RESUMO
Simultaneous microorganism inactivation and organic microcontaminant removal in municipal wastewater treatment plant (WWTP) secondary effluents by the solar photo-Fenton process mediated by Fe3+-NTA is studied in depth. To achieve this objective, different key aspects were addressed: (i) the effect of initial Fe3+-NTA concentration at 1:1 molar ratio (0.10-0.30 mM) and H2O2 concentration (1.47-5.88 mM), (ii) the effect of initial microorganism load (103 and 106 CFU/mL) and (iii) the impact of the disinfection target on treatment cost. The first stage of this work was carried out in simulated WWTP effluent spiked with 100 µg/L of imidacloprid (IMD) as model microcontaminant and inoculated with Escherichia coli (E. coli) K-12 as reference strain, in a pilot scale raceway pond reactor with 5-cm of liquid-depth. Secondly, the most cost-effective conditions were validated in actual WWTP effluent. The kinetic analysis revealed that increasing Fe3+-NTA concentration over 0.20 mM does not significantly reduce treatment time due to the limited effect caused on the volumetric rate photon absorption. Treatment cost is determined by the disinfection process, since IMD removal was always faster than E. coli inactivation. The most cost-effective strategy to achieve 10 CFU/100 mL of E. coli (Regulation EU 2020/741) was 0.20/4.41 mM Fe3+-NTA/H2O2, with a cost of 0.32 /m3. A less restrictive disinfection target, 100 CFU/100 mL, allowed reducing reactant concentration and cost, 0.10/1.47 mM Fe3+-NTA/H2O2 and 0.15 /m3, respectively. In both cases, no regrowth at 24 h and more than 90% of IMD removal were observed.
Assuntos
Águas Residuárias , Purificação da Água , Desinfecção , Escherichia coli , Peróxido de Hidrogênio , Ferro , CinéticaRESUMO
In the context of a regional Chilean project (FIC Taltape project, BIP code 30158422-0), a multi-effect distillation (MED) pilot plant has been built and installed in a small community in the north of Chile (Taltape, Arica) in order to supply treated water for agricultural and domestic purposes. The aim of this paper is to assess the techno-economic feasibility of this system for supplying water with the required quality to the population. The characterization of the feed water and the effluents from the MED pilot plant (distillate and brine), obtained during five months of operation, has been firstly performed. Then, the prediction of the operation of the water treatment system with solar energy has been carried out using a typical meteorological year and the design of a static solar field that cover the thermal energy needs of the water treatment plant. The annual simulations of the MED pilot plant operating with solar energy showed that the water needs can be mostly covered using a static solar thermal field with a total area of 113.2â¯m2, which would generate roughly 46% of the total heat required by the water treatment plant. The technical analysis has been completed with an exhaustive economic assessment. The specific water costs have been determined for the MED pilot plant and the scale factor when the productivity is increased up to 5000â¯m3/day has been evaluated. The cost of distillated water produced by the MED plant varied from 15.0â¯USD$/m3 for the 10â¯m3/day production capacity to 1.25â¯USD$/m3 when this variable is increased to 5000â¯m3/day.
Assuntos
Irrigação Agrícola/métodos , Purificação da Água/métodos , Irrigação Agrícola/economia , Chile , Destilação , Água , Purificação da Água/economia , Abastecimento de ÁguaRESUMO
The purpose of this work was to study the ozonation of nanofiltration (NF) retentates of real municipal wastewater treatment plant (MWTP) effluents for removal of microcontaminants (MCs) and toxicity. MCs present in these effluents were monitored using LC-MS/MS. Acute and chronic toxicity was addressed with Daphnia magna, Vibrio fischeri and Selenastrum capricornutum. Up to 40 MCs were found, most of them in concentrations over 100ng/L. 90% degradation of the sum of MCs was the critical point of comparison. When the NF membrane system was applied to MWTP effluents, treatment of NF rejection needed 2.75-4.5g O3/m3,4.5g O3/m3, which is less than 50% of the ozone needed for direct treatment of MWTP effluent. Treatment time (lower than 11min) was not influenced by MCs concentration, at least in the range tested (25-190µg/L). It has been demonstrated that consumption of ozone increased with organic load and inorganic content of different real effluents. MCs were eliminated by ozonation but acute toxicity (against V. fischeri and D. magna) increased. Chronic toxicity results were different and contrary in D. magna and S. capricornutum, due to the generation of new transformation products more toxic to D. magna than the parent contaminants. S. capricornutum inhibition percentage decreased in all cases after ozonation treatment. According to these results, before ozonation is implemented in MWTPs for the removal of MCs, the transformation products must first be examined and the treatment time or ozone doses should be extended to complete degradation if necessary.
