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1.
J Environ Manage ; 338: 117761, 2023 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-37030142

RESUMO

Decreasing greenhouse gas (GHG) emissions and enhancing soil carbon (C) sequestration in cropland are necessary to achieve carbon neutrality at national scale. The major objective of this study is to quantify the GHG mitigation potential of adopted climate resilient (CR) practices in CR villages using Ex-ACT tool developed by Food and Agriculture Organization (FAO). Intensively cultivated area of Punjab and Haryana was selected for carrying out this study. In both the states, villages were selected by considering the climate for past 30 years. In the selected villages, a set of CR practices were implemented in annuals, perennials, irrigated rice, fertilizer use, land use change and livestock and quantified the GHG mitigation potential in these villages for next twenty years. The tool predicted that the CR practices adopted were successful in enhancing the overall sink (carbon balance) in all the study villages. The villages of Punjab had recorded higher mitigation potential as compared to the villages of Haryana. The overall sink potential in these villages ranged from -354 to -38309 Mg CO2-eq. The change in sink potential varied from 3.16 to 112% with lowest in Radauri and highest in Badhauchhi kalan village. The sink potential got doubled in Badhauchhi kalan village due to stopping rice straw burning and increase in area under perennials by 25%. The source potential varied from 6.33 to -7.44% across the study villages. Even with the implementation of NICRA, there was increase in source by 5.58 and 6.33% in Killi Nihal Singh Wala and Radauri due to irrigated rice, land use change and livestock. Majorly, rice straw burning was seen in most of the study villages, yet, with proper residue management and adoption of CR practices (mainly intermittent flooding) in rice cultivation resulted in emissions reduction up to 5-26% with enhanced productivity up to 15-18%, which can be considered for scaling up. Fertilizer management reduced the emissions by average of 13% across the study villages. Farm gate emission intensity per ton of milk and rice recorded highest emission intensity compared to annuals and perennials suggesting strict implementation of CR practices in rice cultivation and livestock sector. Implementation and scaling up of CR practices could potentially reduce the emissions and make the village C negative in intensive rice-wheat production system.


Assuntos
Gases de Efeito Estufa , Oryza , Efeito Estufa , Carbono/análise , Fertilizantes , Agricultura/métodos , Solo/química
2.
J Hosp Infect ; 133: 38-45, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36521581

RESUMO

BACKGROUND: Due to increased requirement for personal protective equipment during the coronavirus disease 2019 pandemic, many medical centres utilized sterilization systems approved under Food and Drug Administration Emergency Use Authorization for single-use N95 mask re-use. However, few studies have examined the real-world clinical challenges and the role of ongoing quality control measures in successful implementation. AIMS: To demonstrate successful implementation of quality control measures in mask reprocessing, and the importance of continued quality assurance. METHODS: A prospective quality improvement study was conducted at a tertiary care medical centre. In total, 982 3M 1860 masks and Kimberly-Clark Tecnol PFR95 masks worn by healthcare workers underwent sterilization using a vaporized hydrogen peroxide gas plasma-based reprocessing system. Post-processing qualitative fit testing (QFT) was performed on 265 masks. Mannequin testing at the National Institute for Occupational Safety and Health (NIOSH) laboratory was used to evaluate the impact of repeated sterilization on mask filtration efficacy and fit. A locally designed platform evaluated the filtration efficiency of clinically used and reprocessed masks. FINDINGS: In total, 255 N95 masks underwent QFT. Of these, 240 masks underwent post-processing analysis: 205 were 3M 1860 masks and 35 were PFR95 masks. Twenty-five (12.2%) of the 3M masks and 10 (28.5%) of the PFR95 masks failed post-processing QFT. Characteristics of the failed masks included mask deformation (N=3, all 3M masks), soiled masks (N=3), weakened elastic bands (N=5, three PFR95 masks), and concern about mask shrinkage (N=3, two 3M masks). NIOSH testing demonstrated that while filter efficiency remained >98% after two cycles, mask strap elasticity decreased by 5.6% after reprocessing. CONCLUSIONS: This study demonstrated successful quality control implementation for N95 mask disinfection, and highlights the importance of real-world clinical testing beyond laboratory conditions.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , SARS-CoV-2 , Estudos Prospectivos , Respiradores N95 , Esterilização , Desinfecção , Reutilização de Equipamento , Máscaras
3.
Clin Radiol ; 77(8): 613-620, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35589431

