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PURPOSE: Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in Latin American Countries. METHODS: From 01/01/2014 to 02/10/2022, we conducted a prospective cohort study in 145 ICUs of 67 hospitals in 35 cities in nine Latin American countries: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Peru. To estimate CAUTI incidence, we used the number of UC-days as the denominator, and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: gender, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, UC-type, hospitalizationtype, ICU type, facility ownership, and time period. RESULTS: 31,631 patients, hospitalized for 214,669 patient-days, acquired 305 CAUTIs. The pooled CAUTI rate per 1000 UC-days was 2.58, for those using suprapubic catheters, it was 2.99, and for those with indwelling catheters, it was 2.21. The following variables were independently associated with CAUTI: age, rising risk 1% yearly (aOR = 1.01; 95% CI 1.01-1.02; p < 0.0001 female gender (aOR = 1.28; 95% CI 1.01-1.61; p = 0.04), LOS before CAUTI acquisition, rising risk 7% daily (aOR = 1.07; 95% CI 1.06-1.08; p < 0.0001, UC/DU ratio (aOR = 1.14; 95% CI 1.08-1.21; p < 0.0001, public facilities (aOR = 2.89; 95% CI 1.75-4.49; p < 0.0001. The periods 2014-2016 and 2017-2019 had significantly higher risks than the period 2020-2022. Suprapubic catheters showed similar risks as indwelling catheters. CONCLUSION: The following CAUTI RFs are unlikely to change: age, gender, hospitalization type, and facility ownership. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.
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Infecções Relacionadas a Cateter , Infecção Hospitalar , Infecções Urinárias , Humanos , Feminino , Infecção Hospitalar/epidemiologia , Infecções Relacionadas a Cateter/complicações , Estudos Prospectivos , Incidência , América Latina/epidemiologia , Infecções Urinárias/etiologia , Unidades de Terapia Intensiva , Cateteres de Demora/efeitos adversos , Fatores de RiscoRESUMO
INTRODUCTION: Most of the pregnant women do not achieve the recommended dietary intake of vitamins A and E. These vitamins may counteract oxidative stress involved in some adverse perinatal outcomes. We aimed to assess the associations between maternal vitamin A and E at mid-pregnancy with both maternal and fetal outcomes and to identify possible early biomarkers during pregnancy to predict and prevent oxidative stress in the offspring. METHODS: Data on dietary and serum levels of vitamins A and E were collected from 544 pregnant women from the Nutrition in Early Life and Asthma (NELA) study, a prospective mother-child cohort set up in Spain. RESULTS: There were large discrepancies between low dietary vitamin E intake (78% of the mothers) and low serum vitamin E levels (3%) at 24 weeks of gestation. Maternal serum vitamins A and E at mid-pregnancy were associated with higher antioxidant status not only in the mother at this time point (lower hydroperoxides and higher total antioxidant activity [TAA]) but also with the newborn at birth (higher TAA). Gestational diabetes mellitus (GDM) was negatively associated with maternal serum vitamin A (OR: 0.95 CI: 0.91-0.99, p = 0.009) at mid-pregnancy. Nevertheless, we could not detect any association between GDM and oxidative stress parameters. CONCLUSIONS: In conclusion, maternal vitamin A and E serum levels may be used as an early potential biomarker of antioxidant status of the neonate at birth. Control of these vitamins during pregnancy could help avoid morbid conditions in the newborn caused by oxidative stress in GDM pregnancies.
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Antioxidantes , Diabetes Gestacional , Recém-Nascido , Feminino , Gravidez , Humanos , Vitamina A , Estudos Prospectivos , Sangue Fetal , Vitaminas , Vitamina ERESUMO
Depleted Monolithic Active Pixel Sensors (DMAPSs) are foreseen as an interesting choice for future high-energy physics experiments, mainly because of the reduced fabrication costs. However, they generally offer limited time resolution due to the stringent requirements of area and power consumption imposed by the targeted spatial resolution. This work describes a methodology to optimize the design of time-to-digital converter (TDC)-based timing electronics that takes advantage of the asymmetrical shape of the pulse at the output of the analog front-end (AFE). Following that methodology, a power and area efficient implementation fully compatible with the RD50-MPW3 solution is proposed. Simulation results show that the proposed solution offers a time resolution of 2.08 ns for a range of energies from 1000 e- to 20,000 e-, with minimum area and zero quiescent in-pixel power consumption.
