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ANTECEDENTES: La obesidad se ha asociado con estado proinflamatorio de bajo grado que se ha relacionado con el desarrollo del cáncer en general incluyendo el hematológico. OBJETIVOS: El presente trabajo tiene el objetivo de identificar la asociación del diagnóstico de obesidad acorde al índice de masa corporal (IMC) con indicadores pronóstico de pacientes adultos con Leucemia Linfoblástica Aguda (LAL). PACIENTES Y MÉTODO: Se trata de un estudio observacional, retrospectivo que incluyó pacientes hospitalizados con diagnóstico de LAL de linaje de células B. Se estimó el IMC con base al peso y talla registrado al ingreso de los pacientes. Se determinó el riesgo de recaídas, recaídas a médula ósea y supervivencia. Se utilizó el método de Kaplan-Meier mediante el test log-Rank en el análisis estadístico. RESULTADOS: Se incluyeron 128 pacientes. El peso y el IMC no mostraron una asociación significativa con el riesgo de recaídas. La frecuencia de recaída a médula ósea fue del 43,8%. La obesidad no impactó con la supervivencia global (p = 0,640) ni en la supervivencia libre de enfermedad (p = 0,527). La presencia de obesidad no se comportó como una variable de riesgo de recaída (p = 0,873). El IMC con punto de corte de 30 kg/m2 no se comportó como un factor de riesgo de recaída (OR 1.078). Conclusión: La obesidad no es un factor de riesgo independiente para el pronóstico de los pacientes adultos portadores de Leucemia Linfoblástica Aguda de linaje B.
BACKGROUND: Obesity has been associated with a low-grade proinflammatory state, and it has been related to the development of cancer in general, including hematologic cancer. AIM: The present work aimed to identify the association of the diagnosis of obesity according to the body mass index (BMI) with prognostic factors of adult patients with Acute Lymphoblastic Leukemia (ALL). PATIENTS AND METHOD: This observational, retrospective study included hospitalized patients diagnosed with ALL of the B-cell lineages. BMI was estimated based on the weight and height registered on clinical records at the admission of the patients. The relapse risk and bone marrow relapse were determined, and the survival rate was measured. The statistical analysis included the Kaplan-Meier method using the log-Rank test. Results: This study included 128 clinical records of patients. Weight had no significant association with relapse risk. The frequency of bone marrow relapse was 43.8%. Obesity did not impact overall survival (p = 0.640) or disease-free survival (p = 0.527). The presence of obesity does not behave as a relapse risk variable (p = 0.873). BMI with a 30 kg/m2 cut-off point did not influence relapse risk (OR 1.078). CONCLUSION: Obesity is not an independent risk factor for the prognosis of adult patients with Acute Lymphoblastic Leukemia B-lineage.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Índice de Massa Corporal , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Obesidade/complicações , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de Risco , Intervalo Livre de Doença , Estimativa de Kaplan-MeierRESUMO
BACKGROUND: Obesity has been associated with a low-grade proinflammatory state, and it has been related to the development of cancer in general, including hematologic cancer. AIM: The present work aimed to identify the association of the diagnosis of obesity according to the body mass index (BMI) with prognostic factors of adult patients with Acute Lymphoblastic Leukemia (ALL). PATIENTS AND METHOD: This observational, retrospective study included hospitalized patients diagnosed with ALL of the B-cell lineages. BMI was estimated based on the weight and height registered on clinical records at the admission of the patients. The relapse risk and bone marrow relapse were determined, and the survival rate was measured. The statistical analysis included the Kaplan-Meier method using the log-Rank test. RESULTS: This study included 128 clinical records of patients. Weight had no significant association with relapse risk. The frequency of bone marrow relapse was 43.8%. Obesity did not impact overall survival (p = 0.640) or disease-free survival (p = 0.527). The presence of obesity does not behave as a relapse risk variable (p = 0.873). BMI with a 30 kg/m2 cut-off point did not influence relapse risk (OR 1.078). CONCLUSION: Obesity is not an independent risk factor for the prognosis of adult patients with Acute Lymphoblastic Leukemia B-lineage.
