RESUMO
Bottled water has emerged as a possible healthier alternative due to concerns about the quality of drinking water sources. However, recent studies have detected worrying concentrations of environmental contaminants in bottled water, including microplastics. Therefore, it is an emerging need to quantify their concentrations in local suppliers which could differ among countries and regions. In this work, we used fluorescence microscopy with Nile Red for the identification and quantification of potential microplastics in twelve brands of bottled water distributed in the Santiago Metropolitan Region of Chile. The average concentration of microplastics was 391 ± 125 p L-1, while the highest concentration observed was 633 ± 33 p L-1. Microplastics between 5 and 20 µm were the major contributors, a size fraction that has been reported to be susceptible to accumulate in the digestive tract or generate potential alterations in the lymphatic and circulatory systems. The estimated daily intake value for per capita was estimated to be 229 p kg-1 year-1 for people weighing 65 kg and 198 p kg-1 year-1 for those weighing 75 kg.
Assuntos
Água Potável , Poluentes Químicos da Água , Humanos , Água Potável/análise , Plásticos , Microplásticos , Chile , Poluentes Químicos da Água/análise , Monitoramento AmbientalRESUMO
Oxidative potential (OP) has gained attention as a parameter that can reveal the ability of different properties of particulate matter (PM) to generate reactive oxygen species (ROS) as one single value. Moreover, OP is also believed to be a predictor of toxicity and hence the health effects of PM. This study evaluated the OP of PM10, PM2.5,and PM1.0samples using dithiothreitol assays in two cities of Chile (Santiago and Chillán). The results showed that the OP was different between cities, PM size fractions, and seasons. Additionally, OP was strongly correlated with certain metals and meteorological variables. Higher mass-normalized OP was observed during cold periods in Chillán and warm periods in Santiago and was associated with PM2.5 and PM1. On the other hand, volume-normalized OP was higher during winter in both cities and for PM10. Additionally, we compared the OP values to the Air Quality Index (AQI) scale and found cases of days that were classified as having "good" air quality (supposed to be less harmful to health) showing extremely high OP values that were similar to those on days that were classified as "unhealthy". Based on these results,we suggest using the OP as a complementary measure to the PM mass concentration because it includes important new information related to PM properties and compositions that could help improvecurrent air quality management tools.
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Poluentes Atmosféricos , Material Particulado , Material Particulado/análise , Poluentes Atmosféricos/análise , Chile , Monitoramento Ambiental/métodos , Estações do Ano , Estresse Oxidativo , Tamanho da PartículaRESUMO
Agriculture is one of the main economic activities in Chile and is associated with extensive use of pesticides, which can represent a risk to the environment and to human health. Currently, there are over 400 pesticides approved for commerce in Chile, including chemicals banned in other countries (e.g., flocoumafen and chlorfenapyr). An empirical analysis of their potential environmental effects is difficult due to this large number, thus opening the doors for the use of computational tools for prioritization efforts based on their persistence, bioaccumulation, and transport potential in the environment. The main objectives of this study were to estimate the properties and environmental distribution of pesticides approved for commerce in Chile and to generate a priority list for further evaluation in local environments. We used the Estimation Program Interface Suite interface to estimate the distribution coefficients, half-lives, and bioaccumulation potential of all pesticides registered in the Chilean Agriculture and Livestock Services. Additionally, the Pov & LRTP Screening Tool was used to estimate their overall persistence and long-range transport potential in the environment. The results were used to develop a P-B-lon range transport (LRT) score, which considered persistence, bioaccumulation, and long-range transport potential. All pesticides were compared to a group of polychlorinated biphenyls (PCBs), used as reference compounds, to generate a list of priority pesticides with persistent organic pollutants characteristics. The results showed that most pesticides were distributed between the organic phase and water, where they also showed the longest half-lives and bioaccumulation potential. A group of 21 pesticides showed relatively high P-B-LRT scores, compared to PCBs, and were classified as priority compounds. The list was further refined based on the volume of sales for each pesticide. Integr Environ Assess Manag 2023;19:676-683. © 2022 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).
