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Recently, fish consumption has been increasing; subsequently, the number of by-products has also increased. However, generated residues are frequently discarded, and an appropriate management is necessary to properly use all fish by-products. Fishery by-products are well known for their content of bioactive compounds, such as unsaturated fatty acids, amino acids, minerals, peptides, enzymes, gelatin, collagen, and chitin. Several studies have reported that fishery by-products could provide significant properties, including antioxidant, antihypertensive, antimicrobial, anti-inflammatory, and antiobesity. Consequently, fish discards are of considerable interest to different industrial sectors, including food, nutraceuticals, medical, and pharmacology. In the food industry, the interest in using fishery by-products is focused on hydrolysates as food additives, collagen and gelatin as protein sources, chitin and chitosan to form edible films to protect food during storage, and oils as a source of Omega-3 and useful as antioxidants. Although different studies reported good results with the use of these by-products, identifying new applications in the food sector, as well as industrial applications, remains necessary.
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The control of ticks through vaccination offers a sustainable alternative to the use of chemicals that cause contamination and the selection of resistant tick strains. However, only a limited number of anti-tick vaccines have reached commercial realization. In this sense, an antigen effective against different tick species is a desirable target for developing such vaccines. A peptide derived from the tick P0 protein (pP0) conjugated to a carrier protein has been demonstrated to be effective against the Rhipicephalus microplus, Rhipicephalus sanguineus, and Amblyomma mixtum tick species. The aim of this work was to assess the efficacy of this peptide when conjugated to the Bm86 protein against Dermacentor nitens and Ixodes ricinus ticks. An RNAi experiment using P0 dsRNA from I. ricinus showed a dramatic reduction in the feeding of injected female ticks on guinea pigs. In the follow-up vaccination experiments, rabbits were immunized with the pP0-Bm86 conjugate and challenged simultaneously with larvae, nymphs, and the adults of I. ricinus ticks. In the same way, horses were immunized with the pP0-Bm86 conjugate and challenged with D. nitens larva. The pP0-Bm86 conjugate showed efficacies of 63% and 55% against I. ricinus and D. nitens ticks, respectively. These results, combined with previous reports of efficacy for this conjugate, show the promising potential for its development as a broad-spectrum anti-tick vaccine.
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Developing countries face great challenges to couple agricultural intensification and sustainable supply chain development. This paper explores the opportunities for innovation in the conservation of the locally adapted Curraleiro Pé-Duro (CPD) cattle. The CPD is a historical Brazilian breed, related to regional culture, which exhibits remarkable adaptability in tropical biomes. The research method consisted of interviewing and analyzing the discourse of CPD breeders in Tocantins, Brazil. The systematization of the data resulted in four categories and eleven subcategories, which were defined a posteriori. Our findings reveal motivational aspects, potentialities, and prospects for valuation, besides the needs and perceived challenges faced by CPD farmers. A better understanding of the current situation may guide public policies, encourage stakeholders, benefit farmers, and lead to sustainable agri-food initiatives. The empirical contributions of our diagnosis are discussed, and we show how they bring forward and provide valuable lessons to prospect innovations in the conservation of CPD cattle. These findings may support scholars and people who are also interested in accessing and supporting the conservation of indigenous livestock. In general, the study supports the definition of strategies, planning, and investments for the value chain, including the participation of upstream and downstream segments of the farms.
Os países em desenvolvimento enfrentam grandes desafios para combinar a intensificação da agricultura com o desenvolvimento sustentável das cadeias de abastecimento. Este documento explora as oportunidades de inovação na conservação do gado Curraleiro Pé-Duro (CPD). O CPD é uma raça brasileira histórica, relacionada à cultura regional, que apresenta notável adaptabilidade em biomas tropicais. O método de pesquisa consistiu em entrevistar e analisar o discurso dos criadores de CPD no Tocantins, Brasil. A sistematização dos dados resultou em quatro categorias e onze subcategorias, que foram definidas a posteriori. Nossas descobertas revelam aspectos motivacionais, potencialidades e perspectivas de valorização, além das necessidades e desafios percebidos pelos produtores de CPD. Uma melhor compreensão da situação atual pode orientar as políticas públicas, incentivar os interessados, beneficiar os agricultores e levar a iniciativas agroalimentares sustentáveis. As contribuições empíricas de nosso diagnóstico são discutidas e mostramos como elas trazem e fornecem lições valiosas para prospectar inovações na conservação do gado de CPD. Estas descobertas podem apoiar acadêmicos e pessoas que também estão interessadas em acessar e apoiar a conservação e produção animal com uso de raças crioulas. Em geral, o estudo apoia a definição de estratégias, planejamento e investimentos relacionados com cadeia de valor, incluindo a participação de segmentos a montante e a jusante das fazendas.
