RESUMO
Resumen Objetivo: Comparar los resultados obtenidos en calidad de vida, pérdida ponderal y resolución de comorbilidades al año, en pacientes con obesidad mórbida intervenidos de Gastrectomía vertical laparoscópica (GVL) o bypass gástrico en Y de Roux laparoscópico (BGYRL) en nuestro centro. Materiales y Método: Estudio observacional de una base de datos prospectiva. Las variables del estudio fueron IMC pre y posoperatorio, porcentaje de exceso de IMC perdido (PEIMCP), puntuación obtenida en los cuestionarios Gastrointestinal Quality of Life Index (GIQLI) y Bariatric Analysis and Reporting Outcomes System (BAROS) y la resolución de las comorbilidades. Resultados: De 60 pacientes: 37 fueron intervenidos de GVL y 23 de BGYRL. El IMC posoperatorio al año fue 29,9 ± 4 kg/m2 en BGYRL y 31,3 ± 5 kg/m2 en GVL. El PEIMCP fue de 74,5 ± 19,2% (BGYRL) y de 67,5 ± 23,1% (GVL). Con BAROS, se obtuvieron resultados buenos o superiores en el 87% (BGYRL) y en 83,8% (GVL). Con GIQLI se obtuvo una puntuación media de 108,3 ± 19 (BGYRL) y 109,8 ± 18,3 (GVL). No se observaron diferencias estadísticamente significativas entre ambos grupos en ninguna de las variables previas. En cuanto a la evolución de las comorbilidades, 50% de BGYRL y 53,8% de GVL presentaron resolución de todas las comorbilidades. Conclusiones: Ambas técnicas son eficaces en cuanto al PEIMCP, a la calidad de vida y al control de comorbilidades al año de la intervención. El BGYRL presenta mejores resultados en PEIMCP y BAROS, y la GVL presenta mejor puntación global y especifica de síntomas digestivos con GIQLI, sin ser diferencias estadísticamente significativas.
Aim: The purpose of our study was to compare the postoperative quality of life, weight loss and improvement of co-morbidities in laparoscopic Roux-en-Y gastric bypass (LRYGB) and Laparoscopic sleeve gastrectomy (LSG) patients one year after surgery. Materials and Method: Match pair analysis of the prospectively collected database of the 23 gastric bypass and 37 gastric sleeve patients operated on in our hospital was performed. Weight loss, quality of life and improvement of co-morbidities were measured at one year after surgery. The quality of life parameters were measured with two standard questionnaires: Gastrointestinal Quality of Life Index (GIQLI) and Bariatric Analysis and Reporting Outcomes System (BAROS). Results: After one year of follow-up the mean BMI was 29.9 ± 4 kg/m2 in LRYGB and 31.3 ± 5 kg/m2 in LSG. The percent excess BMI Loss (%EBMIL) was 74.5 ± 19.2% (LRYGB) and 67.5 ± 23.1% (LSG). A success score in BAROS was obtained in 87% (LRYGB) and 83.8% (LSG). The mean GIQLI score was 108.3 ± 19 (LRYGB) and 109.8 ± 18.3 (LSG). These results did not differ significantly. Remission of co-morbidities was similar in the BGYRL and LSG groups (50 vs 53.8%). Conclusions: Both types of surgery are effective in quality of life, co-morbidities and weight loss after one year of follow-up. The LRYGB produced better results in %EBMIL and BAROS, and the LSG produced better results in GIQLI (overall and digestive symptoms). These results did not differ significantly.
