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ABSTRACT Purpose: To determine the clinical outcomes in patients after type 1 Boston keratoprosthesis surgery and the significance of ultrasound biomicroscopy imaging for postoperative follow-up. Methods: This retrospective analysis included 20 eyes of 19 patients who underwent corneal transplantation with type 1 Boston keratoprosthesis between April 2014 and December 2021. Data on patient demographics, preoperative diagnosis, visual acuity, and postoperative clinical findings were analyzed. Results: Type 1 Boston keratoprosthesis implantation resulted in intermediate- and long-term positive outcomes. However, blindness and other serious complications such as glaucoma, retroprosthetic membrane formation, endophthalmitis, or retinal detachment also occurred. The use of ultrasound biomicroscopy imaging allowed for better evaluation of the back of the titanium plate, anterior segment structures, and the relationship of the prosthesis with surrounding tissues, which provided valuable postoperative information. Conclusion: Regular lifetime monitoring and treatment are necessary in patients who undergo Boston type 1 keratoprosthesis implantation for high-risk corneal transplantation. ultrasound biomicroscopy imaging can be a valuable imaging technique for the evaluation of patients with Boston type 1 keratoprosthesis, providing important information on anterior segment anatomy and potential complications. Further studies and consensus on postoperative follow-up protocols are required to optimize the management of patients with Boston type 1 keratoprosthesis.
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OBJECTIVE: To generate normative data for the Verbal Fluency Test (VFT) and the Boston Naming Test (BNT) in the Costa Rican population. METHOD: The sample consisted of 563 healthy older people (aged 59-90 years). Polynomial multiple regression analyses were run to evaluate the effects of the age, sex, and education variables on VFT and BNT scores. RESULTS: The results showed a significant linear effect of education on the four-letter VF scores and an effect of sex on the letter P score, with females performing better than males. The explained variance ranged from 20.9% to 28.3%. A linear effect of age and education was also found for the four semantic VF scores, with scores decreasing with increasing age and lower education. The sex variable was significant for all semantic categories, with females performing better than males except in the animal category. The explained variance ranged from 21.7% to 30.9%. In the BNT, a linear effect of education was found, so that the more education, the better the score. In addition, a sex effect was also found, with males having higher scores than females. The predictors of the model explained 9.6% of the variance. CONCLUSIONS: This is the first study that generates normative data for the VF and BNT in the Costa Rican population over 59 years of age based on demographic variables. The use of these normative data will help clinicians in Costa Rica to better understand language functioning in the elderly, allowing for better classification and diagnosis in the future.
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It is presented as an innovative technique in the treatment of atrial fibrillation, with the aim of improving the quality of life of affected patients. OBJECTIVES: The study aims to describe the ablation procedure using the Boston Scientific System Farapulse medical equipment and analyze the results in a specific clinical case. METHODS: A pulmonary vein ablation procedure was performed using the aforementioned equipment. Details of the procedure were recorded, including catheter placement and applications performed in each pulmonary vein. RESULTS: Good tolerance was observed by the patient during the procedure, with an adequate number of applications in each pulmonary vein. Postablation electrocardiogram showed no significant abnormalities, suggesting electrical stability of the heart. It is concluded that the pulsed field pulmonary vein ablation technique using the Boston Scientific System medical equipment is safe and effective in the treatment of atrial fibrillation.
Se presenta como una técnica innovadora en el tratamiento de la fibrilación auricular, con el objetivo de mejorar la calidad de vida de los pacientes afectados. OBJETIVOS: El estudio tiene como objetivo describir el procedimiento de ablación utilizando el equipo médico Boston Scientific System Farapulse y analizar los resultados en un caso clínico específico. Métodos: Se realizó un procedimiento de ablación de venas pulmonares utilizando el equipo mencionado. Se registraron los detalles del procedimiento, incluyendo la colocación de catéteres y las aplicaciones realizadas en cada vena pulmonar. RESULTADOS: Se observó una buena tolerancia por parte del paciente durante el procedimiento, con un número adecuado de aplicaciones en cada vena pulmonar. El electrocardiograma postablación no mostró anomalías significativas, lo que sugiere una estabilidad eléctrica del corazón. Se concluye que la técnica de ablación de venas pulmonares con campo pulsado utilizando el equipo médico Boston Scientific System es segura y eficaz en el tratamiento de la fibrilación auricular.
