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1.
Lancet Public Health ; 6(10): e709-e719, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34474014

RESUMO

BACKGROUND: Preliminary data suggest that COVID-19 has reduced access to solid organ transplantation. However, the global consequences of the COVID-19 pandemic on transplantation rates and the effect on waitlisted patients have not been reported. We aimed to assess the effect of the COVID-19 pandemic on transplantation and investigate if the pandemic was associated with heterogeneous adaptation in terms of organ transplantation, with ensuing consequences for waitlisted patients. METHODS: In this population-based, observational, before-and-after study, we collected and validated nationwide cohorts of consecutive kidney, liver, lung, and heart transplants from 22 countries. Data were collected from Jan 1 to Dec 31, 2020, along with data from the same period in 2019. The analysis was done from the onset of the 100th cumulative COVID-19 case through to Dec 31, 2020. We assessed the effect of the pandemic on the worldwide organ transplantation rate and the disparity in transplant numbers within each country. We estimated the number of waitlisted patient life-years lost due to the negative effects of the pandemic. The study is registered with ClinicalTrials.gov, NCT04416256. FINDINGS: Transplant activity in all countries studied showed an overall decrease during the pandemic. Kidney transplantation was the most affected, followed by lung, liver, and heart. We identified three organ transplant rate patterns, as follows: countries with a sharp decrease in transplantation rate with a low COVID-19-related death rate; countries with a moderate decrease in transplantation rate with a moderate COVID-19-related death rate; and countries with a slight decrease in transplantation rate despite a high COVID-19-related death rate. Temporal trends revealed a marked worldwide reduction in transplant activity during the first 3 months of the pandemic, with losses stabilising after June, 2020, but decreasing again from October to December, 2020. The overall reduction in transplants during the observation time period translated to 48 239 waitlisted patient life-years lost. INTERPRETATION: We quantified the impact of the COVID-19 pandemic on worldwide organ transplantation activity and revealed heterogeneous adaptation in terms of organ transplantation, both at national levels and within countries, with detrimental consequences for waitlisted patients. Understanding how different countries and health-care systems responded to COVID-19-related challenges could facilitate improved pandemic preparedness, notably, how to safely maintain transplant programmes, both with immediate and non-immediate life-saving potential, to prevent loss of patient life-years. FUNDING: French national research agency (INSERM) ATIP Avenir and Fondation Bettencourt Schueller.


Assuntos
COVID-19/epidemiologia , Saúde Global/estatística & dados numéricos , Transplante de Órgãos/estatística & dados numéricos , Pandemias , Humanos
2.
Transpl Immunol ; 68: 101441, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34358637

RESUMO

Highly sensitized (HS) patients accumulate on deceased donor kidney transplantation (DDKT) waitlists worldwide due to matching difficulty and inequity of allocation policies. Current situation of HS patients on KT waitlist in Brazil has not been published. All patients enrolled on the KT waitlist of the State of São Paulo from 2002 to 2017 were retrospectively assessed. Patients were divided into eight groups according to their degree of sensitization, PRA of 0%, >0-40%, >40-80%, >80-85%, >85-90%, >90-95%, >95-98% and > 98%. Cumulative incidence curves for transplantation or mortality/removal from waitlist were estimated by competing risk. Among 50,249 waitlisted candidates, 1247 prioritized, 2467 with age < 18 or > 75 years and 4152 submitted to living-donor KT were excluded from the analysis, remaining 42,383 patients. There were 29,664(70%) PRA 0%, 5611(13.2%) PRA > 0-40%, 3442(8.2%) PRA > 40-80%, 507(1.2%) PRA > 80-85%, 564(1.3%) PRA > 85-90%, 825(1.9%) PRA >90-95%, 859(2%) PRA > 95-98% and 911(2.2%) PRA > 98%. There was a progressive increase in the need of prioritization, waiting time for KT or on waitlist and time on dialysis as PRA increased (p < 0.001). Probability of DDKT clearly increased as PRA decreased so that PRA 0% candidates were much more likely to be transplanted compared to PRA > 98% patients(HR:13.02, p < 0.001). Waiting list mortality/removal was higher among PRA > 0-40%(HR1.05,p = 0.03), PRA > 90-95%(HR:1.10,p = 0.05), PRA > 95-98%(HR:1.26,p < 0.001) and PRA > 98%(HR:1.09,p = 0.05) patients compared to PRA zero candidates. HS patients in Sao Paulo-Brazil required greater prioritization due to lack of venous access, longer dialysis and waitlist times, lower probability of DDKT and higher rates of waitlist mortality/removal. We confirmed the disparity of access to KT among HS patients in Sao Paulo-Brazil, indicating the need of new strategies that optimize transplantation for this subcategory of patients.


