RESUMO
BACKGROUND: MS severity may be affected by genetic, patient-related, disease-related and environmental factors. Socioeconomic status, including income and healthcare access, amongst others, may also have a role in affecting diagnostic delay or therapy prescription. In Chile, two main healthcare systems exist, public-healthcare and private-healthcare, nonetheless universal care laws (e.g., access to High Efficacy Therapy-HET), including both systems, have been recently enacted for people with MS. OBJECTIVE: To assess the role of Socioeconomic Conditions (SEC), clinical variables and public health policies on the impact of disease severity of MS patients in Chile. METHODS: Multicentric, observational, cross-sectional study including patients from two reference centres (1 national reference centre from the private-health system and 1 regional reference centre from the public-health system). SEC and clinical variables included healthcare insurance (private or public), subclassification of health insurance according to monthly income, sex, age at onset, diagnostic delay, disease duration, diagnosis before HET law (as a proxy of HET delay), and current HET treatment. Progression Index (PI), EDSS ≥6.0 and Progressive MS diagnosis were used as outcome measures. Multivariable binary logistic regression was performed. RESULTS: We included 604 patients (460 private-health, 144 public-health), 67% women, 100% white/mestizo, 88% RRMS, mean age 42±12 years, mean age at onset 32±11 years, mean disease duration 10±6 years, median diagnostic delay 0 (0-34) years, 86% currently receiving any DMT, 55% currently receiving HET, median EDSS at last visit of 2.0 (0-10), and median PI 0.17 (0-4.5). Lower monthly income was associated with higher EDSS and higher PI. In the multivariable analysis, public-healthcare (OR 10.2), being diagnosed before HET-law (OR 4.89), longer diagnostic delay (OR 1.26), and older age at onset (OR 1.05) were associated with a higher risk of PI>0.2, while current HET (OR 0.39) was a protective factor. Diagnosis before HET-law (OR 7.59), public-healthcare (OR 6.49), male sex (OR 2.56), longer disease duration (OR 1.2) and older age at onset (OR 1.1) were associated with a higher risk of Progressive MS. Public-healthcare (OR 5.54), longer disease duration (OR 1.14) and older age at onset (OR 1.08) were associated with a higher risk of EDSS ≥6.0 while current treatment with HET had a trend as being a protective factor (OR 0.44, p = 0.05). CONCLUSION: MS severity is impacted by non-modifiable factors such as sex and age at onset. Interventions focused on shortening diagnostic delay and encouraging early access to high-efficacy therapies, as well as initiatives that may reduce the disparities inherent to lower socioeconomic status, may improve outcomes in people with MS.
RESUMO
OBJETIVO: proponer una clasificación preoperatoria a los pacientes con tumor de cuerpo Carotídeo y relacionarlos con complicaciones postoperatorias. MATERIAL Y MÉTODOS: todos los pacientes operados con diagnóstico de tumor del cuerpo Carotídeo entre el 2005 al 2014 en el Hospital Obrero N° 1 de la Caja Nacional de Salud en La Paz - Bolivia RESULTADOS: se analizaron y operaron 115 pacientes con un promedio de edad de 52 años (DE±11,725 y una moda de 57 años) de los cuales el 109 (94,80%) correspondieron al género femenino con una razón de 18:1. Todos los pacientes eran originarios y residentes de ciudades ubicadas a más de 2500 m.s.n.m. El promedio de evolución fue de 3 años (DE±2,189), y solo 7 pacientes (6,1%) presentan hábito tabáquico. 