ABSTRACT
Medical research is constantly looking for causality. Among study designs, randomized controlled trials are the most reliable way to estimate causal effects but are not always feasible. When this is the case, observational studies must be performed but this type of design unavoidably implies bias. Propensity scores, defined as the probability to receive a treatment conditional to a set of covariables allows to overcome confusion bias when searching for causal effects.
Subject(s)
Causality , Observational Studies as Topic , Propensity Score , Bias , Humans , Multivariate Analysis , Reference StandardsABSTRACT
BACKGROUND: Controversy exists regarding the optimal dose of radioiodine ((131)I) therapy in autoimmune hyperthyroidism (i.e., Graves' Disease). METHODS: In order to evaluate the efficacy and safety of high dose (131)I therapy in autoimmune hyperthyroidism, a retrospective review of patients who received (131)I therapy for Graves' disease from 1980 to 2000 in the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City was carried out. RESULTS: The study population consisted of 596 autoimmune hyperthyroid patients with a mean age of 35 years. The mean follow-up period was 10.31 +/- 2.37 years. Remission of hyperthyroidism occurred in 81.9%, persistent hyperthyroidism was recorded in 14.4% and recurrence in 3.7%. (131)I doses of 5-9 mCi (185-333 MBq) and > or =20 mCi (> or =740 MBq) were associated with remission rates of 65.5% and 87.7% respectively. Remission occurred earlier and more often with high doses of (131)I. The high-dose group (20-30 mCi [740-1110 MBq]) had the lowest rate of persistence (9.7, 27.5 and 34.3%, for 20-30 [740-1110 MBq], 10-14 [370-518 MBq] and 5-9 [185-333 MBq] mCi, respectively p <0.05) and hypothyroidism occurred earlier in this group (p = 0.05). CONCLUSIONS: Remission of autoimmune hyperthyroidism is more likely with doses of 20-30 mCi (740-1110 MBq).
Subject(s)
Autoimmune Diseases/radiotherapy , Graves Ophthalmopathy/radiotherapy , Hyperthyroidism/radiotherapy , Iodine Radioisotopes/therapeutic use , Radioisotope Teletherapy , Adult , Dose-Response Relationship, Drug , Female , Humans , Male , Treatment OutcomeABSTRACT
Resumen Introducción: Las personas con diálisis de mantenimiento se consideran una población en alto riesgo de infección por SARS-CoV-2, complicaciones y muerte. La periodicidad de la diálisis, la organización y la demanda en las unidades de diálisis y las limitaciones de alfabetización en salud poblacional limitan el cumplimiento del aislamiento y el distanciamiento social. Objetivo: Desarrollar, mediante un consenso de expertos, recomendaciones informadas en evidencia para la prevención, el diagnóstico y el manejo de la infección por SARS-CoV-2/COVID-19 en pacientes con enfermedad renal crónica. Materiales y métodos: Se realizó una revisión rápida de literatura en Pubmed, Embase y sociedades científicas. La calidad de evidencia fue evaluada según el tipo de estudio incluido. El acuerdo se definió para cada recomendación con umbral de al menos 70% de aprobación. La fuerza de las recomendaciones fue graduada como fuerte o débil. Resultados: El colectivo fue consultado entre el 17 y 19 de mayo de 2020. Se obtuvo respuesta de 44 expertos clínicos que declararon conflicto de interés previo a la consulta. El acuerdo de las recomendaciones estuvo entre 70,5 y 100%. Se presentan las recomendaciones de un colectivo experto para la prevención, el diagnóstico y el manejo de infección por SARS-CoV-2/COVID-19 en pacientes con enfermedad renal crónica. Conclusión: Debido a la reciente aparición de la infección por SARS-CoV-2 y las incertidumbres respecto a la prevención, el diagnóstico y el manejo, las recomendaciones presentadas se conciben como un estándar colombiano que permita garantizar un cuidado centrado en las personas con enfermedad renal crónica y la protección de los profesionales de la salud.