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Humanos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/cirurgia , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Reprodutibilidade dos Testes , Resultado do Tratamento , Ablação por Cateter/efeitos adversosRESUMO
The present study aims to explore the neuropsychological performance and exposure to mercury (Hg) and arsenic (As) in Colombian children and adolescents considering biomarkers in hair and blood. The total sample consisted of 70 participants from the Mojana region, Colombia. A neuropsychological evaluation protocol was used, consisting of 11 internationally recognized tests, with evidence of national validation and use for measurement in neurotoxicology contexts. A 57.1% of the sample presented levels above the reference value according to the USEPA, the WHO, and the ATSDR for total mercury in hair (HgH), blood mercury (HgB), and/or blood arsenic (AsB). The mean values reported for HgH were 1.76 ± 3.1 µg/g (95% CI 1.02-2.50) with ranges between 0.23 and 17.20; for HgB: 4.11 ± 5.93 µg/l (CI 2.69-5.52), ranging between 0.25 and 25.80, and for AsB: 1.96 ± 2.73 (CI 1.31-2.61) ranging between 0.50 and 15.50. In the comparison of groups in relation to the level of exposure, a significant difference was found (p < 0.05) for the subtest The Boston Naming Test (BNT). Correlation analyses found, on the one hand, significant negative relationships in tests integrated within the verbal (CVB) and executive function (EF) components as well as evidence of positive relationships in the manifestation of errors in their performance with the levels of Hg and/or As transformed by biomarker (Log10). In the linear regression analyses it was found that for each increase in the concentration of HgH, HgB, and AsB it is estimated that, both for the models with and without data adjustment, there is a loss of scores in integrated measures within the CVB and EF for the transformed levels of HgH, HgB, and AsB; and an increase in the reported errors in their processing within these functions. According to these results, exposure to mercury and/or arsenic is related with performance in verbal neuropsychological skills and executive functioning.
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Arsênio , Mercúrio , Criança , Humanos , Adolescente , Mercúrio/análise , Arsênio/toxicidade , Arsênio/análise , Colômbia/epidemiologia , Cabelo/química , Testes Neuropsicológicos , Biomarcadores , Cognição , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análiseRESUMO
BACKGROUND: Several subtypes of primary progressive aphasia (PPA) have been proposed. Most reports use small samples, and few have included Spanish-speaking participants. AIM: To analyze the language profile and nonlinguistic deficits in a large sample of PPA Spanish monolingual participants. METHOD: 177 individuals were diagnosed with PPA in a sample consisting of 69 men and 108 women (Mage = 66.40 years, SD = 9.30). The participants were assessed using the Spanish versions of the Western Aphasia Battery Revised (SWAB-R) and the Boston Diagnostic Aphasia Examination (SBDAE). Non-verbal reasoning was evaluated with the Raven's Colored Progressive Matrices. RESULTS: 41.8% of the sample met the criteria for the logopenic variant (lvPPA), while 28.2% met the criteria for semantic (svPPA), 15.3% for lexical (lxvPPA), and 14.7% for nonfluent/agrammatic (nfvPPA) variants. Language difficulties were similar in all variants except for lxvPPA. Scores on Spontaneous Language, Auditory Comprehension, Repetition, and Naming were significantly higher for the lxvPPA group. Raven's Colored Progressive Matrices scores were significantly lower in lvPPA. Years of education correlated with all test scores, while age was negatively associated with naming. When the PPA variants were classified according to the traditional aphasia classification, discrepancies were evident. Furthermore, the most frequent type of aphasia was Amnesic, while the least frequent was Wernicke's aphasia. CONCLUSION: The SWAB-R is useful in describing the clinical characteristics of aphasia for each variant of PPA, but quantitative scores from this battery are not capable of distinguishing between variants of PPA, with the exception of lxvPPA.