Assuntos
Recuperação e Remediação Ambiental/métodos , Ozônio/química , Ultrafiltração/métodos , Eliminação de Resíduos Líquidos/métodos , Águas Residuárias/química , Poluentes Químicos da Água/química , Poluentes Químicos da Água/toxicidade , Aliivibrio fischeri/efeitos dos fármacos , Animais , Clorófitas/efeitos dos fármacos , Daphnia/efeitos dos fármacos , Membranas Artificiais , Purificação da ÁguaRESUMO
Sharp-force injuries are injuries caused by a mechanical force using sharp objects against the skin. Sharp-force injuries are mainly classified as stab, incised, chop, and therapeutic wounds and are less frequent than blunt-force injuries in animals. The analysis of the edges of the wound is crucial, especially if more than one type of lesion is involved. It may be difficult to differentiate between sharp trauma and blunt trauma, because lacerations can resemble incised wounds. The accurate documentation and examination of these injuries may indicate the instrument involved, the relationship between the animal and the perpetrator, and the force of the stab. Situations in which this type of trauma occurs may involve social violence, accidents, hunting, veterinary medical management, and religious rituals. The causes of death related to this type of trauma include hypovolemic shock, pneumothorax, or asphyxiation due to aspiration of blood. Necropsy findings should provide objective and unbiased information about the cause and manner of death to aid the investigation and further judgment of a possible crime.
Assuntos
Patologia Legal/métodos , Patologia Veterinária/métodos , Ferimentos Perfurantes/veterinária , Bem-Estar do Animal , Autopsia/veterinária , Crime , Humanos , Ferimentos Perfurantes/diagnóstico , Ferimentos Perfurantes/patologiaRESUMO
BACKGROUND: Metaplasic carcinoma of the breast was initially described by Huvos in 1974. It is a rare and aggressive entity characterized by the presence of mesenchymal and epithelial components. OBJECTIVE: To know the incidence and biologic behaviour of the metaplasic carcinoma of the breast at the Instituto de Enfermedades de la Mama, FUCAM, AC. METHODS: Data on women diagnosed with metaplasic carcinoma of the breast between January 2005 and December 2014 was collected by retrospectively reviewing in FUCAM. Clinical, pathological and immunohistochemical characteristics were assessed. The five-year disease-free survival (DFS) and overall survival (OS) were evaluated. RESULTS: a total of 4198 patients have been diagnosed with breast cancer in our institution, 40 (0.95%) of them with metaplasic carcinoma. The median age of the patients was 46 years (27-73). 60% of the patients were diagnosed with an advanced clinical stage (III) and the triple-negative subtype was the most frequently found. A mean follow-up of 24 months showed rates of overall survival and disease-free survival of 80% and 69.9%, respectively. The presence of both, cytokeratins 5/6 and p63, seems to have a negative impact in local recurrence. CONCLUSION: this study demonstrates that metaplasic carcinoma is a rare and aggressive disease. Expression of both tumor cytokeratins was associated with a worse outcome.
