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1.
Braz. j. biol ; 83: e253009, 2023. tab, graf
Artigo em Inglês | MEDLINE, LILACS, VETINDEX | ID: biblio-1339373

RESUMO

Abstract Today, global focus of research is to explore the solution of energy crisis and environmental pollution. Like other agricultural countries, bulk quantities of watermelon peels (WMP) are disposed-off in environment as waste in Pakistan and appropriate management of this waste is the need of hour to save environment from pollution. The work emphasizes the role of ethanologenic yeasts to utilize significant sugars present in WMP for low-cost bioethanol fermentation. Dilute hydrochloric acid hydrolysis of WMP was carried out on optimized conditions employing RSM (response surface methodology) following central composite design (CCD). This experimental design is based on optimization of ethanologenesis involving some key independent parameters such as WMP hydrolysate and synthetic media ratio (X1), incubation temperature (X2) and incubation temperature (X3) for maximal ethanol yield exploiting standard (Saccharomyces cerevisiae K7) as well as experimental (Metchnikowia cibodasensisY34) yeasts. The results revealed that maximal ethanol yields obtained from S. cerevisiae K7 was 0.36±0.02 g/g of reducing sugars whereas M. cibodasensisY34, yielded 0.40±0.01 g ethanol/g of reducing sugars. The yeast isolate M. cibodasensisY34 appeared as promising ethanologen and embodies prospective potential for fermentative valorization of WMP-to-bioethanol.


Resumo Hoje, o foco global da pesquisa é explorar a solução da crise energética e da poluição ambiental. Como em outros países agrícolas, grandes quantidades de cascas de melancia (WMP) são descartadas como resíduos no meio ambiente no Paquistão, mas a gestão adequada desses resíduos é a mais recente solução para salvar o meio ambiente da poluição. O trabalho enfatiza o papel das leveduras etanologênicas para utilizar açúcares significativos presentes no WMP para fermentação de bioetanol de baixo custo. A hidrólise de ácido clorídrico diluído de WMP foi realizada em condições otimizadas empregando RSM (metodologia de superfície de resposta) e seguindo o projeto de composto central (CCD). Este projeto experimental é baseado na otimização da etanologenesis envolvendo alguns parâmetros independentes importantes, como hidrolisado de WMP e razão de meio sintético (X1), temperatura de incubação (X2) e temperatura de incubação (X3) para rendimento máximo de etanol explorando o padrão (Saccharomyces cerevisiae K7) também como leveduras experimentais (Metchnikowia cibodasensis Y34). Os resultados revelaram que os rendimentos máximos de etanol obtidos a partir de S. cerevisiae K7 foi de 0,36 ± 0,02 g / g de açúcares redutores, enquanto M. cibodasensis Y34 rendeu 0,40 ± 0,01 g de etanol / g de açúcares redutores. O isolado de levedura M. cibodasensis Y34 apareceu como um etanologeno promissor e incorpora um potencial prospectivo para a valorização fermentativa de WMP em bioetanol.


Assuntos
Cucurbitaceae , Etanol , Saccharomyces cerevisiae , Água , Biotransformação , Estudos Prospectivos , Fermentação
2.
J Ethnopharmacol ; 291: 115145, 2022 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-35219821

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Shenling Baizhu San (SBS) is commonly employed to improve gastrointestinal dysfunction in patients with ulcerative colitis (UC) in China. SBS combined with mesalamine has been demonstrated to result in improve its curative effects without increasing any adverse reactions, but the underlying mechanism remains unclarified. AIM OF THE STUDY: Our study aimed to illuminate the potential therapeutic effects and mechanisms of SBS, which is a medicine complementary to mesalamine, in the treatment of UC. MATERIALS AND METHODS: A prospective cohort study was conducted to evaluate the efficacy of SBS as a complementary medicine to mesalamine for patients with UC (n = 48). The patients in the control group (n = 24) were given mesalamine alone, whereas those in the experimental group were administered mesalamine combined with SBS. The therapeutic outcome was assessed at 8 weeks. The structures of the gut microbiota (GMB) were characterized by 16S rRNA sequencing, and the microbial tryptophan metabolites were analyzed by UPLC-MS/MS to investigate the mechanism through which SBS achieves its effects. RESULTS: Our results showed that the combination of SBS and mesalamine could significantly improve the clinical signs of UC by achieving mucosal healing and relieving colon damage. Interestingly, the combination of SBS and mesalamine could alter the GMB structures and increase the microbial levels of tryptophan metabolites, including indole-3-propionic acid and indole-3-acetic acid. CONCLUSION: SBS combined with mesalamine is effective in improving the clinical and endoscopic outcomes of patients with UC. SBS, as a complementary therapy to conventional treatment, alleviates UC via the GMB-tryptophan metabolite axis.


Assuntos
Colite Ulcerativa , Terapias Complementares , Microbioma Gastrointestinal , Cromatografia Líquida , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/metabolismo , Medicamentos de Ervas Chinesas , Humanos , Mesalamina/farmacologia , Mesalamina/uso terapêutico , Estudos Prospectivos , RNA Ribossômico 16S , Espectrometria de Massas em Tandem , Triptofano
3.
Dermatol Ther ; 35(2): e15229, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34820974

