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1.
BMJ Open ; 12(7): e056408, 2022 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-35798525

RESUMO

OBJECTIVE: The COVID-19 pandemic necessitated the use of telemedicine to maintain continuity of care for patients with cardiovascular diseases (CVDs). This study aimed to demonstrate the feasibility of implementing a nurse-led teleconsultation strategy for CVD management during the COVID-19 pandemic in India and evaluated the impact of nurse-led teleconsultations on patient treatment satisfaction. DESIGN, SETTING AND PARTICIPANTS: We developed a two-stage teleconsultation strategy and tested the feasibility of implementing a nurse-led teleconsultation strategy to manage CVD in a northern state (Punjab) in India. A multidisciplinary team of experts developed the treatment protocol used for teleconsultations to manage CVD. Nurses were trained to provide teleconsultation, triaging of patients and referrals to the physicians. Patients with CVD who had an outpatient visit or hospitalisation between September 2019 and March 2020 at the Dayanand Medical College Hospital, Ludhiana, India, were contacted by phone and offered teleconsultations. Telemedicine strategy comprised: stage 1 nurse-led teleconsultations and stage 2 physician-led teleconsultations. Descriptive analysis was performed to report the proportion of patients triaged by the two-stage telemedicine strategy, and patient's clinical characteristics, and treatment satisfaction between the nurse-led versus physician-led teleconsultations. RESULTS: Overall, nurse-led stage 1 teleconsultations were provided to 12 042 patients with CVD. The mean (SD) age of the participants was 58.9 years (12.8), and men were 65.4%. A relatively small proportion of patients (6.3%) were referred for the stage-2 physician-led teleconsultations and of these only 8.4% required hospitalisations. During stage 1 nurse-led teleconsultations, patients were referred to the physicians due to uncontrolled diabetes (24.9%), uncontrolled hypertension (18.7%) and congestive heart failure (16.2%). The patient's treatment satisfaction was similar between the nurse-led versus physician-led teleconsultations (p=0.07). CONCLUSION: This study showed that a nurse-led telemedicine strategy is feasible to implement in a resource-constraint setting for triaging patients with CVD and reduces physician's burden.


Assuntos
COVID-19 , Doenças Cardiovasculares , Consulta Remota , Telemedicina , Doenças Cardiovasculares/terapia , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem , Pandemias , Consulta Remota/métodos , Telemedicina/métodos
2.
J Environ Sci (China) ; 121: 77-89, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35654518

RESUMO

This work was to study composition characteristics and the subsequent effect on the lead (Pb) binding properties of dissolved organic matter (DOM) derived from seaweed-based (SWOF) and chicken manure organic fertilizers (CMOF) during a one-year field incubation experiment using the excitation-emission matrix-parallel factor (EEM-PARAFAC) and two-dimensional correlation spectroscopy (2DCOS) analysis. Results showed that high aromatic and hydrophobic fluorescent substances were enriched in CMOF-derived DOM and SWOF-derived DOM and enhanced over time. And phenolic groups in the fulvic-like substances for SWOF-derived DOM and carboxyl groups in the humic-like substances for CMOF-derived DOM had the fastest responses over time, respectively. Moreover, both non-fluorescent polysaccharides and fluorescent humic-like substances or fulvic-like substances with aromatic (C=C) groups first participated in the binding process of Pb to SWOF-derived DOM on day 0 and 180 during the lead binding process. In contrast, humic-like substances associated with aromatic (C=C) and phenolic groups gave a faster response to Pb binding on day 360. Regarding CMOF-derived DOM, the fulvic-like substances associated with aromatic (C=C) and carboxylic groups displayed a faster response to Pb ions on day 0. Nonetheless, polysaccharides and humic-like associated with phenolic groups had a faster response on days 180 and 360. It is noteworthy that the polysaccharides, which participated in Pb binding to CMOF-derived DOM, posed a higher risk of Pb in the environment after 360 days. Therefore, these findings gave new insights into the long-term applications of commercial organic fertilizers for the amendment of soil.