Assuntos
Neoplasias da Mama/metabolismo , Carcinoma/metabolismo , Queratina-5/biossíntese , Queratina-6/biossíntese , Fatores de Transcrição/biossíntese , Proteínas Supressoras de Tumor/biossíntese , Adulto , Idoso , Neoplasias da Mama/mortalidade , Carcinoma/mortalidade , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Background: Breast cancer is the leading cause of cancer death in women in Mexico, is a heterogeneous disease, and knowledge of prognostic factors are critical in making treatment decisions. Objetive: determine the overall survival (OS) and disease-free survival (DFS) at 5 years, analyzed by risk groups. Material and methods: Patients diagnosed with breast treated at the Institute of Breast Diseases FUCAM from July 2005 to December 2014 were included. Simple frequencies were used for analysis of the general characteristics, and 5- year OS and DFS were analyzed using Kaplan-Meier curves. A subset analysis of the clinical stage and comparing survival in those patients diagnosed by mammography screening program was performed. Results: 4,902 patients with breast cancer were included, general clinical and pathological features are described and 3,762 patients were included for analysis of 5-year OS and DFS. The average age at diagnosis was 53.7 years; 13.3% were <40 years, which deleteriously reflects on the supervivencia global 76 vs 84% in >40. At diagnosis predominated locally advanced stages (45%), OS and DFS at 5 years was 96.8 ± 0.6% and 93.4%±0.9 respectively for early stages, 74.6 ± 1.7% and 68.7 ± 2% for locally advanced and 35.9 ± 5.1% and 37.4 ± 10.3% for metastatic tumors. Women diagnosed in the screening program had significantly better OS and DFS compared with symptomatic patients (95 and 93% vs 79 and 77%). For biological subtypes, OS and DFS was 89 and 84% for luminal, 81 and 81% for luminal Her +, 74 and 78% for pure Her 2, and 69 and 73% for triple negative. Conclusion: Knowledge of the prognostic factors that affect survival of patients with breast cancer is essential for categorizing risk groups and to individualize treatment in order to improve life expectancy.
Assuntos
Neoplasias da Mama/patologia , Mamografia/métodos , Programas de Rastreamento/métodos , Adulto , Idoso , Neoplasias da Mama/diagnóstico , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Proximal focal femoral deficiency (PFFD) is a rare skeletal condition characterized by development failure of the subtrochanteric region of the femoral axis, with several degrees of shortening of the proximal region. There are no case reports of patients with this condition associated with a subtrochanteric fracture. We therefore describe herein the case of a newborn patient with clinical and radiographic diagnosis of proximal focal femoral deficiency complicated by a proximal femur fracture, and managed conservatively with pelvipodalic immobilization, which led to bone healing. The patient will continue to be managed in the long-term to assess and treat the sequelae of PFFD according to the growth stage he is in.
Assuntos
Doenças Ósseas/complicações , Fêmur , Fraturas do Quadril/etiologia , Feminino , Humanos , Recém-NascidoRESUMO
OBJECTIVE: To present 10 cases of congenital brachymetatarsia treated with elongation by means of callotaxis with external minifixators. INTRODUCTION: Brachymetatarsia of one or more of the matatarsals involving one or both extremities is a congenital condition, more frequent in the right foot, with the 4th metatarsal most commonly affected. MATERIAL AND METHODS: From May 2007 to September 2008, 7 patients with congenital brachymetatarsia, ages 8 to 15 years, were operated on. Two metatarsals were involved in 3 of them and thus the series included 10 procedures. All of them underwent lengthening through callotaxis with a monoaxial external mini-fixator. RESULTS: Mean lengthening was 21.1 mm, with a range of 17 to 25 mm. The complications included two cases of lengthening regression of 5 mm each. Delayed healing was reported in one of these two cases, and healing occurred spontaneously at 6 months. Nine metatarsals healed without any problems; no infections or material intolerance occurred. CONCLUSION: Lengthening of metatarsals through callotaxis with external mini-fixators is an appropriate procedure for pediatric and adolescent patients with congenital brachymetatarsia.
Assuntos
Osteogênese por Distração/métodos , Falanges dos Dedos do Pé/anormalidades , Falanges dos Dedos do Pé/cirurgia , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
West Nile virus (WNV) was probably introduced in southern and northern Mexico from the USA in two independent events. Since then, WNV activity has been reported in several Mexican states bordering the USA and the Gulf of Mexico, but disease manifestations seen there in humans and equids are quite different to those observed in the USA. We have analysed WNV seroprevalence in asymptomatic, unvaccinated equids from two Mexican states where no data had been previously recorded. WNV IgG antibodies were detected in 31.6% (91/288) of equine sera from Chiapas and Puebla states (53.3% and 8.0%, respectively). Analysis by plaque reduction neutralization test (PRNT) showed good specificity (99.4%) and sensitivity (84.9%) with the ELISA results. Further analyses to detect antibodies against three different flaviviruses (WNV, St Louis encephalitis virus, Ilheus virus) by haemagglutination inhibition (HI) tests on a subset of 138 samples showed that 53% of the 83 HI-positive samples showed specific reaction to WNV. These data suggest continuous expansion of WNV through Mexico.
