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BACKGROUND: Pulmonary arterial hypertension (PAH) guidelines suggest that achieving a low-risk profile should be the treatment goal. Our aim was to assess a risk assessment strategy based on three non-invasive variables from the ESC/ERS 2015 guidelines in a Latin American cohort. METHODS: 92 incident patients (mean [SD] age 47, 77% female, 53% idiopathic PAH) were included in this retrospective, multicenter study. Patients were stratified at baseline and at early follow-up, within the first year, using three non-invasive variables (WHO functional class, 6-minute walking distance, BNP/NT-proBNP) from the ESC/ERS 2015 risk assessment instrument. Median (IQR) follow-up was 3.11 years (3.01 years). RESULTS: At baseline assessment, 25% of patients were at low risk, 61.9% at intermediate-risk, and 13% at high-risk. At early follow-up (median 9.5 months), 56.5% of patients were at low-risk, 40.2% at intermediate-risk, and 3.2% at high-risk (p<0.001 vs. baseline). According to risk stratification at early follow-up, one, three and five-year overall survival was 100% in the low-risk group (no deaths at five-year follow-up), and 100%, 84% (95% CI: 72-98%), and 66% (95% CI: 48-90%) respectively in the intermediate-risk group, p = 0.0003. Mortality in the high-risk patients at early follow-up was 1/3 (33.3%). One, three, and five-year event-free survival (death or transplant or first hospitalization due to worsening PAH) based on early follow-up risk assessment was higher in the low-risk group, p = 0.0003. CONCLUSION: Our study validates a risk assessment strategy based on three non-invasive variables and confirms that early achievement of a low-risk profile should be the treatment goal.
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Hipertensão Pulmonar , Hipertensão Arterial Pulmonar , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Hipertensão Arterial Pulmonar/diagnóstico , Hipertensão Arterial Pulmonar/epidemiologia , Hipertensão Arterial Pulmonar/terapia , América Latina/epidemiologia , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/terapia , Estudos Retrospectivos , Hipertensão Pulmonar Primária Familiar , Medição de Risco , PrognósticoRESUMO
The objective of this work was to evaluate the antimicrobial potential of different extracts of Simira ecuadorensis, a characteristic plant of Ecuador, and to validate its potential as a food preservative. Four extracts referred to as ethanol, ethanol-water (50:50 v/v), spray-dried, and freeze-dried were obtained under different processes. Initially, their antimicrobial activities were evaluated against a wide group of microorganisms consisting of 20 pathogenic and spoilage microbial strains found in foods through the agar diffusion method. Then, the extracts with the best yields and antimicrobial properties against microorganisms of greatest interest were selected to determine their effect on model foods preserved under normal commercial conditions through challenge tests. Spray-dried and ethanol-water extracts were tested for their ability to inhibit C. jejuni in chicken model products, where is a common pathogen and Shew. putrefaciens in fish model products as it is a spoilage microorganism frequently found in fish. One solid and one liquid were chosen as model foods: burger and broth, respectively. Campylobacter jejuni and Shewanella putrefaciens were effectively inhibited by the four extracts with minimum inhibitory concentration (MIC) of 80 mg/mL. Bacillus cereus, Yersinia enterocolitica, Clostridium perfringens, and Leuconostoc mesenteroides were also inhibited by ethanolic extract. The ethanol-water extract showed greater antimicrobial activity in fish products, whereas spray-dried extract had low growth inhibition of C. jejuni in chicken burgers; however, it was quite effective on C. jejuni in broth. The spray-dried extract significantly decreased the pH of the chicken burgers, while the ethanolic extract had a slight impact on the pH of the fish burgers. The presence of antibacterial effects revealed that the S. ecuadorensis extracts could be potentially used in food preservation and as a natural antimicrobial.
