Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 28
Filtrar
1.
Crit Care Nurse ; 44(3): 45-53, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38821530

RESUMO

BACKGROUND: Chlorhexidine gluconate has been considered the criterion standard of oral care for patients receiving mechanical ventilation because of its ability to reduce the incidence of ventilator-associated events. Optimal concentrations and frequencies remain unclear, as do adverse events related to mortality in various intensive care unit populations. OBJECTIVE: To examine the current evidence for the efficacy of chlorhexidine gluconate in reducing the incidence of ventilator-associated events, mortality, intensive care unit length of stay, and duration of mechanical ventilation in patients receiving ventilator support. METHODS: In this integrative review, CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE, and Health Source: Nursing/Academic Edition were searched using terms related to mechanical ventilation and chlorhexidine gluconate oral care with dates ranging from 2012 to 2023. RESULTS: Seventeen articles were included in this review: 8 systematic reviews, 8 randomized clinical trials (3 of which were not included in any systematic review), and 1 quasi-experimental study. Chlorhexidine gluconate oral care was associated with a reduced incidence of ventilator-associated events, but efficacy depended on concentration and frequency of administration. With stratification by intensive care unit population type, a nonsignificant trend toward increased mortality was found among non-cardiac surgical patients who received this care. CONCLUSION: The evidence regarding the efficacy of chlorhexidine gluconate oral care in reducing ventilator-associated events in specific intensive care unit populations is contradictory. Recently published guidelines recommend de-implementation of chlorhexidine gluconate oral care in all patients receiving mechanical ventilation. Such care may be beneficial only in the cardiac surgical population.


Assuntos
Clorexidina , Respiração Artificial , Clorexidina/análogos & derivados , Clorexidina/uso terapêutico , Clorexidina/efeitos adversos , Clorexidina/administração & dosagem , Humanos , Masculino , Feminino , Anti-Infecciosos Locais/uso terapêutico , Anti-Infecciosos Locais/administração & dosagem , Adulto , Pessoa de Meia-Idade , Idoso , Enfermagem de Cuidados Críticos/normas , Higiene Bucal/métodos , Higiene Bucal/enfermagem , Unidades de Terapia Intensiva , Idoso de 80 Anos ou mais , Antissépticos Bucais/uso terapêutico , Administração Oral
2.
Vaccine ; 41(15): 2524-2533, 2023 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-36894395

RESUMO

Here we report the development of a thermally stable, orally administered, candidate Zika vaccine using human serotype 5 adenovirus (AdHu5). We engineered AdHu5 to express the genes for the envelope and NS1 proteins of Zika virus. AdHu5 was formulated using a proprietary platform, OraPro, comprising a mix of sugars and modified amino acids that can overcome elevated temperatures (37 C), and an enteric coated capsule that protects the integrity of the AdHu5 from the acid in the stomach. This enables the delivery AdHu5 to the immune system of the small intestine. We show that oral delivery of AdHu5 elicited antigen-specific serum IgG immune responses in a mouse model and in a non-human primate model. Importantly, these immune responses were able reduce viral counts in mice and to prevent detectable viraemia in the non-human primates on challenge with live Zika virus. This candidate vaccine has significant advantages over many current vaccines that are maintained in a cold or ultra-cold chain and require parenteral administration.


Assuntos
Vacinas , Vacinas Virais , Infecção por Zika virus , Zika virus , Humanos , Animais , Camundongos , Primatas , Antígenos , Anticorpos Antivirais , Anticorpos Neutralizantes
3.
BMC Psychiatry ; 22(1): 244, 2022 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-35387644