Assuntos
Matéria Orgânica Dissolvida , Fertilizantes , Substâncias Húmicas/análise , Íons , Chumbo , Esterco , Espectrometria de Fluorescência/métodos
3.
Comp Med ; 72(3): 181-194, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35659382

RESUMO

Alfaxalone, a synthetic neuroactive steroid, has been tested as an immersion anesthetic in ornamental fish, but its safety and efficacy in sport fish have not been investigated. In the current study, we compared the physiologic and behavioral effects of alfaxalone with those of tricaine methanesulfonate (MS222) for anesthesia of rainbow trout (Oncorhynchus mykiss) via water immersion. We also analyzed alfaxalone-exposed tissues to determine residue clearance times. Fish were anesthetized for 10 min by immersion in low-dose alfaxalone (Alow; 5 mg/L induction, 1 mg/L maintenance), high-dose alfaxalone (Ahigh; 5 mg/L induction, 2 mg/L maintenance), or MS222 (MS; 150 mg/L induction, 100 mg/L maintenance). Fish received all 3 treatments, separated by a washout period of at least 18 d in a blinded, complete crossover design. We hypothesized that immersion in Alow or Ahigh would provide a stable plane of anesthesia in rainbow trout, with dose-dependent time to recovery, and that opercular rates and depths of anesthesia would be equivalent to that of MS222. The time to anesthesia induction was longer for alfaxalone than MS222 but averaged less than 100 s. The time to recovery from anesthesia was also longer for alfaxalone than MS222, with significantly shorter recovery time for Alow than for Ahigh. All treatments decreased opercular rate and response to noxious stimuli. Alfaxalone residue clearance was greater than 80% from all tissues within 1 h, greater than 99% from muscle within 4 h, and 100% from all tissues within 36 h after exposure. We conclude that alfaxalone immersion at 5 mg/L for induction and 2 mg/L for maintenance provides a safe, viable alternative to MS222 for the anesthesia of rainbow trout.


Assuntos
Anestésicos , Oncorhynchus mykiss , Aminobenzoatos , Anestesia Geral , Anestésicos/farmacologia , Animais , Imersão , Mesilatos , Pregnanodionas
4.
Integr Comp Biol ; 2022 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-35588370

RESUMO

In general, males should be particularly attentive to cues of sexual availability and females should advertise accordingly. Vaginal patency (i.e., the openness of the vagina) is a reliable indicator of sexual maturity; if the vagina is closed, the female is unable to copulate. The southern giant pouched rat (Cricetomys ansorgei) is unusual because females can have fully fused vaginal openings (i.e., vaginal nonpatency) despite being considered 'adults' by other metrics. Moreover, some females reversibly close their vaginal openings. Thus, vaginal patency in the pouched rat is a 'flexible' reproductive state. We subcutaneously implanted a long-acting GnRH agonist (deslorelin), which over time inhibits sex steroid secretion, to better understand the endocrinology and social behavior relating to vaginal patency in this species. We hypothesized that altering GnRH would impact both patency and behavior through its effects on circulating levels of estradiol. Six months of deslorelin treatment did not alter vaginal patency. Behaviorally, deslorelin-treated females spent less time interacting with, and were more aggressive towards males (compared to controls). Notably, deslorelin did not alter female scent marking. We conclude that behavioral receptivity, but not vaginal patency, is impacted by GnRH hormonal cascades in the pouched rat.

