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1.
Philos Trans A Math Phys Eng Sci ; 382(2272): 20230223, 2024 Jun 09.
Article in English | MEDLINE | ID: mdl-38679052

ABSTRACT

This paper provides a comprehensive review of recent theoretical investigations concerning magnetohydrodynamic (MHD) waves in partially ionized solar plasma. First, we examine the properties of linear MHD waves in a uniform partially ionized plasma and discuss the relevant effects arising from partial ionization. Subsequently, we delve into MHD wave studies in the more intricate settings of the lower solar atmosphere and solar prominences. These investigations involve topics such as MHD waves in magnetic flux tubes, wave excitation, linear and nonlinear mode coupling and wave heating. We outline new challenges that future research should tackle. This article is part of the theme issue 'Partially ionized plasma of the solar atmosphere: recent advances and future pathways'.

2.
Genomics ; 114(2): 110283, 2022 03.
Article in English | MEDLINE | ID: mdl-35143886

ABSTRACT

The liver plays a principal role in avian migration. Here, we characterised the liver transcriptome of a long-distance migrant, the Northern Wheatear (Oenanthe oenanthe), sampled at different migratory stages, looking for molecular processes linked with adaptations to migration. The analysis of the differentially expressed genes suggested changes in the periods of the circadian rhythm, variation in the proportion of cells in G1/S cell-cycle stages and the putative polyploidization of this cell population. This may explain the dramatic increment in the liver's metabolic capacities towards migration. Additionally, genes involved in anti-oxidative stress, detoxification and innate immune responses, lipid metabolism, inflammation and angiogenesis were regulated. Lipophagy and lipid catabolism were active at all migratory stages and increased towards the fattening and fat periods, explaining the relevance of lipolysis in controlling steatosis and maintaining liver health. Our study clears the way for future functional studies regarding long-distance avian migration.


Subject(s)
Animal Migration , Songbirds , Animal Migration/physiology , Animals , Liver , Songbirds/genetics , Transcriptome
3.
World J Oncol ; 13(6): 350-358, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36660210

ABSTRACT

Background: With the ongoing expansion of life-prolonging therapies approved to treat advanced prostate cancer, there is currently an unmet need to better understand real-world treatment patterns and identify optimal treatment sequencing for men with metastatic castration-resistant prostate cancer (mCRPC). Methods: In this retrospective, observational cohort analysis, patients with confirmed mCRPC were identified in the Auditron claims database and used to describe mCRPC treatment patterns and trends in the Brazilian private healthcare system from 2014 to 2019. Demographics and clinical characteristics, prostate cancer stage at diagnosis, and type and number of treatment lines were evaluated. The primary endpoint was identification of the drugs used in first-line therapies in mCRPC, and the secondary endpoint included a description of sequential lines of therapy (second and third lines) in mCRPC. Results: A total of 168 electronic patient records were reviewed. Docetaxel was the most frequently used first-line treatment (35.7%), followed by abiraterone (33.3%) and enzalutamide (13.1%). Docetaxel, abiraterone, and enzalutamide also accounted for 34.6%, 28.0%, and 15.0%, respectively, of second-line therapies. In third-line therapies, cabazitaxel (26.1%), enzalutamide (23.9%), docetaxel (15.2%), and abiraterone (15.2%) were most commonly prescribed. Irrespective of stage at diagnosis, treatment patterns were similar once the disease progressed to the metastatic castration-resistance stage. Conclusions: Docetaxel was the most frequently utilized therapy for mCRPC treatment, followed by abiraterone and enzalutamide. Although the current analyses provide real-world insights into treatment patterns for patients with mCRPC in Brazil, additional real-world data are needed to further validate and expand on these findings.

