RESUMO
O objetivo do presente estudo foi avaliar em tomografias computadorizadas as dimensões dos tecidos periodontais supracrestais (TPSC). Cem pacientes, 600 dentes anteriores da maxila (200 incisivos centrais, 200 incisivos laterais e 200 caninos), foram avaliados. A distância média da margem gengival até a crista óssea alveolar (COA) foi de 3.25mm (95% IC: 3.20-3.30), enquanto que da junção cemento-esmalte até a COA foi de 1.77mm (95% IC: 1.72-182mm). As medidas foram significativamente diferentes entre os grupos de dentes (ANOVA, p < 0.001). A tomografia, pode representar uma importante ferramenta para a avaliação das dimensões dos TPSC.
The aim of this study was to evaluate the dimensions of the supracrestal periodontal tissues (SPT) on tomographic scans. One hundred patients, 600 maxillary anterior teeth (200 central incisors, 200 lateral incisors and 200 canines), were evaluated. The average distance from the gingival margin to the alveolar bone crest (ABC) was 3.25mm (95% CI: 3.20-3.30), while the distance from the cemento-enamel junction to ABC was 1.77mm (95% CI: 1.72-182mm). The measurements were significantly different between the tooth groups (ANOVA, p < 0.001). When properly indicated, tomography can be an important tool for assessing the dimensions of TPSCs on a case-by-case basis.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Tecidos , Periodonto , Tomografia Computadorizada de Feixe Cônico , MaxilaRESUMO
Purpose: To quantify outer retina structural changes and define novel biomarkers of inherited retinal degeneration associated with biallelic mutations in RPE65 (RPE65-IRD) in patients before and after subretinal gene augmentation therapy with voretigene neparvovec (Luxturna). Methods: Application of advanced deep learning for automated retinal layer segmentation, specifically tailored for RPE65-IRD. Quantification of five novel biomarkers for the ellipsoid zone (EZ): thickness, granularity, reflectivity, and intensity. Estimation of theâ EZarea in single and volume scans was performed with optimized segmentation boundaries. The control group was age similar and without significant refractive error. Spherical equivalent refraction and ocular length were evaluated in all patients. Results: We observed significant differences in the structural analysis of EZ biomarkers in 22 patients with RPE65-IRD compared with 94 healthy controls. Relative EZ intensities were already reduced in pediatric eyes. Reductions of EZ local granularity and EZ thickness were only significant in adult eyes. Distances of the outer plexiform layer, external limiting membrane, and Bruch's membrane to EZ were reduced at all ages. EZ diameter and area were better preserved in pediatric eyes undergoing therapy with voretigene neparvovec and in patients with a milder phenotype. Conclusions: Automated quantitative analysis of biomarkers within EZ visualizes distinct structural differences in the outer retina of patients including treatment-related effects. The automated approach using deep learning strategies allows big data analysis for distinct forms of inherited retinal degeneration. Limitations include a small dataset and potential effects on OCT scans from myopia at least -5 diopters, the latter considered nonsignificant for outer retinal layers.
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Aprendizado Profundo , Terapia Genética , Mutação , Tomografia de Coerência Óptica , cis-trans-Isomerases , Humanos , cis-trans-Isomerases/genética , Tomografia de Coerência Óptica/métodos , Masculino , Feminino , Terapia Genética/métodos , Adulto , Criança , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Degeneração Retiniana/genética , Degeneração Retiniana/terapia , Pré-Escolar , Acuidade Visual/fisiologia , Retina/diagnóstico por imagem , Retina/patologiaRESUMO
PURPOSE: The presence of chaperones during intimate physical examinations is a matter of ongoing debate. While most guidelines recommend the use of chaperones in all cases, there are no clinical trials specifically investigating intimate exams performed on women by male physicians. We aimed to evaluate female patients' perceptions regarding the presence or absence of chaperones during proctological examinations conducted by male physicians. METHODS: In this randomised clinical trial, patients were assigned, unaware that they were participating in a study, to either Group 1 (without a chaperone during their proctological exam) or Group 2 (with a chaperone). After the appointment, they completed a questionnaire regarding the examination they had just undergone. The study was conducted at two hospitals in Southern Brazil. RESULTS: Ninety-five patients were included in each group. The mean (SD) comfort score was 8.3 (2.9) with a chaperone and 8.8 (2.5) without a chaperone (P = 0.25). When asked if they would want the exam performed the same way in the future, 72.6% in Group 1 answered 'yes', compared to 58.9% in Group 2 (P = 0.046). In Group 2, 48.4% of patients did not feel more protected by the chaperone, while none of the patients in Group 1 felt less protected without one. CONCLUSIONS: Forgoing chaperones during proctological examinations of women, when the physician is male, is well accepted by most patients. Preferences regarding chaperones are complex, demanding a selective approach. The use of chaperones should remain a recommendation, not a requirement, to accommodate individual needs while maintaining the doctor-patient relationship. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT03615586.
