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Resumen La alineación de ADN es un proceso clave para la reconstrucción de genomas, a partir de los millones de lecturas cortas producidas por las máquinas de secuenciación paralela masiva. Tal proceso suele realizarse mediante algoritmos con elevada complejidad espacial y temporal, requiriendo varias horas para entregar los resultados, así como decenas de GB de RAM. Esto ha motivado la búsqueda de nuevos algoritmos y/o estrategias que permitan disminuir los tiempos de ejecución, mientras se utilizan recursos mínimos de memoria. En este artículo se presenta ABPSE, un nuevo alineador de ADN que combina el algoritmo de Ferragina y Manzini (o índices de FM) y el algoritmo de Myers, mediante la estrategia siembra y extiende. En la siembra, los índices de FM permiten calcular de manera rápida regiones con alta probabilidad de alineación; mientras que en la extensión, el algoritmo de Myers refina la alineación utilizando operaciones basadas en vectores de bits, calculando simultáneamente varias celdas de la matriz de programación dinámica. Los resultados muestran un 96.1% de lecturas alineadas correctamente, un factor de aceleración de 2.45x en relación a BWA-SW y un uso de memoria de apenas 7.6 GB, cuando se alinea el genoma humano completo.
Abstract DNA alignment is a key process in the assembly of genomes from the millions of short reads that are produced by massive parallel sequencing machines. Such a process is usually done by means of high spatial and temporal complexity algorithms, which takes hours to deliver the results as well as tens of GB of RAM. This has prompted the search for new algorithms and/or strategies that allow shorter runtimes, while using minimal memory footprint. In this article, we present ABPSE, a new DNA aligner that combines the Ferragina and Manzini algorithm (or FM indexes) and the Myers algorithm, by means of the seed and extend strategy. In the seeding, the FM indices allow a rapid calculation of the regions with high probability of alignment. In the extension, the Myers algorithm refines the alignment using operations based on bit vectors. It simultaneously calculates several cells of the dynamic programming matrix. The results show 96.1% of correctly aligned reads, an acceleration factor of 2.45x in relation to BWA-SW and a memory footprint of only 7.6 GB when aligning the entire human genome.
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INTRODUCTION: The risk of falls in older adults increases because of the decrease in strength, flexibility, balance and sensory changes affecting functionality and quality of life. For this reason, an integral system of evaluation of equilibrium is necessary, for preventive purposes or for early therapeutic interventions. AIM: To present the results of the transcultural translation and adaptation process of the Balance Evaluation Systems Test (BESTest) to Spanish language. SUBJECTS AND METHODS: The original version of the BESTest was translated into Spanish, following the process of retro-traduction and cultural adaptation considering the semantic, idiomatic, conceptual and experiential equivalences. Subsequently the version was reviewed by a panel of experts qualifying clarity, coherence, relevance and sufficiency. The pilot test included 32 adults between 50 and 80 years old. RESULTS: It was possible to carry out the complete translation of the instrument, the instructions for the subject and for the evaluator. Most items of the test reached the maximum score of 4.0 (100%), nine items achieved an average score of 3.9 (99%), one item got an average score of 3.8 (95%) and two items achieved an average score of 3.7 (92.5%). CONCLUSIONS: With this study the Spanish speakers community has a pertinent sufficient, coherent and clear instrument in order to identify the control postural system altered to focus treatment and to get better functional outcomes from balance evaluation in older adults.
TITLE: Adaptacion transcultural al castellano del sistema de evaluacion del equilibrio (BESTest) en adultos mayores.Introduccion. El riesgo de caidas en adultos mayores se incrementa a consecuencia de la disminucion de la fuerza, la flexibilidad, el equilibrio y los cambios sensoriales, que afectan a la funcionalidad y la calidad de vida. Por tal razon se hace necesario un sistema integral de evaluacion del equilibrio con fines preventivos o para intervenciones terapeuticas tempranas. Objetivo. Presentar los resultados del proceso de traduccion y adaptacion transcultural del sistema de evaluacion del equilibrio (BESTest) al castellano. Sujetos y metodos. Se tradujo al castellano la version original del BESTest, siguiendo el proceso de retrotraduccion y adaptacion cultural y teniendo en cuenta las equivalencias semanticas, idiomaticas, conceptual y experiencial. Posteriormente, la version fue revisada por un panel de expertos que califico la claridad, la coherencia, la pertinencia y la suficiencia. En la prueba piloto participaron 32 adultos de 50-80 años. Resultados. Se realizo la traduccion completa del instrumento y de las instrucciones para el sujeto y para el evaluador. La mayoria de items de la prueba alcanzaron la puntuacion maxima de 4 (100%), nueve items lograron una calificacion media de 3,9 (99%); un item, una calificacion media de 3,8 (95%), y dos items, una calificacion media de 3,7 (92,5%). Conclusiones. Con este estudio, la comunidad de habla hispana cuenta con un instrumento pertinente, suficiente, coherente y claro para identificar el sistema del equilibrio afectado, enfocar el tratamiento y obtener mejores resultados funcionales a partir de la evaluacion del equilibrio en adultos mayores.