Assuntos
Transplante de Rim , Idoso , Brasil , Humanos , Diálise Renal , Estudos Retrospectivos , Listas de Espera
3.
Quintessence Int ; 52(10): 868-878, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34076379

RESUMO

OBJECTIVE: The aim of the present study was to evaluate the efficacy of Passiflora incarnata L for the control of anxiety during third mandibular molar extraction and compare it to midazolam, the most used benzodiazepine in dentistry. METHOD AND MATERIALS: The investigators implemented a prospective, randomized, double-blind, split-mouth study. The degree of anxiety of the patients was assessed before the surgical procedure. The surgeries took place in two sessions: one on each side of the hemi-mandible and, on each of them, the patient received one of the drugs, crosswise. Anxiety control was measured through physical parameters, at the following periods during the surgery: (1) immediately administration of anxiolytic medication, (2) 30 minutes after anxiolytic medication, (3) after extraoral antisepsis, (4) after local anesthesia, (5) during incision, (6) during osteotomy, (7) between osteotomy and odontosection, (8) during odontosection, (9) during surgical store curettage, (10) during suture, and (11) immediately after postoperative care guidelines. Lastly, the volunteers received a self-assessment form in order to report their experience. Statistical analysis was performed using the Wilcoxon test. RESULTS: The final sample was composed of 20 patients, with a mean age of 22.5 years. The results of the physical parameters showed statistically significant differences (P < .05) for certain times and physical parameters, especially heart rate (P = .036), which showed the highest control for Passiflora at time point (3). The undesirable effects reported by patients such as drowsiness, muscle relaxation, and dizziness were greater with benzodiazepine. CONCLUSION: The results of this study suggest that Passiflora may be considered as an alternative to midazolam in controlling anxiety in dentistry. Future studies will focus on other benzodiazepines and herbal medicines.


Assuntos
Sedação Consciente , Passiflora , Preparações de Plantas/uso terapêutico , Extração Dentária , Adulto , Estudos Cross-Over , Método Duplo-Cego , Humanos , Dente Serotino/cirurgia , Boca , Passiflora/química , Extratos Vegetais , Estudos Prospectivos , Adulto Jovem
4.
Brasília; IPEA; 2021. 28 p. ilus.(Nota Técnica / IPEA. Dirur, 22).
Monografia em Português | LILACS, ECOS | ID: biblio-1152605

RESUMO

Nesta NT, a abordagem se voltará ao período que compreende desde os primeiros casos e óbitos no país, até 30 de novembro de 2020. Terá como objetivo retomar algumas hipóteses levantadas na NT nº 16 (Pêgo et al., 2020), elaborada com base em informações até 15 de abril de 2020, e avançar na prospecção de tendências. Encontra-se organizada em cinco seções, sendo a primeira esta introdução. Na segunda, serão atualizadas a leitura da posição do país no contexto geral da pandemia, a análise dos números registrados e a distribuição de casos e óbitos no território. A terceira discorrerá sobre os impactos do fechamento das fronteiras com os países limítrofes, particularmente em relação aos arranjos transfronteiriços. Na quarta seção, a abordagem particularizará as relações transfronteiriças e vulnerabilidades dos povos indígenas frente à Covid-19. A NT será finalizada, em sua quinta seção, com algumas considerações sínteses ou complementares.


