RESUMEN
In response to the global call to mitigate risks associated with antimicrobial resistance (AMR), new regulations on the access and use of veterinary antibiotics are currently being developed by the Lao government. This study aims to explore how the implementation of these new regulations might effectively reduce and adapt the sale, distribution and use of veterinary antibiotics in Lao PDR. To this end, we used the theory of change, framing the AMR issue within the context of the stakeholders involved in the veterinary antibiotics supply chain. Qualitative and quantitative methods were used to collect data, based on questionnaires (n=36 antibiotic suppliers, n=96 chicken farmers, n=96 pig farmers), and participatory tools such as a workshop (n=10 participants), semi-structured interviews (n=20), and focus group discussions (n=7 participants). The stakeholders' understanding of the AMR issue and potential challenges related to the implementation of new regulations regarding access and use of antibiotics, were also investigated. We mapped the veterinary antibiotic supply chain in Lao PDR, and analysed the roles and interactions of its stakeholders. Twenty-three stakeholders representing the private and the public sectors were identified. Many informal and formal links connected these stakeholder within this supply chain. The lack of veterinarian-farmer interaction and the evolving nature of the veterinary antibiotics supply chain accentuated the challenges of achieving behaviour change through regulations. Most of the antibiotics found on farms were categorized by the World Health Organisation's as critically important antibiotics used in human medicine. We argue that AMR risk mitigation strategy requires dialogue and engagement between private and public sectors stakeholders, involved in the importation, distribution, sale and use of veterinary antibiotics. This study further highlighted that AMR is a complex adaptive challenge requiring multi-sectoral approach. We believed that a sustainable approach to reduce and adapt veterinary antibiotics use should be prepared in collaboration with stakeholders from private and public sectors identified in this study, in addition to the new regulations. This collaboration should start with the co-construction of a common understanding of AMR issue and of the objectives of new regulations.
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Antibacterianos/provisión & distribución , Farmacorresistencia Bacteriana , Participación de los Interesados , Medicina Veterinaria/estadística & datos numéricos , Animales , Antibacterianos/uso terapéutico , Agricultores , Humanos , Laos , Sector Público , Control Social Formal , Encuestas y Cuestionarios , PorcinosRESUMEN
κ-(BEDT-TTF)2Cu(NCS)2 has been investigated by Raman scattering in both bulk and nanoparticle compounds. Phonon modes from 20 to 1600 cm-1 have been assigned. Focusing on the unexplored low frequency phonons, a plateau in frequencies is observed in the bulk phonons between 50 and 100 K and assigned to the signature of the bad metal phase. Nanoparticles of κ-(BEDT-TTF)2Cu(NCS)2 exhibit anomalies at 50 K associated to the crossover from a bad metal to a Fermi liquid whose origins are discussed.
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BACKGROUND: Quantum noise intrinsically limits the quality of fluoroscopic images. The lower is the X-ray dose the higher is the noise. Fluoroscopy video processing can enhance image quality and allows further patient's dose lowering. This study aims to assess the performances achieved by a Noise Variance Conditioned Average (NVCA) spatio-temporal filter for real-time denoising of fluoroscopic sequences. The filter is specifically designed for quantum noise suppression and edge preservation. It is an average filter that excludes neighborhood pixel values exceeding noise statistic limits, by means of a threshold which depends on the local noise standard deviation, to preserve the image spatial resolution. The performances were evaluated in terms of contrast-to-noise-ratio (CNR) increment, image blurring (full width of the half maximum of the line spread function) and computational time. The NVCA filter performances were compared to those achieved by simple moving average filters and the state-of-the-art video denoising block matching-4D (VBM4D) algorithm. The influence of the NVCA filter size and threshold on the final image quality was evaluated too. RESULTS: For NVCA filter mask size of 5 × 5 × 5 pixels (the third dimension represents the temporal extent of the filter) and a threshold level equal to 2 times the local noise standard deviation, the NVCA filter achieved a 10% increase of the CNR with respect to the unfiltered sequence, while the VBM4D achieved a 14% increase. In the case of NVCA, the edge blurring did not depend on the speed of the moving objects; on the other hand, the spatial resolution worsened of about 2.2 times by doubling the objects speed with VBM4D. The NVCA mask size and the local noise-threshold level are critical for final image quality. The computational time of the NVCA filter was found to be just few percentages of that required for the VBM4D filter. CONCLUSIONS: The NVCA filter obtained a better image quality compared to simple moving average filters, and a lower but comparable quality when compared with the VBM4D filter. The NVCA filter showed to preserve edge sharpness, in particular in the case of moving objects (performing even better than VBM4D). The simplicity of the NVCA filter and its low computational burden make this filter suitable for real-time video processing and its hardware implementation is ready to be included in future fluoroscopy devices, offering further lowering of patient's X-ray dose.
