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Resumen Introducción: la válvula St. Jude Trifecta® es una bioprótesis diseñada para implante en posición aórtica supraanular. Objetivo: Evaluar el comportamiento hemodinámico de la válvula y el estadio clínico de los pacientes, entre 3 a 72 meses luego del implante. Materiales y método: Estudio de cohorte en el que se incluyeron pacientes mayores de 18 años, llevados a cambio valvular aórtico en quienes se implantó una bioprótesis St. Jude Trifecta® entre marzo de 2012 a diciembre de 2018, y se hizo un seguimiento mediante evaluación clínica y ecocardiográfica desde tres meses hasta seis años posquirúrgicos. Resultados: Se incluyeron 165 pacientes, 53.3% hombres. Edad promedio 69.6 años (30-90). El 66.7% con estenosis valvular aórtica y el 21.2% con insuficiencia. El promedio de EuroSCORE II fue 4.18 (0.56-24.35). En el preoperatorio, 60.6%, 29.6% y 9.69% de los pacientes se encontraban en clase funcional NYHA II, III y IV, respectivamente. Luego del implante, el promedio de área del orificio efectivo indexado fue 1.025 cm2/m2 para bioprótesis N.o 19 1.089cm2/m2, 1.085 cm2/m2 y 1.069 cm2/m2 para prótesis N.o 21, 23 y 25, respectivamente. El gradiente medio transvalvular en el posoperatorio inmediato (en sala de cirugía) fue 3.08 mmHg. Durante el seguimiento ecocardiográfico a 3, 6, 12, 24, 36 y 72 meses, el gradiente medio fue de 4.2, 5.7, 6.3, 7.1, 8.3 y 9.1 mmHg, respectivamente. La mortalidad quirúrgica fue del 2.42%. Ningún paciente presentó desproporción prótesis-paciente, accidente cerebrovascular o endocarditis. Durante el tiempo del estudio ninguno ha requerido reintervención por deterioro valvular estructural. Al seguimiento, 83.6% se encontraron en NYHA I. Conclusión: En el grupo estudiado, el reemplazo valvular aórtico con bioprótesis St. Jude Trifecta® demostró excelentes resultados clínicos (NYHA I, 83%) y hemodinámicos (no reoperación por deterioro valvular estructural, bajos gradientes transvalvulares y adecuado orificio efectivo indexado), durante el tiempo de evaluación clínica y ecocardiográfica (3 a 72 meses).
Abstract Background: The St. Jude Trifecta valve is a latest generation bioprosthetic designed for supra annular aortic placement. The study main objective is the evaluation of the hemodynamic valve performance and the 3 to 72 months post implantation clinical status of the patients. Method and materials: Cohort study on patients older than 18 years, undergoing aortic valve replacement with St. Jude Trifectabiological valve prosthesis between march 2012 and december 2018. The follow up was made by clinical evaluation and serial echocardiogram from 3 months to 6 years after surgery. Results: 165 patients where included, 53.3% male. Mean age 69.6 years (30-90). The main indication for valve replacement was aortic stenosis (66.7%). Mean EuroSCORE II was 4.18 (0.56-24.35). Preoperative 60.6%, 29.6% and 9.69% of patients where in New York Heart Association functional class (NYHA) II, III and IV respectively. After the surgery, the mean effective orifice area index (IEOA) was 1.025 cm2/m2 for prosthesis N.o 19; 1.089cm2/m2 (prosthesis 21); 1.085 cm2/m2 (prosthesis 23) and 1.069 cm2/m2 (prosthesis 25). The mean transvalvular gradient was 3.08 mmHg at the immediate posoperative period, and the mean gradient at 3,6,12,24,36 and 72 months was 4.2, 5.7, 6.3, 7.1, 8.3 and 9.1 mmHg, respectively. 30 days mortality was 2.42%. None of the patients have a posoperative patient-prosthesis mismatch (PPM), neither thromboembolic events or endocarditis. There is no patients with re-operation for structural valve deterioration. After follow up, 83.6% of the patients are in NYHA I functional class. Conclusion: In this Study group, St. Jude Trifecta valve for aortic valve replacement provides excellent clinical (NYHA I, 83%) and hemodynamic outcomes (demostrated by no patients with re-operation for structural valve deterioration, a low post operative transvalvular gradients; IEOA that avoid PPM; excellent clinical and echocardiographic outcome during follow up (3 to 72 months).
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The methanolic extracts of Pterocaulon alopecuroides and Pterocaulon angustifolium were assayed for antibacterial activity and biofilm formation inhibition of four community-acquired-MRSA isolates representative of ST30 t975, ST30 t021, ST5 t311, and ST4335 t008 clones that are responsible for invasive infections in Paraguayan children. Both Pterocaulon extracts showed significant antibacterial activity with a minimum inhibitory concentration of 200 µg/mL against the four isolates. P. angustifolium showed inhibition of biofilm formation for the four isolates, whereas P. alopecuroides showed inhibition for three of them. The chemical constituents were identified by liquid chromatography coupled to tandem mass spectrometry. Phenolic compounds were detected in the two species as well as coumarins. These results showed that these plants are sources of compounds with activity against MRSA.