RESUMO

AIM: To investigate if the pattern of fluorine-18-labelled sodium fluoride (18F-NaF) uptake on integrated positron-emission tomography (PET)/magnetic resonance imaging (MRI) of bone marrow lesions (BML) and osteophytes differs between different knee compartments. MATERIALS AND METHODS: Sixteen patients with no prior history of knee injury with or without pain were recruited for the study. The images of both knees were acquired on simultaneous PET/MRI. The acquisition was done after 45 minutes of intravenous injection of 18F-NaF 185-370 MBq (5-10 mCi) for 40 minutes. Each knee was divided into eight compartments patella, trochlea, medial central femur, lateral central femur, medial posterior femur, lateral posterior femur, medial tibia, lateral tibia, and cruciate ligament insertion specifically for BML. BML and osteophytes were scored using MRI Osteoarthritis Knee Score (MOAKS) criteria and their corresponding maximum standardised uptake values (SUVmax) recorded. RESULTS: BML and osteophytes both showed statistically significant differences among knee compartments, i.e., p-value <0.000 and < 0.043 respectively. SUVmax for BML and osteophytes was greatest in the medial tibia. CONCLUSION: 18F-NaF PET/MRI showed that BML and osteophytes had differential uptake values due to bone remodelling amongst the various knee compartments and this may help to design disease-modifying osteoarthritis drugs in the future.


Assuntos
Doenças Ósseas , Osteoartrite do Joelho , Osteófito , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Imageamento por Ressonância Magnética/métodos , Osteoartrite do Joelho/diagnóstico por imagem , Osteófito/patologia , Tomografia por Emissão de Pósitrons/métodos , Fluoreto de Sódio
4.
Dig Dis Sci ; 66(12): 4197-4207, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33409801

RESUMO

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease of immense public health relevance. Understanding illness perceptions in the NAFLD population will provide sound scientific evidence for planning high-quality patient-centered care and implementing effective interventions. The Brief Illness Perception Questionnaire (BIPQ) is a robust psychometric tool to systematically assess the dimensions of illness perceptions in various chronic ailments. METHODS: In a cross-sectional study enrolling patients with newly diagnosed NAFLD, the sociodemographic, anthropometric, biochemical, and radiological determinants of enhanced illness perceptions (measured by the BIPQ score) were investigated using univariate and multivariable binary logistic regression analyses. Finally, the association between individual domains of the BIPQ and willingness to participate in comprehensive medical management was explored. RESULTS: In total, 264 patients (mean age 53 ± 11.9 years, 59.8% males) were enrolled in the final analysis. The mean and median BIPQ scores in the study population were 30.3 ± 12.8 and 31.0 (IQR, 22.0-40.0), respectively. The variables having a significant independent association with heightened perceptions (BIPQ > 31) were family history of liver disease (aOR, 5.93; 95% CI, 1.42-24.74), obesity (aOR, 3.33; 95% CI, 1.57-7.05), diabetes mellitus (aOR, 2.35; 95% CI, 1.01-5.49), and transaminitis (aOR, 2.85; 95% CI, 1.42-5.69). Patients with a higher level of illness perceptions (31.6 ± 12.9 vs 27.8 ± 12.3, p = 0.022) were more likely to express a willingness to participate in the comprehensive management plan, with 3 of the 8 domains (consequence, identity, and treatment control) mainly affecting willingness. CONCLUSION: A family history of liver disease, obesity, diabetes, and transaminitis were independently associated with increased illness perceptions. A belief in serious consequences, a strong illness identity, and higher perceived treatment control were significantly associated with the willingness to undergo comprehensive care for NAFLD.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Comportamento de Doença , Hepatopatia Gordurosa não Alcoólica/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Idoso , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/psicologia , Participação do Paciente , Psicometria , Fatores de Risco , Inquéritos e Questionários
5.
Indian Heart J ; 72(3): 145-150, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32768012

RESUMO

An echocardiographic investigation is one of the key modalities of diagnosis in cardiology. There has been a rising presence of cardiological comorbidities in patients positive for COVID-19. Hence, it is becoming extremely essential to look into the correct safety precautions, healthcare professionals must take while conducting an echo investigation. The decision matrix formulated for conducting an echocardiographic evaluation is based on presence or absence of cardiological comorbidity vis-à-vis positive, suspected or negative for COVID-19. The safety measures have been constructed keeping in mind the current safety precautions by WHO, CDC and MoHFW, India.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Ecocardiografia/métodos , Pandemias/prevenção & controle , Segurança do Paciente , Pneumonia Viral/prevenção & controle , COVID-19 , Cardiologia , Doenças Cardiovasculares/epidemiologia , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Índia , Controle de Infecções/métodos , Masculino , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/prevenção & controle , Sociedades Médicas
6.
Eur J Neurol ; 27(6): 1039-1047, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32149450

