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OBJECTIVE: The aim was to describe the characteristics of the transport system of critically ill pediatric patients in the emergency departments (EDs) in Latin America (LA). METHODOLOGY: This is a prospective cross-sectional study in a 1-year period. Patients were recruited on days 1, 7, 14, 21, and 28 of each month in the EDs in LA. We included ill-pediatric patients aged 1 month to 18 years. Patients who needed transfer for a diagnostic study, with arrival mode not by ambulance, or with the impossibility of interviewing the transfer team were excluded from the study. RESULTS: A total of 389 patients were included in the study. The majority were males (57%) with a median age of 49 months (interquartile range, 10-116). Thirty-three percent (129) of transfers had the participation of a coordinating center; 97.1% (375) were carried out by road ambulance, and 84.3% (323) were interhospital transfers, with a mean distance traveled of 83.2 km (SD, 105 km). The main reason for transfer in 88.17% (343) was the need for a more complex health center. The main diagnosis was respiratory distress (71; 18.2%), acute abdomen (70; 18%), Traumatic Brain Injury (33; 8.48%), multiple trauma (32; 8.23%), septic shock (31; 7.9%), and COVID-19-related illness (19; 4.8%). A total of 296 (76.5%) patients had peripheral vascular access, and 171 (44%) patients had oxygen support with 49 (28.6%) having invasive ventilation; the most frequent monitoring method (67.8%) was pulse oximetry, and 83.4% (313) did not record adverse events. Regarding the transfer team, 88% (342) had no specialized personnel, and only 62.4% (243) had a physician on their teams. CONCLUSIONS: In LA, there is great variability in personnel training, equipment for pediatric transport, team composition, and characterization of critical care transport systems. Continued efforts to improve conditions in our countries may help reduce patient morbidity and mortality.
Assuntos
Ambulâncias , Serviço Hospitalar de Emergência , Masculino , Criança , Humanos , Pré-Escolar , Feminino , Estudos Prospectivos , América Latina/epidemiologia , Estudos Transversais , Transferência de Pacientes/métodos , Estado Terminal/epidemiologia , Estado Terminal/terapiaRESUMO
BACKGROUND: To date, there are only sporadic reports of acute abdomen and appendicitis in children with coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C). METHODS: Children 17 years of age or younger assessed in 5 Latin American countries with a diagnosis of microbiologically confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and children fulfilling MIS-C definition were included. For children with acute abdomen, we investigate main radiologic patterns, surgical treatment and intraoperative findings, outcomes. FINDINGS: One-thousand ten children were enrolled. Forty-two children (4.2%) had a clinical diagnosis of acute abdomen. Four (9.5%) were diagnosed with MIS-C and did not undergo surgery. The remaining 38 children (3.8%) underwent abdominal surgery due to suspected appendicitis, 34 of them (89.7%) had an intraoperative diagnosis of acute appendicitis (AA), while 4 of them had nonsurgical findings. Eight children died (0.8%), none of them being diagnosed with appendicitis. Children with AA were significantly older than those without (P < 0.0001). Children with complicated appendicitis had more frequently fever (85.7% vs. 60%), intestinal distension on the abdominal radiograph (7.1% vs. none), leukocytosis (85.7% vs. 40%) and high levels of C-reactive protein (35.7% vs. 5%), although differences were not statistically significant. CONCLUSIONS: Our study showed that children may present with acute abdomen during COVID-19 or MIS-C, which is not always associated with intraoperative findings of appendicitis, particularly in case of MIS-C. Further studies are needed to better characterize children with acute abdomen during COVID-19 or MIS-C, to avoid delay in diagnosis of surgical conditions and at the same time, minimize unnecessary surgical approaches.