Assuntos
Humanos , Masculino , Feminino , Adulto , Obesidade Mórbida/cirurgia , Derivação Gástrica/métodos , Laparoscopia , Gastrectomia/métodos , Qualidade de Vida , Redução de Peso , Índice de Massa Corporal , Comorbidade , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To evaluate the predictive and prognostic value of total tumor load (TTL) in sentinel lymph nodes (SLNs) in patients with infiltrating breast cancer after neoadjuvant systemic therapy (NST). METHODS: This retrospective multicenter study used data from a Spanish Sentinel Lymph Node database. Patients underwent intraoperative SLN biopsy after NST. TTL was determined from whole nodes using a one-step nucleic acid amplification (OSNA) assay and defined as the total sum of CK19 mRNA copies in all positive SLNs. Cox-regression models identified independent predictive variables, which were incorporated into a nomogram to predict axillary non-SLN metastasis, and identified prognostic variables for incorporation into a disease-free survival (DFS) prognostic score. RESULTS: A total of 314 patients were included; most had no lymph node involvement prior to NST (cN0; 75.0% of patients). Most received chemotherapy with or without biologic therapy (91.7%), and 81 patients had a pathologic complete response. TTL was predictive of non-SLN involvement (area under the concentration curve = 0.87), and at a cut-off of 15,000 copies/µL had a negative predictive value of 90.5%. Nomogram parameters included log (TTL + 1), maximum tumor diameter and study-defined NST response. TTL was prognostic of disease recurrence and DFS at a cut-off of 25,000 copies/µL. After a 5-year follow-up, DFS was higher in patients with ≤ 25,000 copies/µL than those with > 25,000 (89.9% vs. 70.0%; p = 0.0017). CONCLUSIONS: TTL > 15,000 mRNA copies/µL was predictive of non-SLN involvement and TTL > 25,000 mRNA copies/µL was associated with a higher risk of disease recurrence in breast cancer patients who had received NST.
Assuntos
Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Técnicas de Amplificação de Ácido Nucleico , Linfonodo Sentinela/patologia , Carga Tumoral , Feminino , Humanos , Metástase Linfática , Terapia Neoadjuvante , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Biópsia de Linfonodo SentinelaRESUMO
PURPOSE: Trastuzumab has proven to improve the prognosis of HER2-positive breast cancer, but the information available about its administration for small tumors is still limited. Therefore, we assessed the use of adjuvant regimens with trastuzumab for the treatment of small HER2-positive breast cancer in routine clinical practice. METHODS: This observational study was conducted in patients with HER2-positive breast adenocarcinoma ≤1.5 cm who received trastuzumab-based adjuvant treatment in clinical practice. Clinical/histopathological data were retrieved from patients' medical charts. RESULTS: A total of 101 evaluable patients were enrolled (median age [range], 56.7 [49.0-64.8] years; ECOG 0, 98.0 %; ductal carcinoma, 88.1 %; lymph nodes N0, 79.2 %). Only five (5.0 %) patients received neoadjuvant treatment, while all patients underwent tumor surgery. Adjuvant trastuzumab was administered at a mean (±SD) dose of 5.9 ± 1.5 mg/kg/cycle, and mostly in a three-weekly schedule (89 [89.0 %] patients). The most frequent adjuvant therapy used with trastuzumab was chemotherapy (87 [86.1 %] patients), followed by radiotherapy (63 [62.4 %] patients) and hormone therapy (52 [51.5 %] patients). Chemotherapy regimens mainly included doxorubicin, cyclophosphamide and paclitaxel/docetaxel (n = 30), docetaxel and cyclophosphamide (n = 15), docetaxel and carboplatin (n = 13). Hormone therapy mainly included letrozole (n = 17) and tamoxifen (n = 17). Nine (8.9 %) patients reported trastuzumab-related adverse events; only one allergic reaction reached grade 3 toxicity. CONCLUSION: This study shows that trastuzumab-based adjuvant treatment of small HER2-positive breast cancer is mostly based on chemotherapy-mainly paclitaxel/docetaxel. Adjuvant administration of trastuzumab for small HER2-positive breast cancer seems to be similar to that used for larger tumors.