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Afasia Primária Progressiva , Idoso , Afasia Primária Progressiva/diagnóstico , Compreensão , Feminino , Humanos , Idioma , Testes de Linguagem , Masculino , SemânticaRESUMO
El artículo tiene como objetivo general comparar el desempeño de las tareas del test de Boston y de la Prueba para la evaluación del procesamiento del lenguaje en el adulto (PEPLA) en adultos mayores de 60 años en Bogotá, Colombia. Para ello se evalúa con la Prueba para la Evaluación del Procesamiento del Lenguaje en el Adulto (PEPLA) y el test de Boston, a 11 adultos mayores de 60 años, pertenecientes a la ciudad de Bogotá, la aplicación de las pruebas se llevó a cabo mediante el ejercicio de telepráctica, con la aplicación Google Meet. Se presenta el análisis e interpretación de los resultados estadísticos obtenidos en el software R que mediante la opción prueba t, se compararon las variables A y B. La variable A representa las tareas del test de Boston, la variable B representa las tareas de la prueba PEPLA. Allí se evidenciaron valores que representa si las variables son estadísticamente significativas o no. Se concluyó que las tareas del test de Boston y PEPLA guardan niveles de desempeño similares, es por esta razón que PEPLA ofrece un avance para la población colombiana y es pertinente que se realicen las modificaciones para su validación
To compare the performance of the tasks of the Boston test and the Test for the assessment of language processing in adults (PEPLA) in adults over 60 years in Bogotá, Colombia. It is evaluated with the Test for the Evaluation of Language Processing in the Adult (PEPLA) and the Boston test, 11 adults over 60 years old, belonging to the city of Bogotá, the application of the tests was carried out by means of the telepractic exercise, with the Google Meet application. The analysis and interpretation of the statistical results obtained in the R software is presented, which by means of the t-test option, variables A and B were compared. Variable A represents the tasks of the Boston test, variable B represents the tasks of the test PEPLA. There, values were evidenced that represent whether the variables are statistically significant or not. It was concluded that the tasks of the Boston and PEPLA test have similar performance levels, it is for this reason that PEPLA offers an advance for the Colombian population and it is pertinent that the pertinent modifications be made for its validation
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Humanos , Software , Idioma , População , PertencimentoRESUMO
Resumen La ictiosis canina es un trastorno queratoseborreico primario de carácter hereditario, el cual se ha reportado en Golden retriever, Bull dog americano, Jack Russell terrier, Cavalier King Charles spaniel y Gran danés. En el presente reporte se describe un caso clínico en un Boston terrier que desde cachorro ha presentado diferentes lesiones cutáneas, tiene años de evolución y varios tratamientos previos sin éxito. El diagnóstico se realizó mediante el descarte de otras dermatopatías y un estudio histopatológico. Se instauró un tratamiento multimodal de por vida para reestablecer la barrera cutánea y manejar el desorden de la cornificación.
Abstract Canine ichthyosis is a hereditary primary keratoseborreheic disorder, which has been reported in Golden retrievers, American bulldogs, Jack Russell terriers, Cavalier King Charles spaniel and Great danes. This report describes a clinical case in a Boston terrier that has presented multiples skin lesions since she was a puppy, has years of evolution and several previous unsuccessful treatments. The diagnosis was made by ruling out other dermatopathies and a histopathological study. Lifelong multimodal treatment was instaured to reestablish the skin barrier and manage the cornification disorder.
Resumo A ictiose canina é um transtorno queratosseborreico primário de caráter hereditário, sendo reportado em Golden retriever, Buldogue americano, Jack Russell terrier, Cavalier King Charles Spaniel e Dogue alemão. No presente relato se descreve um caso clínico em um Boston terrier que, desde filhote, apresentou diferentes lesões cutâneas, tendo evoluído por anos com tratamentos prévios sem êxito. O diagnóstico se realizou mediante o descarte de outras dermatopatias e um estudo histopatológico. Se instaurou um tratamento multimodal de uso contínuo, visando reestabelecer a barreira cutânea e manejar a desordem de cornificação.
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BACKGROUND: There remains a dearth of cross-city comparisons on the impact of climate change through extreme temperature and precipitation events on road safety. We examined trends in traffic fatalities, injuries and property damage associated with high temperatures and heavy rains in Boston (USA) and Santo Domingo (Dominican Republic). METHODS: Official publicly available data on daily traffic outcomes and weather conditions during the warm season (May to September) were used for Boston (2002-2015) and Santo Domingo (2013-2017). Daily maximum temperatures and mean precipitations for each city were considered for classifying hot days, warm days, and warm nights, and wet, very wet, and extremely wet days. Time-series analyses were used to assess the relationship between temperature and precipitation and daily traffic outcomes, using a quasi-Poisson regression. RESULTS: In Santo Domingo, the presence of a warm night increased traffic fatalities with a rate ratio (RR) of 1.31 (95% CI [confidence interval]: 1.00,1.71). In Boston, precipitation factors (particularly, extremely wet days) were associated with increments in traffic injuries (RR 1.25, 95% CI: 1.18, 1.32) and property damages (RR 1.42, 95% CI: 1.33, 1.51). CONCLUSION: During the warm season, mixed associations between weather conditions and traffic outcomes were found across Santo Domingo and Boston. In Boston, increases in heavy precipitation events were associated with higher traffic injuries and property damage. As climate change-related heavy precipitation events are projected to increase in the USA, the associations found in this study should be of interest for road safety planning in a rapidly changing environment.