RESUMO

BACKGROUND AND PURPOSE: We investigated the effectiveness of intravenous thrombolysis (IVT) in acute ischaemic stroke (AIS) patients with large vessel or distal occlusions and mild neurological deficits, defined as National Institutes of Health Stroke Scale scores < 6 points. METHODS: The primary efficacy outcome was 3-month functional independence (FI) [modified Rankin Scale (mRS) scores 0-2] that was compared between patients with and without IVT treatment. Other efficacy outcomes of interest included 3-month favorable functional outcome (mRS scores 0-1) and mRS score distribution at discharge and at 3 months. The safety outcomes comprised all-cause 3-month mortality, symptomatic intracranial hemorrhage (ICH), asymptomatic ICH and severe systemic bleeding. RESULTS: We evaluated 336 AIS patients with large vessel or distal occlusions and mild stroke severity (mean age 63 ± 15 years, 45% women). Patients treated with IVT (n = 162) had higher FI (85.6% vs. 74.8%, P = 0.027) with lower mRS scores at hospital discharge (P = 0.034) compared with the remaining patients. No differences were detected in any of the safety outcomes including symptomatic ICH, asymptomatic ICH, severe systemic bleeding and 3-month mortality. IVT was associated with higher likelihood of 3-month FI [odds ratio (OR), 2.19; 95% confidence intervals (CI), 1.09-4.42], 3-month favorable functional outcome (OR, 1.99; 95% CI, 1.10-3.57), functional improvement at discharge [common OR (per 1-point decrease in mRS score), 2.94; 95% CI, 1.67-5.26)] and at 3 months (common OR, 1.72; 95% CI, 1.06-2.86) on multivariable logistic regression models adjusting for potential confounders, including mechanical thrombectomy. CONCLUSIONS: Intravenous thrombolysis is independently associated with higher odds of improved discharge and 3-month functional outcomes in AIS patients with large vessel or distal occlusions and mild stroke severity. IVT appears not to increase the risk of systemic or symptomatic intracranial bleeding.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Administração Intravenosa , Idoso , Isquemia Encefálica/tratamento farmacológico , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Hemorragias Intracranianas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/tratamento farmacológico , Trombectomia , Terapia Trombolítica , Resultado do Tratamento
7.
Indian Pediatr ; 56(11): 965-967, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31729328

RESUMO

We performed a review of case records of children diagnosed with hepatic venous outflow tract obstruction at our center in last 10 years. Out of 11 cases identified, 6 had variable blocks in the hepatic venous system and 4 had combined hepatic venous and inferior vena cava (IVC) block. One child with paroxysmal nocturnal hemoglobinuria (PNH) had isolated IVC involvement. Angioplasty was attempted in 3 patients; among them 2 had successful outcome. Seven children with advanced liver disease underwent transplantation, which was successful in six. With availability of modalities like interventional radiology and transplantation, the overall prognosis of hepatic venous outflow tract obstruction seems to be good when managed in a well-equipped center.


Assuntos
Angioplastia/métodos , Síndrome de Budd-Chiari , Doença Hepática Terminal , Veias Hepáticas , Transplante de Fígado , Síndrome de Budd-Chiari/etiologia , Síndrome de Budd-Chiari/fisiopatologia , Síndrome de Budd-Chiari/cirurgia , Criança , Doença Hepática Terminal/complicações , Doença Hepática Terminal/fisiopatologia , Doença Hepática Terminal/cirurgia , Feminino , Hemoglobinúria Paroxística/complicações , Hemoglobinúria Paroxística/fisiopatologia , Veias Hepáticas/diagnóstico por imagem , Veias Hepáticas/cirurgia , Humanos , Índia/epidemiologia , Transplante de Fígado/métodos , Transplante de Fígado/estatística & dados numéricos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Prognóstico , Radiografia Intervencionista/métodos
8.
Eur J Neurol ; 25(12): 1417-1424, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29953701

