213 results on '"Ramirez AJ"'
Search Results
2. Influence of delay on survival in patients with breast cancer: a systematic review
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Richards, MA, Westcombe, AM, Love, SB, Littlejohns, P., and Ramirez, AJ
- Published
- 1999
3. Manifestaciones orales en pacientes con diabetes mellitus tipo 2 atendidos en el Hospital Alberto Sabogal
- Author
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Linares Vega Nm, Zavaleta Solorzano S, Siapo García F, Ignacio Cconchoy F, and Vásquez Ramirez Aj
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Pediatrics ,medicine.medical_specialty ,Edentulism ,business.industry ,Type 2 Diabetes Mellitus ,medicine.disease ,Comorbidity ,Gingivitis ,Diabetes mellitus ,medicine ,Statistical analysis ,medicine.symptom ,Complication ,business ,Retinopathy - Abstract
Objective: To determine the most frequent oral manifestations of type 2 diabetes mellitus patients at the Sabogal Hospital during 2016. Methods: Descriptive, cross-sectional study. 47 patients were evaluated with an age range of = 65 years and in the female / male ratio was 1/1, with type 2 diabetes mellitus from the Sabogal Hospital during October, 2016. Data were collected with a chart that included socio-demographic variables of the patients and oral cavity examinations. The statistical analysis was frequency distribution and association of variables with chi-square analysis. Results: The most frequent age group was, patients over 65 years of age (48.94%). Arterial hypertension was the most frequent comorbidity with 57.45% and retinopathy as a chronic complication with 42.55%. From the sample 63.83% were insulin-dependent. The most frequent oral manifestation was partial edentulism with 85.11%, followed by caries with 82.98%, 78.72% gingivitis
- Published
- 2017
4. May measurement month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension (vol 40, pg 2006, 2019)
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Beaney, T, Burrell, LM, Castillo, RR, Charchar, FJ, Cro, S, Damasceno, A, Kruger, R, Nilsson, PM, Prabhakaran, D, Ramirez, AJ, Schlaich, MP, Schutte, AE, Tomaszewski, M, Touyz, R, Wang, JG, Weber, MA, Poulter, NR, Burazeri, G, Qirjako, G, Roshi, E, Cunashi, R, Fernandes, MJCC, Pereira, VSS, Neto, MFMP, Oliveira, PNM, Feijao, ACG, Cerniello, Y, Marin, MJ, Vasquez, GF, Espeche, WG, Stisman, D, Fuentes, IA, Zilberman, JM, Rodriguez, P, Babinyan, KY, Engibaryan, AH, Avagyan, AM, Minasyan, AA, Gevorkyan, AT, Carnagarin, R, Carrington, MJ, Sharman, JE, Lee, R, Perl, S, Niederl, E, Malik, FT, Choudhury, SR, Al Mamun, MA, Ishraquzzaman, M, Anthony, F, Connell, K, De Backer, TLM, Krzesinski, J, Houenassi, MD, Houehanou, CY, Sokolovic, S, Bahtijarevic, R, Tiro, MB, Mosepele, M, Masupe, TK, Barroso, WS, Gomes, MAM, Feitosa, ADM, Brandao, AA, Miranda, RD, Azevedo, VMAA, Dias, LM, Garcia, GDN, Martins, IPP, Dzudie, A, Kingue, S, Djomou, FAN, Njume, E, Khan, N, Lanas, FT, Garcia, MS, Paccot, MF, Torres, P, Li, Y, Liu, M, Xu, L, Li, L, Chen, X, Deng, J, Zhao, W, Fu, L, Zhou, Y, Lopez-Jaramillo, P, Otero, J, Camacho, PA, Accini, JL, Sanchez, G, Arcos, E, M'Buyamba-Kabangu, JR, Katamba, FK, Ngoyi, GN, Buila, NM, Bayauli, PM, Mbolla, EBF, Bakekolo, PR, Landa, KCM, Kaky, KGS, Kramoh, EK, Ngoran, YNK, Olsen, MH, Valoy, VL, Santillan, M, Rafael, AGM, Penaherrera, CE, Villalba, J, Ramirez, M, Arteaga, F, Delgado, P, Beistline, H, Cappuccio, FP, Keitley, J, Tay, T, Goshu, DY, Kassie, DM, Gebru, SA, Pathak, A, Denolle, T, Tsinamdzgvrishvili, B, Trapaidze, D, Sturua, L, Abesadze, T, Grdzelidze, N, Grabfelder, M, Kramer, BK, Schmeider, RE, Twumasi-Ankrah, B, Tannor, EK, Lincoln, MD, Deku, EM, Quintana, WFS, Kenerson, J, Baptiste, JED, Saintilmond, WW, Barrientos, AL, Jose, PA, More, A, Takalkar, A, Turana, Y, Widyantoro, B, Danny, SS, Djono, S, Handari, SD, Tambunan, M, Tiksnadi, BB, Hermiawaty, E, Tavassoli, E, Zolfaghari, M, Dolan, E, O'Brien, E, Borghi, C, Ferri, C, Torlasco, C, Parati, G, Nwokocha, CR, Nwokocha, M, Ogola, EN, Gitura, BM, Barasa, AL, Barasa, FA, Wairagu, AW, Nalwa, WZ, Najem, RN, Abu Alfa, AK, Fageh, HA, Msalam, OM, Derbi, HA, Bettamar, KA, Zakauskiene, U, Vickiene, A, Calmes, J, Alkerwi, A, Gantenbein, M, Ndhlovu, HLL, Masiye, JK, Chirwa, ML, Nyirenda, NM, Dhlamini, TD, Chia, YC, Ching, SM, Devaraj, NK, Ouane, N, Fane, T, Kowlessur, S, Ori, B, Heecharan, J, Alcocer, L, Chavez, A, Ruiz, G, Espinosa, C, Gomez-Alvarez, E, Neupane, D, Bhattarai, H, Ranabhat, K, Adhikari, TB, Koirala, S, Toure, IA, Soumana, KH, Wahab, KW, Omotoso, AB, Sani, MU, Okubadejo, NU, Nadar, SK, Al-Riyami, HA, Ishaq, M, Memon, F, Sidique, S, Choudhry, HA, Khan, RA, Ayala, M, Maidana, AJO, Bogado, GG, Ona, D, Atilano, A, Granada, C, Bartolome, R, Manese, L, Mina, A, Dumlao, MC, Villaruel, MC, Gomez, L, Jozwiak, J, Malyszko, J, Banach, M, Mastej, M, Rodrigues, DCMM, Martins, LL, Paval, A, Dorobantu, M, Konradi, AO, Chazova, IE, Rotar, O, Spoares, MC, Viegas, D, Almustafa, BA, Alshurafa, SA, Brady, A, Bovet, P, Viswanathan, B, Oladapo, OO, Russell, JW, Beheiry, HM, Ali, IA, Osman, AAA, Fahal, NAW, Osman, HA, Altahir, F, Persson, M, Wuerzner, G, Burkard, T, Wang, TD, Lin, HJ, Pan, HY, Chen, WJ, Lin, E, Mondo, CK, Ingabire, PM, Khomazyuk, TT, Krotova, VV, Negresku, E, Evstigneeva, O, Bazargani, NN, Agrawal, A, Bin Belaila, BA, Suhail, AM, Muhammed, KO, Shuri, HH, Wainford, RD, Levy, PD, Boggia, JJ, Garre, LL, Hernandez-Hernandez, R, Octavio-Seijas, JA, Lopez-Rivera, JA, Morr, I, Duin, A, Huynh, M, Cao, ST, Nguyen, VL, To, M, Phan, HN, Cockroft, J, McDonnell, B, Goma, FM, Syatalimi, C, Chifamba, J, Gwini, R, Tiburcio, O, and Xia, X
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Science & Technology ,Cardiac & Cardiovascular Systems ,Cardiovascular System & Hematology ,Cardiovascular System & Cardiology ,1103 Clinical Sciences ,Life Sciences & Biomedicine ,1102 Cardiorespiratory Medicine and Haematology - Published
- 2019
5. Informational needs of patients with melanoma and their views on the utility of investigative tests
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Constantinidou, A, Afuwape, SA, Linsell, L, Hung, T, Acland, K, Healy, C, Ramirez, AJ, and Harries, M
- Abstract
BACKGROUND: The aim of the study was to identify the informational needs of patients with melanoma on disease status and prognosis, and to ascertain their views on the utility of positron emission tomography (PET) and sentinel node biopsy (SNB). PATIENTS AND METHODS: Patients attending the weekly melanoma outpatient clinic at St Thomas' Hospital London UK between February and August 2007 participated in this cross-sectional survey. Views of 106 melanoma patients were elicited using a face-to face semi-structured questionnaire. RESULTS: The majority of participants wanted to know everything about their disease (88%). Prognostic information (> 85%) and information on palliative care input (97%) were highly valued. More than 50% expected the doctor to impart this information without negotiation. Nearly 70% of the responders who had previously had a PET scan felt they should decide if and when the scans should be performed. Fifty three percentage had undergone the SNB because the doctor had suggested it. CONCLUSIONS: Patients with melanoma want detailed and prompt information about their disease including prognosis. Regular PET scans provide reassurance. The role of SNB is not clear to all patients.
