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We study some geometric aspects that influence the transport properties of particles that diffuse on curved surfaces. We compare different approaches to surface diffusion based on the Laplace-Beltrami operator adapted to predict concentration along entire membranes, confined subdomains along surfaces, or within porous media. Our goal is to summarize, firstly, how diffusion in these systems results in different types of diffusion coefficients and mean square displacement measurements, and secondly, how these two factors are affected by the concavity of the surface, the shape of the possible barriers or obstacles that form the available domains, the sinuosity, tortuosity, and constrictions of the trajectories and even how the observation plane affects the measurements of the diffusion. In addition to presenting a critical and organized comparison between different notions of MSD, in this review, we test the correspondence between theoretical predictions and numerical simulations by performing finite element simulations and illustrate some situations where diffusion theory can be applied. We briefly reviewed computational schemes for understanding surface diffusion and finally, discussed how this work contributes to understanding the role of surface diffusion transport properties in porous media and their relationship to other transport processes.
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We study the transport properties of diffusing particles restricted to confined regions on curved surfaces. We relate particle mobility to the curvature of the surface where they diffuse and the constraint due to confinement. Applying the Fick-Jacobs procedure to diffusion in curved manifolds shows that the local diffusion coefficient is related to average geometric quantities such as constriction and tortuosity. Macroscopic experiments can record such quantities through an average surface diffusion coefficient. We test the accuracy of our theoretical predictions of the effective diffusion coefficient through finite-element numerical solutions of the Laplace-Beltrami diffusion equation. We discuss how this work contributes to understanding the link between particle trajectories and the mean-square displacement.
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INTRODUCTION: rotator cuff tears are one of the most common shoulder injuries. The treatment of choice is arthroscopic repair with the use of anchors. The modified Mason-Allen technique, which combines the benefits of suture bridge and mattress sutures, has shown satisfactory results. This study aims to report and analyze the clinical results using these suture techniques in rotator cuff tears. RESULTS: preoperative mean active flexion 126o, 169o at three months, 175o at 12 months (p < 0.0001), active abduction 98o, 159o at three months and 167o at 12 months (p < 0.0001), internal rotation preoperative value 4.4 ± 3, at three months 7.1 ± 1.7 (p < 0.05) and 12 months 7.6 ± 1.1 (p < 0.001). Constant score 45.76 ± 16.35 (p < 0.0001) at three months 87.27 ± 10.94 and 12 months 91.30 ± 6.00. SSV 41.30 ± 20.89, three months 81.43 ± 18.31 and 12 months 94.37 ± 6.90 (p = 0.0001). Initial mean VAS 6.6 ± 1.6 and 12 months 0.63 ± 1.02 (p < 0.0001). CONCLUSION: in rotator cuff tears, using a single row with the modified Mason-Allen technique is a recommended and replicable option with satisfactory results and statistically significant clinical improvement at three and 12 months post-surgery.
INTRODUCCIÓN: la lesión del manguito de los rotadores es una de las lesiones más comunes del hombro. El tratamiento por elección es la reparación artroscópica con uso de anclas. La técnica Mason-Allen modificada, que integra los beneficios de las suturas puente y colchonero, ha demostrado resultados satisfactorios. El propósito de este estudio es reportar y analizar los resultados clínicos del uso de dicha sutura en rupturas del manguito de los rotadores. RESULTADOS: flexión activa media 126o inicial, 169o a tres meses, 175o a 12 meses (p < 0.0001), abducción activa 98o, tres meses 159o y 167o a 12 meses (p < 0.0001), rotación interna valor prequirúrgico 4.4 ± 3, a los tres meses 7.1 ± 1.7 (p < 0.05) y 12 meses 7.6 ± 1.1 (p < 0.001). Constant Score 45.76 ± 16.35 con un valor de p < 0.0001, a tres meses 87.27 ± 10.94 y 12 meses 91.30 ± 6.00. SSV 41.30 ± 20.89, tres meses 81.43 ± 18.31 y 12 meses 94.37 ± 6.90 (p = 0.0001). EVA media inicial 6.6 ± 1.6 y 12 meses 0.63 ± 1.02 (p < 0.0001). CONCLUSIÓN: en rupturas del manguito de los rotadores, el uso de hilera simple con técnica Mason-Allen modificada es una opción recomendada y replicable con resultados satisfactorios y mejoría clínica estadísticamente significativa a los tres y 12 meses postquirúrgicos.