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Asteraceae , Staphylococcus aureus Resistente à Meticilina , Criança , Humanos , Metanol , Asteraceae/química , Testes de Sensibilidade Microbiana , Antibacterianos/farmacologia , Antibacterianos/química , Extratos Vegetais/farmacologia , BiofilmesRESUMO
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emergent pathogen responsible for the coronavirus disease 2019 (COVID-19). Since its emergence, the novel coronavirus has rapidly achieved pandemic proportions causing remarkably increased morbidity and mortality around the world. A hypercoagulability state has been reported as a major pathologic event in COVID-19, and thromboembolic complications listed among life-threatening complications of the disease. Platelets are chief effector cells of hemostasis and pathological thrombosis. However, the participation of platelets in the pathogenesis of COVID-19 remains elusive. This report demonstrates that increased platelet activation and platelet-monocyte aggregate formation are observed in severe COVID-19 patients, but not in patients presenting mild COVID-19 syndrome. In addition, exposure to plasma from severe COVID-19 patients increased the activation of control platelets ex vivo. In our cohort of COVID-19 patients admitted to the intensive care unit, platelet-monocyte interaction was strongly associated with tissue factor (TF) expression by the monocytes. Platelet activation and monocyte TF expression were associated with markers of coagulation exacerbation as fibrinogen and D-dimers, and were increased in patients requiring invasive mechanical ventilation or patients who evolved with in-hospital mortality. Finally, platelets from severe COVID-19 patients were able to induce TF expression ex vivo in monocytes from healthy volunteers, a phenomenon that was inhibited by platelet P-selectin neutralization or integrin αIIb/ß3 blocking with the aggregation inhibitor abciximab. Altogether, these data shed light on new pathological mechanisms involving platelet activation and platelet-dependent monocyte TF expression, which were associated with COVID-19 severity and mortality.
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Betacoronavirus/imunologia , Transtornos da Coagulação Sanguínea/patologia , Plaquetas/patologia , Infecções por Coronavirus/complicações , Monócitos/patologia , Pneumonia Viral/complicações , Tromboplastina/metabolismo , Adulto , Biomarcadores/metabolismo , Transtornos da Coagulação Sanguínea/imunologia , Transtornos da Coagulação Sanguínea/metabolismo , Transtornos da Coagulação Sanguínea/virologia , Plaquetas/metabolismo , Plaquetas/virologia , COVID-19 , Estudos de Casos e Controles , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/metabolismo , Infecções por Coronavirus/virologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Monócitos/metabolismo , Monócitos/virologia , Selectina-P/metabolismo , Pandemias , Ativação Plaquetária , Pneumonia Viral/imunologia , Pneumonia Viral/metabolismo , Pneumonia Viral/virologia , Prognóstico , Estudos Prospectivos , SARS-CoV-2 , Taxa de SobrevidaRESUMO
RESUMEN El coriocarcinoma es una variante muy vascularizada, invasiva y poco común de la enfermedad trofoblástica gestacional. Es potencialmente fatal sin tratamiento adecuado y se caracteriza por la proliferación maligna de tejido trofoblástico con una alta tasa de metástasis. Se presenta el caso de una paciente joven con hemorragia intracerebral como primera manifestación de un coriocarcinoma metástasico. Se describen las características clínicas e imagenológicas y se hace una revisión de la literatura actual, con énfasis en los detalles más relevantes respecto al diagnóstico diferencial de la hemorragia intracerebral de presentación atípica y el tratamiento más apropiado.
SUMMARY Choriocarcinoma is an invasive, highly vascularized, rare gestational trophoblastic disease. It is potentially fatal without proper treatment and is characterized by malignant proliferation of trophoblastic tissue with a high rate of metastases. We present the case of a young patient with intracerebral hemorrhage as the first manifestation of metasta-tic choriocarcinoma. We describe the clinical and imaging characteristics and review current literature, with emphasis on the most relevant details regarding the differential diagnosis of intracerebral hemorrhage atypical presentation and the most appropriate treatment.
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Mobilidade UrbanaRESUMO
Investigar a formação docente é essencial à universidade com o intuito de alcançar melhorias. Neste sentido, a temática deste estudo está inserida no projeto "Os fatores de acesso e permanência que envolvem a formação docente na UFRGS e seus contrastes com as expectativas e demandas do mundo do trabalho em escolas públicas da rede básica no Estado do RS". O objetivo é contribuir para a compreensão dos fatores que levam à adaptação do estudante à universidade e o impacto deste processo no bem-estar do aluno de Licenciatura em Pedagogia a partir de cinco dimensões de adaptação (pessoal, interpessoal, carreira, estudo e institucional). Para verificar a adaptação do aluno ao curso utilizou-se o Questionário de Vivências Acadêmicas, com amostra estudantil dos alunos da Pedagogia, em versão adaptada ao contexto brasileiro. Os dados foram analisados a partir de estatística descritiva e relacionados com a fundamentação teórica apresentada, permitindo, assim, uma interpretação referencial apoiada desses dados. Em suma, poucos estudantes apresentaram sintomas relacionados à ansiedade, depressão ou estresse na pesquisa. A maioria dos alunos demonstrou-se satisfeitos com sua escolha pelo curso, seu desempenho acadêmico e os recursos oferecidos pela universidade. Além disso, apesar de demonstrarem algum nível de ansiedade e altas expectativas, isso não interfere de forma direta em seu desempenho acadêmico ou desejo de concluir o curso.
