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1.
Langmuir ; 40(9): 4615-4622, 2024 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-38387073

RESUMO

The cellular environment is crowded with macromolecules of different shapes and sizes. The effect of this macromolecular crowding has been studied in a variety of synthetic crowding environments: two popular examples are the compact colloid-like Ficoll macromolecule and the globular protein bovine serum albumin (BSA). Recent studies have indicated that a significant component of bound or surface-associated water in these crowders reduces the available free volume. In this work, Brillouin light scattering experiments were performed on aqueous solutions of Ficoll 70 and Ficoll 400 with concentrations ranging from 1 to 35 wt % and BSA with concentrations of 1 to 27 wt %. From the dependence of spectral peak parameters on polymer concentration, we determined fundamental solution properties: hypersound velocity, adiabatic bulk modulus and compressibility, apparent viscosity, and hypersound attenuation. The existing theory that ignores intermolecular interactions can capture only the observed linear trends in the frequency shift up to a threshold concentration, beyond which a quadratic term accounting for intermolecular interactions is necessary. This likely indicates a transition from the dilute to semidilute regime. In the Ficoll solutions (but not BSA), we see evidence for a central mode, which is indicative of relaxation in the hydration shell of Ficoll.


Assuntos
Soroalbumina Bovina , Água , Ficoll/química , Soroalbumina Bovina/química , Substâncias Macromoleculares , Análise Espectral , Soluções/química
2.
Bull World Health Organ ; 101(9): 558-570G, 2023 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-37638357

RESUMO

Objective: To estimate the prevalence of individual chronic conditions and multimorbidity among adults admitted to hospital in countries in sub-Saharan Africa. Methods: We systematically searched MEDLINE®, Embase®, Global Index Medicus, Global Health and SciELO for publications reporting on patient cohorts recruited between 1 January 2010 and 12 May 2023. We included articles reporting prevalence of pre-specified chronic diseases within unselected acute care services (emergency departments or medical inpatient settings). No language restrictions were applied. We generated prevalence estimates using random-effects meta-analysis alongside 95% confidence intervals, 95% prediction intervals and I2 statistics for heterogeneity. To explore associations with age, sex, country-level income status, geographical region and risk of bias, we conducted pre-specified meta-regression, sub-group and sensitivity analyses. Findings: Of 6976 identified studies, 61 met the inclusion criteria, comprising data from 20 countries and 376 676 people. None directly reported multimorbidity, but instead reported prevalence for individual conditions. Among medical admissions, the highest prevalence was human immunodeficiency virus infection (36.4%; 95% CI: 31.3-41.8); hypertension (24.4%; 95% CI: 16.7-34.2); diabetes (11.9%; 95% CI: 9.9-14.3); heart failure (8.2%; 95% CI: 5.6-11.9); chronic kidney disease (7.7%; 95% CI: 3.9-14.7); and stroke (6.8%; 95% CI: 4.7-9.6). Conclusion: Among patients seeking hospital care in sub-Saharan Africa, multimorbidity remains poorly described despite high burdens of individual chronic diseases. Prospective public health studies of multimorbidity burden are needed to generate integrated and context-specific health system interventions that act to maximize patient survival and well-being.


Assuntos
Doença Crônica , Atenção à Saúde , Pacientes , Adulto , Humanos , África Subsaariana/epidemiologia , Hospitais , Estudos Prospectivos
3.
Int Ophthalmol ; 33(2): 159-62, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23015023

RESUMO

Peripapillary choroidal neovascularisation (CNV) in the context of ocular syphilis is exceptional and little is known about its natural history and optimal therapeutic management. We report here a case of right eye peripapillary CNV with subretinal fluid encroaching on the fovea in a patient with mild bilateral ocular inflammation and cystoid macular oedema (CMO) in his contralateral eye. Extensive investigations revealed positive serology for active syphilitic infection. The patient received treatment with intravenous benzylpenicillin according to the algorithm for neurosyphilis complemented with oral corticosteroids as prophylaxis against Jarisch-Herxsheimer reaction for a period of 17 days. On the 15th day, receding of subretinal fluid in his right eye to a small pocket around the optic disc was identified as well as resolution of left eye CMO. We suggest that a course of antibiotic treatment for neurosyphilis with the addition of oral corticosteroids may be an effective therapeutic option for CNV in the context of ocular syphilis and thus more invasive treatment approaches are not warranted.