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Lesões do Manguito Rotador , Lesões do Ombro , Humanos , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Artroscopia , Técnicas de Sutura , Resultado do TratamentoRESUMO
Introducción: el tratamiento con activador recombinante del plasminógeno tisular (siglas en inglés rt-PA), aplicado vía intravenosa (IV) es el procedimiento de primera línea en casos de evento vascular cerebral (EVC) en una ventana de 4,5 horas a partir del inicio de los síntomas y con bajo riesgo de transformación hemorrágica del infarto cerebral. El personal de enfermería es un elemento clave para el tratamiento de las personas que han padecido un EVC y se encuentra en su etapa aguda. La fibrinólisis con alteplasa (rt-PA) se ha establecido como tratamiento de primera línea para los casos de ictus isquémico, la administración de este fármaco, control y seguimiento de estos pacientes idealmente debe realizarse por el personal de enfermería en las unidades de ictus. Objetivo: investigar el nivel de conocimiento del personal de enfermería en la administración del activador recombinante del plasminógeno tisular (rt-PA) en el servicio de urgencias en una institución de tercer nivel. Material y métodos: se realizó un estudio descriptivo y transversal en el Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez de la Ciudad de México, con un muestreo por conveniencia, participaron 33 profesionales de enfermería que laboran en el servicio de urgencias, se observaron las 24 horas del día. Se tomó en cuenta a enfermeras de todas las categorías, excluyendo a personal médico, camilleros y enfermeras suplentes. Se aplicó un instrumento para evaluar el conocimiento sobre enfermedad vascular isquémica e intervenciones de enfermería en el cuidado inmediato y mediato en la administración del fármaco activador tisular de plasminógeno (rt-PA). Resultados: llama la atención que sólo 58 % del personal de enfermería conozca el tiempo vital para recuperar al cerebro, otro dato que alarma es que el 30 % no tiene claro el concepto de ictus y al ser una institución de especialidad neurológica de debe establecer un programa de capacitación para establecer intervenciones oportunas con (rt-PA) para reducir secuelas o daño neurológico. Discusión: el papel del personal de enfermería en unidades especializadas en afecciones neurológicas a los pacientes con ictus es proporcionar un cuidado de calidad, eficaz y eficiente, además de participar en la valoración integral del paciente y en la administración del actilyse cuando se trata de una terapia fibrinolítica. En consecuencia, la enfermera debe estar formada sobre los cuidados que requiere este tipo de pacientes, las complicaciones propias de la patología, tratamiento y efectos secundarios del mismo. Proponer un plan de cuidados integral, porque ya el personal tiene conocimientos al respecto de la enfermedad y la aplicación del activador tisular, pero sería interesante implementar para los profesionales en formación, sin olvidar la elaboración de una propuesta como guía de actuación. Conclusión: los cuidados que el personal de enfermería lleva a cabo deben ser especializados en constante actualización y capacitación para ser capaces de detectar y prevenir las complicaciones del proceso patológico y tratamiento.
Introduction: recombinant tissue plasminogen activator (rt-PA) therapy, given intravenously (IV), is the first-line procedure in cases of cerebral vascular event (CVE) within 4.5 hours of symptom onset and with low risk of haemorrhagic transformation of cerebral infarction. Nurses are a key element in the management of people who have suffered a stroke and are in the acute stage. Fibrinolysis with alteplase (rt-PA) has been established as the first-line treatment for ischaemic stroke, and the administration of this drug, control and follow-up of these patients should ideally be carried out by nurses in stroke units. Objective: to investigate the level of nursing staff knowledge in the administration of recombinant tissue plasminogen activator (rt-PA) in the emergency department of a tertiary care institution. Material and methods: a descriptive, cross-sectional study was carried out at the Manuel Velasco Suárez National Institute of Neurology and Neurosurgery in Mexico City, with convenience sampling. 33 nursing professionals working in the emergency department participated, and 24 hours a day were observed. All categories of nurses were considered, excluding medical staff, orderlies and substitute nurses. An instrument was used to assess knowledge of ischaemic vascular disease and nursing interventions in immediate and intermediate care in the administration of tissue plasminogen activator (rt-PA). Results: It is striking that only 58 % of nursing staff are aware of the vital time to recover the brain, another alarming fact is that 30 % are not clear about the concept of stroke and, being a neurological speciality institution, a training programme should be established to establish timely interventions with (rt-PA) to reduce sequelae or neurological damage. Discussion: the role of nurses in units specialising in neurological disorders in stroke patients is to provide quality, effective and efficient care, in addition to participating in the comprehensive assessment of the patient and in the administration of actilyse in the case of fibrinolytic therapy. Consequently, the nurse must be trained in the care required by this type of patient, the complications of the pathology, treatment and its side effects. Propose a comprehensive care plan, because the staff already has knowledge of the disease and the application of the tissue activator, but it would be interesting to implement it for professionals in training, without forgetting the development of a proposal as a guide for action. Conclusion: the care carried out by nursing staff must be specialised and constantly updated and trained in order to be able to detect and prevent complications of the pathological process and treatment.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Terapia Trombolítica , Acidente Vascular Cerebral , Ativador de Plasminogênio Tecidual , Cuidados de EnfermagemRESUMO
A new Mexican leafhopper species, Amblysellus raygozai sp. nov., is described and illustrated from western Mexico. Specimens were collected over perennial grasses. A key for all recognized species within the country is provided.
