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Ultrasmall nanoparticles (usNPs) have emerged as promising theranostic tools in cancer nanomedicine. With sizes comparable to globular proteins, usNPs exhibit unique physicochemical properties and physiological behavior distinct from larger particles, including lack of protein corona formation, efficient renal clearance, and reduced recognition and sequestration by the reticuloendothelial system. In cancer treatment, usNPs demonstrate favorable tumor penetration and intratumoral diffusion. Active targeting strategies, incorporating ligands for specific tumor receptor binding, serve to further enhance usNP tumor selectivity and therapeutic performance. Numerous preclinical studies have already demonstrated the potential of actively targeted usNPs, revealing increased tumor accumulation and retention compared to non-targeted counterparts. In this review, we explore actively targeted inorganic usNPs, highlighting their biological properties and behavior, along with applications in both preclinical and clinical settings.
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BACKGROUND: Access to essential diagnostics is crucial for primary healthcare (PHC) in low-and-middle income countries (LMICs). Many LMICs have invested in equipping PHC with point-of-care (PoC) diagnostics for infectious diseases, however there has been no similar investment to improve PHC capacities for clinical chemistry. The biochemistry gap is among the deterrents to universal health coverage. METHODS: A social sciences project was conducted with the aim to understand the key PHC stakeholders' insights on the pertinence of PoC biochemistry for PHC in LMICs. Data generation was conducted between July-November 2023 in Mongolia, Nigeria and Peru. Decision-makers in healthcare delivery, healthcare professionals, and patient and community advocates were engaged using a combination of sampling techniques. Unstructured individual and group conversations, and non-participant observation were conducted. Analysis involved an inductive line-by-line coding on printed transcripts, followed by a deductive coding and theme-by-theme analysis on digitized transcripts. RESULTS: Fifteen, 51 and 20 informants from Mongolia, Nigeria and Peru, respectively, participated. Fifty-five of the 94 informants were female. Most informants considered that PoC biochemistry in PHC would be pertinent, from a clinical and a resources-saving perspective. Those households that currently bear the burden of referrals (i.e., the poor, the bedridden, the older adults) would benefit the most from the deployment of PoC biochemistry for essential biochemistry parameters. Improved access to PoC glycated hemoglobin (HbA1c), lipid, liver and kidney profile was perceived as helpful to inform clinicians' decision-taking. The value of PoC biochemistry for the management of noncommunicable diseases (diabetes, hypertension) and infectious conditions (dengue, malaria, tuberculosis), to improve child health outcomes (severe dehydration in children with diarrhea and/or malnutrition) and to reduce preventable causes of death (dengue-related renal failure) was highlighted. CONCLUSIONS: PoC biochemistry holds potential to revert the impact that the biochemistry gap has for patient care in some LMICs' PHC settings. PoC equipment for parameters such as HbA1c, urea, creatinine or electrolytes could enhance community-level management of preventable causes of mortality, improve service delivery for patients affected by locally-prevalent infectious conditions, and improve the psychosocial and economic wellbeing of patients facing the burden of referrals to remote biochemistry-equipped centers. TRIAL REGISTRATION: Not applicable.