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Animais , Bovinos , Inquéritos e Questionários , Empreendedorismo , Gado , FazendeirosRESUMO
STATEMENT OF PROBLEM: Denture stomatitis affects complete denture wearers and is frequently treated with antifungals drugs, as well as treating the denture with sodium hypochlorite. Whether the limitations of these treatments can be overcome with local hygiene protocols that do not damage the denture materials or adversely affect the patient is unclear. PURPOSE: The purpose of this randomized controlled trial was to evaluate the effect of denture hygiene protocols on complete denture wearers with denture stomatitis. MATERIAL AND METHODS: For this randomized, double-blind controlled clinical trial, 108 participants were assigned to parallel groups: 0.25% sodium hypochlorite (positive control) 0.15% Triclosan, denture cleaning tablets, or denture cleaning tablets plus gingival cleaning tablets. The participants were instructed to brush the dentures and the palate and immerse the denture in the solutions. The outcomes of denture stomatitis remission, biofilm removal, decrease of microbial load (colony-forming units), and odor level of the mouth and denture were measured at baseline and after 10 days. Descriptive analyses were used for sociodemographic characterization of the participants; the Pearson chi-square test was used to compare participant frequency with different degrees of denture stomatitis. The data were not normally distributed (Shapiro-Wilks test) or homogeneous (Levene test). So, the Kruskal-Wallis and Dunn post hoc tests and Wilcoxon test were used to compare the effects of solutions and time on the variables (α=.05). RESULTS: The frequency of the highest to lowest denture stomatitis scores was significantly different for the 0.15% Triclosan and denture cleaning tablets groups. No significant difference was found among the groups in terms of denture stomatitis scores, biofilm, or colony-forming unit count of Candida spp. or C. albicans and S. mutans; a significant reduction was found in these parameters. The 0.25% sodium hypochlorite and 0.15% Triclosan treatments caused a significant reduction in Gram-negative microorganisms; these 2 protocols, and the denture cleaning tablets showed a significant reduction in Staphylococcus spp.; all protocols had similar effects. Only the S. mutans count of the palate decreased after 10 days. The odor level of the mouth and the denture was not significantly different (P=.778). CONCLUSIONS: The evaluated protocols can be recommended for the hygiene of complete dentures, since they were effective for all the variables studied.
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Estomatite sob Prótese , Triclosan , Humanos , Higienizadores de Dentadura/uso terapêutico , Higienizadores de Dentadura/farmacologia , Estomatite sob Prótese/tratamento farmacológico , Hipoclorito de Sódio/uso terapêutico , Hipoclorito de Sódio/farmacologia , Odorantes , Triclosan/uso terapêutico , Triclosan/farmacologia , Biofilmes , Candida albicans , Higiene , Contagem de Colônia Microbiana , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
A peptide from the P0 acidic ribosomal protein (pP0) of ticks conjugated to keyhole limpet hemocyanin from Megathura crenulata has shown to be effective against different tick species when used in host vaccination. Turning this peptide into a commercial anti-tick vaccine will depend on finding the appropriate, technically and economically feasible way to present it to the host immune system. Two conjugates (p64K-Cys1pP0 and p64K-ßAla1pP0) were synthesized using the p64K carrier protein from Neisseria meningitidis produced in Escherichia coli, the same cross-linking reagent, and two analogues of pP0. The SDS-PAGE analysis of p64K-Cys1pP0 showed a heterogeneous conjugate compared to p64K-ßAla1pP0 that was detected as a protein band at 91kDa. The pP0/p64K ratio determined by MALDI-MS for p64K-Cys1pP0 ranged from 1 to 8, being 3-5 the predominant ratio, while in the case of p64K-ßAla1pP0 this ratio was 5-7. Cys1pP0 was partially linked to 35 out of 39 Lys residues and the N-terminal end, while ßAla1pP0 was mostly linked to the six free cysteine residues, to the N-terminal end, and, in a lesser extent, to Lys residues. The assignment of the conjugation sites and side reactions were based on the identification of type 2 peptides. Rabbit immunizations showed the best anti-pP0 titers and the highest efficacy against Rhipicephalus sanguineus ticks when the p64K-Cys1pP0 was used as vaccine antigen. The presence of high molecular mass aggregates observed in the SDS-PAGE analysis of p64K-Cys1pP0 could be responsible for a better immune response against pP0 and consequently for its better efficacy as an anti-tick vaccine. Graphical abstract.