RESUMO

Carboxytherapy has been used in the treatment of autoimmune skin diseases such as psoriasis and morphea. Carboxytherapy has antioxidant effects, and leads to better tissue oxygenation, and release of growth factors. In this article, we decided to evaluate efficacy of combined carboxytherapy and narrowband-ultraviolet B (NB-UVB) compared to NB-UVB alone in the treatment of vitiligo. This is a prospective, split-body double-blind comparative study performed in patients with generalized stable vitiligo in acral areas and extremities referred to dermatology clinic of Afzalipour hospital in Kerman University of Medical Sciences. NB-UVB was performed three times a week in non-consecutive days for 4 months. In each patient, one lesion was randomly treated with carboxytherapy (weekly sessions for total of 16 sessions). Efficacy of treatment was evaluated by percentage of repigmentation of the lesions. Chi-square test and analysis of variance test (ANOVA) were used to compare efficacy of treatment based on demographic features of the patients and clinical features of the lesions, respectively. Twenty-eight patients with mean age of 32.35 ± 7.37 years old completed the study. At the end of the treatment, 37% of the patients in combination therapy group demonstrated more than 75% improvement compared to 0% in the monotherapy group (p = 0.001). There was no significant difference between either demographic features of the patients (age, sex, and skin phototypes) or duration of disease with efficacy of the treatment in both groups. Combination of carboxytherapy with NB-UVB leads to higher percentage of repigmentation and patients' satisfaction compared to monotherapy with NB-UVB.


Assuntos
Terapia Ultravioleta , Vitiligo , Adulto , Terapia Combinada , Humanos , Estudos Prospectivos , Pele/patologia , Resultado do Tratamento , Terapia Ultravioleta/efeitos adversos , Vitiligo/diagnóstico , Vitiligo/tratamento farmacológico , Vitiligo/radioterapia , Adulto Jovem
4.
J Nerv Ment Dis ; 210(4): 257-263, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35212665

RESUMO

ABSTRACT: We aimed to explore the prevalence and determinants of severe COVID-19 disease and mortality in patients with schizophrenia in this study. We conducted a retrospective observational study of 1620 patients with schizophrenia. Of the 1620 patients, 52 (3.2%) tested positive for SARS-CoV-19. Among SARS-CoV-2-positive patients, 40 patients were hospitalized, and 17 patients required intensive care unit admission due to COVID-19 (76.9% and 32.7%, respectively). Severe COVID-19 disease was noted in 17 patients (32.7%) requiring intubation. In the logistic regression analysis, antipsychotic dose, and comorbidity score were independently associated with a greater risk of severe COVID-19 disease in patients with schizophrenia. Our study suggests that factors such as age, sex, comorbidities, and a daily antipsychotic dose may have effects on the poor outcome of SARS-CoV-2 disease in schizophrenia patients. In addition, the current findings propose that mortality may be associated with an older age, comorbidity score, and a longer duration of psychiatric disease among the SARS-CoV-2-positive patients with schizophrenia. However, the findings of our study should be verified in prospective and larger sample studies.


Assuntos
COVID-19 , Esquizofrenia , COVID-19/epidemiologia , Comorbidade , Demografia , Hospitalização , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2 , Esquizofrenia/epidemiologia
5.
Artif Organs ; 46(4): 597-605, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34951495

RESUMO

BACKGROUND: M101 is an extracellular hemoglobin isolated from a marine lugworm and is present in the medical device HEMO2 life®. The clinical investigation OXYOP was a paired kidney analysis (n = 60) designed to evaluate the safety and performance of HEMO2 life® used as an additive to preservation solution in renal transplantation. The secondary efficacy endpoints showed less delayed graft function (DGF) and better renal function in the HEMO2 life® group but due to the study design cold ischemia time (CIT) was longer in the contralateral kidneys. METHODS: An additional analysis was conducted including OXYOP patients and patients from the ASTRE database (n = 6584) to verify that the decrease in DGF rates observed in the HEMO2 life® group may not be due solely to the shorter CIT but also to HEMO2 life® performance. Kaplan-Meier estimate curves of cumulative probability of achieving a creatinine level below 250 µmol/L were generated and compared in both groups. A Cox model was used to test the effect of the explanatory variables (use of HEMO2 life® and CIT). Finally, a bootstrap strategy was used to randomly select smaller samples of patients and test them for statistical comparison in the ASTRE database. RESULTS: Kaplan-Meier estimate curves confirmed the existence of a relation between DGF and CIT and Cox analysis showed a benefit in the HEMO2 life® group regardless of the associated CIT. Boostrap analysis confirmed these results. CONCLUSIONS: The present study suggested that the better recovery of renal function observed among kidneys preserved with HEMO2 life® in the OXYOP study is a therapeutic benefit of this breakthrough innovative medical device.


Assuntos
Isquemia Fria , Transplante de Rim , Isquemia Fria/efeitos adversos , Isquemia Fria/métodos , Função Retardada do Enxerto , Sobrevivência de Enxerto , Hemoglobinas , Humanos , Rim/fisiologia , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Estudos Prospectivos , Fatores de Risco
6.
Horm Metab Res ; 54(2): 94-103, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35130570

RESUMO

Glycated hemoglobin (HbA1c) variability is emerging as an indicator of long-term glycemic control, which may play a significant role during vascular complications. We conducted a systematic review and meta-analysis to assess the association between the scope of HbA1c variability and vascular complications in patients with type 2 diabetes mellitus. PubMed and Embase were searched for studies that evaluated the association of HbA1c variability with vascular complications in patients with type 2 diabetes. Two reviewers independently completed data extraction. Random-effects meta-analysis was conducted with stratification according to the type of vascular complications. Nine studies were eligible for inclusion in our systematic review and meta-analysis. Six studies evaluated the impact of the standard deviation of HbA1c (HbA1c-SD) on cardiovascular events and showed an association of HbA1c-SD with cardiovascular events (HR: 1.25, 95% CI 1.18-1.32, 5 studies). Six studies evaluated renal disease associated with HbA1c-SD and showed that HbA1c-SD was correlated with an increased risk of renal disease (HR: 1.19, 95% CI 1.13-1.24). Two studies evaluated HbA1c-SD and the risk of retinopathy and showed that no significant association was found between retinopathy and HbA1c-SD (HR 1.08, 95% CI 0.92-125). For HbA1c-SD ranging from 0.6 to 0.8%, HbA1c-SD was associated with an increased risk of cardiovascular events (HR: 1.25, 95% CI 1.15-1.35) and renal disease (HR: 1.16, 95% CI 1.11-1.22). For individuals with index HbA1c variability greater than or equal to 0.6%, HbA1c variability was significantly associated with vascular complications in patients with type 2 diabetes mellitus.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Glicemia/análise , Doenças Cardiovasculares/complicações , Diabetes Mellitus Tipo 2/complicações , Hemoglobina A Glicada/análise , Humanos , Estudos Prospectivos
7.
Psychooncology ; 31(1): 54-61, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34498358