RESUMO

BACKGROUND AND PURPOSE: To determine the association of differential leukocyte counts on admission with efficacy and safety outcomes in patients with acute ischaemic stroke (AIS) treated with intravenous thrombolysis (IVT). METHODS: Consecutive patients with AIS receiving IVT were evaluated at two stroke centers. Differential leukocyte counts and neutrophil:lymphocyte ratio (NLR) were determined during the initial 12 h of admission. Efficacy outcomes were favorable functional outcome (FFO) (modified Rankin Scale scores of 0-1) and functional independence (FI) (modified Rankin Scale scores of 0-2) at 3 months, whereas safety outcomes were symptomatic intracranial hemorrhage and 3-month mortality. RESULTS: Among 657 IVT-treated patients with AIS, the mean age was 64 ± 14 years, 50% were female and median National Institutes of Health Stroke Scale score was 7 points (interquartile range, 4-13). Lower neutrophil and leukocyte counts and NLR counts were observed in patients with 3-month FFO and FI, whereas higher counts were observed in patients who died at 3 months. The best discriminative factors for 3-month FFO and FI were NLR < 2.2 (sensitivity 51.4%, specificity 63.1%) and leukocyte count <8100/µL (sensitivity 57.5%, specificity 55.1%), respectively. After adjustment for potential confounders, NLR < 2.2 was associated with higher odds of FFO [odds ratio (OR), 1.56; 95% confidence interval (CI), 1.08-2.24; P = 0.018], whereas leukocyte count <8100/µL demonstrated higher odds of 3-month FI (OR, 1.69; 95% CI, 1.11-2.57; P = 0.014) and lower odds of 3-month mortality (OR, 0.31; 95% CI, 0.16-0.60; P = 0.001). Combined neutrophil (<6800/µL) and leukocyte (<8100/µL) counts demonstrated a strong interaction for 3-month FI (OR, 1.73; 95% CI, 1.13-2.67; P interaction = 0.012). CONCLUSIONS: Differential leukocyte counts on admission were independently associated with clinical outcomes in patients with AIS treated with IVT. These inflammatory biomarkers are potential targets for adjunctive neuroprotection in this stroke subgroup.


Assuntos
Isquemia Encefálica/sangue , Fibrinolíticos/uso terapêutico , Contagem de Leucócitos , Acidente Vascular Cerebral/sangue , Terapia Trombolítica/métodos , Administração Intravenosa , Idoso , Isquemia Encefálica/tratamento farmacológico , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Acidente Vascular Cerebral/tratamento farmacológico , Resultado do Tratamento
9.
Clin Genet ; 93(1): 119-125, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28692196

RESUMO

Mutations in valosin-containing protein (VCP), an ATPase involved in protein degradation and autophagy, cause VCP disease, a progressive autosomal dominant adult onset multisystem proteinopathy. The goal of this study is to examine if phenotypic differences in this disorder could be explained by the specific gene mutations. We therefore studied 231 individuals (118 males and 113 females) from 36 families carrying 15 different VCP mutations. We analyzed the correlation between the different mutations and prevalence, age of onset and severity of myopathy, Paget's disease of bone (PDB), and frontotemporal dementia (FTD), and other comorbidities. Myopathy, PDB and FTD was present in 90%, 42% and 30% of the patients, respectively, beginning at an average age of 43, 41, and 56 years, respectively. Approximately 9% of patients with VCP mutations had an amyotrophic lateral sclerosis (ALS) phenotype, 4% had been diagnosed with Parkinson's disease (PD), and 2% had been diagnosed with Alzheimer's disease (AD). Large interfamilial and intrafamilial variation made establishing correlations difficult. We did not find a correlation between the mutation type and the incidence of any of the clinical features associated with VCP disease, except for the absence of PDB with the R159C mutation in our cohort and R159C having a later age of onset of myopathy compared with other molecular subtypes.


