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1.
Qual Manag Health Care ; 28(1): 51-62, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30586123

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM) is an impaired glucose tolerance with onset or first recognition during pregnancy. The purpose of this study is to evaluate the clinical outcomes of a blood glucose monitoring protocol implemented by nurses and dietitians in a diabetes team to the previously established protocol of direct monitoring of GDM patients by a diabetologist. METHODS: Two groups of patients were formed: The first group was based on a traditional protocol (P1: 230 patients) with patients' blood glucose constantly checked by a diabetologist. In the second structured group (P2: 220 patients) patients were referred to a diabetologist only if they required insulin therapy. RESULTS: The number of medical visits (P2: 1.28 ± 0.70 vs P1: 3.27 ± 1.44; P < .001) and the percentage of patients with hypoglycemia (P2: 6.8% vs P1: 15.2%; P < .006) were found to be lower in group P2 than in group P1. In both groups, a direct relationship was found between a parental history of diabetes and the risk of GDM (odds ratio [OR]: P1 = 2.2 [1.17-4.12]; P2 = 2.5 [1.26-5.12]). In group P1, it was observed that hyperweight gain in patients who were already overweight before becoming pregnant significantly increased the risk of macrosomia (OR: 3.11 [1.39-25.7]), whereas this was not detected in patients in group P2. In group P2, a correlation was found between macrosomia and insulin therapy (OR: 0.066 vs 0.34). In group P1 and group P2, a correlation was observed between insulin therapy and a family history of diabetes (OR: 2.20 vs 2.27), and a body mass index of greater than 30 kg/m in group P2 (OR: 3.0 vs 1.47). CONCLUSIONS: The data we collected show that creating a structured protocol for GDM management reduces the number of medical visits required by patients without increasing the risk of hypoglycemia, macrosomia, or hyperweight gain during pregnancy.


Assuntos
Diabetes Gestacional/diagnóstico , Programas de Rastreamento , Modelos Organizacionais , Papel do Profissional de Enfermagem , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade , Gravidez , Adulto Jovem
2.
Hepat Oncol ; 4(2): 39-43, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30191052

RESUMO

AIM: We investigated the behavior of circulating endothelial cells (CEC) in patients with hepatocellular carcinoma (HCC) receiving sorafenib, and whether CEC levels were associated with time to progression (TTP). MATERIALS & METHODS: CECs in advanced HCC patients receiving sorafenib were counted at baseline and every 4 weeks. RESULTS: Twenty four HCC patients were enrolled in the study. Median TTP was 3.2 months (1-6). Median baseline CEC levels were 67 cells/ml, with an increase of 169.8% after 4 weeks of treatment. Any time CEC levels in patients with a TTP lower than 4 months were higher, but not statistically significant, compared with those in patients with TTP more than 4 months. CONCLUSION: Treatment with sorafenib changed CEC levels in HCC patients.

3.
Joint Bone Spine ; 83(2): 167-71, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26750762

RESUMO

OBJECTIVES: To evaluate the relevance of anti-adalimumab (anti-ADA) antibodies (Abs) and their relationship with clinical/laboratory features in rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). METHODS: Fifty-eight patients affected with RA, AS and PsA were prospectively enrolled. Clinical/laboratory characteristics, disease activity, anti-ADA, anti-nuclear (ANA), anti-double strand (ds)DNA, anti-extractable nuclear antigens (anti-ENA) and anti-phospholipid Abs (aPL) were evaluated at baseline, 4, 12 and 24 weeks of adalimumab treatment. RESULTS: Anti-ADA Abs were observed in 11/58 (19%) patients; they were detected within the 4th week of therapy in 90.9% of the positive subjects. Anti-ADA positivity was associated with significantly lower mean adalimumab serum levels (P<0.05). Treatment failure was observed in 20/58 (34.5%) patients and was significantly associated with anti-ADA Abs (P<0.05). Mean adalimumab serum levels were significantly lower in patients with treatment failure than in the responders one, both in the whole cohort (P<0.01) and in the group of anti-ADA positive patients (P<0.01). Adverse events happened more often in anti-ADA positive then in anti-ADA negative patients (27.3% vs 14.9%). CONCLUSIONS: Anti-ADA abs could be considered an early marker associated to a poor clinical response to adalimumab treatment. Routine ANA/anti-ENA/aPL monitoring did not reveal as useful tools to predict the development of anti-ADA abs.


Assuntos
Adalimumab/imunologia , Anticorpos Monoclonais Humanizados/imunologia , Antirreumáticos/imunologia , Artrite Psoriásica/imunologia , Artrite Reumatoide/imunologia , Espondilite Anquilosante/imunologia , Adalimumab/análise , Adulto , Anticorpos Monoclonais Humanizados/análise , Antirreumáticos/análise , Artrite Psoriásica/tratamento farmacológico , Artrite Reumatoide/tratamento farmacológico , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Espondilite Anquilosante/tratamento farmacológico
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