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Wilms tumor has been selected as an index tumor by the WHO Global Initiative for Childhood Cancer with the aim to improve cure rates worldwide. Nevertheless, there is a scarcity of published data on outcomes beyond those of the major cooperative groups. Therefore, we conducted a retrospective analysis including all patients with Wilms tumor treated at our referral center in Uruguay between 1995 and 2020. Treatment consisted of North American (NA) strategies in 23 cases (1995-2004), followed by the SIOP strategy in 35 cases thereafter. Staging included: I-II = 28, III = 7, IV = 14, and V = 9. There were no major surgical or medical complications; however, a delay in the administration of local radiotherapy was observed (median of 21 days after surgery). There were no cases of toxicity- or surgery-related deaths or treatment abandonment. Five-year probability of overall survival was 0.72 and 0.92 for the NA and SIOP groups, respectively. We conclude that outcomes were better for the SIOP strategy with no unexpected toxicities and high treatment compliance in both strategies. Timely implementation of radiotherapy was challenging.
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Tumor de Wilms , Humanos , Tumor de Wilms/terapia , Tumor de Wilms/mortalidade , Uruguai , Masculino , Feminino , Estudos Retrospectivos , Pré-Escolar , Lactente , Neoplasias Renais/terapia , Neoplasias Renais/mortalidade , Criança , Taxa de Sobrevida , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêuticoRESUMO
BACKGROUND: Stress and unhealthy lifestyle are serious problems in public health and education, particularly due to their significant relevance in the context of the COVID-19 pandemic. OBJECTIVES: To determine the correlation between stress and lifestyle in teachers at some schools in Lima, Peru, during telework in 2020. METHODS: This observational, quantitative, analytical, cross-sectional study was conducted in 217 school teachers from Lima. Lifestyle was measured using the FANTASTIC questionnaire; stress was measured using the Teaching Stress Scale (ED-6), comprised of the anxiety, depression, maladaptive beliefs, work pressure and poor coping dimensions. The Spearman correlation between numerical variables, and the difference of the FANTASTIC score according to the categorical variables, were analyzed with the Mann-Whitney U test or Kruskal-Wallis test, as necessary. Multivariable analysis was done with a multiple linear regression model to find raw and adjusted ß (ßa). RESULTS: The median of the ED-6 scale was 81 (RI: 64-105). Sixty-four percent of the teachers had a good-excellent lifestyle; 27.2%, regular; and 8.49%, bad-dangerous. The FANTASTIC score had an inverse correlation with ED-6 (ßa: -0.16, 95%; CI: -0.20 to -0.12) adjusted for age and cohabitation with children. Likewise, teachers between 40 and 49 years old (ßa: 2.89, 95%; CI: 0.17 to 5.62) had a better lifestyle; and teachers who lived with children (ßa: -5.48, 95%; CI: -7.89 to -3.06), a worse lifestyle. CONCLUSIONS: As stress increased, the lifestyle quality worsened in teachers at some schools in Lima, Peru, during telework in 2020.
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COVID-19 , Docentes , Adulto , COVID-19/epidemiologia , Criança , Estudos Transversais , Humanos , Estilo de Vida , Pessoa de Meia-Idade , Pandemias , Peru , Professores Escolares , TeletrabalhoRESUMO
BACKGROUND: Cryptococcus neoformans is an opportunistic fungal pathogen that can cause meningitis in immunocompromised individuals. The objective of this work was to study the relationship between the phenotypes and genotypes of isolates of clinical origin from different cities in Colombia. METHODS: Genome classification of 29 clinical isolates of C. neoformans var. grubii was performed using multilocus sequence typing (MLST), and genomic sequencing was used to genotype protein-coding genes. Pathogenicity was assessed in a larval model, and melanin production and capsule size were evaluated in vitro and in vivo. RESULTS: Eleven MLST sequence types (STs) were found, the most frequent being ST69 (n = 9), ST2, ST93, and ST377 (each with n = 4). In the 29 isolates, different levels of pigmentation, capsule size and pathogenicity were observed. Isolates classified as highly pathogenic showed a tendency to exhibit larger increases in capsule size. In the analysis of polymorphisms, 48 non-synonymous variants located in the predicted functional domains of 39 genes were found to be associated with capsule size change, melanin, or pathogenicity. CONCLUSIONS: No clear patterns were found in the analysis of the phenotype and genotype of Cryptococcus. However, the data suggest that the increase in capsule size is a key variable for the differentiation of pathogenic isolates, regardless of the method used for its induction.