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Países em Desenvolvimento , Atenção Primária à Saúde , Pesquisa Qualitativa , Humanos , Nigéria/epidemiologia , Peru , Feminino , Masculino , Mongólia , Sistemas Automatizados de Assistência Junto ao Leito , Testes Imediatos , AdultoRESUMO
This paper reports a comprehensive study of Theobroma cacao pericarp (TCP) residues, which has been prepared, characterized, and tested as an inexpensive and efficient biosorbent of Cr(VI) from aqueous solutions. The maximum adsorption capacity of TCP obtained at optimal conditions (pH = 2, dose = 0.5 g L-1, C0 = 100 mg L-1) was qmax = 48.5 mg g-1, which is one of the highest values reported by the literature. Structural and morphological characterization has been performed by FTIR, SEM/EDX, and pHPZC measurements. FTIR analysis revealed the presence of O-H, -NH, -NH2, C = H, C = O, C = C, C-O, and C-C functional groups that would be involved in the Cr(VI) biosorption processes. The experimental equilibrium data of biosorption process were successfully fitted to non-linear Langmuir (R2 = 0.95, χ2 = 11.0), Freundlich (R2 = 0.93, χ2 = 14.8), and Temkin (R2 = 0.93, χ2 = 14.7) isotherm models. Kinetics experimental data were well adjustment to non-linear pseudo-2nd (R2 = 0.99, χ2 = 2.08)- and pseudo-1st-order kinetic models (R2 = 0.98, χ2 = 2.25) and also to intra-particle Weber-Morris (R2 = 0.98) and liquid film diffusion (R2 = 0.99) models. These results indicate that Cr(VI) biosorption on heterogeneous surfaces as well as on monolayers of TCP would be a complex process controlled by chemisorption and physisorption mechanisms. The thermodynamic results indicate that the Cr(VI) biosorption on TCP is a feasible, spontaneous, and endothermic process. TCP can be regenerated with NaOH and reused up to 3 times.
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Cacau , Cromo , Cacau/química , Cromo/química , Adsorção , Cinética , Poluentes Químicos da Água/químicaRESUMO
Early exposure to stressors affects how the organism reacts to stimuli, its emotional state throughout life, and how it deals with emotional memories. Consequently, it may affect susceptibility to psychopathology later in life. We used an animal model of early stress by maternal separation to study its potential impact on the extinction of aversive memories and anxiety-like behavior in adulthood, as well as its effects on mitochondrial functionality, inflammatory and astrocytic markers in the amygdala. We also assessed whether a diet enriched with linseed oil, known for its high content in omega-3 fats, could be used to attenuate the behavioral and neurochemical effects of early stress. Litters of Wistar rats were divided into controls (intact) or subjected to maternal separation (MS). They were subdivided into two groups receiving isocaloric diets enriched in soy or linseed oils at weaning. In adulthood, the animals were exposed to the open field and the elevated plus maze, to evaluate exploratory activity and anxiety-like behavior. They were also trained in a context of fear conditioning, and afterward subjected to an extinction session, followed by a test session to evaluate the extinction memory. Amygdalae were evaluated for inflammatory cytokines (interleukin (IL)-1beta, IL-6, and tumor-necrose factor (TNF)-alpha), mitochondrial functionality, and astrocyte markers (glial fibrillary acidic protein - GFAP, S100B, and glutamine synthetase activity). MS induced anxiety-like behavior in the elevated plus-maze, which was reversed by a diet enriched in linseed oil offered from weaning. When testing the memory of an extinction session of fear conditioning, MS animals showed more freezing behavior. MS males receiving a linseed oil-enriched diet had lower functional mitochondria in the amygdala. In addition, MS led to increased inflammatory cytokines, particularly IL-1beta, and the diet enriched in linseed oil further increased these levels in MS animals. MS also increased S100B levels. These results point to a higher emotionality presented by MS animals, with higher levels of inflammatory cytokines and S100B. While a diet enriched in linseed oil attenuated anxiety-like behavior, it further altered amygdala IL-1beta and reduced mitochondria functionality, particularly in males. MS also increased glutamine synthetase activity in the amygdala, and this effect was higher when the animals received a diet enriched in linseed oil, particularly in females. In conclusion, these results point to MS effects on emotional behavior, and neurochemical alterations in the amygdala, with sex-specific effects. Although a diet enriched in linseed oil appears to be able to reverse some of MS behavioral effects, these results must be considered with caution, since biochemical parameters could be worsened in MS animals receiving a linseed oil-enriched diet. This knowledge is important for the understanding of mechanisms of action of strategies aiming to reverse early stress effects, and future studies are warranted to determine possible interventions to promote resilience.
