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Antifungal stewardship is a critical component of healthcare management that focuses on optimizing the use of antifungal medications to improve patient outcomes, minimize resistance, and reduce healthcare costs. In resource-limited settings, the prevalence of fungal infections remains a significant health concern, often exacerbated by factors such as compromised immune systems, inadequate diagnostic capabilities, and limited access to antifungal agents. This paper reviews the current state of antifungal stewardship practices in developing countries, addressing the unique socioeconomic and healthcare landscape.
Maternal obesity increases the risk of nonalcoholic fatty liver disease (NAFLD) in offspring. The Roux-en-Y gastric bypass (RYBG) is effective for achieving weight loss and ameliorates NAFLD. To determine whether these benefits are maintained after pregnancy and/or lactation, and whether they modulate hepatic morphofunction in the next generation, we evaluated hepatic lipid metabolism in Western diet (WD)-obese female rats that underwent RYGB and in their F1 offspring at adulthood. Female Wistar rats consumed a WD from 21 to 130 days of age, before being submitted to RYGB (WD-RYGB-F0) or SHAM (WD-SHAM-F0) operations. After 5 weeks, these females were mated with control male breeders, and the male and female F1 offspring were identified as WD-RYGB-F1 and WD-SHAM-F1. WD-RYGB-F0 dams exhibited lower serum lipids levels, but severe hepatic steatosis and pathological features of advanced liver injury. The hepatic proteins involved in lipogenesis were reduced in WD-RYGB-F0, as were the genes related to β-oxidation and bile acids (BAs). Although the female and male WD-RYGB-F1 groups did not exhibit hepatic steatosis, the livers of female WD-RYGB-F1 demonstrated higher amounts of lipogenic genes and proteins, while male WD-RYGB-F1 presented a similar downregulation of lipogenic factors to that seen in WD-RYGB-F0 dams. In contrast, maternal and offspring groups of both sexes displayed reductions in the expressions of genes involved in BAs physiology and gluconeogenesis. As such, RYGB aggravates NAFLD after pregnancy and lactation and induces a gender-dependent differential expression of the hepatic lipogenesis pathway in offspring, indicating that female WD-RYGB-F1 may be an increased risk of developing NAFLD.
The study of respiratory dysfunction following a cerebrovascular event may permit localization of the neuroanatomical lesion. In addition, some respiratory dysfunctions are related to the etiology and the prognosis of stroke. This chapter reviews current knowledge regarding these associations. Unilateral hemispheric ischemic strokes appear to affect respiratory function to a modest degree. In contrast to cerebral hemispheric involvement, brainstem strokes may induce a more typical respiratory pattern, allowing more precise correlation between structure and function. Patients with severe obstructive sleep apnea (OSA) syndrome may develop ischemic stroke more frequently, as OSA syndrome with an apnea-hypopnea index (AHI) >30 was associated with stroke in an elderly population. The adverse effects of central hyperventilation may be related to arterial vasoconstriction induced by hypocapnia, leading to decrease in cerebral blood flow but also inducing impairment in cerebral autoregulation and cerebral arterial compliance.
Background: Higher mild cognitive impairment (MCI) prognostic variability has been related to sample characteristics (community-based or specialized clinic) and to diverse operationalization criteria. The aim of the study was to evaluate the trajectory of MCI of Alzheimer type in a population-based elderly cohort in Southern Brazil. We also estimated the risk for the development of probable Alzheimer's disease (AD) in comparison with healthy subjects.
Methods: Data were derived from a population-based cohort (the PALA study). MCI outcomes were sub-classified into three categories: conversion, stabilization, and reconversion. The risk of progression to dementia was compared between MCI and normal participants. The analysis was based on 21 MCI subjects and 220 cognitively intact participants (N = 241).
Results: Of the 21 MCI subjects, 38% developed dementia, 24% remained stable and 38% improved. The MCI annual conversion rate to AD was 8.5%. MCI was associated with significantly higher risk of conversion to AD (HR = 49.83, p = 0.004), after adjustment for age, education, sex and Mini-Mental State Examination score.
Conclusions: Independent of the heterogeneity of the outcomes, MCI of the Alzheimer type participants showed significantly higher risk of developing probable AD, demonstrating the impact of the use of these MCI criteria that emphasize long-term episodic memory impairment.
The posterior cerebral arteries (PCAS) are the major sources of blood supply to the midbrain, thalamus, occipital lobes, inferior and medial temporal lobes, and portions of the posterior inferior parietal lobes. The PCAs originate from the terminal bifurcation of the basilar artery, encircle the midbrain, and then divide into cortical branches as they reach the dorsal surface of the midbrain (Margolis et al., 1974). The peduncular, ambient, and quadrigeminal segments of the PCAs are named after the cisterns through which the arteries pass. The initial portion of a PCA, before the posterior communicating artery anastomosis from the internal carotid artery, is referred to as the PI segment, the mesencephalic artery, or the precommunal portion of the PCA. In about 10% of individuals, a fetal pattern of origin of one PCA from the internal carotid artery will persist into adult life, in which case the PI segment from the basilar artery will be hypoplastic (Hoyt et al., 1974). One PCA may be unusually large (29% of individuals) or unusually small (24%) (Hoyt et al., 1974).
Arterial branches that supply the medial portions of the midbrain and the posteromedial thalamus, including the paramedian mesencephalic arteries, the thalamic subthalamic arteries (also called the thalamoperforating arteries), and the medial posterior choroidal arteries, arise from the peduncular, precommunal segments of the PCAs. The anterior and anterolateral portions of the thalamus are usually fed by the tuberothalamic (polar) arteries, which branch from the posterior communicating arteries, not the PCAs. However, in some patients the tuberothalamic arteries are absent, and their usual territory is supplied by the thalamic-subthalamic arteries.
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