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Abdome Agudo/etiologia , Abdome Agudo/virologia , Apendicite/etiologia , Apendicite/virologia , COVID-19/complicações , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/virologia , Adolescente , COVID-19/etiologia , COVID-19/virologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , América Latina , Masculino , SARS-CoV-2/patogenicidadeRESUMO
AIM: This study aims to assess rates of antibiotic prescriptions and its determinants in in children with COVID-19 or Multisystem Inflammatory Syndrome (MIS-C). METHODS: Children <18 years-old assessed in five Latin Americas countries with a diagnosis of COVID-19 or MIS-C were enrolled. Antibiotic prescriptions and factors associated with their use were assessed. RESULTS: A total of 990 children were included: 921 (93%) with COVID-19, 69 (7.0%) with MIS-C. The prevalence of antibiotic use was 24.5% (n = 243). MIS-C with (OR = 45.48) or without (OR = 10.35) cardiac involvement, provision of intensive care (OR = 9.60), need for hospital care (OR = 6.87), pneumonia and/or ARDS detected through chest X-rays (OR = 4.40), administration of systemic corticosteroids (OR = 4.39), oxygen support, mechanical ventilation or CPAP (OR = 2.21), pyrexia (OR = 1.84), and female sex (OR = 1.50) were independently associated with increased use of antibiotics. There was significant variation in antibiotic use across the hospitals. CONCLUSION: Our study showed a high rate of antibiotic prescriptions in children with COVID-19, in particular in those with severe disease or MIS-C. Prospective studies are needed to provide better evidence on the recognition and management of bacterial infections in COVID-19 children.
Assuntos
COVID-19 , Adolescente , Antibacterianos/uso terapêutico , Criança , Feminino , Humanos , América Latina/epidemiologia , Prescrições , Estudos Prospectivos , SARS-CoV-2 , Síndrome de Resposta Inflamatória SistêmicaRESUMO
The aim of this descriptive cross-sectional study was to investigate the following factors associated with sexually transmitted infections and human immunodeficiency virus prevention: (a) knowledge, (b) attitudes, (c) self-efficacy, (d) vulnerability, (e) risky behaviors, (f) preventive behaviors, and (g) internet use among 40 Chilean women between 18 and 24 years who participated in the pilot of an Internet based STI/HIV prevention intervention (I-STIPI). A structured questionnaire available in a secure website was used for data collection and it included questions related to STI and HIV prevention. The results of the study indicated that young women are at risk of acquiring STIs and HIV and have special needs for prevention. Familiarity and frequency of use of internet in this population can be used for STIs and HIV prevention.
Assuntos
Infecções por HIV/prevenção & controle , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Assunção de Riscos , Autoeficácia , Comportamento Sexual , Infecções Sexualmente Transmissíveis/prevenção & controle , Adolescente , Adulto , Chile , Estudos Transversais , Feminino , Humanos , Internet , Projetos Piloto , Fatores de Risco , Infecções Sexualmente Transmissíveis/etiologia , Inquéritos e Questionários , Adulto JovemRESUMO
Background. Morbidity and mortality patterns are not the same for women and men. In health service attendance women's troubles might be minimized. Objective. To analyze some capacities regarding gender approach that are generated in the medical education process. Materials and Methods. An observational, analytic, cross-sectional research was made in a University located in Southeast Mexico. Semi-structured interviews were applied to students, men and women, belonging to both second and eighth semester, until all analysis categories were filled in. Results. Although students did not perceive it as a public health problem, they accepted the existence of gender discrimination and physical and psychological violence against women. The answers of the eighth semester students showed no conceptual construction that could help them in handling this problem in the medical practice. Discussion. There were failures in identifying morbidity differences between women and men.
Antecedentes. Los patrones de morbilidad y mortalidad son diferentes para mujeres y hombres. En los servicios de salud se suelen minimizar los problemas de las mujeres. Objetivo. Analizar algunas capacidades respecto al enfoque de género que se forman en el proceso de educación médica. Materiales y métodos. Se realizó una investigación observacional, analítica y transversal con estudiantes de Medicina de una universidad del Sureste de México. Se realizaron entrevistas semiestructuradas a estudiantes, mujeres y hombres, hasta que se saturaron las categorías de análisis. Resultados. Los estudiantes no perciben la violencia como problema de salud, aunque aceptaron la existencia de discriminación y de violencia psicológica y física. Las respuestas de los estudiantes avanzados no mostraron construcciones conceptuales que les permitieran manejar este problema en la práctica de la medicina. Conclusiones. Hubo fallas para identificar la diferencia en morbilidad entre mujeres y hombres.
