RESUMO
Resumen El comportamiento circadiano de la presión arterial se clasifica en distintos fenotipos que aportan conocimiento adicional sobre el estado mórbido y el pronóstico de los pacientes. La monitorización ambulatoria de la presión arterial (MAPA) es la herramienta ideal para obtener un registro de estas variaciones. Su etiología es multifactorial, incluyendo disregulaciones en el sistema nervioso autónomo, ejes neuroendocrinos y sistema de recambio mineral, mostrando un comportamiento complejo desde el punto de vista fisiopatológico. Existen diversas asociaciones de fenotipos circadianos alterados, como el non dipper, con desenlaces cardiovasculares adversos como mortalidad cardiovascular, enfermedad coronaria, cerebrovascular, enfermedad renal crónica y hospitalización por falla cardiaca. El conocimiento de estos aspectos es fundamental para definir grupos especiales de riesgo en pacientes con hipertensión.
Abstract Circadian blood pressure variations are classified into different phenotypes that provide additional knowledge about patients morbidity and prognosis of patients. Ambulatory blood pressure monitoring (ABPM) is the ideal tool to obtain a record of these variations. The etiology of non-dipper hypertension is multifactorial, including dysregulations in the autonomic nervous system, neuroendocrine axes, and mineral turnover system, with complex pathophysiological behavior. There are many associations between altered circadian phenotypes (such as the non dipper phenotype) and adverse cardiovascular outcomes such as cardiovascular mortality, coronary and cerebrovascular disease, chronic kidney disease, and heart failure. Knowledge of these aspects is essential to define special risk groups in patients with hypertension.
RESUMO
BACKGROUND: Cervical cancer screening is a cost-effective method responsible for reducing cervical cancer-related mortality by 70% in countries that have achieved high coverage through nationwide screening strategies. However, there are disparities in access to screening. In Ecuador, although cervical cancer is the second most common cancer in women, only 58.4% of women of reproductive age have ever been screened for cervical cancer. METHODOLOGY: A qualitative study was performed to understand the current barriers to screening and to identify strategies that could increase uptake in Azuay province, Ecuador. Seven focus group discussions (FGDs) were conducted with under-screened women and health professionals (HPs). The FGDs were recorded and transcribed. Content analysis was done using the socio-ecological framework to categorize and analyse the data. RESULTS: Overall, 28 women and 27 HPs participated in the study. The two groups perceived different barriers to cervical cancer screening. The HPs considered barriers to be mainly at the policy level (lack of a structured screening plan; lack of health promotion) and the individual level (lack of risk perception; personal beliefs). The women identified barriers mainly at organizational level, such as long waiting times, lack of access to health centres, and inadequate patient-physician communication. Both groups mentioned facilitators at policy level, such as national campaigns promoting cervical cancer screening, and at community and individual level, including health literacy and women's empowerment. CONCLUSIONS: The women considered access to health services the main barrier to screening, while the HPs identified a lack of investment in screening programmes and cultural patterns at the community level as major obstacles. To take an integrated approach to cervical cancer prevention, the perspectives of both groups should be taken into account. Additionally, new strategies and technologies, such as self-administered human papillomavirus (HPV) testing and community participation, should be implemented to increase access to cervical cancer screening.
Assuntos
Detecção Precoce de Câncer , Neoplasias do Colo do Útero , Humanos , Feminino , Detecção Precoce de Câncer/métodos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Equador , Aceitação pelo Paciente de Cuidados de Saúde , Programas de Rastreamento/métodosRESUMO
BACKGROUND: Patients with rectal cancer who achieve complete clinical response after neoadjuvant chemoradiation have been managed by organ-preserving strategies and acceptable long-term outcomes. Controversy still exists regarding optimal timing for the assessment of tumor response after neoadjuvant chemoradiation. OBJECTIVE: The purpose of this study was to estimate the time interval for achieving complete clinical response using strict endoscopic and clinical criteria after a single neoadjuvant chemoradiation regimen. DESIGN: This was a retrospective review of consecutive patients managed by 54-Gy and consolidation 5-fluorouracil-based chemotherapy. Assessment of response was performed at 10 weeks after radiation. Patients with suspected complete clinical response were offered watch-and-wait strategy and reassessment every 6 to 8 weeks until achievement of strict criteria of complete clinical response or overt residual cancer. SETTINGS: This study was conducted at a single tertiary care center. PATIENTS: Patients with complete clinical response who underwent a successful watch-and-wait strategy until last follow-up were eligible. Dates of radiation completion and achievement of strict endoscopic and clinical criteria (mucosal whitening, teleangiectasia, and no ulceration or irregularity) were recorded. Patients with incomplete response or with initial complete clinical response followed by local recurrence or regrowth were excluded. MAIN OUTCOMES MEASURES: The distribution of time intervals between completion of radiation and achievement of strict complete clinical response was measured. Patients who achieved early complete clinical response (≤16 wk) were compared with late complete clinical response (>16 wk). RESULTS: A total of 49 patients achieved complete clinical response and were successfully managed nonoperatively. A median interval of 18.7 weeks was observed for achieving strict complete clinical response. Only 38% of patients achieved complete clinical response between 10 and 16 weeks from radiation completion. Patients with earlier cT status (cT2/T3a) achieved a complete clinical response significantly earlier when compared with those patients with more advanced disease (T3b-d/4; 19 vs 26 wk; p = 0.03). LIMITATIONS: This was a retrospective study with a small sample size. CONCLUSIONS: Assessment at 10 to 16 weeks may detect a minority of patients who achieve complete clinical response without additional recurrence after neoadjuvant chemoradiation. Patients suspected for a complete clinical response should be considered for reassessment beyond 16 weeks before definitive management when considered for a watch and wait strategy. See Video Abstract at http://links.lww.com/DCR/A901.
Assuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Quimiorradioterapia Adjuvante , Fluoruracila/uso terapêutico , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/terapia , Conduta Expectante , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Metástase Neoplásica , Estadiamento de Neoplasias , Tratamentos com Preservação do Órgão , Neoplasias Retais/patologia , Reto , Estudos Retrospectivos , Fatores de TempoRESUMO
Currently, archaeologists perform excavations determined by previous geophysical studies to accurately establish the prospective targets and minimize site disturbance. Among others, one of the methods most widely employed is the Electrical Resistivity Tomography (ERT-2D, -3D). However, investigation of the subsoil of archaeological buildings is not possible to carry out with traditional geophysical methods, because the structure itself prevents it. Therefore, it is necessary to design non-invasive special arrays capable of characterizing the subsoil of such buildings, while preserving their historical context. Here we show how this procedure combined with sequences of resistivity observations at depth allowed us to detect a low resistivity body beneath the pyramid of El Castillo in Chichen Itza (Mexico). This feature may be associated with a cavity (karst) partially filled with sweet water. On the other hand, a natural cavity was discovered under El Osario pyramid (south of El Castillo), at the end of the 19th century. Therefore, this pyramid was also studied to validate the effectiveness of this methodology, obtaining outstanding results. This method provides an interesting procedure to investigate the subsoil of archaeological structures for unveiling evidences that allow specialists to understand the religious meaning of these temples.