Assuntos
Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Hepatite B/diagnóstico , Programas de Rastreamento/métodos , Adulto , Idoso , Antivirais/administração & dosagem , Antivirais/economia , Antivirais/uso terapêutico , Austrália/epidemiologia , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Fibrose/economia , Fibrose/epidemiologia , Fibrose/prevenção & controle , Acessibilidade aos Serviços de Saúde/normas , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Vacinas contra Hepatite B/administração & dosagem , Vacinas contra Hepatite B/uso terapêutico , Humanos , Neoplasias Hepáticas/economia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/prevenção & controle , Programas de Rastreamento/normas , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , PrevalênciaAssuntos
Fibrose/epidemiologia , Hepatite B/epidemiologia , Hepatite D/epidemiologia , Vírus Delta da Hepatite/isolamento & purificação , Hepatopatias/virologia , Adulto , Doença Crônica , Feminino , Fibrose/mortalidade , Carga Global da Doença , Antígenos de Superfície da Hepatite B/imunologia , Vírus da Hepatite B/isolamento & purificação , Hepatite D/complicações , Hepatite D/tratamento farmacológico , Hepatite D/mortalidade , Vírus Delta da Hepatite/imunologia , Humanos , Incidência , Interferon-alfa/economia , Interferon-alfa/uso terapêutico , Lipopeptídeos/uso terapêutico , Hepatopatias/epidemiologia , Hepatopatias/imunologia , Masculino , Pessoa de Meia-Idade , Piperidinas/uso terapêutico , Prevalência , Piridinas/uso terapêutico , Fatores de Risco , Superinfecção/complicações , Uzbequistão/epidemiologiaRESUMO
Low endogenous testosterone and sex hormone-binding globulin (SHBG) concentrations have been reported to be associated with metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD). However, little is known about the relationships between testosterone or SHBG and liver fibrosis in NAFLD. Thus, we aimed to clarify the relationships between serum testosterone or SHBG concentration and fibrosis-4 (FIB-4) index, a marker of liver fibrosis. Serum testosterone was assayed in various forms (total testosterone [TT], calculated free testosterone [cFT], calculated bioavailable testosterone [cbT], and SHBG) and metabolic markers were also measured in 363 Japanese men (mean age 51.1 ± 8.7 years) at routine health examinations. We then attempted to identify the factors contributing to liver fibrosis by investigating the associations between the metabolic markers, including testosterone, and FIB-4 index. People with a relatively high FIB-4 index (≥1.3) demonstrated lower cFT, cbT, homeostasis model assessment (HOMA)-ß, low-density lipoprotein-cholesterol, and blood urea nitrogen, but higher SHBG, than those with a lower FIB-4 index (<1.3). There were no significant differences in HbA1c, fasting glucose concentration, HOMA-R, or metabolic syndrome prevalence between the two groups. Binary regression analysis revealed that SHBG ≥52 nmol/L and cFT <8.0 ng/dL were statistically significant risk factors for FIB-4 index ≥1.3. Receiver operating characteristic analysis revealed that cFT <7.62 ng/dL (area under the curve [AUC] = 0.639) and SHBG ≥49.8 nmol/L (AUC = 0.649) were the strongest risk factors for FIB-4 index ≥1.3. In contrast to previous findings showing low SHBG concentrations in NAFLD, we provide evidence that high SHBG and low bioactive testosterone are associated with liver fibrosis.
Assuntos
Indicadores Básicos de Saúde , Cirrose Hepática/diagnóstico , Globulina de Ligação a Hormônio Sexual/análise , Adulto , Biomarcadores/análise , Biomarcadores/sangue , Fibrose/sangue , Fibrose/diagnóstico , Fibrose/epidemiologia , Humanos , Japão/epidemiologia , Cirrose Hepática/sangue , Cirrose Hepática/epidemiologia , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Fatores de Risco , Globulina de Ligação a Hormônio Sexual/metabolismo , Testosterona/sangueRESUMO
Patients with Crohn's disease commonly develop ileal and less commonly colonic strictures, containing various degrees of inflammation and fibrosis. While predominantly inflammatory strictures may benefit from a medical anti-inflammatory treatment, predominantly fibrotic strictures currently require endoscopic balloon dilation or surgery. Therefore, differentiation of the main components of a stricturing lesion is key for defining the therapeutic management. The role of endoscopy to diagnose the nature of strictures is limited by the superficial inspection of the intestinal mucosa, the lack of depth of mucosal biopsies and by the risk of sampling error due to a heterogeneous distribution of inflammation and fibrosis within a stricturing lesion. These limitations may be in part overcome by cross-sectional imaging techniques such as ultrasound, CT and MRI, allowing for a full thickness evaluation of the bowel wall and associated abnormalities. This systematic literature review provides a comprehensive summary of currently used radiologic definitions of strictures. It discusses, by assessing only manuscripts with histopathology as a gold standard, the accuracy for diagnosis of the respective modalities as well as their capability to characterise strictures in terms of inflammation and fibrosis. Definitions for strictures on cross-sectional imaging are heterogeneous; however, accuracy for stricture diagnosis is very high. Although conventional cross-sectional imaging techniques have been reported to distinguish inflammation from fibrosis and grade their severity, they are not sufficiently accurate for use in routine clinical practice. Finally, we present recent consensus recommendations and highlight experimental techniques that may overcome the limitations of current technologies.
