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2.
Int J Mol Sci ; 25(2)2024 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-38256058

RESUMO

Lipids are a large group of natural compounds, together with proteins and carbohydrates, and are essential for various processes in the body. After death, the organism's tissues undergo a series of reactions that generate changes in some molecules, including lipids. This means that determining the lipid change profile can be beneficial in estimating the postmortem interval (PMI). These changes can also help determine burial sites and advance the localization of graves. The aim was to explore and analyze the decomposition process of corpses, focusing on the transformation of lipids, especially triglycerides (TGs) and fatty acids (FAs), and the possible application of these compounds as markers to estimate PMI and detect burial sites. A systematic review of 24 scientific articles from the last 23 years (2000-2023) was conducted. The results show that membrane glycerophospholipids (such as phosphatidylcholine and phosphatidylglycerol, among others) are the most studied, and the most promising results are obtained, with decreasing patterns as PMI varies. Fatty acids (FAs) are also identified as potential biomarkers owing to the variations in their postmortem concentration. An increase in saturated fatty acids (SFAs), such as stearic acid and palmitic acid, and a decrease in unsaturated fatty acids (UFAs), such as oleic acid and linoleic acid, were observed. The importance of intrinsic and extrinsic factors in decomposition is also observed. Finally, as for the burial sites, the presence of fatty acids and some sterols in burial areas of animal and human remains can be verified. In conclusion, glycerophospholipids and fatty acids are good markers for estimating PMI. It has been observed that there are still no equations for estimating the PMI that can be applied to forensic practice, as intrinsic and extrinsic factors are seen to play a vital role in the decomposition process. As for determining burial sites, the importance of soil and textile samples has been demonstrated, showing a direct relationship between saturated fatty acids, hydroxy fatty acids, and some sterols with decomposing remains.


Assuntos
Lipidômica , Fitosteróis , Animais , Humanos , Ácidos Graxos , Cadáver , Esteróis , Glicerofosfolipídeos
3.
Toxics ; 10(6)2022 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-35736927

RESUMO

Suicide affects all sociodemographic levels, age groups, and populations worldwide. The factors that can increase the risk of suicidal tendencies are widely studied. The aim of this study was to analyze the types and combinations of toxics found in fatal suicide victims with different suicide mechanisms. A total of 355 autopsies were retrospectively studied, and 26 toxics were determined and related to mechanisms of suicide. Hanging (55%), drug overdose (22.7%), and jumping from a height (17.8%) were most represented suicide mechanisms with positive toxicology. Hanging was the most represented in men (50.3%; p = 0.019), while jumping from a height was more represented in women (29.7%, p = 0.028). Drugs of abuse were the most frequent toxics found in men (55.5%; p < 0.001), while medicines were the most frequent type found in women (70.3%, p < 0.001). Alcohol, nordiazepam, cocaine, and venlafaxine were the most consumed toxics. Benzodiazepines and venlafaxine were found in suicides involving drug overdose, hanging, and jumping from a height. In conclusion, most suicides were associated with drug abuse in men. Hanging was more represented in men and jumping from a height in women. Alcohol was present in combination with other toxics and medicines. The toxicological analysis is fundamental to understanding consumption patterns and establishing strategies and protocols for detecting and preventing suicide.

4.
Arch Med Sci ; 17(3): 682-693, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34025838

RESUMO

INTRODUCTION: The Child-Pugh and model for end-stage liver disease (MELD) scores are widely used to predict the outcomes of liver transplant (LT). Both have similar prognostic values in most cases, although their benefits might differ in some specific conditions. The aim of our study was to analyze the influence of pre-transplant ascites and encephalopathy in post-transplant liver rejection development and survival in alcohol cirrhosis (AC) patients undergoing LT to determine the usefulness of the Child-Pugh score for the assessment of prognosis in such patients. MATERIAL AND METHODS: Two hundred and eighty-one AC patients, classified according to viral infections and pre-transplant complications, were analyzed. Acute (AR) and chronic (CR) liver rejections and Child-Pugh, MELD and albumin-bilirubin (ALBI) scores were studied in all cases. RESULTS: Similar AC rejection percentages were observed in ascites or encephalopathy groups (18.5% and 16.5%, p = 0.735), although a higher but not statistically significant AC rate was observed in patients with grade III ascites (p = 0.777) and with grade II encephalopathy (p = 0.089). Chronic rejection was only developed by 9.1% of AC patients, regardless of the presence of ascites (6.2%) or encephalopathy (5.5%). The presence of ascites and encephalopathy complications did not seem to influence post-transplant survival. Neither the Child-Pugh nor the ALBI score can be considered the best for predicting patient survival in the short or long term. CONCLUSIONS: Ascites and encephalopathy do not seem to influence AC or CR in patient survival, regardless of the presence of viral infections, so in our study neither the Child-Pugh nor ALBI score seems to be the best score to predict the outcomes of these patients.

