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1.
Can J Urol ; 27(2): 10174-10180, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32333737

RESUMO

INTRODUCTION: To improve the success rate and safety of ureteral stent insertion, we sought to identify the effect of guidewire type and prior use upon the force needed to advance a 6Fr ureteral stent over various guidewires. MATERIALS AND METHODS: Two-hundred forty stent insertion trials were performed in an ex vivo porcine urinary tract model. Ten trials were randomly performed over 12 new and 12 used guidewires. For each trial, the force required to advance a 6Fr Cook double-pigtail ureteral stent was recorded. Guidewires included the Olympus Glidewire, Cook Fixed Core, and Boston Scientific Amplatz Super Stiff, Sensor, ZIPwire, and Zebra wire. RESULTS: The mean force needed for stent advancement was the lowest for the new Glidewire (0.18N) and ZIPwire (0.22N), with no significant difference to each other (p = 0.90). The following new wires required increasingly higher stent insertion forces compared to the Glidewire, the Zebra (0.60N; p < 0.01), Fixed Core (1.25N; p < 0.01), Sensor (1.43N; p < 0.01), and Amplatz Super Stiff wires (2.03N; p < 0.01). There was no statistical difference between new and used Glidewires (0.18N versus 0.29N; p = 0.14) and Zebra wires (0.59N versus 0.60N; p = 0.88). All other used wires required a significantly greater advancement force than their new counterparts (p < 0.01). CONCLUSIONS: For the same stent, the force required for stent advancement varies greatly between guidewire types. In addition, used guidewires typically required more force compared to new guidewires. In long or difficult cases, switching to a new wire may improve the ease of stent placement and reduce potential complications.

3.
N Engl J Med ; 382(8): 697-705, 2020 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-31860793

RESUMO

BACKGROUND: The causative agents for the current national outbreak of electronic-cigarette, or vaping, product use-associated lung injury (EVALI) have not been established. Detection of toxicants in bronchoalveolar-lavage (BAL) fluid from patients with EVALI can provide direct information on exposure within the lung. METHODS: BAL fluids were collected from 51 patients with EVALI in 16 states and from 99 healthy participants who were part of an ongoing study of smoking involving nonsmokers, exclusive users of e-cigarettes or vaping products, and exclusive cigarette smokers that was initiated in 2015. Using the BAL fluid, we performed isotope dilution mass spectrometry to measure several priority toxicants: vitamin E acetate, plant oils, medium-chain triglyceride oil, coconut oil, petroleum distillates, and diluent terpenes. RESULTS: State and local health departments assigned EVALI case status as confirmed for 25 patients and as probable for 26 patients. Vitamin E acetate was identified in BAL fluid obtained from 48 of 51 case patients (94%) in 16 states but not in such fluid obtained from the healthy comparator group. No other priority toxicants were found in BAL fluid from the case patients or the comparator group, except for coconut oil and limonene, which were found in 1 patient each. Among the case patients for whom laboratory or epidemiologic data were available, 47 of 50 (94%) had detectable tetrahydrocannabinol (THC) or its metabolites in BAL fluid or had reported vaping THC products in the 90 days before the onset of illness. Nicotine or its metabolites were detected in 30 of 47 of the case patients (64%). CONCLUSIONS: Vitamin E acetate was associated with EVALI in a convenience sample of 51 patients in 16 states across the United States. (Funded by the National Cancer Institute and others.).


Assuntos
Lesão Pulmonar Aguda/patologia , Líquido da Lavagem Broncoalveolar/química , Sistemas Eletrônicos de Liberação de Nicotina , Vaping/efeitos adversos , Vitamina E/análise , Lesão Pulmonar Aguda/etiologia , Adolescente , Adulto , Idoso , Fumar Cigarros , Óleo de Coco/análise , Feminino , Humanos , Limoneno/análise , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
4.
MMWR Morb Mortal Wkly Rep ; 68(45): 1040-1041, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31725707

RESUMO

CDC, the Food and Drug Administration (FDA), state and local health departments, and multiple public health and clinical partners are investigating a national outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI). Based on data collected as of October 15, 2019, 86% of 867 EVALI patients reported using tetrahydrocannabinol (THC)-containing products in the 3 months preceding symptom onset (1). Analyses of THC-containing product samples by FDA and state public health laboratories have identified potentially harmful constituents in these products, such as vitamin E acetate, medium chain triglyceride oil (MCT oil), and other lipids (2,3) (personal communication, D.T. Heitkemper, FDA Forensic Chemistry Center, November 2019). Vitamin E acetate, in particular, might be used as an additive in the production of e-cigarette, or vaping, products; it also can be used as a thickening agent in THC products (4). Inhalation of vitamin E acetate might impair lung function (5-7).