Assuntos
Doença de Crohn/epidemiologia , Obstrução Intestinal/epidemiologia , Intestino Delgado/patologia , Imagem Multimodal/métodos , Comorbidade , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/epidemiologia , Constrição Patológica/patologia , Doença de Crohn/diagnóstico por imagem , Doença de Crohn/patologia , Estudos Transversais , Técnicas de Imagem por Elasticidade/métodos , Feminino , Fibrose/diagnóstico por imagem , Fibrose/epidemiologia , Humanos , Incidência , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/patologia , Intestino Delgado/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Masculino , Prognóstico , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia Doppler/métodosRESUMO
Background/Aim: Due to epidemic levels of obesity and type 2 diabetes mellitus (DM), nonalcoholic fatty liver disease (NAFLD) and resulting nonalcoholic steatohepatitis (NASH) will be driving factors in liver disease burden in the coming years in Saudi Arabia and United Arab Emirates (UAE). Materials and Methods: Models were used to estimate NAFLD and NASH disease progression, primarily based on changes in adult prevalence rates of adult obesity and DM. The published estimates and expert interviews were used to build and validate the model projections. Results: In both countries, the prevalence of NAFLD increased through 2030 parallel to projected increases in the prevalence of obesity and DM. By 2030, there were an estimated 12,534,000 NAFLD cases in Saudi Arabia and 372,000 cases in UAE. Increases in NASH cases were relatively greater than the NAFLD cases due to aging of the population and disease progression. Likewise, prevalent cases of compensated cirrhosis and advanced liver disease are projected to at least double by 2030, while annual incident liver deaths increase in both countries to 4800 deaths in Saudi Arabia and 140 deaths in UAE. Conclusions: Continued high rates of adult obesity and DM, in combination with aging populations, suggest that advanced liver disease and mortality attributable to NAFLD/NASH will increase across both countries. Reducing the growth of the NAFLD population, along with potential therapeutic options, will be needed to reduce liver disease burden.
Assuntos
Hepatopatias/epidemiologia , Fígado/patologia , Hepatopatia Gordurosa não Alcoólica/economia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Adulto , Efeitos Psicossociais da Doença , Diabetes Mellitus Tipo 2/epidemiologia , Progressão da Doença , Feminino , Fibrose/epidemiologia , Fibrose/mortalidade , Humanos , Hepatopatias/mortalidade , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/mortalidade , Obesidade/epidemiologia , Prevalência , Arábia Saudita/epidemiologia , Emirados Árabes Unidos/epidemiologiaRESUMO
Successful eradication of recurrent hepatitis C virus (HCV) infection following liver transplantation (HCV) improves graft survival. This study aimed at evaluation of hepatic fibrosis changes among long-term responders to DAA therapy for recurrent HCV after liver transplantation using noninvasive methods. Patients with significant hepatic fibrosis (≥F2) who achieved SVR12 after treatment with DAAs for recurrent HCV were included (n = 52). Hepatic fibrosis status was assessed, noninvasively, by calculation of fibrosis-4 score (FIB-4) and Aspartate Aminotransferase Platelet Ratio Index (APRI) and by measurement of graft stiffness using FibroScan at baseline and 12 and 18 months post-treatment. Acoustic radiation force imaging (ARFI) was done for all patients 12 and 18 months post-treatment. Patients were classified into two groups based on baseline liver stiffness measurement (LSM) by FibroScan; significant fibrosis (F2; n = 28) and advanced fibrosis groups (≥F3). Over 18-month follow-up period, there was serial improvement of FIB-4, APRI, and LSM by FibroScan in both groups. Higher baseline LSM and delayed initiation of antiviral therapy were significant predictors of lack of fibrosis regression (P-value 0.01 and 0.04, respectively). Fibroindices and LSM improved over time in liver transplant recipients who responded to DAAs. Baseline LSM can predict post-treatment fibrosis regression.
