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Plastic accumulation in the world amounts to approximately 8300 million tons. Polyurethanes (PU) account for 7.7 % of total plastics production worldwide, and their diverse chemical composition makes them highly recalcitrant to biodegradation. Several works have reported polyurethane-degrading microbial communities. However, it is still necessary to learn more about the chemical, biochemical, and genetic bases linked to the polyurethanolytic phenotype and the microbial taxonomic determinants responsible for metabolizing the PU polymer and its associated chemical additives. To shed light on this problem, we applied physical, chemical, biochemical, metagenomic, and bioinformatic analyses to explore the biodegradation capability and related biochemical and genetic determinants of the BP6 microbial community that can grow in PolyLack, a commercial coating containing a polyether polyurethane acrylate (PE-PU-A) copolymer and several additives, as sole carbon source. We observed complete additives (isopropanol, N-methyl-2-pyrrolidone, 2-butoxyethanol, alkyl glycol ethers) biodegradation and the appearance of released polymer components (toluene diisocyanate (TDI) and methylene diphenyl diisocyanate (MDI) derivatives), and multiple degradation products since early cultivation times. The Hi-C metagenomic analysis identified a complex microbiome with 35 deconvolved Metagenome-Assembled Genomes (MAGs) - several new species - and biodegradation markers that suggest the coexistence of hydrolytic, oxidative, and reductive metabolic strategies for degrading the additives and the PU copolymer. This work also provides evidence of the metabolic capability the BP6 community has for biodegrading polyether polyurethane foams. Based on these analyses, we propose a novel metabolic pathway for 4,4'-methylenedianiline (MDA), an initial biodegradation intermediate of MDI-based PU, encoded in the complex BP6 community metagenome and suggest that this community is a potential biotechnological tool for PU bio-recycling.
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Microbiota , Poliuretanos , Poliuretanos/química , Metagenoma , Plásticos , Biodegradação Ambiental , Instalações de Eliminação de ResíduosRESUMO
OBJECTIVE: To evaluate the association between depressive symptoms in the caregiver and the presen ce of affective and behavioral problems in children and adolescents. SUBJECTS AND METHOD: Descripti ve correlational cross-sectional research. SAMPLE: 1100 children and adolescents with their respective parents or caregivers from public schools in Caldas, Colombia. Instruments used: Child Behavior Checklist (CBCL) and Patient Health Questionnaire (PHQ-9). RESULTS: The mean age was 12.1 years. According to the CBCL, up to 20% of the children and adolescents showed alteration in one of the syndromes for affective or behavioral difficulties. 34% of mothers and 14% of fathers showed for at least two weeks sadness, discouragement, depression, and loss of interest. When applying the PHQ- 9, 32.4% of the parents/caregivers were classified with depression. Parents/caregivers with such di sorders tend to perceive greater difficulty in coping with their daily lives compared with parents/ caregivers of children and adolescents who are not at risk (p < 0.003). CONCLUSIONS: The presence of depressive symptoms in the parents/caregivers is related to an increase in internalizing and externali zing symptoms in children and adolescents.
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Depressão , Comportamento Problema , Feminino , Humanos , Criança , Adolescente , Depressão/epidemiologia , Depressão/psicologia , Comportamento Problema/psicologia , Cuidadores/psicologia , Estudos Transversais , MãesRESUMO
The incidence of inflammatory bowel disease (IBD) is increasing. Microbiome is one of the most important factors in its development and affects the different clinical outcomes of IBD patients depending on its composition and different alterations. We conducted a systematic review to discuss the association between microbiome and IBD in terms of immune regulation, and therapies that can modify microbiota. A comprehensive systematic literature search was performed through April 2020 in PubMed, Web of Science, the Cochrane Library, and clinicaltrials.gov. Inclusion criteria required IBD immune regulation and alternate therapeutics for IBD. This analysis helps explain the multifactorial origin of microbiome diversity including normal immune regulation, immune pathophysiology of IBD, and shows the evidence of several therapeutic targets to change microbiome in patients with IBD, such as prebiotics, probiotics, antibiotics, fecal microbiota transplant, and others.
