RESUMEN

OBJECTIVE: Investigate the association between potentially inappropriate medication (PIM) use and the risk of death among community-dwelling older Brazilian adults. METHODS: Participants from the Health, Well-Being, and Aging Cohort Study (SABE) in São Paulo, Brazil, between 2000 and 2016 were included. The dependent variable was all-cause mortality, measured as the time elapsed until death. The exposure of interest was the use of PIM according to the Beers Criteria 2019 version. All covariates, except for sex and education, were considered time-varying. RESULTS: PIM use was not associated with mortality after adjusting for covariates (HR = 0.99; 95 % CI: 0.88-1.12). There was a significant interaction between PIM use and age (HR = 0.98; 95 % CI: 0.96-0.99). CONCLUSION: The association between PIM use and the risk of death was moderated by age. Future studies should consider the impact of necessary medication omissions when assessing the mortality risk associated with PIM use.

RESUMEN

Polypharmacy, considered as the use of multiple medications, has been one of the factors associated with a higher risk of falls among older adults. However, the association of this factor regardless of the use of Fall-Risk-Increasing Drugs (FRIDs) has not been extensively explored. OBJECTIVES: This study aimed to evaluate the longitudinal association of polypharmacy with falls and verify whether this association is independent of FRID use. METHODS: A longitudinal study was conducted with a representative sample of the urban population aged 60 years and over in the city of São Paulo, Brazil, from 2000 to 2006. The analysis of the association among polypharmacy, the use of FRIDs, and the occurrence of falls over the years was performed using Generalized Estimating Equation (GEE) models adjusted for covariates. RESULTS: The association between polypharmacy and falls was significantly attenuated after the adjustment for covariates and FRIDs. Users of two or more FRIDs had higher odds of falls (OR = 1.51; CI [1.16; 1.96]). CONCLUSION: FRID use was associated with the occurrence of falls among older adults. The number of medications must be kept to the minimum necessary, and FRIDs should be avoided in approaches to preventing falls among older adults.

Asunto(s)

Polifarmacia , Humanos , Persona de Mediana Edad , Anciano , Estudios de Cohortes , Brasil/epidemiología , Estudios Longitudinales , Factores de Riesgo

RESUMEN

Introducción y objetivos Recientemente se han descrito mutaciones missense en la filamina C (FLNC) como causa de miocardiopatía. Los conocimientos sobre la patogenicidad y la correlación genotipo-fenotipo son escasos. Nuestro objetivo es describir un fenotipo cardiaco distintivo relacionado con mutaciones missense en el dominio ROD2 de FLNC (FLNC-mRod2). Métodos Incluimos 21 familias independientes con fenotipo de miocardiopatía hipertrófica (MCH)/miocardiopatía restrictiva (MCR) portadoras de variantes missense en FLNC-mRod2. Se estudió clínicamente a los portadores, además de hacer un cribado en cascada. Se analizó histológicamente el tejido miocárdico de tres corazones explantados y se comparó con un corazón portador de un truncamiento de FLNC y con un control sano. Se transfectaron plásmidos con mutaciones missense de FLNC y se analizaron mediante microscopía confocal. Resultados En 11 familias (52%) con 20 individuos evaluados (37 [23,7-52,7] años), 15 casos presentaron un fenotipo cardiaco consistente en una superposición de MCH-MCR e hipertrabeculación ventricular izquierda (apariencia de dientes de sierra). Durante una mediana de seguimiento de 6,49 años presentaron principalmente insuficiencia cardiaca avanzada (16 (80%) disfunción diastólica, 3 trasplantes cardiacos, 3 muertes por insuficiencia cardiaca) en ausencia de alteraciones de la conducción cardiaca o miopatía esquelética. Un total de 6 familias presentaban segregación genotipo-fenotipo leve, y las restantes eran mutaciones de novo. Se observó una remodelación de la matriz extracelular y distribución de la FLNC diferencial en los cardiomiocitos. Las células HT1080 y H9c2 no revelaron agregados citoplasmáticos de FLNC. Conclusiones Las variantes en FLNC-mRod2 exhiben una alta prevalencia de fenotipo solapado de MCR, MCH e hipertrabeculación en dientes de sierra, con una remodelación histopatológica cardiaca distintiva (AU)