4.
Biol Lett ; 17(7): 20210195, 2021 07.
Article in English | MEDLINE | ID: mdl-34314642

ABSTRACT

The fuelling capacity of migratory birds and their ability to avoid health conditions derived from the subsequent fat overload are exceptional among vertebrates. In this work, we screen the expression of the genes involved in the production of ketone bodies (KB) in the liver of northern wheatears (Oenanthe oenanthe) during the development and resolution of migratory fattening. Thirteen genes were found to be regulated among the migratory stages. Based on the dynamics of gene expression, we concluded that KB play a versatile role in wheatears' energy metabolism homeostasis. The ketogenic pathway can adaptively: (i) provide carbon equivalents for lipogenesis, speeding up fuelling; (ii) replace glucose during long-distance flights using lipids as the substrate; (iii) act as a floodgate to avoid steatosis; and (iv) might provide a metabolic solution to defatting in captive birds.


Subject(s)
Oenanthe , Songbirds , Animal Migration , Animals , Ketone Bodies
5.
Curr Med Res Opin ; 36(8): 1403-1415, 2020 08.
Article in English | MEDLINE | ID: mdl-32329367

ABSTRACT

Objective: To evaluate the effect of individual lower urinary tract symptoms (LUTS) and LUTS-specific bother on daily/leisure activities, work productivity and treatment behaviors and satisfaction in a Brazilian population reporting symptoms of the overactive bladder (OAB) syndrome.Methods: Secondary analysis of Brazil LUTS study data, including individuals ≥40 years old with a possible diagnosis of OAB, based on a score of ≥8 on the OAB-V8 questionnaire. Participants used a 5-point Likert scale to rate occurrence of LUTS during the previous month. Regression models were constructed to analyze association of symptom frequency and bother, controlled for demographics, comorbid conditions, habits and body mass index, to outcomes related to people's lives and treatment patterns.Results: This analysis included 5184 individuals (53% female), 24.4% of whom received a possible diagnosis of OAB. There was a greater likelihood of OAB symptoms in men reporting depression/anxiety (2.0 times), diabetes (1.8 times), or constipation (1.9 times) and women reporting depression/anxiety (2.6 times), constipation (1.7 times), and being overweight (1.4 times) or obese (1.8 times). Symptoms of all categories, including voiding, storage, and post-micturition, were associated with a negative impact on individuals' lives, quality of life and treatment-related outcomes. Treatment seeking for OAB was low among men and women overall (35.1 and 43.6%, respectively), with highest rates among individuals in the 60-69 age group.Conclusions: LUTS of all categories impacted all domains studied. These results highlight the importance of comprehensive LUTS assessment in OAB patients, including voiding, storage and post-micturition symptoms.


Subject(s)
Efficiency , Lower Urinary Tract Symptoms/psychology , Patient Acceptance of Health Care , Quality of Life , Urinary Bladder, Overactive/psychology , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Middle Aged
6.
J. bras. econ. saúde (Impr.) ; 12(1): 56-65, Abril/2020.
Article in Portuguese | LILACS, ECOS | ID: biblio-1096410

ABSTRACT

Objetivo: Avaliar a relação de custo-efetividade de mirabegrona como tratamento de primeira escolha de pacientes adultos com síndrome da bexiga hiperativa (SBH) comparada a antimuscarínicos orais comumente prescritos no manejo dessa condição. Métodos: O modelo de Markov foi utilizado, com ciclos mensais e horizonte temporal de um ano, para analisar a relação de custo-efetividade de mirabegrona em comparação a tolterodina, oxibutinina, darifenacina e solifenacina. Os pacientes iniciaram o modelo em tratamento com mirabegrona ou um dos comparadores, sendo distribuídos em cinco níveis de gravidade da doença, de acordo com a frequência miccional e número de episódios de incontinência, e a cada ciclo mensal poderiam melhorar, piorar ou permanecer no mesmo nível de severidade do ciclo anterior. Os resultados foram apresentados por meio de uma razão de custo-efetividade incremental. Resultados: Considerando a perspectiva do sistema de saúde suplementar, o custo total do tratamento com mirabegrona foi de R$ 2.455,26 e os parâmetros de efetividade em 0,491 e 0,498 (melhora na gravidade da incontinência e frequência miccional, respectivamente), sendo mais efetivo que os comparadores. Com relação à perspectiva pública, foi estimado um custo com o tratamento de R$ 1.396,01, com características similares de efetividade. De maneira geral, o tratamento com mirabegrona foi dominante quando comparado à tolterodina e custo-efetivo na comparação com os demais antimuscarínicos, em ambas as perspectivas analisadas. Conclusão: Mirabegrona demonstrou ser a melhor opção para tratamento de primeira escolha da SBH com potencial de redução de custos ao longo do tempo, tanto para o sistema público quanto para o sistema de saúde suplementar brasileiro.