Asunto(s)
Algoritmos , Fluoroscopía , Aumento de la Imagen/métodos , Dosis de Radiación , Relación Señal-Ruido , Fantasmas de Imagen , Distribución de Poisson , Factores de TiempoRESUMEN
BACKGROUND: Ultrasound (US) is a real-time non-invasive technique that has been demonstrated to support an early diagnosis and a more precise assessment of hidradenitis suppurativa (HS). OBJECTIVES: To compare the clinical and US evaluation of a series of HS patients. METHODS: 434 HS patients (259 F, 175 M; mean age 33.82 ±13.31 years) observed across 19 Italian dermatology centres [members of the Italian Ultrasound Working Group (IUWG)] were enrolled in a retrospective study. Clinical staging was obtained by the Hidradenitis Suppurativa Physician's Global Assessment score (HS-PGA), while the ultrasonographic staging was determined by the US HS-PGA, based on the same scores as clinical HS-PGA but performed with the aid of US. RESULTS: At the end of the study, the mean clinical and US HS-PGA scores were 2.70 and 2.92, respectively. Direct comparison of clinical and ultrasonographic assessment revealed that a higher proportion of patients was classified as having moderate and very severe disease by US. In particular, 117 patients (26.96%) had a worse classification by US HS-PGA compared to clinical assessment. CONCLUSION: Our findings confirm that the use of clinical grading only to assess HS severity may underestimate the real disease severity. US examination can be considered an essential non-invasive imaging tool available to dermatologists for a more accurate diagnosis, staging, treatment planning and monitoring of HS and should be included in the pathway to an optimal standard of care of HS.
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Hidradenitis Supurativa/diagnóstico por imagen , Examen Físico , Índice de Severidad de la Enfermedad , Ultrasonografía , Adulto , Femenino , Hidradenitis Supurativa/terapia , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
Genetically engineered bacteria can be used for a wide range of applications, from monitoring environmental toxins to studying complex communication networks in the human digestive system. Although great strides have been made in studying single strains of bacteria in well-controlled microfluidic environments, there remains a need for tools to reliably control and measure communication between multiple discrete bacterial populations. Stable long-term experiments (e.g., days) with controlled population sizes and regulated input (e.g., concentration) and output measurements can reveal fundamental limits of cell-to-cell communication. In this work, we developed a microfluidic platform that utilizes a porous monolith to reliably and stably partition adjacent strains of bacteria while allowing molecular communication between them for several days. We measured small molecule production by the bacterial populations in response to stimuli using analytical chemistry methods and measured fluorescent output. The results are compared with communication and diffusion delay models. This porous monolith microfluidic system enables bacterial cell-to-cell communication assays with dynamic control of inputs, relatively long-term experimentation with no cross contamination, and stable bacterial population size. This system can serve as a valuable tool in understanding bacterial communication and improving biosensor design capabilities.
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Livestock production has a variety of environmental impacts such as greenhouse gas emissions, water pollution, acidification, and primary energy consumption. The demand for livestock products is expected to grow substantially, creating even more environmental pressure. The use of specialty feed ingredients (SFI) such as supplemented AA and phytase can reduce nutrient input into the system without compromising productivity and consequently can reduce emissions. The global change impact of using SFI in pig and broiler production systems in Europe and North and South America was studied. A life cycle assessment according to international standards (ISO 14040/44) analyzed contributions from producing SFI and animals to global change. Three different alternatives were analyzed. In addition, partial sensitivity analysis was conducted using 5 scenarios for each region for both production systems. Specialty feed ingredient supplementation in pig and broiler diets reduced greenhouse gas emissions (cradle to farm gate) by 56% and 54% in Europe, 17% and 15% in North America, and 33% and 19% in South America, respectively, compared to an unsupplemented diet. A total of 136 Mt CO equivalent (CO eq) was saved in 2012, rising to 146 Mt CO eq in 2050 on the basis of United Nations population projections. Considerable benefits of supplementation with SFI were apparent in European and South American diets when direct land use change was considered because of the reduced demand for soybean meal. The eutrophication potential of unsupplemented diets was reduced by up to 35% in pig and 49% in broiler production systems compared to supplemented alternatives. The acidification potential of supplemented strategies was reduced by up to 30% in pig and 79% in broiler production systems. The primary energy demand was similar in all alternatives, and this could be an area where the SFI industry can improve. Overall, SFI supplementation substantially reduced the global warming, eutrophication, and acidification potentials in all regions studied.
