Subject(s)
Humans , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Cardiac Output, Low/complications , Cardiovascular Agents/administration & dosage , Myocardial Reperfusion , Heart Transplantation , Coronary Care Units , Hypovolemia/therapy , Electrocardiography/methods , Acute Coronary Syndrome/etiologyABSTRACT
Obesity is a major worldwide health problem that is related to most chronic diseases, including male infertility. Owing to its wide impact on health, mechanisms underlying obesity-related infertility remain unknown. In this study, we report that mice fed a high-fat diet (HFD) for over 2 months showed reduced fertility rates and increased germ cell apoptosis, seminiferous tubule degeneration, and decreased intratesticular estradiol (E2) and E2-to-testosterone ratio. Interestingly, we also detected a decrease in testicular fatty acid levels, behenic acid (C22:0), and docosahexaenoic acid (DHA, 22:6n-3), which may be related to the production of dysfunctional spermatozoa. Overall, we did not detect any changes in the frequency of seminiferous tubule stages, sperm count, or rate of in vitro capacitation. However, there was an increase in spontaneous and progesterone-induced acrosomal exocytosis (acrosome reaction) in spermatozoa from HFD-fed mice. These data suggest that a decrease in E2 and fatty acid levels influences spermatogenesis and some steps of acrosome biogenesis that will have consequences for fertilization. Thus, our results add new evidence about the adverse effect of obesity in male reproduction and suggest that the acrosomal reaction can also be affected under this condition.
ABSTRACT
Background@#and PurposeAcute colonic pseudo-obstruction (ACPO) is a common but understudied complication in neurocritically ill patients. The acetylcholinesterase inhibitor neostigmine can be used to treat ACPO in patients who do not respond to conventional treatment. This study investigated the effectiveness and adverse events when using neostigmine to manage ACPO in neurocritically ill patients. @*Methods@#This retrospective study investigated patients with ACPO who were treated using neostigmine in the neurological intensive-care units at two centers between March 2017 and August 2020. Neostigmine was administered intravenously or subcutaneously (at doses ranging from 0.25 mg to 2 mg) according to the protocols at the two centers. The outcomes were bowel movements and the changes in colon diameters on abdominal radiographs. Safety events such as bradycardia, vomiting, salivation, and sweating were evaluated. @*Results@#This study included 31 subjects with a mean age of 46.8 years (65.4% males). All patients had a bowel movement at a median of 120 minutes after administering neostigmine. The colon diameter decreased by a median of 17.5 mm (paired t-test: p<0.001) regardless of the dose and treatment protocols. Multilevel analysis confirmed that the mean colon diameter decreased from 66 mm pretreatment to 47.5 mm posttreatment (p<0.001), with an intraclass correlation coefficient of 13%. Three patients (9.7%) exhibited hypersalivation, sweating, bradycardia, and vomiting. Bradycardia (heart rate, 42 beats/minute) occurred in one patient (3.2%), and was successfully managed by injecting atropine. @*Conclusions@#Neostigmine injection is a safe and effective treatment option for ACPO in neurocritically ill patients who fail to respond to conservative management.
ABSTRACT
Background@#and PurposeAcute colonic pseudo-obstruction (ACPO) is a common but understudied complication in neurocritically ill patients. The acetylcholinesterase inhibitor neostigmine can be used to treat ACPO in patients who do not respond to conventional treatment. This study investigated the effectiveness and adverse events when using neostigmine to manage ACPO in neurocritically ill patients. @*Methods@#This retrospective study investigated patients with ACPO who were treated using neostigmine in the neurological intensive-care units at two centers between March 2017 and August 2020. Neostigmine was administered intravenously or subcutaneously (at doses ranging from 0.25 mg to 2 mg) according to the protocols at the two centers. The outcomes were bowel movements and the changes in colon diameters on abdominal radiographs. Safety events such as bradycardia, vomiting, salivation, and sweating were evaluated. @*Results@#This study included 31 subjects with a mean age of 46.8 years (65.4% males). All patients had a bowel movement at a median of 120 minutes after administering neostigmine. The colon diameter decreased by a median of 17.5 mm (paired t-test: p<0.001) regardless of the dose and treatment protocols. Multilevel analysis confirmed that the mean colon diameter decreased from 66 mm pretreatment to 47.5 mm posttreatment (p<0.001), with an intraclass correlation coefficient of 13%. Three patients (9.7%) exhibited hypersalivation, sweating, bradycardia, and vomiting. Bradycardia (heart rate, 42 beats/minute) occurred in one patient (3.2%), and was successfully managed by injecting atropine. @*Conclusions@#Neostigmine injection is a safe and effective treatment option for ACPO in neurocritically ill patients who fail to respond to conservative management.
