Asunto(s)

Procedimientos Quirúrgicos Cardíacos/normas , Cardiología/normas , Recuperación Mejorada Después de la Cirugía/normas , Cardiopatías Congénitas/cirugía , Pediatría/normas , Factores de Edad , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Consenso , Técnica Delphi , Medicina Basada en la Evidencia/normas , Humanos , Recuperación de la Función , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

BACKGROUND: Stillbirth rates are high and represent a substantial proportion of the under-5 mortality in low and middle-income countries (LMIC). In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented cause of stillbirths or the trends in rate of stillbirth over time. METHODS: We undertook a prospective, population-based multi-country research study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, Democratic Republic of Congo, India, Pakistan, and Guatemala). Staff collected demographic and health care characteristics with outcomes obtained at delivery. Cause of stillbirth was assigned by algorithm. RESULTS: From 2010 through 2018, 573,148 women were enrolled with delivery data obtained. Of the 552,547 births that reached 500 g or 20 weeks gestation, 15,604 were stillbirths; a rate of 28.2 stillbirths per 1000 births. The stillbirth rates were 19.3 in the Guatemala site, 23.8 in the African sites, and 33.3 in the Asian sites. Specifically, stillbirth rates were highest in the Pakistan site, which also documented a substantial decrease in stillbirth rates over the study period, from 56.0 per 1000 (95% CI 51.0, 61.0) in 2010 to 44.4 per 1000 (95% CI 39.1, 49.7) in 2018. The Nagpur, India site also documented a substantial decrease in stillbirths from 32.5 (95% CI 29.0, 36.1) to 16.9 (95% CI 13.9, 19.9) per 1000 in 2018; however, other sites had only small declines in stillbirth over the same period. Women who were less educated and older as well as those with less access to antenatal care and with vaginal assisted delivery were at increased risk of stillbirth. The major fetal causes of stillbirth were birth asphyxia (44.0% of stillbirths) and infectious causes (22.2%). The maternal conditions that were observed among those with stillbirth were obstructed or prolonged labor, antepartum hemorrhage and maternal infections. CONCLUSIONS: Over the study period, stillbirth rates have remained relatively high across all sites. With the exceptions of the Pakistan and Nagpur sites, Global Network sites did not observe substantial changes in their stillbirth rates. Women who were less educated and had less access to antenatal and obstetric care remained at the highest burden of stillbirth. STUDY REGISTRATION: Clinicaltrials.gov (ID# NCT01073475).

Asunto(s)

Parto Obstétrico , Países en Desarrollo , Complicaciones del Trabajo de Parto , Mortinato/epidemiología , Femenino , Guatemala/epidemiología , Humanos , India , Recién Nacido , Kenia , Masculino , Pakistán/epidemiología , Vigilancia de la Población , Embarazo , Estudios Prospectivos , Zambia/epidemiología

RESUMEN

OBJECTIVE: To characterize preterm infants that demonstrates respiratory improvement 7 days after ligation of a patent ductus arteriosus (PDA). STUDY DESIGN: We performed a 2-phase study of preterm infants (birthweight <1500 g between 2010 and 2016). We first did a retrospective analysis using regression modeling of ligation population. We then performed a case-control study comparing a ligation group with infants matched by gestational age, postnatal age, and preligation respiratory condition (ventilator mode, mean airway pressure [MAP], and fraction of inspired oxygen [FiO2]). Respiratory improvement was defined as either extubation, downgrading of ventilatory mode, reduction in MAP >25%, or decrease in FiO2 >25%. RESULTS: Forty-five (42%) of 107 preterm infants (gestational age 25.5 ± 1.7 weeks) with ligation showed respiratory improvement at 7 days. Infants on high frequency ventilation (HFV) were more likely to have respiratory improvement (aOR 5.03, 95% CI [1.14-22.18]). In matched-control analysis of 89 pairs, there was no difference in respiratory improvement. Among infants on HFV, the ligation group had an increase in MAP during 3 days prior to ligation. For infants on conventional ventilation, the ligation group had higher MAP and FiO2 than the control group during the first 2-3 postoperative days. CONCLUSIONS: Among infants undergoing PDA ligation, those on HFV were more likely to have respiratory improvement in the first week, possibly because of the prevention of further respiratory deterioration. For infants on conventional ventilation, ligation was associated with higher respiratory support in the immediate postligation period without respiratory benefits at 7 days. As HFV was used as a rescue mode, our findings suggest that those with worse lung disease may achieve greater short term benefit from PDA ligation.