5.
Arch Med Sci ; 17(3): 764-774, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34025847

RESUMO

INTRODUCTION: The molecular mechanisms underlying alcoholic liver fibrosis and cirrhosis are not completely understood. Hepatic fibrosis involves the interplay of diverse cells and factors, including hepatic stellate cells (HSCs), Kupffer, NK cells, and T-lymphocyte subsets. Killer-cell immunoglobulin-like receptors (KIR) are membrane receptors involved in mediation between NK and activated HSCs, regulating NK cell function through their interaction with HLA-I molecules. The aim of this study was to analyse the genetic association between KIR genes and the susceptibility to or protection from alcoholic cirrhosis (AC) in a cohort of male AC patients undergoing liver transplantation (LT) with and without concomitant viral infections. MATERIAL AND METHODS: KIR genotyping was performed in nuclear DNA extracted from 281 AC patients and compared with 319 male controls. RESULTS: Significant differences between total AC patients and healthy controls were only found in the case of KIR2DL2 and KIR2DS5. KIR2DL2 was significantly underrepresented in non-viral AC patients (52.6% vs. 63.3%; p = 0.015), while patients heterozygous for KIR2DL2 were also underrepresented in the non-viral AC group compared with controls (p = 0.034). KIR2DS5 was overrepresented in this group compared with healthy controls (p = 0.002). All these observations were only evident in AC patients older than 54 years old. CONCLUSIONS: Our data suggest a contrary effect of KIR2DL2 and KIR2DS5 in AC patients older than 54 years, in whom the presence of KIR2DL2 appears to be protective against AC, whereas the presence of KIR2DS5 seems to promote the fibrotic process, particularly in patients with no associated viral infection.

6.
J Anal Toxicol ; 44(9): 985-992, 2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-32453428

RESUMO

A procedure based on gas chromatography-mass spectrometry was developed for the analysis of benzodiazepines (nordiazepam, oxazepam, lormetazepam, lorazepam, clonazepam, bromazepam and alprazolam) in postmortem human ribs. Powdered bone samples, including marrow remains inside, with the internal standard diazepam-d5 were subjected to enzymatic hydrolysis with 100 µL of ß-glucoronidase and were incubated in sodium hydroxide for 1 h in a 70°C oven. Samples underwent liquid phase extraction and ethyl acetate was used as eluent. Chromatography was performed on a fused silica capillary column and the selected-ion-monitoring mode was used for analytes determination. The method was validated in the range 0.1-0.5 ng/mg (depending on the benzodiazepine) to 100 ng/mg with average values of recovery, matrix effect and process efficiency ranged from 83.2 to 94.3%, from 97.3 to 102.1% and from 80.5 to 91.2%, respectively. The intra- and inter-day accuracy was <15%. The procedure was tested in rib specimens obtained during routine autopsies from 20 cases where these benzodiazepines were found in blood. Benzodiazepines were detected in the combined bone and marrow samples in 60% of cases. Lorazepam was detected in bone in the range of 0.3-0.7 ng/mg, nordiazepam at 1.3-4.2 ng/mg and oxazepam at 1.1-1.2 ng/mg. To our knowledge, this protocol for the simultaneous analysis of these benzodiazepines is the first performed and validated using human ribs.