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Eletrônica , Tomografia por Emissão de Pósitrons , Tomografia por Emissão de Pósitrons/métodos , Fatores de Tempo , Simulação por ComputadorRESUMO
Colloidal lead-halide perovskite nanocrystals (LHP NCs) have emerged over the past decade as leading candidates for efficient next-generation optoelectronic devices, but their properties and performance critically depend on how they are purified. While antisolvents are widely used for purification, a detailed understanding of how the polarity of the antisolvent influences the surface chemistry and composition of the NCs is missing in the field. Here, we fill this knowledge gap by studying the surface chemistry of purified CsPbBrxI3-x NCs as the model system, which in itself is considered a promising candidate for pure-red light-emitting diodes and top-cells for tandem photovoltaics. Interestingly, we find that as the polarity of the antisolvent increases (from methyl acetate to acetone to butanol), there is a blueshift in the photoluminescence (PL) peak of the NCs along with a decrease in PL quantum yield (PLQY). Through transmission electron microscopy and X-ray photoemission spectroscopy measurements, we find that these changes in PL properties arise from antisolvent-induced iodide removal, which leads to a change in halide composition and, thus, the bandgap. Using detailed nuclear magnetic resonance (NMR) and Fourier-transform infrared spectroscopy (FTIR) measurements along with density functional theory calculations, we propose that more polar antisolvents favor the detachment of the oleic acid and oleylamine ligands, which undergo amide condensation reactions, leading to the removal of iodide anions from the NC surface bound to these ligands. This work shows that careful selection of low-polarity antisolvents is a critical part of designing the synthesis of NCs to achieve high PLQYs with minimal defect-mediated phase segregation.
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BACKGROUND: Ruxolitinib is approved for patients with polycythemia vera (PV) who are resistant/intolerant to hydroxyurea, but its impact on preventing thrombosis or disease-progression is unknown. METHODS: A retrospective, real-world analysis was performed on the outcomes of 377 patients with resistance/intolerance to hydroxyurea from the Spanish Registry of Polycythemia Vera according to subsequent treatment with ruxolitinib (n = 105) or the best available therapy (BAT; n = 272). Survival probabilities and rates of thrombosis, hemorrhage, acute myeloid leukemia, myelofibrosis, and second primary cancers were calculated according to treatment. To minimize biases in treatment allocation, all results were adjusted by a propensity score for receiving ruxolitinib or BAT. RESULTS: Patients receiving ruxolitinib had a significantly lower rate of arterial thrombosis than those on BAT (0.4% vs 2.3% per year; P = .03), and this persisted as a trend after adjustment for the propensity to have received the drug (incidence rate ratio, 0.18; 95% confidence interval, 0.02-1.3; P = .09). There were no significant differences in the rates of venous thrombosis (0.8% and 1.1% for ruxolitinib and BAT, respectively; P = .7) and major bleeding (0.8% and 0.9%, respectively; P = .9). Ruxolitinib exposure was not associated with a higher rate of second primary cancers, including all types of neoplasia, noncutaneous cancers, and nonmelanoma skin cancers. After a median follow-up of 3.5 years, there were no differences in survival or progression to acute leukemia or myelofibrosis between the 2 groups. CONCLUSIONS: The results suggest that ruxolitinib treatment for PV patients with resistance/intolerance to hydroxyurea may reduce the incidence of arterial thrombosis. LAY SUMMARY: Ruxolitinib is better than other available therapies in achieving hematocrit control and symptom relief in patients with polycythemia vera who are resistant/intolerant to hydroxyurea, but we still do not know whether ruxolitinib provides an additional benefit in preventing thrombosis or disease progression. We retrospectively studied the outcomes of 377 patients with resistance/intolerance to hydroxyurea from the Spanish Registry of Polycythemia Vera according to whether they subsequently received ruxolitinib (n = 105) or the best available therapy (n = 272). Our findings suggest that ruxolitinib could reduce the incidence of arterial thrombosis, but a disease-modifying effect could not be demonstrated for ruxolitinib in this patient population.
