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1.
Rev. enferm. UERJ ; 29: e56924, jan.-dez. 2021.
Artigo em Inglês, Português | LILACS | ID: biblio-1224444

RESUMO

Objetivo: descrever a incidência de complicações em feridas operatórias de mastectomia e identificar fatores associados. Método: estudo retrospectivo desenvolvido em uma coorte hospitalar de 545 mulheres mastectomizadas por câncer de mama no ano 2018 em um centro de assistência de alta complexidade em oncologia da cidade do Rio de Janeiro, Brasil, após aprovação por Comitê de Ética em Pesquisa. Os dados foram coletados a partir dos prontuários, permitindo cálculos da taxa de incidência e da razão da taxa de incidência para cada complicação. Resultados: a complicação que apresentou maior taxa de incidência foi o sangramento (57,14/100 mastectomias-dia), tendo como fatores associados a raça/cor da pele não branca (Razão da Taxa de Incidência: 3,11) e a diabetes mellitus (Razão da Taxa de Incidência: 0,48). Conclusão: os fatores associados ao sangramento da ferida operatória apontam para a necessidade de novas práticas no cuidado ao pós-operatório de mulheres mastectomizadas.


Objective: to describe the incidence of complications in mastectomy surgical wounds and to identify associated factors. Method: this retrospective study was conducted in a hospital cohort of 545 women mastectomized for breast cancer in 2018 at a high-complexity cancer care center Rio de Janeiro City, Brazil, after approval by the research ethics committee. Data were collected from medical records, allowing incidence rate and incidence rate ratio to be calculated for each complication. Results: the complication with the highest incidence rate was bleeding (57.14/100 mastectomies-day), associated factors being non-white race/skin color (incidence rate ratio 3.11) and diabetes mellitus (incidence rate ratio 0.48). Conclusion: the factors associated with bleeding from the surgical wound point to the need for new practices in post-operative care for women with mastectomies.


Objetivo: describir la incidencia de complicaciones en heridas quirúrgicas de mastectomía e identificar factores asociados. Método: estudio retrospectivo desarrollado en una cohorte hospitalaria de 545 mujeres mastectomizadas por cáncer de mama en 2018 en un centro de atención de alta complejidad en oncología de la ciudad de Río de Janeiro, Brasil, previa aprobación del Comité de Ética en Investigación. Los datos se obtuvieron de las historias clínicas, lo que permitió calcular la tasa de incidencia y el cociente de la tasa de incidencia para cada complicación. Resultados: la complicación que presentó mayor tasa de incidencia fue el sangrado (57,14 / 100 mastectomías-día), con factores asociados a la raza / color de piel no blanca (índice de tasa de incidencia: 3,11) y diabetes mellitus (índice de tasa de incidencia: 0,48). Conclusión: los factores asociados al sangrado de la herida quirúrgica apuntan a la necesidad de nuevas prácticas en el cuidado al postoperatorio de las mujeres con mastectomía.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Complicações Pós-Operatórias/epidemiologia , Ferida Cirúrgica/complicações , Mastectomia/efeitos adversos , Brasil/epidemiologia , Neoplasias da Mama/cirurgia , Incidência , Estudos Retrospectivos , Fatores de Risco , Hemorragia Pós-Operatória/epidemiologia
2.
Infectio ; 25(4): 284-288, oct.-dic. 2021. tab
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1286723

RESUMO

Resumen Objetivo: Determinar los factores de riesgo a la infección en cavidad residual post quistectomía hepática en los pacientes del hospital Ramiro Prialé Prialé - EsSalud -Huancayo. Materiales y Métodos: Se realizó una cohorte retrospectiva, entre enero del 2014 y enero del 2018. Se utilizó una ficha de recolección de datos. Se obtuvieron los riesgos relativos (RR) crudos y ajustados, con intervalos de confianza al 95%. Resultados: Participaron 83 pacientes. El 41,2% de las mujeres presentaron infección en la cavidad postquistectomía y la mediana de edad de los pacientes infecta dos fue de 33 años. Los antecedentes patológicos que se relacionaron con la infección fueron obesidad o sobrepeso (62,5%), neoplasia previa (100%) y enferme dad inmunológica previa (31%). La infección en cavidad residual postquistectomía estuvo relacionada a la presencia de obesidad o sobrepeso, diabetes mellitus, neoplasia previa , cirugía previa y al uso de antibióticos posteriores a la cirugía. Conclusiones: La obesidad o sobrepeso, diabetes mellitus, haber padecido alguna neoplasia o cirugía previa y el uso de antibióticos luego de la cirugía; son factores de riesgo para la infección en cavidad residual postquistectomía hepática en los pacientes del Hospital Nacional Ramiro Prialé Prialé EsSalud de Huancayo, Perú.


