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Objective: This study aimed to determine if personality disorder (PD) predicted functional outcomes in patients with major depressive disorder (MDD). Methods: Data (n=71) from a double-blind, randomized, placebo-controlled 12-week trial assessing the efficacy of 200 mg/day adjunctive minocycline for MDD were examined. PD was measured using the Standardized Assessment of Personality Abbreviated Scale. Outcome measures included Clinical Global Impression - Improvement (CGI-I), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Social and Occupational Functioning Scale (SOFAS), and Range of Impaired Functioning (RIFT). Analysis of covariance was used to examine the impact of PD (dichotomized factor [≥ 3] or continuous measure) on the outcome measures-treatment group correlation. Results: PD was identified in 69% of the sample. After adjusting for age, sex, and baseline scores for each of the outcome measures, there was no significant difference between participants with and without PD on week 12 scores for any of the outcome measures (all p > 0.14). Conclusion: In this secondary analysis of a primary efficacy study, PD was a common comorbidity among those with MDD, but was not a significant predictor of functional outcomes. This study adds to the limited literature on PD in randomized controlled trials for MDD. Clinical trial registration: ACTRN12612000283875.
Subject(s)
Humans , Male , Female , Adult , Aged , Personality Disorders/psychology , Depressive Disorder, Major/psychology , Depressive Disorder, Major/drug therapy , Minocycline/administration & dosage , Antidepressive Agents/administration & dosage , Personal Satisfaction , Personality Tests , Psychiatric Status Rating Scales , Quality of Life , Comorbidity , Placebo Effect , Double-Blind Method , Treatment Outcome , Self Report , Middle AgedABSTRACT
RESUMEN Objetivo: Determinar el impacto sobre la resistencia bacteriana de la revisión previa de la prescripción de antibióticos por parte del servicio farmacéutico en hospitales de mediana y alta complejidad del departamento del Atlántico (Colombia). Metodología: Se analizaron los valores de resistencia de bacterias Gram positivas, Enterobacterias y Gram negativos no fermentadores reportados en cinco institutos prestadores de salud (IPS) del departamento del Atlántico, en dos periodos (preintervención e intervención), de 12 meses cada uno, entre junio de 2015 y mayo de 2017. Resultados: Durante los dos periodos de estudio se identificaron 68 microorganismos en 8590 aislamientos microbiológicos provenientes de muestras de orina (40,3 %), sangre (21,7 %), tejidos (8,5 %) y otras (29,5 %). Los microorganismos aislados más frecuentemente fueron Escherichia coli (28,9 %), Staphylococcus coagulasa negativo (12,1%), Klebsiella pneumoniae (12,0 %), Pseudomonas aeruginosa (11,1 %) y Staphylococcus aureus (7,2 %). Durante los dos periodos la resistencia global osciló entre 27 y 40 %. Durante la Preintervención la resistencia osciló entre el 33 y el 39 %, mientras que durante la Intervención estuvo entre el 27 y 40 %. Al comparar los periodos de estudio solo hubo disminución significativa de la resistencia en los primeros nueve meses del periodo de intervención (p < 0.05). Conclusiones: Los valores de resistencia bacteriana reportados en el periodo de intervención fueron menores que en el periodo de preintervención. Se evidenció que la revisión previa de la prescripción por parte del servicio farmacéutico en las instituciones participantes influye en una disminución significativa de la resistencia bacteriana, pero que esta debe ser tanto continua como incremental.
ABSTRACT Objective: To determine the impact on bacterial resistance of the previous review of the prescription of antibiotics by the pharmaceutical service in medium and high complexity hospitals of the Department of Atlántico (Colombia). Methodology: Resistance values were analyzed for Gram-positive bacteria, Enterobacte-rial and non-fermenting Gram-negative bacteria reported in five health care institutions (IPS) of the Atlántico Department, in two periods (pre-intervention and intervention), of 12 months each between the months of June 2015 and May 2017. Results: During the two study periods, 68 microorganisms were identified in 8,590 microbiological isolates from urine samples (40.3 %), blood samples (21.7 %), tissues (8.5%) and others (29.5 %). The most frequently isolated microorganisms were Escherichia coli (28.9 %), Coagulase Negative Staphylococcus (12.1 %), Klebsiella pneumoniae (12.0 %), Pseudomonas aeruginosa (11.1 %) and S. aureus (7.2 %). During both periods the global resistance ranged between 27 and 40 %. During the Pre-intervention the resistance ranged between 33 and 39 %, while during the Intervention it was between 27 and 40 %. When comparing study periods, there was only significant decrease in resistance in the first nine months of the intervention period (p <0.05). Conclusions: the bacterial resistance values reported during the intervention period were lower than in the pre-intervention period. It was evidenced that the previous revision of the prescription by the pharmaceutical service in the participating institutions influences a significant decrease of the bacterial resistance; but that this must be both continuous and incremental.