RESUMO

BACKGROUND: Doctors report high rates of workplace stress and are at increased risk of mental health disorders. However, there are few real-world studies evaluating the effectiveness of interventions aimed at addressing workplace risk factors and improving doctors' mental health in a hospital setting. This study was conducted over two years (2017-2019) to assess the effects of a multi-modal intervention on working conditions doctors' mental health and help-seeking for mental health problems in two Australian teaching hospitals. METHODS: The multimodal intervention consisted of organisational changes, such as reducing unrostered overtime, as well as strategies for individual doctors, such as mental health training programs. Hospital-based doctors at all career stages were eligible to participate in two cross-sectional surveys. 279 doctors completed the baseline survey (19.2% response rate) and 344 doctors completed the follow-up survey (31.3% response rate). A range of workplace risk and protective factors, mental health (psychological distress and suicidal ideation) and help-seeking outcomes were assessed. RESULTS: There were significant improvements in key workplace protective factors, with small effects found for doctors' job satisfaction, stress, work-life balance and perceived workplace support and a significant reduction in workplace risk factors including a moderate reduction in reported bullying behaviour between baseline to follow-up (job satisfaction p < 0.05, all other outcomes p < 0.01). However, no significant changes in doctors' mental health or help-seeking outcomes were found over the intervention period. CONCLUSION: Following the implementation of individual and organisational-level strategies in two Australian tertiary hospitals, doctors reported a reduction in some key workplace stressors, but no significant changes to their mental health or help-seeking for mental health problems. Further research is warranted, particularly to determine if these workplace changes will lead to improved mental health outcomes for doctors once maintained for a longer period.


Assuntos
Saúde Mental , Local de Trabalho , Austrália , Estudos Transversais , Hospitais , Humanos , Local de Trabalho/psicologia
7.
Mindfulness (N Y) ; 9(4): 1063-1075, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30100931

RESUMO

We aimed to evaluate whether mindfulness-based cognitive therapy (MBCT) was feasible and acceptable for young people, their parents and the clinicians working with them; whether a parallel course for parents was a useful addition; and whether attendance at MBCT was associated with improved outcomes. The design was a mixed-method service evaluation of an eight-session MBCT programme for young people who were recovering from depression. The course was a manualised eight-session group intervention. Both young people (n = 18) and parents (n = 21) completed validated measures before and after the course. Semi-structured interviews were completed with some group participants and clinical staff working in the service. Care records were searched for additional contact following the intervention. Qualitative data from young people, parents and clinicians suggested that MBCT was acceptable and feasible and provided strategies to cope. The parent course was reported to provide personal support to parents and helped them cope with their child's depression whilst also impacting the family, promoted shared understanding of depression and strategies to combat it and addressed intergenerational aspects of depression. Eighty-four per cent of participants attended at least 6/8 sessions, and 48% required no further intervention within the following year. Young people had statistically significant improvements across all outcome measures, whilst parents had statistically significant improvements in rumination, self-compassion and decentring.

8.
Hematol Oncol Clin North Am ; 31(6): 995-1010, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29078934

RESUMO

Patients with complications of chemotherapy, either acute or chronic, are frequently encountered in the emergency department (ED). Some patients present with complaints immediately after chemotherapy administration, whereas others may show subtle, secondary signs or may have no signs or symptoms of chemotoxicity. An increased index of suspicion prompts early recognition, diagnosis, and prevention of further iatrogenic injury. This article reviews characteristic hypersensitivity reactions, typical organ system dysfunction, and treatment strategies for adult patients who present to the ED with complications after chemotherapy.


Assuntos
Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/terapia , Serviços Médicos de Emergência/métodos , Adulto , Serviço Hospitalar de Emergência , Humanos
9.
eNeuro ; 4(3)2017.
Artigo em Inglês | MEDLINE | ID: mdl-28674699

