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1.
J Neurosci Res ; 102(6): e25360, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38847288

RESUMO

Childhood obesity increases the risk of health and cognitive disorders in adulthood. Consuming high-fat diets (HFD) during critical neurodevelopmental periods, like childhood, impairs cognition and memory in humans and animals, affecting the function and connectivity of brain structures related to emotional memory. However, the underlying mechanisms of such phenomena need to be better understood. This study aimed to investigate the neurochemical profile of the amygdala and hippocampus, brain structures involved in emotional memory, during the acquisition of conditioned odor aversion in male rats that consumed a HFD from weaning to adulthood. The rats gained weight, experienced metabolic changes, and reduced insulin sensitivity and glucose tolerance. Rats showed enhanced odor aversion memory, contrary to the expected cognitive impairments. This memory enhancement was accompanied by increased noradrenergic and glutamatergic neurotransmission in the amygdala and hippocampus. Importantly, this upregulation was specific to stimuli exposure, as basal neurotransmitter levels remained unaltered by the HFD. Our results suggest that HFD modifies cognitive function by altering neurochemical signaling, in this case, upregulating neurotransmitter levels rendering a stronger memory trace, demonstrating that metabolic dysfunctions do not only trigger exclusively detrimental plasticity processes but also render enhanced plastic effects depending on the type of information.


Assuntos
Tonsila do Cerebelo , Dieta Hiperlipídica , Ácido Glutâmico , Hipocampo , Transmissão Sináptica , Animais , Masculino , Dieta Hiperlipídica/efeitos adversos , Hipocampo/metabolismo , Tonsila do Cerebelo/metabolismo , Transmissão Sináptica/fisiologia , Ratos , Ácido Glutâmico/metabolismo , Norepinefrina/metabolismo , Ratos Wistar , Cognição/fisiologia , Aprendizagem da Esquiva/fisiologia
2.
Public Health Rep ; 139(2): 180-186, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38111103

RESUMO

A key component of decreasing severe disease, hospitalizations, and death due to COVID-19 has been increasing vaccine accessibility to residents in communities where access to health care is poor and residents are at increased risk of poor health outcomes. Driven by the expansive geography and diverse population it serves, the Los Angeles County Department of Public Health built an extensive school vaccination network by partnering with the county's roughly 3000 schools and vaccine providers. We report on the process of building this network and its impact on vaccination coverage. We describe a unique equity metric (HPI+) that used a combination of the Healthy Places Index (HPI) and COVID-19 transmission and vaccination data to prioritize school-located vaccination efforts. More than 328 991 doses of COVID-19 vaccine were administered at 1050 schools in Los Angeles County from April 15, 2021, through June 18, 2022. Nearly 10% of all doses administered to children aged 5-11 years in Los Angeles County were at school-located vaccine clinics. Most vaccine clinic days (77.3%) were held at schools in HPI+ zip codes. Most doses (68.3%) were administered in HPI+ regions and to people aged ≥12 years (70.3%). Vaccinating the community at schools is an effective public health intervention; however, increased outreach efforts were required in HPI+ regions to ensure equitable access to vaccines. This case study can be used to replicate public health interventions using schools to support access to health care services for students and the surrounding community.


Assuntos
COVID-19 , Vacinas , Humanos , Criança , Vacinas contra COVID-19 , Los Angeles/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Instituições Acadêmicas , Vacinação
3.
Salud Publica Mex ; 65(2 mar-abr): 160-166, 2023 Mar 10.
Artigo em Espanhol | MEDLINE | ID: mdl-38060853

RESUMO

OBJETIVO: Estimar la diversidad de garrapatas, la prevalencia de infestación y tasa de infección de Rickettsia spp. en ganado bovino en la costa del estado de Chiapas. Material y métodos. Se realizó un estudio transversal de octubre de 2021 a marzo de 2022, que incluyó la extracción de garrapatas de 297 vacas pertenecientes a 5 municipios. Se calcularon los índices de diversidad. El diagnóstico de Rickettsia spp en las garrapatas se realizó mediante PCR anida. RESULTADOS: Se encontró una baja diversidad de especies. Las especies Rhipicephalus microplus, Amblyomma cajennense y Rhipicephalus sanguineus hembra adultas fueron positivas a Rickettsia spp. Los municipios de Pijijiapan y Tonalá presentaron la TMI más alta con 7.5 y 7.2%. Conclusión. Este es primer estudio México que reporta infección de Rickettsia spp, en garrapatas colectadas de ganado bovino, lo cual indica un riesgo de salud pública.