Assuntos
Características Culturais , Avaliação Geriátrica/métodos , Equilíbrio Postural , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Projetos Piloto , TraduçõesRESUMO
El pH es el grado de acidez de una solución. En cavidad bucal, el pH define diferentes sucesos tanto bioquímicos como microbiológicos, entre los factores que ejercen influencia en todos estos eventos intrabucales encontramos: 1) capacidad buffer salival, la saliva no estimulada es de pH ligeramente ácido, la saliva estimulada posee pH básico. 2) carbohidratos exógenos. 3) bacterias acidógenas de la biopelícula dental, las cuales coexisten en microambientes altamente organizados, pudiendo metabolizar rápidamente ciertos azúcares a glucanos y productos finales ácidos. 4) agentes químicos, tales como hidróxido de calcio, el cual libera iones hidroxilos al medio, alcalinizándolo y haciéndolo no viable para el metabolismo bacteriano; clorhexidina, antiséptico de gran sustantividad, activo en bacterias Gram positivas y Gram negativas; fluoruros, que exhiben capacidad de inhibición metabólica, mecanismo antiadherente, producción de cambios en la carga superficial del diente. 5) azúcares alcoholes edulcorantes (xilitol), presenta la propiedad de retardar el flujo metabólico de ciertas bacterias cariogénicas.
pH is the acidity of a solution. In oral cavity, pH defines different events both biochemical and microbiological, factors that influence these intraoral events are: 1) salivary buffer capacity, unstimulated saliva is slightly acidic, stimulated saliva has basic pH. 2) exogenous carbohydrates. 3) acidogenic bacteria of dental biofilm , which coexist in highly organized microenvironments , can rapidly metabolize some sugars to glucans and acidic end products . 4) chemical agents, such as calcium hydroxide , which releases hydroxyl ions to the medium, and makes it non viable for bacterial metabolism; chlorhexidine antiseptic with high substantivity , active in Gram positive and Gram negative bacteria; fluorides exhibit metabolic inhibition capacity, antiadherent mechanism, production of changes in the surface charge of the tooth. 5) Sweeteners sugar alcohols (xylitol), has the property of retarding certain metabolic flux of cariogenic bacteria.
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Humanos , Masculino , Feminino , Biofilmes/crescimento & desenvolvimento , Boca/anatomia & histologia , Concentração de Íons de Hidrogênio , OdontologiaRESUMO
El síndrome de Boca Ardiente (SBA) se caracteriza por ardor, picor, escozor y dolor bucal sin causa orgánica que lo justifique. La boca ardiente aún es un desafío en el campo de la medicina. Su etiología es desconocida, a pesar de que diversos estudios indican que intervienen una serie de factores locales, sistémicos y psicológicos que se consideran como posibles agentes causales. La saliva puede desempeñar un papel importante en la sintomatología del ardor bucal, presenta propiedades físicas y químicas (reológicas) que determinan funciones imprescindibles para el equilibrio de la cavidad bucal. En pacientes con boca ardiente hay cambios en la composición y tasa del flujo salival relacionados con boca seca, viscosidad, ardor bucal, humedad entre otros. En esta revisión se trata de actualizar varios aspectos que relacionan las distintas causas del síndrome de boca ardiente con la saliva y sus alteraciones como uno de los factores más importantes en la etiología del ardor bucal. Estudios recientes sugieren que el ácido alfa lipoico combinado con gabapentina es un tratamiento efectivo para este síndrome
Burning mouth syndrome is characterized by burning, smarting and oral pain without any organic cause justifying it. Burning mouth is still a challenge in medical field. It has an unknown aetiology; despite many studies indicate the involvement of local, systemic and psychological factors that can be considered possible causal agents. Saliva can perform an important role in oral smarting symptomatology, shows physico-chemical properties (rheological) determining vital functions for oral cavity equilibrium. There are changes in composition and salivary flow rate of burning mouth patients, related with dry mouth, viscosity, oral smarting, and humidity, among others. This review pretends to update many aspects that relate different causes of burning mouth syndrome with saliva and its alterations as one of the most important factors in the aetiology of oral smarting. Recent studies suggest that alpha lipoic acid combined with gabapentin is an effective treatment for this syndrome