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Leucemia Mieloide Aguda , Segunda Neoplasia Primária , Policitemia Vera , Mielofibrose Primária , Trombose , Hemorragia/induzido quimicamente , Humanos , Hidroxiureia/efeitos adversos , Leucemia Mieloide Aguda/tratamento farmacológico , Segunda Neoplasia Primária/tratamento farmacológico , Nitrilas , Policitemia Vera/tratamento farmacológico , Mielofibrose Primária/tratamento farmacológico , Pirazóis , Pirimidinas , Estudos Retrospectivos , Trombose/induzido quimicamente , Trombose/tratamento farmacológico , Trombose/prevenção & controleRESUMO
Hematological control, incidence of complications, and need for cytoreduction were studied in 453 patients with low-risk polycythemia vera (PV) treated with phlebotomies alone. Median hematocrit value decreased from 54% at diagnosis to 45% at 12 months, and adequate hematocrit control over time (< 45%) was observed in 36%, 44%, and 32% of the patients at 6, 12, and 24 months, respectively. More than 5 phlebotomies per year in the maintenance phase were required in 19% of patients. Worsening thrombocytosis, age > 60 years, and microvascular symptoms constituted the main indications for starting cytoreduction. Median duration without initiating cytoreduction was significantly longer in patients younger than 50 years (< 0.0001). The incidence rate of thrombosis under phlebotomies alone was 0.8% per year and the estimated probability of thrombosis at 10 years was 8.5%. The probability of arterial thrombosis was significantly higher in patients with arterial hypertension whereas there was a trend to higher risk of venous thrombosis in cases with high JAK2V617F allele burden. Rates of major bleeding and second primary neoplasm were low. With a median follow-up of 9 years, survival probability at 10 years was 97%, whereas the probability of myelofibrosis at 10 and 20 years was 7% and 20%, respectively. Progression to acute myeloid leukemia was documented in 3 cases (1%). Current management of low-risk PV patients is associated with low rate of thrombosis and long survival. New treatment strategies are needed for improving hematological control and, in the long term, reducing progression to myelofibrosis.
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Leucemia Mieloide Aguda , Policitemia Vera , Mielofibrose Primária , Trombose , Humanos , Leucemia Mieloide Aguda/complicações , Pessoa de Meia-Idade , Flebotomia/efeitos adversos , Policitemia Vera/complicações , Policitemia Vera/diagnóstico , Policitemia Vera/cirurgia , Mielofibrose Primária/diagnóstico , Sistema de Registros , Trombose/complicações , Trombose/etiologiaRESUMO
Exposure to repeated social stress may cause maladaptive emotional reactions that can be reduced by healthy nutritional supplementation. Histaminergic neurotransmission has a central role in orchestrating specific behavioural responses depending on the homeostatic state of a subject, but it remains to be established if it participates in the protective effects against the insults of chronic stress afforded by a healthy diet. By using C57BL/6J male mice that do not synthesize histamine (Hdc-/-) and their wild type (Hdc+/+) congeners we evaluated if the histaminergic system participates in the protective action of a diet enriched with polyunsaturated fatty acids and vitamin A on the deleterious effect of chronic stress. Behavioural tests across domains relevant to cognition and anxiety were performed. Hippocampal synaptic plasticity, cytokine expression, hippocampal fatty acids, oxylipins and microbiota composition were also assessed. Chronic stress induced social avoidance, poor recognition memory, affected hippocampal long-term potentiation, changed the microbiota profile, brain cytokines, fatty acid and oxylipins composition of both Hdc-/- and Hdc+/+ mice. Dietary enrichment counteracted stress-induced deficits only in Hdc+/+ mice as histamine deficiency prevented almost all the diet-related beneficial effects. Interpretation: Our results reveal a previously unexplored and novel role for brain histamine as a mediator of many favorable effects of the enriched diet. These data present long-reaching perspectives in the field of nutritional neuropsychopharmacology.