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La litiasis urinaria representa una patología importante en la práctica médica y requiere de un abordaje multidisciplinario. Su incidencia es del 10% y afecta a un grupo de edad extenso, con factores que pueden influir en su aumento en determinados lugares. Su diagnóstico aparece como hallazgo en controles rutinarios de salud o a través del síndrome de cólico renal, cuadro característico y de consulta frecuente en los servicios de urgencia. La tomografía computarizada para el estudio de la litiasis renal puede brindar información más detallada. Tiene una sensibilidad, especificidad y seguridad mucho mayor que la radiografía simple del abdomen y que la de la urografía excretora. Los hallazgos directos incluyen el cálculo en el uréter, dilatación ureteral por arriba del cálculo, signo del halo con densidad de tejido blando rodeando al cálculo y los indirectos son dilatación del sistema colector y del uréter, aumento de volumen del riñón y edema perinefrítico. (provisto por Infomedic International)
Urinary lithiasis represents an important pathology in medical practice and requires a multidisciplinary approach. Its incidence is 10% and affects a large age group, with factors that can influence its increase in certain places. Its diagnosis appears as a finding in routine health checks or through renal colic syndrome, a characteristic condition and frequent consultation in the emergency services. Computed tomography for the study of renal lithiasis can provide more detailed information. It has a sensitivity, specificity and safety much greater than simple radiography of the abdomen and of excretory urography. Direct findings include calculus in the ureter, ureteral dilation above the calculus, halo sign with soft tissue density surrounding the calculus, and indirect findings include dilatation of the collecting and ureter system, increased kidney volume, and peri nephritic edema. (provided by Infomedic International)
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BACKGROUND: Little is known about factors affecting implementation of patient safety programmes in low and middle-income countries. The goal of our study was to evaluate the implementation of a patient safety programme for paediatric care in Guatemala. METHODS: We used a mixed methods design to examine the implementation of a patient safety programme across 11 paediatric units at the Roosevelt Hospital in Guatemala. The safety programme included: (1) tools to measure and foster safety culture, (2) education of patient safety, (3) local leadership engagement, (4) safety event reporting systems, and (5) quality improvement interventions. Key informant staff (n=82) participated in qualitative interviews and quantitative surveys to identify implementation challenges early during programme deployment from May to July 2018, with follow-up focus group discussions in two units 1 year later to identify opportunities for programme modification. Data were analysed using thematic analysis, and integrated using triangulation, complementarity and expansion to identify emerging themes using the Consolidated Framework for Implementation Research. Salience levels were reported according to coding frequency, with valence levels measured to characterise the degree to which each construct impacted implementation. RESULTS: We found several facilitators to safety programme implementation, including high staff receptivity, orientation towards patient-centredness and a desire for protocols. Key barriers included competing clinical demands, lack of knowledge about patient safety, limited governance, human factors and poor organisational incentives. Modifications included use of tools for staff recognition, integration of education into error reporting mechanisms and designation of trained champions to lead unit-based safety interventions. CONCLUSION: Implementation of safety programmes in low-resource settings requires recognition of facilitators such as staff receptivity and patient-centredness as well as barriers such as lack of training in patient safety and poor organisational incentives. Embedding an implementation analysis during programme deployment allows for programme modification to enhance successful implementation.
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Segurança do Paciente , Melhoria de Qualidade , Criança , Grupos Focais , Guatemala , Humanos , Pesquisa QualitativaRESUMO
The TaqMan-based quantitative Polymerase Chain Reaction (qPCR) method and the Plate Count (PC) method are both used in combination with primary and secondary mathematical modeling, to describe the growth curves of Leuconostoc mesenteroides and Weissella viridescens in vacuum-packaged meat products during storage under different isothermal conditions. Vacuum-Packaged Morcilla (VPM), a typical cooked blood sausage, is used as a representative meat product, with the aim of improving shelf-life prediction methods for those sorts of meat products. The standard curves constructed by qPCR showed good linearity between the cycle threshold (CT) and log10 CFU/g, demonstrating the high precision and the reproducible results of the qPCR method. The curves were used for the quantification of L. mesenteroides and W. viridescens in artificially inoculated VPM samples under isothermal storage (5, 8, 13 and 18 °C). Primally, both the qPCR and the PC methods were compared, and a linear regression analysis demonstrated a statistically significant linear correlation between the methods. Secondly, the Baranyi and Roberts model was fitted to the growth curve data to estimate the kinetic parameters of L. mesenteroides and W. viridescens under isothermal conditions, and secondary models were used to establish the dependence of the maximum specific growth rate on the temperature. The results proved that primary and secondary models were adequate for describing the growth curves of both methods in relation to both bacteria. In conclusion, the results of all the experiments proved that the qPCR method in combination with the PC method can be used to construct microbial growth kinetics and that primary and secondary mathematical modeling can be successfully applied to describe the growth of L. mesenteroides and W. viridescens in vacuum-packaged morcilla and, by extension, other cooked meat products with similar characteristics.