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RESUMEN Fundamento: estudios clínicos en pacientes con drepanocitosis han demostrado que el uso de hidroxiurea se asocia a una reducción de complicaciones agudas y crónicas, incluyendo las relacionadas con el estado nutricional de estos pacientes. Objetivo: evaluar el estado nutricional en pacientes con drepanocitosis tratados con hidroxiurea en el Hospital Pediátrico Universitario Paquito González Cueto de Cienfuegos. Métodos: se realiza un estudio descriptivo, analítico y prospectivo de la totalidad de los pacientes con drepanocitosis tratados con hidroxiurea, atendidos en el Servicio de Hematología del Hospital Pediátrico de Cienfuegos en el periodo de enero 2012 a diciembre 2018. Las variables del estudio fueron: edad, sexo, variante de hemoglobina, manifestaciones clínicas y evaluación nutricional, parámetros hematológicos, hospitalizaciones y requerimientos transfusionales. La información se obtuvo de los expedientes clínicos. Resultados: se estudiaron 15 pacientes, hubo predomino del sexo femenino (60 %) y los adolescentes representaron el 80 % de los pacientes en estudio. Presentaban la forma homocigota 10 pacientes (66,7 %); la variante Sβ talasemia y SC estuvo representada con 2 y 3 pacientes, respectivamente. No hubo diferencias significativas al comparar los valores hematológicos antes y después del tratamiento. Se observó una disminución en la frecuencia y gravedad de las crisis, en el número de hospitalizaciones y requerimientos transfusionales en la totalidad de los pacientes. La desnutrición estuvo presente en solo 4 pacientes del total. Conclusiones: el tratamiento con hidroxiurea para los pacientes en estudio resultó en mejoría clínica, reducción del número de ingresos y disminución de los requerimientos transfusionales, lo cual repercutió favorablemente en su estado nutricional.
ABSTARCT Background: clinical studies in patients with sickle cell disease have shown that the use of hydroxyurea is associated with a reduction in acute and chronic complications, including those related to the nutritional status of these patients. Objective: to evaluate the nutritional status in patients with sickle cell disease treated with hydroxyurea at the Paquito González Cueto University Pediatric Hospital in Cienfuegos. Methods: a descriptive, analytical and prospective study was carried out of all the patients with sickle cell disease treated with hydroxyurea, treated at the Hematology Service of the Pediatric Hospital of Cienfuegos in the period from January 2012 to December 2018. The study variables were: age, sex, hemoglobin variant, clinical manifestations and nutritional evaluation, hematological parameters, hospitalizations and transfusion requirements. The information was obtained from the clinical records. Results: 15 patients were studied, there was a predominance of females (60 %) and adolescents represented 80 % of the patients in the study. 10 patients (66.7 %) presented the homozygous form; the Sβ thalassemia and SC variant were represented with 2 and 3 patients, respectively. There were no significant differences when comparing hematological values before and after treatment. A decrease was observed in the frequency and severity of the seizures, in the number of hospitalizations and transfusion requirements in all the patients. Malnutrition was present in only 4 patients out of the total. Conclusions: treatment with hydroxyurea for the study patients resulted in clinical improvement, reduction in the number of admissions and decrease in transfusion requirements, which favorably affected their nutritional status.