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Feminino , Glossalgia/etiologia , Saliva/química , Síndrome da Ardência Bucal/etiologia , Doenças da BocaRESUMO
Los virus del papiloma humano (VPH), son virus ADN de doble cadena helicoidal, epiteliotrópicos que producen lesiones verrugosas en piel y mucosas. Algunas evidencias indican que ciertos tipos específicos de estos virus son necesarios pero no totalmente suficientes para ocasionar la transformación maligna, debido a que requieren algunas acciones sinérgicas de otros eventos iniciadores. Existen más de 230 tipos de VPH, 118 tipos están bien caracterizados, más de 40 tipos anogenitales, de los cuales 15 de ellos son oncogénicos; y en humanos constituyen uno de los grupos virales más frecuentes que infectan el epitelio de piel y mucosas: conjuntivas, cavidad bucal, laringe, árbol traqueobronquial, esófago, vejiga, ano y tracto genital. El examen clínico de la boca y sus anexos, constituye el paso inicial para la detección de una infección por este virus. El examen histológico revela el cambio morfológico y patognomónico más relevante de la infección por VPH, las células coilocíticas; las técnicas moleculares, como la Reacción en Cadena de la Polimerasa, la Hibridación in situ, entre otras, están basadas en la detección del genoma del virus. El VPH puede asociarse a distintos agentes físicos y químicos que promueven el desarrollo del carcinoma bucal, siendo los tipos (16, 18, 31, 32, 33 y 35) potencialmente oncogénicos. Esta revisión se propone analizar los diferentes tipos de VPH asociados con lesiones malignas de la cavidad bucal
Human papillomaviruses (HPV) are epitheliotropic and double-helix stranded DNA viruses, which produce warty lesions in mucosae and skin. A bigger amount of evidence suggests that specific types of viruses are necessary but not enough to produce the malignant transformation, also it´s necessary the synergistic action of other indicators. There are more than 230 types of HPV, 118 types are well characterized, more than 40 types anus genital, 15 of them have an oncogenic potential; in humans constitutes one of the most frequent viral groups infecting skin epithelium and mucosae: conjunctives, oral cavity, tracheo-bronchial tree, esophagus, bladder, anus and genital tract. Clinical exam of the mouth and its annexes constitutes the initial step for the detection of an infection by this virus. Histological exam reveals morphological and pathognomonic most relevant changes of HPV infection, koilocytes; molecular techniques such as Polimerase Chain Reaction, in situ hybridization, among others, are based in the detection of virus genome. HPV can act with different types of physical and chemical agents that promote the development of oral carcinoma being (16, 18, 31, 32, 33 y 35) HPV´s potentially oncogenic. This review analyzes the different types of HPV associated with malignant lesions of oral cavity
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Humanos , Doenças Transmissíveis , Infecções por Papillomavirus/etiologia , Neoplasias Bucais/etiologia , Assistência OdontológicaRESUMO
The aim of this paper was to develop a thermoluminescent dosimetry method for the absorbed dose determination of 6 MeV high-energy electron beams by thermoluminescent dosimetry. Total body irradiation (TBI) was performed using four dual fields angled at 252° and 285° in high-dose rate (HDR) mode. TBI measurements were investigated to estimate the absorbed dose in different anatomical parts of the patient. Experimental results were obtained using thermoluminescent detectors and solid water phantoms. The TL response of the dosimeters, as a function of the high-energy electron beam (HEEB) absorbed dose, was linear, from 0.1 to 500 cGy. The entrance skin dose (ESD) and isodose distribution on the surface of the treatment were investigated graphically.
