130 research outputs found
Healthcare network operation in Iquique after the 2014, Pisagua earthquake
On April 1st, 2014, the 8.2 Mw Pisagua earthquake affected the population in the north of Chile and generated disruption of
services in the region. The largest effects of the earthquake were observed in the city of Iquique, capital of the Tarapaca
Region, where more than 80% of the population of the region lives. This research describes the response of the public
healthcare network of Iquique after the earthquake, and aims to identify the principal factors contributing to the network
resilience during the early response and recovery phase after the earthquake. Despite the large magnitude of the earthquake,
the observed structural damage was minor in the five healthcare centers considered (i.e., the regional hospital and 4 Primary
Healthcare Attention Centers, PHACs). However, disruption of services in the healthcare network was large and due mainly
to the collapse of non-structural components. Overall, the proper response of the healthcare network of Iquique was heavily
supported by the PHACs, which largely provided first-aid, containment, and low-complexity attention to the population,
allowing the hospital to focus on more complex procedures. The findings of this study suggest that the resilience of the
healthcare network system, besides the robustness of the networkâs facilities and their critical units, is also highly dependent
on the interrelations and interactions between them in early post-earthquake recovery phases
Impact on Chilean hospitals following the 2015 Illapel earthquake
In a post-disaster environment, hospitals play a critical role in healthcare services continuities to the population while
effectively coping with eventual losses of functionality. These losses come from physical damage to the facility, loss of
utility lifelines, failure in supply chains, and reduction of personnel. However, data describing the detailed performance of
hospitals during past earthquakes are scarce. Consequently, following the 2015 Mw 8.3 Illapel earthquake in central Chile,
an exhaustive field campaign was carried out in the Coquimbo region to collect substantial perishable data to describe
physical damage to hospitals and functionality losses. This study presents first the baseline information obtained in nine
surveyed government hospitals, including size, location and type of infrastructure. Then, the seismic impact was analyzed
and classified to show the main physical structural and non-structural damage, lifeline interruptions, losses in hospital units,
and variations in flow of patients and staff. Transfers, discharges and evacuations of patients that occurred after the event
were also reported. We found that the earthquake did not affect strongly the healthcare service despite the fact that most of
the structural and non-structural damage was localized in the largest regional hospital. The archival nature of the data
collected may deepen our understanding of the post-earthquake healthcare system performance, which is very useful in
improving disaster preparation and overall resilience
Liver fibrosis in non-alcoholic fatty liver disease and progression to hepatocellular carcinoma in patients with inflammatory bowel disease: a systematic review
The aim of the systematic review is to assess the prevalence and risk factors of liver fibrosis in patients with Inflammatory Bowel Disease (IBD) and Non-Alcoholic Fatty Liver Disease (NAFLD) and to discuss the role of liver fibrosis in the progression to hepatocellular carcinoma (HCC). We performed a structured search in PubMed, Web of Science, Embase, and Scopus up to 3 March 2023 to identify observational studies reporting liver fibrosis in patients with NAFLD and IBD. Quality of studies was assessed using the Newcastle-Ottawa Scale (NOS) score. A total of 23 studies met our inclusion criteria, including 629,781 patients. A total of 10 cross-sectional, 3 case-control, and 10 cohort studies were included. Fourteen studies had a NOS score â„ 7 points. NAFLD was diagnosed in 2162/6332 (34.1%) IBD participants. However, NAFLD diagnosis was established in 924/2962 (31.2%) healthy individuals without IBD. Advanced liver fibrosis was found in 116 (11.6%) of 992 IBD patients with NAFLD. Most studies found an association between NAFLD and classic cardiovascular risk factors such as older age, male sex, higher BMI, diabetes, hypertension and dyslipidemia. In addition, metabolic syndrome features were also associated with an increased risk of significant and advanced liver fibrosis. Although no strong association between NAFLD and IBD therapy was reported, some studies associated NAFLD with IBD diagnosis, Crohnâs Disease, a complicated course of IBD, disease activity, and IBD duration. Advanced liver fibrosis was also associated with Crohnâs disease in several studies. In conclusion, NAFLD and advanced liver fibrosis are prevalent and clinically relevant extraintestinal manifestations, so its diagnosis and potential progression to HCC should be carefully considered in daily clinical practice
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Selective delipidation of plasma HDL enhances reverse cholesterol transport in vivo
Uptake of cholesterol from peripheral cells by nascent small HDL circulating in plasma is necessary to prevent atherosclerosis. This process, termed reverse cholesterol transport, produces larger cholesterol-rich HDL that transfers its cholesterol to the liver facilitating excretion. Most HDL in plasma is cholesterol-rich. We demonstrate that treating plasma with a novel selective delipidation procedure converts large to small HDL [HDL-selectively delipidated (HDL-sdl)]. HDL-sdl contains several cholesterol-depleted species resembling small alpha, prebeta-1, and other prebeta forms. Selective delipidation markedly increases efficacy of plasma to stimulate ABCA1-mediated cholesterol transfer from monocytic cells to HDL. Plasma from African Green monkeys underwent selective HDL delipidation. The delipidated plasma was reinfused into five monkeys. Prebeta-1-like HDL had a plasma residence time of 8 +/- 6 h and was converted entirely to large alpha-HDL having residence times of 13-14 h. Small alpha-HDL was converted entirely to large alpha-HDL. These findings suggest that selective HDL delipidation activates reverse cholesterol transport, in vivo and in vitro. Treatment with delipidated plasma tended to reduce diet-induced aortic atherosclerosis in monkeys measured by intravascular ultrasound. These findings link the conversion of small to large HDL, in vivo, to improvement in atherosclerosis
Receptor Complementation and Mutagenesis Reveal SR-BI as an Essential HCV Entry Factor and Functionally Imply Its Intra- and Extra-Cellular Domains
HCV entry into cells is a multi-step and slow process. It is believed that the
initial capture of HCV particles by glycosaminoglycans and/or lipoprotein
receptors is followed by coordinated interactions with the scavenger receptor
class B type I (SR-BI), a major receptor of high-density lipoprotein (HDL), the
CD81 tetraspanin, and the tight junction protein Claudin-1, ultimately leading
to uptake and cellular penetration of HCV via low-pH endosomes.