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Polo-like kinase (PLK1) has been identified as a potential target for cancer treatment. Although a number of small molecules have been investigated as PLK1 inhibitors, many of which showed limited selectivity. PLK1 harbors a regulatory domain, the Polo box domain (PBD), which has a key regulatory function for kinase activity and substrate recognition. We report on 3-bromomethyl-benzofuran-2-carboxylic acid ethyl ester (designated: MCC1019) as selective PLK1 inhibitor targeting PLK1 PBD. Cytotoxicity and fluorescence polarization-based screening were applied to a library of 1162 drug-like compounds to identify potential inhibitors of PLK1 PBD. The activity of compound MC1019 against the PLK1 PBD was confirmed using fluorescence polarization and microscale thermophoresis. This compound exerted specificity towards PLK1 over PLK2 and PLK3. MCC1019 showed cytotoxic activity in a panel of different cancer cell lines. Mechanistic investigations in A549 lung adenocarcinoma cells revealed that MCC1019 induced cell growth inhibition through inactivation of AKT signaling pathway, it also induced prolonged mitotic arrest-a phenomenon known as mitotic catastrophe, which is followed by immediate cell death apoptosis and necroptosis. MCC1019 significantly inhibited tumor growth in a murine lung cancer model without affecting body weight or vital organ size, and reduced the growth of metastatic lesions in the lung. We propose MCC1019 as promising anti-cancer drug candidate.
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OBJECTIVE@#To identify and synthesize the most recent available evidence of effectiveness of acupuncture on pain, physical function and health-related quality of life (HRQoL) in patients with rheumatoid arthritis (RA).@*METHODS@#A comprehensive search of 12 Western and Chinese databases was undertaken from their inception up to end of 2016. Randomized controlled trials (RCTs), concerning patients with RA treated with needle acupuncture, written in English, Portuguese, German or Chinese were included. Primary outcomes included pain, physical function and HRQoL. Secondary outcomes included morning stiffness, functional impairment, number of tender and swollen joints and serum concentrations of inflamatory markers. Methodological quality was assessed by three independent reviewers using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument.@*RESULTS@#Twenty-two studies met the inclusion criteria. Of those, 9 studies were excluded after assessment of their methodological quality. The remaining 13 original RCTs included 974 patients. Ten of these studies published in China, showed favorable statistical significant effects of acupuncture in relieving symptoms of RA compared with controls.@*CONCLUSIONS@#Evidence suggests that acupuncture interventions may have a positive effect in pain relief, physical function and HRQoL in RA patients. However, due to the heterogeneity and methodologic limitations of the studies included in this systematic review, evidence is not strong enough to produce a best practice guideline.
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Resumen Introducción: La evaluación de la contractilidad segmentaria es un marcador importante para determinar la extensión de la enfermedad coronaria manifestada a través de un evento isquémico cardiaco. La resonancia magnética cardíaca es el patrón estándar para evaluar dicha motilidad; sin embargo, debido al elevado número de exámenes, la disponibilidad de equipos de resonancia magnética y el costo de los exámenes de resonancia magnética, el uso del ecocardiograma transtorácico es el método diagnóstico de elección. Objetivo: Evaluar la concordancia de la evaluación de la motilidad de diferentes segmentos miocárdicos y de agrupación de segmentos por territorios de irrigación arterial obtenidos por resonancia magnética cardiaca y ecocardiograma transtorácico en pacientes hospitalizados por infarto agudo de miocardio. Métodos: A un grupo de pacientes que llegaron al servicio de emergencia por infarto agudo de miocardio, se les realizó ecocardiograma transtorácico y resonancia magnética cardiaca y se compararon los resultados. La resonancia magnética cardiaca fue el valor de referencia a comparar para fracción de eyección y contractilidad segmentaria. Las pruebas comparativas se hicieron a un 95% de confianza mediante el coeficiente de Kappa-Cohen para evaluar la concordancia entre las medidas. Resultados: No se encontraron diferencias entre la fracción de eyección del ventrículo izquierdo medida por ecocardiograma transtorácico y resonancia magnética cardiaca. Los territorios irrigados por las arterias coronarias descendente anterior y circunfleja tenían una concordancia mediana y buena. En aquellos asociados con la arteria coronaria derecha la concordancia fue baja y media. Conclusiones: La evaluación de la fracción de eyección por ecocardiograma transtorácico no difiere de la evaluación por resonancia magnética cardiaca. En la evaluación de la motilidad segmentaria, la resonancia magnética cardiaca es mejor que el ecocardiograma.