Assuntos
Líquido da Lavagem Broncoalveolar/química , Surtos de Doenças , Lesão Pulmonar/epidemiologia , Vaping/efeitos adversos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
5.
MMWR Morb Mortal Wkly Rep ; 68(36): 787-790, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31513561

RESUMO

On September 6, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). As of August 27, 2019, 215 possible cases of severe pulmonary disease associated with the use of electronic cigarette (e-cigarette) products (e.g., devices, liquids, refill pods, and cartridges) had been reported to CDC by 25 state health departments. E-cigarettes are devices that produce an aerosol by heating a liquid containing various chemicals, including nicotine, flavorings, and other additives (e.g., propellants, solvents, and oils). Users inhale the aerosol, including any additives, into their lungs. Aerosols produced by e-cigarettes can contain harmful or potentially harmful substances, including heavy metals such as lead, volatile organic compounds, ultrafine particles, cancer-causing chemicals, or other agents such as chemicals used for cleaning the device (1). E-cigarettes also can be used to deliver tetrahydrocannabinol (THC), the principal psychoactive component of cannabis, or other drugs; for example, "dabbing" involves superheating substances that contain high concentrations of THC and other plant compounds (e.g., cannabidiol) with the intent of inhaling the aerosol. E-cigarette users could potentially add other substances to the devices. This report summarizes available information and provides interim case definitions and guidance for reporting possible cases of severe pulmonary disease. The guidance in this report reflects data available as of September 6, 2019; guidance will be updated as additional information becomes available.


Assuntos
Pneumopatias/epidemiologia , Guias de Prática Clínica como Assunto , Índice de Gravidade de Doença , Vaping/efeitos adversos , Humanos , Estados Unidos/epidemiologia
6.
Clin Toxicol (Phila) ; : 1-4, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31456429

RESUMO

Introduction: The jequirity bean (Abrus precatorius) seed contains abrin, a toxalbumin, that irreversibly binds the 60-s ribosomal subunit inhibiting protein synthesis. Neurologic manifestations of ingestions are rare. Case details: We present a case of a 20-year-old man with 24 h of vomiting, diarrhea and 2 h of hematemesis and hematochezia. He admitted to purchasing 1000 jequirity beans online, crushing and ingesting them 26 h prior to presentation in a suicide attempt. Over the next 2 days, he developed hallucinations, incomprehensible mumbling and grunting, disconjugate gaze with abnormal roving eye movements and a left gaze preference with his right eye deviated medially. There was a fine tremor of the upper extremities and he had brief episodes of choreoathetoid movements of his legs. A head CT was normal with no cerebral edema. He progressed to minimally responsive to noxious stimuli, and was unable to converse or follow commands and displayed increased choreoathetoid movements of his extremities. An electroencephalogram (EEG) showed only mild background slowing. Magnetic resonance imaging (MRI) was performed showing bilaterally symmetric signal abnormalities in the basal ganglia, brainstem, corpus callosum and corona radiata with diffuse leptomeningeal enhancement. The patient developed a tonic-clonic seizure followed by pulseless electrical activity, from which he was resuscitated. He was provided comfort care and died just under 5 days after his ingestion. Results: Urine analysis using liquid chromatography coupled to tandem mass spectrometry was positive for 8.84 ng/ml of l-abrine (4.96 ng l-abrine/mg creatinine) 61 h after admission to the hospital (approximately 87 h post-ingestion). Serum concentrations for l-abrine and ricinine were both below the limits of detection. Discussion: Ingestion of 1000 crushed jequirity beans purchased on the internet resulted in progressive encephalopathy and death.