Assuntos
Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/microbiologia , Neurossífilis/complicações , Neurossífilis/tratamento farmacológico , Penicilina G/administração & dosagem , Prednisolona/administração & dosagem , Antibacterianos/administração & dosagem , Quimioterapia Combinada , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/microbiologia , Glucocorticoides/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade
4.
Intensive Care Med ; 49(7): 772-784, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37428213

RESUMO

There is a high burden of critical illness in low-income countries (LICs), adding pressure to already strained health systems. Over the next decade, the need for critical care is expected to grow due to ageing populations with increasing medical complexity; limited access to primary care; climate change; natural disasters; and conflict. In 2019, the 72nd World Health Assembly emphasised that an essential part of universal health coverage is improved access to effective emergency and critical care and to "ensure the timely and effective delivery of life-saving health care services to those in need". In this narrative review, we examine critical care capacity building in LICs from a health systems perspective. We conducted a systematic literature search, using the World Heath Organisation (WHO) health systems framework to structure findings within six core components or "building blocks": (1) service delivery; (2) health workforce; (3) health information systems; (4) access to essential medicines and equipment; (5) financing; and (6) leadership and governance. We provide recommendations using this framework, derived from the literature identified in our review. These recommendations are useful for policy makers, health service researchers and healthcare workers to inform critical care capacity building in low-resource settings.


Assuntos
Atenção à Saúde , Mão de Obra em Saúde , Humanos , Cuidados Críticos , Análise de Sistemas , Recursos em Saúde
5.
J Intensive Care Soc ; 23(3): 297-304, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36033240

RESUMO

Background: Critically ill children presenting to district general hospitals (DGH) are admitted to adult intensive care units (AICUs) for stabilisation prior to transfer to paediatric intensive care units (PICUs). Current training in PICU for adult intensive care physicians is only three months. This single centre retrospective case series examines the case mix of children presenting to a DGH AICU and a multidisciplinary survey assesses confidence and previous experience, highlighting continued training needs for DGH AICU staff. Methods: all paediatric admissions to AICU and paediatric retrievals were reviewed over a 6-year period (2014-2019). Cases were identified from the Electronic Patient Record (EPR) and from data provided by the regional paediatric retrieval service. A questionnaire survey was sent to AICU doctors and nurses to assess confidence and competence in paediatric critical care. Results: Between 2014-2019, 284 children were managed by AICU. In total 35% of cases were <1 y, 48% of cases were <2 y and 64% of cases were <5 y, and 166/284 (58%) children were retrieved. Retrieval reduced with increasing age (OR 0.49 [0.40-0.60], p < 0.0001). The survey had an 82% response rate, and highlighted that only 13% of AICU nurses and 50% of doctors had received prior PICU training. Conclusion: At least one critically unwell child presents to the AICU each week. Assessment, stabilisation and management of critically unwell children are vital skills for DGH AICU staff, but confidence and competence are lacking. Formalised strategies are required to develop and maintain paediatric competencies for AICU doctors and nurses.