RESUMO

Cardiac arrest is a common cause of global hypoxic-ischemic brain injury. Poor neurologic outcome among cardiac arrest survivors results not only from direct cellular injury but also from subsequent long-term dysfunction of neuronal circuits. Here, we investigated the long-term impact of cardiac arrest during development on the function of cortical layer IV (L4) barrel circuits in the rat primary somatosensory cortex. We used multielectrode single-neuron recordings to examine responses of presumed excitatory L4 barrel neurons to controlled whisker stimuli in adult (8 ± 2-mo-old) rats that had undergone 9 min of asphyxial cardiac arrest and resuscitation during the third postnatal week. Results indicate that responses to deflections of the topographically appropriate principal whisker (PW) are smaller in magnitude in cardiac arrest survivors than in control rats. Responses to adjacent whisker (AW) deflections are similar in magnitude between the two groups. Because of a disproportionate decrease in PW-evoked responses, receptive fields of L4 barrel neurons are less spatially focused in cardiac arrest survivors than in control rats. In addition, spiking activity among L4 barrel neurons is more correlated in cardiac arrest survivors than in controls. Computational modeling demonstrates that experimentally observed disruptions in barrel circuit function after cardiac arrest can emerge from a balanced increase in background excitatory and inhibitory conductances in L4 neurons. Experimental and modeling data together suggest that after a hypoxic-ischemic insult, cortical sensory circuits are less responsive and less spatially tuned. Modulation of these deficits may represent a therapeutic approach to improving neurologic outcome after cardiac arrest.


Assuntos
Potenciais de Ação/fisiologia , Parada Cardíaca/patologia , Parada Cardíaca/terapia , Neurônios/fisiologia , Córtex Somatossensorial , Vibrissas/inervação , Vias Aferentes/fisiologia , Animais , Animais Recém-Nascidos , Simulação por Computador , Modelos Animais de Doenças , Eletrocardiografia , Complexo IV da Cadeia de Transporte de Elétrons/metabolismo , Feminino , Parada Cardíaca/etiologia , Hipóxia-Isquemia Encefálica/complicações , Modelos Neurológicos , Inibição Neural/fisiologia , Estimulação Física , Ratos , Ratos Sprague-Dawley , Córtex Somatossensorial/crescimento & desenvolvimento , Córtex Somatossensorial/patologia , Córtex Somatossensorial/fisiopatologia , Tálamo/fisiologia
10.
Dent Mater ; 32(11): 1343-1351, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27613394

RESUMO

OBJECTIVES: The purpose of this study was to evaluate the effect of various surface treatments on the mechanical properties and antibacterial activity of desiccated glass-ionomer (GI) and resin-modified glass-ionomer (RMGI) materials. METHODS: One hundred GI and RMGI specimens were fabricated in a mold, stored in 100% humidity for 24h, placed in air to desiccate for 24h, and then stored for one week in one of the five media [casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), chlorhexidine (CHX), sodium fluoride (NaF), cetylpyridinium chloride (CPC), or 100% humidity (control)]. Fifty GI and RMGI specimens were tested in flexure to determine flexural strength and modulus, with the fragments used for Knoop hardness testing. The remaining 50 GI and RMGI specimens were covered with a suspension of Streptococcus mutans and incubated for 24h. The bacterial suspension was removed and the specimens were washed. Sterile saline was added, vortex mixed, serially diluted, and plated. CFU/mLs were calculated after 3days of incubation. RESULTS: Compared to the 100% humidity control group, surface treatment of the desiccated GI and RMGI materials had a variable effect on the mechanical properties. In general, NaF provided the greatest improvement in flexural strength and modulus. Surface treatment of the desiccated GI or RMGI specimens with CHX or CPC resulted in no growth of the S. mutans. NaF resulted in significantly lower CFU/mL than CPP-ACP, which was significantly lower than the control group. SIGNIFICANCE: Surface treatment with 5% NaF provides improved antimicrobial and strength properties of desiccated GI or RMGI materials.


Assuntos
Anti-Infecciosos , Cimentos de Ionômeros de Vidro , Resinas Acrílicas , Teste de Materiais , Dióxido de Silício , Propriedades de Superfície
11.
Emerg Med Clin North Am ; 32(3): 563-78, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25060250

RESUMO

Patients with complications of chemotherapy, either acute or chronic, are frequently encountered in the emergency department (ED). Some patients present with complaints immediately after chemotherapy administration, whereas others may show subtle, secondary signs or may have no signs or symptoms of chemotoxicity. An increased index of suspicion prompts early recognition, diagnosis, and prevention of further iatrogenic injury. This article reviews characteristic hypersensitivity reactions, typical organ system dysfunction, and treatment strategies for adult patients who present to the ED with complications after chemotherapy.