5.
Artigo em Inglês | MEDLINE | ID: mdl-35390403

RESUMO

BACKGROUND: Allergic conjunctivitis (AC) is an ocular inflammatory disease with symptoms driven by eosinophils and mast cells. Allergic comorbidities are common. Current treatments are often ineffective in severe AC and limited by potential side effects. Lirentelimab is an anti-sialic acid-binding immunoglobulin-like lectin-8 mAb that depletes eosinophils and inhibits mast cells. OBJECTIVE: We sought to determine safety and preliminary efficacy of lirentelimab in an open-label, phase 1b study. METHODS: Patients with chronic, severely symptomatic atopic keratoconjunctivitis, vernal keratoconjunctivitis, and perennial AC, and who had history of topical or systemic corticosteroid use, were enrolled to receive up to 6 monthly lirentelimab infusions (dose 1: 0.3 mg/kg, dose 2: 1 mg/kg, subsequent doses: 1 or 3 mg/kg). Changes from baseline in peripheral blood eosinophils, changes in patient-reported symptoms (measured by daily Allergic Conjunctivitis Symptom Questionnaire, including atopic comorbidities), changes in investigator-reported ocular signs and symptoms (Ocular Symptom Scores), changes in quality of life, and changes in tear cytokine and chemokine levels were assessed. RESULTS: Thirty patients were enrolled (atopic keratoconjunctivitis n = 13, vernal keratoconjunctivitis n = 1, perennial AC n = 16), 87% of whom had atopic comorbidities. After lirentelimab treatment, mean improvement was observed in Allergic Conjunctivitis Symptom Questionnaire score (-61%; 95% CI, -75% to -48%) and Ocular Symptom Scores (-53%; 95% CI, -76% to -31%), consistent across atopic keratoconjunctivitis, vernal keratoconjunctivitis, and perennial AC groups. There was substantial improvement in atopic comorbidities, with -55% (95% CI, -78% to -31%), -50% (95% CI, -82% to -19%), and -63% (95% CI, -87% and -38%) reduction in symptoms of atopic dermatitis, asthma, and rhinitis, respectively. Levels of key mediators of inflammation were reduced in patient tears after lirentelimab treatment. The most common adverse effects were mild to moderate infusion-related reactions. CONCLUSIONS: Lirentelimab was well tolerated, improved severe AC and concomitant atopic symptoms, and reduced inflammatory mediators in patient tears.

6.
Int Angiol ; 41(4): 356-363, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35373940

RESUMO

BACKGROUND: Coronavirus disease-2019 (COVID-19) infection and thrombosis are of great clinical importance as this association has shown to increase mortality. We intend to estimate the incidence of thrombotic events (TE) and their impact on clinical outcomes in hospitalized COVID-19 patients. METHODS: This was an analytical cross-sectional study. The study population comprised of hospitalized COVID-19 patients between 1st March 2021 and 31st May 2021. The clinico-demographic data, thrombotic events, and clinical outcomes were collected from electronic health records. RESULTS: A total of 1274 patients were analyzed. The median age of the study population was 56 years (IQR: 44-66 years). The estimated incidence of TE was 5.8% (N.=74); 60.8% of these TE occurred in patients having severe/critical COVID-19 illness and 70.3% of TE occurred in patients in the intensive care unit. Venous events (3.9%) were common compared to arterial events(1.9%). On multivariate logistic regression analysis, total leukocyte count, C-reactive protein, and D-dimer level were found to be the independent predictors of having TE. Receiver operator curve revealed a cut-off point of 872.5 DDU µg/L for D-dimer level (sensitivity: 67.6% and specificity: 72.1%; P<0.001, area under curve 0.78) for predicting TE. Patients with TE had significantly higher mortality compared to those without TE (58.1% vs. 22.2%; P<0.001); and the presence of TE (OR=2.94; 95% CI:1.7-5.1, P<0.001) was found to be the independent predictor of mortality. CONCLUSIONS: The incidence of TE is high for hospitalized COVID-19 patients and it is even higher in severe/critical COVID illness. Its presence has shown to double the mortality compared to those without it.


Assuntos
COVID-19 , Trombose , Adulto , Idoso , COVID-19/epidemiologia , Estado Terminal , Estudos Transversais , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Retrospectivos , SARS-CoV-2 , Trombose/epidemiologia
7.
Sci Total Environ ; 831: 154857, 2022 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-35351510

RESUMO

The contamination of food and potable water with microorganisms may cause food-borne and water-borne diseases. The common contaminants include Escherichia coli (E. coli), Salmonella sp. etc. The conventional methods for monitoring the water quality for the presence of bacterial contaminants are time-consuming, expensive, and not suitable for rapid on-spot detection in field conditions. In the current study, super paramagnetic iron oxide nanoparticles (SPIONs) were synthesized and conjugated with E. coli specific Aptamer I to detect E. coli cells qualitatively as well as quantitatively. The sludge consisting of E. coli- SPION complex was separated via magnetic separation. The presence of E. coli cells was confirmed with the help of standard techniques and confocal laser scanning microscopy (CLSM) employing Aptamer II conjugated CdTe-MPA quantum dots (QDs). Finally, an ATmega 328P prototype biosensor based on Aptamer II conjugated CdTe MPA QDs exhibited quantitative and qualitative abilities to detect E.coli. This prototype biosensor can even detect low bacterial counts (up to 1 × 102 cfu) with the help of a photodiode and plano-convex lens. Further, the prototype biosensor made up of ultraviolet light-emitting diode (UV LED), liquid crystal display (LCD) and ATmega328Pmicrocontroller offers on-spot detection of E.coli in water samples with high resolution and sensitivity. Similarly, this in-house developed prototype biosensor can also be utilized to detect bacterial contamination in food samples.