Assuntos
Doenças dos Cavalos/epidemiologia , Febre do Nilo Ocidental/veterinária , Animais , Doenças dos Cavalos/imunologia , Cavalos , México/epidemiologia , Estudos Soroepidemiológicos , Febre do Nilo Ocidental/epidemiologia , Febre do Nilo Ocidental/imunologiaRESUMO
Ductal carcinoma in situ (DCIS) represents a small number of cases in countries with inadequate breast cancer screening programs, and in the majority of cases is diagnosed as a palpable lump. It has been proposed that DCIS with palpable lump > or = 2.5 cm can be associated with microinvasion or invasive carcinoma and risk of axillary metastasis. The purpose of the present study is to evaluate incidence of microinvasion, invasion, and the role of lymphatic mapping and sentinel lymph node biopsy in DCIS > or = 2.5 cm. We conducted a retrospective analysis of patients with histologically proven incisional, excisional, or core biopsy of DCIS lump > or = 2.5 cm at a tertiary-care hospital. All patients underwent lymphatic mapping with sentinel lymph node biopsy.A total of 24 patients were included with average tumor size of 4 cm (range, 2.5-6 cm); 29% had microinvasive and 12.5% had invasive disease, three patients (12.5%) had positive sentinel lymph node, all had micrometastasis, and no metastasis were found in non-sentinel lymph nodes. Incidence of microinvasion and invasion were directly related with tumor size (10% for DCIS tumor size of 2.5-3.5 cm, 57% for 3.6-4.5 cm, and 71% for tumors between 4.5 and 6 cm). In addition, axillary metastasis incidence had a direct relationship with tumor size. (0% in 2.5-3.5-cm tumor size, 14% for 3.6-4.5 cm, and 28% in DCIS between 4.6 and 6.0 cm). The present study shows high incidence of microinvasion and invasion in DCIS diagnosed in tumors > or = 2.5 cm and supports the importance of axillary evaluation in patients with tumors >3.5 cm by means of lymphatic mapping and sentinel lymph node biopsy.
Assuntos
Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/secundário , Linfonodos/patologia , Adulto , Idoso , Axila , Feminino , Humanos , Incidência , Metástase Linfática , Pessoa de Meia-Idade , Invasividade Neoplásica , Valor Preditivo dos Testes , Estudos Retrospectivos , Biópsia de Linfonodo SentinelaRESUMO
The generation of vorticity in the two-dimensional creeping flow of an incompressible, electrically conducting viscous fluid past a localized magnetic field distribution is analyzed under the low magnetic Reynolds number approximation. It is shown that the Lorentz force produced by the interaction of the induced electric currents with the nonuniform magnetic field acts as an obstacle for the flow, creating different steady flow patterns that are reminiscent of those observed in the flow past bluff bodies. First, analytic solutions are obtained for a creeping flow past a magnetic point dipole, modeled as a Gaussian distribution. Using a perturbation scheme, the vorticity is expressed as an expansion in the small Reynolds number, and first- and second-order approximations are calculated. The induced magnetic field, pressure, and stream function are also determined. Further, full numerical finite difference solutions are obtained for a uniform creeping flow past a finite size magnetic field distribution produced by a square magnetized plate. Hartmann numbers in the range 1< or =Ha< or =100 are explored. Depending on the strength of the magnetic force, stagnation zones or steady vortical structures are obtained. The analysis contributes to the understanding of flows in nonuniform magnetic fields and flows produced by localized forces.