Assuntos
Adenocarcinoma/tratamento farmacológico , Antineoplásicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Trastuzumab/uso terapêutico , Adenocarcinoma/genética , Adenocarcinoma/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Carboplatina/administração & dosagem , Quimiorradioterapia/métodos , Quimioterapia Adjuvante/métodos , Estudos Transversais , Ciclofosfamida/administração & dosagem , Docetaxel , Doxorrubicina/administração & dosagem , Feminino , Humanos , Letrozol , Pessoa de Meia-Idade , Nitrilas/administração & dosagem , Paclitaxel/administração & dosagem , Receptor ErbB-2/genética , Tamoxifeno/administração & dosagem , Taxoides/administração & dosagem , Triazóis/administração & dosagemRESUMO
Phenotype-linked fertility hypothesis (PLFH) predicts that male secondary sexual traits reveal honest information about male fertilization ability. However, PLFH has rarely been studied in humans. The aim of the present study was to test PLFH in humans and to investigate whether potential ability to select fertile partners is independent of sex or cultural background. We found that on the contrary to the hypothesis, facial masculinity was negatively associated with semen quality. As increased levels of testosterone have been demonstrated to impair sperm production, this finding may indicate a trade-off between investments in secondary sexual signalling (i.e. facial masculinity) and fertility or status-dependent differences in investments in semen quality. In both sexes and nationalities (Spanish and Colombian), ranked male facial attractiveness predicted male semen quality. However, Spanish males and females estimated facial images generally more attractive (gave higher ranks) than Colombian raters, and in both nationalities, males gave higher ranks than females. This suggests that male facial cues may provide culture- and sex-independent information about male fertility. However, our results also indicate that humans may be more sensitive to facial attractiveness cues within their own populations and also that males may generally overestimate the attractiveness of other men to females.
Assuntos
Face , Masculinidade , Análise do Sêmen , Adulto , Colômbia , Sinais (Psicologia) , Características Culturais , Feminino , Humanos , Masculino , Fenótipo , Análise de Regressão , Espanha , Adulto JovemRESUMO
The solvatochromic behavior of sulfamethoxazole (SMX) was investigated using UV-vis spectroscopy and DFT methods in neat and binary solvent mixtures. The spectral shifts of this solute were correlated with the Kamlet and Taft parameters (α, ß and π(*)). Multiple lineal regression analysis indicates that both specific hydrogen-bond interaction and non specific dipolar interaction play an important role in the position of the absorption maxima in neat solvents. The simulated absorption spectra using TD-DFT methods were in good agreement with the experimental ones. Binary mixtures consist of cyclohexane (Cy)-ethanol (EtOH), acetonitrile (ACN)-dimethylsulfoxide (DMSO), ACN-dimethylformamide (DMF), and aqueous mixtures containing as co-solvents DMSO, ACN, EtOH and MeOH. Index of preferential solvation was calculated as a function of solvent composition and non-ideal characteristics are observed in all binary mixtures. In ACN-DMSO and ACN-DMF mixtures, the results show that the solvents with higher polarity and hydrogen bond donor ability interact preferentially with the solute. In binary mixtures containing water, the SMX molecules are solvated by the organic co-solvent (DMSO or EtOH) over the whole composition range. Synergistic effect is observed in the case of ACN-H2O and MeOH-H2O, indicating that at certain concentrations solvents interact to form association complexes, which should be more polar than the individual solvents of the mixture.