6.
Am J Trop Med Hyg ; 106(2): 685-694, 2022 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-35008056

RESUMO

Schistosomiasis control requires multisectoral approaches including praziquantel treatment, access to safe water, sanitation and hygiene, and health education. Community input can help ensure health education programs are culturally appropriate to effectively direct protective behavior change. This study reports on the three-stage development of an education program for Malagasy children, with an impact evaluation on their knowledge, attitudes, and practices (KAP) related to intestinal schistosomiasis. A cross-sectional study took place in 2017 with follow-up in 2018 in the hard-to-reach Marolambo district, Madagascar. A novel schistosomiasis education program (SEP) was designed in collaboration with researchers, stakeholders, and local community and included cartoon books, games, songs, puzzles, and blackboard lessons, costing $10 USD per school. KAP questionnaires were completed by 286 children pre-SEP and 273 children post-SEP in 2017, and by 385 and 337 children pre-SEP and post-SEP, respectively, in 2018. Improvements were observed in responses to all questions between pre- and post-education answers in 2017 (53-77%, P < 0.0001) and 2018 (72-98%, P < 0.0001) and in the pre-education answers between years (53-72%, P < 0.0001). Praziquantel mass drug administration attendance improved, rising from 64% to 91% (P < 0.0001), alongside improved latrine use, from 89% to 96% (P = 0.005). This community-consulted and -engaged SEP resulted in substantial improvements in children's understanding of schistosomiasis, with improvements in praziquantel uptake and latrine use. Socioculturally tailored education programs can help gain schistosomiasis control. Continued investment in SEP will help promote the future well-being of children through increased participation in control and treatment activities.


Assuntos
Saúde da Criança/etnologia , Participação da Comunidade/métodos , Educação em Saúde/métodos , Conhecimentos, Atitudes e Prática em Saúde , Avaliação de Programas e Projetos de Saúde , Esquistossomose/prevenção & controle , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Humanos , Madagáscar , Masculino
7.
J Child Adolesc Psychiatr Nurs ; 34(4): 352-359, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34216414

RESUMO

PURPOSE: To describe observed nursing responses and interventions to adolescent inpatients experiencing distress. METHODS: Thorne's interpretive descriptive approach guided data collection and analysis of nonparticipant observations of a purposive sample of adolescents, and nurses. FINDINGS: Three major themes are presented: engagement: responses and interventions for working with distress; adolescent reactions and nurses' clinical decision making to manage distress; and outcomes: escalation or resolution of distress. CONCLUSIONS: The TAR3 conceptual model developed from this study can guide nurses' responses to distressed adolescents and promote safety, enhance positive outcomes, and reduce the use of coercive interventions.


Assuntos
Saúde Mental , Enfermeiras e Enfermeiros , Adolescente , Criança , Família , Humanos , Pacientes Internados , Pesquisa Qualitativa
8.
Infect Dis Poverty ; 10(1): 87, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34172089

RESUMO

School-aged children (SAC) have a considerable burden of intestinal schistosomiasis in Madagascar yet its burden in pre-school aged children (PSAC) is currently overlooked. To assess the at-risk status of PSAC, we undertook a pilot epidemiological survey in June 2019 examining children (n = 89), aged 2-4-years of balanced gender, in six remote villages in Marolambo District, Madagascar. Diagnosis included use of urine-circulating cathodic antigen (CCA) dipsticks and coproscopy of stool with duplicate Kato-Katz (K-K) thick smears. Prevalence of intestinal schistosomiasis by urine-CCA was 67.4% (95% confidence interval [CI]: 56.5-77.2%) and 35.0% (95% CI: 24.7-46.5%) by K-K. The relationship between faecal eggs per gram (epg) and urine-CCA G-scores (G1 to G10) was assessed by linear regression modelling, finding for every increment in G-score, epg increased by 20.4 (6.50-34.4, P = 0.006). Observed proportions of faecal epg intensities were light (78.6%), moderate (17.9%) and heavy (3.6%). Soil-transmitted helminthiasis was noted, prevalence of ascariasis was 18.8% and trichuriasis was 33.8% (hookworm was not reported). Co-infection of intestinal schistosomiasis and soil-transmitted helminthiasis occurred in 36.3% of PSAC. These results provide solid evidence highlighting the overlooked burden of intestinal schistosomiasis in PSAC, and they also offer technical  guidance for better surveillance data for the Madagascan national control programme.