Asunto(s)

Conducto Arterioso Permeable/cirugía , Ventilación de Alta Frecuencia/efectos adversos , Ligadura/métodos , Estudios de Casos y Controles , Conducto Arterioso Permeable/complicaciones , Femenino , Edad Gestacional , Humanos , Lactante , Recien Nacido Extremadamente Prematuro , Recién Nacido , Recién Nacido de muy Bajo Peso , Masculino , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/prevención & control , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento

RESUMEN

Classical protein kinase C (cPKC) enzymes are ser/thr protein kinases that have been an important factor in regulating a variety of cellular functions required for both in terms of health and disease. Therefore, precise control of cPKC-mediated signal is necessary for cellular homeostasis; however, their dysregulation leads to the development of several pathophysiological conditions including cancer. In cellular microenvironment, cPKC-mediated signaling is accompanied by multiple molecular mechanisms including phosphorylation, second messenger binding, and scaffold proteins. Functional cPKC interacts with a number of cellular proteins involved in the regulation of multiple biological functions such as cell growth, survival, migration, and adhesion. Further, the role of cPKC varies from cell to cell, substrate to substrate and, therefore, it is plausible to assume that the dysregulation of cPKC activity causes cellular transformation. Currently, there is no sufficient literature available to provide better understating to develop an effective therapeutic regimen to reverse pathophysiological condition caused by functionally dysregulated cPKC. Therefore, in the present review, we have focused on to provide a better and detail information on the various aspects of cPKC such as structure, mode of activation, regulation, and distinct cellular functions useful for the development of an effective therapeutic regimen against the breast cancer.

Asunto(s)

Neoplasias de la Mama/enzimología , Proteína Quinasa C/metabolismo , Femenino , Humanos

RESUMEN

It is difficult to establish the properties of massive stars that explode as supernovae. The electromagnetic emission during the first minutes to hours after the emergence of the shock from the stellar surface conveys important information about the final evolution and structure of the exploding star. However, the unpredictable nature of supernova events hinders the detection of this brief initial phase. Here we report the serendipitous discovery of a newly born, normal type IIb supernova (SN 2016gkg), which reveals a rapid brightening at optical wavelengths of about 40 magnitudes per day. The very frequent sampling of the observations allowed us to study in detail the outermost structure of the progenitor of the supernova and the physics of the emergence of the shock. We develop hydrodynamical models of the explosion that naturally account for the complete evolution of the supernova over distinct phases regulated by different physical processes. This result suggests that it is appropriate to decouple the treatment of the shock propagation from the unknown mechanism that triggers the explosion.

RESUMEN

BACKGROUND: Patients undergoing abdominoplasty with previous upper abdominal wall scars are at an increased risk for postoperative complications. The corset trunkplasty is a newer technique to treat abdominal wall laxity of the entire anterolateral abdomen while incorporating any previous open cholecystectomy scar. The authors performed a comparative outcomes study to determine whether the corset procedure would decrease the incidence of postoperative complications in patients with abdominal wall laxity and an open cholecystectomy scar when compared with traditional abdominoplasty. METHODS: A retrospective study was performed on patients who underwent traditional and corset abdominoplasty. Patients were divided into four groups: traditional with scar, corset with scar, traditional no scar, and corset no scar. Evaluated metrics included procedure time, postoperative length of stay, complications, reoperations, and readmission rates. RESULTS: Fifty-eight subjects were included in the study (traditional with scar, n = 15; corset with scar, n = 13; traditional no scar, n = 15; and corset no scar, n = 15). Demographics were similar among groups: body mass index, 33.7 kg/m; age, 44.3 years; and American Society of Anesthesiologists status, 2.5. The corset procedure took longer than the traditional method, regardless of whether a scar was present (146.1 minutes versus 125.7 minutes). However, the traditional with scar group had the greatest length of stay and higher complication, readmission, and reoperation rates. The corset with scar group had comparable outcomes to the corset no scar and traditional no scar groups. CONCLUSIONS: The corset trunkplasty procedure resulted in fewer adverse outcomes compared with traditional abdominoplasty in patients with previous open cholecystectomy scar. Its use should be considered in patients with significant abdominal wall laxity and existing upper abdominal surgical scars. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Asunto(s)