Assuntos
Antivirais/uso terapêutico , Biomarcadores/metabolismo , Fibrose/diagnóstico , Hepacivirus/isolamento & purificação , Hepatite C/tratamento farmacológico , Hepatite C/cirurgia , Transplante de Fígado/métodos , Adolescente , Adulto , Idoso , Egito/epidemiologia , Feminino , Fibrose/epidemiologia , Fibrose/metabolismo , Seguimentos , Hepatite C/virologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Resultado do Tratamento , Adulto JovemRESUMO
Importance: Cirrhosis is associated with hemorrhagic and thrombotic extrahepatic complications. The risk of cerebrovascular complications is less well understood. Objective: To investigate the association between cirrhosis and various stroke types. Design, Setting, and Participants: We performed a retrospective cohort study using inpatient and outpatient Medicare claims data from January 1, 2008, through December 31, 2014, for a random 5% sample of 1 618 059 Medicare beneficiaries older than 66 years. Exposures: Cirrhosis, as defined by a validated diagnosis code algorithm. Main Outcomes and Measures: The primary outcome was stroke, and secondary outcomes were ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage as defined by validated diagnosis code algorithms. Results: Among 1â¯618â¯059 beneficiaries, 15â¯586 patients (1.0%) had cirrhosis (mean [SD] age, 74.1 [6.9] years; 7263 [46.6%] female). During a mean (SD) of 4.3 (1.9) years of follow-up, 77â¯268 patients were hospitalized with a stroke. The incidence of stroke was 2.17% (95% CI, 1.99%-2.36%) per year in patients with cirrhosis and 1.11% (95% CI, 1.10%-1.11%) per year in patients without cirrhosis. After adjustment for demographic characteristics and stroke risk factors, patients with cirrhosis had a higher risk of stroke (hazard ratio [HR], 1.4; 95% CI, 1.3-1.5). The magnitude of association appeared to be higher for intracerebral hemorrhage (HR, 1.9; 95% CI, 1.5-2.4) and subarachnoid hemorrhage (HR, 2.4; 95% CI, 1.7-3.5) than for ischemic stroke (HR, 1.3; 95% CI, 1.2-1.5). Conclusions and Relevance: In a nationally representative sample of Medicare beneficiaries, cirrhosis was associated with an increased risk of stroke, particularly hemorrhagic stroke. A potential explanation of these findings implicates the mixed coagulopathy observed in cirrhosis.
Assuntos
Fibrose/epidemiologia , Medicare/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
The treatment of chronic hepatitis C has considerably changed with the introduction of recent direct acting antivirals. These antivirals have sustained virologic response (SVR) rates above 90â% as well as reduced toxicity and treatment duration. Therefore, current German guidelines recommend these interferon-free regimens as first-choice treatment. Nevertheless, recent developments were accompanied by a significant increase in treatment costs, which led to extensive discussions on reasonable pharmaceutical prices. The aim of the current study was to analyze the average treatment costs and costs per patient cured for guideline treatment recommendations. Analyses were stratified according to genotype, treatment status (naive/experienced), and presence/absence of cirrhosis. Costs were separated in (1.) basic diagnostic procedures, (2.) monitoring, and (3.) pharmaceuticals. The calculation is based on a remuneration scheme in the statutory health insurance system. In treatment-naïve non-cirrhotic patients, the average cost is 41â766â/SVR for the treatment with SOF/LDV calculated (PTV/r/OMV+DSV: 53â129â/SVR). In treatment-naive cirrhotic patients, costs were 60â323â/SVR (SOF/LDV+RBV) and 80â604â/SVR (PTV/r/OMV+DSV+RBV). Treatment-experienced genotype 1 patients had average costs of 60â366â/SVR for SOF/LDV treatment as well as 53â134â/SVR for PTV/r/OMV+DSV±RBV treatment (cirrhotic patients: 62â208â/SVR for SOF/LDV+RBV; 80â824â/SVR for PTV/r/OMV+DSV+RBV). The average treatment costs per SVR in treatment-naive genotype 1 patients are comparable to previous standard of care treatments and lower in treatment-experienced patients. In other genotypes, treatment costs and costs per cure are significantly higher compared to previous standard of care. However, long-term modelling studies show that new regimens are cost-effective.