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Microbioma Gastrointestinal , Doenças Inflamatórias Intestinais , Probióticos , Antibacterianos/uso terapêutico , Doença Crônica , Transplante de Microbiota Fecal , Microbioma Gastrointestinal/fisiologia , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Prebióticos , Probióticos/uso terapêuticoRESUMO
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Introduction: The development of recommendations for the treatment of rheumatoid arthritis (RA) in the Cuban context may be one of the ways to achieve better control of this disease. Objective: To reach a consensus and update relevant aspects of conventional and biological RA modifier therapy in Cuba. Methods: 18 specialists from 8 Cuban provinces, experts in RA care, were summoned, according to the years of dedication to the specialty, the conferences on this topic and their publications. The first meeting took place in March 2016 in the provincial hospital of Villa Clara, Cuba, with the participation of all the experts. A review of the literature on conventional and biological therapy previously collected by the participants was developed, and two teams were formed: the first would address everything related to conventional therapy in RA (HRCT) and the other, biological therapy in RA (TBAR). Three questionnaires related to the use of corticosteroids, HRCT and TBAR, were prepared, answered by the participants via email. In a second meeting, held in October 2016 in Havana, the analysis of all the responses provided was carried out. Questions with a response of 90% or more votes were considered as recommendations. Results: The questionnaires were answered by 95% of the participants. 9 recommendations and 1 algorithm were established. The recommendations are as follows: methotrexate is the drug of choice in the treatment of RA after diagnosis; The administration of another conventional drug (DMARDc) (azathioprine, salazosulfapyridine, antimalarials and leflunomide) is recommended in patients with a diagnosis of active RA in whom methotrexate is contraindicated or there is a failure in response - consider the administration of low doses of prednisone or equivalent (<7.5 mg/d) associated with DMARDc in patients with active moderate to severe RA, for the shortest possible time; perform serological control including tests for hepatitis B and C viruses and screening for HIV in all patients diagnosed with RA before starting treatment with DMARDc and biologics; in patients in remission or, at least, with a DAS-28 below 3.2, consideration should be given to withdrawing one of the DMARDs or reducing, to the minimum possible expression, the dose of both disease modifiers; if methotrexate fails, tocilizumab in combination with methotrexate or as monotherapy will be indicated. Conclusions: Aspects related to conventional therapy with methotrexate, azathioprine, salazosulfapyridine, antimalarials and leflunomide were agreed. The value of early diagnosis and immediate initiation of DMARDc therapy and the use of glucocorticoids was analyzed. Treatment with tocilizumab, the only biological available in Cuba against RA, will be administered when there is a failure in the response to conventional therapy and combinations between these drugs. It is recommended to hold educational conferences through the mass media aimed at patientshttp(AU)
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Humanos , Artrite Reumatoide/tratamento farmacológico , Terapia Biológica/métodos , Antimaláricos/uso terapêutico , Artrite Reumatoide/terapiaRESUMO
The microbial composition of polyurethane degrading communities has been barely addressed, and it is unknown if microenvironmental conditions modify its composition, affecting its biodegradative capacity. The polyurethanolytic activity and taxonomic composition of five microbial communities, selected by enrichment in the polyether-polyurethane-acrylic (PE-PU-A) coating PolyLack®, from deteriorated PU foams collected at different microenvironments in a municipal landfill (El Bordo Poniente, BP) were explored. All BP communities grew similarly in PolyLack® as the sole carbon source, although BP1, BP4, and BP5 showed better performance than BP2 and BP7. FTIR spectroscopy showed that ester, urethane, ether, aromatic and aliphatic groups, and the acrylate component were targets of the biodegradative activity. Extracellular esterase activity was higher at 5 days of cultivation and decreased at 21 days, while urease activity showed the opposite. Microbial composition analysis, assessed by 16S rDNA V3 region PCR-DGGE, revealed a preponderance of Rhizobiales and Micrococcales. The reported PU-degrading genera Paracoccus, Acinetobacter, and Pseudomonas were identified. In contrast, Advenella, Bordetella, Microbacterium, Castellaniella, and Populibacterium, some of them xenobiotics degraders, can be considered potentially PU-degrading genera. Correspondence analysis identified independent groups for all communities, except the BP4 and BP5. Although partial taxonomic redundancy was detected, unique OTUs were identified, e.g., three members of the Weeksellaceae family were present only in the BP4/BP5 group. These results suggest that the microenvironmental conditions where the landfill microbial communities were collected shaped their taxonomical composition, impacting their PE-PU biodegradative capacities. These BP communities represent valuable biological material for the treatment of PU waste and other xenobiotics. KEY POINTS: ⢠Landfill microbial communities display slightly different capacities for growing in polyether-polyurethane-acrylic. ⢠Ester, urethane, ether, aromatic, aliphatic, and acrylate groups were attacked. ⢠Esterase activity was more significant at early culture times while urease activity at latter. ⢠Landfill microenvironments shape partial taxonomical redundancy in the communities. ⢠Best communities' performance seems to be related to unique members' composition.
