RESUMO
OBJECTIVE: The majority of the 65 million people worldwide with epilepsy live in low- and middle-income countries. Many of these countries have inadequate resources to serve the large patient population affected by epilepsy. Panama is a middle-income country that currently has only 2 facilities that can provide basic epilepsy services and no epilepsy surgery services. To address this need, a group of Panamanian physicians partnered with U.S. epilepsy health care providers to test a hybrid epilepsy surgery program, combining resources and expertise. METHODS: From 2011 to 2017, a multidisciplinary team of neurologists, neurosurgeons, and an electroencephalography (EEG) technician from the United States traveled to Panama 6 times and, in collaboration with the local team, performed surgical procedures for intractable epilepsy at the national children's hospital. Resective surgeries were performed with intraoperative electrocorticography and/or implantation of subdural and depth electrodes and extra-operative monitoring. Cost was calculated using Panama government data. RESULTS: Twenty-seven children with intractable epilepsy were surgically treated. Fifteen children are seizure-free (Engle class I), 11 children are Engel II, and one child is Engel III. No major morbidity or mortality occurred, with only one postoperative infection. The average cost of treatment was calculated at $9850 per patient. SIGNIFICANCE: This program is a model for creating a multinational and multi-institutional collaboration to provide surgical epilepsy treatment in a middle-income country without an adequate infrastructure. To be successful, this collaboration needed to address medical, technical, and cultural challenges. This partnership helps to alleviate some of the present need for surgical epilepsy services while laying the groundwork for the development of a future local independent epilepsy surgery program.
Assuntos
Epilepsia/epidemiologia , Epilepsia/cirurgia , Procedimentos Neurocirúrgicos/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Adolescente , Criança , Pré-Escolar , Eletroencefalografia , Epilepsia/economia , Feminino , Seguimentos , Hospitais/estatística & dados numéricos , Hospitais/provisão & distribuição , Humanos , Cooperação Internacional , Masculino , Procedimentos Neurocirúrgicos/economia , Panamá/epidemiologia , Avaliação de Programas e Projetos de Saúde/economia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
On the basis of previous conformational and configurational studies of 4-aryl-substituted cyclophosph(on)ates derived from d-xylofuranose derivatives, wherein it was proposed that the anomeric effect is involved in the spontaneous isomerization of the P atom and the C4 carbon, and consequently, this unusual behavior was associated with the cleavage of the HepDirect prodrugs. We synthesized an analogous series of 2-amino-2-oxo-1,3,2-dioxaphosphorinanes and performed a conformational and configurational analysis in solution and the solid state followed by an examination of their mutagenic activity. The results showed that the 2-amino-2-oxo-1,3,2-dioxaphosphorinanes with the largest mutagenic activity contain either a 4-methoxyphenyl or 4-fluorophenyl group at C4 carbon and presented a major chair conformation, which is prone to weaken the C4-O3 bond via the anomeric effect and facilitates the cleavage for the release of the biologically active metabolite.
Assuntos
Ciclofosfamida/química , Compostos Organofosforados/química , Pró-Fármacos/química , Isomerismo , Modelos Moleculares , Conformação MolecularRESUMO
BACKGROUND: The eastern equine encephalitis (EEE) and Venezuelan equine encephalitis (VEE) viruses are pathogens that infect humans and horses in the Americas. Outbreaks of neurologic disease in humans and horses were reported in Panama from May through early August 2010. METHODS: We performed antibody assays and tests to detect viral RNA and isolate the viruses in serum samples from hospitalized patients. Additional cases were identified with enhanced surveillance. RESULTS: A total of 19 patients were hospitalized for encephalitis. Among them, 7 had confirmed EEE, 3 had VEE, and 1 was infected with both viruses; 3 patients died, 1 of whom had confirmed VEE. The clinical findings for patients with EEE included brain lesions, seizures that evolved to status epilepticus, and neurologic sequelae. An additional 99 suspected or probable cases of alphavirus infection were detected during active surveillance. In total, 13 cases were confirmed as EEE, along with 11 cases of VEE and 1 case of dual infection. A total of 50 cases in horses were confirmed as EEE and 8 as VEE; mixed etiologic factors were associated with 11 cases in horses. Phylogenetic analyses of isolates from 2 cases of equine infection with the EEE virus and 1 case of human infection with the VEE virus indicated that the viruses were of enzootic lineages previously identified in Panama rather than new introductions. CONCLUSIONS: Cases of EEE in humans in Latin America may be the result of ecologic changes that increased human contact with enzootic transmission cycles, genetic changes in EEE viral strains that resulted in increased human virulence, or an altered host range. (Funded by the National Institutes of Health and the Secretaría Nacional de Ciencia, Tecnología e Innovación, Panama.).
