RESUMO
PURPOSE: Current evidence suggests the need to improve the management of breakthrough cancer pain (BTcP). For this reason, we aimed to assess the opinion of a panel of experts composed exclusively of physicians from pain units, who play a major role in BTcP diagnosis and treatment, regarding the key aspects of BTcP management. METHODS: An ad hoc questionnaire was developed to collect real-world data on the management of BTcP. The questionnaire had 5 parts: (a) organizational aspects of pain units (n = 12), (b) definition and diagnosis (n = 3), (c) screening (n = 3), (d) treatment (n = 8), and (e) follow-up (n = 7). RESULTS: A total of 89 pain-unit physicians from 13 different Spanish regions were polled. Most of them agreed on the traditional definition of BTcP (78.9%) and the key features of BTcP (92.1%). However, only 30.3% of participants used the Davies' algorithm for BTcP diagnosis. Respondents preferred to prescribe rapid-onset opioids [mean 77.0% (SD 26.7%)], and most recommended transmucosal fentanyl formulations as the first option for BTcP. There was also considerable agreement (77.5%) on the need for early follow-up (48-72 h) after treatment initiation. Finally, 65.2% of participants believed that more than 10% of their patients underused rapid-onset opioids. CONCLUSIONS: There was broad agreement among pain experts on many important areas of BTcP management, except for the diagnostic method. Pain-unit physicians suggest that rapid-onset opioids may be underused by BTcP patients in Spain, an important issue that need to be evaluated in future studies.
Assuntos
Analgésicos Opioides/uso terapêutico , Dor Irruptiva/tratamento farmacológico , Dor do Câncer/tratamento farmacológico , Neoplasias/complicações , Manejo da Dor/métodos , Padrões de Prática Médica/normas , Dor Irruptiva/diagnóstico , Dor Irruptiva/etiologia , Dor do Câncer/diagnóstico , Dor do Câncer/etiologia , Estudos Transversais , Humanos , Prognóstico , Inquéritos e QuestionáriosRESUMO
The objective of this study was to quantify the radiation dose reduction without impairing image quality, using 100 and 120 kiloVolts acquisition protocols. We analyzed 37 non-obese patients in a private hospital in Santiago, Chile, of which 20 were obtained with a protocol of 120 kiloVolts and the remaining 17 with low energy protocol. The quality of the image was evaluated quantitatively and qualitatively. The average image quality score for the 120 and 100 kiloVolts groups was 3.25 ± 0.8 and 3.41 ± 0.7 respectively, demonstrating an improvement in the image quality, although at a non-significant value (p= 0.58). In the images obtained with the 100 kiloVolts protocol, a reduction of 41.99% in the radiation dose was demonstrated in addition to a significant increase of the intensity of the signal and the noise. It was possible to demonstrate a decrease of the radiation dose without detriment in the diagnostic image quality in coronary angiography using computed tomography.
El objetivo de este estudio fue cuantificar la disminución de la dosis de radiación sin perjudicar la calidad de imagen, utilizando protocolos de adquisición de 100 y 120 kilovolts. Se analizaron 37 pacientes no obesos en un hospital privado de Santiago de Chile, de los cuales 20 fueron obtenidos con un protocolo de 120 kilovolts y los 17 restantes con protocolo de baja energía. Se evaluó la calidad de imagen cuantitativa y cualitativamente. El promedio de puntuación de la calidad de imagen para los grupos de 120 y 100 kilovolts fue de 3,25 ± 0,8 y 3,41 ± 0,7 respectivamente, demostrando una mejora en la calidad de imagen, aunque en un valor no significativo (p= 0,58). En las imágenes obtenidas con el protocolo de 100 kilovolts, se demostró una reducción en la dosis de radiación de un 41,99% además de un aumento significativo de la intensidad de la señal y del ruido. Se logró demostrar una disminución de la dosis de radiación sin perjuicio en la calidad de imagen diagnóstica en angiografía coronaria por tomografía computarizada.
