RESUMO
BACKGROUND: To test whether a Shallow Neural Network (S-NN) can detect and classify vascular tone dependent changes in arterial blood pressure (ABP) by advanced photopletysmographic (PPG) waveform analysis. METHODS: PPG and invasive ABP signals were recorded in 26 patients undergoing scheduled general surgery. We studied the occurrence of episodes of hypertension (systolic arterial pressure (SAP) >140â¯mmHg), normotension and hypotension (SAPâ¯<â¯90â¯mmHg). Vascular tone according to PPG was classified in two ways: 1) By visual inspection of changes in PPG waveform amplitude and dichrotic notch position; where Classes I-II represent vasoconstriction (notch placed >50% of PPG amplitude in small amplitude waves), Class III normal vascular tone (notch placed between 20-50% of PPG amplitude in normal waves) and Classes IV-V-VI vasodilation (notch <20% of PPG amplitude in large waves). 2) By an automated analysis, using S-NN trained and validated system that combines seven PPG derived parameters. RESULTS: The visual assessment was precise in detecting hypotension (sensitivity 91%, specificity 86% and accuracy 88%) and hypertension (sensitivity 93%, specificity 88% and accuracy 90%). Normotension presented as a visual Class III (III-III) (median and 1st-3rd quartiles), hypotension as a Class V (IV-VI) and hypertension as a Class II (I-III); all pâ¯<â¯.0001. The automated S-NN performed well in classifying ABP conditions. The percentage of data with correct classification by S-ANN was 83% for normotension, 94% for hypotension, and 90% for hypertension. CONCLUSIONS: Changes in ABP were correctly classified automatically by S-NN analysis of the PPG waveform contour.
Assuntos
Hipertensão , Hipotensão , Humanos , Pressão Arterial , Fotopletismografia , Hipertensão/diagnóstico , Hipotensão/diagnóstico , Redes Neurais de ComputaçãoRESUMO
Las lesiones por presión representan un problema de salud pública y de seguridad del paciente, debido a las elevadas tasas de prevalencia que condicionan y repercusiones en el ámbito sanitario y económico, tanto a nivel institucional como familiar y personal.Objetivo : analizar la prevalencia de las lesiones por presión en pacientes del Hospital Dr. José María Vargas, 2021-2022.Métodos : estudio retrospectivo, con enfoque cuantitativo, no experimental, descriptivo y de corte transversal, en el cual se efectuó revisión de historias clínicas. Con una población de 1838 pacientes que acudieron al Hospital José María Vargas de Cagua en el periodo de estudio, de los cuales se identificaron 25 casos con diagnóstico de lesión por presión; la muestra fue censal. Como instrumento de recolección de datos se empleó una ficha de registro. Resultados : las úlceras por presión tienen mayor prevalencia en pacientes con edad superior a 71 años, del sexo femenino, con antecedentes de diabetes mellitus, hipertensión arterial o accidente cerebrovascular. Con frecuencia se manifiesta clínicamente como una lesión única, grado II o III; mientras que las regiones anatómicas más afectadas son la región sacra, la región glútea y la cresta ilíaca. La prevalencia de la patología quedó asentada en 1,36%.Conclusión : las lesiones por presión tienen mayor prevalencia en pacientes de edad avanzada, sexo femenino y del entorno urbano, con antecedente de diabetes mellitus e hipertensión arterial. Se presentan como lesiones únicas, grado II-III, en la región sacra, habitualmente con evolución de hasta 7 días, y de origen comunitario(AU)
Pressure injuries represent a public health and patient safety problem, due to the high prevalence rates that condition and repercussions in the health and economic sphere, both at an institutional, family and personal level. Objective: to analyze the prevalence of pressure injuries in patients at the Dr. José María Vargas Hospital, 2021-2022. Methods: retrospective study, with a quantitative, non-experimental, descriptive and cross-sectional approach, in which medical records were reviewed. With a population of 1838 patients who attended the José María Vargas de Cagua Hospital in the study period, of which 25 cases diagnosed with pressure injury were identified; the sample was census. As a data collection instrument, a registration form was used. Results: pressure ulcers are more prevalent in patients older than 71 years, female, with a history of diabetes mellitus, arterial hypertension or stroke. It frequently manifests clinically as a single lesion, grade II or III; while the most affected anatomical regions are the sacral region, the gluteal region and the iliac crest. The prevalence of the pathology was established at 1.36%. Conclusion: pressure injuries are more prevalent in elderly, female and urban patients with a history of diabetes mellitus and arterial hypertension. They present as single lesions, grade II-III, in the sacral region, usually with evolution of up to 7 days, and of community origin(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Úlcera por Pressão/complicaçõesRESUMO
