RESUMO
The mechanism by which glycoside hydrolases control the reaction specificity through hydrolysis or transglycosylation is a key element embedded in their chemical structures. The determinants of reaction specificity seem to be complex. We looked for structural differences in domain B between the 4-α-glucanotransferase from Thermotoga maritima (TmGTase) and the α-amylase from Thermotoga petrophila (TpAmylase) and found a longer loop in the former that extends towards the active site carrying a W residue at its tip. Based on these differences we constructed the variants W131G and the partial deletion of the loop at residues 120-124/128-131, which showed a 11.6 and 11.4-fold increased hydrolysis/transglycosylation (H/T) ratio relative to WT protein, respectively. These variants had a reduction in the maximum velocity of the transglycosylation reaction, while their affinity for maltose as the acceptor was not substantially affected. Molecular dynamics simulations allow us to rationalize the increase in H/T ratio in terms of the flexibility near the active site and the conformations of the catalytic acid residues and their associated pKas.
Assuntos
Sistema da Enzima Desramificadora do Glicogênio , Thermotoga maritima , Hidrólise , Sistema da Enzima Desramificadora do Glicogênio/metabolismo , alfa-Amilases , Especificidade por SubstratoRESUMO
Resumen Objetivo: Definir la presión arterial normal en el primer trimestre de la gestación según el desempeño para predecir preeclampsia. Método: Estudio de cohorte en embarazos de feto único, según el modelo de riesgos en competencia para preeclampsia. La presión arterial se midió de manera estandarizada entre las 11 y 14 semanas de gestación. Resultados: En 797 embarazos incluidos hubo 40 (5.0%, intervalo de confianza del 95% [IC 95%]: 3.6-6.4) partos con preeclampsia. Las presiones arteriales sistólica, diastólica y media fueron respectivamente de 101 (9), 68 (8) y 79 (8) mmHg en las embarazadas que no desarrollaron preeclampsia, frente a 109 (10), 75 (8) y 86 (8) mmHg en las que sí (p < 0.001, prueba t de Student). Las áreas bajo la curva fueron 0.707 (0.637-0.777), 0.728 (0.661-0.795) y 0.738 (0.673-0.803). A 3% de falsos positivos, los puntos de corte fueron 119, 83 y 94 mmHg con valores predictivos negativos del 95.6%. Conclusiones: Es factible definir normalidad para la presión arterial en el embarazo con base bioestadística y clínica.
Abstract Objective: To define normal blood pressure at first trimester of pregnancy by performance for pre-eclampsia prediction. Method: A cohort study in singleton pregnancies, according to the competing risks model for pre-eclampsia. Blood pressure was measured according to a standardized method at 11 to 14 weeks' gestation. Results: Among 797 pregnancies included, there were 40 (5.0%, IC95 3.6; 6.4) deliveries with pre-eclampsia. The systolic, diastolic, and mean arterial blood pressures were respectively of 101(9), 68(8) and 79(8) mmHg in pregnant women who did not develop pre-eclampsia, against 109(10), 75(8) and 86(8) in those who did (p < 0.001, t-test). The areas under the curves were 0.707 (0.637; 0.777), 0.728 (0.661; 0.795), and 0.738 (0.673; 0.803). At a 3% of false positive rate, the cut-off points were 119, 83 and 94 mmHg with predictive values of negative of 95.6%. Conclusions: It is feasible to define the normal values for blood pressure in pregnancy on biostatistic and clinical basis.
