Assuntos
Neoplasias da Mama , COVID-19 , Humanos , Feminino , Neoplasias da Mama/radioterapia , Radioterapia Adjuvante , PandemiasRESUMO
OBJECTIVE: This open-label non-randomized clinical study aimed at evaluating the effects of myo-inositol plus alpha-lactalbumin in two groups of PCOS women, treated in Mexico and Italy. Alpha-lactalbumin was used being effective in increasing myo-inositol intestinal absorption. This effect is very useful in greatly reducing the therapeutic failure of myo-inositol in some patients (inositol resistant subjects). PATIENTS AND METHODS: The study involved 34 normal weight or overweight patients (14 in Mexico and 20 in Italy), aged 18 to 40 years, with anovulation and infertility > 1 year and insulin resistance diagnosed by HOMA-Index. Patients were administered orally with 2 g myo-inositol, 50 mg alpha-lactalbumin, and 200 µg of folic acid twice a day for 6 months. Controls were the same patients at t0 (baseline). The primary outcome was HOMA-index decrease after 3 and 6 months of treatment. Other parameters monitored were BMI, progesterone, LH, FSH, total testosterone, free testosterone, androstenedione, total cholesterol, HDL, LDL, triglycerides. RESULTS: Recovery was general, and its relevance was higher when the starting point was further away from the normal range. The most important results were obtained with insulin, HOMA-index, LH, and androstenedione. No significant adverse effects were detected in both groups of patients. CONCLUSIONS: This clinical trial demonstrated for the first time that myo-inositol and alpha-lactalbumin improve important parameters in PCOS patients characterized by different metabolic profiles.
Assuntos
Inositol/uso terapêutico , Lactalbumina/uso terapêutico , Síndrome do Ovário Policístico/tratamento farmacológico , Adolescente , Adulto , Feminino , Humanos , Itália , México , Sobrepeso/tratamento farmacológico , Adulto JovemRESUMO
PURPOSE: Current cancer treatment options include surgical intervention, radiotherapy, and chemotherapy. The quality of the provision of each of them and their effective coordination determines the results in terms of benefit/risk. Regarding the radiation oncology treatments, there are not stabilised quality indicators to be used to perform control and continuous improvement processes for healthcare services. Therefore, the Spanish Society of Radiation Oncology has undertaken a comprehensive project to establish quality indicators for use with the information systems available in most Spanish healthcare services. METHODS: A two-round Delphi study examines consensus of several possible quality indicators (n = 28) in daily practice. These indicators were defined after a bibliographic search and the assessment by radiation oncology specialists (n = 8). They included aspects regarding treatment equipment, patient preparation, treatment, and follow-up processes and were divided in structure, process, and outcome indicators. RESULTS: After the evaluation of the defined quality indicators (n = 28) by an expert panel (38 radiation oncologist), 26 indicators achieved consensus in terms of agreement with the statement. Two quality indicators did not achieve consensus. CONCLUSIONS: There is a high degree of consensus in Spanish Radiation Oncology specialists on which indicators in routine clinical practice can best measure quality. These indicators can be used to classify services based on several parameters (patients, equipments, complexity of the techniques used, and scientific research). Furthermore, these indicators allow assess our current situation and set improvements' objectives.
Assuntos
Garantia da Qualidade dos Cuidados de Saúde/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Radioterapia (Especialidade)/normas , Consenso , Técnica Delphi , Humanos , Neoplasias/radioterapia , Radioterapia (Especialidade)/organização & administração , EspanhaRESUMO
BACKGROUND: Previous studies have not been able to correlate manometry findings with bolus perception. The aim of this study was to evaluate correlation of different variables, including traditional manometric variables (at diagnostic and extreme thresholds), esophageal shortening, bolus transit, automated impedance manometry (AIM) metrics and mood with bolus passage perception in a large cohort of asymptomatic individuals. METHODS: High resolution manometry (HRM) was performed in healthy individuals from nine centers. Perception was evaluated using a 5-point Likert scale. Anxiety was evaluated using Hospitalized Anxiety and Depression scale (HAD). Subgroup analysis was also performed classifying studies into normal, hypotensive, vigorous, and obstructive patterns. KEY RESULTS: One hundred fifteen studies were analyzed (69 using HRM and 46 using high resolution impedance manometry (HRIM); 3.5% swallows in 9.6% of volunteers were perceived. There was no correlation of any of the traditional HRM variables, esophageal shortening, AIM metrics nor bolus transit with perception scores. There was no HRM variable showing difference in perception when comparing normal vs extreme values (percentile 1 or 99). Anxiety but not depression was correlated with perception. Among hypotensive pattern, anxiety was a strong predictor of variance in perception (R2 up to .70). CONCLUSION AND INFERENCES: Bolus perception is less common than abnormal motility among healthy individuals. Neither esophageal motor function nor bolus dynamics evaluated with several techniques seems to explain differences in bolus perception. Different mechanisms seem to be relevant in different manometric patterns. Anxiety is a significant predictor of bolus perception in the context of hypotensive motility.