Pared Abdominal/patología , Abdominoplastia/métodos , Colecistectomía , Cicatriz/etiología , Complicaciones Posoperatorias , Pared Abdominal/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cicatriz/patología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/patología , Complicaciones Posoperatorias/prevención & control , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Adulto Joven

RESUMEN

OBJECTIVE: To determine associations between patient and clinical factors with postnatal brain metabolism in term neonates with congenital heart disease (CHD) via the use of quantitative magnetic resonance spectroscopy. STUDY DESIGN: Neonates with CHD were enrolled prospectively to undergo pre- and postoperative 3T brain magnetic resonance imaging. Short-echo single-voxel magnetic resonance spectroscopy of parietal white matter was used to quantify metabolites related to brain maturation (n-acetyl aspartate, choline, myo- inositol), neurotransmitters (glutamate and gamma-aminobutyric acid), energy metabolism (glutamine, citrate, glucose, and phosphocreatine), and injury/apoptosis (lactate and lipids). Multivariable regression was performed to search for associations between (1) patient-specific/prenatal/preoperative factors with concurrent brain metabolism and (2) intraoperative and postoperative factors with postoperative brain metabolism. RESULTS: A total of 83 magnetic resonance images were obtained on 55 subjects. No patient-specific, prenatal, or preoperative factors associated with concurrent metabolic brain dysmaturation or elevated lactate could be identified. Chromosome 22q11 microdeletion and age at surgery were predictive of altered concurrent white matter phosphocreatine (P < .0055). The only significant intraoperative association found was increased deep hypothermic circulatory arrest time with reduced postoperative white matter glutamate and gamma-aminobutyric acid (P < .0072). Multiple postoperative factors, including increased number of extracorporeal membrane oxygenation days (P < .0067), intensive care unit, length of stay (P < .0047), seizures in the intensive care unit (P < .0009), and home antiepileptic use (P < .0002), were associated with reduced postoperative white matter n-acetyl aspartate. CONCLUSION: Multiple postoperative factors were found to be associated with altered brain metabolism in term infants with CHD, but not patient-specific, preoperative, or intraoperative factors.

Asunto(s)

Encéfalo/metabolismo , Cardiopatías Congénitas/cirugía , Imagen por Resonancia Magnética/métodos , Espectroscopía de Resonancia Magnética/métodos , Ácido Aspártico/análogos & derivados , Ácido Aspártico/metabolismo , Biomarcadores/metabolismo , Peso al Nacer , Encéfalo/diagnóstico por imagen , Estudios de Cohortes , Femenino , Edad Gestacional , Glutamina/metabolismo , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/mortalidad , Humanos , Recién Nacido , Ácido Láctico/metabolismo , Masculino , Monitoreo Intraoperatorio/métodos , Análisis Multivariante , Fosfocreatina/metabolismo , Cuidados Preoperatorios/métodos , Pronóstico , Estudios Prospectivos , Análisis de Regresión , Medición de Riesgo , Tasa de Supervivencia , Nacimiento a Término , Resultado del Tratamiento