RESUMO
OBJECTIVE: To define normal blood pressure at first trimester of pregnancy by performance for pre-eclampsia prediction. METHOD: A cohort study in singleton pregnancies, according to the competing risks model for pre-eclampsia. Blood pressure was measured according to a standardized method at 11 to 14 weeks' gestation. RESULTS: Among 797 pregnancies included, there were 40 (5.0%, IC95 3.6; 6.4) deliveries with pre-eclampsia. The systolic, diastolic, and mean arterial blood pressures were respectively of 101(9), 68(8) and 79(8) mmHg in pregnant women who did not develop pre-eclampsia, against 109(10), 75(8) and 86(8) in those who did (p < 0.001, t-test). The areas under the curves were 0.707 (0.637; 0.777), 0.728 (0.661; 0.795), and 0.738 (0.673; 0.803). At a 3% of false positive rate, the cut-off points were 119, 83 and 94 mmHg with predictive values of negative of 95.6%. CONCLUSIONS: It is feasible to define the normal values for blood pressure in pregnancy on biostatistic and clinical basis.
OBJETIVO: Definir la presión arterial normal en el primer trimestre de la gestación según el desempeño para predecir preeclampsia. MÉTODO: Estudio de cohorte en embarazos de feto único, según el modelo de riesgos en competencia para preeclampsia. La presión arterial se midió de manera estandarizada entre las 11 y 14 semanas de gestación. RESULTADOS: En 797 embarazos incluidos hubo 40 (5.0%, intervalo de confianza del 95% [IC 95%]: 3.6-6.4) partos con preeclampsia. Las presiones arteriales sistólica, diastólica y media fueron respectivamente de 101 (9), 68 (8) y 79 (8) mmHg en las embarazadas que no desarrollaron preeclampsia, frente a 109 (10), 75 (8) y 86 (8) mmHg en las que sí (p < 0.001, prueba t de Student). Las áreas bajo la curva fueron 0.707 (0.637-0.777), 0.728 (0.661-0.795) y 0.738 (0.673-0.803). A 3% de falsos positivos, los puntos de corte fueron 119, 83 y 94 mmHg con valores predictivos negativos del 95.6%. CONCLUSIONES: Es factible definir normalidad para la presión arterial en el embarazo con base bioestadística y clínica.
Assuntos
Pré-Eclâmpsia , Gravidez , Feminino , Humanos , Pressão Sanguínea , Estudos de Coortes , Pressão Arterial , Primeiro Trimestre da Gravidez , BiomarcadoresRESUMO
INTRODUCTION: Population-specific reference ranges for uterine artery (UtA) mean pulsatility index (PI) throughout pregnancy have been shown to be of value in antenatal care. OBJECTIVE: To construct reference values for UtA mean PI throughout pregnancy, customized by maternal characteristics, transvaginal measurement and blood pressure in a Mexican population. METHODS: Cross-sectional study in 2286 normal singleton pregnancies in Mexico City. Blood pressure and UtA mean PI were measured using standardized methodology. Reference ranges by gestation were constructed. The effects of independent variables were tested by multiple linear regression. RESULTS: UtA mean PI median value between 11 and 41 weeks decreased from 1.714 to 0.523. The 95th percentile decreased from 2.600 to 0.653. Previous parity without preeclampsia had the main effect on UtA mean PI. Mean blood pressure had an effect on UtA mean PI by interaction with parity. Previous preeclampsia had an effect on UtA mean PI by interaction with maternal characteristics. A correction factor was obtained for transvaginal measurement. CONCLUSIONS: UtA mean PI usually decreases according to placentation and maternal adaptation to pregnancy. The effects of parity on blood pressure and UtA mean PI might reflect cardiovascular remodeling after gestation.