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Proteínas da Membrana Bacteriana Externa/imunologia , Cromatografia Líquida/métodos , Neisseria meningitidis/imunologia , Espectrometria de Massas em Tandem/métodos , Carrapatos/imunologia , Vacinas/imunologia , Animais , Eletroforese em Gel de Poliacrilamida , Hemocianinas/imunologia , Coelhos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodosRESUMO
Monoterpenes are non-polar secondary metabolites widely used by industry due to their excellent therapeutic, food-ingredient and cosmetic properties. However, their low solubility in water limits their use. In this sense, cyclodextrins (CDs) have been widely used to solve these technological challenges. Thus, this study aims to use (-)-borneol as a monoterpene model to prepare inclusion complexes between ß-CD and hydroxypropyl-ß-CD (HP-ß-CD) through different ways and characterize them in order to choose the best inclusion method to improve physicochemical properties of monoterpenes. To achieve this goal, the samples were prepared by physical mixture (PM), paste complex (PA) and freeze-drying complex (FD) and then, extensively characterized by thermal analysis, Fourier-transform infrared spectroscopy, scanning electron microscopy, size particle, X-ray diffraction and nuclear magnetic resonance. The physicochemical results showed that freeze-drying was more effective to form inclusion complexes between (-)-borneol with both CDs. This research highlights the importance of recognizing the best method to prepare inclusion complexes, including food additives as (-)-borneol, to achieve better results in food preparations.
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Canfanos/química , beta-Ciclodextrinas/química , 2-Hidroxipropil-beta-Ciclodextrina/química , Varredura Diferencial de Calorimetria , Ingredientes de Alimentos , Liofilização/métodos , Espectroscopia de Ressonância Magnética , Microscopia Eletrônica de Varredura , Monoterpenos/química , Tamanho da Partícula , Solubilidade , Espectroscopia de Infravermelho com Transformada de Fourier/métodos , Difração de Raios XRESUMO
OBJECTIVE: To assess outcomes in a large cohort of patients with Alagille syndrome (ALGS) who underwent pulmonary artery reconstruction surgery for complex pulmonary artery disease. STUDY DESIGN: Patients with ALGS who underwent pulmonary artery reconstruction surgery at Lucile Packard Children's Hospital Stanford were reviewed. Patients were examined as an overall cohort and based on the primary cardiovascular diagnosis: severe isolated branch pulmonary artery stenosis, tetralogy of Fallot (TOF) without major aortopulmonary collateral arteries (MAPCAs), or TOF with MAPCAs. RESULTS: Fifty-one patients with ALGS underwent pulmonary artery surgery at our center, including 22 with severe branch pulmonary artery stenosis, 9 with TOF without MAPCAs, and 20 with TOF and MAPCAs. Forty-one patients (80%) achieved a complete repair. Five of the patients with TOF with MAPCAs (25%) underwent complete repair at the first surgery, compared with 8 (89%) with TOF without MAPCAs and 19 (86%) with isolated branch pulmonary artery stenosis. At a median follow-up of 1.7 years after the first surgery, 39 patients (76%) were alive, 36 with a complete repair and a median pulmonary artery:aortic systolic pressure of 0.38. Nine patients (18%), including 8 with isolated branch pulmonary artery stenosis, underwent liver transplantation. CONCLUSIONS: Most patients with ALGS and complex pulmonary artery disease can undergo complete repair with low postoperative right ventricular pressure. Patients with TOF/MAPCAs had the worst outcomes, with higher mortality and more frequent pulmonary artery interventions compared with patients with TOF without MAPCAs or isolated branch pulmonary artery stenosis. Complex pulmonary artery disease is not a contraindication to liver transplantation in patients with ALGS.