Assuntos
Ansiedade/psicologia , Transtornos da Motilidade Esofágica/diagnóstico , Manometria/métodos , Percepção , Adolescente , Adulto , Idoso , Esôfago , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVES: High-resolution manometry (HRM) is the preferred method for the evaluation of motility disorders. Recently, an update of the diagnostic criteria (Chicago 3.0) has been published. The aim of this study was to compare the performance criteria of Chicago version 2.0 (CC2.0) vs. 3.0 (CC3.0) in a cohort of healthy volunteers and symptomatic patients. METHODS: HRM studies of asymptomatic and symptomatic individuals from several centers of Spain and Latin America were analyzed using both CC2.0 and CC3.0. The final diagnosis was grouped into hierarchical categories: obstruction (achalasia and gastro-esophageal junction obstruction), major disorders (distal esophageal spasm, absent peristalsis, and jackhammer), minor disorders (failed frequent peristalsis, weak peristalsis with small or large defects, ineffective esophageal motility, fragmented peristalsis, rapid contractile with normal latency and hypertensive peristalsis) and normal. The results were compared using McNemar's and Kappa tests. RESULTS: HRM was analyzed in 107 healthy volunteers (53.3% female; 18-69 years) and 400 symptomatic patients (58.5% female; 18-90 years). In healthy volunteers, using CC2.0 and CC3.0, obstructive disorders were diagnosed in 7.5% and 5.6%, respectively, major disorders in 1% and 2.8%, respectively, minor disorders in 25.2% and 15%, respectively, and normal in 66.4% and 76.6%, respectively. In symptomatic individuals, using CC2.0 and CC3.0, obstructive disorders were diagnosed in 11% and 11.3%, respectively, major disorders in 14% and 14%, respectively, minor disorders in 33.3% and 24.5%, respectively, and normal in 41.8% and 50.3%, respectively. In both groups of individuals, only an increase in normal and a decrease in minor findings using CC3.0 were statistically significant using McNemar's test. DISCUSSIONS: CC3.0 increases the number of normal studies when compared with CC2.0, essentially at the expense of fewer minor disorders, with no significant differences in major or obstructive disorders. As the relevance of minor disorders is questionable, our data suggest that CC3.0 increases the relevance of abnormal results.
Assuntos
Acalasia Esofágica/diagnóstico , Espasmo Esofágico Difuso/diagnóstico , Manometria , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Acalasia Esofágica/classificação , Acalasia Esofágica/fisiopatologia , Doenças do Esôfago/classificação , Doenças do Esôfago/diagnóstico , Doenças do Esôfago/fisiopatologia , Transtornos da Motilidade Esofágica/classificação , Transtornos da Motilidade Esofágica/diagnóstico , Transtornos da Motilidade Esofágica/fisiopatologia , Espasmo Esofágico Difuso/classificação , Espasmo Esofágico Difuso/fisiopatologia , Junção Esofagogástrica/fisiopatologia , Feminino , Voluntários Saudáveis , Humanos , América Latina , Masculino , Pessoa de Meia-Idade , Peristaltismo/fisiologia , Espanha , Adulto JovemRESUMO
OBJECTIVE: To determine the prevalence of Chlamydia, Ureaplasma and Mycoplasma in patients with peritoneal tubal factor infertility and altered. MATERIAL AND METHODS: A descriptive, observational, retrospec- tive, transversal, infertility patients Juarez Hospital of Mexico 2013 to 2015. Study included patients with infertility diagnosis and detection of antibodies (IgG) by ELISA for Chlamydia and vaginal cultures for Mycoplasma and Ureaplasma, hysterosalpingography and histerolapa- roscopia with chromotubation RESULTS: 46 patients with a mean age of 32.5 years. It was found that 36% were positive for these infections (n = 17): Chlamydia in 8.7% (n = 4), Ureaplasma in 21.7% (n = 10) and Mycoplasma in 6.5% (n = 3). Chlamydia patients and bilateral tubal occlusion (OTB) in 5.8% (n = 1), Ureaplasma and OTB (n = 5) were identified in 29.4% of them with pelvic inflammatory disease (PID) and tubal obstruction Ureaplasma right (OTD) in 5.8% (n = 1), Ureaplasma and tubal patency but with loose adhesions in 5.8% (n = 1) and Mycoplasma with OTB in 11.1% (n = 2), p = 0.425. Hysterosalpingography showed a sensitivity of 59% and specificity of 79%. CONCLUSIONS: Although there was no association of variables, Ureaplasma infection was more common in patients with infertility and tubal damage.