Assuntos
Coronavirus , Infecções por Coronavirus , Pandemias , Política Pública , Sistema Único de Saúde , Brasil
5.
Brasília; IPEA; 2021. 28 p. ilus.(Nota Técnica / IPEA. Dirur, 21).
Monografia em Português | ECOS, LILACS | ID: biblio-1152603

RESUMO

Nesta NT, a abordagem se voltará ao período que compreende desde os primeiros casos e óbitos no país até 30 de novembro de 2020. Terá como objetivo retomar algumas hipóteses levantadas na NT n° 16/2020 (Pêgo et al., 2020), elaborada com base em informações até 15 de abril de 2020, e avançar na prospecção de tendências. Encontra-se organizada em cinco seções, sendo a primeira esta introdução. Na segunda seção, será atualizada a análise das medidas e decisões das esferas de governo, federal e estaduais, no enfrentamento à Covid-19 e das medidas econômicas dos estados, segundo grandes regiões, culminando com os números sobre a evolução dos óbitos nas Unidades da Federação (UF). A terceira seção está dedicada à vulnerabilidade socioespacial e ao direito à moradia durante a pandemia, com ênfase nas precárias condições de enfrentamento em regiões carentes das periferias metropolitanas. Na quarta seção, a análise se volta ao enfrentamento da Covid-19 por meio do desenvolvimento de vacinas e de agentes terapêuticos, abordando sucintamente as reincidências pandêmicas. Na quinta e última seção, estarão as considerações finais.


Assuntos
Adaptação Psicológica , Coronavirus , Infecções por Coronavirus , Mortalidade , Pandemias , Vacinas , Vulnerabilidade Social , Brasil
6.
J Exp Orthop ; 7(1): 75, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32990809

RESUMO

PURPOSE: This study aims to describe and biomechanically evaluate a novel technique using a strip of the flexor carpi ulnaris tendon for distal radioulnar joint reconstruction. METHODS: Surgical technique was thoroughly detailed, and a cadaveric biomechanical test was conducted to evaluate sagittal plane stability. Pronosupination range of motion was measured before and after the procedure. Dorsal and volar translation resistances were checked in three situations: with the uninjured triangular fibrocartilage complex, after its complete resection and after the surgical procedure. RESULTS: For distal radioulnar joint translation, higher values were found both in dorsal and volar translation in situations with an injured triangular fibrocartilage complex, with means equal to 25.4 mm (SD: 9.4 mm) and 26.1 mm (SD: 8.0 mm), respectively. For intact triangular fibrocartilage complex, both dorsal and volar translations averages were 3.4 mm (SD: 0.9 mm) and 4.5 mm (SD: 1.8 mm), respectively. Finally, when evaluating dorsal and volar translations after surgical reconstruction, means were 6.3 mm (SD: 1.3 mm) and 6.8 mm (SD: 0.9 mm), respectively. Regarding supination and pronation range of motion, which ranged from 57.9 to 63.4o, there were no differences in mean and median measures, when the cadavers with intact and reconstructed triangular fibrocartilage complex were compared (p > 0.05). CONCLUSION: Promising mechanical evaluations encourage us to hypothesize that the technique effectively reconstructs the dorsal and volar radioulnar ligaments, preserving pronosupination and maintaining the physiological characteristics of the wrist joint. Clinical comparative studies are still necessary to fully validate this procedure. LEVEL OF EVIDENCE: Therapeutic - Level V.