83 pacientes (72,2%) de los TCC se localizan en el lado izquierdo En las manifestaciones clínicas, todos los pacientes presentan el tumor localizado en el ángulo mandibular, por delante del musculo esternocleidomastoideo, describiéndose un crecimiento paulatino y permanente en 72 sujetos (62,6%), cefalea en 45 (39,1%), presencia de latido en 30 sujetos (26,1%), disfagia en 9 (7,9%), mareos en 16 (13,9%) y disfonía en 6 (5,2%). Entre los signos más evidentes de TCC, se describe el signo de Fontaine en 114 sujetos (99,2%), adenomegalia en 20 (17,4%) y otros menos frecuentes como soplo, abombamiento parafaringeo y compromiso de pares craneales. Todos los pacientes fueron clasificados en ambos sistemas (Shamblin y la nuestra llamada de los Andes). Se describen 39 pacientes (33,2%) con complicaciones postoperatorias, Grado I: 1 paciente sin complicaciones; Grado II: de 58 sujetos, 4 (3,5%) presentaban parálisis temporal del Hipogloso; en el Grado III: de los 41 sujetos, 24 (20,8%) presentaron ligadura de la arteria carótida externa, parálisis del hipogloso y glosofaringeo, lesión de recurrente y del laríngeo superior. En el grupo IV, de los 15 sujetos operados, 11 presentaron complicaciones (9,6% del total y 73% del grupo) entre las cuales están ligadura de la arteria carótida externa, lesión del hipogloso y un paciente con AVC y hemiparesia. Se describe una reoperación (0,86%) y ninguna mortalidad. CONCLUSIÓN: proponer una clasificación preoperatoria que tenga la posibilidad de asociarse a complicaciones y pronóstico.
OBJECTIVE: to propose a preoperative classification of patients with Carotid Body Tumor and relate them to postoperative complications. MATERIAL AND METHODS: all patients operated with a diagnosis of Carotid Body Tumor between 2005 and 2014 at the Obrero Hospital No. 1 of the National Health Fund in La Paz - Bolivia RESULTS: 115 patients with an average age of 52 years (SD±11.725 and a mode of 57 years) were analyzed and operated on, of which 109 (94.80%) corresponded to the female gender with a ratio of 18: 1. All the patients were from and residents of cities located more than 2,500 meters above sea level. The mean evolution was 3 years (SD±2.189), and only 7 patients (6.1%) had a smoking habit. 83 patients (72.2%) of CBTs are located on the left side In the clinical manifestations, all patients present the tumor located in the mandibular angle, in front of the sternocleidomastoid muscle, describing a gradual and permanent growth in 72 subjects (62.6%), headache in 45 (39.1%), presence of heartbeat in 30 subjects (26.1%), dysphagia in 9 (7.9%), dizziness in 16 (13.9%) and dysphonia in 6 (5.2%). Among the most obvious signs of CBT, the Fontaine sign is described in 114 subjects (99.2%), adenomegaly in 20 (17.4%) and other less frequent signs such as murmur, parapharyngeal bulging and cranial nerve involvement. All patients were classified in both systems (Shamblin and ours called from the Andes). 39 patients (33.2%) with postoperative complications were described, grade I: 1 patient without complications; Grade II: of 58 subjects, 4 (3.5%) had temporary hypoglossal paralysis; in Grade III: of the 41 subjects, 24 (20.8%) presented external carotid artery ligation, hypoglossal and glossopharyngeal paralysis, recurrent lesion and superior larynx. In group IV, of the 15 operated subjects, 11 presented complications (9.6% of the total and 73% of the group), among which are external carotid artery ligation, hypoglossal injury and one patient with stroke and hemiparesis. A reoperation (0.86%) and no mortality are described. CONCLUSION: propose a preoperative classification that has the possibility of being associated with complications and prognosis.
Assuntos
Humanos , Corpo Carotídeo , Tumor do Corpo Carotídeo , Cefaleia , Sinais e Sintomas , NeoplasiasRESUMO
The in vitro screening of small molecules for enzymatic inhibition provides an efficient means of finding new compounds for developing drug candidates. This strategy has the advantage of being rapid and inexpensive to perform. Enzymes are suitable targets for screening when simple methods to obtain them and measure their activities are available and there is evidence of their essential role in the parasite's life cycle. Here, we describe the screening of small molecules as inhibitors of two Fasciola hepatica enzyme targets (cathepsin L and triose phosphate isomerase), an initial step to find new potential compounds for drug development strategies.
