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Most patients with schizophrenia (SCZ) do not exhibit violent behaviors and are more likely to be victims rather than perpetrators of violent acts. However, a subgroup of forensic detainees with SCZ exhibit tendencies to engage in criminal violations. Although numerous models have been proposed, ranging from substance use, serotonin transporter gene, and cognitive dysfunction, the molecular underpinnings of violence in SCZ patients remains elusive. Lithium and clozapine have established anti-aggression properties and recent studies have linked low cholesterol levels and ultraviolet (UV) radiation with human aggression, while vitamin D3 reduces violent behaviors. A recent study found that vitamin D3, omega-3 fatty acids, magnesium, and zinc lower aggression in forensic population. In this review article, we take a closer look at aryl hydrocarbon receptor (AhR) and the dysfunctional lipidome in neuronal membranes, with emphasis on cholesterol and vitamin D3 depletion, as sources of aggressive behavior. We also discuss modalities to increase the fluidity of neuronal double layer via membrane lipid replacement (MLR) and natural or synthetic compounds. This article is part of the Special Issue on "Personality Disorders".
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Antipsicóticos , Esquizofrenia , Humanos , Esquizofrenia/metabolismo , Antipsicóticos/uso terapéutico , Colesterol/metabolismo , Animales , Colecalciferol/metabolismo , Agresión/fisiología , Agresión/efectos de los fármacosRESUMEN
Resumen Este artículo pretende identificar la relación que existe entre: institucionalismo, cambio y organización, desde una investigación donde primero se abordaron los textos fundacionales de los conceptos indagados, y luego se revisó el estado del arte de artículos incluidos entre otros en SCOPUS y el Web of Science, para presentar el resultado del análisis en forma de tablas y gráficas, abordando para los distintos autores: el foco, la descripción o el aporte. Finalmente, se propone una interacción teórica para el análisis del cambio. El resultado de esta investigación es soporte conceptual para futuras indagaciones. Clasificación JEL: M10.
Abstract This paper aims to identify the relationship between: institutionalism, change and organization, from a research where the fundamental texts of the concepts investigated were first addressed, and then the state of the art of the articles included among others in SCOPUS and the Web of Science was reviewed, to obtain the result of the analysis in the form of tables and graphs, addressing for the different author authors: the focus, the description or the report. Finally a theoretical interaction is proposed for the analysis of change. The result of this investigation is a conceptual support for future inquiries. JEL Classification: M10.
Resumo Este artigo tem como objetivo identificar a relação entre: institucionalismo, mudança e organização, a partir de uma pesquisa em que os textos fundacionais dos conceitos investigados foram abordados pela primeira vez; e, em seguida, revisou-se o estado da arte dos artigos incluídos entre outros no SCOPUS e na Web of Science para apresentar o resultado da análise na forma de tabelas e gráficos, apresentando d i ferentes autores: o foco, a descrição ou a contribuição. Finalmente, propõe-se uma interação teórica para a análise da mudança. O resultado desta pesquisa é o suporte conceitual para futuras investigações. Classificações JEL: M10.
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Mechanisms controlling mitochondrial function, protein folding in the endoplasmic reticulum (ER) and nuclear processes such as telomere length and DNA repair may be subject to epigenetic cues that relate the genomic expression and environmental exposures in early stages of life. They may also be involved in the comorbid appearance of cardiometabolic (CMD) and neuropsychiatric disorders (NPD) during adulthood. Mitochondrial function and protein folding in the endoplasmic reticulum are associated with oxidative stress and elevated intracellular calcium levels and may also underlie the vulnerability for comorbid CMD and NPD. Mitochondria provide key metabolites such as nicotinamide adenine dinucleotide (NAD+), ATP, α-ketoglutarate and acetyl coenzyme A that are required for many transcriptional and epigenetic processes. They are also a source of free radicals. On the other hand, epigenetic markers in nuclear DNA determine mitochondrial biogenesis. The ER is the subcellular organelle in which secretory proteins are folded. Many environmental factors stop the ability of cells to properly fold proteins and modify post-translationally secretory and transmembrane proteins leading to endoplasmic reticulum stress and oxidative stress. ER functioning may be epigenetically determined. Chronic ER stress is emerging as a key contributor to a growing list of human diseases, including CMD and NPD. Telomere loss causes chromosomal fusion, activation of the control of DNA damage-responses, unstable genome and altered stem cell function, which may underlie the comorbidity of CMD and NPD. The length of telomeres is related to oxidative stress and may be epigenetically programmed. Pathways involved in DNA repair may be epigenetically programmed and may contribute to diseases. In this paper, we describe subcellular mechanisms that are determined by epigenetic markers and their possible relation to the development of increased susceptibility to develop CMD and NPD.