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Microbiota , Biodegradação Ambiental , DNA Ribossômico , Poliuretanos , RNA Ribossômico 16S/genética , Instalações de Eliminação de ResíduosRESUMO
Refractoriness remains as one of the challenges in patients with lymphoma under chemotherapy, and among biological regulators in cells driving this type of response are microRNAs (miRNAs). Different genes are constantly turned on or off according to the miRNAs expression profiles affecting the drug response in patients and their stability in serum and plasma makes them potential prognostic biomarkers in several diseases. Here we described a profile of miRNAs in plasma of diffuse large B cell lymphoma (DLBCL) patients. miRNA expression arrays were carried using pre-treatment plasma samples of sixteen patients, followed by a comparison between the responder and the non-responders. After six cycles of R-CHOP treatment, twelve out of sixteen patients were clinically diagnosed with complete response while in four patients no clinical response was observed. Between these groups, a signature of fifteen differential expressed miRNAs was found. The circulating miRNAs in plasma of patients with no response were related to the drug resistance in other types of cancer, by targeting genes involved in cell proliferation and apoptosis, among other cell processes.
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Abstract Introduction Major depressive disorder (MDD) is a prevalent disease affecting women more than men worldwide. Various factors are involved in the genesis of depression, including hormones such as testosterone and certain metabolic factors Objective To evaluate hormone levels and metabolic variables in women with major depression and healthy controls. Method A cross-sectional, comparative analytical study was conducted in 40 participants, 23 patients with an MDD diagnosis and 17 controls, all of women in reproductive age between the ages of 18 and 45. Sociodemographic variables, hormonal profile, and metabolic variables were assessed and the 17-item Hamilton Depression Scale was used to evaluate depressive symptoms. Results No statistically significant differences were observed between the groups in the hormonal and metabolic variables explored. Nevertheless, it was observed that the lower the testosterone levels and the higher the serum glucose levels, the more intense depressive symptoms were. Discussion and conclusion Testosterone is associated with a lower depressive symptoms score on the Hamilton Depression scale, suggesting a potential antidepressant effect, whereas high glucose levels are associated with a higher score on this scale. We believe that the measurement of hormonal and metabolic variables in women can contribute to a better understanding of the pathophysiology of depression.
Resumen Introducción El trastorno depresivo mayor (TDM) es una enfermedad prevalente a nivel mundial, que afecta más a mujeres que a hombres. En la génesis de la depresión se consideran diversos factores, entre ellos algunas hormonas como la testosterona y ciertos factores metabólicos Objetivo Evaluar los niveles de hormonas y variables metabólicas en mujeres con depresión mayor y controles sanas. Método Se realizó un estudio transversal, comparativo y analítico en 40 participantes, 23 pacientes con diagnóstico de TDM y 17 controles, todas ellas mujeres de 18 a 45 años en periodo reproductivo. Se evaluaron variables sociodemográficas, perfil hormonal y variables metabólicas, y se aplicó la Escala de Depresión de Hamilton de 17 reactivos para evaluar los síntomas depresivos. Resultados No se observaron diferencias estadísticamente significativas entre los grupos en las variables hormonales y metabólicas exploradas. Sin embargo, se observó que, cuanto menores eran los niveles de testosterona y mayores los de glucosa sérica, los síntomas depresivos eran de mayor intensidad. Discusión y conclusión La testosterona se asocia con un menor puntaje de síntomas depresivos en la Escala Hamilton, lo que sugiriere un potencial efecto antidepresivo, mientras que los niveles altos de glucosa se asocian con un mayor puntaje en dicha escala. Consideramos que la medición de variables hormonales y metabólicas en la mujer puede contribuir a mejorar el conocimiento de la fisiopatología de la depresión.