Assuntos
Antineoplásicos/efeitos adversos , Hipersensibilidade a Drogas/terapia , Anemia/induzido quimicamente , Morte Súbita Cardíaca/etiologia , Diagnóstico Diferencial , Hipersensibilidade a Drogas/diagnóstico , Serviço Hospitalar de Emergência , Humanos , Neoplasias/tratamento farmacológico , Trombocitopenia/diagnóstico , Síndrome de Lise Tumoral/diagnóstico
12.
Bioorg Med Chem ; 21(21): 6582-91, 2013 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-24021582

RESUMO

Optimization of a 7-azaindole-3-acetic acid CRTh2 receptor antagonist chemotype derived from high throughput screening furnished a highly selective compound NVP-QAV680 with low nM functional potency for inhibition of CRTh2 driven human eosinophil and Th2 lymphocyte activation in vitro. The molecule exhibited good oral bioavailability in the rat, combined with efficacy in rodent CRTh2-dependent mechanistic and allergic disease models and was suitable for clinical development.


Assuntos
Indolizinas/química , Receptores Imunológicos/antagonistas & inibidores , Receptores de Prostaglandina/antagonistas & inibidores , Administração Oral , Animais , Células CHO , Cricetinae , Cricetulus , Dermatite de Contato/tratamento farmacológico , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Eosinófilos/efeitos dos fármacos , Eosinófilos/metabolismo , Meia-Vida , Humanos , Hipersensibilidade/tratamento farmacológico , Indolizinas/farmacocinética , Indolizinas/uso terapêutico , Camundongos , Camundongos Endogâmicos BALB C , Ligação Proteica , Ratos , Ratos Sprague-Dawley , Receptores Imunológicos/genética , Receptores Imunológicos/metabolismo , Receptores de Prostaglandina/genética , Receptores de Prostaglandina/metabolismo , Relação Estrutura-Atividade , Células Th2/imunologia , Células Th2/metabolismo
13.
Urology ; 82(4): 773-9, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23876586

RESUMO

OBJECTIVE: To determine if there is any difference in the clinical outcome for patients receiving aspirin, clopidogrel, and warfarin undergoing ureteroscopy and laser lithotripsy for urolithiasis compared with patients on no antithrombotic medication. METHODS: We retrospectively reviewed patients who underwent ureteroscopy for urolithaisis from July 1, 2005 to October 1, 2010. If patients continued aspirin, clopidogrel, or warfarin within 48 hours of surgery, they were considered to be on antithrombotic therapy. Patients not on these medications or those who discontinued the medications atleast 5 days before surgery comprised the control group. Six hundred forty-six patients met our inclusion criteria for analysis including 137 on aspirin alone, 17 on clopidogrel, 22 on warfarin, and 470 in the control group. RESULTS: Patients on antiplatelet and anticoagulants were older and were more likely to have risk factors for thromboembolism. When comparing patients on aspirin, clopidogrel, or warfarin with patients not on these medications, there was no difference in bleeding complications or need for an unplanned repeat ureteroscopy. There was also no difference in complications within 30 days of surgery. CONCLUSION: Among patients undergoing elective ureteroscopy and laser lithotripsy on the antithrombotic medications aspirin, clopidogrel, and warfarin, the procedure was as successful, and complications were not increased, compared with patients on no antithrombotic medications.


Assuntos
Anticoagulantes/uso terapêutico , Aspirina/uso terapêutico , Litotripsia a Laser , Inibidores da Agregação Plaquetária/uso terapêutico , Ticlopidina/análogos & derivados , Ureteroscopia , Urolitíase/diagnóstico , Varfarina/uso terapêutico , Idoso , Clopidogrel , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ticlopidina/uso terapêutico , Resultado do Tratamento
14.
Skeletal Radiol ; 42(9): 1311-5, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23615775

RESUMO

Post-transplant distal limb bone marrow edema syndrome or calcineurin inhibitor-induced pain syndrome (CIPS) is generally a self-limiting but debilitating acute pain syndrome that has been reported in 2-14 % of renal transplant recipients. The disease is extensively described in the transplant literature in patients receiving the calcineurin inhibitors cyclosporine and tacrolimus. We present a case of CIPS arising in a patient 73 days after renal allograft, review the imaging findings, and discuss proposed etiologies and differential diagnoses. To the authors' knowledge, CIPS has not been characterized as a distinct entity in the radiology literature.