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Hemípteros , Animais , México , PoaceaeAssuntos
Dor nas Costas/etiologia , Fraturas por Osteoporose/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Fraturas por Osteoporose/etiologia , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Fraturas da Coluna Vertebral/etiologiaRESUMO
Introducción: La neoplasia sólido papilar del páncreas (NSPP) descrita por Frantz en 1959 es una lesión rara, indolente, cuyo origen no ha sido dilucidado. La OMS lo establece como una neoplasia usualmente benigna, con un incremento en su frecuencia en los últimos años. Se presenta en mujeres jóvenes cuya edad promedio es 30 años. Raros casos son reportados en hombres. El presente estudio tiene como finalidad determinar el patrón al USE de la neoplasia solido papilar y correlacionarlos con los hallazgos citológicos de la punción aspiración por aguja fina. (PAAF). Métodos: Se evaluaron retrospectivamente 10 casos visualizados por USE y diagnosticados por PAAF como NSP durante Julio del 2006 a Junio del 2009. Resultados: 90% de los casos eran de género femenino, cuya edad promedio fue 35,2 años. El 90% fueron tumores únicos, con un tamaño tumoral predominante entre 4 a 6 cm en el 60%. No hubo preferencias en la localización. Al USE las lesiones eran de paredes gruesas, 90% ecomixtas, con áreas hiper e hipoecogénicas, macro, microquistes y áreas sólidas, el 10% mostró calcificaciones. En el 100% de los casos los extendidos citológicos presentaron, estructuras papilares con material metacromático en patrón de letras chinas, células con núcleos uniformes, cromatina finamente granular y hendiduras. Conclusión: La PAAF guiada por USE es un método eficaz para el diagnóstico de las NSPP.
Introduction: Solid papillary neoplasia of the pancreas (NSPP) described by Frantz in 1959 is a rare lesion, indolent, whose origin has not been elucidated. WHO establishes it as a neoplasm usually benign, with an increase in frequency in recent years. It occurs in young women whose average age is 30 years. Rare cases are reported in men. This study aims to determine the USE pattern of the solid papillary neoplasia and correlate them with the cytological findings of fine needle aspiration (PAAF). Methods: 10 cases were evaluated retrospectively visualized by USE and diagnosed by PAAF as NSP during July 2006 to June 2009. Results: 90% of the cases were female, whose average age was 35.2 years. 90% were single tumors with a predominant tumoral size between 4 to 6 cm in 60%. There was no preference in location. At USE the lesions were thick-walled, 90% mixed echogenic images with hyper and hypoechoic areas, macro, micro-cysts and solid areas, 10% showed calcifications. In 100% of the cases the cytological study presented papillary structures with metachromatic material in chinese characters pattern, cells with uniform nuclei, finely granular chromatin and crevices. Conclusion: PAAF guided by USE is an effective method for diagnosis of the NSPP.
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Humanos , Adulto , Feminino , Biópsia por Agulha/métodos , Endossonografia/métodos , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas , Neoplasias/patologia , GastroenterologiaRESUMO
La pancreatitis crónica es un proceso inflamatorio caracterizado por la destrucción del parénquima pancreático y de estructuras ductales con la formación de fibrosis. El Ultrasonido endoscópico (USE) permite la visualización de cambios en el parénquima y del conducto pancreático, permitiendo la identificación de criterios específicos para pancreatitis crónica en forma temprana. Objetivo: Correlacionar cito morfológicamente los cambios de la ecoestructura del páncreas en patrones areolares con áreas hiper e hipoecogénicas y los cambios cito-histológicos obtenidos por punción con aguja fina sugestivos de pancreatitis crónica, fibrosis y/o esteatosis. Método: Se incluyeron 8 pacientes, a quienes se les realizó USE superior presentando criterios de pancreatopatia crónica areolar leve a severa. Se realizó punción aspiración por aguja fina de las áreas hiperecogenicas e hipoecogénicas siendo procesadas con coloraciones especiales rápidas y estudio de bloque celular, en forma ciega, por separado, para su estudio cito-histológico. Los datos fueron vaciados en tablas y analizados en porcentajes. Resultados: Los cambios más frecuentes en las áreas hiperecogenicas fueron la presencia de infiltrado inflamatorio, fibrosis, calcificaciones, esteatosis y hemorragia. No hubo diferencias en cuanto a la presencia de detritus, necrosis grasa ni material proteináceo. En los tipos celulares no pareciera haber diferencias, sin embargo, se observaron células acinares en mayor proporción, seguidas ductales y ocasionalmente de islotes, en su mayoría con cambios reactivos y degenerativos moderados. Conclusión: Existen cambios reactivos demostrados por cito-histología en pacientes con pancreatopatía de patrones areolares en USE que sugieren inflamación y fibrosis crónica, debiendo realizarse estudios con mayor población para establecer grados de severidad.
