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1.
; Fiocruz.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud, LIS-bvsms | ID: lis-LISBR1.1-47174

RESUMEN

Qual é a situação atual e o que esperar da pandemia de Covid-19 no Brasil? Foi lançado, na última sexta-feira (27/3), um painel para monitoramento da doença no país, com atualização em tempo real. A plataforma permite que o usuário visualize os dados atuais, a evolução dos casos, os óbitos, a concentração da doença e a previsão da situação nos próximos dias em todos os estados no Brasil.


Asunto(s)
Monitoreo , Coronavirus , Toma de Decisiones , Pandemias/estadística & datos numéricos
2.
Zhonghua Er Ke Za Zhi ; 58(4): 308-313, 2020 Apr 02.
Artículo en Chino | MEDLINE | ID: mdl-32234138

RESUMEN

Objective: To investigate the coverage rate and the adverse reactions of National Immunization Program vaccines in children with spinal muscular atrophy (SMA). Methods: A cross-sectional retrospective cohort study was carried out from July 2016 to June 2019, 192 children (116 boys and 76 girls) with SMA registered by Capital Institute of Pediatrics and 191 healthy children (115 boys and 76 girls) vaccinated in Chaoyang Olympic Village Community Health Service Center from July 2016 to December 2018 were included. Questionnaire survey was designed to investigate the vaccination coverage rate and associated adverse events. The t-test and χ(2) test were used to compare the difference between SMA patients and healthy children. Results: The coverage rate of age-appropriate immunization in SMA children was 62.0% (119/192) in general, and were 52.2% (12/23), 55.7% (68/122), and 83.0% (39/47) for SMA type 1-3 patients, respectively (χ(2)=12.23, P=0.002). The vaccination coverage rates of Bacillus Calmette-Guerin (BCG) vaccine, the 3(rd) dose of hepatitis B, the 3(rd) dose of polio, the 3(rd) dose of diphtheria-pertussis-tetanus, the 1(st) dose of meningococcal polysaccharide group A, the 1(st) dose of measles or measles and rubella vaccine, the 1(st) dose of Japanese encephalitis vaccine, hepatitis A, measles-mumps-rubella, and group A+C meningococcal polysaccharide vaccine were 100.0% (192 cases), 94.3% (181 cases), 81.8% (157 cases), 88.5% (170 cases), 83.9% (161 cases), 76.6% (147 cases), 80.2% (154 cases), 68.2% (131 cases), 69.8% (134 cases), 54.7% (105 cases), respectively. Among the 73 patients who did not have their planned immunization completed, 57 cases (78.1%) gave up the vaccination due to parents' concern of potential aggravation of their disease, and 16 cases (21.9%) had the plan discontinued by the immunization department because of the disease. Fever, local redness and swelling were the most common side-effects after vaccination both in SMA patients and healthy children (19.8% (38/192) vs. 18.8% (36/191) , χ(2)=0.055, P=0.815). The main abnormal reactions of vaccination were rash and neurovascular edema, without significant difference between these two groups (2.6% (5/192) vs. 3.7% (7/191), χ(2)=0.355, P=0.551). The coverage rate of Influenza and pneumococcal vaccine in SMA patients were 22.4% (43 cases) and 31.8% (61 cases), respectively. The incidence of pneumonia in the SMA patients decreased from 59.0% (23/39) to 41.0% (16/39) after vaccination. And none of the Influenza vaccinated patients had the flu in the year of vaccination. Conclusions: The coverage rate of National Immunization Program vaccines in the SMA children is low, especially in type 1 SMA patients, which is mainly due to their guardians' concern of potential adverse events, even though the incidence of adverse reactions is similar in SMA patients and healthy children. Influenza and pneumococcal vaccine can reduce the risk of pneumonia and flu in children with SMA effectively.


