Publications by authors named "A Silvestre"

337 Publications

Role of portable ultrasound during a short-term medical service trip to rural Guatemala: a collaborative mission of trainees and physicians.

Rural Remote Health 2021 May 29;21(2):6056. Epub 2021 May 29.

Department of Radiology, University of Washington, Seattle, WA 98195, USA

Introduction: Access to health care in developing countries is scarce. One solution to this problem has been for doctors from the USA to provide single-visit care through short-term medical service trips. There is interest in using ultrasound imaging as a portable diagnostic tool; however, data describing its usefulness are scarce. Therefore, the goal of this study was to determine the usefulness of portable ultrasound imaging during a medical service trip to rural Guatemala.

Methods: A multidisciplinary team of physicians examined patients at a mobile clinic in Antigua, Guatemala. Patients with clinical indications for ultrasound had their suspected diagnoses recorded before ultrasound testing. After imaging, updated diagnoses were recorded and compared with the pre-test suspected diagnoses to determine how often ultrasound results changed the medical management of the patients and to assess the most common indications for ultrasound imaging.

Results: During the trip, 205 patients were seen. Of these, 24 (12%) were given ultrasound exams. The results of 13 (54%) exams altered their medical management, and the remaining 11 (46%) exams confirmed the pre-test suspected diagnoses. The most common indications for ultrasound testing were suspected cardiac (11 patients, 46%) and gastrointestinal (8 patients, 33%) diseases.

Conclusion: Portable ultrasound imaging improved the medical team's ability to diagnose disease and clinically manage patients in a rural medical service trip. Ultrasound imaging may provide a low-cost solution to the growing demand for care in developing countries.
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http://dx.doi.org/10.22605/RRH6056DOI Listing
May 2021

Ten-year assessment of a cancer fast-track programme to connect primary care with oncology: reducing time from initial symptoms to diagnosis and treatment initiation.

ESMO Open 2021 May 11;6(3):100148. Epub 2021 May 11.

Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain. Electronic address:

Background: Cancer is the second leading cause of mortality worldwide. Integrating different levels of care by implementing screening programmes, extending diagnostic tools and applying therapeutic advances may increase survival. We implemented a cancer fast-track programme (CFP) to shorten the time between suspected cancer symptoms, diagnosis and therapy initiation.

Patients And Methods: Descriptive data were collected from the 10 years since the CFP was implemented (2009-2019) at the Clinico-Malvarrosa Health Department in Valencia, Spain. General practitioners (GPs), an oncology coordinator and 11 specialists designed guidelines for GP patient referral to the CFP, including criteria for breast, digestive, gynaecological, lung, urological, dermatological, head and neck, and soft tissue cancers. Patients with enlarged lymph nodes and constitutional symptoms were also considered. On identifying patients with suspected cancer, GPs sent a case proposal to the oncology coordinator. If criteria were met, an appointment was quickly made with the patient. We analysed the timeline of each stage of the process.

Results: A total of 4493 suspected cancer cases were submitted to the CFP, of whom 4019 were seen by the corresponding specialist. Cancer was confirmed in 1098 (27.3%) patients: breast cancer in 33%, urological cancers in 22%, gastrointestinal cancer in 19% and lung cancer in 15%. The median time from submission to cancer testing was 11 days, and diagnosis was reached in a median of 19 days. Treatment was started at a median of 34 days from diagnosis.

Conclusions: The findings of this study show that the interval from GP patient referral to specialist testing, cancer diagnosis and start of therapy can be reduced. Implementation of the CFP enabled most patients to begin curative intended treatment, and required only minimal resources in our setting.
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http://dx.doi.org/10.1016/j.esmoop.2021.100148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136438PMC
May 2021

Knee Extensor Muscle Strength Is More Important Than Postural Balance for Stair-Climbing Ability in Elderly Patients with Severe Knee Osteoarthritis.