Chronic pancreatitis is an inflammatory process characterized by the destruction of pancreatic parenchyma and ductal structures with the formation of fibrosis. Endoscopic Ultrasound (USE) allows the visualization of changes in the parenchyma and pancreatic duct, allowing the identification of specific criteria for chronic pancreatitis early. Objective: Correlate cyto morphologically the changes of the echoestructure of the pancreas in areolar patterns with hyper and hypoechoic areas and cyto-histological changes obtained by fine needle aspiration suggestive of chronic pancreatitis, fibrosis and/ or steatosis. Method: Were included 8 patients who underwent upper USE presenting criteria of areolar chronic pancreatopathy mild to severe. A fine needle aspiration of the hyperechoic and hypoechoic areas was performed and processed with special fast colorations and cell block study, in a blind way, separately, for the cytohistological study. Data were emptied into tables and analyzed in percentages. Results: The most frequent changes in hyperechoic areas were the presence of inflammatory infiltrate, fibrosis, calcification, steatosis and bleeding. There were no differences in the presence of detritus, fat necrosis and proteinaceous material. In cell types do not seems to be differences, however, acinar cells were observed in greater proportion, followed by ductal and occasionally islet, mostly with moderate reactive and degenerative changes. Conclusion: There are reactive changes demonstrated by cytohistology in patients with pancreatopathy in areolar patterns in USE suggesting chronic inflammation and fibrosis, studies with larger populations should be conducted to establish degrees of severity.
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Humanos , Masculino , Feminino , Biópsia por Agulha/métodos , Endoscopia Gastrointestinal/métodos , Pancreatite Crônica/diagnóstico , Pancreatite Crônica , GastroenterologiaRESUMO
Se validó una metodología analítica que permite cuantificar residuos de carbofuran en muestras de suelo. La extracción del plaguicida desde la matriz se realizó mediante agitación mecánica empleando acetato de etilo como solvente, los extractos obtenidos se sometieron a extracción en fase sólida (EFS) utilizando cartuchos C18, finalmente, la determinación y cuantificación del carbofuran se llevó a cabo mediante cromatografía líquida de alta eficiencia con detección ultravioleta (CLAR-UV) a una longitud de onda de 205 nm. La metodología validada es específica y selectiva para el carbofuran, lineal en el rango desde 0,47 hasta 2,36 mgKg-1, precisa con un coeficiente de variación típico (CVtip) de 10,78%; exacta brindando un porcentaje de recuperación para la metodología global (porcentaje de R) equivalente a 98,25±3,97% y sensible con límites de detección y cuantifica-ción de 0,045 y 0,149 mgKg-1, respectivamente. También se verificó la robustez del método. Se analizaron dos muestras de suelo dedicados al cultivo de café, y se encontraron residuos de carbofuran durante los primeros 30 días después de su aplicación.
An analytic method was validated to quantify Carbofuran residues in soil samples. The pesticides were extracted from the matrix by mechanic stirring, using ethyl acetate as a solvent. These extracts were cleaned by using cartridges C18. The determination and quantification of Carbofuran was made by high performance liquid chromatography with ultraviolet detection (HPLC-UV). The wavelength was 205 nm. The validated method is specific and selective for Carbofuran, is linear in the range from 0.47 to 2.36 mg kg-1, is accurate with a typical variation coefficient of 10.78%, is exact with recovering percentage (% R) equivalent to 98.25±3.97% and sensitive with detection and quantification limits since 0.045 and 0.149 mg kg-1 respectively. The robustness of the method was recognized. Two samples from soil of coffee cultivation were analyzed. Residues ofCarbofuranwerefoundduringthe first thirty days after application. Two samples of soil coffee were analyzed finding residues of carbofuran during the first thirty days after application.
Neste artigo validou-se uma metodologia analítica que quantifica resíduos de carbo-furano em amostras de solo. Por agitação mecânica se extraíram pesticidas da matriz, utilizando acetato de etilo como solvente. Os extratos obtidos foram submetidos à extração em fase sólida (EFS) com cartuchos de C18. Em seguida, a identificação e quantificação de Carbofuran foi realizada por cromatografia líquida de alta eficiência com detecção ultravioleta (CLAE-UV). A longitude de onda foi 205 nm. A metodologia validada é específica e seletiva para car-bofuran; linear no intervalo de 0,47-2,36 mgkg-1, cocomumcoeficientedevariação (C. Vtip) típico de 10,78%, fornecendo uma taxa de recuperação precisa da meto-dologiaglobal(R%)equivalentea98,25± 3,97%. Os limites de sensibilidade de detecção e quantificação são 0,045 e 0,149 mg kg-1, respectivamente. Verificou-se também a robustez do método. Analisadas duas amostras de terra dedicada ao cultivo do café, se encontraram resíduos de carbofuran nos trinta primeiros dias após aplicá-lo.
