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Resumen En la práctica clínica, la radiografía de tórax permite confirmar el diagnóstico y la extensión de la neumonía adquirida en la comunidad (NAC). Objetivos: Examinar las características radiográficas de la NAC según el agente causal y el grado de concordancia interobservador (CI) en la descripción de los hallazgos radiográficos. Métodos: Se evaluaron las radiografías de tórax de 300 pacientes adultos inmunocompetentes hospitalizados por NAC, tres residentes de radiología consignaron el patrón de los infiltrados pulmonares, su localización anatómica y extensión, la presencia de derrame pleural y otros hallazgos radiográficos. Se realizaron cultivos de esputo, hemocultivos, pruebas serológicas y técnicas de biología molecular de hisopado nasofaríngeo para identificar los principales patógenos respiratorios. Resultados: Las manifestaciones clínicas y los hallazgos de la radiografía de tórax fueron similares en las neumonías causadas por diferentes patógenos respiratorios: bacterias clásicas, virus respiratorios y microorganismos atípicos. En las neumonías bacterianas predominó el patrón de relleno alveolar de distribución lobar, en las neumonías vírales y atípicas predominó el patrón intersticial o mixto alvéolo-intersticial con opacidades en vidrio esmerilado. La CI fue satisfactoria (kappa > 0,6) para determinar el patrón principal de los infiltrados pulmonares, su localización anatómica y la presencia de derrame pleural, su localización y extensión. La CI fue moderada (kappa 0,4-0,6) para definir la extensión de la neumonía y detectar signos radiológicos asociados a congestión pulmonar. Conclusión: Los hallazgos de la radiografía de tórax no permitieron identificar con precisión el agente causal de la neumonía, siendo útil en la caracterización de los infiltrados pulmonares y para detectar complicaciones como el derrame paraneumónico.
In a clinical setting the chest radiograph is the reference standard in establishing the diagnosis of community-acquired pneumonia (CAP). Objectives: This study aimed to assess interobserver reliability (IR) of radiographic findings and the relationship to different respiratory pathogens in CAP. Methods: Chest radiographs of 300 immunocompetent adult patients hospitalized with pneumonia, obtained from a database, were reviewed by three residents of radiology without specific clinical information. Main pattern of pulmonary infiltrates, topographic localization, extent of pneumonia, presence of pleural fluid, thickened bronchial walls, lymphadenopathy and air bronchogram were scored. Sputum and blood cultures, serological tests and nasopharyngeal swab for respiratory virus detection by molecular diagnostic techniques were performed to identify the causative pathogen. Results: Clinical manifestations and chest X-ray findings were similar in pneumonias caused by different respiratory pathogens: classic bacteria, respiratory viruses and atypical microorganisms. The alveolar pattern of lobar distribution predominated in bacterial pneumonia; meanwhile, interstitial or mixed alveolar-interstitial pattern with ground glass opacities predominated in viral and atypical pneumonias. IR was fair to good (kappa > 0.6) for determining the main pattern of infiltrates, anatomical location and the presence of pleural effusion, their anatomical location and extension. IR was moderate (kappa 0.4-0.6) for determining the extent of pneumonia and signs of congestive heart failure. Conclusion: Simple features such as main pattern description, anatomical location, identifying the involved lobes and pleural fluid recognition showed fair to excellent interobserver reliability. Chest radiographs was of limited value in predicting the causative pathogen but were of beneficial use to characterize pulmonary infiltrates and to detect complications such as parapneumonic effusion.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Infecções Comunitárias Adquiridas/etiologia , Infecções Comunitárias Adquiridas/diagnóstico por imagem , Bactérias/isolamento & purificação , Vírus/isolamento & purificação , Radiografia Torácica , Variações Dependentes do Observador , Estudos Prospectivos , Reprodutibilidade dos Testes , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/virologia , ImunocompetênciaRESUMO
Dada la importancia obstétrica y metabólica de la Diabetes Gestacional, hemos querido estudiar las correlaciones de los biomarcadores de primer trimestre con el peso fetal en las 20 semanas y con el de la madre en las 28 semanas para embarazadas con y sin diabetes gestacional, en una investigación desarrollada en atención primaria. Se trata de un estudio de casos y controles. Las variables cuantitativas analizadas han sido: PAPPA (Pregnancy Associated Plasma Protein A) (mU/ml), Betahidroxicoriónica (ngrs/ml), TSH (pUI/ml) y T4 libre (ngrs/dl) a las 12 semanas, peso fetal a las 20 semanas y peso materno en kilogramos a las 28 semanas. Como variable complementaria descriptiva hemos utilizado la edad en años de la gestante. Se han muestreado seis centros de salud del Distrito Sanitario de Atención Primaria de Sevilla (España). Utilizamos la regresión lineal simple por el método de los mínimos cuadrados y la técnica de suavización denominada LOESS (Locally Weighted Scatterplot Smoothing). Destacamos sobre todas las demás, las correlaciones inversas y las líneas de mínimos cuadrados de las variables PAPPA y TSH en las 12 semanas de gestación, y las correlaciones entre peso fetal a las 20 semanas con Betahidroxicoriónica y con PAPP-A. La más importante es la primera por el cambio y la magnitud de la R2 de Pearson (+0,10) en gestantes con diabetes gestacional. Hemos encontrado un cambio ostensible en la correlación de la PAPP-A con la TSH en las gestantes con Diabetes Gestacional. El intervalo de confianza superior del coeficiente de correlación llega a alcanzar +0,3. Una posible explicación fisiopatológica para esta correlación encontrada en nuestro trabajo podría ser la acción de la TSH sobre los factores de crecimiento similares a insulina en células osteoblásticas humanas.