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Anti-Helmínticos/farmacologia , Fasciola hepatica/efeitos dos fármacos , Proteínas de Helminto/antagonistas & inibidores , Bibliotecas de Moléculas Pequenas/farmacologia , Animais , Sistemas de Liberação de Medicamentos/métodos , Estágios do Ciclo de Vida/efeitos dos fármacosAssuntos
Carcinoma de Células em Anel de Sinete/terapia , Neoplasias do Colo/terapia , Adulto , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Carcinoma de Células em Anel de Sinete/diagnóstico por imagem , Carcinoma de Células em Anel de Sinete/patologia , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/patologia , Feminino , Humanos , Masculino , Cuidados Paliativos , Prognóstico , Recusa do Paciente ao TratamentoRESUMO
Resumen: Antecedentes: La osteoartritis de rodilla es una enfermedad articular caracterizada por degeneración, pérdida del cartílago y alteración del hueso subcondral asociadas a cambios en los tejidos blandos. En una muestra de 2,500 individuos se encontró una prevalencia de artrosis de 2.3% (IC 95% 1.7 a 2.9) en adultos. En nuestro hospital representa la segunda causa de consulta. Material y métodos: Se tomaron dos grupos de pacientes: el primero, de 70 pacientes a los que se les aplicó hilano G-F 20 en tres infiltraciones; al otro grupo, de 40 pacientes, se le aplicó colágeno-PVP en cuatro aplicaciones. Se les realizó un interrogatorio basado en el cuestionario de WOMAC, con el cual pudimos valorar dolor, rigidez y capacidad funcional antes y después de la aplicación de los medicamentos. Resultados: Nuestro estudio presentó que en ambos grupos hubo mejora de la calidad de vida al disminuir los síntomas tales como dolor, rigidez y limitación funcional; el colágeno fue más eficiente para la disminución del dolor y el hialino G-F 20, para la disminución de la rigidez y la limitación funcional. Conclusiones: Ambos tratamientos mostraron seguridad y eficacia. Su uso en nuestro instituto para los pacientes fuera de tratamiento quirúrgico puede disminuir de manera importante los internamientos por dolor, con lo que podemos hacer un uso más eficiente de los recursos con que contamos.
Abstract: Background: Knee osteoarthritis is a joint disease characterized by degeneration, loss of cartilage and subchondral bone alteration associated with changes in the soft tissues. In a sample of 2,500 individuals, the prevalence of osteoarthritis was found in 2.3% (IC 95% 1.7 a 2.9) in adults; it represents the second cause of consultation in our hospital. Material and methods: Two groups of patients were studied: the first included 70 patients who received hylan G-F 20 in three infiltrations; the other group, of 40 patients, received collagen-PVP in four applications. A subjective questionnaire based on the WOMAC evaluation was applied, with which we could assess pain, stiffness and functional capacity before and after the application. Results: Both hylan G-F 20 and collagen-PVP improved the quality of life of our patients by reducing symptoms such as pain, stiffness and functional limitation, collagen being more efficient for reducing pain and hylan G-F 20 for reducing stiffness and functional limitation. Conclusions: Both treatments were safe and effective; they can be used in our institute as a conservative treatment to decrease hospitalizations for pain management.