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Electrochemical impedance spectroscopy (EIS) is a powerful technique that can be used to investigate the properties of materials, interfaces, and their redox reactions. It is applied to describe electrochemical systems and support the development of important technologies, offering a much more detailed investigation of properties than other conventional electrochemical techniques. EIS employs a modulated frequency to understand frequency-dependent electrochemical processes, thereby clarifying both fast and slow processes. As a dynamic and robust tool, a thorough understanding of this technique allows the precise use of the information it provides. In this review, we cover the history of the technique's development, its fundamental theory, and necessary conditions for proper use, in addition to providing guidelines on how to use EIS for data collection and the acquisition of relevant information provided by the technique. We also discuss complications related to the necessary conditions, equivalent circuits used for describing systems, commonly used plots, the configuration of electrochemical cells and the possibilities for the use and application of EIS techniques to characterize supercapacitors and batteries. This paper provides meaningful information and discussion related to EIS and ways to better utilize it for investigating the properties of materials.
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OBJECTIVE: To determine the effectiveness of the McKenzie Method compared to any conservative interventions on pain and disability in patients with chronic low back pain (LBP) with directional preference (DP). METHODS: We searched six electronic databases up to September 2022. Eligible randomized controlled trials were those assessing the McKenzie Method delivered by credentialed therapists for chronic LBP with DP. Two reviewers independently selected studies, extracted data, assessed risk of bias with the revised Cochrane Risk of Bias 2.0 tool and certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS: Five trials (n = 743) were included. There was low-certainty evidence that the McKenzie Method, compared to all other interventions combined, produced clinically important reductions in short-term pain (mean difference [MD] -1.11 points on a 10-point scale; 95% CI -1.83 to -0.40) and in intermediate-term disability (standardized mean difference [SMD] -0.53; 95% CI -0.97 to -0.09). Low-to-moderate certainty evidence showed that the McKenzie Method also resulted in clinically important improvements in short-term pain (MD -1.53; 95% CI -2.51 to -0.54) and disability (SMD -0.50; 95% CI -0.74 to -0.25) when compared specifically to other exercise approaches, and in intermediate-term pain (MD -2.10; 95% CI -2.94 to -1.26) and disability (SMD -1.01; 95% CI -1.58 to -0.43) as well as long-term disability (SMD -0,59; 95% CI -1.14 to -0.03) when compared to minimal intervention. Low-certainty evidence showed usually small, clinically unimportant effects in comparison to manual therapy. CONCLUSION: We found low-to-moderate certainty evidence that the McKenzie Method was superior to all other interventions combined for up to 6 months for pain and up to 12 months for disability, with clinically important differences versus exercise in the short term and versus minimal interventions in the intermediate term. The only clinically important long-term effect was on disability compared to minimal intervention.
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Background: Despite the growing number of elderly kidney transplant (Ktx) recipients, few studies have examined the effects of immunosuppression on their lymphocyte profiles. Methods: We evaluated the early conversion from mycophenolate sodium (MPS) to everolimus (EVL) after rabbit antithymocyte globulin (rATG) 2 mg/kg induction in elderly kidney recipients. Three groups of KTx patients were compared: (a) Young (n=20, 36 ± 7 y) receiving standard immunosuppression (Group A1) (prednisone, tacrolimus, and MPS), (b) Elderly (n=35, 65 ± 3 y) receiving standard immunosuppression (Group B1), and (c) Elderly (n=16, 65 ± 3 y) with early (mean 30 d) conversion from MPS to EVL (Group B2). Naive, memory, and regulatory peripheral blood TCD4+ lymphocytes were quantified at 0, 30, and 365 d. Results: Results are reported as [mean(p25-p75)]. Young recipients had higher lymphocyte counts at baseline [2,100(1,630-2,400) vs. 1,310 (1,000-1,600)/mm3, p<0.0001] maintained higher counts within 365 d [1,850(1,590-2,120) vs. 1,130(460-1,325)/mm3, p=0.018 and vs. 1,410(805-1,895)/mm3, p=0.268]. Elderly recipients showed a decrease in lymphocytes within 30 d [1,310(1,000-1,600) vs. 910(700-1,198)/mm3, p=0.0012] with recovery within 365 d. The same pattern was observed in total lymphocytes and TCD4+ counts. Rabbit antithymocyte globulin induced a reduction in central memory T-cell percentages at 30 d in both young recipients [6.2(3.77-10.8) vs. 5.32(2.49-7.28)% of CD4+, p=0.036] and in elderly recipients [8.17(5.28-12.88) vs. 6.74(4.36-11)% of CD4+, p=0.05] on standard immunosuppression, returning to baseline at 365 d in elderly recipients but not in young recipients. Regulatory T CD39+ cells (Treg) percentages decreased at 30 d in elderly recipients [2.1(1.23-3.51) vs. 1.69(0.8-2.66)% of CD4+, p=0.0028] and in young recipients [1.29(0.45-1.85) vs. 0.84(0.18-1.82)% of CD4+, p=0.0038], returning to baseline at 365 d in elderly recipients [2.1(1.23-3.51) vs. 2.042(0.88-2.42)% of CD4+], but not in young recipients [1.29(0.45-1.85) vs. 0.86(0.7-1.34) % of CD4+]. The elderly everolimus conversion group did not show significant changes in cell profile over time or compared to elderly recipients with standard immunosuppression. Conclusion: Aging favored the maintenance of Treg during the late transplantation period despite ongoing immunosuppression. Lymphocyte depletion due to rATG was more prominent in elderly recipients and affected memory subsets with a temporary reduction in central memory T cells. However, conversion to everolimus did not impact Treg profile. Reducing the dose of rATG in elderly recipients seems necessary for the expected lymphocyte changes with EVL to occur. Clinical trial registration: nEverOld Trial, identifier NTC01631058.
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Imunossupressores , Transplante de Rim , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Etários , Soro Antilinfocitário/uso terapêutico , Everolimo , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Terapia de Imunossupressão/métodos , Imunossupressores/uso terapêutico , Contagem de Linfócitos , Ácido Micofenólico/administração & dosagem , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/efeitos dos fármacos , Subpopulações de Linfócitos T/metabolismo , Tacrolimo/administração & dosagem , Tacrolimo/uso terapêutico , TransplantadosRESUMO
Malaria is a global health challenge, and international efforts are underway to alleviate its impact by 2035. Within the 249 million global cases, 0.6 million occur in the Americas, mainly in Venezuela, Brazil, and Colombia. Considering Brazil's geographical proximity to malaria-endemic countries in South America, this study objective is to analyze the epidemiological characteristics and time trends of imported malaria cases in Brazil from 2007 to 2022, discussing their influence on the elimination process. This is an ecological time-series study that analyses malaria imported cases (infected in other countries) notified in Brazil, from 2007 to 2022. Brazil's Ministry of Health data were used. Descriptive statistics were employed to analyze sociodemographic and spatial patterns, while the impact of the Covid-19 pandemic on imported malaria trends was assessed using Prais-Winsten regression methods. In the study period there was a total of 109,914 imported cases (2.6% of Brazil's total malaria burden). There was an annual reduction of 515.3 cases (p = 0.001) prior to the Covid-19 pandemic. During the pandemics there was an overall reduction of -3,301.8 cases (p = 0.001). In the Amazon region P. vivax imported infections predominated, whereas in the extra-Amazon region P. falciparum imported infections were more prevalent. Most imported cases were males (67.8%), of Black ethnicity (47.5%), with incomplete primary education (45.1%), aged 20-39 (61.1%), and primarily gold miners (54.0%). Most cases are from French Guiana (31.7%), Venezuela (30.0%), and Guyana (17.9%). African nations, notably Angola and Nigeria, were primary sources of imported cases to the extra-Amazon region. The imported cases flux, predominantly from Latin America, threatens Brazil's elimination goals by potentially reintroducing the disease into previously cleared areas and sustaining the transmission in endemic areas. Strengthening epidemiological surveillance at the borders and fostering international cooperation are imperative steps in addressing this challenge.