Abstract Introduction: The evaluation of segmental contractility is an important marker to determine the extent of the coronary disease manifested by an ischaemic event. Cardiac magnetic resonance is the standard pattern to evaluate this contractility. However, due to lower availability of magnetic resonance equipment, as well as the increased cost of magnetic resonance tests, the use of the transthoracic echocardiogram is the diagnostic method of choice. Objective: The aim of the study is to compare the evaluation of the motility of different myocardial segments and segments grouped by coronary artery supply territories obtained by cardiac magnetic resonance and transthoracic electrocardiogram performed on patients admitted to hospital with acute myocardial infarction. Methods: A cardiac magnetic resonance and transthoracic electrocardiogram was performed on a group of patients that arrived in the Emergency Department due to an acute myocardial infarction, and the results were compared. The cardiac magnetic resonance was the reference value to compare for the ejection fraction and segmental contractility. Comparative tests were performed with 95% confidence limits using a Kappa-Cohen coefficient to evaluate the agreement between the measurements. Results: No differences were found between the left ventricular ejection fraction measured by cardiac magnetic resonance and transthoracic electrocardiogram. There was average and good agreement in the coronary and circumflex artery supply territories, respectively. In those associated with the right coronary artery, the concordance was low and average. Conclusions: There was no difference between the evaluation of the ejection fraction by transthoracic electrocardiogram or that by cardiac magnetic resonance. In the evaluation of segmental motility, cardiac magnetic resonance was better than transthoracic electrocardiogram.
Subject(s)
Humans , Male , Female , Aged , Echocardiography , Magnetic Resonance Spectroscopy , Cell Movement , Myocardial InfarctionABSTRACT
Resumen La transfusión es la infusión de componentes de la sangre o sangre total en el torrente sanguíneo, considerada una medida terapéutica, de la cual se debe tener un conocimiento fisiológico claro y preciso en la edad pediátrica. El objeto de las transfusiones es aportar los elementos de la sangre en cantidad suficiente y con la mayor capacidad funcional posible en una situación de emergencia. Los conocimientos inmunohematológicos logran evitar, en la mayor parte de los casos, problemas de incompatibilidad y sensibilización. En nuestro país no existen registros claros acerca de los requerimientos transfusionales por edades, o los más solicitados. En este artículo hacemos una revisión sistemática sobre los diferentes componentes sanguíneos, indicaciones, características y dosis, y por último, los efectos transfusionales adversos.
Abstract La transfusión es la infusión de componentes de sangre o sangre entera en el torrente sanguíneo, considerado una medida terapéutica, de la que se debe tener un conocimiento fisiológico claro y preciso en la edad pediátrica. El propósito de las transfusiones es proporcionar los elementos sanguíneos en cantidad suficiente y con la mayor capacidad funcional posible en una situación de emergencia. El conocimiento inmunohematológico es capaz de evitar, en la mayoría de los casos, problemas de incompatibilidad y sensibilización. En nuestro país, no hay registros claros de los requerimientos de transfusión relacionados con la edad o los más solicitados. Realizamos una revisión sistemática de los diferentes componentes, indicaciones, características y dosis de sangre, y por último los efectos transfusionales adversos.