Assuntos
Antivirais/economia , Fibrose/economia , Fibrose/prevenção & controle , Custos de Cuidados de Saúde/estatística & dados numéricos , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/economia , Guias de Prática Clínica como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , Antivirais/normas , Antivirais/uso terapêutico , Comorbidade , Simulação por Computador , Feminino , Fibrose/epidemiologia , Alemanha/epidemiologia , Hepatite C Crônica/epidemiologia , Humanos , Interferons/economia , Interferons/uso terapêutico , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Prevalência , Adulto JovemRESUMO
OBJECTIVE: This study compared the cost-effectiveness of direct-acting antiviral therapies currently recommended for treating genotypes (GT) 1 and 4 chronic hepatitis C (CHC) patients in the US. METHODS: A cost-effectiveness analysis of treatments for CHC from a US payer's perspective over a lifelong time horizon was performed. A Markov model based on the natural history of CHC was used for a population that included treatment-naïve and -experienced patients. Treatment alternatives considered for GT1 included ombitasvir/paritaprevir/ritonavir + dasabuvir ± ribavirin (3D ± R), sofosbuvir + ledipasvir (SOF/LDV), sofosbuvir + simeprevir (SOF + SMV), simeprevir + pegylated interferon/ribavirin (SMV + PR) and no treatment (NT). For GT4 treatments, ombitasvir/paritaprevir/ritonavir + ribavirin (2D + R), SOF/LDV and NT were compared. Transition probabilities, utilities and costs were obtained from published literature. Outcomes included rates of compensated cirrhosis (CC), decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC) and liver-related death (LrD), total costs, life-years and quality-adjusted life-years (QALYs). Costs and QALYs were used to calculate incremental cost-effectiveness ratios. RESULTS: In GT1 patients, 3D ± R and SOF-containing regimens have similar long-term outcomes; 3D ± R had the lowest lifetime risks of all liver disease outcomes: CC = 30.2%, DCC = 5.0 %, HCC = 6.8%, LT = 1.9% and LrD = 9.2%. In GT1 patients, 3D ± R had the lowest cost and the highest QALYs. As a result, 3D ± R dominated these treatment options. In GT4 patients, 2D + R had lower rates of liver morbidity and mortality, lower cost and more QALYs than SOF/LDV and NT. LIMITATIONS: While the results are based on input values, which were obtained from a variety of heterogeneous sources-including clinical trials, the findings were robust across a plausible range of input values, as demonstrated in probabilistic sensitivity analyses. CONCLUSIONS: Among currently recommended treatments for GT1 and GT4 in the US, 3D ± R (for GT1) and 2D + R (for GT4) have a favorable cost-effectiveness profile.
Assuntos
Antivirais/economia , Antivirais/uso terapêutico , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , 2-Naftilamina , Adulto , Idoso , Idoso de 80 Anos ou mais , Anilidas/economia , Anilidas/uso terapêutico , Antivirais/administração & dosagem , Benzimidazóis/economia , Benzimidazóis/uso terapêutico , Carbamatos/economia , Carbamatos/uso terapêutico , Carcinoma Hepatocelular/economia , Carcinoma Hepatocelular/epidemiologia , Análise Custo-Benefício , Ciclopropanos , Quimioterapia Combinada , Feminino , Fibrose/economia , Fibrose/epidemiologia , Fluorenos/economia , Fluorenos/uso terapêutico , Genótipo , Humanos , Lactamas Macrocíclicas , Neoplasias Hepáticas/economia , Neoplasias Hepáticas/epidemiologia , Compostos Macrocíclicos/economia , Compostos Macrocíclicos/uso terapêutico , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Modelos Econométricos , Prolina/análogos & derivados , Anos de Vida Ajustados por Qualidade de Vida , Ribavirina/economia , Ribavirina/uso terapêutico , Simeprevir , Sofosbuvir/economia , Sofosbuvir/uso terapêutico , Sulfonamidas/economia , Sulfonamidas/uso terapêutico , Uracila/análogos & derivados , Uracila/economia , Uracila/uso terapêutico , ValinaRESUMO
Schistosoma mansoni disease is endemic in most parts of rural Zambia, and associated complications are common. We conducted a cross-sectional study among 754 people in rural communities of Kaoma District, western Zambia to determine the burden of S. mansoni infection and associated morbidity. Parasitology and ultrasonography assessments were conducted on consenting participants. The overall prevalence of S. mansoni infection and geometric mean egg count (GMEC) were 42.4% (304) and 86.6 eggs per gram (95% confidence interval = 75.6-99.6), respectively. Prevalence was highest in the age group of 15-19 years old (adjusted prevalence ratio = 1.70, P = 0.017). S. mansoni-related portal fibrosis was detected in 26% of the participants screened. Participants above 39 years old were 2.93 times more likely to have fibrosis than the 7-9 years old age group (P = 0.004). The study highlights the high burden of S. mansoni disease in this area and calls for immediate interventions to avert complications associated with the disease.