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Síndrome de Alagille/cirurgia , Artéria Pulmonar/cirurgia , Estenose da Valva Pulmonar/mortalidade , Estenose da Valva Pulmonar/cirurgia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Circulação Colateral , Feminino , Seguimentos , Humanos , Lactente , Transplante de Fígado/estatística & dados numéricos , Masculino , Circulação Pulmonar , Tetralogia de Fallot , Malformações Vasculares/cirurgiaRESUMO
We developed a pectin-based hydrogel containing nanocapsules as a new strategy for melanoma treatment. Our first objective was to evaluate the nanoencapsulation effect of imiquimod on melanoma. Imiquimod-loaded polymeric nanocapsules (NCimiq) showed significant time-dependent decrease in cell viability after treatment at 3 µmol L-1 (79% viable cells in 24 h and 55% in 72 h), which was not observed in cells treated with the solution of the drug (IMIQ) (99% viable cells in 24 h and 91% in 72 h). The second objective was to develop the hydrogel containing the drug-loaded nanocapsules (PEC-NCimiq). In vitro release study showed that 63% of imiquimod was released from the pectin-based hydrogel containing the drug (PEC-imiq) after 2 h, while 60% of the drug was released from PEC-NCimiq after 8 h. In the permeation study, 2.5 µg of imiquimod permeated the skin within 8 h after the initial contact of PEC-NCimiq, whereas only 2.1 µg of drug permeated after 12 h of contact when PEC-imiq was assayed. Pectin-based hydrogels enabled the drug penetration in all skin layers, especially the dermis (PEC-NCimiq = 6.8 µg and PEC-imiq = 4.3 µg). In the adhesion study, PEC-NCimiq showed the highest adhesiveness (42% removed from the skin) in comparison to PEC-imiq (71% removed from the skin). In conclusion, the nanoencapsulation provided a higher cytotoxic effect of imiquimod in SK-MEL-28, and the incorporation of the drug-loaded nanocapsules in pectin-based hydrogel showed higher adhesiveness and deeper penetration of the drug into the skin. Graphical abstract.
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Hidrogéis , Imiquimode/administração & dosagem , Melanoma , Nanocápsulas , Pectinas , Animais , Linhagem Celular Tumoral , Humanos , Melanoma/tratamento farmacológico , SuínosRESUMO
BACKGROUND: Denture-related stomatitis (DS) is chronic multifactorial inflammation, strongly related to the presence of the biofilm that is the complex structure formed by microorganisms held together by a mucus-like matrix of carbohydrate that adheres to different surfaces, including the denture surface. DS has recently been correlated with deleterious cardiovascular alterations. The potential effect of hygiene protocols in the control of DS and randomized clinical trials that address this oral condition with cardiovascular complications are important in clinical decision-making. MATERIAL/DESIGN: A clinical trial, randomized, double-blind, and with parallel groups, will be conducted in Brazil The sample will consist of 100 patients without teeth in both arches, users of at least maxillary complete dentures, and diagnosed with DS, who will be allocated to groups (n = 25 per group) according to the different hygiene protocols: (1) brushing of the palate and immersion of the prosthesis in 0.25% sodium hypochlorite solution (positive control); (2) brushing of the palate and immersion of the prosthesis in 0.15% triclosan solution; (3) brushing of the palate and immersion of the prosthesis in lactose monohydrate; or (4) brushing the palate with citric acid and immersing the prosthesis in lactose monohydrate. The response variables will be heart rate variability and alteration of blood pressure (systemic level), remission of DS, removal of biofilm, reduction of microbial load (colony-forming units (CFU)), mouth and prosthesis odor level, expression of MUC1, proinflammatory cytokines, C-reactive protein (CRP), viscosity, pH and salivary flow (locally); patient-centred qualitative analysis will also be undertaken. Measurements will be performed at baseline and 10 days after the interventions. The results obtained will be statistically analyzed as pertinent, with a level of significance of 0.05. DISCUSSION: This study will provide a guideline for clinical practice regarding the use of hygiene protocols in the treatment of oral diseases (DS) mediated by biofilm. Also, it may provide evidence of correlation of oral manifestation with cardiac risk. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials, RBR-4hhwjb. Registered on 9 November 2018.