INTRODUCCIÓN: Los rangos de referencia de población específica para el índice de pulsatilidad medio de la arteria uterina (IPmAUt) durante el embarazo han demostrado valor en el cuidado prenatal. OBJETIVO: Construir valores de referencia para el IPmAUt durante el embarazo, personalizados por características maternas, medición transvaginal y presión arterial en una población mexicana. MÉTODOS: Estudio transversal de 2286 embarazos normales de feto único en la Ciudad de México. La presión arterial y el IPmAUt se midieron mediante metodología estandarizada. Se construyeron rangos de referencia por gestación. Los efectos de las variables independientes se probaron mediante regresión lineal múltiple. RESULTADOS: La mediana del IPmAUt entre las 11 y 41 semanas disminuyó de 1.714 a 0.523. El percentil 95 disminuyó de 2.600 a 0.653. La paridad sin preeclampsia previa representó el principal efecto sobre el IPmAUt. La presión arterial media tuvo efecto sobre el IPmAUt por interacción con la paridad. La preeclampsia previa tuvo efecto sobre el IPmAUt por interacción con las características maternas. Se obtuvo un factor de corrección para medición transvaginal. CONCLUSIONES: El IPmAUt disminuye normalmente según la placentación y adaptación materna al embarazo. Los efectos de la paridad sobre la presión arterial y el IPmAUt podrían reflejar remodelación cardiovascular posterior a la gestación.
Assuntos
Pré-Eclâmpsia , Artéria Uterina , Pressão Sanguínea , Estudos Transversais , Feminino , Humanos , Paridade , Gravidez , Estudos Prospectivos , Valores de Referência , Ultrassonografia Pré-Natal/métodos , Artéria Uterina/diagnóstico por imagem , Artéria Uterina/fisiologiaRESUMO
Resumen Introducción: Los rangos de referencia de población específica para el índice de pulsatilidad medio de la arteria uterina (IPmAUt) durante el embarazo han demostrado valor en el cuidado prenatal. Objetivo: Construir valores de referencia para el IPmAUt durante el embarazo, personalizados por características maternas, medición transvaginal y presión arterial en una población mexicana. Métodos: Estudio transversal de 2286 embarazos normales de feto único en la Ciudad de México. La presión arterial y el IPmAUt se midieron mediante metodología estandarizada. Se construyeron rangos de referencia por gestación. Los efectos de las variables independientes se probaron mediante regresión lineal múltiple. Resultados: La mediana del IPmAUt entre las 11 y 41 semanas disminuyó de 1.714 a 0.523. El percentil 95 disminuyó de 2.600 a 0.653. La paridad sin preeclampsia previa representó el principal efecto sobre el IPmAUt. La presión arterial media tuvo efecto sobre el IPmAUt por interacción con la paridad. La preeclampsia previa tuvo efecto sobre el IPmAUt por interacción con las características maternas. Se obtuvo un factor de corrección para medición transvaginal. Conclusiones: El IPmAUt disminuye normalmente según la placentación y adaptación materna al embarazo. Los efectos de la paridad sobre la presión arterial y el IPmAUt podrían reflejar remodelación cardiovascular posterior a la gestación.
Abstract Introduction: Population-specific reference ranges for uterine artery (UtA) mean pulsatility index (PI) throughout pregnancy have been shown to be of value in antenatal care. Objective: To construct reference values for UtA mean PI throughout pregnancy, customized by maternal characteristics, transvaginal measurement and blood pressure in a Mexican population. Methods: Cross-sectional study in 2286 normal singleton pregnancies in Mexico City. Blood pressure and UtA mean PI were measured using standardized methodology. Reference ranges by gestation were constructed. The effects of independent variables were tested by multiple linear regression. Results: UtA mean PI median value between 11 and 41 weeks decreased from 1.714 to 0.523. The 95th percentile decreased from 2.600 to 0.653. Previous parity without preeclampsia had the main effect on UtA mean PI. Mean blood pressure had an effect on UtA mean PI by interaction with parity. Previous preeclampsia had an effect on UtA mean PI by interaction with maternal characteristics. A correction factor was obtained for transvaginal measurement. Conclusions: UtA mean PI usually decreases according to placentation and maternal adaptation to pregnancy. The effects of parity on blood pressure and UtA mean PI might reflect cardiovascular remodeling after gestation.