Assuntos
Benzodiazepinas/análise , Toxicologia Forense/métodos , Cromatografia Gasosa-Espectrometria de Massas , Alprazolam , Autopsia , Cromatografia Líquida , Clonazepam , Diazepam , Humanos , Extração Líquido-Líquido , Lorazepam/análogos & derivados , Nordazepam , Oxazepam , Espectrometria de Massas em Tandem
7.
Leg Med (Tokyo) ; 48: 101817, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33264697

RESUMO

The paper presents the procedure followed to fully solve a forensic case which occurred in Southeastern Spain through the collaboration of specialists from different scientific areas belonging to two different government institutions, a public University and the Guardia Civil. Entomological evidence was required to estimate the PMI in order to settle the perimortem circumstances. Piophila megastigmata (Diptera: Piophilidae) is reported for the first time from a forensic case in Spain, enhancing the interest of its presence in corpses to estimate the PMI. The procedure followed for each scientific specialist is detailed and the possibilities and requirements of each discipline are discussed in detail. Taking into account that institutional interdisciplinary collaboration is not a rule in solving cases of forensic investigation in Spain, the relevance and need of such interdisciplinary collaboration in solving cases of forensic investigation is emphasized.


Assuntos
Autopsia/métodos , Dípteros , Entomologia Forense/métodos , Medicina Legal/métodos , Comunicação Interdisciplinar , Mudanças Depois da Morte , Animais , Cadáver , Dermatoglifia , Larva , Espanha , Fatores de Tempo
8.
Front Med (Lausanne) ; 8: 786798, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-35071269

RESUMO

Background: In forensic autopsies, examining the wounds is one of the most critical aspects to clarify the causal relationship between the cause of death and the wounds observed on the corpse. However, on many occasions, it is difficult to differentiate antemortem injuries from post-mortem injuries, mainly when they occur very close to the moment of death. At present, various studies try to find biomarkers and clarify the molecular mechanisms involved in a wound due to the high variability of conditions in which they occur, thus being one of the most challenging problems in forensic pathology. This review aimed to study the omics data to determine the main lines of investigation emerging in the diagnosis of vital injuries, time of appearance, estimation of the age and vitality of the wound, and its possible contributions to the forensic field. Methods: A systematic review of the human wound concerning forensic science was carried out by following PRISMA guidelines. Results: This study sheds light on the role of omics research during the process of wounding, identifying different cytokines and other inflammatory mediators, as well as cells involved in the specific stage of the wound healing process, show great use in estimating the age of a wound. On the other hand, the expression levels of skin enzymes, proteins, metal ions, and other biomarkers play an essential role in differentiating vital and post-mortem wounds. More recent studies have begun to analyze and quantify mRNA from different genes that encode proteins that participate in the inflammation phase of a wound and miRNAs related to various cellular processes. Conclusions: This study sheds light on the role of research in the molecular characterization of vital wounds, heralding a promising future for molecular characterization of wounds in the field of forensic pathology, opening up an important new area of research. Systematic Review Registration: URL: https://www.crd.york.ac.uk/prospero/#myprospero, Identifier: CRD42021286623.

9.
Cuad Bioet ; 31(103): 309-317, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-33375798

RESUMO

Lately, number of divorces is increasing, nevertheless, a parents' divorce can become a traumatic problem for paediatric patients. Consequently, the aim of this study was to analyze the ethical conflicts that appear in the relationship between physician/parents/son/daughter, and more specifically those that a divorce generates. A descriptive study was developed through a survey composed by 39 items. Previously, an exhaustive bibliographic analysis was carried out. Our results show that only 35% of paediatricians interviewed have been educated in bioethics although this issue is important in daily practice. Other items show that 57,5% would not cancel a pharmacological treatment in order to improve quality of life. Also, they would react against a wrong parents' decision (82,5%). They give low value to the minor`s decision (6,05%), and rarely inform exclusively to adolescents (5%). In contrast, paediatricians sometimes ask to adolescents (20%) in first place and involved them to decide in 90% of cases. Besides, there are differences in the relation with fathers and mothers, 17,5% of mothers are informed exclusively, a fact that never happens with fathers. Ethics has an intrinsic value very important in daily clinical decisions in order to respect the rules and to adapt them to the situation of every paediatric patient. When an important ethical conflict become, as a divorce is, it is essential to know who must be informed and the rights everyone has to make a decision. It is complicated to the paediatricians yet to develop 41/2002 law for Patient's autonomy.