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Introduction and objectives Missense mutations in the filamin C (FLNC) gene have been reported as cause of inherited cardiomyopathy. Knowledge of the pathogenicity and genotype-phenotype correlation remains scarce. Our aim was to describe a distinctive cardiac phenotype related to rare missense FLNC variants in the ROD2 domain. Methods We recruited 21 unrelated families genetically evaluated because of hypertrophic cardiomyopathy (HCM)/restrictive cardiomyopathy (RCM) phenotype carrying rare missense variants in the ROD2 domain of FLNC (FLNC-mRod2). Carriers underwent advanced cardiac imaging and genetic cascade screening. Myocardial tissue from 3 explanted hearts of a missense FLNC carrier was histologically analyzed and compared with an FLNC-truncating variant heart sample and a healthy control. Plasmids independently containing 3 FLNC missense variants were transfected and analyzed using confocal microscopy. Results Eleven families (52%) with 20 assessed individuals (37 [23.7-52.7]) years showed 15 cases with a cardiac phenotype consisting of an overlap of HCM-RCM and left ventricular hypertrabeculation (saw-tooth appearance). During a median follow-up of 6.49 years, they presented with advanced heart failure: 16 (80%) diastolic dysfunction, 3 heart transplants, 3 heart failure deaths) and absence of cardiac conduction disturbances or skeletal myopathy. A total of 6 families had moderate genotype-phenotype segregation, and the remaining were de novo variants. Differential extracellular matrix remodeling and FLNC distribution among cardiomyocytes were confirmed on histology. HT1080 and H9c2 cells did not reveal cytoplasmic aggregation of mutant FLNC. Conclusions FLNC-mRod2 variants show a high prevalence of an overlapped phenotype comprising RCM, HCM and deep hypertrabeculation with saw-tooth appearance and distinctive cardiac histopathological remodeling (AU)

Asunto(s)

Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Cardiomiopatía Hipertrófica/genética , Cardiomiopatía Restrictiva/genética , Mutación/genética , Filaminas/genética , Fenotipo

RESUMEN

INTRODUCTION AND OBJECTIVES: Missense mutations in the filamin C (FLNC) gene have been reported as cause of inherited cardiomyopathy. Knowledge of the pathogenicity and genotype-phenotype correlation remains scarce. Our aim was to describe a distinctive cardiac phenotype related to rare missense FLNC variants in the ROD2 domain. METHODS: We recruited 21 unrelated families genetically evaluated because of hypertrophic cardiomyopathy (HCM)/restrictive cardiomyopathy (RCM) phenotype carrying rare missense variants in the ROD2 domain of FLNC (FLNC-mRod2). Carriers underwent advanced cardiac imaging and genetic cascade screening. Myocardial tissue from 3 explanted hearts of a missense FLNC carrier was histologically analyzed and compared with an FLNC-truncating variant heart sample and a healthy control. Plasmids independently containing 3 FLNC missense variants were transfected and analyzed using confocal microscopy. RESULTS: Eleven families (52%) with 20 assessed individuals (37 [23.7-52.7]) years showed 15 cases with a cardiac phenotype consisting of an overlap of HCM-RCM and left ventricular hypertrabeculation (saw-tooth appearance). During a median follow-up of 6.49 years, they presented with advanced heart failure: 16 (80%) diastolic dysfunction, 3 heart transplants, 3 heart failure deaths) and absence of cardiac conduction disturbances or skeletal myopathy. A total of 6 families had moderate genotype-phenotype segregation, and the remaining were de novo variants. Differential extracellular matrix remodeling and FLNC distribution among cardiomyocytes were confirmed on histology. HT1080 and H9c2 cells did not reveal cytoplasmic aggregation of mutant FLNC. CONCLUSIONS: FLNC-mRod2 variants show a high prevalence of an overlapped phenotype comprising RCM, HCM and deep hypertrabeculation with saw-tooth appearance and distinctive cardiac histopathological remodeling.