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Epigénesis Genética , Cardiopatías/etiología , Cardiopatías/metabolismo , Trastornos Mentales/etiología , Trastornos Mentales/metabolismo , Enfermedades Metabólicas/etiología , Enfermedades Metabólicas/metabolismo , Enfermedades del Sistema Nervioso/etiología , Enfermedades del Sistema Nervioso/metabolismo , Animales , Comorbilidad , Retículo Endoplásmico/metabolismo , Estrés del Retículo Endoplásmico , Cardiopatías/epidemiología , Humanos , Espacio Intracelular/metabolismo , Trastornos Mentales/epidemiología , Enfermedades Metabólicas/epidemiología , Mitocondrias/metabolismo , Enfermedades del Sistema Nervioso/epidemiología , Biogénesis de Organelos , Transducción de Señal , Respuesta de Proteína DesplegadaRESUMEN
Corticotrophin releasing factor, vasopressin, oxytocin, natriuretic hormones, angiotensin, neuregulins, some purinergic substances, and some cytokines contribute to the long-term modulation and restructuring of cardiovascular regulation networks and, at the same time, have relevance in situations of comorbid abnormal stress responses. The synthesis, release, and receptor expression of these mediators seem to be under epigenetic control since early stages of life, possibly underlying the comorbidity to coronary artery disease (CAD) and stress-related disorders (SRD). The exposure to environmental conditions, such as stress, during critical periods in early life may cause epigenetic programming modifying the development of pathways that lead to stable and long-lasting alterations in the functioning of these mediators during adulthood, determining the risk of or resilience to CAD and SRD. However, in contrast to genetic information, epigenetic marks may be dynamically altered throughout the lifespan. Therefore, epigenetics may be reprogrammed if the individual accepts the challenge to undertake changes in their lifestyle. Alternatively, epigenetics may remain fixed and/or even be inherited in the next generation. In this paper, we analyze some of the common neuroendocrine functions of these mediators in CAD and SRD and summarize the evidence indicating that they are under early programming to put forward the theoretical hypothesis that the comorbidity of these diseases might be epigenetically programmed and modified over the lifespan of the individual.
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Comorbilidad , Enfermedad de la Arteria Coronaria/genética , Epigénesis Genética , Receptores de Superficie Celular/metabolismo , Estrés Psicológico/genética , Animales , Humanos , Factores de RiesgoRESUMEN
A study was conducted on the transformation of SnO to SnO2 using X-ray diffraction and subjecting the SnO to heat treatments between 300 °C < T < 600 °C in two different atmospheres, argon and air. The intermediary oxide that appears in the disproportionation process was identified as Sn2O3. In an argon atmosphere, decomposition occurs in three stages: (1) a direct transformation of SnO to SnO2, (2) the formation of some intermediary Sn2O3 from SnO, and (3) the conversion of the Sn2O3 to SnO2 with the formation of metallic tin, Sn (l). When an atmosphere of air is used, however, a reaction occurs, concurrent with the decomposition reactions, that relates to the specific oxidation of the metallic tin produced in the course of the three process stages.