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Alimentación Animal , Ambiente , Ganado/crecimiento & desarrollo , Aves de Corral/crecimiento & desarrollo , Sus scrofa/crecimiento & desarrollo , Animales , Pollos/crecimiento & desarrollo , Dieta/veterinaria , Suplementos Dietéticos , Europa (Continente) , América del Norte , Productos Avícolas , Glycine maxRESUMEN
Este artículo es una revisión de tema sobre cáncer de cuello uterino, con el fin de visibilizar la necesidad de un enfoque diferencial \r\ncon perspectiva de género y evidenciar que el contexto social, cultural y de desigualdad de las mujeres las hace más vulnerables \r\na este tipo de enfermedad. El enfoque biologicista ha limitado la mirada desde la morbilidad femenina diferencial y de esta forma \r\nha evitado poner de manifiesto cómo las mujeres, debido a su condición de género, tienen mayor probabilidad de enfermar y \r\ncómo la falta de autonomía sobre su cuerpo las pone en riesgo de sufrir esta clase de cáncer.\r\nEl texto plantea la importancia de realizar investigaciones sobre cáncer de cuello uterino para redefinir políticas públicas inclu\r\n-\r\nyentes con enfoque de género, que procuren cambios de paradigmas en la población, para generar transformaciones que \r\nconduzcan a un abordaje integral de esta patología
A review article on the topic of cervical cancer is presented \r\nin order to visualize the need of a differentiated approach to \r\ngender, and to demonstrate that social, cultural and egalitarian \r\nattitudes towards women makes women more vulnerable to \r\nthis type of disease. The biological focus has limited the view \r\nfrom the differential female morbidity, and has hindered the \r\ncase that women, due to the specifics of their gender, are more \r\nlikely to get sick and are at a higher risk of developing this type \r\nof cancer due to the lack of autonomy over their bodies.\r\nThe article shows the importance of cervical cancer research \r\nto redefine inclusive public policies with a gender perspective, \r\nwhich promote paradigm shifts in the population, to generate \r\ntransformations leading to a comprehensive approach to this \r\ncondition.
O artigo tem como objetivo rever o tema câncer de colo do \r\nútero, a fim de visualizar a necessidade de uma abordagem \r\ndiferenciada em relação ao sexo, e demonstrar que o contexto \r\nsocial, cultural e de desigualdade das mulheres as torna mais \r\nvulneráveis a este tipo doença. A abordagem biológica tem \r\nlimitado a visão da morbidade feminina diferencial e, desta \r\nforma, evitado colocar em destaque como as mulheres, por \r\ncausa da carga de gênero, são mais propensas a ficar doentes \r\ne, com a falta de autonomia sobre seus corpos, coloca-as em \r\nrisco de desenvolvimento deste tipo de câncer.\r\nO artigo mostra a importância da investigação sobre o câncer \r\nde colo do útero para redefinir políticas públicas inclusivas com \r\nenfoque de gênero, que promovam mudanças de paradigma \r\nadotivos na população, para gerar transformações que levem \r\na uma abordagem abrangente desta condição.