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Primary biliary cholangitis (PBC) is an autoimmune liver disease associated with altered lipoprotein metabolism, mainly cholesterol. Hypercholesterolaemia, a major modifiable risk factor for cardiovascular disease in the general population, occurs in 75%-95% of individuals with PBC. The impact of hypercholesterolaemia on cardiovascular risk in PBC, however, is controversial. Previous data have shown that hypercholesterolaemia in PBC is not always associated with an increase in cardiovascular events. However, patients with PBC with cardiovascular risk factors may still warrant cholesterol-lowering therapy. Treatment of hypercholesterolaemia in PBC poses unique challenges among primary care providers due to concerns of hepatotoxicity associated with cholesterol-lowering medications. This review summarises the current understanding of the pathophysiology of hypercholesterolaemia in PBC and its pertinent cardiovascular risk. We will also discuss indications for treatment and the efficacy and safety of available agents for hypercholesterolaemia in PBC.
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Microbial communities are more effective in degrading natural polymers and xenobiotics than pure cultures. Biodegradation of polyacrylic and polyurethane polymers by bacterial and fungal strains has been addressed, but limited information about their biodegradation by microbial communities exists. The aim of this work was to evaluate the ability of three enriched microbial communities (BP1h, BP3h, and BP7h), selected from deteriorated foam pieces collected in a landfill, to biodegrade the polyacrylic component of the 2K-PU coating Bayhydrol® A2470 and the polyester polyurethane coating NeoRez™ R-9637. Two communities were further selected to quantify extracellular esterase, protease, and urease activities, to identify their taxonomic composition, and to analyze the ability of their isolated members to grow in those polymers. The growth of the three communities was larger in polyester polyurethane than in polyacrylic and their biodegradative activities affected ester, urethane, ether, aromatic, and aliphatic groups of the compounds present in the coatings. From all the communities growing in polyacrylic or in polyester polyurethane, two and five different types of colonies were isolated, respectively. In polyacrylic, extracellular esterase and protease activities were at their maximum level at 7 days of culture, whereas in polyester polyurethane, protease and urease were greatest at 21 days. All the isolated community members were identified as xenobiotics degraders. The complete communities grew better in media with the polymers than the isolated members. This is one of the few studies reporting biodegradation of synthetic polymers by microbial communities and serves as basis for developing synthetic consortia with enhanced degradative abilities.
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Biodegradação Ambiental , Microbiota , Poliésteres/metabolismo , Poliuretanos/metabolismo , Xenobióticos/metabolismo , Bactérias/metabolismo , Fungos/metabolismo , Microbiologia do SoloRESUMO
Polyurethanes (PU) are the sixth most produced plastics with around 18-million tons in 2016, but since they are not recyclable, they are burned or landfilled, generating damage to human health and ecosystems. To elucidate the mechanisms that landfill microbial communities perform to attack recalcitrant PU plastics, we studied the degradative activity of a mixed microbial culture, selected from a municipal landfill by its capability to grow in a water PU dispersion (WPUD) as the only carbon source, as a model for the BP8 landfill microbial community. The WPUD contains a polyether-polyurethane-acrylate (PE-PU-A) copolymer and xenobiotic additives (N-methylpyrrolidone, isopropanol and glycol ethers). To identify the changes that the BP8 microbial community culture generates to the WPUD additives and copolymer, we performed chemical and physical analyses of the biodegradation process during 25 days of cultivation. These analyses included Nuclear magnetic resonance, Fourier transform infrared spectroscopy, Thermogravimetry, Differential scanning calorimetry, Gel permeation chromatography, and Gas chromatography coupled to mass spectrometry techniques. Moreover, for revealing the BP8 community structure and its genetically encoded potential biodegradative capability we also performed a proximity ligation-based metagenomic analysis. The additives present in the WPUD were consumed early whereas the copolymer was cleaved throughout the 25-days of incubation. The analysis of the biodegradation process and the identified biodegradation products showed that BP8 cleaves esters, C-C, and the recalcitrant aromatic urethanes and ether groups by hydrolytic and oxidative mechanisms, both in the soft and the hard segments of the copolymer. The proximity ligation-based metagenomic analysis allowed the reconstruction of five genomes, three of them from novel species. In the metagenome, genes encoding known enzymes, and putative enzymes and metabolic pathways accounting for the biodegradative activity of the BP8 community over the additives and PE-PU-A copolymer were identified. This is the first study revealing the genetically encoded potential biodegradative capability of a microbial community selected from a landfill, that thrives within a WPUD system and shows potential for bioremediation of polyurethane- and xenobiotic additives-contamitated sites.
