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1.
Pediatr Pulmonol ; 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-33819392

RESUMO

BACKGROUND AND OBJECTIVES: Extubation failure in preterm infants is associated with an increased risk of mortality and morbidity. There is limited evidence to suggest if the increased morbidities are due to inherent differences among infants who fail or succeed; or whether these are due to a true respiratory setback among those who fail extubation. The aim of this study was to evaluate the respiratory status of infants who fail extubation and to assess the time taken for these infants to achieve pre-extubation respiratory status. METHODS: This was a retrospective study of infants with birth weight ≤ 1250 g who were born between January 2009 and December 2016. Infants were eligible if they failed first elective extubation. Extubation failure was defined as need for re-intubation within 5 days of extubation. Ventilator settings, blood gas parameters, respiratory severity score (RSS), and ventilation index (VI) were used to assess the respiratory status of infants. RESULTS: Out of 384 infants, 76% were successful and 24% failed extubation. Among those who failed extubation 91%, 77%, and 56% infants remained intubated at 24 h, 72 h, and 7 days, respectively. Respiratory status was worse at 24 and 72 h after re-intubation when compared to pre-extubation levels. The median times for RSS and VI to reach pre-extubation levels were 4 and 7 days, respectively. CONCLUSION: Among preterm infants, failed elective extubation is associated with a significant setback in the respiratory status. Infants who fail an extubation attempt may not achieve pre-extubation respiratory status for many days after reintubation.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33826292

RESUMO

Tunable optical properties in nanomaterials enable a variety of applications in multidisciplinary areas. These properties are directly related to several different factors such as solvent conditions, synthesis methods, and most significantly, the oxidation states of metals participating in the absorption or emission properties. Lanthanide metals containing ABO3 perovskites are among such nanomaterials that can be tuned to a great extent by only modifying the charged states on the metals in the composition. We report a green synthesis method through sonication to synthesize ABO3 perovskites to incorporate Tb4+ into the perovskite composition at room temperature. The optical properties of the nanomaterial show emission in the entire ultraviolet-visible-near-infrared spectral regions through charge transfer between europium and terbium. The combination of cerium (C), molybdenum (M), europium (E), and terbium (T) results in a sheet-like CMET perovskite obeying hexagonal geometry. The nanomaterial is highly stable in an aqueous medium, showing finely suspended Tyndall effect due to particle size <300 nm. Owing to their wide range of emission behavior, surface charge, and aqueous stability, CMET perovskites were used to study the defibrillation of hen egg-white lysozyme (HEWL) as an amyloid model protein. The intrinsic property of the nanomaterial assists in the interaction of the fibrils with the perovskite and the emission range becomes the reporter of the defibrillation. Infrared spectroscopy shows the change in the material properties during the defibrillation. A preliminary test on the varying concentration of HEWL incubated with CMET perovskites shows linear behavior with R2 = 0.9841. The tunable emission characteristic and aqueous stability of the perovskite material make it suitable for future biological applications.

3.
ACS Infect Dis ; 2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33843204

RESUMO

Here we have described a systematic structure activity relationship (SAR) of a set of compounds inspired from cladosporin, a tool compound that targets parasite (Plasmodium falciparum) lysyl tRNA synthetase (KRS). Four sets of analogues, synthesized based on point changes in the chemical scaffold of cladosporin and other logical modifications and hybridizations, were assessed using high throughput enzymatic and parasitic assays along with in vitro pharmacokinetics. Co-crystallization of the most potent compound in our series (CL-2) with PfKRS revealed its structural basis of enzymatic binding and potency. Further, we report that CL-2 has performed better than cladosporin in terms of metabolic stability. It thus represents a new lead for further optimization toward the development of antimalarial drugs. Collectively, along with a lead compound, the series offers insights on how even the slightest chemical modification might play an important role in enhancing or decreasing the potency of a chemical scaffold.

4.
Urologia ; : 3915603211010636, 2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33845708

RESUMO

Gossypiboma or retained surgical sponge in abdominal cavity is an avoidable complication which has wide variety of clinical presentations and associated medico-legal issues as well. The incidence is under-reported. Pre-operative diagnosis is difficult and management is surgical. We present a case of gossypiboma in a male with multiple vesico-cutaneous and colo-vesical fistulae.