Assuntos
Doença de Alzheimer/genética , Esclerose Lateral Amiotrófica/genética , Predisposição Genética para Doença/genética , Mutação , Doença de Parkinson/genética , Proteína com Valosina/genética , Adulto , Idade de Início , Idoso , Estudos de Coortes , Saúde da Família , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Adulto Jovem
10.
PLoS One ; 12(2): e0172023, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28199363

RESUMO

INTRODUCTION: Infra-popliteal angioplasty continues to be widely performed with minimal evidence to guide practice. Endovascular device selection is contentious and there is even uncertainty over which artery to treat for optimum reperfusion. Direct reperfusion (DR) targets the artery supplying the ischaemic tissue. Indirect reperfusion (IR) targets an artery supplying collaterals to the ischaemic area. Our unit practice for the last eight years has been to attempt to open all tibial arteries at the time of angioplasty. When successful, this results in both direct and indirect; or combined reperfusion (CR). The aim was to review the outcomes of CR and compare them with DR or IR alone. METHODS: An eight year retrospective review from a single unit of all infra-popliteal angioplasties was undertaken. Wound healing, limb salvage, amputation-free and overall survival data as well as re-intervention rates were captured for all patients. Subgroup analysis for diabetics was undertaken. Kaplan Meier curves are presented for survival outcomes. All odds and hazard ratios (HR) and p values were corrected for bias from confounders using multivariate analysis. RESULTS: 250 procedures were performed: 22 (9%) were CR; 115 (46%) DR and 113 (45%) IR. Amputation-free survival (HR 0.504, p = 0.039) and re-intervention and amputation-free survival (HR 0.414, p = 0.005) were significantly improved in patients undergoing CR compared to IR. Wound healing was similarly affected by reperfusion strategy (OR = 0.35, p = 0.047). Effects of CR over IR were similar when only diabetic patients were considered. CONCLUSIONS: Combined revascularisation can only be achieved in approximately 10% of patients. However, when successful, it results in significant improvements in wound healing and amputation-free survival over simple indirect reperfusion techniques.


Assuntos
Angioplastia , Isquemia/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Complicações do Diabetes/complicações , Complicações do Diabetes/patologia , Intervalo Livre de Doença , Feminino , Humanos , Isquemia/mortalidade , Estimativa de Kaplan-Meier , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Modelos de Riscos Proporcionais , Reperfusão , Estudos Retrospectivos , Cicatrização
11.
Gene ; 611: 1-8, 2017 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-28188871

RESUMO

LIM domains are zinc-binding motifs that mediate protein-protein interactions and are found in a wide variety of cytoplasmic and nuclear proteins. The nuclear LIM domain family members have a number of different functions including transcription factors, gene regulation, cell fate determination, organization of the cytoskeleton and tumour formation exerting their function through various LIM domain interacting protein partners/cofactors. Nuclear LIM domain interacting proteins/factors have not been reported in any protozoan parasites including Leishmania. Here, we report for the first time cloning, characterization and subcellular localization of nuclear LIM interactor-interacting factor (NLI) like protein from Leishmania donovani, the causative agent of Indian Kala-azar. Primary sequence analysis of LdNLI revealed presence of characteristic features of nuclear LIM interactor-interacting factor. However, leishmanial NLI represents a distinct kinetoplastid group, clustered in a separate branch of the phylogenic tree. The sub-cellular distribution of LdNLI revealed the discreet localization in nucleus and kinetoplast only, suggesting that the gene may have a role in parasite gene expression.


Assuntos
Proteínas de Ligação a DNA/metabolismo , Proteínas com Domínio LIM/metabolismo , Leishmania donovani/metabolismo , Proteínas Nucleares/metabolismo , Proteínas de Protozoários/metabolismo , Sequência de Aminoácidos , Southern Blotting , Western Blotting , Núcleo Celular/metabolismo , Clonagem Molecular , DNA de Cinetoplasto/metabolismo , DNA de Protozoário/química , DNA de Protozoário/genética , Proteínas de Ligação a DNA/classificação , Proteínas de Ligação a DNA/genética , Dosagem de Genes , Regulação da Expressão Gênica , Proteínas com Domínio LIM/genética , Leishmania donovani/genética , Microscopia de Fluorescência , Proteínas Nucleares/classificação , Proteínas Nucleares/genética , Filogenia , Proteínas de Protozoários/classificação , Proteínas de Protozoários/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Análise de Sequência de DNA , Homologia de Sequência de Aminoácidos
12.
J Perinatol ; 37(2): 144-149, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27735928

RESUMO

OBJECTIVE: The objective of the study was to determine the association of home visiting with subsequent pregnancy outcomes. STUDY DESIGN: Retrospective study of Ohio mothers delivering their first infant from 2007 to 2009. First, we compared mothers enrolled in home visiting with a matched eligible group. Second, we compared outcomes within home visiting based on program participation (low <25% of recommended home visits, moderate 25 to 75%, high 75 to 100% and very high >100%). Time to subsequent pregnancy within 18 months was evaluated using Cox proportional hazards regression; logistic regression tested the likelihood of subsequent preterm birth. RESULTS: Of 1516 participants, 1460 were matched 1:1 to a comparison mother (n=2920). After multivariable adjustment, enrollment was associated with no difference in pregnancy spacing or subsequent preterm birth. Among those enrolled, moderate vs low participants had reduced risk of repeat pregnancy over 18 months (hazard ratio 0.68, P=0.003). CONCLUSION: Increased pregnancy spacing is observed among women with at least moderate home visiting participation.