Assuntos
Dosimetria Termoluminescente/métodos , Irradiação Corporal Total/métodos , Elétrons/uso terapêutico , Humanos , Micose Fungoide/radioterapia , Imagens de Fantasmas , Dosagem RadioterapêuticaRESUMO
BACKGROUND: In a variety of dystonias, functional magnetic resonance imaging has shown deviations of cortical and basal ganglia activations within the motor network, which might cause the movement disturbances. Because these investigations have never been performed in secondary dystonia due to Pantothenate-Kinase Associated Neurodegeneration, we report our results in a small group of such patients from the Dominican Republic. METHODS: Functional magnetic resonance imaging was carried out in 7 patients with a genetically confirmed mutation of the PANK2 gene and a non-affected control group (matched pairs) using an event-related motor activation paradigm (hand movements). RESULTS: Compared to the control group (p ≤ 0.01), patients showed a larger amount of activated voxels starting in the contralateral cerebellum and contralateral premotor cortex 2 s before the actual hand movement. Whereas these "hyperactivations" gradually diminished over time, activations in the contralateral primary motor cortex and the supplementary motor area peaked during the next second and those of the contralateral putamen at the time of the actual hand movement. In a multiple regression analysis, all these areas correlated positively with the degree of dystonia of the contralateral arm as judged by the Burke-Fahn-Marsden-scale (p ≤ 0.001). CONCLUSION: As in other forms of dystonia, the increased activations of the motor system found in our patients could be related to the origin of the dystonic movements. Because in this condition the primary lesion affects the pallidum, a defect of the feed-back control mechanism between basal ganglia and cortex might be the responsible factor.
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Cerebelo/irrigação sanguínea , Imageamento por Ressonância Magnética , Córtex Motor/irrigação sanguínea , Movimento/fisiologia , Neurodegeneração Associada a Pantotenato-Quinase/patologia , Neurodegeneração Associada a Pantotenato-Quinase/fisiopatologia , Adolescente , Mapeamento Encefálico , Estudos de Casos e Controles , Cerebelo/fisiopatologia , Feminino , Mãos/fisiopatologia , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Córtex Motor/fisiopatologia , Oxigênio/sangue , Adulto JovemRESUMO
The assessment of shunt reduction after an embolization of an arteriovenous malformation (AVM) or fistula (AVF) from conventional angiography is often difficult and may be subjective. Here we present a completely non-invasive method using magnetic resonance imaging (MRI) to measure shunt reduction. Using pulsed arterial spin labeling (PASL), we determined the relative amount of signal attributed to the shunt over 1.75 s and 6 different slices covering the lesion. This amount of signal from the shunt was related to the total signal from all slices and measured before and after embolization. The method showed a fair agreement between the PASL results and the judgement from conventional angiography. In the case of a total or subtotal shunt occlusion, PASL showed a shunt reduction between 69% and 92%, whereas in minimal shunt reduction as judged by conventional angiography, the ASL result was -6% (indicating slightly increased flow) to 35% in a partially occluded vein of Galen aneurysm. The PASL method proved to be fairly reproducible (up to 2% deviation between three measurements without interventions). On conclusion, PASL is able to reliably measure the amount of shunt reduction achieved by embolization of AVMs and AVFs.
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Circulação Cerebrovascular/fisiologia , Embolização Terapêutica , Malformações Arteriovenosas Intracranianas/patologia , Malformações Arteriovenosas Intracranianas/terapia , Angiografia por Ressonância Magnética/métodos , Marcadores de Spin , Adulto , Humanos , Malformações Arteriovenosas Intracranianas/fisiopatologia , Angiografia por Ressonância Magnética/normas , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Resultado do TratamentoRESUMO
A large proportion of cardiovascular diseases might be preventable, however, majority of this diseases occurs in rural areas where there is a poor presence of cardiologists. To overcome this issue, the use of wearable devices within the telemedicine framework would be of benefit. However, implementation of processing algorithms in smart-phones at mobile environments imposes restrictions ensuring high measurement quality of acquired ECG data, while maintaining low computation burden. This work presents an algorithm for scoring the quality of measured ECG recordings is developed. Particularly, a quality score is provided that takes into account the proportional correlation observed in acceptable signals based on a diversity scheme, and their inverse relation with standard deviation. Testing of proposed algorithm is carried out upon two different databases, the first one is of own production, while the second one is obtained from Physionet. As a result, high values of sensitivity and specificity are achieved.