RESUMO

OBJECTIVES: To examine the impact of breast reconstruction on women's perceptions of body image over time and to assess the influence of sociodemographic variables on body image. METHODS: A prospective, longitudinal cohort study, using validated breast cancer-specific questionnaires, to compare patient-reported outcomes in women choosing immediate (n = 61), delayed (n = 16) or no (n = 23) breast reconstruction. RESULTS: One hundred women completed baseline questionnaires that included items on body image; 30 women completed all four annual follow-up sets, while 20 women completed baseline only. The three groups were well matched at baseline and similar trajectories in body image measures were identified over 48 months in all groups. At 12 months post-mastectomy, significant changes were seen in eight of the 10 subscales; this reduced to seven subscales at 24 months and four at 36 months. By 48 months, only three subscales remained significantly different to baseline scores: women remained less vulnerable and had fewer limitations (improved outcomes); the one worse outcome was persistently higher levels of arm concern. Three of the sociodemographic variables (health insurance, age and employment status) showed significant inter-group differences at some time points. CONCLUSION: These findings suggest women recover from the negative impact of mastectomy on body image within four years of surgery, whether they have immediate, delayed or no reconstruction. Our results provide some indirect evidence that having a choice of BR options is important, regardless of the choice made. Four years appears to be a suitable follow-up period for future studies in this area.


Assuntos
Neoplasias da Mama , Mamoplastia , Imagem Corporal , Neoplasias da Mama/cirurgia , Feminino , Humanos , Estudos Longitudinais , Mamoplastia/métodos , Mastectomia , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Qualidade de Vida
8.
Ars pharm ; 63(2)abr.-jun. 2022. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-202810

RESUMO

Introducción: La alfabetización en salud es una medida de la capacidad de los pacientes de leer, comprender y tomar decisiones en base a instrucciones médicas. La inadecuada alfabetización se asocia a un peor estado de salud en pacientes con enfermedades crónicas. El momento de la dispensación podría ser una oportunidad para evaluar esta condición por el farmacéutico de atención primariaEl objeto de este estudio fue evaluar la relación de alfabetización en salud y los valores de colesterol total y comorbilidades en personas con prescripción de hipolipemiantes atendidos en un centro de jubilados.Método:Se diseñó un estudio prospectivo donde se evaluó la relación de la alfabetización utilizando Short Assessment of Health Literacy for Spanish-speaking Adults y el valor de colesterol , medicamentos , factores de riesgo y comorbilidades. Todas estas variables se analizaron en forma integrada en un análisis multivariado. Resultados: Participaron 178 pacientes, 63% mujeres. El puntaje promedio de SAHLSA fue 43,4 ± 5,5. Se encontró una inadecuada alfabetización en 24%. pacientes El valor promedio de colesterol en estre grupo de pacientes fue 235,17mg/dl vs 193,53mg/dl quienes tenian adecuada alfabetización en salud.Se realizó un análisis multivariado que mostró asociación entre inadecuada alfabetización en salud, bajo nivel de educación y conocimiento del paciente . El número de internaciones y la aparición de eventos coronarios fueron significativamente mayor en los pacientes con alfabetización en salud insuficiente. Conclusiones: Se encontró relación directa entre el grado de alfabetización en salud y los valores de colesterol total en pacientes en tratamiento por hipercolesterolemia (AU)


Introduction: Health literacy is a measure of the ability of patients to read, understand and make decisions based on medical instructions. Inadequate health literacy is associated with poorer health in patients with chronic diseases. Time of dispensing could be an opportunity for the primary care pharmacist to evaluate this condition by the. The purpose of this study was to evaluate the relationship of Health literacy and the values of total cholesterol and comorbidities in people with a prescription of lipid-lowering drugs treated in a retirement center. Method: A prospective study was designed where the relationship of Health literacy was evaluated using Short Assessment of Health Literacy for Spanish-speaking Adults and the value of cholesterol, medications, risk factors and comorbidities. All these variables were analyzed in an integrated manner in a multivariate analysis.Results:178 patients participated, 63% women. The mean SAHLSA score was 43.4 ± 5.5. Inadequate HL was found in 24%. patients.The mean cholesterol value in patients with inadequate Health literacy was 235.17mg / dl vs 193.53mg / dl among those with adequate Health literacy.A multivariate analysis was performed that showed an association between inadequate Health literacy, the level of education and the patient’s knowledge of normal values of total cholesterol. The number of hospitalizations and the occurrence of coronary events were significantly higher in patients with insufficient Health literacy. Conclusions: A direct relationship was found between the degree of Health literacy and total cholesterol values in patients undergoing treatment for hypercholesterolemia (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Letramento em Saúde , Atenção Primária à Saúde , Hipolipemiantes/uso terapêutico , Colesterol/sangue , Hipercolesterolemia/tratamento farmacológico , Assistência Farmacêutica , Estudos Prospectivos , Fatores de Risco , Análise Multivariada , Comorbidade , Escolaridade , Estudos Transversais
9.
Emergencias (Sant Vicenç dels Horts) ; 34(3): 165-173, Jun. 2022. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-203719