7.
Clin Kidney J ; 12(3): 437-442, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31198546

RESUMO

Background: The use of marijuana in the USA has been steadily increasing over the last 10 years. This study is the first to investigate the effect of marijuana use by live kidney donors upon outcomes in both donors and recipients. Methods: Living kidney donor transplants performed between January 2000 and May 2016 in a single academic institution were retrospectively reviewed. Donor and recipient groups were each divided into two groups by donor marijuana usage. Outcomes in donor and recipient groups were compared using t-test, Chi-square and mixed linear analysis (P < 0.05 considered significant). Results: This was 294 living renal donor medical records were reviewed including 31 marijuana-using donors (MUD) and 263 non-MUDs (NMUD). It was 230 living kidney recipient records were reviewed including 27 marijuana kidney recipients (MKRs) and 203 non-MKRs (NMKR). There was no difference in donor or recipient perioperative characteristics or postoperative outcomes based upon donor marijuana use (P > 0.05 for all comparisons). There was no difference in renal function between NMUD and MUD groups and no long-term difference in kidney allograft function between NMKR and MKR groups. Conclusions: Considering individuals with a history of marijuana use for living kidney donation could increase the donor pool and yield acceptable outcomes.

9.
Urology ; 123: 151-156, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30261178

RESUMO

OBJECTIVE: To compare the efficacy of communication via the standard Da Vinci Si speaker system with a wireless, hands-free audio system in a prospective blinded study. METHODS: Nine hundred and sixty surgical phrases were spoken in a simulated robotic operating room (OR), including 480 phrases expressed via the Da Vinci Si speakers and 480 phrases expressed through a wireless, hands-free system. Using a dual console robotic system, communication was evaluated. Wireless headsets were given to the console and assistant robotic console surgeons, bedside assistant, anesthesiologist, and circulating nurse. An accurate response was defined as hearing the phrase correctly and transcribing it on a data sheet. The primary outcome was the number of correct phrases recorded during the study and secondary outcomes included subjective clarity and effectiveness of communication reported using a Likert scale. RESULTS: Overall, the wireless, hands-free system increased the accuracy of communication (390/480 [81.3%]) compared to the conventional robotic system (310/480 [64.4%]; P <.001). The bedside assistant, anesthesiologist, and circulating nurse had significantly fewer correct phrases recorded than the assistant robotic console surgeon when using the robotic speakers (P <.05 for all). In contrast, there were no significant differences in the number of correct phrases recorded between different positions when using the wireless system. Subjectively, the wireless system resulted in improved clarity and effectiveness of communication (P = .021; P <.001, respectively). CONCLUSION: Robotic operating systems have intrinsic barriers to effective communication between the surgeon and the rest of the operating room team. Improved communication could reduce surgical errors and improve patient safety.


Assuntos
Comunicação , Salas Cirúrgicas , Procedimentos Cirúrgicos Robóticos , Tecnologia sem Fio , Simulação de Paciente , Estudos Prospectivos , Método Simples-Cego
11.
Artigo em Inglês | MEDLINE | ID: mdl-30056267

RESUMO

Hypoglycin A (HGA) and methylenecyclopropylglycine (MCPG) are naturally-occurring amino acids known to cause hypoglycemia and encephalopathy. Exposure to one or both toxins through the ingestion of common soapberry (Sapindaceae) fruits are documented in illness outbreaks throughout the world. Jamaican Vomiting Sickness (JVS) and seasonal pasture myopathy (SPM, horses) are linked to HGA exposure from unripe ackee fruit and box elder seeds, respectively. Acute toxic encephalopathy is linked to HGA and MCPG exposures from litchi fruit. HGA and MCPG are found in several fruits within the soapberry family and are known to cause severe hypoglycemia, seizures, and death. HGA has been directly quantified in horse blood in SPM cases and in human gastric juice in JVS cases. This work presents a new diagnostic assay capable of simultaneous quantification of HGA and MCPG in human plasma, and it can be used to detect patients with toxicity from soapberry fruits. The assay presented herein is the first quantitative method for MCPG in blood matrices.


Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Ciclopropanos/sangue , Glicina/análogos & derivados , Hipoglicinas/sangue , Espectrometria de Massas em Tandem/métodos , Glicina/sangue , Humanos , Limite de Detecção , Modelos Lineares , Intoxicação por Plantas , Reprodutibilidade dos Testes , Sapindaceae
12.
J Anal Toxicol ; 42(9): 630-636, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29931062

RESUMO

Ricin and abrin are toxic ribosome-inactivating proteins found in plants. Exposure to these toxins can be detected using the biomarkers ricinine and abrine, which are present in the same plant sources as the toxins. The concentration of the biomarkers in urine and blood will be dependent upon the purification of abrin or ricin, the route of exposure, and the length of time between exposure and sample collection. Here, we present the first diagnostic assay for the simultaneous quantification of both ricinine and abrine in blood matrices. Furthermore, this is the first-ever method for the detection of abrine in blood products. Samples were processed by isotope-dilution, solid-phase extraction, protein precipitation and quantification by HPLC-MS-MS. This analytical method detects abrine from 5.00 to 500 ng/mL and ricinine from 0.300 to 300 ng/mL with coefficients of determination of 0.996 ± 0.003 and 0.998 ± 0.002 (n = 22), respectively. Quality control material accuracy was determined to have <10% relative error, and precision was within 19% relative standard deviation. The assay's time-to-first result is three hours including sample preparation. Furthermore, the method was applied for the quantification of ricinine in the blood of a patient who had intentionally ingested castor beans to demonstrate the test was fit-for-purpose. This assay was designed to support the diagnosis of ricin and abrin exposures in public health investigations.


Assuntos
Abrina/urina , Alcaloides/urina , Toxicologia Forense/métodos , Alcaloides Indólicos/urina , Piridonas/urina , Ricina/urina , Alcaloides/envenenamento , Biomarcadores/urina , Calibragem , Humanos , Alcaloides Indólicos/envenenamento , Limite de Detecção , Envenenamento/urina , Piridonas/envenenamento , Reprodutibilidade dos Testes , Manejo de Espécimes
13.
Food Chem ; 264: 449-454, 2018 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-29853400

RESUMO

Methylenecyclcopropylglycine (MCPG) and hypoglycin A (HGA) are naturally occurring amino acids found in various soapberry (Sapindaceae) fruits. These toxins have been linked to illnesses worldwide and were recently implicated in Asian outbreaks of acute hypoglycemic encephalopathy. In a previous joint agricultural and public health investigation, we developed an analytical method capable of evaluating MCPG and HGA concentrations in soapberry fruit arils as well as a clinical method for the urinary metabolites of the toxins. Since the initial soapberry method only analyzed the aril portion of the fruit, we present here the extension of the method to include the fruit seed matrix. This work is the first method to quantitate both MCPG and HGA concentrations in the seeds of soapberry fruit, including those collected during a public health investigation. Further, this is the first quantitation of HGA in litchi seeds as well as both toxins in mamoncillo and longan seeds.


Assuntos
Cromatografia Líquida de Alta Pressão , Ciclopropanos/análise , Glicina/análogos & derivados , Hipoglicinas/análise , Sapindus/metabolismo , Espectrometria de Massas em Tandem , Frutas/química , Frutas/metabolismo , Glicina/análise , Sementes/metabolismo
15.
J Endourol ; 32(5): 424-430, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29455556

RESUMO

PURPOSE: Ultrasound (US) guidance during renal access and mass biopsy reduces radiation exposure, but can be technically challenging. A needle guidance system might simplify these procedures. The purpose of this randomized crossover trial was to compare conventional and computer-assisted US needle guidance systems for renal access and mass biopsy. MATERIALS AND METHODS: Seventy-one subjects were randomized to perform renal access or mass biopsy on a phantom using conventional and computer-assisted US guidance in a crossover study design. The primary outcome was success rate including subgroup analysis by experience level. Secondary outcomes included total procedure time, time to hit target, number of course corrections, and total punctures. In addition, subjective preferences of participants were also collected. RESULTS: Procedure success rate was higher with the computer-assisted US than with conventional US for both novice (98.0% (48/49) vs 81.6% (40/49); p < 0.001) and experienced US users (100% (22/22) vs 81.8% (18/22); p < 0.001). Computer-assisted US significantly shortened the total procedure time (94.0 seconds vs 192.9 seconds; p ≤ 0.001), time required to hit the target (62.5 seconds vs 121.6 seconds; p ≤ 0.001), and the number of course corrections (0.56 vs 2.89; p < 0.001) compared with conventional US. Computer-assisted US did not significantly reduce the number of needle punctures (1.75 vs 2.39; p = 0.132). Seventy-three percent of subjects preferred the computer-assisted US system. CONCLUSION: A computer-assisted needle guidance system increases effective US targeting for renal access and mass biopsy for novice and experienced users.


