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1.
Ann Transl Med ; 9(3): 261, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33708888

RESUMO

BACKGROUND: Borderline ovarian tumors (BTs) must be recognized during the surgery by intraoperative consultation (IOC) to guide surgical treatment; however, this diagnosis can be imprecise. Therefore, this study aimed to evaluate the diagnostic accuracy of IOC for the diagnosis of BT. METHODS: A retrospective cohort study was carried out including all women diagnosed with a pelvic tumor consecutively surgically treated from 2005 to 2015 with IOC. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LR) for the IOC and BTs. RESULTS: A total of 758 patients were enrolled, the median age was 44 years, the median tumor size was 11.8 cm, and the median CA-125 levels were 45.65 U/µL. After IOC, 458 (64.1%) cases were diagnosed as benign, 111 (14.7%) as BT, and 161 (21.2%) as malignant. The definitive diagnosis was a benign tumor in 448 (59.1%) cases, BT in 110 (14.5%), and 200 (26.4%) cases were malignant. The diagnostic accuracy of the IOC for BT diagnosis was 89.8% (sensitivity =65.5%, specificity =93.9%). The diagnosis performance of IOC for the diagnosis between BT and benign tumors (n=546) had a sensitivity of 69.9%, a specificity of 98.4%, and a diagnostic accuracy of 84%; meanwhile for the diagnosis between BT and malignant tumors (n=242) IOC had a sensitivity of 92.3%, a specificity of 81.7%, and a diagnostic accuracy of 87%. CONCLUSIONS: For practitioners, knowing the accuracy and limitations of the IOC for BT enables the better selection of cases to perform a complete staging surgery.

2.
Rev. Urug. med. Interna ; 6(1): 14-23, mar. 2021. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1155637

RESUMO

Resumen: Introducción: La actividad inflamatoria persistente el Lupus Eritematoso Sistémico provoca daño permanente. El daño permanente puede ser atribuido a la enfermedad y/o al tratamiento, en particular los glucocorticoides. El objetivo de este trabajo fue conocer la relación entre el daño crónico y la exposición a glucocorticoides. Material y métodos: Se realizó un muestreo no probabilístico de pacientes con lupus eritematoso sistémico. Se analizaron variables demográficas, niveles de actividad, dosis prednisona iniciales y acumuladas y niveles de daño medidos por "SLICC Damage Index " en diferentes periodos de la enfermedad. El daño fue clasificado en "relacionado" y "no relacionado" con el uso de glucocorticoides. Resultados: Se analizaron 30 pacientes, todos de sexo femenino. La media de seguimiento fueron 155 (DE 127) meses. Al final del seguimiento 13/30 (43,3%) pacientes presentaron daño orgánico. Los pacientes que presentaron daño orgánico "relacionado" con glucocorticoides al final del seguimiento presentaron dosis de inicio de prednisona significativamente mayores que los que no presentaron daño 53,3 (DE 10,3) mg/día vs. 28, 3 (DE 24) mg/día, p<0,05. Dosis de inicio mayores a 30 mg/día se relacionaron con el daño al final del seguimiento, independientemente de los niveles de actividad considerados, OR 2,05 (IC 95% 1,5 - 4,0). Las dosis acumuladas de prednisona mayores a 3000 mg en el primer año se asociaron con daño relacionado con glucocorticoides al final del seguimiento (p < 0,05). Conclusiones: Existe una acumulación de daño a lo largo del tiempo relacionado con los glucocorticoides. Esta relación es precoz, esto es, las dosis de inicio pueden relacionarse con la acumulación de daño a largo plazo, particularmente considerando los dominios relacionados con glucocorticoides, independientemente del nivel de actividad considerado.


Abstract: Introduction: Persistent activity causes irreversible organ damage in Systemic Lupus Erythematosus (SLE). Permanent damage can be attributed to the disease and to the treatment, particularly glucocorticoids. We aimed to know the relationship between the presence of organ damage and the exposure to glucocorticoids (GCC). Methodology: A non-probabilistic retrospective study of patients with SLE was performed. Demographic variables, activity levels, initial, accumulated prednisone dose and damage measured by "SLICC Damage Index (SDI)" at various stages from the diagnosis of the disease, were analyzed. Damage was classified in related and not related to GCC. Results: Thirty patients were analyzed, all women. The mean follow-up was 155 (SD: 127) months. At the end of follow-up 13/30 (43.3%) patients presented organ damage. Patients who had GCC-related damage at the end of follow-up had a significantly higher mean starting dose of prednisone, 53.3 (SD: 10.3) mg/d vs. 28.3 (SD: 24) mg/d, p <0.05. The effect on damage was observed with prednisone starting dose greater than 30 mg/d, regardless of the level of activity at the onset of the disease, OR 2.05 (CI 95% 1.5 - 4.0). Cumulative doses of prednisone at one year greater than 3000 mg, were related to GCC-related damage at the end of the follow-up (p < 0.05). Conclusions: There is an accrual of damage over time associated to glucocorticoids exposure. It is highlighted that the relationship is early, that is, the starting dose will probably signify the accumulation of damage, especially in glucocorticoid-related domains, regardless of activity levels.


Resumo: Introdução: A atividade inflamatória persistente do Lúpus Eritematoso Sistêmico (LES) causa danos permanentes. Danos permanentes podem ser atribuídos a doenças e / ou tratamento, particularmente glicocorticóides. O objetivo deste trabalho foi conhecer a relação entre dano crônico e exposição a glicocorticóides. Material e métodos: Foi realizada uma amostragem não probabilística de pacientes com LES. Variáveis demográficas, níveis de atividade, doses iniciais e acumuladas de prednisona e níveis de dano medidos pelo "SLICC Damage Index (SDI)" foram analisados em diferentes períodos da doença. O dano foi classificado como "relacionado" e "não relacionado" ao uso de glicocorticóides. Resultados: 30 pacientes, todos do sexo feminino, foram analisados. O seguimento médio foi de 155 (DP 127) meses. Ao final do seguimento 13/30 (43,3%) pacientes apresentavam lesão orgânica. Os pacientes que apresentaram lesão orgânica "relacionada" aos glicocorticoides ao final do seguimento tiveram doses iniciais de prednisona significativamente maiores do que aqueles que não apresentaram lesão: 53,3 (DP 10,3) mg / dia vs. 28,3 (SD 24) mg / dia, p <0,05. Doses iniciais maiores que 30 mg / dia foram relacionadas a danos ao final do seguimento, independentemente dos níveis de atividade considerados, OR 2,05 (IC 95% 1,5 - 4,0). Doses cumulativas de prednisona maiores que 3000 mg no primeiro ano foram associadas a danos relacionados aos glicocorticoides no final do acompanhamento (p <0,05). Conclusões: Há um acúmulo de danos ao longo do tempo relacionados aos glicocorticóides. Essa relação é precoce, ou seja, as doses iniciais podem estar relacionadas ao acúmulo de danos em longo prazo, principalmente considerando os domínios relacionados aos glicocorticóides, independentemente do nível de atividade considerado.