RESUMO
Resumen Objetivo: Determinar la presión arterial (PA) normal en embarazadas en la Ciudad de México. Método: Estudio transversal descriptivo de la PA en embarazos normales de feto único en la Ciudad de México. Las mediciones siguieron un método estandarizado con uso de dispositivos electrónicos automatizados. Se construyeron valores de referencia de las presiones sistólica (PS), diastólica (PD) y arterial media (PAM). Se probaron los efectos de las características maternas y de la gestación sobre la PA. Los intervalos de referencia de la PA se ajustaron para las variables significativas. Resultados: En 1,056 mujeres con edad media de 33 años y 160 cm medios de estatura se realizaron 1,915 mediciones entre las 5 y 41 semanas de edad gestacional (EG) con peso medio de 65 kg. La PA durante el embarazo fue de 102.7/67.2 ± 9.3/7.4 DE mmHg y 79.0 ± 7.4 DE mmHg la PAM. La PA tuvo una relación cuadrática con la EG, la más baja en el segundo trimestre. La PS y la PD mostraron una correlación lineal (r = 0.71). El peso materno tuvo el efecto más significativo sobre PS y PAM; la estatura sobre la PD. La edad, etnia, paridad, consumo de tabaco y antecedente familiar ejercieron efectos diferentes en cada PA. La gestación no tuvo efecto significativo en el modelo multivariado de la PS. Conclusiones: La PA se halló por debajo de la norma convencional en embarazadas. Los criterios diagnósticos para hipertensión en el embarazo deben revisarse; los valores de referencia pueden ajustarse a características maternas y gestacionales.
Abstract Objective: To determine the normal blood pressure (BP) in pregnancy, Mexico City. Methods: A cross-sectional observational study was carried out of BP on singleton normal pregnancies in Mexico City. Measurements followed a standardised methodology using automated electronic devices. Reference values of systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP) were constructed. Maternal and gestation characteristics effects on BP were tested. The reference ranges of BP were adjusted for significant variables. Results: On 1,056 women of 33 years old mean age and 160.0 cm mean height, 1,915 measurements were made between 5 and 41 weeks of gestational age (GA) with 65.0 kg of mean weight. The median BP throughout pregnancy was 102.7/67.2 ± 9.3/7.4 SD mmHg, and 79.0 ± 7.4 SD mmHg the MAP. BP had a quadratic relationship with GA, being the lowest in 2nd trimester. SBP and DBP had a r = 0.71 linear correlation. Maternal weight had the most significant effect on SBP and MAP; height, on DBP. Maternal age, ethnic origin, parity, tobacco habit and family history had differential effects on BP. Gestation had no significant effect on SBP multivariate model. Conclusions: BP resulted lower than conventional standard for pregnant women. Diagnostic criteria for hypertension in pregnancy must be revised; reference values can be adjusted by maternal and gestation characteristics.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Pressão Sanguínea/fisiologia , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão/complicações , Pré-Eclâmpsia/diagnóstico , Valores de Referência , Estudos Transversais , Ganho de Peso na Gestação , MéxicoRESUMO
OBJECTIVE: To determine the normal blood pressure (BP) in pregnancy, Mexico City. METHODS: A cross-sectional observational study was carried out of BP on singleton normal pregnancies in Mexico City. Measurements followed a standardised methodology using automated electronic devices. Reference values of systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP) were constructed. Maternal and gestation characteristics effects on BP were tested. The reference ranges of BP were adjusted for significant variables. RESULTS: On 1,056 women of 33 years old mean age and 160.0 cm mean height, 1,915 measurements were made between 5 and 41 weeks of gestational age (GA) with 65.0 kg of mean weight. The median BP throughout pregnancy was 102.7/67.2 ± 9.3/7.4 SD mmHg, and 79.0 ± 7.4 SD mmHg the MAP. BP had a quadratic relationship with GA, being the lowest in 2nd trimester. SBP and DBP had a r = 0.71 linear correlation. Maternal weight had the most significant effect on SBP and MAP; height, on DBP. Maternal age, ethnic origin, parity, tobacco habit and family history had differential effects on BP. Gestation had no significant effect on SBP multivariate model. CONCLUSIONS: BP resulted lower than conventional standard for pregnant women. Diagnostic criteria for hypertension in pregnancy must be revised; reference values can be adjusted by maternal and gestation characteristics.