Asunto(s)
Política Pública , Mujeres , Neoplasias del Cuello Uterino , Salud de la Mujer , Cultura , Disparidades en el Estado de Salud , Identidad de Género , Salud Holística , NeoplasiasRESUMEN
El diagnóstico clínico diferencial entre el epitelioma basocelular y el nevus melanocítico intradérmico facial puede ser a veces complicado, sobre todo en pacientes jóvenes o con múltiples nevus. La dermatoscopia es una herramienta útil que permite observar signos dermatoscópicos asociados a epitelioma como las ruedas de carro, las hojas de arce, los nidos y puntos azul grisáceos y la ulceración, además permite distinguir los vasos telangiéctasicos arboriformes y los vasos cortos curvados bien enfocados característicos de los epiteliomas basocelulares de los vasos en coma presentes en los nevus melanocíticos intradérmicos. Sin embargo, el diagnóstico diferencial clínico y dermatoscópico entre estas 2 afecciones dermatológicas puede ser complejo. Presentamos 2 lesiones faciales en 2 pacientes de 38 años de difícil diagnóstico clínico y dermatoscópico en los que la microscopia confocal mostró nidos celulares con separación entre los nidos y el estroma, y polarización de los núcleos de las células tumorales, que son signos confocales asociados a epitelioma basocelular
The clinical distinction between basal cell carcinoma (BCC) and intradermal melanocytic nevus lesions on the face can be difficult, particularly in young patients or patients with multiple nevi. Dermoscopy is a useful tool for analyzing characteristic dermoscopic features of BCC, such as cartwheel structures, maple leaflike areas, blue-gray nests and dots, and ulceration. It also reveals arborizing telangiectatic vessels and prominent curved vessels, which are typical of BCC, and comma vessels, which are typical of intradermal melanocytic nevi. It is, however, not always easy to distinguish between these 2 conditions, even when dermoscopy is used. We describe 2 facial lesions that posed a clinical and dermoscopic challenge in two 38-year-old patients; confocal microscopy showed separation between tumor nests and stroma and polarized nuclei, which are confocal microscopy features of basal cell carcinoma
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Femenino , Humanos , Carcinoma Basocelular/clasificación , Carcinoma Basocelular/etiología , Nevo/clasificación , Nevo/diagnóstico , Nevo/terapia , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular , Pruebas Intradérmicas/métodos , Diagnóstico Diferencial , Microscopía Confocal/instrumentación , Microscopía Confocal/métodos , Microscopía Confocal , Nevo/patología , Nevo , Síndrome del Nevo Basocelular/diagnóstico , Síndrome del Nevo Basocelular/terapia , Síndrome del Nevo BasocelularRESUMEN
The clinical distinction between basal cell carcinoma (BCC) and intradermal melanocytic nevus lesions on the face can be difficult, particularly in young patients or patients with multiple nevi. Dermoscopy is a useful tool for analyzing characteristic dermoscopic features of BCC, such as cartwheel structures, maple leaf-like areas, blue-gray nests and dots, and ulceration. It also reveals arborizing telangiectatic vessels and prominent curved vessels, which are typical of BCC, and comma vessels, which are typical of intradermal melanocytic nevi. It is, however, not always easy to distinguish between these 2 conditions, even when dermoscopy is used. We describe 2 facial lesions that posed a clinical and dermoscopic challenge in two 38-year-old patients; confocal microscopy showed separation between tumor nests and stroma and polarized nuclei, which are confocal microscopy features of basal cell carcinoma.
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Carcinoma Basocelular/diagnóstico por imagen , Neoplasias Faciales/diagnóstico por imagen , Microscopía Confocal , Nevo Pigmentado/diagnóstico por imagen , Neoplasias Cutáneas/diagnóstico por imagen , Adulto , Carcinoma Basocelular/irrigación sanguínea , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/patología , Fármacos Dermatológicos/efectos adversos , Fármacos Dermatológicos/uso terapéutico , Dermoscopía , Diagnóstico Diferencial , Neoplasias Faciales/irrigación sanguínea , Neoplasias Faciales/diagnóstico , Neoplasias Faciales/patología , Femenino , Humanos , Nevo Pigmentado/irrigación sanguínea , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/patología , Psoriasis/complicaciones , Psoriasis/tratamiento farmacológico , Neoplasias Cutáneas/irrigación sanguínea , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , Ustekinumab/efectos adversos , Ustekinumab/uso terapéuticoRESUMEN
Estudio retrospectivo de pacientes atendidos con diagnóstico de Alopecia Areata en el Servicio de Dermatología del Centro de Diagnóstico de la Pontificia Universidad Católica de Chile. Se revisaron las fichas de 77 pacientes con diagnóstico de Alopecia Areata, 38 por ciento hombres, 62 por ciento mujeres, con un promedio de edad de 26.7 (DSI 15.7; rango 2-65): 15 por ciento presentaron depresión, 11 por ciento rinitis alérgica, 6,5 por ciento presentaron ansiedad, 3,9 por ciento hipotiroidismo y 2,6 por ciento, vitíligo. La Alopecia Areata se asocia a un evento estresante en 27 por ciento de los pacientes. Dentro de los exámenes solicitados, un 2/26 tuvieron anticuerpos antitiroídeos positivos y 2/27, TSH alterada. Se discuten las diversas modalidades terapéuticas para tratar la Alopecia Areata.