Assuntos
Infecções por Chlamydia/epidemiologia , Doenças das Tubas Uterinas/complicações , Infecções por Mycoplasma/epidemiologia , Infecções por Ureaplasma/epidemiologia , Adulto , Infecções por Chlamydia/complicações , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Doenças das Tubas Uterinas/epidemiologia , Feminino , Humanos , Histerossalpingografia , Infertilidade Feminina/etiologia , Infertilidade Feminina/microbiologia , México/epidemiologia , Infecções por Mycoplasma/complicações , Prevalência , Estudos Retrospectivos , Sensibilidade e Especificidade , Infecções por Ureaplasma/complicações , Adulto JovemRESUMO
Measles had practically been eliminated in Granada since the systematic vaccination of children with two doses introduced in 1984. However, in 2009 the disease returned in the form of small outbreaks. This study describes the measles outbreak that occurred in Granada from October 2010 to August 2011 and the measures imposed to control it. Information was sourced from the records of the Andalusian epidemiological surveillance system. A total of 308 cases were recorded, representing an incidence rate of 33.6 cases per 100,000 inhabitants. The first wave of the epidemic took place in Granada city, with the majority of cases occurring among families who lived in the Albaycín neighbourhood and were opposed to vaccination for ideological and/or religious reasons. The initial cases were in unvaccinated children aged 1 to 13 years. The outbreak later spread throughout the province. To control the outbreak, the vaccination schedule for the exposed children was brought up to date. The Regional Ministry of Health decided to take legal action in order to ensure vaccination of those in the initial nucleus of the outbreak.
Assuntos
Surtos de Doenças , Vacina contra Sarampo/administração & dosagem , Sarampo/epidemiologia , Sarampo/prevenção & controle , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Notificação de Doenças , Humanos , Programas de Imunização/organização & administração , Incidência , Lactente , Masculino , Sarampo/diagnóstico , Vigilância da População , Distribuição por Sexo , Espanha/epidemiologia , Vacinação/estatística & dados numéricosAssuntos
Equinococose/diagnóstico , Equinococose/complicações , Humanos , Masculino , Dor/etiologia , Estômago , Adulto JovemRESUMO
En la literatura médica se ha sugerido el uso de aleaciones con un mínimo de 50 por ciento de contenido de oro para minimizar la corrosión en la unión implante-restauración. Sin embargo, las implicaciones clínicas a largo plazo de la colocación de dos metales diferentes en restauraciones sobre implantes es aún desconocido. El objetivo de este estudio es realizar la caracterización electroquímica de cuatro biomateriales metálicos de uso odontológico para determinar la posibilidad de corrosión entre ellos cuando se ponen en contacto durante los procedimientos restauradores sobre implantes. Se realizó un estudio in vitro de tipo descriptivo, prospectivo y comparativo. Se trabajó con cuatro tipos de biomateriales metálicos: titanio comercialmente puro, tomando como muestra un implante SuperCAT® de la casa Lifecore (Lifecore Biomedical Inc., Chaska, MN.); metal altamente noble, con un colado que se realizó a partir de un pilar plástico tipo UCLA® (Lifecore Biomedical Inc., Chaska, MN), con aleación IPS d.sign 91® (Williams, Ivoclar Vivadent AG, Liechtenstein); aleación de metal base con un colado que se realizó a partir de un pilar plástico tipo UCLA® con aleación IPS d.sign 15®, y aleación de titanio (Ti6Al 4V), usando un aditamento protésico tipo COC® de la casa comercial Lifecore. Se hizo la caracterización electroquímica de las cuatro aleaciones metálicas mediante un potenciostato Bas Zãhner, con una celda de tres electrodos, usando como electrodo de referencia el electrodo de Ag/AgCl, obteniendo tres curvas de polarización para cada grupo en su forma pasivada y sin pasivar. La lectura de las curvas potenciodinámicas realizadas en este estudio, con cuatro biomateriales metálicos, y tomando como criterio el potencial de corrosión, concluye un excelente comportamiento para la aleación de titanio y de metales altamente nobles. La mejor combinación, teniendo en cuenta los criterios de potencial de corrosión y corriente a potenciales anódicos, se da con el titanio...