5.
Curr Drug Targets ; 2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33845737

RESUMO

Psoriasis is an immune-mediated chronic skin inflammation. This disease can be associated with several manifestation like red flaks, silver scale, patches, plaques and silvery-white squams. Approximately 70% of the patients treated with topical dosage forms have a mild-to-moderate form of psoriasis, whereas a moderate-to-severe form of psoriasis is treated with systemic, photo, and biological therapies. Considering the big fraction that topicals cover, we present the current market potential, clinical relevance, and recent advances in the topical delivery of the drug for psoriasis. Though we witnessed several advancements in the recent few decades, delivering new immunomodulatory and biological molecules for topical psoriatic treatment have been proved efficient and safe option for the large percentage of patients for whom systemic therapy is not indicated. This article enumerates the promising topical dosage forms at present under assessment for their clinical pertinence. The competency of conventional topicals to reach and transform the world market is enumerated in terms of their success rate after proving the clinical pertinence against psoriasis. However, the entrance of novel drug delivery systems based advanced topical products in the global market is highly anticipated as they have immense potential to precedent tremendous impact on psoriasis treatment in near future.

6.
Artigo em Inglês | MEDLINE | ID: mdl-33823023

RESUMO

Malaria surveillance is weak in high malaria burden countries. Surveillance is considered as one of the core interventions for malaria elimination. Impressive reductions in malaria-associated morbidity and mortality have been achieved across the globe, but sustained efforts need to be bolstered up to achieve malaria elimination in endemic countries like India. Poor surveillance data become a hindrance in assessing the progress achieved towards malaria elimination and in channelizing focused interventions to the hotspots. A major obstacle in strengthening India's reporting systems is that the surveillance data are captured in a fragmented manner by multiple players, in silos, and is distributed across geographic regions. In addition, the data are not reported in near real-time. Furthermore, multiplicity of malaria data resources limits interoperability between them. Here, we deliberate on the acute need of updating India's surveillance systems from the use of aggregated data to near real-time case-based surveillance. This will help in identifying the drivers of malaria transmission in any locale and therefore will facilitate formulation of appropriate interventional responses rapidly.

7.
J Infect ; 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-33831459

RESUMO

OBJECTIVES: A systematic review and meta-analysis (SR-MA) of the available Indian literature on severe vivax malaria (SVM) was undertaken. METHODS: Relevant studies in eight electronic databases were retrieved and reviewed. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. The methodological quality of the studies included in the MA was assessed. RESULTS: Overall, 162 studies were included in the work. The pooled proportion of SVM was 29.3 %. The main severity signs/symptoms seen in SVM were jaundice, severe thrombocytopenia (ST), multi-organ dysfunction, and severe anaemia with pooled proportion of 37.4 %, 37.2 %, 24.2 % and 20.4 %, respectively. P. falciparum was inducing 6% less ST (RR = 0.94, 95 % CI 0.5-1.5, I2 = 77.87 %), 10 % less thrombocytopenia (RR = 0.9, 95 % CI 0.7-1.1, I2 = 91.68 %) and 20 % less DIC (RR = 0.8, 95 % CI 0.3-1.9, I2 = 0 %) than P. vivax. An atypical condition like myocarditis, was most commonly observed amongst the studied SVM cases. The mortality rate in SVM cases ranged from 0-12.9 % among hospital patients with P. vivax mono-infections. CONCLUSIONS: The present SR-MA provides evidence for P. vivax as the etiologic agent of severe malaria leading to deaths in few cases as seen recently in India. However, research gaps outlined here emphasise the need for further studies on SVM in pregnancy, SVM in drug resistance and correlations with cytoadherence in disease severity due to P. vivax.

8.
Int J Clin Pract ; : e14163, 2021 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-33743546

RESUMO

AIM: of the study The study aimed to investigate the impact of the patients' physical activity status and the type of cooking oil consumed by patients in their daily routine on glycemic profile, lipid profile, the hypertensive profile of the patients, and the length of stay, and overall cost of the treatment. METHODS: A prospective observational study. All the patients referred to the medicine department of the three different hospitals located in Moga, City Punjab and those hospitalized due to diabetes mellitus (type-I and type-II) with coexisting hypertension were asked to participate in the study. RESULTS: The patients' mean age was found to be M= 53.85, SD= 11.54 years. Out of 1914 patients, 914 were male (47.8%); it was observed that the majority of the patients 525 (27.43%) in North India using butter or ghee- clarified butter as edible oil, followed by mustard oil 517 (27.01%) patients. About 345 (18.03%) of the patients consume soybean oil, whereas 226 (11.81%) of the patients like sunflower oil. CONCLUSION: This study explored that cooking oil and physical activity are associated with length of stay in days & overall cost of the treatment, respectively. Our study results revealed that the type of oil compared with the treatment's overall cost was significant for olive oil, soybean oil, and groundnut oil. The study revealed that moderate and low physical activity increases the length of stay compared to high physical activity. The consumption of olive oil as a regular food habit in daily routine decreases patients' length of stay with diabetes with coexisting hypertension when doing the high physical activity but increases the overall cost of treatment.

