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1.
Br J Cancer ; 125(9): 1261-1269, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34493820

RESUMO

INTRODUCTION: Molecular-matched therapies have revolutionized cancer treatment. We evaluated the improvement in clinical outcomes of applying an in-house customized Next Generation Sequencing panel in a single institution. METHODS: Patients with advanced solid tumors were molecularly selected to receive a molecular-matched treatment into early phase clinical trials versus best investigators choice, according to the evaluation of a multidisciplinary molecular tumor board. The primary endpoint was progression-free survival (PFS) assessed by the ratio of patients presenting 1.3-fold longer PFS on matched therapy (PFS2) than with prior therapy (PFS1). RESULTS: Of a total of 231 molecularly screened patients, 87 were eligible for analysis. Patients who received matched therapy had a higher median PFS2 (6.47 months; 95% CI, 2.24-14.43) compared to those who received standard therapy (2.76 months; 95% CI, 2.14-3.91, Log-rank p = 0.022). The proportion of patients with a PFS2/PFS1 ratio over 1.3 was significantly higher in the experimental arm (0.33 vs 0.08; p = 0.008). DISCUSSION: We demonstrate the pivotal role of the institutional molecular tumor board in evaluating the results of a customized NGS panel. This process optimizes the selection of available therapies, improving disease control. Prospective randomized trials are needed to confirm this approach and open the door to expanded drug access.


Assuntos
Terapia de Alvo Molecular/métodos , Neoplasias/genética , Análise de Sequência de DNA/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Teorema de Bayes , Ensaios Clínicos como Assunto , Intervalo Livre de Doença , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Medicina de Precisão , Estudos Prospectivos , Padrão de Cuidado
2.
Parasitol Res ; 119(8): 2521-2529, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32591864

RESUMO

The enzyme-linked immunoelectrotransfer blot (EITB) assay to detect antibodies in serum is a complementary tool for the diagnosis of neurocysticercosis (NCC). Presence of at least one glycoprotein band corresponding to a Taenia solium (T. solium) antigen indicates a positive result; however, EITB assays have multiple glycoprotein bands, and previous work has suggested that band patterns may have additional diagnostic value. We included 58 participants with a definitive diagnosis of NCC who received care at the Instituto Nacional de Neurología y Neurocirugía in Mexico City. Three different EITB tests were applied to participants' serum samples (LDBio, France; US Centers for Disease Control and Prevention [CDC]; and Instituto de Diagnóstico y Referencia Epidemiológicos [InDRE]). There was substantial variability in specific glycoprotein band patterns among the three assays. However, in age- and sex-adjusted logistic regression models, the number of glycoprotein bands was positively associated with the presence of vesicular extraparenchymal cysts (InDRE adjusted odds ratio [aOR] 1.60 p < 0.001; CDC aOR 6.31 p < 0.001; LDBio aOR 2.45 p < 0.001) and negatively associated with the presence of calcified parenchymal cysts (InDRE aOR 0.63 p < 0.001; CDC aOR 0.25 p < 0.001; LDBio aOR 0.44 p < 0.001). In a sensitivity analysis also adjusting for cyst count, results were similar. In all three EITB serum antibody tests, the number of glycoprotein bands consistently predicted cyst stage and location, although magnitude of effect differed.


Assuntos
Ensaio de Imunoadsorção Enzimática/métodos , Glicoproteínas/análise , Proteínas de Helminto/análise , Neurocisticercose/diagnóstico , Taenia solium/isolamento & purificação , Animais , Anticorpos Anti-Helmínticos/análise , Antígenos de Helmintos/análise , Antígenos de Helmintos/imunologia , Feminino , França , Glicoproteínas/imunologia , Proteínas de Helminto/imunologia , Humanos , Masculino , México , Neurocisticercose/parasitologia , Razão de Chances , Sensibilidade e Especificidade , Taenia solium/crescimento & desenvolvimento , Taenia solium/imunologia
3.
Rev Argent Microbiol ; 52(4): 288-292, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32507326

RESUMO

This work aimed to investigate the prevalence of Trichinella infection in horses (Equus ferus caballus) handled by rural slaughterhouses across five distinctive socioeconomic regions in Mexico. Serum samples were obtained by non-probabilistic convenience sampling in the Eastern, Southern Central and Western regions (100 samples of each). Additionally, muscle tissue samples were collected from the East (n=45), Southeastern (n=88), Southern Central (n=39) and Southwestern (n=11) regions. Antibodies were determined by Western blot and the muscle tissue was examined by artificial digestion. A global antibody prevalence of 2% was obtained. Regionally, a prevalence of 5% was observed in the East and 1% in the Southern Central region. No antibodies were detected in the West region and no larvae were found in the muscle tissue samples. These findings support the low presence of Trichinella in Mexican horses, which can positively impact the Mexican horse meat trade.