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Índice de Massa Corporal , Obesidade , Leucemia-Linfoma Linfoblástico de Células Precursoras , Humanos , Masculino , Estudos Retrospectivos , Feminino , Obesidade/complicações , Adulto , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Fatores de Risco , Pessoa de Meia-Idade , Adulto Jovem , Prognóstico , Adolescente , Recidiva , Idoso , Estimativa de Kaplan-Meier , Intervalo Livre de DoençaRESUMO
INTRODUCTION: Various biomarkers based on blood counts have been useful for the prognosis of patients critically ill with COVID-19. OBJECTIVE: To describe the usefulness of the neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR) and lymphocyte-to-platelet (LPR) ratios for the prognosis of mortality and ventilatory support requirement for COVID-19. METHOD: Retrospective cohort of clinical records of patients with COVID-19 who required hospital care. RESULTS: One-hundred and -twenty-five cases were analyzed; mean age was 51 years, and 60 % were of the male gender; 21.6 % had type 2 diabetes mellitus, and 18.4 % had hypertension. Mean leukocyte count was 9.5 x 103/µL, with a neutrophil mean of 8.0 x 103/µL. Mean NLR was 12.01, while for MLR it was 0.442, and for LPR, 373.07. Regarding the area under the curve, the following values were recorded for mortality: 0.594 for NLR, 0.628 for MLR and 0.505 for LPR; as for mechanical ventilation, the values were 0.581 for NLR, 0.619 for MLR and 0.547 for LPR. In the univariate analysis, an NLR value > 13 (OR: 2.750, p = 0.001) and an MLR of > 0.5 (OR: 2.069, p = 0.047) were associated with mortality; LPR showed no impact on mortality or respiratory support. CONCLUSION: NLR and MLR are useful for predicting mortality in patients with COVID-19.
INTRODUCCIÓN: Diversos biomarcadores basados en conteos sanguíneos han sido de utilidad para el pronóstico de los pacientes en estado crítico por COVID-19. OBJETIVO: Describir la utilidad de los índices neutrófilo/linfocito (INL), monocito/linfocito (IML) y linfocito/plaqueta (IPL) para el pronóstico de la mortalidad y necesidad de soporte ventilatorio por COVID-19. MÉTODO: Cohorte retrospectiva de registros clínicos de pacientes con COVID-19 que requirieron atención hospitalaria. RESULTADOS: Se analizaron 125 casos, la edad media fue de 51 años y 60 %, del sexo masculino; 21.6 % padecía diabetes mellitus tipo 2 y 18.4 %, hipertensión. La media de leucocitos fue 9.5 × 103/µL y la de neutrófilos, de 8.0 × 103/µL. La media del INL fue de 12.01; del IML, de 0.442 y del IPL, de 373.07. Respecto al área bajo la curva se registraron los siguientes valores en cuanto a mortalidad: INL, 0.594; IML, 0.628 e ILP, 0.505; en cuanto a ventilación mecánica: INL, 0.581; IML, 0.619 e ILP, 0.547. En el análisis univariado, INL > 13 (RM = 2.750, p = 0.001) e IML > 0.5 (RM = 2.069, p = 0.047) se asociaron a mortalidad; ILP no mostró impacto en la mortalidad ni en el soporte respiratorio. CONCLUSIÓN: INL e IML son de utilidad para predecir la mortalidad en pacientes con COVID-19.
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COVID-19/sangue , COVID-19/mortalidade , Idoso , Idoso de 80 Anos ou mais , COVID-19/complicações , Estudos de Coortes , Feminino , Humanos , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Monócitos , Contagem de Plaquetas , Prognóstico , Estudos RetrospectivosRESUMO
Resumen Introducción: Diversos biomarcadores basados en conteos sanguíneos han sido de utilidad para el pronóstico de los pacientes en estado crítico por COVID-19. Objetivo: Describir la utilidad de los índices neutrófilo/linfocito (INL), monocito/linfocito (IML) y linfocito/plaqueta (IPL) para el pronóstico de la mortalidad y necesidad de soporte ventilatorio por COVID-19. Método: Cohorte retrospectiva de registros clínicos de pacientes con COVID-19 que requirieron atención hospitalaria. Resultados: Se analizaron 125 casos, la edad media fue de 51 años y 60 %, del sexo masculino; 21.6 % padecía diabetes mellitus tipo 2 y 18.4 %, hipertensión. La media de leucocitos fue 9.5 × 103/mL y la de neutrófilos, de 8.0 × 103/mL. La media del INL fue de 12.01; del IML, de 0.442 y del IPL, de 373.07. Respecto al área bajo la curva se registraron los siguientes valores en cuanto a mortalidad: INL, 0.594; IML, 0.628 e ILP, 0.505; en cuanto a ventilación mecánica: INL, 0.581; IML, 0.619 e ILP, 0.547. En el análisis univariado, INL > 13 (RM = 2.750, p = 0.001) e IML > 0.5 (RM = 2.069, p = 0.047) se asociaron a mortalidad; ILP no mostró impacto en la mortalidad ni en el soporte respiratorio. Conclusión: INL e IML son de utilidad para predecir la mortalidad en pacientes con COVID-19.