Assuntos
Humanos , Adulto , Colágeno/uso terapêutico , Povidona/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Ácido Hialurônico/análogos & derivados , Qualidade de Vida , Resultado do Tratamento , Ácido Hialurônico/uso terapêutico , Injeções Intra-ArticularesRESUMO
BACKGROUND: Knee osteoarthritis is a joint disease characterized by degeneration, loss of cartilage and subchondral bone alteration associated with changes in the soft tissues. In a sample of 2,500 individuals, the prevalence of osteoarthritis was found in 2.3% (IC 95% 1.7 a 2.9) in adults; it represents the second cause of consultation in our hospital. MATERIAL AND METHODS: Two groups of patients were studied: the first included 70 patients who received hylan G-F 20 in three infiltrations; the other group, of 40 patients, received collagen-PVP in four applications. A subjective questionnaire based on the WOMAC evaluation was applied, with which we could assess pain, stiffness and functional capacity before and after the application. RESULTS: Both hylan G-F 20 and collagen-PVP improved the quality of life of our patients by reducing symptoms such as pain, stiffness and functional limitation, collagen being more efficient for reducing pain and hylan G-F 20 for reducing stiffness and functional limitation. CONCLUSIONS: Both treatments were safe and effective; they can be used in our institute as a conservative treatment to decrease hospitalizations for pain management.
ANTECEDENTES: La osteoartritis de rodilla es una enfermedad articular caracterizada por degeneración, pérdida del cartílago y alteración del hueso subcondral asociadas a cambios en los tejidos blandos. En una muestra de 2,500 individuos se encontró una prevalencia de artrosis de 2.3% (IC 95% 1.7 a 2.9) en adultos. En nuestro hospital representa la segunda causa de consulta. MATERIAL Y MÉTODOS: Se tomaron dos grupos de pacientes: el primero, de 70 pacientes a los que se les aplicó hilano G-F 20 en tres infiltraciones; al otro grupo, de 40 pacientes, se le aplicó colágeno-PVP en cuatro aplicaciones. Se les realizó un interrogatorio basado en el cuestionario de WOMAC, con el cual pudimos valorar dolor, rigidez y capacidad funcional antes y después de la aplicación de los medicamentos. RESULTADOS: Nuestro estudio presentó que en ambos grupos hubo mejora de la calidad de vida al disminuir los síntomas tales como dolor, rigidez y limitación funcional; el colágeno fue más eficiente para la disminución del dolor y el hialino G-F 20, para la disminución de la rigidez y la limitación funcional. CONCLUSIONES: Ambos tratamientos mostraron seguridad y eficacia. Su uso en nuestro instituto para los pacientes fuera de tratamiento quirúrgico puede disminuir de manera importante los internamientos por dolor, con lo que podemos hacer un uso más eficiente de los recursos con que contamos.
Assuntos
Colágeno , Ácido Hialurônico/análogos & derivados , Osteoartrite do Joelho , Povidona , Adulto , Colágeno/uso terapêutico , Humanos , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares , Osteoartrite do Joelho/tratamento farmacológico , Povidona/uso terapêutico , Qualidade de Vida , Resultado do TratamentoRESUMO
BACKGROUND AND OBJECTIVE: The increasing rate of resistance of microorganisms to penicillin and other antibiotics has generated concern among health authorities in Latin America. The present investigation determined the in vitro susceptibility of Porphyromonas gingivalis, Fusobacterium nucleatum, black-pigmented Prevotella spp. and Aggregatibacter actinomycetemcomitans to metronidazole, amoxicillin, amoxicillin/clavulanic acid, clindamycin and moxifloxacin in patients with chronic periodontitis. MATERIAL AND METHODS: Subgingival plaque samples from patients with periodontitis were collected and cultured on selective and nonselective culture media. The antimicrobial susceptibility of periodontopathogenic isolates was studied in chronic periodontitis patients in Colombia. Metronidazole, amoxicillin, amoxicillin/clavulanic acid, clindamycin and moxifloxacin were tested on all bacterial isolates and the percentage of resistant strains was calculated. RESULTS: Of the 150 bacteria identified, 51 were P. gingivalis, 45 were black-pigmented Prevotella spp., 36 were F. nucleatum and 18 were A. actinomycetemcomitans. All the isolates were sensitive to amoxicillin/clavulanic acid and to moxifloxacin, but exhibited variable susceptibility patterns to the other antimicrobial agents tested. CONCLUSION: The results of the present study suggest that periodontal microorganisms in patients with chronic periodontitis can be resistant to the antimicrobial agents commonly used in anti-infective periodontal therapy. We suggest that the indiscriminate use of antimicrobials could result in the appearance of more highly antibiotic-resistant strains of bacteria associated with periodontal diseases in our population compared with the populations of other countries.