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El uso de relajantes neuromusculares en la práctica clínica es cada día más frecuente e indispensable en el acto anestésico y la unidad de cuidado intensivo. Aunque los bloqueantes neuromusculares tanto aminoesteroideos como benzilisoquinolinas de última generación tienen efectos adversos mínimos, la relajación residual es una complicación de incidencia considerable asociada con un incremento en la morbilidad y mortalidad. Debido a esto planteamos la importancia de conocer los diferentes métodos de monitoria del bloqueo neuromuscular con su interpretación, haciendo énfasis en la monitoria con el tren de cuatro(TOF), la razón entre la primera y la cuarta respuesta T4/T1 (TOF RATIO) y estrategias de prevención de la relajación residual...
The use of neuromuscular blocking agents in clinical practice is more common every day and is indispensable in anesthesia and in the intensive care unit. Although neuromuscular blocking agents, both the latest generation of aminosteroids as well as benzylisoquinolines, have minimal adverse effects, a significant incidence of residual neuromuscular blockade constitutes a complication associated with increased morbidity and mortality. For this reason we advocate the importance of knowledge on the various neuromuscular block monitoring methods and their interpretation, emphasizing train-of-four (TOF) stimulation, ratio between the first response to the fourth response T4/T1 (TOF RATIO) and prevention strategies of residual neuromuscular blockade...
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Anestesiología , Complicaciones Posoperatorias , Bloqueo Neuromuscular , Relajación MuscularRESUMEN
Introducción: Los trastornos del espectro autista (TEA) son un grupo de discapacidades del desarrollo, de características crónicas y que afectan de manera distinta a cada paciente. Los TEA se definen como una disfunción neurológica crónica con fuerte base genética que desde edades tempranas se manifiesta en una serie de síntomas basados en la tríada de Wing que incluye: la comunicación, flexibilidad e imaginación e interacción social. No existe tratamiento curativo para el TEA, las terapias están dirigidas al control de los síntomas. Debido a la heterogeneidad de los síntomas, las terapias deben adaptarse al caso individual del paciente. Las intervenciones para los pacientes con diagnóstico de TEA pueden incluir educación, terapia conductual, o manejo farmacológico. Objetivo: realizar una revisión, apreciación crítica y síntesis de la evidencia disponible sobre la efectividad y seguridad de la risperidona para el tratamiento de personas con diagnóstico de trastorno del espectro autista. Metodología: la evaluación fue realizada de acuerdo con un protocolo definido a priori por el grupo desarrollador. Se realizó una búsqueda sistemática en MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, LILACS y Google, sin restricciones de idioma, fecha de publicación y tipo de estudio. Las búsquedas electrónicas fueron hechas en octubre de 2014 y se complementaron mediante búsqueda manual en bola de nieve y una consulta con expertos temáticos. La tamización de referencias se realizó por dos revisores de forma independiente y los desacuerdos fueron resueltos por consenso. La selección de estudios fue realizada mediante la revisión en texto completo de las referencias preseleccionadas, verificando los criterios de elegibilidad predefinidos. Las características y hallazgos de los estudios fueron extraídos a partir de las publicaciones originales. Resultados: Se identificó evidencia proveniente de 4 revisiones sistemáticas de moderada y alta calidad, que compraban risperidona con placebo, se encontró que risperidona fue superior a placebo en los desenlaces de impresión global de salud, irritabilidad, hiperactividad, estereotipias. Conclusiones: La risperidona comparada con placebo sugiere efectividad en relación a mejoría de síntomas como irritabilidad, hiperactividad y estereotipias, así como, de la impresión clínica global. No se puede establecer con la evidencia actual el perfil de seguridad de la risperidona, solo se evidenció que los pacientes que reciben risperidona tienen mayor riesgo de aumento de peso y de presentar síndrome de extrapiramidalismo.