Abstract Introduction: Various biomarkers based on blood counts have been useful for the prognosis of patients critically ill with COVID-19. Objective: To describe the usefulness of the neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR) and lymphocyte-to-platelet ([LPR) ratios for the prognosis of mortality and ventilatory support requirement for COVID-19. Method: Retrospective cohort of clinical records of patients with COVID-19 who required hospital care. Results: One-hundred and twenty-five cases were analyzed; mean age was 51 years, and 60 % were of the male gender; 21.6 % had type 2 diabetes mellitus, and 18.4 % had hypertension. Mean leukocyte count was 9.5 × 103/mL, with a neutrophil mean of 8.0 × 103/mL. Mean NLR was 12.01, while for MLR it was 0.442, and for LPR, 373.07. Regarding the area under the curve, the following values were recorded for mortality: 0.594 for NLR, 0.628 for MLR and 0.505 for LPR; as for mechanical ventilation, the values were 0.581 for NLR, 0.619 for MLR and 0.547 for LPR. In the univariate analysis, an NLR value > 13 (OR: 2.750, p = 0.001) and an MLR of > 0.5 (OR: 2.069, p = 0.047) were associated with mortality. LPR showed no impact on mortality or respiratory support. Conclusion: NLR and MLR are useful for predicting mortality in patients with COVID-19.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , COVID-19/mortalidade , COVID-19/sangue , Contagem de Plaquetas , Prognóstico , Monócitos , Estudos Retrospectivos , Estudos de Coortes , Contagem de Linfócitos , COVID-19/complicações , Contagem de LeucócitosRESUMO
Introducción: el movimiento corporal humano es el resultado de la interacción entre elementos psicológicos, biológicos y sociales. Las amputaciones generan alteraciones en la estructura mental del individuo ocasionando restricciones en la participación social; por ello, es necesario comprender la influencia de la imagen y el esquema corporal de los sujetos con amputación según la teoría del movimiento continuo. Métodos: se realizó una revisión de la literatura en las bases de datos PubMed, Science Direct, Clinical Key, PEDro, SciELO en el mes de abril de 2020; la selección de artículos se dividió en 3 fases, utilizando los términos"body schema", "body image", "amputee" y "movement".Resultados: se encontró un total de 142 artículos, de los cuales se incluyeron 13 que cumplían con los criterios de selección. Discusión: posterior a una amputación se producen alteraciones de la imagen y el esquema corporal, además de cambios plásticos en el sistema nervioso central; derivado de esto existirán modificaciones en el movimiento corporal de la persona.Se requiere favorecer el manejo integral del sujeto con amputación basado en la teoría del movimiento continuo abarcando esferas psicológicas, biológicas y sociales. Conclusión: la aceptación e integración de la imagen y esquema corporal son fundamentales para restablecer la capacidad máxima de movimiento de la persona con amputación.
Introduction: Human body movement is the result of the interaction among psychological, biological and social elements; ampu-tations generate alterations in the individual's mental structure causing restrictions on social participation; therefore, it is necessary to understand the influence of the image and body schema of amputee subjects according to the theory of continuous movement. Methods:A review of the literature was carried out in the databases PubMed, Science Direct, Clinical Key, PEDro, SciELO in April 2020; the selection of articles was divided into 3 phases, using the terms "body schema", "body image", "amputee" and "movement". Results: A total of 142 articles were found, of which 13 that met the selection criteria were included. Discussion: After an amputation, alterations of the image and body schema will occur. In addition to plastic changes in the central nervous system, therefore will be modifications in the person's body movement. It is necessary to favor the comprehensive management of the subject with amputation based on the theory of continuous movement, covering psychological, biological and social spheres. Conclusion: The acceptance and integration of the image and body schema are fundamental to reestablish the maximum capacity of movement of the person with amputation
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HumanosRESUMO
OBJECTIVE: Our aim was to analyze the role of thyroid hormones in follicular fluid (FF) in relation to the number of oocytes retrieved in women recruited for an assisted fertilization procedure. METHODS: Retrospective cohort study of 51 women 37.5±3.3 years, range 29-42, evaluated after a controlled ovarian stimulation protocol in a University Hospital. FF was sampled by transvaginal ultrasound-guided aspiration after ovarian hyperstimulation and we measured T3 (T3f), T4 (T4f), TSH (TSHf) and free T4 (T4ff). The oocyte maturation rate was calculated as: Number of metaphase II oocytes/Number of oocytes retrieved x 100. Statistical analysis was performed using the SPSS-19 software. RESULTS: Hormone levels in FF were: TSHf 1.3µIU/ml (0.4 - 2.7), T3f: 1.52±0.46 nmol/L, T4f 88.8±30.9nmol/L and T4ff: 15.44±2.57pmol/L. The number of oocytes recovered was dependent onT4f following the equation: Log (oocyte) = 0.379+0.042*T4f (r:0.352, p=0.012). After a logistic regression model analysis, T3f showed a tendency to be associated with the OMR: OR (95 % CI)= 0.977 (0.954 to 1.001), p=0.057. CONCLUSIONS: The correlation found between thyroid hormones and the number of oocytes retrieved suggests an interaction between thyroid and gonadal axes in relation to follicular development.
