Estimación de la demanda para la ayuda humanitaria ante un desastre natural en la Costa Verde, distrito de Miraflores

La presente tesis busca estimar la cantidad de personas vulnerables ante un evento sísmico y posterior tsunami en la Costa Verde en el distrito de Miraflores a través del análisis del comportamiento vehicular en la vía expresa. En un primer término, se comienza revisando la literatura y casos de estudio realizados en distintas zonas que pertenecen al Cinturón de Fuego que servirán para una comparación con la situación real descrita en la segunda parte. En esta segunda parte se presentará un análisis cualitativo y cuantitativo sobre el estado en que se encuentran los acantilados, el estado de las autopistas, el estado de los puentes, la gestión de riesgos y los puntos a evacuar durante un aviso de tsunami. Luego de una comparación entre la situación actual y la revisión literaria, se realiza el conteo vehicular de la zona para la toma de datos y proponer un modelamiento de transporte a través de la simulación. De acuerdo a los resultados de la simulación, bajo condiciones normales, la cantidad de personas vulnerables es de 3 835 aproximadamente en horario pico. Se propone tres escenarios, siendo el escenario 1 el resultado más favorable, el escenario 1 estima no tener víctimas si se da prioridad a la salida de vehículos durante el terremoto y posterior tsunami, además de bloquear las entradas a la Costa Verde y que no ocurra algún deslizamiento en el acantilado

Design and Fabrication of Flexible Copper Sensor Decorated with Bismuth Micro/Nanodentrites to Detect Lead and Cadmium in Noninvasive Samples of Sweat

The use of economic methods to design and fabricate flexible copper sensors decorated with bismuth micro/nanodentrites for the detection of lead and cadmium in sweat is demonstrated. The flexible copper sensors were constructed with simple and cost-effective materials; namely, flexible and adhesive conductive copper tape, adhesive label containing the design of a three-electrode electrochemical system, and nail polish or spray as a protective layer. The flexible copper device consisted of a working electrode decorated with bismuth micro/nanodentrites using an electrodeposition technique, a copper pseudo-reference and copper counter electrodes. Under optimal experimental conditions, the flexible sensing platform showed excellent performance toward the detection of lead and cadmium using differential pulse anodic stripping voltammetry (DPAdSV) in a wide linear range from 2.0 μM to 50 μM with acceptable reproducibility and repeatability, and limits of detection and quantification of 5.36 and 17.9 μM for Cd2+ ions and 0.76 μM and 2.5 for Pb2+ ions. Studies of addition and recovery in spiked artificial sweat sample were performed, with a recovery of 104.6%. The flexible copper device provides a great opportunity for application in wearable perspiration-based healthcare systems or portable sensors to detect toxic metals in biological samples

Trihexyphenidyl: characterization of its abusive consumption by a group of users in the city of São Paulo