Assuntos
Técnicas Biossensoriais , Compostos de Cádmio , Infecções por Escherichia coli , Nanopartículas de Magnetita , Pontos Quânticos , Técnicas Biossensoriais/métodos , Escherichia coli , Humanos , Pontos Quânticos/química , Telúrio
8.
Echocardiography ; 39(4): 645-646, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35279874

RESUMO

A 22-year male presented with complaints of dyspnea. Multimodality imaging revealed a polypoidal right atrial mass with submassive pulmonary embolism. The patient underwent urgent surgery. The pathological examination confirmed it as cardiac myxoma. Cardiac myxoma, a most common primary cardiac tumor, is commonly found in the left atrium. The right atrium is an uncommon site and the usual mode of presentation is the tumor or thrombus embolization to the pulmonary circulation.


Assuntos
Neoplasias Cardíacas , Mixoma , Embolia Pulmonar , Trombose , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Masculino , Mixoma/diagnóstico , Mixoma/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia
9.
Diagnostics (Basel) ; 12(2)2022 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-35204333

RESUMO

Risk stratification at the time of hospital admission is of paramount significance in triaging the patients and providing timely care. In the present study, we aim at predicting multiple clinical outcomes using the data recorded during admission to a cardiac care unit via an optimized machine learning method. This study involves a total of 11,498 patients admitted to a cardiac care unit over two years. Patient demographics, admission type (emergency or outpatient), patient history, lab tests, and comorbidities were used to predict various outcomes. We employed a fully connected neural network architecture and optimized the models for various subsets of input features. Using 10-fold cross-validation, our optimized machine learning model predicted mortality with a mean area under the receiver operating characteristic curve (AUC) of 0.967 (95% confidence interval (CI): 0.963-0.972), heart failure AUC of 0.838 (CI: 0.825-0.851), ST-segment elevation myocardial infarction AUC of 0.832 (CI: 0.821-0.842), pulmonary embolism AUC of 0.802 (CI: 0.764-0.84), and estimated the duration of stay (DOS) with a mean absolute error of 2.543 days (CI: 2.499-2.586) of data with a mean and median DOS of 6.35 and 5.0 days, respectively. Further, we objectively quantified the importance of each feature and its correlation with the clinical assessment of the corresponding outcome. The proposed method accurately predicts various cardiac outcomes and can be used as a clinical decision support system to provide timely care and optimize hospital resources.

10.
Sci Total Environ ; 824: 153783, 2022 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-35176355

RESUMO

Incorporating amendments of industrial waste such as biochar and steel slag in cropland has been used to enhance the storage of soil organic carbon (SOC) while sustaining crop production. Short-term laboratory and field studies have identified important influences of biochar on active SOC fractions associated with soil microbial activity in paddy soils, but the long-term effects remain poorly understood. To address these knowledge gaps, we examined the effects of slag, biochar, and slag+biochar treatments on total SOC concentration, active SOC fractions and soil microbial communities in a paddy field two years after incorporation. Across both two seasons, the addition of slag, biochar, slag+biochar increased soil salinity by 26-80%, 1.3-37% and 42-79%, and also increased soil pH by 0.8-5.7%, 2.1-2.4% and 4.0-6.3%, respectively, relative to the control. SOC concentration was higher in the slag, biochar, and slag+biochar treatments across both rice seasons by 4.3-5%, 0.5-17% and 4.3-7%, respectively. Soil C-pool activity and C-pool management indices in the late paddy season were significantly lower in the slag+biochar treatment than the control by 26.3 and 21.3%, respectively, indicating that the amendments contributed to the stability of SOC. The C concentrations of the biochar and slag amendments affected bacterial abundance more than fungal abundance and affected C cycling. Our study suggests that combined slag and biochar amendments may increase bacterial abundance that may maintain SOC storage and reduce the abundances of potential SOC decomposers in key functional genera, indicating strong coupling relationships with changes of soil properties such as salinity, pH, and SOC concentration. These outcomes due to the amendments (e.g. slag+biochar) may increase microbial C-use efficiency and support the stability of active SOC fractions, with opportunities for long-term C sequestration.