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Time-frequency representations (TFR) are one of the most popular characterization methods for non-stationary biosignals. Despite of their potential advantages, these representations suffer of large quantity of redundant and irrelevant data which makes them difficult to use for classification purposes. In this work, a methodology for reduction of irrelevant and redundant data is explored. This approach consists on removing irrelevant data, applying a relevance measure on the t-f plane that measures the dependence of each t-f point with the class labels. Then, principal component analysis (PCA) and partial least squares (PLS) are used as non-supervised and supervised linear decomposition approaches to reduce redundancy of remaining t-f points. Results show that the proposed methodology improves the performance of classifier up to 3% when no relevance and redundancy on TFRs is reduced.
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Eletroencefalografia/métodos , Humanos , Análise dos Mínimos Quadrados , Análise de Componente PrincipalRESUMO
The detection of murmurs from phonocardiographic recordings is an interesting problem that has been addressed before using a wide variety of techniques. In this context, this article explores the capabilities of an enhanced time-frequency representation (TFR) based on a time-varying autoregressive model. The parametric technique is used to compute the TFR of the signal, which serves as a complete characterization of the process. Parametric TFRs contain a large quantity of data, including redundant and irrelevant information. In order to extract the most relevant features from TFRs, two specific approaches for dimensionality reduction are presented: feature extraction by linear decomposition, and tiling partition of the t-f plane. In the first approach, the feature extraction was carried out by means of eigenplane-based PCA and PLS techniques. Likewise, a regular partition and a refined Quadtree partition of the t-f plane were tested for the tiled-TFR approach. As a result, the feature extraction methodology presented, which searches for the most relevant information immersed on the TFR, has demonstrated to be very effective. The features extracted were used to feed a simple k-nn classifier. The experiments were carried out using 45 phonocardiographic recordings (26 normal and 19 records with murmurs), segmented to extract 548 representative individual beats. The results using these methods point out that better accuracy and flexibility can be accomplished to represent non-stationary PCG signals, showing evidences of improvement with respect to other approaches found in the literature. The best accuracy obtained was 99.06 +/- 0.06%, evidencing high performance and stability. Because of its effectiveness and simplicity of implementation, the proposed methodology can be used as a simple diagnostic tool for primary health-care purposes.
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Sopros Cardíacos/diagnóstico , Sopros Cardíacos/fisiopatologia , Humanos , Análise dos Mínimos Quadrados , Modelos Logísticos , Fonocardiografia/métodos , Análise de Componente Principal , Fatores de TempoRESUMO
Introducción: las instituciones prestadoras de servicios odontológicos incorporan cada vez más la evaluación de la satisfacción del usuario como componente de la calidad. El objetivo de este estudio fue evaluar la satisfacción de los estudiantes de la Universidad de Antioquia, sede Medellín, con los servicios odontológicos prestados por la Institución Prestadora de Servicios de Salud (IPS) de la misma Universidad, desde la perspectiva del usuario y el profesional que brinda atención. Métodos: se llevó a cabo un estudio descriptivo por medio de técnicas cualitativas y cuantitativas como una encuesta realizada en 98 estudiantes sobre aspectos tales como el trato del personal, la eficacia en la atención recibida, información, accesibilidad, oportunidad, seguridad, opinión sobre las instalaciones, satisfacción global; y se complementó con entrevistas semiestructuradas a los profesionales y a los mismos estudiantes. Resultados: se encontró una alta satisfacción global (95,9 porciento), acompañada de elementos que resaltan la confianza técnica y profesional del personal odontológico y de la institución en sí (promedios en las variables estudiadas por encima de 7 y porcentajes de alta satisfacción por encima del 50 porciento); con algunos elementos críticos en la atención que deben mejorarse como la privacidad y la oportunidad en el servicio. Conclusiones: la satisfacción del usuario es alta en comparación con otros estudios locales, y depende de factores como el sexo, la edad, el estrato socioeconómico, la institución y la relación profesional-paciente. Se sugiere avanzar en la construcción de propuestas investigativas en el componente satisfacción del usuario en otras instituciones y en la construcción de escalas de satisfacción del usuario ante los servicios de atención en salud bucal con validación de constructo para ser utilizadas en el medio.