Assuntos
Elétrons , Modelos Moleculares , Teoria Quântica , Solventes/química , Sulfametoxazol/química , Absorção Fisico-Química , Acetonitrilas/química , Dimetil Sulfóxido/química , Dimetilformamida/química , Etanol/química , Espectrofotometria Ultravioleta , TermodinâmicaRESUMO
Stoichiometry and apparent stability constant (K(C)) of the complex formed between Al(III) and 3-hydroxyflavone were determined in methanol and water-methanol mixtures (% water w/w: 3.11; 6.15; 10.4; 15.2; 19.9 and 25.3) by UV-vis spectroscopy at 25.0°C and constant ionic strength (0.05 M, sodium chloride). Stoichiometry of the complex (1:2, metal:ligand) is not modified with an increase in water percentage in the analyzed interval. The value of K(C) in methanol is greater than in the binary solutions. The effects of changing solvent composition on K(C) data were explained by linear solvation free energy relationships using the solvatochromic parameter of Kamlet and Taft (α, ß and π(*)). Multiple linear regression analysis indicates that the hydrogen bond donating ability (α) of the solvent and non-specific interactions (π(*)) play an important role in the degree of occurrence of the reaction. The effect of temperature on K(C) was also analyzed by assessing standard entropy and enthalpy variations of the reaction in methanol. Finally, the structure of the complex was investigated using FTIR spectroscopy and DFT calculations. The ligand exhibits small structural changes upon complexation, localized on the chelating site. The calculated vibrational frequencies of the complex were successfully compared against the experimental values.
Assuntos
Alumínio/química , Flavonoides/química , Metanol/química , Água/química , Absorção , Cinética , Conformação Molecular , Concentração Osmolar , Soluções , Solventes/química , Espectrofotometria Infravermelho , Temperatura , VibraçãoRESUMO
A prospective study was conducted on 72 patients of pulmonary tuberculosis (TB) and 201 healthy controls in a third level hospital. The HRQoL questionnaire (12-Item Short Form Health Survey, SF-12) was used to assess the QoL at the onset of treatment DOTS. Patients with TB had significantly lower mean scores than controls for overall QoL (51.1 +/- SD 22.6) versus 75.9 (+/- SD 17.6), p < 0.0001. The most affected domains were physical and psychological. Active TB patients shown difficulties in activities of daily living and alterations of the psychological state.
Assuntos
Qualidade de Vida , Tuberculose , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
The complexation of Al(III) by 2,4(OH)(2)-acetophenone in methanol and ethanol was investigated using spectroscopic methods (UV-vis) and theoretical procedures (DFT) in order to determine its stoichiometry and stability constant and to analyze the effect of temperature, ionic strength and solvent on the reaction rate. The stoichiometric composition of the complex is 1:1 and the stability constant in methanol is greater than in ethanol. The parameters obtained by the Arrhenius equation and the transition-state theory permitted to explain why the reaction proceeds more rapidly in EtOH. The reaction is favoured when the ionic strength and the reaction medium permittivity decrease. Taking into account the kinetic results and the theoretical calculations performed, a reaction mechanism in three steps is proposed that considers the interaction between ionic species of opposite unitary charge to generate the metal complex. In the formation of the complex, the aluminium atom interacts forming a covalent bond with the oxygen atom of the hydroxyl group of the ligand and its carbonyl group by means of a strong Coulombic interaction.
Assuntos
Acetofenonas/química , Alumínio/química , Etanol/química , Cinética , Ligantes , Metanol/química , Modelos Químicos , Concentração Osmolar , Solventes/química , Espectrofotometria Ultravioleta , TemperaturaRESUMO
Cell adhesion molecules act as signal transducers from the extracellular environment to the cytoskeleton and the nucleus and consequently induce changes in the expression pattern of structural proteins. In this study, we showed the effect of thyroid hormone (TH) inhibition and arrest of metamorphosis on the expression of E-cadherin, beta-and alpha-catenin in the developing kidney of Bufo arenarum. Cell adhesion molecules have selective temporal and spatial expression during development suggesting a specific role in nephrogenesis. In order to study mechanisms controlling the expression of adhesion molecules during renal development, we blocked the B. arenarum metamorphosis with a goitrogenic substance that blocks TH synthesis. E-cadherin expression in the proximal tubules is independent of thyroid control. However, the blockage of TH synthesis causes up-regulation of E-cadherin in the collecting ducts, the distal tubules and the glomeruli. The expression of beta-and alpha-catenin in the collecting ducts, the distal tubules, the glomeruli and the mesonephric mesenchyme is independent of TH. TH blockage causes up-regulation of beta-and alpha-catenin in the proximal tubules. In contrast to E-cadherin, the expression of the desmosomal cadherin desmoglein 1 (Dsg-1) is absent in the control of the larvae kidney during metamorphosis and is expressed in some interstitial cells in the KClO4 treated larvae. According to this work, the Dsg-1 expression is down-regulated by TH. We demonstrated that the expression of E-cadherin, Dsg-1, beta-catenin and alpha-catenin are differentially affected by TH levels, suggesting a hormone-dependent role of these proteins in the B. arenarum renal metamorphosis.