Assuntos
Humanos , Masculino , Feminino , Tomografia Computadorizada por Raios X , Angiografia por Tomografia Computadorizada , Tomografia Computadorizada por Raios X , Angiografia por Tomografia Computadorizada/métodos , Angiografia por Tomografia ComputadorizadaRESUMO
INTRODUCCIÓN Es importante abordar la mortalidad infantil con la perspectiva de un análisis en el contexto, como indicador útil para la gestión local. OBJETIVOS Describir los perfiles de mortalidad en menores de 5 años en la provincia de Tucumán y caracterizar su relación con la oferta de los servicios públicos de salud y los factores socioeconómicos en el trienio 2009-2011. MÉTODOS Se realizó un estudio ecológico de la mortalidad de menores de 5 años durante 2009-2011 en las unidades poblacionales político-administrativas más pequeñas de la provincia de Tucumán. Variable dependiente defunción de menores de cinco años. Variables independientes peso al nacer, edad al morir, mes de ocurrencia, criterios de reducibilidad y edad, grado de instrucción y situación conyugal materna. Se calculó la proporción de muertes para cada categoría y la tasa de mortalidad específica con factor de amplificación por 1 000 nacidos vivos (NV). Se compararon mediante intervalos de confianza al 95%. RESULTADOS Se analizaron 1 339 fallecimientos en menores de 5 años y 88 610 NV en el trienio 2009-2011. El 69,01% (924) de las defunciones ocurrieron en establecimientos públicos de salud. La muerte domiciliaria en 1-4 años fue del 17,46%. El 66,02% de las defunciones correspondieron a la etapa neonatal precoz. Hubo criterios de reducibilidad en el 18,89% de las muertes neonatales y en el 75,38% de las posneonatales. La razón de tasa de mortalidad de <5 años entre las localidades agrupadas con mayor y con menor tasa fue de 9,09. Hubo heterogeneidad en la distribución proporcional de NV, defunciones infantiles, defunciones evitables y muertes domiciliarias entre localidades con mayor tasa de mortalidad de <5 años y con mayor número de muertes de <5 años. DISCUSIÓN Para definir las brechas poblacionales, es necesario ampliar el análisis del impacto de los cambios sociales, considerando patrones culturales propios en las unidades más pequeñas asociadas a un gobierno local.
Assuntos
Condições Sociais , Mortalidade InfantilRESUMO
Y chromosome microdeletion is the most important genetic cause of impairment of spermatogenesis. Nevertheless, a significant proportion of patients with spermatogenic failure do not have this condition. This study investigated the expression level of AZF genes, DDX3Y (DBY), RBMY1, DAZ and TSPY in testicular tissues of 42 subjects with impaired spermatogenesis compared with 33 with normal spermatogenesis. Histopathological evaluation was performed in all subjects and tissues were classified according to Johnsen Score. Transcript amounts were determined by quantitative-competitive RT-PCR. Patients with complete Sertoli cell-only syndrome (SCOS) did not exhibit RBMY1, DAZ and TSPY gene expression, however, we detected very low expression of DDX3Y transcript. Tissue samples with focal SCOS showed significantly decreased expression of all genes (P < 0.001). Maturation arrest and hypospermatogenesis tissues expressed significantly low levels of DDX3Y testicular transcript (P < 0.001), while the mRNA levels of the other genes were similar to that in tissues from the normal spermatogenesis group. Negative or diminished gene expression of DDX3Y, RBMY1, DAZ and TSPY in tissues samples with SCOS or focal SCOS reflects the absence or the lower number of germ cells, respectively. The finding that the testicular transcript of DDX3Y is significantly decreased in patients with severe spermatogenenic failure, especially in those presenting maturation arrest, suggests an important role of DDX3Y during spermatogenesis.