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- 2016
6. Promoting early symptomatic presentation in older women with breast cancer in the NHS breast screening programme
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Forbes, LJL, primary, Atkins, L, additional, Sellars, S, additional, Patnick, J, additional, Tucker, L, additional, and Ramirez, AJ, additional
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- 2010
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7. RENAL HYPERFILTRATION IN YOUNG INDIVIDUALS WITH METABOLIC SYNDROME: PP.34.396
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Sanchez, R, primary, Giunta, G, additional, Trentadue, G, additional, Hnatiuk, A, additional, Chiaramonti, L, additional, Pereyra, A, additional, Stampone, A, additional, Mendez, P, additional, Ramirez, AJ, additional, and Baglivo, H, additional
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- 2010
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8. Promoting early presentation of breast cancer
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Ramirez, AJ, primary
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- 2008
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9. Stress and burnout in doctors
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Graham, J, primary, Potts, HWW, additional, and Ramirez, AJ, additional
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- 2002
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10. Delay in diagnosis in breast cancer
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Richards, MA, primary, Sainsbury, JRC, additional, Ramirez, AJ, additional, Westcombe, AM, additional, and Haward, RA, additional
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- 1999
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11. Do patients with advanced breast cancer benefit from chemotherapy?
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Ramirez, AJ, primary, Towlson, KE, additional, Leaning, MS, additional, Richards, MA, additional, and Rubens, RD, additional
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- 1998
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12. Who and what influences delayed presentation in breast cancer?
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Burgess, CC, primary, Ramirez, AJ, additional, Richards, MA, additional, and Love, SB, additional
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- 1998
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13. Quality of life: the main outcome measure of palliative care
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Richards, MA, primary and Ramirez, AJ, additional
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- 1997
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14. Job Stress and Satisfaction among Palliative Physicians
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Graham, J, primary, Ramirez, AJ, additional, Cull, A, additional, Finlay, I, additional, Hoy, A, additional, and Richards, MA, additional
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- 1996
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15. Can mood disorder in women with breast cancer be identified preoperatively?
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Ramirez, AJ, primary, Richards, MA, additional, Jarrett, SR, additional, and Fentiman, IS, additional
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- 1995
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16. Burnout and psychiatric disorder among cancer clinicians
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Ramirez, AJ, primary, Graham, J, additional, Richards, MA, additional, Cull, A, additional, Gregory, WM, additional, Leaning, MS, additional, Snashall, DC, additional, and Timothy, AR, additional
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- 1995
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17. Iododoxorubicin in advanced breast cancer: a phase II evaluation of clinical activity, pharmacology and quality of life
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Twelves, CJ, primary, Dobbs, NA, additional, Lawrence, MA, additional, Ramirez, AJ, additional, Summerhayes, M, additional, Richards, MA, additional, Towlson, KE, additional, and Rubens, RD, additional
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- 1994
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18. A daily diary for quality of life measurement in advanced breast cancer trials
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Fraser, SCA, primary, Ramirez, AJ, additional, Ebbs, SR, additional, Fallowfield, LJ, additional, Dobbs, HJ, additional, Richards, MA, additional, Bates, T, additional, and Baum, M, additional
- Published
- 1993
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19. CMF versus epirubicin in advanced breast cancer: Validating a new QoL tool
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Fraser, SCA, primary, Dobbs, HJ, additional, Ramirez, AJ, additional, Ebbs, SR, additional, Fallowfield, LJ, additional, Richards, MA, additional, Bates, T, additional, and Baum, M, additional
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- 1992
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20. Latin American guidelines on hypertension.
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Sanchez RA, Ayala M, Baglivo H, Velazquez C, Burlando G, Kohlmann O, Jimenez J, Jaramillo PL, Brandao A, Valdes G, Alcocer L, Bendersky M, Ramirez AJ, Zanchetti A, and Latin America Expert Group
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- 2009
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21. Telmisartan improves insulin resistance in high renin nonmodulating salt-sensitive hypertensives.
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Sanchez RA, Masnatta LD, Pesiney C, Fischer P, and Ramirez AJ
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- 2008
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22. Learning the hard way! Setting up an RCT of aromatherapy massage for patients with advanced cancer.
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Westcombe, AM, Gambles, MA, Wilkinson, SM, Barnes, K, Fellowes, D, Maher, EJ, Young, T, Love, SB, Lucey, RA, Cubbin, S, and Ramirez, AJ
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AROMATHERAPY ,MASSAGE ,PSYCHOLOGICAL distress ,SERVICES for cancer patients ,PALLIATIVE treatment of cancer - Abstract
Aromatherapy massage is used in cancer palliative care to improve quality of life but there is little evidence for its effectiveness. A large pragmatic multicentre randomized controlled trial was set up to examine the effectiveness of aromatherapy in improving psychological distress and quality of life in patients with cancer. This paper examines the challenges encountered in the design and execution of the study. The original design, i) focused on palliative care patients with advanced disease; ii) had both a no-intervention and a treatment control group (relaxation therapy); and iii) adopted 90% power for sample size calculations. A varied measurement strategy was employed. Recruitment proved difficult, referrers were 'gate-keeping', patients were often too ill to approach and others declined. The trial was modified to ensure viability. Eligibility was extended to all patients with cancer irrespective of stage, the relaxation group was removed and the power reduced to 80%. Although it is not generally good practice to change a study design once recruitment has started, the changes were consistent with the original basic study aims and design principles. The data collection phase was successfully completed in July 2002. [ABSTRACT FROM AUTHOR]
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- 2003
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23. Mental health of hospital consultants: the effects of stress and satisfaction at work.