Assuntos
Bufo arenarum/embriologia , Moléculas de Adesão Celular/metabolismo , Rim/embriologia , Percloratos/farmacologia , Compostos de Potássio/farmacologia , Tri-Iodotironina/antagonistas & inibidores , Animais , Bufo arenarum/metabolismo , Caderinas/metabolismo , Embrião não Mamífero , Feminino , Imuno-Histoquímica , Rim/metabolismo , alfa Catenina/metabolismo , beta Catenina/metabolismoRESUMO
Cell adhesion molecules act as signal transducers from the extracellular environment to the cytoskeleton and the nucleus and consequently induce changes in the expression pattern of structural proteins. In this study, we showed the effect of thyroid hormone (TH) inhibition and arrest of metamorphosis on the expression of E-cadherin, β-and α-catenin in the developing kidney of Bufo arenarum. Cell adhesion molecules have selective temporal and spatial expression during development suggesting a specific role in nephrogenesis. In order to study mechanisms controlling the expression of adhesion molecules during renal development, we blocked the B. arenarum metamorphosis with a goitrogenic substance that blocks TH synthesis. E-cadherin expression in the proximal tubules is independent of thyroid control. However, the blockage of TH synthesis causes up-regulation of E-cadherin in the collecting ducts, the distal tubules and the glomeruli. The expression of β-and α-catenin in the collecting ducts, the distal tubules, the glomeruli and the mesonephric mesenchyme is independent of TH. TH blockage causes up-regulation of β-and α-catenin in the proximal tubules. In contrast to E-cadherin, the expression of the desmosomal cadherin desmoglein 1 (Dsg-1) is absent in the control of the larvae kidney during metamorphosis and is expressed in some interstitial cells in the KClO4 treated larvae. According to this work, the Dsg-1 expression is down-regulated by TH. We demonstrated that the expression of E-cadherin, Dsg-1, β-catenin and α-catenin are differentially affected by TH levels, suggesting a hormone-dependent role of these proteins in the B. arenarum renal metamorphosis.
Moléculas de adesão celular atuam como tradutores do ambiente extracelular para o citoesqueleto e o núcleo e, conseqüentemente, induzindo mudanças no padrão da expressão das proteínas estruturais. Neste estudo, observamos os efeitos da inibição do hormônio tireóidea (TH) e detenção da metamorfose na expressão da E-caderina, β- e α- catenina no desenvolvimento do rim do Bufo arenarum. As moléculas de adesão celular durante o desenvolvimento têm uma expressão temporal e espacial seletiva, sugerindo um papel específico na nefrogênese. Com o propósito de estudar os mecanismos de controle da expressão das moléculas de adesão durante o desenvolvimento renal, bloqueou-se a metamorfose do B. arenarum com uma substancia goitrogênica que bloqueia a síntese de TH. A expressão da E-caderina nos tubos proximais é independente do controle da tireóide. Entretanto, o bloqueio da síntese de TH provoca uma sobre elevação da E-caderina nos dutos coletores, nos tubos distais e nos glomérulos. A expressão da β- e α-catenina nos dutos coletores, nos tubos distais, nos glomérulos e no mesênquima mesonéfrico é independente da TH. O bloqueio da TH causa uma sobre-regulação da β- e α-catenina nos tubos proximais. Em contraste com a E-caderina, a expressão da caderina desmossomal demogloína 1 (Dsg-1) é ausente no controle durante a metamorfose da fase larval dos rins e se expressa em algumas células intersticiais nas larvas tratadas com KClO4. De acordo com este trabalho, a expressão Dsg-1 é subregulada pela TH. Demonstramos que a expressão da E-caderina, Dsg-1, β-catenina e α-catenina são afetadas de forma diferencial pelos níveis de TH, sugerindo um dependência hormonal destas proteínas na metamorfose renal do B. arenarum.