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Masculino , Adolescente , Adulto , Humanos , Femenino , Preescolar , Niño , Persona de Mediana Edad , Alopecia Areata/complicaciones , Alopecia Areata/etiología , Alopecia Areata/tratamiento farmacológico , Ciclopropanos/uso terapéutico , Corticoesteroides/uso terapéutico , Quimioterapia Combinada , Enfermedades de la Piel/complicaciones , Enfermedades de la Tiroides/complicaciones , Inmunoterapia , Acontecimientos que Cambian la Vida , Minoxidil/uso terapéutico , Estudios Retrospectivos , Trastornos Mentales/complicacionesRESUMEN
En los últimos años hemos asistido a un interés creciente por eltratamiento de la insuficiencia cardíaca mediante el trasplante decélulas madre. Mientras que los estudios con células madre de músculo(mioblastos) se iniciaron hace mas de 10 años, la posibilidadde que las células madre de la médula ósea tengan un enorme potencialde diferenciación y proliferación han estimulado la investigacióncon otros tipos de células madre. Estos estudios experimentales handemostrado, en no pocas ocasiones, resultados contradictorios loque ha llevado a posturas enfrentadas en cuanto a la ética de iniciarestudios clínicos. Creemos que es adecuado tratar de ofrecer unavisión crítica sobre la utilización de las células madre en la insuficienciacardíaca. Quizá la pregunta mas difícil de contestar en estemomento es, si la realización de ensayos clínicos esta justificado ono a la luz de los conocimientos actuales o si por el contrario debemosadquirir un conocimiento mucho más preciso de la posibleeficacia de este tipo de tratamiento y de los mecanismos que justificandicha eficacia, antes de siquiera iniciar los estudios en humanos.En nuestra opinión existen suficientes evidencias que justifican eldesarrollo de ensayos clínicos a pesar de que, sin duda, existenmuchos interrogantes que debemos resolver mediante estudios experimentalesen animales
The last few years have witnessed a growing interest in regenerative therapy of the failing heart by cell transplantation. Initial studies with skeletal myoblasts were conducted more than 10 years ago. However, the potential of bone marrow derived cells has more recently led to a flurry of experimental studies generating overall positive but occasionally conflicting results. The ethics of initiating clinical trials with stem cells in patients with heart failure has been questioned. Although laboratory research attempts to overcome a number of questions surrounding the usefulness and safety of cell therapy, the accumulated body of evidence warrants implementation of clinical trials. The earliest of these have now documented the feasibility of cell therapy. It is now appropriate to conduct safety and efficacy studies which, if carefully done, should allow assessment of the extent to which this concept of regenerative therapy can be made a clinical reality (AU)
Asunto(s)
Humanos , Corazón/fisiología , Mioblastos Cardíacos/trasplante , Regeneración , Ensayos Clínicos como Asunto , Miocardio/citología , Trasplante de Células Madre/métodosRESUMEN
The last few years have witnessed a growing interest in regenerative therapy of the failing heart by cell transplantation. Initial studies with skeletal myoblasts were conducted more than 10 years ago. However, the potential of bone marrow derived cells has more recently led to a flurry of experimental studies generating overall positive but occasionally conflicting results. The ethics of initiating clinical trials with stem cells in patients with heart failure has been questioned. Although laboratory research attempts to overcome a number of questions surrounding the usefulness and safety of cell therapy, the accumulated body of evidence warrants implementation of clinical trials. The earliest of these have now documented the feasibility of cell therapy. It is now appropriate to conduct safety and efficacy studies which, if carefully done, should allow assessment of the extent to which this concept of regenerative therapy can be made a clinical reality.