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Amyloid-ß (Aß) oligomers are a key factor in Alzheimer's disease (AD)-associated synaptic dysfunction. Aß oligomers block the induction of hippocampal long-term potentiation (LTP) in rodents. The activation of Wnt signaling prevents Aß oligomer-induced neurotoxic effects. The compound WASP-1 (Wnt-activating small molecule potentiator-1), has been described as a synergist of the ligand Wnt-3a, enhancing the activation of Wnt/ß-catenin signaling. Herein, we report that WASP-1 administration successfully rescued Aß-induced synaptic impairments both in vitro and in vivo. The activation of canonical Wnt/ß-catenin signaling by WASP-1 increased synaptic transmission and rescued hippocampal LTP impairments induced by Aß oligomers. Additionally, intra-hippocampal administration of WASP-1 to the double transgenic APPswe/PS1dE9 mouse model of AD prevented synaptic protein loss and reduced tau phosphorylation levels. Moreover, we found that WASP-1 blocked Aß aggregation in vitro and reduced pathological tau phosphorylation in vivo. These results indicate that targeting canonical Wnt signaling with WASP-1 could have value for treating AD.
Assuntos
Proteínas de Sinalização Intercelular CCN/uso terapêutico , Hipocampo/efeitos dos fármacos , Neurônios/efeitos dos fármacos , Síndromes Neurotóxicas/tratamento farmacológico , Síndromes Neurotóxicas/patologia , Proteínas Proto-Oncogênicas/uso terapêutico , Sinapses/efeitos dos fármacos , Peptídeos beta-Amiloides/toxicidade , Precursor de Proteína beta-Amiloide/genética , Animais , Células Cultivadas , Potenciais Pós-Sinápticos Excitadores/efeitos dos fármacos , Potenciais Pós-Sinápticos Excitadores/genética , Regulação da Expressão Gênica/efeitos dos fármacos , Regulação da Expressão Gênica/genética , Hipocampo/patologia , Hipocampo/fisiologia , Humanos , Masculino , Camundongos , Camundongos Transgênicos , Síndromes Neurotóxicas/etiologia , Síndromes Neurotóxicas/genética , Fosforilação/efeitos dos fármacos , Fosforilação/genética , Presenilina-1/genética , Ratos , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Sinapses/genética , Sinapses/fisiologia , Sinapses/ultraestrutura , Fatores de TempoRESUMO
The role of the Wnt signaling pathway during synaptic development has been well established. In the adult brain, different components of Wnt signaling are expressed, but little is known about its role in mature synapses. Emerging in vitro studies have implicated Wnt signaling in synaptic plasticity. Furthermore, activation of Wnt signaling has shown to protect against amyloid-ß-induced synaptic impairment. The present study provides the first evidence that in vivo activation of Wnt signaling improves episodic memory, increases excitatory synaptic transmission, and enhances long-term potentiation in adult wild-type mice. Moreover, the activation of Wnt signaling also rescues memory loss and improves synaptic dysfunction in APP/PS1-transgenic mice that model the amyloid pathology of Alzheimer's diseases. These findings indicate that Wnt signaling modulates cognitive function in the adult brain and could be a novel promising target for Alzheimer's disease therapy.
Assuntos
Doença de Alzheimer/metabolismo , Transtornos Cognitivos/metabolismo , Cognição/fisiologia , Modelos Animais de Doenças , Via de Sinalização Wnt/fisiologia , Doença de Alzheimer/patologia , Doença de Alzheimer/psicologia , Animais , Transtornos Cognitivos/patologia , Transtornos Cognitivos/psicologia , Hipocampo/metabolismo , Hipocampo/patologia , Masculino , Camundongos , Camundongos Transgênicos , Técnicas de Cultura de ÓrgãosRESUMO
During development of the central nervous system the Wnt signaling pathway has been implicated in a wide spectrum of physiological processes, including neuronal connectivity and synapse formation. Wnt proteins and components of the Wnt pathway are expressed in the brain since early development to the adult life, however, little is known about its role in mature synapses. Here, we review evidences indicating that Wnt proteins participate in the remodeling of pre- and post-synaptic regions, thus modulating synaptic function. We include the most recent data in the literature showing that Wnts are constantly released in the brain to maintain the basal neural activity. Also, we review the evidences that involve components of the Wnt pathway in the development of neurological and mental disorders, including a special emphasis on in vivo studies that relate behavioral abnormalities to deficiencies in Wnt signaling. Finally, we include the evidences that support a neuroprotective role of Wnt proteins in Alzheimer's disease. We postulate that deregulation in Wnt signaling might have a fundamental role in the origin of neurological diseases, by altering the synaptic function at stages where the phenotype is not yet established but when the cognitive decline starts.