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Dieta , Disbiose , Microbioma Gastrointestinal , Histamina/metabolismo , Comportamento Social , Estresse Psicológico , Animais , Comportamento Animal , Biomarcadores , Peso Corporal , Citocinas/metabolismo , Ácidos Graxos/metabolismo , Expressão Gênica , Hipocampo/metabolismo , Hipocampo/fisiopatologia , Locomoção , Masculino , Metagenoma , Metagenômica , Camundongos , Camundongos Knockout , Modelos AnimaisRESUMO
We report here fast A-site cation cross-exchange between APbX3 perovskite nanocrystals (NCs) made of different A-cations (Cs (cesium), FA (formamidinium), and MA (methylammonium)) at room temperature. Surprisingly, the A-cation cross-exchange proceeds as fast as the halide (X=Cl, Br, or I) exchange with the help of free A-oleate complexes present in the freshly prepared colloidal perovskite NC solutions. This enabled the preparation of double (MACs, MAFA, CsFA)- and triple (MACsFA)-cation perovskite NCs with an optical band gap that is finely tunable by their A-site composition. The optical spectroscopy together with structural analysis using XRD and atomically resolved high-angle annular dark-field scanning transmission electron microscopy (HAADF-STEM) and integrated differential phase contrast (iDPC) STEM indicates the homogeneous distribution of different cations in the mixed perovskite NC lattice. Unlike halide ions, the A-cations do not phase-segregate under light illumination.
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Cobalamin (B12) is an essential cofactor that is exclusively synthesized by some prokaryotes while many prokaryotes and eukaryotes require an external supply of B12. The spatial and temporal availability of B12 is poorly understood in marine ecosystems. Field measurements of B12 along with a large set of ancillary biotic and abiotic factors were obtained during three oceanographic cruises in the NW Iberian Peninsula, covering different spatial and temporal scales. B12 concentrations were remarkably low (<1.5 pM) in all samples, being significantly higher at the subsurface Eastern North Atlantic Central Water than at shallower depths, suggesting that B12 supply in this water mass is greater than demand. Multiple regression models excluded B12 concentration as predictive variable for phytoplankton biomass or production, regardless of the presence of B12-requiring algae. Prokaryote production was the best predictor for primary production, and eukaryote community composition was better correlated with prokaryote community composition than with nutritional resources, suggesting that biotic interactions play a significant role in regulating microbial communities. Interestingly, co-occurrence network analyses based on 16S and 18S rRNA sequences allowed the identification of significant associations between potential B12 producers and consumers (e.g. Thaumarchaeota and Dynophyceae, or Amylibacter and Ostreococcus respectively), which can now be investigated using model systems in the laboratory.
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Microbiota , Plâncton , Oceano Atlântico , Plâncton/genética , Água do Mar , Vitamina B 12RESUMO
BACKGROUND: Coffee is one of the most popular beverages around the world, consumed as an infusion of ground roasting coffee beans with a characteristic taste and flavor. Two main varieties, Arabica and Robusta, are produced worldwide. Furthermore, interest of consumers in quality attributes related to coffee production region and varieties is increasing. Thus, it is necessary to encourage the development of simple methodologies to authenticate and guarantee the coffee origin, variety and roasting degree, aiming to prevent fraudulent practices. RESULTS: C18 high-performance liquid chromatography with fluorescence detection (HPLC-FLD) fingerprints obtained after brewing coffees without any sample treatment other than filtration (i.e. considerably reducing sample manipulation) were employed as sample chemical descriptors for subsequent coffee characterization and classification by principal component analysis (PCA) and partial least squares regression-discriminant analysis (PLS-DA). PLS-DA showed good classification capabilities regarding coffee origin, variety and roasting degree when employing HPLC-FLD fingerprints, although overlapping occurred for some sample groups. However, the discrimination power increased when selecting HPLC-FLD fingerprinting segments richer in discriminant features, which were deduced from PLS-DA loading plots. In this case, excellent separation was observed and 100% classification rates for both PLS-DA calibrations and predictions were obtained (all samples were correctly classified within their corresponding groups). CONCLUSION: HPLC-FLD fingerprinting segments were3 found to be suitable chemical descriptors for discriminating the origin (country of production), variety (Arabica and Robusta) and roasting degree of coffee. Therefore, HPLC-FLD fingerprinting can be proposed as a feasible, simple and cheap methodology to address coffee authentication, especially for developing coffee production countries. © 2020 Society of Chemical Industry.