Asunto(s)
Corazón/fisiología , Mioblastos Cardíacos/trasplante , Regeneración , Ensayos Clínicos como Asunto , Humanos , Miocardio/citología , Trasplante de Células Madre/métodosRESUMEN
La alopecia areata es una enfermedad dermatológica caracterizada por áreas o parches de alopecia con bordes netos en cuero cabelludo (principalmente) y resto del cuerpo. Es no cicatricial y tiene un curso impredecible, incluso la involución espontánea. Corresponde al 2 por ciento de las consultas dermatológicas. Puede asociarse a alteraciones autoinmunes como la tiroiditis de Hashimoto, vitíligo y atopia. Hasta una 20 por ciento de los pacientes tienen antecedentes familiares de la enfermedad. Actualmente puede tratarse con corticoides intralesionales, inmunoterapia tópica o sistémica, antralina, minoxidil y fotoquimioterapia. El tratamiento y la evolución dependen principalmente de dos factores: extensión y la edad de los pacientes.
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Humanos , Alopecia Areata/diagnóstico , Alopecia Areata/etiología , Alopecia Areata/tratamiento farmacológico , Alopecia Areata/genética , Alopecia Areata/inmunología , Corticoesteroides/uso terapéutico , Diagnóstico Diferencial , Pronóstico , Signos y SíntomasRESUMEN
Streptococcus grupo anginosus, y sus especies constellatus, anginosus e intermedius, causan infecciones supuradas. Su identificación microbiológica es compleja pues pueden ser b-hemolíticos y comparten antígenos de Lancefield con otros estreptococos. Si bien morfológicamente son colonias pequeñas y presentan un olor característicos, si sólo se realiza test de látex para aglutinación del carbohidrato C pueden ser clasificados erróneamente. El objetivo de nuestro trabajo fue evaluar un algoritmo que utiliza 3 pruebas bioquímicas, conocer su susceptibilidad a antimicrobianos y describir las características clínicas de infecciones producidas por Streptococcus grupo anginosus. Se estudiaron cepas de Streptococcus grupo C, G y F, determinando sus características morfológicas de colonia, para identificar cepas de colonia pequeña que se incluyeron en el algoritmo de bajo costo propuesto (b-glucuronidasa y el test Voges-Proskauer) comparándose al método API Rapid ID 32 Strept½, establecido como estándar de oro. Se estudiaron 219 cepas, de las cuales 101 presentaron las características morfológicas compatibles con grupo anginosus, identificándose S. constellatus en 58 por ciento (59/101), S. anginosus en 37 por ciento (37/101) y S. intermedius en 5 por ciento (5/101). Las cepas aisladas procedían principalmente de infecciones piogénicas (61 por ciento, 62/101), en especial de foco abdominal. Se observó 98 por ciento de susceptibilidad a penicilina y cefotaxima y resistencia a eritromicina y clindamicina en 6,8 y 5 por ciento, respectivamente. La edad promedio de los pacientes fue de 30 años (2-85), con distribución similar por sexo y predominio de pacientes hospitalizados. Los resultados expuestos demuestra la efectividad del algoritmo de bajo costo para la detección de S. grupo anginosus. En nuestra experiencia este grupo bacteriano conserva su susceptibilidad a penicilina y cefotaxima, siendo necesario vigilar clindamicina y eritromicina.
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Humanos , Pruebas de Sensibilidad Microbiana , Streptococcus anginosus/aislamiento & purificación , Antibacterianos/farmacología , Técnicas de Tipificación Bacteriana , Chile , Farmacorresistencia Bacteriana , Infecciones Estreptocócicas/microbiología , Penicilinas , Streptococcus pyogenes , Streptococcus anginosus/clasificaciónRESUMEN
We report a case of a large false aortic aneurysm that had developed in a 43-year-old man who had had coarctation repair 30 years previously. The coarctation repair had been done by inserting an end-to-end Dacron tubular graft which was sutured with silk. The re-operation was successfully performed under deep hypothermic arrest and it was noted that there was complete separation of the graft from both ends and no sutures were visualised. The deep hypothermic technique has considerably improved the ease and safety of this operation. We attribute this complication to the reabsorption of the silk sutures. Patients after coarctectomy with graft material should have regular chest X-rays for life in order to detect false aneurysms.