The abuse of anticholinergic drugs to induce mental alterations as hallucinations and delirium is widely known. Trihexyphenidyl (Artane®), among these drugs, seems to be the most abused. In Brazil, its use has been already observed among psychotic patients, first and second grade students, street children and crack-cocaine addicts. Faced to the lack of Brazilian reports describing such inadequate use of trihexyphenidyl, this study was conducted to characterize recreacional use as well as reasons that justify the misuse. Adopting qualitative methodology and a Purposeful Sampling achieved by a Criterion Sampling (21 users and 16 ex-users), it was observed predominance of single poliusers men, without employment bonds, who abused of trihexyphenidyl in the attainment of mental alterations, mainly hallucinations and deliriums. Trihexyphenidyl is consumed in association with alcohol, other licit drugs (BDZ) and illicit drugs, impairing cognitive functions as memory, attention and learning, intervening with some activities of users' daily life. Reported as an easy access medicine, with low-cost and resulting in drastic effects in the life of the user, these results pointed to the necessity of more effective measures in its release, beyond the necessity of adoption of prevention measures to avoid its abuse.O abuso de drogas anticolinérgicas na indução de estados mentais alterados, como alucinações e delírios, é amplamente conhecido. Entre essas, a triexifenidila (TEF) (Artane®) parece ser a mais abusada. No Brasil, seu consumo já foi observado entre pacientes psicóticos, estudantes de 1º e 2º graus da rede pública, meninos de rua e usuários de crack. Diante da carência de relatos brasileiros que retratassem o consumo inadequado da triexifenidila, esse estudo foi conduzido para caracterizar a população usuária e as razões subjacentes ao seu abuso. Utilizando-se de metodologia qualitativa e amostra intencional selecionada por critérios (21 usuários e 16 ex-usuários), observou-se a predominância de homens solteiros, poliusuários e sem vínculos empregatícios, que relataram o abuso da droga na obtenção, principalmente, de alucinações e delírios. A TEF, consumida em associação a álcool, outras drogas lícitas (BZD) e ilícitas, interfere nas funções cognitivas, como memória, atenção e aprendizado, prejudicando os usuários no desempenho de muitas de suas atividades cotidianas. Por ser relatada como medicamento de fácil acesso, baixo custo e com efeitos drásticos na vida do usuário, os resultados apontam para a necessidade de medidas mais efetivas em sua liberação, além da necessidade de adoção de medidas preventivas para que seu abuso seja evitado.Universidade Federal de São Paulo (UNIFESP) Departamento de PsicobiologiaCentro Brasileiro de Informações sobre Drogas Psicotrópicas (CEBRID)UNIFESP Departamento de PsicobiologiaCEBRIDUNIFESP, Depto. de PsicobiologiaUNIFESP, Depto. de PsicobiologiaSciEL

Medical adverse events in elderly hospitalized patients: a prospective study

OBJECTIVES: To determine the frequency of medical adverse events in elderly patients admitted to an acute care geriatric unit, the predictive factors of occurrence, and the correlation between adverse events and hospital mortality rates. METHODS: This prospective study included 171 admissions of patients aged 60 years and older in the acute care geriatric unit in a teaching hospital in Brazil between 2007 and 2008. The following variables were assessed at admission: the patient age, gender, number of prescription drugs, geriatric syndromes (e.g., immobility, postural instability, dementia, depression, delirium, and incontinence), comorbidities, functional status (evaluated with the Katz Index of Independence in Activities of Daily Living), and severity of illness (evaluated with the Simplified Acute Physiology Score Il). The incidence of delirium, infection, mortality, and the prescription of potentially inappropriate medications (based on the Beers criteria) were assessed during hospitalization. An observer who was uninvolved in patient care reported the adverse events. RESULTS: The mean age of the sample was 78.12 years. A total of 187 medical adverse events occurred in 94 admissions (55%). The predictors of medical adverse events were undetermined. Compared with the patients with no adverse events, the patients with medical adverse events had a significantly longer hospital stay (21.41 ± 15.08 days versus 10.91 ± 7.21 days) and a higher mortality rate (39 deaths [41.5%] versus 17 deaths [22.1%]). Mortality was significantly predicted by the Simplified Acute Physiology Score II score (odds ratio [OR] = 1.13, confidence interval [CI] 95%, 1.07 to 1.20), the Katz score (OR=1.47, CI 95%, 1.18 to 1.83), and medical adverse events (OR = 3.59, CI 95%, 1.55 to 8.30). CONCLUSION: Medical adverse events should be monitored in every elderly hospitalized patient because there is no risk profile for susceptible patients, and the consequences of adverse events are serious, sometimes leading to longer hospital stays or even death

Sarcoma sinovial das extremidades: fatores de prognóstico em 20 casos não-metastáticos e um novo sistema de graduação histológica com significado prognóstico