RESUMO
El trasplante renal es la mejor alternativa para el tratamiento de la insuficiencia renal crónica terminal. En el caso de los niños, junto con mejorarles significativamente la calidad de vida, contribuye a la normalización del desarrollo pondoestatural. Los trasplantes renales se iniciaron en el Hospital San Juan de Dios a fines del 70. Hasta la fecha se han efectuado 285, y 64 en pacientes pediátricos. El objetivo de ésta presentación fue conocer nuestros resultados en términos de morbimortalidad, sobrevida de injertos renales y comparar estas cifras con otras publicaciones. Se efectuó un análisis retrospectivo de las fichas clínicas de todos los receptores. El promedio de edad fue de 11 años, con un 94 por ciento de los receptores con más de 20 kg de peso. Un 73 por ciento recibió un injerto cadavérico, con un promedio de 23 horas de isquemia fría. La primera causa de insuficiencia renal crónica fue la hipoplasia y displasia congénita (36 por ciento). 92 por ciento de los receptores estaban en diálisis al momento del trasplante. La trombosis arterial estuvo presente en 4,6 por ciento. Un 7 por ciento de los injertos se perdieron por abandono de inmunosupresión. Un 17 por ciento requirió diálisis post-trasplante, transitoria,. La sobrevida actuarial global de los injertos renales fue de 83 por ciento al primer año y 77 por ciento al tercer y quinto años. El trasplante renal pediátrico representa más del 20 por ciento de nuestros receptores. Los resultados en términos de complicaciones y sobrevida actuarial de los injertos, son parecidos a los publicados en la literatura. A futuro, debemos trasplantar a éstos niños a edades más tempranas y antes de que ingresen a diálisis.
Assuntos
Masculino , Adolescente , Humanos , Feminino , Criança , Insuficiência Renal Crônica/cirurgia , Transplante de Rim , Complicações Pós-Operatórias/epidemiologia , Creatinina/sangue , Rejeição de Enxerto , Sobrevivência de Enxerto , Insuficiência Renal Crônica/etiologia , Estudos Retrospectivos , Doadores de Tecidos , Transplante de Rim/mortalidade , Trombose/complicaçõesRESUMO
Antecedentes: El tratamiento integral de la hipertensión arterial esencial involucra el tratamiento farmacológico y el control de los factores de riesgo cardiovascular. Objetivo: Estudiar a largo plazo la magnitud y frecuencia del cambio de los factores de riesgo, incluida la presión arterial, sobre la morbi-mortalidad de la hipertensión. Método: Estudio observacional durante 30 años de una cohorte de 1.360 hipertensos esenciales tratados con fármacos habituales (tiazidicos, B-bloqueadores, antagonistas del Ca++ e inhibidores ECA) y medidas dietéticas, educacionales y farmacológicas tendientes a mejorar el estilo de vida (cigarrillo, alcohol y sedentarismo) y controlar adecuadamente las enfermedades concomitantes (diabetes, dislipidemia, obesidad, gota). Se analizó el cambio individual de los 8 factores de riesgo fijando como éxito: PA <140/90 mmHg, cero consumo de cigarrillos, alcohol > 2 vasos de vino al día, colesterol total <200 mg por ciento, glicemia < 120mg por ciento e índice de masa corporal <30 peso/talla². De acuerdo al éxito individual, se separaron dos grupos: B con cambio adecuado de 4 o más FR y M, sin ese resultado. Se comparó la morbi-mortalidad entre ellos, en total y en forma separada para pacientes complicados y no complicados al ingreso. Estadística según tasas acumulativas y diferencias según método de Cox. Resultados: mortalidad general 0.91 por ciento/año y morbilidades comparables a las de la literatura reciente. Cambio de los factores de riesgo inferior al 50 por ciento, en especial diabetes (26 por ciento) obesidad (18 por ciento) y sedentarismo (15 por ciento). El grupo B con control adecuado de más de 4 factores de riesgo presentó significativamente una menor mortalidad, menor morbilidad total y menor incidencia de Infarto miocárdico, tanto en pacientes previamente complicados como sin ellas al ingreso. Conclusión: Este resultado positivo, a pesar del moderado control de los FR, enfatiza la necesidad de realizar no solo prevención primaria sino también secundaria en forma más intensa y agresiva.
