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Pulmonary regurgitation is the most common complication in repaired tetralogy of Fallot patients. Severe chronic pulmonary regurgitation can be tolerated for decades, but if not treated, it can progress to symptomatic, irreversible right ventricular dilatation and dysfunction. We investigated clinical associations with pulmonary valve replacement among patients with significative pulmonary regurgitation and how interventional developments can change their management.
All adult patients with repaired tetralogy of Fallot who were followed at an adult CHD Clinic at a single centre from 1980 to 2022 were included on their first outpatient visit. Follow-up was estimated from the time of correction surgery until one of the following events occurred first: pulmonary valve replacement, death, loss to follow-up or conclusion of the study.
We included 221 patients (116 males) with a median age of 19 (18–25). At a median age of 33 (10) years old, 114 (51%) patients presented significant pulmonary regurgitation. Among patients with significant pulmonary regurgitation, pulmonary valve replacement was associated with male gender, older age at surgical repair, and longer QRS duration in adulthood. Pulmonary valve replacement was performed in 50 patients, including four transcatheter pulmonary valve implantations, at a median age of 34 (14) years.
Pulmonary regurgitation affects a large percentage of tetralogy of Fallot adult patients, requiring a long-term clinical and imaging follow-up. Sex, age at surgical repair and longer QRS are associated with the need of PVR among patients with significative pulmonary regurgitation. Clinical practice and current literature support TPVI as the future gold standard intervention.
Helminth species of Neotropical bats are poorly known. In Mexico, few studies have been conducted on helminths of bats, especially in regions such as the Yucatan Peninsula where Chiroptera is the mammalian order with the greatest number of species. In this study, we characterized morphologically and molecularly the helminth species of bats and explored their infection levels and parasite–host interactions in the Yucatan Peninsula, Mexico. One hundred and sixty-three bats (representing 21 species) were captured between 2017 and 2022 in 15 sites throughout the Yucatan Peninsula. Conventional morphological techniques and molecular tools were used with the 28S gene to identify the collected helminths. Host–parasite network analyses were carried out to explore interactions by focusing on the level of host species. Helminths were found in 44 (26.9%) bats of 12 species. Twenty helminth taxa were recorded (7 trematodes, 3 cestodes and 10 nematodes), including 4 new host records for the Americas. Prevalence and mean intensity of infection values ranged from 7.1 to 100% and from 1 to 56, respectively. Molecular analyses confirmed the identity of some helminths at species and genus levels; however, some sequences did not correspond to any of the species available on GenBank. The parasite–host network suggests that most of the helminths recorded in bats were host-specific. The highest helminth richness was found in insectivorous bats. This study increases our knowledge of helminths parasitizing Neotropical bats, adding new records and nucleotide sequences.
This brief report aims to describe and determine the association of family functioning (e.g., cohesion and expressiveness) with psychosocial needs among Spanish Latinx patients coping with advanced cancers.
Descriptive and correlation analyses were performed on data from 103 patients coping with advanced cancer (Stages III and IV). The measures used were the Family Relationships Index, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy: General.
Results indicated that most of the participants had low family function (65%). Participants with higher family functioning (35%) had high levels of quality of life [r(103) .318, p < .002]. A higher level of quality of life was also strongly associated with lower levels of anxiety [r(95) −.653, p < .000], lower levels of depression [r(95) −.733, p < .000], and lower levels of hopelessness [r(95) −.585, p = .000]. A total of 22.3% of Latinx advanced cancer patients reported poor cohesiveness; those with low cohesiveness also had higher levels of depression [r(103) −.28, p = .004] and anxiety [r(103) −.27, p = .005]. Correlations between expressiveness and hopelessness were significant; namely, those with higher expressiveness had lower hopelessness [r(103) −.274, p = .005].
Significance of results
Findings present a high correlation between family functioning and psychosocial symptoms.
The anti-leishmania effects of HIV peptidase inhibitors (PIs) have been widely reported; however, the biochemical target and mode of action are still a matter of controversy in Leishmania parasites. Considering the possibility that HIV-PIs induce lipid accumulation in Leishmania amazonensis, we analysed the effects of lopinavir on the lipid metabolism of L. amazonensis promastigotes. To this end, parasites were treated with lopinavir at different concentrations and analysed by fluorescence microscopy and spectrofluorimetry, using a fluorescent lipophilic marker. Then, the cellular ultrastructure of treated and control parasites was analysed by transmission electron microscopy (TEM), and the lipid composition was investigated by thin-layer chromatography (TLC). Finally, the sterol content was assayed by gas chromatography–mass spectrometry (GC/MS). TEM analysis revealed an increased number of lipid inclusions in lopinavir-treated cells, which was accompanied by an increase in the lipophilic content, in a dose-dependent manner. TLC and GC–MS analysis revealed a marked increase of cholesterol-esters and cholesterol. In conclusion, lopinavir-induced lipid accumulation and affected lipid composition in L. amazonensis in a concentration–response manner. These data contribute to a better understanding of the possible mechanisms of action of this HIV-PI in L. amazonensis promastigotes. The concerted action of lopinavir on this and other cellular processes, such as the direct inhibition of an aspartyl peptidase, may be responsible for the arrested development of the parasite.