Objective: To assess the cost-effectiveness of mirabegron as first-choice treatment in adult patients with of overactive bladder (OAB) compared to oral antimuscarinics, usually prescribed for this condition. Methods: A Markov model has been adopted, with monthly cycles and a one-year time horizon, to analyze the cost-effectiveness of mirabegron compared to antimuscarinic agents: tolterodine; oxybutynin; darifenacin; and solifenacin. The model started with patients receiving treatment with mirabegron or one of the comparators and then, they were assigned to five disease severity levels according to micturition frequency and number of incontinence episodes, and within each monthly cycle they could improve, worsen or remain at the same symptom severity level. Results were presented using an incremental cost-effectiveness ratio. Results: Considering the Brazilian private perspective, treatment with mirabegron resulted in a total cost of R$ 2,455.26 and effectiveness parameters at 0.491 and 0.498 (improvement in incontinence severity and micturition, respectively), being more effective than the comparators. Regarding the Brazilian public perspective, treatment with mirabegron resulted in a total cost of R$ 1,396.01 with similar effectiveness estimation. In general, a dominance was observed when mirabegron was compared to tolterodine and a cost-effectiveness profile against the other muscarinic antagonists, considering both health perspectives. Conclusion: Mirabegron has proven to be the best option for OAB first-line treatment with potential cost savings over time for both the public and private health care systems in Brazil.


Subject(s)
Urinary Bladder , Cost-Benefit Analysis , Adrenergic beta-Agonists , Muscarinic Antagonists , Urinary Bladder, Overactive
7.
Article in English | MEDLINE | ID: mdl-32222683

ABSTRACT

Most of the birds's adaptations for migration have a neuroendocrine origin, triggered by changes in photoperiod and the patterns of Earth's magnetic field. Migration phenomenology has been well described in the past decades, yet the genetic structure behind it remains terra incognita. We used RNA-Seq data to investigate which biological functions are linked with the seasonal brain adaptations of a long-distance trans-continental migratory passerine, the Northern Wheatear (Oenanthe oenanthe). We sequenced the wheatear's transcriptomes at three different stages: lean birds, a characteristic phenotype before the onset of migration, during fattening, and at their maximal migratory body mass. We identified a total of 15,357 genes in the brain of wheatears, of which 84 were differentially expressed. These were mostly related to nervous tissue development, angiogenesis, ATP production, innate immune response, and antioxidant protection, as well as GABA and dopamine signalling. The expression pattern of differentially expressed genes is correlated with typical phenotypic changes before migration, such as hyperphagia, migratory restlessness, and a potential increment in the visual and spatial memory capacities. Our work points out, for future studies, biological functions found to be involved in the development of the migratory phenotype -a unique model to study the core of neural, energetic and muscular adaptations for endurance exercise. Comparison of wheatears' transcriptomic data with two other studies with similar goals shows no correlation among the trends in the gene expression. It highlights the complexity and diversity of adaptations for long-distance migration in birds.