7.
Brasília; IPEA; 20200500. 60 p. ilus.(Nota Técnica / IPEA. Dirur, 16).
Monografia em Português | LILACS, ECOS | ID: biblio-1102189

RESUMO

Esta nota técnica (NT) tem como objetivo analisar a trajetória da pandemia após cruzar as fronteiras do território brasileiro, avaliar as medidas adotadas para sua contenção e encaminhar sugestões. Este estudo terá como grande questão norteadora responder de que forma o Brasil se preparou para enfrentar esse evento global, tendo exemplos de medidas empreendidas por países que já enfrentavam a então epidemia do Sars-COV-2, e que ações desencadeou, com particular atenção ao papel de suas fronteiras. Nesse sentido, serão destacadas as principais medidas adotadas e apontadas aquelas que necessitam de uma maior adequação à realidade local e regional na fronteira brasileira, diante da propagação exponencial do vírus no país. Para tanto, serão consideradas informações sistematizadas pelo Ministério da Saúde (MS), pela Organização Mundial da Saúde (OMS) e pela Fundação Oswaldo Cruz (Fiocruz) em suas análises sobre o processo e na orientação das medidas a serem tomadas em relação ao que se pode chamar de a grande crise humanitária desde o início deste século.


Assuntos
Áreas de Fronteira , Sistema Único de Saúde , Infecções por Coronavirus , Coronavirus , Pandemias
8.
Diabetes Metab Syndr ; 14(2): 155-157, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32088646

RESUMO

AIM: To verify if the guidelines are being followed for the treatment of patients with type 1 diabetes mellitus (T1DM) who receive insulin by lawsuits. METHODS: A descriptive study was conducted with secondary data of these patients in a Brazilian city. RESULTS: 53.9% acquired insulin by lawsuits without previously registered use of another insulin in the Public Health System (SUS). CONCLUSION: The guidelines are not being followed for most patients analyzed, which may result in unnecessary expenses for the SUS. Therefore, this data can support the awareness of prescribers in relation to the savings generated for municipalities through the follow-up of the guidelines.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Fidelidade a Diretrizes/legislação & jurisprudência , Insulina/economia , Adolescente , Adulto , Brasil , Feminino , Fidelidade a Diretrizes/economia , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
Rev. bras. med. fam. comunidade ; 15(42): 2561, 20200210. tab
Artigo em Português | LILACS | ID: biblio-1282585

RESUMO

Introdução: O aumento contínuo do número de processos de judicialização da saúde, a relevância epidemiológica do diabetes mellitus tipo 2 (DM2), a escassez de recursos utilizados para monitorar os investimentos dos processos judiciais e do seu alto custo para a saúde pública, diante disso torna-se necessário estudos que analisem o perfil da judicialização dos antidiabéticos, que é a principal classe de medicamentos alvo dos processos judiciais. Objetivo: Analisar se os pacientes com DM2 atendidos via judicial, foram acompanhados e monitorados no Sistema Único de Saúde (SUS) antes e após os processos judiciais. Além de analisar o perfil de medicamentos judicializados para tratamento da DM2. Métodos: Trata-se de um estudo longitudinal retrospectivo, que utilizou dados secundários, prontuários e arquivos de processos judiciais, de 56 pacientes com DM2 que adquiriram pelo menos um de seus medicamentos por meio da judicialização, no ano de 2019, em um município mineiro. Os dados foram analisados 12 meses antes e 12 meses após a judicialização. Resultados: Dentre as 56 ações judiciais, 39% se concentraram em apenas três unidades de saúde do município. Somente 30 pacientes (53%) antes e 29 (51%) após a judicialização tiveram consultas no SUS. Além disso, apenas 15 (26%) e 13 (23%) pacientes, respectivamente antes e após a judicialização, apresentaram algum exame laboratorial realizado pelo SUS. As insulinas Levemir Flex Pen® (13%), Novo Rapid® (11%) e Lantus® (7%) foram os medicamentos mais judicializados. Conclusão: Observou-se que apesar do SUS prover o insumo terapêutico de elevado custo por meio de uma porta de entrada não convencional, não há monitorização clínica e laboratorial para avaliação da efetividade do uso da tecnologia, conforme recomendam os protocolos clínicos e dispositivos legais brasileiros sobre acesso a medicamentos.