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Líquido Folicular/metabolismo , Recuperação de Oócitos , Oócitos/metabolismo , Indução da Ovulação/métodos , Hormônios Tireóideos/metabolismo , Adulto , Feminino , HumanosRESUMO
BACKGROUND: The aim of this study was to evaluate the non-genomic action of thyroxin on sperm kinetic and its probable use to improve sperm recovery after applying an en- richment method like "swim-up" in comparison with the available one, pentoxifylline. MATERIALS AND METHODS: This is an experimental study. A total of 50 patients were re- cruited, followed by infertility consultation. Conventional sperm assays were performed according to World Health Organization criteria-2010 (WHO-2010). A Computer Aided Semen Analysis System was employed to assess kinetic parameters and concentrations. Number of the motile sperm recovered after preparation technique was calculated. RESULTS: Addition of T4 (0.002 µg/ml) to semen samples increased hypermotility at 20 minutes (control: 14.18 ± 5.1% vs. 17.66 ± 8.88%, P<0.03, data expressed as mean ± SD) and remained unchanged after 40 minutes. Significant differences were found in the motile sperm recovered after swim-up (control: 8.93×10(6) ± 9.52× 06vs. 17.20×10(6) ± 21.16×10(6), P<0.03), achieving all of the tested samples a desirable threshold value for artificial insemination outcome, while adding pentoxifylline increased the number of recovered sperm after swim-up in 60% of the studied cases. No synergism between two treatments could be determined. CONCLUSION: We propose a new physiological tool to artificially improve insemination. The discussion opens windows to investigate unknown pathways involved in sperm ca- pacitation and gives innovative arguments to better understand infertility mechanisms.
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La prevalencia de alteraciones morfológicas palpables tiroideas no supera el 8% en la población adulta. En el Hospital de Clínicas de la Universidad de Buenos Aires se llevó a cabo un programa gratuito para la detección de enfermedades tiroideas, convocándose a sujetos que desconocieran antecedentes tiroideos. Nuestro objetivo fue establecer la frecuencia de patología morfológica palpable tiroidea, en una población seleccionada de pacientes, y comparar dichos resultados con los hallazgos de un programa de detección similar, realizado en el año 2001¹. Adicionalmente, evaluar la prevalencia de alteraciones funcionales y de autoinmunidad tiroidea. Los individuos que concurrieron se dividieron en 3 grupos: Grupo 1 (n = 186) pacientes con antecedentes personales de enfermedad tiroidea conocida (excluidos del análisis); Grupo 2 (n = 184) sujetos con antecedentes familiares, otras enfermedades autoinmunes, o sintomatología que pudiera atribuirse a alteración de la función tiroidea (grupo inducido), y Grupo 3 (n = 288) sujetos que consultaron por mera curiosidad (grupo random). La función y autoinmunidad tiroidea se evaluó en 144 participantes del Grupo 3, citados al azar. En el grupo random, la prevalencia de alteraciones morfológicas tiroideas, detectadas por palpación, fue del 11,09%. Al comparar estos resultados con los obtenidos 12 años atrás en un estudio similar, realizado en nuestro hospital, no se encontraron diferencias estadísticamente significativas (8,7 vs. 11,09%; p = 0,25). En cuanto a la función tiroidea, se halló hipotiroidismo subclínico en el 6,25%, hipertiroidismo subclínico en el 0,7% y autoinmunidad en el 11% de los sujetos evaluados. En conclusión, la prevalencia de alteraciones palpables de la glándula tiroides no cambió en laúltima década. Esta investigación realizada en una población correctamente seleccionada constituye una herramienta útil para referencias futuras como población control en Argentina.