Assuntos
Acompanhantes Formais em Exames Físicos , Preferência do Paciente , Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Inquéritos e Questionários , Médicos/psicologia , Exame Físico , Relações Médico-PacienteRESUMO
INTRODUCTION: Very low-calorie diets with hospitalization have demonstrated promise as a viable therapeutic option for severe obesity and its associated comorbidities. However, large studies providing a comprehensive longitudinal observation of patients undergoing this therapy are lacking. We evaluated the effectiveness of treating severe obesity in hospitalized patients, using very low-calorie diets and clinical support to develop lifestyle changes. METHODS: This study was a retrospective cohort comparing exposure variables in a secondary data analysis with a pre-post treatment design. Data were obtained from medical records of patients with severe obesity (grade II or III) treated in a Brazilian obesity specialist hospital from 2016 to 2022. The patients underwent a very low-calorie diet (500-800 kCal/day) and immersive changes in lifestyle habits, monitored by a multidisciplinary team. At 3 months, 777 patients presented complete data and 402 presented complete data at 6 months. The study compared changes in bioimpedance and laboratory tests, between men and women and age groups. RESULTS: Three months of hospitalization yielded significant reductions in weight, body mass index (BMI), body fat, skeletal muscle mass, glucose, inflammatory, and lipid parameters. These reductions were more pronounced after 6 months, nearly doubling those observed at 3 months. In women, BMI and fat mass reduced by 10.4% and 15.2% at 3 months and 20.4% and 31.3% at 6 months, respectively. In men, BMI and fat mass decreased by 12.9% and 25.3 at 3 months and 23.6% and 45.3% at 6 months, respectively. Elderly individuals (aged ≥ 60 years) had smaller reductions in BMI and fat mass than non-elderly individuals (aged < 60 years) but still presented significant improvements. CONCLUSION: This study suggests the viability of treating severe obesity by hospitalization with low-calorie diets and immersive lifestyle changes. This treatment modality significantly improves anthropometric measurements, glucose, lipids, and inflammatory markers, thereby reducing cardiovascular risk.
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Índice de Massa Corporal , Pacientes Internados , Obesidade Mórbida , Humanos , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Brasil/epidemiologia , Adulto , Obesidade Mórbida/terapia , Obesidade Mórbida/dietoterapia , Hospitalização , Restrição Calórica/métodos , Idoso , Análise de Dados , Estilo de Vida , Análise de Dados SecundáriosRESUMO
Polymorphisms in the MBL2 gene exon 1 can decrease serum levels of mannose-binding lectin (MBL), increasing the risk of infection in immunocompromised individuals. This study evaluated the association between the polymorphism in exon 1 of the MBL2 gene, genotypes, serum MBL levels, and infection in 122 patients with acute lymphoid leukemia (ALL). The MBL*A allele exhibited the highest frequency (0.37) within the study population. The MBL*D (0.32) was the predominant variant. The combined frequency of O polymorphic alleles (either B or D) was 0.63. The frequencies of the A/A, A/O and O/O genotypes were 0.13, 0.49 and 0.38, respectively. All patients exhibited consistently low levels of serum MBL, irrespective of their exon 1 genotype. Parasitic infections (n = 103), bacterial (n = 69) and viral (n = 48). A/O genotype (0.49) had higher infection rates, A/A (0.13) had lower rates, and O/O showed increased viral susceptibility (OR: 0.37; 95% CI 0.13-1.06; p = 0.05). Our findings demonstrated that the study population were MBL-deficient, regardless of their MLB2 genotype. Individuals with the A/O genotype had more infections, while those with the O/O genotype appeared more susceptible to viral infections. These findings highlight the impact of MBL levels and genetic variants on infection susceptibility in ALL patients.
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Éxons , Predisposição Genética para Doença , Lectina de Ligação a Manose , Leucemia-Linfoma Linfoblástico de Células Precursoras , Humanos , Lectina de Ligação a Manose/genética , Lectina de Ligação a Manose/sangue , Masculino , Feminino , Éxons/genética , Adulto , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue , Pessoa de Meia-Idade , Adolescente , Genótipo , Adulto Jovem , Idoso , Alelos , Polimorfismo de Nucleotídeo Único , Criança , Frequência do Gene , Polimorfismo GenéticoRESUMO
Unhealthy lifestyles risk factors, such as smoking, alcohol consumption, physical inactivity, poor diet, and obesity, have been associated with a higher risk of all-cause and cause-specific mortality. However, composite score of these unhealthy behaviours has not been considered, particularly in Latin American populations. Herein, we examined the association of lifestyle risk factors score with all-cause and cause-specific mortality in Mexican adults. A total of 159,517 adults from the Mexico City Prospective Study (MCPS) were included. Data on sociodemographic, lifestyle risk factors and medical histories was collected through a self-reported baseline questionnaire in a census-style door-to-door interviews. Lifestyle risk factors assessment was based on five modifiable lifestyle risk factors and their respective cut-off points according to current health recommendations, including obesity, physical inactivity, tobacco, alcohol consumption and fruits and vegetables intake. Multivariable Cox regression models were used to estimate the associations of lifestyle risk factor score (ranging from 0 to 5) with all-cause and cause-specific mortality (cardiovascular disease, renal or hepatobiliary diseases, diabetes, respiratory diseases, cancer and all-cause mortality). We excluded the first 2, 5, 10, and 15 years of follow-up to account for reverse causation bias. We found a high prevalence (77%) of Mexican adults, with two or more lifestyle risk factors. Hazard ratio for respiratory diseases and renal or hepatobiliary diseases were 1.86 (95%CI: 1.45-2.39) and 2.00 (95%CI: 1.60-2.52) comparing participants with 4-5 lifestyle risk factors vs. those with none. For all-cause mortality, participants with 4-5 lifestyle risk factors had a 49% (HR: 1.49; 95%CI: 1.03-2.16) higher risk as compared to participants with none. The magnitude of the associations increased as the exclusion of follow-up time increased after 2, 5, 10 and 15 years. There was a positive association between the number of lifestyle risk factors and all-cause and cause-specific mortality, showing the highest rate of respiratory, renal or hepatobiliary and all-cause mortality among participants with 4-5 lifestyle risk factors. After accounting for reverse causation, associations were stronger.