Subject(s)
Adaptation, Physiological , Animal Migration/physiology , Brain/metabolism , Seasons , Songbirds/physiology , Transcriptome , Animals , Songbirds/genetics
8.
Sex Med ; 8(1): 45-56, 2020 Mar.
Article in English | MEDLINE | ID: mdl-31810862

ABSTRACT

INTRODUCTION: Lower urinary tract symptoms (LUTS) affect ≥60% of adult men and are associated with erectile dysfunction (ED) and sexual dissatisfaction. AIM: The aim of this study was to evaluate the relationship among male LUTS, ED, and sexual satisfaction. METHODS: This was a secondary analysis of the Brazil LUTS study, a cross-sectional, epidemiological survey conducted by telephone interview in 5 cities in Brazil. This analysis included men aged ≥40 years. MAIN OUTCOME MEASURE: LUTS were identified using International Continence Society definitions. LUTS severity was assessed using the International Prostate Symptom Score questionnaire. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) questionnaire and sexual satisfaction was rated on a 5-point scale. RESULTS: 2,433 men participated in the study. Of 2,183 men reporting data on LUTS, 873 (40%) had LUTS "about half the time" or more. The prevalence of ED and sexual dissatisfaction was 14.4% and 7.8%, respectively. The proportion of men reporting ED and sexual dissatisfaction was higher among men with LUTS (24.6% and 13.8%, respectively) than men without LUTS (8.7% and 4.5%, respectively; P < .001). LUTS severity was negatively correlated with IIEF-5 scores (r = -0.199; P < .001); we estimated a 0.431-point decrease in IIEF-5 score per 3-point increase in International Prostate Symptom Score. Increased age and the presence of LUTS were associated with a greater chance of ED and sexual dissatisfaction; depression/anxiety and diabetes were associated with a greater chance of sexual dissatisfaction only. Among men with LUTS, urgency with fear of leaking, urgency urinary incontinence, and nocturnal enuresis were associated with a greater chance of ED, whereas slow stream and urgency urinary incontinence were associated with a greater chance of sexual dissatisfaction. CONCLUSION: These results demonstrate that the presence of LUTS is associated with an increased chance of ED and sexual dissatisfaction in Brazilian men and reinforce the importance of a comprehensive assessment of these conditions. Gomes CM, Averbeck MA, Koyama M, et al. Association Among Lower Urinary Tract Symptoms, Erectile Function, and Sexual Satisfaction: Results from the Brazil LUTS Study. Sex Med 2019;8:45-56.

9.
Neurourol Urodyn ; 38(6): 1579-1587, 2019 08.
Article in English | MEDLINE | ID: mdl-31037759

ABSTRACT

AIMS: To report on the impact of lower urinary tract symptoms (LUTS) on treatment-related behaviors and quality of life in Brazilian adults greater than or equal to 40 years. METHODS: Data were from a computer-assisted telephone survey conducted in Brazil between 1 September and 31 December 2015 (Brazil LUTS study). Participants were adults greater than or equal to 40 years with landlines living in major cities from five geographical regions in Brazil. Participants rated how often they experienced individual LUTS during the previous month and associated bother, and the impact on quality of life (QoL), treatment seeking, treatment, treatment satisfaction, and treatment discontinuation. Multiple logistic regression models were adjusted to analyze the simultaneous effects of predictor variables on each dependent variable. RESULTS: When the presence of LUTS was defined as symptoms occurring less than half the time or more, one-quarter of respondents sought treatment but 6% fewer actually received treatment. Of these, around 25% reported dissatisfaction with treatment and almost 10% reported treatment discontinuation. The occurrence of some symptoms and, in particular, the resultant bother were significantly related to worse QoL and to treatment-related outcomes, such as treatment seeking, actual treatment, treatment dissatisfaction, and treatment discontinuation. Symptoms of all three categories were associated with all these domains for both sexes. CONCLUSIONS: This is the first population-based study carried out in South America showing that treatment seeking and treatment rates for LUTS are low. Since the LUTS prevalence is high, this reinforces the importance of a comprehensive medical assessment, focusing on the resulting bother, for more appropriate and personalized patient management.