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Algoritmos , Arritmias Cardíacas/diagnóstico , Diagnóstico por Computador/métodos , Eletrocardiografia/métodos , Humanos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatística como AssuntoRESUMO
The aim of this study was to compare in vitro survival rates of in vivo and in vitro -produced bovine embryos by slow freezing or solid surface v itrification. In vivo -produced blastocysts (n = 210) and in vitro - produced blastocysts (n = 445) were randomly allocated in two cryopreservation groups. Group 1 - embryos were exposed to 1.5 M ethylene glycol (EG) for 5 min, loaded in 0.5 ml straws, frozen at -6.5ºC and seeded. After 10 min of equilibration, straws were cooled at -0.6ºC/min until - 35ºC, and then plunged into liquid nitrogen (-196ºC). Group 2 - embryos were exposed to a 15% EG + 0.25 M trehalose solution for 1 min and then a 30% EG + 1 M trehalose solution for 30 sec to be vitrified using the Cryologic Vitrification Method (CVM ® ). After at least one week of storage, embryos in the slow freezing group were thawed in a wate r bath at 30°C for 12 sec and then placed in holding medium for 5 min and transferred into SOF culture media. Vitrified embryos were placed directly into a 0.25 M sucrose solution for 5 min then cultured in SOF medium. Re-expansion and hatching rates were evaluated at 24 and 72 h, respectively. In vivo -produced embryos had higher (P < 0.01) re-expansion (179/210, 81% vs . 244/445, 54%) and hatching rates (159/210, 72% vs . 177/445, 39%) than in vitro -produced embryos, regardless of the cryopreservation method. However, re-expansion and hatching rates were higher (P < 0.01) for in vitro -produced vitrified embryos (155/223, 69% and 132/223, 59%) than in vitro -produced embryos cryopreserved by slow freezing (89/222, 40% a nd 45/222, 20%). Although similar re-expansion rates were obtained with in vivo - produced embryos cryopreserved by the two systems, hatching rates tended to be lower (P = 0.09) with in vivo -produced embryos that were vitrified as compared to slow freezing. In conclusion, solid surface vitrification improved the cryosurvival rates of in vitro - produced embryos compared to the conventional slow freezing procedure.
Assuntos
Animais , Preservação do Sêmen/veterinária , Sacarose/análise , Bovinos/classificaçãoRESUMO
The aim of this study was to compare in vitro survival rates of in vivo and in vitro -produced bovine embryos by slow freezing or solid surface v itrification. In vivo -produced blastocysts (n = 210) and in vitro - produced blastocysts (n = 445) were randomly allocated in two cryopreservation groups. Group 1 - embryos were exposed to 1.5 M ethylene glycol (EG) for 5 min, loaded in 0.5 ml straws, frozen at -6.5ºC and seeded. After 10 min of equilibration, straws were cooled at -0.6ºC/min until - 35ºC, and then plunged into liquid nitrogen (-196ºC). Group 2 - embryos were exposed to a 15% EG + 0.25 M trehalose solution for 1 min and then a 30% EG + 1 M trehalose solution for 30 sec to be vitrified using the Cryologic Vitrification Method (CVM ® ). After at least one week of storage, embryos in the slow freezing group were thawed in a wate r bath at 30°C for 12 sec and then placed in holding medium for 5 min and transferred into SOF culture media. Vitrified embryos were placed directly into a 0.25 M sucrose solution for 5 min then cultured in SOF medium. Re-expansion and hatching rates were evaluated at 24 and 72 h, respectively. In vivo -produced embryos had higher (P < 0.01) re-expansion (179/210, 81% vs . 244/445, 54%) and hatching rates (159/210, 72% vs . 177/445, 39%) than in vitro -produced embryos, regardless of the cryopreservation method. However, re-expansion and hatching rates were higher (P < 0.01) for in vitro -produced vitrified embryos (155/223, 69% and 132/223, 59%) than in vitro -produced embryos cryopreserved by slow freezing (89/222, 40% a nd 45/222, 20%). Although similar re-expansion rates were obtained with in vivo - produced embryos cryopreserved by the two systems, hatching rates tended to be lower (P = 0.09) with in vivo -produced embryos that were vitrified as compared to slow freezing. In conclusion, solid surface vitrification improved the cryosurvival rates of in vitro - produced embryos compared to the conventional slow freezing procedure.(AU)
Assuntos
Animais , Sacarose/análise , Preservação do Sêmen/veterinária , Bovinos/classificaçãoAssuntos
Humanos , Masculino , Pessoa de Meia-Idade , Diafragma/anatomia & histologia , Eletrocardiografia Ambulatorial/métodos , Soluço/classificação , Soluço/patologia , Soluço/terapia , Nervo Frênico/lesões , Nervo Vago/anatomia & histologia , Palpação/efeitos adversos , Estômago/lesões , Glote/fisiologia , Anamnese , Refluxo Gastroesofágico/etiologiaRESUMO
A thermoluminescence dosimetry (TLD) system was characterised at SSDL-ININ to verify the air-kerma strength (S(K)) and dose-to-water (D(W)) values for (137)Cs sources used in low dose rate (LDR) brachytherapy treatments at the Hospital General de Mexico (HGM). It consists of a Harshaw 3500 reader and a set of TLD-100 powder capsules. The samples of TLD-100 powder were calibrated in terms of D(W) vs. nC or nC mg(-1), and their dose response curves were corrected for supralinearity. The D(W) was calculated using the AAPM TG-43 formalism using S(K) for a CDCSM4 (137)Cs reference source. The S(K) value was obtained by using a NE 2611 chamber, and with two well chambers. The angular anisotropy factor was measured with the NE 2611 chamber for this source. The HGM irradiated TLD-100 powder capsules to a reference dose D(W) of 2 Gy with their (137)Cs sources. The percent deviations between the imparted and reference doses were 1.2% < or = Delta < or = 6.5%, which are consistent with the combined uncertainties: 5.6% < or = u(c) < or = 9.8% for D(W).