Assuntos
Doenças dos Cavalos , Trichinella , Triquinelose , Matadouros , Animais , Doenças dos Cavalos/epidemiologia , Cavalos , Carne , México/epidemiologia , Fatores Socioeconômicos , Triquinelose/epidemiologia , Triquinelose/veterinária
4.
Parasitol Res ; 118(10): 2891-2899, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31418112

RESUMO

Immunodiagnosis has a supportive role in the diagnosis of neurocysticercosis (NCC). The aim of this study was to compare the validity of seven immunodiagnostic tests among serum samples from 58 patients with NCC, 26 patients with neurological diseases other than NCC, and 15 healthy controls. One test for viable parasite detection (HP10 antigen assay) and six for antibody detection were evaluated. For the entire sample, sensitivities ranged from 55.2% (NOVALISA) to 81.0% (enzyme-linked immunosorbent assay [ELISA] Taenia solium antibody), with the sensitivity of the latter test significantly higher than that of the in-house ELISA Taenia crassiceps, NOVALISA, enzyme-linked immunoelectrotransfer blot (EITB) CDC, and HP10. Overall, specificities were high, ranging from 85.4% (ELISA Ts) to 97.1% (NOVALISA), with no statistically significant differences. Detection of HP10 antigen was significantly associated with the presence of vesicular parasites. The simple and low-cost ELISA Taenia solium antibody Ab instead of EITB is recommended to support NCC diagnosis in both rural and hospital settings in Mexico.


Assuntos
Anticorpos Anti-Helmínticos/sangue , Antígenos de Helmintos/imunologia , Testes Diagnósticos de Rotina/métodos , Neurocisticercose/diagnóstico , Taenia solium/imunologia , Adulto , Animais , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Humanos , Testes Imunológicos/métodos , Masculino , México , Neurocisticercose/imunologia , População Rural , Sensibilidade e Especificidade
5.
Br J Clin Pharmacol ; 84(12): 2928-2932, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30229993

RESUMO

AIMS: Human papillomavirus (HPV) vaccines prevent infection with oncogenic virus types. We analysed reports to the US Vaccine Adverse Event Reporting System (VAERS) of adverse events (AE) following bivalent HPV vaccine (2vHPV). METHODS: We conducted descriptive analysis of 2vHPV reports, reviewed individual reports, calculated crude AE reporting rates and conducted empirical Bayesian data mining. RESULTS: Of 241 2vHPV reports, 158 were in females, 64 in males (2vHPV is approved for females only) and 19 with unknown sex; 95.8% were classified as nonserious. Dizziness, headache, nausea and injection site reactions were the most common symptoms. Crude AE reporting rates were 33.3 reports per 100 000 doses distributed overall, and 1.4 per 100 000 for serious reports. Empirical Bayesian data mining identified disproportional reporting for three types of medical errors; assessment indicated findings that were probably driven by inadvertent 2vHPV use in males. CONCLUSIONS: We did not identify any new or unexpected safety concerns in our review of 2vHPV reports to VAERS.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos , Vacinas contra Papillomavirus/efeitos adversos , Adolescente , Adulto , Teorema de Bayes , Criança , Feminino , Humanos , Masculino , Fatores de Tempo , Estados Unidos , Adulto Jovem
6.
Indian J Microbiol ; 56(3): 379-82, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27407304

RESUMO

A comparison of DOT-ELISA and Standard-ELISA was made for detection of Vibrio cholerae toxin in culture supernatants of bacteria isolated from human and environmental samples. A total of 293 supernatants were tested in a double blind assay. A correlation of 100 % was obtained between both techniques. The cholera toxin was found in 20 Inaba and 3 Ogawa strains. Positive samples were from seafood (17 samples), potable water (1 sample) and sewage (5 samples). The DOT-ELISA was useful as the standard-ELISA to confirm the presence of cholera toxin in the environmental samples.