10.
Int J Parasitol ; 2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33775670

RESUMO

The global spread of sulfadoxine (Sdx, S) and pyrimethamine (Pyr, P) resistance is attributed to increasing number of mutations in DHPS and DHFR enzymes encoded by malaria parasites. The association between drug resistance mutations and SP efficacy is complex. Here we provide an overview of the geographical spread of SP resistance mutations in Plasmodium falciparum (Pf) and Plasmodium vivax (Pv) encoded dhps and dhfr genes. In addition, we have collated the mutation data and mapped it on to the three-dimensional structures of DHPS and DHFR which have become available. Data from genomic databases and 286 studies were collated to provide a comprehensive landscape of mutational data from 2005 to 2019. Our analyses show that the Pyr-resistant double mutations are widespread in Pf/PvDHFR (P. falciparum ∼61% in Asia and the Middle East, and in the Indian sub-continent; in P. vivax ∼33% globally) with triple mutations prevailing in Africa (∼66%) and South America (∼33%). For PfDHPS, triple mutations dominate South America (∼44%), Asia and the Middle East (∼34%) and the Indian sub-continent (∼27%), while single mutations are widespread in Africa (∼45%). Contrary to the status for P. falciparum, Sdx-resistant single point mutations in PvDHPS dominate globally. Alarmingly, highly resistant quintuple and sextuple mutations are rising in Africa (PfDHFR-DHPS) and Asia (Pf/PvDHFR-DHPS). Structural analyses of DHFR and DHPS proteins in complexes with substrates/drugs have revealed that resistance mutations map proximal to Sdx and Pyr binding sites. Thus new studies can focus on discovery of novel inhibitors that target the non-substrate binding grooves in these two validated malaria parasite drug targets.

11.
Rheumatol Int ; 2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33723658

RESUMO

Acute pancreatitis (AP) is a rare but life threatening manifestation of Systemic Lupus Erythematosus (SLE). The current study aims to study the clinical characteristics, severity, mortality, and outcome of SLE-related AP in Indian population. We retrospectively reviewed medical records of patients with SLE who had AP in the past. Data from 13 rheumatology centers across India were compiled. All patients satisfied SLICC criteria for SLE and ATLANTA criteria for AP. AP was classified in to mild, moderate and severe using revised Atlanta classification. Patients with known risk factors like gall stone and alcohol were excluded.Sixty-six patients (six, children) were studied. Majority of patients were females (82%). The median age of presentation was 24 (11-63) years and most patients (57.5%) presented within first year of diagnosis of lupus. AP occurred mostly in the setting of active lupus (89%). Active nephritis was seen in 39% while a fourth had CNS disease. Patients with severe AP had lower C3. Ascites and sepsis were most common local and systemic complications, respectively. Mortality was 17%. Hypocalcemia, presence of sepsis and shock predicted mortality. In the multivariate analysis, only presence of shock remained as independent predictor of death (OR 63.0, 95% CI: 5.2-760.3). Pancreatitis is an early manifestation of SLE and is associated with active disease. Significant mortality is seen particularly with severe pancreatitis.

12.
Chaos ; 31(1): 013114, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33754750

RESUMO

The network of self-sustained oscillators plays an important role in exploring complex phenomena in many areas of science and technology. The aging of an oscillator is referred to as turning non-oscillatory due to some local perturbations that might have adverse effects in macroscopic dynamical activities of a network. In this article, we propose an efficient technique to enhance the dynamical activities for a network of coupled oscillators experiencing aging transition. In particular, we present a control mechanism based on delayed negative self-feedback, which can effectively enhance dynamical robustness in a mean-field coupled network of active and inactive oscillators. Even for a small value of delay, robustness gets enhanced to a significant level. In our proposed scheme, the enhancing effect is more pronounced for strong coupling. To our surprise even if all the oscillators perturbed to equilibrium mode were delayed negative self-feedback is able to restore oscillatory activities in the network for strong coupling strength. We demonstrate that our proposed mechanism is independent of coupling topology. For a globally coupled network, we provide numerical and analytical treatment to verify our claim. To show that our scheme is independent of network topology, we also provide numerical results for the local mean-field coupled complex network. Also, for global coupling to establish the generality of our scheme, we validate our results for both Stuart-Landau limit cycle oscillators and chaotic Rössler oscillators.