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Serviços de Saúde , Satisfação do Paciente , Garantia da Qualidade dos Cuidados de Saúde , Qualidade da Assistência à SaúdeRESUMO
BACKGROUND: Tramadol is increasingly used for the treatment of osteoarthritis because, in contrast to nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol does not produce gastrointestinal bleeding or renal problems, and does not affect articular cartilage. OBJECTIVES: We sought to determine the analgesic effectiveness, the effect on physical function, the duration of benefit and the safety of oral tramadol in people with osteoarthritis. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS databases up to August 2005. SELECTION CRITERIA: We included randomized controlled trials (RCTs) that evaluated the effect of tramadol or tramadol plus paracetamol on pain levels and/or physical function in people with osteoarthritis. No language restriction was applied. DATA COLLECTION AND ANALYSIS: We analyzed separately placebo-controlled and active-controlled studies. We used fixed-effect models for the meta-analyses as the results across studies were similar. MAIN RESULTS: We included eleven RCTs with a total of 1019 participants who received tramadol or tramadol/paracetamol and 920 participants who received placebo or active-control. The placebo-controlled studies indicated that participants who received tramadol had less pain (-8.5 units on a 0 to 100 scale; 95% confidence interval (CI) -12.0 to -5.0) than patients who received placebo. This represents a 12% relative decrease in pain intensity from baseline. Participants who received tramadol had a 37% increase (95% CI 1.2 to 1.5) in the likelihood of reporting moderate improvement (number needed to treat to benefit = 6; 95% CI 4 to 9). Participants who received tramadol had 2.27 times the risk of developing minor adverse events and 2.6 times the risk of developing major adverse events, compared to participants who received placebo. Of every eight people who receive tramadol or tramadol/paracetamol, one will stop taking the medication because of adverse events, number needed to treat to harm (NNTH)= 8 (95% CI 7 to 12) for major adverse events. No conclusion could be drawn on how tramadol or tramadol/paracetamol compared with available pharmacological treatments because of the limited number of studies that evaluated such therapies. AUTHORS' CONCLUSIONS: Tramadol or tramadol/paracetamol decreases pain intensity, produces symptom relief and improves function, but these benefits are small. Adverse events, although reversible and not life threatening, often cause participants to stop taking the medication and could limit tramadol or tramadol plus paracetamol usefulness.
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Analgésicos não Narcóticos/uso terapêutico , Osteoartrite/tratamento farmacológico , Tramadol/uso terapêutico , Acetaminofen/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Estudio retrospectivo de los primeros 149 casos de conización cervical mediante asa electroquirúrgica efectuados en el Hospital Regional de Copiapó, entre enero de 1994 y diciembre de 1999, con seguimiento por 5 años. Correspondieron a lesiones de alto grado 115 casos, 7 a NIE I, 3 a virus papiloma humano y 24 sin lesión. En todos los casos se realizó un primer cono exocervical, con un grosor promedio de 6,95 milímetros, a 138 pacientes se les realizó una segunda escisión endocervical superficial con grosor promedio de 5,67 milímetros, a 63 pacientes una tercera escisión endocervical profunda con grosor promedio de 5,78 milímetros, y a 9 pacientes una escisión adicional más profunda con un grosor promedio de 8 milímetros. En la primera escisión el 75 por ciento correspondió a lesión de alto grado, en la segunda escisión el 25 por ciento correspondió a lesión de alto grado, en la tercera escisión el 16 por ciento correspondió lesión de alto grado y en la cuarta escisión no hubo lesiones de alto grado. En aquellos casos con diagnóstico preoperatorio citocolposcópico de cáncer in situ con compromiso endocervical, encontramos en la escisión endocervical superficial un 44 por ciento de lesión de alto grado y para la escisión endocervical profunda un 23 por ciento de lesión alto grado. Para evitar recidivas en casos de lesiones de alto grado se recomienda la escisión endocervical profunda. Hubo un 4 por ciento de hallazgos positivos post cono.
A retrospective study was performed analyzing the first 149 patients who had conizations by loop excision at the Regional Hospital of Copiapo during 1994-1999, with a five year follow up. There where 115 cases of high-grade squamous intraepithelial lesions (H-SIL), 7 low-grade squamous intraepithelial lesions (L-SIL), 3 HPV and 24 normal biopsies. All patients had an exocervical excision biopsy, with an average depth of 6.95mm, 138 patients had a second superficial endocervical biopsy with an average depth of 5.67mm, 63 patients had a third deeper endocervical sample averaging 5.78mm and 9 patients had an even deeper 8mm excision. The biopsy results obtained from the operative specimens where, for the first excision 75 percent H-SIL, for the second excision 25 percent H-SIL, for the third excision 16 percent H-SIL. No H-SIL where found on the fourth excision. When the cytocolposcopic diagnosis prior to the surgery was a CIS with endocervical involvement, the biopsy of the superficial endocervical excision determined a H-SIL in 44 percent of the cases, while deep endocervical excisions where a H-SIL in 23 percent of the cases. To avoid recurrence it could be recommendable to apply a deeper endocervical excision in patients with a diagnosis of H-SIL. During the follow up, positive findings occurred in 4 percent of the study group.
