ABSTRACT
Background@#and Purpose Effect of endovascular therapy (EVT) in acute large vessel occlusion (LVO) patients with tandem lesions (TLs) within 6–24 hours after last known well (LKW) remains unclear. We evaluated the clinical and safety outcomes among TL-LVO patients treated within 6–24 hours. @*Methods@#This multicenter cohort was divided into two groups, based on LKW to puncture time: early window (<6 hours), and late window (6–24 hours). Primary clinical and safety outcomes were 90-day functional independence measured by the modified Rankin Scale (mRS: 0–2) and symptomatic intracranial hemorrhage (sICH). Secondary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2b), first-pass effect, early neurological improvement, ordinal mRS, and in-hospital and 90-day mortality. @*Results@#Of 579 patients (median age 68, 32.1% females), 268 (46.3%) were treated in the late window and 311 (53.7%) in the early window. Late window group had lower median National Institutes of Health Stroke Scale score at admission, Alberta Stroke Program Early Computed Tomography Score, rates of intravenous thrombolysis, and higher rates for perfusion imaging. After adjusting for confounders, the odds of 90-day mRS 0–2 (47.7% vs. 45.0%, adjusted odds ratio [aOR] 0.71, 95% confidence interval [CI] 0.49–1.02), favorable shift in mRS (aOR 0.88, 95% CI 0.44–1.76), and sICH (3.7% vs. 5.2%, aOR 0.56, 95% CI 0.20–1.56) were similar in both groups. There was no difference in secondary outcomes. Increased time from LKW to puncture did not predicted the probability of 90-day mRS 0–2 (aOR 0.99, 95% CI 0.96–1.01, for each hour delay) among patients presenting <24 hours. @*Conclusion@#EVT for acute TL-LVO treated within 6–24 hours after LKW was associated with similar rates of clinical and safety outcomes, compared to patients treated within 6 hours.
ABSTRACT
Abstract INTRODUCTION Toxoplasmosis is a zoonosis caused by Toxoplasma gondii. This study investigated the prevalence and factors associated with toxoplasmosis among pregnant women. METHODS We followed an analytical observational study. From July 2016 to June 2017, 218 pregnant women were selected. The infection was detected through serological dosage of anti-T.gondii Immunoglobulin(Ig) M and IgG antibodies. RESULTS The seroprevalence was 35.8%; the factors associated with infection were consumption of non-drinking water, residence in an urban area, and threatened abortion during the current pregnancy. CONCLUSIONS The seroprevalence of toxoplasmosis among pregnant women is high. The risk factors are dependent on environmental determinants.
Subject(s)
Humans , Female , Pregnancy , Adult , Antibodies, Protozoan/blood , Toxoplasmosis/epidemiology , Pregnancy Complications, Parasitic/parasitology , Pregnancy Complications, Parasitic/epidemiology , Peru/epidemiology , Socioeconomic Factors , Immunoglobulin G/blood , Immunoglobulin M/blood , Seroepidemiologic Studies , Toxoplasmosis/diagnosis , Prevalence , Risk Factors , Pregnancy Complications, Parasitic/diagnosisABSTRACT
PURPOSE: Disseminated tumor cells (DTCs) from bone marrow (BM) are a surrogate of minimal residual disease (MRD) in primary breast cancer (PBC) patients and associated with an adverse prognosis. However, BM sampling is an invasive procedure. Although there is growing evidence that circulating tumor cells (CTCs) from the blood are also suitable for monitoring MRD, data on the simultaneous detection of DTCs and CTCs are limited. MATERIALS AND METHODS: We determined the presence of DTCs using immunocytochemistry and the pan-cytokeratin antibody A45-B/B3. CTCs were determined simultaneously using a reverse transcription-polymerase chain reaction-based assay (AdnaTest Breast Cancer) and CellSearch (at least one CTC per 7.5 mL blood). We compared the detection of DTCs and CTCs and evaluated their impact on disease-free and overall survival. RESULTS: Of 585 patients, 131 (22%) were positive for DTCs; 19 of 202 (9%) and 18 of 383 (5%) patients were positive for CTCs, as shown by AdnaTest and CellSearch, respectively. No significant association was observed between DTCs and CTCs (p=0.248 and p=0.146 as shown by AdnaTest and CellSearch, respectively). The presence of DTCs (p=0.046) and the presence of CTCs as shown by CellSearch (p=0.007) were predictive of disease-free survival. CONCLUSION: Our data confirm the prognostic relevance of DTCs and CTCs in patients with PBC. As we found no significant relationship between DTCs and CTCs, prospective trials should include their simultaneous detection. Within those trials, the question of whether or not DTCs and CTCs are independent subpopulations of malignant cell clones should be determined by molecular characterization.