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Higiene Bucal , Ensaios Clínicos Controlados Aleatórios como Assunto , Estomatite sob Prótese/terapia , Biofilmes , Método Duplo-Cego , Frequência Cardíaca , Humanos , Estomatite sob Prótese/fisiopatologiaRESUMO
INTRODUCTION: Pain management can be challenging following bariatric surgery, and patients with obesity tend to increase opioid use after undergoing surgery. This report quantifies marijuana (MJ) use and its relationship to pain and other surgery-related outcomes in a population from a state that has legalized MJ. METHODS: Data were collected for consecutive patients undergoing weight reduction surgeries between May 1, 2014 and July 31, 2015. Demographics, preoperative comorbidities, medications, and perioperative opioid use were analyzed. The primary outcome evaluated was inpatient opioid pain medication use quantified using natural log morphine equivalents. Secondary outcomes included percentage of total body weight loss after three months, postoperative complications, and changes in medical comorbidities. RESULTS: A total of 434 patients, among whom 36 (8.3%) reported MJ use, comprised the study population. Perioperative opioid requirements were significantly higher in the MJ-user group (natural log morphine equivalents of 3.92 vs 3.52, p = 0.0015) despite lower subjective pain scores (3.70 vs 4.24, p = 0.07). MJ use did not affect percentage of 90-day total body weight loss, development of postoperative complications, or improvement in medical comorbidities. CONCLUSION: Perioperative opioid use was significantly higher in the MJ-user group despite lower subjective pain scores. The difference in opioid requirements suggests an interaction between MJ use and opioid tolerance or pain threshold. The percentage of total body weight loss, improvement in medical comorbidity, and incidence of postoperative complications at 90-day follow-up were not affected by MJ use in this cohort analysis.
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Cirurgia Bariátrica/estatística & dados numéricos , Cannabis/efeitos adversos , Dor Pós-Operatória , Redução de Peso/efeitos dos fármacos , Adulto , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Incidência , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Complicações Pós-OperatóriasRESUMO
OBJECTIVES: To review current institutional practice and describe factors contributing to variation in inpatient postoperative imaging surveillance after congenital heart surgery. STUDY DESIGN: We reviewed records of all children who underwent congenital heart surgery from June to December 2014. Number and primary indications for postoperative transthoracic echocardiograms (TTEs), providers involved, cardiovascular intensive care unit (CVICU) and total hospital length of stay, and Risk-Adjustment for Congenital Heart Surgery-1 scores were recorded. RESULTS: A total of 253 children (age at surgery: 8 months [2 days-19 years]) received 556 postoperative TTEs (median 1 TTE/patient [1-14]), and 23% had ≥3 TTEs. Fifteen of 556 TTEs (2.7%) revealed a new abnormal finding. The majority of TTEs (59%) were performed in the CVICU (1.5 ± 1.1 TTEs/week/patient), with evaluation of function as the most common indication (44%). Attending physician practice >10 years was not associated with fewer TTEs (P = .12). Patients with ≥3 TTEs had higher Risk-Adjustment for Congenital Heart Surgery-1 scores (P = .001), longer CVICU lengths of stay (22 vs 3 days; P < .0001), longer overall hospitalizations (28 vs 7 days; P < .0001), and a higher incidence of mechanical circulatory support (10% vs 0%; P < .0001) than those with <3 TTEs. Eight patients with ≥3 TTEs did not survive, compared with 3 with <3 TTEs (P = .0004). CONCLUSIONS: There was wide intra-institutional variation in echocardiographic use among similar complexity surgeries. Frequency of postoperative echocardiographic surveillance was associated with degree of surgical complexity and severity of postoperative clinical condition. Few studies revealed new abnormal findings. These results may help establish evidence-based guidelines for inpatient echocardiographic surveillance after congenital heart surgery.