Asunto(s)

Cardiomiopatías , Cardiomiopatía Hipertrófica , Cardiomiopatía Restrictiva , Insuficiencia Cardíaca , Humanos , Cardiomiopatía Restrictiva/genética , Mutación Missense , Mutación , Filaminas/genética , Fenotipo , Miocardio , Cardiomiopatías/diagnóstico , Cardiomiopatías/genética , Cardiomiopatía Hipertrófica/diagnóstico , Cardiomiopatía Hipertrófica/genética

RESUMEN

Millions of people across the world live off-grid not by choice but because they live in rural areas, have low income, and have no political clout. Delivering sustainable energy solutions to such a substantial amount of the world's population requires more than a technological fix; it requires leveraging the knowledge of underserved populations working together with a transdisciplinary team to find holistically derived solutions. Our original research has resulted in an innovative Convergence Framework integrating the fields of engineering, social sciences, and communication, and is based on working together with communities and other stakeholders to address the challenges posed by delivering clean energy solutions. In this paper, we discuss the evolution of this Framework and illustrate how this Framework is being operationalized in our on-going research project, cocreating hybrid renewable energy systems for off-grid communities in the Brazilian Amazon. The research shows how this Framework can address clean energy transitions, strengthen emerging industries at local level, and foster Global North-South scholarly collaborations. We do so by the integration of social science and engineering and by focusing on community engagement, energy justice, and governance for underserved communities. Further, this solution-driven Framework leads to the emergence of unique approaches that advance scientific knowledge, while at the same time addressing community needs.

Asunto(s)

Sistemas de Computación , Energía Renovable , Humanos , Ingeniería , Tecnología , Altruismo

RESUMEN

In this work we assessed the environmental factors associated with the spatial distribution of a cutaneous leishmaniasis (CL) outbreak during 2015-2016 in north-eastern Argentina to understand its typical or atypical eco-epidemiological pattern. We combined locations of human CL cases with relevant predictors derived from analysis of remote sensing imagery in the framework of ecological niche modelling and trained MaxEnt models with cross-validation for predictors estimated at different buffer areas relevant to CL vectors (50 and 250 m radii). To account for the timing of biological phenomena, we considered environmental changes occurring in two periods, 2014-2015 and 2015-2016. The remote sensing analysis identified land cover changes in the surroundings of CL cases, mostly related to new urbanization and flooding. The distance to such changes was the most important variable in most models. The weighted average map denoted higher suitability for CL in the outskirts of the city of Corrientes and in areas close to environmental changes. Our results point to a scenario consistent with a typical CL outbreak, i.e. changes in land use or land cover are the main triggering factor and most affected people live or work in border habitats.

Asunto(s)

Insectos Vectores , Leishmaniasis Cutánea , Animales , Argentina/epidemiología , Brotes de Enfermedades , Ecosistema , Humanos , Leishmaniasis Cutánea/epidemiología

RESUMEN

Ultrafast gas chromatography (UFGC) using a moderately polar column was compared to traditional gas chromatography (GC) for evaluation of biodiesel-diesel blended fuels. Several biodiesel feedstocks (soybean, tallow, canola, palm, camelina) and concentrations (1-20%) were evaluated, with specific attention to the separation of fatty acid methyl esters (FAMEs) from the biodiesel component. UFGC is compared to traditional GC using a similar column chemistry. Principal component analysis (PCA) is performed to identify clustering based on feedstock and concentration. UFGC proves an effective and fast technique, comparable to traditional GC, for the analysis of biodiesel-diesel blended fuels.

Asunto(s)

Biocombustibles , Gasolina , Biocombustibles/análisis , Cromatografía de Gases/métodos , Ácidos Grasos/análisis , Gasolina/análisis , Glycine max , Emisiones de Vehículos

RESUMEN

Background: Polypharmacy is common among older adults and is of public health concern, since pharmacological therapy influences the quality of care for older individuals. Few studies have addressed its prevalence and correlates in low or middle-income countries. Objective: To evaluate the prevalence of polypharmacy in a representative sample of the Brazilian older population and its association with sociodemographic conditions and factors related to access to health services. Methods: Cross-sectional study with data from the last National Health Survey, conducted in 2019. The dependent variable was polypharmacy (five or more medications) and independent variables were: sociodemographic characteristics, general health conditions and access to health services indicator. Results: The prevalence of polypharmacy was 19.2%. Polypharmacy was higher among those aged 80 years and over compared to those aged 60-69 years (prevalence ratio (PR) 1.47; 95% CI: 1.30; 1.66); individuals with complete elementary education (PR 1.35; 95% CI: 1.13; 1.60) versus those who did not go to school; with 3+ chronic diseases (PR 11.14; 95% CI: 7.94; 15.63); those with limitations in basic activities of daily life (PR 1.49; 95% CI: 1.35; 1.63) and possession of private medical health insurance (PR 1.32; 95% CI 1.19; 1.46). Being in a marital relationship was inversely associated with polypharmacy (PR 0.88; 95% CI: 0.80; 0.96). Conclusion: Polypharmacy affects a significant proportion of the Brazilian older population and is associated with sociodemographic factors and access to health services.