Assuntos
Braquiterapia/normas , Radioisótopos de Césio/análise , Radioisótopos de Césio/uso terapêutico , Dosimetria Termoluminescente/métodos , Dosimetria Termoluminescente/normas , Água , Carga Corporal (Radioterapia) , Braquiterapia/métodos , México , Dosagem Radioterapêutica , Valores de Referência , Eficiência Biológica RelativaRESUMO
Syringomyelia associated with posterior fossa tumours is a very infrequent combination of pathological entities. The few cases which have been reported generally were asymptomatic in respect of the spinal cavitations. The authors report on a 36-year-old woman with a large extradural posterior fossa epidermoid tumour with a concomitant holocord symptomatic syringomyelia. Some of her symptoms were clearly attributed to the intraspinal cavitation. The lesions were both diagnosed by magnetic resonance imaging (MR). The patient did well after surgery of the brain lesion, with an objective improvement in her neurological status and a complete resolution of the syrinx documented by the MR 7 months after tumour removal. Syringomyelia in this case could be explained by blockage of the cerebrospinal fluid (CSF) circulation at the foramen magnum which in turn resulted in cranio-spinal pressure dissociation. This led to an accumulation of extracellular fluid (ECF) in the central canal, starting cavitation. Consequently, the syrinx was slowly expanded by the long-standing "slosh" effect of the systolic pressure waves. However, also via a distortion mechanism within the posterior fossa a pathologically plugged obex could have contributed to syrinx formation by means of preventing drainage of fluid from the ventricular CSF system.
Assuntos
Neoplasias Infratentoriais/complicações , Neoplasias Infratentoriais/cirurgia , Siringomielia/etiologia , Adulto , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/etiologia , Pressão do Líquido Cefalorraquidiano , Feminino , Humanos , Imageamento por Ressonância Magnética , Siringomielia/patologia , Resultado do TratamentoRESUMO
Presentamos una serie de 48 pacientes (de 14 a 20 años) con adenoma hipofisario. De éstos, 46 (96 por ciento) presentaban tumores secretantes, 3 enfermedad de Cushing, 9 somatotrofinomas y 34 (29 mujeres y 5 hombres) prolactinomas. Treinta casos fueron diagnosticados como adenomas intraselares (62 por ciento) mientras los restantes 18 (38 por ciento) presentaron expansión extraselar. De los 9 pacientes acromegálicos, 7 desarrollaron bioquímica y clínica típica de la enfermedad mientras 2 fueron exclusivamente diagnosticadas con niveles de GH basales normales, pero pruebas dinámicas anormales. Los prolactinomas fueron no invasivos en mujeres y de crecimiento rápido y de mayor tamaño en hombres. Cuarenta y siete pacientes fueron sometidos a cirugía. Cinco de ellos requirieron craneotomía y el resto fueron abordados por víatranseptoesfenoidal (TSE). Se consiguió remisión de la enfermedad de Cushing, acromegalia y prolactinoma intraselar femeninos. Los resultados en tumores mayores tales como los adenomas no secretantes y prolactinomas masculinos fueron malos luego de haber sido tratados mediante una resección subtotal y los disturbios endocrinológicos persistieron. Nuestros hallazgos demuestran que estos tumores son más agresivos en los jóvenes que en los adultos. Como hubo una estrecha relación entre el tamaño del tumor, su invasividad y el resultado final del paciente, concluímos que el diagnóstico temprano y el tratamiento son esenciales. Las frecuentes consultas de adolescentes tales como menstruaciones irregulares, retraso puberal y alteraciones de crecimiento deberían ser investigadas cuidadosamente y no simplemente consideradas como hechos transitorios o funcionales (AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Neoplasias Hipofisárias/diagnóstico , Adenoma/complicações , Neoplasias Hipofisárias/classificação , Acromegalia/diagnóstico , Acromegalia/etiologia , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/etiologia , Prolactina/antagonistas & inibidores , Prolactina/sangue , Octreotida/uso terapêutico , Amenorreia/etiologia , Oligomenorreia/etiologia , Ergolinas/uso terapêutico , Prolactinoma/diagnóstico , Prolactinoma/tratamento farmacológicoRESUMO