Given the obstetric and metabolic importance of Gestational Diabetes, we wanted to study the correlations of the first trimester biomarkers with the weight of the fetus at 20 weeks and with that of the mother at 28 weeks of gestation for pregnant women with and without gestational diabetes in a research carried out in primary care. This is an observational study of cases and controls. The quantitative variables analyzed were: PAPPA (Pregnancy Associated Plasma Protein A) (mU / ml), Betahydroxychorionic (ngrs / ml), TSH (pUI / ml) and free T4 (ngrs / dl) at 12 weeks, fetal weight at 20 weeks and maternal weight in kilograms at 28 weeks. As a descriptive balancing variable, we have used the age of the pregnant woman in years. Six health centers of the Primary Healthcare District of Seville (Spain) have been sampled. We applied simple linear regression using the least squares method and the smoothing technique called LOESS (Locally Weighted Scatterplot Smoothing). A finding was highlighted above all the others, the inverse correlations and the least squares lines of the PAPP-A and TSH variables at 12 weeks of gestation, and the correlations between fetal weight at 20 weeks with Betahydroxychorionic and with PAPPA. The most important is the first because of the change and the magnitude of Pearson's R2 (+0.10) in pregnant women with gestational diabetes. We have found a noticeable change in the correlation of PAPPA with TSH in pregnant women with Gestational Diabetes. The upper confidence interval of the Pearson correlation coefficient reaches +0.3. A possible pathophysiological explanation for this correlation found in our work could be the action of TSH on insulin-like growth factors in human osteoblastic cells
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RESUMEN Objetivo. Determinar la seroprevalencia y los factores epidemiológicos asociados a Mycobacterium avium subsp Paratuberculosis (MAP) en dos razas de bovinos criollos del centro de investigación AGROSAVIA-Turipaná. Materiales y métodos. Se realizó un estudio epidemiológico de corte transversal. Fueron muestreados 848 bovinos criollos, 403 Romosinuanos y 445 costeño con cuernos (CCC); para el diagnóstico serológico de anticuerpos se utilizó la prueba Elisa Indirecta mediante el kit comercial Parachek® de Prionics. Las variables sexo, edad, raza y tipo de hato fueron los factores epidemiológicos evaluados y correlacionados con la presencia de anticuerpos contra MAP; la asociación estadística fue determinada mediante Odds Ratio y con un modelo multivariado de regresión logística, utilizando un nivel de significancia con p<0.05. Resultados. La seroprevalencia general de los bovinos criollos a MAP fue de 2.35% (IC 95%, 1.34-3.38); sin embargo, en los Romosinuano fue de 0.74% y en los CCC fue de 3.82%, siendo las diferencias estadísticamente significativas (valor p=0.003). También, empleando un análisis univariado, fueron más afectados las hembras y los animales mayores a un año. El análisis multivariado identificó como factores epidemiológicos las variables raza y sexo. Conclusiones. En las razas criollas del centro de investigación AGROSAVIA-Turipaná, la seroprevalencia a MAP fue baja; sin embargo, en la raza CCC el riesgo de contraer la enfermedad es seis veces mayor con relación a la raza Romosinuano. Más aún, se pudo evidenciar que las hembras tienen mayor riesgo de adquirir la enfermedad.
ABSTRACT Objective. Determine the seroprevalence and epidemiological factors associated with Mycobacterium avium subsp. paratuberculosis (MAP) in two Creole cattle breeds of the Turipaná research center -AGROSAVIA. Materials and methods. A cross-sectional epidemiological study was conducted,a total of 848 Creole bovine animals were sampled, 403 Romosinuano and 445 costeño con cuernos (CCC); for the serological diagnosis of antibodies, the Elisa Indirect test was used with the commercial kit Parachek®2 by Prionics. The variables sex, age, breed and herd type were the epidemiological factors evaluated and correlated with the presence of antibodies against MAP; the statistical association was established using the Odds Ratio and a multivariate logistic regression model, employing a significance level with p<0.05. Results. The general seroprevalence of the Creole cattle to MAP was 2.35% (95% CI, 1.34-3.38); however, in the Romosinuano it was 0.74% and in the CCC it was 3.82%, being this difference statistically significant (p=0.003). Furthermore, employing a univariate way analysis, females and animals older than one year of age were more affected. The multivariate analysis identified the breed and sex variables as epidemiological factors. Conclusions. In the Creole breeds of the AGROSAVIA-Turipaná research center, MAP seroprevalence was low; however, in the Costeño Con Cuernos breed, the risk of contracting the disease is six times higher than in the Romosinuano breed. Moreover, it was shown that females have a higher risk of acquiring the disease.
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Animais , Bovinos , Paratuberculose , Bovinos , Testes Sorológicos , Mycobacterium avium subsp. paratuberculosisRESUMO
In this paper, we review the current state of breakthrough cancer pain (BTcP) management. BTcP is a heterogeneous condition and a global problem for cancer patients. It is often managed suboptimally, which results in a negative outcome for patients, healthcare providers, and healthcare systems. Several barriers to the appropriate management of BTcP have been identified. These include, among others, an incomplete definition of BTcP, poor training of healthcare providers and patients alike, a lack of a multidisciplinary approach and the absence of specific protocols and tools. We provide some actions to help physicians and patients improve their approach to BTcP, including specific training, the design of easy-to-use tools for BTcP identification and assessment (such as checklists and pocket-sized cards), individualized treatment, and the use of multidisciplinary teams.