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Rheumatoid arthritis (RA) is a chronic, inflammatory disease closely linked with atherosclerosis. Recommended cardiovascular disease (CVD) integral evaluation includes screening for asymptomatic atherosclerosis plaques with carotid ultrasound (US). The aim of this study is to evaluate the carotid US characteristics, including carotid intima media thickness (cIMT) and carotid plaque (CP), and compare RA-patients and controls in a Mexican-mestizo population. METHOD: Prospective cross-sectional, observational study comparing RA-patients and matched controls without RA. Medical history and physical exam was performed in all subjects by a rheumatologist and two clinical blinded radiologists did the carotid US. Increased cIMT was defined as ≥0.9 mm. CP was defined as a focal narrowing ≥0.5 mm of the surrounding lumen or a cIMT ≥1.2 mm. Multivariable analysis was done comparing RA-patients and control subjects characteristics with carotid US. RESULT: In the final analysis 209 patients were included, 103 patients with RA and 106 controls. Bilateral CP was found more than twice in RA than controls (15.5% vs 6.6%). Unilateral CP was more common in either side evaluated, being heterogeneous plaques the most common in RA-patients. The prevalence of increased cIMT was found higher in RA-patients either in both sides (right 37.9% vs 15.1%, P = 0.00; left 43.7% vs 19.8%, P = 0.00) were statistically significant. CONCLUSION: It was confirmed that RA-patients have greater subclinical atherosclerosis represented in the carotid US measuring cIMT and CP as surrogates. RA-patients with subclinical atherosclerotic disease have more heterogeneous plaques characteristics.
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Artrite Reumatoide/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Ultrassonografia Doppler em Cores , Adulto , Idoso , Artrite Reumatoide/etnologia , Artrite Reumatoide/patologia , Doenças Assintomáticas , Artérias Carótidas/patologia , Doenças das Artérias Carótidas/etnologia , Doenças das Artérias Carótidas/patologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Incidência , Indígenas Norte-Americanos , Masculino , México , Pessoa de Meia-Idade , Placa Aterosclerótica , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Fatores de RiscoRESUMO
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in patients with rheumatoid arthritis (RA). Chronic inflammation and traditional risk factors increase cardiovascular risk (CVR) in these patients. Several CVR calculators are used in general population and in RA patients to predict cardiovascular outcomes and tailor therapy but the precision of these calculators in RA patients has yet to be determined. The aim of this study is to determine which risk calculator correlates best with carotid ultrasound (US) findings, specifically carotid plaque (CP) and carotid intima-media thickness (CIMT) in RA patients without clinical manifestations. This was a cross-sectional observational study relating CVR scores in RA patients with the presence of carotid US findings. A total of 97 patients 40 to 75 years old who fulfilled the 2010 ACR/EULAR and/or the 1987 ACR classification criteria for RA were selected. Clinical assessment of cardiovascular risk was performed using seven calculators and carotid US measurement of intima-media thickness and plaque. The tests with the highest sensitivity for CIMT were the Framingham BMI, Framingham lipids, ACC/AHA 2013, and QRISK2. In CP, the highest sensitivity was in QRISK2, SCORE, and ACC/AHA 2013. RA patients should be comprehensively evaluated to detect cardiovascular risk. Carotid US may be routinely recommended to detect subclinical atherosclerosis in RA patients. A lower cutoff point in CVR scales may be necessary to identify patients with a low and intermediate CVR to detect subclinical atherosclerosis earlier and personalize therapy.
