32 research outputs found

    Multicentric recurrent parotid pleomorphic adenoma in a child

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    Mixed tumours of the parotid gland are rare in childhood and recurrence of this tumour is infrequent. Some authors report a higher rate of recurrence with some histological subtypes, like hypocellular variant. Female sex and young age at initial treatment are also risk factor for recurrence. Also the first surgical treatment, tumour enucleation or parotidectomy, has been implicated as a cause for recurrence. We present a case of a multicentric doubly recurrent parotid pleomorphic adenoma, 7 and 14 years after tumour enucleation, in a 9-year-old child. All the nodules resected showed the hypocellular variant of pleomorphic adenoma. We consider the relationships between the choice of treatment, the histologic subtypes of pleomorphic adenomas and multifocal tumours and recurrence. In this case, we believe the recurrence was related to surgical enucleation previously performed and the hypocellular histological subtype. We conclude that tumour enucleation is a risk factor for recurrence and total parotidectomy is the treatment of choice for pleomorphic parotid adenoma also in childhood

    Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

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    Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

    Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

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    BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

    Primary Malignant Melanoma of the Esophagus: A Case Report and Review of the Literature

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    Entre plantas y animales : una muestra de la diversidad del DRMI Rabanal (Boyacá) y el piedemonte llanero Sabanalarga (Casanare).

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    La presente publicación es el resultado de la ejecución del Convenio de Colaboración 5211740 celebrado entre la Universidad Pedagógica y Tecnológica de Colombia y la Empresa Colombiana de Petróleos, Ecopetrol S. A., en el Proyecto 6, el cual tuvo como objetivo principal ejecutar acciones de restauración ecológica de 105 ha en el DRMI Rabanal (Ventaquemada, Boyacá) y en el municipio de Sabanalarga (Casanare). Lo anterior, como medida de compensación ambiental en el marco de la ejecución del Proyecto del Poliducto Andino. Es muy importante para Ecopetrol S.A., demostrar que los proyectos de infraestructura son ejecutados con un sello de responsabilidad social y ambiental, en los que siempre se ha procurado mitigar al máximo el impacto sobre los ecosistemas. Se debe tener en cuenta que sobre los sitios de estudio se han venido desarrollando procesos históricos de impactos de tipo antropogénico como talas, quemas, minería, ganadería extensiva y la ampliación de la frontera agrícola, que afectan directamente la diversidad de especies en la zona. Por lo anterior, el presente trabajo pretende mostrar la riqueza de fauna y flora de los ecosistemas de alta montaña, páramo y piedemonte llanero, y destacar la provisión de servicios ecosistémicos que estos sitios ofrecen. Esta iniciativa quiere dar a conocer, lo importante que es cuidar y preservar los bosques, ya que son el hogar de una amplia gama de plantas y animales que cumplen un rol en el desarrollo de una serie de procesos como el ciclaje de nutrientes, el ciclo del agua y la regulación hídrica. La fauna y la flora son el tema principal, se muestran las plantas vasculares y no vasculares, además de insectos, reptiles y anfibios más representativos de los ecosistemas alto andino de páramo, así como del piedemonte llanero, haciendo énfasis en los municipios de Ventaquemada (Boyacá) y Sabanalarga (Casanare). Este material bibliográfico pretende convertirse en una herramienta útil no solo para la comunidad académica, sino también para la comunidad en general y sobre todo para los habitantes de las localidades de influencia del proyecto, con el fin último de conocer algunas de las especies, de una manera fácil y didáctica. Se debe resaltar la labor y el trabajo que ha venido haciendo el grupo de investigación Sistemática Biológica (SisBio) de la Universidad Pedagógica y Tecnológica de Colombia, ya que sus integrantes catalogaron y realizaron inventarios completos en las diferentes localidades, además del montaje y preparación de especímenes que reposan en colección de referencia, la cual se convertirá también en una herramienta y punto de partida para futuros estudios. El personal profesional y técnico que realizó sus aportes a este libro está comprometido con entregar un producto de calidad y con el que buscan demostrar que los proyectos de investigación también deben involucrar a la comunidad campesina, ya que con ellos y su conocimiento empírico el aporte cobra un significado importante.</jats:p

    Entre plantas y animales : una muestra de la diversidad del DRMI Rabanal (Boyacá) y el piedemonte llanero Sabanalarga (Casanare).