Abstract Objective: To determine the risk factors with the infection in the residual cavity after hepatic cystectomy in the patients of the Ramiro Prialé Prialé hospital - EsSalud -Huancayo. Materials and Methods: A retrospective cohort was conducted, between January 2014 and January 2018. A data collection sheet was used. Crude and adjusted relative risks (RR) were obtained, with 95% confidence intervals. Results: 83 patients participated. 41.2% of women infected in the post-cystectomy cavity and the median age of infected patients was 33 years. The pathological antecedents that were related to the infection were obesity or overweight (62.5%), previous neoplasia (100%) and previous immune disease (31%). Post-cystectomy residual cavity infection was affected by the presence of obesity or overweight (aRR: 1.56; 95% CI: 1.15-2.13; p value = 0.005), diabetes mellitus (aRR: 2.67; 95% CI : 2.09-3.41; p value <0.001), previous neoplasia (aRR: 2.49; 95% CI: 1.94-3.20; p value <0.001), previous surgery (aRR: 1.49; 95% CI: 1.36-1.64; p value <0.001) and the use of post-surgery antibiotics (aRR: 2.14; 95% CI: 1.30-3.51; p value = 0.003) Conclusions: Obesity or overweight, diabetes mellitus, having suffered some neoplasia or previous surgery and the use of antibiotics after surgery; they are factors associated with infection in the residual post-cystectomy liver cavity in patients of the Ramiro Prialé Prialé EsSalud National Hospital in Huancayo, Peru.


Assuntos
Humanos , Feminino , Adulto , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Fatores de Risco , Infecções , Peru , Ranunculaceae , Diabetes Mellitus , Equinococose Hepática , Hospitais , Doenças do Sistema Imunitário , Neoplasias
3.
Infectio ; 25(4): 262-269, oct.-dic. 2021. tab, graf
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1286720

RESUMO

Abstract Objective: To analyse the clinic characteristics, risk factors and evolution of the first cohort of hospitalised patients with confirmed infection by COVID-19 in 5 Colombian institutions. Materials and methods: Is a retrospective observational study of consecutive hospitalized patients with a diagnosis of COVID-19 confirmed from March 01 to May 30, 2020 in Colombia. Results: A total of 44 patients were included. The median age was 62 years. 43.2% had a history of smoking, while 69.8% were overweight or obese. 88.6% had at least one comorbidity and 52.3% had three or more comorbidities. Hypertension and dyslipidaemia were the most frequent comorbidities (40.9% and 34.1%, respectively). The 30-day mortality rate was 47.7% with a median of 11 days. The composite outcome occurred in the 36.4%. The biomarkers associated with mor tality risk included troponin higher than 14 ng/L (RR: 5.25; 95% CI 1.37-20.1, p = 0.004) and D-dimer higher than 1000 ng/ml (RR: 3.0; 95% CI 1.4-6.3, p = 0.008). Conclusions: The clinical course of SARS-CoV-2 infection in hospitalized Colombian was characterised by a more advanced stage of the infection.


Resumen Objetivo: Analizar las características, clínicas, factores de riesgo, y la evolución de pacientes hospitalizados con infección confirmada por COVID-19 en 5 Institu ciones de Colombia. Material y método: Es un estudio observacional retrospectivo de pacientes consecutivos hospitalizados con diagnóstico de COVID-19 confirmado entre 01 de Febrero de 2020 y 30 de Mayo de 2020 en Colombia. Resultados: Un total de 44 pacientes fueron incluidos. La mediana de edad fue de 62 años y la mayoría del sexo masculino. El 43.2% tenían historia de tabaquismo, mientras que el 69.8% tenían sobrepeso u obesidad. El 88.6% tenían al menos una comorbilidad y el 52.3% tenían tres o más comorbilidades. La hipertensión arterial fue la comorbilidad más frecuente (40.9%), seguido de la dislipidemia (34.1%). La tasa de letalidad a 30 días fue de 47.7% y ocurrió con una mediana de 11 días. El 36.4% presentó el desenlace compuesto. Los biomarcadores asociados con el riesgo de muerte fue troponina > 14 ng/mL (RR:5.25, IC95% 1.37-20.1, p=0.004) y dímero D mayor a 1000 mg/dL (RR: 3.0, IC95% 1.4-6.3, p=0.008). Conclusiones: El curso clínico de la infección por SARS-CoV-2 en colombianos hospitalizados fue un estadio más avanzado de la infección.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Biomarcadores , COVID-19 , Pacientes , Tabagismo , Comorbidade , Risco , Fatores de Risco , Mortalidade , Colômbia , Sobrepeso , Cursos , Infecções , Obesidade
4.
Anticancer Res ; 41(10): 5195-5202, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34593472

RESUMO

BACKGROUND/AIM: Population aging results in increasing numbers of elderly persons undergoing surgery for colorectal cancer. We sought to identify objective preoperative indicators of outcomes, with a view toward development of safe, effective treatments for such patients. PATIENTS AND METHODS: The study included 99 patients aged 80 years or more, who were treated surgically for stage I- III colorectal cancer. Preoperative nutritional status was compared retrospectively between those who suffered postoperative complications (n=40) and those who did not (n=59). RESULTS: Univariate analysis revealed low prealbumin (PreAlb) concentration (p=0.032) and low platelet-to-lymphocyte ratio (p=0.116) as risk factors for postoperative complications. Multivariate analysis showed preoperative PreAlb concentration to be an independent risk factor (OR=0.884; 95% confidence interval=0.791-0.989; p=0.024) associated with postoperative length of hospital stay (coef.=-0.336, p=0.002). CONCLUSION: PreAlb, a rapid turnover protein, shows promise as a simple predictor of postoperative complications in elderly patients treated for colorectal surgery.