Assuntos
Oryza , Solo , Carbono , Carvão Vegetal/química , China , Solo/química
11.
Environ Sci Pollut Res Int ; 29(8): 11831-11842, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34553280

RESUMO

Biochar is a beneficial soil amendment; however, biochar-based properties are mainly determined by the feedstocks and the pyrolysis temperature. Nevertheless, considering the vast biomass of halophyte, little is known about how the halophyte-derived biochar improves saline soils. In this study, we firstly produced biochars by using three different halophytes, including Tamarix chinensis (recretohalophyte), Suaeda salsa (euhalophyte), and Phragmites australis (pseudo-halophyte) at 300, 500, and 700 °C, and compared their chemical and physical properties. We applied halophyte (Tamarix chinensis and Phragmites australis) biochars (pyrolysis at 500 °C) into 0-20 cm saline soil at 2% and 4% (w/w) rates to investigate the saline soil water, salt, and pH dynamics in a 12-month column experiment. The results showed that as the pyrolytic temperature increase, biochar yield and pore diameter decreased by 37.5-44.0% and 34.6-89.7%, respectively; in contrast, biochar pH, specific surface area, and total volume increased by 24.8-47.8%, 3-37 times and 1-9 times, respectively. The halophyte types significantly controlled biochar carbon and dissolved salt content and electrical conductivity. Halophyte biochar application can increase soil water and salt content, and application of 4% of Tamarix chinensis-derived biochar can increase more soil moisture than the soil salinity, and it can maintain soil pH at a stable level, which would be a potential way to improve saline soil properties. The results are valuable for choosing halophyte types and optimizing pyrolytic temperatures for halophyte biochar production through specific environmental usage.


Assuntos
Plantas Tolerantes a Sal , Solo , Carvão Vegetal , Água
12.
Drug Deliv Transl Res ; 12(5): 1136-1160, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-33966178

RESUMO

Raloxifene hydrochloride, a second-generation selective estrogen receptor modulator, has been approved for the management of breast cancer. However, it is known to exhibit poor (~ 2%) and inconsistent oral bioavailability in humans, primarily ascribable to its low aqueous solubility, extensive first-pass metabolism, P-gp efflux, and presystemic glucuronide conjugation. The present research work entails the systematic development and evaluation of SLNs of RLX for its enhanced biopharmaceutical performance against breast cancer. Factor screening studies were conducted using Taguchi design, followed by optimization studies employing Box-Behnken design. Preparation of SLNs was carried out using glyceryl monostearate and Compritol® 888 ATO (i.e., lipid), Phospholipid S-100 (i.e., co-surfactant), and TPGS-1000 (i.e., surfactant) employing solvent diffusion method. The optimized formulation was evaluated for zeta potential, average particle size, field emission scanning electron microscope, transmission electron microscopy, and in vitro release study. Further, MCF-7 cells (cell cytotoxicity assay, apoptosis assay, and reactive oxygen species assay) and Caco-2 cells (cell uptake studies and P-gp efflux assay) were employed to evaluate the in vitro anticancer potential of the developed optimized formulation. In vivo pharmacokinetic studies were conducted in Sprague-Dawley rats to evaluate the therapeutic profile of the developed formulation. The optimized SLN formulations exhibited a mean particle size of 109.7 nm, PDI 0.289 with a zeta potential of - 13.7 mV. In vitro drug dissolution studies showed Fickian release, with release exponent of 0.137. Cell cytotoxicity assay, apoptosis assay, and cellular uptake indicated 6.40-, 5.40-, and 3.18-fold improvement in the efficacy of RLX-SLNs vis-à-vis pure RLX. Besides, the pharmacokinetic studies indicated quite significantly improved biopharmaceutical performance of RLX-SLNs vis-à-vis pure drug, with 4.06-fold improvement in Cmax, 4.40-fold in AUC(0-72 h), 4.56-fold in AUC(0-∞), 1.53-fold in Ka, 2.12-fold in t1/2, and 1.22-fold in Tmax. Further, for RLX-SLNs and pure drug, high degree of level A linear correlation was established between fractions of drug dissolved (in vitro) and of drug absorbed (in vivo) at the corresponding time-points. Stability studies indicated the robustness of RLX-SLNs when stored at for 3 months. Results obtained from the different studies construe promising the anticancer potential of the developed RLX-SLNs, thereby ratifying the lipidic nanocarriers as an efficient drug delivery strategy for improving the biopharmaceutical attributes of RLX.