Assuntos
Artralgia/induzido quimicamente , Artralgia/diagnóstico , Inibidores de Calcineurina , Transplante de Rim/efeitos adversos , Imagem Multimodal , Pré-Medicação/efeitos adversos , Tacrolimo/efeitos adversos , Adulto , Diagnóstico Diferencial , Rejeição de Enxerto/prevenção & controle , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Masculino , Síndrome , Tacrolimo/uso terapêutico
15.
Urology ; 78(3): 508-10, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21741682

RESUMO

OBJECTIVE: To describe three patients who presented to a single institution within four years of each other with isolated granuloma annulare of the penis. Granuloma annulare is an inflammatory disease of the dermis that can affect men of any age including childhood. Granuloma annulare of the penis is a remarkably uncommon presentation with only 12 cases previously reported. METHODS: A retrospective review of pathologic records was conducted confirming three cases of penile granuloma annulare diagnosed at our institution. RESULTS: The three cases are described in detail including the history, presentation, histological findings and treatment of each patient. The clinical variants, characteristic histology, classic clinical presentation, differential diagnosis and recurrence following surgery of granuloma annulare are reviewed. CONCLUSION: We describe three individuals from a single institution with isolated granuloma annulare of the penis suggesting this condition is more common than previously thought. Patients with penile granuloma annulare may present to practicing urologists and it is important to be familiar with this idiopathic subcutaneous disorder in order to avoid unnecessary aggressive surgery.


Assuntos
Granuloma Anular/diagnóstico , Doenças do Pênis/diagnóstico , Adolescente , Adulto , Granuloma Anular/patologia , Humanos , Masculino , Doenças do Pênis/patologia , Tela Subcutânea/patologia
16.
Am J Respir Cell Mol Biol ; 42(4): 472-81, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19556605

RESUMO

Excessive mucus production has been linked to many of the pathologic features of respiratory diseases, including obstruction of the airways, decline in lung function, increased rates of mortality, and increased infections. The mucins, MUC5AC and MUC5B, contribute to the viscoelastic properties of mucus, and are found at elevated levels in the airways of individuals with chronic respiratory diseases. The T helper type 2 cell cytokine, IL-13, is known to regulate MUC5AC expression in goblet cells of the airways, although much less is known about the regulation of MUC5B expression. In a study to further understand the mediators of MUC5AC and MUC5B expression, neuregulin (NRG) 1beta1 was identified as novel regulator of goblet cell formation in primary cultures of human bronchial epithelial cells (HBECs). NRG1beta1 increased expression of MUCAC and MUC5B proteins in a time- and dose-dependent fashion in HBEC cultures. NRG1beta1-induced expression of MU5AC and MUC5B was shown to involve v-erb-b2 erythroblastic leukemia viral oncogene homolog (ErbB) and ErbB3 receptors, but not ErbB4 receptors. Treatment of HBECs with inhibitors of p38 mitogen-activated protein kinase, extracellular signal-regulated kinase1/2, and phosphatidylinositol 3-kinase indicated that these kinases were involved in NRG1beta1-induced MUC5AC and MUC5B expression. Additionally, NRG1beta1 was shown to induce the phosphorylation of the ErbB2 receptor, AKT, and extracellular signal-regulated kinase 1/2. NRG1beta1 protein was found increased in the airways of antigen-challenged mice, together with increases in MUC5AC and MUC5B message. Together, these data indicate that NRG1beta1 is a novel mediator of MUC5AC and MUC5B expression in HBECs, and may represent a novel therapeutic target for mucus hypersecretion in respiratory diseases.