The prevalence of palpable thyroid morphological abnormalities does not exceed 8% in the adult population. A free program was conducted in the Hospital de Clínicas (University of Buenos Aires) for the detection of thyroid diseases, inviting subjects who were unaware of a history of these diseases. The aim was to establish the frequency of goitre in the selected population, as well as to evaluate the prevalence of functional disorders and thyroid autoimmunity, and to compare these results with the findings of a similar study performed in 2001¹. The subjects were divided into three groups: Group 1 (n = 186) patients with a history of previously known thyroid disorders (excluded subjects); Group 2 (n = 184) subjects with a family history of thyroid disease, other autoimmune diseases, or symptoms that could be attributed to changes in thyroid function (Induced Group), and Group 3 (n = 288) subjects who participated in this program due to mere curiosity (Random Group). Autoimmunity and thyroid function was assessed in 144 randomly selected participants in Group 3. In Group 3, the prevalence of morphological alterations of the thyroid gland was 11.09%. Comparing these results with those obtained 12 years ago in a similar study performed in our hospital, no statistically significant differences were found when the prevalence of morphological thyroid alterations were compared (8.7% vs 11.09%, p=.25). As for thyroid function, subclinical hypothyroidism was found in 6.25%, subclinical hyperthyroidism in 0.7%, and autoimmunity in 11% of subjects evaluated. It was concluded that the prevalence of palpable thyroid abnormalities had not change in the last decade. This study, made in a correctly selected population, is a useful tool for future reference as a control population in Argentina.
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PURPOSE: There is a substantial gap in the literature about the perceptions of QOL of caregivers of Mexican ancestry. This qualitative study explores the role of culture on the perceptions of QOL of this understudied population. METHODS: Twenty caregivers providing care to adults with advanced cancer were interviewed. Thematic analysis identified several themes for each domain of QOL, including physical, psychological, social, and spiritual domains and the role of culture. RESULTS: Cultural background influenced all of the QOL domains. There was a tremendous synergy across domains of physical, psychological, social, and spiritual well-being. Extended family and religious beliefs, life experiences, and culture were important components of QOL for these caregivers. Cultural expectations influenced role functioning and caregiver burden. CONCLUSION: This study informs our understanding of the role of culture on perceptions of QOL. Future investigations should be conducted with other Latino subgroups to describe QOL and to determine the role of culture on perceived QOL. Interventions should be specifically designed to improve caregivers' QOL and to reduce the burden of cancer in this underserved population.
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Adaptação Psicológica , Cuidadores/psicologia , Americanos Mexicanos/psicologia , Neoplasias/terapia , Percepção , Qualidade de Vida/psicologia , Adulto , Cultura , Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologiaRESUMO
The act of providing care may be the same in all ethnic groups, but the way caregiving is defined by family members is influenced by cultural values and beliefs. This study describes the caregiving experience and challenges of caregivers of Mexican ancestry. Qualitative interviews of 20 family caregivers and thematic analysis of transcribed audiotapes identified four themes that characterized their caregiving experience. These themes include an emphasis on family values, a strong commitment to care, difficulties dealing with everyday life realities, and a reliance on spirituality, all of which added to the meaningfulness and burden of caregiving. Further investigation within a cultural context is warranted in the development of interventions and programs to better assist caregivers in coping with the challenges of providing cancer care.