Assuntos
Albuminas/metabolismo , Biomarcadores Tumorais/metabolismo , Neoplasias Colorretais/mortalidade , Tempo de Internação/estatística & dados numéricos , Cuidados Pré-Operatórios , Idoso de 80 Anos ou mais , Neoplasias Colorretais/metabolismo , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Cirurgia Colorretal , Feminino , Seguimentos , Humanos , Masculino , Estado Nutricional , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
5.
Medicine (Baltimore) ; 100(39): e27310, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34596129

RESUMO

ABSTRACT: The association between serum total cholesterol (TC) level and incident atherosclerotic cardiovascular disease (ASCVD) in patients with follicular thyroid cancer postthyroidectomy is unknown.This was a retrospective study and patients (n = 384) were divided into low and high TC groups according to the median TC level. Incidence of composite ASCVD (myocardial infarction, ischemic stroke, and cardiovascular death) was compared between these 2 groups and factors contributing to the association of TC and ASCVD were evaluated.Patients in the high TC group were older and more likely to have diabetes and have higher C-reactive protein level. After thyroidectomy, serum levels of free triiodothyronine and free thyroxine were lower while thyroid-stimulating hormone level was higher in the high TC group. 31.6% and 39.7% of patients developed hypothyroidism in the low and high TC groups (P < .05) postthyroidectomy. The incidence rate of composite ASCVD was higher in the high TC versus low TC groups, with incidence rate ratio of 1.69 (95% confidence interval [CI]: 1.07-2.69), which was mainly driven by a higher incidence rate of myocardial infarction in the high TC group (incidence rate ratio: 2.11 and 95% CI: 1.10-4.20). In unadjusted model, higher TC was associated with 73% higher risk of composite ASCVD. After adjustment for hypothyroidism, the association of higher TC and composite ASCVD was attenuated into insignificance, with hazard ratio of 0.92 and 95% CI: 0.81 to 1.34.Increased TC level was associated with composite ASCVD, which might be attributed to hypothyroidism postthyroidectomy. The use of levothyroxine might help to prevent hypercholestemia and reduce the incidence of ASCVD.


Assuntos
Adenocarcinoma Folicular/epidemiologia , Aterosclerose/epidemiologia , Colesterol/sangue , Neoplasias da Glândula Tireoide/epidemiologia , Adenocarcinoma Folicular/cirurgia , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Comorbidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Hormônios Tireóideos/sangue , Neoplasias da Glândula Tireoide/cirurgia
6.
Medicine (Baltimore) ; 100(39): e27339, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34596139

RESUMO

ABSTRACT: The effect of hypothermia as a mortality risk factor at 30 days in the elderly who had hip fracture (HF) surgery is still controversial because it may be due to a set of poorly identified factors. In this study, we aim to determine if exposure to intra and immediate postoperative hypothermia increases the incidence of mortality at 30 days in elderly patients who had HF surgery.Survival study in the elderly who had HF surgery with and without exposure to hypothermia. Sociodemographic, anesthetic and surgical factors were collected. The temperature of the rectum was measured at the end of the surgery and in the recovery room. The effect of hypothermia was analyzed by the incidence of mortality at 30 days. Other results were considered, such as, surgical site infection (SSI), blood transfusions, and influence of implants used in the 30-day mortality.Three hundred eighty five subjects were eligible, to include 300. Inadvertent hypothermia was 12%, the 30-day overall mortality was 9% and in subjects with hypothermia it was 25% (P = .002). Subjects with hypothermia had a higher risk of SSI (relative risk 4.2, 95% confidence interval 1.3-13.6, P = .03) and receive more transfusions (relative risk 3.6, 95% confidence interval 2.0-6.5, P < .001).Elderly subjects with HF exposed to hypothermia who undergo hip hemiarthroplasty and who receive 2 or more blood transfusions during their treatment, are at greater risk of dying after 30 days of the surgery. Hypothermia, as a possible causative factor of mortality, should continue to be studied.


Assuntos
Hemiartroplastia/mortalidade , Hemiartroplastia/métodos , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Hipotermia/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Temperatura Corporal , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Infecção da Ferida Cirúrgica/epidemiologia
7.
Medicine (Baltimore) ; 100(39): e27350, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34596141