Assuntos
Proteínas de Ciclo Celular/genética , RNA Helicases DEAD-box/genética , Proteínas Nucleares/genética , Proteínas de Ligação a RNA/genética , Espermatogênese/genética , Testículo/metabolismo , Adulto , Azoospermia/genética , Azoospermia/patologia , Proteína 1 Suprimida em Azoospermia , Humanos , Masculino , Pessoa de Meia-Idade , Antígenos de Histocompatibilidade Menor , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Testículo/patologiaRESUMO
BACKGROUND: The pathophysiology of the testicular damage in varicocele has not been completely understood. Oxidative stress and related sperm DNA damage have been identified as significant causes of male infertility. The current study was designed to determine the extent of sperm nuclear DNA damage in patients with varicocele and to examine its relationship with oxidative stress. METHODS: Semen samples from 55 patients with clinical varicocele and 25 normozoospermic donors were examined. Varicocele sperm samples were classified as normal or abnormal according to World Health Organization guidelines. Sperm DNA damage was evaluated by the sperm chromatin structure assay/flow cytometry and by the terminal deoxyribonucleotidyl transferase-mediated dUTP nick-end labelling (TUNEL) assay. Levels of reactive oxygen species (ROS) and total antioxidant capacity were assessed by a chemiluminescence assay. RESULTS: DNA fragmentation index (DFI) (percentage of sperm with denatured DNA) values and the percentage of TUNEL-positive cells were significantly greater in patients with varicocele, either with normal (DFI, 20.7 +/- 4.0; TUNEL positive, 26.1 +/- 3.2) or with abnormal (DFI, 35.5 +/- 9.0; TUNEL positive, 32.2 +/- 4.1) semen profile, compared with controls (DFI, 7.1 +/- 0.9; TUNEL positive, 14.2 +/- 1.2). Similarly, ROS levels were significantly higher (P < 0.01) in both groups of patients with varicocele. CONCLUSIONS: The presence of a varicocele is associated with high levels of DNA-damage spermatozoa even in the presence of normal semen profile. The results also indicate that oxidative damage is associated with sperm DNA damage in these patients.
Assuntos
Dano ao DNA , Estresse Oxidativo/fisiologia , Espermatozoides/ultraestrutura , Varicocele/genética , Biomarcadores , Fragmentação do DNA , Humanos , Marcação In Situ das Extremidades Cortadas , Masculino , Espécies Reativas de Oxigênio/metabolismoRESUMO
2,4-D is a chlorophenoxyherbicide used worldwide. We have studied the morphological alterations of 5-HT neurons and glial cells in the mesencephalic nuclei of adult rats exposed to 2,4-D both perinatally (during pregnancy and lactation) and chronically (during pregnancy, lactation and after weaning) with quantitative methods. Pregnant rats were daily exposed to 70 mg/kg of 2,4-D from gestation day (GD) 16 to post-natal day (PND) 23 through diet. After weaning, pups were assigned to one of two sub-groups: T1 (fed with untreated diet until PND 90) and T2 (maintained with 2,4-D diet until PND 90). Brain sections were immunocytochemically stained using polyclonal anti-5-HT, anti-GFAP and anti-S-100 protein antibodies as cells markers. 2,4-D exposure during pregnancy and lactancy (T1 group) produced an increase in 5-HT neuronal area and immunoreactivity (IR) in the mesencephalic nuclei studied. However, with the chronical 2,4-D exposure (T2 group) only the 5-HT neuronal area from the dorsal raphe nucleus (DRN) was increased, suggesting an adaptable response of 5-HT neurons in median raphe nucleus (MRN). The presence of reactive astrocytes in mesencephalic nuclei and in hippocampus were also different for the two 2,4-D exposure designs, showing the existence of a correspondence between neuronal changes and astrogliosis. Results support evidences that 2,4-D alters the serotoninergic system and that 5-HT neurons of each mesencephalic nuclei show different responses to the 2,4-D exposure designs which are parallel to astrogliosis.