Assuntos
Efeitos Psicossociais da Doença , Fibrose/epidemiologia , Schistosoma mansoni/isolamento & purificação , Esquistossomose mansoni/epidemiologia , Adolescente , Adulto , Fatores Etários , Animais , Criança , Estudos Transversais , Feminino , Fibrose/parasitologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Morbidade , Análise Multivariada , Contagem de Ovos de Parasitas , Prevalência , População Rural , Esquistossomose mansoni/diagnóstico , Fatores Sexuais , Adulto Jovem , Zâmbia/epidemiologiaRESUMO
PURPOSE: Patients with decompensated liver cirrhosis who are admitted to intensive care units (ICU) are perceived, within the UK, as having a particularly poor prognosis. METHODS: We performed a descriptive analysis of cirrhosis patients admitted to general critical care units 1995-2008 compared to patients admitted with pre-existing chronic renal failure. Data were obtained from the Intensive Care National Audit and Research Centre Case Mix Programme Database incorporating 192 adult critical care units in England, Wales and Northern Ireland. RESULTS: Cirrhosis accounted for 2.6 % (16,096 patients) of total admissions with mean age 52.5 years and male preponderance (~60 %). Hospital mortality was high (>55 %) although this improved 5 % in recent years, and median length of stay was short (2.5 days). Mortality in cirrhotics with severe sepsis requiring organ support was 65-90 %, compared to 33-39 % in those without. Conversely, patients with chronic renal failure had lower mortality (42 %) despite similar characteristics and higher acute physiology and chronic health evaluation (APACHE) II scores. The APACHE II score under-predicted mortality in cirrhotics. CONCLUSIONS: Cirrhosis patients exhibit worse outcomes compared to pre-existing renal failure patients, despite similar characteristics. Survival worsens considerably with organ failure, especially with sepsis. They represent a small number of admissions, albeit increasing over recent years, and, in general, have a short ICU stay. Patients with single organ failure have acceptable survival rates and mortality has improved; although we have no data on those refused ICU admission potentially causing survival bias. Given the extremely high mortality in patients with multi-organ failure, support should be limited/withdrawn in such patients.
Assuntos
Fibrose/epidemiologia , Unidades de Terapia Intensiva , Falência Renal Crônica/terapia , Avaliação de Resultados em Cuidados de Saúde , Diálise Renal , Grupos Diagnósticos Relacionados , Feminino , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Prevalência , Reino Unido/epidemiologiaRESUMO
The life expectancy of persons cycling through the prison system is unknown. The authors sought to determine the 15.5-year survival of 23,510 persons imprisoned in the state of Georgia on June 30, 1991. After linking prison and mortality records, they calculated standardized mortality ratios (SMRs). The cohort experienced 2,650 deaths during follow-up, which were 799 more than expected (SMR = 1.43, 95% confidence interval (CI): 1.38, 1.49). Mortality during incarceration was low (SMR = 0.85, 95% CI: 0.77, 0.94), while postrelease mortality was high (SMR = 1.54, 95% CI: 1.48, 1.61). SMRs varied by race, with black men exhibiting lower relative mortality than white men. Black men were the only demographic subgroup to experience significantly lower mortality while incarcerated (SMR = 0.66, 95% CI: 0.58, 0.76), while white men experienced elevated mortality while incarcerated (SMR = 1.28, 95% CI: 1.10, 1.48). Four causes of death (homicide, transportation, accidental poisoning, and suicide) accounted for 74% of the decreased mortality during incarceration, while 6 causes (human immunodeficiency virus infection, cancer, cirrhosis, homicide, transportation, and accidental poisoning) accounted for 62% of the excess mortality following release. Adjustment for compassionate releases eliminated the protective effect of incarceration on mortality. These results suggest that the low mortality inside prisons can be explained by the rarity of deaths unlikely to occur in the context of incarceration and compassionate releases of moribund patients.