RESUMEN

AIMS: The aim of this study was to determine the frequency of heterozygous truncating ALPK3 variants (ALPK3tv) in patients with hypertrophic cardiomyopathy (HCM) and confirm their pathogenicity using burden testing in independent cohorts and family co-segregation studies. METHODS AND RESULTS: In a discovery cohort of 770 index patients with HCM, 12 (1.56%) were heterozygous for ALPK3tv [odds ratio(OR) 16.11, 95% confidence interval (CI) 7.94-30.02, P = 8.05e-11] compared to the Genome Aggregation Database (gnomAD) population. In a validation cohort of 2047 HCM probands, 32 (1.56%) carried heterozygous ALPK3tv (OR 16.17, 95% CI 10.31-24.87, P < 2.2e-16, compared to gnomAD). Combined logarithm of odds score in seven families with ALPK3tv was 2.99. In comparison with a cohort of genotyped patients with HCM (n = 1679) with and without pathogenic sarcomere gene variants (SP+ and SP-), ALPK3tv carriers had a higher prevalence of apical/concentric patterns of hypertrophy (60%, P < 0.001) and of a short PR interval (10%, P = 0.009). Age at diagnosis and maximum left ventricular wall thickness were similar to SP- and left ventricular systolic impairment (6%) and non-sustained ventricular tachycardia (31%) at baseline similar to SP+. After 5.3 ± 5.7 years, 4 (9%) patients with ALPK3tv died of heart failure or had cardiac transplantation (log-rank P = 0.012 vs. SP- and P = 0.425 vs. SP+). Imaging and histopathology showed extensive myocardial fibrosis and myocyte vacuolation. CONCLUSIONS: Heterozygous ALPK3tv are pathogenic and segregate with a characteristic HCM phenotype.

Asunto(s)

Cardiomiopatía Hipertrófica , Proteínas Musculares/genética , Proteínas Quinasas/genética , Cardiomiopatía Hipertrófica/genética , Heterocigoto , Humanos , Mutación , Sarcómeros

RESUMEN

Assessment of fidelity that is effective, efficient, and differentiates from usual practices is critical for effectively implementing evidence-based programs for families. This quasi-experiemntal study sought to determine whether observational ratings of fidelity to the Family Check-Up (FCU) could differentiate between levels of clinician training in the model, and from services as usual, and whether rating segments of sessions could be equivalent to rating complete sessions. Coders rated 75 videotaped sessions-complete and 20-min segments-for fidelity, using a valid and reliable rating system across three groups: (a) highly trained in FCU with universal, routine monitoring; (b) minimally trained in FCU with optional, variable monitoring; and (c) services as usual with no training in the FCU. We hypothesized that certain dimensions of fidelity would differ by training, whereas others would not. The results indicated that, as expected, one dimension of fidelity to the FCU, Conceptually accurate to the FCU, was reliably different between the groups (χ2 = 44.63, p < .001). The differences observed were in the expected direction, showing higher scores for therapists with more training. The rating magnitude of session segments largely did not differ from those of complete session ratings; however, interrater reliabilities were low for the segments. Although observational ratings were shown to be sensitive to the degree of training in the FCU on a unique and theoretically critical dimension, observational coding of complete sessions is resource intensive and limits scalability. Additional work is needed to reduce the burden of assessing fidelity to family-centered programs.

Asunto(s)

Técnicas de Observación Conductual/métodos , Conducta Infantil/psicología , Terapia Familiar/métodos , Familia/psicología , Niño , Preescolar , Femenino , Humanos , Masculino , Matrimonio/psicología , Responsabilidad Parental/psicología , Resultado del Tratamiento

