Group II with LUT. In both groups Sealapex was used as a cement. The teeth were sectioned horizontally at 2, 4, 6 and 8 mm from the apex; slices were the viewed through a stereomicroscope (56X) and pictures were taken. The percentage of gutta-percha filled area, percentage of non-filled area and percentage of sealer filled area were calculated for each section using the ImageJ program. Statistical analysis was performed using the Wilcoxon Rank-Sum test. RESULTS: LUT had a higher percentage of gutta-percha in the root canal compared to CLT (94.4% and 87.4% respectively), lower percentage of non-filled area (1.3% and 4.2% respectively), and lower percentage of area occupied by sealer (3.8 % and 7.2% respectively). The differences were statistically significant(P <0.05).CONCLUSION: The results of this study showed that the modification of lateral compaction technique with ultrasonic described in this investigation presents in vitro results superior to CLT


Assuntos
Humanos , Obturação do Canal Radicular/métodos , Terapia por Ultrassom/métodos , Guta-Percha/uso terapêutico , Cimentos Dentários/uso terapêutico , Teste de Materiais , Reprodutibilidade dos Testes , Hidróxido de Cálcio/uso terapêutico , Salicilatos/uso terapêutico
13.
J Neuroimmunol ; 346: 577321, 2020 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-32682141

RESUMO

Fatal Familial Insomnia (FFI) is a rare prionopathy with autosomal dominant inheritance. Although it owes its name because insomnia is one of the most frequent and core symptoms, its clinical phenotype can be wide and heterogeneous. This usually makes it necessary to rule out other clinical processes, such as limbic encephalitis or Creutzfeldt Jakob disease, whose symptoms can sometimes overlap. We present the case of a 46-year-old male with a rapidly progressive multidomain cognitive impairment, associated with instability in gait, myoclonus and persistent and progressive insomnia. His mother had died from a genetically determined FFI (D178N mutation). Due to clinical course, an immunomediated encephalopathy was suspected, and immunosuppressive treatment with steroids and immunoglobulins was initiated. The patient showed initial improvement, but later rapidly progressive deterioration until his death 7 months after clinical onset. Cranial magnetic resonance, electroencephalogram and cerebrospinal fluid (CSF) did not show any findings. The antiTPO and antineuronal antibodies were negative. The genetiic study demonstrated the missense mutation c.532G > A (p.Asp178Asn) compatible with FFI. Postmortem study showed synaptic deposits of PrPsc in the entorhinal cortex and in thalamus, which confirmed FFI diagnosis.

14.
BMC Vet Res ; 15(1): 225, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269952

RESUMO

BACKGROUND: Acute ruminal acidosis (ARA) is a metabolic disease of cattle characterized by an aseptic synovitis. ARA is the result of an increased intake of highly fermentable carbohydrates that frequently occurs in dairy cattle subjected to high production requirements. In human joint diseases such as rheumatoid arthritis and gout, several pro-inflammatory molecules are increased in the synovial fluid, including cytokines, prostaglandin E2 (PGE2), metalloproteinases, and neutrophil extracellular traps (NETs). The aim of this study was to identify the presence of proinflammatory mediators and neutrophils in the synovial fluid of heifers with ARA, induced by an oligofructose overload. Five heifers were challenged with an oligofructose overload (13 g/kg BW) dissolved in water. As a control, a similar vehicle volume was used in four heifers. Synovial fluid samples were collected from the tarso-crural joint and PGE2, IL-6, IL-1ß, ATP, lactate dehydrogenase (LDH), albumin, glucose, matrix metalloproteinase-9 (MMP-9), cellular free DNA, NETs, and serpin B1 were analyzed at 0, 9, and 24 h post treatment. RESULTS: At 9 h post oligofructose overload, an increase of IL-1ß, IL-6, PGE2, serpin B1 and LDH was detected in the joints when compared to the control group. At 24 h, the synovial fluid was yellowish, viscous, turbid, and contained abundant neutrophils. An increase of DNA-backbone-like traps, histone 3 (H3cit), aggregated neutrophil extracellular traps (aggNETs), and serpin B1 were observed 24 h post treatment. Furthermore, albumins, LDH, ATP, MMP-9, IL-6, and IL-1ß were increased after 24 h. CONCLUSIONS: The overall results indicate that IL-1ß, IL-6 and PGE2, were the earliest proinflammatory parameters that increased in the synovial fluid of animals with ARA. Furthermore, the most sever inflammatory response in the joint was observed after 24 h and could be associated with a massive presence of neutrophils and release of aggNETs.