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Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM, Ramirez, A J, Graham, J, Richards, M A, Cull, A, and Gregory, W M
- Abstract
Background: Burnout and psychiatric morbidity among gastroenterologists, surgeons, radiologists, and oncologists in the UK have been estimated by means of a questionnaire-based survey. The relationship between consultants' mental health and their job stress and satisfaction, as well as their job and demographic characteristics, were also examined.Methods: Psychiatric morbidity was estimated using the 12-item General Health Questionnaire. The three components of burnout-emotional exhaustion, depersonalization, and low personal accomplishment-were assessed using the Maslach Burnout Inventory. Job stress and satisfaction were measured using study-specific questions.Findings: Of 1133 consultants, 882 (78%) returned questionnaires. The estimated prevalence of psychiatric morbidity was 27%, with no significant differences between the four specialist groups. Radiologists reported the highest level of burnout in terms of low personal accomplishment. Job satisfaction significantly protected consultants' mental health against job stress. Three sources of stress were associated with both burnout and psychiatric morbidity; feeling overloaded, and its effect on home life; feeling poorly managed and resourced; and dealing with patients' suffering. Burnout was also associated with low satisfaction in three domains: relationships with patients, relatives and staff; professional status/esteem; intellectual stimulation. In addition, being aged 55 years or less and being single were independent risk factors for burnout. Burnout was also more prevalent among consultants who felt insufficiently trained in communication and management skills.Interpretation: Consultants' mental health is likely to be protected against the high demands of medical practice by maintaining or enhancing job satisfaction, and by providing training in communication and management skills. [ABSTRACT FROM AUTHOR]- Published
- 1996
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24. Plasma renin activity levels influence the effect of converting enzyme inhibitors in preserving renal function in hypertension.
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Sanchez RA, Migliorini M, Giannone C, and Ramirez AJ
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- 1996
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25. Multidisciplinary team working in cancer: what is the evidence?
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Taylor C, Munro AJ, Glynne-Jones R, Griffith C, Trevatt P, Richards M, and Ramirez AJ
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- 2010
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26. NON MODULATING SUBJECTS.
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Sanchez, RA, Ramos, F, Nolly, H, Masnatta, L, Fischer, P, Giannone, C, Miatello, H, Baglivo, H, and Ramirez, AJ
- Published
- 1999
27. Validation of a measurement tool to assess awareness of breast cancer.
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Linsell L, Forbes LJL, Burgess C, Kapari M, Thurnham A, and Ramirez AJ
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AIM: Until now, there has been no universally accepted and validated measure of breast cancer awareness. This study aimed to validate the new Breast Cancer Awareness Measure (BCAM) which assesses, using a self-complete questionnaire, knowledge of breast cancer symptoms and age-related risk, and frequency of breast checking. METHODS: We measured the psychometric properties of the BCAM in 1035 women attending the NHS Breast Screening Programme: acceptability was assessed using a feedback questionnaire (n=292); sensitivity to change after an intervention promoting breast cancer awareness (n=576), and test-retest reliability (n=167). We also assessed readability, and construct validity using the 'known-groups' method. RESULTS: The readability of the BCAM was high. Over 90% of women found it acceptable. The BCAM was sensitive to change: there was an increase in the proportion of women obtaining the full score for breast cancer awareness one month after receiving the intervention promoting breast cancer awareness; this was greater among those who received a more intensive version (less intensive version (booklet): 9.3%, 95% confidence interval (CI): 4.5-14.1%; more intensive version (interaction with health professional plus booklet): 30%, 95% CI: 23.4-36.6%). Test-retest reliability of the BCAM was moderate to good for most items. Cancer experts had higher levels of cancer awareness than non-medical academics (50% versus 6%, p=0.001), indicating good construct validity. CONCLUSIONS: The BCAM is a valid and robust measure of breast cancer awareness suitable for use in surveys of breast cancer awareness in the general population and to evaluate the impact of awareness-raising interventions. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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28. Changes in mental health of UK hospital consultants since the mid-1990s.
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Taylor C, Graham J, Potts HWW, Richards MA, Ramirez AJ, Taylor, Cath, Graham, Jill, Potts, Henry W W, Richards, Michael A, and Ramirez, Amanda J
- Abstract
We assessed changes in the mental health of UK hospital consultants from five specialties, on the basis of surveys done in 1994 (880 participants) and 2002 (1308 participants). The proportion of consultants with psychiatric morbidity rose from 27% (235) in 1994 to 32% (414) in 2002. The prevalence of emotional exhaustion increased from 32% (284) in 1994 to 41% (526) in 2002. Multivariate analyses showed that increased job stress without a comparable increase in job satisfaction accounted for the decline in mental health, which was especially marked in clinical and surgical oncologists. Action is needed to improve the working lives of consultants. [ABSTRACT FROM AUTHOR]
- Published
- 2005
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29. Insulin resistance is associated to future hypertension in normotensive salt-sensitive individuals: a 10-year follow-up study.
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Sanchez RA, Sanchez MJ, Pessana F, and Ramirez AJ
- Abstract
Background: Salt-sensitive hypertension is associated with insulin resistance in nonobese individuals. However, no data have been reported for normotensive offspring of hypertensive salt-sensitive parents., Aims: To evaluate in normotensive salt-sensitive or salt-resistant offspring of hypertensive parents (offSS-HT and offSR-HT, respectively): the possible association between insulin resistance and endothelial dysfunction, and the risk of developing hypertension in a 10-year follow-up., Design and Methods: Forty-one offSS-HT (29 ± 2 years; 20 female) and 36 offSR-HT (25 ± 3 years; 16 female) were followed up for 10 years. Both groups were considered lean. At baseline, creatinine clearance (CrCl), 24 h urinary albumin excretion (UAE), glycemia, and insulinemia were measured before and after 60 and 120 min of glucose overload (75 g). HOMA Index and the area under the curve (AUC) were calculated. Blood pressure (BP) and 24 h urine sodium excretion was measured annually. Postischemic minimum vascular resistance (forearm plethysmography) was assessed at baseline., Results: In offSS-HT, UAE (53 ± 3 mg/min) and CrCl (136 ± 8 ml/min) were higher in offSS-HT than in offSR-HT. (UAE: 12 ± 4 mg.min; p,0.01 and CrCl 107 ± 6 ml.min; P < 0.01). An impaired vasodilatory postischemic response was observed in offSS-HT compared with offSR-HT (P < 0.01). In offSS-HT glycemia, insulin, AUC at 69 and 120 min post OTG were greater than in offSS-HT, p < 0.02. In offSS-HT, blood pressure rose (P < 0.01) the 10 years follow-up compared with offSR-HT., Conclusion: Salt sensitivity in the offspring of hypertensive salt-sensitive individuals is associated with insulin resistance and endothelial dysfunction and is prone to hypertension over a short period of time., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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30. Heat affected zone liquation cracking evaluation on FeMnAl alloys.