13.
Int J Clin Pract ; : e14134, 2021 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-33683774

RESUMO

BACKGROUND: The global cases of COVID-19 increasing day by day. On 25 November 2020, a total of 59 850 910 cases reported globally with a 1 411 216 global death. In India, total cases in the country now stand at 91 77 841 including 86 04 955 recoveries and 4 38 667 active cases as on 24 November 2020, as per the data issued by ICMR. A new generation of voice/audio analysis application can tell whether the person is suffering from COVID-19 or not. AIMS: To describe how to established a new generation of voice/audio analysis application to identify the suspected COVID-19 hidden cases in hotspot areas with the help of an audio sample of the general public. MATERIALS & METHODS: The different patents and data available as literature on the internet are evaluated to make a new generation of voice/audio analysis application with the help of an audio sample of the general public. RESULTS: The collection of the audio sample will be done from the already suffered COVID-19 patients in (.Wave files) personally or through phone calls. The audio samples such as the sound of the cough, the pattern of breathing, respiration rate and way of speech will be recorded. The parameters will be evaluated for loudness, articulation, tempo, rhythm, melody and timbre. The analysis and interpretation of the parameters can be made through machine learning and artificial intelligence to detect corona cases with an audio sample. DISCUSSION: The voice/audio application current project can be merged with a mobile App called 'AarogyaSetu' by the Government of India. The project can be implemented in the high-risk area of COVID-19 in the country. CONCLUSION: This new method of detecting cases will decrease the workload in the COVID-19 laboratory.

14.
Brain Res Bull ; 171: 113-125, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33684458

RESUMO

BACKGROUND: Protein tyrosine phosphatase 1B (PTP1B) inhibitors are potential candidates for the treatment of peripheral insulin resistance and diabetes mellitus. Similar to peripheral action within the brain also, PTP1B activation impairs insulin signaling pathways. Activation of PTP1B in brain also accentuates neuroinflammation, oxidative stress and decreases neurotrophic factors in various brain dysfunctions including cognitive decline. OBJECTIVES: The main objective of our study was to elucidate the role of alendronate, a potent PTP1B inhibitor (blood brain barrier crossing bisphosphonate) in central insulin resistance and associated memory deficits. METHODOLOGY: To induce central insulin resistance, streptozotocin (3 mg/kg) intracerebroventricular (ICV) was administered in two alternate days (1st and 3rd). After 21 days, memory was assessed via using the passive avoidance and Morris water maze paradigm. At the end of behavioral studies, animals were sacrificed to assess a variety of biochemical and molecular parameters in the hippocampus and cerebral cortex region of the brain. Treatment drug alendronate (3 mg/kg/day, p.o) and standard drug donepezil (3 mg/kg/i.p.) were administered from the 3rd day of STZ administration till the end of the study. Inhibition of PTP1B activates phosphoinsotide-3 kinase (PI3 K) (down-stream regulator of insulin signaling pathway).Thus, to illuminate the mechanism of action of alendronate, PI3 K inhibitor, wortmannin was administered in presence of alendronate in one group. RESULTS: Administration of alendronate to ICV streprozotocin treated rats resulted in modulation of the insulin signaling pathway and associated behavioral, biochemical and molecular changes in central insulin resistance. However, the protective effect of alendronate was entirely vanished when it was administered in the presence of wortmannin. CONCLUSION: Alendronate can be an important treatment strategy in central insulin signaling pathway dysfunction and associated cognitive deficits. Protective effect of alendronate is via modulation of PI3-K/Akt signaling pathway.

