To determine whether teleophthalmology can help physicians in assessing and managing eye conditions and to ascertain which clinical conditions can be addressed by teleophthalmology in primary care ...setting.
We evaluated the resolution capacity of TeleOftalmo, strategy implemented in the public health system of southern Brazil. Resolution capacity was defined as the ability to fully address patients' eye complaints in primary care with remote assistance from ophthalmologists. Data from tele-eye reports were collected over 14 months. Resolution capacity was compared across different age groups and different ocular conditions.
Overall, 8,142 patients had a tele-eye report issued in the study period. Resolution capacity was achieved in 5,748 (70.6%) patients. When stratified into age groups, the lowest capacity was 43.1% among subjects aged ≥65 years, while the highest was 89.7% among subjects aged 13-17 years (p<0.001). Refractive error (70.3%) and presbyopia (56.3%) were the most prevalent conditions followed by cataract (12.4%) and suspected glaucoma (7.6%). Resolution capacity was higher in cases of refractive error, presbyopia, spasm of accommodation and lid disorders than in patients diagnosed with other condition (p<0.001).
With telemedicine support, primary care physicians solved over two-thirds of patients' eye or vision complaints. Refractive errors had high case resolution rates, thus having a great impact on reducing the number of referrals to specialty care. Teleophthalmology adoption in primary-care settings as part of the workup of patients with eye or vision complaints promotes a more effective use of specialty centers and will hopefully reduce waiting times for specialty referral.
Cancer‐bearing often exhibits hypoinsulinemia, insulin (INS) resistance and glutamine depletion associated with cachexia. However, INS and glutamine effects on cachexia metabolic abnormalities, ...particularly on tumor‐affected proteins related to INS resistance, are poorly known. The main purpose of this study was to investigate the effects of INS and glutamine dipeptide (GDP) treatments on phospho‐protein kinase B (p‐Akt), and phospho‐hormone sensitive lipase (p‐HSL) in Walker‐256 tumor‐bearing rats. INS (NPH, 40 UI/kg, subcutaneous), GDP (1.5 g/kg, oral), INS+GDP or vehicle (control rats) were administered for 13 days, once a day, starting at the day of inoculation of tumor cells. The experiments were performed 4 hours after the last treatment to evaluate acute effects of INS and GDP, besides the chronic effects. INS and/or INS+GDP treatments, which markedly increased the insulinemia, increased the p‐Akt: total Akt ratio and prevented the increased p‐HSLSer552: total HSL ratio in the retroperitoneal fat of tumor‐bearing rats, without changing the INS resistance and increased expression of factor tumor necrosis‐α (TNF‐α) in this tissue. INS and INS+GDP also increased the p‐Akt: total Akt ratio, whereas GDP and INS+GDP increased the GLUT4 glucose transporter gene expression, in the gastrocnemius muscle of the tumor‐bearing rats. Accordingly, treatments with INS and INS+GDP markedly reduced glycemia, increased retroperitoneal fat and attenuated the body mass loss of tumor‐bearing rats. In conclusion, hyperinsulinemia induced by high‐dose INS treatments increased Akt phosphorylation and prevented increased p‐HSLSer552: total HSL ratio, overlapping INS resistance. These effects are consistent with increased fat mass gain and weight loss (cachexia) attenuation of tumor‐bearing rats, evidencing that Akt activation is a potential strategy to prevent loss of fat mass in cancer cachexia.
Cancer carriers often exhibit hypoinsulinemia and insulin resistance associated with cachexia; ‐Akt activation by insulin treatment increased Akt phosphorylation and adipose mass gain and attenuated weight loss (cachexia) of tumor‐bearing rats.
Abstract
Leishmania (L.) amazonensis is one of the species responsible for the development of cutaneous leishmaniasis in South America. After entering the vertebrate host, L. (L.) amazonensis invades ...mainly neutrophils, macrophages and dendritic cells. Studies have shown that gal-3 acts as a pattern recognition receptor. However, the role of this protein in the context of L. (L.) amazonensis infection remains unclear. Here, we investigated the impact of gal-3 expression on experimental infection by L. (L.) amazonensis. Our data showed that gal-3 plays a role in controlling parasite invasion, replication and the formation of endocytic vesicles. Moreover, mice with gal-3 deficiency showed an exacerbated inflammatory response. Taken together, our data shed light to a critical role of gal-3 in the host response to infection by L. (L.) amazonensis.
To evaluate the effect of an extended visitation model compared with a restricted visitation model on the occurrence of delirium among ICU patients.
Prospective single-center before and after study.
...Thirty-one-bed medical-surgical ICU.
All patients greater than or equal to 18 years old with expected length of stay greater than or equal to 24 hours consecutively admitted to the ICU from May 2015 to November 2015.
Change of visitation policy from a restricted visitation model (4.5 hr/d) to an extended visitation model (12 hr/d).