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Praguicidas , Bifenilos Policlorados , Humanos , Praguicidas/análise , Bioacumulação , Chile , Agricultura , Monitoramento Ambiental/métodosRESUMO
Indigenous communities from northern Chile have historically been exposed to the impacts of massive copper industrial activities conducted in the region. Some of the communities belonging to the Alto El Loa Indigenous Development Area are located less than 10â¯km from the "Talabre'' tailings dam, which contains residues from copper production and other metals that can be toxic to human health (e.g., As, Sb, Cd, Mo, Pb). Given the increasing demand of copper production to achieve net-zero emission scenarios and concomitant expansions of the tailings, the exposure to toxic metals is a latent risk to local communities. Despite the impact that copper production could generate on ancestral communities from northern Chile, studies and monitoring are limited and the results are often not made accessible for local communities. Here, we evaluate such risks by characterizing metal concentrations in dust collected from roofs and windows of houses from the Alto El Loa area. Our results showed that As, Sb, Cd, Cu, Mo, Ag, S, and Pb concentrations in these matrices can be connected to local copper mining activities. Additionally, air transport models indicate that high concentrations of toxic elements (As, Sb, and Cd) can be explained by the atmospheric transport of particles from the tailings in a NE direction up to 50â¯km away. Pollution indices and Health Risk Assessment suggested a highly contaminated region with a health risk for its inhabitants. Our analysis on a local scale seeks to make visible the case of northern Chile as a critical territory where actions should be taken to mitigate the effects of mining in the face of this new scenario of international demand for the raw materials necessary for the transition to a net-zero carbon global society.
Assuntos
Metais Pesados , Poluentes do Solo , Cádmio/análise , Carbono/análise , Chile , Cobre/análise , Poeira/análise , Monitoramento Ambiental/métodos , Humanos , Chumbo/análise , Metais Pesados/análise , Poluentes do Solo/análiseRESUMO
INTRODUCTION: Previous research has used proxy variables or a unique construct to quantify healthcare access. However, there is a need for a different model that can handle this multivariable problem. This study seeks to develop a way to measure access to the local healthcare system with higher local resolution. METHODS: A new survey was developed based on communitarian claims, following a behavioural model and an ontological framework. The survey was used to identify local barriers to healthcare services and the local preferences for priority settings. The results were analysed using multiattribute utility functions and individual weights were assigned by a panel of experts. National and regional indexes of access to healthcare were developed. RESULTS: The survey contained seven modules and 104 questions. It was conducted on 1885 participants at 42 rural and 231 urban locations in three regions of Chile. The total disutility of the identified barriers to healthcare access at the national level was low (0.1448; values ranged between 0 and 1, with 1 representing a higher barrier) and was higher in the northern region (0.1467). The barriers associated with the health-policy component showed the highest disutility value, and specific barriers for each community were identified. CONCLUSIONS: These results have the potential to improve health decision-making in Chile and can be used to assess the impacts of new health policy reforms. Although this model was tested in Chile, it can be adapted for use in any other country. PATIENT OR PUBLIC CONTRIBUTION: Participants contributed to this study by completing a survey, participating in general talks and receiving brochures with the results obtained from this study.
Assuntos
Acessibilidade aos Serviços de Saúde , Serviços de Saúde , Chile , Política de Saúde , HumanosRESUMO
The sanitary measures implemented to control and prevent an increase in infections due to the COVID-19 pandemic have produced an improvement in the air quality of many urban areas around the world. We assessed air quality during the COVID-19 pandemic for particulate matter (PM2.5 and PM10), NO2 and O3 in in metropolitan area of Lima, Peru between pre-lockdown period (February 1 and March 15 of 2020), historical period (March 16 to April 30 2017-2019) and lockdown period (March 16 to April 30, 2020). The complete national lockdown that was implemented in Peru produced statistically significant reductions in the in-air pollutant (PM10 (-40% and -58%), PM2.5 (-31% and -43%) and NO2 (-46% and -48%)), as recorded by the by the ground-based air quality monitoring network throughout the metropolitan area, compared with the corresponding concentrations for the previous weeks and over the same period for 2017-2019. Analysis of the spatial Distribution of satellite data also show decreases in the concentrations of PM10, PM2.5 and NO2 as a result of the containment measures and suspension of activities implemented by the Peruvian government. The concentrations of O3 significantly increased (11% and 170%) as a result of the decrease in the concentration of NO2, confirming that the study area is a hydrocarbon-limited system, as previously reported. The results obtained contribute to the assessment by the regulatory agencies of the possible strategies of control and monitoring of air pollution in the study area. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11869-021-00990-3.