Assuntos
Intervalo entre Nascimentos/estatística & dados numéricos , Visita Domiciliar/estatística & dados numéricos , Cuidado Pós-Natal/métodos , Nascimento Prematuro/epidemiologia , Adolescente , Adulto , Feminino , Serviços de Assistência Domiciliar/organização & administração , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Mães , Análise Multivariada , Ohio/epidemiologia , Gravidez , Resultado da Gravidez , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Adulto Jovem
13.
J Orthop Surg (Hong Kong) ; 24(1): 3-6, 2016 04.
Artigo em Inglês | MEDLINE | ID: mdl-27122503

RESUMO

PURPOSE: To determine whether intra-articular tranexamic acid (TXA) use after total knee arthroplasty (TKA) results in decreased postoperative blood transfusion and length of hospital stay. METHODS: Medical records of 1981 patients (mean age, 69.2 years) who underwent primary TKA with (n=1006) or without (n=975) TXA use by any of 4 knee arthroplasty surgeons were reviewed. TXA (3000 mg/30ml) was administered via an epidural catheter into the knee joint after wound closure. Postoperative blood transfusion was given to patients with haemoglobin (Hb) level <80 g/dl on days 1 and 2 or with symptoms of acute anaemia. RESULTS: Intra-articular TXA use after TKA resulted in a lower blood transfusion rate (4.5% [45/1006] vs. 14.8% [144/975], p<0.0001), fewer units of blood transfused (86 vs. 313 units, p<0.0001), fewer units of blood transfused per 100 patients (8.5 vs. 32.1, p<0.0001), and shorter length of hospital stay (4.7±2.3 vs. 5.3±2.7 days, p<0.0001). Total cost savings with respect to the reduction in blood transfusion was AU$143.68 per patient. When the change in length of hospital stay and TXA costs were included, the overall saving was AU$631.36 per patient. CONCLUSION: Intra-articular TXA use can reduce costs as a result of decreased blood transfusion rate and length of hospital stay in patients undergoing TKA.


Assuntos
Antifibrinolíticos/administração & dosagem , Artroplastia do Joelho , Artropatias/cirurgia , Ácido Tranexâmico/administração & dosagem , Idoso , Transfusão de Sangue , Redução de Custos , Feminino , Humanos , Injeções Intra-Articulares , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Estudos Retrospectivos
14.
Scand J Immunol ; 83(5): 338-44, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26946082

RESUMO

Extrapulmonary tuberculosis (EPTB) remains a challenging diagnosis both for clinicians and microbiologists. We hypothesized that the profile of IFN-ɤ/IL-2 ratio in clinically diagnosed cases of EPTB would be distinct from that of age- and sex-matched healthy controls. Therefore, in our study, we have assessed the ratio of serum levels of IFN-ɤ and IL-2 in clinically diagnosed cases of EPTB to assess their potential role as diagnostic biomarkers. Sixty-nine (69) clinically confirmed EPTB cases and 69 age- and sex-matched healthy controls were included in the study. All the extrapulmonary specimens were subjected to Ziehl-Neelsen staining for acid-fast bacilli and culture on Lowenstein-Jensen (LJ) medium. Detection of serum levels of IFN-ɤ and IL-2 was carried out using commercially available ELISA kits following manufacturers' instructions. The ratio of serum levels of IFN-ɤ and IFN-ɤ/IL-2 was discriminative for the diagnosis of EPTB cases (p < 0.001), although the same was not observed with IL-2 (p > 0.05). Distribution of all biomarkers significantly differed between culture-positive and culture-negative cases (p < 0.05). Among the smear-positive and smear-negative ones, only IFN-ɤ and IFN-ɤ/IL-2 ratio could significantly differentiate (p < 0.05). Ratio of IFN-ɤ and IL-2 rather than the individual levels was the best discriminatory biomarker with the highest area under the ROC curve. Although IFN-ɤ and IFN-ɤ/ IL-2 ratio could aid in the diagnosis of EPTB, IL-2 has a limited utility in the diagnosis of EPTB. Further elaborate studies to validate these results are required.