RESUMEN

The valid and reliable assessment of fidelity is critical at all stages of intervention research and is particularly germane to interpreting the results of efficacy and implementation trials. Ratings of protocol adherence typically are reliable, but ratings of therapist competence are plagued by low reliability. Because family context and case conceptualization guide the therapist's delivery of interventions, the reliability of fidelity ratings might be improved if the coder is privy to client context in the form of an ecological assessment. We conducted a randomized experiment to test this hypothesis. A subsample of 46 families with 5-year-old children from a multisite randomized trial who participated in the feedback session of the Family Check-Up (FCU) intervention were selected. We randomly assigned FCU feedback sessions to be rated for fidelity to the protocol using the COACH rating system either after the coder reviewed the results of a recent ecological assessment or had not. Inter-rater reliability estimates of fidelity ratings were meaningfully higher for the assessment information condition compared to the no-information condition. Importantly, the reliability of the COACH mean score was found to be statistically significantly higher in the information condition. These findings suggest that the reliability of observational ratings of fidelity, particularly when the competence or quality of delivery is considered, could be improved by providing assessment data to the coders. Our findings might be most applicable to assessment-driven interventions, where assessment data explicitly guides therapist's selection of intervention strategies tailored to the family's context and needs, but they could also apply to other intervention programs and observational coding of context-dependent therapy processes, such as the working alliance.

Asunto(s)

Medicina Basada en la Evidencia , Terapia Familiar/normas , Familia , Preescolar , Humanos

RESUMEN

Latina/o high school students without documentation face a challenging situation when they graduate from high school, with pathways to work and postsecondary education stymied by their immigration status. We examined the effects of anticipated barriers associated with immigration status, age, and sex on the dependent variables of vocational outcome expectations, anticipated external and internal barriers, and postsecondary schooling plans in a sample of 475 Latina/o high school students. Findings include that students anticipating immigration status problems had lower vocational outcome expectations and anticipated more external barriers to pursuing their postsecondary plans. Latina girls and older high school students anticipating immigration status problems were more likely to plan to attend 2-year rather than 4-year colleges, and less likely to plan on postsecondary education, respectively. Implications for practice, policy, and research are discussed.

Asunto(s)

Educación , Emigrantes e Inmigrantes/psicología , Emigración e Inmigración/legislación & jurisprudencia , Hispánicos o Latinos/psicología , Intención , Estudiantes/psicología , Adolescente , Emigrantes e Inmigrantes/educación , Femenino , Hispánicos o Latinos/educación , Humanos , Masculino , Instituciones Académicas , Factores Sexuales , Universidades , Adulto Joven

RESUMEN

Este trabalho objetivou investigar a ocorrência de pedido judicial de medicamento para indicações não aprovadas pela Agência Nacional de Vigilância Sanitária, por meio de ações judiciais contra o Estado de Minas Gerais no ano de 2010. É um estudo transversal, exploratório, com coleta retrospectiva de dados primários. A fonte dos dados foi o parecer técnico referente à solicitação de medicamento realizada por ordem judicial. Os dados considerados foram: patologia informada na ação judicial, medicamento solicitado e a concessão, ou não, de antecipação de tutela ou de liminar. No total de 1.981 pareceres analisados, foram identificadas 212 solicitações de medicamentos para uso off label. Dentre esses medicamentos, 46 por cento não estavam incluídos em programas de assistência farmacêutica do Sistema Único de Saúde. Os medicamentos mais solicitados para uso off label foram micofenolato de mofetila (23 por cento),bevacizumabe (11 por cento) e rituximabe (8 por cento). A classe terapêutica mais solicitada, de acordo com Sistema Anatômico e Terapêutico Químico, foi a dos agentes antineoplásicos e imunomoduladores (54,20 por cento). Dentre os medicamentos solicitados para uso off label, 78,30 por cento foram obtidos por meio de antecipação de tutela ou de liminar. Os resultados apontam para a necessidade de o Poder Judiciário continuar na busca pelo entendimento das questões técnicas que norteiam essas ações judiciais e de os gestores evoluírem na busca pela melhoria da assistência farmacêutica, sem, entretanto, deixar de atender àqueles casos não previstos nos protocolos clínicos, mas que, pelo avanço da ciência e por suas peculiaridades, se mostrarem necessários.