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Humanos , Trastorno del Espectro Autista/diagnóstico , Trastorno del Espectro Autista/tratamiento farmacológico , Placebos/administración & dosificación , Benzodiazepinas/administración & dosificación , Reproducibilidad de los Resultados , Resultado del Tratamiento , Clonidina/administración & dosificación , Clozapina/administración & dosificación , Colombia , Risperidona/administración & dosificación , Tecnología Biomédica , Fumarato de Quetiapina/administración & dosificación , Aripiprazol/administración & dosificación , Haloperidol/administración & dosificaciónRESUMEN
Abstract Lacan did not propose a totalized subject, but he proposed a divided one whose representation is structured in each interaction with its peers through Saussure's argumentative language. This shows the real, the imaginary or the symbolic as (a), (a') or (A). This study tries to propose and discuss that it is currently possible to establish virtual issues, taking into account social and psychological effects of the cyberspace and the capacity to decide and execute actions. Virtually, the representation is given by the Avatar known as (A'), since it is an evolution of the Other (A). This interaction is being done through the use of language, with the construction of signifieds and signifiers. Signifieds are conceived in the virtual world and signifiers in the real one, but the last one could allow the first one to materialize the Other (A) in the Avatar (A'). Second Life is a metaverse, a massively multiplayer online role-playing game (MMORPG), which shows 3D virtual worlds where each subject is able to create its Avatars characterizing its own identity through the subject's desires.
Resumen Lacan no propuso un sujeto totalizado, pero propuso uno dividido cuya representación se estructura en cada interacción con sus pares a través del lenguaje argumentativo de Saussure. Esto demuestra lo real, lo imaginario y lo simbólico como (a), (a ") o (A). Este estudio trata de proponer y discutir que es posible actualmente establecer cuestiones virtuales, teniendo en cuenta los efectos sociales y psicológicos del ci-berespacio y la capacidad de decidir y ejecutar acciones. Prácticamente, la representación es dada por el Avatar conocido como (A ya que es una evolución de las otras (A). Esta interacción se lleva a cabo mediante el uso del lenguaje, con la construcción de significados y significantes. Significados son concebidos en el mundo virtual y significantes en la real, pero el último podría permitir al primero materializar el Otro (A) en el Avatar (A '). Second Life es un metaverso, un juego del rol multi-jugador masivo en línea (MMORPG), que muestra mundos virtuales en 3D en el que cada sujeto es capaz de crear sus avatares caracterizar su propia identidad a través de los deseos del sujeto.
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Objective:To determine the prescribing patterns for protonpump inhibitors and to estimate the economic cost of their usein a group of patients affiliated with the Colombian Health Sys-tem.Methods:This is a descriptive observational study. Data foranalysis consisted of prescriptions dispensed between October1st, 2010 and October 31st, 2010 and were collected from a sys-tematic database of 4.2 million members. Socio-demographicvariables were considered along with the defined daily dose,comedication, convenience of the indication for proton pumpinhibitor use and costs.Results:In this study, 113,560 prescriptions were dispensed in89 cities, mostly to women (57.6 percent) with a mean age of 54.4 ±18.7 years; the drugs were omeprazole (n=111,294; 97.81 percent),esomeprazole (n=1,378; 1.2 percent), lansoprazole (n=524; 0.4 percent),pantoprazole and rabeprazole. The indication for 87,349 of theformulas (76.9 percent) was justified and statistically associated withthe use of NSAIDs, antithrombotics, corticosteroids, anti-ul-cer, antibiotics and prokinetics. No justification was found for26,211 (23.1 percent) of the prescriptions, which were associated withantidiabetics, antihypertensives,hypolipidemics andothers(p <0.001). The annual justified cost was estimated to beUS$ 1,654,701 and the unjustified cost was estimated tobe U.S. $ 2,202,590, as calculated using the minimum re-ference prices.