Asunto(s)
Programas de Inmunización , Atrofia Muscular Espinal , Vacunación/estadística & datos numéricos , Vacunas/efectos adversos , Niño , China , Estudios Transversales , Femenino , Humanos , Masculino , Estudios Retrospectivos
3.
West J Emerg Med ; 2020 03 27.
Artículo en Inglés | MEDLINE | ID: mdl-32223871

RESUMEN

INTRODUCTION: On March 10, 2020, the World Health Organization declared a global pandemic due to widespread infection of the novel coronavirus 2019 (COVID-19). We report the preliminary results of a targeted program of COVID-19 infection testing in the ED in the first 10 days of its initiation at our institution. METHODS: We conducted a review of prospectively collected data on all ED patients who had targeted testing for acute COVID-19 infection at two EDs during the initial 10 days of testing (March 10-19, 2020). During this initial period with limited resources, testing was targeted toward high-risk patients per Centers for Disease Control and Prevention guidelines. Data collected from patients who were tested included demographics, clinical characteristics, and test qualifying criteria. We present the data overall and by test results with descriptive statistics. RESULTS: During the 10-day study period, the combined census of the study EDs was 2157 patient encounters. A total of 283 tests were ordered in the ED. The majority of patients were 18-64 years of age, male, non-Hispanic white, had an Emergency Severity Index score of three, did not have a fever, and were discharged from the ED. A total of 29 (10.2%) tested positive. Symptoms-based criteria most associated with COVID-19 were the most common criteria identified for testing (90.6%). All other criteria were reported in 5.51-43.0% of persons being tested. Having contact with a person under investigation was significantly more common in those who tested positive compared to those who tested negative (63% vs 24.5%, respectively). The majority of patients in both results groups had at least two qualifying criteria for testing (75.2%). CONCLUSION: In this review of prospectively collected data on all ED patients who had targeted testing for acute COVID-19 infection at two EDs in the first 10 days of testing, we found that 10.2% of those tested were identified as positive. The continued monitoring of testing and results will help providers understand how COVID-19 is progressing in the community.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Coronavirus/aislamiento & purificación , Servicio de Urgencia en Hospital/estadística & datos numéricos , Neumonía Viral/diagnóstico , Adolescente , Adulto , Betacoronavirus , Femenino , Fiebre , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Estados Unidos , Organización Mundial de la Salud , Adulto Joven
4.
J Korean Med Sci ; 35(12): e72, 2020 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-32233156

RESUMEN

BACKGROUND: There could be a gap between asthma management guidelines and current practice. We evaluated the awareness of and compliance with asthma management guidelines, and the internal and external barriers to compliance, for the first time in Korea. METHODS: From March to September of 2012, 364 physicians treating asthma patients at primary, secondary, and tertiary teaching hospitals were enrolled. They completed a questionnaire on the awareness of and compliance with asthma management guidelines, and the barriers and alternatives to their implementation. RESULTS: Of the 364 physicians, 79.1% were men and 56.9% were primary care physicians. The mean age was 40.5 ± 11.2 years. Most of them were aware of asthma management guidelines (89.3%). However, only a portion (11.0%) of them complied with the guidelines for asthma. Pulmonary function tests for diagnosis of asthma were performed by 20.1% of all physicians and 9.2% of primary care physicians, and by 9.9% of all physicians and 5.8% of primary care physicians for monitoring. Physicians stated that 'asthma monitoring' was the most difficult part of the guidelines, followed by 'environmental control and risk factors.' Only 39.6% (31.9% of the primary care physicians) prescribed an inhaled corticosteroid (ICS) as the first-line treatment for persistent asthma. The internal barriers were physician's preference for oral medications, difficulty in use even with inhaler training, and concern over ICS side effects. The external barriers were possible rejection of medical reimbursement by health insurance, refusal by the patient, cost, and a poor environment for teaching the patient how to use the inhaler. Alternatives proposed by physicians to implement asthma management guidelines were to improve medical reimbursement policies and the level of awareness of such guidelines. CONCLUSION: Compliance with the asthma management guidelines, including ICS prescription, is low despite the awareness of the guidelines. It is necessary to develop a strategy to overcome the internal and external barriers.