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Analgésicos Opioides/administração & dosagem , Dor Irruptiva/tratamento farmacológico , Dor do Câncer/tratamento farmacológico , Fentanila/administração & dosagem , Manejo da Dor/métodos , Algoritmos , Dor Irruptiva/diagnóstico , Dor Irruptiva/etiologia , Dor do Câncer/diagnóstico , Dor do Câncer/etiologia , Comunicação , Humanos , Oncologistas/educação , Manejo da Dor/psicologia , Medição da Dor/métodos , Relações Médico-Paciente , Guias de Prática Clínica como AssuntoRESUMO
INTRODUCTION: Recent medical investigations suggest that HLA-G, due to its tolerogenic properties, can be used as a biomarker in the diagnosis, treatment, and prognosis of different neoplasms. This observational prospective pilot study aims at detecting sHLA-G in the serum and saliva of patients diagnosed with colorectal cancer (CRC). For this purpose, we compared the expression of sHLA-G from patients with a control sample from a healthy population. MATERIALS AND METHODS: Using the specific enzyme-linked immunosorbent assay (ELISA) method, the expression of sHLA-G in the serum and saliva samples from patients affected by CRC (n = 20) and in a control sample (n = 10) were analyzed. RESULTS: The data showed that in patients with CRC, salivary sHLA-G values were significantly higher than in the control group (18.84 U/ml versus 6.3 U/ml, p = 0.036). In addition, higher levels of sHLA-G were observed in the saliva of patients with CRC in more advanced stages, compared with patients in early stages (24.2 U/ml vs. 8.1 U/ml, p = 0.019). A significant correlation was observed between the concentration of sHLA-G in the serum and saliva of the analyzed samples (Spearman correlation 0.7, p = 0.004). CONCLUSIONS: This study demonstrates, for the first time, the possibility of detecting sHLA-G in the saliva of patients with CRC, resulting in a less invasive alternative to venipuncture. Likewise, we propose that sHLA-G could be an attractive molecular target based on its significant high levels in advanced stages.
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Biomarcadores Tumorais/sangue , Carcinoma/sangue , Neoplasias Colorretais/sangue , Antígenos HLA-G/sangue , Saliva/química , Idoso , Biomarcadores Tumorais/metabolismo , Carcinoma/metabolismo , Estudos de Casos e Controles , Neoplasias Colorretais/metabolismo , Ensaio de Imunoadsorção Enzimática , Feminino , Antígenos HLA-G/metabolismo , Humanos , Masculino , Projetos Piloto , Estudos ProspectivosRESUMO
OBJECTIVE: To assess effectiveness of pharmacologic interventions to relieve pain in patients suffering an acute stone episode. METHODS: Relevant trials that included patients with acute renal colic and radiological findings of urinary stones were identified in four databases. The main outcome was pain relief evaluated by Visual Analogue Scale score (VAS). RESULTS: In overall, diclofenac was superior to other NSAIDs for pain relief (MD of -12.57 [95% CI: -19.26, -5.88]). Paracetamol was superior to morphine for pain reduction at 30minutes (MD of -3.92 [95% CI: -6.41, -1.43]) and also to placebo at 15minutes (MD of -24.77 [95% CI: -33.19, -16.35]) and at 30minutes (MD of -16 [95% CI:-29, -2.96]) after drug administration. Finally, diclofenac was superior to paracetamol for pain reduction at 60 (MD of 6.60 [95% CI: 4.37, 8.83]) and 90minutes (MD of 3.4 [95% CI: 2.01, 4.79]). CONCLUSIONS: Diclofenac was superior to other NSAIDs and paracetamol for diminishing pain in patients suffering an acute stone episode. Paracetamol was superior to morphine and placebo for short pain relief. Future trials should address the role of paracetamol in the management of pain in patients suffering an acute stone episode.
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Manejo da Dor , Cólica Renal/tratamento farmacológico , Doença Aguda , Humanos , Cálculos Renais/complicações , Cólica Renal/etiologia , Doenças Ureterais/complicaçõesRESUMO
OBJECTIVES: To estimate the frequency of metabolic syndrome (MetS) in a daily urology practice and to determine its association with lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). MATERIAL AND METHODS: A retrospective study was conducted. Data from all male patients aged ≥40 years who attended our outpatient urology clinic from 2010 to 2011 was collected. Prevalence of MetS was determined, and LUTS and ED were assessed. A logistic model was used to determine possible associations, controlling for confounders and interaction factors. RESULTS: A total of 616 patients were included. MetS was observed in 43.8% (95% CI 39.6-48.3). The bivariate model showed an association between MetS and LUTS (p<0.01), but not between MetS and ED. The logistic model showed an association between MetS and the International Prostate Symptom Score (IPSS), while controlling for other variables. Patients exhibiting moderate LUTS had a greater risk for MetS than patients with mild LUTS (OR 1.83, 95% CI 1.14-2.94). After analyzing for individual components of MetS, positive associations were found between diabetes and severe LUTS (OR 1.3, 95% CI 1.24-7.1), and between diabetes and ED (OR 2.57, 95% CI 1.12-5.8). CONCLUSION: This study was able to confirm an association between MetS and LUTS, but not for ED. Specific components such as diabetes were associated to both. Geographical differences previously reported in the literature might account for these findings. Given that MetS is frequent among urological patients, it is advisable that urologists actively screen for it.