RESUMO

ABSTRACT: A community-based cross-sectional study was undertaken by the Cardiology Society of India (Kerala Chapter) to determine the prevalence of coronary artery disease (CAD) and its risk factors. The periodontal health status of the rural and urban participants in the Thiruvananthapuram district of Kerala was evaluated to document any association between periodontal disease (PD) and CAD and to describe any shared risk factors.The participants were selected using a multistage cluster random sampling method. Socio-demographic data and personal histories were collected using a structured interview schedule and validated tools. Body mass index, blood pressure, electrocardiogram, and biochemical investigations were recorded and analyzed using standard protocols. A modification of the Ramfjord periodontal disease index was used to assess periodontal health.PD was more frequent among rural (61.4%) than in the urban population (35.5%). The frequencies of CAD associated with PD in the rural and urban populations were 82.6% and 40.5%, respectively. PD was not found to be a significant risk factor for CAD in the univariate regression analysis of urban populations. In the rural population, the odds of PD as a risk factor for CAD were found to be 3.08 (95% CI [1.38-8.38]) and significant (P = .043) in univariate regression analysis and 1.54 (95% CI: 0.44-5.4) and non-significant (P = .503) in the multivariate regression analysis.In rural areas, male sex and dyslipidemia demonstrated borderline significance as risk factors for CAD. PD was not found to be an independent risk factor after adjusting for age, sex, tobacco use, hypertension, sedentary lifestyle, and dyslipidemia. Male sex and dyslipidemia were identified as shared risk factors between PD and CAD, which could have confounded the significant association between the latter. In urban areas, age, male sex, and dyslipidemia demonstrated an independent association with CAD. This study could not establish an independent association between PD and CAD in either community. Future epidemiological studies should identify and recruit novel environmental factors to understand the interrelationships between PD and CAD and focus on the role of effect modifiers that may have a protective role against PD colluding with CAD.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Doenças Periodontais/epidemiologia , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , Idoso , Pressão Sanguínea , Índice de Massa Corporal , Comorbidade , Estudos Transversais , Dislipidemias/epidemiologia , Eletrocardiografia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
8.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 29(5): 1471-1477, 2021 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-34627426

RESUMO

OBJECTIVE: To investigate the optimal time of monitoring minimal residual disease (MRD) for predicting survival and prognosis in children with T-cell acute lymphoblastic leukemia (T-ALL) after treated by CCLG-ALL2008 chemotherapy. METHODS: 96 children with T-ALL receiving CCLG-ALL2008 chemotherapy treated in our hospital from January 2015 to January 2020 were retrospectively summarized. The follow-up time was 9.0-65.0 months, with a median of 43.5 months. Kaplan-Meier survival curve was used to detect the overall event-free survival (EFS) and overall survival (OS) of the patients. The clinical data, MRD levels after 15 d, 33 d and 90 d chemotherapy between EFS group and relapse group, as well as OS group and death group were compared by using univariate analysis. Multivariate Logistic regression analysis was used to screen the main risk factors affecting EFS and OS of the patients. The patients were divided into low, moderate and high-risk according to the MRD level after 15 d, 33 d and 90 d, the differences of EFS and OS between each groups were compared again. RESULTS: By the end of follow-up, 50 patients recurred and other 46 patients non-recurred; 40 patients died and 56 patients survived, the EFS was (49.5±6.3)% and OS was (61.5±5.9)%. Univariate analysis showed that the initial WBC count in EFS group (n=46) was significantly lower than that in relapse group (n=50), and MRD levels after 33 d and 90 d were significantly less also (P<0.05). Prednisone response in OS group (n=56) was better than that in death group (n=40), and central nerve invasion rate was lower, MRD level after 33 and 90 d were lower (P<0.05). Logistic regression analysis showed that MRD level after 90 d was the main risk factor affecting EFS of the patients; prednisone reaction, central nerve invasion and MRD level after 90 d were the main risk factors affecting OS of the patients (P<0.05). There were no differences of EFS or OS between the groups according to the MRD levels after 15 and 33 d (P>0.05), however for 90 d, EFS and OS of the patients in high-risk group were significantly lower than those in medium-risk group, and those in medium-risk group were lower than those in low-risk group (P<0.05). CONCLUSION: The MRD level after 90 days CCLG-ALL2008 chemotherapy may be the best time to predict the survival and prognosis in T-ALL children.


Assuntos
Leucemia-Linfoma Linfoblástico de Células Precursoras , Leucemia-Linfoma Linfoblástico de Células T Precursoras , Criança , Intervalo Livre de Doença , Humanos , Neoplasia Residual , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Linfócitos T
9.
Spine (Phila Pa 1976) ; 46(21): E1155-E1160, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34618707

RESUMO

STUDY DESIGN: Retrospective review. OBJECTIVE: Identify co-occurring perioperative complications and associated predictors in a population of patients undergoing surgery for adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA: Few studies have investigated the development of multiple, co-occurring complications following ASD-corrective surgery. Preoperative risk stratification may benefit from identification of factors associated with multiple, co-occurring complications. METHODS: Elective ASD patients in National Surgical Quality Improvement Program (NSQIP) 2005 to 2016 were isolated; rates of co-occurring complications and affected body systems were assessed via cross tabulation. Random forest analysis identified top patient and surgical factors associated with complication co-occurrence, using conditional inference trees to identify significant cutoff points. Binary logistic regression indicated effect size of top influential factors associated with complication co-occurrence at each factor's respective cutoff point. RESULTS: Included: 6486 ASD patients. The overall perioperative complication rate was 34.8%; 28.5% of patients experienced one complication, 4.5% experienced two, and 1.8% experienced 3+. Overall, 11% of complication co-occurrences were pulmonary/cardiovascular, 9% pulmonary/renal, and 4% integumentary/renal. By complication type, the most common co-occurrences were transfusion/urinary tract infection (UTI) (24.3%) and transfusion/pneumonia (17.7%). Surgical factors of operative time ≥400 minutes and fusion ≥9 levels were the strongest factors associated with the incidence of co-occurring complications, followed by patient-specific variables like American Society of Anesthesiologists (ASA) physical status classification grade ≥2 and age ≥65 years. Regression analysis further showed associations between increasing complication number and longer length of stay (LOS), (R2 = 0.202, P < 0.001), non-home discharge (R2 = 0.111, P = 0.001), and readmission (R2 = 0.010, P < 0.001). CONCLUSION: For surgical ASD patients, the overall rate of co-occurring perioperative complications was 6.3%. Body systems most commonly affected by complication co-occurrences were pulmonary and cardiovascular, and common co-occurrences included transfusion/UTI (24.3%) and transfusion/pneumonia (17.7%). Increasing number of perioperative complications was associated with greater LOS, non-home discharge, and readmission, highlighting the importance of identifying risk factors for complication co-occurrences.Level of Evidence: 3.