4.
Psicooncología (Pozuelo de Alarcón) ; 20(2): 283-304, 26 oct. 2023. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-226867

RESUMO

Introducción. Los psicólogos tienen un papel relevante en el manejo integral en la atención de pacientes en cuidados paliativos y su familia, por lo que deben contar con competencias específicas para proporcionar la atención psicológica en los diferentes niveles de atención en salud. Objetivo: Diseñar un Instrumento de Detección de Necesidades de Capacitación en Psicología de Cuidados Paliativos (IDNCPsic-CP), analizar su validez y confiabilidad. Método: Se realizó un estudio prospectivo, transversal mediante una encuesta en línea para psicólogos que laboraran en Unidades/Servicios de Cuidados Paliativos en México. Se utilizó un muestreo por conveniencia. Resultados: La muestra total fue de 132 profesionales del Psicología. El IDNCPsic-CP en su versión final fue de 122 reactivos divididos en características generales del psicólogo y la institución, proceso de atención y la Detección de Necesidades de Capacitación se conformó por 3 subescalas: a) Relevancia donde en el Análisis Factorial Exploratorio (AFE) se agrupó en 7 factores (alpha de Cronbach de ,930), y en el Análisis Factorial Confirmatorio (AFC) se confirmaron sólo 4. b) Frecuencia donde el AFE identificó 4 factores, (alpha de cronbach de .977), y en el AFC los siguientes índices de ajuste: χ2/gl= 1,784; CFI=0,917; TLI=0,908, SRMR=0,054 y RMSEA =0,077; y c) Autopercepción de habilidades con un solo factor, (alfa de Cronbach=0.945), el AFC con índices de ajuste: χ2/gl= 1,519; CFI=0,994; TLI=0,987, SRMR=0,023 y RMSEA=0,063. Conclusiones: El IDCNPsic-CP cuenta con puntuaciones altas de validez, confiabilidad y ajuste, que confirman que el instrumento cuenta con las propiedades psicométricas para su uso (AU)


Introduction. Psychologists have a relevant role in the comprehensive management of palliative care patients and their families, so they must have specific competencies to provide psychological care at different levels of health care. Objective: To design an Instrument for the Detection of Training Needs in Palliative Care Psychology (IDNCPsic-CP) and to analyze validity and reliability. Methods: A prospective, cross-sectional study was conducted through an online survey for psychologists working in Palliative Care Units/Services in Mexico. Convenience sampling was used. Results: The total sample was 132 psychology professionals. The final version of the IDNCPsic-CP consisted of 122 items divided into general characteristics of the psychologist and the institution, process of care and Detection of Training Needs was made up of 3 subscales: a) Relevance, where in the Exploratory Factor Analysis (EFA) it was grouped into 7 factors (cronbach’s alpha of .930), and the Confirmatory Factor Analysis (CFA) only 4 were confirmed. b) Frequency where EFA identified 4 factors, (cronbach’s alpha of .977), and in CFA the following adjustment indexes: χ2/gl= 1.784; CFI .917; TLI=.908, SRMR=.054 and RMSEA =.077; and c) Self-perception of skills with a single factor, (Cronbach’s alpha=0.945), the AFC with fit indices: χ2/gl= 1.519; CFI=0.994; TLI=0.987, SRMR=0.023 and RMSEA=0.063. Conclusions: The IDCNPsic-CP has high validity, reliability, and fit scores, which confirm that the instrument has the psychometric properties for use (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Capacitação de Recursos Humanos em Saúde , Avaliação das Necessidades , Cuidados Paliativos/psicologia , Pesquisas sobre Atenção à Saúde , Reprodutibilidade dos Testes , Estudos Prospectivos , Estudos Transversais
5.
Pharmaceuticals (Basel) ; 16(6)2023 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-37375794