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Resumen La anemia hemolítica más frecuente en la población mundial es la anemia de células falciformes (ACF), con una incidencia de 1/600 recién nacidos en Estados Unidos y en algunas regiones de España con incidencia de 1/5000 neonatos; en Colombia no hay registros respecto a la incidencia y prevalencia. La transmisión de la ACF es autosómica dominante. Los homocigotos (SS) no sintetizan Hb A y poseen eritrocitos con un 90 % de Hb S. El portador o heterocigoto (AS) tiene hematíes con Hb A mayor que 50 % y Hb S de 20 - 40 % y son usualmente asintomáticos. La Hb S se debe a una mutación en el gen de la cadena beta de globina, lo cual conlleva a la polimerización de la Hb en condiciones de baja oxigenación, lo cual origina un cambio en la morfología del eritrocito que adquiere la forma falciforme. La sintomatología es secundaria a la anemia hemolítica crónica, la vaso-oclusión en los diferentes órganos y la asplenia funcional, la cual predispone a la infección. Otras manifestaciones asociadas son el secuestro esplénico, la aplasia eritroide y las complicaciones órgano - especificas, que disminuyen la calidad de vida y predisponen a mayor mortalidad. Su manejo debe realizarse en centros de referencia donde haya un manejo integral, incluyendo el recurso humano y físico, ya que el manejo inadecuado y sus complicaciones disminuyen la sobrevida, la cual no es superior a los 45 años según reportes.
Abstract The most common hemolytic anemia in the world population is sickle cell anemia, with an incidence of 1/600 newborns in the United States and Spain some regions 1/5000 incidence of infants; in Colombia there are no records regarding the incidence and prevalence. ACF transmission is autosomal dominant. Homozygotes (SS) do not synthesize Hb A and possess erythrocytes with 90 % Hb S. The carrier or heterozygous (AS) is greater Hb RBCs with 50 % A and Hb S of 20 - 40 % and are usually asymptomatic. Hb S is due to a mutation in the gene for beta globin chain, leading to polymerization of Hb in low oxygenation, resulting in a change in morphology sickle erythrocyte acquiring form. The symptoms are secondary to chronic hemolytic anemia, vaso-occlusion in the different organs and functional asplenia which predisposes to infection. Other associated manifestations are splenic sequestration, erythroid aplasia complications and organ - specific, which decrease the quality of life and predispose to increased mortality. Its management must be performed in reference centers where there is a comprehensive management including human and physical resources, as improper handling and its complications decreased survival which is not more than 45 years according to reports.
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<p><b>BACKGROUND</b>Rheumatoid arthritis (RA) is a systemic inflammatory disease characterized by functional disability and pain. Although acupuncture is widely used, until now Western acupuncture studies on RA have not shown conclusive positive results. Acupuncture is regarded as a reflex therapy that has effects on the human autonomic nervous system. By establishing a traditional Chinese medicine (TCM) diagnosis first, the practitioner is able to choose acupoints according to the state of each individual patient.</p><p><b>METHODS/DESIGN</b>We are interested if acupuncture, using a classical diagnostic procedure to allocate acupoints to the patient according to the Shang Han Lun theory, can be effective in relieving pain, improving hand function and increasing health-related quality of life in RA.The authors intend to harmonize TCM diagnosis according to clinical and genetic profiles. Patients with the TCM diagnosis of a so-called Turning Point syndrome will be followed up in a randomized, prospective, double-blind, placebo-controlled, multicenter and three-armed parallel-group study with a standardized treatment in order to optimize potential therapeutic effects of acupuncture on pain, strength and muscle function of patients with RA as well as the influence on inflammation and quality of life.</p><p><b>DISCUSSION</b>The findings of this study will provide important clinical information about the feasibility and efficacy of acupuncture treatment for RA patients. In addition, it will explore the feasibility of further acupuncture research.</p><p><b>TRIAL REGISTRATION NUMBER</b>ClinicalTrials.gov Identifier NCT02553005.</p>
Subject(s)
Humans , Acupuncture Therapy , Arthritis, Rheumatoid , Psychology , Therapeutics , Clinical Protocols , Double-Blind Method , Hand , Medicine, Chinese Traditional , Pilot Projects , Quality of LifeABSTRACT
Background: The clinical manifestations of Leigh Syndrome (LS) are heterogeneous and its diagnosis is often based on information acquired from multiple levels of inquiry. To identify LS, Oral Glucose Lactate Stimulation Test (OGLST) and Magnetic Resonance Spectroscopy (MRS) have been used as additional tools for evaluation of this metabolic disorder. The objective of the study was to report the clinical manifestations, neuroimaging assessments, and multidisciplinary approaches of lactate in pediatric patients with LS. Methods: We performed a retrospective charts review of pediatric patients with LS, which underwent the investigations using laboratory tests and Magnetic Resonance Images (MRI)/MRS of the brain. Results: The distributions of the lesions on the MRI of the brain studies were as the following: basal ganglia (7/8), brainstem (7/8), and cortex (3/8). Despite all of the patients showed disorient neurological manifestations and symmetrical lesions over the basal ganglion and brainstem on MRI, elevated levels of serum lactate were detected in 6 of 8 patients by either random serum sample obtained for lactate or OGLST. Subsequently, the remaining 2 cases were demonstrated with lactate peak over the affected areas by MRS. Cranial MRS showed lactate duplex and decreased N-acetylaspartate/creatine ratio over the affected areas in the 5 of 6 patients. Conclusions: The study shows the importance of multidisciplinary approaches in the diagnosis of LS. Approach of LS may not only depend on the elevation of the value of random serum lactate but also can be further aided by OGLST or MRS to evaluate metabolic disorder in such patients.