Assuntos
Procedimentos Neurocirúrgicos , Complicações Pós-Operatórias , Adulto , Idoso , Humanos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
10.
J Headache Pain ; 22(1): 119, 2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620097

RESUMO

BACKGROUND: Migraine is a common neurological disease with extremely debilitating, but fully reversible symptoms. Women suffer from migraine more often than men. It was assumed that fluctuation of oestrogen level during menstrual cycle is one of many factors responsible for more frequent migraine attacks. The second-to-fourth digit ratio (2D:4D) is considered as an indicator of prenatal sex steroids. Balance of prenatal androgens (testosterone) and oestrogen has been studied in numerous diseases that are affected by hormones. However, the relationship between migraine and the sex steroids balance in prenatal development is still unexplained. The aim of this paper is to provide an evidence of relationship between prenatal oestrogen and testosterone exposure following 2D:4D digit ratio, and migraine prevalence in adults. METHODS: We examined a group of 151 adults (33 males, 118 females) with migraine and a control group of 111 adults (45 males, 66 females). 2D:4D digit ratio of both hands was measured using sliding Vernier calliper. RESULTS: Significant differences were found in the right hand. Female migraineurs had lower value of 2D:4D ratio than the control group and the right 2D:4D was lower than left 2D:4D (Δ2D:4D), suggesting prenatal testosterone dominance. The opposite relationship was observed in males. Male migraineurs had higher value of 2D:4D ratio and Δ2D:4D was greater than the control group, suggesting prenatal oestrogen dominance. CONCLUSIONS: Our results suggest that depending on sex, different proportion of prenatal sex steroids might be a risk factor of migraine in adults. Women with migraine were presumably exposed in prenatal life to higher testosterone levels relative to oestrogen, while men with migraine were probably exposed in prenatal life to higher levels of oestrogen relative to testosterone.


Assuntos
Transtornos de Enxaqueca , Testosterona , Adulto , Estrogênios , Feminino , Hormônios Esteroides Gonadais , Humanos , Masculino , Transtornos de Enxaqueca/epidemiologia , Fatores de Risco
11.
BMC Infect Dis ; 21(1): 1040, 2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620102

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a declared global pandemic, causing a lot of death. How to quickly screen risk population for severe patients is essential for decreasing the mortality. Many of the predictors might not be available in all hospitals, so it is necessary to develop a simpler screening tool with predictors which can be easily obtained for wide wise. METHODS: This retrospective study included all the 813 confirmed cases diagnosed with COVID-19 before March 2nd, 2020 in a city of Hubei Province in China. Data of the COVID-19 patients including clinical and epidemiological features were collected through Chinese Disease Control and Prevention Information System. Predictors were selected by logistic regression, and then categorized to four different level risk factors. A screening tool for severe patient with COVID-19 was developed and tested by ROC curve. RESULTS: Seven early predictors for severe patients with COVID-19 were selected, including chronic kidney disease (OR 14.7), age above 60 (OR 5.6), lymphocyte count less than < 0.8 × 109 per L (OR 2.5), Neutrophil to Lymphocyte Ratio larger than 4.7 (OR 2.2), high fever with temperature ≥ 38.5℃ (OR 2.2), male (OR 2.2), cardiovascular related diseases (OR 2.0). The Area Under the ROC Curve of the screening tool developed by above seven predictors was 0.798 (95% CI 0.747-0.849), and its best cut-off value is > 4.5, with sensitivity 72.0% and specificity 75.3%. CONCLUSIONS: This newly developed screening tool can be a good choice for early prediction and alert for severe case especially in the condition of overload health service.


Assuntos
COVID-19 , Humanos , Masculino , Programas de Rastreamento , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
12.
Nutr J ; 20(1): 83, 2021 10 03.
Artigo em Inglês | MEDLINE | ID: mdl-34602079

RESUMO

BACKGROUND: A growing number of researches supported that dietary fructose was associated with most of the key features of metabolic syndrome (MetS). However, there was no related epidemiological studies among Chinese population, despite the sharp increase in MetS cases. This study explores the relationship between dietary fructose and MetS among Chinese residents aged 45 and above. METHODS: A total of 25,528 participants (11,574 males and 13,954 females) were included in this nationwide representative cross-sectional study of China National Nutrition and Health Survey. Dietary fructose intake was assessed by 3-day 24-h dietary records. MetS was defined by the International Diabetes Federation and Chinese Diabetes Society criteria. RESULTS: The consumption of dietary fructose was 11.6 g/day for urban residents and 7.6 g/day for rural residents. Fruits and vegetables as well as their products were the main sources of fructose intake. There was no association between dietary fructose intake and the odds of having MetS in both urban (P = 0.315) and rural residents (P = 0.230) after adjustment for confounding factors. Moreover, for urban residents participating physical activities, the odds of having MetS in the fourth quartiles (OR: 0.67; 95%CI: 0.52-0.87) was lower than that in the first quartile. In the sensitivity analysis, a significant reduction in the odds of having MetS was also found in the fourth quartiles (OR, 95%CI: 0.68, 0.51-0.90; 0.67, 0.49-0.91; 0.74, 0.56-0.99) compared with the first quartile when excluding smokers, alcohol users, and underweight/obesity, respectively. And there was no association between dietary fructose intake and the odds of having MetS after multivariate adjustment stratified by gender, smoking and alcohol use. CONCLUSIONS: Under the current dietary fructose intake status, there was no association between dietary fructose intake and the odds of having MetS among Chinese residents aged 45 and above. Physical activity and relatively low fructose intake may have a beneficial synergistic effect on MetS.