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Adaptação Psicológica , Cuidadores , Cultura , Família , Assistência Domiciliar , Americanos Mexicanos , Neoplasias , Adulto , Idoso , Atitude , Cuidadores/psicologia , Feminino , Assistência Domiciliar/psicologia , Humanos , Entrevistas como Assunto , Masculino , México , Pessoa de Meia-Idade , Neoplasias/enfermagem , Pesquisa Qualitativa , Apoio Social , Espiritualidade , Estresse Psicológico , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The objective of this study was to determine the association between preoperative nutritional status and postoperative outcomes in children undergoing surgery for congenital heart defects (CHD). METHODS: Seventy-one patients with CHD were enrolled in a prospective, 2-center cohort study. We adjusted for baseline risk differences using a standardized risk adjustment score for surgery for CHD. We assigned a World Health Organization z score for each subject's preoperative triceps skin-fold measurement, an assessment of total body fat mass. We obtained preoperative plasma concentrations of markers of nutritional status (prealbumin, albumin) and myocardial stress (B-type natriuretic peptide [BNP]). Associations between indices of preoperative nutritional status and clinical outcomes were sought. RESULTS: Subjects had a median (interquartile range [IQR]) age of 10.2 (33) months. In the University of California at San Francisco (UCSF) cohort, duration of mechanical ventilation (median, 19 hours; IQR, 29 hours), length of intensive care unit stay (median, 5 days; IQR 5 days), duration of any continuous inotropic infusion (median, 66 hours; IQR 72 hours), and preoperative BNP levels (median, 30 pg/mL; IQR, 75 pg/mL) were associated with a lower preoperative triceps skin-fold z score (P < .05). Longer duration of any continuous inotropic infusion and higher preoperative BNP levels were also associated with lower preoperative prealbumin (12.1 ± 0.5 mg/dL) and albumin (3.2 ± 0.1; P < .05) levels. CONCLUSIONS: Lower total body fat mass and acute and chronic malnourishment are associated with worse clinical outcomes in children undergoing surgery for CHD at UCSF, a resource-abundant institution. There is an inverse correlation between total body fat mass and BNP levels. Duration of inotropic support and BNP increase concomitantly as measures of nutritional status decrease, supporting the hypothesis that malnourishment is associated with decreased myocardial function.
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Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Transtornos da Nutrição Infantil/complicações , Fenômenos Fisiológicos da Nutrição Infantil , Cardiopatias Congênitas/cirurgia , Transtornos da Nutrição do Lactente/complicações , Desnutrição/complicações , Estado Nutricional , Complicações Pós-Operatórias/etiologia , Adiposidade , Biomarcadores/sangue , Procedimentos Cirúrgicos Cardíacos/mortalidade , Cardiotônicos/uso terapêutico , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/mortalidade , Transtornos da Nutrição Infantil/fisiopatologia , Pré-Escolar , Feminino , Guatemala , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/fisiopatologia , Humanos , Lactente , Transtornos da Nutrição do Lactente/diagnóstico , Transtornos da Nutrição do Lactente/mortalidade , Transtornos da Nutrição do Lactente/fisiopatologia , Recém-Nascido , Tempo de Internação , Modelos Lineares , Modelos Logísticos , Masculino , Desnutrição/diagnóstico , Desnutrição/mortalidade , Desnutrição/fisiopatologia , Análise Multivariada , Peptídeo Natriurético Encefálico/sangue , Projetos Piloto , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Pré-Albumina/análise , Estudos Prospectivos , Respiração Artificial , Fatores de Risco , São Francisco , Albumina Sérica/análise , Albumina Sérica Humana , Dobras Cutâneas , Fatores de Tempo , Resultado do TratamentoRESUMO
Cancer and cancer screening disparities exist across Latino subgroups; however the reasons for these disparities are not fully known. This study examines (1) mammography screening among Latinas born in Mexico, Central-America and South-America and (2) the impact of birthplace and acculturation on mammography screening. Data were derived from the California Health Interview Survey 2007. Analyses included 1,675 Latina women 40 years of age and older. Multivariate logistic regression examined predictors of mammography screening. Mexican and Central-American women were less likely to report ever receiving a mammogram while Mexican women were less likely to report a recent mammogram. Low-acculturated women were less likely to report ever receiving a mammogram and less likely to report recent mammography. Different screening patterns across Latina subgroups were observed. Differences in screening patterns and the factors associated with screening highlight the need for unique intervention strategies tailored specifically to Latinas.
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Hispânico ou Latino/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Aculturação , Adulto , Idoso , California , América Central/etnologia , Feminino , Inquéritos Epidemiológicos , Humanos , México/etnologia , Pessoa de Meia-IdadeRESUMO
En México el cáncer cérvico uterino al igual que en otros países de América representa un grave problema de salud pública. El tratamiento depende de su extensión; los estadios localmente avanzados son tratados con una combinación de quimioterapia con cisplatino y radioterapia. Ambas terapias utilizadas son consideradas oxidativas y por ello son capaces de influir en las toxicidades del propio tratamiento, el objetivo de este trabajo es determinar la eficacia de la suplementación con antioxidantes y su efecto sobre la prevención de la toxicidad renal por cisplatino. Ensayo clínico aleatorizado que incluyó a pacientes con cáncer cérvico uterino en estadios localmente avanzados cuyo tratamiento antineoplásico consistió en radioterapia y quimioterapia con cisplatino. Se asignó aleatoriamente a las pacientes a recibir un suplemento antioxidante diariamente o bien un placebo. Se determinó la función renal mediante la depuración de creatinina antes de iniciar el tratamiento y al término del mismo. Se realizaron pruebas t-Student inter e intra grupales a fin de determinar el efecto de la suplementación sobre los parámetros evaluados. No se encontraron diferencias estadísticamente significativas entre ambos grupos; en cambio, existió una disminución significativa en ambos grupos al finalizar el tratamiento. La suplementación con antioxidantes no es capaz de prevenir la toxicidad a nivel renal producida por la quimioterapia con cisplatino.
