RESUMO
BACKGROUND: Non-alcoholic steatohepatitis (NASH) is a chronic disease characterized by inflammation, steatosis, and liver fibrosis. The liver is particularly affected by alterations in lipid metabolism. Our aim was to evaluate the effect of ß-hydroxyphosphocarnitine (ß-HPC) on NASH induced in rats. METHODS: NASH was produced via the ad libitum daily chronic administration of a fructose solution (400 kcal) for 9 weeks, an oral dose of fat solution (16 kcal) for 7 weeks and a subcutaneous injection of CCl4 (30%) two times a week for 2 weeks to Wistar rats. To evaluate the effect of ß-HPC, a dose of 100 mg/kg was administered perorally for 4 weeks and its biochemical and hepatic effects on rats with NASH were analyzed. Serum levels of glucose, triglycerides, cholesterol, and liver enzymes were quantified. Histological changes were evaluated on slices stained with H&E, trichromic and PAS. Glycogen content was measured in liver samples. α-SMA and SREBP-1 immunopositive cells were identified in liver tissue. RESULTS: NASH was characterized by elevated triglycerides, elevated liver damage enzymes, and the presence of necrosis, inflammation, steatosis, and fibrosis. Significant amounts of glycogen were found, along with α-SMA positive cells in fibrosis areas. The over-expression of SREBP-1 in cytoplasm and nuclei was evident. Animals with NASH treated with ß-HPC showed a significant reduction in inflammation, necrosis, and glycogen content in the liver. A reduction in α-SMA and SREBP-1 immunopositive cells correlated with a significant reduction in the degree of fibrosis and steatosis found in liver tissue. ß-HPC reduced the levels of ALP and GGT, and significantly reduced triglyceride levels. Animals treated with ß-HPC did not show any alterations in liver enzyme function. CONCLUSIONS: Our research shows that ß-HPC can improve liver function and morphology in the case of NASH induced in rats, suggesting ß-HPC could be potentially used in the treatment of NASH.
Assuntos
Hepatopatia Gordurosa não Alcoólica , Animais , Carnitina/análogos & derivados , Colesterol , Dieta Hiperlipídica , Modelos Animais de Doenças , Frutose/metabolismo , Frutose/farmacologia , Frutose/uso terapêutico , Glucose/metabolismo , Glicogênio/metabolismo , Glicogênio/farmacologia , Glicogênio/uso terapêutico , Inflamação/tratamento farmacológico , Fígado , Cirrose Hepática/metabolismo , Necrose , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Hepatopatia Gordurosa não Alcoólica/metabolismo , Organofosfatos , Ratos , Ratos Wistar , Proteína de Ligação a Elemento Regulador de Esterol 1/metabolismo , Proteína de Ligação a Elemento Regulador de Esterol 1/farmacologia , TriglicerídeosRESUMO
BACKGROUND: Evidence on the prevalence and determinants of burnout among military acute and critical care nursing personnel from developing countries is minimal, precluding the development of effective preventive measures for this high-risk occupational group. In this context, we aimed to examine the association between the dimensions of burnout and selected socio-demographic and occupational factors in military acute/critical care nursing personnel from Lima, Peru. METHODS AND FINDINGS: We conducted a cross-sectional study in 93 nurses/nurse assistants from the acute and critical care departments of a large, national reference, military hospital in Lima, Peru, using a socio-demographic/occupational questionnaire and a validated Spanish translation of the Maslach Burnout Inventory. Total scores for each of the burnout dimensions were calculated for each participant. Higher emotional exhaustion and depersonalisation scores, and lower personal achievement scores, implied a higher degree of burnout. We used linear regression to evaluate the association between each of the burnout dimensions and selected socio-demographic and occupational characteristics, after adjusting for potential confounders. The associations of the burnout dimensions were heterogeneous for the different socio-demographic and occupational factors. Higher emotional exhaustion scores were independently associated with having children (p<0.05) and inversely associated with the time working in the current department (p<0.05). Higher depersonalization scores were independently associated with being single compared with being divorced, separated or widowed (p<0.01), working in the emergency room/intensive care unit compared with the recovery room (p<0.01), and inversely associated with age (p<0.05). Finally, higher personal achievement scores were independently associated with having children (p<0.05). CONCLUSION: Among Peruvian military acute and critical care nursing personnel, potential screening and preventive interventions should focus on younger/less experienced nurses/nurse assistants, who are single, have children, or work in the most acute critical care areas (e.g. the emergency room/intensive care unit).