Asunto(s)

Protocolos Clínicos , Vigilancia Sanitaria , Decisiones Judiciales , Poder Judicial , Preparaciones Farmacéuticas , Derecho a la Salud , Sistema Único de Salud , Ensayos Clínicos como Asunto , Demografía

RESUMEN

Este trabalho objetivou investigar a ocorrência de pedido judicial de medicamento para indicações não aprovadas pela Agência Nacional de Vigilância Sanitária, por meio de ações judiciais contra o Estado de Minas Gerais no ano de 2010. É um estudo transversal, exploratório, com coleta retrospectiva de dados primários. A fonte dos dados foi o parecer técnico referente à solicitação de medicamento realizada por ordem judicial. Os dados considerados foram: patologia informada na ação judicial, medicamento solicitado e a concessão, ou não, de antecipação de tutela ou de liminar. No total de 1.981 pareceres analisados, foram identificadas 212 solicitações de medicamentos para uso off label. Dentre esses medicamentos, 46 por cento não estavam incluídos em programas de assistência farmacêutica do Sistema Único de Saúde. Os medicamentos mais solicitados para uso off label foram micofenolato de mofetila (23 por cento),bevacizumabe (11 por cento) e rituximabe (8 por cento). A classe terapêutica mais solicitada, de acordo com Sistema Anatômico e Terapêutico Químico, foi a dos agentes antineoplásicos e imunomoduladores (54,20 por cento). Dentre os medicamentos solicitados para uso off label, 78,30 por cento foram obtidos por meio de antecipação de tutela ou de liminar. Os resultados apontam para a necessidade de o Poder Judiciário continuar na busca pelo entendimento das questões técnicas que norteiam essas ações judiciais e de os gestores evoluírem na busca pela melhoria da assistência farmacêutica, sem, entretanto, deixar de atender àqueles casos não previstos nos protocolos clínicos, mas que, pelo avanço da ciência e por suas peculiaridades, se mostrarem necessários.(AU)

Asunto(s)

Preparaciones Farmacéuticas , Decisiones Judiciales , Vigilancia Sanitaria , Sistema Único de Salud , Poder Judicial , Derecho a la Salud/legislación & jurisprudencia , Protocolos Clínicos , Demografía , Ensayos Clínicos como Asunto

RESUMEN

A infecção pelo HPV em mulheres abaixo de 30 anos é transitória, entretanto, algumas destas mulheres progridem para Lesão Intra-Epitelial de Alto Grau (LIAG). Este estudo investigou características virais, morfológicas e variáveis sócio-comportamentais em mulheres com LIAG, entre estas a determinação dos genótipos oncogênicos do HPV, a carga viral total e específica de HPV 16, a expressão da proteína p16INK4a assim como variáveis epidemiológicas. Foram selecionadas 88 mulheres provenientes de dois serviços de oncologia ginecológica de Salvador, Bahia, a Clínica IDEM e o CICAN, entre julho de 2006 e janeiro de 2009 com diagnóstico citopatológico de LIAG. As pacientes preencheram o Termo de Consentimento Livre e Esclarecido e responderam um questionário contendo informações sócio-demográficas e clínicas. Em seguida, foi realizada a colheita de células esfoliadas do colo uterino para genotipagem através da técnica Linear Array e avaliação da carga viral do HPV por PCR em tempo real, e a biópsia para análise histopatológica. Destas 88 mulheres, apenas 41 (46,6%) tiveram o diagnóstico de LIAG confirmado através do exame histopatológico. Desta forma, as pacientes foram divididas em 3 grupos: sem LIAG (< NIC 2), com LIAG ( NIC 2) menores que 30 anos e com LIAG ( NIC 2) com idade igual ou superior a 35 anos. Dentre os co-fatores analisados, a escolaridade, o uso de anticoncepcional oral e paridade diferiram nos dois grupos de idade com LIAG. A expressão da proteína p16INK4a foi observada em todos os graus histopatológicos com LIAG, entretanto, sua intensidade não diferiu entre estes. Foi observada uma maior prevalência de LIAG em mulheres mais jovens. Os genótipos mais prevalentes nas mulheres com LIAG foram: HPV 16, HPV 35, HPV 56, HPV 45 e HPV 70; no grupo sem LIAG foram: HPV 16, HPV 31, HPV 56, HPV 61 e HPV CP6108. A carga viral total foi maior em mulheres com LIAG em relação a mulheres sem LIAG. Houve associação entre aumento da carga viral específica...