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BACKGROUND: Stress urinary incontinence carries a significant healthcare burden for women worldwide. Single incision slings are minimally invasive mesh devices designed to treat stress urinary incontinence. For prolapse repair, meshes with higher porosity and lower structural stiffness have been associated with improved outcomes. OBJECTIVE: In this study, we compared the higher stiffness, lower porosity Altis sling with the lower stiffness, higher porosity Solyx sling in an ovine model. We hypothesized that SIS-B would have a negative impact on the host response. STUDY DESIGN: A total of Altis and Solyx single incision slings were implanted suburethrally into sheep according to the manufacturer's instructions on minimal tension. The mesh-urethral-vaginal complex and adjacent ungrafted vagina (no mesh control) were harvested en bloc at 3 months. Masson's trichrome and picrosirius red staining of 6 µm thin sections was performed to measure interfiber distance and tissue integration. Smooth muscle contractility to a 120 mM KCl stimulus was performed in an organ bath to measure myofiber-driven contractions. Standard biochemical assays were used to quantify glycosaminoglycan, total collagen, and elastin content, and collagen subtypes. Bending stiffness was performed in response to a uniaxial force to define susceptibility to folding/buckling. Statistical analysis was performed using Mann-Whitney, Gabriel's pairwise post hoc, Wilcoxon matched-pairs, and chi-square tests. RESULTS: The animals had similar ages (3-5 years), parity (multiparous), and weights (45-72 kg). Trichrome cross sections showed that the Altis sling buckled in a "C" or "S" shape in most samples (8 of 11), whereas buckling after Solyx sling implantation was observed in only a single sample (1 of 13; P=.004). Tissue integration, as measured by the presence of collagen or smooth muscle between the mesh fibers on trichrome 4× imaging, was increased in samples implanted with the Solyx sling compared with the Altis sling (P<.05). Total collagen content decreased significantly with both products when compared with the ungrafted vagina consistent with stress shielding. There was no difference in the 2 groups with regard to glycosaminoglycan or elastin content. The Altis sling mesh tissue complex demonstrated significantly higher amounts of both collagen types I and III than the Solyx sling-implanted tissue and the ungrafted control. Smooth muscle contractility in response to 120 mM KCl was decreased after implantation of both slings compared with the sham (P=.011 and P<.01), with no difference between mesh types (P=.099). Bending stiffness in the Altis sling was more than 4 times lower than in the Solyx, indicating an increased propensity to buckle (0.0186 vs 0.0883). CONCLUSION: The structurally stiffer Altis sling had decreased tissue integration and increased propensity to buckle after implantation. Increased collagen types I and III after the implantation of this device suggests that these changes may be associated with a fibrotic response. In contrast, the Solyx sling largely maintained a flat configuration and had improved tissue integration. The deformation of the Altis sling is not an intended effect and is likely caused by its lower bending stiffness. Both meshes induced a decrease in collagen content and smooth muscle contractility similar to previous findings for prolapse meshes and consistent with stress shielding. The long-term impact of buckling warrants further investigation.
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Modelos Animais , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Vagina/cirurgia , Animais , Feminino , OvinosRESUMO
RESUMO A doença de Parkinson (DP) é uma doença neurodegenerativa, caracterizada por disfunções motoras e não motoras. Pacientes com DP também podem apresentar problemas de linguagem, incluindo deficit em tarefas de nomeação. Dificuldade em tarefas de nomeação é uma característica importante da afasia de Broca, transtorno de linguagem associado a lesões pós-acidente vascular cerebral (AVC) no córtex pré-frontal inferior esquerdo (área de Broca). Aqui, apresenta-se o caso de um paciente de 79 anos diagnosticado com DP (estágio 4 na escala de Hoehn e Yahr) e afasia crônica não fluente pós-AVC, com deficit de nomeação severos. O paciente foi tratado com uma nova combinação de terapia audiovisual de produção e estimulação transcraniana por corrente contínua (ETCC), técnica neuromodulatória não invasiva, que tem sido cada vez mais adotada para potencializar terapias fonoaudiológicas. ETCC anodal (2 mA) foi aplicada sobre o córtex pré-frontal inferior esquerdo (F7 no sistema 10/20), durante nove sessões de 20 minutos, ao longo de duas semanas, enquanto o paciente tentava nomear imagens de objetos comuns com o auxílio de vídeos curtos mostrando uma boca articulando os sons do nome do objeto (pista audiovisual). Observou-se aumento significativo nos escores de nomeação entre o pré e o pós-tratamento, tanto para imagens treinadas, quanto para não treinadas, mas fonemicamente similares (generalização). Os resultados apresentaram indícios iniciais de que terapia audiovisual de produção associada à ETCC anodal sobre a área de Broca pode representar uma alternativa viável para pacientes com deficits de nomeação severos.