3.
Bol. méd. Hosp. Infant. Méx ; 77(6): 312-319, Nov.-Dec. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1142481

RESUMO

Resumen Introducción: El aumento o la reducción del arco longitudinal medial (ALM) puede afectar funciones esenciales en la biomecánica del pie, con repercusiones en la salud a largo plazo. El objetivo del presente estudio fue determinar la altura del ALM en niños de 3 a 6 años, a través de cinco métodos de análisis de huella para el diagnóstico de pie plano. Métodos: Se realizó un estudio observacional transversal con 367 niños de 3 a 6 años en un municipio del Estado de México. Se llevó a cabo una evaluación postural completa, plantoscopía por medio de la clasificación de Viladot y análisis de la huella en pedigrafía, calculando la altura del ALM mediante el ángulo de Clarke (AC), el índice de Staheli (IS), el índice de Chippaux-Smirak (ICS) y el ángulo gamma (Ag). Resultados: La prevalencia de pie plano utilizando el podoscopio fue del 57.7%. Mediante los ángulos y los índices, la prevalencia fue del 86.9% por IS, del 83.3% por ICS, del 95.9% por AC y del 22.3% por Ag. El Ag fue menos sensible para la detección de pie plano en comparación con el ICS, el IS y el AC. Conclusiones: De acuerdo con los resultados del presente estudio, se propone utilizar métodos de análisis de huella para el diagnóstico de pie plano, además de la valoración clásica con el podoscopio. Se recomienda incluir el diagnóstico y la vigilancia del pie plano en la consulta del niño sano, ya que desde edades tempranas puede detectarse la tendencia en la arquitectura podálica.


Abstract Background: The increase or reduction of the medial longitudinal arch (MLA) can affect essential functions in the foot biomechanics with long-term health consequences. The aim of the present study was to determine the height of the MLA in children from 3 to 6 years of age through five methods of footprint analysis for the diagnosis of flat foot. Methods: A cross-sectional observational study was conducted with 367 children aged 3 to 6 years in a municipality of the State of Mexico. We conducted a complete postural evaluation, plantoscopy by Viladot classification, and footprint analysis calculating the height of the ALM using the Clarke angle (CA), the Staheli index (SI), the Chippaux-Smirak index (CSM), and the gamma angle (gA). Results: The prevalence of flat feet using the podoscope was 57.7%. Through the angles and indexes, the prevalence was 86.9% for SI, 83.3% for CSI, 95.9% for CA, and 22.3% for gA. The gA was less sensitive for flat foot detection compared to CSI, SI and CA. Conclusions: Based on the present results, we propose that footprint analysis should be used for flat foot diagnosis besides the classic evaluation by podoscope. We recommend that flat foot diagnosis and surveillance should be included on in the consultation of the healthy child, as a trend for podalic architecture can be detected from early ages.


Assuntos
Criança , Pré-Escolar , Humanos , Pé Chato , Pé Chato/diagnóstico , Pé Chato/epidemiologia , Prevalência , Estudos Transversais , México
4.
Horiz. sanitario (en linea) ; 19(1): 27-36, ene.-abr. 2020. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1143045

RESUMO

Abstract Objective To determine the effect of resistance exercise routine and dancing in the lower limbs of no institutionalized elderly, cognitively intact, functional for basic activities of daily living without falling risks. Material and Methods A quasi-experimental study, the effect of an intervention on a single group, consisting of 26 persons aged 60 AM considering criteria of inclusion and non-inclusion was determined. The Short Portable Mental Status Questionnaire was used; Katz Scale and the Scale of Tinetti. The information obtained was analyzed in two stages, descriptive and inferential. In the first phase, frequency distribution tables and measures of central tendency and dispersion for all variables were obtained, as discussed in qualitative or quantitative variables, respectively. In the second phase, the effect of the intervention trophism comparing averages, muscle strength and arcs of movement group and individual pre- and post-intervention was evaluated. Results There was a trend for improvement in the flexibility of the hip, knee and ankle mostly knee extension remained the same, 84.61% and 80.76% right left. Left hip extension remains the same at 50% and 53.84%, the right side. Muscle strength increased overall in all muscle groups of both lower extremities. Trophism increased in diameter thighs, calves by 46% and over 50% were similar diameters, some of the older adults lost weight so their diameter decreased. Conclusions This program showed significant changes in muscle strength and range of motion in the study participants could see the significant association between dancing Zumba Gold and resistance exercises to increase muscle strength, flexibility lower extremities and increased level of activity in older adults. Exercise and physical activity are important for the positive effects that cause health and improvements in the diameter of the thighs and increased functionality of the elderly.