Assuntos
Atenção à Saúde , Prisioneiros/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Estudos de Coortes , Intervalos de Confiança , Atenção à Saúde/organização & administração , Feminino , Fibrose/epidemiologia , Seguimentos , Georgia/epidemiologia , Infecções por HIV/epidemiologia , Cardiopatias/epidemiologia , Hepatite C/epidemiologia , Homicídio/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Intoxicação/epidemiologia , Prevalência , Fatores de Risco , Distribuição por Sexo , Suicídio/estatística & dados numéricos , Taxa de SobrevidaRESUMO
Nephrogenic systemic fibrosis is a severely physically disabling phenomenon experienced by a specific subset of patients with renal disease. Several of the 200 reported cases worldwide are currently treated within the author's facility. My colleagues and I have witnessed first-hand the life altering effects of NSF on our patients' physical, psychological, and social health, not to mention the unseen effects on family dynamics and changes in the interpretation and function of individual roles. Outside of the ESRD community, NSF is a largely unknown entity, likely due to the infrequency of incidence and relatively cohorted population. Despite the infrequency, we in the nephrology specialty must spread awareness of this condition and share our common knowledge and experiences to help those suffering from NSF to maintain their quality of life. In collaboration with the Centers for Disease Control (CDC), the Yale University International Center for NSF Research has established a website (www.icnfdr.org) for reporting of new cases of NSF/NFD. Until a causative agent is irrefutably identified, it is of the utmost importance that new cases be reported immediately. We expend a great deal of effort and gain valuable experience in helping our patients live their lives as richly as possible. If we as professional nurses share our knowledge and experience in managing the life-altering effects of NSF, our patients as a collective whole will benefit. It is, therefore, our responsibility to collaborate within and outside of the profession to reduce the number of new cases of NSF and help existing patients live their lives with the highest quality standard possible.
Assuntos
Células Dendríticas/patologia , Falência Renal Crônica/complicações , Pele/patologia , Fator de Crescimento Transformador beta/fisiologia , Atividades Cotidianas , Idoso , Biópsia , Meios de Contraste/efeitos adversos , Efeitos Psicossociais da Doença , Feminino , Fibrose/diagnóstico , Fibrose/epidemiologia , Fibrose/etiologia , Fibrose/terapia , Gadolínio DTPA/efeitos adversos , Humanos , Internet , Cuidados Paliativos , Troca Plasmática , Sistema de Registros , Fatores de RiscoRESUMO
The estimated prevalence of hepatitis C in the UK is alarming. Many people are unaware of their condition and the associated implications of the disease. The aims of this article are to provide an evidence-based update on the implications of being HCV positive and the role of the hepatitis nurse specialist in the management of patients with this virus. This article also reviews the service offered to patients with hepatitis by the Chelsea and Westminster Healthcare NHS Trust.
Assuntos
Hepatite C/epidemiologia , Hepatite C/terapia , Adulto , Antivirais/uso terapêutico , Comorbidade , Feminino , Fibrose/epidemiologia , Hepatite C/diagnóstico , Humanos , Interferons/uso terapêutico , Masculino , Papel do Profissional de Enfermagem , Cooperação do Paciente , Prevalência , Fatores de Risco , Especialidades de Enfermagem/organização & administração , Resultado do Tratamento , Reino Unido/epidemiologiaRESUMO
The management of blunt splenic trauma in children has remained controversial, with different physicians advocating observation, splenorrhaphy, and splenectomy. Proponents for each position have debated the relative importance of rebleeding (delayed splenic rupture), posttransfusion hepatitis with its sequelae, and overwhelming postsplenectomy sepsis. In an attempt to guide the clinician, a decision analysis was performed. Variables evaluated included the incidence of transfusion, postsplenectomy sepsis, posttransfusion hepatitis, chronic active hepatitis, cirrhosis, and rebleeding. The quality-adjusted life expectancies (QALEs) when the average incidence of the variables were used in the decision analysis were 62.69 years for observation, 62.32 years for splenorrhaphy, and 61.14 years for splenectomy. Sensitivity analysis showed that there was very little difference between observation and splenorrhaphy when the transfusion rate and hepatitis rate were varied. But these treatment options produced longer QALEs than splenectomy. Therefore, in appropriately selected patients, observation is a safe and effective therapeutic option. If an operation is necessary, every effort should be made to preserve the spleen. Splenectomy may still be required in those cases of complete devascularization, persistent hemorrhage, or other associated significant injuries.