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Estilo de Vida , Humanos , México/epidemiologia , Masculino , Feminino , Fatores de Risco , Estudos Prospectivos , Pessoa de Meia-Idade , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/efeitos adversos , Idoso , Fumar , Obesidade/mortalidade , Obesidade/epidemiologia , Mortalidade , Causas de MorteRESUMO
People with peripheral arterial disease (PAD) and intermittent claudication (IC) experience impaired walking due to an imbalance between muscle oxygen supply and demand during exercise. Studies with near-infrared spectroscopy (NIRS) during treadmill tests reveal notable tissue deoxygenation with slow recovery. This cross-sectional study aimed to compare behavior of calf muscle oxygenation during the incremental shuttle walking test (ISWT) with a continuous treadmill test (3.2 km/h, 10% incline) and to correlate NIRS results between tests in PAD patients. Sixty individuals with IC, 37 men (61.7%), mean age 66.25 ± 10.35 years participated in the study. Both tests were performed on the same day with a 30-minute rest, in randomized order. NIRS-derived calf muscle tissue oxygenation variables were measured at rest and during exercise. Typical PAD tissue oxygenation patterns were observed in both tests, with significant differences (p < 0.05) in oxygenation values during exercise for the variables delta of tissue oxygen saturation (ΔStO2) and reoxygenation rates. All tissue oxygenation variables analyzed, except reoxygenation rate, showed a significant and directly proportional correlation between the two tests. These results suggest that NIRS during ISWT could be a viable method for assessing tissue oxygenation in PAD.
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Teste de Esforço , Músculo Esquelético , Consumo de Oxigênio , Oxigênio , Doença Arterial Periférica , Espectroscopia de Luz Próxima ao Infravermelho , Caminhada , Humanos , Doença Arterial Periférica/metabolismo , Doença Arterial Periférica/fisiopatologia , Doença Arterial Periférica/diagnóstico , Masculino , Estudos Transversais , Feminino , Idoso , Músculo Esquelético/metabolismo , Pessoa de Meia-Idade , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Caminhada/fisiologia , Oxigênio/metabolismo , Teste de Esforço/métodos , Claudicação Intermitente/metabolismo , Claudicação Intermitente/fisiopatologia , Claudicação Intermitente/diagnóstico , Teste de Caminhada , Perna (Membro)/irrigação sanguíneaRESUMO
BACKGROUND: Adipose tissue distribution plays a crucial role in the development of cardiovascular complications. In particular, visceral adipose tissue (VAT) has been linked to insulin resistance (IR) and cardiovascular disease (CVD). However, the relationship between VAT, cardiac dysfunction and the meditation capacity of VAT related to IR has not been fully characterized. METHODS: This cross-sectional study included adults living with type 2 diabetes (T2D). VAT was measured using electrical bioimpedance and also estimated with the Metabolic Score for Visceral Fat (METS-VF). LV function was assessed using left ventricular global longitudinal strain (LV-GLS) by speckle tracking echocardiography analysis. Spearman correlation coefficients, adjusted linear regression models guided by direct acyclic diagrams and causal mediation analysis were performed. RESULTS: Among 195 adults living with T2D (median age: 57, IQR: 49-64, women: 63%), VAT showed a positive association with LV-GLS (ß = 0.482, 95% CI: 0.060-0.904, p = 0.039) after adjusting for relevant confounders. The effect was strongly replicated using METS-VF as a surrogate for VAT. The mediation analysis revealed that VAT accounted for 60.9% (95% CI: 15.82-171) of the total effect between IR and LV-GLS. CONCLUSION: This study demonstrated a positive association between VAT and LV-GLS. This relationship was consistently observed using the clinical surrogate METS-VF. Visceral adiposity was identified as a strong mediator in the relationship between IR and LV-GLS, underscoring its role in the pathophysiology of cardiovascular disease in patients with T2D.