RESUMO
An emerging view on Alzheimer disease's (AD) pathogenesis considers amyloid-ß (Aß) oligomers as a key factor in synaptic impairment and rodent spatial memory decline. Alterations in the α7-nicotinic acetylcholine receptor (α7-nAChR) have been implicated in AD pathology. Herein, we report that nicotine, an unselective α7-nAChR agonist, protects from morphological and synaptic impairments induced by Aß oligomers. Interestingly, nicotine prevents both early postsynaptic impairment and late presynaptic damage induced by Aß oligomers through the α7-nAChR/phosphatidylinositol-3-kinase (PI3K) signaling pathway. On the other hand, a cross-talk between α7-nAChR and the Wnt/ß-catenin signaling pathway was revealed by the following facts: (1) nicotine stabilizes ß-catenin, in a concentration-dependent manner; (2) nicotine prevents Aß-induced loss of ß-catenin through the α7-nAChR; and (3) activation of canonical Wnt/ß-catenin signaling induces α7-nAChR expression. Analysis of the α7-nAChR promoter indicates that this receptor is a new Wnt target gene. Taken together, these results demonstrate that nicotine prevents memory deficits and synaptic impairment induced by Aß oligomers. In addition, nicotine improves memory in young APP/PS1 transgenic mice before extensive amyloid deposition and senile plaque development, and also in old mice where senile plaques have already formed. Activation of the α7-nAChR/PI3K signaling pathway and its cross-talk with the Wnt signaling pathway might well be therapeutic targets for potential AD treatments.
Assuntos
Doença de Alzheimer/prevenção & controle , Peptídeos beta-Amiloides/toxicidade , Nicotina/farmacologia , Fragmentos de Peptídeos/toxicidade , Receptor Nicotínico de Acetilcolina alfa7/fisiologia , Peptídeos beta-Amiloides/síntese química , Precursor de Proteína beta-Amiloide/genética , Androstadienos/farmacologia , Animais , Bungarotoxinas/farmacologia , Células Cultivadas , Dendritos/efeitos dos fármacos , Dendritos/ultraestrutura , Proteína 4 Homóloga a Disks-Large , Hipocampo/citologia , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Peptídeos e Proteínas de Sinalização Intracelular/análise , Aprendizagem em Labirinto/efeitos dos fármacos , Proteínas de Membrana/análise , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Neuritos/ultraestrutura , Neurônios/efeitos dos fármacos , Neurônios/metabolismo , Neurônios/ultraestrutura , Nicotina/uso terapêutico , Técnicas de Patch-Clamp , Fragmentos de Peptídeos/síntese química , Fosfatidilinositol 3-Quinases/fisiologia , Placa Amiloide/metabolismo , Presenilina-1/genética , Terminações Pré-Sinápticas/efeitos dos fármacos , Terminações Pré-Sinápticas/ultraestrutura , Ratos , Ratos Sprague-Dawley , Proteínas Recombinantes de Fusão/genética , Transdução de Sinais , Sinapsinas/análise , Proteínas Wnt/fisiologia , Via de Sinalização Wnt , Wortmanina , Receptor Nicotínico de Acetilcolina alfa7/agonistas , Receptor Nicotínico de Acetilcolina alfa7/biossíntese , Receptor Nicotínico de Acetilcolina alfa7/genética , beta Catenina/fisiologiaRESUMO
Wnt components are key regulators of a variety of developmental processes, including embryonic patterning, cell specification, and cell polarity. The Wnt signaling pathway participates in the development of the central nervous system and growing evidence indicates that Wnts also regulates the function of the adult nervous system. In fact, most of the key components including Wnts and Frizzled receptors are expressed in the adult brain. Wnt ligands have been implicated in the regulation of synaptic assembly as well as in neurotransmission and synaptic plasticity. Deregulation of Wnt signaling has been associated with several pathologies, and more recently has been related to neurodegenerative diseases and to mental and mood disorders. In this review, we focus our attention on the Wnt signaling cascade in postnatal life and we review in detail the presence of Wnt signaling components in pre- and postsynaptic regions. Due to the important role of Wnt proteins in wiring neural circuits, we discuss recent findings about the role of Wnt pathways both in basal spontaneous activities as well as in activity-dependent processes that underlie synaptic plasticity. Finally, we review the role of Wnt in vivo and we finish with the most recent data in literature that involves the effect of components of the Wnt signaling pathway in neurological and mental disorders, including a special emphasis on in vivo studies that relate behavioral abnormalities to deficiencies in Wnt signaling, as well as the data that support a neuroprotective role of Wnt proteins in relation to the pathogenesis of Alzheimer's disease.