Subject(s)
Lower Urinary Tract Symptoms/therapy , Patient Acceptance of Health Care , Patient Satisfaction , Quality of Life , Adult , Aged , Aged, 80 and over , Brazil/epidemiology , Female , Humans , Lower Urinary Tract Symptoms/epidemiology , Lower Urinary Tract Symptoms/physiopathology , Male , Middle Aged , Prevalence
10.
PeerJ ; 6: e5860, 2018.
Article in English | MEDLINE | ID: mdl-30498627

ABSTRACT

We have sequenced a partial transcriptome of the Northern Wheatear (Oenanthe oenanthe), a species with one of the longest migrations on Earth. The transcriptome was constructed de novo using RNA-Seq sequence data from the pooled mRNA of six different tissues: brain, muscle, intestine, liver, adipose tissue and skin. The samples came from nine captive-bred wheatears collected at three different stages of the endogenous autumn migratory period: (1) lean birds prior the onset of migration, (2) during the fattening stage and (3) individuals at their migratory body mass plateau, when they have almost doubled their lean body mass. The sample structure used to build up the transcriptome of the Northern Wheatears concerning tissue composition and time guarantees the future survey of the regulatory genes involved in the development of the migratory phenotype. Through the pre-migratory period, birds accomplish outstanding physical and behavioural changes that involve all organ systems. Nevertheless, the molecular mechanisms through which birds synchronize and control hyperphagia, fattening, restlessness increase, immunity boosting and tuning the muscles for such endurance flight are still largely unknown. The use of RNA-Seq has emerged as a powerful tool to analyse complex traits on a broad scale, and we believe it can help to characterize the migratory phenotype of wheatears at an unprecedented level. The primary challenge to conduct quantitative transcriptomic studies in non-model species is the availability of a reference transcriptome, which we have constructed and described in this paper. The cDNA was sequenced by pyrosequencing using the Genome Sequencer Roche GS FLX System; with single paired-end reads of about 400 bp. We estimate the total number of genes at 15,640, of which  67% could be annotated using Turkey and Zebra Finch genomes, or protein sequence information from SwissProt and NCBI databases. With our study, we have made a first step towards understanding the migratory phenotype regarding gene expression of a species that has become a model to study birds long-distance migrations.

11.
J Maxillofac Oral Surg ; 17(4): 582-587, 2018 Dec.
Article in English | MEDLINE | ID: mdl-30344404

ABSTRACT

OBJECTIVES: To compare reconstructed area and surface roughness of 3D models acquired using nine image acquisition protocols. Radiation dose was also compared among acquisition protocols. METHODS: A dry craniofacial specimen was scanned using three CT devices (a cone beam CT, a 16-channel fan beam CT, and a 64-channel fan beam CT), with three different acquisition protocols each. Nine 3D models were manufactured using polylactic acid. Surface roughness and reconstructed area were determined for each 3D model. The radiation dose during acquisitions was measured using lithium crystals. ANOVA was used to compare the data among the 3D models. Linear function optimization techniques based on stochastic variables were applied to identify the most suitable protocol for use. RESULTS: For surface roughness, statistically significant differences were observed among all 3D models and the specimen. For reconstructed area, CBCT and one CT-16 channel protocols originated 3D models statistically significant different from the specimen. Higher radiation doses were observed with fan beam CT acquisitions. CONCLUSIONS: All three CT devices were suitable for 3D printing when used at full resolution. The highest reconstruct area vs. radiation dose ratio was found for 64-channel CT devices.