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BACKGROUND: Differences in definitions and operational diagnoses for sarcopenia create difficulties in understanding the epidemiology of the disease. We examined the prevalences of sarcopenia using the revised European Working Group on Sarcopenia in Older People (EWGSOP2) and the Sarcopenia Definitions and Outcomes Consortium (SDOC) consensuses and analyzed their level of agreement in patients receiving hemodialysis. METHODS: Data from the SARCopenia trajectories and associations with clinical outcomes in patients receiving hemodialysis (SARC-HD) multicenter study in Brazil were analyzed. Muscle strength was assessed using handgrip strength, muscle mass by calf circumference, and physical performance by the 4-m gait speed test. Sarcopenia was diagnosed according to both the EWGSOP2 (low muscle strength plus low muscle mass) and the SDOC (low muscle strength plus low physical performance). The Cohen kappa statistic was used to determine the level of agreement between the consensuses. RESULTS: 838 patients (57.8 ± 15.0 years; 61% men) from 19 dialysis units were included. We found similar prevalences of sarcopenia between the consensuses (EWGSOP2, n = 128, 15.3%; SDOC, n = 105, 12.5%) but with weak agreement (50 of 233 patients, 21.5%; κ = 0.34, 95% CI 0.25-0.43). Agreement was also weak within age categories (≥60 years, κ = 0.34; <60 years, κ = 0.15; both P < 0.001). Of the 51 patients diagnosed by the EWGSOP2 criterion as having severe sarcopenia, all but 1 (98.0%) met the SDOC criterion for sarcopenia (κ = 0.61, 95% CI 0.52-0.70). Low muscle strength was more frequently diagnosed using the SDOC than with the EWGSOP2 (52.3% vs 25.9%). CONCLUSION: We found a weak agreement between the EWGSOP2 and SDOC consensuses for the diagnosis of sarcopenia in patients receiving hemodialysis. Although still weak, agreement was marginally better for older patients. These findings highlight the importance of a global and standardized conceptual diagnosis of sarcopenia.
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OBJECTIVE: To verify whether factors associated with Autism Spectrum Disorder (ASD) would have impact on the dental-caries prevalence. MATERIALS AND METHODS: All ASD-individuals receiving care in a specialized center with minimum of 4y old were recruited. Demographic, socioeconomic and behavioral characteristics, level of support/commitment (Childhood Autism Rating Scale), mealtime behavior (Brief Autism Mealtime Behavior Inventory) and medication use were answered by ASD-individual's parents. Behavior during dental care was evaluated from Frankl scale. Dental-caries prevalence was the primary outcome. Three examiners calibrated/trained collected the data. Chi-square test was used to compare the variables impact on the dental-caries prevalence. RESULTS: 61 ASD-individuals were potentially eligible, and the all parents/guardians consent to participate. Dental-caries prevalence was 42.9%, which was statistically associated with lower toothbrushing frequency, higher level of support/commitment, and worse behavior at meals and during in dental care. Dental-caries prevalence was approximately higher twice in ASD-individuals: (i) uncooperative with dental care when compared those cooperative (62% versus 32%, respectively); (ii) with severe level of support when compared to those with mild/moderate level (58% versus 28%, respectively); and (iii) with worse mealtime behavior when compared to those with better behavior (59% versus 28%, respectively). A medium statistical correlation was observed between support level and mealtime behavior (rS=0.39). The BAMBI component statistically associated with dental-caries prevalence was the food refusal (capture problem when a child rejects a presented food, crying, spitting out food). CONCLUSION: higher required level of support, worse mealtime behavior and uncooperative profile in dental care negatively affect the dental-caries prevalence. CLINICAL RELEVANCE: our findings provide evidence of the need of specialized, preventive and individualized dental care among ASD-individuals.
