RESUMO
PURPOSE: The study's aim was to assess whether polyomavirus DNAemia screening was associated with different outcomes in patients with positive viremia compared with negative viremia. METHODS: Case-control retrospective study of patients with polyomavirus DNAemia (viremia > 1000 copies/mL) matched 1:1 with controls. Control group consists of the patient who received a transplant immediately before or after each identified case and did have nil viremia. FINDING: Ultimately, 120 cases of BK polyomavirus (BKPyV) were detected and matched with 130 controls. Of these, 54 were adult kidney transplant recipients (KTRs), 43 were pediatric KTRs, and 23 were undergoing hemato-oncologic therapy, of which 20 were undergoing hematopoietic stem cell transplantation. The odds ratio (OR) for overall risk of poorer outcomes in cases versus controls was 16.07 (95% CI: 5.55-46.54). The unfavorable outcome of switching the immunosuppressive drug (ISD) (14/40,35%) was no different from that of those treated with reduced ISD doses (31/71, 43.6%, P = .250). Acute rejection or graft-versus-host disease, previous transplant, and intensity of immunosuppression (4 ISDs plus induction or conditioning) were risk factors for BKPyV-DNAemia (OR: 13.96, 95% CI: 11.25-15.18, P < .001; OR: 6.14, 95% CI: 3.91-8.80, P < .001; OR: 5.53, 95% CI: 3.37-7.30, P < .001, respectively). CONCLUSIONS: Despite viremia screening, dose reduction, and change in therapeutic protocol, patients with positive BKPyV-DNAemia present poorer outcomes and unfavorable results.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Transplante de Rim , Infecções por Polyomavirus , Infecções Tumorais por Vírus , Viremia/classificação , Adulto , Vírus BK , Estudos de Casos e Controles , Criança , Rejeição de Enxerto , Doença Enxerto-Hospedeiro , Humanos , Infecções por Polyomavirus/complicações , Estudos Retrospectivos , Fatores de Risco , Infecções Tumorais por Vírus/complicaçõesRESUMO
RESUMEN Introducción: En Chile, la sobrevida de las mujeres con cáncer de mama ha aumentado. Así también, la evaluación de la calidad de vida (CV) y la satisfacción usuaria (SU), son determinantes en el impacto de la enfermedad y tratamiento, en áreas como el bienestar general, físico, psicológico, emocional y sexual de las usuarias. El objetivo de esta investigación fue evaluar la relación entre la CV y la SU de atención de mujeres con cáncer de mama en tratamiento de quimioterapia (QT) del Hospital de La Serena. Material y métodos: Estudio transversal analítico a 41 mujeres en QT endovenoso (2°ciclo). Instrumentos para satisfacción usuaria (Worthing Chemotherapy Satisfaction Questionnaire) y calidad de vida (EORTC QLQ C-30 y BR23). Resultados: Promedio de edad 52,7 ± 12,5 años, la QT más frecuente fue paclitaxel con un 65,9%. El 53,7% de las usuarias manifestó satisfacción con la atención de salud y el 73,2% calificó como "buena" su CV, excepto las áreas del funcionamiento sexual (21,9%) y el disfrute sexual (19,5%). Se encontró relación en los puntajes totales entre CV y SU (correlación de Pearson r2=0,459 valor p=0,003), el análisis multivariado reafirma esta relación luego de controlar por edad, lugar de residencia y el estadio del cáncer OR=34 (IC95% 2,2-531,7). Conclusión: La CV se relaciona directamente con los niveles de SU, encontrando que las áreas de la CV con menores puntajes fueron el funcionamiento y el disfrute sexual.