Assuntos
Helmintíase , Esquistossomose mansoni , Animais , Criança , Pré-Escolar , Estudos Transversais , Fezes , Humanos , Madagáscar/epidemiologia , Prevalência , Schistosoma mansoni , Esquistossomose mansoni/epidemiologia
9.
Am J Trop Med Hyg ; 104(5): 1841-1850, 2021 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-33684064

RESUMO

Schistosomiasis is a major public health problem in Madagascar. The WHO recommends preventive chemotherapy by mass drug administration (MDA) with praziquantel as the primary approach to control Schistosoma mansoni-related morbidity in endemic populations, alongside complementary interventions such as health education. The impact of annual MDA and health education programs was assessed in the hard-to-reach Marolambo district of eastern Madagascar, an area endemic for S. mansoni. Repeated cross-sectional studies undertaken 2015-2019 examined between 300 and 381 school-aged children (aged 5-14 years) annually. The prevalence and infection intensity of S. mansoni were assessed by urine-circulating cathodic antigen (CCA) dipsticks and coproscopy using Kato-Katz (KK) methodologies. After four rounds of annual MDA, a reduction in S. mansoni prevalence was seen in CCA (93.9% in year 1-87.7% in year 5; P = 0.007) and KK (73.9% in year 1-59.4% in year 5; P < 0.0001). The prevalence of heavy-intensity infections roughly halved from 23.7% to 10.1% (P < 0.0001), and the mean intensity of infection fell by 55.0% (480.2-216.3 eggs per gram of feces). A malacological survey found Biomphalaria pfeifferi snail intermediate hosts in multiple water contact sites including rice paddies, streams, and Nosivolo River. Despite reductions in infection prevalence and intensity, schistosomiasis still poses a significant public health challenge in Marolambo district. Twice yearly MDA cycles and/or community-wide MDA are suggested to better reduce infections. Expanding health education, improving standards of water, sanitation and hygiene, and attention on snail-related control will also be important, especially in rice paddy irrigated areas.


Assuntos
Esquistossomose mansoni/epidemiologia , Esquistossomose mansoni/patologia , Adolescente , Animais , Anti-Helmínticos/administração & dosagem , Anti-Helmínticos/uso terapêutico , Criança , Pré-Escolar , Doença Crônica , Feminino , Humanos , Madagáscar/epidemiologia , Masculino , Administração Massiva de Medicamentos , Praziquantel/administração & dosagem , Praziquantel/uso terapêutico , Prevalência , Schistosoma mansoni/fisiologia , Esquistossomose mansoni/tratamento farmacológico
10.
Genet Vaccines Ther ; 8: 5, 2010 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-20637091

RESUMO

BACKGROUND: We have previously demonstrated protective efficacy against B. melitensis using formulations of naked DNA vaccines encoding genes ialB and omp25. The present study was undertaken to further understand the immune response generated by the protective vaccination regimens and to evaluate cationic liposome adsorption as a delivery method to improve vaccine utility. METHODS: The protective efficacy and immunogenicity of vaccines delivered as four doses of naked DNA, a single dose of naked DNA or a single dose of DNA surface adsorbed to cationic liposomes were compared using the BALB/c murine infection model of B. melitensis. Antigen-specific T cells and antibody responses were compared between the various formulations. RESULTS: The four dose vaccination strategy was confirmed to be protective against B. melitensis challenge. The immune response elicited by the various vaccines was found to be dependent upon both the antigen and the delivery strategy, with the IalB antigen favouring CD4+ T cell priming and Omp25 antigen favouring CD8+. Delivery of the p-ialB construct as a lipoplex improved antibody generation in comparison to the equivalent quantity of naked DNA. Delivery of p-omp25 as a lipoplex altered the profile of responsive T cells from CD8+ to CD4+ dominated. Under these conditions neither candidate delivered by single dose naked DNA or lipoplex vaccination methods was able to produce a robust protective effect. CONCLUSIONS: Delivery of the p-omp25 and p-ialB DNA vaccine candidates as a lipoplex was able to enhance antibody production and effect CD4+ T cell priming, but was insufficient to promote protection from a single dose of either vaccine. The enhancement of immunogenicity by lipoplex delivery is a promising step toward improving the practicality of these two candidate vaccines, and suggests that this lipoplex formulation may be of value in situations where improvements to CD4+ responses are required. However, in the case of Brucella vaccine development it is suggested that further modifications to the candidate vaccines and delivery strategies will be required in order to deliver sustained protection.