ABSTRACT
ABSTRACT Objective The aim was to describe the clinical features of patients with ectopic Cushing syndrome (ECS) from Colombia and compare these findings with other series to provide the best management for these patients. Materials and methods Records of patients with ECS from 1986 to 2017 were retrospectively reviewed; patients with a diagnosis of adrenal or pituitary Cushing syndrome (CS) were excluded. Results Fourteen patients with ECS were analyzed in this study. The mean age was 54.4 (SD 17.1) years, and the female to male ratio was 1.33:1. Regarding the etiology of ECS, four patients had lung carcinoids (28.6%), three had small-cell lung carcinoma (21.4%), three had pancreatic neuroendocrine tumors (21.4%), one had medullary thyroid cancer (7.1%), one had non-metastatic pheochromocytoma (7.1%), one had metastatic thymoma (7.1%) and one patient had an occult source of ACTH (7.1%). The most common clinical features at presentation were moon-face, muscle weakness, diabetes mellitus and hypertension. Hyperpigmentation was present in 36% of patients, and 12 patients had hypokalemia with a mean value of 2.3 mEq/L (SD 0.71). The median basal cortisol, 24-hour urinary free cortisol (UFC) and ACTH were 30.5 ug/dL (IQR 21-59 ug/dL), 2,600 ug/24 h (IQR 253-6,487 ug/24 h) and 91 pg/mL (IQR 31.9-141.9), respectively. Thirteen patients (92.8%) had the site of the primary lesion identified. Six patients had undergone a surgical intervention to address the primary tumor. Resection was curative in 28.5% of patients. Death occurred in 57.1% of patients, and the median overall survival was 27 months. Intrathoracic tumors had the most aggressive behavior. Conclusions ECS is a rare disease; however, it is associated with high morbidity and mortality. A rapid intervention supported by an interdisciplinary group is required to improve overall survival and quality of life
Subject(s)
Humans , Male , Female , ACTH Syndrome, Ectopic , Cushing Syndrome/etiology , Quality of Life , Retrospective Studies , Colombia , Middle AgedABSTRACT
A Saúde bucal Coletiva trouxe uma nova abordagem de atençäo à saúde bucal, baseada na promoçäo, recuperaçäo e manutençäo da saúde, de forma integral e voltada à coletividade. A concepçäo da Escola Promotora da Saúde tem em seu contexto a integralidade na atençäo à saúde, buscando a construçäo de uma sociedade democrática, envolvendo toda comunidade escolar, visando a promoçäo da saúde. O presente estudo teve como objetivos investigar os conhecimentos e opiniöes dos professores da Rede Pública Estadual do ensino fundamental do Município de Säo Paulo, sobre os programas de saúde bucal desenvolvidos nas Unidades Escolares e sobre a iniciativa das Escolas Promotoras de Saúde. A metodologia utilizada foi qualiquantitativa, como instrumento para a coleta de dados o survey, em um questionário semi-estruturado com perguntas abertas e fechadas. Participaram 166 professores que lecionavam da 1ª a 4ª série em 32 escolas. Os professores classificaram os programas de saúde bucal como bom (42 por cento), efetivo (99 por cento) e que gostariam de participar dos programas 972 por cento0. A maioria näo conhecia o conceito da Escola Promotora da Saúde (88 por cento). Os programas de saúde bucal analisados näo priorizavam e educaçäo em saúde como estratégia de promoçäo de saúde, propöem-se uma maior cobertura dos programas de saúde bucal desenvolvidos nas escolas, recomendando-se a elaboraçäo de um fórum permanente para a discussäo desses programas e a criaçäo de oficinas de capacitaçäo pedagógica à equipe de saúde bucal para efetividade dos programas
Subject(s)
Community Dentistry , Health Promotion , Oral Health , Health Programs and Plans , Public Sector , School Dentistry , School Health Services , SchoolsABSTRACT