Assuntos
Biomarcadores/sangue , Interferon gama/sangue , Interleucina-2/sangue , Mycobacterium tuberculosis/imunologia , Tuberculose dos Linfonodos/diagnóstico , Tuberculose Pleural/diagnóstico , Tuberculose Pulmonar/diagnóstico , Tuberculose Urogenital/diagnóstico , Adolescente , Adulto , Idoso , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
15.
J Neurol Neurosurg Psychiatry ; 87(4): 373-8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25857661

RESUMO

OBJECTIVES: To explore phenotypic differences between individuals with sporadic inclusion body myositis (sIBM) who are seropositive for the NT5c1A antibody compared with those who are seronegative. METHODS: Cross-sectional clinical, serological and functional analysis in 25 consecutive participants with sIBM. RESULTS: All participants met criteria for clinically defined or probable sIBM. 18 of 25 participants with sIBM (72%) were seropositive for the NT5c1A antibody. No differences between median age and duration of illness between the two groups were seen. Females have higher odds of being seropositive (OR=2.30). Participants with seropositive sIBM took significantly longer to get up and stand (p=0.012). There were no significant differences between the two groups in terms of distance covered on a 6 min walk. Seropositive participants were more likely to require assistive devices such as a walker or wheelchair for mobility (OR=23.00; p=0.007). A number of secondary (exploratory) outcomes were assessed. NT5c1A seropositive sIBM cases had lower total Medical Research Council (MRC) sum score and MRC sum score on the right (p=0.03 and 0.02, respectively). Participants with the NT5c1A antibody were significantly more likely to have symptoms of dysphagia (OR=10.67; p=0.03) and reduced forced vital capacity (p=0.005). Facial weakness occurred in 50% of seropositive participants while it was only seen in 14% of seronegative participants. CONCLUSIONS: Even though the small sample size limits definite conclusions, our cross-sectional study showed seropositivity to the NT5c1A antibody is associated with greater motor and functional disability in sIBM. The study also suggests more prominent bulbar, facial and respiratory involvement in individuals positive for NT5c1A antibodies.


Assuntos
5'-Nucleotidase/imunologia , Miosite de Corpos de Inclusão/complicações , Miosite de Corpos de Inclusão/imunologia , 5'-Nucleotidase/análise , Idoso , Anticorpos/análise , Estudos Transversais , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Miosite de Corpos de Inclusão/fisiopatologia , Desempenho Psicomotor , Qualidade de Vida , Transtornos Respiratórios/etiologia , Transtornos Respiratórios/fisiopatologia , Tecnologia Assistiva , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/fisiopatologia , Resultado do Tratamento , Capacidade Vital
17.
Perfusion ; 30(2): 94-105, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24947460

RESUMO

Myocardial infarction is a pathological state which occurs due to severe abrogation of the blood supply (ischemia) to a part of heart, which can cause myocardial damage. The short intermittent cycles of sub-lethal ischemia and reperfusion has shown to improve the tolerance of the myocardium against subsequent prolonged ischemia/reperfusion (I/R)-induced injury, which is known as ischemic preconditioning (IPC). Although, IPC-induced cardioprotection is well demonstrated in various species, including human beings, accumulated evidence clearly suggests critical abrogation of the beneficial effects of IPC in diabetes mellitus, hyperlipidemia and hyperhomocysteinemia. Various factors are involved in the attenuation of the cardioprotective effect of preconditioning, such as the reduced release of calcitonin gene-related peptide (CGRP), the over-expression of glycogen synthase kinase-3ß (GSK-3ß) and phosphatase and tensin homolog (PTEN), impairment of mito-KATP channels, the consequent opening of mitochondrial permeability transition pore (MPTP), etc. In this review, we have critically discussed the various signaling pathways involved in abrogated preconditioning in chronic diabetes mellitus, hyperlipidemia and hyperhomocysteinemia. We have also focused on the involvement of PTEN in abrogated preconditioning and the significance of PTEN inhibitors.