11.
Biologicals ; 38(6): 684-95, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20724180

RESUMO

This report aims to facilitate the implementation of the Three Rs (reduction, refinement and replacement) in the testing of vaccines for regulatory and other purposes. The focus is predominantly on identification of reduction and refinement opportunities in batch potency testing but the principles described are widely applicable to other situations that involve experimental infections of animals. The report should also help to interpret the requirements of the European Pharmacopoeia with regard to the use of alternative tests, humane endpoints and other refinements. Two specific worked examples, for batch potency testing of Clostridium chauvoei and canine leptospira, with recommendations for harmonisation of international test requirements for these and other vaccines, are provided as appendices online.


Assuntos
Vacinas/imunologia , Medicina Veterinária , Animais , Vacinas/administração & dosagem , Vacinas/uso terapêutico
12.
Trans R Soc Trop Med Hyg ; 114(4): 315-322, 2020 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-32181487

RESUMO

BACKGROUND: A cross-sectional survey was performed to estimate the prevalence of periportal fibrosis in children based on ultrasound examination in the Marolambo district of the Atsinanana region of Madagascar. This is a remote area known to have a high prevalence of intestinal schistosomiasis. METHODS: School-aged children (5-14 y) were selected from six villages for parasitological and sonographic examination. Circulating cathodic antigen (CCA) tests and Kato Katz (KK) stool microscopy were performed. Video-clips of liver views were recorded with a SonoSite iViz and interpreted in the UK by comparison with standardised images (WHO protocol). RESULTS: The prevalence of schistosomiasis according to CCA testing was 97.8% (269/275) and 73.8% (203/275) by KK. Sonographic evidence of periportal fibrosis was observed in 11.3% (31/275). The youngest children with fibrosis were aged 6 y. Fibrosis was more common in older children (p=0.03) but was not associated with either infection intensity category (p=0.07) or gender (p=0.67). CONCLUSIONS: Findings of periportal fibrosis among children in these hard-to-reach villages suggests chronic Schistosoma mansoni infection from a very young age. This may reflect other similarly remote schistosomiasis-endemic areas and reinforces the need to investigate morbidity in neglected communities to understand the true extent of disease burden in endemic countries.


Assuntos
Esquistossomose mansoni , Animais , Antígenos de Helmintos , Criança , Estudos Transversais , Fezes , Humanos , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/epidemiologia , Madagáscar/epidemiologia , Prevalência , Schistosoma mansoni , Esquistossomose mansoni/epidemiologia , Instituições Acadêmicas
13.
Vet Ther ; 10(3): 103-12, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-20037964

RESUMO

Canine influenza virus (CIV) subtype H3N8 is an emerging pathogen with sustained horizontal transmission in the dog population in the United States. This study evaluated the efficacy of an inactivated CIV vaccine in 6- to 8-week-old beagle pups challenged with virulent CIV. One group of CIV-seronegative pups was vaccinated with two doses of a CIV vaccine 3 weeks apart; a second group of pups received adjuvanted placebo as a control. Blood samples were collected at various times to determine antibody titers. All pups were challenged with a virulent CIV isolate 13 days after the second vaccination and monitored for clinical signs of respiratory disease, virus shedding, and lung consolidation. Vaccinated pups developed hemagglutination inhibition antibody titers after vaccination. The severity of clinical signs (P < .001) and the magnitude and duration of virus shedding (P < .0001) were significantly lower in vaccinated pups compared with control pups. These results demonstrate that the CIV vaccine used in this study provides protection against virulent CIV challenge in dogs.