Two hundred eighty-six patients were enrolled (141 restricted visitation model, 145 extended visitation model). The primary outcome was the cumulative incidence of delirium, assessed bid using the confusion assessment method for the ICU. Predefined secondary outcomes included duration of delirium/coma; any ICU-acquired infection; ICU-acquired bloodstream infection, pneumonia, and urinary tract infection; all-cause ICU mortality; and length of ICU stay. The median duration of visits increased from 133 minutes (interquartile range, 97.7-162.0) in restricted visitation model to 245 minutes (interquartile range, 175.0-272.0) in extended visitation model (p < 0.001). Fourteen patients (9.6%) developed delirium in extended visitation model compared with 29 (20.5%) in restricted visitation model (adjusted relative risk, 0.50; 95% CI, 0.26-0.95). In comparison with restricted visitation model patients, extended visitation model patients had shorter length of delirium/coma (1.5 d interquartile range, 1.0-3.0 vs 3.0 d interquartile range, 2.5-5.0; p = 0.03) and ICU stay (3.0 d interquartile range, 2.0-4.0 vs 4.0 d interquartile range, 2.0-6.0; p = 0.04). The rate of ICU-acquired infections and all-cause ICU mortality did not differ significantly between the two study groups.
In this medical-surgical ICU, an extended visitation model was associated with reduced occurrence of delirium and shorter length of delirium/coma and ICU stay.
Objetivo: Analisar a produção científica relativa ao desempenho mercadológico no mercado de alta tecnologia no período de 1997 a 2019.Método: Foram utilizadas as metodologias de bibliometria e ...revisão sistemática. O processo de busca foi realizado nas bases Web of Science e SPELL e resultou na seleção de 23 artigos dentro do escopo definido, dentre 82 estudos. Os estudos selecionados foram analisados por meio de estatística descritiva, Classificação Hierárquica Descendente (CHD) e Análise Fatorial de Correspondência (AFC).Principais resultados: Os resultados apontam um recente interesse sobre a mensuração de desempenho no mercado de alta tecnologia, sobretudo nos mercados emergentes como Taiwan e China, com o uso de indicadores multidimensionais, financeiros e não financeiro. Por meio das análises de CHD e AFC observou-se a formação de quatro Classes – ‘Habilidades internas’, ‘Alianças’, ‘Foco a jusante’ e ‘Foco a montante’ – cujas temáticas predominantes explicitam os focos de interesse associados ao desempenho mercadológico no mercado de alta tecnologia.Relevância/originalidade: O estudo inova ao propor um protocolo para realizar análises textuais de artigos científicos com auxílio do software Iramuteq, possibilitando a identificação dos diferentes enfoques dos estudos e agrupamento por semelhanças.Contribuições: É proposta uma agenda de estudos futuros em função dos resultados e de lacunas sobre desempenho e indicadores utilizados pelas empresas no mercado de alta tecnologia. Sob o prisma gerencial, destaca-se que os indicadores mais utilizados nesse mercado são as vendas, a participação de mercado e o desempenho de novos produtos.
Braylin belongs to the group of natural coumarins, a group of compounds with a wide range of pharmacological properties. Here we characterized the pharmacological properties of braylin in vitro, in ...silico and in vivo in models of inflammatory/immune responses. In in vitro assays, braylin exhibited concentration-dependent suppressive activity on activated macrophages. Braylin (10-40 μM) reduced the production of nitrite, IL-1β, TNF-α and IL-6 by J774 cells or peritoneal exudate macrophages stimulated with LPS and IFN-γ. Molecular docking calculations suggested that braylin present an interaction pose to act as a glucocorticoid receptor ligand. Corroborating this idea, the inhibitory effect of braylin on macrophages was prevented by RU486, a glucocorticoid receptor antagonist. Furthermore, treatment with braylin strongly reduced the NF-κB-dependent transcriptional activity on RAW 264.7 cells. Using the complete Freund's adjuvant (CFA)-induced paw inflammation model in mice, the pharmacological properties of braylin were demonstrated in vivo. Braylin (12.5-100 mg/kg) produced dose-related antinociceptive and antiedematogenic effects on CFA model. Braylin did not produce antinociception on the tail flick and hot plate tests in mice, suggesting that braylin-induced antinociception is not a centrally-mediated action. Braylin exhibited immunomodulatory properties on the CFA model, inhibiting the production of pro-inflammatory cytokines IL-1β, TNF-α and IL-6, while increased the anti-inflammatory cytokine TGF-β. Our results show, for the first time, anti-inflammatory, antinociceptive and immunomodulatory effects of braylin, which possibly act through the glucocorticoid receptor activation and by inhibition of the transcriptional activity of NF-κB. Because braylin is a phosphodiesterase-4 inhibitor, this coumarin could represent an ideal prototype of glucocorticoid receptor ligand, able to induce synergic immunomodulatory effects.