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Ecocardiografia , Cardiopatias Congênitas/cirurgia , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/diagnóstico por imagem , Padrões de Prática Médica , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Age is a critical factor in outcome for patients with well-differentiated thyroid cancer. Currently, age 45 years is used as a cutoff in staging, although there is increasing evidence to suggest this may be too low. The aim of this study was to assess the potential for changing the cut point for the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging system from 45 years to 55 years based on a combined international patient cohort supplied by individual institutions. METHODS: A total of 9484 patients were included from 10 institutions. Tumor (T), nodes (N), and metastasis (M) data and age were provided for each patient. The group was stratified by AJCC/UICC stage using age 45 years and age 55 years as cutoffs. The Kaplan-Meier method was used to calculate outcomes for disease-specific survival (DSS). Concordance probability estimates (CPE) were calculated to compare the degree of concordance for each model. RESULTS: Using age 45 years as a cutoff, 10-year DSS rates for stage I-IV were 99.7%, 97.3%, 96.6%, and 76.3%, respectively. Using age 55 years as a cutoff, 10-year DSS rates for stage I-IV were 99.5%, 94.7%, 94.1%, and 67.6%, respectively. The change resulted in 12% of patients being downstaged, and the downstaged group had a 10-year DSS of 97.6%. The change resulted in an increase in CPE from 0.90 to 0.92. CONCLUSIONS: A change in the cutoff age in the current AJCC/UICC staging system from 45 years to 55 years would lead to a downstaging of 12% of patients, and would improve the statistical validity of the model. Such a change would be clinically relevant for thousands of patients worldwide by preventing overstaging of patients with low-risk disease while providing a more realistic estimate of prognosis for those who remain high risk.
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Diferenciação Celular , Técnicas de Apoio para a Decisão , Estadiamento de Neoplasias/métodos , Neoplasias da Glândula Tireoide/patologia , Fatores Etários , Brasil , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , New South Wales , América do Norte , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/terapia , Resultado do TratamentoRESUMO
La embolia grasa (EG) es una obstrucción de los vasos sanguíneos por glóbulos de grasa. Ha sido descrita en la circulación pulmonar con una gran variedad de asociaciones, pero las más comunes e importantes se dan con fracturas de huesos largos y daño de tejido blando debido a traumatismo grave. Por su parte, el síndrome de embolia grasa (SEG) es una manifestación poco frecuente, aunque grave, del fenómeno de embolia grasa, que se caracteriza clínicamente por la tríada disnea, petequias y confusión mental. La razón de la discrepancia entre la presencia de embolia grasa y el desarrollo del síndrome no es clara. Presentamos el caso de un hombre de 41 años que, inmediatamente después del trauma, presentó en la tomografía computada (TC) inicial defectos de llenado de atenuación grasa dentro de las arterias pulmonares. Estos fueron interpretados como múltiples embolias grasas macroscópicas. Los valores de atenuación de la tomografía computada multidetector (TCMD) de las embolias pulmonares deben examinarse cuidadosamente en el contexto de un traumatismo agudo o después de procedimientos ortopédicos, debido a la complicación rara pero potencialmente fatal del SEG. En los centros de trauma, la TCMD es una herramienta esencial para hacer el diagnóstico de la embolia grasa macroscópica, así como también para descartar otras causas de hipoxia, como la embolia pulmonar trombótica. La reconstrucción de cortes finos debe utilizarse para la evaluación detallada de la vasculatura pulmonar.
Fat embolism (FE) may be defined as the blockage of blood vessels by fat globules. Pulmonary fat embolisms are reported to be associated with a wide variety of conditions, with the most common and important ones being with long bone fractures and soft tissue damage due to severe trauma. Fat embolism syndrome (FES) is a rare but serious manifestation of the fat embolism phenomenon, characterized clinically by a triad of dyspnea, petechiae, and mental confusión. The discrepancy between the presence of a fat embolism and the development of fat embolism syndrome is unclear. The case is presented of a 41 year-old mate who, on the initial trauma CT sean, presented with filling defeets of fat attenuation within the pulmonary arteries. Those were interpreted as múltiple macroscopic fat emboli. The CT attenuation valúes of pulmonary embolism should be carefully examined in the setting of acute trauma or after orthopedic procedures, as the rare but potentially fatal complicaron of FES may result. In trauma centers, multidetectorcomputed tomography is an essential tool to make the diagnosis of macroscopic fat embolism, and to exelude other causes of hypoxia, such as thrombotic pulmonary embolism. These reconstructions should be used for detailed evaluation of the pulmonary vasculature.
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Humanos , Masculino , Adulto , Embolia Pulmonar/diagnóstico por imagem , Embolia Gordurosa/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Radiografia Abdominal , Radiografia Torácica , Tomografia Computadorizada por Raios X , Cérebro/diagnóstico por imagem , Angiografia por Tomografia ComputadorizadaRESUMO
La cistitis enfisematosa es una entidad infrecuente que se presenta como complicación de las infecciones urinarias. Se caracteriza por la presencia de gas intravesical y/o intraparietal, producto de la fermentación bacteriana. Más de la mitad de los casos aparecen en pacientes inmunocomprometidos o con historia de diabetes mellitus mal controlada. Afecta predominantemente al sexo femenino y la magnitud del cuadro clínico es variable. Comunicamos un caso de cistitis enfisematosa en un paciente sin compromiso inmunológico ni diabetes, detallando la presentación clínica, las características imagenológicas y la conducta terapéutica de esta entidad poco común...