Assuntos
Animais , Feminino , Bufo arenarum/embriologia , Moléculas de Adesão Celular/metabolismo , Rim/embriologia , Percloratos/farmacologia , Compostos de Potássio/farmacologia , Tri-Iodotironina/antagonistas & inibidores , Bufo arenarum/metabolismo , Caderinas/metabolismo , Embrião não Mamífero , Imuno-Histoquímica , Rim/metabolismo , alfa Catenina/metabolismo , beta Catenina/metabolismoRESUMO
The influence of temperature and solvent effects on the stability of the complex formed by two molecules of 1,2-dihydroxybenzene and one molecule of AlCl3 were experimentally and theoretically studied, by means of UV spectroscopic methods and Density Functional Theory methods. The changes of the stability constant with the temperature were analyzed using the van't Hoff equation, while the variations with the permittivity of the reaction medium were explained with an equation proposed by us. The experimental and theoretical data obtained allowed proving that the increase in the hydrogen-bond donor ability of the solvents favors a higher thermodynamic stability of the reactants with respect to the complex and, therefore a decrease in the corresponding stability constant. The non-planar structure proposed for the 2:1 ligand-metal complex is coherent with the small batochromic shift experimentally observed. In the complex molecule, the planes containing the phenyl rings are tilted by approximately 89 degrees with each other. It was concluded that the complexation reaction is an endothermic process in which the solvent-solute interactions play an essential role.
Assuntos
Alumínio/química , Catecóis/química , Compostos Organometálicos/química , Estabilidade de Medicamentos , Solventes , Espectrofotometria Ultravioleta , Temperatura , TermodinâmicaRESUMO
Introducción: La relación del HTLV con patología neoplásica y neurológica y su capacidad para transmitirse por hemocomponentes ha llevado a la necesidad de su detección en los Bancos de Sangre. También se ha informado acerca de la coinfección de este virus con el HIV. Objetivo: Estudiar la prevalencia de HTLV en nuestra población de donantes de sangre y en una población de pacientes infectados con HIV. Material y método: Se estudiaron 4.125 donantes de sangre y 84 pacientes con reciente diagnóstico de infección por HIV. Se realizó el tamizaje por ELISA o aglutinación de partículas de gelatina y las muestras reactivas se confirmaron por WB. Resultados: La detección en donantes en la fase de tamizaje fue de 0,31 por ciento, no confirmándose resultado por WB. En los pacientes con HIV se encontró una 10,7 por ciento de reactivos por tamizaje, siendo un 8,33 por ciento del total confirmado como positivos. Discusión: La asociación de HTLV e HIV resultó significativa. Si bien en donantes no se confirmó ningún caso, hay argumentos suficientes para realizar su búsqueda en las unidades a transfundir a fin de garantizar mayor seguridad transfusional.