Assuntos
Doenças dos Bovinos/metabolismo , Líquido Sinovial/citologia , Sinovite/veterinária , Acidose/induzido quimicamente , Acidose/patologia , Animais , Bovinos , Doenças dos Bovinos/patologia , Feminino , Neutrófilos/patologia , Oligossacarídeos/administração & dosagem , Rúmen/química , Líquido Sinovial/química , Sinovite/induzido quimicamente , Sinovite/patologia
15.
Sci Rep ; 9(1): 5452, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30932023

RESUMO

Acute ruminal acidosis (ARA) is the result of increased intake of highly fermentable carbohydrates, which frequently occurs in dairy cattle and is associated with aseptic polysynovitis. To characterise the metabolic changes in the joints of animals with ARA, we performed an untargeted gas chromatography-mass spectrometry (GC-MS)-based metabolomic analysis of synovial fluid. Seven heifers were challenged with an intraruminal oligofructose overload (13 g/kg of body weight [BW]) dissolved in water. Synovial fluid samples were collected at 0, 9 and 24 h post-overload. Metabolome analysis revealed the presence of 67 metabolites. At 9 h post-overload, glyceric acid, cellobiose, fructose and lactic acid were all increased, whereas at 24 h, sorbitol, lactic acid and fructose levels were all increased >10-fold. At 24 h, citric acid and threonine levels were significantly reduced. We detected increased L- and D-lactate, and the presence of interleukin-6 (IL-6) in synovial fluid. Furthermore, using bovine fibroblast-like synoviocytes, we observed that D-lactate induces IL-6 synthesis. Our results suggest that ARA produces severe metabolomic changes in synovial fluid, including disturbances in starch and sucrose metabolism, and increased lactate levels. These changes were observed prior to the appearance of synovitis, suggesting a potential role in the onset of polysynovitis.


Assuntos
Acidose/metabolismo , Rúmen/metabolismo , Líquido Sinovial/metabolismo , Sinovite/metabolismo , Animais , Bovinos , Cromatografia Líquida de Alta Pressão , Feminino , Concentração de Íons de Hidrogênio , Interleucina-6/metabolismo , Ácido Láctico/administração & dosagem , Metabolômica , Neutrófilos/patologia , Oligossacarídeos/administração & dosagem
16.
Rev. odontol. mex ; 22(4): 197-205, oct.-dic. 2018. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1014421

RESUMO

RESUMEN En la práctica odontológica, en la toma de radiografías no es común la colocación de dosímetros en los pacientes, sin embargo, por medio de la dosimetría podemos mantener un mejor control de la cantidad de radiación que es emitida a los pacientes, de la dosis de radiación y de la sensibilidad del tejido frente a la radiación, para así prevenir en algún momento los posibles efectos nocivos de la radiación ionizante; puesto que en odontología se encuentran por debajo las dosis umbral requeridas para producir reacciones tisulares (efectos deterministas), sin embargo, los efectos estocásticos pueden desarrollarse y presentarse con cualquier dosis de radiación. En este estudio nos enfocaremos en las ortopantomografías que son auxiliares de diagnóstico previo a un tratamiento odontológico.


ABSTRACT In dentistry, the use of dosimeters is not frequently to evaluate the patient radiation; however, through dosimetry, we can maintain a better control of the amount of radiation emitted to patients, radiation doses and the tissue radiosensitivity, to prevent at any time the posible harmful effects of ionizing radiation (deterministic effects), however the stochastic effects can be developed and presented with any doce of radiation. In this study we will focus on orthopantomographies that are diagnostic auxiliaries prior to dental treatment.

18.
Rev. odontol. mex ; 19(2): 121-126, abr.-jun. 2015. ilus, tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: lil-748840

RESUMO

Se presenta en la Clínica de Endodoncia de la División de Estudios de Postgrado e Investigación (DEPeI) de la Facultad de Odontología (UNAM) una paciente diagnosticada con mucormicosis rinocerebral; en este artículo se presentan las variaciones en el manejo clínico de esta paciente y la importancia de mantener el mayor número de órganos dentales en boca para una mejor estabilidad del obturador palatino, tanto para las funciones de fonación como de masticación adecuadas.