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Disfunção Erétil/epidemiologia , Sintomas do Trato Urinário Inferior/epidemiologia , Síndrome Metabólica/epidemiologia , Adulto , Idoso , Causalidade , Colômbia/epidemiologia , Comorbidade , Fatores de Confusão Epidemiológicos , Diabetes Mellitus Tipo 2/epidemiologia , Disfunção Erétil/etiologia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , Fumar/epidemiologia , UrologiaRESUMO
AIM: To determine the composition and diversity of the microbiota associated to Crassostrea sikamea treated during 30 days with Streptomyces strains N7 and RL8. METHODS AND RESULTS: DNA was extracted from oysters followed by 16S rRNA gene amplification and pyrosequencing. The highest and lowest species diversity richness was observed in the initial and final control group, whereas Streptomyces-treated oysters exhibited intermediate values. Proteobacteria was the most abundant phylum (81·4-95·1%), followed by Bacteroidetes, Actinobacteria and Firmicutes. The genera Anderseniella, Oceanicola, Roseovarius, Ruegeria, Sulfitobacter, Granulosicoccus and Marinicella encompassed the core microbiota of all experimental groups. The genus Bacteriovorax was detected in all groups except in the final control and the depurated N7, whereas Vibrio remained undetected in all Streptomyces-treated groups. RL8 was the only group that harboured the genus Streptomyces in its microbiota. Principal component analysis showed that Streptomyces strains significantly changed oyster microbiota with respect to the initial and final control. CONCLUSIONS: Crassostrea sikamea treated with Streptomyces showed high species diversity and a microbiota composition shift, characterized by keeping the predator genus Bacteriovorax and decreasing the pathogenic Vibrio. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first culture-independent study showing the effect of Streptomyces over the oyster microbiota. It also sheds light about the potential use of Streptomyces to improve mollusc health and safety for consumers after the depuration process.
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Crassostrea/microbiologia , Microbiota , Streptomyces/fisiologia , Actinobacteria/classificação , Actinobacteria/genética , Actinobacteria/isolamento & purificação , Animais , Bacteroidetes/classificação , Bacteroidetes/genética , Bacteroidetes/isolamento & purificação , Biodiversidade , Gammaproteobacteria/classificação , Gammaproteobacteria/genética , Gammaproteobacteria/isolamento & purificação , Análise de Componente Principal , Proteobactérias/classificação , Proteobactérias/genética , Proteobactérias/isolamento & purificação , RNA Ribossômico 16S/genética , Rhodobacteraceae/classificação , Rhodobacteraceae/genética , Rhodobacteraceae/isolamento & purificação , Streptomyces/genética , Vibrio/classificação , Vibrio/genética , Vibrio/isolamento & purificaçãoRESUMO
The BCG vaccine induces a Th1 phenotype, which is essential for protection against Mycobacterium tuberculosis. However, the effects of BCG vaccination over time on the T helper subpopulation and the microRNAs involved in adulthood have not been studied. In the present study, we explored the involvement of microRNAs, transcription factors and multifunctional cytokines in BCG vaccination by examining their levels both before and after vaccination of healthy adults. Peripheral blood mononuclear cells were obtained at 0, 2 and 6 months after vaccination. Cells were cultured in the presence or absence of ESAT-6 and CFP-10 or M. tuberculosis filtrate. The expression levels of miRNAs and transcription factors were evaluated using qRT-PCR. Cytokine production in supernatants and serum samples was evaluated using ELISA. Multifunctional CD4+ T cells were analyzed using multiparametric flow cytometry. We observed a decrease in the expression levels of T-BET, GATA3 and FOXP3 at 2 months and miR-146a, miR-326 and miR-155 at 6 months after receiving the vaccine. In the supernatant, the production of IL-17 was increased after 6 months, with both stimuli. In contrast, IL-10, TNF-α and IFN-γ increased at 2 months. In the serum, high levels of IL-10 were found after 2 months compared to time 0 and 6 months. The production of multifunctional cells that expressed the cytokine profiles CD4+TNF-α+IFN-γ-IL-10-, CD4+TNF-α+IL-1IFN-γ-, CD4+IL-10+IFN-γ-TNF-α- and CD4+IL-17+IFN-γ- predominantly increased after 2 months with and without the stimulus. Correlation analysis revealed a negative association between FOXP3 and miR-155 (r=-0.5120, p=0.0176) and between IL-17 and miR-326 (r=-0.5832, p=0.0364). This study is the first to demonstrate roles for microRNAs, transcription factors and cytokines in the T helper differentiation lineage and to describe the possible mechanism by which their expression is modulated by the presence of the BCG vaccine in adulthood. In conclusion, our results suggest that the BCG vaccine induces a modulation in transcription factors and miRNAs with high production of multifunctional cells CD4+TNF-α+IL-10+IFN-γ-.