7.
Clin Infect Dis ; 61(6): 980-7, 2015 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-26021988

RESUMO

BACKGROUND: Vaccines are among the safest medical products in use today. Hundreds of millions of vaccinations are administered in the United States each year. Serious adverse reactions are uncommon. However, temporally associated deaths can occur following vaccination. Our aim was to characterize main causes of death among reports submitted to the US Vaccine Adverse Event Reporting System (VAERS), a spontaneous vaccine safety surveillance system. METHODS: We searched VAERS for US reports of death after any vaccination from 1 July 1997 through 31 December 2013. Available medical records, autopsy reports, and death certificates were reviewed to identify cause of death. RESULTS: VAERS received 2149 death reports, most (n = 1469 [68.4%]) in children. Median age was 0.5 years (range, 0-100 years); males accounted for 1226 (57%) reports. The total annual number of death reports generally decreased during the latter part of the study period. Most common causes of death among 1244 child reports with available death certificates/autopsy reports included sudden infant death syndrome (n = 544 [44%]), asphyxia (n = 74 [6.0%]), septicemia (n = 61 [4.9%]), and pneumonia (n = 57 [4.6%]). Among 526 adult reports, most common causes of death included diseases of the circulatory (n = 247 [46.9%]) and respiratory systems (n = 77 [14.6%]), certain infections and parasitic diseases (n = 62 [11.8%]), and malignant neoplasms (n = 20 [3.8%]). For child death reports, 79.4% received >1 vaccine on the same day. Inactivated influenza vaccine given alone was most commonly associated with death reports in adults (51.4%). CONCLUSIONS: No concerning pattern was noted among death reports submitted to VAERS during 1997-2013. The main causes of death were consistent with the most common causes of death in the US population.


Assuntos
Causas de Morte , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/mortalidade , Vacinas/efeitos adversos , Adolescente , Adulto , Sistemas de Notificação de Reações Adversas a Medicamentos , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Estados Unidos/epidemiologia , Vacinas/administração & dosagem , Adulto Jovem
8.
Folia Parasitol (Praha) ; 622015 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-26384366

RESUMO

We have studied the influence of both levamisole (AL) and Freund's adjuvant (AF) on the immunisation of mice with the secretory antigens of adults of the liver fluke Fasciola hepatica Linnaeus, 1758. Total IgG antibodies were detected in all groups where the F. hepatica antigen was administered, been levels of IgG1 increased respect to IgG2a antibodies. During immunisation, IL-4 and IFN-γ were only detected in AL and AF groups, but after infection, IL-4 boosted in all groups. IFN-γ increased two fold in AF and AL groups compared to the saline solution (AS) group. Worm recovering was of 32-35% in groups administered without antigen whereas in AS, AL and AF groups recovering was of 25%, 12% and 8%, respectively. Macroscopical lesions in the liver were scarce in AL and AF groups. Our data suggest that immunisation of mice with antigens of F. hepatica enhances the immune response avoiding both liver damage and worm establishment after challenge infection. The murine model of fasciolosis has appeared to be useful to elucidate the mechanism by which the parasite modulates immune responses toward a Th2 type but also the development of Th1 type-inducing vaccines.

9.
Vet Res Commun ; 48(2): 1211-1217, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37938422

RESUMO

Trichinella is a nematode that are spread by the consumption of parasitized meat. Carnivora, a mammalian order, serve as key hosts for this parasite. However, evidence of Trichinella in wildlife from the Neotropics is extremely scarce, with reports documenting its presence only for five carnivore species: two Felidae, one Otariidae and two Mustelidae. Other widely distributed species that are consumed as bushmeat, such as Procyonidae, have not been studied in this context. A long-term study was performed for antibodies against Trichinella in coatis (Nasua narica) and common raccoons (Procyon lotor) in southeastern Mexico. Between the summer of 2009 to the winter 2013, a total of 291 coati samples and 125 raccoon samples were collected from a tropical green area located within an urban zone. An Enzyme-linked immunosorbent assay (ELISA) was used to detect antibodies against the excretory and secretory products of Trichinella spiralis muscle larva. ELISA-positive samples were further confirmed by Western Blot analysis. Results showed no evidence of antibodies during the first two years of study. However, in 2011, a sudden appearance of anti-Trichinella occurred. The seroprevalence reached its highest peak of 43% for coatis during winter 2013 and 53% for raccoons in summer 2013. This is the first study that provides evidence of Trichinella circulation within a neotropical procyonid community.