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Microbiologia de Alimentos/métodos , Embalagem de Alimentos/métodos , Lactobacillales/crescimento & desenvolvimento , Produtos da Carne/microbiologia , Modelos Teóricos , Animais , Contagem de Colônia Microbiana , Reação em Cadeia da Polimerase em Tempo Real , Temperatura , VácuoRESUMO
Se desarrolló un programa piloto educativo de teleconferencia para determinar la factibilidad de realizar rondas de educación pediátrica en un entorno internacional. Mediante el uso de teleconferencia se desarrollaron rondas educativas entre el Hospital de Niños de Johns Hopkins en San Petesburg, Florida y Pediatras de Guatemala y el Salvador. El programa fue desarrollado para evaluar la viabilidad de que los médicos de postgrado participen en la educación internacional a través de videoconferencias. Para compensar las diferencias de horario entre los países participantes se usaron conferencias previamente grabadas, obtenidas de un banco de datos de conferencias magistrales pediátricas. Para aliviar la barrera del idioma y proporcionar interacción "cara a cara" con el público, especialistas locales con amplio conocimiento sobre el tema estuvieron presentes durante las conferencias. La asistencia y las puntuaciones de satisfacción fueron evaluadas a través de una encuesta que cada participante respondió al final del evento. Los aspectos técnicos y costos del programa fueron mínimos y el promedio de puntuaciones de satisfacción fueron altas. para responder con éxito algunos de los problemas didácticos en teleconferencia internacional, se introdujeron nuevos conceptos tales como el uso de conferencias previamente grabadas, participación de especialistas locales trabajar en horarios regionales y reducción de los costos.
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Pediatria , Educação de Pós-Graduação , Realidade VirtualRESUMO
In order to obtain an antimicrobial gel, a starch-based hydrogel reinforced with silica-coated copper nanoparticles (Cu NPs) was developed. Cu NPs were synthesized by use of a copper salt and hydrazine as a reducing agent. In order to enhance Cu NP stability over time, they were synthesized in a starch medium followed by a silica coating. The starch hydrogel was prepared by use of urea and water as plasticizers and it was treated with different concentrations of silica-coated copper nanoparticles (Si-Cu NPs). The obtained materials were characterized by Fourier transform infrared (FT-IR) spectroscopy, electron paramagnetic resonance (EPR) spectroscopy, scanning electron microscopy (SEM), and rheometry. FT-IR and EPR spectra were used for characterization of Cu NPs and Si-Cu NPs, confirming that a starch cap was formed around the Cu NP and demonstrating the stability of the copper nanoparticle after the silica coating step. SEM images showed Cu NP, Si-Cu NP, and hydrogel morphology. The particle size was polydisperse and the structure of the gels changed along with particle concentration. Increased NP content led to larger pores in starch structure. These results were in accordance with the rheological behavior, where reinforcement by the Si-Cu NP was seen. Antimicrobial activity was evaluated against Gram-negative (Escherichia coli) and Gram-positive (Staphylococcus aureus) bacterial species. The hydrogels were demonstrated to maintain antimicrobial activity for at least four cycles of use. A dermal acute toxicity test showed that the material could be scored as slightly irritant, proving its biocompatibility. With these advantages, it is believed that the designed Si-Cu NP loaded hydrogel may show high potential for applications in various clinical fields, such as wound dressings and fillers.