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Objetivo: Evaluar el efecto genotóxico de las mezclas complejas de hidrocarburos en los trabajadores de estaciones de servicio de gasolina en Barranquilla (Atlántico, Colombia) a través de la prueba Cometa(CA) alcalina. Materiales y métodos: Se realizó un estudio transversal, prospectivo inferencial de casos y controles. El grupo control estuvo conformado por 15 personas no expuestas laboralmente a hidrocarburos y el expuesto por 38 personas que trabajaron al menos 1 año como despachador de combustible. Se realizó un ensayo cometa alcalino en sangre venosa. Se determinó el efecto genotóxico utilizando el porcentaje de ADN n la cola y por Unidades Arbitrarias de daño. La comparación entre grupos se realizó por la prueba t-student o W-Wilcoxon. Los datos fueron modelados con una regresión simple ajustada. Los análisis de datos fueron realizados con el paquete estadístico R. Resultados: Las edades de los grupos control y experimental fueron de 33±9 y 38±10 años, respectivamente; no hubo diferencia estadísticamente significativa para esta variable (t = -1.82; p-valor > 0,05; a = 95%). Hubo asociación entre Edad y Tiempo de Exposición (x² = 24.9; p-valor < 0,05; a = 95%). El %ADN en la cola para el grupo control fue de 20,67±25,79, mientras que para el grupo expuesto fue 53,35±40,28. El modelo de degradación de ADN es «y=√l(512,687+733,899√1(t))¼. Conclusiones: Las mezclas complejas de heterocíclicos son potencialmente genotóxicas. El daño progresivo se encuentra al 80 % después de 6 años de exposición, siendo igual a los 9 años de exposición que a los 15.
Objective: To evaluate the genotoxic effects of complex mixtures of hydrocarbons in gasoline stations's workers in Barranquilla (Atlántico, Colombia) using the alkaline Comet Assay (CA). Materials and methods: Study was transversal, prospective inferential of case and control. The controls were 15 persons without occupationally exposed to hydrocarbons and the exposed were 38 persons that were working at least one year as fuel dispenser. The alkaline Comet Assay was performed on venous blood. Genotoxic effects was determined throug DNA percentage in tail and damage Arbitrary Units. The comparison between groups was performed by t-student or W-Wilcoxon test. The data were modeled with a simple regression adjusted. The data analyses were performed with the statistical package R. Results: Age of control and experimental groups were 33±9 and 38±10 years respectively, there was no statistically significant difference for this variable (t = -1.82; p-value > 0.05; a = 95 %). There was an association between Age and Exposure Time (x² = 24.9; p-value < 0.05, a = 95%). The %DNA tail for the control group was 20.67 ± 25.79, while for the exposed group was 53.35± 40.28. The DNA degradation model is «y=√ (512.687+733,899√ (t))¼. Conclusions: The complex mixtures of heterocyclic are potentially genotoxic. As the progressive damage is 80 % after 6 years of exposure, being equal damage to the 9 to 15 years of exposure.