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Vacina BCG/imunologia , Linfócitos T CD4-Positivos/imunologia , Diferenciação Celular/imunologia , Citocinas/biossíntese , MicroRNAs/biossíntese , Fatores de Transcrição/biossíntese , Adolescente , Ensaio de Imunoadsorção Enzimática , Feminino , Citometria de Fluxo , Fatores de Transcrição Forkhead/biossíntese , Humanos , Interferon gama/biossíntese , Interleucina-10/biossíntese , Masculino , Reação em Cadeia da Polimerase , Proteínas com Domínio T/biossíntese , Adulto JovemRESUMO
Acute Respiratory Distress Syndrome (ARDS) is a clinical condition secondary to a variety of insults leading to a severe acute respiratory failure and high mortality in critically ill patients. Patients with ARDS generally require mechanical ventilation, which is another important factor that may increase the ALI (acute lung injury) by a series of pathophysiological mechanisms, whose common element is the initial volutrauma in the alveolar units, and forming part of an entity known clinically as ventilator-induced lung injury (VILI). Injured lungs can be partially protected by optimal settings and ventilation modes, using low tidal volume (VT) values and high positive-end expiratory pressure (PEEP). The benefits in ARDS outcomes caused by these interventions have been conï¬rmed by several prospective randomized controlled trials (RCTs) and are attributed to reduction in volutrauma. The purpose of this article is to present an approach to VILI pathophysiology focused on the effects of volutrauma that lead to lung injury and the 'mechanotransduction' mechanism. A more complete understanding about the molecular effects that physical forces could have, is essential for a better assessment of existing strategies as well as the development of new therapeutic strategies to reduce the damage resulting from VILI, and thereby contribute to reducing mortality in ARDS.
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Humans may be exposed to arsenic (As) and fluoride (F) through water consumption. However, the interaction between these two elements and gene expression in apoptosis or inflammatory processes in children has not been thoroughly investigated. Herein, the expression of cIAP-1, XIAP, TNF-α, ENA-78, survivin, CD25, and CD40 was evaluated by RT-PCR. Additionally, the surface expression of CD25, CD40, and CD40L on peripheral blood mononuclear cells was analyzed by flow cytometry, and TNF-α was measured by Western blotting. This study examined 72 children aged 6-12 years who were chronically exposed to As (154.2µg/L) and F (5.3mg/L) in drinking water and in food cooked with the same water. The urine concentrations of As (6.9-122.4µg/L) were positively correlated with the urine concentrations of F (1.0-8.8mg/L) (r(2)=0.413, p<0.0001). The CD25 gene expression levels and urine concentrations of As and F were negatively correlated, though the CD40 expression levels were negatively correlated only with the As concentration. Age and height influenced the expression of cIAP-1, whereas XIAP expression was correlated only with age. Additionally, there was a lower percentage of CD25- and CD40-positive cells in the group of 6- to 8-year-old children exposed to the highest concentrations of both As and F when compared to the 9- to 12-year-old group (CD25: 0.7±0.8 vs. 1.1±0.9, p<0.0014; CD40: 16.0±7.0 vs. 21.8±5.8, p<0.0003). PHA-stimulated lymphocytes did not show any changes in the induction of CD25, CD69, or CD95. In summary, high concentrations of As and F alter the expression patterns of CD25 and CD40 at both the genetic and protein levels. These changes could decrease immune responses in children exposed to As and F.
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Apoptose/efeitos dos fármacos , Arsênio/toxicidade , Exposição Ambiental , Fluoretos/toxicidade , Expressão Gênica/efeitos dos fármacos , Imunidade Ativa/efeitos dos fármacos , Leucócitos Mononucleares/efeitos dos fármacos , Poluentes Químicos da Água/toxicidade , Apoptose/genética , Proteínas Reguladoras de Apoptose/genética , Proteínas Reguladoras de Apoptose/metabolismo , Arsênio/urina , Criança , Feminino , Fluoretos/urina , Humanos , Inflamação/genética , Inflamação/metabolismo , Leucócitos Mononucleares/metabolismo , Ativação Linfocitária/efeitos dos fármacos , Masculino , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/metabolismo , Poluentes Químicos da Água/urinaRESUMO
The prebiotic effect of agave fructans (Agave salmiana) was evaluated through the growth of two lactic acid bacterial (LAB) strains (Lactobacillus casei and Bifidobacterium lactis). The immune system was activated through the stimulation of peripheral blood mononuclear cells (PBMC) of healthy subjects testing fructans, LAB or a mixture of these compounds at different concentrations. Immune responses, such as early cell activation (CD69), cell cycle progression, nitric oxide (NO) production and the expression of transcription factors for lymphocyte differentiation, were analyzed. Compared with other fructans, the extracted agave fructans showed the highest prebiotic activity and increased levels of CD69 expression, proliferative activity and NO production when administered with the probiotic L. casei. The Th1 lymphocyte differentiation produced through LAB stimulation was greatly diminished after the incorporation of agave fructans. In conclusion, these types of fructans (A. salmiana) are involved in the activation and selective differentiation of cells of the immune system through interactions with probiotics. Thus, agave fructans represent a novel immunomodulator that might benefit the functional food industry.