Assuntos
Mustelidae , Procyonidae , Trichinella , Animais , Guaxinins/parasitologia , Procyonidae/parasitologia , México , Estudos Soroepidemiológicos
10.
Vet Med Sci ; 10(4): e1474, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38767566

RESUMO

BACKGROUND: Parasitic diseases of pigs are a public and veterinary health problem. Helminths influence pork production, whereas backyard pigs can transmit these parasites. OBJECTIVES: This work aimed to investigate the prevalence of antibodies against Ascaris suum and Trichinella spiralis in backyard pigs from Jamiltepec, Region de la Costa, Oaxaca, in Southwestern Mexico. METHODS: Six hundred sixty-four serum samples were obtained from backyard pigs from 23 rural villages distributed in 5 municipalities; samples were taken in a non-probabilistic manner with the owner's consent. The presence of serum antibodies against a total extract of A. suum adult worm was determined by ELISA. In contrast, antibodies to the excretion-secretion products of the T. spiralis muscle larva were determined by Western blot. RESULTS: The global seroprevalence for A. suum was 5.12% and 2.41% for T. spiralis; however, antibodies were only found in 8 villages and distributed in 3 municipalities. The highest frequency of positivity for Ascaris was found in the municipality of Santa Catarina Mechoacán (13.01%), whereas, in Santa María Huazalotitlán, the highest frequency of positivity for Trichinella was found (5.75%). In San Andrés, frequencies were 7.23% and 4.82%, respectively. No statistical differences were observed between populations. CONCLUSIONS: Our data suggest that helminth transmission is restricted by locality. However, further studies must be conducted to understand the factors limiting this transmission to promote pork meat production in parasite-free zones.


Assuntos
Ascaríase , Ascaris suum , Doenças dos Suínos , Trichinella spiralis , Triquinelose , Animais , México/epidemiologia , Doenças dos Suínos/epidemiologia , Doenças dos Suínos/parasitologia , Triquinelose/epidemiologia , Triquinelose/veterinária , Triquinelose/parasitologia , Suínos , Ascaríase/epidemiologia , Ascaríase/veterinária , Trichinella spiralis/isolamento & purificação , Trichinella spiralis/imunologia , Estudos Soroepidemiológicos , Prevalência , Sus scrofa , Anticorpos Anti-Helmínticos/sangue , Anticorpos Anti-Helmínticos/análise , População Rural/estatística & dados numéricos
11.
Diabetes Metab Syndr Obes ; 17: 1667-1673, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38616987

RESUMO

Purpose: Diabetes is a public health problem that requires strategies to impact glycemic control and reduce the risk of long-term medical complications. Pharmacological management is a necessary treatment for this disease. Therefore, semaglutide is an essential tool to achieve the treatment targets. The present study aimed to evaluate the semaglutide effects on a cohort with type 2 diabetes mellitus (T2DM) in Colombia. Materials and Methods: The cohort included 49 patients with T2DM that have been treated in a specialized care center. Their glycemic outcomes, weight, renal function, and adverse events were evaluated through a 3-, 6- and 12-month follow-up. Results: Significant differences were observed in the outcome evaluation: reduction of glycated hemoglobin levels (MD -2.74 CI -1.95 to -3.52 in 6 months), fasting plasma glucose levels, body weight (MD -7.11 CI -5.97 to -8.24), and the albumin-to-creatinine ratio. The results were maintained throughout the treatment period. The adverse event rate was 16.3%, predominating gastrointestinal events. Conclusion: This real-world evidence shows the efficacy of semaglutide in achieving treatment goals in patients with T2DM.

12.
Transl Res ; 271: 105-115, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38782356

RESUMO

Understanding progression mechanisms and developing new targeted therapies is imperative in pancreatic ductal adenocarcinoma (PDAC). In this study, 80 metastatic PDAC patients were prospectively recruited and divided into discovery (n=37) and validation (n=43) cohorts. Tumor and plasma samples taken at diagnosis were pair analyzed using whole exome sequencing (WES) in patients belonging to the discovery cohort alone. The variant allele frequency (VAF) of KRAS mutations was measured by ddPCR in plasma at baseline and response assessment in all patients. Plasma WES identified at least one pathogenic variant across the cohort, uncovering oncogenic mechanisms, DNA repair, microsatellite instability, and alterations in the TGFb pathway. Interestingly, actionable mutations were mostly found in plasma rather than tissue. Patients with shorter survival showed enrichment in cellular organization regulatory pathways. Through WES we could identify a specific molecular profile of patients with liver metastasis, which exhibited exclusive mutations in genes related to the adaptive immune response pathway, highlighting the importance of the immune system in liver metastasis development. Moreover, KRAS mutations in plasma (both at diagnosis and persistent at follow-up) correlated with shorter progression free survival (PFS). Patients presenting a reduction of over 84.75 % in KRAS VAF at response assessment had similar PFS to KRAS-negative patients. Overall, plasma WES reveals molecular profiles indicative of rapid progression, potentially actionable targets, and associations between adaptive immune response pathway alterations and liver tropism.