Resumen Objetivo Determinar el efecto de una rutina de ejercicios de resistencia y baile en miembros inferiores de adultos mayores no institucionalizados, cognitivamente íntegros, funcionales para actividades básicas de la vida diaria, sin riesgo de caídas. Material y métodos Estudio cuasi-experimental, se determinó el efecto de una intervención sobre un grupo único, constituido por 26 personas AM de 60 años considerando criterios de inclusión y de no inclusión. Se utilizó el Short Portable Mental Status Questionnaire; la Escala de Katz y la Escala de Tinetti. La información obtenida fue analizada en dos fases, descriptiva e inferencial. En la primera fase, se obtuvieron tablas de distribución de frecuencias así como medidas de tendencia central y de dispersión para todas las variables, según se trató de variables cualitativas o cuantitativas, respectivamente. En la segunda fase, se evaluó el efecto de la intervención comparando los promedios de trofismo, fuerza muscular y de arcos de movimientos, individuales y grupales pre- y post intervención. Resultados Hubo tendencia a la mejoría en la flexibilidad en cadera, rodilla y tobillo en su mayoría, la extensión de rodilla se mantuvo igual, 84.61% derecha y 80.76% izquierda. La extensión de cadera izquierda permanece igual en un 50% y 53.84%, del lado derecho. La fuerza muscular incrementó en general en todos los grupos musculares de ambas extremidades inferiores. El trofismo de muslos aumentó en su diámetro, las pantorrillas en un 46% y más del 50% mantuvieron diámetros similares Algunos de los AM bajaron de peso, por lo tanto sus diámetros disminuyeron. Conclusiones Este programa mostró modificaciones significativas en la fuerza muscular y rangos de movimientos en los participantes del estudio, se pudo ver la asociación importante que existe entre el baile de Zumba Gold y Ejercicios de Resistencia con el incremento de la fuerza muscular, flexibilidad de las extremidades inferiores y el incremento en el nivel de la actividad en los adultos mayores. El ejercicio y la actividad física son importantes, por los efectos positivos que causan sobre la salud y la mejoría en el diámetro de los muslos y el aumento en la funcionalidad del adulto mayor.


Resumo Objetivo Para determinar o efeito de uma rotina de exercícios de resistência e dança nos membros inferiores de idosos não institucionalizados, cognitivamente íntegros e funcionais para atividades básicas da vida diária, sem risco de queda. Material e métodos Estudo quase experimental, determinou-se o efeito de uma intervenção sobre um único grupo, constituído por 26 pessoas AM de 60 anos considerando critérios de inclusão e não-inclusão. Utilizou-se o Short Portable Mental Status Questionnaire; a escala Katz e a escala de Tinetti. A informação obtida foi analisada em duas fases, descritiva e inferencial. Na primeira fase, foram obtidos tabelas de distribuição de frequência assim como medidas de tendência central e de dispersão para todas as variáveis, segundo se tratou de variáveis qualitativas ou quantitativas, respectivamente. Na segunda fase, avaliou-se o efeito da intervenção através da comparação da média de trofismo, força muscular e arcos de movimentos, individual, em grupo pré- e pós-intervenção. Resultados Houve uma tendência de melhora na flexibilidade do quadril, joelho e tornozelo principalmente, a extensão do joelho permaneceu a mesma, 84,61% direita e 80,76% para a esquerda. A extensão do quadril esquerdo permanece igual em um 50% e 53,84%, no lado direito. A força muscular aumentou geralmente em todos os grupos musculares de ambas as extremidades inferiores. O trofismo de coxas aumentou em diâmetro, pantorilha em um 46% e mais do 50% mantiveram diâmetros semelhantes. Alguns dos AM perderam peso, pelo que os seus diâmetros diminuíram. Conclusões Este programa mostrou mudanças significativas na força muscular e amplitude de movimento nas participantes do estudo, pôde-se ver a associação significativa que existe entre a dança Zumba Ouro e Exercícios de Resistência com o aumento da força muscular, flexibilidade das extremidades inferiores e o aumento no nível da atividade em adultos mais velhos. O exercício e a atividade física são importantes, pelos efeitos positivos que causam sobre a saúde e a melhoria do diâmetro das coxas e do aumento da funcionalidade do idoso.


résumé est disponible dans le document

5.
Rev. Urug. med. Interna ; 5(2): 28-36, 2020. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1125752

RESUMO

Resumen: Introducción: Las enfermedades autoinmunes sistémicas son un grupo de enfermedades de baja prevalencia, cuya patogenia está basada en la pérdida de la auto-tolerancia. A pesar de su baja incidencia y prevalencia, la profundización en el estudio y conocimiento de estas enfermedades ha permitido importantes avances diagnósticos y terapéuticos en los últimos años, constituyendo un desafío en la práctica clínica. Objetivo: determinar la prevalencia y características clínico-humorales de estas patologías en la Policlínica de Enfermedades Autoinmunes del Hospital Pasteur, en el periodo 2016 -2019. Resultados: El total de población fue de 62 pacientes., 55/62 (88%) son mujeres. La más prevalente fue Lupus Eritematoso Sistémico, representando un 32% de esta población (20/62), la artritis reumatoide en un 21% (13/62), la esclerosis sistémica en un 8% (5/62), vasculitis sistémica 8% (5/62), Overlap 6% (4/62), Bechet 5% (3/62). Conclusiones: Se destaca un claro predominio del lupus y de la artritis reumatoide como enfermedades más prevalentes, así como un incremento mantenido de otras patologías menos habituales. Es de suma importancia fomentar el desarrollo de unidades especializadas en estas enfermedades para poder mejorar y protocolizar el manejo de estos pacientes.


Abstract: Introduction: Systemic Autoimmune Diseases are a group of low-prevalence diseases whose pathogeny is based on the loss of self-tolerance. Despite their low incidence and prevalence, deepening the study and knowledge of these diseases has enabled significant diagnostic and therapeutic advances in recent years, constituting a challenge in clinical practice. Objective: to determine the prevalence and clinical-humoral characteristics of these pathologies in the Polyclinic of Autoimmune Diseases of Pasteur Hospital, in the period 2016 -2019. Results: The total population was 62 patients., 55/62 (88%) were women. Most prevalent was Systemic Lupus Erythematosus (SLE), representing 32% of this population (20/62), Rheumatoid Arthritis by 21% (13/62), Systemic Sclerosis by 8% (5/62), Systemic vasculitis 8% (5/62), Overlap syndrome 6% (4/62), Bechet 5% (3/62). Conclusions: Lupus and rheumatoid arthritis as more prevalent diseases, as well as a maintained increase in other less common diseases. It is very important to promote the development of specialized units in these área, in order to improve and protocol the management of these patients.