Assuntos
Surtos de Doenças , Vírus da Encefalite Equina do Leste , Vírus da Encefalite Equina Venezuelana , Encefalomielite Equina do Leste , Encefalomielite Equina Venezuelana , Adolescente , Animais , Anticorpos Antivirais/sangue , Criança , Pré-Escolar , Vírus da Encefalite Equina do Leste/genética , Vírus da Encefalite Equina do Leste/imunologia , Vírus da Encefalite Equina do Leste/isolamento & purificação , Vírus da Encefalite Equina Venezuelana/genética , Vírus da Encefalite Equina Venezuelana/imunologia , Vírus da Encefalite Equina Venezuelana/isolamento & purificação , Encefalomielite Equina do Leste/epidemiologia , Encefalomielite Equina do Leste/veterinária , Encefalomielite Equina Venezuelana/epidemiologia , Encefalomielite Equina Venezuelana/veterinária , Evolução Fatal , Feminino , Doenças dos Cavalos/epidemiologia , Cavalos , Humanos , Lactente , Masculino , Panamá/epidemiologia , Filogenia , RNA Viral/sangueRESUMO
Caspases are key proteins for the transduction and ejection of the apoptotic signals induced by several stimuli. These proteins are present within the cell as inactive precursors that need a proteolytic cleavage in order to be active. There are two main caspases group, the initiators and executors. The formers are activated by autoproteolysis when translocated to specific cell compartments or trough the coupling of adapters and or activators. The executors caspases are activated by cleavage of an initiator caspase. These proteases are responsible then for the final cleavage of diverse substrates that mediate the morphologic changes during apoptosis. Among these there are signalization, DNA repairing, structure, transcription proteins, etc. Caspases represent a new paradigm in the signal transduction pathway, and are implicated in a large number of physiologic and pathologic processes. In a near future they could be useful pathologic markers and therapeutic targets.
Assuntos
Apoptose/fisiologia , Caspases/fisiologia , Animais , Inibidores de Caspase , HumanosRESUMO
OBJECTIVES: This study evaluated the effect of treatment with abacavir/lamivudine/zidovudine versus lamivudine/zidovudine on cerebrospinal fluid (CSF) human immunodeficiency virus (HIV) RNA and clinical manifestations of HIV encephalopathy in children. STUDY DESIGN: HIV-infected children 7 months to 10 years of age (n = 23) were studied. CSF and plasma were obtained at baseline and weeks 8, 16, and 48. Genotype analysis of HIV was attempted at baseline and week 48. Neurologic evaluations were performed at baseline and weeks 16, 32, and 48. RESULTS: At baseline, 83% of children had >2.00 log(10) copies/mL HIV RNA in CSF, but only 10% had HIV RNA measurable at week 48. Among children in whom paired genotyping of HIV was possible, 8 of 11 had identical patterns in both CSF and plasma at baseline, whereas at week 48, only 1 of 9 children had similar patterns. Neurologic abnormalities were observed in 83% of children at baseline but only 35% of children at week 48 (P =.004), suggesting a benefit of treatment. CONCLUSIONS: Antiretroviral therapy was associated with a decline in CSF HIV RNA and an improvement in neurologic status. The development of genotypic mutations was different in CSF and plasma, suggesting discordant viral evolution. These results suggest that antiretroviral treatment in children should include agents with activity in the CNS.