Subject(s)
Humans , Bone Marrow , Breast Neoplasms , Breast , Clone Cells , Disease-Free Survival , Immunohistochemistry , Neoplasm, Residual , Neoplastic Cells, Circulating , Prognosis , Prospective StudiesABSTRACT
In April 2004, an outbreak of acute diarrheal illness occurred among the Orang Asli (aborigine) in the Cameron Highlands, Pahang State, Peninsular Malaysia, where rotavirus was later implicated as the cause. In the course of the epidemic investigation, stool samples were collected and examined for infectious agents including parasites. Soil transmitted helminthes (STH), namely Ascaris lumbricoides (25.7%), Trichuris trichiura (31.1%) and hookworm (8.1%), and intestinal protozoa, which included Giardia lamblia (17.6%), Entamoeba histolytica/E. dispar (9.4%), Blastocystis hominis (8.1%) and Cryptosporidium parvum (2.7%), were detected. Forty-four (59.5%) were infected with at least one parasite, 24 (32.4%), 12 (16.2%) and 8 (10.8%) had single, double and triple parasitic infections, respectively. STH were prevalent with infections occurring as early as in infancy. Giardia lamblia, though the most commonly found parasite in samples from symptomatic subjects, was within the normally reported rate of giardiasis among the various communities in Malaysia, and was an unlikely cause of the outbreak. However, heavy pre-existing parasitic infections could have contributed to the severity of the rotavirus diarrheal outbreak.
Subject(s)
Adolescent , Adult , Animals , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Malaysia/epidemiology , Parasitic Diseases/epidemiology , Population Groups , Population Surveillance/methodsABSTRACT
BACKGROUND: Although overtreatment with antiepileptic drugs contributes to the morbidity associated with epilepsy, many children still are overtreated. OBJECTIVE: To evaluate if the withdrawal of at least one antiepileptic drug (AED) in children with refractory epilepsy using polytherapy enable a better seizure control. METHOD: This was a prospective study. Children with refractory epilepsy using at least two AEDs were included. Once the patient, or guardian, agreed to participate in the study, one or more AED were slowly tapered off. The remaining AEDs dosages could be adjusted as needed, but a new AED could not be introduced. RESULTS: Fifteen patients were evaluated, three girls; ages ranging from 3 to 18 (mean=8.7 years). After at least one AED withdrawal, two (13.5 percent) patients became seizure free, seizures improved >50 percent in 5 (33.5 percent) patients, did not change in 5 (33.5 percent), and seizure frequency became worse in 3 (20 percent). Adverse events improved in 12 patients (80 percent). CONCLUSION: The withdrawal of at least one AED is a valuable option in the treatment of selected children with refractory epilepsy.
INTRODUÇÃO: Apesar do tratamento excessivo com drogas antiepilépticas (DAE) contribuir para a morbidade associada à epilepsia, muitas crianças ainda são submetidas a politerapia desnecessária. OBJETIVO: Avaliar se a retirada de pelo menos uma DAE em crianças com epilepsia refratária utilizando politerapia pode proporcionar melhor controle das crises epilépticas. MÉTODOS: Este foi um estudo prospectivo. Crianças com epilepsia refratária em uso de pelo menos duas DAE foram incluídas. Após assinatura do consentimento informado, uma ou mais DAE foram lentamente retiradas. As doses das outras DAE que não foram retiradas poderiam ser ajustadas se necessário, mas uma nova DAE não pode ser introduzida. RESULTADOS: Quinze pacientes foram avaliados, três eram meninas, com idades entre 3 e 18 anos (média=8,7). Após a retirada de pelo menos uma DAE, 2 (13,5 por cento) pacientes ficaram livre de crises, as crises melhoraram em 5 (33,5 por cento), não mudaram em 5 (33,5 por cento) e a frequencia das crises pioraram em 3 (20 por cento) pacientes. Os eventos adversos melhoraram em 12 patientes (80 por cento). CONCLUSÃO: A retirada de pelo menos uma DAE é uma opção válida no tratamento de crianças com epilepsia refratária.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Anticonvulsants/administration & dosage , Epilepsy/drug therapy , Anticonvulsants/adverse effects , Drug Administration Schedule , Prospective Studies , Risk FactorsABSTRACT
El Proyecto Municipios Centinela, coordinado por el Ministerio de Salud a través del Programa Sistemas Municipales de Salud y financiado con recursos de crédito del Banco Interamericano de Desarrollo, es una fase más desagregada del Plan de Evaluación, el cual pretende ofrecer una guía para construir un sistema de información flexible y eficiente y dar respuesta en el corto y mediano plazo a las necesidades de información para la toma de decisiones en diferentes sectores del desarrollo. La presente investigación tuvo como propósito una rápida evaluación de los resultados del Sistema General de Seguridad Social en Salud, en el período comprendido entre 1995 y 1998, en localidades concretas con características similares al conjunto de los municipios colombianos clasificados en categorías 5 y 6, en lo que hace referencia a condiciones socioeconómicas, geográficas, demográficas e institucionales y con un grado importante de marginación social. En el estudio se utilizó la Metodología de Observatorios Municipales, previa selección de municipios considerados Centinela, articulándola a la metodología de Marco Lógico que incluye Análisis de Factores; todo el proceso fue enriquecido con el apoyo de métodos de investigación cualitativa. El estudio se realizó simultáneamente en 14 municipios del país, ubicados en los departamentos de Antioquia, Atlántico, Boyacá, Caldas, Cauca, Cundinamarca, Huila, Nariño y Sucre. Este artículo presenta la metodología y los resultados obtenidos en 5 de los 14 municipios del estudio: Betulia y Yolombó de Antioquia, Toluviejo de Sucre, Piojó y Ponedera del Atlántico, los cuales correspondieron al convenio suscrito entre la Secretaría Ejecutiva del Convenio Andrés Bello SECAB y la Facultad Nacional de Salud Pública de la Universidad de Antioquia