RESUMO
The implementation of confinement and physical distancing measures to restrict people's activities and transit in the midst of the COVID-19 pandemic allowed us to study how these measures affect the air quality in urban areas with high pollution rates, such as Santiago, Chile. A comparative study between the concentrations of PM10, PM2.5, NOx, CO, and O3 during the months of March to May 2020 and the corresponding concentrations during the same period in 2017-2019 is presented. A combination of surface measurements from the air quality monitoring network of the city, remote satellite measurements, and simulations of traffic activity and road transport emissions allowed us to quantify the change in the average concentrations of each pollutant. Average relative changes of traffic emissions (between 61% and 68%) implied statistically significant concentrations reductions of 54%, 13%, and 11% for NOx, CO, and PM2.5, respectively, during the pandemic period compared to historical period. In contrast, the average concentration of O3 increased by 63% during 2020 compared to 2017-2019. The nonlinear response observed in the pollution levels can be attributed to the changes in the vehicular emission patterns during the pandemic and to the role of other sources such as residential emissions or secondary PM.
RESUMO
Air pollution problems can be large, complex, and ill-structured. They can vary from location to location and combine many complex components: urban expansion, increasing vehicles and industrial emissions, biomass burning, geographic and meteorological conditions, cultural aspects, and economic effects. However, the existing research, accumulated knowledge, and local research priorities are spread over many disciplines and lack a systematic mapping to help manage and develop new strategies for researchers and policy makers. Ontological analysis can be used as a tool to capture this complexity through simple natural-language descriptions and a structured terminology. We describe the development of an ontological framework for "Air Quality Management in Chile" and its application to evaluate the current state of the research. The process was based on focus groups and validated by a panel of multidisciplinary experts. We used the developed framework to highlight the topics that have been heavily emphasized, lightly emphasized, or overlooked in the Chilean research. The framework developed can help researchers, practitioners, and policy makers systematically navigate the domain and provide the opportunity to correct blind spots by enabling more informed hypotheses that deal with air quality issues at a national level. We believe that applying this same process to different countries will yield different results (due to differences in local knowledge and experience). The framework presented could be used to evaluate other important stakeholders (government, media, NGOs, etc.), which will provide a complete picture of how local societies deal with air quality issues at different levels. Additionally, local government institutions will benefit from this analysis by improving funding allocation and opening new research opportunities to improve the distribution of the local body of knowledge. Integr Environ Assess Manag 2021;17:273-281. © 2020 SETAC.
Assuntos
Poluição do Ar , Poluição do Ar/análise , Chile , PesquisaRESUMO
Oxidative stress is considered as one of the main mechanisms by which airborne particles produce adverse health effects. Several methods to estimate the oxidative potential (OP) of particulate matter (PM) have been proposed. Among them, the dithiothreitol (DTT) assay has gained popularity due to its simplicity and overall low implementation cost. Usually, the estimations of OPDTT are based on n-replicates of a set of samples and their associated standard deviation. However, interlaboratory comparisons of OPDTT can be difficult and lead to misinterpretations. This work presents an estimation of the total uncertainty for the OPDTT measurement of PM10 and PM2.5 samples collected in Santiago (Chile), based on recommendations by the Joint Committee for Guides in Metrology and Eurachem. The expanded uncertainty expressed as a percentage of the mass-normalized OPDTT measurements was 18.0% and 16.3% for PM10 and PM2.5 samples respectively. The dominating contributor to the total uncertainty was identified (i.e., DTT consumption rate, related to the regression and repeatability of experimental data), while the volumetric operations (i.e., pipettes) were also important. The results showed that, although the OP measured following the DTT assay has been successfully used to estimate the potential health impacts of airborne PM, uncertainty estimations must be considered before interpreting the results.