Assuntos
Complexo AIDS Demência/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Didesoxinucleosídeos/uso terapêutico , HIV-1 , Lamivudina/uso terapêutico , Zidovudina/uso terapêutico , Complexo AIDS Demência/classificação , Complexo AIDS Demência/diagnóstico , Fármacos Anti-HIV/farmacologia , Criança , Pré-Escolar , Didesoxinucleosídeos/farmacologia , Farmacorresistência Viral , Quimioterapia Combinada , HIV-1/efeitos dos fármacos , HIV-1/genética , Humanos , Lactente , Lamivudina/farmacologia , RNA Viral/sangue , RNA Viral/líquido cefalorraquidiano , Estatísticas não Paramétricas , Carga Viral , Zidovudina/farmacologiaRESUMO
La situación del área de salud del Instituto Politécnico Tomás Katari (IPTK) se determina mediante un diagnóstico que respalda el problema planteado. Para esta tarea se utiliza los métodos directos como la entrevista a pacientes, métodos informales, datos estadísticos, prevalencias de patologías atendidas en el policlínico del IPTK determinando de esta forma las condicionantes en las que se desarrolla nuestro objeto de estudio, que se constituye en un grupo de pacientes, que tienen un problema común, el incumplimiento de tratamiento prescrito por el médico
RESUMO
De agosto a septiembre de 1991, se realizó una encuesta epidemiológica transversal dirigida a 260 odontólogos de Santo Domingo, República Dominicana, para obtener sus opiniones sobre el SIDA y la discriminación de que son objeto los pacientes. Se obtuvo respuesta de 215 adontólogos, es decir, 82.7 por ciento. Los resultados de la encuesta señalan que 82.4 por ciento de los odontólogos interroga a sus pacientes sobre el SIDA, no encontrándose significación estadistica (p-NS) al compararlos según edad, sexo y especialidad. La mayoria (88.4 por ciento ) no solicita a sus pacientes la prueba del HIV. La encuesta reveló que solo 4.7 por ciento de los odontólogos ha atendido a pacientes seropositivos y/o con SIDA, y 64.7 por ciento los discrimina. Los homosexuales (70.2 por ciento ), las trabajadoras del sexo (55.0 por ciento ), los toxicómanos (52.1 por ciento ) y los hemofílicos (40.5 por ciento ) son los grupos de riesgo más discriminados, justificando esta actitud por temor a: "perder sus clientes" (78.1 por ciento ), a "contagiarse" (47.9 por ciento ), "contaminar sus instrumentos" (38.1 por ciento ) y "afectación de su imagen social" (20.5 por ciento ). Sin embargo, admiten que el codigo deontológico los obliga a brindar sus servicios, aunque 24.7 por ciento no reconoce esta obligación moral. Por último, según estos resultados, debe admitirse un claro reconocimiento de que el riesgo existe y que la preocupación entre los profesionales de la salud es justificada
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Inquéritos Epidemiológicos , Odontólogos , Síndrome da Imunodeficiência Adquirida/psicologia , Discriminação PsicológicaRESUMO
Las enfermedades han afectado siempre a la humanidadpero el esfuerzo en la investigacion y el conocimiento adquirido en estos trabajos, permitio descubrir medicamentos que a lo largo de nuestra historia han servido para curar diferentes males. En la lista de medicamentos indespensables indicados por la O.M.S.para el uso de los paisesdel tercer mundo, se encuentra la vitamina C. cuyos efectos beneficiosos son ampliamente conocidos. Siendo esta vitamina de gran consumo en nuestra sociedad, las industrias farmaceuticas deben tener los mecanismos de control que garanticen la optima calidad de estos, ya que se trata no solamente de la economia de las personas, sino de la salud de las mismas. La industria farmaceutica nacional, elabora vitamina C en diferentes formas farmaceuticas Tabletas, comprimidos, granulados, gotas, ampollas, utilizando normas internacionales. Existen en circulacion ampollas de vitamina C, provenientes del contrabando, que por sus precios competitivos son preferidos por la poblacion de escasos recursos economicos. No existiendo un control rigoroso de los productos que entran por esa via, de los productos de donacion...