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Giorjao R, Riffel KC, Brizes E, Sebeck K, and Ramirez AJ
- Abstract
FeMnAl steels are currently generating a lot of interest with potential applications for structural parts in armored vehicles due to their lower density and outstanding mechanical properties. Despite the extensive mechanical performance and heat treatment exploration of this alloy class, further weldability investigation is required for future large-scale deployment. In the present study, the liquation cracking of four heats of cast FeMnAl alloys was investigated by the spot-Varestraint technique. The study focuses primarily on the effect of the major elements of the FeMnAl system: C, Mn and Al. Optical and electron microscopy were employed to investigate the microstructural features, and CALPHAD was employed to aid the discussion regarding the alloy's composition differences and their effect on the liquation cracking susceptibility. The study was able to identify that compositions with the higher Mn, C, and lower Al presented the highest liquation cracking susceptibility. Conversely, composition presenting lower Mn, C, and Al showed the most resistant behavior. Furthermore, lower Al content promoted a fully-γ microstructure at low temperatures, which encouraged the appearance of longer cracks as a γ-matrix is more susceptible to HAZ cracking than a fully ferritic (α) or duplex (α + γ) microstructure., Competing Interests: No potential conflict of interest was reported by the author(s)., (This work was authored as part of the Contributor’s official duties as an Employee of the United States Government and is therefore a work of the United States Government. In accordance with 17 U.S.C. 105, no copyright protection is available for such works under U.S. Law.)
- Published
- 2024
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31. 2022 World Hypertension League, Resolve To Save Lives and International Society of Hypertension dietary sodium (salt) global call to action.
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Campbell NRC, Whelton PK, Orias M, Wainford RD, Cappuccio FP, Ide N, Neal B, Cohn J, Cobb LK, Webster J, Trieu K, He FJ, McLean RM, Blanco-Metzler A, Woodward M, Khan N, Kokubo Y, Nederveen L, Arcand J, MacGregor GA, Owolabi MO, Lisheng L, Parati G, Lackland DT, Charchar FJ, Williams B, Tomaszewski M, Romero CA, Champagne B, L'Abbe MR, Weber MA, Schlaich MP, Fogo A, Feigin VL, Akinyemi R, Inserra F, Menon B, Simas M, Neves MF, Hristova K, Pullen C, Pandeya S, Ge J, Jalil JE, Wang JG, Wideimsky J, Kreutz R, Wenzel U, Stowasser M, Arango M, Protogerou A, Gkaliagkousi E, Fuchs FD, Patil M, Chan AW, Nemcsik J, Tsuyuki RT, Narasingan SN, Sarrafzadegan N, Ramos ME, Yeo N, Rakugi H, Ramirez AJ, Álvarez G, Berbari A, Kim CI, Ihm SH, Chia YC, Unurjargal T, Park HK, Wahab K, McGuire H, Dashdorj NJ, Ishaq M, Ona DID, Mercado-Asis LB, Prejbisz A, Leenaerts M, Simão C, Pinto F, Almustafa BA, Spaak J, Farsky S, Lovic D, and Zhang XH
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- Humans, Sodium Chloride, Dietary adverse effects, Sodium Chloride, Sodium, Dietary adverse effects, Hypertension diagnosis, Hypertension drug therapy, Hypertension epidemiology
- Published
- 2023
- Full Text
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32. Impact and Sustainability of Foreign Medical Aid: A Qualitative Study with Honduran Healthcare Providers.
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Faktor KL, Payán DD, Ramirez AJ, and May FP
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- Humans, International Cooperation, Qualitative Research, Community Health Workers, Medical Missions, Physicians
- Abstract
Background: There is growing concern about the sustainability and long-term impact of short-term medical missions (STMMs)-an increasingly common form of foreign medical aid-given that brief engagements do little to address the underlying poverty and fragmented healthcare system that plagues many low- and middle-income countries (LMICs). In the absence of formal evaluations, unintended but serious consequences for patients and local communities may arise, including a lack of continuity of patient care, poor alignment with community needs, and cultural and language barriers., Objective: We conducted semi-structured interviews with Honduran healthcare providers (n = 88) in 2015 to explore local providers' perceptions of the impact and sustainability of foreign medical aid on patient needs, community health, and the country's healthcare system., Methods: Respondents represented a random sample of Honduran healthcare providers (physicians, dentists, nurses) who worked for either a government-run rural clinic or non-governmental organization (NGO) in Honduras., Findings: Honduran healthcare providers largely framed foreign medical teams as being assets that help to advance community health through the provision of medical personnel and supplies. Nonetheless, most respondents identified strategies to improve implementation of STMMs and reduce negative impacts. Many respondents emphasized a need for culturally- and linguistically-tailored medical care and health education interventions. Participants also recommended strengthening local partnerships to mitigate the risk of dependence, including on-going training and support of community health workers to promote sustainable change., Conclusions: Guidelines informed by local Honduran expertise are needed to increase accountability for more robust training of foreign physicians in the provision of context-appropriate care. These findings provide valuable local perspectives from Honduran healthcare providers to improve the development and implementation of STMMs, informing strategies that can complement and strengthen healthcare systems in LMICs., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2023 The Author(s).)
- Published
- 2023
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33. Droplet Microfluidic Technology for the Early and Label-Free Isolation of Highly-Glycolytic, Activated T-Cells.
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Zielke C, Gutierrez Ramirez AJ, Voss K, Ryan MS, Gholizadeh A, Rathmell JC, and Abbyad P
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A label-free, fixation-free and passive sorting method is presented to isolate activated T-cells shortly after activation and prior to the display of activation surface markers. It uses a recently developed sorting platform dubbed "Sorting by Interfacial Tension" (SIFT) that sorts droplets based on pH. After polyclonal (anti-CD3/CD28 bead) activation and a brief incubation on chip, droplets containing activated T-cells display a lower pH than those containing naive cells due to increased glycolysis. Under specific surfactant conditions, a change in pH can lead to a concurrent increase in droplet interfacial tension. The isolation of activated T-cells on chip is hence achieved as flattened droplets are displaced as they encounter a micro-fabricated trench oriented diagonally with respect to the direction of flow. This technique leads to an enrichment of activated primary CD4+ T-cells to over 95% from an initial mixed population of naive cells and cells activated for as little as 15 min. Moreover, since the pH change is correlated to successful activation, the technique allows the isolation of T-cells with the earliest activation and highest glycolysis, an important feature for the testing of T-cell activation modulators and to determine regulators and predictors of differentiation outcomes.
- Published
- 2022
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34. In vitro-in vivo biotransformation and phase I metabolite profiling of benzo[a]pyrene in Gulf killifish (Fundulus grandis) populations with different exposure histories.