Asunto(s)
Corticoesteroides/administración & dosificación , Asma , Adhesión a Directriz , Administración por Inhalación , Adulto , Asma/diagnóstico , Asma/tratamiento farmacológico , Actitud del Personal de Salud , Manejo de la Enfermedad , Femenino , Adhesión a Directriz/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Médicos , Pautas de la Práctica en Medicina/estadística & datos numéricos , República de Corea , Pruebas de Función Respiratoria
5.
J Korean Med Sci ; 35(12): e76, 2020 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-32233157

RESUMEN

BACKGROUND: Healthcare personnel (HCP) are at risk of being exposed to or transmitting infections in hospitals, and vaccination against vaccine-preventable diseases (VPDs) is a well-known preventive strategy. Vaccination against influenza, hepatitis B virus, measles-mumps-rubella, varicella, and pertussis is recommended for HCP. However, there is no information on the current status of hospitals' vaccination policies for HCP in Korea. METHODS: We conducted a nationwide survey on hospital vaccination policies and barriers to implementing recommended vaccination programs in 2018. The online survey questionnaire was distributed to 652 hospitals, and 200 of them responded. RESULTS: Of the 200 surveyed hospitals, 151 (75.5%) conducted a pre-employment screening program for at least one VPD, and 196 (98%) had vaccination programs that included at least one vaccine. Influenza vaccine was most commonly included in their programs (97.5%, n = 195), followed by hepatitis B vaccines (69%, n = 138). However, < 25% of the hospitals included other vaccines in their policies (measles-mumps-rubella, 24.5%; varicella, 18.5%; pertussis, 11%). Only 13 hospitals (6.5%) included the five recommended vaccines for HCP in their policies. Influenza vaccination coverage had a mean of 89.9% and was significantly higher in hospitals fully funding the vaccination cost (91.8% vs. 80.4%, P < 0.001). Among hospitals funding influenza vaccines, the coverage was lower in hospitals with ≥ 700 beds (-6.5%, P = 0.003). Hospitals' financial burden was the most important barrier to implementing vaccination polices as recommended (78.6%, 121/154), followed by lack of awareness (21%) or campaign (21%) and lack of leadership (17%). CONCLUSION: Despite the recommendations on vaccination for HCP, the vaccination policies for HCP differ in hospitals and appear to be insufficient to protect HCP and prevent nosocomial transmission. Strong leadership of each hospital to protect HCP and financial support from the government are required to implement appropriate vaccination policies in hospitals.


Asunto(s)
Hospitales/estadística & datos numéricos , Política Organizacional , Vacunación/estadística & datos numéricos , Vacunas , Vacuna contra la Varicela , Infección Hospitalaria/prevención & control , Humanos , Vacunas contra la Influenza , Vacuna contra el Sarampión-Parotiditis-Rubéola , Vacuna contra la Tos Ferina , República de Corea , Vacunas/uso terapéutico
6.
Medwave ; 20(2): e7833, 2020 Mar 19.
Artículo en Español | MEDLINE | ID: mdl-32225131

RESUMEN

Background: Out-of-pocket spending on medicines and supplies can lead to a heavy financial burden in households. Objective: To determine the out-of-pocket spending on medicines and supplies in Peru and the population groups with the highest out-of-pocket spending on medicines and supplies in 2007 and 2016. Methods: We conducted an analytical cross-sectional study of the Peruvian National Household Survey on Living and Poverty Conditions for the years 2007 and 2016. Mean and median out-of-pocket spending on medicines and supplies are reported in USD for the general population, and according to the presence or not of factors described in the literature as associated with out-of-pocket spending on medicines and supplies. Results: 92 148 and 130 296 participants from 2007 and 2016 were included. In 2007, a median of 3.19 (interquartile range: 0.96 to 7.99) and an average of 8.14 (95% confidence interval: 7.80 to 8.49) were found for the out-of-pocket spending on medicines and supplies. In 2016, the median and mean out-of-pocket spending on medicines and supplies were 3.55 (interquartile range: 1.48 to 8.88) and 9.68 (95% confidence interval: 9.37 to 9.99), respectively. For 2016, higher out-of-pocket spending on medicines and supplies was found in women, children under five and over 60 years of age, people of higher educational level, having private or armed forces insurance, living in the coastal region, and being in one of the highest per capita quintile of expenditure. Between 2007 and 2016, the out-of-pocket spending on medicines and supplies was significantly increased in children under five (p < 0.001), uninsured persons (p < 0.001), insured to the Seguro Integral de Salud (p < 0.001) or the Armed Forces (p = 0.035), for the urban and rural area (both p < 0.001), and in people without chronic diseases (p < 0.001). Conclusions: An increase in out-of-pocket spending on medicines and supplies was found in the study period. There were population groups with significant increases in out-of-pocket spending on medicines and supplies. It is necessary to explore further the factors associated with out-of-pocket spending on medicines and supplies in groups of greater economic vulnerability regarding direct health spending in Peru.