Assuntos
Doenças do Cão/prevenção & controle , Vírus da Influenza A Subtipo H3N8/imunologia , Vacinas contra Influenza/normas , Infecções por Orthomyxoviridae/veterinária , Animais , Anticorpos Antivirais/sangue , Antígenos Virais/análise , Cães , Feminino , Testes de Inibição da Hemaglutinação/veterinária , Imuno-Histoquímica/veterinária , Vírus da Influenza A Subtipo H3N8/isolamento & purificação , Vacinas contra Influenza/imunologia , Pulmão/patologia , Pulmão/virologia , Masculino , Infecções por Orthomyxoviridae/patologia , Infecções por Orthomyxoviridae/prevenção & controle , Infecções por Orthomyxoviridae/virologia , Vacinas de Produtos Inativados/imunologia , Vacinas de Produtos Inativados/normas , Eliminação de Partículas Virais
14.
Int J Ment Health Nurs ; 28(3): 712-720, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30675749

RESUMO

Adolescents admitted to acute mental health inpatient units can experience episodes of distress for numerous reasons. Little is known about how they attempt to cope with this distress. This paper explores adolescent experiences of distress in an acute mental health inpatient unit. Fifty hours of non-participant observations were conducted and documented using a critical incident technique (CIT) framework. An interpretive descriptive approach was used to analyse the observation data collected. Nineteen episodes of adolescent distress were observed and five themes emerged, of which two will be explored in this paper: clinical contexts and triggers, and coping or help-seeking actions. The findings of this study will help mental health nurses working on acute adolescent units understand how adolescents attempt to cope with, and seek help for, episodes of distress, and enhance early responses to prevent escalation of distress.


Assuntos
Transtornos Mentais/psicologia , Unidade Hospitalar de Psiquiatria , Estresse Psicológico/etiologia , Adolescente , Feminino , Humanos , Pacientes Internados/psicologia , Masculino , Transtornos Mentais/terapia , Pesquisa Qualitativa , Estresse Psicológico/psicologia
15.
Resuscitation ; 142: 175-181, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31251894

RESUMO

INTRODUCTION: Witnessing traumatic experiences can cause post-traumatic stress disorder (PTSD). The true impact on healthcare staff of attending in-hospital cardiac arrests (IHCAs) has not been studied. This cross-sectional study examined cardiac arrest debriefing practices and the burden of attending IHCAs on nursing and medical staff. METHODS: A 33-item questionnaire-survey was sent to 517 doctors (of all grades), nurses and health-care assistants (HCAs) working in the emergency department, the acute medical unit and the intensive care unit of a district general hospital between April and August 2018. There were three sections: demographics; cardiac arrest and debriefing practices; trauma-screening questionnaire (TSQ). RESULTS: The response rate was 414/517 (80.1%); 312/414 (75.4%) were involved with IHCAs. Out of 1463 arrests, 258 (17.6%) were debriefed. Twenty-nine of 302 (9.6%) staff screened positively for PTSD. Healthcare assistants and Foundation Year 1 doctors had higher TSQ scores than nurses or more senior doctors (p = 0.02, p = 0.02, respectively). Debriefing was not associated with PTSD risk (p = 0.98). Only 8/67 (11.9%) of resuscitation leaders had prior debriefing training. CONCLUSIONS: Nearly 10% of acute care staff screened positively for PTSD as a result of attending an IHCA, with junior staff being most at risk of developing trauma symptoms. Very few debriefs occurred, possibly because of a lack of debrief training amongst cardiac arrest team leaders. More support is required for acute care nursing and medical staff following an IHCA.


Assuntos
Reanimação Cardiopulmonar/psicologia , Pessoal de Saúde , Parada Cardíaca/psicologia , Liderança , Papel do Médico , Trauma Psicológico , Transtornos de Estresse Pós-Traumáticos , Adulto , Reanimação Cardiopulmonar/métodos , Competência Clínica , Feminino , Pessoal de Saúde/psicologia , Pessoal de Saúde/normas , Parada Cardíaca/terapia , Humanos , Masculino , Avaliação das Necessidades , Trauma Psicológico/complicações , Trauma Psicológico/psicologia , Trauma Psicológico/terapia , Sistemas de Apoio Psicossocial , Pesquisa Qualitativa , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/prevenção & controle
16.
J Trauma Acute Care Surg ; 84(1): 133-138, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28640779