12.
Neurourol Urodyn ; 37(5): 1559-1566, 2018 06.
Article in English | MEDLINE | ID: mdl-29357104

ABSTRACT

AIMS: The objective of this study was to evaluate the expression of bladder receptors in patients with defunctionalized bladder (DB) and to assess voiding behavior after refunctionalization. METHODS: A total of 68 pretransplant patients were divided in two groups: DB (diuresis <300 mL/24 h; n = 33) and NDB (non-DB; diuresis ≥300 mL/24 h; n = 35). A sample of mucosa and detrusor at the site of the future ureteral implantation was collected. The following receptors were assessed by real-time polymerase chain reaction (qRT-PCR): M2 , M3 , α1D , ß3 , P2X2 , P2X3 , TRPV1, TRPV4, TRPA1, and TRPM8. At 3, 6, and 12 months after transplant patients answered IPSS and ICIQ-OAB questionnaires and filled a 3-day 24 h frequency/volume chart (FVC) at 6 and 12 months. RESULTS: The expression of all receptors in the mucosa and in the detrusor was similar in both groups, except from α1D , which was overexpressed in the detrusor of DB relatively to NDB group. ICIQ-OAB symptom score was similar between the groups at 3, 6, and 12 months. There was a reduction of this score in both groups with time. The same pattern was found for IPSS score. Bother scores were similar between groups. No difference was observed for all FVC parameters between DB and NDB patients. CONCLUSION: Gene expression of bladder receptors involved in micturition control was similar in patients with or without DB. Bladder behavior had a similar pattern independently of pretransplant residual diuresis. These findings question the relevance of the term DB in pretransplant patients.


Subject(s)
Kidney Transplantation/adverse effects , Transplant Recipients , Urinary Bladder Diseases/physiopathology , Urination , Adult , Female , Gene Expression , Humans , Kidney Failure, Chronic/surgery , Kidney Transplantation/methods , Lower Urinary Tract Symptoms/etiology , Male , Middle Aged , Mucous Membrane/drug effects , Postoperative Period , Surveys and Questionnaires , Urinary Bladder/innervation , Urodynamics
13.
Neurourol Urodyn ; 37(4): 1356-1364, 2018 04.
Article in English | MEDLINE | ID: mdl-29106747

ABSTRACT

AIMS: We performed the first large population-based study to evaluate lower urinary tract symptoms (LUTS) in Brazil. The study objective was to assess the prevalence and bother of LUTS in the population aged ≥40 years in five major cities of Brazil. METHODS: This study was conducted as a telephone survey with assessment of LUTS using a standardized protocol, which included the International Prostate Symptom Score (IPSS) and, for overactive bladder (OAB), the OAB-V8 questionnaire. Participants were asked to rate how often they experienced individual LUTS and the degree of associated bother. RESULTS: Of the 5184 participants, 53% were women, and the age group with most participants (34%) was 50-59 years. The prevalence of LUTS (symptoms occurring less than half the time or more) was 75%: 69% in men and 82% in women. There was a statistically significant association between the frequency and bother intensity of each symptom (P < 0.001). The prevalence of OAB was similar in men and women (25% and 24%, respectively). According to the IPSS questionnaire, moderate-to-severe symptoms were present in 21% of men and 24% of women. LUTS detrimentally affected quality of life in many individuals: 39% would be "mostly dissatisfied," "unhappy," or consider it "terrible" to spend the rest of their life with their urinary condition as it is currently. CONCLUSIONS: This was the first nationwide, population-based epidemiological study of LUTS to be performed in Brazil. LUTS are highly prevalent and often bothersome among men and women aged ≥40 years.


Subject(s)
Lower Urinary Tract Symptoms/epidemiology , Quality of Life , Adult , Aged , Aged, 80 and over , Brazil/epidemiology , Cross-Sectional Studies , Female , Health Surveys , Humans , Male , Middle Aged , Prevalence
14.
Rev. esp. enferm. dig ; 108(5): 240-245, mayo 2016. tab
Article in English | IBECS | ID: ibc-152762