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    La presente publicación es el resultado de la ejecución del Convenio de Colaboración 5211740 celebrado entre la Universidad Pedagógica y Tecnológica de Colombia y la Empresa Colombiana de Petróleos, Ecopetrol S. A., en el Proyecto 6, el cual tuvo como objetivo principal ejecutar acciones de restauración ecológica de 105 ha en el DRMI Rabanal (Ventaquemada, Boyacá) y en el municipio de Sabanalarga (Casanare). Lo anterior, como medida de compensación ambiental en el marco de la ejecución del Proyecto del Poliducto Andino. Es muy importante para Ecopetrol S.A., demostrar que los proyectos de infraestructura son ejecutados con un sello de responsabilidad social y ambiental, en los que siempre se ha procurado mitigar al máximo el impacto sobre los ecosistemas. Se debe tener en cuenta que sobre los sitios de estudio se han venido desarrollando procesos históricos de impactos de tipo antropogénico como talas, quemas, minería, ganadería extensiva y la ampliación de la frontera agrícola, que afectan directamente la diversidad de especies en la zona. Por lo anterior, el presente trabajo pretende mostrar la riqueza de fauna y flora de los ecosistemas de alta montaña, páramo y piedemonte llanero, y destacar la provisión de servicios ecosistémicos que estos sitios ofrecen. Esta iniciativa quiere dar a conocer, lo importante que es cuidar y preservar los bosques, ya que son el hogar de una amplia gama de plantas y animales que cumplen un rol en el desarrollo de una serie de procesos como el ciclaje de nutrientes, el ciclo del agua y la regulación hídrica. La fauna y la flora son el tema principal, se muestran las plantas vasculares y no vasculares, además de insectos, reptiles y anfibios más representativos de los ecosistemas alto andino de páramo, así como del piedemonte llanero, haciendo énfasis en los municipios de Ventaquemada (Boyacá) y Sabanalarga (Casanare). Este material bibliográfico pretende convertirse en una herramienta útil no solo para la comunidad académica, sino también para la comunidad en general y sobre todo para los habitantes de las localidades de influencia del proyecto, con el fin último de conocer algunas de las especies, de una manera fácil y didáctica. Se debe resaltar la labor y el trabajo que ha venido haciendo el grupo de investigación Sistemática Biológica (SisBio) de la Universidad Pedagógica y Tecnológica de Colombia, ya que sus integrantes catalogaron y realizaron inventarios completos en las diferentes localidades, además del montaje y preparación de especímenes que reposan en colección de referencia, la cual se convertirá también en una herramienta y punto de partida para futuros estudios. El personal profesional y técnico que realizó sus aportes a este libro está comprometido con entregar un producto de calidad y con el que buscan demostrar que los proyectos de investigación también deben involucrar a la comunidad campesina, ya que con ellos y su conocimiento empírico el aporte cobra un significado importante

    PIONEER 1: Randomized Clinical Trial of the Efficacy and Safety of Oral Semaglutide Monotherapy in Comparison With Placebo in Patients With Type 2 Diabetes

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    OBJECTIVE This trial compared the efficacy and safety of the first oral glucagon-like peptide 1 (GLP-1) receptor agonist, oral semaglutide, as monotherapy with placebo in patients with type 2 diabetes managed by diet and exercise alone. Two estimands addressed two efficacy-related questions: a treatment policy estimand (regardless of trial product discontinuation or rescue medication use) and a trial product estimand (on trial product without rescue medication use) in all randomized patients. RESEARCH DESIGN AND METHODS This was a 26-week, phase 3a, randomized, double-blind, placebo-controlled, parallel-group trial conducted in 93 sites in nine countries. Adults with type 2 diabetes insufficiently controlled with diet and exercise were randomized (1:1:1:1) to once-daily oral semaglutide 3 mg, 7 mg, 14 mg, or placebo. The primary end point was change from baseline to week 26 in HbA1c. The confirmatory secondary end point was change from baseline to week 26 in body weight. RESULTS In the 703 patients randomized (mean age 55 years, 50.8% male, and mean baseline HbA1c 8.0% [64 mmol/mol]), oral semaglutide reduced HbA1c (placebo-adjusted treatment differences at week 26: treatment policy estimand, −0.6% [3 mg], −0.9% [7 mg], and −1.1% [14 mg]; trial product estimand, −0.7% [3 mg], −1.2% [7 mg], and −1.4% [14 mg]; P &amp;lt; 0.001 for all) and body weight (treatment policy, −0.1 kg [3 mg], −0.9 kg [7 mg], and −2.3 kg [14 mg, P &amp;lt; 0.001]; trial product, −0.2 kg [3 mg], −1.0 kg [7 mg, P = 0.01], and −2.6 kg [14 mg, P &amp;lt; 0.001]). Mild-to-moderate transient gastrointestinal events were the most common adverse events with oral semaglutide. Trial product discontinuations occurred in 2.3–7.4% with oral semaglutide and 2.2% with placebo. CONCLUSIONS In patients with type 2 diabetes, oral semaglutide monotherapy demonstrated superior and clinically relevant improvements in HbA1c (all doses) and body weight loss (14 mg dose) versus placebo, with a safety profile consistent with other GLP-1 receptor agonists. </jats:sec

    Filosofía y producción textual Así contamos Tomo III Monstruos y narraciones

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    321 páginas Libro electrónicoEstas narraciones son el resultado de la implementación del proyecto «Filosofía y producción textual

    Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF

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    BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes

    Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation: Results from GARFIELD-AF

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    Introduction A principal aim of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) was to document changes in treatment practice for patients with newly diagnosed atrial fibrillation during an era when non-vitamin K antagonist oral anticoagulants (NOACs) were becoming more widely adopted. In these analyses, the key factors which determined the choice between NOACs and vitamin K antagonists (VKAs) are explored.Methods Logistic least absolute shrinkage and selection operator regression determined predictors of NOAC and VKA use. Data were collected from 24,137 patients who were initiated on AC +/- antiplatelet (AP) therapy (NOAC [51.4%] or VKA [48.6%]) between April 2013 and August 2016.Results The most significant predictors of AC therapy were country, enrolment year, care setting at diagnosis, AF type, concomitant AP, and kidney disease. Patients enrolled in emergency care or in the outpatient setting were more likely to receive a NOAC than those enrolled in hospital (OR 1.16 [95% CI: 1.04-1.30], OR: 1.15 [95% CI: 1.05-1.25], respectively). NOAC prescribing seemed to be favored in lower-risk groups, namely, patients with paroxysmal AF, normotensive patients, and those with moderate alcohol consumption, but also the elderly and patients with acute coronary syndrome. By contrast, VKAs were preferentially used in patients with permanent AF, moderate to severe kidney disease, heart failure, vascular disease, and diabetes and with concomitant AP.Conclusion GARFIELD-AF data highlight marked heterogeneity in stroke prevention strategies globally. Physicians are adopting an individualized approach to stroke prevention where NOACs are favored in patients with a lower stroke risk but also in the elderly and patients with acute coronary syndrome
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