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Frutanos/administração & dosagem , Sistema Imunitário/efeitos dos fármacos , Imunomodulação/efeitos dos fármacos , Prebióticos , Agave/química , Bifidobacterium/metabolismo , Proliferação de Células/efeitos dos fármacos , Frutanos/química , Frutanos/isolamento & purificação , Humanos , Lacticaseibacillus casei/metabolismo , Leucócitos Mononucleares/efeitos dos fármacos , Ativação Linfocitária/efeitos dos fármacosRESUMO
Registration studies show entecavir (ETV) to be effective and safe in NUC-naïve patients with chronic hepatitis B, but relapse rates after treatment discontinuation have not been well established. Relapse rates and predictors of relapse were evaluated in naïve HBeAg-positive and HBeAg-negative patients treated with ETV. Treatment duration was defined according to international guidelines. Virological relapse was defined as reappearance in serum of hepatitis B virus (HBV) DNA to >2000 IU/mL after discontinuation of treatment. A hundred and sixty-nine consecutive patients were treated for a median 181 weeks. 61% were HBeAg positive, 23% had cirrhosis, and mean HBV DNA level was 6.88 ± 1.74 log10 IU/mL. Ninety-two per cent became HBV DNA negative; 71% of HBeAg+ve patients became HBeAg negative and 68% anti-HBe positive; 14% became HBsAg negative and 13% anti-HBs positive. At the end of the study, 36 patients discontinued treatment: one due to breakthrough associated with resistant variants and 35 (20%) due to sustained virological response; 33 of these patients developed HBeAg seroconversion and 18 HBsAg seroconversion. Median off-treatment time was 69 weeks. Nine patients (26%), all HBeAg positive at baseline, developed virological relapse after a median 48 weeks off-treatment, 3 of them showed HBeAg reversion and 4 lost anti-HBe. No patient with HBsAg seroconversion relapsed. HBeAg clearance after week 48 of treatment was associated with an increase risk of relapse. After ETV discontinuation, HBsAg seroconversion was maintained in 100% of the patients, HBeAg seroconversion maintained in 90%, and virological relapse rate was 24%.
Assuntos
Antivirais/uso terapêutico , Guanina/análogos & derivados , Vírus da Hepatite B/isolamento & purificação , Hepatite B Crônica/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , DNA Viral/sangue , Feminino , Guanina/uso terapêutico , Antígenos de Superfície da Hepatite B/sangue , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Adulto JovemRESUMO
Objetivo: evaluar la tasa libre de cálculo y de obliteración del divertículo, con la técnica percutánea, en el tratamiento quirúrgico de los divertículos caliciales asociados a litiasis. Materiales y Métodos: se revisaron las historias clínicas de pacientes operados por divertículo calicial asociado a litiasis en su interior de 2004 a 2010. Fueron evaluados con Urocultivo, Rx simple de árbol urinario, Urograma Excretor y Tomografía de abdomen y pelvis. Se determinó la presencia del divertículo, su asociación a litiasis y su proyección anterior o posterior. Se realizó nefrolitotricia percutánea (NLPC) más dilatación del cuello del divertículo en todos los casos. Con respecto a la técnica quirúrgica, en decúbito ventral, previa colocación de un catéter ureteral tipo "open end". Se accedió directamente al divertículo, con dilatación hasta 30 Fr. Luego de realizar la litotricia neumática y extraer los fragmentos litiásicos, se dilató el cuello del divertículo hasta 18 Fr, dejando luego un catéter doble jota o un tubo de nefrostomía a través del cuello del mismo hasta la pelvis renal. Los resultados respecto a los restos litiásicos y al divertículo se evaluaron en el postquirúrgico inmediato con Rx árbol urinario y urocultivo, a los 6 meses con Urograma Excretor y luego anualmente con ecografía. Resultados: 11 pacientes fueron tratados con NLPC por divertículos caliciales asociados a litiasis. La edad promedio fue de 41,8 años (14-58). El seguimiento medio fue de 29,7 meses (12-70). Los 11 divertículos tenían proyección posterior y estaban asociados a liltiasis renal. En todos los casos se pudo identificar el cuello diverticular y se realizó la dilatación del mismo. En 8 pacientes se dejó un catéter doble J desde el divertículo hasta la vejiga y en 3 un tubo de nefrostomía (K-11) desde el divertículo hasta la pelvis renal. Ninguno de los pacientes presentó sangrado con requerimiento de transfusión, neumotórax ni hemotórax. La tasa libre de cálculo fue del 10%...
Objective: Assessing the stone-free rate and diverticulum obliteration with percutaneous technique in the managment of the caliceal diverticula associated with stones. Material and methods: We reviewed medical records of patients undergoing surgery for calyceal diverticulum associated with lithiasis from 2004 to 2010. They were evaluated by urine culture, simple urinary Rx, intravenous urography and CT. Percutaneous nephrolithotomy (PCNL) plus dilatation of the diverticular neck was performed in all cases. First an ureteral catheter open end type was placed. In prone position the diverticulum was accessed directly. After pneumatic lithotripsy and extraction of fragments, diverticular neck was dilated to 20 Fr, leaving a double J catheter or a nephrostomy tube. The results were evaluated immediately after surgery with urinary Rx and urien culture, at 6 months with intravenous urography and annual follow-up with ultrasound. Results: 11 patients were treated with PCNL for caliceal diverticula with stones. The mean age was 41,8 years (range 14-58). The mean follow up was 29,7 months (range 12-70). All caliceal diverticulum had a posterior projection. In all cases the diverticular neck was identify and the dilation was performed. None of the patients experienced pneumothorax or hemothorax and blood transfusions were not required. The stone-free rate was 100%, all patients had complete remission of symptoms. No recurrence of the diverticulum was observed during the follow up. Conclusions: the results proves that percutaneous management with dilation of the diverticular neck is secure, effective and mini invasive technique for the treatment of the caliceal diverticula associated with stones
Assuntos
Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Divertículo/cirurgia , Doenças Renais Císticas/congênito , Nefrostomia Percutânea , Nefrolitíase/terapia , UreteroscopiaRESUMO
El objetivo del presente artículo es destacar y validar la psicoeducación como herramienta en el proceso de intervención de enfermería en personas que presenten desviación de salud mental, específicamente esquizofrenia. Se describe el trabajo realizado por un grupo de estudiantes de enfermería, organizado en cuatro sesiones que tuvieron lugar en el Hogar Protegido "Nuevo Hogar", ubicado en la comuna de Independencia, Santiago de Chile, compuesto por 13 mujeres en etapa del ciclo vital de adulto mayor con antecedentes de esquizofrenia. El objetivo general pretendido es potenciar sus habilidades de autocuidado y a partir de ello lograr mayor autonomía y autosatisfacción, todo esto a través de la psicoeducación.