Assuntos
Humanos , Doenças Cardiovasculares/prevenção & controle , Hipertensão/complicações , Hipertensão/mortalidade , Chile , Consumo de Bebidas Alcoólicas/efeitos adversos , Diabetes Mellitus/complicações , Seguimentos , Hiperlipidemias , Obesidade/complicações , Prevenção Primária , Fatores de Risco , Taxa de Sobrevida , Tabagismo/efeitos adversosRESUMO
Many risk factors have been identified in differentiated thyroid cancer, with them, some prognostic scores have been designed to asign the risk of recurrence and survival. In Mexican population, this type of study is scarce. This is a retrospective review of 180 patients with differentiated thyroid cancer completely treated at the Hospital de Oncologia, IMSS, in Mexico City from 1980 to 1990. All prognostic factors were analyzed and a score obtained either by the method of AGES, MACIS, or SKMH. Correlation of recurrences and survival was carried out according to score or risk assignment. There was a predominance of females (4.8:1), 48% had metastatic cervical nodes, median tumor size was 4 cm, 16% had multiple macroscopic thyroid tumors, in 12% resection was incomplete, 96% were papillary, and 4% follicular cancers. According to AGES, 46% were high risk patients, 49.4% with MACIS and 45.5% with SKMH, respectively. Median follow-up was 8.3 years. There were 67 (37%) recurrences. Ten-year overall survival was 89.4% and disease-free survival was 79.2%. There was no statistical significant difference of survival of AGES until the score reached 6 or more or the MACIS score reached 8 or more. Cox multivariate model showed that above the age of 45, tumor size of 5 cm or more, follicular histology, multiple macroscopic thyroid tumors, and extracapsular node invasion affected ten-year survival. In conclusions our patients are diagnosed at more advanced stages than patients in the U.S. or European countries. Nearly one half of our patients belonged to the high-risk group. This study confirms that patients over the age of 45, tumor size > 5 cm, and follicular histology are adverse prognostic factors and report that extracapsular node invasion and multiple macroscopic thyroid tumors are also adverse prognostic factors. In Mexican population, with 50% of high-risk patients, AGES and MACIS scores reached statistical differences with higher qualifications than observed in the U.S.
Assuntos
Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/mortalidade , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/mortalidade , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/mortalidade , Adenocarcinoma Folicular/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Medular/diagnóstico , Carcinoma Medular/mortalidade , Carcinoma Medular/terapia , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/mortalidade , Carcinoma Papilar/terapia , Diferenciação Celular , Feminino , Humanos , Radioisótopos do Iodo/uso terapêutico , Excisão de Linfonodo , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia , Resultado do TratamentoRESUMO
The aim of this study was to evaluate the efficacy of cefuroxime, compared with the combination of dicloxacillin/chloramphenicol, for the treatment of children with parapneumonic pleural effusion or empyema. Forty patients, aged 3 months to 5 years, with pleural effusion or empyema were randomized to receive cefuroxime (100 mg/kg/day) IV (n=20) or chloramphenicol (100 mg/kg/day) plus dicloxacillin (200 mg/kg/day) IV (n=20). Both groups were similar in age, days of illness, clinical and radiological findings, and etiology. Most patients (70%) had an empyema at presentation. There was no difference in clinical outcomes, including days to defervescence, duration of respiratory distress, duration of chest tube drainage, and days to discharge from hospital. The complication rates were similar in both groups. Pleural thickening occurred in four patients, bronchopleural fistula in two, and loculated empyema in one patient of each treatment group. Adverse effects attributed to cefuroxime were mild and infrequent. These results suggest that cefuroxime is an effective and well-tolerated alternative for the treatment of children with pleural effusion and empyema.