Assuntos
Aggregatibacter actinomycetemcomitans/efeitos dos fármacos , Periodontite Crônica/microbiologia , Farmacorresistência Bacteriana , Fusobacterium nucleatum/efeitos dos fármacos , Porphyromonas gingivalis/efeitos dos fármacos , Prevotella/efeitos dos fármacos , Adulto , Idoso , Aggregatibacter actinomycetemcomitans/isolamento & purificação , Amoxicilina/uso terapêutico , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Resistência a Ampicilina , Anti-Infecciosos/uso terapêutico , Compostos Aza/uso terapêutico , Técnicas Bacteriológicas , Periodontite Crônica/tratamento farmacológico , Clindamicina/uso terapêutico , Colômbia , Placa Dentária/microbiologia , Feminino , Fluoroquinolonas , Fusobacterium nucleatum/isolamento & purificação , Hemorragia Gengival/classificação , Hemorragia Gengival/microbiologia , Humanos , Masculino , Metronidazol/uso terapêutico , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Moxifloxacina , Perda da Inserção Periodontal/classificação , Perda da Inserção Periodontal/microbiologia , Bolsa Periodontal/classificação , Bolsa Periodontal/microbiologia , Porphyromonas gingivalis/isolamento & purificação , Prevotella/isolamento & purificação , Quinolinas/uso terapêutico , Resistência beta-LactâmicaRESUMO
Thaumasioscolex didelphidis n. gen., n. sp. is described from the intestine of the black-eared opossum Didelphis marsupialis L. (Marsupialia: Didelphidae) from Los Tuxtlas, Veracruz, Mexico. The new genus differs from all proteocephalidean genera in the morphology of the scolex that is formed by 4 well separated lobes each containing 1 noncircular sucker opening laterally inside the exterolateral cavity, a large-sized body (length up to 1 m), a large number of testes, the shape of gravid proglottids that are inversely craspedote (the anterior border of a proglottid overlaps the posterior border of a preceding proglottid), eggs in groups mostly of 4-6 eggs each, and an embryophore bearing digitiform projections on its external surface. This is the first tapeworm of the Proteocephalidea, the members of which were previously reported exclusively from poikilotherm vertebrates (freshwater fishes, amphibians, and reptiles), found in a homoiotherm vertebrate.
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Cestoides/classificação , Infecções por Cestoides/veterinária , Gambás/parasitologia , Animais , Cestoides/anatomia & histologia , Infecções por Cestoides/parasitologia , MéxicoRESUMO
We describe the cardiovascular abnormalities found at autopsy in patients with AIDS and a description of the opportunistic infections in these cases studied between January 1988 and August 1993. There were 51 cases with such diagnosis. Pericardial effusion appeared in 9, pleural effusion in 7, myocarditis in 5, 7 with pericarditis, endocarditis in 6, left ventricular hypertrophy in 20, right ventricular hypertrophy in 21 and evidence of atherosclerosis in 15. Thus, data of cardiovascular damage was present in 42.7% of our patients. The cardiovascular abnormalities in this group are common, in contrast to the paucity of clinical findings. Diagnosis of cardiac pathology was made in only 12% of them. So in every case with diagnosis of AIDS, a careful clinical examination and cardiac diagnostic oriented tests must be done for detection of these abnormalities.