Assuntos
Poluentes Atmosféricos/análise , Material Particulado/análise , Animais , Chile , Ditiotreitol , Monitoramento Ambiental , Oxirredução , Estresse Oxidativo , IncertezaRESUMO
This work presents a study on the use of wood and plastic wastes generated in abundance in Merida, Mexico, to help to reduce them in order to mitigate environmental deterioration. The use of these wastes is proposed to obtain a low-cost building material. So, the escalation process (i.e., extrusion) at the pilot level to obtain a prototype of a wood-plastic composite (WPC) corrugated sheet to evaluate the technical feasibility to make a low-cost product is reported. A corrugated sheet with recycled high-density polyethylene (R-HDPE) was produced. The R-HDPE was collected from Merida's Separation Plant. The wood came from the trimmings of different varieties of trees and shrubs that are periodically pruned. WPC sheets with virgin HDPE were prepared to assess its effect on the materials' mechanical performance. The wood/HDPE weight ratio was 40/60. The performance of the WPC sheets was compared with that of commercial products with similar characteristics, namely acrylic and polyester sheets reinforced with fibreglass, and black asphalt-saturated cardboard sheets. Thus, the effect of natural weathering on the maximum tensile tearing force and on the maximum flexural load of the different types of sheets was evaluated. Although the mechanical performance of the WPC sheets was lower than that of the acrylic and polyacrylic sheets, their performance was much better than that of the cheap black asphalt-saturated cardboard sheets. So, they are a good option to be used as low-cost temporary roofing.
Assuntos
Plásticos , Árvores , México , Reciclagem , MadeiraRESUMO
The performance of silicon wristband passive samplers (WB), combined with comprehensive two-dimensional gas-chromatography/time-of-flight mass-spectrometry (GC × GC/ToF-MS), for the analysis of urban derived pollutants in the personal environment was evaluated. Cumulative 5-day exposure samples from 27 individuals in areas with different geographical/socioeconomic characteristics within the Santiago Metropolitan Region (Chile) were collected during winter and summer (2016-2017). Samples were extracted without cleanup/fractionation and analyzed using targeted and nontargeted methods. The quantified semivolatile organic compounds (SVOCs, n = 33) (targeted analysis), and tentatively identified features ( n = 595-1011) (nontargeted analysis) were classified according to their use/source. Seasonal differences were observed in the targeted analysis, while seasonal and spatial differences were observed in the nontargeted analysis. Higher concentrations of combustion products were observed in winter, while higher concentrations of consumer products were found in summer. Spatial differences were observed in hierarchical clustering analysis of the nontargeted data, with distinct clusters corresponding to specific subregions of the urban area. Results from this study provide spatial and seasonal distributions of urban pollutants within an urban area and establish the utility of linking WB with nontargeted analysis as a tool to identify and prioritize new exposures to urban contaminants at the local/community level.
Assuntos
Poluentes Ambientais , Animais , Chile , Cromatografia Gasosa-Espectrometria de Massas , Compostos Orgânicos , Estações do AnoRESUMO
A preliminary study on the use of wood and plastic wastes generated in Merida, Mexico to assess their potential for the development of building materials is reported. Composites based on recycled, high-density polyethylene (R-HDPE) loaded with wood particles were prepared. The R-HDPE was collected from Merida's Separation Plant, where it was sorted from other residues, either organic or inorganic. Composites based on virgin, high-density polyethylene (V-HDPE) were also prepared to assess the effect of the R-HDPE on the composite's mechanical properties. The wood came from the trims of different varieties of the city's trees that are periodically pruned as part of the cleaning and urbanising programmes implemented by the City Council. A batch of this material was selected at random to incorporate into both the R-HDPE and V-HDPE. Different wood particle sizes were experimented with to obtain extruded composites with contents of 50% and 60% by weight of wood that were characterized under tension and impact. Flat wood-plastic extrudates with reasonable good appearance were also produced at the laboratory level as a first step to find an adequate route to scale-up the process to a pilot level to evaluate the feasibility of producing alternative building materials.
Assuntos
Plásticos/química , Resíduos/análise , Madeira/química , Teste de Materiais , México , Polietileno/química , Reciclagem , Eliminação de ResíduosRESUMO
Two hundred and forty one patients with iron deficiency anemia (IDA) were identified in a single institution over a 24-year period; of these, 75 individuals were studied as the result of persistent IDA despite the administration of oral iron hydroxide polymatose (IP). The levels of hemoglobin when the patients were referred for study after being given oral IP had a median of 10.3 g/dl; after administration of oral iron fumarate during periods ranging from 1 to 14 months, the levels of hemoglobin rose to a median of 12.5 g/dl (p>0.01). Our data support previous observations made in other countries about the ineffectiveness of oral IP in the treatment of individuals with IDA and should alert the clinician to avoid unnecessary consultations and misdiagnosis.