RESUMO

Objetivo. Validar prospectivamente un modelo predictivo de ingreso hospitalario para los pacientes atendidos en el servicio de urgencias hospitalario (SUH) con baja prioridad de visita y determinar la capacidad predictiva del modelo para realizar con seguridad la derivación inversa. Método. Estudio observacional unicéntrico de una cohorte prospectiva de validación de un modelo predictivo basado en variables demográficas, de proceso y las constantes vitales (modelo 3). Se incluyeron los episodios de pacientes >15 años con prioridades IV y V MAT-SET atendidos entre octubre 2018 y junio 2019. Se evaluó la discriminación mediante el área bajo la curva de la característica operativa del receptor (ABC). Para determinar la capacidad de discriminación se crearon 3 categorías de riesgo: bajo, intermedio y alto. Resultados. Se incluyeron 2.110 episodios, de los cuales 109 (5,2%) ingresaron. La mediana de edad fue de 43,5 años (RIC 31-60,3) con un 55,5% de mujeres. El ABC fue de 0,71 (IC 95%: 0,64-0,75). Según el modelo predictivo, 357 episodios (16,9%) puntuaron de bajo riesgo de ingreso y 240 (11,4%) de alto riesgo. El porcentaje de ingreso observado de los pacientes clasificados de alto riesgo fue de 15,8% mientras que el de los pacientes de bajo riego fue de 2,8%. Conclusiones. El modelo predictivo validado permite estratificar el riesgo de ingreso de los pacientes con baja priori- dad de visita. Los pacientes con alto riesgo de ingreso se les podría ofrecer una atención preferente dentro del mismo nivel de prioridad, mientras que los de bajo riesgo podrían ser redirigidos al recurso asistencial más adecuado (derivación inversa).


Objectives. To prospectively validate a model to predict hospital admission of patients given a low-priority classification on emergency department triage and to indicate the safety of reverse triage. Methods. Single-center observational study of a prospective cohort to validate a risk model incorporating demographic and emergency care process variables as well as vital signs. The cohort included emergency visits from patients over the age of 15 years with priority level classifications of IV and V according to the Andorran–Spanish triage system (Spanish acronym, MAT-SET) between October 2018 and June 2019. The area under the receiver operating characteristic curve (AUC) of the model was calculated to evaluate discrimination. Based on the model, we identified cut-off points to distinguish patients with low, intermediate, or high risk for hospital admission. Results. A total of 2110 emergencies were included in the validation cohort; 109 patients (5.2%) were hospitalized. The median age was 43.5 years (interquartile range, 31-60.3 years); 55.5% were female. The AUC was 0.71 (95% CI, 0.64-0.75). The model identified 357 patients (16.9%) at low risk of hospitalization and 240 (11.4%) at high risk. A total of 15.8% of the high-risk patients and 2.8% of the low-risk patients were hospitalized. Conclusions. The validated model is able to identify risk for hospitalization among patients classified as low priority on triage. Patients identified as having high risk of hospitalization could be offered preferential treatment within the same level of priority at triage, while those at low risk of admission could be referred to a more appropriate care level on reverse triage.


Assuntos
Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Triagem/organização & administração , Serviços Médicos de Emergência , Hospitalização , Visita a Consultório Médico , Emergências , Estudos Prospectivos , Comportamento de Redução do Risco
10.
Emergencias (Sant Vicenç dels Horts) ; 34(3): 181-189, Jun. 2022. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-203721

RESUMO

Objetivo. Evaluar y comparar la capacidad del lactato, la procalcitonina (PCT) y de los criterios definitorios de sepsis (síndrome de respuesta inflamatoria sistémica –SRIS– y del quick Sepsis-related Organ Failure Assessment –qSOFA–) para predecir mortalidad a 30 días, o infección –con confirmación microbiológica o bacteriemia verdadera (BV)– en los pa- cientes que acuden al servicio de urgencias hospitalario (SUH) por un episodio de sospecha de infección. Método. Estudio observacional de cohortes, multicéntrico, prospectivo. Se incluyó por oportunidad a pacientes $ 18 años atendidos por sospecha de infección en 71 SUH españoles desde el 01/10/2019 al 31/03/2020. Se analizó la capacidad predictiva con el área bajo la curva (ABC) de la característica operativa del receptor (COR) y puntos de de- cisión predeterminados. Resultados. Se incluyeron 4.439 pacientes con edad media de 67 (18) años, 2.648 (59,7%) fueron hombres, fallecie- ron a los 30 días 459 (10,3%), se consideraron BV 899 (20,2%) y se consiguió confirmación microbiológica en 2.057 (46,3%). Para la mortalidad a 30 días la mejor ABC-COR fue la obtenida con el modelo qSOFA $ 2 más lactato $ 2 mmol/l con un ABC-COR de 0,738 (0,711-0,765). Para predecir BV y confirmación microbiológica el mejor rendi- miento se obtuvo con el modelo de SRIS $ 2 más PCT $ 0,51 ng/ml, con un ABC-COR de 0,890 (0,880-0,901) y 0,713 (0,698-0,728), respectivamente. Conclusiones. Para la predicción de mortalidad a 30 días, el qSOFA $ 2 es superior al SRIS $ 2 y el mejor rendimien- to lo consigue el modelo qSOFA $ 2 más lactato $ 2 mmol/l. Para predecir BV y confirmación microbiológica, la PCT es superior al lactato y el mejor rendimiento lo obtiene el modelo SRIS $ 2 más PCT $ 0,51 ng/ml.