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Omeprazol , Farmacoepidemiología , Servicios FarmacéuticosRESUMEN
OBJECTIVE: To determine the prescribing patterns for proton pump inhibitors and to estimate the economic cost of their use in a group of patients affiliated with the Colombian Health System. METHODS: This is a descriptive observational study. Data for analysis consisted of prescriptions dispensed between October 1st, 2010 and October 31st, 2010 and were collected from a systematic database of 4.2 million members. Socio-demographic variables were considered along with the defined daily dose,comedication, convenience of the indication for proton pump inhibitor use and costs. RESULTS: In this study, 113,560 prescriptions were dispensed in 89 cities, mostly to women (57.6%) with a mean age of 54.4 ± 18.7 years; the drugs were omeprazole (n= 111.294; 97.81%),esomeprazole (n= 1.378; 1.2%), lansoprazole (n= 524; 0.4%), pantoprazole and rabeprazole. The indication for 87.349 of the formulas (76.9%) was justified and statistically associated with the use of NSAIDs, antithrombotics, corticosteroids, anti-ulcer, antibiotics and prokinetics. No justification was found for 26.211 (23.1%) of the prescriptions, which were associated with antidiabetics, antihypertensives, hypolipidemics and others (p <0.001).The annual justified cost was estimated to be US$ 1,654,701 and the unjustified cost was estimated to be U.S. $2,202,590, as calculated using the minimum reference prices. DISCUSSION: Each month, the Colombian health system is overloaded by unjustified costs that include payments for non-approved indications of proton pump inhibitors and for drugs outside the list of essential medications. This issue is contributing to rising costs of healthcare in Colombia.
OBJETIVOS: Determinar los patrones de prescripción de inhibidores de la bomba de protones y estimar el costo económico que genera su utilización en pacientes afiliados al Sistema General de Seguridad Social en Salud de Colombia. METODOLOGÍA: Estudio descriptivo observacional. Se analizarondatos de formulas dispensadas entre 1 y 31 de octubre de 2010 de una base de datos sistematizada de 4.2 millones de afiliados.Se consideraron variables socio-demograficas, dosis diaria definida,comedicación recibida, conveniencia o no del tipo de indicación de IBP y costos. RESULTADOS: Se dispensaron 113 560 formulas en 89 municipios,principalmente a mujeres (57.6%); promedio de edad 54.4±18.7 años; los medicamentos fueron omeprazol (n= 111294, 97.8%),esomeprazol (n= 1378, 1.2%), lanzoprazol (n= 524, 0.4%), pantoprazol y rabeprazol a dosis diarias definidas adecuadas. Se halló justificación en la indicación de 87349 fórmulas (76.9%) asociadas estadísticamente con uso de AINEs, antitrombóticos, corticoides, antiulcerosos, antibióticos, procinéticos, y sin justificación 26211 (23.1%) asociadas a antidiabéticos, antihipertensivos e hipolipemiantes y otros (p <0.001). El costo anual justificado fue de US$1.654.701 y no justificado de U.S.$2,202,590 empleando mínimos precios de referencia. DISCUSIÓN: Mensualmente se está cargando al sistema de salud colombiano con costos no justificados del uso de inhibidores de bomba de protones en indicaciones no aprobadas y con medicamentos por fuera del listado de esenciales que contribuyen a encarecer la atención sanitaria.
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El síndrome de PHACE es un acrónimo propuesto en 1996 por Frieden y cols. en relación con la asociación de múltiples anomalías neurocutáneas: malformaciones de fosa posterior (P), hemangioma (H), anomalías arteriales (A), cardíacas (C), oculares (E), y en ocasiones esternales (S). Se presenta el caso de una lactante de 7 meses, quien ingresó al Servicio de Urgencias por dificultad respiratoria, y por la presencia de anomalías anatómicas características se logró el diagnóstico de este síndrome, el cual describiremos posteriormente. Es importante conocer esta patología debido a su baja frecuencia, 0.1/10000, y así poder orientar a los clínicos en futuras exploraciones para identificar las características clínicas de este síndrome.
PHACE syndrome is an acronym introduced in 1996 by Frieden et al. on the association of multiple anomalies in neurocutaneas including malformations of the posterior fossa (P), hemangioma (H), arterial anomalies (A), heart (C ), eye (E), and sometimes sternal (S). A case of an infant of 7 months who enters the emergency department for respiratory distress, and the presence of anatomical abnormalities, making possible the diagnosis of such syndrome which will be described later. It is important to know this pathology due to the low frequency 0.1/10000 and this way to be able to orientate the clinical ones in future explorations to identify the clinical characteristics of this syndrome.