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Transtorno do Espectro Autista , Cárie Dentária , Humanos , Estudos Transversais , Prevalência , Feminino , Masculino , Cárie Dentária/epidemiologia , Pré-Escolar , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/psicologia , Refeições , Comportamento Alimentar , Inquéritos e Questionários , Assistência OdontológicaRESUMO
The consumption of fatty acids offers significant health benefits; however, they are prone to degradation by environmental factors. One method to preserve these fatty acids is the addition of synthetic antioxidants. This study focuses on the determination of peroxide and MDA formation rates at temperatures of 25 °C, 45 °C, and 65 °C. The oxidative stability of cold-pressed avocado oil was evaluated using pure astaxanthin, TBHQ, and H. pluvialis extract at concentrations of 100, 500, and 1000 ppm. Kinetic models and thermodynamic analysis were applied to determine the oxidation rate and compare the antioxidant effects of H. pluvialis extract with astaxanthin and TBHQ. The Arrhenius model was used to estimate activation energy (Ea), enthalpy, entropy, and free energy. Avocado oil with 500 ppm of H. pluvialis extract showed antioxidant effects comparable to TBHQ and pure astaxanthin. The activation energy of plain avocado oil was 40.47 kJ mol-1, while with H. pluvialis extract, it was 54.35 kJ mol-1. These findings suggest that H. pluvialis extract offers effective antioxidant properties and could serve as a natural alternative to synthetic antioxidants in food applications, despite the limitations of unprotected astaxanthin.
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SUMMARY OBJECTIVE: This study was conducted to determine the effect of relaxation exercise on fatigue symptoms in hemodialysis patients. METHODS: This is a meta-analysis study. The literature review was carried out by searching studies published between 2011 and 2020. This meta-analysis was recorded on PROSPERO in the National Health Research Institute (Registration no: CRD42022313646). RESULTS: Seven studies meeting the inclusion criteria were included in the meta-analysis. The effect size of the studies included in the meta-analysis was found to be g=1.232 (p=0.028), which indicated a "huge effect size." The scale used in the subgroup analyses, the application time of the relaxation exercise, and the number of relaxation exercise applications were evaluated, and a significant difference was found at p<0.05. CONCLUSION: Relaxation exercises can be used as an effective method for reducing fatigue in hemodialysis patients.
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BACKGROUND: Long-term enlargement of the aortic arch after aortic arch reconstruction (AAR) in hypoplastic left heart syndrome (HLHS) is not well described. METHODS: Aortic arch measurements for 50 patients with HLHS who achieved Fontan completion were converted to Pediatric Heart Network z-scores. Dimensions were assessed using linear mixed models and differences among time points were evaluated with F-tests. Sub-analysis was conducted comparing Norwood (n=36) vs hybrid (n=14) strategies. RESULTS: Median time to last imaging was 6.4 (IQR, 3.5-11.3) years. Prior to intervention, the main pulmonary artery was dilated whereas the ascending aorta (AA), transverse arch (TA), and isthmus (ISTH) were hypoplastic. With AAR, there were expected increases in all arch z-scores. The aortic arch continued to dilate after AAR reaching peak values at 7 months [Neo-Aortic Complex (NAC): z= 6.9 (5.6-8.0)] or 12 months following stage I [AAo: z=6.1 (2.9-8.3); TA: z=4.7 (3.0-5.9)]. Following peak values, there was a gradual decline in z-scores with most components still at least mildly dilated at 16 years [NAC: z=3.2 (3.1-3.9), AAo: z=3.9 (3.3-4.2); TA: z=3.1 (2.5-3.7)] with abrupt calibre change at ISTH: z= -0.8 (-1.1- -0.3)]. Norwood and hybrid strategies showed similar enlargement profiles after 7 months of age. CONCLUSIONS: Neo-aortic root and aortic arch in HLHS are enlarged early after AAR and continue to enlarge out of proportion to normal controls until 12 months of age, with gradual decline in enlargement up to adolescence. Further work should focus on modifiable surgical factors which may prove important to optimize arch growth and geometry.