Objectives. To evaluate lactate, procalcitonin, criteria defining systemic inflammatory response syndrome (SIRS), and the Quick Sepsis-Related Organ Failure Assessment (qSOFA) and compare their ability to predict 30-day mortality, infection with microbiologic confirmation, and true bacteremia in patients treated for infection in hospital emergency departments. Methods. Prospective multicenter observational cohort study. We enrolled a convenience sample of patients aged 18 years or older attended in 71 Spanish emergency departments from October 1, 2019, to March 31, 2020. Each model’s predictive power was analyzed with the area under the receiver operating characteristic curve (AUC), and predetermined decision points were assessed. Results. A total of 4439 patients with a mean (SD) age of 18 years were studied; 2648 (59.7%) were men and 459 (10.3%) died within 30 days. True bacteremia was detected in 899 (20.25%), and microbiologic confirmation was on record for 2057 (46.3%). The model that included the qSOFA score ($ 2) and lactate concentration ($ 0.738 mmol/L; 95% CI, 0.711-0.765 mmol/L) proved to be the best predictor of 30-day mortality, with an AUC of 0.890 (95% CI, 0.880-0.901). The model that included the SIRS score ($ 2) and procalcitonin concentration ($ 0.51 ng/mL) proved to be the best predictor of true bacteremia and microbiologic confirmation, with an AUC of 0.713 (95% CI, 0.698-0.728). Conclusions. A qSOFA score of 2 or more plus lactate concentration ($ 0.738 mmol/L) predict 30-day mortality better than the combination of a SIRS score of 2 or more and procalcitonin concentration. A SIRS score of 2 or more plus procalcitonin concentration ($ 0.51 ng/mL) predict true bacteremia and microbiologic confirmation.


Assuntos
Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Mortalidade , Serviços Médicos de Emergência , Síndrome de Resposta Inflamatória Sistêmica , Ácido Láctico , Pró-Calcitonina , Sepse , Bacteriemia , Infecções , Estudos Prospectivos , Espanha
11.
Emergencias (Sant Vicenç dels Horts) ; 34(3): 196-203, Jun. 2022. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-203723

RESUMO

Objetivo. Validación de un indicador de mortalidad previamente descrito en pacientes con COVID-19 en un servicio de urgencias hospitalario (SUH). Método. Estudio observacional prospectivo no intervencionista. Se incluyeron pacientes $ 18 años diagnosticados de COVID-19 (1 de diciembre de 2020 hasta 28 de febrero de 2021). Se calculó el indicador para cada paciente: edad $ 50 años (2 puntos), índice de Barthel < 90 puntos (1 punto), alteración de consciencia (1 punto), índice de SaO2/ FIO2 < 400 (1 punto), auscultación respiratoria patológica (1 punto), plaquetas < 100 x 109/L (1 punto), proteína C reactiva $ 5 mg/dL (1 punto) y filtrado glomerular < 45 mL/min (1 punto). La variable dependiente fue la mortalidad observada a 30 días. El rendimiento del indicador se valoró con el análisis del área bajo la curva de la característica operativa del receptor (ABC-COR). Resultados. La validación del indicador se realizó sobre una cohorte de 1.223 pacientes. Tras una mediana de seguimiento de 80 días, 143 pacientes habían fallecido. Un total de 901 pacientes fueron catalogados como riesgo bajo (indicador # 4 puntos), 270 lo fueron como riesgo intermedio (5-6 puntos) y 52 como riesgo alto ($ 7 puntos). La mortalidad a 30 días observada en cada categoría fue de 2,8%, 22,5% y 65,4%, respectivamente. El ABC-COR fue de 0,883 para el indicador utilizado cuantitativamente y de 0,818 cuando se usó cualitativamente en forma de categorías de riesgo. Conclusión. El indicador descrito es una herramienta útil para estratificar el riesgo de mortalidad de los pacientes con COVID-19 que consultan a un SUH de un centro de tercer nivel.


Objective. To validate a previously described hospital emergency department risk model to predict mortality in patients with COVID-19. Methods. Prospective observational noninterventional study. Patients aged over 18 years diagnosed with COVID-19 were included between December 1, 2020, and February 28, 2021. We calculated a risk score for each patient based on age $50 years (2 points) plus 1 point each for the presence of the following predictors: Barthel index <90 points, altered level of consciousness, ratio of arterial oxygen saturation to fraction of inspired oxygen <400, abnormal breath sounds, platelet concentration <100 × 109/L, C reactive protein level $5 mg/dL, and glomerular filtration rate <45 mL/min. The dependent variable was 30-day mortality. We assessed the score’s performance with the area under the receiver operating characteristic curve (AUC). Results. The validation cohort included 1223 patients. After a median follow-up of 80 days, 143 patients had died; 901 patients were classified as having low risk (score, #4 points), 270 as intermediate risk (5-6 points), and 52 as high risk ($7 points). Thirty-day mortality rates at each risk level were 2.8%, 22.5%, and 65.4%, respectively. The AUC for the score was 0.883; for risk categorization, the AUC was 0.818. Conclusion. The risk score described is useful for stratifying risk for mortality in patients with COVID-19 who come to a tertiary-care hospital emergency department.