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Adiposidade , Diabetes Mellitus Tipo 2 , Resistência à Insulina , Gordura Intra-Abdominal , Função Ventricular Esquerda , Humanos , Feminino , Gordura Intra-Abdominal/fisiopatologia , Gordura Intra-Abdominal/diagnóstico por imagem , Gordura Intra-Abdominal/metabolismo , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Transversais , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/metabolismo , Medição de Risco , Idoso , Deformação Longitudinal GlobalRESUMO
INTRODUCTION: Tackling the inertia of growing threat of antimicrobial resistance (AMR) requires changes in how antibiotics are prescribed and utilized. The monitoring of antimicrobial prescribing in hospitals is a critical component in optimizing antibiotic use. Point prevalence surveys (PPSs) enable the surveillance of antibiotic prescribing at the patient level in small hospitals that lack the resources to establish antimicrobial stewardship programs (ASP). In this study, we analyzed antibiotic use at two public secondary care hospitals in Mexico using PPSs. METHODS: Following WHO methodology, we conducted four cross-sectional PPSs on antibiotic use in two public secondary care facilities in Mexico: two surveys in a women's specialty hospital (H1) and two in a general referral hospital (H2). We collected data from clinical records of all patients with active antibiotic prescriptions (APs) across the medical, surgical, and mixed (MIX) wards, and intensive care units (ICUs). Descriptive statistics were computed to analyze the PPSs data using Stata. RESULTS: The PPSs collected data on 127 patients, and 283 active APs. The prevalence of antibiotic use was 60.4% (H1, n = 29/48) and 70.5% (H2, n = 98/139). Antibiotics were more frequently used among patients in the MIX wards (H1: 87.5%, n = 14/16) and ICUs (H2: 90%, n = 9/10). The most frequent patient indications for antibiotic use were medical prophylaxis (H1: 51.7%, n = 15/29), community-acquired infections (H2: 42.9%, n = 42/98), and preoperative prophylaxis (H1: 27.6%, n = 8/29; H2: 23.5%, n = 23/98). The APs were mostly empirical (H1: 97%, n = 64/66; H2: 98.2%, n = 213/217), and parenterally administered (H1: 90.9%, n = 60/66; H2: 96.8%, n = 210/217). Most clinical records lacked documented post-prescription reviews (H1: 82.8%, n = 24/29; H2: 98%, n = 96/98). Preoperative prophylaxis was predominantly administered as multiple doses for more than one day. Penicillins with extended-spectrum (24.2%, n = 16/66), aminoglycosides (22.7%, n = 15/66), and first-generation cephalosporins (16.7%, n = 11/66) were the most prescribed antibiotic classes in H1, while third-generation cephalosporins (35%, n = 76/217), fluoroquinolones (14.3%, n = 31/217), and carbapenems (13.4%, n = 29/217) were the most prescribed in H2. No hospital had formally established ASP. CONCLUSIONS: This study shows high prevalence rates of antibiotic use and variations in commonly prescribed antibiotic classes in public Mexican secondary care hospitals, along with shared practices in broad-spectrum antibiotic prescription. PPS-based surveillance enables the identification of specific targets to optimize antibiotic use according to the healthcare needs of patients in each hospital and facilitates comparative evaluations across hospitals.
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Antibacterianos , Gestão de Antimicrobianos , Humanos , México/epidemiologia , Antibacterianos/uso terapêutico , Feminino , Estudos Transversais , Pessoa de Meia-Idade , Adulto , Masculino , Prevalência , Idoso , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Atenção Secundária à Saúde/estatística & dados numéricos , Adulto Jovem , Inquéritos e Questionários , Adolescente , Prescrições de Medicamentos/estatística & dados numéricosRESUMO
Studies have noted the connection between Mycobacterium avium subspecies paratuberculosis (MAP) and autoimmunity. MAP is an intracellular pathogen that infects and multiplies in macrophages. To overcome the hostile environment elicited by the macrophage, MAP secretes a battery of virulence factors to neutralize the toxic effects of the macrophage. One of the virulence factors is the Protein Tyrosine Phosphatase A (PtpA), a protein secreted by MAP that interferes in the phago-lysosome fusion, rendering the pathogen unnoticed in the cytoplasm of the macrophage. This study aimed to assess the presence of PtpA antibodies in the sera of Mexican individuals with rheumatoid arthritis (RA) and investigate its possible use as a biomarker for disease activity. We compared RA patients (n = 100) to control subjects (CS) (n = 100) by assessing specific immune responses to PtpA (the antigen) by an indirect ELISA method. Results showed a significant difference in PtpA levels between RA and CS, with RA patients having a median OD of 0.4645 compared to 0.1372 in CS. Antibodies against PtpA were present in 95% of RA patients and 16% of CS (AUC = 0.9163, p = 0.0001). Male control subjects showed higher PtpA reactivity than female CS. The Disease Activity Score (DAS-28) analysis showed that individuals with moderate to high disease activity had lower levels of PtpA reactivity. The results suggest a potential connection between RA and MAP infection.