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Humanos , Masculino , Adulto , Cistite , Doenças da Bexiga Urinária , Dor Abdominal , Disuria , Hematúria , Imageamento por Ressonância MagnéticaRESUMO
BACKGROUND: The Selenium and Vitamin E Cancer Prevention Trial found no effect of selenium supplementation on prostate cancer (PCa) risk but a 17% increased risk from vitamin E supplementation. This case-cohort study investigates effects of selenium and vitamin E supplementation conditional upon baseline selenium status. METHODS: There were 1739 total and 489 high-grade (Gleason 7-10) PCa cases and 3117 men in the randomly selected cohort. Proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for effects of supplementation within quintiles of baseline toenail selenium. Cox proportional hazards models were used to estimate hazard ratios, and all statistical tests are two-sided. RESULTS: Toenail selenium, in the absence of supplementation, was not associated with PCa risk. Selenium supplementation (combined selenium only and selenium + vitamin E arms) had no effect among men with low selenium status (<60th percentile of toenail selenium) but increased the risk of high-grade PCa among men with higher selenium status by 91% (P = .007). Vitamin E supplementation (alone) had no effect among men with high selenium status (≥40th percentile of toenail selenium) but increased the risks of total, low-grade, and high-grade PCa among men with lower selenium status (63%, P = .02; 46%, P = .09; 111%, P = .008, respectively). CONCLUSIONS: Selenium supplementation did not benefit men with low selenium status but increased the risk of high-grade PCa among men with high selenium status. Vitamin E increased the risk of PCa among men with low selenium status. Men should avoid selenium or vitamin E supplementation at doses that exceed recommended dietary intakes.
Assuntos
Antioxidantes/efeitos adversos , Negro ou Afro-Americano/estatística & dados numéricos , Suplementos Nutricionais/efeitos adversos , Unhas/química , Neoplasias da Próstata/induzido quimicamente , Selênio/efeitos adversos , Vitamina E/efeitos adversos , Idoso , Antioxidantes/administração & dosagem , Antioxidantes/análise , Canadá/epidemiologia , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Razão de Chances , Modelos de Riscos Proporcionais , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/patologia , Porto Rico/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco , Selênio/administração & dosagem , Selênio/análise , Oligoelementos/efeitos adversos , Estados Unidos/epidemiologia , Vitamina E/administração & dosagem , Vitamina E/análise , Vitaminas/efeitos adversosRESUMO
OBJECTIVE: To identify risk factors for developing a first febrile status epilepticus (FSE) among children with a first febrile seizure (FS). STUDY DESIGN: Cases were children with a first FS that was FSE drawn from the Consequences of Prolonged Febrile Seizures in Childhood and Columbia cohorts. Controls were children with a first simple FS and separately, children with a first complex FS that was not FSE. Identical questionnaires were administered to family members of the 3 cohorts. Magnetic resonance imaging protocol and readings were consistent across cohorts, and seizure phenomenology was assessed by the same physicians. Risk factors were analyzed using logistic regression. RESULTS: Compared with children with simple FS, FSE was associated with younger age, lower temperature, longer duration (1-24 hours) of recognized temperature before FS, female sex, structural temporal lobe abnormalities, and first-degree family history of FS. Compared with children with other complex FS, FSE was associated with low temperature and longer duration (1-24 hours) of temperature recognition before FS. Risk factors for complex FS that was not FSE were similar in magnitude to those for FSE but only younger age was significant. CONCLUSIONS: Among children with a first FS, FSE appears to be due to a combination of lower seizure threshold (younger age and lower temperatures) and impaired regulation of seizure duration. Clinicians evaluating FS should be aware of these factors as many episodes of FSE go unnoticed. Further work is needed to develop strategies to prevent FSE.