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Artrite Reumatoide/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Adulto , Idoso , Índice de Massa Corporal , Doenças Cardiovasculares/etiologia , Doenças das Artérias Carótidas/etiologia , Estudos Transversais , Diabetes Mellitus Tipo 2 , Feminino , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Patients with rheumatoid arthritis (RA) have a high risk for comorbid conditions which increase mortality, hospital admissions, costs of care and inability. To evaluate the prevalence of comorbidities in Mexican mestizo patients with RA and determine the associated risk factors. Cross-sectional study in which RA patients admitted to our outpatient clinic were consecutively enrolled. We collected data regarding demographics, disease characteristics and comorbidities at the time of the patient's visit to the clinic. We analyzed 225 patients. Their mean age was 55.7 ± 8.3 years; disease duration, 9.5 (3.8-15.5) years; female gender, 93.8%; Disease Activity Score using 28 joints-C-reactive protein, 3 (2-4); methotrexate use, 84.9%; use of any other conventional disease modifying anti-rheumatic drug, 65.7%; use of biological agents, 8%. The most frequently associated diseases were: hypertension, 29.8%; dyslipidemia, 27.1%; osteoporosis, 19.1%; diabetes, 12.4%; hypothyroidism, 6.2%; solid malignancies 4.4%. Risk factors were also evaluated, the most prevalent was overweight in 101 (44.9%) of our patients. A total of 71 (31.6%) had obesity. We also detected high blood pressure in 12.4%, hyperglycemia in 27.1% and hyperlipidemia in 49.8%. Due to the high frequency of comorbidities among RA patients, it is important to follow existing recommendations for their timely detection and management. Cardiovascular diseases must be evaluated with priority. The initial evaluation should include a thorough examination to prevent the deleterious effect of comorbidities in RA.
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Artrite Reumatoide/etnologia , Indígenas Norte-Americanos , Adulto , Idoso , Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Prospectivos , Fatores de Risco , Fatores de TempoRESUMO
Variability of the 10-year cardiovascular (CV) risk predicted by the Framingham Risk Score (FRS) using lipids, FRS using body mass index (BMI), Reynolds Risk Score (RRS), QRISK2, Extended Risk Score-Rheumatoid Arthritis (ERS-RA), and algorithm developed by the American College of Cardiology and the American Heart Association in 2013 (ACC/AHA 2013) according to the European League Against Rheumatism (EULAR) 2015/2016 update of its evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis (RA) has not been evaluated in Mexican mestizo patients. CV risk was predicted using six different risk calculators in 116 patients, aged 40-75, who fulfilled the ACR/EULAR 2010 classification criteria. Results were multiplied by 1.5 according to the EULAR 2015/2016 update. Global comparison of the risk predicted by all scales was done using the Friedman test, considering a P value of ≤0.05 as statistically significant. Individual comparison between the algorithms was made using the Wilcoxon signed-rank test, and a P value of ≤0.003 was considered statistically significant. All calculators showed to be different in the Friedman test (p ≤ 0.001). Median values of predicted 10-year CV risk were 11.02% (6.18-17.55) for FRS BMI; 8.47% (4.6-13.16) for FRS lipids; 5.55% (2.5-11.85) for QRISK2; 5% (3.1-8.65) for ERS-RA; 3.6% (1.5-9.3) for ACC/AHA 2013; and 1.5% (1.5-4.5) for RRS. ERS-RA showed no difference when compared against QRISK2 (p = 0.269). CV risk calculators showed variability among them and cannot be used indistinctly in RA-patients.
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Artrite Reumatoide/complicações , Doenças Cardiovasculares/etiologia , Idoso , Artrite Reumatoide/epidemiologia , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Medição de Risco/métodosRESUMO
OBJECTIVE: To analyze the clinical characteristics, outcomes and prognostic factors in elderly patients (aged 75 years and elder) with acute nonvariceal upper gastrointestinal bleeding (UGIB). METHODS: Consecutive patients admitted with acute nonvariceal UGIB who underwent upper gastrointestinal endoscopy were prospectively recruited and subdivided into two age-based groups, elderly (aged ≥75 years) and younger patients (<75 years). The patients' characteristics and outcomes were recorded. RESULTS: Altogether 1136 patients were included in the study, 276 (24.3%) aged ≥75 years. Peptic ulcers, gastroduodenal erosions and esophagitis represented the three most common endoscopic lesions found in 87.7% of the elderly patients compared with 80.8% in younger patients ( P = 0.008). Overall, the rebleeding rate (4.0% vs 3.3%, P = 0.568), need for blood transfusion (66.3% vs 61.0%, P = 0.122), surgery rate (1.2% vs 1.4%, P = 0.947) and in-hospital mortality (13.0% vs 10.0%, P = 0.157) were not different between the two groups. In elderly patients, serum albumin was the only predictive variable independently associated with mortality in the overall analysis (OR 5.867, 95% CI 2.206-15.604, P < 0.001) and in the subgroup patients with peptic ulcers (OR 5.230, 95% CI 2.099-13.029, P = 0.001). Elderly patients with serum albumin >23.5 g/L at admission presented a low mortality (negative predictive value 97.3%). CONCLUSIONS: Clinical evolution and mortality do not differ between the elderly and younger patients with acute nonvariceal UGIB. Serum albumin level at admission is a prognostic marker for mortality in elder patients.