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Artrite Reumatoide , Biomarcadores , Mycobacterium avium subsp. paratuberculosis , Humanos , Artrite Reumatoide/imunologia , Artrite Reumatoide/sangue , Artrite Reumatoide/microbiologia , Feminino , Masculino , Mycobacterium avium subsp. paratuberculosis/imunologia , Biomarcadores/sangue , Pessoa de Meia-Idade , Adulto , Proteínas de Bactérias/imunologia , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologia , Idoso , Estudos de Casos e Controles , Proteínas Tirosina Fosfatases/imunologiaRESUMO
OBJECTIVES: This study aimed to evaluate socioeconomic inequalities in self-reported oral health among community-dwelling Brazilian older adults and evaluate the oral health factors contributing to the inequalities. METHODS: This was a cross-sectional study with data from the Brazilian National Health Survey conducted in 2019. The dependent variable is the self-report of oral health categorized as good or poor. Household per capita income in quintiles and schooling were used as socioeconomic variables. The explanatory covariates were age; gender; limitation in basic activities of daily living; number of teeth, use of dental prostheses; difficulty in eating; and recent dental visit. The Oaxaca-Blinder two-fold decomposition for binary outcomes was used to evaluate the factors contributing to the inequalities in self-reported oral health. RESULTS: Self-reported poor oral health was found among 35.8% of the dentate and 29.6% of the edentulous individuals. Poor self-reported oral health was more prevalent among older adults with low income and educational levels. Among dentate individuals, the difference in the proportion of poor self-reported oral health (the gap) between those with no schooling and those with some schooling was 12.8 percent points (p.p.), favoring the poor. The gap between dentate in the lowest and highest income groups was 14.8 p.p. favoring the poor. Among edentulous individuals, those with no schooling had a higher proportion of self-reported oral health (total gap 10.6 p.p.). Concerning income inequalities, the gap favored the poorer group and was 5.4 p.p. higher among individuals in the lowest income group. CONCLUSION: The decomposition analyses suggested that oral health variables explained most of the education and income inequalities; difficulties in eating were the most contributing factor in both the dentate and edentulous groups. There was a relatively reduced contribution of recent dental visits to socioeconomic inequality.
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Saúde Bucal , Autorrelato , Fatores Socioeconômicos , Humanos , Saúde Bucal/estatística & dados numéricos , Brasil/epidemiologia , Masculino , Feminino , Idoso , Estudos Transversais , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Renda , Disparidades nos Níveis de SaúdeRESUMO
BACKGROUND: Blood-based Alzheimer's disease (AD) biomarkers have been increasingly employed for diagnostic, prognostic, and therapeutic monitoring purposes, due to accuracy in distinguishing AD pathophysiologic process. Compared to other p-tau isoforms, plasma p-tau217 exhibits stronger associations with AD hallmarks in CSF and brain. However, most studies have been conducted in non-Hispanic Whites, limiting our understanding of the performances and utility of these biomarkers across ethnicities. METHODS: We examined a cohort of Peruvians from the GAPP study, a recently established cohort of Peruvian mestizos from Lima and indigenous groups from Southern Peru (Aymaras and Quechuas). We tested plasma levels of p-tau using the Quanterix Simoa ALZpathp-tau217 assay in 525 samples and tested the association between p-tau217 and clinical diagnosis (healthy controls n = 234 vs. AD n = 113) using generalized mixed regression models, adjusting for sex, age, education, APOE-e4 allele (fixed effects) and study site (random effect). We also tested biomarker levels in MCI (n = 178) vs. other groups. The receiver operating characteristics area under the curve (ROC-AUC) was used to evaluate the biomarker's classification performances. RESULT: Participants showed on average 80% Native American ancestry. p-tau217 was significantly associated with AD (ß = 2.61, 95%CI = 0.61-4.29) and its levels were inversely correlated with cognitive performances; p-tau217 levels did not differ between controls and MCI (p-value > 0.05). p-tau217 levels were higher in participants carrying at least one APOE-e4 allele (OR = 2.31, 95%CI = 1.85-2.90). The ROC-AUC for p-tau217 was estimated at 82.82% in the fully adjusted model. CONCLUSION: To our knowledge, this is the largest study conducted in a South American cohort phenotyped for AD with available p-tau217. Most investigations have previously focused on highly selected cohorts with established AD-endophenotypes (CSF biomarkers, autopsy report, PET etc.), while data on cohorts with clinical assessment are currently lacking, especially in non-European populations.
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Doença de Alzheimer , Biomarcadores , Proteínas tau , Humanos , Doença de Alzheimer/sangue , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/genética , Doença de Alzheimer/líquido cefalorraquidiano , Proteínas tau/sangue , Proteínas tau/líquido cefalorraquidiano , Feminino , Masculino , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Idoso , Estudos de Coortes , Peru , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , FosforilaçãoRESUMO
Patients with radiographic axial spondyloarthritis (r-axSpA) experience a higher prevalence of fragility fractures, though the pathophysiology of osteoporosis associated with this disease remains poorly understood. The objective of this study was to evaluate the histomorphometric data in r-axSpA patients. Male r-axSpA patients up to 55 years old were enrolled in this cross-sectional study. Clinical, lab, and imaging data, including spine X-Ray to evaluate vertebral fractures and new bone formation, as well as dual-energy X-ray absorptiometry (DXA) at spine, hip, and forearm and trabecular bone score (TBS), were performed in all patients. Transiliac histomorphometry was also underwent in all patients, and data were compared with 21 male cadavers' material. A total of 21 patients were included, with a mean age of 45.8 years, long disease duration (median 17.5 years), mostly white (66.7%) and positive for HLA-B27 (90.5%). The prevalence of DXA abnormalities and low TBS (≤ 1.338) was 42.8% and 57.1%, respectively. There was higher osteoid trabecular thickness (p = 0.027) and cortical bone changes, including reduced thickness (p = 0.031) and increased porosity (p = 0.015) in r-axSpA patients. In addition, a pattern of cortical trabecularization was observed in 52.3%. Dynamic evaluation revealed a longer mineralization lag time (p = 0.0074) and lower mineralized surface (p = 0.0029) and bone formation rate (p = 0.0074) in patients compared to reference values. Our results showed a pattern of low trabecular remodeling, bone mineralization impairment, as well as cortical thickness and porosity abnormalities in men with r-axSpA. These findings may impact future treatment of bone fragility in this disease.