Assuntos
Anemia Ferropriva/tratamento farmacológico , Compostos Férricos/uso terapêutico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Avaliação de Medicamentos , Feminino , Compostos Férricos/administração & dosagem , Hemoglobinas/análise , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Falha de TratamentoRESUMO
Two main techniques are being used for the detection of minimal residual disease (MRD) in acute leukemia (AL): immunophenotypic analysis and polymerase chain reaction (PCR). In this paper, we analyze the results of assessing MRD by means of flow cytometry (FC) in a group of 93 patients with AL who were prospectively studied and treated in a single institution over a 9-year period. The presence or absence of MRD was established at a cut-off level of 2%, as judged by FC; a single result above this level was considered to define the positivity. The patients were grouped in 4 subsets: (1) acute lymphoblastic leukemia (ALL) patients with MRD (n = 36); (2) acute myeloblastic leukemia (AML) patients with MRD (n = 13); (3) ALL patients without MRD (n = 31); and (4) AML patients without MRD (n = 13). The relapse rates in these groups were 17%, 8%, 0%, and 0%, respectively, whereas the overall 7-year survival was 65%, 69%, 83%, and 98%, respectively. Our results support the usefulness of serially assessing MRD in patients with AL by means of FC; because this method is applicable to all cases of AL, despite being less sensitive than a molecular biology study; it is a good option to follow-up patients and to decide therapeutic and timely interventions.
Assuntos
Leucemia Mieloide Aguda/sangue , Recidiva Local de Neoplasia/sangue , Neoplasia Residual/sangue , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Criança , Pré-Escolar , Citometria de Fluxo , Humanos , Lactente , Estudos Longitudinais , Pessoa de Meia-Idade , Neoplasia Residual/diagnóstico , Valor Preditivo dos Testes , Análise de SobrevidaRESUMO
We analyze the prevalence and clinical features of a group of patients with t(8;21) (q22;q22) acute myeloblastic leukemia, identified in a single institution in México over a 10-year period. Fifteen patients presented at the Centro de Hematología y Medicina Interna de Puebla from February 1995 to August 2005; only nine were treated and followed in the institution. Median age was 24 years, (range 7-49); there was only one male. According to the French-American-British (FAB) morphological classification of leukemia, the morphology was M2 in four cases, M4 in three cases, M3 in one case and M0 in one. In addition to the myeloid markers, lymphoid markers were identified in 6 patients. Patients were induced to remission with combined chemotherapy and three subsequently underwent bone marrow transplantation (BMT). The median overall and disease-free survival has not been reached, being above 3390 days, the probability of survival at this time was 73%. In this single-center experience in México, we found that the t(8;21) (q22;q22) variant of leukemia was more frequent than in Caucasian populations, that the co-expression of lymphoid markers in the blast cells is very frequent and that this malignancy is associated with a relatively good prognosis.
Assuntos
Cromossomos Humanos Par 21/genética , Cromossomos Humanos Par 8/genética , Subunidade alfa 2 de Fator de Ligação ao Core/genética , Leucemia Mieloide/genética , Proteínas de Fusão Oncogênica/genética , Transplante de Células-Tronco de Sangue Periférico/estatística & dados numéricos , Translocação Genética , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Pré-Escolar , Cromossomos Humanos Par 21/ultraestrutura , Cromossomos Humanos Par 8/ultraestrutura , Terapia Combinada , Citarabina/administração & dosagem , Intervalo Livre de Doença , Doxorrubicina/administração & dosagem , Feminino , Humanos , Lactente , Estimativa de Kaplan-Meier , Leucemia Mieloide/tratamento farmacológico , Leucemia Mieloide/epidemiologia , Leucemia Mieloide/cirurgia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Proteína 1 Parceira de Translocação de RUNX1 , Indução de Remissão , Terapia de Salvação , Transplante Autólogo/estatística & dados numéricos , Transplante Homólogo/estatística & dados numéricos , Resultado do TratamentoRESUMO
In two institutions in México, twelve patients were given a second allogeneic stem cell transplantation, using the "Mexican" non-myeloablative preparative regimen. Eight had a malignant condition (six acute leukemias, one myelofibrosis and one myelodysplasia), eleven individuals were allografted twice from the same donor and in one case, cells from two different umbilical cords were used. The median time to conduct the second allograft after the first one was 6 months (range 1-41). The five patients who failed to engraft after the first transplant failed also to engraft after the second one; all of them had been heavily transfused. Only three patients were successfully rescued with the second transplant, two with acute leukemia and one with aplastic anemia. Seven patients are alive 10-41 months (median 35) after the second transplant, but only three (25%) remain disease-free. The 52-month overall survival (SV) of the patients is 58%, whereas the median overall SV has not been reached, being above 52 months. Conducting a second allograft may be useful to rescue some individuals relapsing after a first hematopoietic allotransplant.
