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In Mexico occurs 25% of all worldwide cases of scorpion sting envenomation (SSE). An outbreak of SSE was identified in Villa Unión, Sinaloa, Mexico. The objective of this study is to describe the outbreak, and prevention and control strategies implemented. The design was a cross-sectional study. Eligibility criteria included confirmed cases (n = 425) identified from the date the outbreak was recognized (from November 08, 2023 to July 10, 2023). The cases from Villa Unión (n = 231) were included for the analysis of epidemiological and clinical findings. The research followed the recommendations of the Initiative Reporting of studies Conducted Using Observational Routinely collected Data (RECORD). Of the total cases (n = 425), 398 (93.6%) were from the municipality of Mazatlán, and 231 (58%) were from Villa Unión. The incidence rate was 13.64 per 1000 persons. The average cases per week was 51.5(SD ± 12). The male-to-female ratio was 3:4, the average age was 30.7(SD ± 19) years. Most of cases occurred in the 25-44 age group. The sting occurred mostly inside houses (n = 200, 86.5%). The predominant symptoms were local pain (95.2%), and local paresthesia (75.8%). The Case fatality rate was 0%. Implementation of prevention and control strategies based on field epidemiological research and scientific evidence are necessary to reduce the incidence and prevent fatal complications.
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Picaduras de Escorpión , Venenos de Escorpión , Animales , Masculino , Humanos , Femenino , Adulto , Picaduras de Escorpión/epidemiología , Picaduras de Escorpión/prevención & control , México/epidemiología , Estudios Transversales , Escorpiones , Brotes de Enfermedades/prevención & controlRESUMEN
Resumen: Introducción: el objetivo de este estudio fue evaluar los resultados clínicos y complicaciones de la transferencia del tendón tibial anterior (TTTA) en niños con pie bot y supinación dinámica. Material y métodos: se incluyeron niños con recurrencia dinámica del pie bot después de tratamiento con método Ponseti o cirugía, que se sometieron a TTTA entre 2008 y 2020. Se analizaron datos demográficos, tratamientos previos, procedimientos asociados y método de fijación. Los resultados funcionales fueron evaluados con el sistema de graduación descrito por Thompson. Se analizaron las complicaciones y su tratamiento. Resultados: se analizaron 39 pacientes (57 pies). Setenta por ciento recibió tratamiento previo con método Ponseti, a 19.3% se le realizó liberación posteromedial y a 10.7% otro tipo de tratamiento quirúrgico. Ochenta y ocho por ciento de los casos requirió procedimientos asociados: tenotomía o alargamiento del tendón de Aquiles, fasciotomía plantar, osteotomía desrotadora de tibia, acortamiento de columna lateral, liberación posterior. El tipo de fijación predominante fue pull-out con botón (96.5%). El seguimiento promedio fue de 31.5 meses. De acuerdo al sistema de Thompson, 52 pacientes presentaron resultados buenos, dos regulares y tres malos. 98.2% de los pies mostraron contracción activa del tendón del tibial anterior transferido. Se presentaron cuatro complicaciones: irritación plantar, quiste sinovial en dorso e infección profunda. Dos pies requirieron cirugía no programada. Conclusión: la transferencia del tendón del tibial anterior es una técnica eficaz para corregir la supinación dinámica residual en pacientes con pie bot.
Abstract: Introduction: our aim was to evaluate the clinical outcomes and complications of anterior tibialis tendon transfer (ATTT) in children with dynamic supination after clubfoot treatment. Material and methods: children with dynamic supination after initial treatment with Ponseti method or surgery who underwent ATTT between 2008 and 2020 were included for evaluation. Demographic data, previous treatment, associated procedures and fixation method were analyzed. Functional results were evaluated with the grading system described by Thompson. Complications and their treatment were analyzed. Results: a total of 39 patients (57 feet) were analyzed. 70% received previous treatment with Ponseti method, 19.3% underwent surgical posteromedial release, and 10.7% another type of surgical treatment. 88% of cases required associated procedures including Achilles tendon lengthening or tenotomy, plantar fasciotomy, tibial osteotomy, lateral column shortening, posterior release. The predominant type of fixation was the pull-out button method (96.5%). The average follow-up was 31.5 months. According to the Thompson grading system, 52 patients presented good results, two fair and three poor. 98.2% of the feet showed active contraction of the transferred tibialis anterior tendon. There were four complications: plantar irritation, synovial cyst in the dorsum of the foot and deep infection. Two feet required unplanned surgery. Conclusion: anterior tibialis tendon transfer is an effective technique to correct residual dynamic supination in patients with clubfoot.