Assuntos
Produtos Biológicos , Neoplasias da Mama , Nanopartículas , Animais , Disponibilidade Biológica , Produtos Biológicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Células CACO-2 , Portadores de Fármacos/uso terapêutico , Feminino , Humanos , Tamanho da Partícula , Cloridrato de Raloxifeno/farmacocinética , Ratos , Ratos Sprague-Dawley , Tensoativos
13.
Environ Sci Pollut Res Int ; 29(4): 6093-6102, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34431054

RESUMO

Biostimulant application is an effective strategy to enhance soil fertility and plant growth. However, its comprehensive impacts on nitrogen (N) uptake and reactive N (Nr) losses via leaching, ammonia (NH3) volatilization, and nitrous oxide (N2O) emission from plastic-shed greenhouse vegetable system are still little known. Therefore, a field experiment was conducted with cauliflower-tomato growth rotation (from September 6, 2018, to July 17, 2019) receiving three biostimulants, i.e., humic acid (HA), algae extract (AE), and chitosan (CT), as well as a control without stimulant. The cumulative Nr losses over the cauliflower-tomato growth cycle via leaching, NH3 volatilization, and N2O emission were 104-175 kg N ha-1, 2.32-3.85 kg N ha-1, and 0.70-0.85 kg N ha-1, respectively. Biostimulant application significantly (P < 0.05) retarded the total N leaching by 17-44% in tomato season, while suppressed the NH3 volatilization by 18-38% in cauliflower season. Overall, AE showed the best inhibition efficiency on Nr losses by significantly (P < 0.05) decreasing total N leaching and NH3 volatilization by 36-44% and 38-52% in both vegetable seasons, compare to the control. However, all three biostimulants stimulated the N2O emission under both vegetable cycles. Interestingly, all biostimulant-added treatments promote the cauliflower and tomato yield, particularly following the HA and AE amendments, which bring local farmers approximately 4,384-10,035 yuan RMB ha-1 more income. Enhanced yield under biostimulant treatments was due to higher N uptake capacity and enhanced root morphology. In summary, biostimulants have a contrasting influence on three major Nr lost pathways in greenhouse vegetable production. We recommend that AE is the most optimal biostimulant as it increases vegetable yield and decreases total N leaching and NH3 volatilization while not dramatically increase the N2O emission.


Assuntos
Nitrogênio , Solo , Agricultura , Amônia/análise , Fertilizantes/análise , Nitrogênio/análise , Óxido Nitroso/análise , Plásticos , Verduras , Volatilização
15.
Clin Gastroenterol Hepatol ; 20(3): 535-545.e15, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34089846

RESUMO

BACKGROUND & AIMS: Eosinophilic gastritis (EG) and eosinophilic duodenitis (EoD), characterized by chronic gastrointestinal (GI) symptoms and increased numbers or activation of eosinophils and mast cells in the GI tract, are likely underdiagnosed. We aimed to determine rates of EG and EoD and number of biopsies required to optimize detection using screening data from a randomized trial of lirentelimab (AK002), an antibody against siglec-8 that depletes eosinophils and inhibits mast cells. We also characterized endoscopic features and symptoms of EG and EoD. METHODS: Subjects with moderate-to-severe GI symptoms, assessed daily through a validated patient-reported outcome questionnaire, underwent endoscopy with a systematic gastric and duodenal biopsy protocol and histopathologic evaluation. EG diagnosis required presence of ≥30 eosinophils/high-power field (eos/hpf) in ≥5 hpfs and EoD required ≥30 eos/hpf in ≥3 hpfs. We analyzed diagnostic yields for EG and EoD and histologic, endoscopic, and clinical findings. RESULTS: Of 88 subjects meeting symptom criteria, 72 were found to have EG and/or EoD (EG/EoD), including patients with no prior diagnosis of EG/EoD. We found that GI eosinophilia was patchy and that examination of multiple biopsies was required for diagnosis-an average of only 2.6 per 8 gastric biopsies and 2.2 per 4 duodenal biopsies per subject met thresholds for EG/EoD. Evaluation of multiple nonoverlapping hpfs in each of 8 gastric and 4 duodenal biopsies was required to capture 100% of EG/EoD cases. Neither endoscopic findings nor symptom severity correlated with eosinophil counts. CONCLUSIONS: In an analysis of patients with moderate-to-severe GI symptoms participating in a clinical trial of lirentelimab for EG/EoD, we found eosinophilia to be patchy in gastric and duodenal biopsies. Counting eosinophils in at least 8 gastric and 4 duodenal biopsies is required to identify patients with EG/EoD, so they can receive appropriate treatment. (ClinicalTrials.gov, Number: NCT03496571).