In Mexico, our country, the pathology of cervical cancer is a major public health issue, the same situation is present in other American countries. The treatment for this pathology depends on its extension; for locally advanced stages, a combination of radiotherapy and chemotherapy with cisplatin drug is common used. The both therapies are considered to be pro oxidative and this can be implied in the toxicities of the treatment. The objective of this work was to determine the efficacy of antioxidant supplementation on the prevention of cisplatin drug in the renal toxicity. We conducted a randomized clinical trial in the patients with locally advanced stage cervical cancer whose antineoplastic treatment consisted in radiation therapy and chemotherapy with the cisplatin drug. The patients were randomly assigned to receive either an antioxidant supplement or the placebo. We assessed renal function as creatinine clearance before and after concluding the oncologic treatment. We performed inter and intragroupal t-Student tests in order to determine the effect of the antioxidant supplementation on the evaluated parameters. No statistically significant differences we were found between the groups; however, there was a significant decrease in renal function in the both groups after finalizing the oncologic treatment. The antioxidant supplementation does not prevent the renal toxicity from the cisplatin drug chemotherapy.
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Humanos , Feminino , Fármacos Renais/toxicidade , Antioxidantes/uso terapêutico , Cisplatino/administração & dosagem , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/radioterapia , Cisplatino/farmacologia , México , NefrologiaRESUMO
La tuberculosis en Chile ha tenido un considerable descenso en incidencia y mortalidad, encontrándonos en la etapa de eliminación como problema de salud pública. Sin embargo, a medida que la tuberculosis pulmonar disminuye en frecuencia, la proporción de tuberculosis extrapulmonar se incrementa. Como es conocido, el pulmón es el órgano diana por excelencia, pero cualquier órgano puede ser afectado. Dentro de las tuberculosis extrapulmonares, la forma miliar corresponde sólo a un 5 por ciento de los casos. La diseminación miliar es rara en pacientes inmunocompetentes, estando prácticamente restringida a grupos de riesgo. El diagnóstico de la tuberculosis miliar requiere de un alto índice de sospecha, ya que su clínica es inespecífica, y el aislamiento del bacilo de Koch difícil.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose Miliar/diagnóstico , Tuberculose Miliar/tratamento farmacológico , Antibióticos Antituberculose/uso terapêutico , ImunocompetênciaRESUMO
CONTEXT: A large number of hired farmworkers in the United States come from México. Understanding safety and health concerns among the workers is essential to improving prevention programs. PURPOSE: The purpose of this pilot study was to obtain detailed information about safety and health concerns of hired farmworkers in Colorado and in México. METHODS: A total of 10 migrant farmworkers from northern Colorado and 5 seasonal farmworkers from Guanajuato, México, were interviewed using a semi-structured interview process. The social cognitive theory (SCT) served as a framework to gain understanding of safety and health among workers. FINDINGS: Topics of concern identified included causes of farm, home and motor vehicle injuries, and treatment preferences for injuries and illnesses. Four main themes emerged: safety and health concerns, personal control and prevention strategies, factors affecting control and prevention strategies, and the importance of family. CONCLUSIONS: Further study of the themes using a revised semi-structured interview will be done in a larger study among hired farmworkers. The results add to the current work to understand specific health and safety concerns among these workers.