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Franco ME, Ramirez AJ, Johanning KM, Matson CW, and Lavado R
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- Adaptation, Physiological, Animals, Benzo(a)pyrene toxicity, Biotransformation, Humans, Fundulidae, Water Pollutants, Chemical toxicity
- Abstract
Chronic exposure to pollution may lead populations to display evolutionary adaptations associated with cellular and physiological mechanisms of defense against xenobiotics. This could result in differences in the way individuals of the same species, but inhabiting different areas, cope with chemical exposure. In the present study, we explore two Gulf killifish (Fundulus grandis) populations with different exposure histories for potential differences in the biotransformation of benzo[a]pyrene (BaP), and conduct a comparative evaluation of in vitro and in vivo approaches to describe the applicability of new approach methodologies (NAMs) for biotransformation assessments. Pollution-adapted and non-adapted F. grandis were subjected to intraperitoneal (IP) injections of BaP in time-course exposures, prior to measurements of CYP biotransformation activity, BaP liver concentrations, and the identification and quantification of phase I metabolites. Additionally, substrate depletion bioassays using liver S9 fractions were employed for measurements of intrinsic hepatic clearance and to evaluate the production of metabolites in vitro. Pollution-adapted F. grandis presented significantly lower CYP1A activity and intrinsic clearance rates that were 3 to 4 times lower than non-adapted fish. The metabolite profiling of BaP showed the presence of 1‑hydroxy-benzo[a]pyrene in both the in vitro and in vivo approaches but with no significant population differences. Contrarily, 9‑hydroxy-benzo[a]pyrene and benzo[a]pyrene-4,5-dihydrodiol, only identified through the in vivo approach, presented higher concentrations in the bile of pollution-adapted fish relative to non-adapted individuals. These observations further the understanding of the evolutionary adaptation of F. grandis inhabiting heavily polluted environments in the Houston Ship Channel, TX, USA, and highlight the need to consider the evolutionary history of populations of interest during the implementation of NAMs., (Copyright © 2021 Elsevier B.V. All rights reserved.)
- Published
- 2022
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35. Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension.
- Author
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Parati G, Stergiou GS, Bilo G, Kollias A, Pengo M, Ochoa JE, Agarwal R, Asayama K, Asmar R, Burnier M, De La Sierra A, Giannattasio C, Gosse P, Head G, Hoshide S, Imai Y, Kario K, Li Y, Manios E, Mant J, McManus RJ, Mengden T, Mihailidou AS, Muntner P, Myers M, Niiranen T, Ntineri A, O'Brien E, Octavio JA, Ohkubo T, Omboni S, Padfield P, Palatini P, Pellegrini D, Postel-Vinay N, Ramirez AJ, Sharman JE, Shennan A, Silva E, Topouchian J, Torlasco C, Wang JG, Weber MA, Whelton PK, White WB, and Mancia G
- Subjects
- Blood Pressure, Blood Pressure Determination, Humans, Societies, Medical, Blood Pressure Monitoring, Ambulatory, Hypertension diagnosis
- Abstract
The present paper provides an update of previous recommendations on Home Blood Pressure Monitoring from the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring and Cardiovascular Variability sequentially published in years 2000, 2008 and 2010. This update has taken into account new evidence in this field, including a recent statement by the American Heart association, as well as technological developments, which have occurred over the past 20 years. The present document has been developed by the same ESH Working Group with inputs from an international team of experts, and has been endorsed by the ESH., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
36. [São Paulo call to action for the prevention and control of high blood pressure: 2020Chamado à ação de São Paulo para prevenção e controle da hipertensão arterial: 2020].
- Author
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Campbell NR, Schutte AE, Varghese CV, Ordunez P, Zhang XH, Khan T, Sharman JE, Whelton PK, Parati G, Weber MA, Orías M, Jaffe MG, Moran AE, Plavnik FL, Ram VS, Brainin M, Owolabi MO, Ramirez AJ, Barbosa E, Bortolotto LA, and Lackland DT
- Abstract
About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke).There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring.Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated.Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks.Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care.Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.
- Published
- 2021
- Full Text
- View/download PDF
37. [São Paulo call to action for the prevention and control of high blood pressure: 2020Llamado a la acción de San Pablo para la prevención y el control de la hipertensión arterial, 2020].
- Author
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Campbell NR, Schutte AE, Varghese CV, Ordunez P, Zhang XH, Khan T, Sharman JE, Whelton PK, Parati G, Weber MA, Orías M, Jaffe MG, Moran AE, Plavnik FL, Ram VS, Brainin M, Owolabi MO, Ramirez AJ, Barbosa E, Bortolotto LA, and Lackland DT
- Abstract
About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke).There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring.Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated.Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks.Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care.Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.
- Published
- 2021
- Full Text
- View/download PDF
38. Renal Function, Albumin-Creatinine Ratio and Pulse Wave Velocity Predict Silent Coronary Artery Disease and Renal Outcome in Type 2 Diabetic and Prediabetic Subjects.
- Author
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Sanchez RA, Sanchez MJ, and Ramirez AJ
- Subjects
- Aged, Albumins, Creatinine, Female, Humans, Male, Middle Aged, Pulse Wave Analysis, Coronary Artery Disease diagnosis, Coronary Artery Disease epidemiology, Diabetes Mellitus, Type 2 diagnosis, Diabetes Mellitus, Type 2 epidemiology, Kidney physiology, Prediabetic State diagnosis, Prediabetic State epidemiology
- Abstract
Introduction: Silent coronary heart disease is frequently undetected in type 2 diabetes mellitus (DM2) and pre-diabetes determined by glucose intolerance (GI). Pulse wave velocity (PWV) and albumin-creatinine ratio (ACR) have been considered markers of cardiovascular mortality, coronary heart disease and chronic renal failure., Aim: To evaluate the incidence of coronary artery disease (CAD) and the relationship between urinary albumin-creatinine ratio, glomerular filtration rate (GFR) and PWV in type 2 DM with silent CAD., Methods: We analyzed 92 individuals (44 male), 49 (60±7y) type 2 DM non-insulin dependents and 43 prediabetics (43±4y), with Grade I-II hypertension and no symptoms of CAD. All type 2 DM patients were under antidiabetic treatment with A1C hemoglobin between 5.5 and 6.5%. Every patient underwent a myocardial perfusion SPECT scan. In those subjects with ischemic patterns, coronary angiography was performed. In addition, PWV, glomerular filtration rate, and ACR were evaluated., Statistics: mean±SEM, and ANOVA among groups., Results: 48.59% of DM2 and 25.58% of GI patients had silent coronary artery had silent coronary artery disease and higher ACR, PWV and reduced GFR. Higher ACR and PWV and reduced GFR. DM2 and GI showed a negative relationship between GFR and ACR. Moreover, this relation was also observed in different levels of GFR (>60 ml/min and <60ml.min (p<0.05) in patients with CAD, suggesting a cardio-renal interaction in DM2., Conclusion: Higher PWV, lower GFR and ACR predict the incidence of CAD in DM2. Dysglycemic individuals also represent a group of higher risk for coronary artery disease with similar predictors as in DM2. Diabetic and prediabetics still develop renal microalbuminuria. Thus, PWV seems to represent a reliable marker of renal impairment and coronary artery disease., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)
- Published
- 2021
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39. Metabolomic-based assessment reveals dysregulation of lipid profiles in human liver cells exposed to environmental obesogens.