Assuntos
Duodenite , Enterite , Eosinofilia , Esofagite Eosinofílica , Biópsia , Duodenite/diagnóstico , Duodenite/patologia , Enterite/diagnóstico , Enterite/tratamento farmacológico , Eosinofilia/diagnóstico , Eosinofilia/tratamento farmacológico , Esofagite Eosinofílica/patologia , Eosinófilos/patologia , Gastrite , Humanos
17.
Chemosphere ; 287(Pt 1): 131957, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34450367

RESUMO

An increase in technological interventions and ruthless urbanization in the name of development has deteriorated our environment over time and caused the buildup of heavy metals (HMs) in the soil and water resources. These heavy metals are gaining increased access into our food chain through the plant and/or animal-based products, to adversely impact human health. The issue of how to restrict the entry of HMs or modulate their response in event of their ingress into the plant system is worrisome. The current knowledge on the interactive-regulatory role and contribution of different physical, biophysical, biochemical, physiological, and molecular factors that determine the heavy metal availability-uptake-partitioning dynamics in the soil-plant-environment needs to be updated. The present review critically analyses the interactive overlaps between different adaptation and tolerance strategies that may be causally related to their cellular localization, conjugation and homeostasis, a relative affinity for the transporters, rhizosphere modifications, activation of efflux pumps and vacuolar sequestration that singly or collectively determine a plant's response to HM stress. Recently postulated role of gaseous pollutants such as SO2 and other secondary metabolites in heavy metal tolerance, which may be regulated at the whole plant and/or tissue/cell is discussed to delineate and work towards a "not so heavy" response of plants to heavy metals present in the contaminated soils.


Assuntos
Metais Pesados , Poluentes do Solo , Biodegradação Ambiental , Humanos , Metais Pesados/análise , Metais Pesados/toxicidade , Plantas , Solo , Poluentes do Solo/análise , Poluentes do Solo/toxicidade
18.
J Allergy Clin Immunol ; 149(5): 1683-1690.e7, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34954198

RESUMO

BACKGROUND: Chronic urticaria (CU) is a debilitating mast cell-driven disease, often refractory to standard therapy (ie, antihistamines). Lirentelimab, an anti-sialic acid-binding immunoglobulin-like lectin 8 mAb, selectively inhibits mast cells and depletes eosinophils. OBJECTIVE: We sought to determine safety and efficacy of lirentelimab in patients with CU. METHODS: This phase 2a study enrolled patients with CU refractory to up to 4-fold H1-antihistamine doses. Patients received 6 monthly intravenous doses of lirentelimab (0.3, 1, and up to 3 mg/kg). Primary efficacy end point was change in Urticaria Control Test score at week 22. Urticaria Activity Score weekly average (UAS7) was assessed in patients with chronic spontaneous urticaria (CSU), and Cholinergic UAS7 was used for patients with cholinergic urticaria (CholU). RESULTS: A total of 45 patients were enrolled in 4 cohorts (n = 13 omalizumab-naive CSU, n = 11 omalizumab-refractory CSU, n = 11 CholU, n = 10 symptomatic dermographism). Urticaria Control Test scores increased with lirentelimab across cohorts, with mean changes at week 22 of 11.1 ± 4.1, 4.8 ± 7.0, 6.5 ± 6.2, and 3.4 ± 4.1 and complete response rates (Urticaria Control Test score ≥ 12) of 92%, 36%, 82%, and 40%, respectively. In omalizumab-naive and omalizumab-refractory patients with CSU, disease activity decreased at week 22 (mean UAS7 change, -73% and -47%, respectively), with UAS7 response rates (≥50% reduction) of 77% and 45%, respectively. In patients with symptomatic dermographism, 50% (5 of 10) and 40% (4 of 10) had complete itch and hive resolution by FricTest, respectively, and 100% (7 of 7) evaluable patients with CholU had negative responses to Pulse-Controlled Ergometry exercise test. Most common adverse events included infusion-related reactions (43%; all mild/moderate and transient), nasopharyngitis (21%), and headache (19%). No treatment-related serious adverse events occurred. CONCLUSIONS: Lirentelimab demonstrated activity across 3 forms of antihistamine-refractory CU.