ABSTRACT Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and nonmotor symptoms. PD patients may present language problems, including deficits in confrontation naming. Naming deficits are also an important feature of Broca's aphasia, a condition associated with post-stroke damage to the left inferior prefrontal cortex (Broca's area). We present the case of a 79-year old, male patient diagnosed with both PD (stage 4 in Hoehn and Yahr's scale) and chronic post-stroke, non-fluent aphasia. The patient, with particularly severe naming deficits, was treated with a novel combination of audiovisual production therapy and transcranial direct current stimulation (tDCS), a noninvasive neuromodulatory technique that has been increasingly used to potentiate speech therapy. Anodal tDCS (2 mA) was applied to the left inferior prefrontal cortex (F7 in the 10/20 system) in nine 20-min sessions over two weeks while the patient tried to name pictures of common objects aided by short videos of an articulating mouth (audiovisual cue). We found significant pre- to post-training naming improvement for treated items and for untreated, phonemically similar items (generalization). The results provide initial indication that audiovisual production therapy combined with anodal tDCS over Broca's area may represent a viable treatment alternative for patients with severe naming deficits.
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Humanos , Masculino , Idoso , Afasia de Broca/terapia , Doença de Parkinson/terapia , Estimulação Transcraniana por Corrente Contínua/métodos , Testes de LinguagemRESUMO
BACKGROUND: Compared with Caucasians, Latinxs with the hepatitis C virus (HCV) tend to initiate treatment less often, discontinue treatment, become infected younger, and have higher reinfection rates post-treatment. Little is known about HCV treatment experiences among Latinxs who inject drugs in the Northeastern USA. We assessed knowledge, attitudes, and perceptions tied to HCV, as well as HCV treatment readiness, and explored the overall HCV treatment experience of Latinx people who inject drugs (PWID) in Boston. METHODS: We conducted qualitative interviews with monolingual and bilingual Spanish-speaking Latinx PWID (n = 15) in Boston, Massachusetts, between 2015 and 2016. We used a thematic content analysis approach to code and analyze data to identify knowledge, attitudes, and experiences related to HCV treatment. RESULTS: We identified barriers and facilitators to HCV treatment. Six salient themes emerged from the data. For participants who had not initiated HCV treatment, lack of referral, fear of quitting drugs, and fear of relapse were perceived barriers. Trust in medical providers and a willingness to quit drugs were primary facilitators. Most participants had positive HCV treatment experiences, and several emphasized the need for outreach to Latinxs about the advantages of newer treatment options. Concerns about HCV reinfection were also notable. CONCLUSIONS: We identified a range of experiences tied to HCV treatment among Latinx PWID. HCV care providers play a key role in determining treatment uptake, and more treatment information should be disseminated to Latinx PWID. Healthcare providers should capitalize on treatment facilitators by ensuring referrals to treatment and should continue to address perceived barriers.
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Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Hepatite C/etnologia , Hepatite C/terapia , Hispânico ou Latino/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/etnologia , População Urbana/estatística & dados numéricos , Adulto , Boston , Feminino , Guatemala/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico/etnologia , Pesquisa Qualitativa , Venezuela/etnologia , População Branca/estatística & dados numéricosRESUMO
Polyunsaturated fatty acid (PUFA) consumption is recommended as part of a healthy diet, but evidence of the impact of individual species and biological concentrations on cognitive function is limited. We examined prospective associations of PUFA erythrocyte composition and dietary intake with measures of cognitive function among participants of the Boston Puerto Rican Health Study (aged 57 years). Erythrocyte and dietary PUFA composition were ascertained at baseline and associated with 2-year scores on the Mini-Mental State Exam (MMSE) (n = 1032) and cognitive domain patterns derived from a battery of tests (n = 865), as well as with incidence of cognitive impairment. Erythrocyte and dietary n-3 PUFA were not significantly associated with MMSE score. However, total erythrocyte and dietary n-3 very-long-chain fatty acids (VLCFA), and intake of individual species, were associated with better executive function (P-trend < 0.05, for all). There was evidence that greater erythrocyte n-6 eicosadienoic acid concentration was associated with lower MMSE and executive function scores (P-trend = 0.02). Only erythrocyte arachidonic acid (ARA) concentration predicted cognitive impairment (Odds Ratio = 1.26; P = 0.01). Among Puerto Rican adults, we found that n-3 VLCFA consumption may beneficially impact executive function. Further, these findings provide some evidence that n-6 metabolism favoring greater ARA tissue incorporation, but not necessarily dietary intake, could increase the risk of cognitive impairment.
