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1.
PLoS One ; 14(9): e0220911, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31487300

RESUMO

BACKGROUND: Patients and clinicians endorse the importance of compassionate healthcare but patients report gaps between its perceived importance and its demonstration. Empathy and compassion have been associated with quality of life and significant health outcomes but these characteristics are not optimally measured or used for performance and organizational improvement. OBJECTIVE: To address these gaps, we conducted a study with the objective of evaluating the properties of the 12-item Schwartz Center Compassionate Care Scale® using psychometric analysis and cognitive debriefing. METHODS: Non-hospitalized patients with multiple chronic conditions were sampled using an on-line platform. Classical test theory and Rasch measurement theory were used to evaluate psychometric properties of the scale. Structured questions elicited cognitive responses regarding clarity of each item. RESULTS: Classical test theory analysis confirmed that the 12-item Schwartz Center Compassionate Care Scale is a unidimensional scale with excellent internal consistency and test-retest reliability. Patients' ratings of compassionate behaviors using the Schwartz Center Compassionate Care Scale correlated significantly with a related instrument designed to measure empathy, demonstrating convergent validity. Rasch measurement theory showed that reducing the number of response options on 3 items in the scale would improve respondents' discrimination between responses on these items. Although person-item threshold distribution analysis showed that patients may wish to rate compassionate care at levels both higher and lower than the scale permits, items could be ordered on an interval scale from low to high levels of compassionate care. CONCLUSIONS: The current 12-item Schwartz Center Compassionate Care Scale demonstrates excellent psychometric properties by Classical Test Theory and Rasch measurement theory. The 12-item Schwartz Center Compassionate Care Scale adds questions related to understanding and discussing emotional, contextual issues and the needs of the patient and family. Easily completed on-line, it could be used for work-place based assessment and feedback to clinicians and performance or quality improvement.

2.
Int J Obes (Lond) ; 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31467421

RESUMO

OBJECTIVES: High-esterified pectin (HEP) is a prebiotic able to modulate gut microbiota, associated with health-promoting metabolic effects in glucose and lipid metabolism and adipostatic hormone sensitivity. Possible effects regulating adaptive thermogenesis and energy waste are poorly known. Therefore, we aimed to study how physiological supplementation with HEP is able to affect microbiota, energy metabolism and adaptive thermogenic capacity, and to contribute to the healthier phenotype promoted by HEP supplementation, as previously shown. We also attempted to decipher some of the mechanisms involved in the HEP effects, including in vitro experiments. SUBJECTS AND EXPERIMENTAL DESIGN: We used a model of metabolic malprogramming consisting of the progeny of rats with mild calorie restriction during pregnancy, both under control diet and an obesogenic (high-sucrose) diet, supplemented with HEP, combined with in vitro experiments in primary cultured brown and white adipocytes treated with the postbiotic acetate. RESULTS: Our main findings suggest that chronic HEP supplementation induces markers of brown and white adipose tissue thermogenic capacity, accompanied by a decrease in energy efficiency, and prevention of weight gain under an obesogenic diet. We also show that HEP promotes an increase in beneficial bacteria in the gut and peripheral levels of acetate. Moreover, in vitro acetate can improve adipokine production, and increase thermogenic capacity and browning in brown and white adipocytes, respectively, which could be part of the protection mechanism against excess weight gain observed in vivo. CONCLUSION: HEP and acetate stand out as prebiotic/postbiotic active compounds able to modulate both brown-adipocyte metabolism and browning and protect against obesity.

3.
Langmuir ; 35(20): 6693-6707, 2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31063381

RESUMO

The possibility of stabilizing emulsions with polyelectrolyte complexes (PEC) obtained from the interaction of two non-surface-active oppositely charged polyelectrolytes (PEL) is described. Poly(allylamine hydrochloride) (PAH) and poly(4-styrene sulfonate) sodium salt are selected as the weak cationic and the strong anionic polyelectrolyte, respectively. Aqueous polymer mixtures are investigated by light scattering to determine the size of the complexes and whether precipitation or complex coacervation occurs. The effects of PEL mixing ratio, pH, and PEL concentration are studied in detail. By increasing the pH, the transition precipitate-precipitate/coacervate-coacervate-polymer solution is observed. At low pH, both PEL are fully ionized and therefore precipitates (soft particles) arise as a result of strong electrostatic interactions. By increasing the pH, the degree of ionization of PAH decreases and weak electrostatic interactions ensue, supporting the formation of coacervate droplets. The most stable oil-in-water emulsions are prepared from aqueous mixtures around charge neutralization. Although emulsions can be prepared from coacervate droplet dispersions, their coalescence stability is worse than those stabilized by soft PEC particles. By increasing the PEL concentration, the average droplet diameter decreases and the fraction of cream in the emulsion increases for emulsions prepared with PEC particles, following the limited coalescence model. However, at high concentrations, emulsion stability is slightly worse probably due to extensive aggregation of the particles. Viscous high internal phase emulsions can be prepared at low pH in which oil droplets are deformed. Here, PEC particles are detected only at the oil-water interface. At lower oil content, excess particles form a network in the aqueous phase aiding emulsion stability to coalescence.