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<p><b>BACKGROUND</b>Musicians are a prone group to suffer from working-related musculoskeletal disorder (WRMD). Conventional solutions to control musculoskeletal pain include pharmacological treatment and rehabilitation programs but their efficiency is sometimes disappointing.</p><p><b>OBJECTIVE</b>The aim of this research is to study the immediate effects of Tuina techniques on WRMD of professional orchestra musicians from the north of Portugal.</p><p><b>DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS</b>We performed a prospective, controlled, single-blinded, randomized study. Professional orchestra musicians with a diagnosis of WRMD were randomly distributed into the experimental group (n=39) and the control group (n=30). During an individual interview, Chinese diagnosis took place and treatment points were chosen. Real acupoints were treated by Tuina techniques into the experimental group and non-specific skin points were treated into the control group. Pain was measured by verbal numerical scale before and immediately after intervention.</p><p><b>RESULTS</b>After one treatment session, pain was reduced in 91.8% of the cases for the experimental group and 7.9% for the control group.</p><p><b>CONCLUSION</b>Although results showed that Tuina techniques are effectively reducing WRMD in professional orchestra musicians of the north of Portugal, further investigations with stronger measurements, double-blinding designs and bigger simple sizes are needed.</p>
Subject(s)
Adult , Female , Humans , Male , Follow-Up Studies , Medicine, Chinese Traditional , Methods , Musculoskeletal Diseases , Rehabilitation , Music , Occupational Diseases , Rehabilitation , Prospective Studies , Single-Blind Method , Surveys and QuestionnairesABSTRACT
<p><b>BACKGROUND</b>Musicians are frequently affected by playing-related musculoskeletal disorders (PRMD). Common solutions used by Western medicine to treat musculoskeletal pain include rehabilitation programs and drugs, but their results are sometimes disappointing.</p><p><b>OBJECTIVE</b>To study the effects of self-administered exercises based on Tuina techniques on the pain intensity caused by PRMD of professional orchestra musicians, using numeric visual scale (NVS).</p><p><b>DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS</b>We performed a prospective, controlled, single-blinded, randomized study with musicians suffering from PRMD. Participating musicians were randomly distributed into the experimental (n=39) and the control (n=30) groups. After an individual diagnostic assessment, specific Tuina self-administered exercises were developed and taught to the participants. Musicians were instructed to repeat the exercises every day for 3 weeks.</p><p><b>MAIN OUTCOME MEASURES</b>Pain intensity was measured by NVS before the intervention and after 1, 3, 5, 10, 15 and 20 d of treatment. The procedure was the same for the control group, however the Tuina exercises were executed in points away from the commonly-used acupuncture points.</p><p><b>RESULTS</b>In the treatment group, but not the control group, pain intensity was significantly reduced on days 1, 3, 5, 10, 15 and 20.</p><p><b>CONCLUSION</b>The results obtained are consistent with the hypothesis that self-administered exercises based on Tuina techniques could help professional musicians controlling the pain caused by PRMD. Although our results are very promising, further studies are needed employing a larger sample size and double blinding designs.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Exercise Therapy , Medicine, Chinese Traditional , Musculoskeletal Diseases , Therapeutics , Music , Prospective Studies , Self Administration , Single-Blind MethodABSTRACT