OBJETIVO: Determinar la presión arterial (PA) normal en embarazadas en la Ciudad de México. MÉTODO: Estudio transversal descriptivo de la PA en embarazos normales de feto único en la Ciudad de México. Las mediciones siguieron un método estandarizado con uso de dispositivos electrónicos automatizados. Se construyeron valores de referencia de las presiones sistólica (PS), diastólica (PD) y arterial media (PAM). Se probaron los efectos de las características maternas y de la gestación sobre la PA. Los intervalos de referencia de la PA se ajustaron para las variables significativas. RESULTADOS: En 1,056 mujeres con edad media de 33 años y 160 cm medios de estatura se realizaron 1,915 mediciones entre las 5 y 41 semanas de edad gestacional (EG) con peso medio de 65 kg. La PA durante el embarazo fue de 102.7/67.2 ± 9.3/7.4 DE mmHg y 79.0 ± 7.4 DE mmHg la PAM. La PA tuvo una relación cuadrática con la EG, la más baja en el segundo trimestre. La PS y la PD mostraron una correlación lineal (r = 0.71). El peso materno tuvo el efecto más significativo sobre PS y PAM; la estatura sobre la PD. La edad, etnia, paridad, consumo de tabaco y antecedente familiar ejercieron efectos diferentes en cada PA. La gestación no tuvo efecto significativo en el modelo multivariado de la PS. CONCLUSIONES: La PA se halló por debajo de la norma convencional en embarazadas. Los criterios diagnósticos para hipertensión en el embarazo deben revisarse; los valores de referencia pueden ajustarse a características maternas y gestacionales.
Assuntos
Pressão Sanguínea/fisiologia , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão/complicações , Adulto , Estudos Transversais , Feminino , Ganho de Peso na Gestação , Humanos , México , Pré-Eclâmpsia/diagnóstico , Gravidez , Valores de ReferênciaRESUMO
BACKGROUND: No preeclampsia screening test has been validated in our country. OBJECTIVE: To assess the fit and performance of the FMF 4.0 Bayesian algorithm in a Mexican population. METHOD: Cohort study in singleton pregnancies, according to the competing risks model for preeclampsia. A priori risk was calculated based on medical history. Mean blood pressure (MBP), uterine artery mean pulsatility index (UtAmPI) and pregnancy-associated plasma protein A (PAPP-A) were measured at 11-14 weeks of gestation using standardized methodology. The value of each marker was transformed into multiples of the median (MoM) by the originala algorithm and by population-correctionb. Multivariate normal distribution and Bayes theorem were applied to obtain post-test probabilities. RESULTS: There was 5.0% (40/807) of preeclampsia. Distributions in women without preeclampsia were MBP = 0.927a vs. 0.991b, UtAmPI = 0.895a vs. 1.030b and PAPP-A = 0.815a vs. 0.963b (p < 0.001). The AUC was 0.821a vs. 0.823b. For a detection rate of 69 %, cutoff points were 1 in 240a and 1 in 120b, with false positive rates of 31 %a and 29 %b. CONCLUSIONS: The model has to be adjusted to the target population.