Asunto(s)
Costos de los Medicamentos , Financiación Personal , Gastos en Salud , Adolescente , Adulto , Niño , Estudios Transversales , Composición Familiar , Femenino , Financiación Personal/economía , Gastos en Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Perú , Pobreza , Adulto Joven
7.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud, LIS-bvsms | ID: lis-LISBR1.1-47122
8.
Recurso de Internet en Inglés, Español, Portugués | LIS - Localizador de Información en Salud | ID: lis-LISBR1.1-47063

RESUMEN

O diretor-geral da Organização Mundial da Saúde (OMS), Tedros Adhanom Ghebreyesus, anunciou nesta quarta-feira (11), em Genebra, na Suíça, que a COVID-19, doença causada pelo novo coronavírus, é agora caracterizada como uma pandemia.


Asunto(s)
Pandemias , Brotes de Enfermedades/estadística & datos numéricos , Coronavirus , Infecciones por Coronavirus
10.
Bull World Health Organ ; 98(3): 170-176, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32132751

RESUMEN

Objective: To assess the effect of a permanent gun-carrying restriction on gun-related mortality in Colombia between 2008 and 2014, and determine differences in the effect of the restriction by place of death and sex. Methods: In 2012, Bogotá and Medellín introduced a permanent gun-carrying restriction. We compared gun-related mortality rates in these cities (intervention cities) with the rates in all other Colombian cities with more than 500 000 inhabitants (control cities). We used data from the Colombian National Department of Statistics to calculate monthly gun-related mortality rates between 2008 and 2014 for intervention and control cities. We used a differences-in-differences method with fixed effects to assess differences in gun-related mortality in intervention and control cities before and after the introduction of the gun-carrying restriction. We stratified effects by place of death (public area or residence) and sex. We made robustness checks to test the assumptions of the models. Findings: Gun-related deaths in the control and intervention cities decreased between 2008 and 2014; however, the decrease was greater in the intervention cities (from 20.29 to 14.93 per 100 000 population; 26.4%) than in the control cities (from 37.88 to 34.56 per 100 000 population; 8.8%). The restriction led to a 22.3% reduction in the monthly gun-related mortality rate in Bogotá and Medellín. The reduction was greater in public areas and for males. Robustness checks supported the assumptions of the models. Conclusion: The permanent restriction on carrying guns reduced gun-related deaths. This policy could be used to reduce gun-related injuries in urban centres of other countries with large numbers of gun-related deaths.


Asunto(s)
Armas de Fuego/legislación & jurisprudencia , Homicidio/estadística & datos numéricos , Mortalidad , Suicidio/estadística & datos numéricos , Heridas por Arma de Fuego/mortalidad , Colombia , Femenino , Humanos , Masculino , Propiedad
11.
Bull World Health Organ ; 98(3): 177-187C, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32132752

RESUMEN

Objective: To assess antibiotic availability and use in health facilities in low- and middle-income countries, using the service provision assessment and service availability and readiness assessment surveys. Methods: We obtained data on antibiotic availability at 13 561 health facilities in 13 service provision assessment and 8 service availability and readiness assessment surveys. In 10 service provision assessment surveys, child consultations with health-care providers were observed, giving data on antibiotic use in 22 699 children. Antibiotics were classified as access, watch or reserve, according to the World Health Organization's AWaRe categories. The percentage of health-care facilities across countries with specific antibiotics available and the proportion of children receiving antibiotics for key clinical syndromes were estimated. Findings: The surveys assessed the availability of 27 antibiotics (19 access, 7 watch, 1 unclassified). Co-trimoxazole and metronidazole were most widely available, being in stock at 89.5% (interquartile range, IQR: 11.6%) and 87.1% (IQR: 15.9%) of health facilities, respectively. In contrast, 17 other access and watch antibiotics were stocked, by fewer than a median of 50% of facilities. Of the 22 699 children observed, 60.1% (13 638) were prescribed antibiotics (mostly co-trimoxazole or amoxicillin). Children with respiratory conditions were most often prescribed antibiotics (76.1%; 8972/11 796) followed by undifferentiated fever (50.1%; 760/1518), diarrhoea (45.7%; 1293/2832) and malaria (30.3%; 352/1160). Conclusion: Routine health facility surveys provided a valuable data source on the availability and use of antibiotics in low- and middle-income countries. Many access antibiotics were unavailable in a majority of most health-care facilities.


