RESUMO
BACKGROUND: Gastrointestinal bleeding (GIB) is a common adverse event related to anticoagulation therapy. However, evidence comparing the severity, etiology and outcome of GIB in patients taking direct oral anticoagulants (DOAC) vs. vitamin K antagonists (VKA) is scarce. AIMS: To evaluate the severity, etiology and outcomes of GIB in patients under DOACs compared to VKA. METHODS: Patients under oral anticoagulant therapy admitted to the emergency department with acute GIB were prospectively recruited from July 2016 to January 2018 at a tertiary referral hospital. Demographic and clinical outcome were obtained from medical records. Severity of the GIB event was classified as mild, major or severe according to clinical presentation and the type of support needed. Etiology and location of bleeding, number of packed red blood cells transfused (PRBC) and length of hospital stay were recorded until discharge or in-hospital death. RESULTS: A total of 208 patients with acute GIB under oral anticoagulant treatment were recruited: 119 patients were on VKA and 89 patients on DOAC with similar characteristics. Thirty-one patients had severe GIB; 134 major and 43 mild, with no differences in severity, number of PRBC and length of hospital stay between the groups. Peptic disease was the most frequent etiology of GIB in patients on VKA (20.2 % vs. 13.6%, p=0.20). Diverticular bleeding was the most frequent adverse event in patients on DOAC (14.3% vs. 24.8%, p= 0.056). CONCLUSIONS: Severity and clinical outcomes of GIB are similar between patients on DOAC and patients on VKA, regardless of etiology of GIB.
Assuntos
Anticoagulantes , Hemorragia Gastrointestinal , Doença Aguda , Administração Oral , Anticoagulantes/uso terapêutico , Fibrinolíticos/uso terapêutico , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/terapia , Mortalidade Hospitalar , Humanos , Vitamina KRESUMO
El ácido hialurónico es un glicosaminoglicano presente en todos los tejidos del cuerpo, matrizextracelular y revistiendo vasos sanguíneos. El ácido hialurónico es igual en todo el cuerpo y debido a estoes biocompatible al ser aplicado en los seres humanos, tiene diversos usos que lo hacen actualmente objeto de investigaciones. En personas con cáncer de pulmón reduce la propagación de células tumorales e incrementa la regeneración de tejido sano. Tambiénse utiliza en tratamientos para la artritis, ya que resulta beneficioso al regenerar cartílago de las articulaciones y por ende un alivio en personas con dichos problemas. El ácido hialurónico ha tenido aceptación en su utilización para el tratamiento estético, teniendo resultados considerables y con duración semipermanente. Otro uso destacable es su aplicación para el ojo seco, que por su presentación en gotas brinda al paciente una hidratación, permitiendoasí curar este mal. Por los múltiples usos del ácido hialurónico es importante estudiar más sobre él, proponiendo nuevas alternativas en diferentes áreas de salud. La metodología usada en la presente revisión, fue la búsqueda sistemática de artículos actualizadosen revistas médicas nacionales e internacionales; posteriormente se filtró la información obtenida basándose en el objetivo general de la revisión: Descripción de las aplicaciones clínicas del ácido hialurònico, en diferentes áreas de la medicina..(AU).