Assuntos
Materiais Biocompatíveis , Corrosão , Implantes Dentários , TitânioRESUMO
UNLABELLED: One out of ten couples seek some kind of treatment for infertility of which males are infertile between 30-50%. Azoospermia has been reported in the range of 10 to 20% of cases. MATERIAL AND METHODS: We reviewed 331 cases seen at the clinic of Reproductive Biology of the Hospital Juárez de México, SSA, from January 1993 through February 2000. 66 patients were found with azoospermia (19.93%). Studies performed were: seminogram, testicular and transrectal ultrasonography, cariotype, deferentovesiculography and testicular biopsy. Radioimmunoassay of gonadotropins (FSH, LH) and testosterone was also practiced. RESULTS: Twelve patients (18.18%) were excluded either for desertion or incompletion of studies. The etiology of azoospermia of remainder 54 cases was: secretory (85.19%) of which 41.3% was idiopathic, 10.9% had germ cells aplasia, 10.9% varichocele, 10.9% Klinefelter syndrome. Secondary secreting azoospermia was found in two cases with Kallman's syndrome one patient had excretory and 7 obstructive azoospermia. CONCLUSIONS: Azoospermia was diagnosed in 19.93% (n = 54) with a mean age of 30 years. 85.19% had primary secretory azoospermia with FSH & LH hypergonadotropism in 85.8 and 56.4% respectively (p < 0.05). Obstructive azoospermia was seen in 12.96% and only one case (1.85%) presented excretory azoospermia.
Assuntos
Infertilidade Masculina/etiologia , Oligospermia/epidemiologia , Oligospermia/etiologia , Adulto , Humanos , Estudos Longitudinais , Masculino , Oligospermia/complicações , Estudos RetrospectivosRESUMO
UNLABELLED: Insulin resistance (IR) is a central metabolic alteration with impact in human reproduction giving rise to hyperandrogenism, infertility, acanthosis, perimenopausal autoimmunity, obesity, hypertension, diabetes and dyslipidemias. Hence the estimation of insulin resistance is of clinical importance and we seeked to evaluate the correlation between two formulas (formula 1: glucose/insulin; formula 2: glucose x insulin/22.5) for its assessment. MATERIAL AND METHODS: Glucose and insulin was measured to 66 females (age 18-66 years) in whom IR was suspected. RESULTS: Mean age of patients was 23.9 +/- SD 10.9 year. IR was detected through the formulas used in 74%; the correlation coefficient (Pearson) was inversely proportional with both formulas (r = -460; p < 0.02). More than 50% of patients with IR had family background of IR, 81% were obese and 74% had a waist-hip index > 0.85 (central obesity or android), 52% hypercholesterolemia, 56% hypertriglyceridemia, 71% inverse relation of HDL/LDL, 45% had infertility, 71% hyperandrogenism, 65% polycystic ovaries and 4% presented diabetes. CONCLUSIONS: Through the use of two arithmetical formulas we determined the presence of IR in 73% of patients studied albeit with proclivity to IR; the correlation between the two formulas was significant. A high association of obesity, infertility, hyperandorogenism and dyslipidemias with IR was also observed.
Assuntos
Resistência à Insulina , Adolescente , Adulto , Glicemia , Feminino , Humanos , Insulina/sangue , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Pituitary adenoma, familiar type, with apparent affection over the involved somatomammotropin of secretion of growth hormone and prolactin, with dominant autosomic transmission, is described for the first time. It was seen that a couple of members without demonstrable tumour, showed clinical data (phenotype) of acromegaly. On investigation of histocompatibility antigens it was observed that the patients with tumour and other symptomatic ones, but without tumour, shared the same haplotypes, and so is very possible that investigation of HLA antigens in patients with pituitary tumour, contributes to better identify its nature and frequency.