Asunto(s)
Antibacterianos/provisión & distribución , Infecciones Bacterianas/tratamiento farmacológico , Instituciones de Salud/estadística & datos numéricos , Servicios de Salud/estadística & datos numéricos , Antibacterianos/uso terapéutico , Niño , Preescolar , Países en Desarrollo , Humanos , Lactante , Organización Mundial de la Salud
12.
Medicine (Baltimore) ; 99(9): e19328, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118764

RESUMEN

We assessed factors associated with premature physeal closure (PPC) and outcomes after closed reduction of Salter-Harris type II (SH-II) fractures of the distal tibia. We reviewed patients with SH-II fractures of the distal tibia treated at our center from 2010 to 2015 with closed reduction and a non-weightbearing long-leg cast. Patients were categorized by immediate postreduction displacement: minimal, <2 mm; moderate, 2 to 4 mm; or severe, >4 mm. Demographic data, radiographic data, and Lower Extremity Functional Scale (LEFS) scores were recorded.Fifty-nine patients (27 girls, 31 right ankles, 26 concomitant fibula fractures) were included, with a mean (±SD) age at injury of 12.0 ±â€Š2.2 years. Mean maximum fracture displacements were 6.6 ±â€Š6.5 mm initially, 2.7 ±â€Š2.0 mm postreduction, and 0.4 ±â€Š0.7 mm at final follow-up. After reduction, displacement was minimal in 23 patients, moderate in 21, and severe in 15. Fourteen patients developed PPC, with no significant differences between postreduction displacement groups. Patients with high-grade injury mechanisms and/or initial displacement ≥4 mm had 12-fold and 14-fold greater odds, respectively, of PPC. Eighteen patients responded to the LEFS survey (mean 4.0 ±â€Š2.1 years after injury). LEFS scores did not differ significantly between postreduction displacement groups (P = .61).The PPC rate in this series of SH-II distal tibia fractures was 24% and did not differ by postreduction displacement. Initial fracture displacement and high-grade mechanisms of injury were associated with PPC. LEFS scores did not differ significantly by postreduction displacement.Level of Evidence: Level IV, case series.


Asunto(s)
Fijación de Fractura/normas , Fracturas de Salter-Harris/terapia , Adolescente , Niño , Femenino , Fijación de Fractura/métodos , Fijación de Fractura/estadística & datos numéricos , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Retrospectivos , Tibia/anatomía & histología , Tibia/lesiones , Tibia/fisiopatología , Resultado del Tratamiento
13.
Medicine (Baltimore) ; 99(9): e19352, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118775

RESUMEN

Serum albumin is a marker of nutritional and frailty status. This study aimed to assess the association between serum albumin at the time of admission and the risk of acute respiratory failure (ARF) in hospitalized patientsThis cohort study, performed at a tertiary referral hospital, included all hospitalized adult patients from January 2009 to December 2013 who had serum albumin measurement and were not on mechanical ventilation within 24 hours of hospital admission. Serum albumin was stratified into 2.4, 2.5 to 2.9, 3.0 to 3.4, 3.5 to 3.9, 4.0 to 4.4, and ≥4.5 g/dL. Multivariate logistic regression analysis was performed to obtain adjusted odds ratio (OR) of risk of ARF requiring mechanical ventilation based on various admission serum albumin levels.Of 12,719 patients, ARF requiring mechanical ventilation occurred in 1128 (8.9%) during hospitalization. Hypoalbuminemia was associated with increased risk of ARF, in particular when serum albumin was ≤2.4 g/dL. Compared with serum albumin of 4.0-4.4 g/dL, serum albumin ≤2.4 g/dL at admission was associated with 2.38-time higher odds of ARF during hospitalization (OR 2.38, 95% confidence interval [CI] 1.84-3.07). In contrast, elevated serum albumin ≥4.5 g/dL was associated with lower odds of ARF (OR 0.68, 95% CI 0.48-0.97).Admission serum albumin level lower than 3.5 g/dL was associated with a higher risk of ARF requiring mechanical ventilation, whereas elevated serum albumin level at least 4.5 g/dL was associated with a lower risk of ARF. Therefore, admission albumin level at admission might be useful in the prediction of ARF during hospitalization.