Introducción: El aumento continuo en el número de procesos de judicialización de la salud, la relevancia epidemiológica de la diabetes mellitus tipo 2 (DM2), la escasez de recursos utilizados para monitorear las inversiones en procesos judiciales y de su alto costo para la salud pública, se vuelven necesarios estudios que analicen el perfil de la judicialización de los antidiabéticos, que es la principal clase de medicamentos a las que se dirigen los procesos judiciales. Objetivo: Analizar si los pacientes con DM2 atendidos vía judicial, fueron acompañados y monitoreados en el Sistema Único de Salud (SUS) antes y después de los procesos judiciales. Además de analizar el perfil de las drogas legalizadas para el tratamiento de la DM2. Métodos: Se trata de un estudio retrospectivo longitudinal, que utilizó datos secundarios, registros médicos y archivos de demandas, de 56 pacientes con DM2 que adquirieron al menos uno de sus medicamentos a través de la judicialización, en el año 2019, en un municipio de Minas Gerais. Los datos fueron analizados 12 meses antes y 12 meses después de la judicialización. Resultados: Entre las 56 acciones judiciales, el 39% se concentró en solo tres unidades de salud en el municipio. Solo 30 pacientes (53%) antes y 29 (51%) después de la judicialización tuvieron consultas en el SUS. Además, solo 15 (26%) y 13 (23%) pacientes, respectivamente antes y después de la judicialización, se sometieron a pruebas de laboratorio realizadas por el SUS. Las insulinas Levemir Flex Pen® (13.0%), Novo Rapid® (11%) y Lantus® (7%) fueron los medicamentos más judicializadas. Conclusión: Se observó que a pesar de que el SUS proporciona un recurso terapéutico de alto costo a través de una puerta de entrada no convencional, no hay monitoreo clínico y laboratorial para la evaluación de la efectividad del uso de la tecnología, según lo recomendado por los protocolos clínicos y dispositivos legales brasileros sobre el acceso a medicamentos.


Introduction: The continuous increase in the number of health judicialization processes, the epidemiological relevance of type 2 diabetes mellitus (DM2), the scarcity of resources used to monitor the investments of lawsuits, and their high cost to public health, that said there is a need for studies that analyze the profile of the judicialization of antidiabetics, which is the main class of drugs targeted by lawsuits. Objective: To analyze whether patients with DM2 attended by judicial system, are followed up and monitored in Brazilian Public Health System (SUS) before and after judicial proceedings. In addition to analyzing the profile of drugs legalized for the treatment of DM2. Methods: A retrospective observational study, which secondary database, medical records and judicial files, was conducted with 56 patients with DM2 who have acquired at least one of their medicines through lawsuits, in 2019, in a city in Minas Gerais. The data were analyzed 12 months before and 12 months after judicialization process. Results: Among the 56 lawsuits, 39% were concentrated in only three health units. Only 30 patients (53%) before and 29 (51%) after judicialization had appointments in SUS. Furthermore, only 15 (26%) and 13 (23%) patients, respectively before and after judicialization, had some laboratory test performed by SUS. The insulins Levemir Flex Pen® (13%), Novo Rapid® (11%), and Lantus® (7%) were the most judicialized drugs. Conclusion: It was observed that despite the SUS providing the high-cost therapeutic input through an unconventional gateway, there is no clinical and laboratory monitoring to evaluate the effectiveness of the technology, as recommended by clinical protocols and Brazilian laws about access to medicines.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Assistência Farmacêutica , Acesso à Informação , Diabetes Mellitus Tipo 2 , Judicialização da Saúde , Cobertura Universal do Seguro de Saúde
10.
Tempo Mundo (Brasília) ; (23): 203-233, 2020.
Artigo em Português | ECOS, ColecionaSUS | ID: biblio-1150267