PURPOSE: To evaluate 20 cases of nonmetastatic synovial sarcoma of the extremities regarding prognostic factors, and to propose a histologic grading system with prognostic significance. METHODS: The cases of 20 patients (14 females and 6 males) with nonmetastatic synovial sarcomas of the extremities treated between 1985 and 1998, were retrospectively evaluated regarding prognostic factors. A histologic grading system with prognostic significance is proposed. RESULTS: The mean follow-up period was 48.4 months (range, 16-116 months). There was local recurrence in 3 cases (15%), microscopic surgical margin being the only prognostic factor identified. Seven patients (35%) died of the disease in a mean postoperative period of 31.7 months (range, 16-53 months), all with pulmonary or brain metastasis. The survival rate was 65% in 48.4 months of follow-up. CONCLUSION: The unfavorable prognostic factors identified regarding survival were high histologic grade, tumors proximal to the knee or elbow, and spontaneous tumor necrosis over 25%. Local recurrence did not have influence on survival in this study. The presence of mast cells appears to have a positive influence on survival, although statistical significance was not reached (P = 0.07). The oncologic and functional result was good in 6 cases (30%), regular in 7 (35%), and poor in 7 cases (35%).OBJETIVO: Avaliar casos de sarcoma sinovial não-metastático das extremidades no que se refere a fatores prognósticos, e propor um sistema histológico de pontuação com significado prognóstico. MATERIAL E MÉTODO: Vinte casos (14 do sexo feminino e 6 do sexo masculino) de sarcomas sinoviais não-metastáticos das extremidades tratados entre 1985 e 1998 no departamento de Ortopedia foram avaliados retrospectivamente no que se refere a fatores prognósticos e está sendo proposto um sistema de pontuação histológico com significado prognóstico. RESULTADOS: A média dos períodos de acompanhamento foi 48,4 meses (mínimo 16 meses, máximo 116). Houve recorrência localizada em 3 casos (15%), sendo a margem cirúrgica microscópica o único fator prognóstico identificado. Sete pacientes (35%) morreram da doença, todos em período pós-operatório médio de 31,7 meses (mínimo 16 meses, máximo 53), todos com metástase pulmonar ou cerebral. A sobrevida foi de 65% em 48,4 meses de acompanhamento. CONCLUSÃO: Os fatores prognósticos desfavoráveis identificados referentes à sobrevida foram: grau histológico alto, tumores proximais de joelho ou cotovelo e necrose espontânea de tumor acima de 25%. Neste estudo, a recorrência localizada não influiu na sobrevida. Parece que a presença de mastócitos influi positivamente na sobrevida, porém não obtivemos significado estatístico (p=0,07). O resultado oncológico e funcional foi bom em seis casos (30%), regular em sete (35%) e insatisfatório em sete (35%)

Spontaneous poisoning by larvae of Perreyia flavipes in cattle from the State of Santa Catarina, Brazil