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Introduction: Motor compromise characterizes cerebral palsy (CP), and is often associated with intellectual disability (ID). Standardized classification systems have been developed to describe the functions of people with CP. The aim was to functionally characterize children and adolescents aged 0 to 18 years with CP in Argentina and to investigate the association between motor compromise (GMFCS), ID and functional classifications. Methods: Cross-sectional study. Data were collected through family interviews and medical records review. Individuals with CP were included. Data were collected from 19 institutions in different cities of Argentina. Fisher's test and odds ratio [IC95%] were used for data analysis, with significance <0.05. Results: 182 children and adolescents with CP participated. According to GMFCS classification, level V prevailed with 36.3%. Those with more severe motor compromise (GMFCS IV-V) were 72 [25.4;206.0] times and 13 [5.9;28.2] times more likely to present a severe level of MACS and CFCS, respectively. But they were 34 [7.9;146.0] times more likely to have a mild to moderate level of EDACS. Those with DI were 10 [5.1;20.5] times more likely to have severe GMFCS, 6 [3.4;13.2] times more likely to have severe MACS and 4 [2.0;7.8] times more likely to have severe CFCS. On the contrary, they are 4 [1.9;9.5] times more likely to present a mild-moderate EDACS level. Conclusion: the level of GMFCS and the presence of DI influence general functionality and increase severity in engagement, manual and communication skills.
Introducción: El compromiso motor caracteriza la parálisis cerebral (PC), y suele asociarse a la discapacidad intelectual (DI). Se han desarrollado sistemas de clasificación estandarizados para describir las funciones de personas con PC. Objetivo: caracterizar funcionalmente a niños, niñas y adolescentes de 0 a 18 años con PC de Argentina e indagar la asociación entre el compromiso motor (GMFCS), la DI y las clasificaciones funcionales. Métodos: Estudio transversal. Se recolectaron datos a través de entrevistas a las familias y revisión de historias clínicas. Se incluyeron personas con PC. Los datos se recolectaron de 19 instituciones de distintas ciudades de Argentina. Resultados: participaron 182 niños, niñas y adolescentes con PC. Según clasificación GMFCS prevaleció el nivel V con 36,3%. Quienes presentan compromiso motor más severo (GMFCS IV-V), tienen 72 [25,4;206,0] veces y 13 [5,9;28,2] veces más chances de presentar un nivel severo de MACS y CFCS respectivamente. Pero, presentaron 34 [7,9;146,0] veces más chances de un nivel leve a moderado de EDACS. Quienes presentaron DI tuvieron 10 [5,1;20,5] veces más chances de presentar un nivel severo GMFCS, 6 [3,4;13,2] veces más chances un nivel severo MACS y 4 [2,0;7,8] veces más chances de un nivel severo CFCS. Por el contrario, tienen 4 [1,9;9,5] veces más chances de presentar un nivel leve-moderado EDACS. Conclusión: el nivel de GMFCS y la presencia de DI influyen en la funcionalidad general y aumentan la severidad en el compromiso, habilidades manuales y de comunicación.
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Parálisis Cerebral , Discapacidad Intelectual , Trastornos Motores , Niño , Humanos , Adolescente , Argentina , Actividades CotidianasRESUMEN
In this work, it is presented a first approach of a mathematical and kinetic analysis for improving the decoloration and further degradation process of an azo dye named acid red 27 (AR27), by means of a novel microbial consortium formed by the fungus Trametes versicolor and the bacterium Pseudomonas putida. A multivariate analysis was carried out by simulating scenarios with different operating conditions and developing a specific mathematical model based on kinetic equations describing all stages of the biological process, from microbial growth and substrate consuming to decoloration and degradation of intermediate compounds. Additionally, a sensitivity analysis was performed by using a factorial design and the Response Surface Method (RSM), for determining individual and interactive effects of variables like, initial glucose concentration, initial dye concentration and the moment in time for bacterial inoculation, on response variables assessed in terms of the minimum time for: full decoloration of AR27 (R1 = 2.375 days); maximum production of aromatic metabolites (R2 = 1.575 days); and full depletion of aromatic metabolites (R3 = 12.9 days). Using RSM the following conditions improved the biological process, being: an initial glucose concentration of 20 g l-1, an initial AR27 concentration of 0.2 g l-1 and an inoculation moment in time of P. putida at day 1. The mathematical model is a feasible tool for describing AR27 decoloration and its further degradation by the microbial consortium of T. versicolor and P. putida, this model will also work as a mathematical basis for designing novel bio-reaction systems than can operate with the same principle of the described consortium.