The aim of the present article is stand out and validate the psychoeducation as tool in the nursing process in persons who present mental health deviation, specifically schizophrenia. There is described the work realized by a group of nursing students, organized in 4 meetings who took place in the Protected Home "Nuevo hogar ", located in the commune of Independence, Santiago of Chile, composed by 13 women in stage of the vital cycle of major adult with precedents of schizophrenia. The general claimed aim is to promote his skills of autocare and from it to achieve major autonomy and autosatisfaction, all that across the psychoeducation.
Assuntos
Humanos , Feminino , Idoso , Esquizofrenia/diagnóstico , Esquizofrenia/enfermagem , Esquizofrenia/epidemiologia , Transtornos Mentais/enfermagem , Transtornos Mentais/epidemiologia , Recreação , Autocuidado , Estudantes de Enfermagem , Idoso/psicologia , Saúde BucalRESUMO
Los casos clínicos de coccidioidomicosis en Argentina son pocos y han tenido lugar fundamentalmente en la extensa región árida precordillerana. Este trabajo tiene como objetivos realizar una revisión retrospectiva del total de casos de coccidioidomicosis documentados en Argentina desde el año 1892 hasta 2009 y describir una serie de casos ocurridos en los últimos 4 años. En 117 años se documentaron 128 casos. Desde la primera descripción de la enfermedad en 1892 hasta 1939 se registraron 6 casos; desde 1940 hasta 1999, 59 casos (6-14 casos cada 10 años); y los 63 casos restantes (49% del total histórico) se produjeron en el último decenio. La mediana de edad de los 34 pacientes registrados en el período 2006-2009 fue de 31 años (rango: 7-89), la relación hombre:mujer fue 1,3:1; 12 de estos individuos eran inmunocomprometidos. Veintiséis casos se confirmaron por examen microscópico, por cultivo o por ambos procedimientos; los casos restantes se confirmaron por serología. Todos los aislamientos recuperados fueron identificados como Coccidioides posadasii. Treinta pacientes residían en una amplia área geográfica con epicentro en el valle de Catamarca. Entre 2006 y 2009, la tasa de incidencia en la provincia de Catamarca se incrementó desde valores históricos inferiores a 0,5 casos cada 100 000 habitantes hasta 2,0 casos cada 100 000 habitantes. Este aumento sugiere una emergencia de la coccidioidomicosis en el área.
Clinical cases of coccidioidomycosis are rare in Argentina and are generally found in the large arid precordilleran area of the country. This study aims to perform a retrospective review of all coccidioidomycosis cases documented in the country from 1892 to 2009, and to describe those occurring in the last 4 years. One hundred and twenty eight cases were documented in the 117 year-period. Since the original description of the disease in 1892 until 1939, only 6 cases were registered; between 1940 and 1999, 59 (6-14/10 yrs) and the remaining 63 (49% of total cases) occurred in the last decade. The median age of 34 patients registered in 2006-2009 was 31 years (range: 7-89), male/female ratio was 1.3:1 and 12 patients were immunocompromised. Twenty-six cases were confirmed by direct microscopy and/or culture whereas the remaining ones by serology. All isolates were identified as Coccidioides posadasii. Thirty patients lived in a vast geographic region with epicenter in Catamarca Valley. Between 2006 and 2009, annual disease incidence rates in Catamarca Province increased from historical values below 0.5/100,000 to 2/100,000 inhabitants. Such increase suggests an emergency of coccidioidomycosis in that region.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Coccidioidomicose/epidemiologia , Coccidioidomicose/diagnóstico , Coccidioidomicose/parasitologia , Erros de Diagnóstico , Hospedeiro Imunocomprometido , Incidência , Morbidade/tendências , Estudos Retrospectivos , Estudos Soroepidemiológicos , Tuberculose/diagnósticoRESUMO
Clinical cases of coccidioidomycosis are rare in Argentina and are generally found in the large arid precordilleran area of the country. This study aims to perform a retrospective review of all coccidioidomycosis cases documented in the country from 1892 to 2009, and to describe those occurring in the last 4 years. One hundred and twenty eight cases were documented in the 117 year-period. Since the original description of the disease in 1892 until 1939, only 6 cases were registered; between 1940 and 1999, 59 (6-14/10 yrs) and the remaining 63 (49% of total cases) occurred in the last decade. The median age of 34 patients registered in 2006-2009 was 31 years (range: 7-89), male/female ratio was 1.3:1 and 12 patients were immunocompromised. Twenty-six cases were confirmed by direct microscopy and/or culture whereas the remaining ones by serology. All isolates were identified as Coccidioides posadasii. Thirty patients lived in a vast geographic region with epicenter in Catamarca Valley. Between 2006 and 2009, annual disease incidence rates in Catamarca Province increased from historical values below 0.5/100,000 to 2/100,000 inhabitants. Such increase suggests an emergency of coccidioidomycosis in that region.