RESUMO

Atualmente, o Sars-COV-2 se encontra disseminado por uma vasta área geográfica no mundo. A trajetória da pandemia após cruzar as fronteiras do território brasileiro (terrestre e litorânea), acompanhada de uma avaliação das medidas adotadas para sua contenção e os principais conflitos observados e apresentados no presente estudo, cumpre o objetivo de apontar questões atuais e futuras de políticas públicas para o enfrentamento da pandemia nas fronteiras brasileiras. Os resultados das análises realizadas demonstram que as áreas de maior concentração e adensamento populacional urbanos foram as mais afetadas pela contaminação do vírus. No entanto, a Covid-19 não poupou municípios menores, o que se observa pelo seu alastramento no território seguindo os caminhos da mobilidade rodoviária, fluvial e aérea no interior do Brasil. Sobre seu reflexo na área de fronteira, observa-se tanto um conflito interfederativo, com um quadro de descompasso entre medidas do governo federal e unidades subnacionais, quanto a inexistência de diálogos e acordos com os países vizinhos. Como sugestões, apontam-se a criação de instrumentos, protocolos, medidas e mecanismos para o enfrentamento da crise da pandemia da Covid-19 em áreas de fronteira terrestre e litorânea do Brasil.


Nowadays Sars-COV-2 is spread over a vast geographical area in the world. The trajectory of the pandemic after crossing the borders of the Brazilian territory (land and coastal), accompanied by an assessment of the measures adopted for its containment and the main conflicts observed and presented in the present study, fulfill the objective of pointing out current and future public policy issues to tackle the pandemic on Brazilian borders. The results of the analyzes carried out demonstrate that the areas with the highest concentration and urban population density were the most affected by virus contamination. However, Covid-19 did not spare smaller municipalities, which is observed by its spread in the territory following the paths of road, river and air mobility in the interior of Brazil. Regarding its reflection in the border area, there is both an inter-federative conflict, with a picture of mismatch between measures of the federal government and subnational units, and the absence of dialogues and agreements with neighboring countries. As suggestions, we point out the creation of instruments, protocols, measures and mechanisms to face the Covid-19 pandemic crisis in land and coastal borderline areas of Brazil.


Actualmente la Sars-COV-2 se extiende sobre una vasta área geográfica en el mundo. La trayectoria de la pandemia después de cruzar las fronteras del territorio brasileño (terrestre y costero), acompañada de una evaluación de las medidas adoptadas para su contención y los principales conflictos observados y presentados en el presente estudio, cumplen el objetivo de señalar los problemas de política pública actuales y futuros para hacer frente a la pandemia en las fronteras brasileñas. Los resultados de los análisis realizados demuestran que las áreas con mayor concentración y densidad de población urbana fueron las más afectadas por la contaminación viral. Sin embargo, el Covid-19 no perdonó a los municipios más pequeños, lo que se observa por su extensión en el territorio siguiendo los caminos de la movilidad por carretera, río y aire en el interior de Brasil. En cuanto a su reflejo en el área fronteriza, existe un conflicto interfederativo, con un desajuste entre las medidas del gobierno federal y las unidades subnacionales, y la ausencia de diálogos y acuerdos con los países vecinos. Como sugerencias, señalamos la creación de instrumentos, protocolos, medidas y mecanismos para enfrentar la crisis pandémica de Covid-19 en las zonas fronterizas terrestres y costeras de Brasil.


Assuntos
Brasil , Coronavirus , Infecções por Coronavirus , Pandemias
11.
J Oral Maxillofac Surg ; 77(9): 1796.e1-1796.e8, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31158346

RESUMO

PURPOSE: The objective of the present study was to evaluate the effectiveness of an herbal drug (valerian) to control anxiety during mandibular third molar extraction compared with a reference benzodiazepine drug commonly used in dental procedures (midazolam). MATERIALS AND METHODS: Twenty anxious patients with an indication for bilateral extraction of mandibular third molars were selected. The patients received capsules containing valerian 100 mg or midazolam 15 mg orally 60 minutes before the procedures in a randomized, split-mouth, crossover design. Changes in the physiological parameters (eg, oxygen saturation, heart rate, blood pressure, respiratory rate) were assessed at specific times during surgery, and the patients completed a questionnaire postoperatively. The data were analyzed using the Wilcoxon and paired t tests, with a significance level of 5%. RESULTS: No statistically significant differences in oxygen saturation were observed, regardless of the drug used. However, the other physiological parameters were significantly lower when the patients had taken midazolam compared with valerian. Somnolence was the most common side effect reported with both drugs. CONCLUSIONS: Although midazolam was more effective in reducing the physiological parameters studied, valerian seemed to provide the comfort and relaxation required, with no sedation and less somnolence than midazolam, during third molar extraction. Further studies are necessary before valerian can be clinically recommended.