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INTRODUCTION: our aim was to evaluate the clinical outcomes and complications of anterior tibialis tendon transfer (ATTT) in children with dynamic supination after clubfoot treatment. MATERIAL AND METHODS: children with dynamic supination after initial treatment with Ponseti method or surgery who underwent ATTT between 2008 and 2020 were included for evaluation. Demographic data, previous treatment, associated procedures and fixation method were analyzed. Functional results were evaluated with the grading system described by Thompson. Complications and their treatment were analyzed. RESULTS: a total of 39 patients (57 feet) were analyzed. 70% received previous treatment with Ponseti method, 19.3% underwent surgical posteromedial release, and 10.7% another type of surgical treatment. 88% of cases required associated procedures including Achilles tendon lengthening or tenotomy, plantar fasciotomy, tibial osteotomy, lateral column shortening, posterior release. The predominant type of fixation was the pull-out button method (96.5%). The average follow-up was 31.5 months. According to the Thompson grading system, 52 patients presented good results, two fair and three poor. 98.2% of the feet showed active contraction of the transferred tibialis anterior tendon. There were four complications: plantar irritation, synovial cyst in the dorsum of the foot and deep infection. Two feet required unplanned surgery. CONCLUSION: anterior tibialis tendon transfer is an effective technique to correct residual dynamic supination in patients with clubfoot.
INTRODUCCIÓN: el objetivo de este estudio fue evaluar los resultados clínicos y complicaciones de la transferencia del tendón tibial anterior (TTTA) en niños con pie bot y supinación dinámica. MATERIAL Y MÉTODOS: se incluyeron niños con recurrencia dinámica del pie bot después de tratamiento con método Ponseti o cirugía, que se sometieron a TTTA entre 2008 y 2020. Se analizaron datos demográficos, tratamientos previos, procedimientos asociados y método de fijación. Los resultados funcionales fueron evaluados con el sistema de graduación descrito por Thompson. Se analizaron las complicaciones y su tratamiento. RESULTADOS: se analizaron 39 pacientes (57 pies). Setenta por ciento recibió tratamiento previo con método Ponseti, a 19.3% se le realizó liberación posteromedial y a 10.7% otro tipo de tratamiento quirúrgico. Ochenta y ocho por ciento de los casos requirió procedimientos asociados: tenotomía o alargamiento del tendón de Aquiles, fasciotomía plantar, osteotomía desrotadora de tibia, acortamiento de columna lateral, liberación posterior. El tipo de fijación predominante fue pull-out con botón (96.5%). El seguimiento promedio fue de 31.5 meses. De acuerdo al sistema de Thompson, 52 pacientes presentaron resultados buenos, dos regulares y tres malos. 98.2% de los pies mostraron contracción activa del tendón del tibial anterior transferido. Se presentaron cuatro complicaciones: irritación plantar, quiste sinovial en dorso e infección profunda. Dos pies requirieron cirugía no programada. CONCLUSIÓN: la transferencia del tendón del tibial anterior es una técnica eficaz para corregir la supinación dinámica residual en pacientes con pie bot.
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Pie Equinovaro , Niño , Humanos , Pie Equinovaro/cirugía , Transferencia Tendinosa/métodos , Supinación , Resultado del Tratamiento , Pie , Moldes Quirúrgicos , RecurrenciaRESUMEN
Resumen: Introducción: la dehiscencia de herida quirúrgica con exposición de material de fijación interna es un grave problema en cirugía ortopédica y un factor importante de infección. Objetivo: descripción del caso inusual de un paciente adulto con dehiscencia de la herida quirúrgica y exposición completa de 20 cm de largo de una placa de cúbito tras seis años de la cirugía, sin signos de infección, consolidación ósea y reepitelización debajo de la placa y adherida al hueso. Caso clínico: hombre de 39 años que sufrió una fractura-luxación de Monteggia, abierta grado II y multifragmentaria. El paciente tenía historia de drogodependencia en tratamiento con metadona. Fue tratado con fijación interna del cúbito mediante una placa de reconstrucción larga. Postoperatoriamente, el paciente dejó de acudir para evaluación. A los seis años de la cirugía presentaba una completa exposición de la placa (20 cm de longitud), sin signos de infección y consolidación con malalineación de la fractura. Tras el retiro de la placa se observó epitelización espontánea adherida al lecho óseo cubital. La cobertura cutánea fue completa a los dos meses. Conclusión: aunque inusual, es posible la consolidación ósea y la ausencia de infección en una fractura abierta con exposición de larga evolución de una placa de antebrazo en el adulto.
Abstract: Introduction: surgical wound dehiscence with exposure of internal fixation material is a serious problem in orthopedic surgery and an important factor for infection. Objective: presentation of an unusual case of an adult patient with surgical wound dehiscence and complete exposure of 20 cm of the ulnar plate after six years of surgery, without infection signs, with bone healing and skin behind the plate. Case presentation: 39-year-old man with an open Gustilo II Monteggia fracture-dislocation multifracture. The patient had a history of drug dependence. He had an open reduction and internal fixation with an ulnar reconstruction plate. The patient did not have any follow-up. After six years of the surgery, there was a complete exposure of the plate (20 cm) without infection and healing of the fracture with misalignment. After removing the plate, we observed spontaneous epithelialization attached to the bone bed. Skin coverage was complete at two months. Conclusion: although unusual, bone consolidation without infection is possible in an open fracture with long-standing exposure to a forearm plate in the adult.