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HPV infection in young women, below 30 years old is commonly transitory. However, some women may progress to high-grade squamous intraepithelial lesion (HSIL). This study aimed to investigate viral and host factors in young women with a diagnosis of HSIL, such as viral load both total and HPV 16- specific, genotypes, p16INK4a expression and sociodemographic characteristics. Eighty-eight women with a cytological diagnosis of HSIL were recruited from 2 specialized oncoginecologyc services from Salvador, Bahia, in between July 2006 and January 2009. After providing written informed consent, cervical scrapes were obtained for DNA extraction for further molecular testing, including HPV genotyping by Linear array and viral load determination by Real-Time PCR. Biopsies were taken for confirmatory histopathologyc analysis. Forty-one out of 88 enrolled women (46,6%) had the HSIL diagnosis confirmed. Based on that they were classified into three groups: No SIL, HSIL less than 30 years old and HSIL older than 35 years old. Among co-factors studied, education, oral contraceptive use and parity significantly differed between HSIL age groups. p16INK4a expression was observed with similar intensity among all histological grades of CIN. A higher prevalence of HSIL was detected in younger women. The most prevalent genotypes in HSIL patients were HPV 16, HPV 35, HPV 56, HPV 45 and HPV 70; whereas in the No SIL group were: HPV 16, HPV 31, HPV 56, HPV 61 and HPV CP6108. Total HPV viral load was significantly higher in women bearing CIN than in the normal group. A positive association between HPV 16 viral load and increasing histological grades was observed. Total and HPV 16 viral loads were similar among young and older women with HSIL, suggesting that this is not the main factor leading to the early development of these lesions.

Asunto(s)

Humanos , Femenino , Adulto , Adolescente , Adulto , Displasia del Cuello del Útero , Papillomaviridae , Reacción en Cadena de la Polimerasa , Factores de Riesgo , Carga Viral

RESUMEN

Bella Vista City, Corrientes, Argentina, reported an epidemic outbreak of tegumentary leishmaniasis during 2003. The mean age of the 31 cases was 25.0 +/- 13.7 years old, with a sex ratio male:female 1.8, and without mucosal involvement. They clustered in two contiguous neighbourhoods, 96% in the periurban border and 4% in the peripheral outskirts. The transmission peak was estimated to have occurred during April 2003. Four species (3608 sand flies) were captured in nine sites: Lutzomyia neivai (90.1%), Lu. pessoai (8.9%), Lu. migonei (0.8 %), and Brumptomyia avellari (0.2 %). The outskirts/rural capture ratio of Lu. neivai was up to 3, and the outskirts/periurban up to 200. Therefore, the 'urban' transmission in this southernmost known focus is still an ecotone-border associated risk. The changes in human distribution or activities, patches of the secondary vegetation, periurban streams, rainfall of the previous year, and river period floods could all contribute to 'urban' outbreaks in the region. Tegumentary leishmaniasis risk should be assessed for any project that involves changes in land use throughout an endemic area.

Asunto(s)

Brotes de Enfermedades , Insectos Vectores/clasificación , Leishmaniasis Cutánea/epidemiología , Psychodidae/clasificación , Adolescente , Adulto , Animales , Argentina/epidemiología , Niño , Preescolar , Análisis por Conglomerados , Femenino , Humanos , Lactante , Leishmaniasis Cutánea/transmisión , Masculino , Persona de Mediana Edad , Factores de Riesgo , Población Urbana

RESUMEN

Bella Vista City, Corrientes, Argentina, reported an epidemic outbreak of tegumentary leishmaniasis during 2003. The mean age of the 31 cases was 25.0 ± 13.7 years old, with a sex ratio male:female 1.8, and without mucosal involvement. They clustered in two contiguous neighbourhoods, 96 percent in the periurban border and 4 percent in the peripheral outskirts. The transmission peak was estimated to have occurred during April 2003. Four species (3608 sand flies) were captured in nine sites: Lutzomyia neivai (90.1 percent), Lu. pessoai (8.9 percent), Lu. migonei (0.8 percent), and Brumptomyia avellari (0.2 percent). The outskirts/rural capture ratio of Lu. neivai was up to 3, and the outskirts/periurban up to 200. Therefore, the 'urban' transmission in this southernmost known focus is still an ecotone-border associated risk. The changes in human distribution or activities, patches of the secondary vegetation, periurban streams, rainfall of the previous year, and river period floods could all contribute to 'urban' outbreaks in the region. Tegumentary leishmaniasis risk should be assessed for any project that involves changes in land use throughout an endemic area.