Assuntos
Humanos , Feminino , Conização , Eletrocirurgia , Displasia do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/cirurgia , Chile , Seguimentos , Estudos RetrospectivosRESUMO
La esfinterotomía endoscópica realizada durante la pancreatitis aguda biliar severa ha demostrado reducir la morbilidad y mortalidad. El ultrasonido endoscópico es un método menos invasivo y puede identificar a pacientes en los cuales se puede diagnosticar litiasis en la vía biliar principal y tratarla por esfinterotomía endoscópica eco guiada. El objetivo de este estudio fue determinar el lugar del ultrasonido endoscópico en el diagnóstico de la pancreatitis aguda biliar. Entre julio de 1998 y agosto de 2000, acudieron al servicio de gastroenterología 35 pacientes con pancreatitis biliar aguda, de los cuales fueron ingresados a hospitalización y estudiados prospectivamente en nuestro centro 21 pacientes. Con la excepción de un paciente previamente colecistectomizado, los 20 restantes tenían hallazgos sugestivos de litiasis vesicular por ultrasonido abdominal con o sin colestasis extrahepática. A todos se les realizó ultrasonido endoscópico, a los pacientes con litiasis en la vía biliar principal se les realizó esfinterotomia endoscópica y exploración biliar. El ultrasonido endoscópico diagnóstico 14/21 pacientes (66,66 por ciento) sin litiasis en la vía biliar principal en quienes la pancreatitis aguda se resolvió sin esfinterotomía endoscópica y evolucionaron sin complicaciones. Un paciente que presentó un nuevo episodio en un período de 2 semanas se resolvió después que la migración de cálculos fue confirmada por ultrasonido endoscópico. En 7/21 pacientes (33,33) el ultrasonido endoscópico demostró litiasis en la vía biliar principal y la esfinterotomía endoscópica fue realizada inmediatamente en 6 pacientes con extracción de cálculos sin complicaciones. El ultrasonido endoscópico tuvo un valor predictivo positivo del 100 por ciento. El ultrasonido endoscópico es un método altamente sensible y específico para excluir pacientes con pancreatitis aguda biliar y sospecha de litiasis en la vía biliar principal, logrando orientar una verdadera esfinterotomía endoscópica terapéutica
Assuntos
Humanos , Masculino , Feminino , Endossonografia , Pancreatite , Ultrassom , VenezuelaRESUMO
To characterize Ca(2+) transport in newborn rat cortical collecting duct (CCD) cells, we used nifedipine, which in adult rat distal tubules inhibits the intracellular Ca(2+) concentration ([Ca(2+)](i)) increase in response to hormonal activation. We found that the dihydropyridine (DHP) nifedipine (20 microM) produced an increase in [Ca(2+)](i) from 87.6 +/- 3.3 nM to 389.9 +/- 29.0 nM in 65% of the cells. Similar effects of other DHP (BAY K 8644, isradipine) were also observed. Conversely, DHPs did not induce any increase in [Ca(2+)](i) in cells obtained from proximal convoluted tubule. In CCD cells, neither verapamil nor diltiazem induced any rise in [Ca(2+)](i). Experiments in the presence of EGTA showed that external Ca(2+) was required for the nifedipine effect, while lanthanum (20 microM), gadolinium (100 microM), and diltiazem (20 microM) inhibited the effect. Experiments done in the presence of valinomycin resulted in the same nifedipine effect, showing that K(+) channels were not involved in the nifedipine-induced [Ca(2+)](i) rise. H(2)O(2) also triggered [Ca(2+)](i) rise. However, nifedipine-induced [Ca(2+)](i) increase was not affected by protamine. In conclusion, the present results indicate that 1) primary cultures of cells from terminal nephron of newborn rats are a useful tool for investigating Ca(2+) transport mechanisms during growth, and 2) newborn rat CCD cells in primary culture exhibit a new apical nifedipine-activated Ca(2+) channel of capacitive type (either transient receptor potential or leak channel).
