Amiloidosis AL cardiaca avanzada: análisis de estrategias diagnósticas y terapéuticas

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 27-04-201

Fatores protetivos e de risco para o uso de crack e danos decorrentes de sua utilização: revisão de literat

Este estudo objetivou revisar pesquisas que relatam danos decorrentes do uso de crack e possíveis fatores protetivos ou de risco para o uso. Método: Foram realizadas buscas no PsycInfo, PubMed e LILACS. Os descritores utilizados foram: (Crack Cocaine) AND (Street Drugs OR Population Characteristics OR Epidemiology). Resultados: A facilidade de acesso do crack, uso frequente de cocaína injetável, cristais de metanfetamina, envolvimento em comércio sexual e variedade de drogas utilizadas nos últimos seis meses foram considerados fatores de risco para o uso. Não usuários de crack percebem o condicionamento vicário, informações fornecidas pela família e o medo de morrer como fatores protetivos para o uso da droga. O uso de crack pode causar danos físicos, problemas psiquiátricos, neurocognitivos e prejuízos sociais. Conclusão: O uso de crack está associado a danos físicos, mentas e sociais. Fatores protetivos e de risco devem ser considerados na elaboração de políticas públicas de saúde

Toxoplasmosis congénita, una mirada en la actualidad del tratamiento; revisión de la literatura

Introduction. Congenital Toxoplasmosis constitutes a significant cause of neonatal morbimortality in underdeveloped countries like Colombia. It can cause prematurity, pathological after-effects and fetal loss. Screening expectant mothers and in turn, a timely and adequate treatment, reduce vertical transmission and its devastating effects. The objective is to present up-to-date scientific evidence about the pharmacological treatment of Congenital Toxoplasmosis. Methodology. A non-systematic search of databases was conducted: Pubmed, Medline, Clinical Key and Springer. Original and topic review articles were included dating from January 2014 to April 2019. Division of topics covered. Physiopathology and clinical pathology, diagnostic approach, prevention and treatment alternatives were addressed. Conclusions. At this time, pharmacological therapy is limited, management schemes are based on spiramycin or a combination of sulfadiazine/pyrimethamine and folinic acid; these molecules are not very well tolerated and exhibit a wide spectrum of adverse reactions apart from their toxic effects, thus it is necessary to conduct randomized studies to evaluate its effectiveness.Introducción. La Toxoplasmosis congénita constituye una causa significativa de morbi-mortalidad neonatal en países de bajos ingresos como Colombia. Puede originar prematuridad, secuelas patológicas y pérdida fetal. El tamizaje en las gestantes y, a su vez, un tratamiento oportuno y adecuado disminuye la transmisión vertical y sus nefastas secuelas. El objetivo es presentar evidencia científica actualizada sobre el tratamiento farmacológico de la Toxoplasmosis Congénita. Metodología. Se realizó una búsqueda no sistemática en bases de datos: Pubmed, Medline, Clinical Key y Springer. Se incluyeron artículos originales y de revisión de tema publicados desde enero de 2014 hasta abril de 2019. División de los temas tratados. se abordan la fisiopatología y clínica, el abordaje diagnóstico, alternativas de prevención y tratamiento. Conclusiones. En la actualidad la terapia farmacológica es limitada, los esquemas de manejos se basan en espiramicina o la combinación de sulfadiazina/pirimetamina y ácido folínico; estas moléculas no son del todo bien toleradas y presentan un amplio espectro de reacciones adversas secundario a sus efectos tóxicos; resulta necesario la ejecución de estudios aleatorizados para evaluar su efectividad

Six years walking towards the progress: diagnostic evaluation in Andalusia

Con esta comunicación se pretende dar a conocer las características y aspectos más relevantes de las Pruebas de Evaluación de Diagnóstico. Se muestran algunos datos significativos, tanto a nivel mundial como nacional, aunque se hará un recorrido más amplio sobre estas pruebas en la comunidad de Andalucía, recogiendo aspectos como: novedades, finalidad, destinatarios, instrumentos, competencias evaluadas y resultados. También se hace mención al informe PISA, con el que estas pruebas están muy relacionadas.With this communication is intended to inform the most important features and aspects of diagnostic assessment tests. It is shown some significant data, both globally and national, although it will make a more extensive route about these tests at Andalucía, collecting aspects like: news, finality, aims, recipients, tools, skills and results. This kind of tests is related with the PISA report, which is also mentioned

Novas Fronteiras no Oeste: Relação entre sociedade e natureza na microrregião de Ceres em Goiás (1940-2013)