Resumo: Introdução: As doenças autoimunes sistêmicas são um grupo de doenças de baixa prevalência, cuja patogênese se baseia na perda de autotolerância. Apesar de sua baixa incidência e prevalência, o aprofundamento no estudo e conhecimento dessas doenças permitiu importantes avanços diagnósticos e terapêuticos nos últimos anos, constituindo um desafio na prática clínica. Objetivo: determinar a prevalência e as características clínico-humorais dessas patologias no Hospital Pasteur Polyclinic of Autoimmune Diseases, no período 2016-2019. Resultados: a população total foi de 62 pacientes, 55/62 (88%) são mulheres. O mais prevalente foi o lúpus eritematoso sistêmico (LES), representando 32% dessa população (20/62), artrite reumatoide em 21% (13/62), esclerose sistêmica em 8% (5 / 62), vasculite sistêmica 8% (5/62), sobreposição de 6% (4/62), Bechet 5% (3/62). Conclusões: Uma clara predominância de lúpus e artrite reumatoide destaca-se como as doenças mais prevalentes, bem como um aumento sustentado de outras patologias menos comuns. É de extrema importância promover o desenvolvimento de unidades especializadas nessas doenças, a fim de melhorar e protocolar o manejo desses pacientes.

6.
J Inorg Biochem ; 175: 154-166, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28755573

RESUMO

In Latin America Chagas disease is an endemic illness caused by the parasite Trypanosoma cruzi (T. cruzi), killing more people than any other parasitic disease. Current chemotherapies are old and inadequate, thus the development of efficient ones is urgently needed. Vanadium-based complexes have been shown to be a promising approach both against parasitic diseases and cancer and this study aims to achieve significant advances in the pursue of effective compounds. Heteroleptic vanadium complexes of Schiff bases and polypyridine compounds were prepared and their stability in solution evaluated by EPR (Electronic Paramagnetic Resonance) and NMR spectroscopy. Their in vitro activities were evaluated against T. cruzi and a set of cells lines representative of human cancer conditions, namely ovarian, breast and prostate cancer. In T. cruzi, most of the complexes depicted IC50 values in the low µM range, induced changes of mitochondrial membrane potential and apoptosis. In cancer cells, complexes showed good to moderate activity and in metastatic cells (prostate PC3), some complexes inhibited the migratory ability, this suggesting that they display antimetastatic potential. Interestingly, complex 5 seemed to have a dual effect being the most cytotoxic complex on all cancer cells and also the most active anti-T-cruzi compound of the series. Globally the complexes showed promising anticancer and anti T. cruzi activities and also displayed some characteristics indicating they are worth to be further explored as antimetastatic drugs.


Assuntos
Antineoplásicos , Doença de Chagas/tratamento farmacológico , Complexos de Coordenação , Neoplasias da Próstata/tratamento farmacológico , Piridinas , Tripanossomicidas , Trypanosoma cruzi/metabolismo , Vanadatos , Antineoplásicos/síntese química , Antineoplásicos/química , Antineoplásicos/farmacologia , Linhagem Celular Tumoral , Doença de Chagas/metabolismo , Doença de Chagas/patologia , Complexos de Coordenação/síntese química , Complexos de Coordenação/química , Complexos de Coordenação/farmacologia , Humanos , Masculino , Neoplasias da Próstata/metabolismo , Neoplasias da Próstata/patologia , Piridinas/química , Piridinas/farmacologia , Tripanossomicidas/síntese química , Tripanossomicidas/química , Tripanossomicidas/farmacologia , Vanadatos/química , Vanadatos/farmacologia
8.
Rev. chil. endocrinol. diabetes ; 10(3): 100-102, jul. 2017. ilus
Artigo em Espanhol | LILACS | ID: biblio-998985

RESUMO

Introducción: Diabetes insipidus as the first clinical manifestation of pituitary neoplasm metastasis Up to de 90 percent of the masses that are detected in the pituitary gland correspond to adenomas. On the contrary, pituitary metastasis only represent a 1 percent, which is a diagnostic challenge in the medical practice. Most of the time, these lesions are detected casually in autopsy; but it is important to consider that aproximatelly a 7 percent of these lesions can be clinically expresed as diabetes insipidus. Here we present a patient with initial symptoms of diabetes insipidus with the final diagnostic of lung adenocarcinoma


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias Hipofisárias , Adenocarcinoma/secundário , Diabetes Insípido , Neoplasias Pulmonares/patologia , Neoplasias Hipofisárias
9.
J Gastrointest Oncol ; 8(1): 96-101, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28280614

RESUMO

BACKGROUND: There is an increase in the incidence of rectal carcinoma (RC) in young patients. METHODS: We analyzed 175 patients with sporadic RC which were divided in two groups according their age: 24 patients ≤40 years and 151 patients >40 years and the two groups were compared in order to determine if the outcomes (especially overall 5-year survival) were different. RESULTS: Overall 5-year survival was similar between groups (67.1% for patients over 40 years and 70.4% for those under 40 years, P=0.803). The only differences found were in some clinicopathologic features: patients <40 years showed more dissected lymph nodes (LNs) (21 vs. 15, P=0.035) and more LN metastasis (54.2% vs. 39.1%, P=0.048). In multivariate analysis factors associated with worse survival were incomplete resection and no use of neoadjuvant therapy. Age did not demonstrate prognostic value (P=0.077). CONCLUSIONS: RC in people ≤40 years demonstrated greater number of LN harvested and LN metastases but oncologic outcomes, especially 5-year overall survival, were similar between groups.