RESUMO

BACKGROUND: The Society of Vascular Surgery (SVS) guidelines currently suggest thoracic endovascular aortic repair (TEVAR) for grade II-IV and nonoperative management (NOM) for grade I blunt traumatic aortic injury (BTAI). However, there is increasing evidence that grade II may also be observed safely. The purpose of this study was to compare the outcome of TEVAR and NOM for grade I-IV BTAI and determine if grade II can be safely observed with NOM. METHODS: The records of patients with BTAI from 2004 to 2015 at a Level I trauma center were retrospectively reviewed. Patients were separated into two groups: TEVAR versus NOM. All BTAIs were graded according to the SVS guidelines. Minimal aortic injury (MAI) was defined as BTAI grade I and II. Failure of NOM was defined as aortic rupture after admission or progression on subsequent computed tomography (CT) imaging requiring TEVAR or open thoracotomy repair (OTR). Statistical analysis was performed using Mann-Whitney U and χ tests. RESULTS: A total of 105 adult patients (≥16 years) with BTAI were identified over the 11-year period. Of these, 17 patients who died soon after arrival and 17 who underwent OTR were excluded. Of the remaining 71 patients, 30 had MAI (14 TEVAR vs. 16 NOM). There were no failures in either group. No patients with MAI in either group died from complications of aortic lesions. Follow-up CT imaging was performed on all MAI patients. Follow-up CT scans for all TEVAR patients showed stable stents with no leak. Follow-up CT in the NOM group showed progression in two patients neither required subsequent OTR or TEVAR. CONCLUSIONS: Although the SVS guidelines suggest TEVAR for grade II-IV and NOM for grade I BTAI, NOM may be safely used in grade II BTAI. LEVEL OF EVIDENCE: Therapeutic study, level IV.


Assuntos
Aorta Torácica/lesões , Procedimentos Endovasculares , Lesões do Sistema Vascular/terapia , Ferimentos não Penetrantes/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
17.
Parasit Vectors ; 10(1): 307, 2017 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-28646926

RESUMO

BACKGROUND: A school-based survey was undertaken to assess prevalence and infection intensity of schistosomiasis in school-aged children in the Marolambo District of Madagascar. METHODS: School-aged children from six purposively selected schools were tested for Schistosoma haematobium by urine filtration and Schistosoma mansoni using circulating cathodic antigen (CCA) and Kato-Katz stool analysis. The investigators did not address soil-transmitted helminths (STH) in this study. RESULTS: Of 399 school-aged children screened, 93.7% were infected with S. mansoni based on CCA analysis. Kato-Katz analysis of stool revealed S. mansoni infection in 73.6% (215/ 292). Heavy infections (> 400 eggs per gram) were common (32.1%; 69/ 215), with a mean of 482 eggs per gram of stool. Moderate infection intensities were detected in 31.2% (67/ 215) and light infection intensities in 36.7% (79/ 215) of infected participants. No infection with S. haematobium was detected by urine filtration. CONCLUSIONS: Intestinal schistosomiasis appears a considerable public health issue in this remote area of Madagascar where there is a pressing need for mass drug administration.


Assuntos
Esquistossomose mansoni/epidemiologia , Adolescente , Distribuição por Idade , Animais , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Fezes/parasitologia , Feminino , Humanos , Madagáscar/epidemiologia , Masculino , Análise Multivariada , Contagem de Ovos de Parasitas , Prevalência , Schistosoma mansoni/isolamento & purificação , Distribuição por Sexo
18.
Artigo em Inglês | MEDLINE | ID: mdl-12452537

RESUMO

Studies of high-risk offspring (HR) of schizophrenic patients have found abnormalities in attention, working memory and executive functions, suggesting impaired integrity of the prefrontal cortex and related brain regions. The authors conducted a preliminary high-field (3 T) functional magnetic resonance imaging (fMRI) study to assess performance and activation during a memory-guided saccade (MGS) task, which measures spatial working memory. HR subjects showed significant decreases in fMRI-measured activation in the dorsolateral prefrontal cortex (Brodmann's areas 8 and 9/46) and the inferior parietal cortex (Brodmann's area 40) compared to age- and sex-matched healthy controls (HC). Abnormal functional integrity of prefrontal and parietal regions of the heteromodal association cortical (HAC) regions in subjects at genetic risk for schizophrenia is consistent with findings observed in adults with the illness [Callicott et al., Cereb. Cortex 10 (2000) 1078; Manoach et al., Biol. Psychiatry 48 (2000) 99.]. These abnormalities need to be prospectively investigated in nonpsychotic individuals at risk for schizophrenia in order to determine their predictive value for eventual emergence of schizophrenia or related disorders.