Objetivo: establecer los factores predictivos y causas de conversión de la colecistectomía laparoscópica. Métodos: se trata de un metaanálisis en el que se realizó revisión bibliográfica a través de 8 bases de datos, se incluyeron 14 publicaciones correspondientes al periodo 2019 2023.Resultados : se encontró que los factores predictivos de conversión de colecistectomía laparoscópica se dividen en: factores propios del paciente: edad, género, índice de masa corporal, comórbidos, antecedente de cirugía abdominal; factores de la enfermedad: forma de ingreso del paciente bien sea electiva o de urgencia, presencia de colecistitis aguda, incremento del grosor de la pared vesicular, presencia de adherencias en el lecho operatorio; y factores del cirujano: que incluyen tanto la experiencia de este como la percepción de colecistectomía difícil.Conclusión : se ha logrado establecer en el presente trabajo que el sexo masculino, la edad avanzada, el mayor grosor de la pared de la vesícula biliar y la presencia de colecistitis aguda, representan factores predictivos de conversión de colecistectomía laparoscópica. Las principales causas de conversión fueron adherencias, dificultad de disección o visualización de las estructuras que componen el triángulo de Calot y hemorragia no controlada(AU)
Objective: to establish the predictive factors and causes of conversion of laparoscopic cholecystectomy. Methods: this is a qualitative research in which a bibliographic review was carried out through 8 databases, 14 publications corresponding to the period 2019 - 2023 were included.Results : it was found that the predictive factors of laparoscopic cholecystectomy conversion were They are divided into: factors specific to the patient: age, gender, body mass index, comorbidities, history of abdominal surgery; disease factors: admission of the patient, whether elective or urgent, presence of acute cholecystitis, increased thickness of the gallbladder wall, presence of adhesions in the surgical bed; and surgeon factors: which include both the surgeon's experience and the perception of difficult cholecystectomy.Conclusion : it has been established in the present work that the male sex, advanced age, greater thickness of the gallbladder wall and the presence of acute cholecystitis represent predictive factors for laparoscopic cholecystectomy conversion. The main causes of conversion were adhesions, difficulty in dissection or visualization of the structures that make up Calot's triangle, and uncontrolled bleeding(AU)
Assuntos
Humanos , Masculino , Feminino , Procedimentos Cirúrgicos Operatórios , Colecistectomia Laparoscópica , Conversão para Cirurgia Aberta , Vesícula Biliar , Cirurgia Geral , Colelitíase , Índice de Massa Corporal , ComorbidadeRESUMO
Fatty acids (FA) have a multitude of biological actions on living cells. A target of their action is cell motility, a process of critical importance during cancer cell dissemination. Here, we studied the effect of unsaturated FA on ovarian cancer cell migration in vitro and its role in regulating cytoskeleton structures that are essential for cell motility. Scratch wound assays on human ovary cancer SKOV-3 cell monolayers revealed that low doses (16 µM) of linoleic acid (LA, 18:2 ω6) and oleic acid (OA; 18:1 ω9) promoted migration, while α-linolenic acid (ALA, 18:3 ω3), showed a migration rate similar to that of the control group. Single cell tracking demonstrated that LA and OA-treated cells migrated faster and were more orientated towards the wound closure than control. In vitro addition of those FA resulted in an increased number, length and protrusion speed of filopodia and also in a prominent and dynamic lamellipodia at the cell leading edge. Using time-lapse video-microscopy and FRAP we observed an increase in both the speed and frequency of actin waves associated with more mobile actin and augmented Rac1 activity. We also observed that FA induced microtubule-organizing center (MTOC)-orientation towards the cell front and affected the dynamics of microtubules (MT) in the direction of cell migration. We propose that environmental cues such as OA and LA present in ascitic fluid, should be taken into account as key factors for the regulation of cell migration.