RESUMO

Iron deficiency (ID) and iron deficiency anemia (IDA) are highly prevalent worldwide. Oral iron salts, especially ferrous sulfate, are commonly used for the treatment of iron deficiency (ID). However, its use is associated with gastrointestinal side effects, thus compromising treatment compliance. Intravenous iron administration is a more costly and logistically complex alternative and is not risk-free, as infusion and hypersensitivity reactions may occur. Sucrosomial® iron is an oral formulation consisting of ferric pyrophosphate conveyed by a phospholipid and sucrester matrix (sucrosome®). Intestinal Sucrosomial® iron absorption is mediated by enterocytes and M cells, through the paracellular and transcellular routes, and occurs mostly as intact particles. These pharmacokinetic properties of Sucrosomial® iron result in higher iron intestinal absorption and excellent gastrointestinal tolerance compared to oral iron salts. The evidence derived from clinical studies supports the use of Sucrosomial® iron as a valid first option for the treatment of ID and IDA, especially for subjects who are intolerant or refractory to conventional iron salts. Newer evidence also demonstrates the effectiveness of Sucrosomial® iron, with a lower cost and fewer side effects, in certain conditions usually treated with IV iron in current clinical practice.

6.
Physiol Behav ; 254: 113910, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-35820628

RESUMO

Childhood and adolescent exposure to obesogenic environments has contributed to the development of several health disorders, including neurocognitive impairment. Adolescence is a critical neurodevelopmental window highly influenced by environmental factors that affect brain function until adulthood. Post-weaning chronic exposure to a high-fat diet (HFD) adversely affects memory performance; physical activity is one approach to coping with these dysfunctions. Previous studies indicate that voluntary exercise prevents HFD's detrimental effects on memory; however, it remains to evaluate whether it has a remedial/therapeutical effect when introduced after a long-term HFD exposure. This study was conducted on a diet-induced obesity mice model over six months. After three months of HFD exposure (without interrupting the diet) access to voluntary physical activity was provided. HFD produced weight gain, increased adiposity, and impaired glucose tolerance. Voluntary physical exercise ameliorated glucose tolerance and halted weight gain and fat accumulation. Additionally, physical activity mitigated HFD-induced spatial and recognition memory impairments. Our data indicate that voluntary physical exercise starting after several months of periadolescent HFD exposure reverses metabolic and cognitive alterations demonstrating that voluntary exercise, in addition to its known preventive effect, also has a restorative impact on metabolism and cognition dysfunctions associated with obesity.


Assuntos
Dieta Hiperlipídica , Transtornos da Memória , Animais , Dieta Hiperlipídica/efeitos adversos , Exercício Físico , Transtornos da Memória/etiologia , Transtornos da Memória/prevenção & controle , Camundongos , Obesidade , Desmame , Aumento de Peso
7.
Cancer Causes Control ; 33(7): 995-1003, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35579774

RESUMO

PURPOSE: The Comprehensive Cancer Control Cancer Communication Mentorship Program ("Mentorship Program") was created by the George Washington University Cancer Center (GWCC) to provide technical assistance (TA) in implementing evidence-based cancer screening communication interventions and support networking for comprehensive cancer control (CCC) professionals. The Mentorship Program matched entry-to mid-level CCC professionals with health communication and/or CCC experts and offered monthly web-based discussions with academic researchers and practitioners who shared their knowledge and provided applied learning opportunities throughout mentees' project planning, implementation and evaluation. The program objective was for mentees to improve health communication skills and apply evidence-based knowledge to reduce the burden of cancer. METHODS: A mixed methods evaluation was conducted, including a qualitative description of each project and its outcomes as well as quantitative measures of satisfaction with the program and self-rated changes in competence. RESULTS: Mentees represented the following locations: New Jersey, Arkansas, Michigan, West Virginia, and Republic of Palau. Project topics ranged from increasing Human papillomavirus (HPV) vaccinations to increasing screening uptake for colorectal cancer, lung cancer, cervical cancer, and breast cancer. Evaluation results from pre- and post-program communication competency self-assessments and mid- and post-program surveys revealed that the Mentorship Program advanced personal and professional goals and improved public health communication skills. CONCLUSION: The Mentorship Program achieved its objectives for peer networking and offering expert TA in cancer prevention and control communication, offering a promising model for others involved in supporting implementation of evidence in practice.