10.
Melanoma Res ; 27(2): 140-144, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28125448

RESUMO

Several studies have reported that a high neutrophil-to-lymphocyte ratio (NLR) is associated with poor clinical outcomes in several cancers, but this ratio has not been thoroughly studied in melanoma except in stage IV. This is the first study on NLR in melanoma stages I-III. This was a retrospective study of 742 melanoma patients. The NLR was classified into NLR<2 and a NLR≥2 on the basis of a receiver operating characteristic curve. Associations of NLR with clinicopathological characteristics and survival were examined. The median patient age was 57 years (range: 15-91; Q1=46, Q3=70), and the median Breslow's thickness was 3.0 mm (range: 0.5-60; Q1=1.0, Q3=7). Clinical stage at presentation was as follows: (i) stage I in 27%; (ii) stage II in 33.2%; (iii) stage III in 36.5%; and (iv) stage IV in 3.3%. NLR≥2 was associated with lymph node metastasis (36.6 vs. 18.1%) and recurrence (28.2 vs. 22.1%). The 5-year overall survival (OS) was 63% for the NLR<2 group and 53% for the NLR≥2 group. Stage-by-stage analysis showed that the 5-year OS in the NLR≥2 group for stages I, II, III, and IV were 91, 60, 28, and 0%, respectively, whereas for the NLR<2 group the 5-year OS were 98, 68, 31, and 0%, respectively. Significant differences between NLR<2 and ≥2 occurred only in stage II (P=0.014). Univariate analysis showed that factors associated with decreased OS clinical stage were Breslow's thickness, ulceration, male sex, and NLR≥2. In the multivariate analysis, all of these factors were predictors of decreased survival. The NLR appears to be an accurate prognostic marker for decreased OS in patients with melanoma, especially in clinical stage II. NLR≥2 correlated with lymph node metastasis and recurrence.


Assuntos
Linfócitos , Melanoma/sangue , Melanoma/secundário , Neutrófilos , Neoplasias Cutâneas/sangue , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
11.
Cir Cir ; 85(3): 245-249, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-26997294

RESUMO

BACKGROUND: Androgen insensitivity syndrome is an X-linked disorder, and is characterised by a female phenotype in a chromosomally male individual. It usually occurs in puberty with primary amenorrhoea or as an inguinal tumour in a female infant. In recent years, it is often also diagnosed in fertility clinics in adulthood. OBJECTIVE: The case is presented of a pure seminoma in a woman with the reference diagnosis of inguinal hernia. CLINICAL CASE: A 53 year old woman, who was operated on in 2014 due to a nodule in left groin. Androgen insensitivity syndrome was corroborated, and histopathology reported it as a right testicular seminoma. DISCUSSION: The importance of early diagnosis is discussed, highlighting the consequences of misdiagnosis, and question whether these patients have been adequately treated in the past. The risk of malignant transformation of an undescended testicle increases with age, thus gonadectomy should be performed after puberty, and in some cases hormone replacement therapy.


Assuntos
Síndrome de Resistência a Andrógenos/complicações , Criptorquidismo/complicações , Disgenesia Gonadal 46 XY/complicações , Neoplasias Primárias Múltiplas/diagnóstico , Seminoma/diagnóstico , Neoplasias Testiculares/diagnóstico , Síndrome de Resistência a Andrógenos/sangue , Síndrome de Resistência a Andrógenos/diagnóstico , Biomarcadores Tumorais/sangue , Gonadotropina Coriônica/sangue , Diagnóstico Tardio , Erros de Diagnóstico , Disgerminoma/diagnóstico , Detecção Precoce de Câncer , Feminino , Hérnia Inguinal/complicações , Humanos , Hormônio Luteinizante/sangue , Imageamento por Ressonância Magnética , Masculino , Neoplasias Ovarianas/diagnóstico , Seminoma/sangue , Seminoma/etiologia , Neoplasias Testiculares/sangue , Neoplasias Testiculares/etiologia , Testosterona/sangue
12.
Melanoma Res ; 27(2): 116-120, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28030434

RESUMO

The objective of this study is to determine whether a less exhaustive pathologic work-up to detect melanoma metastasis is clinically useful and does not affect patient prognosis. The success and evolution of the sentinel lymph node (SLN) depends on histological techniques. Several exhaustive protocols of SLN analysis have been published, but are time and cost consuming, with slight increases in the rates of metastasis detection. From 281 patients with SLN biopsy, each SLN was sectioned every 2 mm and from each paraffin block, 2-3 histological sections were evaluated. The patients were divided as follows: the first group (n=185) was subjected to extensive SLN examination (eSLNe) and the second group (n=96) was not subjected to an extensive SLN examination (wSLNe). The average SLN resected was 2 (range: 1-7), evaluating one in 50.9%. The SLN metastasis detection rate was 28.5%, whereas eSLNe increased by 3.2%. During follow-up, 4/26 (17.4%) cases in the wSLNe group showed recurrence in the SLN basin. Factors associated with decreased survival in univariant analysis were recurrence, Breslow thickness, advanced clinical stage, ulceration, and SLN metastasis. eSLNe did not affect disease-specific survival. Multivariate analysis showed recurrence (hazard ratio 23.475, 95% confidence interval: 1903-4559, P<0.001) and Breslow thickness of more than 3.5 mm (hazard ratio 15.222, 95% confidence interval: 1448-3059, P<0.001) as independent risk factors for decreased survival. Our routine for SLN examination enabled an adequate rate of SLN metastasis detection and the eSLNe increased the rate of detection in 3.2%, but did not affect the survival. We did not find any benefit from performing the eSLNe in patients with Breslow thickness less than 3.5 mm.


Assuntos
Melanoma/secundário , Recidiva Local de Neoplasia/patologia , Linfonodo Sentinela/patologia , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Técnicas Histológicas , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Patologia/métodos , Biópsia de Linfonodo Sentinela , Úlcera Cutânea/etiologia , Taxa de Sobrevida , Carga Tumoral , Adulto Jovem
13.
Med Arch ; 70(4): 256-260, 2016 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-27703284

RESUMO

BACKGROUND: Several studies have reported that an elevation in neutrophils/lymphocyte ratio (NLR) is correlated with poor survival in patients with colorectal cancer, but in rectal cancer (RC), it has been reported only in a few studies. It is necessary to separate colon cancer and rectal cancer to clarify the prognostic significance of NLR, especially in patients who received chemoradiotherapy. METHODS: It is a comparative, observational retrospective study of a cohort of 175 patients. We grouped the patients into two based on their NLR (0-3 vs. > 3) to correlate with disease-specific survival (DSS) and pathologic complete response (pCR). RESULTS: The average NLR was 2.65 + 1.32 (range 0.58-6.89), and 144 (82.3%) patients had an NLR of 0-3. The median follow-up was 33.53 months. There were no differences in pCR between the two groups. The 5-year DSS was 78.8%. NLR did not correlate with survival. Mesorectal quality, pT3-4 tumors, lymph node metastasis, lymphovascular invasion, perineural invasion, positive margins and recurrence were statistically significant predictors of increased mortality in univariate analysis. In multivariate analysis, only overall recurrence correlated with poor survival. The analysis of the association of NLR with outcomes with different cut points (2.0, 2.5, 4 and 5) did not show differences in DSS and pCR. CONCLUSION: In our cohort, the NLR did not serve as a prognostic marker in patients with locally advanced rectal cancer and who received chemoradiotherapy and did not correlate with pCR as well.