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Introducción: Las infecciones asociadas a la asistencia sanitaria son consideradas uno de los indicadores de calidad en la atención hospitalaria, estas tienen un origen multifactorial complejo, cuyos factores involucrados son difíciles de modificar; sin embargo, existe la posibilidad de intervenir en el personal. Objetivo: Evaluar la efectividad de un programa de superación en la prevención de infecciones asociadas a la asistencia sanitaria aplicando la teoría ambientalista de Florencia Nightingale. Métodos: Se realizó una investigación preexperimental longitudinal en servicios de mayor incidencia con estas infecciones en el Hospital General Mártires del 9 de abril, de Villa Clara en el periodo 2019-2020. La población 139 profesionales de enfermería con una muestra de 125, a los que se aplicó una encuesta y se realizó una observación participante. Asimismo, se recogió además el criterio de especialistas de grupos nominales. Resultados: 78,40 % licenciados en enfermería, 49,60 % con menos de 5 años de desempeño laboral. Sobre definición, localizaciones y gérmenes más frecuentes de IAAS antes de la capacitación 84,00 % tenían inadecuado conocimiento y después 92,80 %. En normas de prevención y control antes de aplicada la capacitación el lavado de manos sólo alcanzo 24,80 %; después 96,00 %. En la observación de procederes 77,60 % recibieron evaluación de inadecuado, perfeccionando estas técnicas en un 90,40 % después de aplicada la misma. La afectividad de la superación 95.20 %Conclusión: El programa de superación en la prevención de infecciones asociadas a la asistencia sanitaria aplicando la teoría ambientalista de Florencia Nightingale resultó efectivo, al actualizar conocimientos, modificar prácticas y actitudes al fomentar un entorno cordial.
Introduction: Health care-associated infections are considered one of the quality indicators in hospital care, they have a complex multifactorial origin, whose factors involved are difficult to modify, however, there is the possibility of intervening in the staff. Objective: To evaluate the effectiveness of an improvement program in the prevention of infections associated with health care applying the environmentalist theory of Florence Nightingale. Methods: A longitudinal pre-experimental investigation was carried out in services with the highest incidence of these infections at the Hospital General Mártires del 9 de abril, in Villa Clara in the period 2019-2020. The population was 139 nursing professionals with a sample of 125, to whom a survey was applied and a participant observation was carried out. The criteria of nominal group specialists were also collected.Results: 78.40% were nursing graduates, 49.60% with less than 5 years of work performance. About the definition, locations and most frequent germs of IAAS before the training, 84.00% had inadequate knowledge and after 92.80%. In prevention and control standards, before the training was applied, hand washing only reached 24.80% and after 96.00%. In the observation of procedures, 77.60% received an evaluation of inadequate, perfecting these techniques in 90.40% after applying it. The affectivity of overcoming was 95.20%. Conclusions: The improvement program in the prevention of infections associated with health care applying the environmentalist theory of Florence Nightingale was effective, updating knowledge, modifying practices and attitudes and promoting a pleasant environment
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Control de Infecciones , Conocimientos, Actitudes y Práctica en Salud , Infección HospitalariaRESUMEN
Resumen: Se presenta el aspecto ético, esencial en la enseñanza de la medicina, la ética del profesor (educador, facilitador, maestro), del alumno (tanto como partícipe de la enseñanza o como docente) y con el paciente, una relación que debe ser holística y humanitaria. Se mencionan los errores en los que se puede caer en la enseñanza y que crean un conflicto ético entre educador y educando. Se presentan las Normas Oficiales Mexicanas que establecen y rigen la enseñanza de pregrado y postgrado (procesos todos en la formación de recursos humanos para la salud), se comenta la Norma Oficial Mexicana que rige la investigación en seres humanos y su ética, la cual es fundamental en la formación del médico.
Abstract: The important ethical aspect of medical education is presented; the ethics of the professor (educator, facilitator, teacher), of the student (both as a participant in the teaching or as a teacher) and with the patient, a relationship that should be holistic and humanitarian. Mention is made of the mistakes that can be made in teaching and that create an ethical conflict between educator and student. The Mexican Official Norms that establish and govern undergraduate and postgraduate teaching (all processes in the formation of Human Resources for Health) are presented. The Mexican Official Norm that governs research on human beings and its ethics, which is essential for the formation of the physician, is commented on.