Assuntos
Ácido 2,4-Diclorofenoxiacético/toxicidade , Astrócitos/efeitos dos fármacos , Astrócitos/ultraestrutura , Encéfalo/citologia , Herbicidas/toxicidade , Neurônios/efeitos dos fármacos , Neurônios/ultraestrutura , Serotonina/fisiologia , Animais , Feminino , Proteína Glial Fibrilar Ácida/metabolismo , Hipocampo/efeitos dos fármacos , Hipocampo/patologia , Hipocampo/ultraestrutura , Processamento de Imagem Assistida por Computador , Imuno-Histoquímica , Indicadores e Reagentes , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Núcleos da Rafe/efeitos dos fármacos , Núcleos da Rafe/patologia , Núcleos da Rafe/ultraestrutura , Ratos , Proteínas S100/metabolismoRESUMO
BACKGROUND: Male infertility is responsible for 35% of infertile couples. AIM: To investigate the causes of male infertility and the relative importance of endocrine factors. PATIENTS AND METHODS: Patients referred to an andrology clinic due to an abnormal spermiogram were studied. A testicular examination, spermiogram and determination of FSH, LH, testosterone and prolactin were done to all. Testicular biopsy was done to patients with severe oligospermia or azoospermia. Causes of infertility were defined and classified as pretesticular, testicular, posttesticular or unclassified. RESULTS: Two hundred fifty seven males were studied. In 3.5% of them, the cause of infertility was defined as pretesticular (that included hypothalamic and pituitary endocrine causes), in 66.9% it was classified as testicular, in 15.6% as posttesticular and in 14%, as unclassified. Thirty percent of infertility cases were idiopathic, 17.9% were associated to varicocele, 12.8% were associated to cryptorchidism, 8.9% to Klinefelter syndrome and 6.6% to exposure to toxic substances. In 50% of patients with cryptorchidism, this abnormality was found during the specialized andrological examination and referrals for surgical correction were made late. Two thirds of patients with Klinefelter syndrome were hypoandrogenic. CONCLUSIONS: Causes for male infertility should be investigated and diagnosed accurately. Primary hypoandrogenic testicular failures must be treated with hormone replacement therapy.
Assuntos
Doenças do Sistema Endócrino/complicações , Infertilidade Masculina/etiologia , Adolescente , Adulto , Hormônio Foliculoestimulante/sangue , Humanos , Infertilidade Masculina/sangue , Hormônio Luteinizante/sangue , Masculino , Pessoa de Meia-Idade , Prolactina/sangue , Doenças Testiculares/complicações , Testosterona/sangueRESUMO
Neonate rats were exposed to 100 mg/kg from the PND 7 to PND 25 or at 70 mg/kg from PND 12 to PND 25. Treated and control pups were subjected to several behavioral tests (righting reflex, negative geotaxy, forelimbs support and open field) during the period of treatment. At PND 25 the regional effects of 2,4-D on gangliosides composition and myelin deposition were determined. The results indicate that the first design of exposure to 2,4-D produces significant diminutions in body and brain weight from PND 21. Furthermore, these pups showed decrease in GM1 level, diminution in myelin deposition and alterations in all behavioral tests. On the other hand, when treatment was not too severe (minor dose and shorter period of treatment), pups showed alterations in forelimb support and in open field tests without body or brain weight modifications. They also presented diminutions in GM1, mayoritary ganglioside of myelin, and in myelin deposition. These results suggest that in this latter 2,4-D exposure design, undernutrition could not be involved.
Assuntos
Ácido 2,4-Diclorofenoxiacético/toxicidade , Animais Recém-Nascidos/fisiologia , Comportamento Animal/efeitos dos fármacos , Química Encefálica/efeitos dos fármacos , Encéfalo/crescimento & desenvolvimento , Gangliosídeos/metabolismo , Herbicidas/toxicidade , Bainha de Mielina/efeitos dos fármacos , Animais , Peso Corporal/efeitos dos fármacos , Encéfalo/efeitos dos fármacos , Encéfalo/patologia , Feminino , Membro Anterior/fisiologia , Imuno-Histoquímica , Masculino , Bainha de Mielina/patologia , Tamanho do Órgão/efeitos dos fármacos , Equilíbrio Postural/efeitos dos fármacos , Reflexo/efeitos dos fármacosRESUMO
The aim of this study was to determine the predictive value of sperm penetration into the perivitelline space of human cadaveric oocytes on in vitro fertilization outcome. Forty-two patients with tubal infertility undergoing ovarian stimulation with gonadotropin for in vitro fertilization and embryo transfer participated in the study. The number of spermatozoa bound to the human zona pellucida, the percentage of cadaveric oocytes with one or more spermatozoa in the perivitelline space, and the in vitro fertilization outcome were evaluated. Spermatozoa from 37 of 42 patients were able to penetrate the perivitelline space of cadaveric oocytes as well as to fertilize human oocytes in vitro. In three individuals, no penetration of the perivitelline space of cadaveric oocytes was observed and no in vitro fertilization was detected. Only two patients were able to fertilize the couple's oocytes without penetration of the cadaveric oocytes. Based on these results the specificity and the sensitivity of the assay to predict in vitro fertilization was 100% and 94.1%, respectively. Accordingly, these results suggest that sperm-zona penetration is a useful bioassay to predict male fertility potential in IVF outcome.