Int J Environ Res Public Health 2021 03 31;18(7). Epub 2021 Mar 31.

Department of Physical Therapy, University of Valencia, 46010 Valencia, Spain.

Knee osteoarthritis is a chronic joint disease which damages articular cartilage. In its severe stages, it results in impairments in balance and muscle strength loss, which affect daily life activities such as walking or climbing stairs. This study sought to investigate associated factors with stair-climbing ability in this population, with special interest in measuring the relevance of postural balance for this task. Forty-four patients scheduled to undergo unilateral total knee arthroplasty were assessed. Timed up and go test, stair ascent-descent test, three different isometric strength tests (knee flexion, knee extension and hip abduction), active knee extension and flexion range of movement and static postural balance assessment were evaluated. Spearman's correlation coefficients and multiple linear regression analysis determined the strength of association between the different variables and stair-climbing time. No significant association between the stair-climbing time and static balance was found. Significant associations were found between stair-climbing time and timed up and go (r = 0.71; < 0.0001) and maximal knee extensor strength (r = -0.52; = 0.0003). One-year increase in age was associated with 0.15 s (95% CI 0.00 to 0.30) slower stair-climbing time. In conclusion, muscle strength is more important than postural balance for stair-climbing ability in this population.
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http://dx.doi.org/10.3390/ijerph18073637DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037849PMC
March 2021

Bacterial Nanocellulose toward Green Cosmetics: Recent Progresses and Challenges.

Int J Mol Sci 2021 Mar 11;22(6). Epub 2021 Mar 11.

CICECO-Aveiro Institute of Materials, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal.

In the skin care field, bacterial nanocellulose (BNC), a versatile polysaccharide produced by non-pathogenic acetic acid bacteria, has received increased attention as a promising candidate to replace synthetic polymers (e.g., nylon, polyethylene, polyacrylamides) commonly used in cosmetics. The applicability of BNC in cosmetics has been mainly investigated as a carrier of active ingredients or as a structuring agent of cosmetic formulations. However, with the sustainability issues that are underway in the highly innovative cosmetic industry and with the growth prospects for the market of bio-based products, a much more prominent role is envisioned for BNC in this field. Thus, this review provides a comprehensive overview of the most recent (last 5 years) and relevant developments and challenges in the research of BNC applied to cosmetic, aiming at inspiring future research to go beyond in the applicability of this exceptional biotechnological material in such a promising area.
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http://dx.doi.org/10.3390/ijms22062836DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000719PMC
March 2021

Illicit drugs seizures in 2013-2018 and characteristics of the illicit market within the Neapolitan area.

Forensic Sci Int 2021 Apr 19;321:110738. Epub 2021 Feb 19.

Department of Advanced Biomedical Science-Legal Medicine Section. University of Naples "Federico II", Naples, Italy.

The study presents results of toxicological analysis performed on seized material in Neapolitan area in the period from 2013 to 2018. A constancy in THC and heroin percentages is evidenced (%THC ~10% and ~11.5% for marijuana and hashish; heroine: 20-24%), with mean values exceeding the European data. Data on cocaine revealed a constant increment of active principle percentage over the studied period (from 40% in 2013 to ~65% in 2018), with peak of 70% in 2017; also, number of samples exceeding the mean value increased over years. Active principles contents resulted higher than the ones reported in other Italian area ever the same period; marijuana was prevalent on hashish, confirming an Italian trend different from other European countries. A map of the Campania region evidenced two main "storage" districts, one corresponding to the city center and the second located in the northern part. If compared with literature data on the presence of local mafia, these areas are perfectly superimposable to those with the highest risk of homicides, thus confirming the degree of radicalization of local organizations and the relative weight of proceeds from drugs sale. Moreover, such radicalization within the territory seems to be the main reason of the absence of new psychoactive substances among the seized material.
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http://dx.doi.org/10.1016/j.forsciint.2021.110738DOI Listing
April 2021