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Hemorragia Gastrointestinal/etiologia , Doença Aguda , Adulto , Fatores Etários , Idoso , Biomarcadores/sangue , Transfusão de Sangue , Endoscopia Gastrointestinal/métodos , Esofagite/complicações , Esofagite/diagnóstico , Esofagite/terapia , Feminino , Hemorragia Gastrointestinal/terapia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica/complicações , Úlcera Péptica/diagnóstico , Úlcera Péptica/terapia , Prognóstico , Estudos Prospectivos , Recidiva , Ressuscitação/métodos , Albumina Sérica/análise , Resultado do TratamentoRESUMO
Hypokalemic paralysis and respiratory failure associated with distal renal tubular acidosis as first clinical manifestation of primary Sjögren's syndrome has been reported a few times. In this article, we describe the case of a previously healthy 38-year-old female patient who presented to the emergency department with a three-day history of dyspnea at rest and rapidly progressive generalized muscular weakness. Her initial work-up revealed an uncompensated hyperchloremic metabolic acidosis and severe hypokalemia. Additionally, urine pH of 8.0 and other findings consistent with distal renal tubular acidosis were found. We excluded the most common causes of distal renal tubular acidosis and finally established the diagnosis of primary Sjögren's syndrome. Our patient was treated with potassium citrate and later discharged on this treatment.
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RNA-binding proteins (RNPs) participate in diverse processes of mRNA metabolism, and phosphorylation changes their binding properties. In spinach chloroplasts, 24RNP and 28RNP are associated with polynucleotide posphorylase forming a complex on charge of pre-mRNA 3'-end maturation. Here, we tested the hypothesis that the phosphorylation status of 24RNP and 28RNP, present in a spinach chloroplast mRNA 3'-UTR processing extract (CPE), controls the transition between petD precursor stabilization, 3'-UTR processing, and RNA degradation in vitro. The CPE processed or stabilized petD precursor depending on the ATP concentration present in an in vitro 3'-UTR processing (IVP) assay. These effects were also observed when ATP was pre-incubated and removed before the IVP assay. Moreover, a dephosphorylated (DP)-CPE degraded petD precursor and recovered 3'-UTR processing or stabilization activities in an ATP concentration dependent manner. To determine the role 24/28RNP plays in regulating these processes a 24/28RNP-depleted (Δ24/28)CPE was generated. The Δ24/28CPE degraded the petD precursor, but when it was reconstituted with recombinant non-phosphorylated (NP)-24RNP or NP-28RNP, the precursor was stabilized, whereas when Δ24/28CPE was reconstituted with phosphorylated (P)-24RNP or P-28RNP, it recovered 3'-UTR processing, indicating that 24RNP or 28RNP is needed to stabilize the precursor, have a redundant role, and their phosphorylation status regulates the transition between precursor stabilization and 3'-UTR processing. A DP-Δ24/28CPE reconstituted or not with NP-24/28RNP degraded petD precursor. Pre-incubation of DP-Δ24/28CPE with NP-24/28RNP plus 0.03 mM ATP recovered 3'-UTR processing activity, and its reconstitution with P-24/28RNP stabilized the precursor. However, pre-incubation of DP-Δ24/28CPE with 0.03 mM ATP, and further reconstitution with NP-24/28RNP or P-24/28RNP produced precursor stability instead of RNA degradation, and RNA processing instead of precursor stability, respectively. Moreover, in vitro phosphorylation of CPE showed that 24RNP, 28RNP, and other proteins may be phosphorylated. Altogether, these results reveal that phosphorylation of 24RNP, 28RNP, and other unidentified CPE proteins mediates the in vitro interplay between petD precursor stability, 3'-UTR processing, and degradation, and support the idea that protein phosphorylation plays an important role in regulating mRNA metabolism in chloroplast.