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Aneurisma Falso/etiología , Aneurisma de la Aorta/etiología , Coartación Aórtica/cirugía , Prótesis Vascular/efectos adversos , Falla de Prótesis , Adulto , Aneurisma Falso/cirugía , Aneurisma de la Aorta/cirugía , Humanos , Masculino , Factores de TiempoRESUMEN
Se presenta en forma preliminar la experiencia en cirugía ambulatoria de 300 pacientes en edades entre los 30 días y 15 años realizadas en el Servicio de Cirugía Infantil del Hospital Base de Valdivia, entre los años 1997 y octubre 2002, entendiendo por cirugía ambulatoria a la internación electiva, tratamiento y alta de pacientes durante el transcurso de un día hábil, excluyendo las cirugías menores efectuadas a pacientes occidentados o tratados en la Unidad de Emergencia. Se utilizaron criterios de selección como la edad (>30 días a <15 años), problemas anestésicos previsibles de acuerdo a la clasificación de estado físico de la Sociedad Americana de Anestesiología (status ASA I y II). Las patologías más frecuentemente resueltas mediante cirugía ambulatoria fueron las hernias inguinales, fimosis y testículos no descendidos. Las complicaciones no superaron el 1 por ciento y no obligaron a prolongar la estadía de los pacientes. La experiencia presentada sugiere continuar y extender esta práctica.
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Humanos , Preescolar , Adolescente , Recién Nacido , Lactante , Niño , Procedimientos Quirúrgicos Ambulatorios/métodos , Procedimientos Quirúrgicos Ambulatorios/economía , Procedimientos Quirúrgicos Ambulatorios/tendenciasRESUMEN
BACKGROUND: The plasminogen activator inhibitor-1 (PAI-1), which modulates fibrinolysis and cell migration, may influence proteolysis and neointimal formation in the arterial wall contributing to restenosis after vascular injury. Antioxidants have been proposed as inhibiting multiple proatherogenic events. We explore the effect of vitamins C and E on PAI-1 expression in an experimental model of angioplasty in hypercholesterolemic pigs. METHODS AND RESULTS: A total of 44 Yucatan minipigs were divided into three diet groups: a normal-cholesterol (NC), a high-cholesterol (HC), and a high-cholesterol plus vitamins C+E (HCV) group. Balloon injury was induced in the right internal iliac artery 4 weeks after initiation of either dietary regimen, and plasma and tissue samples were taken at different time periods to measure PAI-1 activity and vascular inhibitor expression. The cholesterol-rich diet induced an increased in vascular PAI-1 expression in the intima, media and adventitia which was markedly reduced in the HCV group. After injury, severe structural changes were observed in NC and HC animals associated with increased systemic PAI-1 activity (P<0.001) and local PAI-1 expression being more intense in HC group. Vitamins C and E significantly reduced plasma PAI-1 activity (P=0.018) and attenuated the inhibitor expression as compared with HC. CONCLUSIONS: This experimental study in a porcine model of hypercholesterolemia demonstrates that vitamins C and E reduce local and systemic PAI-1 induced after angioplasty as well as the hypercholesterolemia-induced vascular PAI-1.