Assuntos
Convulsões Febris/complicações , Estado Epiléptico/etiologia , Estudos de Casos e Controles , Pré-Escolar , Estudos de Coortes , Saúde da Família , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Razão de Chances , Análise de Regressão , Fatores de Risco , Convulsões Febris/patologia , Estado Epiléptico/patologia , Inquéritos e Questionários , Fatores de TempoRESUMO
BACKGROUND: The Selenium and Vitamin E Cancer Prevention Trial (SELECT) was a randomized, double-blind, placebo-controlled prostate cancer prevention study funded by the National Cancer Institute (NCI) and conducted by the Southwest Oncology Group (SWOG). A total of 35,533 men were assigned randomly to one of the four treatment groups (vitamin E + placebo, selenium + placebo, vitamin E + selenium, and placebo + placebo). The independent Data and Safety Monitoring Committee (DSMC) recommended the discontinuation of study supplements because of the lack of efficacy for risk reduction and because futility analyses demonstrated no possibility of benefit of the supplements to the anticipated degree (25% reduction in prostate cancer incidence) with additional follow-up. Study leadership agreed that the randomized trial should be terminated but believed that the cohort should be maintained and followed as the additional follow-up would contribute important information to the understanding of the biologic consequences of the intervention. Since the participants no longer needed to be seen in person to assess acute toxicities or to be given study supplements, it was determined that the most efficient and cost-effective way to follow them was via a central coordinated effort. PURPOSE: A number of changes were necessary at the local Study Sites and SELECT Statistical Center to transition to following participants via a Central Coordinating Center. We describe the transition process from a randomized clinical trial to the observational Centralized Follow-Up (CFU) study. METHODS: The process of transitioning SELECT, implemented at more than 400 Study Sites across the United States, Canada, and Puerto Rico, entailed many critical decisions and actions including updates to online documents such as the SELECT Workbench and Study Manual, a protocol amendment, reorganization of the Statistical Center, creation of a Transition Committee, development of materials for SELECT Study Sites, development of procedures to close Study Sites, and revision of data collection procedures and the process by which to contact participants. RESULTS: At the time of the publication of the primary SELECT results in December 2008, there were 32,569 men alive and currently active in the trial. As of 31 December 2011, 17,761 participants had been registered to the CFU study. This number is less than had been anticipated due to unforeseen difficulties with local Study Site institutional review boards (IRBs). However, from this cohort, we estimate that an additional 580 prostate cancer cases and 215 Gleason 7 or higher grade cancers will be identified. Over 109,000 individual items have been mailed to participants. Active SELECT ancillary studies have continued. The substantial SELECT biorepository is available to researchers; requests to use the specimens are reviewed for feasibility and scientific merit. As of April 2012, 12 proposals had been approved. LIMITATIONS: The accrual goal of the follow-up study was not met, limiting our power to address the study objectives satisfactorily. The CFU study is also dependent on a number of factors including continued funding, continued interest of investigators in the biorepository, and the continued contribution of the participants. Our experience may be less pertinent to investigators who wish to follow participants in a treatment trial or participants in prevention trials in other medical areas. CONCLUSIONS: Extended follow-up of participants in prevention research is important to study the long-term effects of the interventions, such as those used in SELECT. The approach taken by SELECT investigators was to continue to follow participants centrally via an annual questionnaire and with a web-based option. The participants enrolled in the CFU study represent a large, well-characterized, generally healthy cohort. The CFU has enabled us to collect additional prostate and other cancer endpoints and longer follow-up on the almost 18,000 participants enrolled. The utility of the extensive biorepository that was developed during the course of the SELECT is enhanced by longer follow-up.
Assuntos
Estudos de Coortes , Coleta de Dados , Suplementos Nutricionais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Neoplasias da Próstata/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Comitês de Monitoramento de Dados de Ensaios Clínicos , Determinação de Ponto Final , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , National Cancer Institute (U.S.) , Placebos/administração & dosagem , Neoplasias da Próstata/epidemiologia , Porto Rico/epidemiologia , Projetos de Pesquisa , Selênio/administração & dosagem , Estados Unidos/epidemiologia , Vitamina E/administração & dosagemRESUMO
This prospective multicenter study of 200 patients with fever-associated status epilepticus (FSE), of whom 136 underwent a nontraumatic lumbar puncture, confirms that FSE rarely causes cerebrospinal fluid (CSF) pleocytosis. CSF glucose and protein levels were unremarkable. Temperature, age, seizure focality, and seizure duration did not affect results. CSF pleocytosis should not be attributed to FSE.