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Heat treatment during pasteurization of mango (Mangifera indica L.) pulp reduces the phenolic content and its potential health benefits. The bioactive content, phenolics profile, and antioxidant capacity of 'Ataulfo' mango pulp after ohmic heating (OH) treatment (15.0-20.0 V/cm), and conventional heating (CT, 72 °C) were evaluated. No significant differences were observed in the gallic acid and mangiferin content and its antioxidant capacity (ABTS). Mass spectrometry analysis (LC/MS-TOF) showed that all treatments produced the same profile of phenolic compounds, including 6 phenolic acids, 2 gallotannins, 1 benzophenone, 2 xanthones, and 3 flavonoids. PCA analysis confirmed that mangiferin and gallic acid were the main contributors to the ABTS antioxidant capacity. These results demonstrate that OH treatments can preserve the compositions of phenolic compounds mango pulp, thus maintaining its potential health benefits.
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Mangifera , Antioxidantes/análisis , Frutas/química , Calefacción , Mangifera/química , Fenoles/análisisRESUMEN
INTRODUCTION: surgical wound dehiscence with exposure of internal fixation material is a serious problem in orthopedic surgery and an important factor for infection. OBJECTIVE: presentation of an unusual case of an adult patient with surgical wound dehiscence and complete exposure of 20 cm of the ulnar plate after six years of surgery, without infection signs, with bone healing and skin behind the plate. CASE PRESENTATION: 39-year-old man with an open Gustilo II Monteggia fracture-dislocation multifracture. The patient had a history of drug dependence. He had an open reduction and internal fixation with an ulnar reconstruction plate. The patient did not have any follow-up. After six years of the surgery, there was a complete exposure of the plate (20 cm) without infection and healing of the fracture with misalignment. After removing the plate, we observed spontaneous epithelialization attached to the bone bed. Skin coverage was complete at two months. CONCLUSION: although unusual, bone consolidation without infection is possible in an open fracture with long-standing exposure to a forearm plate in the adult.
INTRODUCCIÓN: la dehiscencia de herida quirúrgica con exposición de material de fijación interna es un grave problema en cirugía ortopédica y un factor importante de infección. OBJETIVO: descripción del caso inusual de un paciente adulto con dehiscencia de la herida quirúrgica y exposición completa de 20 cm de largo de una placa de cúbito tras seis años de la cirugía, sin signos de infección, consolidación ósea y reepitelización debajo de la placa y adherida al hueso. CASO CLÍNICO: hombre de 39 años que sufrió una fractura-luxación de Monteggia, abierta grado II y multifragmentaria. El paciente tenía historia de drogodependencia en tratamiento con metadona. Fue tratado con fijación interna del cúbito mediante una placa de reconstrucción larga. Postoperatoriamente, el paciente dejó de acudir para evaluación. A los seis años de la cirugía presentaba una completa exposición de la placa (20 cm de longitud), sin signos de infección y consolidación con malalineación de la fractura. Tras el retiro de la placa se observó epitelización espontánea adherida al lecho óseo cubital. La cobertura cutánea fue completa a los dos meses. CONCLUSIÓN: aunque inusual, es posible la consolidación ósea y la ausencia de infección en una fractura abierta con exposición de larga evolución de una placa de antebrazo en el adulto.
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Fracturas Abiertas , Luxaciones Articulares , Fracturas del Cúbito , Masculino , Adulto , Humanos , Dehiscencia de la Herida Operatoria/etiología , Dehiscencia de la Herida Operatoria/cirugía , Fijación Interna de Fracturas , Fracturas Abiertas/cirugía , Cicatrización de Heridas , Luxaciones Articulares/cirugía , Placas Óseas , Resultado del Tratamiento , Infección de la Herida QuirúrgicaRESUMEN
The important ethical aspect of medical education is presented; the ethics of the professor (educator, facilitator, teacher), of the student (both as a participant in the teaching or as a teacher) and with the patient, a relationship that should be holistic and humanitarian. Mention is made of the mistakes that can be made in teaching and that create an ethical conflict between educator and student. The Mexican Official Norms that establish and govern undergraduate and postgraduate teaching (all processes in the formation of Human Resources for Health) are presented. The Mexican Official Norm that governs research on human beings and its ethics, which is essential for the formation of the physician, is commented on.
Se presenta el aspecto ético, esencial en la enseñanza de la medicina, la ética del profesor (educador, facilitador, maestro), del alumno (tanto como partícipe de la enseñanza o como docente) y con el paciente, una relación que debe ser holística y humanitaria. Se mencionan los errores en los que se puede caer en la enseñanza y que crean un conflicto ético entre educador y educando. Se presentan las Normas Oficiales Mexicanas que establecen y rigen la enseñanza de pregrado y postgrado (procesos todos en la formación de recursos humanos para la salud), se comenta la Norma Oficial Mexicana que rige la investigación en seres humanos y su ética, la cual es fundamental en la formación del médico.