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Cromatografia Líquida de Alta Pressão/métodos , Coffea/química , Cromatografia Líquida de Alta Pressão/classificação , Cromatografia Líquida de Alta Pressão/instrumentação , Culinária , Análise Discriminante , Geografia , Temperatura Alta , Controle de Qualidade , Sementes/químicaRESUMO
Ingestion of foreign bodies is common in the pediatric population. Most foreign bodies have a benign behavior and are usually eliminated without generating greater morbidity and mortality. In relation to the intake of magnets, its frequency has increased to the point that it currently represents a public health problem in the pediatric population. The ingestion of a single magnet does not generate any risk, but the ingestion of 2 or more of these, or even of magnets and metals in succession is considered an emergency since they can attract each other and can cause serious symptoms of intestinal obstruction, bleeding, fistulas, perforation and even intestinal necrosis. We present 2 pediatric patients, who ingested multiple magnets, in these cases we highlight the variety in the clinical presentation, as well as the complications presented in relation to a late diagnosis.
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Corpos Estranhos , Obstrução Intestinal , Perfuração Intestinal , Pediatria , Criança , Ingestão de Alimentos , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , ImãsRESUMO
Lead-halide perovskites (LHPs), in the form of both colloidal nanocrystals (NCs) and thin films, have emerged over the past decade as leading candidates for next-generation, efficient light-emitting diodes (LEDs) and solar cells. Owing to their high photoluminescence quantum yields (PLQYs), LHPs efficiently convert injected charge carriers into light and vice versa. However, despite the defect-tolerance of LHPs, defects at the surface of colloidal NCs and grain boundaries in thin films play a critical role in charge-carrier transport and nonradiative recombination, which lowers the PLQYs, device efficiency, and stability. Therefore, understanding the defects that play a key role in limiting performance, and developing effective passivation routes are critical for achieving advances in performance. This Review presents the current understanding of defects in halide perovskites and their influence on the optical and charge-carrier transport properties. Passivation strategies toward improving the efficiencies of perovskite-based LEDs and solar cells are also discussed.
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This work focuses on the systematic investigation of the shape, size, and composition-controlled synthesis of perovskite nanocrystals (NCs) under inert gas-free conditions and using pre-synthesized precursor stock solutions. In the case of CsPbBr3 NCs, we find that the lowering of reaction temperature from â¼175 to 100 °C initially leads to a change of morphology from bulk-like 3D nanocubes to 0D nanocubes with 3D-quantum confinement, while at temperatures below 100 °C the reaction yields 2D nanoplatelets (NPls) with 1D-quantum confinement. However, to our surprise, at higher temperatures (â¼215 °C), the reaction yields CsPbBr3 hexapod NCs, which have been rarely reported. The synthesis is scalable, and their halide composition is tunable by simply using different combinations of precursor solutions. The versatility of the synthesis is demonstrated by applying it to relatively less explored shape-controlled synthesis of FAPbBr3 NCs. Despite the synthesis carried out in the air, both the inorganic and hybrid perovskite NCs exhibit nearly-narrow emission without applying any size-selective separation, and it is precisely tunable by controlling the reaction temperature.