4.
Nutrients ; 11(5)2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31100942

RESUMO

A main challenge in nutritional studies is the valid and reliable assessment of food intake, as well as its effects on the body. Generally, food intake measurement is based on self-reported dietary intake questionnaires, which have inherent limitations. They can be overcome by the use of biomarkers, capable of objectively assessing food consumption without the bias of self-reported dietary assessment. Another major goal is to determine the biological effects of foods and their impact on health. Systems analysis of dynamic responses may help to identify biomarkers indicative of intake and effects on the body at the same time, possibly in relation to individuals' health/disease states. Such biomarkers could be used to quantify intake and validate intake questionnaires, analyse physiological or pathological responses to certain food components or diets, identify persons with specific dietary deficiency, provide information on inter-individual variations or help to formulate personalized dietary recommendations to achieve optimal health for particular phenotypes, currently referred as "precision nutrition." In this regard, holistic approaches using global analysis methods (omics approaches), capable of gathering high amounts of data, appear to be very useful to identify new biomarkers and to enhance our understanding of the role of food in health and disease.

5.
Int J Med Inform ; 127: 9-17, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31128837

RESUMO

OBJECTIVE: To examine the patient perspective on the risks and benefits of linking existing data sources for research. MATERIALS AND METHODS: Between December 2015 and February 2016, we fielded a questionnaire in PatientsLikeMe, an online patient community representing over 2500 health conditions. The questionnaire was developed using subject matter expertise and patient feedback from a concept elicitation phase (N = 57 patients). The final questionnaire consisted of 37 items. RESULTS: Of n = 5741 who opened the email invitation, n = 3516 respondents completed the questionnaire (61.2%). Of these, 73.8% were women, 86.4% were Caucasian, 14.5% were 65 or older, and 44.9% had completed college or post-graduate education. Questionnaire respondents indicated that the most important benefits of sharing data were "helping my doctor make better decisions about my health" (94%) and "helping make new therapies available faster" (94%). The most important data sharing risk identified was health data being "stolen by hackers" (87%). Of 693 patients who were not comfortable with researchers accessing their de-identified data, most reported that their comfort levels would increase if they were able to learn how their data was protected (84%). In general, responders felt more comfortable when unique identifiers such as social security number (90%) and insurance ID (82%) were removed from the data for linkage and research use. DISCUSSION: The majority of patients in a US-based online community are comfortable with researchers accessing their de-identified data for research purposes. CONCLUSIONS: Developing methods to link databases minimizing the exposure of unique identifiers may improve patient comfort levels with linking data for research purposes.

6.
Nutr. hosp ; 36(2): 296-302, mar.-abr. 2019. tab, graf
Artigo em Espanhol | LILACS-Express | ID: ibc-FGT-1781

RESUMO

Introducción: en la población geriátrica institucionalizada existe un elevado número de adultos mayores dependientes y en riesgo de malnutrición. Entre otros, los factores relacionados son la pérdida de peso inherente a la edad, que favorece la fragilidad y la sarcopenia, el índice de masa corporal (IMC) bajo y el empeoramiento de enfermedades crónicas, lo cual conlleva un deterioro en la calidad de vida. Objetivo: analizar la relación entre dependencia y estado nutricional en personas mayores que viven institucionalizadas. Método: estudio prospectivo observacional y descriptivo en una muestra de ancianos institucionalizados. Se valoraron la dependencia mediante el índice de Barthel, el género, el IMC, la presencia de enfermedades crónicas y el estado nutricional mediante el Mini Nutricional Assessment (MNA). La asociación entre las distintas variables se llevó a cabo mediante la correlación de Spearman. Resultados: ciento sesenta y cuatro pacientes fueron incluidos en el estudio. Según el índice de Barthel, el 45,10% (n = 74) de los pacientes tenían una dependencia total y un 18,30% (n = 30), una dependencia moderada. Las mujeres tenían mayor riesgo de dependencia total que los hombres (p < 0,0001). Existió una relación significativa entre el nivel de dependencia y el estado nutricional: a mayor dependencia, mayor riesgo de desnutrición (p < 0,0001). Los residentes que tenían bajo peso tenían un riesgo mayor de sufrir dependencia total en un RR de 11,05 (IC 95% 4,41; 27,7). Los residentes que presentaban demencia tenían mayor dependencia (p < 0,0001). Conclusión: la mayoría de los ancianos institucionalizados presentaron algún grado de dependencia, lo que implicó un riesgo para el estado nutricional que se vio agravado si padecían demencia y bajo peso