Assuntos
Regulação da Expressão Gênica , Células Caliciformes/metabolismo , Mucina-5AC/biossíntese , Mucina-5B/biossíntese , Neuregulina-1/metabolismo , Animais , Linhagem Celular , Células Cultivadas , Doença Crônica , Receptores ErbB/metabolismo , Humanos , Interleucina-13/metabolismo , Camundongos , Proteína Quinase 3 Ativada por Mitógeno/metabolismo , Neuregulina-1/farmacologia , Fosforilação/efeitos dos fármacos , Inibidores de Proteínas Quinases/farmacologia , Receptor ErbB-2/metabolismo , Receptor ErbB-3/metabolismo , Receptor ErbB-4 , Transtornos Respiratórios/metabolismo , Células Th2/metabolismo , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo
17.
J Cell Sci ; 122(Pt 23): 4287-95, 2009 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-19887585

RESUMO

At least 17 members of the protein disulphide isomerase (PDI) family of oxidoreductases are present in the endoplasmic reticulum (ER) of mammalian cells. They are thought to catalyse disulphide formation to aid folding or to regulate protein function; however, little is known about their individual functions. Here, we show that some proteins that enter the ER are clients for single oxidoreductases, whereas others are clients for several PDI-like enzymes. We previously identified potential substrates for ERp57, and here identify substrates for ERp18 and ERp46. In addition, we analysed the specificity of substrates towards PDI, ERp72, ERp57, ERp46, ERp18 and P5. Strikingly, ERp18 shows specificity towards a component of the complement cascade, pentraxin-related protein PTX3, whereas ERp46 has specificity towards peroxiredoxin-4, a thioredoxin peroxidase. By contrast, most PDI family members react with Ero1alpha. Moreover, P5 forms a non-covalent complex with immunoglobulin heavy chain binding protein (BiP) and shows specificity towards BiP client proteins. These findings highlight cooperation between BiP and P5, and demonstrate that individual PDI family members recognise specific substrate proteins.


Assuntos
Isomerases de Dissulfetos de Proteínas/metabolismo , Western Blotting , Linhagem Celular , Eletroforese em Gel Bidimensional , Retículo Endoplasmático/metabolismo , Humanos , Ligação Proteica , Proteína Dissulfeto Redutase (Glutationa)/genética , Proteína Dissulfeto Redutase (Glutationa)/metabolismo , Isomerases de Dissulfetos de Proteínas/genética , Especificidade por Substrato
18.
Stroke ; 40(11): 3472-7, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19713540

RESUMO

BACKGROUND AND PURPOSE: Patients with stroke and patients with transient ischemic attack (TIA) are at high risk for vascular events and may not exhibit the signs and symptoms of peripheral arterial disease (PAD). We investigated if asymptomatic PAD detected by ankle brachial index <0.9 is independently associated with recurrent vascular events in patients with stroke or TIA. METHODS: In this prospective longitudinal hospital-based cohort study, asymptomatic PAD was detected by ankle brachial index measurement in consecutive patients with stroke and patients with TIA. They were assessed for stroke risk factors, ankle brachial index measurement, and laboratory parameters known to be associated with stroke risk. These patients were followed for composite vascular events, including stroke, TIA, myocardial infarction, and vascular death. RESULTS: In a 1-year period, 102 patients were evaluated, of whom 26% had asymptomatic PAD. All patients were followed for a median period of 2.1 years from the index stroke/TIA (range, 1.0 to 2.7 years) for vascular events. Kaplan-Meier curve showed fewer patients with asymptomatic PAD remained free of composite vascular events (48% compared with 84% in the no-PAD group; log rank, P=0.0001). Asymptomatic PAD was significantly associated with composite vascular events before (hazard ratio, 4.2; 95% CI, 1.9 to 9.3; P=0.0003) and after adjustment for confounders (hazard ratio, from Model 1, 2.8; 95% CI, 1.1 to 7.2; P=0.03 and Model 2, 3.4; 95% CI, 1.4 to 8.2, P=0.006). Asymptomatic PAD was also significantly associated with stroke before (hazard ratio, 6.5; 95% CI, 2.1 to 19.9; P=0.001) and after adjustment for confounders (hazard ratio from Model 1, 4.8; 95% CI, 1.5 to 15.3; P=0.009 and Model 2, 5.2; 95% CI, 1.5 to 17.6; P=0.008). CONCLUSIONS: In patients with stroke or TIA, asymptomatic PAD is independently associated with recurrent vascular events and stroke.