Assuntos
Mentores , Neoplasias , Comunicação , Humanos , Neoplasias/diagnóstico , Neoplasias/prevenção & controle , Avaliação de Programas e Projetos de Saúde/métodos , Universidades , Washington
8.
Psychoneuroendocrinology ; 127: 105178, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33706043

RESUMO

Increasing evidence suggests that long-term consumption of high-caloric diets increases the risk of developing cognitive dysfunctions. In the present study, we assessed the catecholaminergic activity in the hippocampus as a modulatory mechanism that is altered in rats exposed to six months of a high-sucrose diet (HSD). Male Wistar rats fed with this diet developed a metabolic disorder and showed impaired spatial memory in both water maze and object location memory (OLM) tasks. Intrahippocampal free-movement microdialysis showed a diminished dopaminergic and noradrenergic response to object exploration during OLM acquisition compared to rats fed with normal diet. In addition, electrophysiological results revealed an impaired long-term potentiation (LTP) of the perforant to dentate gyrus pathway in rats exposed to a HSD. Local administration of nomifensine, a catecholaminergic reuptake inhibitor, prior to OLM acquisition or LTP induction, improved long-term memory and electrophysiological responses, respectively. These results suggest that chronic exposure to HSD induces a hippocampal deterioration which impacts on cognitive and neural plasticity events negatively; these impairments can be ameliorated by increasing or restituting the affected catecholaminergic activity.


Assuntos
Catecolaminas , Sacarose Alimentar , Hipocampo , Animais , Catecolaminas/fisiologia , Sacarose Alimentar/efeitos adversos , Hipocampo/fisiopatologia , Potenciação de Longa Duração/fisiologia , Masculino , Transtornos da Memória/fisiopatologia , Ratos , Ratos Wistar , Memória Espacial/fisiologia
9.
Tob Control ; 30(1): 36-41, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32047102

RESUMO

BACKGROUND: Tobacco prevalence in Colombia is small compared with other Latin America despite the nation's tobacco taxes being among the lowest in the region. However, tobacco taxes have increased several times during the last decade, and large increases in 2010 and 2016 impacted consumer prices. OBJECTIVE: This paper aims to estimate the price smoking participation elasticity (PPE) in Colombia, with specific reference to regional increases in consumer prices after 2010 tax policy changes. METHODS: The PPE is computed using logistic regression based on individual-level data from the National Psychoactive Substances Consumption Survey for 2008 and 2013. Our specific focus is state-level variation in Colombian cigarette prices between 2008 and 2013 induced by the tax hike in 2010. RESULTS: The estimated PPE in Colombia is around -0.66 (p value=0.046). We find almost no differences across socioeconomic level, but price sensitivity was greater for women than men, and for relatively older individuals (ages 51-64). CONCLUSIONS: PPE for Colombia is above estimates for comparable middle-income countries such as Mexico. As a result, current estimates for health gains of tax policies are likely to be underestimated. Moreover, in contrast with the literature, we find that the PPE for the youth (≤25 years) is lower than older age groups, and there is no evidence of a prominent socio-economic status (SES) gradient.


Assuntos
Comércio , Produtos do Tabaco , Adolescente , Idoso , Colômbia/epidemiologia , Elasticidade , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Fumar/epidemiologia , Impostos
11.
Econ Hum Biol ; 39: 100902, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32622932

RESUMO

This paper estimates the short-term impact of a twofold increase of the tobacco excise tax on consumption of illicit cigarette trade in Colombia. Using data collected before and after the tax increase from a novel smoker survey (DEICS-Col), the impact is estimated as the change in the probability that a smoker has illicit cigarettes. The methodology follows a difference-in-differences strategy, measuring the year-to-year variation of the proportion of illicit cigarettes between smokers who report buying low-priced cigarettes (the highest treatment intensity) and those who bought high-priced cigarettes (lowest treatment intensity). Estimations of the impact show an average increase of 4-5 percentage points on the proportion of illicit cigarettes relative to an initial penetration of low-priced illicit cigarettes of nearly 5.1 %.


Assuntos
Crime/estatística & dados numéricos , Impostos/estatística & dados numéricos , Produtos do Tabaco/estatística & dados numéricos , Colômbia , Comércio/estatística & dados numéricos , Humanos , Inquéritos e Questionários
12.
Molecules ; 24(19)2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31547094