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Resumen Este documento fue preparado (en junio de 2020) por y para los profesionales médicos (clínicos y proveedores de salud), y está disponible públicamente para propósitos de recomendaciones relacionada con pacientes pediátricos y enfermedad por coronavirus 2019 (COVID-19). Según datos disponibles hasta la fecha, los niños de todas las edades pueden contraer la COVID-19; sin embargo, tienen mejor pronóstico que los adultos, siendo pocos los casos graves reportados, y los casos leves se recuperan en 1-2 semanas después del inicio de la enfermedad. El objetivo de este documento es aportar peculiaridades que consideramos importantes para el diagnóstico y tratamiento. Debido a los cambios en la actual situación epidemiológica se pueden modificar algunos conceptos y acciones, por lo que la información aquí contenida debe ser adaptada a cada paciente, basada en el juicio clínico, necesidades del paciente y recursos disponibles.
Abstract This document was prepared (June 2020) by and for medical professionals (clinicians and health providers), and it is available as a guideline for pediatric patients with coronavirus disease 2019 (COVID-19). So far, according to available data although children of all ages can acquire COVID-19, they have better outcome than adults, with a little proportion of severe disease, and in mild cases they have a 1 to 2-week recovery after the beginning of the infection. The objective of this document is to provide particularities that we consider important for diagnosis and treatment. Owe to the changing epidemiological situation some concepts and actions can change, so this information must be adapted to each specific case, based on the clinical judgement according to patient requirements and available resources.
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Although water quality from freshwater recreational aquatic environments (RAEs) has been long analyzed worldwide, little information is available about their sediments. The aim of this work was to study the physicochemical and bacteriological quality of water and sediment under different seasonal events. For that, Wierna River (WR) and General Belgrano reservoir (GB) were used as freshwater RAEs models. A total of 33 water and 33 sediment samples (15 from WR and 18 from GB from each phase) were collected and analyzed. Physicochemical variables in water (pH, turbidity, dissolved oxygen, temperature, conductivity, alkalinity, hardness) and sediments (organic matter, humidity, ash, and conductivity) were measured. For the bacteriological characterization, total aerobic mesophiles, total and thermotolerant coliforms, E. coli, enteroccocci, Salmonella spp., and Pseudomonas aeruginosa were evaluated using culture-based methods. Universal and human Bacteroides were also quantified by real-time PCR. Univariate (Kruskall-Wallis), bivariate (Spearman correlation), and multivariate (cluster analysis, principal component analysis) statistical techniques were applied for data analysis. All bacterial indicators were almost two-logs higher in sediments than in water, for both RAEs. Also, due to rainfall events and recreational activities, sediments were resuspended in surface water exceeding in most cases the limit values established by international regulation for bacteria. Significant correlation was observed between culturable bacteria and turbidity (pâ¯<â¯0.05) supporting this. We found that while physicochemical variables clustered samples by geographical location in water and sediments, microbiological aggrupation in water was mostly driven by seasonal events. No aggrupation was observed when using microbiological variables in sediments. Thus, geographical location, type of water and sediments, and seasonal events influenced on RAEs quality. Including sediment analysis during RAEs monitoring campaigns is essential as it will allow knowing the real health risk to which bathers are exposed and proposing solutions to mitigate it.
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Monitoramento Ambiental , Sedimentos Geológicos/microbiologia , Poluição da Água/análise , Ecossistema , Água Doce , Rios/microbiologia , Microbiologia da Água , Poluição da Água/estatística & dados numéricos , Qualidade da ÁguaRESUMO
We conducted a prospective evaluation of drug-induced severe hyponatremia (adverse drug reaction (ADR)) through the Prospective Pharmacovigilance Program from Laboratory Signals at Hospital over a period of 10 years. Cases of serum sodium (Na(s)) < 116 mM were recorded from July 2007 to June 2017 (first period). Also cases of Na(s) 116-122 mM were recorded from July 2012 to June 2017 (second period). Drugs were the primary cause of severe hyponatremia. The incidence rate of Na(s) < 116 mM by drugs was increased threefold over the decade. Compared with other causes of hyponatremia, patients with adverse drug reaction-serum sodium (ADR-Na(s)) in the first period were older (79 years (interquartile range (IQR) 68.6-89 vs. 65 years (IQR 48-81); P < 0.001) and were more often women (70.8% vs. 48.9% men, P < 0.001); in the second period were also older (79 years (IQR 65.3-89) vs. 63 years (IQR 46-80.6); P < 0.001) and were more often women (70% vs. 53%, P = 0.002), and ADR-Na(s) occurred more often in summer. The most frequent therapeutic groups of culprit drugs were the cardiovascular system and nervous system. The 65.3% in the first period and 71.2% in the second period of the ADR-Na(s) cases responded to hydration and had been diagnosed with hypovolemic hyponatremia.