Assuntos
Bloqueadores dos Canais de Cálcio/farmacologia , Cálcio/metabolismo , Permeabilidade da Membrana Celular/efeitos dos fármacos , Córtex Renal/fisiologia , Túbulos Renais Coletores/fisiologia , Nifedipino/farmacologia , Éster Metílico do Ácido 3-Piridinacarboxílico, 1,4-Di-Hidro-2,6-Dimetil-5-Nitro-4-(2-(Trifluormetil)fenil)/farmacologia , Animais , Animais Recém-Nascidos , Transporte Biológico/efeitos dos fármacos , Permeabilidade da Membrana Celular/fisiologia , Células Cultivadas , Citosol/metabolismo , Di-Hidropiridinas/farmacologia , Diltiazem/farmacologia , Ácido Egtázico/farmacologia , Gadolínio/farmacologia , Peróxido de Hidrogênio/farmacologia , Isradipino/farmacologia , Córtex Renal/citologia , Túbulos Renais Coletores/citologia , Túbulos Renais Coletores/efeitos dos fármacos , Cinética , Lantânio/farmacologia , Protaminas/farmacologia , Ratos , Ratos Sprague-Dawley , Tapsigargina/farmacologia , Verapamil/farmacologiaRESUMO
La Ecoendoscopia es una herramienta diagnóstica importante en la evaluación de lesiones gastrointestinales benignas, sin embargo la utilidad clínica es incierta. Objetivo: Determinar la utilidad del Ultrasonido Endoscópico en las lesiones gastrointestinales benignas. Métodos: Estudiamos retrospectivamente 59 pacientes consecutivos sometidos a Ultrasonido Endoscópico. Se obtuvo información completa en 53 pacientes (15 hombres, 38 mujeres) con edad promedio de 44 años. El diagnóstico final fue confirmado por cirugía convencional o endoscópica (n= 10), colangiopancreatografía endoscópica retrógrada con o sin esfinterotomía (n= 18), histología (n= 4) y seguimiento médico (n= 21) con una media de 4,6 meses, 35 pacientes tenían diagnóstico inicial dudoso: lesión submocosal (n= 10), lesión pancreática (n= 16), lesión biliar (n= 7) y otras lesiones (n= 2), 18 pacintes tenían diagnóstico inicial sindromático: colestasis extrahepática (n= 10), pancreatitis aguda o recurrente (n= 5), hemobilia (n= 1), dolor abdominal (n= 1) e hipoglicemia severa (n= 1). Resultados: Los hallazgos endosonográficos fueron: 1 papiloma esofágico, 4 lesiones gástricas, 21 lesiones pancreáticas, 13 lesiones biliares, 12 estudios normales y 2 no concluyentes. Hubo 3 falsos negativos y 5 falsos positivos. La Ecoendoscopia fue de ayuda en 85 por ciento (45/53) de los casos porque aportó diagnóstico etiológico en 9, recomendó terapia curativa en 16 evitó estudios sucesivos en 20. En 11 por ciento de casos no mejoró el diagnóstico preliminar y en 4 por ciento de casos se consideró equivocado con un error y una terapia quirúrgica no curativa
Assuntos
Humanos , Masculino , Feminino , Endossonografia , Gastroenteropatias , Gastroenterologia , VenezuelaRESUMO
The aim of this study was to compare the effect of thrombin (Thr) on cytosolic calcium [Ca2]+i and intracellular pH [pH]i in human and murine platelets. Rich-platelet suspensions from both species were loaded with Fura-2 (2 microM) or BCECF (0.75 microM) by incubation with their respective acetoxymethyl esters to measure cytosolic calcium [Ca2+]i or intracellular pH [pH]i, respectively. Suspensions were challenged with increasing concentrations of Thr, from 0.1 to 10 IU/ml. Basal [Ca2+]i in human platelets was 98 +/- 6 and 99.1 +/- 9 nM in rat platelets (n = 20). Thr increased [Ca2+]i, EC50 was 1.1 +/- 0.04 in human and 0.97 +/- 0.06 IU/ml in rat platelets (n = 7). Extracellular Mg2+ (4 or 8 mM) abolished Thr response on [Ca2+]i. [pH]i in human was 7.09 +/- 0.08 and 7.11 +/- 0.04 in rat platelets. Thr induced alkalinization of platelets in both species. Our results indicate that the potency of Thr to change [Ca2+]i and [pH]i was similar in both species, allowing for comparisons between human and murine platelets and to extrapolate results from an animal model to human pathology.
Assuntos
Plaquetas/metabolismo , Cálcio/metabolismo , Trombina/farmacologia , Adulto , Animais , Citosol/metabolismo , Feminino , Fluoresceínas , Corantes Fluorescentes , Fura-2 , Humanos , Concentração de Íons de Hidrogênio/efeitos dos fármacos , Processamento de Imagem Assistida por Computador , Magnésio/farmacologia , Microscopia de Fluorescência , Ratos , Ratos Wistar , Especificidade da EspécieRESUMO
BACKGROUND: Tight junctions play a critical role in tubular function. In mammalian kidney, the transepithelial electrical resistance and the complexity of the tight junction increase from the proximal to the collecting tubule. The differential expression of three tight junction proteins, ZO-1, ZO-2, and occludin, along isolated rabbit renal tubules is examined in this article. METHODS: Microdissected rabbit renal tubules were processed for immunofluorescence detection of ZO-1, ZO-2, and occludin. The quantitation of these proteins was done by Western blot determinations in Percoll isolated tubules. RESULTS: ZO-1 stained cell boundaries independently of the identity of the tubule. However, the amount found in distal segments was significantly higher than that expressed in proximal regions. ZO-2 in the proximal region was found diffusely distributed in the cytoplasm, with faint staining at cell borders, while a clear signal at cell perimeters was detectable from the Henle's loop to collecting tubules. Nuclear staining of ZO-2 was found along the whole nephron. The presence of occludin at the proximal region was faint and discontinuous, while its expression in the more distant portions was conspicuous. The quantity of ZO-2 and occludin present at the distal region was significantly higher compared with the proximal segment. CONCLUSIONS: The distribution of ZO-1, ZO-2, and occludin follows the increase in junction complexity encountered in renal tubules. The amount of the three proteins found in proximal and distal segments is significantly higher in the latter.