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Transtornos Cognitivos/psicologia , Cognição , Eritrócitos/metabolismo , Ácidos Graxos Ômega-3/administração & dosagem , Ácidos Graxos Ômega-6/administração & dosagem , Biomarcadores/sangue , Boston/epidemiologia , Transtornos Cognitivos/sangue , Transtornos Cognitivos/etnologia , Transtornos Cognitivos/prevenção & controle , Função Executiva , Ácidos Graxos Ômega-3/sangue , Ácidos Graxos Ômega-6/efeitos adversos , Ácidos Graxos Ômega-6/sangue , Feminino , Hispânico ou Latino/psicologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Proteção , Porto Rico/etnologia , Fatores de RiscoRESUMO
OBJECTIVE: The Boston Naming Test (BNT) is a widely used measure of confrontation naming ability that has been criticized for its questionable construct validity for non-English speakers. This study investigated item difficulty and construct validity of the Spanish version of the BNT to assess cultural and linguistic impact on performance. METHODS: Subjects were 1298 healthy Spanish speaking adults from Colombia. They were administered the 60- and 15-item Spanish version of the BNT. A Rasch analysis was computed to assess dimensionality, item hierarchy, targeting, reliability, and item fit. RESULTS: Both versions of the BNT satisfied requirements for unidimensionality. Although internal consistency was excellent for the 60-item BNT, order of difficulty did not increase consistently with item number and there were a number of items that did not fit the Rasch model. For the 15-item BNT, a total of 5 items changed position on the item hierarchy with 7 poor fitting items. Internal consistency was acceptable. CONCLUSIONS: Construct validity of the BNT remains a concern when it is administered to non-English speaking populations. Similar to previous findings, the order of item presentation did not correspond with increasing item difficulty, and both versions were inadequate at assessing high naming ability.
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Testes de Linguagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colômbia , Feminino , Voluntários Saudáveis , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Traduções , Adulto JovemRESUMO
PURPOSE: To report the outcomes of implantation of the Boston Type I keratoprosthesis in three patients with Acanthamoeba keratitis (AK), a severe infection that can lead to significant visual loss. OBSERVATIONS: Case series reporting three patients with difficult cases of AK that needed multiple corneal transplantations and glaucoma surgeries. All patients were implanted with the Boston Type I keratoprosthesis device. The main outcomes measure were the visual function and anatomical retention after implantation of the Boston Type I keratoprosthesis. All patients retained the device over the long-term and had good visual function. In one patient a retroprosthetic membrane developed and in another patient an epithelial lip developed over the anterior surface of the keratoprosthesis. The visual acuities range from 20/25 to 20/80 in the implanted eyes. CONCLUSIONS AND IMPORTANCE: The Boston Type I keratoprosthesis resulted in good anatomic and functional results after multiple graft failures after AK.
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The hepatic lipase (LIPC) locus is a well-established determinant of high-density lipoprotein cholesterol (HDL-C) concentrations, an association that is modified by dietary fat in observational studies. Dietary interventions are lacking. We investigated dietary modulation of LIPC rs1800588 (-514 C/T) for lipids and glucose using a randomized crossover design comparing a high-fat Western diet and a low-fat traditional Hispanic diet in individuals of Caribbean Hispanic descent (n = 42, 4 wk/phase). No significant gene-diet interactions were observed for HDL-C. However, differences in dietary response according to LIPC genotype were observed. In major allele carriers (CC/CT), HDL-C (mmol/l) was higher following the Western diet compared with the Hispanic diet: phase 1 (Western: 1.3 ± 0.03; Hispanic: 1.1 ± 0.04; P = 0.0004); phase 2 (Western: 1.4 ± 0.03; Hispanic: 1.2 ± 0.03; P = 0.0003). In contrast, HDL-C in TT individuals did not differ by diet. Only major allele carriers benefited from the higher-fat diet for HDL-C. Secondarily, we explored dietary fat quality and rs1800588 for HDL-C and triglycerides (TG) in a Boston Puerto Rican Health Study (BPRHS) subset matched for diabetes and obesity status (subset n = 384). In the BPRHS, saturated fat was unfavorably associated with HDL-C and TG in rs1800588 TT carriers. LIPC rs1800588 appears to modify plasma lipids in the context of dietary fat. This new evidence of genetic modulation of dietary responses may inform optimal and personalized dietary fat advice and reinforces the importance of studying genetic markers in diet and cardiometabolic health.