Assuntos
Humanos , Pessoa de Meia-Idade , Mortalidade , Infecções por Coronavirus , Modelos de Riscos Proporcionais , Estudos Prospectivos , Serviços Médicos de Emergência , Medição de Risco , Modelos Logísticos
12.
Clin. transl. oncol. (Print) ; 24(6): 959-967, junio 2022.
Artigo em Inglês | IBECS | ID: ibc-203799

RESUMO

Colorectal cancer (CRC) is the third most common cancer in both men and women, accounting for 8% of all new cancer cases in both. CRC is typically diagnosed at advanced stages, which leads to a higher mortality rate. The 5-year survival rate for CRC is 64% in all cases and just 12% in metastatic cases. Mesenchymal stem cells (MSCs) are one of the most recent approaches for therapeutic interventions in cancer. MSCs have multiple properties, including paracrine signaling, immunologic functions, and the ability to migrate to the targeted tissue. MSCs can produce and secrete exosomes in tumor microenvironments. These exosomes can transfer compounds across tumor cells, stromal cells, fibroblasts, endothelial cells, and immune cells. Studies showed that modified MCS-derived exosomes have enhanced specificity, reduced immunogenicity, and better targeting capabilities in comparison to other frequently used delivery systems such as liposomes. Therefore, this study aimed to provide a comprehensive view of the role of natural MSC-derived exosomes in CRC, as well as the most current and prospective advancements in MSC-derived exosome therapeutic modifications.


Assuntos
Humanos , Neoplasias Colorretais/terapia , Células Endoteliais , Exossomos , Microambiente Tumoral , Células-Tronco Mesenquimais , Estudos Prospectivos
13.
Clin. transl. oncol. (Print) ; 24(6): 1157-1167, junio 2022. tab, graf
Artigo em Inglês | IBECS | ID: ibc-203814

RESUMO

PurposeA significant percentage of colorectal cancer patients proceeds to metastatic disease. We hypothesised that mitochondrial DNA (mtDNA) polymorphisms, generated by the high mtDNA mutation rate of energy-demanding clonal immune cell expansions and assessable in peripheral blood, reflect how efficiently systemic immunity impedes metastasis.Patients and methodsWe studied 44 rectal cancer patients from a population-based prospective biomarker study, given curative-intent neoadjuvant radiation and radical surgery for high-risk tumour stage and followed for metastatic failure. Blood specimens were sampled at the time of diagnosis and analysed for the full-length mtDNA sequence, composition of immune cell subpopulations and damaged serum mtDNA.ResultsWhole blood total mtDNA variant number above the median value for the study cohort, coexisting with an mtDNA non-H haplogroup, was representative for the mtDNA of circulating immune cells and associated with low risk of a metastatic event. Abundant mtDNA variants correlated with proliferating helper T cells and cytotoxic effector T cells in the circulation. Patients without metastatic progression had high relative levels of circulating tumour-targeting effector T cells and, of note, the naïve (LAG-3+) helper T-cell population, with the proportion of LAG-3+ cells inversely correlating with cell-free damaged mtDNA in serum known to cause antagonising inflammation.ConclusionNumerous mtDNA polymorphisms in peripheral blood reflected clonal expansion of circulating helper and cytotoxic T-cell populations in patients without metastatic failure. The statistical associations suggested that patient’s constitutional mtDNA manifests the helper T-cell capacity to mount immunity that controls metastatic susceptibility.


Assuntos
Humanos , DNA Mitocondrial/genética , Mitocôndrias/genética , Neoplasias Retais/genética , Estudos Prospectivos , Metástase Neoplásica
14.
Clin. transl. oncol. (Print) ; 24(6): 1177-1183, junio 2022.
Artigo em Inglês | IBECS | ID: ibc-203816

RESUMO

IntroductionAim of this analysis was to report toxicity and clinical outcomes in oligorecurrent prostate cancer (PCa) patients treated with single fraction stereotactic radiosurgery (SRS) for bone metastases.MethodsWe separately analyzed clinical data of PCa patients with bone oligometastases enrolled in a prospective phase I trial (DESTROY-2). DESTROY-2 was based on SRS delivered using volumetric modulated arc therapy in patients with primary or metastatic tumors in several extra-cranial body sites. Acute and late toxicity, biochemical tumor response, local control (LC), distant metastases-free (DPFS), progression-free (PFS), time to next-line systemic treatment-free (NEST-FS), and overall survival (OS) were calculated.ResultsData on 37 PCa patients, carrying out 50 bone metastases, candidates for curative-intent treatment and treated with SRS at our Institution were collected. SRS dose ranged between 12 and 24 Gy. One grade 1 acute skin toxicity in one patient treated on the hip (24 Gy) and one grade 1 late skin toxicity in a patient with a scapular lesion (24 Gy) were recorded. No cases of bone fracture were registered in the treated population. With a median follow-up of 25 months (range 3–72 months) 2-year actuarial LC, DPFS, PFS, and OS were 96.7%, 58.1%, 58.1%, and 95.8%, respectively. Median and 2-year NEST-FS were 30 months (range 1–69 months) and 51.2%, respectively.ConclusionsData analysis showed few toxicity events, high local control rate and prolonged NEST-FS after linear accelerator-based radiosurgery of bone oligometastases from PCa. The possibility of postponing systemic treatments in patients with oligometastatic PCa by means of SRS should be taken into account. Further prospective studies on larger series are needed to confirm the reported results.