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Absorciometria de Fóton , Espondiloartrite Axial , Densidade Óssea , Remodelação Óssea , Humanos , Masculino , Pessoa de Meia-Idade , Remodelação Óssea/fisiologia , Estudos Transversais , Adulto , Densidade Óssea/fisiologia , Espondiloartrite Axial/epidemiologia , Osso Cortical/diagnóstico por imagem , Osso Cortical/patologia , Osteoporose/patologia , Calcificação Fisiológica/fisiologiaRESUMO
To assess and compare two techniques of low-level laser application-transgingival (TLLLT) and intrasulcular (ILLLT)-used in photobiomodulation as an adjunct to basic periodontal therapy (BPT) in patients with periodontitis. A randomized, split-mouth, double-blind clinical trial was conducted, selecting three diseased periodontal sites from different quadrants in each patient. These sites were assigned to one of three treatment groups: SRP (control), SRP + TLLLT (test 1), and SRP + ILLLT (test 2). Low-level laser therapy in the test groups was applied at 48 h, 7 days, and 14 days after full-mouth SRP. Clinical parameters such as probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were assessed at baseline (T0), 3 months (T1), and 6 months (T2). Standardized periapical radiographs were used to assess radiographic bone density (RBD) 6 months post-treatment. Statistical analyses included repeated measures ANOVA for continuous variables and chi-square tests for categorical variables, with significance set at p < 0.05 and a 95% confidence interval. Significant reductions in PD (p < 0.001) and CAL (p < 0.001) were observed across all groups at 3 and 6 months, with no significant differences between groups. There were also no significant changes in BOP and RBD between groups at the follow-up intervals. Adjunctive photobiomodulation did not provide additional clinical or radiographic benefits over SRP alone, regardless of the laser application technique employed.
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Terapia com Luz de Baixa Intensidade , Humanos , Terapia com Luz de Baixa Intensidade/métodos , Método Duplo-Cego , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Periodontite/radioterapia , Periodontite/terapia , Raspagem Dentária/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Breast cancer (BC) is a significant burden on healthcare systems, especially in low- and middle-income countries where access to diagnosis and treatment is challenging. OBJECTIVES: The purpose of this study was to assess the diagnostic accuracy and cost using tissue microarray (TMA) instead of traditional immunohistochemical (IHC) evaluation for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 (HER2), and the proliferation marker Ki-67 and BC subtyping within the Brazilian public health system. DESIGN: This is a retrospective cohort study comparing TMA slides with traditional whole-slide evaluation for IHC markers in 242 BC cases. METHODS: We used formalin-fixed tissue blocks for TMA assembly. Clinical data and IHC scores for ER, PR, HER2, and Ki-67 were obtained from pathology reports. Cohen's kappa (k) was used to assess TMA performance. RESULTS: BC samples were distributed in 10 TMAs and 968 cores were scored (242 BC cases × 4 markers). In 97% of these, TMA reached high quality to adequate IHC scoring with minimal technical issues. Inter-examiner agreement was almost perfect for all markers (ranging from 0.85 for HER2 to 0.91 for ER, p < 0.001). The intratumoral heterogeneity ranged from almost perfect agreement for ER and HER2 to moderate to substantial for PR and Ki-67. TMA offers substantial time and cost savings, with an approximately 11-fold reduction compared to traditional methods. The concordance between TMA and original reports was almost perfect, with 93% overall agreement (k = 0.81, p < 0.001). However, TMA performance varied between markers, with intratumoral heterogeneity significantly impacting discordant results, particularly for Ki-67 and HER2. This ultimately affected the accuracy of BC subtyping. TMA performed well in identifying luminal A and triple-negative cases, but misclassification was common for luminal B and HER2-positive cases. CONCLUSION: TMA offers accurate and lower-cost results in the individualized IHC assessment of BC markers. However, we do not recommend the use of TMA in the subtyping of BC, where analysis of the whole section remains necessary for more accurate results. We advocate more studies using the TMA approach in the Brazilian public health system to advance women's health care.