Assuntos
Humanos , Bases de Dados Bibliográficas/estatística & dados numéricos , Ácido Hialurônico/farmacocinética , Polissacarídeos , Regeneração/genéticaRESUMO
Mesoamerican spider monkeys (Ateles geoffroyi sensu lato) are widely distributed from Mexico to northern Colombia. This group of primates includes many allopatric forms with morphologically distinct pelage color and patterning, but its taxonomy and phylogenetic history are poorly understood. We explored the genetic relationships among the different forms of Mesoamerican spider monkeys using mtDNA sequence data, and we offer a new hypothesis for the evolutionary history of the group. We collected up to â¼800 bp of DNA sequence data from hypervariable region 1 (HV1) of the control region, or D-loop, of the mitochondrion for multiple putative subspecies of Ateles geoffroyi sensu lato. Both maximum likelihood and Bayesian reconstructions, using Ateles paniscus as an outgroup, showed that (1) A. fusciceps and A. geoffroyi form two different monophyletic groups and (2) currently recognized subspecies of A. geoffroyi are not monophyletic. Within A. geoffroyi, our phylogenetic analysis revealed little concordance between any of the classifications proposed for this taxon and their phylogenetic relationships, therefore a new classification is needed for this group. Several possible clades with recent divergence times (1.7-0.8 Ma) were identified within Ateles geoffroyi sensu lato. Some previously recognized taxa were not separated by our data (e.g., A. g. vellerosus and A. g. yucatanensis), while one distinct clade had never been described as a different evolutionary unit based on pelage or geography (Ateles geoffroyi ssp. indet. from El Salvador). Based on well-supported phylogenetic relationships, our results challenge previous taxonomic arrangements for Mesoamerican spider monkeys. We suggest a revised arrangement based on our data and call for a thorough taxonomic revision of this group.
Assuntos
Atelinae/classificação , Evolução Biológica , Filogenia , Animais , Atelinae/genética , Teorema de Bayes , América Central , Mapeamento Cromossômico , DNA Mitocondrial/genética , Geografia , Funções Verossimilhança , México , Modelos Genéticos , Análise de Sequência de DNARESUMO
Spider monkeys (Ateles) are one of the most endangered groups of primates in the Neotropics. The genus is widely distributed from Mexico to the north of Bolivia and includes many morphologically distinct forms in terms of pelage color and patterning. The taxonomy, phylogenetic relationships, and biogeographic history of the genus have been subject to much debate, making scientific communication difficult and creating challenges for conservation actions. We extracted DNA from samples of all currently recognized species of spider monkeys collected from across the geographic range of the genus, sequenced â¼3.5 kilobases of coding sequence from the mitochondrial genome, and used this large dataset to (a) infer the phylogenetic relationships among the different forms of spider monkeys, (b) evaluate whether currently recognized species of spider monkeys form reciprocally monophyletic groups that are concordant with contemporary classifications, and (c) estimate divergence dates among the different lineages of Ateles. We found that all proposed species of spider monkeys for which we have samples from multiple localities indeed appear to form monophyletic groups. However, in contrast to previous studies, several of our analyses robustly inferred Ateles marginatus from northeast Brazil as the sister taxon to all other spider monkeys. A Bayesian dating analysis suggests that the most recent common ancestor of extant Ateles dates to â¼6.7 Ma, in the late Miocene, and most species-level splits within the genus took place in the late Pliocene, suggesting that the modern diversity in spider monkeys cannot be explained principally by isolation and divergence of populations in forest refugia during the Pleistocene. Based on our new phylogenetic inference and dating analysis, we propose a revised biogeographic scenario for the evolution of this genus.
Assuntos
Atelinae/classificação , Evolução Biológica , Filogenia , Animais , Atelinae/genética , Teorema de Bayes , América Central , DNA Mitocondrial/genética , Loci Gênicos , Funções Verossimilhança , Modelos Genéticos , Análise de Sequência de DNA , América do SulRESUMO
Se evaluo la efectividad de la visita domiciliaria de control prenatal realizado por la promotora de salud rural con los procedimientos de evaluacion establecidos por el Servicio Seccional de Saud de Cundinamarca, en las sedes UPA de la Unidad Regional de Factativa, durante el segundo semestre de 1985. Para efectos del presente estudio se tomaron el 54% de las sedes UPA y el 75% de las promotoras rurales correspondientes, obteniendose los siguientes resultados: la visita domiciliaria es satisfactoria para las embarazadas y el concenso en la adecuacion de la ensenanza impartida se sugiere mayor contacto entre la promotora rural y la enfermera con el proposito de estimular la continuidad de la labor y desarrollar tecnicamente a este persona. En relacion con la utilizacion de equipos se observo la no auscultacion de fetocardio, aun cuando se dispone de estetoscopios de Pinard, en contraste con la frecuente utilizacion de vascula para pesar a las madres y la medicion del perimetro con la cintilla..