Assuntos
Sedação Consciente , Dente Serotino , Extratos Vegetais , Extração Dentária , Valeriana , Estudos Cross-Over , Método Duplo-Cego , Humanos , Dente Serotino/cirurgia , Extratos Vegetais/uso terapêutico
12.
BMC Musculoskelet Disord ; 19(1): 427, 2018 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-30501623

RESUMO

BACKGROUND: Studies have shown that cytokines play a role in bone remodeling. METHODS: In 1993, all hospital births occurred in Pelotas (Brazil) were identified and a total of 5249 newborns were included in the present cohort. Sub-samples of this cohort were visited during childhood and all members were traced at 11, 15, 18 and 22 years old. At 18 and 22 years the following biomarkers were measured: IL-6, CRP and adiponectin (the last one in a sub-sample) and bone mineral density (BMD-mg/cm2) was evaluated at 22 years. Crude regression analysis as well as adjusted for confounders (birth weight, pregnancy maternal smoking, gestational age, skin color, schooling, income, smoking, alcohol, physical activity, medical diagnosis of asthma, diabetes and hypertension, BMI, height, calcium intake, corticosteroid use, age at menarche, insulin and testosterone) were performed between the three biomarkers and the whole-body, lumbar spine and femoral BMD. RESULTS: No statistical significant association was found between IL-6 and CRP with BMD, in males. Significant inverse association in the adjusted analysis, among females, was found for the highest tertiles of CRP at 22 y (beta - 15.2 mg/cm2; 95% CI: -25.4; - 4.9; p = 004), of CRP and IL-6 at 22 years (beta - 20.0 mg/cm2; 95% CI: -31.7; - 8.3; p = 0.003), and of IL-6 and CRP at both ages (beta - 20.3 mg/cm2; 95% CI: -38.0; - 2.5; p = 0.001) with total body BMD. Significant association, among males, was also found between the highest tertile of adiponectin at 22 y (beta - 23.3 mg/cm2; 95% CI: -35.5; - 11.1; p = < 001; beta - 22.5 mg/cm2; 95% CI: -42.9; - 2.2; p = 0.03; and beta - 31.8 mg/cm2; 95% CI: -55.5; - 9.1; p = 0.006) and total body, lumbar spine and femur neck BMD, respectively; and, among females, - 17.8 mg/cm2; 95% CI: -34.9; - 0.9; p = 0.033, with lumbar spine BMD. CONCLUSION: CRP at 22 years, in females, seems to be a marker for total body BMD; adiponectin at 22 years is also a marker for BMD at the three sites, in males, and for lumbar spine BMD, in females.


Assuntos
Adiponectina/sangue , Densidade Óssea , Proteína C-Reativa/análise , Interleucina-6/sangue , Adolescente , Antropometria , Biomarcadores/sangue , Criança , Fatores de Confusão Epidemiológicos , Feminino , Colo do Fêmur/fisiologia , Humanos , Estudos Longitudinais , Vértebras Lombares/fisiologia , Masculino , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
13.
HU rev ; 43(4): 407-413, 2017.
Artigo em Português | LILACS | ID: biblio-980613