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Ética Médica , Enseñanza , Humanos , MéxicoRESUMEN
BACKGROUND: Hand osteoarthritis (HOA) is one of the most common causes of pain and functional disability in western countries and there is still no definitive cure. Low-dose radiation therapy (LDRT) has anti-inflammatory properties that have shown to be effective in the symptomatic relief of various degenerative musculoskeletal disorders. We designed a clinical protocol using LDRT for symptomatic HOA and present results and tolerance in the first 100 patients included. MATERIALS AND METHODS: Between April 2015 and March 2021, 100 patients with a median age of 60 were treated. Fifty-seven patients suffering from proximal/distal interphalangeal joint pain, 40 patients with thumb arthritis, 2 patients with radiocarpal joint affection and 1 patient with metacarpophalangeal joint pain were enrolled. LDRT comprised of 6 fractions of 0.5-1 Gy on every other day up to a total dose of 3-6 Gy. Clinical response was evaluated according to the visual analog scale (VAS) for pain level and the von Pannewitz score (VPS) for joint functionality. Any patients not achieving subjective adequate pain relief after 8 weeks of treatment were offered a second identical LDRT course. RESULTS: With a median follow-up of 10.5 months (range 7.55-12.45), 94% reported an improvement in the pain, with a significant reduction in the VAS level after 3, 6 and 12 months (p < 0.001). Sixty-three patients needed a second course of treatment at a median time interval of 12 weeks (range 9-14). The mean VAS score before treatment was 8 (range 3-10). After treatment, it was 5 (range 1-10). After 3, 6 and 12 months, the mean VAS scores were 4 (range 0-9), 3 (range 0-9) and 3.5 (range 0-9), respectively. Seventy patients reported functionality improvements after LDRT according to the von Pannewitz score. No acute or late complications were observed. CONCLUSION: LDRT appears to be safe and useful for HOA and is associated with good rates of pain relief and functionality improvements. However, further studies are necessary to confirm these promising results.
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Articulaciones de la Mano , Osteoartritis/radioterapia , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Dosificación Radioterapéutica , Resultado del TratamientoRESUMEN
BACKGROUND: Fracture risk assessment tool (FRAX) index was developed for estimating of the 10-year risk of major or hip osteoporotic fracture. To date, there is insufficient information regarding the correlation between FRAX and serum bone turnover markers (BTMs), such as soluble ligand of receptor activator of nuclear factor-κB (sRANKL), osteoprotegerin (OPG), and other molecules related with secondary osteoporosis in rheumatoid arthritis (RA). Therefore, this study is aimed at assessing the correlation between the FRAX and serum levels of sRANKL, OPG, sRANKL/OPG ratio, Dickkopf-1 (DKK-1), and sclerostin (SOST) in RA. METHODS: Cross-sectional study included 156 postmenopausal women with RA. Bone mineral density (BMD) was measured at lumbar spine (L1-L4) and total hip using dual-energy X-ray absorptiometry (DXA). RA patients were divided into (A) RA + osteoporosis and (B) RA without osteoporosis. FRAX scores were calculated including the total hip BMD. Serum sRANKL, OPG, DKK-1, and SOST levels were measured by ELISA. Pearson tests were used for assessing the correlation between serum levels of these molecules and FRAX scores in RA. RESULTS: The RA + osteoporosis group had elevated sRANKL levels (p = 0.005), higher sRANKL/OPG ratio (p = 0.017), decreased DKK-1 (p = 0.028), and lower SOST levels (p < 0.001). Low total hip BMD correlated with high sRANKL (p = 0.001) and sRANKL/OPG ratio (p = 0.005). Total hip and lumbar spine BMD correlated with DKK-1 (p = 0.009 and p = 0.05, respectively) and SOST levels (p < 0.001 and p < 0.001, respectively). Higher sRANKL levels and sRANKL/OPG ratio correlated with estimated 10-year risk of a major osteoporotic fractures (p = 0.003 and p = 0.003, respectively) and hip fracture (p = 0.002 and p = 0.006, respectively). High serum SOST levels were associated with a low estimated 10-year risk of a major osteoporotic fracture (p = 0.003) and hip fracture (p = 0.009). CONCLUSION: High sRANKL levels and sRANKL/OPG ratio can be useful to detect a subgroup of RA patients who has an increased 10-year risk of major and hip osteoporotic fractures.