Assuntos
Quimiorradioterapia , Linfócitos , Terapia Neoadjuvante , Neutrófilos , Neoplasias Retais/sangue , Neoplasias Retais/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/mortalidade , Estudos Retrospectivos , Sensibilidade e Especificidade , Taxa de Sobrevida , Adulto Jovem
14.
Qual Health Res ; 26(12): 1674-88, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27578852

RESUMO

The aim of this article was to describe and analyze the doctor-patient relationship between fibromyalgia patients and rheumatologists in public and private health care contexts within the Mexican health care system. This medical anthropological study drew on hospital ethnography and patients' illness narratives, as well as the experiences of rheumatologists from both types of health care services. The findings show how each type of medical care subsystem shape different relationships between patients and doctors. Patient stigmatization, overt rejection, and denial of the disease's existence were identified. In this doctor-patient-with-fibromyalgia relationship, there are difficult encounters, rather than difficult patients. These encounters are more fluid in private consultations compared with public hospitals. The doctor-centered health care model is prevalent in public institutions. In the private sector, we find the characteristics of the patient-centered model coexisting with the traditional physician-centered approach.


Assuntos
Fibromialgia/terapia , Relações Médico-Paciente , Reumatologistas , Humanos , México , Médicos
15.
Arch. pediatr. Urug ; 87(3): 245-252, set. 2016. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-796330

RESUMO

El Chagas congénito se produce cuando la embarazada infectada trasmite el parásito al feto, situación que puede suceder en cualquier estadio de la enfermedad y momento del embarazo. Es el único mecanismo de trasmisión presente actualmente en Uruguay, con una incidencia cercana al 4%. La mayoría de los neonatos infectados nacen asintomáticos y un 10% al 40% presentan síntomas que son indistinguibles de otras infecciones de trasmisión vertical. La prematurez, el bajo peso, la hepatoesplenomegalia y las alteraciones hematológicas son los síntomas más frecuentes. El diagnóstico representa un desafío en aquellos lugares del país en donde, si bien la enfermedad era considerada endémica, no se realiza actualmente el screening obligatorio de la embarazada. Se describe un lactante procedente de Paysandú, de medio socioeconómico deficitario, que fue pretérmino severo y que presentó al nacer alteraciones hematológicas de las tres series y hepatoesplenomegalia, lo cual motivó múltiples estudios. Sin embargo, no se sospechó la enfermedad hasta los 5 meses de vida, cuando volvió a ingresar por otra patología. Se confirmó la infección a los 9 meses mediante tres técnicas serológicas diferentes. Se indicó tratamiento con nifurtimox por 2 meses y a los 26 y 36 meses de vida presentó serología negativa. Consideramos importante tener alto índice de sospecha de la enfermedad en neonatos con signos de infección congénita y sin serología materna que la descarte. Es importante saber que el tratamiento antes del primer año de vida tiene una excelente respuesta y evita secuelas crónicas que pueden ser invalidantes en etapa adulta.


Congenital Chagas disease occurs when an infected pregnant woman transmits the parasite to the fetus, a situation that can happen at any stage of disease and time of pregnancy. It is the only transmission mechanism currently present in Uruguay, with an incidence close to 4%. Most infected infants are born asymptomatic and 10 to 40% have symptoms that are indistinguishable from other infections’ vertical transmission. Prematurity, low birth weight, hepatosplenomegaly and hematological disorders are the most common symptoms. Diagnosis is a challenge in those areas where there is no current compulsory screening for pregnant women in spite of the disease being considered endemic. The study presents the case of an infant from Paysandú, coming from a low socio-economic environment, which was a severe preterm, and presented hematologic disorders of the three series at birth and hepatosplenomegaly, which caused many studies. However, there was no suspicion of the disease until the infant was five months old when re-entering by other pathology. Infection at nine months is confirmed by three different serological techniques. Nifurtimox therapy is indicated for two months and at twenty six and thirty six months of life the patient presents negative serology. A high level of suspicion is needed in order to diagnose the disease in infants with signs of congenital infection without maternal serology. It is important to know that treatment before the first year of life has excellent response and prevents chronic sequelae that can be disabling in adulthood.


Assuntos
Humanos , Masculino , Lactente , Doença de Chagas/diagnóstico , Transmissão Vertical de Doenças Infecciosas , Anormalidades Congênitas , Tripanossomicidas/uso terapêutico , Uruguai , Doença de Chagas , Doença de Chagas/complicações , Doença de Chagas/epidemiologia , Técnicas e Procedimentos Diagnósticos , Nifurtimox/uso terapêutico
16.
Ann Surg Oncol ; 23(13): 4189-4194, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27401447

RESUMO

BACKGROUND: The aim of this study was to analyze the clinicopathologic features of melanoma in México as the demographics of melanoma are not well known in Mexican and Latin American people. MATERIALS AND METHODS: A total of 1219 patients with cutaneous melanoma were analyzed through a retrospective database collected from a cancer referral institute, and the results were compared with developed countries. RESULTS: Median age was 57 years, and 713 (58.5 %) were females. The most common melanoma subtype was acral lentiginous melanoma (ALM), which was observed in 538 (44.1 %) patients. Median Breslow thickness was 5.2 mm. Among 837 patients with complete data, the 5-year disease-specific survival (DSS) was 52.3 %. Factors associated with worse DSS on univariate analysis were Breslow thickness (p < 0.001), recurrence (p < 0.001), ulceration (p < 0.001), positive margin (p < 0.001), ALM (p = 0.001), and male sex (p = 0.001). Multivariate analysis demonstrated Breslow thickness [hazard ratio (HR) 1.45, 95 % confidence interval (CI) 1.27-1.65; p < 0.001], positive margin (HR 1.25, 95 % CI 1.03-1.57; p = 0.018), recurrence (HR 9.56, 95 % CI 6.89-9.87; p = 0.002), ALM (HR 8.07, 95 % CI 6.77-8.95; p = 0.004), and male sex (HR 1.33, 95 % CI 1.06-1.68; p = 0.013) as independent risk factors for DSS. CONCLUSION: Our patients had worse prognosis compared with data from the US Surveillance, Epidemiology, and End Results database. We found male sex and ALM as independent risk factors for worse survival, in addition to known risk factors.