RESUMEN

PURPOSE: Biomarkers, such as mutant RAS, predict resistance to anti-EGFR therapy in only a proportion of patients, and hence, other predictive biomarkers are needed. The aims were to identify candidate genes upregulated in colorectal cancer cell lines resistant to anti-EGFR monoclonal antibody treatment, to knockdown (KD) these genes in the resistant cell lines to determine if sensitivity to anti-EGFR antibody was restored, and finally to perform a pilot correlative study of EGR1 expression and outcomes in a cohort of metastatic colorectal cancer (mCRC) patients given cetuximab therapy. METHODS: Comparative expression array analysis of resistant cell lines (SW48, COLO-320DM, and SNU-C1) vs sensitive cell lines (LIM1215, CaCo2, and SW948) was performed. The highest up-regulated gene in each resistant cell line was knocked down (KD) using RNA interference, and effect on proliferation was assessed with and without anti-EGFR treatment. Expression of the candidate genes in patients' tumours treated with cetuximab was assessed by immunohistochemistry; survival analyses were performed comparing high vs low expression. RESULTS: Genes significantly upregulated in resistant cell lines were EGR1 (early growth response protein 1), HBEGF (heparin-binding epidermal growth factor-like growth factor), and AKT3 (AKT serine/threonine kinase 3). KD of each gene resulted in the respective cells being more sensitive to anti-EGFR treatment, suggesting that the resistant phenotype was reversed. In the pilot study of mCRC patients treated with cetuximab, both median PFS (1.38 months vs 6.79 months; HR 2.77 95% CI 1.2-19.4) and median OS (2.59 months vs 9.82 months; HR 3.0 95% CI 1.3-23.2) were significantly worse for those patients with high EGR1 expression. CONCLUSION: High EGR1 expression may be a candidate biomarker of resistance to anti-EGFR therapy.

Asunto(s)

Antineoplásicos/uso terapéutico , Cetuximab/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Resistencia a Antineoplásicos/genética , Proteína 1 de la Respuesta de Crecimiento Precoz/biosíntesis , Biomarcadores de Tumor/análisis , Estudios de Cohortes , Neoplasias Colorrectales/mortalidad , Receptores ErbB/antagonistas & inhibidores , Humanos , Estimación de Kaplan-Meier , Proyectos Piloto

RESUMEN

We document the distribution of Didymosphenia geminata in central-southern Chilean rivers and identify the chemical and physical factors associated with its presence/absence (p/a). Repeated surveys in five successive years provided evidence that D. geminata could be nearing a biogeographic equilibrium in the region. D. geminata databases from extensive biological and environmental surveys in 187 rivers, within ten catchments, south of 38°S commenced in November 2010 and ran through May 2013. In addition, data from two other field surveys were used. The sites evenly distributed latitudinally were climatically characterized. The recent sampling program, following a published species distribution model, was designed to explore D. geminata distribution within thirteen catchments (34°S-48°S). An extensive river survey in 2014 (spring-summer) and in 2015 (autumn) included the p/a, and relative abundance of D. geminata cells in phytobenthos and in the drift. These p/a results showed that the probability of re-encountering D. geminata cells at sites where the species was previously found was significantly high while the probability of finding D. geminata cells at sites previously without the species was significantly low. This suggests that the distribution of D. geminata cells among suitable habitats was nearing completion. The relative abundance of D. geminata cells in the phytobenthos versus in the drift indicates seasonality with higher proportion of cells in the phytobenthos during the spring-summer than during the autumn. During the final surveys, principal component analysis of chemical and physical characteristics of rivers showed significant differences between rivers with and without D. geminata. Based on our observations of the distribution of D. geminata cells among rivers with suitable habitat conditions and the fluctuating rate of spread between rivers, we conclude that D. geminata is probably in the ending stage of its spatial demographic expansion in Chile surmounting the different barriers of the invasive process.