Investigating teacher education is essential to the university in order to design improvements and achieve challenges. The theme of this study is part of a larger project on the factors of access and permanence that involve teacher education and its contrasts with the expectations and demands of the working world in public schools of the basic network. The objective is to contribute to the understanding of the factors that lead to the adaptation of the student to the university and the impact of this process on the well-being of undergraduate student in Pedagogy from ï¬ve dimensions of adaptation (personal, interpersonal, career, study and institutional). In order to verify the student's adaptation to the course, the Student Experience Questionnaire was used, with a student sample of Pedagogy students, in a version adapted to the Brazilian context. The data were analyzed from descriptive statistics and related to the theoretical basis presented, allowing, therefore, a supported reference interpretation of these data. In short, few students had symptoms related to anxiety, depression or stress in the research. Most students were satisï¬ed with their choice of course, their academic performance, and the resources oï¬ered by the university. In addition, although they demonstrate some level of anxiety and high expectations, this does not seem to interfere directly with their academic performance or desire to complete the course.
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O objetivo do trabalho foi analisar os dados relacionados à transmissão da leishmaniose visceral (LV), no município de Fortaleza, e discutir a respeito da distribuição do vetor, reservatório doméstico e casos humanos ocorridos no período de 2009 a 2013. O presente estudo é do tipo descritivo realizado por meio de levantamento de dados secundários. A correlação entre casos humanos, caninos e número de flebotomíneos foi feita pelo teste de correlação de Spearman, com nível de significância de 5%. No período de 2009 a 2013 foram confirmados 941 casos e 55 óbitos. A letalidade média no período foi de 5,84%. Na distribuição por sexo, houve uma maior proporção de casos no sexo masculino em todos os anos analisados. A faixa etária de 1 a 4 anos apresentou a maior porcentagem de casos, destacando-se o ano de 2010 com 31,5% dos casos. A distribuição média de casos por regional demonstrou um predomínio nas regionais I, V e VI. Em relação aos flebotomíneos, a espécie encontrada em maior abundância foi Lutzomyia (Lutzomyia) longipalpis, seguido de Lutzomyia (Lutzomyia) migonei e Lutzomyia (Lutzomyia) lenti. Segundo os registros da Secretaria Municipal de Saúde de Fortaleza, 39.626 cães foram soro reagentes para LV nos anos de 2009 a 2013, destes 14.313 foram eutanasiados. O ano de 2013 destacou-se com 17.808 cães soro reagentes, sendo 1.273 da SER (Secretaria Executiva Regional) III, 2.572 da SER V e 1.909 da SER VI. Não foi observada correlação significativa entre o número de flebotomíneos capturados e o número de casos caninos de LV(p>0,05). Houve correlação negativa entre casos humanos e caninos (r=-0,0388) e correlação positiva entre casos humanos e número de flebotomíneos (r=0,7469). Os achados criam perspectivas para a identificação de outros fatores que podem influenciar a incidência de casos humanos e caninos, como a participação de outros possíveis reservatórios e vetores na cadeia de transmissão da leishmaniose visceral no município de Fortaleza.(AU)
The objective was to analyze the data relating to the transmission of visceral leishmaniasis (LV) in Fortaleza municipality, and discuss about the vector distribution, domestic reservoir and human cases from 2009 to 2013.This study is descriptive conducted through a survey of secondary data. The correlation between human and canine cases and sandflies number was taken by Spearman correlation test, with 5% significance level. In the period 2009 to 2013, 941 cases and 55 deaths were confirmed. The mortality rate for the period was 5.84%. There was a higher proportion of cases among men in all the years analyzed. The age group 1-4 years old had the highest percentage of cases, highlighting the year 2010 with 31.5% of the cases. The average distribution of cases by SER demonstrated a predominance in SER I, V and VI. With regard to the vector species found in greater abundance was Lutzomyia (Lutzomyia) longipalpis, followed by Lutzomyia (Lutzomyia) migonei and Lutzomyia (Lutzomyia) lenti. According to the records, 39,626 dogs were serum reagents for LV in the years 2009-2013, these 14,313 were killed. The year 2013 stood out with 17,808 dogs serum reagents, and 1,273 of SER III, 2572 of SER V and 1909 of SER VI. There was no significant correlation between the number of sand flies and the number of canine VL cases (p?γτ;0.05). There was a negative correlation between human and canine cases (r = -0.0388) and correlation was observed between human cases and number of sand flies (r= 0.7469).Our findings create prospects for the identification of other factors that may influence the incidence of human and canine cases, such as the participation of other possible reservoirs and vectors in the transmission of the visceral leishmaniasis in Fortaleza.(AU)