ANTECEDENTES: Ninguna prueba de tamiz de preeclampsia ha sido validada en nuestro país. OBJETIVO: Evaluar el ajuste y rendimiento del algoritmo bayesiano FMF 4.0 en una población mexicana. MÉTODO: Estudio de cohorte en embarazos de feto único, según el modelo de riesgos en competencia para preeclampsia. El riesgo a priori se calculó por historia clínica. La presión arterial media (PAM), el índice de pulsatilidad medio de la arteria uterina (IPmAUt) y la proteína plasmática A asociada al embarazo (PAPP-A) se midieron a las 11-14 semanas de gestación con metodología estandarizada. El valor de cada marcador se transformó en múltiplos de la mediana (MoM) por el algoritmo originala y el corregidob a la población. Se aplicaron la distribución normal multivariante y el teorema de Bayes para las probabilidades posprueba. RESULTADOS: Hubo un 5.0% (40/807) de preeclampsia. Las distribuciones sin preeclampsia fueron PAM 0.927a vs. 0.991b, UtAmPI 0.895a vs. 1.030b y PAPP-A 0.815a vs. 0.963b (p < 0.001). El área bajo la curva fue 0.821a vs. 0.823b. Para una detección del 69%, los puntos de corte fueron 1 en 240a y 1 en 120b, a falsos positivos del 31%a y 29%b. CONCLUSIONES: El modelo debe ajustarse a la población diana.
Assuntos
Pré-Eclâmpsia , Teorema de Bayes , Estudos de Coortes , Feminino , Humanos , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/epidemiologia , Gravidez , Primeiro Trimestre da Gravidez , Medição de RiscoRESUMO
The Monterrey Metropolitan Area (MMA) has shown a high concentration of PM2.5 in its atmosphere since 2003. The contribution of possible sources of primary PM2.5 and its precursors is not known. In this paper we present the results of analyzing the chemical composition of sixty 24-hr samples of PM2.5 to determine possible sources of PM2.5 in the MMA. The samples were collected at the northeast and southeast of the MMA between November 22 and December 12, 2007, using low-volume devices. Teflon and quartz filters were used to collect the samples. The concentrations of 16 airborne trace elements were determined using x-ray fluorescence (XRF). Anions and cations were determined using ion chromatography. Organic carbon (OC) and elemental carbon (EC) were determined by thermal optical analysis. The results show that Ca had the maximum mean concentration of all elements studied, followed by S. Enrichment factors above 50 were calculated for S, Cl, Cu, Zn, Br and Pb. This indicates that these elements may come from anthropogenic sources. Overall, the major average components of PM2.5 were OC (41.7%), SO4(2-) (22.9%), EC (7.4%), crustal material (11.4%), and NO3- (12.6%), which altogether accounted for 96% of the mass. Statistically, we did not find any difference in SO4(2-) concentrations between the two sites. The fraction of secondary organic carbon was between 24% and 34%. The results of the factor analysis performed over 10 metals and OC and EC show that there are three main sources of PM2.5: crustal material and vehicle exhaust; industrial activity; and fuel oil burning. The results show that SO4(2-), OC, and crustal material are important components of PM2.5 in MMA. Further work is necessary to evaluate the proportion of secondary inorganic and organic aerosol in order to have a better understanding of the sources and precursors of aerosols in the MMA.
Assuntos
Material Particulado/análise , Poluentes Atmosféricos/análise , Algoritmos , Carbono/análise , Monitoramento Ambiental/métodos , Análise Fatorial , México , Tamanho da Partícula , Emissões de Veículos/análiseRESUMO
The objective of this study was to obtain an estimate for seroprevalences of Theileria equi (Babesia equi) and Babesia caballi in horses from northeastern Mexico. Sera were collected in spring of 2007 in 248 clinically healthy horses used for different purposes. Antibodies were detected by the indirect immunofluorecent technique. The overall seroprevalence was 61.7% and those for T. equi and B. caballi were 45.2% and 27.4%, respectively. Horse purpose, sex, and age group were not associated with infection with Theileria equi or Babesia caballi.