Assuntos
Síndrome da Imunodeficiência Adquirida/patologia , Doenças Cardiovasculares/patologia , HIV-1 , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/mortalidade , Adulto , Distribuição por Idade , Idoso , Autopsia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Causas de Morte , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Distribuição por SexoRESUMO
Se analizaron los objetivos del plan de estudios de la educación general básica de Chile, desde la perspectiva de promoción de salud. El universo son 1.782 objetivos de asignaturas del decreto supremo N-4.002 modificado. Variables independientes: asignatura, curso, nivel de específicidad y dominio. Variables dependientes: relación con promoción de salud calificada independientemente por tres expertos en cuatro categorías: promotores, facilitadores, inciertos y neutros. Se encontró que 14,3% de los objetivos son promotores, 20,4 facilitadores, 0,6% inciertos y 64,7% neutros en la promoción de salud. Existe asociación estadísticamente significativa entre nivel, dominio, asignatura, curso y la relación con promoción de salud. Educación física tiene el mayor porcentaje de objetivos promotores de salud (82,5% de sus 234 objetivos). Dado que se están preparando modificaciones al plan de estudios se presenta una excelente oportunidad de avanzar hacia un currículum moderno de salud escolar en educación básica
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Planos e Programas de Saúde , Promoção da Saúde/métodos , Serviços de Saúde Escolar , Educação em Saúde/métodosRESUMO
Data for PM10 and TSP collected from SEDUE's (Secretary of Urban Development and Ecology) five principal air monitoring stations from March of 1988 to March of 1989 were analyzed with an emphasis on spatial and temporal distributions. The Mexico City sites consisted of a mixed residential and industrial setting in the NW, a highly industrialized area in the NE, the commercial and administrative district downtown, and areas in the SW and SE dominated by residential neighborhoods. High volume samplers for TSP and PM10 running in parallel were used following a protocol similar to the one specified by the U.S. Environmental Protection Agency. The individual data collected ranged from 24 to 1494 micrograms/m-3 for TSP and from 17 to 607 micrograms/m-3 for PM10. The PM10-to-TSP ratios ranged from 0.104 to 0.914 for a one year period, 0.495 being the overall mean ratio. Seasonal and geographical differences in this ratio may reflect the range of sources, transport and transformations of primary and secondary particles. High concentrations of particles were found during the winter and early spring, followed by relatively low concentrations during the summer. Statistically significant differences were found for the two most contrasting sites, the NE and SW areas of the city. The northern and eastern parts were the most impacted by particulate matter, while the area at the southwestern edge of the city was least polluted by fine and total suspended particles. Two interesting observations have emerged from this analysis. First, there is the exceedingly high daily and annual values for both TSP and PM10, relative to the Mexican and U.S. standards and WHO criteria for particulate matter. Second, although the SW area of Mexico City had the lowest fine suspended particle concentrations, it is in this area that the highest concentrations of ozone have been observed.
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Poluentes Atmosféricos/análise , Monitoramento Ambiental/métodos , Saúde da População Urbana , Protocolos Clínicos , Humanos , Indústrias , Concentração Máxima Permitida , México , Tamanho da Partícula , Características de Residência , Estudos de Amostragem , Estações do Ano , Fatores de TempoRESUMO
Up until now, the composition of goat's milk has not been well known. However, every day it is more and more evident that this milk is quite different from cow's and other mammal's milk. This difference depends on a major concentration in some of milk elements. Caseins, in goat's milk are found in a minor concentration (their inner components have, besides, different relative proportions). On the other hand, non-proteinic nitrogen, calcium and phosphorus exist in a major concentration and biggest micellar size in goat's milk than in other milks. All these goat's milk qualities result in a different physicochemical composition which explains some of its characteristics and its very particular technological behaviour. They prevent, also, our associating goat's milk to cow's milk, as it has been done until recently.
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Queijo , Cabras , Leite/química , Animais , Fenômenos Químicos , Físico-Química , Concentração de Íons de Hidrogênio , Lipídeos/análise , Micelas , Proteínas do Leite/análise , Minerais/análise , Desnaturação Proteica , Vitaminas/análiseRESUMO
After some remarks about the particular position of the elderly in the Inca period, some demographic data concerning the present-day situation of the elderly are presented. Their extremely deficient living conditions and the insufficient institutions taking care of the aged are described. In the second part, findings of an experimental study based on the Rorschachtest are given.