Assuntos
Biomarcadores Tumorais , Neoplasias da Mama , Imuno-Histoquímica , Antígeno Ki-67 , Receptor ErbB-2 , Receptores de Estrogênio , Receptores de Progesterona , Análise Serial de Tecidos , Humanos , Feminino , Neoplasias da Mama/patologia , Neoplasias da Mama/diagnóstico , Brasil , Imuno-Histoquímica/métodos , Estudos Retrospectivos , Receptores de Progesterona/metabolismo , Receptores de Estrogênio/metabolismo , Receptor ErbB-2/metabolismo , Biomarcadores Tumorais/metabolismo , Pessoa de Meia-Idade , Antígeno Ki-67/metabolismo , Adulto , Idoso , Saúde PúblicaRESUMO
PURPOSE: Metastatic urothelial carcinoma (mUC) poses a challenge to health care systems, given its treatment complexity and mortality. We aimed to describe the characteristics, treatment patterns, and survival outcomes of Mexican patients with mUC. METHODS: A retrospective study was conducted across eight centers for adults with mUC from January /2001 to December 2021. We recorded medical history, eligibility for first-line platinum therapy, treatment lines received, and access to novel drugs. Descriptive statistics were used and survival analysis, including Kaplan-Meier curves and Cox proportional hazards model, was performed. RESULTS: We identified 379 patients with mUC; 37 were excluded, and 76% was male, with a median age of 67 years. The median follow-up was 8.4 months. Among those who received a first-line treatment (65%), cisplatin-based chemotherapy (45%) was the most common followed by carboplatin (39%). Causes of cisplatin ineligibility were Eastern Cooperative Oncology Group ≥2 (41%) and glomerular filtration rate <60 mL/min (33%). The overall response rate to up-front platinum therapy was 33%, with a median progression-free survival of 6.1 months (95% CI, 4.9 to 6.9). Second-, third-, and fourth-line treatment was given to 24.6%, 8.8%, and 3.5%, respectively. Chemotherapy was the most common regimen prescribed. Access to novel drugs was limited, 14 patients received avelumab, and 25% received immunotherapy as second-line treatment. The median overall survival was 11.8 months (95% CI, 10.2 to 15.2). Multivariate analysis showed that first-line treatment was independently associated with better survival, whereas poor performance status and visceral disease were associated with worse survival. CONCLUSION: To our knowledge, these data represent the first effort to delineate treatment trends of mUC in Mexico. First-line treatment prescription and rates of progression to platinum therapy were higher than those described worldwide. Factors affecting survival included performance status, first-line treatment, and visceral disease. Our study highlights unequal access to novel treatments, underscoring the need for equitable care.
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Carcinoma de Células de Transição , Humanos , Masculino , Feminino , Idoso , Estudos Retrospectivos , Pessoa de Meia-Idade , México/epidemiologia , Carcinoma de Células de Transição/tratamento farmacológico , Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/terapia , Carcinoma de Células de Transição/secundário , Carcinoma de Células de Transição/patologia , Carboplatina/administração & dosagem , Carboplatina/uso terapêutico , Cisplatino/uso terapêutico , Cisplatino/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Idoso de 80 Anos ou mais , Neoplasias Urológicas/tratamento farmacológico , Neoplasias Urológicas/mortalidade , Neoplasias Urológicas/patologia , Neoplasias Urológicas/terapia , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/terapia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/patologia , Metástase Neoplásica , Anticorpos Monoclonais Humanizados/uso terapêutico , Intervalo Livre de ProgressãoRESUMO
O avanço da tecnologia de digitalização de imagens e desenvolvimento de dispositivos de fresagem possibilitaram a otimização de diversos processos na Odontologia. O emprego do escaneamento intraoral e do sistema CAD-CAM (CAD - Computer Aided Design; CAM - Computer Aided Manufacturing) aprimorou a realização de reabilitações protéticas, permitindo a obtenção de peças de alta qualidade em tempo reduzido. O objetivo deste trabalho é relatar um caso de reabilitação de um incisivo central inferior a partir de escaneamento intraoral, com scanner Omnicam (DentsplySirona Charlotte, NC, EUA) e aplicação do sistema CAD-CAM.
The advancement of image digitization technology and the development of milling devices have made it possible to optimize various processes in Dentistry. The use of intraoral scanning and the CAD-CAM system (CAD - Computer Aided Design; CAM - Computer Aided Manufacturing) has improved the performance of prosthetic rehabilitations, allowing the obtaining of high quality parts in a reduced time. The objective of this work is to report a case of rehabilitation of a lower central incisor using intraoral scanning, with an Omnicam scanner (Dentsply Sirona) and application of the CAD-CAM system.
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Humanos , Masculino , Pessoa de Meia-Idade , Reabilitação , Desenho Assistido por Computador , Odontologia , Modelos AnatômicosRESUMO
BACKGROUND AND PURPOSE: The integration of evidence-based practice (EBP) into clinical decision-making is crucial for ensuring optimal patient care. However, there are various factors influencing the utilization of academic sources among physiotherapists, highlighting the need for a deeper understanding of these dynamics. The present study aimed to investigate the association between personal factors (age, time since graduation, number of patients, and education level), barriers to EBP implementation and perceptions about EBP, and physiotherapists' preference for using non-academic sources when seeking technical information about physiotherapy. METHODS: This was a cross-sectional study involving 610 physiotherapists. Participants completed an online questionnaire covering demographic characteristics, sources of information, barriers to EBP implementation, and perceptions regarding the importance of scientific information in clinical practice. Logistic regression was used to investigate the factors associated with the preference for non-academic sources of information. RESULTS: Nearly a quarter of the sample exhibited a preference for non-academic sources, with age over 34 years, perceived lack of abilities to apply scientific findings, and understanding issues related to EBP being significant associated with the preference of this types of sources of information. Physiotherapists with these characteristics were twice as likely to prefer non-academic sources when compared to physiotherapists who do not have these characteristics. DISCUSSION: These findings underscore the importance of enhancing professional competencies in EBP and fostering confidence in utilizing academic sources. While efforts have been made to incorporate EBP promotion in academic curricula, further initiatives are needed to bridge the gap between established knowledge and the competencies required for daily practice. Future studies should continue to explore the role of age in EBP applicability and the adoption of scientific knowledge, aiming to inform targeted interventions and educational programs tailored to the evolving needs of physiotherapy professionals.