This study aimed to identify and characterize the antimicrobial susceptibility profile of bacteria found in primary endodontic infections in the teeth of patients treated at the Dental Clinic of the ...University of Ribeirão Preto, São Paulo, Brazil. From September to December 2019, samples were obtained from 21 patients with primary endodontic infections. The collections were carried out in triplicate using paper cones placed close to the total length of the root canal. Bacterial isolation was performed in Brain Heart Infusion agar, Blood agar, and other selective culture media cultured at 37°C for up to 48 h under aerobiosis and microaerophilic conditions. The bacterial species were identified using the Vitek 2 automated system. The disk diffusion method on agar Müeller-Hinton was used to assess antimicrobial susceptibility with the recommended antimicrobials for each identified bacterial species. A total of 49 antibiotics were evaluated. Fifteen of the 21 samples collected showed bacterial growth, and 17 bacterial isolates were found. There were 10 different bacterial species identified: Enterococcus faecalis (four isolates), Streptococcus mitis/oralis (three isolates), Streptococcus anginosus (three isolates) being the most common, followed by Staphylococcus epidermidis, Enterococcus faecium, Streptococcus constellatus, Streptococcus alactolyticus, Enterobacter cloacae, Klebsiella variicola, and Providencia rettgeri (one isolate of each species). The analysis demonstrated significant susceptibility to most of the tested antibiotics. However, some Enterococcus isolates resisted the antibiotic's erythromycin, ciprofloxacin, and tetracycline. A Staphylococcus epidermidis isolate was characterized as multidrug-resistant. Five Streptococcus isolates were non-susceptible to all antibiotics tested.
The aim of this study was to compare the shaping ability of 4 different nickel-titanium systems, considering their variation in alloy treatment, kinematics, and design, used to prepare canals with ...severe curvature using micro–computed tomographic analysis.
Thirty-two mesial roots of mandibular molars with severe curvature were matched based on similar morphologic dimensions and assigned to 4 experimental groups (n = 8) according to the canal preparation: ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), Reciproc (RC; VDW GmbH, Munich, Germany), Reciproc Blue (RCB, VDW GmbH), and TRUShape (TRU; Dentsply Tulsa Dental Specialties, Tulsa, OK) systems. Changes in 2-dimensional (area and perimeter) and 3-dimensional (volume, surface area, and structure model index) morphologic parameters as well as canal transportation were compared among groups using the analysis of variance post hoc Tukey tests with the significance level set at 5%.
Preparation significantly increased all analyzed parameters. No statistically significant differences (P > .05) were observed between RC and RCB or between PTN and TRS in any of the analyzed parameters. In the cervical third, RC and RCB presented higher mean increases than PTN and TRU. In the apical third, there were no statistically significant differences (P > .05) among the systems.
The instruments of greater taper may promote greater morphologic changes. However, regardless of the number of instruments (multiple or single), the type of movement (rotation or reciprocating), the type of heat treatment of alloys, and the particular characteristics of each instrument (taper and design), the evaluated systems did not result in different dimensional changes and canal transportation in the critical apical area.
•There is a lack of studies in the literature regarding root canal anatomy and new generation of instruments with different designs and nickel-titanium alloy heat treatments.•No geometric changes and canal transportation in the apical third were observed in curved canals regardless of the number of instruments, type of movement, type of heat treatment of alloys, and the particular characteristics of each evaluated instrument.
Justificativa e Objetivo: A alteração do fluxo sanguíneo periférico (FSP) é fator de risco para diminuição da atividade física e amputação de membro inferior (MI). Avaliar a associação entre o FSP e ...a capacidade funcional de amputados traumáticos e não traumáticos de MI. Métodos: Estudo transversal realizado com 15 amputados de MI, usuários do Serviço de Reabilitação Física. Os pacientes foram avaliados pelo Índice Tornozelo Braquial (ITB), em decúbito dorsal, utilizando-se um esfigmomanômetro em membros superiores e MI preservado, para aferição da pressão arterial sistólica (com doppler vascular portátil) e cálculo do ITB. O Duke Activity Status Index (DASI) foi utilizado para avaliar atividades de vida diárias. Os pacientes foram alocados em dois grupos de amputados: não traumática (GAnT=6) e traumática (GAT=9). A análise estatística foi realizada pelo teste t de Student e correlação de Spearman para verificar associação entre as variáveis. Resultados: GAnT demonstrou predominância de amputação à esquerdo (n=3), mulheres (n=4), idade média 59,0±17,4 anos, Índice de Massa Corporal- IMC 35,5±7,3 Kg/m², DASI: 20,7±10,5 e classificação do ITB em normal (n=4) e DAP (n=2). No GAT houve predominância de amputação à esquerdo (n=7), homens (n=9), idade 50,4±17,4 anos, IMC 24,8±5,1 Kg/m², DASI: 24,2±8,1 e classificação do ITB em normal (n=8) e ITB limítrofe (n=1). O ITB geral diferiu significativamente entre GAnT e GAT 0,93±0,17 vs 1,11±0,12,p=0,03 e houve correlação positiva entre ITB e DASI no GAnT (r=0,85; p=0,03). Conclusão: GAnT apresentam valores reduzidos de ITB e pior fluxo sanguíneo periférico que interfere diretamente na sua capacidade funcional.
PDF