Assuntos
Coccidioidomicose/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Coccidioidomicose/diagnóstico , Coccidioidomicose/parasitologia , Erros de Diagnóstico , Feminino , Humanos , Hospedeiro Imunocomprometido , Incidência , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Estudos Retrospectivos , Estudos Soroepidemiológicos , Tuberculose/diagnóstico , Adulto JovemRESUMO
To assess the value of using whole blood samples for the molecular diagnosis of histoplasmosis, we applied an in-house DNA extraction method and a nested PCR targeting a 210 bp specific segment of the Histoplasma capsulatum HcP100 gene. A whole blood volume of 2.5-3 milliliters was centrifuged and the cellular pellet was treated with Trichoderma harzianum lyticase and proteinase K prior to applying a conventional phenol DNA extraction. This procedure allowed complete cell lysis, high DNA yield and specific amplification. The PCR detection limit was 0.25-1 yeast cells/ml of blood sample. The method was assessed on 31 blood samples from 19 patients with microbiological diagnosis of histoplasmosis, 30 healthy persons and 21 patients with other mycoses or mycobacterial diseases. Positive results were obtained in samples from 17/19 patients with histoplasmosis (14/15 immunocompromised and 3/4 without known immunological disorder). Blood samples from the 30 healthy controls and 20 patients with other conditions proved negative; the only false positive result was obtained from a patient with Mycobacterium avium-intracellulare infection. With 89% sensitivity and 98% specificity, this molecular method for detection of the agent in blood shows promising for the rapid diagnosis of human histoplasmosis.
Assuntos
Fungemia/diagnóstico , Histoplasmose/diagnóstico , Reação em Cadeia da Polimerase/métodos , Adulto , Idoso , Argentina/epidemiologia , Criança , Comorbidade , DNA Fúngico/isolamento & purificação , Doenças Endêmicas , Reações Falso-Positivas , Feminino , Fungemia/epidemiologia , Infecções por HIV/epidemiologia , Histoplasma/genética , Histoplasma/isolamento & purificação , Histoplasmose/sangue , Histoplasmose/epidemiologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Infecção por Mycobacterium avium-intracellulare/sangue , Infecção por Mycobacterium avium-intracellulare/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/microbiologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
Se evaluó el uso de sangre entera para el diagnóstico molecular de histoplasmosis utilizando un método artesanal de extracción de ADN fúngico y una PCR anidada que amplifica una porción del gen HcP100 específica de Histoplasma capsulatum. La sangre entera se trató con liticasa, enzima lisante de Trichoderma harzianum y proteinasa K, seguido de una extracción fenólica. Este tratamiento permitió una lisis completa de las células, mostró buen rendimiento en la obtención de ADN y posibilitó la detección de la banda de 210 pb específica de H. capsulatum en la PCR anidada. El límite de detección fue de 0,25-1 levaduras/ml de sangre. El método se evaluó en 31 muestras de sangre de 19 pacientes con diagnóstico microbiológico de histoplasmosis, en 21 muestras de pacientes con otras micosis o infecciones por micobacterias y en 30 controles sanos. La PCR fue positiva en sangre para 17/19 pacientes con histoplasmosis (14/15 inmunocomprometidos y 3/4 sin inmunocompromiso aparente). Las muestras de sangre de los 30 controles sanos y de 20 pacientes con otras patologías fueron negativas, sólo hubo un falso positivo correspondiente a un paciente con infección por Mycobacterium avium-intracellulare. El método presentó 89% de sensibilidad y 96% de especificidad para el diagnóstico de histoplasmosis en sangre entera.
To assess the value of using whole blood samples for the molecular diagnosis of histoplasmosis, we applied an in-house DNA extraction method and a nested PCR targeting a 210 bp specific segment of the Histoplasma capsulatum HcP100 gene. A whole blood volume of 2.5-3 milliliters was centrifuged and the cellular pellet was treated with Trichoderma harzianum lyticase and proteinase K prior to applying a conventional phenol DNA extraction. This procedure allowed complete cell lysis, high DNA yield and specific amplification. The PCR detection limit was 0.25-1 yeast cells/ml of blood sample. The method was assessed on 31 blood samples from 19 patients with microbiological diagnosis of histoplasmosis, 30 healthy persons and 21 patients with other mycoses or mycobacterial diseases. Positive results were obtained in samples from 17/19 patients with histoplasmosis (14/15 immunocompromised and 3/4 without known immunological disorder). Blood samples from the 30 healthy controls and 20 patients with other conditions proved negative; the only false positive result was obtained from a patient with Mycobacterium avium-intracellulare infection. With 89% sensitivity and 98% specificity, this molecular method for detection of the agent in blood shows promising for the rapid diagnosis of human histoplasmosis.