Assuntos
Sarda Melanótica de Hutchinson/patologia , Recidiva Local de Neoplasia , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Extremidades , Feminino , Humanos , Sarda Melanótica de Hutchinson/epidemiologia , Sarda Melanótica de Hutchinson/mortalidade , Incidência , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Estadiamento de Neoplasias , Neoplasia Residual , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/mortalidade , Taxa de Sobrevida , Carga Tumoral , Adulto Jovem
17.
Arch. pediatr. Urug ; 86(1): 14-25, mar. 2015. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-754231

RESUMO

Introducción: la infección por Toxoplasma gondii durante el embarazo puede resultar en graves complicaciones para el feto y dejar importantes secuelas en el recién nacido (RN). El objetivo del estudio fue realizar un seguimiento clínico y serológico de los recién nacidos cuyas madres tenían IgM reactiva para toxoplasmosis en el embarazo y analizar las características clínicas y serológicas de los que presentaron toxoplasmosis congénita (TC). Material y método: estudio descriptivo, prospectivo y longitudinal de RN cuyas madres tuvieron serología IgM reactiva en el embarazo y que fueron derivados para su seguimiento a la Policlínica de Infectología Pediátrica del Hospital de Paysandú en el período junio de 2008 a junio de 2013. Resultados: de los 51 RN evaluados, 50 fueron de término con una media de peso al nacer de 3.120 g y 5 fueron pequeños para la edad gestacional (PEG). Dos presentaron microcefalia y dos estuvieron expuestos a otras infecciones durante el embarazo (sífilis y virus de la inmunodeficiencia humana). De los 42 (82,3%) que completaron su seguimiento, en siete se diagnosticó TC (13,7%) y se descartó la infección en 35 (68,5%). En éstos la media de desaparición de la IgG fue de 6,2 meses. Tres de los infectados fueron sintomáticos y tenían IgM reactiva al nacer. Cuatro presentaron secuelas en la evolución. De ocho RN a los que se les indicó tratamiento, tres lo completaron. En 6 (85,7%) de los infectados se confirmó la seroconversión materna durante el embarazo. Conclusiones: si bien la TC no es muy frecuente en nuestro país, la morbilidad es muy importante. La presencia de seroconversión materna obliga a estudiar y tratar al RN hasta que se descarte la infección. La serología en el RN demuestra, en nuestro medio, una escasa sensibilidad y a falta de otras técnicas obliga a realizar el seguimiento clínico y serológico con IgG durante el primer año de vida.


Introduction: Toxoplasma gondii infection during pregnancy can result in serious complications for the fetus and causes serious sequelae in the newborn. The study aimed to conduct a clinical and serological follow-up of newborns whose mothers were toxoplasma IgM positive during pregnancy and to analyze the clinical and serological evolution of those with congenital toxoplasmosis (CT) features. Method: descriptive, prospective, longitudinal study of newborns whose mothers were toxoplasma IgM positive during pregnancy and who were referred for follow-up to the Pediatrics Infectious Diseases Polyclinic. Escuela del Litoral Hospital, Paysandú, from June, 2008 through June, 2013. Results: out of 51 newborns assessed, 50 were term newborns with a mean birth weight of 3,120 g and 5 were small for gestational age (SGA). Two had microcephaly and 2 were exposed to other infections during pregnancy (syphilis and human immunodeficiency virus). Seven (13.7%) of the 42 (82.3%) newborns who completed follow-up CT were diagnosed with toxoplasmosis, and infection was ruled out in 35 (68.5%) newborns. In the latter half of the disappearance of IgG was 6.2 months. Three (43%) were infected symptomatic and had reactive IgM at birth. Four (57%) evidenced sequelae in evolution. Eight newborns were prescribed treatment, 3 of them completed it. In six (85.7%) of them infected maternal seroconversion during pregnancy was confirmed. Conclusions: although CT is not very common in our country, the disease is very important. The presence of maternal seroconversion forced to study and treat the newborns until infection is ruled out. Serology in the newborns demonstrates, in our environment, poor sensitivity and lack of other techniques necessary to undertake clinical and serological follow-up of IgM during the first year of life.


Assuntos
Humanos , Toxoplasmose Congênita , Toxoplasmose Congênita/complicações , Toxoplasmose Congênita/diagnóstico , Toxoplasmose Congênita/epidemiologia , Uruguai , Testes Sorológicos , Protocolos Clínicos , Gestantes
18.
Arch. pediatr. Urug ; 84(supl.1): S3-S12, 2013. ilus
Artigo em Espanhol | LILACS | ID: lil-756661

RESUMO

Los programas de vacunación han logrado disminuirlas enfermedades inmunoprevenibles. Las vacunas atrasadas reflejan la población expuesta a las mismas. Objetivos:1) Investigar la proporción de esquemas de vacunación atrasados (EAV) en niños menores de 36 meses de Paysandú. 2) Analizar las causas de EAV y las oportunidades perdidas de vacunación (OPV). Metodología: estudio transversal y descriptivo de cuatro cohortes de niños nacidos en Paysandú de 6,12, 24 y 36 meses. Se obtuvieron datos mediante entrevista a los padres y registro del carné esquemade vacunas (CEV). Resultados: se entrevistaron 399 niños, de 6 (28%),12 (25%), 24 (25%) y 36 (21%) meses. El 60% pertenecía al sector público. Se encontró 16,5% de EAV, con la siguiente distribución: 24%, 9%, 20% y 12% en los de 6, 12, 24 y 36 meses respectivamente. El sector público tuvo 22% de EAV versus 9% el mutual. Los principales factores asociados a EAV fueron: menor escolaridad materna, mayor número de hijos, no trabajo materno, controles de salud inadecuados y no solicitaren los mismos el CEV. Se detectaron 61% de OPV,siendo 82% en atención primaria. Los motivos principales de EAV fueron: enfermedad leve (38%) y situación socioeconómica (20%). Conclusiones: la tasa de EAV fue menor que en otrose studios regionales. Aun asi, se deben lograr mejores coberturas, principalmente en los mas pequeños, en el sector público y grupos socioeconómicos vulnerables; reforzar las campañas educativas para erradicar falsas contraindicaciones y concientizar al personal sanitario sobre la importancia del control del CEV.