Assuntos
Esgotamento Profissional/epidemiologia , Enfermagem Militar/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PeruRESUMO
Objetivo: Comparar fuerzas de resistencia a la compresión, flexión y tensión de dos resinas microhíbridas disponibles en el mercado. Metodología: Se realizó un estudio cuasi experimental in vitro para evaluar las propiedades físico-mecánicas de las resinas Miris®, (Coltene) y EsthetX®, (Dentsply). Fundamentadas en las normas ISO internacionales se elaboraron probetas de aluminio para utilizarlas en la confección de un molde maestro con tres compartimentos destinados a la obtención de las muestras de cada una de las resinas. Por medio de una máquina universal de ensayos a cada muestra se le realizaron pruebas específicas de resistencia y los datos obtenidos se compararon con los de la otra resina. La información recolectada fue analizada con estadística no paramétrica (test de Mann-whitney, P≤0.05). Resultados: Bajo las pruebas de resistencia a la flexión los resultados fueron mas altos para la resina Miris® que para la Esthet-X® (P=0.0286). El módulo elástico (Young) fue mayor para Miris® (P= 0.0286) Bajo las pruebas de resistencia a la compresión los resultados fueron mas altos para la resina Esthet-X® que para la Miris® (P=0.0159) En la prueba de resistencia a la tracción no se obtuvieron valores confiables. Conclusiones: El módulo de Flexión más alto se relacionó con el menor porcentaje de deformación, obtenido para la resina Miris®. En contraste sus valores de resistencia a la compresión fueron menores a Esthet-X®. Miris® fue más rígida que Esthet-X®, pero Esthet-X® resistió mejor cargas compresivas. Ambas resinas mostraron resultados aceptables para ser usadas en el sector posterior, pero se recomienda limitar su uso en restauraciones conservadoras en premolares y molares.
Objective: To compare flexural and compressive strength of two microhibrid composite resins. Methods: A quasi-experimental in vitro study was performed to evaluate physical-mechanical properties of Miris®, (Coltene) and EsthetX®, (Dentsply) Results: Flexural resistance strength test showed higher values for Miris® than for Esthet-X® (P=0.0286). The elastic modulus (Young) test presented higher results for Miris® (P= 0.0286). Compressive resistance strength results were higher for Esthet-X® than for Miris ® (P=0.0159). When the tensional strength test was applied to the microhibrid resins, no reliable data were obtained. Conclusions: Higher Flexural modulus was correlated to lower deformation values, as showed by Miris®. In contrast, its compressive values were lower than Esthet-X®. Miris® was more rigid than Esthet-X®, but Esthet-X® resisted higher compressive load. Both systems showed acceptable physical-mechanical values to be considered for posterior restorations. Limited use of these resins to conservative preparations in bicuspids and molars should be considered.
Assuntos
Módulo de Elasticidade , Ensaio Clínico , Resinas , Restauração Dentária Permanente/métodosRESUMO
Histological changes of the distal ileum were evaluated in thirteen (13) patients suffering from chronic diarrhea associated with Megaloblastic Anaemia (MA). The patients were seven (7) men and six (6) women with an average age of 55.6 (34-74). They were all diagnosed with MA and treated with cianocobalamin and folic acid, which resulted in fast recovery. Follow up on the patients did not show any other cause related to chronic diarrhea. Biopsies from the distal ileum were taken by colonoscopy. Endoscopy findings were not relevant except for a light paleness or slightly-rough mucose. The following changes were found by examining the histological radiographies: chronic inflammatory infiltration 92% (12), intestinal villous atrophy 62% (8), erosions at villous surface 46% (6), slight ectasia of the lymphatics 46% (6), flattening of the epithelium cells of the villous 38% (5), and focal fibrosis 38% (5). The patients suffering chronic diarrhea associated with MA showed significant changes of the distal intestinal mucose (ileum). Those changes are probably also in the surrounding area and could explain not only the chronic diarrhea, but the poor absorption observed on some of the patients. The quick response to cobalamins and folates treatment showed the important role of these elements in intestinal restoration.
Assuntos
Anemia Megaloblástica/patologia , Diarreia/patologia , Íleo/patologia , Mucosa Intestinal/patologia , Adulto , Idoso , Anemia Megaloblástica/complicações , Doença Crônica , Diarreia/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Este estudio evalúa los cambios histológicos del íleon distal en 13 pacientes con diarrea crónica asociada con Anemia Megaloblástica (AM). La edad promedio de los pacientes fue de 55.6 años (34-74), 7 fueron varones y 6 mujeres, todos tuvieron diagnóstico definido de AM y se recuperaron rápidamente con ciancobalamina y ácido fólico; en el seguimiento no se encontró otra causa asociada con diarrea crónica. Se ingresó al ileon distal con un colonoscopio y se tomaron biopsias dirigidas. Los hallazgos endoscópicos del ileon no fueron significativos, excepto leve palidez o mucosa levemente "despulida". Las láminas histológicas fueron revisadas, y se encontraron los siguientes cambios: infiltrado inflamatorio crónico 12 (92 por ciento), atrofia de las vellosidades intestinales: 8 (62 por ciento), erosiones en la superficie de las vellosidades: 6 (46 por ciento), ectasia leve de los conductillos linfáticos 6 (46 por ciento), aplanamiento de las células epiteliales de la vellosidad 5 (38 por ciento) y fibrosis focal: 5 (38 por ciento). Los pacientes con diarrea crónica asociada a AM presentan alteraciones importantes de la mucosa intestinal distal (íleon), cambios que probablemente también están presentes en los segmentos proximales; y podrían explicar no solo la diarrea crónica, sino la malabsorción observada en algunos pacientes. La respuesta rápida a la reposición de cobalaminas y folatos indican el rol fundamental de estos elementos en la renovación intestinal.
Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Diarreia , Ileíte , Anemia Megaloblástica , Íleo , Estudos Retrospectivos , Epidemiologia DescritivaRESUMO
La Proctitis actínica es una complicación tardía de la radioterapia pélvica. El presente estudio describe la experiencia del empleo de probeta caliente en el manejo de pacientes con sangrado rectal causado por proctitis actínica refractaria a tratamiento médico. Material y métodos: El presente estudio es descriptivo prospectivo, el período de estudio fue Junio 2000-Abril 2001. Se incluyeron 30 pacientes, con sangrado rectal persistente, diario, que no mejoró con enemas de dexametasona o sucralfato. Se incluyeron pacientesque por lo menos tuvieron 2 sesiones. Se empleóuna probeta caliente de 2,8 mm marca Olympus modelo HPU, se aplicó a través de un Video -Colonoscopio marca Olympus modelo CF140L. Aplicándose la probeta firmemente contra la telangiectasia hasta su coagulación, tratando de abarcar la mayor área posible por sesión. Se aplicaban toques de 25 a 30 J cada uno, con 6 a 12 toques por sesión. Se empleó de 150 a 300 Joules/sesión, con 1 a 2 sesiones por mes. En cada sesión el paciente refería el grado de mejoría con una escala de 1 a 10 puntos y si habían recibido transfusiones. Se consideró pacientes de alta a aquellos en los que el sangrado rectal desapareció o fue mínimo con mejoría endoscópica. No se reportaron complicaciones. Resultados: Se incluyeron 30 pacientes. 28 fueron mujeres (93.3%). Todos refirieron mejoría en cada sesión con rangos de 3 a 10 (escala de 1 a 10). El puntaje promedio de mejoría por sesión para todos los pacientes fue: luego de la 1ra sesión: 5.8 puntos, luego de la 2da sesión: 6.7 puntos; la mayor puntuación fue luego de la 6ta sesión: 7.8 puntos, se obtuvo un promedio de 6.6 puntos de mejoría por sesión. El puntaje promedio de mejoría según el número total de sesiones por paciente fue 2 sesiones: 6,2 puntos, 3 sesiones: 6.5 puntos, con mayor puntuación los que tuvieron 5 y 7 sesiones con 7 y 7.7 puntos respectivamente.
Radiation proctitis is a late complication of pelvic radiation. The present study describes the experience of using heater probe in the management of patients with rectal bleeding caused by this entity that is unresponsive to medical local treatment. Material and methods: This is a prospective descriptive study at National Hospital "Edgardo Rebagliati Martins" of Lima Peru, between June 2000 and April 2001. We included 30 patients with persistent rectal bleeding, daily, that didn't improve with sucralphate or corticoid enemas. We included patients with at least 2 sessions. We used Olympus heater probe unit (2.8mm) and Olympus colonoscope CF140L. Heater probe was applied over bleeding vascular lesions, until complete coagulation was obtained, using 25 to 30 joules per application , 6 to 12 times until a total of 150 to 300 Joules was completed. The sessions were 2 per month and the patient completed a questionnaire. Symptoms improved (scale 1 to 10) an need for transfusion was recorded. Patients were discharged from follow up endoscopic improvement and no bleeding. Results: 30 patients were included, 28 females (93.3%). All reported clinical improvement at each session with score range 3 to 10 and mean 5.8 for the first session, 6.7 for the second. The major improvement was 7.8 for 6th session. Overall rate improvement was 6.6 per session. The mean rate applied to number of sessions per patient was 6.2 for 2 sessions, 6.5 for three sessions, 7 and 7.7 for 5 and 7 sessions. At the time of reporting results for this study, 9 (30%) patients were discharged, with a mean of 4.5 sessions. The benefit of treatment was noted in 29 patients (96.7%), lowering the grade of bleeding and requirements for transfusions. We didn't have complications. Conclusions: Heater probe is an effective and safe method for manageme of radiation proctitis inpatients not responding to conventional local treatment.