Assuntos
Divórcio/ética , Negociação , Adolescente , Fatores Etários , Bioética/educação , Criança , Custódia da Criança/ética , Direitos Civis , Tomada de Decisão Clínica , Divórcio/legislação & jurisprudência , Educação Médica , Pai , Feminino , Humanos , Consentimento Livre e Esclarecido , Masculino , Mães , Pediatras/educação , Papel do Médico , Relações Profissional-Família , Psicologia do Adolescente , Psicologia da Criança , Consentimento do Representante Legal/ética , Consentimento do Representante Legal/legislação & jurisprudência , Revelação da Verdade/ética
10.
Cuad. bioét ; 31(103): 309-317, sept.-dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-200023

RESUMO

En los últimos años el número de divorcios ha ido aumentando, siendo en ocasiones, para el paciente pediátrico, el divorcio de sus padres un elemento traumático. Nuestro objetivo fue analizar los conflictos éticos que se producen en la relación sanitaria médico-padres-hijo y de forma más específica en niños procedentes de separación/divorcio. Se realizó un estudio descriptivo mediante una encuesta compuesta de 39 items. Previamente se realizó un análisis bibliográfico exhaustivo de artículos relacionados. Nuestros resultados muestran que solo el 35% de los pediatras ha recibido formación en bioética pese a su importancia en la práctica diaria. Sobre otras cuestiones, la mayoría (57,5%) no retiraría el tratamiento de un paciente enfermo pese a que aumentara su calidad de vida, y actuaría ante una decisión equivocada de los padres (82,5%). Dan poco valor a las decisiones del menor (6,05%), raramente informados exclusivamente (5%). En cambio, se les informa primero en un 20% de los casos y en el 90% se les implica. Respecto a los progenitores, el 17,5% de las madres son informadas en exclusiva, nunca los padres. La ética tiene un valor intrínseco muy importante en las decisiones clínicas habituales, respetándose generalmente las normas y adaptándose a la situación particular de cada niño/a. En los casos en los que hay un conflicto importante, como divorcios, es importante conocer a quién se debe informar, y qué derecho tiene cada uno a decidir. Aún resulta difícil para algunos pediatras aplicar la ley 41/2002 de Autonomía del Paciente


Lately, number of divorces is increasing, nevertheless, a parents' divorce can become a traumatic problem for paediatric patients. Consequently, the aim of this study was to analyze the ethical conflicts that appear in the relationship between physician/parents/son/daughter, and more specifically those that a divorce generates. A descriptive study was developed through a survey composed by 39 items. Previously, an exhaustive bibliographic analysis was carried out. Our results show that only 35% of paediatricians interviewed have been educated in bioethics although this issue is important in daily practice. Other items show that 57,5% would not cancel a pharmacological treatment in order to improve quality of life. Also, they would react against a wrong parents' decision (82,5%). They give low value to the minor`s decision (6,05%), and rarely inform exclusively to adolescents (5%). In contrast, paediatricians sometimes ask to adolescents (20%) in first place and involved them to decide in 90% of cases. Besides, there are differences in the relation with fathers and mothers, 17,5% of mothers are informed exclusively, a fact that never hap-pens with fathers. Ethics has an intrinsic value very important in daily clinical decisions in order to respect the rules and to adapt them to the situation of every paediatric patient. When an important ethical conflict become, as a divorce is, it is essential to know who must be informed and the rights everyone has to make a decision. It is complicated to the paediatricians yet to develop 41/2002 law for Patient's autonomy


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Relações Médico-Paciente/ética , Menores de Idade , Divórcio/ética , Custódia da Criança/ética , Relações Pais-Filho , Pediatras/ética , Autonomia Pessoal , Direitos do Paciente/ética , Inquéritos e Questionários , Conhecimentos, Atitudes e Prática em Saúde , Padrões de Prática Médica
11.
Leg Med (Tokyo) ; 46: 101717, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32442861