RESUMO

O transplante renal é descrito como a melhor terapêutica para pacientes com doença renal crônica terminal, pois promove maior qualidade de vida ao paciente e está associado a outros benefícios, como a diminuição de custos em saúde. Objetivou-se analisar as características da população que se encontra em lista única de espera para realização do transplante renal em Juiz de Fora. Estudo quantitativo, transversal de cunho descritivo, retrospectivo, que foi realizado em uma clínica que é referência para tratamento de doenças renais. Os dados foram coletados por meio de consulta no prontuário e ficha de atendimento dos pacientes atendidos na clínica no período de Dezembro de 2014 a Janeiro de 2015. Em lista única de espera, encontravam-se 252 pacientes, sendo que 51,6% eram do sexo masculino, 55,6% com escolaridade até o ensino fundamental, 46,5% de raça branca, 61,1% de religião católica e 54,4% eram do tipo sanguíneo O. Um total de 38,5% com renda mensal de 3 a 4 salários mínimos, 46,0% casados, 69,0% possuíam casa própria e 69,0% eram provenientes de outras cidades. Em relação a modalidade de tratamento dialítico, 90,9% realizavam hemodiálise. Além disso, 62,5% já haviam realizado transfusões sanguíneas, 44,8% faziam o uso contínuo de mais de seis medicações e 27,5% tinham causa desconhecida para a doença renal crônica. O perfil dos pacientes encontrados em lista única de espera no centro analisado, como também o tempo em lista é semelhante a estudos nacionais. Demonstrando a similaridade do serviço prestado ao restante do país, apesar da cidade encontrar-se no interior de Minas Gerais.


Kidney transplantation is described as the best therapy for patients with end-stage renal disease, since it promotes a better quality of life for the patient and is associated with other benefits, such as the reduction of health costs. The objective of this study was to analyze the characteristics of the population that is in a single waiting list for renal transplantation in Juiz de Fora. This is a quantitative, cross-sectional, descriptive, retrospective study that was performed in a clinic that is a reference for the treatment of renal diseases. The data were collected by means of a consultation in the medical records and attendance form of the patients attended at the clinic from December 2014 to January 2015. A single waiting list included 252 patients, of whom 51.6% were from the male, 55.6% with primary schooling, 46.5% white, 61.1% Catholic, and 54.4% were of blood type O. A total of 38.5% with monthly income from 3 to 4 minimum wages, 46.0% married, 69.0% owned their own house and 69.0% came from other cities. Regarding the mode of dialysis treatment, 90.9% underwent hemodialysis. In addition, 62.5% had blood transfusions, 44.8% had continued use of more than six medications and 27.5% had an unknown cause for chronic kidney disease. The profile of the patients found in a single waiting list in the analyzed center, as well as the time in list is similar to the national studies. Demonstrating the similarity of the service provided to the rest of the country, despite the city being in the interior of Minas Gerais.


Assuntos
Transplante de Rim , Insuficiência Renal Crônica , Qualidade de Vida , Perfil de Saúde , Listas de Espera , Custos de Cuidados de Saúde , Custos e Análise de Custo , Atenção à Saúde
14.
Indian J Med Ethics ; 8(2): 112-4, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22106622

RESUMO

Brazil has established the largest public kidney transplantation system in the world .46.2% of transplants in 2008 came from living donors. The vast majority of these involved relatives of the recipient; less than 8% came from unrelated donors. In 2008, Brazil's health minister proposed banning unrelated donors in kidney transplantation. A large number of the over 35,000 Brazilians on the waiting list for a kidney would be denied a transplant without the use of unrelated donors. Brazilian culture has a unique feature, the "informal family", that is not legally recognised as a "family entity and is bound by affection rather than genetic or legal ties. It is vital that Brazil establishes a regulated, standardised, and ethical system of organ procurement; creates awareness about transplantation in physicians and the public; upgrades facilities and standardises medical care, and enforces legislation for transplantation. However, outlawing the use of unrelated donors would result in injustice for many patients who seek kidneys.


Assuntos
Transplante de Rim/ética , Doadores Vivos/ética , Doadores Vivos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Brasil , Setor de Assistência à Saúde/ética , Setor de Assistência à Saúde/legislação & jurisprudência , Humanos
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