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Franco ME, Fernandez-Luna MT, Ramirez AJ, and Lavado R
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- Cell Line, Hepatocytes drug effects, Hepatocytes metabolism, Homeostasis drug effects, Humans, Lipid Metabolism drug effects, Metabolomics methods, Non-alcoholic Fatty Liver Disease chemically induced, Non-alcoholic Fatty Liver Disease metabolism, PPAR gamma metabolism, Environmental Exposure adverse effects, Environmental Pollutants adverse effects, Liver drug effects, Liver metabolism, Obesity chemically induced, Obesity metabolism
- Abstract
Significant attention has been given to the potential of environmental chemicals to disrupt lipid homeostasis at the cellular level. These chemicals, classified as obesogens, are abundantly used in a wide variety of consumer products. However, there is a significant lack of information regarding the mechanisms by which environmental exposure can contribute to the onset of obesity and non-alcoholic fatty liver disease (NAFLD). Several studies have described the interaction of potential obesogens with lipid-related peroxisome proliferator-activated receptors (PPAR). However, no studies have quantified the degree of modification to lipidomic profiles in relevant human models, making it difficult to directly link PPAR agonists to the onset of lipid-related diseases. A quantitative metabolomic approach was used to examine the dysregulation of lipid metabolism in human liver cells upon exposure to potential obesogenic compounds. The chemicals rosiglitazone, perfluorooctanoic acid, di-2-ethylexylphthalate, and tributyltin significantly increased total lipids in liver cells, being diglycerides, triglycerides and phosphatidylcholines the most prominent. Contrarily, perfluorooctane sulfonic acid and the pharmaceutical fenofibrate appeared to lower total lipid concentrations, especially those belonging to the acylcarnitine, ceramide, triglyceride, and phosphatidylcholine groups. Fluorescence microscopy analysis for cellular neutral lipids revealed significant lipid bioaccumulation upon exposure to obesogens at environmentally relevant concentrations. This integrated omics analysis provides unique mechanistic insight into the potential of these environmental pollutants to promote diseases like obesity and NAFLD. Furthermore, this study provides a significant contribution to advance the understanding of molecular signatures related to obesogenic chemicals and to the development of alternatives to in vivo experimentation., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
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40. Microfluidic Platform for the Isolation of Cancer-Cell Subpopulations Based on Single-Cell Glycolysis.
- Author
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Zielke C, Pan CW, Gutierrez Ramirez AJ, Feit C, Dobson C, Davidson C, Sandel B, and Abbyad P
- Subjects
- Cell Line, Tumor, Glycolysis, Humans, Cell Separation, Lab-On-A-Chip Devices, Single-Cell Analysis
- Abstract
High rates of glycolysis in tumors have been associated with cancer metastasis, tumor recurrence, and poor outcomes. In this light, single cells that exhibit high glycolysis are specific targets for therapy. However, the study of these cells requires efficient tools for their isolation. We use a droplet microfluidic technique developed in our lab, S orting by I nter f acial T ension (SIFT), to isolate cancer cell subpopulations based on glycolysis without the use of labels or active sorting components. By controlling the flow conditions on chip, the threshold of selection can be modified, enabling the isolation of cells with different levels of glycolysis. Hypoxia in tumors, that can be simulated with treatment with CoCl
2 , leads to an increase in glycolysis, and more dangerous tumors. The device was used to enrich CoCl2 treated MDA-MB 231 breast cancer cells from an untreated population. It is also used to sort K562 human chronic myelogenous leukemia cells that have either been treated or untreated with 2-deoxy-d-glucose (2DG), a pharmaceutical that targets cell metabolism. The technique provides a facile and robust way of separating cells based on elevated glycolytic activity; a biomarker associated with cancer cell malignancy.- Published
- 2020
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41. Bioreductively Activatable Prodrug Conjugates of Combretastatin A-1 and Combretastatin A-4 as Anticancer Agents Targeted toward Tumor-Associated Hypoxia.
- Author
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Winn BA, Devkota L, Kuch B, MacDonough MT, Strecker TE, Wang Y, Shi Z, Gerberich JL, Mondal D, Ramirez AJ, Hamel E, Chaplin DJ, Davis P, Mason RP, Trawick ML, and Pinney KG
- Subjects
- A549 Cells, Animals, Antineoplastic Agents, Phytogenic chemistry, Breast Neoplasms drug therapy, Cell Hypoxia, Colchicine metabolism, Drug Screening Assays, Antitumor, Female, Humans, Mice, Mice, Inbred BALB C, NADPH-Ferrihemoprotein Reductase chemistry, NADPH-Ferrihemoprotein Reductase metabolism, Prodrugs chemistry, Stilbenes chemistry, Tubulin drug effects, Tubulin metabolism, Antineoplastic Agents, Phytogenic pharmacology, Prodrugs pharmacology, Stilbenes pharmacology
- Abstract
The natural products combretastatin A-1 (CA1) and combretastatin A-4 (CA4) function as potent inhibitors of tubulin polymerization and as selective vascular disrupting agents (VDAs) in tumors. Bioreductively activatable prodrug conjugates (BAPCs) can enhance selectivity by serving as substrates for reductase enzymes specifically in hypoxic regions of tumors. A series of CA1-BAPCs incorporating nor- methyl, mono -methyl, and gem- dimethyl nitrothiophene triggers were synthesized together with corresponding CA4-BAPCs, previously reported by Davis ( Mol. Cancer Ther. 2006 , 5 (11), 2886), for comparison. The CA4- gem -dimethylnitrothiophene BAPC 45 proved exemplary in comparison to its nor- methyl 43 and mono -methyl 44 congeners. It was stable in phosphate buffer (pH 7.4, 24 h), was cleaved (25%, 90 min) by NADPH-cytochrome P450 oxidoreductase (POR), was inactive (desirable prodrug attribute) as an inhibitor of tubulin polymerization (IC
50 > 20 μM), and demonstrated hypoxia-selective activation in the A549 cell line [hypoxia cytotoxicity ratio (HCR) = 41.5]. The related CA1- gem -dimethylnitrothiophene BAPC 41 was also promising (HCR = 12.5) with complete cleavage (90 min) upon treatment with POR. In a preliminary in vivo dynamic bioluminescence imaging study, BAPC 45 (180 mg/kg, ip) induced a decrease (within 4 h) in light emission in a 4T1 syngeneic mouse breast tumor model, implying activation and vascular disruption.- Published
- 2020
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42. São Paulo call to action for the prevention and control of high blood pressure: 2020.
- Author
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Campbell NRC, Schutte AE, Varghese CV, Ordunez P, Zhang XH, Khan T, Sharman JE, Whelton PK, Parati G, Weber MA, Orías M, Jaffe MG, Moran AE, Liane Plavnik F, Ram VS, Brainin M, Owolabi MO, Ramirez AJ, Barbosa E, Bortolotto LA, and Lackland DT
- Subjects
- Alcohol Drinking adverse effects, Brazil epidemiology, Heart Diseases epidemiology, Heart Failure epidemiology, Humans, Hypertension epidemiology, Noncommunicable Diseases epidemiology, Noncommunicable Diseases mortality, Obesity complications, Prevalence, Primary Health Care organization & administration, Public Policy legislation & jurisprudence, Risk Factors, Risk Reduction Behavior, Sedentary Behavior, Social Class, Stroke epidemiology, Dietary Approaches To Stop Hypertension methods, Global Burden of Disease economics, Hypertension drug therapy, Hypertension prevention & control
- Published
- 2019
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- View/download PDF
43. May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension.
- Author
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Beaney T, Burrell LM, Castillo RR, Charchar FJ, Cro S, Damasceno A, Kruger R, Nilsson PM, Prabhakaran D, Ramirez AJ, Schlaich MP, Schutte AE, Tomaszewski M, Touyz R, Wang JG, Weber MA, and Poulter NR
- Subjects
- Adult, Antihypertensive Agents therapeutic use, Awareness, Blood Pressure physiology, Case-Control Studies, Cross-Sectional Studies, Female, Global Burden of Disease, Humans, Hypertension drug therapy, Hypertension mortality, Male, Middle Aged, Surveys and Questionnaires statistics & numerical data, Blood Pressure Determination methods, Hypertension diagnosis, Mass Screening methods
- Abstract
Aims: Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries., Methods and Results: Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension., Conclusion: May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Published
- 2019
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44. Corbicula fluminea rapidly accumulate pharmaceuticals from an effluent dependent urban stream.