RESUMO

In this study quetiapine and pregabalin were analyzed in human bones. A method previously developed for the determination of antidepressants in human bone was tested for the analysis of these two substances. Bones were pulverized and subjected to the extraction protocol, and after undergoing solid-phase extraction, samples were analyzed using gas chromatography-mass spectrometry. The assay was validated in the range 0.3-500 ng/mg, mean analytical recovery was 76.9% for quetiapine and 90.9% for pregabalin, matrix effect was 83% for quetiapine and 91% for pregabalin and process efficiency was 63.8% for quetiapine and 82.7% for pregabalin. The intra- and inter-day precision was below 3% in all cases and the intra- and inter-assay accuracy values were in almost all cases better than 12%. The validated method was then applied to bone samples from forensic cases. Drugs were detected in bone in 2 of the 3 blood positive cases. The approximate concentrations in bone were 40 ng/mg for pregabalin and 7 ng/mg for quetiapine. To our knowledge, this is the first time these substances were detected in bones. With this study the number of substances with a validated protocol to be used in human bones in case of necessity is expanded.


Assuntos
Antidepressivos/análise , Osso e Ossos/metabolismo , Toxicologia Forense/métodos , Pregabalina/análise , Fumarato de Quetiapina/análise , Antidepressivos/isolamento & purificação , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Pregabalina/isolamento & purificação , Fumarato de Quetiapina/isolamento & purificação
12.
Molecules ; 24(13)2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31261852

RESUMO

A method based on gas chromatography-mass spectrometry (GC-MS) is described for the determination of bisoprolol and atenolol in human bone. After the addition of lobivolol as internal standard, pulverized samples were incubated in acetonitrile for 1 h under ultrasounds. After adjusting the pH of the samples to 6, they were centrifuged, and the supernatants were subjected to solid phase extraction. Elution was achieved by using 3 mL of 2% ammonium hydroxide in 80:20 dichloromethane:isopropanol solution. Eluted samples were evaporated and derivatized. Chromatography was performed on a fused silica capillary column and analytes were determined in the selected-ion-monitoring (SIM) mode. The assay was validated in the range 0.1-0.3 ng/mg (depending on the drug) to 150 ng/mg, the mean absolute recoveries were 60% for bisoprolol and 106% for atenolol, the matrix effect was 69% for bisoprolol and 70% for atenolol and process efficiency was 41% for bisoprolol and 80% for atenolol. The intra- and inter-assay accuracy values were always better than 12%. The validated method was then applied to bone samples from two real forensic cases in which toxicological analysis in blood were positive for atenolol in the first case (0.65 µg/mL) and bisoprolol in the second case (0.06 µg/mL). Atenolol was found in bone samples from the corresponding case at the approximate concentration of 148 ng/mg and bisoprolol was found at 8 ng/mg.


Assuntos
Atenolol/análise , Bisoprolol/análise , Osso e Ossos/química , Toxicologia Forense , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Reprodutibilidade dos Testes , Extração em Fase Sólida
13.
J Proteomics ; 192: 54-63, 2019 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-30145274

RESUMO

Proteomic techniques in bones forensic samples are increasingly, being applied. The main aim of forensic sciences is the estimation of postmortem interval. Most current techniques are useful for the first post-mortem stages. However, in the case of osseous remains, these techniques may be difficult to use due to the high level of decomposition of the sample. Our objective was to attempt to know whether there is a protein profile in human bone remains that would enable a late postmortem. interval ranging from 5 to 20 years postmortem to be estimated. A total of 40 femur bones from 40 different cadavers (data range 5-20 years) were use. Of the 275 total proteins, we excluded the circulating ones (n = 227), leaving a total of 48 proteins (29 structural and 19 functional) were found. A multiple correspondence analysis was applied on the 48 proteins. Finally selecting 32 proteins that allowed us to discriminate between the. two groups of postmortem interval. Analysis of the protein profile present in bone permits an approximation of the date of death within the studied interval, and could be used to complement other tests for estimating the postmortem interval.