Assuntos
Agricultura , Nível de Saúde , Saúde Ocupacional , Migrantes , Acidentes Domésticos/prevenção & controle , Acidentes de Trabalho/prevenção & controle , Acidentes de Trânsito/prevenção & controle , Adolescente , Adulto , Colorado , Família , Feminino , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Projetos Piloto , Adulto JovemRESUMO
Stenotrophomonas maltophilia is an emerging nosocomial bacterial pathogen associated with several infectious diseases and opportunistic infections, especially in immunocompromised patients. These bacteria adhere avidly to medical implants and catheters forming a biofilm that confers natural protection against host immune defences and different antimicrobial agents. The nature of the bacterial surface factors involved in biofilm formation on inert surfaces and in adherence of S. maltophilia to epithelial cells is largely unknown. In this study, we identified and characterized fimbrial structures produced by S. maltophilia grown at 37 degrees C. The S. maltophilia fimbriae 1 (SMF-1) are composed of a 17 kDa fimbrin subunit which shares significant similarities with the N-terminal amino acid sequences of several fimbrial adhesins (G, F17, K99 and 20K) found in Escherichia coli pathogenic strains and the CupA fimbriae of Pseudomonas aeruginosa. All of the clinical S. maltophilia isolates tested produced the 17 kDa fimbrin. Antibodies raised against SMF-1 fimbriae inhibited the agglutination of animal erythrocytes, adherence to HEp-2 cells and biofilm formation by S. maltophilia. High resolution electron microscopy provided evidence of the presence of fimbriae acting as bridges between bacteria adhering to inert surfaces or to cultured epithelial cells. This is the first characterization of fimbriae in this genus. We provide compelling data suggesting that the SMF-1 fimbriae are involved in haemagglutination, biofilm formation and adherence to cultured mammalian cells.
Assuntos
Aderência Bacteriana/fisiologia , Células Epiteliais/microbiologia , Fímbrias Bacterianas/metabolismo , Stenotrophomonas maltophilia/metabolismo , Sequência de Aminoácidos , Biofilmes , Linhagem Celular , Proteínas de Fímbrias/metabolismo , Fímbrias Bacterianas/ultraestrutura , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Dados de Sequência Molecular , Alinhamento de Sequência , Stenotrophomonas maltophilia/ultraestrutura , TemperaturaRESUMO
Stenotrophomonas maltophilia is an emerging nosocomial bacterial pathogen associated with several infectious diseases and opportunistic infections, especially in immunocompromised patients. These bacteria adhere avidly to medical implants and catheters forming a biofilm that confers natural protection against host immune defences and different antimicrobial agents. The nature of the bacterial surface factors involved in biofilm formation on inert surfaces and in adherence of S. maltophilia to epithelial cells is largely unknown. In this study, we identified and characterized fimbrial structures produced by S. maltophilia. The S. maltophilia fimbriae 1(SMF-1) are composed of a 17 kDa fimbrin subunit which shares significant similarities with the Nterminal amino acid sequences of several fimbrial adhesins (G, F17, K99 and 20K) found in Escherichia coli pathogenic strains and the CupA fimbriae of Pseudomonas aeruginosa. All of the clinical S. maltophilia isolates tested produced the 17 kDa fimbrin. Antibodies raised against SMF-1 fimbriae inhibited the agglutination of animal erythrocytes, adherence to HEp-2 cells and biofilm formation by S. maltophilia.High resolution electron microscopy ovided evidence of the presence of fimbriae acting as bridges between bacteria adhering to inert surfaces or to cultured epithelial cells. This is the first characterization of fimbriae in this genus. We provide compelling data suggesting that the SMF-1 fimbriae are involved in haemagglutination, biofilm formation and adherence to cultured mammalian cells...
Assuntos
RNA , Aderência Bacteriana , Células Epiteliais , Células Epiteliais/parasitologia , Fímbrias Bacterianas/microbiologia , Stenotrophomonas maltophilia/patogenicidade , Fatores Abióticos , Infecção Hospitalar/microbiologiaRESUMO
Stenotrophomonas maltophilia is an emerging nosocomial pathogen associated with opportunistic infections in patients with cystic fibrosis, cancer, and HIV. Adherence of this organism to abiotic surfaces such as medical implants and catheters represents a major risk for hospitalized patients. The adhesive surface factors involved in adherence of these bacteria are largely unknown, and their flagella have not yet been characterized biochemically and antigenically. We purified and characterized the flagella produced by S. maltophilia clinical strains. The flagella filaments are composed of a 38-kDa subunit, SM(FliC), and analysis of its N-terminal amino acid sequence showed considerable sequence identity to the flagellins of Serratia marcescens (78.6%), Escherichia coli, Proteus mirabilis, Shigella sonnei (71.4%), and Pseudomonas aeruginosa (57.2%). Ultrastructural analysis by scanning electron microscopy of bacteria adhering to plastic showed flagellalike structures within the bacterial clusters, suggesting that flagella are produced as the bacteria spread on the abiotic surface.