15.
Transl Res ; 2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33711514

RESUMO

Iodinated contrast is used for imaging and invasive procedures and it can cause contrast induced acute kidney injury (CI-AKI), which is the third leading hospital-acquired health problem. The purpose of the present study was to determine the effect of α-adrenergic receptor-1b (Adra1b) inhibition by using terazosin on change in kidney function, gene, and protein expression in C57BL/6J male mice, 6-8 weeks with chronic kidney disease (CKD). CKD was induced by surgical nephrectomy. Twenty eight days later, 100-µL of iodinated contrast (CI group) or saline (S group) was given via the carotid artery. Whole-transcriptome RNA-sequencing (RNA-Seq) analysis of the kidneys was performed at day 2. Mice received either 50-µL of saline ip or terazosin (2 mg/kg) in 50-µL of saline ip 1 hour before contrast administration which was continued every 12 hours until the animals were euthanized 2 and 7 days later. The kidneys were removed for gene expression, immunohistochemical analysis, and blood serum analyzed for kidney function. Differential gene expression analysis identified 21 upregulated and 436 downregulated genes (fold change >2; P < 0.05) that were common to all sample (n = 3 for both contrast and saline). We identified Adra1b using bioinformatic analysis. Mice treated with terazosin had a significant decrease in serum creatinine, urinary Kim-1 levels, HIF-1α, apoptosis, and downstream Adrab1 genes including Ece1, Edn1, pMAPK14 with increased cell proliferation. Contrast exposure upregulated Adra1b gene expression in HK-2 cells. Inhibition of Adra1b with terazosin abrogated Ece1, Edn1, and contrast-induced Fsp-1, Mmp-2, Mmp-9 expression, and caspase-3/7 activity in HK-2 cells.

16.
Virology ; 558: 13-21, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33706207

RESUMO

India is one of the most affected countries by COVID-19 pandemic; but little is understood regarding immune responses to SARS-CoV-2 in this region. Herein we examined SARS-CoV-2 neutralizing antibodies, IgG, IgM, IgA and memory B cells in COVID-19 recovered individual from India. While a vast majority of COVID-19 recovered individuals showed SARS-CoV-2 RBD-specific IgG, IgA and IgM antibodies (38/42, 90.47%; 21/42, 50%; 33/42, 78.57% respectively), only half of them had appreciable neutralizing antibody titers. RBD-specific IgG, but not IgA or IgM titers, correlated with neutralizing antibody titers and RBD-specific memory B cell frequencies. These findings have timely significance for identifying potential donors for plasma therapy using RBD-specific IgG assays as surrogate measurement for neutralizing antibodies in India. Further, this study provides useful information needed for designing large-scale studies towards understanding of inter-individual variation in immune memory to SARS CoV-2 natural infection for future vaccine evaluation and implementation efforts.

17.
Plant Biotechnol J ; 2021 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-33759354

RESUMO

The CRISPR/Cas9 system is an RNA-guided sequence-specific genome editing tool, which has been adopted for single or multiple gene editing in a wide range of organisms. When working with gene families with functional redundancy, knocking out multiple genes within the same family may be required to generate a phenotype. In this study, we tested the possibility of exploiting the known tolerance of Cas9 for mismatches between the single-guide RNA (sgRNA) and target site to simultaneously introduce indels in multiple homologous genes in the marine diatom Phaeodactylum tricornutum. As a proof of concept, we designed two sgRNAs that could potentially target the same six light-harvesting complex (LHC) genes belonging to the LHCF subgroup. Mutations in up to five genes were achieved simultaneously using a previously established CRISPR/Cas9 system for P. tricornutum. A visible colour change was observed in knockout mutants with multiple LHCF lesions. A combination of pigment, LHCF protein and growth analyses was used to further investigate the phenotypic differences between the multiple LHCF mutants and WT. Furthermore, we used the two same sgRNAs in combination with a variant of the existing Cas9 where four amino acids substitutions had been introduced that previously have been shown to increase Cas9 specificity. A significant reduction of off-target editing events was observed, indicating that the altered Cas9 functioned as a high-fidelity (HiFi) Cas9 nuclease.