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The study of reproductive biology is an important tool in identifying protective measures to preserve fish stocks, providing essential data for a reliable management system that ensures a balance between the environment and the economy. This study aims to analyze the first sexual maturity and type of spawning of the fish Conodon nobilis (Linnaeus, 1758) on the Amazon coast, specifically in the Gulf Maranhense region. 360 specimens were obtained from commercial fishing activity in the community of Raposa-MA during the period from January to December 2021. Biometric data were recorded, and the gonadal maturation stages were determined through macro (maturation scale) and microscopic (histology) analyzes. Sex ratio, mean length of first sexual maturation and type of spawning were determined. Negative allometric growth was recorded for both sexes, indicating a greater increase in length than in weight, and the length varied from 11 to 31.8 cm and the sex ratio was 1 male:1.5 female. Individuals in all stages of maturation were observed throughout the year, with a predominance of individuals in spawning capacity and reproductive peaks in January, April and May, indicating that the species presents multiple spawning. The length at first sexual maturity (L50) for females was 18.41 cm and for males was 18.91 cm. Knowledge of the mean size at sexual maturity can help define appropriate regulations for fishing, ensuring that individuals have the opportunity to reproduce at least once before being captured.
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Reprodução , Estações do Ano , Maturidade Sexual , Animais , Maturidade Sexual/fisiologia , Brasil , Masculino , Feminino , Reprodução/fisiologia , Razão de MasculinidadeRESUMO
Background: There has been an increase in certain cancers among young adults (YA) aged 20-39, particularly in Latin America. This is the first study to examine cancer incidence and mortality in YA in Costa Rica, focusing on sex-specific patterns. Methods: Invasive cancer cases (excluding non-melanoma skin cancer) in YA from 2006 to 2015 were obtained from the Costa Rican National Registry of Tumors. Utilising SEER∗Stat software, age-standardized incidence rates (IRs) and incidence rate ratios (IRRs) were calculated. Trends and annual percent changes (APCs) in IRs were estimated using the Joinpoint regression analysis program. Cancer deaths from 2000 to 2021 were obtained from the Costa Rican National Institute of Statistics and Census. Age-standardised mortality rates were calculated using STATA®17. Findings: YA comprised 10.7% of all invasive cancer cases diagnosed from 2006 to 2015. The age-standardized incidence rate (ASIR) of invasive cancer in YA was 50.9/100,000 person-years. The ASIR was twofold higher for females compared to males (IRR = 2.03, 95% CI:1.94, 2.13). This difference increased with age, peaking in the 35-39-year age group (IRR = 2.84, 95% CI:2.62, 3.10). Thyroid, breast, and cervical cancer were the most common in females. Testicular cancer was the most common in males. Leading causes of cancer-related deaths included cervical and breast cancer in females and stomach and brain/nervous system cancer in males. Interpretation: The study highlights sex-specific patterns in cancer incidence and mortality among YA in Costa Rica to increase understanding and improve cancer outcomes in this age group. Funding: This study was funded by the Intramural Research Program of the National Cancer Institute.
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This dataset includes spectra obtained through Raman spectroscopy of acetylsalicylic acid, paracetamol, and ibuprofen commercialized in San Lorenzo, Central Department of Paraguay. The pharmaceuticals were randomly purchased from pharmacies, official sales points, and street vendors, simulating purchases for self-consumption. These drugs were selected due to their high demand and consumption by the population, aiming to document and facilitate the identification of adulterations or alterations in their original structures caused by poor storage conditions. Additionally, this database will support multivariate studies for clustering using various techniques, both supervised and unsupervised, and will allow for signal processing and spectroscopic data handling.