RESUMO

Marine bioactive compounds have been found in very different sources and exert a very vast array of activities. Squid skin, normally considered a discard, is a source of bioactive compounds such as pigments. Recovering these compounds is a potential means of valorizing seafood byproducts. Until now, the structure and molecular properties of the bioactive pigments in jumbo squid skin (JSS) have not been established. In this study, methanol-HCl (1%) pigment extracts from JSS were fractionated by open column chromatography and grouped by thin-layer chromatography in order to isolate antioxidant pigments. Antioxidant activity was determined by the 2,2-diphenyl-1-picrylhydrazyl (DPPH●) and 2,2'-azino-bis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS●+) radical scavenging assays and ferric reducing power (FRAP) assay. Fractions 11-34 were separated and grouped according to flow rate values (F1-F8). Fractions F1, F3, and F7 had the lowest IC50 against ABTS●+ per milligram, and fractions F3 and F7 showed the lowest IC50 in the FRAP assay. Finally, fraction F7 had the highest DPPH● scavenging activity. The chemical structure of the F7 fraction was characterized by infrared spectroscopy, 1H nuclear magnetic resonance, and electrospray ionization-mass spectrometry. One of the compounds identified in the fraction was xanthommatin (11-(3-amino-3-carboxypropanoyl)-1-hydroxy-5-oxo-5H-pyrido[3,2-a]phenoxazine-3-carboxylic acid) and their derivatives (hydro- and dihydroxanthommatin). The results show that JSS pigments contain ommochrome molecules like xanthommatin, to which the antioxidant activity can be attributed.


Assuntos
Antioxidantes/química , Decapodiformes/química , Oxazinas/química , Pele/química , Xantenos/química , Animais , Cromatografia em Camada Fina , Espectroscopia de Ressonância Magnética
13.
Transfus Apher Sci ; 58(4): 369-374, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31416710

RESUMO

In major elective surgery, patient may be exposed to the effects of pre-operative anemia, blood loss and red cell transfusion, all of which may adversely influence post-operative rates of morbidity, mortality and readmission, and length of hospital stay. Preoperative anemia is prevalent among patients scheduled for major surgery (30-40%), while postoperative anemia is even more frequent (up to 80-90%). However, preoperative anemia is usually regarded as no more than a surrogated marker of patient's physical status, and it is not always adequately addressed before surgery, whereas red blood cell transfusion is the usual default treatment for postoperative anemia. Absolute iron deficiency and iron sequestration are the leading causes of preoperative anemia, whereas surgery-associated blood loss and inflammation may induce and/or maintain postoperative anemia. Hematinic deficiencies without anemia may hamper pre-operative hemoglobin optimization and/or recovery from postoperative anemia. As modifiable risk factors, preoperative anemia and hematinic deficiencies should be detected, classified and treated prior to any major surgery. For elective non-cancer procedures, this may entail to postpone surgery until anemia improvement or resolution.


Assuntos
Anemia , Perda Sanguínea Cirúrgica , Procedimentos Cirúrgicos Eletivos , Transfusão de Eritrócitos , Período Perioperatório , Anemia/epidemiologia , Anemia/terapia , Humanos , Prevalência , Fatores de Risco
14.
Chemosphere ; 234: 496-504, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31229710

RESUMO

Tannery wastewater is characterized by high and variable concentrations of diverse pollutants, which makes it difficult and costly to treat. In the search for sustainable treatment options for tannery effluents, two pilot-scale horizontal subsurface flow (HSF) constructed wetlands (CW) were built and operated for the treatment of synthetic water of quality similar to that of pre-treated tannery effluents. Five different loading phases were examined with gradual increase of inflow COD, NH4+-N and Cr loads until reaching and exceeding the typical composition of a tannery effluent. High COD and NH4+-N removals were observed (82 and 96%, respectively), and almost complete Cr removal in the outflow, which met the Venezuela national standards for environmental discharge. Plant uptake was measured, but microbial processes appear to be the main ammonium transformation/removal mechanism. Nitrogen, chlorophyll and Cr in the plant aerial parts and roots indicated the capacity of Phragmites sp. to grow and survive even under high loads. The measured heterotrophic bacteria in the substrate and rhizomes indicated the biofilm development and the oxidation of organic matter and nitrogen. Water losses via evapotraspiration were also measured and reached 14%. Overall, the tested CW design proved to be a sustainable and feasible alternative for the treatment of tannery wastewater in tropical climates.