Assuntos
Citoesqueleto de Actina/metabolismo , Ácido Linoleico/farmacologia , Microtúbulos/efeitos dos fármacos , Ácido Oleico/farmacologia , Neoplasias Ovarianas/metabolismo , Proteínas rac1 de Ligação ao GTP/metabolismo , Líquido Ascítico/química , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Relação Dose-Resposta a Droga , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , Microtúbulos/metabolismo , Análise de Célula Única , Imagem com Lapso de Tempo , Regulação para CimaRESUMO
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by progressive joint destruction associated with increased pro-inflammatory mediators. In inflammatory microenvironments, exogenous ATP (eATP) is hydrolyzed to adenosine, which exerts immunosuppressive effects, by the consecutive action of the ectonucleotidases CD39 and CD73. Mature B cells constitutively express both ectonucleotidases, converting these cells to potential suppressors. Here, we assessed CD39 and CD73 expression on B cells from treated or untreated patients with RA. Neither the frequency of CD73+CD39+ and CD73-CD39+ B cell subsets nor the levels of CD73 and CD39 expression on B cells from untreated or treated RA patients showed significant changes in comparison to healthy controls (HC). CpG+IL-2-stimulated B cells from HC or untreated RA patients increased their CD39 expression, and suppressed CD4+ and CD8+ T cell proliferation and intracellular TNF-production. A CD39 inhibitor significantly restored proliferation and TNF-producing capacity in CD4+ T cells, but not in CD8+ T cells, from HC and untreated RA patients, indicating that B cells from untreated RA patients conserved CD39-mediated regulatory function. Good responder patients to therapy (R-RA) exhibited an increased CD39 but not CD73 expression on B cells after treatment, while most of the non-responder (NR) patients showed a reduction in ectoenzyme expression. The positive changes of CD39 expression on B cells exhibited a negative correlation with disease activity and rheumatoid factor levels. Our results suggest modulating the ectoenzymes/ADO pathway as a potential therapy target for improving the course of RA.
Assuntos
Apirase/metabolismo , Artrite Reumatoide/imunologia , Artrite Reumatoide/metabolismo , Linfócitos B/imunologia , Linfócitos B/metabolismo , Imunomodulação , Adenosina/metabolismo , Apirase/genética , Artrite Reumatoide/patologia , Artrite Reumatoide/terapia , Linfócitos B Reguladores/imunologia , Linfócitos B Reguladores/metabolismo , Estudos de Casos e Controles , Citocinas/biossíntese , Gerenciamento Clínico , Suscetibilidade a Doenças , Expressão Gênica , Humanos , Ativação Linfocitária , Contagem de Linfócitos , Linfócitos T/imunologia , Linfócitos T/metabolismo , Resultado do TratamentoRESUMO
Resumen La enfermedad aneurismática coronaria se define como la dilatación de un segmento arterial coronario más 1,5 veces el diámetro de las arterias adyacentes de tamaño normal. Puede ser difusa, y afectar todo el trayecto de la arteria, o localizada y afectar sólo un segmento arterial específico. Puede encontrarse entre un 3 a un 8% de los estudios angiográficos y entre un 0,22% a un 1,4% de las necropsias clínicas. Se presenta 3 reportes de casos, donde la presentación clínica, los hallazgos angiográficos y el manejo farmacológico es diverso como corresponde a esta entidad.
Abstract Coronary aneurysm disease is defined as the dilation of a coronary artery segment more than 1.5 times the diameter of the adjacent arteries of normal size. It may be diffuse, and affect the whole trajectory of the artery, or localised and only affect a specific arterial segment. It can be found in between 3% and 8% of angiograph studies, with between 0.22% and 1.4% in clinical post-mortems. Three case reports are presented in which the clinical presentation, the angiographic findings, and the pharmacological management are shown to be as diverse as this condition itself.
Assuntos
Humanos , Masculino , Idoso , Vasos Coronários , Aneurisma Coronário , Cateterismo Cardíaco , Dilatação PatológicaRESUMO
BACKGROUND: While PWID of Puerto Rican origin have been migrating to the US for decades, the range of factors influencing their migration to the US and the resources they draw on to do so are not well understood. This is particularly true for rural Puerto Rican PWID, and the present study is the first empirical research to document migration patterns among this population. The specificities of their migration raise important challenges that need to be documented in order to implement more effective harm reduction policies at home (Puerto Rico) and abroad (US). METHODS: This paper draws from data obtained employing a modified NHBS survey which was administered to (N =296) PWID in four rural municipalities of Puerto Rico with participants 18 years or older. The primary dependent variables for this paper are the number of times a person has lived in the continental US, and if they are planning on moving to the continental US in the future. RESULTS: Findings suggest that 65% of the sample reported ever lived in the US and that 49% are planning on moving in the future. The number of times living in the US is associated with higher education and older age, but not with self-reported positive HIV or HCV statuses. Planning to move to the US is associated with knowing PWID who have moved or plan to move, negatively associated with age, and is not associated with HIV or HCV status. Around one third of those that lived in the US reported having some sort of support, with the majority receiving support from family sources. No participant received help to enter HIV/HCV treatment. CONCLUSIONS: A multi-region approach to prevention is required to make a dent in curbing HIV/HCV transmission in this population. Understanding PWID migration patterns, risk behaviors, and health care needs in the US is now more important than ever as natural disasters prompted by human-made climate change will only increase in the future, raising demands not only for service providers but also harm reduction policies to cope with an increasing influx of "climate refugees" as PWID move across national borders.