Abstract Introduction: People with chronic dialysis are considered a population at high risk of SARS CoV2 infection and its derived complications and death. The need to go to strict dialysis schedules, the high demand in the kidney facilities and the difficulties derived from the time and space organization in the rooms in the face to the pandemic added to the difficult learning, teaching and adapting new protocols manifest the needed of standard recommendation according to this problem in people who couldn't have an ideal isolation. Objective: Develop through an expert consensus, evidence-informed recommendations for the prevention, diagnosis, and management of SARS-CoV-2/COVID-19 infection in patients with chronic kidney disease on Dialysis. Materials and methods: We carried out a quick literature review, PubMed, Embase and scientific societies were consulted. The quality of the evidence was considered according to the type of study included. The agreement threshold defined for each recommendation was > 70% approval among experts. The strength of the recommendations was rated as strong or weak. Results: Between May 17 and 19, 2020, was conformed a team of 44 clinical experts who declared their interest conflict prior to the consultation. The agreement of the recommendations was between 70.5% and 100%. The recommendations were separated in prevention, early identification, and diagnostic, isolation in hemodialysis facilities and peritoneal dialysis, and team protection. Ethical considerations also were included. Conclusion: Due to the recent appearance of SARS-CoV-2 infection and the uncertainties regarding prevention, diagnosis and management, the recommendations presented are conceived as a Colombian standard that allows guaranteeing focused care for people with chronic kidney disease and the protection of health team.
Subject(s)
Humans , Male , Female , Renal Insufficiency, Chronic , COVID-19 , Patients , Renal Dialysis , Colombia , DiagnosisABSTRACT
The objective of this study is to estimate the prevalence, treatment, and control of high blood pressure, hypertension (HBP) in Panama and assess its associations with sociodemographic and biologic factors.A cross-sectional, descriptive study was conducted in Panama by administering a survey on cardiovascular risk factors to 3590 adults and measuring their blood pressure 3 times. A single-stage, probabilistic, and randomized sampling strategy with a multivariate stratification was used. The average blood pressure, confidence intervals (CIs), odds ratio (OR), and a value of P ≤ 0.05 were used for the analysis.The estimated prevalence of HBP was 29.6% (95% CI, 28.0-31.1); it was more prevalent in men than in women, OR = 1.37 (95% CI, 1.17-1.61); it increased with age and was more frequent among Afro-Panamanians (33.8%). HBP was associated with a family history of HBP with being physically inactive and a body mass index ≥25.0 kg/m or a waist circumference >90 cm in men and >88 cm in women (P < 0.001). Of those found to have HBP, 65.6% were aware of having HBP and taking medications, and of these, 47.2% had achieved control (<140/90 mm Hg).HBP is the most common cardiovascular risk factor among Panamanians and consequently an important public health problem in Panama. The health care system needs to give a high priority to HBP prevention programs and integrated care programs aimed at treating HBP, taking into consideration the changes in behavior that have been brought about by alterations in nutrition and sedentary lifestyles.
Subject(s)
Hypertension/epidemiology , Hypertension/therapy , Adolescent , Adult , Aged , Cross-Sectional Studies , Demography , Female , Humans , Hypertension/prevention & control , Male , Middle Aged , Panama/epidemiology , Prevalence , Risk Factors , Socioeconomic Factors , Young AdultABSTRACT
Medical research is constantly looking for causality. Among study designs, randomized controlled trials are the most reliable way to estimate causal effects but are not always feasible. When this is the case, observational studies must be performed but this type of design unavoidably implies bias. Propensity scores, defined as the probability to receive a treatment conditional to a set of covariables allows to overcome confusion bias when searching for causal effects.
Subject(s)
Humans , Causality , Observational Studies as Topic , Propensity Score , Reference Standards , Bias , Multivariate AnalysisSubject(s)
Acanthosis Nigricans/pathology , Drug Eruptions/diagnosis , Insulin/adverse effects , Lipodystrophy/pathology , Diabetes Mellitus, Type 2/drug therapy , Diagnosis, Differential , Drug Eruptions/drug therapy , Female , Humans , Hyperpigmentation/chemically induced , Hyperpigmentation/diagnosis , Hypoglycemic Agents/adverse effects , Keratosis/chemically induced , Keratosis/diagnosis , Middle AgedABSTRACT
En Costa Rica, el factor de género dentro de las cifras de internamiento registradas en materia Penal Juvenil es el que más dramáticamente proyecta diferencias marcadas entre los jóvenes y adolescentes que han sido privados de su libertad tanto de manera cautelar o como sanción.
In Costa Rica, according to the imprisonment statistics registered in the Juvenile Criminal Law System, gender is the factor that most dramatically projects deep differences among the youth and adolescent population that has been arrested or sentenced.