Assuntos
Clima Tropical , Águas Residuárias/química , Purificação da Água/métodos , Áreas Alagadas , Bactérias/crescimento & desenvolvimento , Biofilmes/crescimento & desenvolvimento , Nitrogênio/análise , Projetos Piloto , Plantas , Poaceae/crescimento & desenvolvimento , Venezuela , Eliminação de Resíduos Líquidos
15.
Acta Haematol ; 142(1): 21-29, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30970362

RESUMO

Preoperative anemia affects 30-40% of patients undergoing major surgery and is an independent risk factor for perioperative blood transfusion, morbidity, and mortality. Absolute or functional iron deficiency is its leading cause. Nonanemic hematinic deficiencies are also prevalent and may hamper preoperative hemoglobin optimization and/or recovery from postoperative anemia. As modifiable risk factors, anemia and hematinic deficiencies should be detected and corrected prior to major surgical procedures. Postoperative anemia is even more common (up to 80-90%) due to surgery-associated blood loss, inflammation-induced blunted erythropoiesis, and/or preexisting anemia. Preoperative oral iron may have a role in mild-to-moderate anemia, provided there is sufficient time (6-8 weeks) and adequate tolerance of oral preparations. Postoperative oral iron is of little value and rife with gastrointestinal adverse events. Intravenous iron should preferentially be used in cases of moderate-to-severe iron deficiency anemia, concomitant use of erythropoiesis-stimulating agents, short time to surgery or nonelective procedures, and for postoperative anemia management. Minor infusion reactions to intravenous iron are rare, the incidence of severe anaphylactic reactions is extremely low, and there is no increase in infections with intravenous iron. Currently available intravenous iron formulations allowing administration of large single doses are preferred.


Assuntos
Anemia Ferropriva/prevenção & controle , Ferro/administração & dosagem , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/patologia , Artroplastia de Substituição , Transfusão de Eritrócitos , Eritropoetina/uso terapêutico , Gastroenteropatias/etiologia , Humanos , Ferro/efeitos adversos , Assistência Perioperatória
16.
Vox Sang ; 114(1): 3-16, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30411362

RESUMO

In major orthopaedic surgery, it is recommended to detect and correct preoperative anaemia several weeks prior to surgery. However, in many cases, the procedure is urgent or the patient is evaluated shortly before the intervention. As iron deficiency is the leading cause of perioperative anaemia, an exhaustive review of the literature was performed to assess the efficacy and safety of short-term perioperative intravenous, with or without erythropoietin, or postoperative oral or intravenous supplementation in major orthopaedic surgery. Overall, 20 studies met the inclusion criteria. There were 13 randomized trials (moderate quality) and seven observational studies (low to very low quality). The primary outcomes were reduction in transfusion requirements, haemoglobin increase and medication side-effects during the study period. Data analysis showed that postoperative oral iron administration neither increased haemoglobin nor reduced transfusion requirements, and it was associated with significant gastrointestinal adverse effects (15%). In contrast, for some patient populations, perioperative or postoperative administration of intravenous iron, with or without recombinant erythropoietin, may reduce transfusion requirements and/or hasten the recovery from postoperative, with few clinically relevant adverse effects (<2%). However, discrepancies between randomized trials and observational studies on the possible beneficial effects of short-term perioperative intravenous iron administration were found for patients undergoing surgery for hip fracture repair. Further studies are needed to elucidate when the treatment should be started, which combination of drugs should be used, and which patient groups would be most benefit.


Assuntos
Anemia/prevenção & controle , Ferro/uso terapêutico , Ortopedia/métodos , Complicações Pós-Operatórias/prevenção & controle , Administração Oral , Anemia/tratamento farmacológico , Humanos , Infusões Intravenosas , Ferro/administração & dosagem , Ferro/efeitos adversos , Estudos Observacionais como Assunto , Complicações Pós-Operatórias/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Blood Transfus ; 17(2): 137-145, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30418128

RESUMO

Absolute or functional iron deficiency is the most prevalent cause of anaemia in surgical patients, and its correction is a fundamental strategy within "Patient Blood Management" programmes. Offering perioperative oral iron for treating iron deficiency anaemia is still recommended, but intravenous iron has been demonstrated to be superior in most cases. However, the long-standing prejudice against intravenous iron administration, which is thought to induce anaphylaxis, hypotension and shock, still persists. With currently available intravenous iron formulations, minor infusion reactions are not common. These self-limited reactions are due to labile iron and not hypersensitivity. Aggressively treating infusion reactions with H1-antihistamines or vasopressors should be avoided. Self-limited hypotension during intravenous iron infusion could be considered to be due to hypersensitivity or vascular reaction to labile iron. Acute hypersensitivity reactions to current intravenous iron formulation are believed to be caused by complement activation-related pseudo-allergy. However, though exceedingly rare (<1:250,000 administrations), they should not be ignored, and intravenous iron should be administered only at facilities where staff is trained to evaluate and manage these reactions. As preventive measures, prior to the infusion, staff should inform all patients about infusion reactions and identify those patients with increased risk of hypersensitivity or contraindications for intravenous iron. Infusion should be started at a low rate for a few minutes. In the event of a reaction, the very first intervention should be the immediate cessation of the infusion, followed by evaluation of severity and treatment. An algorithm to scale the intensity of treatment to the clinical picture and/or response to therapy is presented.