Asunto(s)
Hospitalización/estadística & datos numéricos , Síndrome de Dificultad Respiratoria del Adulto/sangre , Medición de Riesgo/métodos , Albúmina Sérica/análisis , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Minnesota/epidemiología , Oportunidad Relativa , Síndrome de Dificultad Respiratoria del Adulto/epidemiología , Estudios Retrospectivos , Medición de Riesgo/normas , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo
14.
Medicine (Baltimore) ; 99(9): e19356, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118777

RESUMEN

BACKGROUND: Patent ductus arteriosus (PDA) is a particularly common problem in preterm infants. Although surgical ligation is rarely performed in many contemporary neonatal intensive care units, it remains a necessary treatment option for preterm infants with a large hemodynamically significant PDA under strict clinical criteria, and it can reduce mortality in preterm infants. However, the optimal timing of surgical ligation is still controversial. We conducted this systematic review and meta-analysis to compare the mortality and morbidity of early and late surgical ligation of PDA in preterm or very-low-birth-weight (VLBW) infants. METHODS: This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019133686). We searched the databases of PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the World Health Organization International Clinical Trials Registry Platform up to May 2019. RESULTS: This review included 6 retrospective studies involving 397 premature or VLBW infants with PDA. Pooled analysis showed that compared with the late ligation group, the early ligation group had a lower fraction of inspired oxygen (FiO2) at 24 hours postoperatively (mean difference [MD] -6.34, 95% confidence interval [CI] -9.45 to -3.22), fewer intubation days (MD -19.69, 95% CI -29.31 to -10.07), earlier date of full oral feeding (MD -22.98, 95% CI -28.63 to -17.34) and heavier body weight at 36 weeks of conceptional age (MD 232.08, 95% CI 57.28 to 406.88). No significant difference in mortality or other complications was found between the early and late groups. CONCLUSION: Our meta-analysis implies that compared with late surgical ligation, early ligation might have a better respiratory outcome and nutritional status for PDA in preterm or VLBW infants. There was no difference in mortality or postoperative complications between early and late ligation. A randomized prospective clinical trial with a possible large sample size is urgently needed to reinvestigate this conclusion. PROSPERO REGISTRATION NUMBER: CRD42019133686.


Asunto(s)
Conducto Arterioso Permeable/cirugía , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Ligadura/clasificación , Factores de Tiempo , Conducto Arterioso Permeable/complicaciones , Femenino , Humanos , Lactante , Recién Nacido , Ligadura/métodos , Ligadura/estadística & datos numéricos , Masculino
15.
Medicine (Baltimore) ; 99(9): e19357, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118778