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Chagas disease is a neglected tropical disease caused by the parasite Trypanosoma cruzi. Chronic Chagas cardiomyopathy (CCC), the most severe form of target organ involvement in Chagas disease, is characterized by a complex pathophysiology and a unique phenotype that differentiates it from other cardiomyopathies, highlighting its worse prognosis compared to other aetiologies of heart failure. The three pathophysiological mechanisms with the largest impact on this differential mortality include rapidly progressive heart failure, a high incidence of stroke, and a high burden of ventricular arrhythmias. However, despite significant advances in understanding the unique molecular circuits underlying these mechanisms, the new knowledge acquired has not been efficiently translated into specific diagnostic and therapeutic approaches for this unique cardiomyopathy. The lack of dedicated clinical trials and the limited CCC-specific risk stratification tools available are evidence of this reality. This review aims to provide an updated perspective of the evidence and pathophysiological mechanisms associated with the higher mortality observed in CCC compared to other cardiomyopathies and highlight opportunities in the diagnostic and therapeutic approaches of the disease.
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OBJECTIVES: The burden of cancer is increasing rapidly in Latin America. Primary care has an essential role in cancer prevention, but implementation levels of prevention practices are not well known. This study evaluated implementation levels and associated factors of cancer preventive practices in primary care over time. STUDY DESIGN: The study incorporated a retrospective multicentre cohort study. METHODS: A population of 59,949 patients registered at three primary care clinics was followed from January 2018 to December 2022 in Santiago, Chile. We studied human papillomavirus (HPV) and hepatitis B virus (HBV) immunisation, brief counselling for smoking cessation and alcohol consumption, and cervical and breast cancer screening practices. Standardised electronic medical records were utilised as the source of information. Social, clinical, and organisational factors associated with prevention practices were studied. RESULTS: The cohort attrition level was 17.1%. Most of the population was of a low socioeconomic status, and 70% visited a primary health centre yearly. Implementation rates of immunisation practices were 90.84% for HPV and 80.94% for HBV in 2022. In contrast, brief counselling for smoking and alcohol consumption was below 20% during the study period. Cervical cancer screening decreased by 25.58% between 2018 and 2022, whereas breast cancer screening reached only 41.71% of the target population. Opportunistic medical visits were strongly associated with brief counselling and breast cancer screening. CONCLUSION: Implementation practices for cancer prevention in a Chilean primary care cohort are high for immunisation and very low for brief counselling and screening practices. A comprehensive non-medical-based model is needed to improve cancer prevention in primary care.
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BACKGROUND: The city of El Pedregal grew out of a desert, following an agricultural irrigation project in southern Peru. OBJECTIVES: To describe infestation patterns by triatomines and bed bugs and their relationship to migration and urbanization. METHODS: We conducted door-to-door entomological surveys for triatomines and bed bugs. We assessed spatial clustering of infestations and compared the year of construction of infested to un-infested households. To gain a better understanding of the context surrounding triatomine infestations, we conducted in-depth interviews with residents to explore their migration histories, including previous experiences with infestation. FINDINGS: We inspected 5,164 households for Triatoma infestans (known locally as the Chirimacha); 21 (0.41%) were infested. These were extremely spatially clustered (Ripley's K p-value < 0.001 at various spatial scales). Infested houses were older than controls (Wilcoxon rank-sum: W = 33; p = 0.02). We conducted bed bug specific inspections in 34 households; 23 of these were infested. These were spatially dispersed across El Pedregal, and no difference was observed in construction age between bed bug infested houses and control houses (W = 6.5, p = 0.07). MAIN CONCLUSIONS: The establishment of agribusiness companies in a desert area demanded a permanent work force, leading to the emergence of a new city. Migrant farmers, seeking work opportunities or escaping from adverse climatic events, arrived with few resources, and constructed their houses with precarious materials. T. infestans, a Chagas disease vector, was introduced to the city and colonized houses, but its dispersal was constrained by presence of vacant houses. We discuss how changes in the socioeconomic and agricultural landscape can increase vulnerability to vector-borne illnesses.