Assuntos
Antialérgicos , Antineoplásicos , Urticária Crônica , Doença Enxerto-Hospedeiro , Urticária , Anticorpos Monoclonais/uso terapêutico , Colinérgicos/uso terapêutico , Doença Crônica , Urticária Crônica/tratamento farmacológico , Cobre/uso terapêutico , Doença Enxerto-Hospedeiro/tratamento farmacológico , Antagonistas dos Receptores Histamínicos/uso terapêutico , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Humanos , Omalizumab/efeitos adversos , Estudo de Prova de Conceito , Resultado do Tratamento , Urticária/induzido quimicamente , Urticária/tratamento farmacológico
19.
Psychiatr Danub ; 33(4): 620-625, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34928920

RESUMO

OBJECTIVES: Physicians across the world have been disproportionately affected by the COVID-19 pandemic. This study was designed and conducted to assess the emotional and behavioural reactions of physicians to the initial phase of the COVID-19 pandemic. SUBJECTS AND METHODS: An online survey questionnaire using the google forms platform was constructed by the authors. The items in the questionnaire were based on clinical experience, relevant literature review and discussion with peers. A list of issues that were deemed as essential components of the experience of the pandemic relevant to physicians was arrived at. Thereafter these issues were operationalized into question form and hosted on the google forms platform. The link to this questionnaire was circulated by the authors among their peer groups in the month of April 2020. RESULTS: We received 295 responses and 3 were unusable. Most of the responses were from India, the United States of America, Australia, Canada and the United Kingdom. About 60% of the respondents identified themselves as frontline and had a decade of clinical experience. Most respondents reported being anxious due to the pandemic and also observed the same in their peers and families. A majority also observed changes in behaviour in self and others and advanced a variety of reasons and concerns. A sense of duty was the most commonly employed coping mechanism. CONCLUSION: Physicians are not immune from information and misinformation, or cues in the environment. Behavioural choices are not always predicted by knowledge but by a combination of knowledge, emotional state, personality and environment. Healthcare settings need to be ready for emergencies and should focus on reducing uncertainty in physicians. These factors may also be gainfully used in the mental health promotion of physicians in COVID-19 care roles.


Assuntos
COVID-19 , Médicos , Humanos , Internet , Pandemias , SARS-CoV-2 , Inquéritos e Questionários
20.
Indian Heart J ; 73(6): 704-710, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34736905

RESUMO

The microbiological profile, associated risk factors and demographic characteristics of patients with IE has changed in the recent times. In the present study, the antibiotic susceptibility profile of 66 isolates (40 from IDU and 26 from non IDU) recovered over a period of three years from the patients with definitive diagnosis of IE along with their absolute minimum inhibitory concentrations (MIC-µg/ml) was determined as per CLSI, 2017 guidelines. Staphylococcus aureus was found to be the predominant pathogen associated with IE out of which 90.2% isolates were MRSA, although none of the isolates were found resistant to vancomycin, teicoplanin, daptomycin and linezolid. Pseudomonas aeruginosa isolates were 100% susceptible to carbapenams, however variable resistance was observed against other antimicrobials. All Enterococci were found to be 100% susceptible to linezolid and daptomycin, whereas vancomycin resistant enterococci phenotype was observed in 25% of the Enterococcal isolates. A noticeable difference in the antimicrobial susceptibility profile and their MICs were observed in the present study, as compared to published literature across the globe and within the country. However, no statistically significant difference (λ 2 test, p > 0.01)in the AST pattern of isolates from IDU vs. Non IDU was observed. After reviewing the local antibiogram it seems that we need to have our own regional guidelines, which may partially replace the currently prevailing AHA/ESC guidelines.


Assuntos
Daptomicina , Endocardite Bacteriana , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Antibacterianos/farmacologia , Humanos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Vancomicina
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