Vaccination programs succeeded in diminishingvaccine-preventable diseases. Overdue vaccinationschemes reflect the population exposed tovaccine-preventable diseases.Objectives: 1) To investigate the proportion of overduevaccination schemes (OVS) in children bellow 36months of age in Paysandu. 2) Analyze OVS causesand lost vaccination opportunities (LVO).Methodology: cross-sectional descriptive study of fourcohorts of children of 6, 12, 24 and 36 months born inPaysandu. Information was retrieved from interviews tothe parents and the vaccination scheme card (VSC).Results: a total of 399 children, of 6 (28%), 12 (25%),24 (25%) and 36 (21%) months were interviewed, and60% belonged to the public health system. Resultsindicate a 16.5% of OVS with a distribution of: 24%,9%, 20% and 12% for 6, 12, 24 and 36 monthsrespectively, with a significant difference betweenpublic (22%) and private (9%) sectors. The mainfactors associated with OVS were lower maternaleducation level, larger amount of children, unemployedmothers, inadequate health checks and not checkingVSC. Results found a 61% of LVO from which 81%corresponded to primary care. The main reasons forOVS were mild disease (38%) and economic situation(20%).Conclusions: the OVS rate was lower than in otherregional studies; even though, better vaccinationcoverage must be achieved, mainly in youngerchildren, in the public sector and in vulnerablesocio-economic groups; to reinforce educationalcampaigns to eradicate false contraindications andmake the sanitary personnel aware of the importanceof controlling VSC.


Assuntos
Humanos , Lactente , Cobertura Vacinal , Esquemas de Imunização , Centros de Saúde , Fatores Socioeconômicos , Uruguai
19.
Mediciego ; 18(2)sept. 2012.
Artigo em Espanhol | LILACS | ID: lil-710906

RESUMO

Como parte del proyecto de investigación “Educadores Destacados del Siglo XX”, se selecciona al Dr. Enrique Meizoso Morales, especialista en Pediatría y profesor consultante de esta especialidad con el objetivo de estudiar la vida y obra de quien es considerado pediatra insigne de la provincia Ciego de Ávila. Se utilizó como método de investigación del nivel teórico: el histórico-lógico, el biográfico o historia de vida y el análisis documental (expediente de cuadro científico pedagógico) y los métodos del nivel empírico la observación, la entrevista y el testimonio. En la entrevista realizada a él se pudo constatar cuanta grandeza humana y amor a los niños encerraba su quehacer asistencial, educativo y de dirección. Le concedía un valor transcendental a la dedicación que los profesionales de la salud deben tener para su preparación científica y lo importante que resulta en la especialidad de pediatría la comunicación con la madre, padre y familia en la obtención de información que permitieran llegar a un diagnóstico más acertado al combinarlo con los resultados de exámenes físicos y los complementarios.


As part of the research project, "Outstanding educators of the 20th century", Dr. Enrique Meizoso Morales, specialist in Pediatric and consultant professor of this specialty is selected with the objective of studying the life and work of who is considered distinguished pediatrician of Ciego de Avila province. It was used as research methods of theoretical level: the historical/logical, biographical or life history and the documentary analysis (box scientific pedagogical dossier) and methods of empirical level such as observation, interview and testimony. In the interview it could see how much human greatness and love to children involve his assistance work; education and management. He conceded a transcendental value to dedication that health professionals should have for their scientific preparation and how important it is in the Pediatric specialty the communication with mother, father and family in obtaining information that would allow reaching a more accurate diagnosis combined with the results of physical examinations and complementary.


Assuntos
Humanos , Masculino , Biografias como Assunto , Pessoas Famosas , Humanismo , Prática Profissional
20.
Clin Rheumatol ; 30(12): 1589-93, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21607552

RESUMO

The purpose of this study is to determine factors associated with a non-ACR 50 response at 6 months of follow-up, in a cohort of patients with early rheumatoid arthritis (RA). Early RA patients (symptom duration <1 year), treated with the same combination treatment (methotrexate and sulfasalazine), were included. Demographic characteristics of the patients including current smoker status (defined as a patient that smokes at least one cigarette per day), years of formal education, a 28-joint count for swelling and tenderness were registered. A basal HAQ questionnaire, visual scales for global assessment, and pain were answered by all patients, and a CDAI basal score was calculated. The ACR 50 response was determined at 6 months follow-up. Multivariable logistic regression analysis was used to calculate adjusted ORs. Two hundred twenty-five patients were evaluated, but only 144 had a complete follow-up, 43% of the latter did not reach an ACR 50 response. The only factor associated with this outcome was current smoking (OR 3.58, P < 0.008, 95% CI 1.23-11.22). Low level of formal education (≤6 years) had a tendency towards a statistical difference (P < 0.08). After controlling with low level of formal education, sex, age in years, and CDAI baseline value with multivariable logistic regression analysis, current smoking status had an adjusted OR of 3.91 (P < 0.009, 95% CI 1.41-10.81). Smoking is associated with a non-ACR 50 response in early rheumatoid arthritis in patients treated with a combination therapy with methotrexate and sulfasalazine.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Perfil de Impacto da Doença , Fumar/fisiopatologia , Adulto , Artrite Reumatoide/fisiopatologia , Estudos de Coortes , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Sulfassalazina/uso terapêutico , Inquéritos e Questionários , Resultado do Tratamento
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