Assuntos
Anticorpos Antiprotozoários/sangue , Babesia/imunologia , Babesiose/veterinária , Doenças dos Cavalos/epidemiologia , Theileria/imunologia , Theileriose/epidemiologia , Distribuição por Idade , Animais , Babesiose/epidemiologia , Distribuição de Qui-Quadrado , Intervalos de Confiança , Feminino , Técnica Indireta de Fluorescência para Anticorpo/veterinária , Doenças dos Cavalos/parasitologia , Cavalos , Masculino , México/epidemiologia , Fatores de Risco , Sensibilidade e Especificidade , Estudos Soroepidemiológicos , Distribuição por SexoRESUMO
CONTEXT: In March 2009, novel 2009 influenza A(H1N1) was first reported in the southwestern United States and Mexico. The population and health care system in Mexico City experienced the first and greatest early burden of critical illness. OBJECTIVE: To describe baseline characteristics, treatment, and outcomes of consecutive critically ill patients in Mexico hospitals that treated the majority of such patients with confirmed, probable, or suspected 2009 influenza A(H1N1). DESIGN, SETTING, AND PATIENTS: Observational study of 58 critically ill patients with 2009 influenza A(H1N1) at 6 hospitals between March 24 and June 1, 2009. Demographic data, symptoms, comorbid conditions, illness progression, treatments, and clinical outcomes were collected using a piloted case report form. MAIN OUTCOME MEASURES: The primary outcome measure was mortality. Secondary outcomes included rate of 2009 influenza (A)H1N1-related critical illness and mechanical ventilation as well as intensive care unit (ICU) and hospital length of stay. RESULTS: Critical illness occurred in 58 of 899 patients (6.5%) admitted to the hospital with confirmed, probable, or suspected 2009 influenza (A)H1N1. Patients were young (median, 44.0 [range, 10-83] years); all presented with fever and all but 1 with respiratory symptoms. Few patients had comorbid respiratory disorders, but 21 (36%) were obese. Time from hospital to ICU admission was short (median, 1 day [interquartile range {IQR}, 0-3 days]), and all patients but 2 received mechanical ventilation for severe acute respiratory distress syndrome and refractory hypoxemia (median day 1 ratio of Pao(2) to fraction of inspired oxygen, 83 [IQR, 59-145] mm Hg). By 60 days, 24 patients had died (41.4%; 95% confidence interval, 28.9%-55.0%). Patients who died had greater initial severity of illness, worse hypoxemia, higher creatine kinase levels, higher creatinine levels, and ongoing organ dysfunction. After adjusting for a reduced opportunity of patients dying early to receive neuraminidase inhibitors, neuraminidase inhibitor treatment (vs no treatment) was associated with improved survival (odds ratio, 8.5; 95% confidence interval, 1.2-62.8). CONCLUSION: Critical illness from 2009 influenza A(H1N1) in Mexico occurred in young individuals, was associated with severe acute respiratory distress syndrome and shock, and had a high case-fatality rate.
Assuntos
Vírus da Influenza A Subtipo H1N1 , Influenza Humana , APACHE , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Criança , Estado Terminal , Feminino , Hospitalização , Humanos , Hipóxia , Influenza Humana/complicações , Influenza Humana/diagnóstico , Influenza Humana/mortalidade , Influenza Humana/terapia , Estimativa de Kaplan-Meier , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Neuraminidase/antagonistas & inibidores , Respiração Artificial , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/mortalidade , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Digestive cancer is an important mortality cause in Mexico. In the past decades a change in the frequency of digestive malignancies has been observed. AIM: To evaluate the frequency of digestive malignancies in four hospitals in México City during a 25 years period. PATIENTS AND METHODS: All digestive cancers were studied at the following hospitals: Hospital General de México (HGM), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirdn (INCMNSZ), Centro Médico Nacional 20 de Noviembre (CMN20Nov) and Hospital Español (HE). The diagnosis was established by histopathology study. Cases frequency is were compared in three-years intervals. RESULTS: 8,879 digestive cancers were documented. Gastric cancer frequency decreased during