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Anti-Infecciosos/química , Anti-Infecciosos/farmacologia , Bactérias/efeitos dos fármacos , Cobre/química , Hidrogéis/química , Nanopartículas Metálicas/química , Amido/química , Espectroscopia de Infravermelho com Transformada de FourierRESUMO
INTRODUCTION: MAGP1 is a glycoprotein present in the elastic fibers and is a part of the microfibrils components. MAGP1 interacts with von Willebrand factor and the active form of TGF-ß and BMP. In mice lacking MAGP1, thrombus formation is delayed, increasing the occlusion time of carotid artery despite presenting normal blood coagulation in vitro. MAGP1-containing microfibrils may play a role in hemostasis and thrombosis. In this work, we evaluated the function of MAGP1 and its relation to TGF-ß in the arterial thrombosis process. METHODS AND RESULTS: We analyzed thrombus formation time in wild type and MAGP1-deficient mice comparing Rose Bengal and Ferric Chloride induced arterial lesion. The potential participation of TGF-ß in this process was accessed when we treated both wild type and MAGP1-deficient mice with losartan (an antihypertensive drug that decreases TGF-ß activity) or captopril (an angiotensin converting enzyme inhibitor that was used as a control antihypertensive drug). Besides, we evaluated thrombus embolization and the gelatinolytic activity in the arterial walls in vitro and ex vivo. Losartan and captopril were able to recover the thrombus formation time without changing blood pressure, activated partial thromboplastin time (aPTT), PT (prothrombin time), platelet aggregation and adhesion, but decreased gelatinase activity. CONCLUSIONS: Our results suggest that both treatments are effective in the prevention of the sub-endothelial ECM degradation, allowing the recovery of normal thrombus formation.
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Anti-Hipertensivos/uso terapêutico , Captopril/uso terapêutico , Proteínas Contráteis/genética , Proteínas da Matriz Extracelular/genética , Losartan/uso terapêutico , Trombose/tratamento farmacológico , Trombose/genética , Animais , Artérias Carótidas/efeitos dos fármacos , Artérias Carótidas/metabolismo , Artérias Carótidas/fisiopatologia , Proteínas Contráteis/metabolismo , Proteínas da Matriz Extracelular/metabolismo , Gelatinases/metabolismo , Deleção de Genes , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Agregação Plaquetária/efeitos dos fármacos , Testes de Função Plaquetária , Fatores de Processamento de RNA , Trombose/metabolismo , Trombose/fisiopatologia , Fator de Crescimento Transformador beta/metabolismoRESUMO
Algunas veces es necesario el transporte aéreo internacional de recién nacidos críticamente enfermos con necesidades especiales que amerita su traslado a centros regionales en el extranjero. Describimos nuestra experiencia con el transporte de neonatos críticamente enfermos desde Guatemala a San Petersburgo, Florida, EE.UU. Este artículo revisa lo relacionado con el transporte aéreo de recién nacidos enfermos incluyendo personal, equipo médico, administración de transporte e implementación de políticas. Los traslados fueron analizados por el tipo de avión, equipo médico y personal a bordo, duración del transporte, condición clínica durante el vuelo y a la llegada, complicaciones durante el transporte y los resultados al egreso de la unidad de cuidados intensivos neonatales . Los resultados indican que el uso de un enfoque multidisciplinario y una planificación cuidados permite un transporte aéreo óptimo y seguro.
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Recém-Nascido , Recém-Nascido , Estado TerminalRESUMO
Pulmonary hypertension (PH) in pregnancy is a rare disorder that carries a high risk to mother and child, and as such, it is considered a contraindication to becoming pregnant. However, there are few published reports related to the diagnosis of this condition after delivery. We describe three PH cases diagnosed after their normal pregnancies and deliveries. Although the causes are unknown, several mechanisms such as hypercoagulation, placental hypoxia or amniotic fluid embolism have been considered as possible causes. It is difficult to define whether a PH diagnosed in the postpartum period, relates to an earlier asymptomatic PH period that was triggered by the physiological stress of labor or if it is a recently acquired condition. Despite the lack of data to support the absence of PH previous to pregnancy in our three patients, lack of events during this period, asymptomatic and normal deliveries, lead us to believe that they did not suffer this disease prior to pregnancy; considering that high hemodynamic demands impair a ventricle with little reserve, and its subsequent appearance at time of delivery.