Assuntos
Humanos , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Radiocirurgia/efeitos adversos , Radiocirurgia/métodos , Estudos Prospectivos , Resultado do Tratamento
15.
BMC Womens Health ; 22(1): 207, 2022 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-35658863

RESUMO

BACKGROUND: Burden of breast cancer it continues to increase largely because of the aging and growth of the world population and assessment of quality of life is an important outcome measure to facilitate and improved care among breast cancer survivors, the aim of this study was to evaluate evidence of reliability, validity, and responsiveness of the Arabic version of the FACT-B + 4 questionnaire among participants with breast cancer related lymphedema (BCRL) in Saudi Arabia. METHODS: A prospective cross-sectional study, 51 participants with BCRL completed the Arabic version of FACT-B + 4. Internal consistency and test-retest-reliability were assessed using Cronbach's alpha, intraclass correlation-coefficient (ICC), and limits of agreement according to the Bland Altman method, respectively. The validation studies were carried-out by examining predefined hypotheses (n = 14) for both construct and Known-groups validity. To investigate the responsiveness, the Arabic version of FACT-B + 4 questionnaire was administrated preoperative and 4 weeks postoperatively among the participants with breast cancer (n = 34). RESULTS: The Cronbach alpha of the Arabic FACT-B + 4 total score was 0.90 and for the different subscales ranged from 0.74 to 0.89. Test-retest reliability for FACT-B + 4 total score and different subscales was found to be moderate to very strong (ICC 0.51-0.94). The Bland-Altman plot was adequate - 19.24 and 22.10 points. Measurement variability was acceptable for Arabic FACT-B + 4 and ARM subscale (standard error of measurement = 5.34, and 1.34). Moderate correlations (r = 0.42-0.62) were found between the subscale of the FACTB + 4 and the corresponding domains of SF-36. For known group validity, 72% (10 of 14) hypotheses on known group validity were accepted. CONCLUSION: FACT-B + 4 has adequate psychometric properties, thus making it useful for assessing QOL quality of life in Arabic speaking women with BCRL.


Assuntos
Linfedema Relacionado a Câncer de Mama , Neoplasias da Mama , Neoplasias da Mama/complicações , Estudos Transversais , Feminino , Humanos , Morbidade , Estudos Prospectivos , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Inquéritos e Questionários
16.
N Engl J Med ; 386(25): 2363-2376, 2022 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-35660797

RESUMO

BACKGROUND: Neoadjuvant chemotherapy and radiation followed by surgical resection of the rectum is a standard treatment for locally advanced rectal cancer. A subset of rectal cancer is caused by a deficiency in mismatch repair. Because mismatch repair-deficient colorectal cancer is responsive to programmed death 1 (PD-1) blockade in the context of metastatic disease, it was hypothesized that checkpoint blockade could be effective in patients with mismatch repair-deficient, locally advanced rectal cancer. METHODS: We initiated a prospective phase 2 study in which single-agent dostarlimab, an anti-PD-1 monoclonal antibody, was administered every 3 weeks for 6 months in patients with mismatch repair-deficient stage II or III rectal adenocarcinoma. This treatment was to be followed by standard chemoradiotherapy and surgery. Patients who had a clinical complete response after completion of dostarlimab therapy would proceed without chemoradiotherapy and surgery. The primary end points are sustained clinical complete response 12 months after completion of dostarlimab therapy or pathological complete response after completion of dostarlimab therapy with or without chemoradiotherapy and overall response to neoadjuvant dostarlimab therapy with or without chemoradiotherapy. RESULTS: A total of 12 patients have completed treatment with dostarlimab and have undergone at least 6 months of follow-up. All 12 patients (100%; 95% confidence interval, 74 to 100) had a clinical complete response, with no evidence of tumor on magnetic resonance imaging, 18F-fluorodeoxyglucose-positron-emission tomography, endoscopic evaluation, digital rectal examination, or biopsy. At the time of this report, no patients had received chemoradiotherapy or undergone surgery, and no cases of progression or recurrence had been reported during follow-up (range, 6 to 25 months). No adverse events of grade 3 or higher have been reported. CONCLUSIONS: Mismatch repair-deficient, locally advanced rectal cancer was highly sensitive to single-agent PD-1 blockade. Longer follow-up is needed to assess the duration of response. (Funded by the Simon and Eve Colin Foundation and others; ClinicalTrials.gov number, NCT04165772.).


Assuntos
Segunda Neoplasia Primária , Neoplasias Retais , Anticorpos Monoclonais Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Quimiorradioterapia/efeitos adversos , Reparo de Erro de Pareamento de DNA , Humanos , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Segunda Neoplasia Primária/patologia , Receptor de Morte Celular Programada 1 , Estudos Prospectivos , Neoplasias Retais/genética , Neoplasias Retais/terapia , Reto/patologia , Resultado do Tratamento
17.
Artigo em Inglês | MEDLINE | ID: mdl-35682483

RESUMO

Physical activity (PA) and screen time (ST) are associated with mental health in adolescents, though little is known about their inter-relationships. This study examined the associations of PA and ST with psychosomatic complaints in adolescents. Data from four cycles of the Canadian Health Behaviour in School-aged Children (HBSC) surveys, collected between 2002 and 2014, were analysed. Eight psychosomatic health complaints were assessed and dichotomised as frequent (≥2 complaints/week) vs. infrequent. PA was assessed by number of days/week participants were physically active for ≥60 min. Discretionary ST was assessed by adding three screen uses: television, electronic games, and computer. Of the 37,829 adolescents (age 13.74 (SD 1.51) years; 52% girls), 25% boys and 39% girls reported frequent psychosomatic complaints. Multilevel logistic analyses showed that ST levels were positively associated while PA levels were negatively associated with reporting frequent psychosomatic complaints in a dose-dependent manner. Compared with ST ≤ 2 hrs/d, ST ≥ 4 hrs/d in girls and ST ≥ 6 hrs/d in boys showed higher odds of reporting psychosomatic complaints. Participating in PA ≥ 60 min every day compared to no PA showed lower odds of reporting psychosomatic complaints by 44% in girls and 57% in boys. Prospective research is needed to understand the causal pathway of these dose-dependent relationships.