Assuntos
Síndrome Metabólica , China/epidemiologia , Estudos Transversais , Feminino , Frutose , Inquéritos Epidemiológicos , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Fatores de Risco
13.
Front Public Health ; 9: 619581, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34604147

RESUMO

Aim: We aimed to estimate the disease burden and risk factors attributable to ovarian cancer, and epidemiological trends at global, regional, and national levels. Methods: We described ovarian cancer data on incidence, mortality, and disability-adjusted life-years as well as age-standardized rates from 1990 to 2017 from the Global Health Data Exchange database. We also estimated the risk factors attributable to ovarian cancer deaths and disability-adjusted life-years. Measures were stratified by region, country, age, and socio-demographic index. The estimated annual percentage changes and age-standardized rates were calculated to evaluate temporal trends. Results: Globally, ovarian cancer incident, death cases, and disability-adjusted life-years increased by 88.01, 84.20, and 78.00%, respectively. However, all the corresponding age-standardized rates showed downward trends with an estimated annual percentage change of -0.10 (-0.03 to 0.16), -0.33 (-0.38 to -0.27), and -0.38 (-0.32 to 0.25), respectively. South and East Asia and Western Europe carried the heaviest disease burden. The highest incidence, deaths, and disability-adjusted life-years were mainly in people aged 50-69 years from 1990 to 2017. High fasting plasma glucose level was the greatest contributor in age-standardized disability-adjusted life-years rate globally as well as in all socio-demographic index quintiles and most Global Disease Burden regions. Other important factors were high body mass index and occupational exposure to asbestos. Conclusion: Our study provides valuable information on patterns and trends of disease burden and risk factors attributable to ovarian cancer across age, socio-demographic index, region, and country, which may help improve the rational allocation of health resources as well as inform health policies.


Assuntos
Carga Global da Doença , Neoplasias Ovarianas , Efeitos Psicossociais da Doença , Feminino , Humanos , Neoplasias Ovarianas/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco
14.
Acta Gastroenterol Belg ; 84(3): 401-405, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34599562

RESUMO

Patients and methods: A prospective registration of patients with colorectal cancer and a colonoscopy within the last 10 years. We tried to classify these post-colonoscopy colorectal cancers (PCCRCs) by most reasonable explanation and into subcategories suggested by the World Endoscopy Organization (WEO) and calculated the unadjusted PCCRC rate. Results: 47 PCCRCs were identified. The average age at diagnosis of PCCRC was 73 years. PCCRCs were more located in the right colon with a higher percentage of MSI-positive and B-RAF mutated tumours. The average period between index colonoscopy and diagnosis of PCCRC was 4.2 years. Sixty-eight % of all PCCRCs could be explained by procedural factors. The mean PCCRC-3y of our department was 2.46%. Conclusions: The data of our centre are in line with the data of the literature from which can be concluded that most postcolonoscopy colorectal cancers are preventable. The PCCRC-3y is an important quality measure for screening colonoscopy. Ideally all centres involved in the population screening should measure the PCCRC-3 y annually, with cooperation of the cancer registry and reimbursement data provided by the Intermutualistic Agency (IMA).


Assuntos
Neoplasias Colorretais , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Humanos , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo
15.
J Nepal Health Res Counc ; 19(2): 327-330, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34601525

RESUMO

BACKGROUND: An ectopic or extra uterine pregnancy is one in which the blastocyst implants anywhere other than the endometrial lining of the uterine cavity. The objective of the study was to find incidence, risk factors, clinical presentation and mode of management of ectopic pregnancy. METHODS: Observational study was conducted at Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu. All the relevant data were recorded in performa. The collected data were entered in MS Excel and exported into SPSS 26 version for statistical analysis. RESULTS: About one third of the patients 10 (33.3%) was of 25-29 age group.The most common risk factor was pelvic infection in 23 (76.6%) cases, abortion in 11 (36.7%), and abdominal surgery in 8 (26.7%) of cases. The of classic triad of amenorrhea (100%), pain abdomen (99.7%) and per vaginal bleeding (66.7%). Ruptured ectopic seen in 26 (86.7%) cases, unruptured status in 1 (3.3%) case, tubal abortion in 1(3.3%) case and organized ectopic in 2(6.7%) cases. The most common site was found to be ampulla in 23 (76.7%) cases, fmbria 3(10%) cases, corneal in 3(10%) cases and ithmus in 1 (3.3%) case. All the cases managed surgically, of them unilateral salphingectomy, unilateral salphingo-opherectomy and wedge resection for corneal pregnancy were done in 25(83.3%), 2(6.7%) and 3(10%) cases respectively. CONCLUSIONS: Ectopic pregnancy mostly present as ruptured form in young females in our context. Pelvic infection is the commonest risk factor with ampulla being the commonest site. All cases required surgical intervention in form of unilateral salphingo-opherectomy and wedge resection.