Neste trabalho, é descrito um surto de intoxicação por Perreyia flavipes ocorrido em agosto de 2006, em um rebanho bovino de 280 animais, no município de Sombrio, em Santa Catarina. Ocorreram 17 mortes em um lote de 77 bovinos de raça mista com idades entre um e dois anos mantidos em um piquete (P1) de aproximadamente 90 hectares por cerca de 30 dias. Após as primeiras duas mortes, os animais foram movidos para um segundo piquete (P2), onde ainda ocorreram 15 mortes nos cinco dias após a transferência. Seis bovinos foram necropsiados, e amostras de tecidos foram avaliadas para exame histológico. Os achados de necropsia incluíam hemorragias subcutâneas na mucosa do abomaso e superfície subepicárdica. Ascite e edema do abomaso, duodeno, pâncreas e vesícula biliar foram observados. O fígado apresentava-se amarelado com petéquias subcapsulares e acentuação do padrão lobular. No rúmen de três bovinos, foram encontrados fragmentos de corpos e cabeças de larvas de P. flavipes em meio ao conteúdo ruminal. Histologicamente o fígado apresentava tumefação hepatocelular e necrose centrolobular e mediozonal, difusa e acentuada, com hemorragia e congestão centrolobular. Havia depleção e necrose linfóide no baço, placas de Peyer e linfonodos mesentéricos. O diagnóstico de intoxicação pelas larvas da P. flavipes foi baseado nos dados epidemiológicos, nos achados de necropsia e nas alterações histopatológicas. As lesões hepáticas e em tecidos linfóides, além da grande quantidade de larvas de P. flavipes no primeiro piquete (P1) e no rúmen de animais necropsiados, foram dados importantes para o diagnóstico. ____________________________________________________________________________ ABSTRACTThis article describes an outbreak of Perreyia flavipes poisoning in August of 2006 in a cattle herd of 280 animals in Sombrio, Santa Catarina, southern Brazil. Seventeen bovines between 1 and 2 years old from one herd of 77 mixed breed cattle died. The herd was kept in a paddock of 90 hectares (P1) for 30 days. After de first two deaths occurred, the herd was transferred to a second paddock (P2), and 15 more animals died in the next 5 days. Samples from 6 of these animals were analyzed. During the necropsy, hemorrhage was seen in the subcutaneous tissue, abomasal mucosa, and subepicardial area. The animals presented ascites and edema of the abomasal folds, duodenum, pancreas, and gallbladder. The liver was yellowish, had subcapsular petechial hemorrhages, and accentuated lobular pattern. P. flavipes larval body fragments and heads were found in the rumen content of three of the animals. In the histological examination the liver showed hepatocellular tumefaction, diffuse coagulative necrosis of centrilobular and midzone hepatocytes, hemorrhage and centrilobular congestion. Lymphoid depletion and diffuse necrosis of germinative centers of lymphoid follicles in mesenteric lymph nodes, Peyer’s patches and spleen were also observed. The diagnosis of intoxication by P. flavipes larvae in this outbreak was based on the epidemiological data, necropsy, and histological findings. The confirmation of P. flavipes larvae as cause of the outbreak was done by the observation of intact larvae and remnants in the ruminal content of the necropsied bovines and by the presence of a great number of larvae clusters in the paddock 1 (P1)

Drug-induced liver injury: A management position paper from the Latin American Association for Study of the liver

Idiosyncratic drug-induced liver injury (DILI) caused by xenobiotics (drugs, herbals and dietary supplements) is an uncommon cause of liver disease presenting with a wide range of phenotypes and disease severity, acute hepatitis mimicking viral hepatitis to autoimmune hepatitis, steatosis, fibrosis or rare chronic vascular syndromes. Disease severity ranges from asymptomatic liver test abnormalities to acute liver failure. DILI has been traditionally classified in predictable or intrinsic (dose-related) or unpredictable (not dose-related) mechanisms. Few prospective studies are assessing the real prevalence and incidence of hepatotoxicity in the general population. DILI registries represent useful networks used for the study of liver toxicity, aimed at improving the understanding of causes, phenotypes, natural history, and standardized definitions of hepatotoxicity. Although most of the registries do not carry out population-based studies, they may provide important data related to the prevalence of DILI, and also may be useful to compare features from different countries. With the support of the Spanish Registry of Hepatotoxicity, our Latin American Registry (LATINDILI) was created in 2011, and more than 350 DILI patients have been recruited to date. This position paper describes the more frequent drugs and herbs-induced DILI in Latin America, mainly focusing on several features of responsible medicaments. Also, we highlighted the most critical points on the management of hepatotoxicity in general and those based on findings from our Latin American experience in particular.Fil: Bessone, Fernando. Universidad Nacional de Rosario. Facultad de Ciencias Médicas. Hospital Nacional del Centenario; ArgentinaFil: Hernandez, Nelia. Hospital de Clinicas Dr. Manuel Quintela; UruguayFil: Tagle, Martin. Universidad Peruana Cayetano Heredia; PerúFil: Arrese, Marco. Pontificia Universidad Católica de Chile; ChileFil: Parana, Raymundo. Universidade Federal da Bahia; BrasilFil: Mendez-Sánchez, Nahum. Fundacion Clinica Medica Sur; México. Universidad Nacional Autónoma de México; MéxicoFil: Ridruejo, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; ArgentinaFil: Mendizabal, Manuel. Universidad Austral. Hospital Universitario Austral; ArgentinaFil: Dagher, Lucy. Policlinica Metropolitana; VenezuelaFil: Contreras, Fernando. Universidad Pedro Henriquez Urena; República DominicanaFil: Fassio, Eduardo. Hospital Nacional Profesor Alejandro Posadas; ArgentinaFil: Pesoa, Mario. Hospital de Clincas; BrasilFil: Brahm, Javier. Clinica Las Condes; ChileFil: Silva, Marcelo. Universidad Austral. Hospital Universitario Austral; Argentin