ABSTRACT

Background: There are limited data concerning endoscopistdirected endoscopic retrograde cholangiopancreatography deep sedation. The aim of this study was to establish the safety and risk factors for difficult sedation in daily practice. Patients and methods: Hospital-based, frequency matched case-control study. All patients were identified from a database of 1,008 patients between 2014 and 2015. The cases were those with difficult sedations. This concept was defined based on the combination of the receipt of high-doses of midazolam or propofol, poor tolerance, use of reversal agents or sedation-related adverse events. The presence of different factors was evaluated to determine whether they predicted difficult sedation. Results: One-hundred and eighty-nine patients (63 cases, 126 controls) were included. Cases were classified in terms of high-dose requirements (n = 35, 55.56%), sedation-related adverse events (n = 14, 22.22%), the use of reversal agents (n = 13, 20.63%) and agitation/discomfort (n = 8, 12.7%). Concerning adverse events, the total rate was 1.39%, including clinically relevant hypoxemia (n = 11), severe hypotension (n = 2) and paradoxical reactions to midazolam (n = 1). The rate of hypoxemia was higher in patients under propofol combined with midazolam than in patients with propofol alone (2.56% vs. 0.8%, p < 0.001). Alcohol consumption (OR: 2.674 [CI 95%: 1.098-6.515], p = 0.030), opioid consumption (OR: 2.713 [CI 95%: 1.096-6.716], p = 0.031) and the consumption of other psychoactive drugs (OR: 2.015 [CI 95%: 1.017-3.991], p = 0.045) were confirmed to be independent risk factors for difficult sedation. Conclusions: Endoscopist-directed deep sedation during endoscopic retrograde cholangiopancreatography is safe. The presence of certain factors should be assessed before the procedure to identify patients who are high-risk for difficult sedation (AU)


No disponible


Subject(s)
Humans , Male , Female , Endoscopy/methods , Risk Factors , Deep Sedation/adverse effects , Deep Sedation/instrumentation , Deep Sedation/methods , Cholangiopancreatography, Endoscopic Retrograde/methods , Midazolam/therapeutic use , Propofol/therapeutic use , Patient Safety , Case-Control Studies , Hypotension/complications , Psychotropic Drugs/therapeutic use , 28599
16.
Rev Esp Enferm Dig ; 108(5): 240-5, 2016 May.
Article in English | MEDLINE | ID: mdl-26912376

ABSTRACT

BACKGROUND: There are limited data concerning endoscopist-directed endoscopic retrograde cholangiopancreatography deep sedation. The aim of this study was to establish the safety and risk factors for difficult sedation in daily practice. PATIENTS AND METHODS: Hospital-based, frequency matched case-control study. All patients were identified from a database of 1,008 patients between 2014 and 2015. The cases were those with difficult sedations. This concept was defined based on the combination of the receipt of high-doses of midazolam or propofol, poor tolerance, use of reversal agents or sedation-related adverse events. The presence of different factors was evaluated to determine whether they predicted difficult sedation. RESULTS: One-hundred and eighty-nine patients (63 cases, 126 controls) were included. Cases were classified in terms of high-dose requirements (n = 35, 55.56%), sedation-related adverse events (n = 14, 22.22%), the use of reversal agents (n = 13, 20.63%) and agitation/discomfort (n = 8, 12.7%). Concerning adverse events, the total rate was 1.39%, including clinically relevant hypoxemia (n = 11), severe hypotension (n = 2) and paradoxical reactions to midazolam (n = 1). The rate of hypoxemia was higher in patients under propofol combined with midazolam than in patients with propofol alone (2.56% vs. 0.8%, p < 0.001). Alcohol consumption (OR: 2.674 [CI 95%: 1.098-6.515], p = 0.030), opioid consumption (OR: 2.713 [CI 95%: 1.096-6.716], p = 0.031) and the consumption of other psychoactive drugs (OR: 2.015 [CI 95%: 1.017-3.991], p = 0.045) were confirmed to be independent risk factors for difficult sedation. CONCLUSIONS: Endoscopist-directed deep sedation during endoscopic retrograde cholangiopancreatography is safe. The presence of certain factors should be assessed before the procedure to identify patients who are high-risk for difficult sedation.


Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/methods , Deep Sedation/adverse effects , Adult , Aged , Aged, 80 and over , Case-Control Studies , Female , Humans , Hypnotics and Sedatives , Male , Midazolam , Middle Aged , Patient Safety , Physicians , Propofol , Retrospective Studies , Risk Factors
17.
Neurourol Urodyn ; 35(3): 371-6, 2016 Mar.
Article in English | MEDLINE | ID: mdl-25557455

ABSTRACT

AIMS: The objective of this study was to evaluate the similarities and differences of the urethral morphological and functional changes following external urethral sphincter EUS injury in male and female rats. METHODS: 30 female and 30 male age-matched Wistar rats were used in the experiments. Half of them underwent electrocauterization of the surrounding tissues lateral to the urethra at the level of the (EUS) and the others, a sham operation. At 2, 6, and 16 weeks after surgeries they underwent anesthetized cystometry, measurement of leak point pressure (LPP) and their urethras were harvested for morphological analyses. RESULTS: There were no differences in cystometric parameters between sex-time-matched animals, ensuring normal bladder function in the manipulated animals. The mean LPP in male and female rats was lower compared with sham animals. Age-time-matched sham operated male rats exhibited a higher LPP compared with female rats. The reduction in LPP comparing electrocauterized and sham time-matched animals was more pronounced in male rats than in female rats. Electrocauterization produced urethral collagen deposition and nerve damage in both male and female animals. Muscle atrophy and disruption also occurred, being more evident in female rats. CONCLUSIONS: The urethras of male and female rats exhibited a similar morphological and functional response to electrocauterization. The time-course evaluation revealed that the male animal model is as reliable, reproducible and long-lasting as the female model. Intact males had a higher LPP than female rats and the nerve injury led to a more drastic impairment of this mechanism.


Subject(s)
Urethra/injuries , Urinary Incontinence, Stress/etiology , Animals , Collagen/metabolism , Disease Models, Animal , Electrocoagulation , Female , Fibrosis , Male , Muscular Atrophy/etiology , Muscular Atrophy/pathology , Muscular Atrophy/physiopathology , Nerve Regeneration , Peripheral Nerve Injuries/etiology , Peripheral Nerve Injuries/pathology , Peripheral Nerve Injuries/physiopathology , Pressure , Rats, Wistar , Sex Factors , Time Factors , Urethra/innervation , Urethra/metabolism , Urethra/physiopathology , Urinary Incontinence, Stress/metabolism , Urinary Incontinence, Stress/pathology , Urinary Incontinence, Stress/physiopathology , Urodynamics
18.
Odontoestomatol ; 17(25): 42-52, mayo.2015.
Article in English, Spanish | LILACS, BNUY, BNUY-Odon | ID: lil-758742

ABSTRACT

Al enfrentarnos a casos que tienen relación con tumores de cabeza y cuello, hay que tener en cuenta la gran diversidad de presentaciones de las neoplasias, histopatología y topografía anatómica de las mismas. Sumado a esto intervendrán factores etiológicos o de riesgo, que darán distintas características epidemiológicas, sintomatológicas, tanto en la forma de progresión de la enfermedad, como en su pronóstico y plan de tratamiento. En este trabajo los autores presentan un caso clínico de una paciente femenino de 25 años con una maxilectomia, por mixoma odontogénico, en su variable histológica de Fibromixoma Odontogénico, ubicado en el seno maxilar derecho. El tratamiento rehabilitador protésico, se realiza con una prótesis obturatriz esquelética, preparando los pilares paralelizados, con los principios de un eje único y preciso de inserción y retiro...


When dealing with neck and head cancer patients, we must consider the many different types of such tumors that appear when conducting histopathologic and anatomic topography assessment. To this we must add etiological or risk factors that will result in various epidemiological and symptomatological characteristics, both regarding the progression of the disease and the prognosis and treatment plan. In this work a clinical case is presented: a 25-year-old female patient who underwent right maxillectomy for an odontogenic myxoma (fibromyxoma) located in her right maxillary sinus. Prosthetic rehabilitation is done with framework obturator prosthesis. The remaining teeth are prepared by creating parallel pillars to obtain a single and accurate axis for insertion and removal...


Subject(s)
Humans , Maxillofacial Prosthesis Implantation , Maxillary Neoplasms/surgery , Maxillofacial Prosthesis
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