Background: there is a high number of dependent older adults with risk of malnutrition in the institutionalized geriatric population. Among others, the related factors are weight loss inherent to age, which favors frailty and sarcopenia, low body mass index (BMI) and the worsening of chronic diseases, which entails a deterioration in the quality of life. Objective: to analyze the relationship between dependence and nutritional status in elderly institutionalized people. Method: prospective observational and descriptive study in a sample of elderly institutionalized people. Dependence was studied by the Barthel index, sex, BMI, presence of chronic diseases and nutritional status with the Mini Nutritional Assessment (MNA). The association between the different variables was made with the Spearman correlation. Results: one hundred and sixty-four patients were included in the study; 45.10% (n = 74) of the patients had a total dependence and 18.30% (n = 30) had a moderate dependence. Women had a higher risk of total dependence than men (p < 0.0001). There was a significant relationship between the level of dependence and nutritional status, so that greater dependence increased the risk of malnutrition (p < 0.0001). Patients who were underweight had a greater risk of total dependence (RR 11.05 [95% CI 4.41, 27.7]). Patients with dementia were more dependent (p < 0.0001). Conclusion: most of the institutionalized elderly people presented some degree of dependence, which supposed a risk for the nutritional status that was aggravated if they suffered dementia and low weight

7.
J Agric Food Chem ; 67(13): 3633-3642, 2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30855142

RESUMO

Detrimental metabolic programming has become a determinant factor in obesity propensity and the development of metabolic disorders; therefore, the search of nutritional strategies to reverse it is very relevant. Pectin is a prebiotic with health-promoting effects, such as control of glucose homeostasis and lipid metabolism, although other possible health effects and the prevention of obesity have been poorly studied. We studied the effects of chronic physiological supplementation with high-esterified pectin (HEP) in the reversion of metabolic nutrition-sensitive malprogramming associated with gestational undernutrition. As a model of nutrition-sensitive malprogramming, we used the progeny of rats with mild calorie restriction (CR) during pregnancy and analyzed their performance under metabolic stress (high-sucrose diet). We focused on the study of the sensitivity to the main adipostatic/adipokine hormones, i.e., leptin, insulin, and adiponectin, at both peripheral (liver and circulating parameters) and central (hypothalamus) levels. Our main findings suggest that chronic HEP supplementation is able to prevent weight/fat gain, to substantially reverse the detrimental malprogramming caused by the CR condition, to improve general health circulating markers, to modulate oxidative/lipogenic balance in the liver and energy metabolism regulators in the hypothalamus, and to restore/improve adipostatic/adipokine sensitivity affected by maternal calorie restriction, both peripherally and centrally. HEP stands out as a food component potentially useful against the development of metabolic disorders and obesity.


Assuntos
Adiponectina/metabolismo , Insulina/metabolismo , Leptina/metabolismo , Pectinas/metabolismo , Gravidez/metabolismo , Adipocinas/metabolismo , Animais , Metabolismo Energético , Esterificação , Feminino , Humanos , Hipotálamo/metabolismo , Fígado/metabolismo , Masculino , Pectinas/química , Ratos , Ratos Wistar
8.
Clin Infect Dis ; 2019 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-30843046