Assuntos
Administração Intravenosa/efeitos adversos , Anafilaxia/induzido quimicamente , Anemia Ferropriva/tratamento farmacológico , Hipotensão/induzido quimicamente , Ferro/efeitos adversos , Anafilaxia/prevenção & controle , Anafilaxia/terapia , Gerenciamento Clínico , Humanos , Hipotensão/prevenção & controle , Hipotensão/terapia , Ferro/administração & dosagem , Fatores de Risco
18.
Pharmaceuticals (Basel) ; 11(4)2018 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-30287781

RESUMO

Iron deficiency (ID) is usually treated with oral iron salts, but up to 50% of patients complain of gastrointestinal side effects, leading to reduced treatment compliance. Intravenous (IV) iron formulations are increasingly safer, but there is still a risk of infusion and hypersensitivity reactions and the need for a venous access and infusion monitoring. Sucrosomial® iron (SI) is an innovative oral iron formulation in which ferric pyrophosphate is protected by a phospholipid bilayer plus a sucrester matrix (sucrosome), which is absorbed through para-cellular and trans-cellular routes (M cells). This confers SI unique structural, physicochemical and pharmacokinetic characteristics, together with high iron bioavailability and excellent gastrointestinal tolerance. The analysis of available evidence supports oral SI iron as a valid option for ID treatment, which is more efficacious and better tolerated than oral iron salts. SI has also demonstrated similar effectiveness, with lower risks, in patients usually receiving IV iron (e.g., chronic kidney disease, cancer, bariatric surgery). Thus, oral SI emerges as a most valuable first option for treating ID, even more for subjects with intolerance to or inefficacy of iron salts. Moreover, SI should be also considered as an alternative to IV iron for initial and/or maintenance treatment in different patient populations.

20.
Blood Transfus ; 16(4): 338-342, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29517968

RESUMO

BACKGROUND: Evidence on the role of intravenous iron (IVI) supplementation after colorectal cancer (CRC) surgery is rather scant. This study was aimed at assessing the benefit of post-operative IVI administration after elective CRC surgery at our institution. MATERIALS AND METHODS: This was a single-centre, retrospective observational study including all patients who underwent CRC surgery during 2014. Anaemia was defined as a haemoglobin (Hb) <13 g/dL, regardless of gender. Anaemic patients received 200 mg IVI up to three times a week to cover iron deficiency (IVI group). Those who did not receive IVI were placed on standard care (NIVI group). The primary outcome was the proportion of anaemic patients on post-operative day (POD)1 and POD30. Secondary outcomes included Hb changes from POD1 to POD30, transfusion requirements and complication rates. RESULTS: Of the 159 patients studied, 139 (87%) presented with anaemia: 47 (34%) of these received post-operative IVI and 92 (66%) did not. Patients in the IVI group had lower POD1 Hb levels compared to those in the NIVI group (p=0.001). On POD30, only 103 had their Hb measured (34 IVI, 69 NIVI). Anaemia was more prevalent and more severe among the patients in the IVI group (p=0.027), despite their greater increment in Hb (2.0±1.5 g/dL vs 1.1±1.2 g/dL; p=0.001). Eleven patients needed post-operative transfusions (7 IVI, 4 NIVI; p=0.044). There were no differences in post-operative complication rates between the groups. No IVI-related adverse events were recorded DISCUSSION: Compared with standard care, post-operative IVI administration to anaemic patients improved the recovery of Hb levels at POD30, without increasing post-operative complications.


Assuntos
Anemia Ferropriva/tratamento farmacológico , Neoplasias Colorretais/cirurgia , Ferro/administração & dosagem , Complicações Pós-Operatórias/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Anemia Ferropriva/sangue , Anemia Ferropriva/etiologia , Neoplasias Colorretais/sangue , Feminino , Humanos , Infusões Intravenosas , Ferro/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Estudos Retrospectivos
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