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Burket SR, White M, Ramirez AJ, Stanley JK, Banks KE, Waller WT, Chambliss CK, and Brooks BW
- Subjects
- Animals, Chromatography, Liquid, Fishes, Texas, Corbicula metabolism, Fresh Water chemistry, Organic Chemicals analysis, Pharmaceutical Preparations analysis, Water Pollutants, Chemical analysis
- Abstract
Freshwater bivalve populations are stressed by watershed development at the global scale. Though pharmaceuticals released from wastewater treatment plant effluent discharges are increasingly reported to bioaccumulate in fish, an understanding of bioaccumulation in bivalves is less defined. In the present study, we examined accumulation of 12 target pharmaceuticals in C. fluminea during a 42 day in situ study in Pecan Creek, an effluent dependent wadeable stream in north central Texas, USA. Caged clams were placed at increasing distances (5 m, 643 m, 1762 m) downstream from a municipal effluent discharge and then subsampled on study days 7, 14, 28 and 42. Acetaminophen, caffeine, carbamazepine, diltiazem, diphenhydramine, fluoxetine, norfluoxetine, sertraline, desmethylsertraline, and methylphenidate were identified in C. fluminea whole body tissue homogenates via isotope dilution liquid chromatography-tandem mass spectrometry. Tissue concentrations ranged from low μg/kg (methylphenidate) to 341 μg/kg (sertraline). By study day 7, rapid and apparent pseudo-steady state accumulation of study compounds was observed in clams; this observation continued throughout the 42 d study. Notably, elevated bioaccumulation factors (L/kg) for sertraline were observed between 3361 and 6845, which highlights the importance of developing predictive bioaccumulation models for ionizable contaminants with bivalves. Future research is also necessary to understand different routes of exposure and elimination kinetics for pharmaceutical accumulation in bivalves., (Copyright © 2019 Elsevier Ltd. All rights reserved.)
- Published
- 2019
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45. May Measurement Month 2017: Results of 39 national blood pressure screening programmes.
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Poulter NR, Borghi C, Castillo RR, Charchar FJ, Ramirez AJ, Schlaich MP, Schutte AE, Stergiou G, Unger T, Wainford RD, and Beaney T
- Abstract
Raised blood pressure is the biggest single risk factor responsible for mortality worldwide. Despite this, the majority of people with hypertension are unaware of having it, are untreated, or are on treatment but uncontrolled. May Measurement Month is a global campaign initiated by the International Society of Hypertension with the aim of raising awareness of high blood pressure. In the first year of the campaign in 2017, over 1.2 million people were screened in 80 countries across the world, finding over 100 000 people with hypertension who were not on treatment and over 150 000 people on anti-hypertensive treatment who were not controlled. The individual national results from 39 countries are presented in this supplement. In this article, we discuss the background to the campaign, along with some of the logistical and methodological challenges that were faced in setting up the campaign, and in collecting and analysing the data from such a large cross-sectional study. With the lessons learned from the 2017 campaign, the campaign was repeated in 2018 and is to be repeated again in 2019.
- Published
- 2019
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46. Diabetic patients with essential hypertension treated with amlodipine: blood pressure and arterial stiffness effects of canagliflozin or perindopril.
- Author
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Ramirez AJ, Sanchez MJ, and Sanchez RA
- Subjects
- Aged, Amlodipine therapeutic use, Antihypertensive Agents therapeutic use, Essential Hypertension complications, Essential Hypertension epidemiology, Essential Hypertension physiopathology, Female, Humans, Male, Middle Aged, Sodium-Glucose Transporter 2 Inhibitors pharmacology, Sodium-Glucose Transporter 2 Inhibitors therapeutic use, Blood Pressure drug effects, Canagliflozin pharmacology, Canagliflozin therapeutic use, Diabetes Mellitus, Type 2 complications, Essential Hypertension drug therapy, Perindopril pharmacology, Perindopril therapeutic use, Vascular Stiffness drug effects
- Abstract
Introduction: Hypertension control reduces cardiovascular and renal risks in type 2 diabetes. Sodium-glucose cotransporter-2 inhibitors prevent renal glucose reabsorption and decrease glucose plasma levels, blood pressure (BP) and weight reduction. Treatment of hypertension and sodium-glucose cotransporter-2 are able to improve arterial stiffness., Aims: To evaluate, in patients with type 2 diabetes and hypertension, the effects of 6 months treatment with canagliflozin, or perindopril, an angiotensin converting enzyme inhibitor, on central BP and carotid-femoral pulse wave velocity (cfPWV)., Methods: Thirty type 2 diabetic patients with hypertension taking amlodipine, 10 mg daily, and metformin, 750-2000 mg daily, were randomized and a third medication was added: canagliflozin, 300 mg daily (n = 15, nine women, mean age: 63 ± 8 years), or perindopril, 10 mg daily (n = 15, five women, mean age 59 ± 4 years), for 6 months. Ambulatory BP monitoring was assessed at baseline and after 3 and 6 months of treatment, whereas cfPWV was measured before and after 6 months of treatment. Plasma fasting glucose, glycated hemoglobin, creatinine, plasma and urinary sodium and potassium were also measured., Results: Both treatments significantly reduced BP and cfPWV. Only canagliflozin maintained the PWV action after adjusting for BP values and reduced glycemia, glycated hemoglobin and 24 h urinary sodium. Other security laboratory parameters, including gluthamic oxaloacetic transaminase, gluthamic piruvic transaminase; and bilirubin failed to show any change., Conclusion: Canagliflozin reduced BP and improve arterial stiffness, independently of the BP effect. These two conditions could explain the cardiovascular protection observed with canagliflozin compared with perindopril.
- Published
- 2019
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47. Promoting breast cancer awareness in older women during the seasonal flu vaccination campaign.
- Author
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Kaushal A, McCormick K, Warburton F, Burton C, Ramirez AJ, and Forbes LJ
- Subjects
- Aged, Early Detection of Cancer, Feasibility Studies, Female, Humans, London, Primary Health Care, Program Evaluation, Risk Assessment, Seasons, Breast Neoplasms diagnosis, Health Knowledge, Attitudes, Practice, Health Promotion methods, Immunization Programs, Influenza Vaccines administration & dosage
- Abstract
Background:: older women are at high risk of presenting with breast cancer when it has reached a late stage, which may be partly because of poor breast cancer awareness., Aim:: the aim of this project was to implement and evaluate a new way of delivering the Promoting Early Presentation (PEP) Intervention during flu vaccination appointments in primary care. The PEP Intervention is a 1-minute intervention, accompanied by a booklet and delivered by primary care health professionals to provide older women with the knowledge, confidence and skills to present promptly on discovering symptoms of breast cancer., Method:: health professionals delivered the PEP Intervention to older women at six general practices in south London. The authors measured changes in breast cancer awareness after the intervention and interviewed practice staff about their experiences of using it., Findings:: knowledge of breast symptoms and breast checking was greater in women aged 70 years and above after the implementation than before. Health professionals' found it acceptable and feasible to implement., Conclusion:: this intervention is a novel way of increasing breast cancer awareness in older women, which could contribute to earlier presentation and diagnosis of breast cancer in the UK.