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Prática Clínica Baseada em Evidências , Fisioterapeutas , Humanos , Estudos Transversais , Fisioterapeutas/educação , Feminino , Masculino , Brasil , Adulto , Inquéritos e Questionários , Pessoa de Meia-Idade , Atitude do Pessoal de Saúde , Comportamento de Busca de InformaçãoRESUMO
INTRODUCTION: Depression is the leading cause of mental health-related illnesses and disabilities. Physical activity (PA) has been included as part of therapeutic approaches for patients with depression. This study aimed to investigate the associations between depressive symptoms and PA levels in a large representative cohort of Brazilian adults and older individuals. METHODS: Data from 58,445 Brazilian adults (68.6 % males and 31.4 % females) aged 18 years or older (42.2 ± 10 years) who participated in health screening initiatives between 2008 and 2022 at the Center for Preventive Medicine at a quaternary hospital in Sao Paulo, Brazil were analyzed. Standardized health data (anthropometric, laboratory, clinical, and behavioral) were collected. A hierarchical regression model was used to examine the associations based on the presence and absence of depressive symptoms. RESULTS: In the final model, age, gender (female), body mass index (BMI) (each kg/m2), presence of hypertension, presence of diabetes mellitus, risk of alcohol consumption, smoking status, and perceived stress were associated with higher odds of depressive symptoms. However, PA levels were associated with lower odds of depressive symptoms. CONCLUSION: The findings revealed that any level of PA was independently and significantly associated reduced risk of depressive symptoms.
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Índice de Massa Corporal , Depressão , Exercício Físico , Humanos , Masculino , Feminino , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Depressão/epidemiologia , Depressão/psicologia , Brasil/epidemiologia , Adulto Jovem , Fatores Sexuais , Idoso , Adolescente , Fatores de RiscoRESUMO
ETHNOPHARMACOLOGICAL RELEVANCE: The Asháninka people are the largest Peruvian Amazonian group, yet the knowledge of their medicinal plants is scarce. This study on Asháninka herbal medicine offers an insight into the Asháninka aetiological system, resting within the wider ontological framework of animism, and cultural expressions of the biomedical understanding of illnesses. AIM OF THE STUDY: To document wild-grown (non-cultivated) plant species in current use by the Asháninka people and look closer at their herbal practices during the Covid-19 pandemic. The study examines whether the knowledge and use of medicinal plants is gendered in this society. It also compares the findings with available literature concerning the Arawakan groups from Peruvian Amazonia. MATERIAL AND METHODS: The fieldwork was conducted in 13 native communities of the Asháninka people along the Tambo River (Selva Central), Peru, between 2016 and 2018 and in 2022. The main field technique were guided walks in the forest with 27 female and 28 male participants, during which voucher specimens were collected and relevant information was recorded. Semi-structured interviews were performed with specialists in Asháninka traditional medicine and with lay Asháninka people to better understand Asháninka illness aetiologies. The analysis of medicinal plants included medicinal categories and uses, modes of preparations, the frequency of use and the knowledge about the plants between the genders. It also presents and discusses detailed testimonies of herbal remedies during the Covid-19 pandemic. The list of recorded plants was compared with ethnobotanical studies of other Arawakan groups from Peruvian Amazonia. RESULTS: Altogether, 169 wild-grown medicinal plant species were documented. Our findings highlight the importance of the Piperaceae and Acanthaceae botanical families in the Asháninka pharmacopoeia. The plants were used for 23 medicinal categories, of which dermatological disorders, digestive problems and venomous bites were the most prevalent. Over 70% of recorded plants were commonly and moderately known by the study participants. More exclusive species were found among the men than women; however, 64 % of all recorded plants were known to both genders. Sixty-one percent of recorded plants were not mentioned by any other study of medicinal plants among other Arawakan groups in Peruvian Amazonia. During the Covid-19 pandemic, nobody in the native communities at the Tambo River died directly due to the virus, which was attributed, amongst others, to effective and culturally-appropriate prophylaxis and treatments with medicinal plants. CONCLUSION: To this day, the Asháninka people at the Tambo River conserve the knowledge and practices related to medicinal plants which meet the daily needs of dwelling in subtropical forest; these are deeply rooted in animistic ontology, with the emphasis on spirit predation and retaliation. And yet, numerous applications of plants are compatible with the biomedical notion of illness and symptoms. Plant knowledge is shared between the genders, although specific plants exist for men and women, which are related to their gendered social and family roles. Some overlap and consensus exists with other studies regarding medicinal uses, which reflects the rich and diverse knowledge of medicinal plants among the Arawakan groups in Peruvian Amazonia, and this deserves further study.