Asunto(s)

Humanos , Animales , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Brotes de Enfermedades , Insectos Vectores/clasificación , Leishmaniasis Cutánea/epidemiología , Psychodidae/clasificación , Argentina/epidemiología , Análisis por Conglomerados , Leishmaniasis Cutánea/transmisión , Factores de Riesgo , Población Urbana

RESUMEN

Polyunsaturated fatty acids (PUFAs) can influence tumor growth and migration, both in vitro and in vivo. The PUFA gamma-linolenic acid (GLA) has been reported to improve the poor prognosis associated with human gliomas, although its effects at sublethal concentrations on residual cells postsurgery are poorly understood. The study investigated the effects sublethal PUFA doses (90 or 150 microM) may have on rat C6 glioma cell energy metabolism, since an adequate energy supply is essential for cell proliferation, migration, and apoptosis. Of note was the identification of mitochondrial heterogeneity in relation to the mitochondrial membrane potential (MMP), which has been suggested but unproven in previous studies. GLA and eicosapentaenoic acid (EPA) caused significant changes in cellular fatty acid composition and increased the percentage of cells with a low MMP after a 96-h exposure period. The presence of PUFAs inhibited C6 cell proliferation and migration, although apoptosis was not induced. The protein expression and activity of glucose-6-phosphate dehydrogenase was increased after 96-h incubation with 90 microM GLA and EPA and would allow redox regulation through increased NADPH production, permitting the maintenance of adequate intracellular reduced glutathione concentrations and limiting rates of lipid peroxidation and reactive oxygen species generation. Neither NADP(+)-isocitrate dehydrogenase nor NADP(+)-malate dehydrogenase activity responded to PUFAs, suggesting it is glucose-6-phosphate dehydrogenase that is the principal source of NADPH in C6 cells. These data compliment studies showing that higher concentrations of GLA induced glioma cell death and tumor regression and suggest that GLA treatment could be useful for the inhibition of residual cell proliferation and migration after surgical removal of the tumor mass.

Asunto(s)

Etidio/análogos & derivados , Ácidos Grasos Insaturados/farmacología , Glioma/patología , Glucosafosfato Deshidrogenasa/metabolismo , Animales , Anexina A5/metabolismo , Bencimidazoles/metabolismo , Western Blotting , Carbocianinas/metabolismo , Movimiento Celular/efectos de los fármacos , Movimiento Celular/fisiología , Células Cultivadas/metabolismo , Citocromos c/metabolismo , Fragmentación del ADN/efectos de los fármacos , Fragmentación del ADN/fisiología , Etidio/metabolismo , Técnica del Anticuerpo Fluorescente/métodos , Colorantes Fluorescentes/metabolismo , Cromatografía de Gases y Espectrometría de Masas/instrumentación , Cromatografía de Gases y Espectrometría de Masas/métodos , Glioma/metabolismo , Potenciales de la Membrana/fisiología , Microscopía Confocal/instrumentación , Microscopía Confocal/métodos , Mitocondrias/efectos de los fármacos , Mitocondrias/fisiología , Mitosis/fisiología , Ratas , Factores de Tiempo

RESUMEN

Objetivo. Estudiar el curso clínico y la supervivencia de 4 pacientes con trasplante hepático ortotópico (THO) realizados en Monterrey, N.L. Antecedentes. El programa de THO en humanos se inicio en 1991 en el Hospital Universitario de la UANL en Monterrey. Resultados. Tres pacientes pediátricos con diagnóstico de cirrosis hepáticos por atresia de vías biliares y un paciente adulto con cirrosis hepática alcohólica, todos con clasificación C Child-Pugh. El trasplante realizado fue completo en dos pacientes. Uno pediátrico y un adulto, reducido en dos pacientes pediátricos, uno de éstos con injerto de donador vivo relacionado. El esquema de inmunosupresión fue a base de ciclosporina, esteroides y azatriopina. Complicaciones: hemorragia abdominal; hipertensión arterial; colangitis y colestasis; insuficiencia renal aguda; neumonía, datos de rechazo, sepsis y fuga biliar en dos casos, respectivamente y pancreatitis aguda en un caso. Sobrevida: límites de 16 horas a 3 años con 5 meses. Conclusiones. El THO en pacientes con enfermedades terminales del hígado es una terapéutica quirúrgica moderna capaz de rehabilitar y prolongar la sobrevida de estos pacientes. La factibilidad de THO reducido con donadores vivos constituye una opción ante la escasez de órganos

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Sobrevivientes , Trasplante de Hígado , México