Several reports have indicated that HDL promotes HCV entry through interaction
with SR-BI. This pathway remains largely elusive, although it was shown that HDL
neither associates with HCV particles nor modulates HCV binding to SR-BI. In
contrast to CD81 and Claudin-1, the importance of SR-BI has only been addressed
indirectly because of lack of cells in which functional complementation assays
with mutant receptors could be performed. Here we identified for the first time
two cell types that supported HCVpp and HCVcc entry upon ectopic SR-BI
expression. Remarkably, the undetectable expression of SR-BI in rat hepatoma
cells allowed unambiguous investigation of human SR-BI functions during HCV
entry. By expressing different SR-BI mutants in either cell line, our results
revealed features of SR-BI intracellular domains that influence HCV infectivity
without affecting receptor binding and stimulation of HCV entry induced by
HDL/SR-BI interaction. Conversely, we identified positions of SR-BI ectodomain
that, by altering HCV binding, inhibit entry. Finally, we characterized
alternative ectodomain determinants that, by reducing SR-BI cholesterol uptake
and efflux functions, abolish HDL-mediated infection-enhancement. Altogether, we
demonstrate that SR-BI is an essential HCV entry factor. Moreover, our results
highlight specific SR-BI determinants required during HCV entry and
physiological lipid transfer functions hijacked by HCV to favor infection
Prediction of uncomplicated pregnancies in obese women: A prospective multicentre study
BACKGROUND: All obese pregnant women are considered at equal high risk with respect to complications in pregnancy and birth, and are commonly managed through resource-intensive care pathways. However, the identification of maternal characteristics associated with normal pregnancy outcomes could assist in the management of these pregnancies. The present study aims to identify the factors associated with uncomplicated pregnancy and birth in obese women, and to assess their predictive performance. METHODS: Data form obese women (BMI â„ 30 kg/m 2 ) with singleton pregnancies included in the UPBEAT trial were used in this analysis. Multivariable logistic regression was used to identify sociodemographic, clinical and biochemical factors at 15 +0 to 18 +6 weeks' gestation associated with uncomplicated pregnancy and birth, defined as delivery of a term live-born infant without antenatal or labour complications. Predictive performance was assessed using area under the receiver operating characteristic curve (AUROC). Internal validation and calibration were also performed. Women were divided into fifths of risk and pregnancy outcomes were compared between groups. Sensitivity, specificity, and positive and negative predictive values were calculated using the upper fifth as the positive screening group. RESULTS: Amongst 1409 participants (BMI 36.4, SD 4.8 kg/m 2 ), the prevalence of uncomplicated pregnancy and birth was 36% (505/1409). Multiparity and increased plasma adiponectin, maternal age, systolic blood pressure and HbA1c were independently associated with uncomplicated pregnancy and birth. These factors achieved an AUROC of 0.72 (0.68-0.76) and the model was well calibrated. Prevalence of gestational diabetes, preeclampsia and other hypertensive disorders, preterm birth, and postpartum haemorrhage decreased whereas spontaneous vaginal delivery increased across the fifths of increasing predicted risk of uncomplicated pregnancy and birth. Sensitivity, specificity, and positive and negative predictive values were 38%, 89%, 63% and 74%, respectively. A simpler model including clinical factors only (no biomarkers) achieved an AUROC of 0.68 (0.65-0.71), with sensitivity, specificity, and positive and negative predictive values of 31%, 86%, 56% and 69%, respectively. CONCLUSION: Clinical factors and biomarkers can be used to help stratify pregnancy and delivery risk amongst obese pregnant women. Further studies are needed to explore alternative pathways of care for obese women demonstrating different risk profiles for uncomplicated pregnancy and birth
The Effects of Apolipoprotein F Deficiency on High Density Lipoprotein Cholesterol Metabolism in Mice
Apolipoprotein F (apoF) is 29 kilodalton secreted sialoglycoprotein that resides on the HDL and LDL fractions of human plasma. Human ApoF is also known as Lipid Transfer Inhibitor protein (LTIP) based on its ability to inhibit cholesteryl ester transfer protein (CETP)-mediated transfer events between lipoproteins. In contrast to other apolipoproteins, ApoF is predicted to lack strong amphipathic alpha helices and its true physiological function remains unknown. We previously showed that overexpression of Apolipoprotein F in mice reduced HDL cholesterol levels by 20â25% by accelerating clearance from the circulation. In order to investigate the effect of physiological levels of ApoF expression on HDL cholesterol metabolism, we generated ApoF deficient mice. Unexpectedly, deletion of ApoF had no substantial impact on plasma lipid concentrations, HDL size, lipid or protein composition. Sex-specific differences were observed in hepatic cholesterol content as well as serum cholesterol efflux capacity. Female ApoF KO mice had increased liver cholesteryl ester content relative to wild type controls on a chow diet (KO: 3.4+/â0.9 mg/dl vs. WT: 1.2+/â0.3 mg/dl, p<0.05). No differences were observed in ABCG1-mediated cholesterol efflux capacity in either sex. Interestingly, ApoB-depleted serum from male KO mice was less effective at promoting ABCA1-mediated cholesterol efflux from J774 macrophages relative to WT controls
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