Identification of Latent Topics in Patients Surviving COVID-19 in Mexico

With the outbreak of the SARS-CoV-2 o COVID-19 pandemic, multiple studies of risk factors and their influence on patient deaths have been developed. However, little attention is often paid to analyzing patients in risk groups despite the fact that they have been infected and inpatients can survive. In this article, with the dataset available from the Ministery of the health of Mexico, this paper proposes the use of the latent topic extraction algorithm Latent Dirichlet Allocation (LDA) for the study of COVID-19 survival factors in Mexico. The results let us conclude that in the year before strategies for prevention and control of COVID-19, the latent topics support that patients without comorbidities have a low risk of death, compared with the period of 2021, wherein in spite of having some risk factors patients can survive

Drug Delivery Approaches for the Treatment of Cervical Cancer

Cervical cancer is a highly prevalent cancer that affects women around the world. With the availability of new technologies, researchers have increased their efforts to develop new drug delivery systems in cervical cancer chemotherapy. In this review, we summarized some of the recent research in systematic and localized drug delivery systems and compared the advantages and disadvantages of these methods

Triexifenidila: caracterização de seu consumo abusivo por um grupo de usuários na cidade de São Paulo

O abuso de drogas anticolinérgicas na indução de estados mentais alterados, como alucinações e delírios, é amplamente conhecido. Entre essas, a triexifenidila (TEF) (Artane®) parece ser a mais abusada. No Brasil, seu consumo já foi observado entre pacientes psicóticos, estudantes de 1º e 2º graus da rede pública, meninos de rua e usuários de crack. Diante da carência de relatos brasileiros que retratassem o consumo inadequado da triexifenidila, esse estudo foi conduzido para caracterizar a população usuária e as razões subjacentes ao seu abuso. Utilizando-se de metodologia qualitativa e amostra intencional selecionada por critérios (21 usuários e 16 ex-usuários), observou-se a predominância de homens solteiros, poliusuários e sem vínculos empregatícios, que relataram o abuso da droga na obtenção, principalmente, de alucinações e delírios. A TEF, consumida em associação a álcool, outras drogas lícitas (BZD) e ilícitas, interfere nas funções cognitivas, como memória, atenção e aprendizado, prejudicando os usuários no desempenho de muitas de suas atividades cotidianas. Por ser relatada como medicamento de fácil acesso, baixo custo e com efeitos drásticos na vida do usuário, os resultados apontam para a necessidade de medidas mais efetivas em sua liberação, além da necessidade de adoção de medidas preventivas para que seu abuso seja evitado.The abuse of anticholinergic drugs to induce mental alterations as hallucinations and delirium is widely known. Trihexyphenidyl (Artane®), among these drugs, seems to be the most abused. In Brazil, its use has been already observed among psychotic patients, first and second grade students, street children and crack-cocaine addicts. Faced to the lack of Brazilian reports describing such inadequate use of trihexyphenidyl, this study was conducted to characterize recreacional use as well as reasons that justify the misuse. Adopting qualitative methodology and a Purposeful Sampling achieved by a Criterion Sampling (21 users and 16 ex-users), it was observed predominance of single poliusers men, without employment bonds, who abused of trihexyphenidyl in the attainment of mental alterations, mainly hallucinations and deliriums. Trihexyphenidyl is consumed in association with alcohol, other licit drugs (BDZ) and illicit drugs, impairing cognitive functions as memory, attention and learning, intervening with some activities of users' daily life. Reported as an easy access medicine, with low-cost and resulting in drastic effects in the life of the user, these results pointed to the necessity of more effective measures in its release, beyond the necessity of adoption of prevention measures to avoid its abuse