Assuntos
Saúde Mental , Comportamento Sedentário , Adolescente , Canadá/epidemiologia , Criança , Feminino , Humanos , Estilo de Vida , Masculino , Estudos Prospectivos
18.
Artigo em Inglês | MEDLINE | ID: mdl-35682505

RESUMO

Depression and related syndromes are well identified in older adults. Depression has been reported to increase the incidence of a multitude of somatic disorders. In older adults, the severity of depression is associated with higher mortality rates. The aim of the study is to examine whether the effect of depression screening on mortality is different between individuals with different physical health status. In order to meet this aim, we will first reprove the relationship between depression and mortality rate, and then we will set a subgroup analysis by using self-reported health (SRH) status. Our data source, Taiwan Longitudinal Study on Aging (TLSA), is a population-based prospective cohort study that was initiated by the Health Promotion Administration, Ministry of Health and Welfare, Taiwan. The depression risk was evaluated by 10-items Center for Epidemiologic Studies Depression (CES-D-10), we set 3 CES-D-10 cutting points (5, 10, and 12) and cut our subjects into four groups. Taking mortality as an end point, we use the Taiwan National Death Registry (TNDR) record from 1999 to 2012. Self-rated health (SRH) was taken as an effect modifier between depression and mortality in the elderly group, and stratification took place into three groups (good, fair, poor). The case numbers of 4 CES-D-10 groups were 2253, 939, 285 and 522, respectively. After dividing into 4 CES-D-10 groups, the mortality prevalence rose as the CES-D-10 level grew (40.7%, 47.82%, 54.39% and 67.62%, respectively). In the subgroup analysis, although the p-value of log-rank test showed <0.05 in three groups, as the SRH got worse the Hazard Ratio became more significant (p = 0.122, 0.033, <0.001, respectively). Kaplan-Meier (K-M) survival estimates for different CES-D groups in SRH were poor, and we can see the curves representing second and third CES-D group going almost together, which may suggest the cutting point of CES-D-10 in predicting depression risk should be adjusted in the relatively unhealthy elderly. The importance of the relationship between depression and mortality is re-emphasized in our study. Moreover, through joining SRH in our analysis, we can conclude that in self-rated poor health any sign of depression may lead to a rise in mortality. Therefore, we should pay attention to the old age group's psychological status, and remember that depressive mood should be scrutinized more carefully in the elderly who feel themselves to be unhealthy.


Assuntos
Depressão , Nível de Saúde , Idoso , Envelhecimento , Depressão/diagnóstico , Depressão/epidemiologia , Humanos , Estudos Longitudinais , Estudos Prospectivos , Taiwan/epidemiologia
19.
Artigo em Inglês | MEDLINE | ID: mdl-35682507

RESUMO

The previous studies found that women and low-income households were more likely to experience unemployment prior to the COVID-19 pandemic. However, there is no cohort study to examine the relationship during the COVID-19 pandemic. The aim of this prospective cohort study is to examine the relationship between sociodemographic factors and unemployment during the COVID-19 pandemic in Japan. We surveyed the socioeconomic status, personal characteristics, and occupation of recruited workers at baseline (22-25 December 2020); subsequent unemployment was examined at follow-up (18-19 February 2021). We determined the odds ratio of unemployment by sociodemographic status and occupation. The multivariate model was adjusted for sex and age. Among the 19,941 participants, 725 (3.6%) had experienced unemployment. Multivariate analysis showed significant high unemployment amongst women and participants of younger age, bereaved or divorced, unmarried, of lower income, or with short educational background. By occupation, the unemployment rate of temporary or contract employees and self-employed is high. COVID-19 expelled socially vulnerable groups from employment. This suggests the need for employment and economic support for such individuals.


Assuntos
COVID-19 , Desemprego , COVID-19/epidemiologia , Feminino , Humanos , Pandemias , Estudos Prospectivos , Fatores Socioeconômicos
20.
J Am Coll Surg ; 234(6): 1147-1159, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35703813

RESUMO

BACKGROUND: Previous randomized trials have assessed the effectiveness of triclosan-coated sutures in fascia closure after midline laparotomy in preventing surgical site infections (SSIs); however, available evidence remain inconclusive. We aimed to evaluate the effectiveness of triclosan-coated sutures in abdominal fascia closure to prevent postoperative SSIs. STUDY DESIGN: This study was a multicenter prospective trial conducted within 24 Japanese secondary and tertiary care centers and a propensity score (PS)-matched analysis. Patients 20 years of age or older who underwent elective surgery for colorectal cancer (CRC) were included. Between July 2016 and July 2019, 2,207 patients were prospectively enrolled into the triclosan-coated sutures or uncoated sutures groups. The per-protocol population comprised 2,195 patients. The PS matching was performed for 1,579 patients: 926 patients in the coated group and 653 patients in the uncoated group. The abdominal fascia after midline laparotomy was closed with triclosan-coated or uncoated sutures depending on group. The primary endpoint was the incidence of an SSI. Secondary endpoints were length of hospital stay and surgical complication rates. RESULTS: The recorded SSI rates were 4.2% in the triclosan-coated group and 6.74% in the uncoated suture group (p = 0.028). There were no serious adverse events in the groups. The final logistic regression model showed that several variables affected the occurrence of SSI. Our meta-analysis included six phase-III trials, and our study evaluated 4,797 patients. The results show a significant superiority of triclosan-coated sutures over uncoated suture material. CONCLUSION: Triclosan-coated sutures reduce the incidence of SSI after elective CRC surgery.


Assuntos
Parede Abdominal , Anti-Infecciosos Locais , Cirurgia Colorretal , Laparoscopia , Triclosan , Humanos , Laparoscopia/efeitos adversos , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Suturas/efeitos adversos , Triclosan/uso terapêutico
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