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Previous investigations have found specific communication patterns in couples dealing with depression, specifically when depression concurs with conjugal conflicts. The presence of these patterns can reflect couples' difficulties in engaging in collaborative communication during their sessions, posing a real challenge for therapists. This exploratory study uses a dialogical approach to examine issues of dominance and type of dialogue in two couples who differed in terms of their levels of dyadic adjustment. The therapists' reactions were explored in order to detect the kinds of responses that were most effective at engendering a collaborative attitude in therapy sessions. The method used to analyze the dialogue was Dialogical Investigations of Happenings of Change (DIHC). Results on dominance indicated that the degree of quantitative and semantic dominance displayed by a different member of the couple in each case was illustrative of their relational dynamics, while in both cases interactional dominance was exercised by the therapists. Results on dialogue revealed that dialogic dialogue might help to coconstruct new shared meanings of depression. The findings indicated that certain responses by therapists as part of the dialogue could be useful in bringing about a reduction in hostility between the members of a couple, provided that the responses are maintained over the course of the session. Some research and clinical implications that emerge from the results are discussed.
En investigaciones previas se han descubierto patrones de comunicación específicos en parejas que afrontan la depresión, particularmente cuando la depresión coincide con conflictos conyugales. La presencia de estos patrones puede reflejar las dificultades de las parejas para entablar una comunicación colaborativa durante sus sesiones, lo cual plantea un verdadero desafío para los terapeutas. Este estudio exploratorio utiliza un enfoque dialógico para analizar las cuestiones de dominación y el tipo de diálogo en dos parejas que diferían en cuanto a sus niveles de ajuste diádico. Se analizaron las reacciones de los terapeutas a fin de detectar los tipos de respuestas que fueron más eficaces para generar una actitud colaborativa en las sesiones de terapia. El método utilizado para analizar el diálogo fue "Investigaciones Dialógicas de Sucesos de Cambio" (Dialogical Investigations of Happenings of Change, DIHC). Los resultados sobre la dominación indicaron que el grado de dominación cuantitativa y semántica demostrado por un integrante diferente de la pareja en cada caso fue ilustrativo de su dinámica relacional, mientras que en ambos casos los terapeutas ejercieron dominación interaccional. Los resultados sobre el diálogo revelaron que el diálogo dialógico podría contribuir a coconstruir nuevos significados comunes de la depresión. Los resultados indicaron que ciertas respuestas de los terapeutas como parte del diálogo podrían ser útiles para producir una reducción de la hostilidad entre los integrantes de una pareja, siempre y cuando se mantengan las respuestas durante el transcurso de la sesión. Se debaten algunas implicancias científicas y clínicas que surgen de los resultados.
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Comunicação , Terapia de Casal/métodos , Depressão/psicologia , Relações Profissional-Paciente , Cônjuges/psicologia , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-IdadeRESUMO
The presence of circulating plasma cells in patients with multiple myeloma is considered a marker for highly proliferative disease. In the study herein, the impact of circulating plasma cells assessed by cytology on survival of patients with multiple myeloma was analyzed. Wright-Giemsa stained peripheral blood smears of 482 patients with newly diagnosed myeloma or plasma cell leukemia were reviewed and patients were classified into 4 categories according to the percentage of circulating plasma cells: 0%, 1-4%, 5-20%, and plasma cell leukemia with the following frequencies: 382 (79.2%), 83 (17.2%), 12 (2.5%) and 5 (1.0%), respectively. Median overall survival according to the circulating plasma cells group was 47, 50, 6 and 14 months, respectively. At multivariate analysis, the presence of 5 to 20% circulating plasma cells was associated with a worse overall survival (relative risk 4.9, 95% CI 2.6-9.3) independently of age, creatinine, the Durie-Salmon system stage and the International Staging System (ISS) stage. Patients with ≥5% circulating plasma cells had lower platelet counts (median 86×109/L vs 214×109/L, P<0.0001) and higher bone marrow plasma cells (median 53% vs 36%, P=0.004). The presence of ≥5% circulating plasma cells in patients with multiple myeloma has a similar adverse prognostic impact as plasma cell leukemia.