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HDL-Colesterol/sangue , Gorduras na Dieta/farmacologia , Lipase/genética , Adulto , HDL-Colesterol/genética , Estudos Transversais , Dieta Hiperlipídica/efeitos adversos , Feminino , Teste de Tolerância a Glucose , Hispânico ou Latino , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Porto RicoRESUMO
Avaliar a eficácia do tratamento não cirúrgico e cirúrgico da síndrome do túnel do carpo através do Questionário de Boston e determinar se o Questionário de Boston é um bom instrumento de avaliação da evolução clínica e do tratamento. A amostra foi constituída por 90 pacientes. Todos os pacientes foram diagnosticados clinicamente e ainda não haviam sido tratados anteriormente ao estudo. Responderam ao Questionário de Boston antes da terapia, após 2 meses de terapia e os que não obtiveram melhora clínica foram submetidos a liberação cirúrgica. Após 30 dias de pós-operatório responderam novamente ao questionário. A epidemiologia foi de acordo com a literatura médica clássica. Através da aplicação do questionário de Boston encontramos um escore de 2,83, com média de 53,8 pontos, nos pacientes antes do início do tratamento não cirúrgico com um desvio padrão de ± 0,64 e após o tratamento de 2,31, com média de 44,02 pontos e com um desvio padrão de ± 0,72. No pós-operatório foi encontrado um escore de 2,1 com desvio padrão de 0,14. O Questionário de Boston demonstrou ser um bom instrumento para avaliar a evolução do tratamento da STC e fornece informações quanto a percepção do paciente em relação a sua doença. Permite que o médico faça uma ligação entre à clínica do paciente e seu grau de habilidade manual e severidade dos sintomas. Apesar de ser uma amostra pequena, não haver grupo controle e o tempo de seguimento ter sido pequeno foi possível perceber que na maioria dos pacientes houve alteração, para melhor, dos escores, mesmo que pequena e mesmo o paciente precisou realizar a cirurgia. Todos que que foram submetidos a cirurgia tiveram seus escores diminuídos.
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Síndrome do Túnel Carpal/terapia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Omega-3 (n-3) fatty acid (FA) consumption is thought to improve depressive symptoms. However, current evidence is limited, and whether this association exists among Puerto Ricans, a population burdened by depression, remains uncertain. OBJECTIVES: We examined the association between ω-3 FA biomarkers and depressive symptoms as well as the potential influence of oxidative stress. METHODS: Baseline and longitudinal analyses were conducted in the Boston Puerto Rican Health Study (n= 787; participants aged 57 ± 0.52 y, 73% women). Urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) concentration, a measure of oxidative stress, and erythrocyte FA composition were collected at baseline. We calculated the omega-3 index as the sum of eicosapentaenoic and docosahexaenoic acids, expressed as a percentage of total FAs. Baseline and 2-y depressive symptoms were characterized by using the Center for Epidemiological Studies-Depression Scale (CES-D). Statistical analyses included linear and logistic regression. RESULTS: Urinary 8-OHdG concentration tended to modify the relation between the erythrocyte omega-3 index and baseline CES-D score (P-interaction = 0.10). In stratified analyses, the omega-3 index was inversely associated with CES-D score (ß = -1.74, SE = 0.88;P= 0.02) among those in the top quartile of 8-OHdG concentration but not among those in the lower quartiles. The relation between the omega-3 index and CES-D at 2 y was more clearly modified by 8-OHdG concentration (P-interaction = 0.04), where the omega-3 index was inversely associated with CES-D at 2 y, adjusted for baseline (ß = -1.66, SE = 0.66;P= 0.02), only among those with elevated 8-OHdG concentrations. Among individuals not taking antidepressant medications and in the top tertile of urinary 8-OHdG concentration, the omega-3 index was associated with significantly lower odds of a CES-D score ≥16 at baseline (OR: 0.72; 95% CI: 0.53, 0.96) but not at 2 y (OR: 0.83; 95% CI: 0.60, 1.15). CONCLUSIONS: An inverse association between the omega-3 index and depressive symptoms was observed among participants with elevated oxidative stress biomarkers. These data suggest that oxidative stress status may identify those who might benefit from ω-3 FA consumption to improve depressive symptoms.