Assuntos
Regiões 3' não Traduzidas , Cloroplastos/metabolismo , Proteínas de Plantas/metabolismo , Polirribonucleotídeo Nucleotidiltransferase/metabolismo , Proteínas de Ligação a RNA/metabolismo , Spinacia oleracea/metabolismo , Trifosfato de Adenosina/metabolismo , Bioensaio , Cloroplastos/genética , Misturas Complexas/química , Fosforilação , Proteínas de Plantas/genética , Polirribonucleotídeo Nucleotidiltransferase/genética , Clivagem do RNA , Estabilidade de RNA , Proteínas de Ligação a RNA/genética , Spinacia oleracea/genética , Transcrição GênicaRESUMO
Introducción: En Colombia se desconoce la magnitud del impacto económico de la depresión. Objetivo: Determinar los costos directos del tratamiento hospitalario de la depresión en pacientes con trastornos depresivos de ambos géneros entre los 18 y 65 años de edad. Método: Estudio de costos directos de la enfermedad, a partir de datos consignados en 279 historias clínicas de pacientes hospitalizados por depresión en ocho instituciones de seis ciudades colombianas entre 2007-2008. Se obtuvieron medias o medianas para datos continuos y proporciones para datos categóricos, con sus respectivas medidas de dispersión. Resultados: El costo total promedio de la hospitalización por depresión se encontró en 1.680.000 pesos. La estancia representa el 74,1% del costo de la hospitalización. El costo promedio por día es 150.000 pesos. Bajo condiciones de acceso a los servicios de salud mental restringidas, el costo total directo de hospitalización por depresión severa o moderada está alrededor de 54.000 millones, en la seis ciudades, y en el país, 162.000 millones de pesos. Bajo condiciones de acceso observadas en el ámbito internacional, el costo total es de 134.000 millones de pesos en las seis ciudades y 399.000 millones en el país. Conclusiones: El presente estudio se constituye en un punto de partida hacia la cuantificación de la carga económica de la depresión en Colombia, concretamente en términos de los recursos monetarios destinados al manejo de la enfermedad en hospitales. Los hallazgos deben ser complementados con información sobre otros costos directos e indirectos de la depresión en la población adulta de Colombia.
Introduction: The magnitude of the economic burden of depression in Colombia is unknown. Objective: To determine the direct costs of hospitalary management of male and female patients with depressive disorders aged 18 to 65. Methods: Study of the costs of the illness, using data from 279 clinical records of patients hospitalized with a diagnosis of depression, in 2007-2008, in eight institutions of six cities in Colombia. Means or medians were estimated for continuous data and proportions for categorical data, along with dispersion measures. Results: The total average cost of hospitalization was 1,68 million Colombian pesos. Hospital stay represents 74.1% of the total cost of hospitalization. The average daily cost was 150,000 pesos. Under restricted access conditions the total direct cost of hospitalization for moderate to severe depression was estimated to be around 54,000 million pesos in the six cities included in the study, and 162,000 million pesos at the national level. Under the access conditions observed at the international level, the cost is 134,000 million pesos in the six cities and 399.000 million at the national level. Conclusions: This study is a starting point towards the quantification of the economic burden of depression in Colombia. Specifically, it provides information about the monetary resources used for depression management at the hospital level. These findings need to be complemented with information about other direct and indirect costs related to depression in the adult population of Colombia.
RESUMO
En nuestro medio no se conocen las características clínicas y paraclínicas de pacientes que acuden a una unidad de dolor torácico y menos con la nueva definición de infarto agudo de miocardio (IAM).Materiales y métodos: se evaluaron de manera prospectiva 398 pacientes que ingresaron a una unidad de dolor torácico en cuanto a las características del dolor, sus factores de riesgo, los hallazgos del examen físico, los hallazgos electrocardiográficos y el comportamiento de la troponina T.Resultados: 29.4 porciento de los pacientes tenía diagnóstico de IAM, 29.9 porciento de angina inestable y 40.7 porciento de dolor torácico de origen no isquémico. El dolor de localización retroesternal, la irradiación al cuello y la presencia de diaforesis, náuseas o vómito se relacionan con mayor probabilidad de diagnóstico de IAM. Igualmente, el género masculino y la presencia de factores de riesgo como diabetes o dislipidemia aumentan la probabilidad del diagnóstico. En el electrocardiograma sólo la presencia de lesión, en especial de la subepicárdica, favorece el diagnóstico. La angina inestable y en general el síndrome coronario agudo, tienen un comportamiento clínico semejante aunque no igual.Conclusiones: en el paciente que consulta a urgencias por dolor torácico no traumático la nueva definición de infarto no produce mayores cambios en la presentación clínica y electrocardiográfica. Palabras clave: dolor torácico, infarto agudo de miocardio, angina inestable.