Assuntos
Cefuroxima/uso terapêutico , Cefalosporinas/uso terapêutico , Cloranfenicol/uso terapêutico , Dicloxacilina/uso terapêutico , Empiema Pleural/tratamento farmacológico , Penicilinas/uso terapêutico , Derrame Pleural/tratamento farmacológico , Pré-Escolar , Esquema de Medicação , Quimioterapia Combinada , Feminino , Humanos , Lactente , Masculino , Resultado do TratamentoRESUMO
Background: Treatment has a definitive impact on mortality in hypertension. The magnitude of blood pressure reduction, the type of drug used and the associated risk factors may modulate the effect of treatment on mortality. Aim: To report the effects of treatment of essential hypertension, in a cohort followed for up to 26 years. Patients and methods: A cohort of 1,172 essential hypertensive patients followed up to 26 years. Patients were treated with different antihypertensive drugs, alone or in combination (diuretics, beta blockers, calcium channel blockers and angiotensin converting enzyme inhibitors) according to international rules and consensus. Subjects were followed until death or loss from follow-up. Blood pressure reduction was aimed to obtain figures near 140/ 90 mm Hg. Causes of death and complications were obtained from hospital records, phone and death certificates. Survival was studied using life tables (Kaplan Meier method and intention to treat analysis) and Cox proportional hazard analysis. Results: Initial blood pressure dropped significantly from 181/109 to 154/92 mm Hg, p <0.001. Mean follow-up time was 10.6ñ6.1 years. There were 143 cardiovascular deaths, 142 acute myocardial infarctions, 101 strokes, 83 subjects had cardiac failure and 49 had renal failure. The observed rates were 0.92 percent per year for cardiovascular mortality, 1.36 percent per year for coronary heart disease, 0.94 percent per year for stroke. Conclusions: Our mortality rate is lower than that found in classical randomized studies but similar or slightly higher than the more recent ones. Morbidity rates were also very similar. Except for mortality rate, frequency of complications did not change in comparison to our previous report after 15 year of follow up. Aging did not seem to negatively influence mortality rates in adequately treated hypertensive patients
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Anti-Hipertensivos , Hipertensão/epidemiologia , Indicadores de Morbimortalidade , Fatores de Risco , SeguimentosRESUMO
Background: Among hypertensive patients, other risk factors for mortality and morbidity, besides blood pressure, must be considered when therapeutic decisions are done. Aim: To assess the incidence and relevance of cardiovascular risk factors in a cohort of patients with essential hypertension. Material and methods: A cohort of 1.072 treated patients with essential hypertension was followed for a period up to 25 years. Four hundred eighty six were men and 586 were women, age ranged from 31 to 70 years. At entry, 56 percent of subjects did not have any organic complications associated to hypertension (stage I WHO criteria), 30 percent had mild alterations (Stage II) and 14 percent had major complications (myocardial infarction, stroke, heart failure or renal failure). Likewise, 43.8 percent had mild, 14.5 percent, moderate and 41.7 percent, severe hypertension. Patients were treated with monotherapy or combined therapy based on diuretics, beta blockers, calcium antagonists and angiotensin converting enzyme inhibitors. Goal of therapy was 140/90 mm Hg. Risk factors associated diseases and complications were registered carefully. Causes of death were obtained from hospital records and death certificates. Mortality was analyzed using life tables (intention to treat method included). Results: Blood pressure dropped significantly during follow up from a mean of 182/110 to 154/92 mm Hg. During follow up, 143 patients died and 429 complications (lethal or non lethal) were recorded. Twenty four percent of patients smoked, 24 percent reported alcohol intake, 56 percent had hypercholesterolemia, 11 percent were obese, 13 percent had diabetes and 3 percent had gout. The proportional hazard model showed that the existence of previous complications, the presence of more than 3 risk factors, and age over 60 and mean systolic and diastolic pressure during therapy, were independent and significant risk factors for mortality. Conclusions: The incidence of risk factors among our hypertensive patients is very similar to that of other national or international cohorts
Assuntos
Humanos , Masculino , Feminino , Hipertensão/complicações , Fumar , Indicadores de Morbimortalidade , Fatores de Risco , Seguimentos , Alcoolismo , Hipercolesterolemia , PrevisõesRESUMO
The dynamic response of an electrically conducting fluid (either Newtonian or Maxwellian) flowing between straight concentric circular cylinders under a constant radial magnetic field, is analyzed. The isothermal flow is studied using the time Fourier transform, so that the dynamic generalization of Darcy's law in the frequency domain is obtained and analytical expressions for the dynamic permeability are derived. For the Newtonian case, the range of frequencies where the dynamic permeability approaches the static value is enlarged the smaller the gap between the cylinders and the higher the magnetic-field strength. For the Maxwell fluid, the presence of the inner cylinder shifts the frequencies that lead to the enhancement of the real part of the dynamic permeability to larger values and increases its maximum values relative to the case where the inner cylinder is absent. In addition, the Ohmic dissipation causes the damping of the amplitude of the response.