Assuntos
Carcinoma Ductal Pancreático , DNA Tumoral Circulante , Progressão da Doença , Sequenciamento do Exoma , Neoplasias Pancreáticas , Humanos , Carcinoma Ductal Pancreático/genética , Carcinoma Ductal Pancreático/patologia , Carcinoma Ductal Pancreático/secundário , Carcinoma Ductal Pancreático/mortalidade , Masculino , Feminino , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/patologia , Pessoa de Meia-Idade , Idoso , DNA Tumoral Circulante/genética , DNA Tumoral Circulante/sangue , Mutação , Metástase Neoplásica , Proteínas Proto-Oncogênicas p21(ras)/genética , Adulto
13.
Clin Interv Aging ; 18: 273-282, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36851976

RESUMO

Purpose: To measure the effects of an exercise program on the physical capacities of older adults such as strength, flexibility, balance, and aerobic capacity. Patients and Methods: This was a quasi-experimental study on a population of 5550 older adults and a sample of 4830 participants in an active aging program designed by the Municipal Health Secretary. The exercise program lasted 12 months, and pre-and post-program intervention measures were recorded using the senior fitness test. Results: Most participants were women (92.4%) and their mean age was 70.7 years (standard deviation, 7.3 years; range, 60-97 years). All areas showed significant differences before and after the program in terms of the participants' physical capabilities (p < 0.05), muscular strength and flexibility had a more significant mean difference and a large effect (>0.80), except for aerobic capacity, which had a small effect. Conclusion: The present study revealed that a supervised physical exercise program at the community level has positive effects on the physical capacities of coordination, balance, flexibility, strength, and aerobic capacity, which are essential components for a better functional capacity at this stage of life, with improvements that encompassed the improved self-perception of their health status, a reduction of overweight and obesity. The reinforcement of these programs is recommended, consequently, promoting pre-sport games and sports championships among the elderly population, as a public health strategy.


Assuntos
Exercício Físico , Força Muscular , Humanos , Idoso , Feminino , Masculino , Envelhecimento , Terapia Comportamental , Terapia por Exercício
14.
Int J Gen Med ; 16: 697-705, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36866168

RESUMO

Purpose: This study aims to determine the seroprevalence of coronavirus disease (COVID-19) among health care workers and describe the associated sociodemographic and labor features. Patients and Methods: An observational study with an analytical component was conducted at a clinic in Cali, Colombia. The sample size was 708 health workers and they were selected by stratified random sampling. A Bayesian analysis was developed to determine the raw and adjusted prevalence. A Poisson regression model was used to estimate the prevalence ratios. Results: Overall seroprevalence of COVID-19 among healthcare workers was 29%. Miscellaneous services workers, healthcare, and administrative workers, was 38%, 33%, and 32%, respectively. Factors related to seropositivity were having a contact with a COVID-19 patient for >120 minutes and being diagnosed with COVID-19 by laboratory tests. Conclusion: The present study shows a adjusted seroprevalence of 29% in health workers, indicating a high level of disease transmission and an increased risk of infection in this population group.