Assuntos
Esquizofrenia/genética , Esquizofrenia/patologia , Adolescente , Encéfalo/patologia , Sinais (Psicologia) , Imagem Ecoplanar , Feminino , Fixação Ocular/fisiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Memória/fisiologia , Oxigênio/sangue , Desempenho Psicomotor/fisiologia , Risco , Movimentos Sacádicos/fisiologia
19.
Artigo em Inglês | MEDLINE | ID: mdl-12954387

RESUMO

A selective and sensitive method based on derivatisation with 2,4-dinitrophenylhydrazine (DNPH) and consecutive HPLC gradient separation is described for the determination of malondialdehyde (MDA) in urine. Preparation of urine samples involved a one-step derivatisation/extraction procedure. Separation was achieved using a Waters SymmetryC(18) column (3.9 x 150 mm) and linear gradient of acetonitrile in water (from 30% to 70% in 30 min). The overall detection limit of the method was 56 nM of MDA in urine. The recovery of MDA was 94.3+/-8.6%. MDA in urine of healthy volunteers, measured using the method of standard additions, was 0.019+/-0.012 microM/mmol creatinine. MDA in the same samples measured using the 2-thiobarbituric acid (TBA) assay was 0.181+/-0.063 microM/mmol creatinine. We demonstrate that the commonly used TBA assay in conjunction with HPLC may overestimate the MDA concentration in human urine by almost 10-fold.


Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Malondialdeído/urina , Fenil-Hidrazinas/química , Humanos , Malondialdeído/química , Reprodutibilidade dos Testes , Tiobarbitúricos/análise
20.
Oecologia ; 80(2): 222-228, 1989 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28313111

RESUMO

The Chinese tallow tree, Sapium sebiferum, was introduced to the Texas Gulf Coast in the early 1900's and has spread into coastal prairie habitats. Since coastal prairie contains few deciduous trees, we studied leaf fall dynamics, rate of decomposition, and the quantity and rate of nutrient input from decomposing tallow leaves. Among-year leaf fall averaged 382.6 g·m-2·yr-1, similar to other south temperat deciduous forests and about as predicted by Meentemeyer et al.'s (1982) AE-lignin model. Decay of tallow leaves (k=-4.33) was much more rapid than native black willow (k=-0.35) and than other temperate deciduous trees (k=-0.77). The ratio of lignin to initial nitrogen concentration, highly correlated with rate of decomposition for hardwood trees, was low for Chinese tallow and may contribute to rapid leaf decay. Taking AE and lignin content into account, Meentemeyer's (1984) model predicted k=-1.39 for Chinese tallow and k=-0.88 for black willow. Decay of tallow was much faster but decay of willow was slower than predicted, suggesting that decay on the coastal prairie may be controlled by factors other than lignin content and climate. N, P, and K characteristically accumulate as leaves decay. However, these elements did not accumulate as tallow leaves decayed, possibly because high densities of Armadillidium vulgare, a detritivore, reduced immobilization of elements by microbes. This would result in increased turnover of these elements. Accumulation of Al, Fe, Zn, and S in decaying tallow litter may be related to flood-drain cycles on coastel prairie clay soils. Ca, N, K, Mg, and S were added to forest soil in greatest amounts from decaying tallow leaves. Concentrations of P, K, NO3-N, Zn, Mn, and Fe were significantly higher and Mg and Na were significantly lower in forest than in prairie soil, raising the possibility that Chinese tallow trees altered the distribution of nutrients in the soil profile. We conclude that the Chinese tallow tree may enhance productivity in ecosystems to which it has been introduced by addition of nutrients from rapid decay of leaves.

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