Presentamos una serie de 48 pacientes (de 14 a 20 años) con adenoma hipofisario. De éstos, 46 (96 por ciento) presentaban tumores secretantes, 3 enfermedad de Cushing, 9 somatotrofinomas y 34 (29 mujeres y 5 hombres) prolactinomas. Treinta casos fueron diagnosticados como adenomas intraselares (62 por ciento) mientras los restantes 18 (38 por ciento) presentaron expansión extraselar. De los 9 pacientes acromegálicos, 7 desarrollaron bioquímica y clínica típica de la enfermedad mientras 2 fueron exclusivamente diagnosticadas con niveles de GH basales normales, pero pruebas dinámicas anormales. Los prolactinomas fueron no invasivos en mujeres y de crecimiento rápido y de mayor tamaño en hombres. Cuarenta y siete pacientes fueron sometidos a cirugía. Cinco de ellos requirieron craneotomía y el resto fueron abordados por víatranseptoesfenoidal (TSE). Se consiguió remisión de la enfermedad de Cushing, acromegalia y prolactinoma intraselar femeninos. Los resultados en tumores mayores tales como los adenomas no secretantes y prolactinomas masculinos fueron malos luego de haber sido tratados mediante una resección subtotal y los disturbios endocrinológicos persistieron. Nuestros hallazgos demuestran que estos tumores son más agresivos en los jóvenes que en los adultos. Como hubo una estrecha relación entre el tamaño del tumor, su invasividad y el resultado final del paciente, concluímos que el diagnóstico temprano y el tratamiento son esenciales. Las frecuentes consultas de adolescentes tales como menstruaciones irregulares, retraso puberal y alteraciones de crecimiento deberían ser investigadas cuidadosamente y no simplemente consideradas como hechos transitorios o funcionales
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Acromegalia/diagnóstico , Acromegalia/etiologia , Adenoma/complicações , Neoplasias Hipofisárias/classificação , Neoplasias Hipofisárias/diagnóstico , Amenorreia/etiologia , Ergolinas/uso terapêutico , Octreotida/uso terapêutico , Oligomenorreia/etiologia , Prolactinoma/diagnóstico , Prolactinoma/tratamento farmacológico , Prolactina/antagonistas & inibidores , Prolactina/sangue , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/etiologiaRESUMO
We report on a series of 48 patients, ages 14 to 20 year, with hypophyseal adenomas. Of these, 46 (96%) had secreting tumors, 3 had Cushing's disease, 9 had somatotrophinomas, and 34 (29 females and 5 males) had prolactinomas. Thirty cases were diagnosed as intrasellar adenomas (62%) while the remaining eighteen (38%) presented extrasellar expansion. Of 9 acromegalic patients, 7 had typical clinical and biochemical features 2 were exclusively prognatic with normal basal GH levels, but abnormal dynamic tests. Prolactinomas were noninvasive in women and faster growing and more extensive in men. Forty seven patients underwent surgery. Five of these required craniotomy and the rest approached through the sphenoidal bone (TSE). Remission was achieved in Cushing's disease, acromegaly, and female intrasellar prolactinomas. Larger tumors such as nonsecreting adenomas and male prolactinomas showed poor results after undergoing subtotal resections, with persistence of endocrinological disturbances. From our findings it appears that these tumors are aggressive in youth than in adults. Because there was a close relationship between tumor size, invasiveness, and the patients' final outcome, we conclude that early diagnosis and treatment is essential. Frequent complaints in adolescents such as irregular menses, retarded puberty, and growth disorders should be thoroughly investigated and not merely considered as transient or 'functional'.