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Mieloma Múltiplo/diagnóstico , Plasmócitos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Medula Óssea/patologia , Humanos , Leucemia Plasmocitária/diagnóstico , Leucemia Plasmocitária/mortalidade , Pessoa de Meia-Idade , Mieloma Múltiplo/patologia , Contagem de Plaquetas , Prognóstico , Estudos Retrospectivos , Análise de SobrevidaRESUMO
Hematocrit control below 45% is associated with a lower rate of thrombosis in polycythemia vera. In patients receiving hydroxyurea, this target can be achieved with hydroxyurea alone or with the combination of hydroxyurea plus phlebotomies. However, the clinical implications of phlebotomy requirement under hydroxyurea therapy are unknown. The aim of this study was to evaluate the need for additional phlebotomies during the first five years of hydroxyurea therapy in 533 patients with polycythemia vera. Patients requiring 3 or more phlebotomies per year (n=85, 16%) showed a worse hematocrit control than those requiring 2 or less phlebotomies per year (n=448, 84%). There were no significant differences between the two study groups regarding leukocyte and platelet counts. Patients requiring 3 or more phlebotomies per year received significantly higher doses of hydroxyurea than the remaining patients. A significant higher rate of thrombosis was found in patients treated with hydroxyurea plus 3 or more phlebotomies per year compared to hydroxyurea with 0-2 phlebotomies per year (20.5% vs. 5.3% at 3 years; P<0.0001). In multivariate analysis, independent risk factors for thrombosis were phlebotomy dependency (HR: 3.3, 95%CI: 1.5-6.9; P=0.002) and thrombosis at diagnosis (HR: 4.7, 95%CI: 2.3-9.8; P<0.0001). The proportion of patients fulfilling the European LeukemiaNet criteria of resistance/intolerance to hydroxyurea was significantly higher in the group requiring 3 or more phlebotomies per year (18.7% vs. 7.1%; P=0.001) mainly due to extrahematologic toxicity. In conclusion, phlebotomy requirement under hydroxyurea therapy identifies a subset of patients with increased proliferation of polycythemia vera and higher risk of thrombosis.
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Hidroxiureia/uso terapêutico , Flebotomia , Policitemia Vera/complicações , Policitemia Vera/terapia , Trombose/epidemiologia , Trombose/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Contagem de Células Sanguíneas , Terapia Combinada , Resistência a Medicamentos , Feminino , Hematócrito , Humanos , Hidroxiureia/administração & dosagem , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fenótipo , Policitemia Vera/diagnóstico , Sistema de Registros , Risco , Espanha/epidemiologia , Trombose/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Asthma is, worldwide, the most frequent non-communicable disease affecting both children and adults, with high morbidity and relatively low mortality, compared to other chronic diseases. In recent decades, the prevalence of asthma has increased in the pediatric population, and, in general, the risk of developing asthma and asthma-like symptoms is higher in children during the first years of life. The "gut-lung axis" concept explains how the gut microbiota influences lung immune function, acting both directly, by stimulating the innate immune system, and indirectly, through the metabolites it generates. Thus, the process of intestinal microbial colonization of the newborn is crucial for his/her future health, and the alterations that might generate dysbiosis during the first 100 days of life are most influential in promoting hypersensitivity diseases. That is why this period is termed the "critical window". This paper reviews the published evidence on the numerous factors that can act by modifying the profile of the intestinal microbiota of the infant, thereby promoting or inhibiting the risk of asthma later in life. The following factors are specifically addressed in depth here: diet during pregnancy, maternal adherence to a Mediterranean diet, mode of delivery, exposure to antibiotics, and type of infant feeding during the first three months of life.
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Proper management of wastewater treatment plant side streams in pulp and paper mills is a matter of great interest. This study evaluates the environmental impact of different strategies in the management of biosludge from pulp and paper mills in Finland through a Life Cycle Assessment methodology. The base industrial standard practice, biosludge incineration for energy recovery and ash landfill disposal (Scenario 1), was compared to the alternative process of hydrothermal carbonization. The hydrochar generated from hydrothermal carbonization was evaluated for energy recovery through incineration (Scenario 2), or for use in composting for nutrient recovery (Scenario 3). The results showed that the hydrothermal process improved the overall environmental performance of the sludge management, particularly in terms of energy consumption and greenhouse gas emissions. The use of hydrochar as a soil amendment in composting also resulted in a significant reduction on the environmental impact compared to the other two scenarios. Overall, this study highlights the potential of hydrothermal carbonization and hydrochar utilization as sustainable options for managing biosludge from pulp mills.