Asunto(s)

Clima , Diatomeas/fisiología , Ecosistema , Ríos , Chile , Especies Introducidas , Modelos Biológicos , Dinámica Poblacional , Factores de Tiempo

RESUMEN

Anthrax, caused by Bacillus anthracis (B anthracis), poses a potential threat as a bioterror agent because after inhalation, the spores rapidly cause bacteraemia and toxaemia. It produces a toxin consisting of three proteins ie protective antigen (PA), oedema factor (EF) and lethal factor (LF). Protective antigen plays a central role in the pathophysiology of anthrax and offers an excellent therapeutic target for treatment of anthrax. Raxibacumab is a recombinant, fully human, IgG1λ monoclonal antibody directed against PA of B anthracis. It inhibits PA binding to the anthrax toxin receptor and inhibits toxin-mediated cell death. It has been approved under animal rule or animal efficacy rule by the United States Food and Drug Administration which comes into play when it is not feasible or ethical to perform controlled clinical trials in humans. It has shown promising results in various animal studies which includes significantly improved survival rates in the raxibacumab group than non-raxibacumab group.

RESUMEN

OBJECTIVE: Death due to burn occurs frequently. This study investigated time-dependent alterations in cardiac troponin T (cTnT) associated with fatal burns. METHODS: Cardiac tissue samples were collected from 10 medico-legal autopsies after informed consent from the relatives and post-mortem degradation by incubation of the cardiac tissue was studied at room temperature for different time periods. The cases included in this study were the subjects of burns without any prior history of disease who died in the hospital and their exact time of death was known. An efficient extraction protocol to analyse the banding pattern of cTnT in post-mortem tissue was developed. RESULTS: The data show a distinct time-dependent profile corresponding to the degradation of cTnT by proteases found in cardiac muscle. Both post-mortem interval and cardiac tissue of burned corpses had a statistically significant effect where the greatest amount of protein breakdown was observed within the first 41.20 hours, after which intact protein slowly disappears. The average molecular weight of all fragments showed intact cTnT to be rapidly degraded into smaller fragments. CONCLUSION: In cases of burns, such knowledge will assist in knowing if there were previous scars that might have mimicked a burn and also help to properly evaluate the real cause of death.

RESUMEN

Epinephelus fuscoguttatus is a commercially important marine fish species in southeast Asia. Due to overfishing and water pollution, this species has been declared as near-threatened. Thus, to provide information to help maintain and preserve the species, microsatellites were developed, using an enriched genomic library method. Thirty individuals were collected from the hatchery of the Fishery Research Institute, Terengganu, Malaysia. These individuals, from four to six years old, originated from Sabah and are maintained in captive culture as broodstock. Genomic DNA was extracted from the fins of selected individuals that weighed 3-8 kg. Ten microsatellite loci were found to be polymorphic in this population, with 5 to 21 alleles per locus. Observed and expected heterozygosities ranged from 0.53 to 0.97 and 0.59 to 0.95, respectively. Only one locus deviated significantly from Hardy-Weinberg equilibrium and no significant linkage disequilibrium was found among the pairs of loci. These polymorphic microsatellite loci will be used by the Malaysian Fishery Research Institute for investigating genetic diversity and for developing breeding strategies.

Asunto(s)

Peces/genética , Repeticiones de Microsatélite/genética , Animales , Secuencia de Bases , Cartilla de ADN , Marcadores Genéticos

RESUMEN

The objective of this study was to develop a sustained release dosage form of Trimetazidine dihydrochloride (TMZ) using a natural polymeric carrier prepared in a completely aqueous environment. TMZ was entrapped in calcium alginate beads prepared with sodium alginate by the ionotropic gelation method using calcium chloride as a crosslinking agent. The drug was incorporated either into preformed calcium alginate gel beads (sequential method) or incorporated simultaneously during the gelation stage (simultaneous method). The beads were evaluated for particle size and surface morphology using optical microscopy and SEM, respectively. Beads produced by the sequential method had higher drug entrapment. Drug entrapment in the sequential method was higher with increased CaCl2 and polymer concentration but lower with increased drug concentration. In the simultaneous method, drug entrapment was higher when polymer and drug concentration were increased and also rose to a certain extent with increase in CaCl2 concentration, where further increase resulted in lower drug loading. FTIR studies revealed that there is no interaction between drug and CaCl2. XRD studies showed that the crystalline drug changed to an amorphous state after formulation. Release characteristics of the TMZ loaded calcium alginate beads were studied in enzyme-free simulated gastric and intestinal fluid.