Asunto(s)
Angioplastia de Balón/efectos adversos , Ácido Ascórbico/uso terapéutico , Hipercolesterolemia/prevención & control , Arteria Ilíaca/lesiones , Inhibidor 1 de Activador Plasminogénico/metabolismo , Vitamina E/uso terapéutico , Análisis de Varianza , Animales , Colesterol/sangre , Suplementos Dietéticos , Hipercolesterolemia/metabolismo , Hipercolesterolemia/terapia , Arteria Ilíaca/química , Arteria Ilíaca/patología , Inmunohistoquímica , Hibridación in Situ , Inhibidor 1 de Activador Plasminogénico/análisis , Recurrencia , Estadísticas no Paramétricas , Porcinos Enanos , Vitamina E/sangreRESUMEN
En la actualidad, las estatinas son los fármacos más empleados en el tratamiento de las dislipidemias. Además de la disminución de los niveles de colesterol LDL, las estatinas tienen otros efectos 'vasculares' y hemostáticos que permiten explicar mejor su probada eficacia clínica. En la presente revisión se describen los mecanismos de acción de las estatinas tratando de explicar mediante ellos no sólo la reducción de los niveles lipídicos, sino también la producción de los citados efectos vasculares y hemostáticos. La mejor comprensión de estos mecanismos permitirá, sin duda, un uso más racional de estos fármacos (AU)
Asunto(s)
Humanos , Aminoácidos/farmacocinética , Hiperlipidemias/tratamiento farmacológico , Lípidos , Endotelio Vascular , Hemostasis , Hipercolesterolemia/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/farmacocinéticaRESUMEN
Premature breast development (thelarche) is the growth of mammary tissue in girls younger than 8 years of age without other manifestations of puberty. Puerto Rico has the highest known incidence of premature thelarche ever reported. In the last two decades since this serious public health anomaly has been observed, no explanation for this phenomenon has been found. Some organic pollutants, including pesticides and some plasticizers, can disrupt normal sexual development in wildlife, and many of these have been widely used in Puerto Rico. This investigation was designed to identify pollutants in the serum of Puerto Rican girls with premature thelarche. A method for blood serum analysis was optimized and validated using pesticides and phthalate esters as model compounds of endocrine-disrupting chemicals. Recovery was > 80% for all compounds. We performed final detection by gas chromatography/mass spectrometry. We analyzed 41 serum samples from thelarche patients and 35 control samples. No pesticides or their metabolite residues were detected in the serum of the study or control subjects. Significantly high levels of phthalates [dimethyl, diethyl, dibutyl, and di-(2-ethylhexyl)] and its major metabolite mono-(2-ethylhexyl) phthalate were identified in 28 (68%) samples from thelarche patients. Of the control samples analyzed, only one showed significant levels of di-isooctyl phthalate. The phthalates that we identified have been classified as endocrine disruptors. This study suggests a possible association between plasticizers with known estrogenic and antiandrogenic activity and the cause of premature breast development in a human female population.
Asunto(s)
Mama/crecimiento & desarrollo , Ácidos Ftálicos/efectos adversos , Plastificantes/efectos adversos , Pubertad Precoz/inducido químicamente , Estudios de Casos y Controles , Niño , Preescolar , Sistema Endocrino/efectos de los fármacos , Exposición a Riesgos Ambientales , Femenino , Cromatografía de Gases y Espectrometría de Masas , Humanos , Lactante , Ácidos Ftálicos/sangre , Pubertad Precoz/epidemiología , Salud Pública , Puerto Rico/epidemiologíaRESUMEN
BACKGROUND: Coronary vasospasms generally occur at rest, but can also be triggered by physical exercise. Anginal pain and ST-segment elevation may be seen during exercise-stress tests. ST-segment depression, due to nonocclusive vasospasms, has also been found to occur. When the result of a test is positive, scintigraphy usually reveals perfusion defects. True silent or clandestine ischemia (normal result of exercise test with perfusion defects) in these patients is very uncommon. OBJECTIVE: To stress the need for suspecting occurrence of coronary vasospasms in order to perform a proper diagnosis. METHODS: Eight patients with angina were selected for this study. They had negative results of exercise tests with perfusion defects detected by thallium-201 tomography, normal coronary arteries and vasospasms. Maximal exercise-stress tests with thallium-201 tomography were performed. Sizes of perfusion defects were quantified by examining polar maps. Coronary angiography and then an intracoronary ergonovine test were performed for each patient. RESULTS: Significant defects were seen in territory of the right coronary artery, the left anterior descending artery, or both. Lung:heart ratio was normal in every case. The coronary arteries were normal and vasospasms were elicited with ergonovine in all the patients. Correspondence between the location of perfusion defects and angiographic spasms was generally observed. After treatment with calcium antagonists and nitrates all of them improved and defects detected by thallium tomography were no longer found when tests were repeated. CONCLUSIONS: Some patients with vasospastic angina may have normal results of exercise-stress tests and reversible perfusion defects detectable by scintigraphy. This finding must lead one to perform coronary angiography without administration of nitroglycerine beforehand and an ergonovine test if the coronary arteries are normal.