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FUNDAMENTOS: Os stents de cromo-cobalto são constituídos de hastes mais finas, apresentando maior flexibilidade e, possivelmente, menor proliferação neointimal que os stents de aço inoxidável. MÉTODO: O registro do stent Cronus (Scitech Produtos Médicos, Goiânia, GO) é um estudo prospectivo, não-randomizado, internacional, desenhado para avaliar a eficácia e a segurança do novo stent de cromo-cobalto de hastes finas em pacientes com insuficiência coronária. No total, 69 lesões foram tratadas em 53 pacientes envolvidos nessa análise. RESULTADOS: Foi constatado sucesso do dispositivo em 98,5% dos casos. A perda luminal tardia foi de 0,7 ± 0,5 mm, tendo ocorrido reestenose binária em 15% e revascularização do vasoalvo em 11,3% dos casos. A incidência de eventos cardíacos adversos maiores (morte, infarto do miocárdio ou revascularização do vaso-alvo) foi de 24,4% após 317 ± 80 dias de acompanhamento. CONCLUSÃO: Nossos resultados iniciais demonstram que o novo stent Cronus mostrou-se seguro e eficaz, com resultados clínicos semelhantes aos observados em outros stents de hastes finas.
BACKGROUND: Thin-strut cobalt-chromium stents have greater flexibility and probably have less neointimal proliferation than stainless steel stents. METHOD: The Cronus (Scitech Produtos Médicos, Goiânia, Brazil) registry is an international, non-randomized, prospective study designed to evaluate the efficacy and safety of a novel thin-strut cobalt-chromium stent in patients with coronary artery disease. A total of 69 lesions were treated in 53 patients included in this analysis. RESULTS: The device success was 98.5%. Mean late luminal loss was 0.7 ± 0.5 mm, binary restenosis occurred in 15% and target vessel revascularization in 11.3% of the cases. The incidence of major adverse cardiac events (death, myocardial infarction or target vessel revascularization) was 24.4% after 317 ± 80 days of follow-up. CONCLUSION: Our initial results demonstrate that the novel Cronus stent proved to be safe and effective, with clinical results similar to other available thin-strut stents.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Prótesis e Implantes , Angioplastia Coronaria con Balón/métodos , Angioplastia Coronaria con Balón , StentsRESUMEN
Esta pesquisa tem como objeto identificar e analisar os determinantes de acidentes ou "lesöes do trabalho" em tripulantes do Sistema Fery-Boat. Buscou-se identificar, também, a frequência e a gravidade das "lesöes" ocorridas nos tripulantes e a relaçäo entre "lesöes do trabalho" e alcoolismo. O referencial teórico trata da navegaçäo marítima e a saúde dos tripulantes; do trabalho e dos acidentes ou lesöes do trabalho relativos aos tripulantes marítimos, além de uma discussäo sobre alcoolismo e acidentes do trabalho. Os dados, objeto de análise, säo de fontes secundárias e primárias, todos obtidos no Consórcio Marítimo da Bahia - COMAB, através de documentos e de história de vida (como técnica) aplicada com quatro tripulantes marítimos, quatro conviventes (familiares) e dois líderes da Empresa. Os resultados, identiificados através dos registros da Empresa e dos depoimentos, evidenciam que as condiçöes de trabalho dos tripulantes marítimos säo precárias necessitando de investimentos para superá-las. Além do mais, revelam diferentes determinantes dos acidentes ou lesöes do trabalho, destacando os de âmbito individual, social, institucional e cultural. Destes determinantes, chamou a atençäo o alcoolismo que, embora näo assumido pelos atores sociais, tanto o discurso destes como o dos conviventes e dos líderes sugerem a sua relaçäo com o trabalho e, possivelmente, com o acidente sofrido pelo trabalhador. Este é, portanto, um estudo que oferece subsídios para que a Marinha Mercante possa repensar os acidentes ou lesöes do trabalho como um problema social