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Analgésicos Opioides/efeitos adversos , Anticonvulsivantes/efeitos adversos , Fármacos Cardiovasculares/efeitos adversos , Antagonistas Colinérgicos/efeitos adversos , Hiponatremia/induzido quimicamente , Psicotrópicos/efeitos adversos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Antineoplásicos/efeitos adversos , Bolívia/epidemiologia , Criança , Pré-Escolar , Feminino , Fármacos Gastrointestinais/efeitos adversos , Humanos , Hipoglicemiantes/efeitos adversos , Hiponatremia/epidemiologia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Farmacovigilância , Estudos Prospectivos , Estações do Ano , Índice de Gravidade de Doença , Adulto JovemAssuntos
Incontinência Pigmentar/diagnóstico , Pele/patologia , Exantema/etiologia , Humanos , Recém-Nascido , MasculinoRESUMO
Pterogyne nitens es un árbol que crece en bosques húmedos del Norte de la Argentina. Por su calidad maderera la especie se utiliza en forestación, reforestación o enriquecimiento de bosques nativos. Una alternativa a los métodos convencionales de propagación son las técnicas de cultivo de tejidos vegetales mediante el uso de la embriogénesis somática. El objetivo del presente trabajo es inducir la formación de callos embriogénicos y la obtención de proembriones somáticos evaluando la influencia del tipo de explanto, tipo y concentración de reguladores de crecimiento y composición del medio basal. Para la inducción de callos embriogénicos se utilizan explantos extraídos de hojas cotiledonares, foliolos, tallos y raíces de plántulas de dos meses de edad. Se emplean tres medios de cultivos MSC, MS50 y MSMOD. Cada medio de cultivo se suplementa con 2,4-D ó ANA en distintas concentraciones. A los 45 días los explantos provenientes de hojas cotiledonares en los medios de MSC con 2,4-D en concentraciones de 67.87, 107.41, 113.12, 135.74 y 180.99 μM, se logra en mayor proporción la formación de masas callosas amarillas. Con 107.41 μM de 2,4-D en el medio MSC se observa la formación de estructuras proembrionarias. Los segmentos radiculares en todos los tratamientos evaluados, no desarrollan callos.
Pterogyne nitens is a tree that grows in wet forests of Northern Argentina. Due to its quality timber especies are used in afforestation, reforestation or enrichment of native forests. An alternative to conventional methods of propagation is the techniques of plant tissue using somatic embryogenic. The aim of this study is to induce the formation of embryogenic callus and of somatic obtaining proembryos, evaluating the influence of type of explant, type and concentration of growth regulators and composition of the basal medium. For induction of embryogenic callus from explants extracted cotyledonary leaves, leaflets, stems and roots of seedling of two months old are used. Three means of MSC culture, MS50 and MSMOD are also used. Each culture medium is supplemented with 2,4-D at different concentration or ANA. After 45 days the explants from cotyledon leaves in MSC media supplement with 2,4-D at concentrations of 67.87, 107.41, 113.12, 135.74 and 180.99 μM, promote greater proportion of yellow callus formation masses. With 107.41 μM 2,4-D proembryos structures formation are observed. The root segments in all treatment tested, do not develop calluses.