Assuntos
Ataque Isquêmico Transitório/complicações , Doenças Vasculares Periféricas/complicações , Acidente Vascular Cerebral/complicações , Idoso , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Ataque Isquêmico Transitório/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/epidemiologia , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
19.
Horm Behav ; 53(2): 358-65, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18078937

RESUMO

Testosterone or its metabolite, estrogen, regulates aggression in males of many mammalian species. Because plasma testosterone levels are typically positively correlated with both aggression and reproduction, aggression is expected to be higher when males are in reproductive condition. However, in some photoperiodic species such as Siberian hamsters (Phodopus sungorus), males are significantly more aggressive in short day lengths when the testes are regressed and circulating testosterone concentrations are reduced. These results led to the formation of the hypothesis that aggression is modulated independently of circulating steroids in Siberian hamsters. Thus, recent studies have been designed to characterize the role of other neuroendocrine factors in modulating aggression. However, aggression may be mediated by testosterone or estrogen despite basal concentrations of these steroids by increasing sensitivity to steroids in specific brain regions. Consistent with this hypothesis, we found that males housed under short days have increased expression of estrogen receptor alpha in the bed nucleus of the stria terminalis, medial amygdala, and central amygdala. Neural activation in response to an aggressive encounter was also examined across photoperiod.


Assuntos
Agressão/fisiologia , Receptor alfa de Estrogênio/metabolismo , Fotoperíodo , Núcleos Septais/metabolismo , Agressão/efeitos da radiação , Tonsila do Cerebelo/metabolismo , Tonsila do Cerebelo/efeitos da radiação , Animais , Cricetinae , Imuno-Histoquímica , Luz , Masculino , Phodopus , Proteínas Proto-Oncogênicas c-fos/metabolismo , Núcleos Septais/efeitos da radiação
20.
BJU Int ; 100(6): 1313-6, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17979929

RESUMO

OBJECTIVE: To survey patient satisfaction, using validated questionnaires, in a group of men with erectile dysfunction who had used and responded to both sildenafil citrate and intracavernosal injection (ICI) therapy. PATIENTS AND METHODS: In all, 300 patients on ICI therapy were mailed questionnaire packets containing a survey enquiring about the patients' medical history, and two sets of the International Index of Erectile Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) sexual function surveys. If patients were using sildenafil alternating with ICI they were asked to complete the IIEF and EDITS questionnaires for each therapy. To identify only patients who had an adequate response to each agent, a score of >/=22 on the EF domain of the IIEF for sildenafil and ICI was required for inclusion in the final analysis. RESULTS: In all, 178 packets were evaluable; 123 men (69%) responded to ICI but not sildenafil, and 11 (6%) responded only to sildenafil and not ICI, leaving 37 patients who responded to both; these patients comprised the study population. There was no difference in EF domain score of the IIEF between the treatments; EDITS scores were significantly higher for ICI therapy than for sildenafil (P < 0.001). CONCLUSIONS: In patients who alternate the use of sildenafil and ICI therapy, satisfaction appears to be higher with ICI, although the erectogenic performance is similar. This suggests that patient satisfaction does not depend solely on erection performance, and that patients might benefit from various treatment options.


Assuntos
Disfunção Erétil/tratamento farmacológico , Satisfação do Paciente , Inibidores de Fosfodiesterase/uso terapêutico , Piperazinas/uso terapêutico , Sulfonas/uso terapêutico , Vasodilatadores/uso terapêutico , Inquéritos Epidemiológicos , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Ereção Peniana/efeitos dos fármacos , Purinas/uso terapêutico , Citrato de Sildenafila , Inquéritos e Questionários , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...