RESUMEN

BACKGROUND: Vonoprazan is a potassium-competitive acid blocker (P-CAB) that is frequently used in Japan for Helicobacter pylori (H. pylori) eradication, treatment of gastroesophageal reflux disease, and treatment of post endoscopic submucosal dissection (ESD) complications. We sought to determine if vonoprazan was superior to proton pump inhibitors (PPIs) for treating ESD-induced ulcers (as assessed by ulcer healing and shrinkage ratios) and preventing delayed bleeding over various treatment durations (2, 4, and 8 weeks). METHODS: We collected randomized controlled trials (RCTs) and observational studies that discussed the effectiveness of vonoprazan and PPIs on ESD-induced ulcers and bleeding from PubMed, Cochrane Library, ClinicalTrials.gov, and Google Scholar. Studies were selected according to pre-established eligibility criteria and data were extracted separately by 2 researchers with double-check. We used the Cochrane risk of bias tool to assess RCTs and the Newcastle-Ottawa Quality Assessment Scale to assess observational studies. Meta-analyses, based on the random-effects model, were conducted to compare differences in ulcer shrinkage ratios (%) and odds ratios (ORs) for ulcer healing and delayed bleeding. Publication bias was evaluated using funnel plots and Egger regression test. Heterogeneity was assessed using I statistics. A sensitivity analysis was conducted to check the robustness of results. The evidential quality of the findings was assessed using the GRADE profiler. RESULTS: Thirteen studies were included in this meta-analysis. The OR effect sizes of vonoprazan relative to PPIs for ulcer healing were 1.33 (P = .13) with a 95% CI (0.33-3.21) at 4 weeks and 1.48 (P = .09) with a 95% CI (0.81-5.20) at 8 weeks. The overall effect size for the shrinkage ratio was 12.24% (P = .16) with a 95% CI (-4.96-29.44) at 2 weeks. The effect size of its subgroup of H. pylori-positive patients was 19.51% (P < .001) with a 95% CI (11.91-27.12). The overall OR for the occurrence of delayed bleeding was 0.66 (P = .26) with a 95% CI (0.32-1.35). After excluding combination drug studies, the overall ORs between vonoprazan and PPIs on ulcer healing and delayed bleeding were 1.44 and 0.76, respectively. CONCLUSION: During the first 2 weeks of treatment, vonoprazan was more effective than PPIs for treating H. pylori-positive patients with ESD-induced gastric ulcers.


Asunto(s)
Resección Endoscópica de la Mucosa/efectos adversos , Inhibidores de la Bomba de Protones/normas , Pirroles/normas , Sulfonamidas/normas , Úlcera/tratamiento farmacológico , Adulto , Resección Endoscópica de la Mucosa/instrumentación , Resección Endoscópica de la Mucosa/métodos , Humanos , Estudios Observacionales como Asunto/estadística & datos numéricos , Complicaciones Posoperatorias , Inhibidores de la Bomba de Protones/uso terapéutico , Pirroles/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Sulfonamidas/uso terapéutico , Úlcera/etiología
16.
Medicine (Baltimore) ; 99(9): e19375, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118782

RESUMEN

The aim of this study is to evaluate the pregnancy outcomes of males with a 47, XYY karyotype following assisted reproductive treatment.A retrospective study was performed using data from infertile men with 47, XYY at a center for reproductive medicine in 2004 to 2017. Of the 19,842 infertile males treated, a total of 21 showed the 47, XYY karyotype and were included in the present study. Clinical variables were collected. Three men were under treatment with their partner before either in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).The incidence of 47, XYY in infertile men is 1/945 (21/19842). Most men are azoospermic or severely oligospermic. Three men and their partners underwent IVF or ICSI treatment with fresh ejaculate samples. The fertilization rate was 52.94% to 83.33%. The embryo cleavage rate was 50% to 90%. One man had abnormal sex hormonal levels and his partner had no clinical pregnancy. The other 2 couples had healthy baby boys.Live spermatozoa can be gathered and fertility is possible for infertile males with 47, XYY syndrome when IVF or ICSI treatment is used. It is recommended that genetic counseling is provided in such cases.


Asunto(s)
Infertilidad Masculina/terapia , Resultado del Embarazo , Cariotipo XYY , Adulto , Estudios de Casos y Controles , Femenino , Fertilización In Vitro/métodos , Fertilización In Vitro/normas , Fertilización In Vitro/estadística & datos numéricos , Humanos , Masculino , Embarazo , Estudios Retrospectivos
17.
Medicine (Baltimore) ; 99(9): e19376, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118783