18.
Artigo em Inglês | MEDLINE | ID: mdl-33534549

RESUMO

The design and synthesis of a stable and efficient hole-transport material (HTM) for perovskite solar cells (PSCs) are one of the most demanding research areas. At present, 2,2',7,7'-tetrakis[N,N-di(4-methoxyphenyl)amino]-9,9'-spirobifluorene (spiro-MeOTAD) is a commonly used HTM in the fabrication of high-efficiency PSCs; however, its complicated synthesis, addition of a dopant in order to realize the best efficiency, and high cost are major challenges for the further development of PSCs. Herein, various diketopyrrolopyrrole-based small molecules were synthesized with the same backbone but distinct alkyl side-chain substituents (i.e., 2-ethylhexyl-, n-hexyl-, ((methoxyethoxy)ethoxy)ethyl-, and (2-((2-methoxyethoxy)ethoxy)ethyl)acetamide, designated as D-1, D-2, D-3, and D-4, respectively) as HTMs. The variation in the alkyl chain has shown obvious effects on the optical and electrochemical properties as well as on the molecular packing and film-forming ability. Consequently, the power conversion efficiency (PCE) of the PSC under one sun illumination (100 mW cm-2) is shown to increase in the order of D-1 (8.32%) < D-2 (11.12%) < D-3 (12.05%) < D-4 (17.64%). Various characterization techniques reveal that the superior performance of D-4 can be ascribed to the well-aligned highest occupied molecular orbital energy level with the counter electrode, the more compact π-π stacking with a higher coherence length, and the excellent hole mobility of 1.09 × 10-3 cm2 V-1 s-1, thus providing excellent energetics for effective charge transport with minimal charge-carrier recombination. Furthermore, the addition of the dopant Li-TFSI in D-4 is shown to deliver a remarkable PCE of 20.19%, along with a short-circuit current density (JSC), open-circuit voltage (VOC), and fill factor (FF) of 22.94 mA cm-2, 1.14 V, and 73.87%, respectively, and superior stability compared to that of other HTMs. These results demonstrate the effectiveness of side-chain engineering for tailoring the properties of HTMs, thus offering new design tactics to fabricate for the synthesis of highly efficient and stable HTMs for PSCs.

19.
Curr Drug Deliv ; 2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33538674

RESUMO

Despite several quality management tools, none or very few systematic operations are taken into account to assure the quality of the pharmaceutical products. Plan Do Check Act (PDCA) analysis is performed based on the problems encountered during the product development. In each step, some of the quality control tools are used for better maintenance of corrective and preventive actions. However, systematic use of these tools is still not made. Here we portray an example of nanoemulsion that will help justify the correct or systematic use of all the seven quality control tools in each section of PDCA cycle for better maintenance of Corrective and Preventive Actions (CAPA). The major limitations associated with the nanoemulsion i.e. non-uniform size distribution, lower encapsulation efficiency, lower magnitude of zeta potential, non-scalable and expensive synthesis procedures have taken into consideration for this portray. This review summarizes the productive use of 7 QC tools in PDCA cycle to ensure the optimum quality of nanoemulsion in an industry.

20.
PLoS One ; 16(2): e0244492, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33534846

RESUMO

BACKGROUND: The objective is to assess cardiovascular (CV), malignancy, infectious, graft outcomes and tacrolimus levels for the Indigenous patients compared to Whites after kidney transplant (KTx). METHODS: 165 Indigenous and 165 White patients matched for the KTx year at Mayo Clinic Arizona from 2007-2015 were studied over a median follow-up of 3 years. Propensity score was calculated to account for baseline differences. RESULTS: Compared to Whites, Indigenous patients had the following characteristics: younger age, more obesity, diabetes, hypertension, and required dialysis prior to KTx (p<0.01). Indigenous patients had longer hospital stay for KTx, shorter follow-up and lived further from the transplant center (p<0.05). 210 (63.6%) received deceased donor KTx and more Whites received a living donor KTx compared to Indigenous patients (55.2% vs 17.6%, p<0.0001). Post-KTx, there was no difference in the CV event rates. The cumulative incidence of infectious complications was higher among the Indigenous patients (HR 1.81, p = 0.0005, 48.5% vs 38.2%, p = 0.013), with urinary causes as the most common. Malignancy rates were increased among Whites (13.3% vs 3.0%, p = 0.001) with skin cancer being the most common. There was a significant increase in the dose normalized tacrolimus level for the Indigenous patients compared to Whites at 1 months, 3 months, and 1 year post-KTx. After adjustment for the propensity score, there was no statistical difference in infectious or graft outcomes between the two groups but the mean number of emergency room visits and hospitalizations after KTx was significantly higher for Whites compared to Indigenous patients. CONCLUSIONS: Compared to Whites, Indigenous patients have similar CV events, graft outcomes and infectious complications after accounting for baseline differences.

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