RESUMO

BACKGROUND: The incidence of herpes zoster is up to 9 times higher in immunosuppressed solid organ transplant recipients than in the general population. We investigated immunogenicity and safety of an adjuvanted recombinant zoster vaccine (RZV) in renal transplant (RT) recipients ≥18 years of age receiving daily immunosuppressive therapy. METHODS: In this phase III, randomized (1:1), observer-blind, multicenter trial (NCT02058589), RT recipients were enrolled and received 2 doses of RZV or Placebo 1-2 months (M) apart 4-18M post-transplant. Anti-glycoprotein E (gE) antibody concentrations, gE-specific CD4 T-cell frequencies, and vaccine response rates were assessed at 1M post-dose 1, and 1M and 12M post-dose 2. Solicited and unsolicited adverse events (AEs) were recorded for 7 and 30 days post-each dose, respectively. Solicited general symptoms and unsolicited AEs were also collected 7 days before first vaccination. Serious AEs (including biopsy-proven allograft rejections) and potential immune-mediated diseases (pIMDs) were recorded up to 12M post-dose 2. RESULTS: 264 participants (RZV: 132; Placebo: 132) were enrolled between March 2014 and April 2017. gE-specific humoral and cell-mediated immune responses were higher in RZV than placebo recipients across post-vaccination time points and persisted above pre-vaccination baseline 12M post-dose 2. Local AEs were reported more frequently by RZV than placebo recipients. Overall occurrences of renal function changes, rejections, unsolicited AEs, SAEs, and pIMDs were similar between groups. CONCLUSIONS: RZV was immunogenic in chronically immunosuppressed RT recipients. Immunogenicity persisted through 12M post-vaccination. No safety concerns arose.

9.
Nutr Hosp ; 36(2): 296-302, 2019 Apr 10.
Artigo em Espanhol | MEDLINE | ID: mdl-30868902

RESUMO

Introduction: Background: there is a high number of dependent older adults with risk of malnutrition in the institutionalized geriatric population. Among others, the related factors are weight loss inherent to age, which favors frailty and sarcopenia, low body mass index (BMI) and the worsening of chronic diseases, which entails a deterioration in the quality of life. Objective: to analyze the relationship between dependence and nutritional status in elderly institutionalized people. Method: prospective observational and descriptive study in a sample of elderly institutionalized people. Dependence was studied by the Barthel index, sex, BMI, presence of chronic diseases and nutritional status with the Mini Nutritional Assessment (MNA). The association between the different variables was made with the Spearman correlation. Results: one hundred and sixty-four patients were included in the study; 45.10% (n = 74) of the patients had a total dependence and 18.30% (n = 30) had a moderate dependence. Women had a higher risk of total dependence than men (p < 0.0001). There was a significant relationship between the level of dependence and nutritional status, so that greater dependence increased the risk of malnutrition (p < 0.0001). Patients who were underweight had a greater risk of total dependence (RR 11.05 [95% CI 4.41, 27.7]). Patients with dementia were more dependent (p < 0.0001). Conclusion: most of the institutionalized elderly people presented some degree of dependence, which supposed a risk for the nutritional status that was aggravated if they suffered dementia and low weight.

11.
Psychooncology ; 2018 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-30312500

RESUMO

OBJECTIVE: The aim of this study was to develop and validate a patient-reported outcome measure to evaluate body image concerns in head and neck cancer (HNC) patients. METHODS: Items were created using a combination of deductive (eg, US Food and Drug Administration Qualification of Clinical Outcome Assessments, literature review) and inductive approaches (eg, subject matter experts, HNC patients). Items were translated for use in both Canadian English and Canadian French using back-translation. A two-step empirical validation process using the Classical Test Theory (CTT) and Rasch Measurement Theory (RMT) was conducted with 224 and 258 HNC patients, respectively, having undergone disfiguring surgery within the past 3 years. RESULTS: Analyses suggest two subscales for MBIS-HNC: social discomfort (10 items) and negative self-image (11 items). The McGill Body Image Concerns Scale-Head and Neck Cancer (MBIS-HNC) is reliable with high internal consistency (0.98), high test-retest reliability over a two-week period (ICC = 0.88), moderate to high convergent validity (range r = 0.43-0.81), and divergent validity (range r = 0.12-0.15). RMT was used in addition to CTT. Disordered thresholds led to the modification of the number of response options, and items were deleted based on differential item functioning and high local dependency. Unidimensionality of both subscales and supporting a total score was confirmed. The measure was however characterized by the presence of an important floor effect, confirmed with poor targeting as demonstrated by the person-item threshold distribution. CONCLUSION: Evidence gathered from our theory-driven validation study using CTT and RMT provides practitioners and researchers with a useful and easy to use self-report measure.