Assuntos
Humanos , Bancos de Sangue , Doadores de Sangue , Transfusão de Sangue , Portador Sadio/transmissão , Estudos Transversais , Deltaretrovirus , Infecções por Deltaretrovirus/epidemiologia , Infecções por HIV/epidemiologia , Testes Sorológicos , Coleta de Amostras Sanguíneas , Triagem Multifásica/métodosRESUMO
Introducción: La relación del HTLV con patología neoplásica y neurológica y su capacidad para transmitirse por hemocomponentes ha llevado a la necesidad de su detección en los Bancos de Sangre. También se ha informado acerca de la coinfección de este virus con el HIV. Objetivo: Estudiar la prevalencia de HTLV en nuestra población de donantes de sangre y en una población de pacientes infectados con HIV. Material y método: Se estudiaron 4.125 donantes de sangre y 84 pacientes con reciente diagnóstico de infección por HIV. Se realizó el tamizaje por ELISA o aglutinación de partículas de gelatina y las muestras reactivas se confirmaron por WB. Resultados: La detección en donantes en la fase de tamizaje fue de 0,31 por ciento, no confirmándose resultado por WB. En los pacientes con HIV se encontró una 10,7 por ciento de reactivos por tamizaje, siendo un 8,33 por ciento del total confirmado como positivos. Discusión: La asociación de HTLV e HIV resultó significativa. Si bien en donantes no se confirmó ningún caso, hay argumentos suficientes para realizar su búsqueda en las unidades a transfundir a fin de garantizar mayor seguridad transfusional. (AU)
Assuntos
Humanos , Estudos Transversais , Doadores de Sangue , Portador Sadio/transmissão , Testes Sorológicos , Bancos de Sangue , Transfusão de Sangue , Deltaretrovirus , Infecções por Deltaretrovirus/epidemiologia , Infecções por HIV/epidemiologia , Triagem Multifásica/métodos , Coleta de Amostras SanguíneasRESUMO
This article reviews literature on the epidemiology, pathogenicity, and control of HIV and Mycobacterium tuberculosis coinfection. Regarding pathogenicity, immune system deterioration makes HIV-infected people more likely to develop active tuberculosis on primary or secondary exposure to the bacillus or to suffer reactivation of latent infections, and to experience considerably higher rates of extrapulmonary manifestations, relapses, and death. Regarding epidemiology, as of 1990 there were an estimated 3 million people coinfected with HIV and M. tuberculosis, with some 300,000 active tuberculosis cases and 120,000-150,000 tuberculosis deaths occurring annually among those coinfected. Over 500,000 coinfected people are thought to reside in the Americas, over 400,000 of them in Latin America. In general, the impact of coinfection is evident. Relatively high and increasing prevalences of HIV infection have been detected among tuberculosis patients around the world, and tuberculosis has become a frequent complication of AIDS cases. Moreover, there is no longer any doubt that coinfection obstructs tuberculosis prevention and control. Among other things, it affects BCG vaccination policies, suggests the need to administer preventive chemoprophylaxis to HIV-infected individuals at high risk of harboring or contracting tuberculosis infections, and complicates both detection and treatment of active tuberculosis cases. The recent proliferation of M. tuberculosis strains resistant to multiple drugs, most notably in the United States, compounds the problem. Tuberculosis prevention and control are still technically and economically feasible. However, more must be done to establish surveillance programs with laboratory support. More research is needed to determine what case prevention measures are best-suited to current circumstances and the HIV/AIDS presence. More effective preventive treatment regimens that are well tolerated, well complied with, and do not pose the risk of multiresistance need to be devised. More health workers need to be trained to suspect tuberculosis and to conduct timely and appropriate tests confirming this diagnosis. And finally, more must be done to standardize the types and durations of the various curative treatment regimens employed.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Tuberculose Pulmonar/epidemiologia , Síndrome da Imunodeficiência Adquirida/complicações , Humanos , Prevalência , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/prevenção & controleRESUMO
BACKGROUND: Acarbose is a reversible inhibitor of the intestinal alpha-glucosidases, the oral administration of which delays or diminishes the postprandial increase of glucose and insulin. METHODS: A multicentric double-blind clinical trial (11 centers), controlled versus placebo, crossed and randomized, was carried out with 137 insulin-dependent diabetic type I patients treated with diet and insulin. During the first 3 months of the trial the patients received placebo or acarbose randomly. Following one month of wash out with placebo the patients received the inverse medication for 3 more months. During the first month of each phase the patients were given 50 mg three times per day of acarbose or placebo and the two following moths received 100 mg x 3/day. RESULTS: Upon comparison of the two treatments significant statistical differences were found in HbA1 (p = 0.0005) and in postprandial glycemia (p = 0.007). There were differences, although not statistically significant, in the amounts of triglycerides, cholesterol and fasting glycemia. One hundred and two patients referred adverse events, most being gastrointestinal (flatulence, meteorism). CONCLUSIONS: Acarbose may be useful in the treatment of insulin-dependent diabetic type I patients treated with insulin and diet since it reduces the levels significantly of HbA1 and postprandial glucose.
Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Inibidores de Glicosídeo Hidrolases , Trissacarídeos/uso terapêutico , Acarbose , Adulto , Terapia Combinada , Diabetes Mellitus Tipo 1/terapia , Dietoterapia , Método Duplo-Cego , Feminino , Humanos , Insulina/uso terapêutico , Masculino , Pessoa de Meia-IdadeRESUMO
The carcinogenic effects of ionizing radiation at high doses are un questionable. On the other hand, the deleterious exposure effects to low doses have not been totally proven, mainly due to methodological problems and difficulty in measuring reliable dose exposure. In this paper, some recent studies examining the effects of ionizing radiation in some occupational groups are reviewed and discussed. Also, the main areas of epidemiologic controversy are stressed. For future experiences, prospective, longitudinal studies with occupational cohorts, measuring radiation exposure with adequate registry and follow-up, are suggested.
Assuntos
Neoplasias Induzidas por Radiação/epidemiologia , Radiação de Fundo , Estudos de Casos e Controles , Estudos de Coortes , Exposição Ambiental , Humanos , Tábuas de Vida , Neoplasias Induzidas por Radiação/etiologia , New Hampshire/epidemiologia , Reatores Nucleares , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Doenças Profissionais/mortalidade , Exposição Ocupacional , Centrais Elétricas , Modelos de Riscos Proporcionais , Doses de Radiação , Tennessee/epidemiologia , Urânio , Washington/epidemiologiaRESUMO
The main aim of this study was to assess the quality and quantity of the Mexican epidemiologic production published in two journals: Salud Pública de México (SPM) and Boletín de la Oficina Sanitaria Panamericana (BOSP). A previously accepted criterion was used to qualify a paper as an epidemiologic work. The period of study was eleven years (1975-1985) with 89 classified paper as "epidemiologic reports" (36 of BOSP and 53 of SPM). The variables included: original or revision's report; epidemiologic design; measures employed (frequency, association or potential impact); condition (contagious diseases, chronic-degenerative diseases or physiologic status); use of prevalent cases, incident cases or deaths; internal and external validity; bias' recognition; and number of references. Among the results that stand out are the proportion of cross-sectional designs (51.75), the weight for communicable diseases (36%), the detection of potential bias (65.7%) and the reports without references (30%). The discussion is centered in the main implications of these results when they are used to make decisions in the planning, operation and assessment of health services and in the generation of new epidemiologic knowledge.
Assuntos
Epidemiologia , Saúde Pública , Editoração/normas , Métodos Epidemiológicos , Estudos de Avaliação como Assunto , México , Publicações Periódicas como AssuntoRESUMO
The differential in mortality by sex has not been broadly studied in Mexico. In this work mortality by sex in under one year old children and infants by federal entity for the main infectious diseases during 1980-1982 was analyzed. The results showed that the rate of mortality by sex (RMS) for under one year old children was higher than one, which means that there is a male over-mortality for that group of age. In the one to four year old children group, there were three entities that showed over-mortality among women. The analysis of the proportional mortality revealed that 40 to 50 percent of deaths in under one year old children were due to gastroenteral and respiratory infections. The probable causes of the male over-mortality observed and the need to determine the regional patterns of mortality are also discussed.