A patient previously diagnosed with cerebral mucormycosis attended the Endodontics Clinic of the Graduate and Research School, National School of Dentistry, National University of Mexico (UNAM). This article presents variations in the clinical handling of the patient; stress is made on the importance of preserving the greatest number of teeth in the mouth to thus achieve better stability of the palatal obturator and establish suitable phonation and mastication functions.

19.
J Vet Sci ; 15(2): 217-24, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25013355

RESUMO

Reactive oxygen species (ROS) production is one of the main mechanisms used to kill microbes during innate immune response. D-lactic acid, which is augmented during acute ruminal acidosis, reduces platelet activating factor (PAF)-induced ROS production and L-selectin shedding in bovine neutrophils in vitro. This study was conducted to investigate whether acute ruminal acidosis induced by acute oligofructose overload in heifers interferes with ROS production and L-selectin shedding in blood neutrophils. Blood neutrophils and plasma were obtained by jugular venipuncture, while ruminal samples were collected using rumenocentesis. Lactic acid from plasma and ruminal samples was measured by HPLC. PAF-induced ROS production and L-selectin shedding were measured in vitro in bovine neutrophils by a luminol chemiluminescence assay and flow cytometry, respectively. A significant increase in ruminal and plasma lactic acid was recorded in these animals. Specifically, a decrease in PAF-induced ROS production was observed 8 h after oligofructose overload, and this was sustained until 48 h post oligofructose overload. A reduction in PAF-induced L-selectin shedding was observed at 16 h and 32 h post oligofructose overload. Overall, the results indicated that neutrophil PAF responses were altered in heifers with ruminal acidosis, suggesting a potential dysfunction of the innate immune response.


Assuntos
Acidose/veterinária , Doenças dos Bovinos/imunologia , Imunidade Inata , Neutrófilos/efeitos dos fármacos , Oligossacarídeos/farmacologia , Fator de Ativação de Plaquetas/farmacologia , Acidose/induzido quimicamente , Acidose/imunologia , Animais , Sangue , Bovinos , Doenças dos Bovinos/induzido quimicamente , Feminino , Citometria de Fluxo/veterinária , Selectina L/metabolismo , Oligossacarídeos/toxicidade , Espécies Reativas de Oxigênio/metabolismo , Rúmen
20.
Vet Immunol Immunopathol ; 160(1-2): 139-44, 2014 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-24852076

RESUMO

Immunosuppression during the calving period in dairy cows is associated with an increased risk of diseases. Correct neutrophil function is a key mechanism of innate immunity that is used to protect the host from pathogenic microorganisms. The aim of this study was to evaluate the function of blood neutrophils obtained from heifers between 30 days preparturition and 30 days postparturition. We assessed the phagocytosis of fluorescent bioparticles using flow cytometry, chemotaxis induced by chemoattractants using the transwell plate assay, lactoferrin release using ELISA and cyclooxygenase-2 (COX-2) gene expression using real time-PCR. Our results showed an increased ability of phagocytosis of bioparticles and chemotaxis induced by the chemotactic agent platelet activating factor (PAF), between day 15 preparturition until day 30 postparturition, and at calving, respectively. COX-2 gene expression induced by PAF was increased only in neutrophils obtained at days 30 pre- and post-parturition (p<0.001). Neutrophil lactoferrin release was reduced between day 15 preparturition and day 30 postparturition compared with that at day 30 preparturition. Furthermore, lactoferrin plasma levels were increased at calving. In conclusion, we provided evidence that neutrophils from heifers around calving time exhibit impairment of particular defensive functions, such as COX-2 mRNA expression and lactoferrin, suggesting that these mechanisms may contribute to immunosuppression in cows around calving.


Assuntos
Bovinos/metabolismo , Ciclo-Oxigenase 2/metabolismo , Lactoferrina/metabolismo , Neutrófilos/metabolismo , Período Periparto , Animais , Ciclo-Oxigenase 2/sangue , Ciclo-Oxigenase 2/genética , Feminino , Lactoferrina/genética , Gravidez , RNA Mensageiro/genética , RNA Mensageiro/metabolismo
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