We present flux-calibrated integrated spectra in the optical spectral range of Galactic open clusters (GOCs) and Magellanic Cloud (MC) stellar clusters (SCs) obtained at CASLEO (Argentina). The SC parameters were derived using the equivalent-width (EW) method and the template-matching procedure by comparing the line strengths and continuum distribution of the cluster spectra with those of template spectra with known parameters. MC cluster reddening values were also estimated by interpolation between the available extinction maps. The derived ages for the GOCs range from 3 Myr to 4 Gyr, while those of the MC SCs vary from 3 Myr to 7 Gyr. E(B−V) colour-excess values in the MCs appear to be all lower than 0.17 mag, while those of the GOCs range from 0.00 to 2.40 mag. The present data led us to upgrade the spectral libraries of reference spectra or templates of solar and MC metallicities.
The present study evaluates for the first time in dogs, the kinetics of green tea catechins and their metabolic forms in plasma and urine. Ten beagles were administered 173 mg (12·35 mg/kg body weight) of catechins as a green tea extract, in capsules. Blood samples were collected during 24 h after intake and urine samples were collected during the following periods of time: 0–2, 2–6, 6–8 and 8–24 h. Two catechins with a galloyl moiety and three conjugated metabolites were detected in plasma. Most of the detected forms in plasma reached their maximum plasma concentration (Cmax) at around 1 h. Median Cmax for ( − )-epigallocatechin-3-gallate (EGCG), ( − )-epicatechin-3-gallate (ECG), ( − )-epigallocatechin glucuronide (EGC-glucuronide), ( − )-epicatechin glucuronide (EC-glucuronide), ( − )-epicatechin sulphate (EC-sulphate) were 0·3 (range 0·1–1·9), 0·1 (range 0–0·4), 0·8 (range 0·2–3·9), 0·2 (range 0·1–1·7) and 1 (range 0·3–3·4) μmol/l, respectively. The areas under the plasma concentration v. time curves (AUC0 → 24) were 427 (range 102–1185) μmol/l × min for EGC-glucuronide, 112 (range 53–919) μmol/l × min for EC-sulphate, 71 (range 26–306) μmol/l × min for EGCG, 40 (range 12–258) μmol/l × min for EC-glucuronide and 14 (range 0·1–124) μmol/l × min for ECG. The values of mean residence time (MRT0 → 24) were 5 (range 2–16), 2 (range 1–11), 10 (range 2–13), 3 (range 2–16) and 2·4 (range 1–18) h for EGCG, ECG, EGC-glucuronide, EC-glucuronide and EC-sulphate, respectively. In urine, catechins were present as conjugated forms, suggesting bile excretion of EGCG and ECG. Green tea catechins are absorbed following an oral administration and EGC-glucuronide is the metabolic form that remains in the organism for a longer period of time, suggesting that this compound could suffer an enterohepatic cycle.
To compare the sensitivity and specificity of two retrospective active surveillance methods based on review of the medical record and review of the discharge form in identifying nosocomial infection, taking the prospective surveillance method as the reference standard.
Blind comparison of three active nosocomial infection surveillance methods.
Department of General Surgery of a tertiary-care hospital with a referral population of 266,000 people.
All operated patients admitted to the Department of Surgery for more than 24 hours and discharged from January 1, 1994, to December 31, 1994, were included. Prospective surveillance consisted of daily review of the patient's record during hospitalization. Retrospective surveillance consisted of review of the medical record and the discharge form. Sensitivity and specificity of both retrospective methods were calculated.
Of the 1,514 patients included in the study, 1,476 (97.5%) were reviewed by means of the retrospective surveillance system. A total of 20, 8, and 4 hours per week was needed for the active prospective system, review of the medical record, and review of the hospital discharge form, respectively. The documented cumulative incidence of nosocomial infection was 21.8% for the prospective system, 19.6% for review of the medical record, and 12.6% for review of the discharge form. The overall sensitivity of review of the medical record was 88% and of the discharge form 56%, with a specificity of 99%. For review of the medical record, the highest sensitivity was 93%, for urinary tract infections; for review of the discharge form, the highest was 57%, for surgical-wound infection.
The retrospective method of review of the medical record was the most efficient active surveillance strategy in detecting nosocomial infection in surgical patients
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