In this study we picked at random 51 cases suffering principally or secondarily from infection of the urinary tract of at least two months duration. Eighty percent of them had received some form of therapy for the urinary tract infection at one time or the other. The number of cases is fair enough to warrant some observations. It is interesting to note that the organisms encountered are the usual pathogens of the urinary tract. Their distribution however, did not exactly follow the pattern observed by investigators abroad. This is the first time this investigation was carried out here so that we have no way of comparing these results with previous observations.In vitro antibiotic screening of these pathogens of the urinary tract did not follow any stereotyped pattern in their susceptibility to the various therapeutic agent tested which included the most commonly accepted and employed medications for urinary tract infection. The results of these in vitro studies point strongly to the emergence of new strains of the usual bacterial pathogens in the urinary tract such that the usual antibiotics and sulfonamide agents employed even in supposedly adequate doses can not be implicitly relied upon. It is observed that the newer antibiotics, like Tetracycline and Furadantin, and the less commonly employed broad spectrum antibiotics, like Chloromycetin, seem to be far more effective than the antibiotics which have long been in use like Penicillin and Streptomycin. The same can be said of the various sulfonamide preparations. We feel that close clinical follow-up of patients under these various therapeutic agents must be made before we can utilize these in vitro observations more widely. It is possible that in vitro behavior of these agents may not necessarily reflect their behavior in the body.In spite of this, however, we feel that more careful attention as to the choice of the therapeutic agent and their dosages should be made; and a reexamination of the sensitivity to the various antibiotics and sulfonamide preparations of various organisms commonly pathogenic in the urinary tract is in order.We wish to emphasize the need for antibiotic screening in the proper management of these cases, since this procedure will enable us to choose more wisely the necessary agent to employ. Lastly, we call attention to the emergence of antibiotic resistant gram negative bacilli in the urinary tract. (Comment)
ABSTRACT
Foram avaliados os testes pós-coito realizados em dois grupos de pacientes estéreis, 126 pacientes em um grupo que engravidou e 114 em um grupo que näo obteve gravidez. Foram calculados a sensibilidade, especificidade, valor preditivo positivo e negativo, realizando-se quatro pontos de corte na interpretaçäo positiva do teste. O primeiro corte foi considerar como positivo mais de 15 espermatozóides móveis por campo, para logo considerar 10 ou mais, cinco ou mais e, finalmente, um ou mais espermatozóides móveis como resultado positivo do teste. A sensibilidade variou de 36 a 83 por cento e a especificidade de 65 a 19 por cento com os diferentes pontos de corte, o que significou que o valor do teste para predizer fertilidade ou esterilidade foi quase igual à sorte ou azar. Avaliaram-se também os testes realizados durante o ciclo fecundante e 20 por cento deles tinham sido considerados negativos, ou seja, näo apresentavam nenhum espermatozóide móvel no colo. Discutem-se o valor na propedêutica do casal estéril e as melhores condiçöes para ser feito.
Subject(s)
Humans , Male , Female , Pregnancy , Adult , Coitus , Infertility/diagnosis , Predictive Value of Tests , Sensitivity and Specificity , Sperm MotilityABSTRACT
Foram estudados 252 casais estéries que conseguiram engravidar durante o estudo ou tratamento de sua esterilidade conjugal. Deste número, 211 (83,9 por cento) deram à luz 220 crianças vivas, a termo ou prematuras, 34 (12,8 por cento) terminaram em aborto espontâneo ou gravidez ectópica e sete (2,8 por cento) foram nascidos mortos e malformados. Quando analisados os fatores etiológicos da esterilidade e sua relaçao com o resultado da gravidez, comprovou-se que o fator mais freqüente entre as gravidezes que terminaram em aborto foi o ovulatório (p<0,009). Por outro lado, ao analisar a idade materna e paterna e sua relaçao com a freqüência de abortos, estes estiveram presentes duas vezes mais nos casos de casais com idade superior a 31 anos que os demais. Conclui-se que os casais com uma destas duas situaçoes, fator ovulatório ou idade acima de 31 anos, devem ser informados sobre o prognóstico se suas gestaçoes, antes de iniciar qualquer propedêutica ou terapêutica de esterilidade.