Assuntos
Precondicionamento Isquêmico Miocárdico , Doenças Metabólicas , Infarto do Miocárdio , Miocárdio/metabolismo , Humanos , Doenças Metabólicas/metabolismo , Doenças Metabólicas/patologia , Doenças Metabólicas/terapia , Proteínas Musculares , Infarto do Miocárdio/metabolismo , Infarto do Miocárdio/patologia , Infarto do Miocárdio/terapia , Miocárdio/patologia
18.
Bone Joint J ; 95-B(1): 4-9, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23307666

RESUMO

Staphylococcus aureus is one of the leading causes of surgical site infection (SSI). Over the past decade there has been an increase in methicillin-resistant S. aureus (MRSA). This is a subpopulation of the bacterium with unique resistance and virulence characteristics. Nasal colonisation with either S. aureus or MRSA has been demonstrated to be an important independent risk factor associated with the increasing incidence and severity of SSI after orthopaedic surgery. Furthermore, there is an economic burden related to SSI following orthopaedic surgery, with MRSA-associated SSI leading to longer hospital stays and increased hospital costs. Although there is some controversy about the effectiveness of screening and eradication programmes, the literature suggests that patients should be screened and MRSA-positive patients treated before surgical admission in order to reduce the risk of SSI.


Assuntos
Programas de Rastreamento/métodos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Procedimentos Ortopédicos , Cuidados Pré-Operatórios/métodos , Infecções Estafilocócicas/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Antibacterianos/economia , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/economia , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/economia , Humanos , Programas de Rastreamento/economia , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Mucosa Nasal/microbiologia , Procedimentos Ortopédicos/economia , Cuidados Pré-Operatórios/economia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/economia , Infecção da Ferida Cirúrgica/economia , Estados Unidos , Virulência
19.
Epidemiol Infect ; 141(10): 2094-100, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23298643

RESUMO

In India, rotavirus infections cause the death of 98621 children each year. In urban neighbourhoods in Delhi, children were followed up for 1 year to estimate the incidence of rotavirus gastroenteritis and common genotypes. Infants aged f1 week were enrolled in cohort 1 and infants aged 12 months (up to +14 days) in cohort 2. Fourteen percent (30/210) gastroenteritis episodes were positive for rotavirus. Incidence rates of rotavirus gastroenteritis episodes in the first and second year were 0.18 [95% confidence interval (CI) 0.10­0.27] and 0.14 (95% CI 0.07­0.21) episodes/child-year, respectively. The incidence rate of severe rotavirus gastroenteritis in the first year of life was 0.05 (95% CI 0.01­0.10) episodes/child-year. There were no cases in the second year. The common genotypes detected were G1P[8] (27%) and G9P[4] (23%). That severe rotavirus gastroenteritis is common in the first year of life is relevant for planning efficacy trials.


Assuntos
Gastroenterite/epidemiologia , Gastroenterite/virologia , Infecções por Rotavirus/epidemiologia , Rotavirus/isolamento & purificação , Pré-Escolar , Fezes/virologia , Seguimentos , Humanos , Incidência , Índia/epidemiologia , Lactente , Recém-Nascido , Intussuscepção/epidemiologia , Intussuscepção/virologia , Rotavirus/genética , Infecções por Rotavirus/virologia , Estações do Ano , Índice de Gravidade de Doença
20.
Clin Radiol ; 68(1): 85-93, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22854266

RESUMO

Clinically equivocal abdominal wall lesions often pose diagnostic dilemmas for clinicians. It can be equally challenging to appreciate the nature of abdominal wall lesions found incidentally on abdominal ultrasound examinations. Ultrasound is a non-ionizing, cheap, and easily accessible investigation for such lesions. It is widely used and has the added advantage of being a dynamic investigation. However, imaging with ultrasound is operator-dependent and relies on technical skills. It is important to understand the imaging of normal anatomy and to be familiar with the imaging appearance of lesions. We present a review of various lesions seen during ultrasound examinations of the abdominal wall or as incidental findings on abdominal ultrasound.


Assuntos
Parede Abdominal/diagnóstico por imagem , Abscesso Abdominal/diagnóstico por imagem , Cicatriz/diagnóstico por imagem , Criptorquidismo/diagnóstico por imagem , Endometriose/diagnóstico por imagem , Feminino , Corpos Estranhos/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Hérnia Abdominal/diagnóstico por imagem , Humanos , Hipertensão Portal/diagnóstico por imagem , Masculino , Neoplasias Musculares/diagnóstico por imagem , Miosite/diagnóstico por imagem , Reto do Abdome/diagnóstico por imagem , Ultrassonografia
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