RESUMO
BACKGROUND: Surgery and/or radiotherapy are the elective therapies for most primary skin cancers. Nevertheless, some patients develop recurrences, and chemotherapy has resulted in poor complete responses. Permeabilization of the cell membrane by electric pulses allows bleomycin to enter into the cell, increasing possibility of cytotoxicity. METHODS: From November 1998 through November 1999, 15 patients with 38 skin lesions participated in a phase II prospective clinical trial, using intralesional bleomycin plus electric pulses delivered 10 min after bleomycin injection, which lasted 100 microsec each at field strength of 1,300 V/cm and a frequency of 1 Hz. There were basal cell carcinomas (BCC) (nine lesions), in-transit metastasis of melanoma (MM) (two patients/13 nodules), squamous cell carcinomas (SCC) of the upper aerodigestive tract metastatic to the skin (two patients/two nodules), and skin metastases from breast cancer (two patients/14 nodules). Mean follow-up was 8.6 months. RESULTS: Overall objective responses were 98%, with complete responses achieved in 49%, partial responses in 49%, and no responses in 2%. No complications were documented related to the treatment and tolerance was adequate. CONCLUSIONS: Electrochemotherapy (ECT) is a new cancer modality of treatment that is effective in a variety of skin cancers. This treatment represents an excellent alternative to standard surgery or radiotherapy, with an outpatient-based treatment applied in one to three sessions. The major impact was obtained in BBC, but ECT is a useful palliative therapy in melanoma, breast cancer, or SCC. More experience and longer follow-up are required to determine long-term results.
Assuntos
Antibióticos Antineoplásicos/administração & dosagem , Bleomicina/administração & dosagem , Carcinoma Basocelular/tratamento farmacológico , Carcinoma Ductal de Mama/secundário , Carcinoma de Células Escamosas/secundário , Eletroporação , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Idoso , Antibióticos Antineoplásicos/farmacocinética , Antibióticos Antineoplásicos/uso terapêutico , Bleomicina/farmacocinética , Bleomicina/uso terapêutico , Neoplasias da Mama , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma de Células Escamosas/tratamento farmacológico , Permeabilidade da Membrana Celular , Neoplasias Faciais/tratamento farmacológico , Neoplasias Faciais/secundário , Feminino , Humanos , Injeções Intralesionais , Masculino , Melanoma/secundário , Pessoa de Meia-Idade , Contração Muscular , Cuidados Paliativos , Indução de Remissão , Neoplasias Cutâneas/secundário , Resultado do TratamentoRESUMO
BACKGROUND: In Mexico, breast carcinoma is the second most frequent malignancy, representing 10.6% of all cases and 16.4% of all cancers in women, with an increase in breast carcinoma mortality rates from 3.6 per 100,000 women in 1985 to 6 per 100,000 women in 1994. Most of the tumors are diagnosed in advanced stages with little chance of cure. METHODS: To determine the age of patients in Mexico at presentation of breast carcinoma, the authors analyzed the cases registered from 1993 to 1996 from the database of the Histopathological Registry of Malignant Neoplasms in Mexico. RESULTS: There were 29,075 cases of breast carcinoma. The median age of Mexican women with breast carcinoma is 51 years, and 45.5% of all breast carcinomas develop before patients reach age 50 years. The most frequently affected age group is that of 40-49 years (29.5%), whereas the groups from 30 to 39 and from 60 to 69 years of age have a similar percentage (14%) of frequency. This contrasts with women from the United States, as well as with women from European countries, where the median age at presentation is 63 years, and only one-fourth of the patients are younger than 50 years of age, and three-fourths are postmenopausal. Similar to Mexico, in Venezuela and in Japan nearly one-half of women with breast carcinoma are younger than 50 years of age, and this resembles rates in many Latin American countries. CONCLUSIONS: It is necessary to change the guidelines of breast carcinoma screening in Mexican women, to increase the possibility of early diagnosis and better survival.