Assuntos
Transplante de Células-Tronco de Sangue do Cordão Umbilical , Transplante de Células-Tronco de Sangue Periférico , Condicionamento Pré-Transplante/métodos , Doença Aguda , Adulto , Anemia Aplástica/cirurgia , Pré-Escolar , Estudos de Coortes , Transplante de Células-Tronco de Sangue do Cordão Umbilical/estatística & dados numéricos , Intervalo Livre de Doença , Feminino , Custos de Cuidados de Saúde , Hospitais/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Lactente , Leucemia/cirurgia , Masculino , México , Pessoa de Meia-Idade , Defeitos do Tubo Neural/cirurgia , Osteopetrose/cirurgia , Transplante de Células-Tronco de Sangue Periférico/estatística & dados numéricos , Mielofibrose Primária/cirurgia , Recidiva , Aplasia Pura de Série Vermelha/cirurgia , Reoperação/estatística & dados numéricos , Análise de Sobrevida , Talassemia/cirurgia , Transplante Homólogo/estatística & dados numéricos , Resultado do TratamentoRESUMO
In two institutions in México, twelve patients were given a second allogeneic stem cell transplantation, using the "Mexican" non-myeloablative preparative regimen. Eight had a malignant condition (six acute leukemias, one myelofibrosis and one myelodysplasia), eleven individuals were allografted twice from the same donor and in one case, cells from two different umbilical cords were used. The median time to conduct the second allograft after the first one was 6 months (range 1-41). The five patients who failed to engraft after the first transplant failed also to engraft after the second one; all of them had been heavily transfused. Only three patients were successfully rescued with the second transplant, two with acute leukemia and one with aplastic anemia. Seven patients are alive 10-41 months (median 35) after the second transplant, but only three (25%) remain disease-free. The 52-month overall survival (SV) of the patients is 58%, whereas the median overall SV has not been reached, being above 52 months. Conducting a second allograft may be useful to rescue some individuals relapsing after a first hematopoietic allotransplant.
En dos instituciones en México se llevaron a cabo doce segundos trasplantes de células hematopoyéticas usando el "método mexicano" de acondicionamiento no mieloablativo. Ocho pacientes tenían una enfermedad maligna (seis leucemias agudas, una mielofibrosis y una mielodisplasia). Once sujetos se retrasplantaron del mismo donador y en un caso se emplearon células hematopoyéticas de dos diferentes cordones umbilicales. La mediana del tiempo transcurrido entre los dos trasplantes fue de seis meses (rango 1 a 41). Los cinco pacientes que no se injertaron con el primer trasplante tampoco se injertaron con el segundo; todos ellos habían sido multitransfundidos antes de los trasplantes. Sólo tres pacientes se pudieron rescatar con el segundo trasplante, dos con leucemia aguda y uno con anemia aplástica. Siete pacientes están vivos 10 a 41 meses (mediana 35) después del segundo trasplante, pero sólo tres (25%) se encuentran libres de enfermedad. La supervivencia (SV) global a 52 meses es de 58%, en tanto que la mediana de SV no se ha alcanzado y es mayor de 52 meses. Hacer un segundo trasplante hematopoyético puede rescatar a algunos pacientes quienes recaen después de un trasplante de médula ósea.