- Published
- 2019
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- View/download PDF
48. May Measurement Month 2017: an analysis of blood pressure screening results worldwide.
- Author
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Beaney T, Schutte AE, Tomaszewski M, Ariti C, Burrell LM, Castillo RR, Charchar FJ, Damasceno A, Kruger R, Lackland DT, Nilsson PM, Prabhakaran D, Ramirez AJ, Schlaich MP, Wang J, Weber MA, and Poulter NR
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anniversaries and Special Events, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Young Adult, Blood Pressure, Global Health statistics & numerical data, Hypertension diagnosis, Hypertension epidemiology, Mass Screening
- Abstract
Background: Increased blood pressure is the biggest contributor to the global burden of disease and mortality. Data suggest that less than half of the population with hypertension is aware of it. May Measurement Month was initiated to raise awareness of the importance of blood pressure and as a pragmatic interim solution to the shortfall in screening programmes., Methods: This cross-sectional survey included volunteer adults (≥18 years) who ideally had not had their blood pressures measured in the past year. Each participant had their blood pressure measured three times and received a a questionnaire about demographic, lifestyle, and environmental factors. The primary objective was to raise awareness of blood pressure, measured by number of countries involved, number of people screened, and number of people who have untreated or inadequately treated hypertension (defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, or both, or on the basis of receiving antihypertensive medication). Multiple imputation was used to estimate the mean of the second and third blood pressure readings if these were not recorded. Measures of association were analysed using linear mixed models., Findings: Data were collected from 1 201 570 individuals in 80 countries. After imputation, of the 1 128 635 individuals for whom a mean of the second and third readings was available, 393 924 (34·9%) individuals had hypertension. 153 905 (17·3%) of 888 616 individuals who were not receiving antihypertensive treatment were hypertensive, and 105 456 (46·3%) of the 227 721 individuals receiving treatment did not have controlled blood pressure. Significant differences in adjusted blood pressures and hypertension prevalence were apparent between regions. Adjusted blood pressure was higher in association with antihypertensive medication, diabetes, cerebrovascular disease, smoking, and alcohol consumption. Blood pressure was higher when measured on the right arm than on the left arm, and blood pressure was highest on Saturdays., Interpretation: Inexpensive global screening of blood pressure is achievable using volunteers and convenience sampling. Pending the set-up of systematic surveillance systems worldwide, MMM will be repeated annually to raise awareness of blood pressure., Funding: International Society of Hypertension, Centers for Disease Control and Prevention, Servier Pharmaceutical Co., (Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2018
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49. The effects of age on pulse wave velocity in untreated hypertension.
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Diaz A, Tringler M, Wray S, Ramirez AJ, and Cabrera Fischer EI
- Subjects
- Age Factors, Aged, Argentina epidemiology, Asymptomatic Diseases, Blood Pressure physiology, Blood Pressure Determination methods, Female, Humans, Male, Middle Aged, Population Surveillance, Sex Factors, Aging physiology, Aorta physiopathology, Carotid Arteries physiopathology, Hypertension diagnosis, Hypertension epidemiology, Hypertension physiopathology, Pulse Wave Analysis methods, Vascular Stiffness
- Abstract
Increased arterial stiffness is an important determinant of cardiovascular risk, able to predict morbidity and mortality, and closely associated with ageing and blood pressure. The aims of this study were: (1) To determine the age-dependent reference pulse wave velocity (PWV), and compare it with values from hypertensive patients, and (2) to evaluate the impact of isolated and untreated hypertension on arterial stiffness. A total of 1079 patients were enrolled and divided into a control group (NT) of asymptomatic normotensive patients and a group of asymptomatic hypertensive patients (HT). Blood pressure, carotid-femoral PWV, and body mass index were measured in each subject, whose blood was drawn for laboratory tests. Aortic mean PWV in the NT group was 6.85 ± 1.66 m/s, which increased linearly (R
2 = 0.62; P < .05) with age. In patients over 50 years of age, PWV was significantly higher than in younger patients (8.35 vs 5.92 m/s, respectively, P < .001). This significant difference persisted when observing male and female patients separately. In the hypertensive group, mean PWV value was 8.04 ± 1.8 m/s (range 4.5-15.8 m/s) and increased (R2 = 0.243; P < .05) with age. The PWV increase in HT was significantly higher (0.93 m/s per decade, P < .001) than in NT (0.44 m/s per decade). Our study provides normal values of PVW per decade, and shows that these values increase with age, especially after 50 years of age, particularly in HT patients. This stiffness growth rate may be responsible for increased cardiovascular risk in both groups., (©2017 Wiley Periodicals, Inc.)- Published
- 2018
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50. Serum Uric Acid Elevation is Associated to Arterial Stiffness in Hypertensive Patients with Metabolic Disturbances.
- Author
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Ramirez AJ, Christen AI, and Sanchez RA
- Subjects
- Biomarkers blood, Blood Glucose analysis, Cross-Sectional Studies, Essential Hypertension blood, Essential Hypertension diagnosis, Female, Humans, Hyperuricemia diagnosis, Hyperuricemia physiopathology, Lipids blood, Male, Metabolic Syndrome diagnosis, Metabolic Syndrome physiopathology, Middle Aged, Pulse Wave Analysis, Risk Factors, Up-Regulation, Arterial Pressure, Essential Hypertension physiopathology, Hyperuricemia blood, Metabolic Syndrome blood, Uric Acid blood, Vascular Stiffness
- Abstract
Introduction: Chronic serum uric acid elevation (SUA) is known to be induced by dyslipidemia, hypertension, inflammation, and insulin resistance. Therefore, it has been associated with higher risk for coronary artery disease and cardiovascular mortality. Also, increased levels of SUA have been associated with regional arterial stiffness, assessed by pulse wave velocity (PWV)., Aims: To evaluate the relationships of PWV, SUA and different metabolic parameters in essential hypertensive patients., Material and Methods: We evaluated 445 essential hypertensive patients, by measuring office blood pressure (BP), weight, height, and waist circumference. In each patient, blood samples were drawn for biochemical evaluations and 24h urine collection. Body Mass Index (BMI) and Glomerular Filtration Rate (GFR) were calculated. Carotid-Femoral PWV and Left Ventricular Mass Index (LVMI) were measured in all patients., Results: All subjects (n=402), 242 males (55±0.9 yrs.; BMI: 28.9±0.3 Kg/m2) and 160 females (58±1 yrs.; BMI: 28.1±0.4 Kg/m2) had normal renal function. PWV values showed a significant association with SUA (p<0.001), Systolic BP (p<0.025) and LVMI (p<0.05). SUA showed a significant association, p<0.025: with BMI, Waist Circumference, and HDL-C; p<0.05: with Glycaemia at 120 min, Insulin at 120 min, TG, and LVMI; and p<0.001: with serum Creatinine. Backward Stepwise Regression showed that PWV could be predicted from SUA (p<0.001) and Systolic BP (p<0.05). BMI, Waist Circumference, DBP and HR did not significantly add to the ability of the equation to predict PWV., Conclusions: In this population of essential hypertensive patients, SUA was associated to increased arterial stiffness and to components of the Metabolic Syndrome. These results raise the possibility that a new approach to the role of SUA, linked to cardiovascular stratification, and a most appropriate treatment might be considered., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)
- Published
- 2018
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