Assuntos
Fêmur/química , Medicina Legal , Mudanças Depois da Morte , Proteínas/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteômica
14.
Exp Clin Transplant ; 17(3): 355-362, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-29957165

RESUMO

OBJECTIVES: The aim of this study was to analyze alcoholic cirrhosis in women who were to undergo liver transplant, including their biochemical and clinical characteristics, main complications, survival rates, and main causes of death compared with men with alcoholic cirrhosis. MATERIALS AND METHODS: Our study included 400 patients with alcoholic cirrhosis, which we divided according to sex and viral infections. Biochemical parameters and the presence and degree of ascites and encephalopathy, liver function status, and liver rejection and survival rates were analyzed from 1 to 10 years and the main cause of death at 10 years. RESULTS: Patients with nonviral alcoholic cirrhosis and liver transplant had significantly better survival rates (84.1%) at 1 year versus those with viral alcoholic cirrhosis (74.5%; P = .036). Men with nonviral alcoholic cirrhosis (14%) and women with hepatitis C virus (29%) had the lowest short-term survival rates. In long-term survival analysis, the lowest rate was observed in women with nonviral alcoholic cirrhosis (26.1%), and the highest rate was observed in women with hepatitis C virus (42.9%). Liver graft failure was one of the main causes of death in male patients (19.5%). CONCLUSIONS: Women with alcoholic cirrhosis showed a higher rate of ascites and encephalopathy but lower liver graft rejection than men with alcoholic cirrhosis. Survival rates were similar between men and women, although slightly lower in women who had hepatitis C virus.


Assuntos
Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado , Causas de Morte , Feminino , Humanos , Cirrose Hepática Alcoólica/complicações , Cirrose Hepática Alcoólica/diagnóstico , Cirrose Hepática Alcoólica/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Taxa de Sobrevida
15.
Adicciones ; 31(2): 95-105, 2019 04 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30059576

RESUMO

Greater attention is focusing on the motivations of subjects recruited for research protocols, especially in vulnerable populations. Although addiction is a highly stigmatized condition, very little research has focused on the factors influencing the decision to participate of patients with an addiction. Our aim is to gather further evidence in relation to the motivations of people with Substance Use Disorders (SUD), comparing their reasoning and willingness to participate in a hypothetical research study of 53 subjects with DSM-5 diagnoses of SUD and 50 controls. Responses on the MacArthur Competence Assessment Tool for Clinical Research were documented and correlated with several variables. There were no significant differences in willingness to participate in research and reasons for doing so between SUD and controls. Among SUD subjects, 59% mentioned altruism, 53.8% expected therapeutic benefits, and 43.6% desired to help others; none mentioned money. Of those patients with SUD who refused to participate in research, 69.2% cited aversion and 46.2% mentioned risk. Willingness to participate was correlated with higher computer literacy and better cognitive performance. In the multivariate analysis, aversion was a significant predictor of willingness to participate in research. When research is not related to their diagnosis, the motivations of SUD and controls are similar and flowed logically from the study. However, elements associated with therapeutic misconceptions were also evident. Therefore, negative views about the motivations of SUD subjects' participation in research are unfounded. Consequently, to improve study recruitment, assessments may be targeted to specific vulnerabilities rather than to diagnoses.


Cada vez se presta más atención a las motivaciones de las personas reclutadas para ensayos clínicos, especialmente si pertenecen a colectivos vulnerables. Aunque la participación en investigación de las personas con trastorno por uso de sustancias (TUS) suscita estereotipos negativos, muy pocos estudios se han centrado en los factores que influyen en la misma. Nuestro objetivo es analizar sus motivaciones comparando las razones y la disposición a participar en un ensayo hipotético de 53 pacientes con diagnósticos DSM-5 de TUS y 50 controles. Las respuestas que dieron a la entrevista MacArthur Competence Assessment Tool for Clinical Research se correlacionaron con diversas variables. No encontramos diferencias significativas entre ambas poblaciones en términos de motivaciones y disposición a participar. El 59% de la población TUS mencionó altruismo, un 53,8% esperaba beneficio terapéutico, y el 43,6% deseaba ayudar a otros. De los pacientes con TUS que rechazaron participar, el 69,2% alegó miedo y el 46,2% incomodidad por los riesgos. La disposición a participar se relacionó con un mayor nivel cognitivo y de alfabetización informática. En el análisis multivariante, la aversión a la investigación permaneció como factor predictivo significativo de la disposición a participar. Cuando la investigación no está relacionada con su diagnóstico, las motivaciones de la población TUS son similares a las de los controles y se deducen lógicamente del estudio, aunque también se evidenciaron elementos de "error terapéutico". Por consiguiente, las visiones negativas sobre las motivaciones de los TUS como participantes en investigación son infundadas. Para mejorar el reclutamiento, las valoraciones deben dirigirse a vulnerabilidades especificas en lugar de al diagnóstico.