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O objetivo deste estudo foi desenvolver forma de liberação controlada de dicloridrato de trimetazidina (TMZ) utilizando transportador plomérico natural em ambiente completamente aquoso. A TMZ foi presa em pérolas de alginato de cálcio preparadas com alginato de sódio pelo método de gelatinização ionotrópica, usando cloreto de cálcio como agente de formação de ligações cruzadas. O fármaco foi incorporado nas pérolas de gel de alginato de cálcio (método sequencial) ou incorporado, simultaneamente, durante o estágio de gelificação (método simultâneo). As pérolas foram avaliadas quanto ao tamanho das partículas e morfologia da superfície utilizando microscopia óptica de SEM, respectivamente. As pérolas produzidas pelo método sequencial apresentaram maior capacidade de inclusão. No método sequencial, a inclusão de fármaco foi maior com o aumento de CaCl2 e da concentração do plímero, mas menor com o aumento da concentração de fármaco. No método simultâneo, a inclusão de fármaco foi mais alta quando as concentrações de fármaco e plímero foram aumentadas e, também, atingiram certa extensão com aumento na concentração de CaCl2, cujo aumento posterior resultou em carga menor de fármaco. Estudos de FTIR revelaram que não há interação entre fármaco e CaCl2. Estudos de XRD mostraram que o fármaco mudou do estado cristalino para o amorfo após a formulação. As características de liberação de TMZ das pérolas carregadas com alginato de cálcio foram estudadas em fluidos simulados, gástrico e intestinal, livres de enzima.

Asunto(s)

Calcio/farmacología , Cápsulas/análisis , Cápsulas/farmacocinética , Cápsulas/química , Técnicas In Vitro , Diseño de Fármacos , Gelificantes , Química Farmacéutica/métodos , Sodio , Trimetazidina/farmacología

RESUMEN

BACKGROUND: The recently constructed river buffalo whole-genome radiation hybrid panel (BBURH5000) has already been used to generate preliminary radiation hybrid (RH) maps for several chromosomes, and buffalo-bovine comparative chromosome maps have been constructed. Here, we present the first-generation whole genome RH map (WG-RH) of the river buffalo generated from cattle-derived markers. The RH maps aligned to bovine genome sequence assembly Btau_4.0, providing valuable comparative mapping information for both species. RESULTS: A total of 3990 markers were typed on the BBURH5000 panel, of which 3072 were cattle derived SNPs. The remaining 918 were classified as cattle sequence tagged site (STS), including coding genes, ESTs, and microsatellites. Average retention frequency per chromosome was 27.3% calculated with 3093 scorable markers distributed in 43 linkage groups covering all autosomes (24) and the X chromosomes at a LOD >or= 8. The estimated total length of the WG-RH map is 36,933 cR5000. Fewer than 15% of the markers (472) could not be placed within any linkage group at a LOD score >or= 8. Linkage group order for each chromosome was determined by incorporation of markers previously assigned by FISH and by alignment with the bovine genome sequence assembly (Btau_4.0). CONCLUSION: We obtained radiation hybrid chromosome maps for the entire river buffalo genome based on cattle-derived markers. The alignments of our RH maps to the current bovine genome sequence assembly (Btau_4.0) indicate regions of possible rearrangements between the chromosomes of both species. The river buffalo represents an important agricultural species whose genetic improvement has lagged behind other species due to limited prior genomic characterization. We present the first-generation RH map which provides a more extensive resource for positional candidate cloning of genes associated with complex traits and also for large-scale physical mapping of the river buffalo genome.