the study period at HGM (59% in 1978 to 38% in 2003) and at INCMNSZ (32% in 1978 to 24% in 2003), p = 0.013 andp = 0.012 respectively. Colon cancer frequency increased significantly at HGM (15% in 1978 to 36% in 2003, p < 0.001) and at CMN20Nov (20% in 1981 to 51% in 2003, p < 0.01) and at INCMNSZ with tower significancy. A change in squamous esophageal cancer (SC) and esophageal adenocarcinoma (EA) frequencies was observed in at the INCMNSZ, with a SC:EA ratio of 7:1 between 1977 to 1987and 1:2 between 1988 to 2005. Alimentary habits questionnaries showed early during the study diferences in caloric intake between the four hospitals (mean HGM: 2,169 kcal, INCMNSZ: 2,195 kcal, CMN2O0Nov: 3,133 y 2,262 kcal HE) and in animal protein intake, being lower at HGM (9.3 g/day) and IN-CMNSZ (11.8 g/day) compared with CMN2ONov (45.6 g/day) and HE (63.4 g/day), in the next questionnary these differences dissapeared and there was an increase in both, the same was observed for lipid intake. CONCLUSIONS: We observed a reduction in gastric cancer fre quency and an increase in colon cancer in 25 years, probably associated to a change in habits dietary. Also a change in the main histological type of esophageal cancer was observed, initially epidermoid cancer was the most frequent and in the last 10 years adenocarcinoma is the most frequent.
Assuntos
Neoplasias Gastrointestinais/epidemiologia , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Neoplasias do Colo/epidemiologia , Neoplasias do Colo/patologia , Dieta , Ingestão de Alimentos , Neoplasias Esofágicas/epidemiologia , Neoplasias Esofágicas/patologia , Comportamento Alimentar , Neoplasias Gastrointestinais/patologia , Humanos , México/epidemiologia , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/patologiaRESUMO
In the performance of a transvascular liver biopsy, the Trucut-type transjugular liver biopsy set is advance over a multipurpose catheter place in the suprahepatic vein. Occasionally there is a sharp bend between the suprahepatic veins and the inferior vein cava and the multipurpose catheter does not provide sufficient support to track the biopsy access set. To deal with this problem we describe the use of a stiff guidewire for an easy introduction of the biopsy set.
Assuntos
Biópsia por Agulha/instrumentação , Veias Hepáticas , Veias Jugulares , Fígado/patologia , Biópsia por Agulha/métodos , Desenho de Equipamento , Segurança de Equipamentos , Humanos , Hepatopatias/diagnóstico , Agulhas , SegurançaRESUMO
There is always a second infection with HCV during the post-transplant period. Recurrence of the disease is one of the main present therapeutic challenges because there are still many questions to answer. Some transplant groups suggest that recurrence is earlier in certain circumstances, especially in face of repetitive episodes of acute rejection in the early post-transplant period. Different transplant centers have various approaches to minimize the risk of recurrence secondary to excessive immunosuppression. They go from absolute avoidance of steroids to single therapy with inhibitors of calcineurin. Some investigators advocate for a fast reduction in the dose of corticosteroids (in less than 3 months), elimination of steroids from the therapy or administration of a single steroid dose in the immediate post-transplant period. Some are trying to establish a regime based on a single inhibitor of calcineurin and supported with mofetil micofenolate if it's effective. There are other inhibitors being studied, like anti-CD25 antibodies. The goals of the treatment for HCV recurrence must be aimed at obtaining an effective therapy that may be able to prevent the damage and to inhibit the viral replication and subsequent inflammation on long term basis. Recently there have been reports about different schemes with IFN and ribavirin, either as single therapy or in combination, that showed modest advances in early viral elimination and delaying the recurrence of the disease. One of the risks of therapy with interferon that has immunomodulation properties, is organ rejection. Ribavirin administration as single therapy is contraindicated. There are still some unanswered questions, since nobody knows for sure how long therapy for HCV should be continued.