13.
Rev Peru Med Exp Salud Publica ; 35(2): 333-337, 2018 Apr-Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-30183926

RESUMO

We present a case of mastitis in a 45-year-old woman with no history of infection in other areas of the body, with unspecific clinical picture, imaging studies, and bacilloscopy. However, histological samples obtained by aspiration showed giant epithelial cells, necrosis, and granulomatous formations, which justified a clinical inclination toward tuberculosis. In the absence of confirmatory evidence of any lesions in other tissues, the existence of mastitis of torpid evolution is a clinical indication to suspect mammary tuberculosis, since the characteristics of the process usually lead to erroneous diagnoses with other breast tumors such as cancer. Tuberculosis in the breast is a rare disease with a difficult diagnosis due to the low clinical and microbiological evidence and the lack of specificity of the imaging results, so the suspicion of its real diagnostic possibility is a fundamental condition for its determination, even when the causal agent is not confirmed.

14.
J Phys Chem A ; 122(40): 7941-7953, 2018 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-30265538

RESUMO

Ultrafast time-resolved electronic and infrared absorption measurements have been carried out on a series of Ru(II) polypyridyl complexes in an effort to delineate the dynamics of vibrational relaxation in this class of charge transfer chromophores. Time-dependent density functional theory calculations performed on compounds of the form [Ru(CN-Me-bpy) x(bpy)3-x]2+ ( x = 1-3 for compounds 1-3, respectively, where CN-Me-bpy is 4,4'-dicyano-5,5'-dimethyl-2,2'-bipyridine and bpy is 2,2'-bipyridine) reveal features in their charge-transfer absorption envelopes that allow for selective excitation of the Ru(II)-(CN-Me-bpy) moiety, the lowest-energy MLCT state(s) in each compound of the series. Changes in band shape and amplitude of the time-resolved differential electronic absorption data are ascribed to vibrational cooling in the CN-Me-bpy-localized 3MLCT state with a time constant of 8 ± 3 ps in all three compounds. This conclusion was corroborated by picosecond time-resolved infrared absorption measurements; sharpening of the CN stretch in the 3MLCT excited state was observed with a time constant of 3.0 ± 1.5 ps in all three members of the series. Electronic absorption data acquired at higher temporal resolution revealed spectral modulation over the first 2 ps occurring with a time constant of τ = 170 ± 50 fs, in compound 1; corresponding effects are significantly attenuated in compound 2 and virtually absent in compound 3. We assign this feature to intramolecular vibrational redistribution (IVR) within the 3MLCT state and represents a rare example of this process being identified from time-resolved electronic absorption data for this important class of chromophores.

15.
Mol Nutr Food Res ; 62(21): e1800463, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30095217

RESUMO

SCOPE: Resveratrol (RSV) and nicotinamide riboside (NR) are food compounds with anti-obesity actions in adult rodents. Here, the long-term effects of RSV and NR mild supplementation throughout lactation on adiposity-related parameters and the appearance of the beige phenotype in white adipose tissue (WAT) in adulthood are assessed. METHODS AND RESULTS: Newborn mice received orally RSV or NR from day 2 to 20 of life. Control littermates received the vehicle. All animals are weaned onto a chow diet on day 21. On day 90, half the animals of each group are assigned to a high-fat diet (HFD) for 10 weeks, while the other remained on a normal-fat diet. Energy-balance-related parameters, blood parameters, and gene expression and immunohistochemical analysis of WAT are assessed. Treated male mice show an improved response to the HFD, such as delayed body weight gain, a blunted increase in the plasma leptin/adiponectin ratio, and a decreased lipolytic response, together with signs of white-to-brown fat remodeling in inguinal WAT. These effects are absent in female mice. CONCLUSION: RSV and NR supplementations in early postnatal life affect WAT's thermogenic/oxidative transcriptional phenotype and metabolic responses in adulthood, with upregulatory and beneficial effects evidenced in male animals.