Assuntos
Pesquisa Biomédica , Competência Mental , Motivação , Participação do Paciente/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Estudos de Casos e Controles , Tomada de Decisões , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/estatística & dados numéricos
16.
Adicciones (Palma de Mallorca) ; 31(2): 95-105, 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185199

RESUMO

Cada vez se presta más atención a las motivaciones de las personas reclutadas para ensayos clínicos, especialmente si pertenecen a colectivos vulnerables. Aunque la participación en investigación de las personas con trastorno por uso de sustancias (TUS) suscita estereotipos negativos, muy pocos estudios se han centrado en los factores que influyen en la misma. Nuestro objetivo es analizar sus motivaciones comparando las razones y la disposición a participar en un ensayo hipotético de 53 pacientes con diagnósticos DSM-5 de TUS y 50 controles. Las respuestas que dieron a la entrevista MacArthur Competence Assessment Tool for Clinical Research se correlacionaron con diversas variables. No encontramos diferencias significativas entre ambas poblaciones en términos de motivaciones y disposición a participar. El 59% de la población TUS mencionó altruismo, un 53,8% esperaba beneficio terapéutico, y el 43,6% deseaba ayudar a otros. De los pacientes con TUS que rechazaron participar, el 69,2% alegó miedo y el 46,2% incomodidad por los riesgos. La disposición a participar se relacionó con un mayor nivel cognitivo y de alfabetización informática. En el análisis multivariante, la aversión a la investigación permaneció como factor predictivo significativo de la disposición a participar. Cuando la investigación no está relacionada con su diagnóstico, las motivaciones de la población TUS son similares a las de los controles y se deducen lógicamente del estudio, aunque también se evidenciaron elementos de "error terapéutico". Por consiguiente, las visiones negativas sobre las motivaciones de los TUS como participantes en investigación son infundadas. Para mejorar el reclutamiento, las valoraciones deben dirigirse a vulnerabilidades especificas en lugar de al diagnóstico


Greater attention is focusing on the motivations of subjects recruited for research protocols, especially in vulnerable populations. Although addiction is a highly stigmatized condition, very little research has focused on the factors influencing the decision to participate of patients with an addiction. Our aim is to gather further evidence in relation to the motivations of people with Substance Use Disorders (SUD), comparing their reasoning and willingness to participate in a hypothetical research study of 53 subjects with DSM-5 diagnoses of SUD and 50 controls. Responses on the MacArthur Competence Assessment Tool for Clinical Research were documented and correlated with several variables. There were no significant differences in willingness to participate in research and reasons for doing so between SUD and controls. Among SUD subjects, 59% mentioned altruism, 53.8% expected therapeutic benefits, and 43.6% desired to help others; none mentioned money. Of those patients with SUD who refused to participate in research, 69.2% cited aversion and 46.2% mentioned risk. Willingness to participate was correlated with higher computer literacy and better cognitive performance. In the multivariate analysis, aversion was a significant predictor of willingness to participate in research. When research is not related to their diagnosis, the motivations of SUD and controls are similar and flowed logically from the study. However, elements associated with therapeutic misconceptions were also evident. Therefore, negative views about the motivations of SUD subjects’ participation in research are unfounded. Consequently, to improve study recruitment, assessments may be targeted to specific vulnerabilities rather than to diagnoses


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Pesquisa Biomédica , Competência Mental , Motivação , Transtornos Relacionados ao Uso de Substâncias/psicologia , Participação do Paciente/psicologia , Estudos de Casos e Controles , Tomada de Decisões , Modelos Logísticos , Participação do Paciente/estatística & dados numéricos
17.
Leg Med (Tokyo) ; 33: 32-35, 2018 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-29751277