Assuntos
Biomarcadores/sangue , Depressão/sangue , Depressão/tratamento farmacológico , Ácidos Graxos Ômega-3/sangue , Estresse Oxidativo , 8-Hidroxi-2'-Desoxiguanosina , Glicemia/metabolismo , Índice de Massa Corporal , Boston , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Estudos Transversais , Dano ao DNA , Desoxiguanosina/análogos & derivados , Desoxiguanosina/urina , Depressão/etnologia , Eritrócitos/metabolismo , Exercício Físico , Ácidos Graxos Ômega-3/administração & dosagem , Feminino , Seguimentos , Humanos , Insulina/sangue , Modelos Lineares , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Porto Rico/etnologia , Fatores Socioeconômicos , Inquéritos e Questionários , Triglicerídeos/sangueRESUMO
BACKGROUND: Synergistic or additive effects or both on cardiometabolic risk may be missed by examining individual fatty acids (FAs). A pattern analysis may be a more useful approach. In addition, it remains unclear whether erythrocyte FA composition relates to insulin resistance among Hispanics/Latinos. OBJECTIVE: We derived erythrocyte FA patterns for a Puerto Rican cohort and examined their association with diet and insulin resistance in cross-sectional and prospective analyses. DESIGN: At baseline, principal components analysis was used to derive factor patterns with the use of 24 erythrocyte FAs from 1157 participants of the Boston Puerto Rican Health Study (aged 45-75 y). Dietary intake was assessed with a validated semiquantitative food-frequency questionnaire. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated at baseline and at the 2-y follow-up. Relations between FA patterns and HOMA-IR were analyzed in a sample of 922 participants with available data. RESULTS: Five FA patterns were derived, differentiated by 1) relatively high de novo lipogenesis (DNL) FAs and low n-6 (ω-6) FAs, 2) high very-long-chain saturated FAs, 3) high n-3 (ω-3) FAs, 4) high linoleic acid and low arachidonic acid, and 5) high trans FAs. The DNL pattern was positively correlated with sugar and inversely with n-6 and monounsaturated FA intakes. Only the DNL pattern was positively related to baseline HOMA-IR [adjusted geometric means (95% CIs) for quartiles 1 and 4: 1.72 (1.58, 1.87) and 2.20 (2.02, 2.39); P-trend < 0.0001]. Similar associations were observed at 2 y, after adjustment for baseline status [quartiles 1 and 4 means (95% CIs): 1.61 (1.48, 1.76) and 1.84 (1.69, 2.00); P-trend = 0.02]. These results remained consistent after the exclusion of participants with diabetes (n = 485). CONCLUSION: Our findings suggest that upregulated DNL associated with a diet high in sugar and relatively low in unsaturated FAs may adversely affect insulin sensitivity in a Hispanic/Latino cohort.
Assuntos
Dieta , Sacarose Alimentar/efeitos adversos , Eritrócitos/metabolismo , Ácidos Graxos/sangue , Resistência à Insulina , Insulina/sangue , Lipogênese , Boston , Estudos Transversais , Gorduras na Dieta/sangue , Gorduras na Dieta/farmacologia , Feminino , Hispânico ou Latino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Porto Rico , Fatores de Risco , Inquéritos e Questionários , Regulação para CimaRESUMO
In 1996, a Spanish edition of the Boston Naming Test (BNT) was published. Changes to the original version were introduced but without an empirical foundation supporting these modifications. This version was later adapted by reordering the items according to their difficulty frequency in a Spanish-speaking population, and norms were developed from this version of the test. However, no validity studies were performed with this new version to determine if the changes introduced had an impact on the test's validity. The current study was performed to assess the construct and concurrent validity of the Spanish-language version of the BNT (SV-BNT). The SV-BNT was administered to 23 patients with Alzheimer's disease (AD) and 36 normal controls. Groups were matched by age and education. Patients with AD showed a significantly lower mean score than the controls on the SV-BNT with a large effect size, which demonstrates adequate construct validity. However, sensitivity was 39% and specificity was 89%. The very low sensitivity shows that the concurrent validity of the test is poor and many patients with AD can score within the normal range. The SV-BNT does not guarantee a proper identification of naming difficulties, and therefore, its clinical use should not be recommended.
Assuntos
Doença de Alzheimer/diagnóstico , Transtornos da Linguagem/diagnóstico , Rememoração Mental/fisiologia , Testes Neuropsicológicos/normas , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Argentina , Comparação Transcultural , Feminino , Humanos , Transtornos da Linguagem/etiologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: There is little research on factors associated with alcohol consumption among Puerto Ricans living in the USA; thus the aim of the present study was to examine alcohol intake patterns, and factors associated with drinking categories, in a cohort of Puerto Rican adults in Massachusetts. DESIGN: Cross-sectional study. Descriptive and polytomous logistic regression analyses were used to identify factors associated with drinking patterns, stratified by gender. SETTING: Greater Boston area, MA, USA. SUBJECTS: Puerto Rican adults (n 1292), aged 45-75 years. RESULTS: Eight per cent of men and 39% of women were lifetime abstainers; 40% of men and 25% of women were former drinkers; 31 % of men and 27% of women were moderate drinkers; and 21% of men and 8% of women were heavy drinkers. Thirty-five per cent of participants reported drinking alcohol while taking medications with alcohol contraindications. After multivariable adjustment, young men were less likely than older men to be moderate drinkers. Among women, higher BMI, age, lower income and lower psychological acculturation were associated with abstention; age and lower perceived emotional support were associated with increased likelihood of former drinking; and women without v. with diabetes were more likely to be heavy drinkers. CONCLUSIONS: High prevalence of chronic disease, heavy drinking and alcohol use while taking medications with alcohol contraindications suggest an urgent need for better screening and interventions tailored to this rapidly growing Hispanic national subgroup. As heavy drinking appears to increase with acculturation for women, public health initiatives are needed to support appropriate alcohol use.