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Artritis Reumatoide/sangre , Remodelación Ósea/fisiología , Osteoporosis/sangre , Fracturas Osteoporóticas/diagnóstico , Osteoprotegerina/sangre , Ligando RANK/sangre , Artritis Reumatoide/complicaciones , Artritis Reumatoide/patología , Biomarcadores/sangre , Densidad Ósea , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Osteoporosis/etiología , Osteoporosis/patología , Fracturas Osteoporóticas/sangre , Fracturas Osteoporóticas/etiología , Posmenopausia/sangre , PronósticoRESUMEN
Historical climate changes and interspecific gene flow have played an important role in shaping the distribution and genetic diversity of the biota in the Neotropics. In this study, we explored the role of both the Pleistocene climate changes and hybridization on the contemporary geographic structure of two Neotropical weedy species: Tithonia tubaeformis and T. rotundifolia. Distribution shifts under past and current climate conditions were explored through ecological niche modelling (ENM). We then tested these hypotheses using chloroplast microsatellite (cpSSR) data in T. tubaeformis and compared the patterns deduced with those previously reported for T. rotundifolia using the same cpSSR loci. Lastly, we searched for shared haplotypes between species. Both species exhibited significant downwards altitudinal shifts during the last interglacial (LIG) and the Last Glacial Maximum (LGM). For instance, T. rotundifolia showed large suitable habitat areas since the LIG at xeric conditions in western Mesoamerica. Tithonia tubaeformis showed a ~five-fold range contraction during the LIG compared to current climate conditions, followed by a range expansion in the LGM. Despite the large shared refugial areas predicted through ENM, we found a low number of shared haplotypes, suggesting a minor role of hybridization in shaping the geographic structure of these species. Our results provide additional patterns of the population history of the northern Neotropics during the Quaternary, and we suggest that weedy widespread species are a well-suited group for the study of the effects of historic climatic changes on the biota of this region.
Asunto(s)
Asteraceae , Cambio Climático , Ecosistema , Variación Genética , Haplotipos , Filogenia , Filogeografía , TithoniaRESUMEN
There is a concern around the world of an increasing caesarean section rate. It was estimated that between 2010 and 2015, caesarean section rates increased by almost 50%. There are several implications for this, considering that caesarean sections are associated with higher costs and worse clinical outcomes. In this context, several interventions have been considered to increase vaginal delivery rates, including the Adequate Childbirth Project (PPA) in Brazil. This study aimed to verify the impact of the strategies adopted internally in the Hospital Israelita Albert Einstein (HIAE) located in São Paulo, Brazil, regarding the reduction of caesarean sections and their perinatal results. Actions to support our study were implemented in two phases based on the PPA schedule. These actions involved three axes: a multidisciplinary team, pregnant women and facility improvements. All pregnant women admitted for childbirth at the HIAE between 2014 and 2019 were included in this study. The overall rate of vaginal delivery in this study population and among primiparous women and the percentage of admissions to the neonatal intensive care unit (NICU) were analysed in three periods: before the implementation of PPA actions (period A), after the first phase of the project (period B) and after its second phase (period C). The results showed an increase in the average vaginal delivery rate from 23.57% in period A to 27.88% in period B, and to 30.06% in period C (AxB, p<0.001; BxC, p=0.004). There was a decrease in the average of NICU admissions over the periods (period A 19.22%, period B 18.71% and period C 13.22%); a significant reduction was observed when periods B and C (p<0.001) were compared.
Asunto(s)
Cesárea , Hospitales Privados , Brasil/epidemiología , Parto Obstétrico , Femenino , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , EmbarazoRESUMEN
Sorghum has been used to expand snacks such as pop sorghum. However, it is still unknown how the structural changes during the popping affect its rheological and functional properties. This study evaluated the structural changes of popped sorghum starch (PS) and their impact on rheological behavior. Moisture sorghum was adjusted to 11, 15, and 20% before popped. Morphology, X-ray pattern (XRP), infrared spectra (IR), thermal properties, and rheological behavior before and after popping were evaluated. Micrographs showed a honeycomb-like structure in PS. XRP showed partial damage to the orthorhombic crystals of the sorghum starch after PS, while the growth of crystalline lamellae was also generated (13.08 and 20.01°). IR showed structural damage as the signal at 1045 cm-1 disappeared in PS. The IM increased to gelatinization of the starch. The rheological behavior of PS displayed better thermal stability, with the lowest breakdown (25 ± 3.5 cP), setback (253 ± 11.3 cP), and final (1337 ± 5.7 cP) viscosity. The consistency coefficient k and flow behavior index n increase, meaning a loss of the pseudoplastic character. Viscoelastic properties increased in PS, suggesting the formation of cross-links and a stable matrix. Correlation analysis showed a strong relationship between structural changes and the rheological behavior of PS.