Traffic fatalities are a major cause of morbidity and mortality in Iran. Occupational sleep medicine field needs more cost-effective and applicable tests for screening purposes. This study reports on a pilot screening study for drowsy drivers in an urban Iranian sample of commercial drivers. The Maintenance of Wakefulness Test [MWT] measures the ability to remain awake objectively. Sleep latency in MWT is a reasonable predictor of driving simulator performance in drivers. In this study, we evaluate whether the Epworth Sleepiness Scale [ESS] and MWT are equally useful in drivers with possible Excessive Daytime Sleepiness [EDS]. 46 consecutive road truck drivers in a transportation terminal entered into this study. The ESS score of patients with normal and abnormal MWT was 3.24 +/- 2.4 and 4.08 +/- 3 respectively which was not significantly differenced [P value = 0.34]. No significant correlation was found between the ESS and sleep latency in MWT [r=-0.28, 95%CI= -0.58 to 0.02]. By using the receiver operating characteristic analysis, the area under the curve was found to be 0.57 [95% confidence interval = 0.37- 0.77] which is not statistically acceptable [P value=0.46]. Our finding showed that the MWT and ESS do not measure the same parameter
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OBJECTIVE: To investigate the effectiveness of radiographic parameters on segmental instability in the lumbar spine using Kinetic magnetic resonance imaging (MRI). METHODS: Segmental motion, defined as excessive (more than 3 mm) translational motion from flexion to extension, was investigated in 309 subjects (927 segments) using Kinetic MRI. Radiographic parameters which can help indicate segmental instability include disc degeneration (DD), facet joint osteoarthritis (FJO), and ligament flavum hypertrophy (LFH). These three radiographic parameters were simultaneously evaluated, and the combinations corresponding to significant segmental instability at each level were determined. RESULTS: The overall incidence of segmental instability was 10.5% at L3-L4, 16.5% at L4-L5, and 7.3% at L5-S1. DD and LFH at L3-L4 and FJO and LFH at L4-L5 were individually associated with segmental instability (p<0.05). At L4-L5, the following combinations had a higher incidence of segmental instability (p<0.05) when compared to other segments : (1) Grade IV DD with grade 3 FJO, (2) Grade 2 or 3 FJO with the presence of LFH, and (3) Grade IV DD with the presence of LFH. At L5-S1, the group with Grade III disc and Grade 3 FJO had a higher incidence of segmental instability than the group with Grade I or II DD and Grade 1 FJO. CONCLUSION: This study showed that the presences of either Grade IV DD or grade 3 FJO with LFH at L4-L5 were good indicators for segmental instability. Therefore, using these parameters simultaneously in patients with segmental instability would be useful for determining candidacy for surgical treatment.
Subject(s)
Humans , Hypertrophy , Incidence , Intervertebral Disc Degeneration , Ligaments , Magnetic Resonance Imaging , Osteoarthritis , Spine , Zygapophyseal JointABSTRACT
Se realizó un estudio descriptivo y transversal para caracterizar las manifestaciones extraarticulares más frecuentes en un grupo de pacientes diagnosticados de artritis reumatoide en la consulta de medicina interna del Hospital Universitario «Manuel Ascunce Domenech¼, desde el 1 de noviembre de 2003 hasta noviembre de 2005. En la investigación realizada se encontró que las manifestaciones extraarticulares más frecuentes fueron las cutáneas y la neuropatía periférica; éstas se encontraron con mayor frecuencia en pacientes con un tiempo de evolución mayor de cinco años y con factor reumatoideo sérico positivo. Se detectó que el sexo femenino y el grupo de edades de 55 años y más fueron los más afectados; más del 75 % de los pacientes fueron seropositivos; dentro de las manifestaciones generales más frecuentes se encontraron los edemas periféricos, pérdida de peso y la astenia.
A descriptive and cross-sectional study to characterize the most frequent extra-articular manifestations was coducted, in a group of patients diagnosed with rheumatoid arthritis in the internal medicine consultation at «Manuel Ascunce Domenech¼ University Hospital, from November 1st, 2003 to November 2005. In the research carried out, the most frequent extra-articular manifestations were the cutaneous and the peripheral neuropathy was found; these ones with greater frequency in patients with a follow-up over five years and with positive serumal rheumatoid factor's. It was detected that female sex and the age group of 55 years-old and older were the most affected; more than the 75% of the patients were seropositive; within the most frequent general manifestations peripheral edemas, loss of weight and asthenia were found.