Assuntos
Fertilização in vitro , Interações Espermatozoide-Óvulo , Zona Pelúcida , Feminino , Humanos , Infertilidade , Masculino , Valor Preditivo dos Testes , Zona Pelúcida/metabolismoRESUMO
We report a case of a nine year-old boy with typhoid fever and complications, including generalized edema, which is not named in the pertinent literature. We discuss finding in this patient.
Assuntos
Edema/etiologia , Febre Tifoide/complicações , Criança , Cloranfenicol/administração & dosagem , Cloranfenicol/uso terapêutico , Seguimentos , Humanos , Masculino , Fatores de Tempo , Febre Tifoide/diagnóstico , Febre Tifoide/tratamento farmacológicoRESUMO
We studied the variability of traditional semen analysis parameters as well as sperm motion characteristics analyzed by computer-assisted-semen analyzer in semen and after 2 hours of incubation in capacitation conditions. Twenty men with probed fertility provided three semen samples and 60 men provide one. The higher variability was observed with seminal sperm concentration, the lower variation was observed for percent motility and percent of normal morphology. Ten Oligospermic donors (12,5%) were observed in our population without other semen parameters abnormalities. Their motion characteristics were comparable to cells analyzed from normospermic men. A lower variability of sperm motion characteristics was observed during sperm capacitation compared to sperm movement in seminal plasma; suggesting that sperm motion characteristics during capacitation may be a usefull method additional to semen analysis to evaluate male fertility potential.
Assuntos
Fertilidade , Sêmen , Capacitação Espermática , Motilidade dos Espermatozoides , Diagnóstico por Computador/métodos , Humanos , Masculino , Oligospermia/diagnóstico , Contagem de Espermatozoides/métodosRESUMO
A survey in the health area of "Héroes del Moncada" Polyclinics in Plaza de la Revolución municipality from Havana City was carried out by means of a multistage sampling in which 352 women in reproductive age (15-49 years old) were randomly chosen. A questionnaire designed by the World Health Organization for this kind of investigation was applied and a work of information and orientation was carried out for the infertile women. Prevalence of infertility in this health area was moderate and was found in 9.1% of the total number of women studied (12.1% of married women). Primary infertility was found in 0.6% of the total number of the women studied (12.1% of married women) and secondary infertility was found in 8.5% (11.3% of married women). A 43.8% of infertile women wanted to be pregnant what inversely correlated with the age and the number of children. The efficacy of the educational work of nursing was evidenced because 85.7% of infertile women who wanted to be pregnant attended the specialized consultation after the interview by the nurse. It is recommended to increase the nursing activity in the field of human reproduction.
Assuntos
Infertilidade Feminina/epidemiologia , Infertilidade Feminina/enfermagem , Adolescente , Adulto , Distribuição por Idade , Cuba/epidemiologia , Feminino , Educação em Saúde , Humanos , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , População Urbana/estatística & dados numéricosRESUMO
A study is made on some significant aspects of the obstetric history and contraceptive practice in an urban health area by means of a random sample that selected 352 women of reproductive potential. They were interviewed by means of a questionnaire designed for that purpose. Most women in all age groups had a male partner, except for the 15-19 age group, and it seems that often marriage duration is not low. Pregnancy average per woman was high (3.04) and high rates for induced abortion per live birth (0.99) and of induced abortion per woman (1.44) were found, which is indicative of inappropriate contraceptive practice. The contraceptives most commonly used were intrauterine devices (74%) and oral tablets (51%); much less frequent is the use of condoms (5.8%), diaphragms (2.9%), periodic abstinence (2.5%) and breast feeding (2.5%). Results indicate an abuse of abortion as a family planning method, as well as a poor contraceptive practice.