Asunto(s)

Búfalos/genética , Bovinos/genética , Genoma , Mapeo de Híbrido por Radiación , Animales , Cromosomas de los Mamíferos/genética , Etiquetas de Secuencia Expresada , Marcadores Genéticos , Genómica , Repeticiones de Microsatélite , Polimorfismo de Nucleótido Simple , Análisis de Secuencia de ADN , Especificidad de la Especie

RESUMEN

BACKGROUND: Economic theory and limited empirical data suggest that costs per unit of HIV prevention program output (unit costs) will initially decrease as small programs expand. Unit costs may then reach a nadir and start to increase if expansion continues beyond the economically optimal size. Information on the relationship between scale and unit costs is critical to project the cost of global HIV prevention efforts and to allocate prevention resources efficiently. METHODS: The "Prevent AIDS: Network for Cost-Effectiveness Analysis" (PANCEA) project collected 2003 and 2004 cost and output data from 206 HIV prevention programs of six types in five countries. The association between scale and efficiency for each intervention type was examined for each country. Our team characterized the direction, shape, and strength of this association by fitting bivariate regression lines to scatter plots of output levels and unit costs. We chose the regression forms with the highest explanatory power (R2). RESULTS: Efficiency increased with scale, across all countries and interventions. This association varied within intervention and within country, in terms of the range in scale and efficiency, the best fitting regression form, and the slope of the regression. The fraction of variation in efficiency explained by scale ranged from 26-96%. Doubling in scale resulted in reductions in unit costs averaging 34.2% (ranging from 2.4% to 58.0%). Two regression trends, in India, suggested an inflection point beyond which unit costs increased. CONCLUSION: Unit costs decrease with scale across a wide range of service types and volumes. These country and intervention-specific findings can inform projections of the global cost of scaling up HIV prevention efforts.

Asunto(s)

Países Desarrollados/economía , Países en Desarrollo/economía , Eficiencia Organizacional/economía , Infecciones por VIH/prevención & control , Costos de la Atención en Salud/estadística & datos numéricos , Servicios Preventivos de Salud/economía , Análisis Costo-Beneficio , Recolección de Datos , Eficiencia Organizacional/estadística & datos numéricos , Femenino , Infecciones por VIH/economía , Infecciones por VIH/epidemiología , Humanos , Renta/clasificación , India/epidemiología , Masculino , México/epidemiología , Modelos Econométricos , Proyectos Piloto , Servicios Preventivos de Salud/organización & administración , Servicios Preventivos de Salud/estadística & datos numéricos , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Años de Vida Ajustados por Calidad de Vida , Análisis de Regresión , Federación de Rusia/epidemiología , Sudáfrica/epidemiología , Uganda/epidemiología

RESUMEN

The positional candidate diacylglycerol O-acyltransferase (DGAT1) gene affecting milk fat percentage is reported in Indian buffaloes (Bubalus bubalis). A comparison with Chinese buffalo (Bubalus bubalis) revealed eight exonic single nucleotide polymorphisms (SNPs), five of which were non-synonymous. A total of 19 SNPs were observed among diverse buffalo breeds in India. A Unique 22 base insertion has been reported in the intron between exon ten and eleven.

RESUMEN

RESUMEN: La axila es un compartimiento piramidal relativamente pequeño, localizado entre la pared torácica y el brazo, que contiene músculos y estructuras neurovasculares. Estas estructuras son importantes desde los puntos de vista clínico y morfológico. En este artículo reportamos la presencia de una variación del músculo latisimocondíleo y de la arteria axilar, la cual se encuentra debajo del músculo mencionado. La variación es única en su tipo. La morfología y el significado clínico del músculo son discutidos.