15.
Vet Res Forum ; 14(10): 525-530, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37901349

RESUMO

The different microorganisms that make up the normal microbiota of birds can be present in different substrates such as the soil and other elements that make up the habitat. In the case of the cattle egret, the intestinal microbiota can change due to partially migratory habits. Thus, this study aimed to isolate and identified fungi and yeasts with zoonotic potential obtained from cattle egret (Bubulcus ibis) droppings settler in Tulancingo, Hidalgo, at Eastern economic zone of Mexico. Cattle egret droppings were collected for analysis, a total of 240 pool samples, which were spread on Sabouraud agar and incubated at 25.00 - 37.00 ˚C for 2 to 3 days. Filamentous fungi and yeast were identified by morphology and Lactophenol Blue staining or Chinese Ink stains. Filamentous fungi genera Mucor spp. (42.35%), Rhizopus spp. (26.71%); Penicillium spp. (13.35%); Paecilomyces spp. (11.40%); Scedosporium spp. (1.95%); and, from yeasts such as Cryptococcus spp. (2.29%); Rhodotorula spp. (1.95%) were identified. In this work, the presence of filamentous fungi genera and yeasts with zoonotic potential were isolated from droppings of cattle egret. The clinical presentation of fungal infections in humans can occur when immunosuppression is present or different predisposition factors are conjugated. The presence of birds and their dropping in anthropogenic activities is not a predisposing factor for the presentation of the disease in immunologically competent humans.

16.
Open Access Emerg Med ; 15: 217-225, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37292453

RESUMO

Data on the optimal diagnostic management of pregnant women with suspected pulmonary embolism are limited. Despite a lack of compelling evidence in some practices, clinical practice guidelines focus on the management of these patients. We present the case of a 24-year-old patient at 36 weeks of pregnancy in whom pulmonary thromboembolism (PTE) was diagnosed in a timely manner also with hemodynamic instability and echocardiographic images with clear involvement of the right cavities. She received thrombolytic therapy with alteplase 100 mg intravenously over 2 hours, which resulted in excellent outcomes for both the pregnant woman and fetus. Understanding the acute approach and management of these patients will improve our clinical practice; therefore, we reviewed a case report of a pregnant patient with high-risk PTE and compared it with current evidence. In conclusion, PE is a common disease with a high mortality rate during pregnancy. Therefore, having made a timely diagnosis using the relevant diagnostic aids and performing thrombolysis with rtPA increase the probability of survival in our patient, leading to successful results for both her and the fetus.

17.
Ther Clin Risk Manag ; 19: 447-454, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37292584

RESUMO

Purpose: Central venous oxygen saturation (ScvO2) has been reported as a prognostic marker of in-hospital mortality when it is below 60% in certain situations. Nevertheless, it has not been widely reported in patients undergoing coronary artery bypass graft (CABG). The study determined the association between ScvO2 and in-hospital mortality in patients undergoing CABG in a high-complexity health institution in Santiago de Cali, Colombia. Patients and Methods: A retrospective cohort study was conducted with patients undergoing isolated CABG. The subject sample included 515 subjects aged 18 years or older. Exposure was defined as ScvO2 <60% upon admission to the intensive care unit (ICU) following surgery. The major outcome was mortality rates after 30 days. Furthermore, exposure variables were measured at preoperative, intra-operative, and postoperative time points. Results: A total of 103 exposed and 412 unexposed subjects were included. The final model revealed a higher mortality risk in individuals with ScvO2 <60% upon ICU admission compared with those with higher saturation levels (relative risk 4.2, 95% confidence interval: 2.4-7.2; p = 0.001). Values were adjusted using variables such as age (>75 years), low socioeconomic stratum, chronic kidney failure before surgery, unstable angina before surgery, ischemia time (>60 min), and intra-operative inotrope use. The primary cause of death was cardiogenic shock (54.7%), followed by sepsis (25.0%) and postoperative bleeding (17.2%). Conclusion: The study identified an association between ScvO2 <60% and in-hospital mortality in patients undergoing CABG.

18.
Chin Clin Oncol ; 12(4): 45, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37599513

RESUMO

BACKGROUND: Tumor lysis syndrome (TLS) is recognized as an oncologic disorder with a variable incidence. TLS can cause the rapid destruction of tumor cells in response to oncologic therapy and is characterized by multiple electrolyte disturbances as well as its secondary complications, including death. This disease is common among patients with hematologic neoplasms, but very rare among those with solid tumors, as is the case with sarcomas. Such patients have a poor prognosis and increased risk of mortality. In the patient's particular case, this occurred after initiating third-line systemic therapy with gemcitabine associated with pazopanib, an event not previously described in the literature. CASE DESCRIPTION: We report the case of a patient with a history of high-grade sarcoma of the left lower limb T4N1M0 stage IIIB undergoing surgical management and exhibiting tumor progression with the need for third-line systemic therapy with pazopanib and gemcitabine. The patient presented with pain at the amputation site, inflammatory changes, and a tumor mass of large components on admission. They later developed electrolyte imbalance and acute renal injury compatible with TLS after systemic therapy was initiated. Pharmacological therapy, including rasburicase, was initiated based on the clinical and laboratory findings. Due to the progression of renal involvement, it was necessary to initiate haemodialysis, and during her hospital stay, the patient presented febrile syndrome associated with pancytopenia. The patient showed a favourable clinical response to the proposed antibiotic therapy and recovery of renal function, for which reason therapy was restarted with pazopanib and gemcitabine, the latter with a 20% reduction for the following cycles. Outpatient follow-up continued, completing eight cycles of treatment with good tolerance and partial clinical response; the patient died of respiratory complications eight months after discharge. CONCLUSIONS: There is limited evidence for TLS in patients with high-grade sarcoma in the literature related to the oncologic therapy used; this indicates that early risk evaluation along with prompt initiation of effective therapies is required to prevent the appearance of this type of complications in the short and long term.