Assuntos
Aborto Induzido , Gravidez Ectópica , Feminino , Humanos , Nepal/epidemiologia , Gravidez , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/cirurgia , Fatores de Risco , Centros de Atenção Terciária
16.
J Coll Physicians Surg Pak ; 31(10): 1214-1218, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34601844

RESUMO

OBJECTIVE: To analyse clinicopathological variables to determine risk factors of postoperative pancreatic fistula in patients having distal pancreatectomy with stapler closure. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Adana City Training and Research Hospital, Adana, Turkey, from January 2015 to May 2020. METHODOLOGY: Medical files of 38 cases having distal pancreatectomy with stapler closure of the pancreatic remnant for conditions emerging from the pancreas or other organs were analysed. Data about demographics, perioperative and pathological findings, postoperative outcomes were gathered. Univariate analysis was utilised for comparisons of categorical data. The possible risk factors found to be significant in the univariate analysis were included into the logistic regression analysis. RESULTS: Based on the description reported by the International Study Group of Pancreatic Surgery, 23.7% and 31.6% of the patients had biochemical leakage and clinically relevant postoperative pancreatic fistula (POPF) respectively. Univariate and multivariate analyses made to determine risk factors of POPF showed a relation between stapler closure alone (p = 0.018) and soft parenchymal texture (p = 0.002) and clinically relevant POPF. Multivariate analyses revealed that parenchymal texture was the sole independent predictor of clinically relevant POPF (OR, 0.016, p = 0.039). CONCLUSION: Soft pancreatic texture is independently predictive of clinically relevant POPF following distal pancreatectomy with stapler closure. However, reinforcement of the stapler line with extra sutures decreases the risk of clinically relevant POPF. Key Words: Distal pancreatectomy, Pancreatic fistula, Stapler closure, Suture reinforcement.


Assuntos
Pancreatectomia , Fístula Pancreática , Humanos , Pâncreas , Pancreatectomia/efeitos adversos , Fístula Pancreática/epidemiologia , Fístula Pancreática/etiologia , Período Pós-Operatório , Fatores de Risco
17.
Arch Esp Urol ; 74(8): 752-761, 2021 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34605415

RESUMO

OBJECTIVE: Determining the complications rate and the risk factors associated with early operative and postoperative complications with a bipolar transurethral resection of the prostate at a complex care institution in Colombia. MATERIALS AND METHODS: A mixed cohort study was conducted involving 340 patients diagnosed with benign prostatic hyperplasia who were taken to bipolar transurethral resection of the prostate between 2012 and 2019. Data based on the baseline and perioperative characteristics were collected, and the rate of complications determined up to 30 postoperative days. RESULTS: A total of 67 patients (19.45%) presented perioperative complications of which 17 (25.37%) were previously hospitalized. According to the Clavien Dindo classification, 14.79% were grade I - II: secondary hematuria was the most reported complication and was present in 18 patients (5.22%), followed by complicated urinary tract infections in 16 (4.64%) and dysfunction of the ureterovesical catheter in 6 (1.76%). The risk factors found were surgery during hospitalization (RR:2.23, 95% CI: 1.14 - 4.39), INR (RR: 7.59, IC95%:4.63 - 12.44), duration in days of cysto/irrigation (RR:1.32, CI95%: 1.22 - 1.42) and urethral catheter use (RR: 1.04, CI95%: 1.02 - 1.05). CONCLUSIONS: In this study, the complication rate after bipolar transurethral resection of the prostate was less than 20%. The most frequent complications were grade Iand II according to the Clavien Dindo classification. The risk factors that were found are modifiable, which could reduce postoperative morbidity.


Assuntos
Ressecção Transuretral da Próstata , Estudos de Coortes , Colômbia/epidemiologia , Humanos , Masculino , Próstata , Fatores de Risco , Ressecção Transuretral da Próstata/efeitos adversos
18.
Mymensingh Med J ; 30(4): 1009-1015, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34605471