16.
Disabil Rehabil ; : 1-15, 2018 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-29976091

RESUMO

PURPOSE: The objectives of this scoping review were to summarize, understand, and disseminate findings from a broad body of literature on rehabilitation interventions used with survivors of head and neck cancer. METHOD: Searches were conducted in six databases. Inclusion criteria were studies of adult head and neck cancer survivors with a predefined primary rehabilitation outcome as a result of an intervention. Excluded were studies not written in English, opinion papers, or studies where the intervention was not carried out by a rehabilitation healthcare service. A second level, full-text review of the studies was conducted. A thematic analysis was used to examine and combine study findings. RESULTS: A total of 3804 results were retrieved from all sources resulting in 39 papers that were analyzed. The thematic analysis of the included papers represented interventions focusing on swallowing and nutrition, speech, physical therapy, assistive devices, complementary and alternative modalities, comprehensive interdisciplinary programs, and preventive rehabilitation programs. CONCLUSION: This review has provided an overview of the scope of rehabilitation interventions available for survivors of head and neck cancer and preliminary information about their efficacy. This is foundational information for the development and refinement of rehabilitation interventions and programs for head and neck cancer survivors. Implications for Rehabilitation The existing evidence suggests that survivors of head and neck cancer can benefit from early screening of potential rehabilitation needs and being involved in preventive rehabilitation programs pre-surgery when possible. Rehabilitation programs should consider swallowing interventions for patients as evidence reports improved swallowing function, decreased pain and discomfort, and reduced duration of feeding tube use. Rehabilitation programs should consider nutritional interventions after radiotherapy: Patients benefited from stabilized weights, improved nutritional status, and an improved quality of life. Physical exercise interventions demonstrated improvements in physical function, muscular endurance, range of motion, overall quality of life, and showed reductions in pain, and fatigue.

17.
Rev. peru. med. exp. salud publica ; 35(2): 333-337, abr.-jun. 2018. graf
Artigo em Espanhol | LILACS-Express | ID: biblio-961869

RESUMO

RESUMEN Presentamos caso de mastitis en mujer de 45 años sin antecedentes de infección en otras regiones corporales. Presentó cuadro clínico, estudios de imágenes y baciloscopia inespecíficos, sin embargo, mediante muestras histológicas obtenidas por punción aspirativa se encontró células epiteliodes gigantes, necrosis y formaciones granulomatosas, lo cual justificó el pensamiento clínico en tuberculosis. En ausencia de evidencias confirmatorias de lesión en otros tejidos, la existencia de mastitis de evolución tórpida es un indicativo clínico para sospechar tuberculosis mamaria, pues usualmente las características del proceso suelen plantear diagnósticos erróneos con otras entidades tumorales de la mama como cáncer. La tuberculosis en mama, representa una rara enfermedad cuyo diagnóstico es difícil por las bajas evidencias clínicas, microbiológicas y la inespecificidad de los resultados imagenológicos, por lo que la sospecha de su real posibilidad diagnóstica es una condición primordial para su determinación, aun cuando no se confirme el agente causal.


ABSTRACT We present a case of mastitis in a 45-year-old woman with no history of infection in other areas of the body, with unspecific clinical picture, imaging studies, and bacilloscopy. However, histological samples obtained by aspiration showed giant epithelial cells, necrosis, and granulomatous formations, which justified a clinical inclination toward tuberculosis. In the absence of confirmatory evidence of any lesions in other tissues, the existence of mastitis of torpid evolution is a clinical indication to suspect mammary tuberculosis, since the characteristics of the process usually lead to erroneous diagnoses with other breast tumors such as cancer. Tuberculosis in the breast is a rare disease with a difficult diagnosis due to the low clinical and microbiological evidence and the lack of specificity of the imaging results, so the suspicion of its real diagnostic possibility is a fundamental condition for its determination, even when the causal agent is not confirmed.

18.
Enferm. nefrol ; 21(1): 81-85, ene.-mar. 2018.
Artigo em Espanhol | IBECS | ID: ibc-171658

RESUMO

Los accesos vasculares son uno de los pilares fundamentales de la hemodiálisis. El acceso ideal debe proporcionar un flujo adecuado de sangre, ser de larga duración, permitir un abordaje fácil y sin complicaciones. La elección del acceso debe ser individualizada para cada paciente, según diversos aspectos como historia clínica, mapa vascular o preferencias del paciente. La fístula arteriovenosa autóloga es el acceso que más se asemeja a las cualidades del acceso ideal, siendo acceso de primera elección. Se restringen los catéteres venosos centrales tunelizados para situaciones con imposibilidad de conseguir accesos de primera elección. El objetivo de este artículo es mostrar la experiencia de un paciente tetrapléjico en HD, en la búsqueda y elección del acceso vascular. La elección del acceso más adecuado en casos como este tiene importantes connotaciones añadidas, por lo que la decisión no siempre es fácil. Por un lado, los accesos de primera elección pueden limitar o condicionar el quehacer diario de pacientes tetrapléjicos/parapléjicos, y, por otro lado, los catéteres elevan sustancialmente el riesgo de infecciones y la morbimortalidad (AU)