This paper aims to present a research project that is result of an ongoing partnership and inter-institutional cooperation of the faculty of the Graduate Program in Geography (Programas de Pós-Graduação em Geografia), of the Universidade Estadual Paulista "Julio Mesquita Filho" - Campus Presidente Prudente (PPGG / UNESP); Society, Technology and Environment (Sociedade, Tecnologia e Meio Ambiente) of the Centro Universitário de Anápolis (PPSTMA/UniEVANGÉLICA); and Sustainable Development (Desenvolvimento Sustentável) at the Universidade de Brasilia (CDS / UNB) in accordance with the objectives of the Programa Nacional de Cooperação Acadêmica (PROCAD), Notice No. 71/2013 Capes. The paper presents the main objectives and the methodological guidelines for the study of the micro region of Ceres, Goiás, through investigating environmental effects of the agricultural expansion during the 1940s...Keywords: Micro Region of Ceres; Frontier; Environment; Natural Resources.Esta nota científica visa apresentar o projeto de pesquisa em andamento resultante da parceria e cooperação interinstitucional dos docentes dos Programas de Pós-Graduação em Geografia, da Universidade Estadual Paulista “Júlio Mesquita Filho” – Campus Presidente Prudente (PPGG/UNESP); em Sociedade, Tecnologia e Meio Ambiente do Centro Universitário de Anápolis (PPSTMA/UniEVANGÉLICA); e em Desenvolvimento Sustentável da Universidade de Brasília (CDS/UnB) de acordo com os objetivos do Programa Nacional de Cooperação Acadêmica (PROCAD), Edital Capes Nº 71/2013. A nota apresenta os principais objetivos e as orientações metodológicas para o estudo da microrregião de Ceres, Goiás, a partir da investigação dos efeitos socioambientais decorrentes da expansão agrícola a partir das décadas de 1940...Palavras chave: Microrregião de Ceres; Fronteira; Meio Ambiente; Recursos Naturai

Association between loop diuretic dose changes and outcomes in chronic heart failure: observations from the ESC-EORP Heart Failure Long-Term Registry

[Abstract] Aims. Guidelines recommend down-titration of loop diuretics (LD) once euvolaemia is achieved. In outpatients with heart failure (HF), we investigated LD dose changes in daily cardiology practice, agreement with guideline recommendations, predictors of successful LD down-titration and association between dose changes and outcomes. Methods and results. We included 8130 HF patients from the ESC-EORP Heart Failure Long-Term Registry. Among patients who had dose decreased, successful decrease was defined as the decrease not followed by death, HF hospitalization, New York Heart Association class deterioration, or subsequent increase in LD dose. Mean age was 66±13 years, 71% men, 62% HF with reduced ejection fraction, 19% HF with mid-range ejection fraction, 19% HF with preserved ejection fraction. Median [interquartile range (IQR)] LD dose was 40 (25–80) mg. LD dose was increased in 16%, decreased in 8.3% and unchanged in 76%. Median (IQR) follow-up was 372 (363–419) days. Diuretic dose increase (vs. no change) was associated with HF death [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.12–2.08; P = 0.008] and nominally with cardiovascular death (HR 1.25, 95% CI 0.96–1.63; P = 0.103). Decrease of diuretic dose (vs. no change) was associated with nominally lower HF (HR 0.59, 95% CI 0.33–1.07; P = 0.083) and cardiovascular mortality (HR 0.62 95% CI 0.38–1.00; P = 0.052). Among patients who had LD dose decreased, systolic blood pressure [odds ratio (OR) 1.11 per 10 mmHg increase, 95% CI 1.01–1.22; P = 0.032], and absence of (i) sleep apnoea (OR 0.24, 95% CI 0.09–0.69; P = 0.008), (ii) peripheral congestion (OR 0.48, 95% CI 0.29–0.80; P = 0.005), and (iii) moderate/severe mitral regurgitation (OR 0.57, 95% CI 0.37–0.87; P = 0.008) were independently associated with successful decrease. Conclusion. Diuretic dose was unchanged in 76% and decreased in 8.3% of outpatients with chronic HF. LD dose increase was associated with worse outcomes, while the LD dose decrease group showed a trend for better outcomes compared with the no-change group. Higher systolic blood pressure, and absence of (i) sleep apnoea, (ii) peripheral congestion, and (iii) moderate/severe mitral regurgitation were independently associated with successful dose decrease

Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%

Model-independent search for the presence of new physics in events including H → γγ with s \sqrt{s} = 13 TeV pp data recorded by the ATLAS detector at the LHC

Abstract A model-independent search for new physics leading to final states containing a Higgs boson, with a mass of 125.09 GeV, decaying to a pair of photons is performed with 139 fb−1 of s $$\sqrt{s}$$ = 13 TeV pp collision data recorded by the ATLAS detector at the Large Hadron Collider at CERN. This search examines 22 final states categorized by the objects that are produced in association with the Higgs boson. These objects include isolated electrons or muons, hadronically decaying τ-leptons, additional photons, missing transverse momentum, and hadronic jets, as well as jets that are tagged as containing a b-hadron. No significant excesses above Standard Model expectations are observed and limits on the production cross section at 95% confidence level are set. Detector efficiencies are reported for all 22 signal regions, which can be used to convert detector-level cross-section limits reported in this paper to particle-level cross-section constraints