RESUMO

This prospective study was conducted to find the rate of deep and risk factors associated with vein thrombosis following major abdominal surgery in Sylhet MAG Osmani Medical College Hospital from 1st November 2017 to 30th April 2018. Total 103 patients aged above 20 years both male and female who got admitted in Department of Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet for their disease requiring routine and emergency major abdominal operation during the study period and fulfilling the inclusion and exclusion criteria were selected in this study. Informed written consent was obtained from the patients after full explanation of the purpose of the study. After full investigations and proper preparation of each patient for operative procedure major abdominal surgery were done. Peroperative findings were noted and post-operative period were followed up routinely. Duplex scanning was done on 3rd POD in all cases. The age of the patients ranged from 25 to 74 years with the mean age of 49.5±13.8 years. There were 60(58.3%) male and 43(41.7%) female. Deep vein thrombosis (DVT) developed in 5(4.9%) of cases and not developed in 98(95.1%) cases. All the five cases were confirmed by color duplex scan. DVT was detected in 2(3.3%) of the 60 males and 3(7.0%) of the 43 females undergoing major general surgical procedures. Among 63 patients in whom the duration of surgery was up to 2 hours, none developed DVT, while among the 40 patients in whom the duration of surgery lasted more than 2 hours, 5(12.5%) developed DVT. Among 23 patients in whom the surgery for malignancy was done, 4(17.4%) developed DVT, while among the 80 patients in whom surgery for non-malignancy, 1(1.2%) developed DVT. The Incidence of DVT in patients undergoing major abdominal surgery is 4.9%. Patients undergoing major abdominal surgery for malignancy and duration of operation greater than 2 hours have higher risk of developing DVT. But there is no significant increase in risk of development of DVT relation to age and sex; and also in patients on oral contraceptives, diabetes mellitus, obesity and smoking. Clinical findings alone cannot be relied upon for the diagnosis of DVT. The study has to be continued with larger sample size to get statistically significant results.


Assuntos
Trombose Venosa , Adulto , Idoso , Bangladesh , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fatores de Risco , Centros de Atenção Terciária , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia
19.
Mymensingh Med J ; 30(4): 1060-1066, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34605477

RESUMO

Osteoporosis is an important systemic manifestation of Chronic Obstructive Pulmonary Disease (COPD). Osteoporosis is a systemic disease of bone which may present as low bone mass and micro-architectural disarray that increases the risk of fracture. The World Health Organization defines osteoporosis as bone density ≥2.5 standard deviations below the bone density of a normal young adult. Osteopenia, a less severe form of bone loss, is defined as a bone density between 1 and 2.5 standard deviations below that reference point. The aetiology of osteoporosis in COPD patients remain unclear, but several factors significantly correspond to reduced bone density in COPD, including older age, female sex and body mass index (BMI). However, the relationship to other factors, such as FEV1, tobacco smoking, physical inactivity and corticosteroid therapy, are still an unresolved issue. This cross-sectional study was done in the Department of Respiratory Medicine, BSMMU from March 2018 to March 2019. A total of 86 patients of which prevalence of osteoporosis is 29.1%, osteopenia 50% and normal BMD in 20.9%, majority of them was belonging to age group 51-60 years. Male were predominant with male-female ratio of 3.5:1. The frequency of osteoporosis was 32.0%, 64.0% and 4.0% in moderate, severe and in very severe COPD patients, respectively. The frequency of osteopenia was 14.0% in mild, 53.5% in moderate, 20.9% in severe and 11.6% were in very severe COPD patients. The p value (p=0.018) was significant for prevalence osteoporosis and osteopenia with increase in severity of COPD. The prevalence of osteoporosis and osteopenia was high in COPD patients under study. The frequency of osteoporosis and osteopenia was more with severity of COPD.


Assuntos
Doenças Ósseas Metabólicas , Osteoporose , Doença Pulmonar Obstrutiva Crônica , Pneumologia , Absorciometria de Fóton , Idoso , Doenças Ósseas Metabólicas/epidemiologia , Doenças Ósseas Metabólicas/etiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/epidemiologia , Pacientes Ambulatoriais , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fatores de Risco
20.
PLoS One ; 16(10): e0257641, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34597325

RESUMO

BACKGROUND: Given the rapid increased in confirmed coronavirus disease 2019 (COVID-19) and related mortality, it is important to identify vulnerable patients. Immunocompromised status is considered a risk factor for developing severe COVID-19. We aimed to determine whether immunocompromised patients with COVID-19 have an increased risk of mortality. METHOD: The groups' baseline characteristics were balanced using a propensity score-based inverse probability of treatment weighting approach. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for the risks of in-hospital mortality and other outcomes according to immunocompromised status using a multivariable logistic regression model. We identified immunocompromised status based on a diagnosis of malignancy or HIV/AIDS, having undergone organ transplantation within 3 years, prescriptions for corticosteroids or oral immunosuppressants for ≥30 days, and at least one prescription for non-oral immunosuppressants during the last year. RESULTS: The 6,435 COVID-19 patients (≥18 years) included 871 immunocompromised (13.5%) and 5,564 non-immunocompromised (86.5%). Immunocompromised COVID-19 patients were older (60.1±16.4 years vs. 47.1±18.7 years, absolute standardized mean difference: 0.738). The immunocompromised group had more comorbidities, a higher Charlson comorbidity index, and a higher in-hospital mortality rate (9.6% vs. 2.3%; p < .001). The immunocompromised group still had a significantly higher in-hospital mortality rate after inverse probability of treatment weighting (6.4% vs. 2.0%, p < .001). Multivariable analysis adjusted for baseline imbalances revealed that immunocompromised status was independently associated with a higher risk of mortality among COVID-19 patients (adjusted odds ratio [aOR]: 2.09, 95% CI: 1.62-2.68, p < .001). CONCLUSIONS: Immunocompromised status among COVID-19 patients was associated with a significantly increased risk of mortality.


Assuntos
COVID-19/diagnóstico , Hospedeiro Imunocomprometido , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/mortalidade , COVID-19/virologia , Comorbidade , Feminino , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Razão de Chances , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Adulto Jovem
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