Assuntos
Adenoma/cirurgia , Neoplasias Hipofisárias/cirurgia , Acromegalia/cirurgia , Adenoma/diagnóstico , Adenoma/epidemiologia , Adolescente , Adulto , Síndrome de Cushing/cirurgia , Feminino , Humanos , Incidência , Masculino , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/epidemiologia , Prolactinoma/diagnóstico , Prolactinoma/epidemiologia , Prolactinoma/cirurgia , Caracteres SexuaisRESUMO
A population genetic study using starch gel electrophoresis was performed on populations of several species of lymnaeid snails acting as intermediate hosts for Fasciola hepatica (Trematoda, Plathyhelminth). Lymnaea viatrix was collected in 16 sites from the Bolivian Northern Altiplano. L. cubensis were obtained in one site from Venezuela, one site from Guadeloupe, three sites from Cuba and one site from the Dominican Republic. L. truncatula were collected in one site from France, one from Portugal and one from Morocco. Multilocus enzyme electrophoresis (MEE) were determined for 282 snails at 18 loci. A complete monomorphism was encountered at each geographic site. However, among these 18 loci, 13 are polymorphic and low and high levels of genetic divergence were observed between samples. Two genotypic groups can be differentiated by their multilocus genotypes. The western genotypic group associates together samples from Venezuela, Guadeloupe, Cuba and Dominican Republic (L. cubensis) while samples from France, Portugal and Morocco (L. truncatula) belong to the eastern genotypic group. Surprisingly, the Northern Bolivian Altiplano populations (L. viatrix) do not present any genetic divergence with the Portuguese sample. Therefore, the Bolivian snails belong entirely to the eastern genetic group. Within each group slight genetic divergences were observed. These results strongly support the European origin of the lymnaeid snails from the Northern Bolivian Altiplano.
Assuntos
Reservatórios de Doenças/classificação , Genética Populacional , Lymnaea/classificação , Lymnaea/genética , Animais , Bolívia , Cuba , República Dominicana , Eletroforese em Gel de Poliacrilamida , Fasciolíase/epidemiologia , França , Guadalupe , Humanos , Lymnaea/parasitologia , Marrocos , Filogenia , Polimorfismo Genético , Portugal , VenezuelaRESUMO
Parallel to the National Health Survey-II, in 1994 a qualitative study was conducted on the patterns and microsocial determinants of health services utilization. The study was conducted in eight urban areas from all over the country among middle class and middle-low class sectors. A total of 192 individual open-ended interviews and eight focus groups were completed among users of health services; 61 service providers both from public and private services were also interviewed. This paper reports the main findings regarding the users' perspective. The first part summarizes the conceptual and methodological design. The second part presents the results from the users' point of view. Individuals distinguish between "becoming sick" and "falling sick"; preventive measures are adopted when becoming sick, in order to avoid falling sick. Another finding refers to the population tendency to add up different and even contradictory curative paradigms, as opposed to the modern medical paradigm which tends to exclude any competing alternative knowledge. A third series of findings refers to the dilemmas that utilizing health services poses for the population, given the high costs, and the low quality that characterize these services, according to the users' point of view. This paper concludes with a series of recommendations for policies, aimed at improving the quality of the health services provided to the population.
Assuntos
Serviços de Saúde/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Inquéritos Epidemiológicos , Humanos , Entrevistas como Assunto/métodos , México , Satisfação do Paciente , Papel do Doente , Fatores Socioeconômicos , População UrbanaRESUMO
This study presents the second part of the general results obtained by a qualitative study conducted within the National Health Survey II. The object of this study was to identify main patterns and micro-social determinants which affect the process of selection and utilization of health services in order to propose policies aimed at more equity, quality and efficiency in health service delivery. The study was conducted in urban areas among the middle and middle-low class sectors. A total of 192 individual open-ended interviews and eight focus groups were completed among health users in four cities. Also, 61 service providers both from public and private services were interviewed. Since a previous work reported findings related to health service users, this study focuses only on the results pertaining to health service providers. The first part briefly discusses the study design which allowed to explore the meaning that actors--health service providers--attach to their job and working conditions. The second part presents the main findings. The sense of economic and material precariousness with which health providers from public institutions do their work is among the most important results. Common conflicts between health service users and providers are also mentioned, mainly those which arise from the organizational problems of the health center and from the scarcity of the basic drug stock. The third part reports the main coincidences and divergences between health service users and providers. Some of the divergences may be the reason for the under-utilization of health services. The work concludes with a series of policy recommendations aimed at improving the quality and opportunity of health services provided by public institutions for the needs of the population.