Assuntos
Biópsia por Agulha/métodos , Rim/diagnóstico por imagem , Rim/cirurgia , Agulhas , Cirurgia Assistida por Computador/métodos , Ultrassonografia de Intervenção/métodos , Adulto , Estudos Cross-Over , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Exposição à Radiação/prevenção & controle , Ultrassonografia de Intervenção/instrumentação
16.
Anal Methods ; 9: 3876-3883, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29181095

RESUMO

An automated dried blood spot (DBS) elution coupled with solid phase extraction and tandem mass spectrometric analysis for multiple fentanyl analogs was developed and assessed. This method confirms human exposures to fentanyl, sufentanil, carfentanil, alfentanil, lofentanil, α-methyl fentanyl, and 3-methyl fentanyl in blood with minimal sample volume and reduced shipping and storage costs. Seven fentanyl analogs were detected and quantitated from DBS made from venous blood. The calibration curve in matrix was linear in the concentration range of 1.0 ng/mL to 100 ng/mL with a correlation coefficient greater than 0.98 for all compounds. The limit of detection varied from 0.15 ng/mL to 0.66 ng/mL depending on target analyte. Analysis of the entire DBS minimized the effects of hematocrit on quantitation. All quality control materials evaluated resulted in <15% error; analytes with isotopically labeled internal standards had <15% RSD, while analytes without matching standards had 15-24% RSD. This method provides an automated means to detect seven fentanyl analogs, and quantitate four fentanyl analogs with the benefits of DBS at levels anticipated from an overdose of these potent opioids.

17.
MMWR Morb Mortal Wkly Rep ; 66(42): 1144-1147, 2017 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-29073124

RESUMO

On April 25, 2017, a cluster of unexplained illness and deaths among persons who had attended a funeral during April 21-22 was reported in Sinoe County, Liberia (1). Using a broad initial case definition, 31 cases were identified, including 13 (42%) deaths. Twenty-seven cases were from Sinoe County (1), and two cases each were from Grand Bassa and Monsterrado counties, respectively. On May 5, 2017, initial multipathogen testing of specimens from four fatal cases using the Taqman Array Card (TAC) assay identified Neisseria meningitidis in all specimens. Subsequent testing using direct real-time polymerase chain reaction (PCR) confirmed N. meningitidis in 14 (58%) of 24 patients with available specimens and identified N. meningitidis serogroup C (NmC) in 13 (54%) patients. N. meningitidis was detected in specimens from 11 of the 13 patients who died; no specimens were available from the other two fatal cases. On May 16, 2017, the National Public Health Institute of Liberia and the Ministry of Health of Liberia issued a press release confirming serogroup C meningococcal disease as the cause of this outbreak in Liberia.


Assuntos
Surtos de Doenças , Meningite Meningocócica/epidemiologia , Meningite Meningocócica/microbiologia , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Serviços de Laboratório Clínico/estatística & dados numéricos , Análise por Conglomerados , Humanos , Libéria/epidemiologia , Meningite Meningocócica/mortalidade , Reação em Cadeia da Polimerase em Tempo Real , Fatores de Tempo
20.
J Agric Food Chem ; 65(30): 6307-6316, 2017 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-28662581

RESUMO

The production of Parma dry-cured ham involves the steps of salting, drying, and ripening. Although sea salt is the only preserving agent, there are strategies being developed with the goal of reducing salt content in order to decrease its negative impact on consumer health. A 24 h pressure treatment was applied before salting to reduce thickness and inequalities in shape. To evaluate the potential impact of the pressure step on the process outcome, differential proteomic analyses by complementary 2D-PAGE and LC-MS/MS were carried out on exudates collected at day 1, 5, and 18 of the salting phase for hams treated or untreated with pressure. Specific proteins were found differentially abundant in exudates from pressed vs unpressed hams and as a function of time. These changes include glycolytic enzymes and several myofibrillar proteins. These findings indicate that pressure causes a faster loosening of the myofibrillar structure with the release of specific groups of proteins.


Assuntos
Produtos da Carne/análise , Proteínas/química , Animais , Eletroforese em Gel Bidimensional , Conservação de Alimentos , Músculo Esquelético/química , Proteômica , Cloreto de Sódio/análise , Suínos , Espectrometria de Massas em Tandem
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