Assuntos
Adulto , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Transplante de Células-Tronco de Sangue do Cordão Umbilical , Transplante de Células-Tronco de Sangue Periférico , Condicionamento Pré-Transplante/métodos , Doença Aguda , Anemia Aplástica/cirurgia , Estudos de Coortes , Transplante de Células-Tronco de Sangue do Cordão Umbilical/estatística & dados numéricos , Intervalo Livre de Doença , Custos de Cuidados de Saúde , Hospitais Universitários/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Leucemia/cirurgia , México , Defeitos do Tubo Neural/cirurgia , Osteopetrose/cirurgia , Transplante de Células-Tronco de Sangue Periférico/estatística & dados numéricos , Mielofibrose Primária/cirurgia , Recidiva , Aplasia Pura de Série Vermelha/cirurgia , Reoperação/estatística & dados numéricos , Análise de Sobrevida , Resultado do Tratamento , Talassemia/cirurgia , Transplante Homólogo/estatística & dados numéricosRESUMO
Twenty-eight children and adults underwent transplantation with allogeneic umbilical cord blood cells (UCB) using a non-ablative conditioning regimen; there were 15 males and 13 females. Seven patients were grafted because a non-malignant condition and 21 for a malignant disease. The median age was 8 years (range 4 months-72 years). Ten UCB were obtained from Mexican cord bloods banks, five cords were from compatible siblings and the remaining 13 cords were obtained from abroad. Median time to recover >0.5 x 10(9)/l granulocytes was 24 days (range 8-32 days), whereas median time to recover >20 x 10(9)/l platelets was 26 days (range 12-50 days). Twelve recipients never engrafted and recovered subsequently endogenous hematopoiesis. The non-engraftment rate was significantly higher in patients allografted for benign conditions (71%) than in those allografted for malignant conditions (28%). The median overall post-transplant survival (SV) was 33 months and the 73-months overall SV was 39%. The cumulative incidence of grade II-IV acute GVHD and grade III-IV GVHD for the entire cohort of patients were 14 and 7%, respectively. Additional studies are needed to define if non-myeloablative conditioning is preferable over conventional conditioning in the case of UCB allografting.
Assuntos
Transplante de Células-Tronco de Sangue do Cordão Umbilical/métodos , Condicionamento Pré-Transplante/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Sobrevivência de Enxerto , Doença Enxerto-Hospedeiro , Humanos , Lactente , Cinética , Masculino , México , Pessoa de Meia-Idade , Taxa de Sobrevida , Doadores de Tecidos , Transplante HomólogoRESUMO
OBJECTIVE: To describe the magnitude, distribution, and determinants of catastrophic health expenditures in Mexico. MATERIAL AND METHODS: The information source was the National Performance Assessment Survey and the methodology, the one developed by the World Health Organization for assessing fair financing. Households with catastrophic expenditures were defined as those with health expenditures over 30% of their ability to pay. Multivariate analysis by logistic and linear regression were used to identify the determinants of catastrophic expenditures. RESULTS: A total of 3.8% of the households incurred in catastrophic health expenditures. There were huge differences by state. The uninsured, poor, and rural households showed a higher impoverishment risk. Sixty percent of the catastrophic expenditures were attributable to outpatient care and medication. A 10% increase of insured households could result in a 9.6% decrease in catastrophic expenditures. Disability, adults 60 years of age and older, and pregnancy increased the probability of catastrophic expenditures. CONCLUSIONS: The insurance of older adults, pregnant women, and persons with disabilities could reduce catastrophic health expenditures in Mexico.
Assuntos
Doença Catastrófica/economia , Financiamento Pessoal , Gastos em Saúde , Seguro Saúde , Adulto , Pessoas com Deficiência , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoas sem Cobertura de Seguro de Saúde , México , Pessoa de Meia-Idade , Modelos Teóricos , Análise Multivariada , Pobreza , Gravidez , População Rural , Organização Mundial da SaúdeRESUMO
Posiblemente, si a lo largo de los 100 años de este siglo XX que termina, nos hubieran encargado este capítulo en diferentes libros de mastología, los criterios expuestos difícilmente hubieran cambiado tanto con otro tema cualquiera. En la primera parte del siglo nos hubiéramos sentido orgullosos de la mastectomía que realizábamos. Por fin podían presentarse resultados satisfactorios en el tratamiento del cáncer de mama con una cirugía radical, que apoyada en la filosofía halstediana, mejoraban incluso, al apoyarla con otras terapéuticas complementarias. Quizas el entusiasmo de esos resultados crecientes y la hegemonía de los principios anatomicistas halstedianos, llevaron la cirugía a su extremo más radical y en la mitad del siglo nos congratulábamos de poder ofertar "más" a nuestras enfermas y llégo la hora de las mastectomías ampliadas. Siempre nos gusto comparar la evolución de la cirugía del cáncer de mama, como de cualquier cirugía oncológica, o tantos criterios no sólo científicos, sino humanos, filosóficos o religiosos, al trayecto de un péndulo, que es este momento llega a su extremo más radical para iniciar su descenso. Y ese descenso de la mano de un mejor conocimiento de la historia natural del cáncer de mama, del inicio de la era biológica y el camino nuevo de la inmunología en las relaciones huesped-tumor, y se apoyó entonces, en lo Fisher llamó su teoría alternativa