RESUMO

A substantial challenge faced by forensic medicine is determining the postmortem interval (PMI) of skeletonized remains. Currently, the luminol method is of limited forensic usefulness, since it uses qualitative and subjective methods to estimate PMI by the naked eye assessing the degree of chemiluminescence (CL) emitted by bone remains, a technique which is not sensitive enough to distinguish between historical or forensically significant time intervals. The aim of the present study was to use a direct and accurate measurement of the CL by luminol technique in relative light units (RLU) using a luminometer to establish this method as a possible complementary and low cost tool for the determination of the PMI for distinguishing between remains of medical-legal (<20 years) and historical (≥20 years) interest in 102 femur remains with a range of PMI between 15 and 64 years. The results suggest that, under favorable conditions, the luminol technique can detect haemoglobin in the bone in a PMI range of 0-65 years, finding significant differences in the CL intensity among samples with PMI < 20 years and PMI ≥ 20 years. In addition, the intensities of CL measured at 10 s, 15 s and 20 s after reaction with luminol show a statistically significant inverse relationship with PMI in the bone studied, following a decreasing logarithmic model. The conclusion is that this quantitative, objective and contrastable technique could be very useful for determining the PMI in bone remains, since it allows a good degree of precision and eliminates the subjectivity introduced by qualitative techniques.

18.
Forensic Sci Int ; 281: 106-112, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29125988

RESUMO

Estimating the postmortem interval (PMI) is an important goal in forensic medicine and continues to be one of the most difficult tasks of the forensic investigator. Few accurate methods exist to determine the time since death of skeletonized human remains due to the great number of intrinsic and external factors that may alter the normal course of postmortem change. The purpose of this research was to assess the usefulness of various biochemical parameters, such as nitrogenous bases (adenine, guanine, purines, cytosine, thymine, pyrimidines, hypoxanthine and xanthine), DNA and Collagen Type I peptides to estimate PMI. These parameters were analysed in cortical bone for the establishment of data in a total of 80 long bones of 80 corpses (50 males, 30 females) with a mean age of 68.31 years (S.D.=18.021, range=20-97). The bones were removed from the cement niches of a cemetery in Murcia (south-eastern Spain), where they had lain for between 5 and 47 years (mean time 23.83 years, S.D.=10.85). Our results show a significant decrease in adenine (p=0.0004), guanine (p=0.0001), purines (p=0.0001), cytosine (p=0.0001), thymine (p=0.0226), pyrimidines (p=0.0002) and the number of peptides of Collagen type I (p=0.0053) in those with a PMI≥20 years. In a curvilinear regression analysis the results show that 30.6% of the variable PMI could be explained by guanine concentration, in bones with a PMI<20 years, while in cases of a PMI≥20 years, the variable that best explained membership of this group was adenine (38.0%). In the discriminant analysis applied to the all the variables as a function of PMI when two groups were established, 86.7% of the cases were correctly classified. These results show that the quantification of Collagen type I proteins and nitrogenous bases could be used as a complementary tool, together with other analyses, in the estimation of PMI.


Assuntos
Osso e Ossos/química , Colágeno Tipo I/análise , DNA/análise , Mudanças Depois da Morte , Purinas/análise , Pirimidinas/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Cromatografia Líquida de Alta Pressão , Análise Discriminante , Feminino , Humanos , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Análise de Regressão , Adulto Jovem
20.
Adicciones ; 29(3): 213-214, 2017 Jun 28.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28492963

RESUMO

Letter to the editor.


Resumen: el consentimiento informado constituye un elemento clave para una investigación ética. La población adicta puede tener deteriorada su capacidad para consentir por varios motivos. Las drogodependencias representan un campo idóneo para un análisis bioético porque implican conflictos de valores a diversos niveles. Constituyen un problema complejo en el que interaccionan intereses económicos, políticos, sociales, y sanitarios. Analizamos las implicaciones de estas cuestiones para la práctica clínica y la investigación con personas con trastornos adictivos y damos unas directrices sobre cuándo, cómo y por qué llevar a cabo valoraciones de la capacidad para participar en investigación.


Assuntos
Pesquisa Biomédica , Tomada de Decisões , Competência Mental , Sujeitos da Pesquisa , Transtornos Relacionados ao Uso de Substâncias/psicologia , Humanos
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