ABSTRACT Introduction: In Chile, the survival of women with breast cancer has increased. Also, the evaluation of the quality of life (QoL) and patient satisfaction (PS) are determinants in the impact of the disease and treatment, in areas such as the general, physical, psychological, emotional and sexual well-being of the users. The aim of the study was to evaluate the relationship between the QoL and the PS of the care in women with breast cancer undergoing chemotherapy treatment (CT) of the Hospital de La Serena. Material and methods: Analytical cross-sectional study of 41 women undergoing intravenous CT (2nd cycle). Instruments for PS (Worthing Chemotherapy Satisfaction Questionnaire) and QoL (EORTC QLQ C-30 and BR23). Results: Average age 52.7 ± 12.5 years, the most frequent CT was paclitaxel with 65.9%. The 53.7% of the users expressed satisfaction with health care and 73.2% rated their QoL as "good", except the areas of sexual functioning (21.9%) and sexual enjoyment (19.5%). A relationship was found in the total scores between QoL and PS (Pearson correlation r2 = 0.459 p-value = 0.003), the multivariate analysis reaffirms this relationship after controlling for age, place of residence and cancer stage, OR = 34 (95% CI 2.2-531.7). Conclusion: The QoL is directly related to the levels of PS, finding that the areas of the QoL with lower scores were sexual functioning and sexual enjoyment.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Qualidade de Vida , Neoplasias da Mama/terapia , Satisfação do Paciente , Neoplasias da Mama/diagnóstico , Estudos Transversais , Tratamento FarmacológicoRESUMO
Inflammatory bowel diseases (IBD) are inflammatory diseases with a multifactorial component that involve the intestinal tract. The two relevant IBD syndromes are Crohn's disease (CD) and ulcerative colitis (UC). One factor involved in IBD development is a genetic predisposition, associated to NOD2/CARD15 and Toll-like receptor 4 (TLR4) polymorphisms that might favor infectious enterocolitis that is possibly associated to the development of IBD. The identification of specific immunologic alterations in IBD and their relationship to the etiology of the disease is a relevant research topic. The role of intra and extracellular molecules, such as transcription factors and cytokines that are involved in the inflammatory response, needs to be understood. The relevance of immunologic molecules that might drive the immune response to a T helper (Th) 1, Th 2 or the recently described Th 17 phenotype, has been demonstrated in animal models and clinical studies with IBD patients. CD and UC predominantly behave with a Th 1 and Th 2 immune phenotype, respectively. Recently, an association between CD and Th 17 has been reported. The knowledge acquired from immunologic and molecular research will help to develop accurate diagnostic methods and efficient therapies.
Assuntos
Doenças Inflamatórias Intestinais/imunologia , Colite Ulcerativa/genética , Colite Ulcerativa/imunologia , Doença de Crohn/genética , Doença de Crohn/imunologia , Diagnóstico Diferencial , Fator de Transcrição GATA3/imunologia , Predisposição Genética para Doença , Humanos , Doenças Inflamatórias Intestinais/genética , Interleucinas/genética , Interleucinas/imunologia , Proteína Adaptadora de Sinalização NOD2/genética , Proteína Adaptadora de Sinalização NOD2/imunologia , Polimorfismo Genético , Receptor 4 Toll-Like/genética , Receptor 4 Toll-Like/imunologiaRESUMO
Inflammatory bowel diseases (IBD) are inflammatory diseases with a multifactorial component that involve the intestinal tract. The two relevant IBD syndromes are Crohn's disease (CD) and ulcerative colitis (UC). One factor involved in IBD development is a genetic predisposition, associated to NOD2/CARD15 and Toll-like receptor 4 (TLR4) polymorphisms that might favor infectious enterocolitis that is possibly associated to the development of IBD. The identification of specific immunologic alterations in IBD and their relationship to the etiology of the disease is a relevant research topic. The role of intra and extracellular molecules, such as transcription factors and cytokines that are involved in the inflammatory response, needs to be understood. The relevance of immunologic molecules that might drive the immune response to a T helper (Th) 1, Th 2 or the recently described Th 17 phenotype, has been demonstrated in animal models and clinical studies with IBD patients. CD and UC predominantly behave with a Th 1 and Th 2 immune phenotype, respectively. Recently, an association between CD and Th 17 has been reported. The knowledge acquired from immunologic and molecular research will help to develop accurate diagnostic methods and efficient therapies.