Vascular accesses are one of the mainstays of hemodialysis. The ideal access should provide an adequate blood flow, be long-lasting, allow easy and uncomplicated handling. The choice of access should be individualized for each patient, according to various aspects such as clinical history, vascular map or patient preferences. Autologous arteriovenous fistula is the access that most resembles the qualities of ideal access, being the first-line access. Tunneled central venous catheters are restricted for situations with inability to achieve first-line access. The aim of this article is to show the experience of a tetraplegic patient in HD, in the search and selection of his vascular access. The choice of the most appropriate access in such cases has important added connotations, so the decision is not always easy. On the one hand, the first-line access may limit or condition the daily work of tetraplegic / paraplegic patients, and, on the other hand, catheters substantially increase the risk of infections and morbimortality (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/terapia , Diálise Renal/métodos , Cateteres de Demora , Dispositivos de Acesso Vascular , Quadriplegia/complicações , Hemofiltração/enfermagem
19.
PLoS One ; 13(1): e0190368, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29293629

RESUMO

The type of fat in the diet determinates the characteristics of gut microbiota, exerting a major role in the development of metabolic syndrome. We hypothesize that a diet enriched with extra virgin olive oil (EVOO) has a distinctive effect on the intestinal microbiome in comparison with an enriched butter diet (BT) and this effect is related to the physiological benefits exerted by EVOO. Swiss Webster mice were fed standard (SD) or two high fat diets enriched with EVOO or butter. Hormonal, physiological and metabolic parameters were evaluated. At the end of the feeding period, DNA was extracted from faeces and the 16S rRNA genes were pyrosequenced. Among the main significant differences found, BT triggered the highest values of systolic blood pressure, correlating positively with the percentage of Desulfovibrio sequences in faeces, which in turn showed significantly higher values in BT than in EVOO. EVOO had the lowest values of plasmatic insulin, correlating inversely with Desulfovibrio, and had the lowest plasmatic values of leptin which correlated inversely with Sutterellaceae, Marispirillum and Mucilaginibacter dageonensis, the three showing significantly higher percentages in EVOO. The lowest total cholesterol levels in plasma were detected in SD, correlating positively with Prevotella and Fusicatenibacter, both taxa with significantly greater presence in SD. These results may be indicative of a link between specific diets, certain physiological parameters and the prevalence of some taxa, supporting the possibility that in some of the proposed effects of virgin olive oil the modulation of intestinal microbiota could be involved.


Assuntos
Manteiga , Dieta , Modelos Animais de Doenças , Microbioma Gastrointestinal , Síndrome Metabólica/fisiopatologia , Azeite de Oliva , Animais , Fezes/microbiologia , Masculino , Camundongos , RNA Ribossômico 16S/genética
20.
Soft Matter ; 14(2): 239-254, 2018 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-29231947

RESUMO

We investigate the possibility of stabilising oil-water emulsions from the polyelectrolyte complexes (PEC) obtained in mixtures of a strong cationic polyelectrolyte (poly(diallyldimethylammonium chloride), PDADMAC) and a weak anionic one (poly(acrylic acid)sodium salt, PAANa). Unlike other previous work however, both polyelectrolytes (PEL) are chosen as they are completely water-soluble and possess no surface activity when present alone over nearly all the pH range. In water, the effects of PEL concentration, PEL mixing ratio and pH on the formation of PEC are studied in detail. At low pH where the anionic PEL is uncharged, complex coacervation occurs in which droplets rich in both polymers are dispersed in water. At intermediate pH, the PEC comprise a mixture of coacervate droplets and solid particles. At high pH where the anionic PEL is significantly charged, only complex coacervation is observed. On addition of dodecane followed by homogenisation, no stable emulsions arose from dispersions containing solid particle PEC due to either the large precursor particle aggregates or their inherent hydrophilicity. By contrast, oil-in-water emulsions stable to coalescence could be prepared from coacervate dispersions. We discuss the feasibility of the coacervate phase spreading at the oil-water interface in terms of the relevant spreading coefficients and compare the predictions with experiment for a range of oils. We encounter oils whose drops become engulfed by the coacervate phase as well as oils where no engulfing occurs.

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