Assuntos
Sarcoma , Síndrome de Lise Tumoral , Feminino , Humanos , Gencitabina , Síndrome de Lise Tumoral/etiologia , Sarcoma/complicações , Sarcoma/tratamento farmacológico , Eletrólitos
19.
Case Rep Oncol ; 16(1): 613-620, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37900810

RESUMO

We present the case of a 64-year-old female with stage IV gastric adenocarcinoma, pulmonary, and abdominal wall metastases, and no history of cardiovascular disease. In palliative care, she received systemic cytotoxic treatment with fluorouracil, leucovorin, oxaliplatin, and docetaxel protocol, which was well tolerated over five cycles. During cycle 6, she presented with cardiovascular symptoms with hemodynamic consequences while receiving oxaliplatin injection without docetaxel or 5-fluorouracil. She was transferred to the emergency department and then to the intensive care unit. She developed no complications during the hospital stay and was discharged after 10 days with preserved systolic function and no structural changes at the myocardial level. The electrocardiogram, echocardiogram, cardiac catheterization, and magnetic resonance imaging findings indicated an oxaliplatin-associated Takotsubo syndrome. The immunochemistry analysis showed PD-L1 expression level TPS: 40% and the foundation one genomic profiling revealed high mutation load, microsatellite instability, and HER2 not found. The patient is currently asymptomatic and on pembrolizumab monotherapy with good tolerance and partial treatment response.

20.
Zoonoses Public Health ; 70(5): 434-444, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-36852740

RESUMO

In Mexico, for the past 30 years, a continuous decrease in the incidence of clinical taeniosis/cysticercosis has been documented. This work aimed to determine the influence of improvement in socioeconomic conditions on the prevalence of Taenia solium in four endemic communities in northwestern Mexico. This study was carried out in two phases. First, documentary information (1989-2018) was collected about the prevalence of Theridion solium in the federal entity of Sinaloa State. Second, a pilot study was performed in four communities of Sinaloa, which had an endemic history of Taenia transmission. In each community, a risk factor questionnaire was applied, and serum and stool samples were collected for convenience in a non-probabilistic way. Anti-cysticercus antibodies and adult worm coproantigen were determined. The documentary analysis showed the incidence of taeniosis and cysticercosis to have decreased by 98 and 53%, respectively, while the human development index increased by 5% (1992-2017). Our data suggest that the risk of parasitic transmission is low, although female sex was a risk factor for reporting tremors or seizures (prevalence rate 2.1336, CI: 1.1821-3.8508) and background of tapeworm infection (prevalence rate 1.2893, CI: 0.9795-1.6972). No tapeworms or eggs were found while examining stool samples, but protozoa cysts were observed in four samples. Unexpectedly, only one of the 79 stool samples was positive for coproantigens. This positive result was confirmed in a second sample. However, the evaluation of a third sample was negative. No antibodies were found in human (n = 377) or pig (n = 69) samples. These data suggest parasite transmission has been interrupted and could be possibly associated with improving socioeconomic conditions. Further studies are needed to determine the real prevalence of zoonoses in Mexico.


Assuntos
Cisticercose , Doenças dos Suínos , Taenia solium , Teníase , Feminino , Humanos , Suínos , Animais , Prevalência , México/epidemiologia , Projetos Piloto , Óvulo , Cisticercose/epidemiologia , Cisticercose/parasitologia , Cisticercose/veterinária , Teníase/epidemiologia , Teníase/parasitologia , Teníase/veterinária , Doenças dos Suínos/epidemiologia , Fatores Socioeconômicos
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