Assuntos
Potenciação de Longa Duração/fisiologia , Memória/fisiologia , Rede Nervosa/fisiologia , Via de Sinalização Wnt/fisiologia , Humanos , Transtornos Mentais/metabolismo , Transtornos Mentais/fisiopatologia , Doenças Neurodegenerativas/metabolismo , Doenças Neurodegenerativas/fisiopatologiaRESUMO
El objetivo de esta investigación fue determinar diferencias de dimorfismo sexual de las características de labios de hombre y mujeres mestizos colombianos a través de análisis fotogramétrico. Se evaluaron fotografías frontales de 120 individuos mestizos sin alteraciones congénitas o adquiridas de los labios, tomadas en relación 1:1. A través del uso de puntos antropométricos en la vista frontal, se evaluaron las dimensiones: grosor del labio superior (Sn-Stms), grosor del bermellon superior (Stms-Ls), grosor del labio inferior (Stmi-Sml), grosor del bermellon inferior (Stmi-Li) y ancho bicomisural (Chd-Chi), con la ayuda del software J image (NIH). El análisis estadístico utilizó la prueba U Mann-Whitney usando el software SPSS 17.0, para determinar diferencias entre los dos sexos en todas las variables. No se encontraron diferencias estadísticamente significativas en la longitud del bermellón del labio superior (Stms-Ls) ni en la longitud del bermellón del labio inferior (Stmi-Li). Se encontraron diferencias estadísticamente significativas (p<0,001) en grosor del labio superior (Sn-Stms), grosor del labio inferior (Stmi-Sml) y ancho bicomisural (Chd-Chi). Estas medidas fueron mayores en individuos mestizos de género masculino. Existe dimorfismo sexual en el ancho bicomisural, longitud de labio superior e inferior en colombianos mestizos.
The aim of this research was to determine sexual dimorphism in lip characteristic in colombian male and female population through a photogrammetric study. Frontal facial photographs, in 1 to 1 scale, from 120 colombian persons without congenital or acquired lip alterations were evaluated. Using frontal landmarks, longitudinal dimensions of upper lip height (Sn-Stms), vermilion height of the upper lip (Stms-Ls), lower lip height (Stmi-Sml), vermilion height of the lower lip (Stmi-Li) and mouth width (ch-ch). J image software was user for phogrammetric analysis (NIH). For stadistical analysis U mann-whitney test was used with SPSS 17.0, in order to determine sexual dimorphism in lip characteristic. No significant sexual dimorphism was found for vermilion height of the upper lip (Stms-Ls) nor vermillion height of the lower lip (Stmi-Li). Significan sexual dimorphism was found for upper lip height (Sn-Stms), lower lip height (Stmi-Sml) and mouth width (ch-ch). All longitudinal measurements were larger in male than female. There was sexual dimorphism in lip measurements in a colombian population, when evaluated using phoptogrammetric methods.
Assuntos
Feminino , Lábio/anatomia & histologia , Caracteres Sexuais , Antropometria , ColômbiaRESUMO
El objetivo del presente trabajo fue determinar el nivel de resistencia a deltametrina en dos poblaciones de Aedes aegypti del Perú. Los bioensayos se realizaron en adultos siguiendo la metodología de la Organización Mundial de la Salud. Se encontró resistencia en la población de mosquitos procedentes de Sullana con un 70% de mortalidad y susceptibilidad en la población procedente de El Porvenir con 99% de mortalidad.
The objective of the present work was to determine the resistance levels to deltamethrine in two populations of Aedes aegypti from Peru. Bioassays in adults were carried out following the methodology of the World Health Organization. We met resistance in the Sullana population with 70% of mortality and susceptibility in the population The Future El Porvenir with 99% of mortality.