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The aim of this study was to determine the critical incidents that contribute to the initiation of substance use and abuse among women in Trinidad and Tobago. Twenty women were randomly selected from 46 women currently attending 43 drug rehabilitation centres, Narcotics Anonymous and Alcoholics Anonymous groups in Trinidad and Tobago. In-depth semi-structured interviews using the critical incident technique were conducted. Interviews were recorded, transcribed and analyzed. Concepts, categories and themes were determined by team study and group discussion. The critical incidents that influenced women to initiate the use and abuse of substances fell into eight major themes: factors intrinsic to the individual woman, family factors, social and environmental factors, life stresses, relationship issues, abuse, peer pressure and substance use and abuse as a coping mechanism. The results imply that the factors contributing to the initiation of substance use and abuse among women in Trinidad and Tobago are many and complex. As such any attempt to address this issue requires a broad-based approach. Such an approach should address family use of such substances, societal acceptance of them, availability, the self-esteem of the individual woman and her ability to cope with peer and internal stresses
El objetivo de este estudio era determinar los incidentes críticos que contribuyen a la iniciación en el uso yabuso de substancias entre las mujeres en Trinidad y Tobago. Se seleccionaron veinte mujeres al azar, de46 mujeres que asistían a 43 centros de rehabilitación de drogas, grupos de Alcohólicos Anónimos, y Narcóticos Anónimos en Trinidad y Tobago. Se realizaron entrevistas profundas semi- structuradas usando la técnica de incidentes críticos. Las entrevistas fueron grabadas, transcriptas, y analizadas. Los conceptos, categorías y temas fueron determinados mediante estudio en equipo y discusión en grupos. Los incidentes críticos que influyeron en que las mujeres se iniciaran en el uso y abuso de substancias comprendían ocho temas principales: factores intrínsecos a la mujer como individuo, factores familiares, factores sociales y medioambientales, estreses cotidianos, problemas en las relaciones, abusos, influencia de los amigos y malas compañías, y el uso y abuso de sustancias como mecanismo para hacer frente al estrés. Los resultados implican que los factores que contribuyen a la iniciación del uso y abuso de sustancias entre las mujeres de Trinidad y Tobago son muchos y complejos. Siendo así, cualquier intento por abordar este problema requiere un enfoque amplio. Tal enfoque debe abordar el uso de substancias por parte de la familia, la aceptación social de las substancias, la disponibilidad, la autoestima de la mujer como individuo y su capacidad para hacer frente tanto a su estrés interno como al que proviene de la presión que ejercen amigos y malas compañías.
Subject(s)
Humans , Female , Adult , Substance-Related Disorders/psychology , Adaptation, Psychological , Alcoholism/psychology , Alcoholism/rehabilitation , Stress, Psychological , Socioeconomic Factors , Risk Factors , Substance-Related Disorders/rehabilitation , Trinidad and TobagoABSTRACT
Metabolic bone disease and some of the disorders of the skeleton are associated with alterations in calcium and phosphorus homeostasis. For example, calcium salts are not freely soluble in body fluids and increases in either calcium or phosphate or both can lead to the deposition of calcium salts in the soft tissues. In addition, because the crystalline material in bone is very tiny, there is a rapid and very active exchange system with the extracellular space, so that disorders of calcium or phosphorus are reflected by a change in bone structure and contribute to the ease with which fractures occur. Also, in many disorders, bone formation and destruction are equal in activity, but opposite in sign. In some conditions such as osteoporosis, a destruction exceeds the production and leads to the weakness of bone structure. The transfer of calcium across lumens such as the gut, kidney or bone requires a system, which consists of parathyroid hormone and 1,2 5-dihydroxy vitamin D and a low phosphate level
Subject(s)
Hyperparathyroidism , Rickets , Osteomalacia , Osteoporosis , Chronic Kidney Disease-Mineral and Bone Disorder , Multiple Myeloma , ReviewABSTRACT
Describe el desempeño del emisario submarino largo tomando en cuenta dilución inicial, horizontal y mortalidad de coliformes; y realiza comparaciones con el tratamiento secundario con descarga cerca del litoral. Explica los requisitos de datos de campo y/o procedimientos para: corrientes, T90, calidad del agua, estudios meteorológicos, batimétricos y geológicos. Incluye consideraciones sobre diseño y construcción, costos y normas de calidad del agua
Subject(s)
Discharge Dilution , Environmental Health , Submarine Outfall , T90 , Costs and Cost AnalysisABSTRACT
Presenta un panorama de las prácticas actuales de disposición de aguas residuales en América Latina y El Caribe. Explica que después del reuso, la alternativa del emisario submarino largo con pretratamiento (militamices) o tratamiento primario, es un método de disposición más atractivo en relación al tratamiento secundario con disposición cercana a la costa en términos de confiabilidad, eficiencia, costo y de bajos requerimientos de operación y mantenimiento. Sin embargo, se deben evitar las descargas de aguas residuales cerca a comunidades biológicas naturales y sensibles tales como los arrecifes corales. Incluye costos y cuadros con detalles técnicos de 82 emisarios submarinos en américa Latina y El Caribe