Assuntos
Emigração e Imigração/estatística & dados numéricos , Hispânico ou Latino/psicologia , População Rural/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/etnologia , Adolescente , Adulto , Idoso , Feminino , Redução do Dano , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico/etnologia , Fatores de Risco , Apoio Social , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Among people who inject drugs (PWID) in New York City (NYC), racial minorities are disproportionately infected with HIV and hepatitis C (HCV). Prior research has shown that PWID who started injecting drugs in Puerto Rico (P.R.) tend to maintain the risky injection behaviors learned there. This study identifies the P.R.-native norms supporting the continued injection risk behavior of migrant Puerto Rican PWID in NYC to inform a culturally appropriate risk-reduction intervention. METHODS: 40 migrant Puerto Rican PWID were recruited in NYC for a longitudinal qualitative study. The sample was stratified to include 20 migrants with <3 years in NYC and 20 migrants with >3-6 years in NYC. Time-location sampling was used to curb possible network bias in recruitment. Over 12 months, migrants completed semi-structured interviews at baseline, monthly follow-ups, and study exit. Analyses were guided by grounded theory. RESULTS: Most participants (90%) reported having had chronic HCV, and 22.5% reported being HIV-positive. Syringe- and cooker-/cotton-sharing were widespread in both P.R. and NYC. The ubiquitous practice of cleaning used syringes by "water-rinsing and air-blowing" was guided by a normative belief, learned in P.R., that "water and air kill HIV." Sterile syringe use was not a priority. HCV was not a concern. P.R.-native abstinence-only narratives discouraged opioid agonist treatment (OAT) enrollment among recent migrants (≤3 years). Experiences with drug dealers, prison-power groups, and injection doctors ("Gancheros") in P.R. influenced migrants' injection risk behavior in NYC. Those who were Gancheros in P.R. continued working as Gancheros in NYC. CONCLUSIONS: Injection risks make migrant Puerto Rican PWID in NYC vulnerable to HIV/HCV. Harm reduction programs should pay closer attention to the rationales behind these injection risks. A risk-reduction intervention that incorporates the Ganchero figure may be a credible way to help migrants reduce injection risk and accept OAT and syringe exchange programs (SEP).
Assuntos
Programas de Troca de Agulhas/provisão & distribuição , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia , Migrantes/psicologia , Adulto , Usuários de Drogas/psicologia , Feminino , Infecções por HIV/epidemiologia , Redução do Dano , Hepatite C/epidemiologia , Humanos , Injeções , Entrevista Psicológica , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Uso Comum de Agulhas e Seringas , Cidade de Nova Iorque/epidemiologia , Porto Rico/epidemiologia , Assunção de Riscos , Fatores Socioeconômicos , Abuso de Substâncias por Via Intravenosa/prevenção & controleRESUMO
Santiago del Estero is a province located in northwestern Argentina. The Dulce River is used for irrigation through a vast network of channels and ditches, including the San Martin Canal (SMC), which crosses the capital city of Santiago del Estero. This canal's water is used for drinking, as well as recreational use for the general population. However, this river has been seriously polluted for several decades. The present study focuses on the identification and the quantification of the water pollution levels of total phenols in the SMC according to the seasonal periods. Water samples from various areas of the canal in different months of the year, extending from December to September, were collected for analysis. Additionally, the concentration of total dissolved solids (TDS), chlorides, sulphates, nitrites and organic matter, as well as water hardness and alkalinity, were analysed in order to conduct a more complete study of the contamination of this area. The results showed a worrying total phenol concentration that exceeded the limit set by Argentine legislation for drinking water, as well as water for recreational use (5⯵g/L). The total phenol (TP) concentration was directly determined by a molecular absorption spectroscopy method based on a new flow injection analysis system (FIA). Under the selected experimental conditions, the detection and quantification limits were 0.0490 and 0.1633⯵g/mL, respectively. The developed method provides a number of improvements related to the speed of analysis, the restricted consumption of the reagents and sample volumes and the unnecessary sample treatment that contribute to environmentally friendly analytical chemistry. The results showed that TP make a significant contribution in the SMC pollution, especially during the months of April (400⯱â¯110⯵g/L) and September (240⯱â¯20⯵g/L). A high sulphate concentration that was higher than the limit allowed by the legislation was also found.