Asunto(s)

Masculino , Femenino , Humanos , Arteria Axilar/anatomía & histología , Arteria Axilar/inervación , Axila/anatomía & histología , Axila/inervación , Axila/irrigación sanguínea , Plexo Braquial/anatomía & histología , Plexo Braquial/irrigación sanguínea

RESUMEN

A fadiga afeta consideralvemente a reabilitacao e ergonomia. Muitas abordagens a este fenomeno complexo, incluindo fisiologicas e psicologicas, tem sido utilizadas para obter medidas significativas da fadiga. No entanto, nenhum dos metodos descritos na literatura mede diretamente a fadiga. E portanto de interesse a determinacao de quais dos metodos indiretos melhor representa a condicao de fadiga. Metodo: a fadiga por contracao foi medida na contracao voluntaria maxima(CVM) e 40 por cento da CVM em musculos biceps braquial, quadriceps e musculos eretores da coluna (tres avaliacoes independentes). As medidas objetivas mais relatadas (forca de contracao, frequencia mediana na eletromiografia, frequencia cardiaca, oxigenacao do leito muscular e volume sanguineo muscular) e as medidas subjetivas (escala visual analogica, avaliacao de desconforto em partes do corpo e avaliacao percebida do esforco) forma anotadas simultaneamente. dados dos tres estudos foram submetidos a analises estatisticas separadamente. Dados estatisticos descritivos, efeitos lineares mistos (para avaliar a previsibilidade da forca de fadiga) e analise de tendencias (correlacao comparativa intra e extra individuos) foram calculadas. Resultados: ANOVA univariada em todas as variaveis objetivas mostraram que o sexo foi um fator importante (p<0,001). Todas as variaveis subjetivas e objetivas foram significantes (p<0,05-0,001) para predizer a forca de fadiga. No entanto as variacoes explicaveis de porcentagem permaneceram pequenas. Atraves da combinacao de avriaveis, a variabilidade explicavel aumentou entre 60,2 por cento e 71,9 por cento. As correlacoes entre as variaveis foram pequenas, porem significativas (p<0,05-0,001). Entre as variaveis simples, a medida da frequencia da eletromiografia foi o fator preditivo um pouco melhor para fadiga CVM (p<0,001), assim como a escala visual analogica para sub_CVM. Conclusao: e desejavel que nao se meca ou prediga a fadiga com base em apenas uma variavel. A combinacao de variaveis melhora as medidas e predicao da fadiga. Indexar uma variavel simples na fadiga muscular localizada e portanto problematico

Asunto(s)

Humanos , Electromiografía , Fatiga , Fatiga Muscular , Dimensión del Dolor

RESUMEN

We report a case of jellyfish envenomation in a 39 year old male. He was stung extensively on both lower limbs by an unidentified jellyfish. This occurred in shallow waters of a beach in the vicinity of Labuan Island, Malaysia. The patient received ambulatory treatment with parenteral and oral ascorbate with remarkable recovery

Asunto(s)

Humanos , Masculino , Adulto , Ácido Ascórbico/uso terapéutico , Antioxidantes/administración & dosificación , Mordeduras y Picaduras/tratamiento farmacológico , Escifozoos , Venenos de Cnidarios/efectos adversos , Ácido Ascórbico/administración & dosificación , Infusiones Intravenosas , Mordeduras y Picaduras/etiología , Resultado del Tratamiento

RESUMEN

Displaced fractures of the lateral humeral condyle have been successfully treated with closed or open reduction and pinning. However, there is no consensus as to when the implants should be removed, with the recommended time ranging from 3 to 8 weeks. The purpose of this study was to assess the results after treatment of displaced lateral condyle fractures of the humerus in children and formulate guidelines for removing the implants. Fifty-five patients with displaced fractures were included in this study. A modified Hardacre functional rating system was used to grade the final clinical result. In 50 patients the fracture was clinically and radiographically healed at 6 weeks, in 4 patients at 5 weeks, and in only 1 patient at 4 weeks. The implants should not be removed until healing can be demonstrated radiographically. This time averaged 6 or more weeks in most of the patients in this study.

Asunto(s)

Fracturas del Húmero/cirugía , Dispositivos de Fijación Ortopédica , Adolescente , Clavos Ortopédicos , Niño , Preescolar , Femenino , Humanos , Fracturas del Húmero/diagnóstico por imagen , Lactante , Masculino , Radiografía