Asunto(s)
Grano Comestible/química , Manipulación de Alimentos , Calor , Sorghum , Almidón/química , Conformación de Carbohidratos , Reología , Sorghum/química , Almidón/aislamiento & purificación , Relación Estructura-Actividad , Viscosidad , Agua/químicaRESUMEN
PURPOSE: To explore the feasibility of image-guided and respiratory-gated Stereotactic Body Radiation Therapy (SBRT) for Accelerated Partial Breast Irradiation (APBI) in patients with very early breast cancer. MATERIAL AND METHODS: Selected patients with early breast carcinoma after breast-conserving surgery were enrolled in this phase II trial. A fiducial marker was percutaneously placed close to surgical bed and five external fiducials were set on the skin. A CT scan for planning was acquired at free breathing. The treatment was planned and DVH were assessed according to international recommendations. Prescription dose was 30 Gy in five consecutive fractions of 6 Gy. A 6MV monoenergetic LINAC (linear accelerator) that combines stereoscopic X-ray imaging system and ExacTrac Adaptive Gating technique was used. PTV (planning target volume) intrafraction motion was controlled and PTV was irradiated in a selected gated area of the respiratory cycle. Shifts for a correct, gated set-up were calculated and automatically applied. RESULTS: Between April 2013 and October 2015, a total of 23 patients were included. The median tumor size was 12 mm. The mean PTV volume was 114 cc. The mean ipsilateral lung V9 Gy was 2.2% and for left-sided breast cancers, the volume of the heart receiving 1.5 Gy was 11.5%. Maximum skin dose was 30.8 Gy. Acute toxicity was grade1 in all the patients and 100% experienced excellent/good breast cosmesis outcomes. With a median follow-up of 66 months (range 8-99 months) local-relapse-free-survival reaches 100%. One patient developed a second breast cancer outside the treated quadrant after 25.1 months. CONCLUSION: APBI with SBRT and ExacTrac Adaptive Gating System was feasible. The acute and late toxicities were almost null and cosmesis was excellent. We also found that the margins of 5 mm applied from CTV to PTV were sufficient to compensate for geometric uncertainties.
Asunto(s)
Neoplasias de la Mama/radioterapia , Carcinoma Ductal de Mama/radioterapia , Radiocirugia/métodos , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/diagnóstico por imagen , Carcinoma Ductal de Mama/patología , Carcinoma Ductal de Mama/cirugía , Supervivencia sin Enfermedad , Fraccionamiento de la Dosis de Radiación , Estudios de Factibilidad , Femenino , Marcadores Fiduciales , Corazón/efectos de la radiación , Humanos , Pulmón/efectos de la radiación , Mastectomía Segmentaria , Persona de Mediana Edad , Movimientos de los Órganos , Órganos en Riesgo/efectos de la radiación , Cuidados Posoperatorios/métodos , Estudios Prospectivos , Radiocirugia/instrumentación , Respiración , Piel/efectos de la radiación , Factores de Tiempo , Tomografía Computarizada por Rayos X , Carga TumoralRESUMEN
RESUMEN La calidad de vida luego de la cirugía de la glándula tiroides es tan importante como el control de la enfermedad. Para mejorar los resultados cosméticos y la satisfacción del paciente se usan abordajes endoscópicos usando incisiones fuera de la región cervical. La tiroidectomía transoral endoscópica no deja ninguna cicatriz visible en la piel y es una técnica quirúrgica segura. Se presenta el caso de una paciente mujer de 29 años con una tumoración benigna de la glándula tiroides con síntomas compresivos y preocupaciones estéticas, sometida a hemitiroidectomia derecha mediante abordaje transoral vestibular endoscópico en un tiempo de 150 minutos y sangrado mínimo. Los resultados son comparables con la técnica quirúrgica abierta, con un mejor resultado estético y mejora en la calidad de vida.
ABSTRACT Quality of life after thyroid gland surgery is as important as disease control. To improve cosmetic results and patient satisfaction, endoscopic approaches are used using incisions outside the cervical region. Endoscopic transoral thyroidectomy does not leave any visible scarring on the skin. We present the case of a 29-year-old female patient with a benign thyroid gland tumor with compressive symptoms and aesthetic concerns, who underwent a right hemithyroidectomy by means of an endoscopic transoral vestibular approach in a time of 150 minutes and minimal bleeding, without complications in the postoperative period. The transoral endoscopic vestibular approach for endoscopic resection of the thyroid gland is safe and the results are comparable with the open surgical technique, with a better cosmetic result and improved quality of life.
RESUMEN
The popping process has been widely used as a technique for obtaining snacks. This study evaluated the effect of the popping process on the structural and thermal properties of sorghum. Seven varieties of sorghum were used. Raw sorghum grains were adjusted to 11% moisture and popped at 210 °C for 90 s with hot air. Microstructure, thermal and viscosity properties, and X-Ray and infrared spectrum were measured in raw and popped sorghum. The popping process produced an ordered honeycomb-like structure in the sorghum. The viscosity profile showed an increase in the thermal stability of popped sorghum. DSC measurements showed a starch gelatinization and a second transition about to 145 °C. XRD diffractograms display a reduction in the amplitude of the crystalline orthorhombic structure peaks. Finally, infrared indicated a change in the short-range structure and protein denaturation due to the popping process.