RESUMO
Military personnel represent a frontline group exposed to multiple stressors. These factors have increased during the COVID-19 pandemic, predisposing to the development of suicidal risk (SR). Given the few studies conducted in this population, we evaluated the prevalence of SR and its associated factors during the health emergency. A cross-sectional survey study was conducted in person among 514 participants in Lambayeque, Peru in 2021. The outcome was SR, and the exposures were depression (PHQ-9), anxiety (GAD-7), PTSD (PCL-C), and other sociodemographic variables. The prevalence of SR was 14.0% (95% CI: 11.12-17.31%) and was significantly higher in people with a family history of mental health (PR: 2.16; 95% CI: 1.13-4.15) and in those with moderate clinical insomnia (PR: 2.21; 95% CI: 1.19-4.12). Military personnel with high resilience had a lower prevalence of SR (PR: 0.54, CI: 0.31-0.95). Anxiety was associated with a higher prevalence of SR (PR: 3.27; 95% CI: 1.76-6.10). Our findings show that at least 1 out of 10 military personnel are at risk of suicide. Special attention should be paid to the associated factors to develop interventions and reverse their consequences. These results may be useful in policy implementation and general statistics of SR in the local and regional context.
Assuntos
COVID-19 , Militares , Transtornos de Estresse Pós-Traumáticos , Suicídio , Humanos , COVID-19/epidemiologia , Estudos Transversais , Militares/psicologia , Pandemias , Peru/epidemiologia , Ansiedade/epidemiologia , Ansiedade/psicologia , Depressão/epidemiologia , Depressão/psicologia , Pessoal de Saúde/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologiaRESUMO
BACKGROUND: The objective of the study is to report our experience with conventional surgery for juxtarenal abdominal aortic aneurysms (JRAs) by evaluating incidence of acute renal failure and perioperative mortality. Secondary objectives are to evaluate general morbidity and the need for permanent postoperative dialysis and to assess the influence on long-term survival of preoperative risk factors and deterioration of perioperative renal function. METHODS: A retrospective cohort study of 110 patients with JRA electively treated by open surgery between March 1992 and March 2018 was made. Data were obtained from clinical records, describing demographics, perioperative variables, and results. Acute kidney injury (AKI) was defined as 50% decrease in glomerular filtration rate or two-fold increase in serum creatinine. Multivariate analysis was performed by logistic regression to establish risk factors for renal failure. The influence of preoperative risk factors and deterioration of perioperative renal function on long-term survival was studied using Cox regression model. Descriptive and inferential statistics were used in the analysis. RESULTS: 110 consecutive patients were treated with an average age of 71 years, 82.7% male; 81% hypertensive and 41% active smokers. 46.3% had stage III or higher preoperative chronic kidney disease. Median diameter of the aneurysm was 5.7 cm. Interruption of bilateral renal flow was required in 73 patients (66.4%) and unilateral in 37 (33.6%). The average renal clamping time was 34.5 min. AKI occurred in 9 patients (8.2%). Two patients (1.8%) required postoperative dialysis, one of them permanent. Median hospital stay was 7 days. Thirty-three patients (30%) had at least one complication. Postoperative mortality was 2.7% (3 patients), two of them developed AKI. Multivariate analysis established a longer operative time and need for renal revascularization as independent risk factors for AKI. In the survival analysis, age, cerebrovascular disease, chronic obstructive pulmonary disease, and perioperative AKI were identified as risk factors for long-term mortality. CONCLUSIONS: JRA open surgical repair can be performed with low morbidity and mortality. Although transient acute renal dysfunction may be relatively frequent, the need for hemodialysis is low. Our study is a reference point to compare with endovascular repair.
Assuntos
Injúria Renal Aguda/etiologia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Insuficiência Renal/etiologia , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/terapia , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Implante de Prótese Vascular/mortalidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Diálise Renal , Insuficiência Renal/diagnóstico , Insuficiência Renal/mortalidade , Insuficiência Renal/terapia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
N-Formyl-methionyl-leucyl-phenylalanine (fMLP) and platelet-activating factor (PAF) induce similar intracellular signalling profiles; but only fMLP induces interleukin-8 (IL-8) release and nicotinamide adenine dinucleotide phosphate reduced (NADPH) oxidase activity in neutrophils. Because the role of ROS on IL-8 release in neutrophils is until now controversial, we assessed if NADPH oxidase is involved in the IL-8 secretions and PI3K/Akt, MAPK, and NF-κB pathways activity induced by fMLP. Neutrophils were obtained from healthy volunteers. IL-8 was measured by ELISA, IL-8 mRNA by qPCR, and ROS production by luminol-amplified chemiluminescence, reduction of ferricytochrome c, and FACS. Intracellular pH changes were detected by spectrofluorescence. ERK1/2, p38 MAPK, and Akt phosphorylation were analysed by immunoblotting and NF-κB was analysed by immunocytochemistry. Hydroxy-3-methoxyaceto-phenone (HMAP), diphenyleneiodonium (DPI), and siRNA Nox2 reduced the ROS and IL-8 release in neutrophils treated with fMLP. HMAP, DPI, and amiloride (a Na(+)/H(+) exchanger inhibitor) inhibited the Akt phosphorylation and did not affect the p38 MAPK and ERK1/2 activity. DPI and HMAP reduced NF-κB translocation induced by fMLP. We showed that IL-8 release induced by fMLP is dependent on NADPH oxidase, and ROS could play a redundant role in cell signalling, ultimately activating the PI3K/Akt and NF-κB pathways in neutrophils.