RESUMEN

To introduce the use of a new surgical approach named single-incision bilateral inguinal herniorrhaphy (SBIH) in pediatric surgical population.This was a STROBE-compliant retrospective cohort study using data from 101 patients who had undergone bilateral inguinal herniorrhaphy in our institution. Children with bilateral inguinal hernias without contraindications for surgery, ranging in age from 6 months to 12 years, were included. Fifty-six children with bilateral inguinal hernias underwent SBIH (SBIH group) and 45 patients underwent laparoscopic bilateral inguinal herniorrhaphy (LBIH) (LBIH group). Differences in operative time, postoperative pain, recurrence, and complications between the 2 groups were analyzed. Patient satisfaction with cosmetic result was also investigated using questionnaires.There were no statistically significant differences in operative time (P = .2257), postoperative pain (P = .0607), recurrence (P = .8756), and complications (P = .7467) between the 2 groups. Interestingly, the operation time of girls in SBIH group was significantly shorter than that of the boys in this group (P < .0001), but also shorter than that of girls in LBIH group (P = .0038). Postoperative pain for boys was lower in SBIH group than in the LBIH group (P = .0340). No ascending testis, testicular atrophy, and hydrocele occurred in either group. According to the questionnaire, both procedures had equally high levels of satisfaction for cosmetic results (P = .7531).Initial results show that SBIH for pediatric patients, regardless of gender, is a safe and feasible procedure compared with LBIH with an equally low recurrence rate, few complication, and satisfactory cosmetic outcomes.


Asunto(s)
Hernia Inguinal/cirugía , Herniorrafia/métodos , Herniorrafia/normas , Distribución de Chi-Cuadrado , Niño , Preescolar , Estudios de Cohortes , Femenino , Hernia Inguinal/epidemiología , Herniorrafia/estadística & datos numéricos , Humanos , Masculino , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Estadísticas no Paramétricas , Resultado del Tratamiento
18.
Medicine (Baltimore) ; 99(9): e19379, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118784

RESUMEN

To examine the willingness to pay (WTP) for a quality-adjusted life year (QALY) gained among advanced non-small cell lung cancer (NSCLC) patients in Viet Nam and to analyze the factors affecting an individual's WTP.A cross-sectional, contingent valuation study was conducted among 400 NSCLC patients across 6 national hospitals in Viet Nam. Self-reported information was recorded from patients regarding their socio-demographic status, EQ-5D (EuroQol-5 dimensions) utility, EQ-5D vas, and WTP for 1 QALY gained. To explore the factors related to the WTP, Gamma Generalized Linear Model and multiple logistic regression tools were applied to analyze data.The overall mean and median of WTP/QALY among the NSCLC patients were USD $11,301 and USD $8002, respectively. Strong association was recorded between WTP/QALY amount and the patient's education, economic status, comorbidity status, and health utility.Government and policymakers should consider providing financial supports to disadvantaged groups to improve their access to life saving cancer treatment.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/economía , Carcinoma de Pulmón de Células no Pequeñas/psicología , Financiación de la Atención de la Salud , Pacientes Internos/psicología , Años de Vida Ajustados por Calidad de Vida , Adolescente , Adulto , Anciano , Carcinoma de Pulmón de Células no Pequeñas/terapia , Estudios Transversales , Femenino , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Vietnam
19.
Medicine (Baltimore) ; 99(9): e19380, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118785

RESUMEN

INTRODUCTION: The "logsplitter injury" is a special type of ankle fractures that results from high energy violence with combined rotational forces and axial loads. So far, the diagnose and treatment of "logsplitter injury" remain largely unsettled and related literature is rare. PATIENT CONCERNS: An 18-year-old male fell from a fence and got his left ankle injured with severe malformation and swollen condition. No open wound was observed. DIAGNOSIS: Logsplitter injury, ankle fracture (AO/OTA classification 44C1.1, Lauge-Hansen classification: pronation-external rotation). INTERVENTIONS AND OUTCOMES: The patient was initially treated by internal fixation of fibular, repair of deltoid ligaments, and 1 syndesmotic screw fixation. When the X-ray applied after surgery, another 2 syndesmotic screws were performed to enhance stability. The syndesmotic screws were removed at 12-week and 16-week respectively. The patient was allowed for full weight-bearing immediately. However, the syndesmotic space was slightly increased compared to the contralateral side in CT views at 1-year follow-up, the function outcome was satisfied. CONCLUSION: The logsplitter injury is a high-energy ankle fracture that requires both axial and rotational load. It is categorized as 44B or 44C by the AO/OTA classification. In the classification scheme of Lauge-Hansen, our case is in line with the pronation-external rotation classification. Anatomic reduction and fixation of ankle syndesmotic injuries are required to restore the biomechanics of the ankle joint so that long-term complications can be prevented. How to fixation the syndesmosis, whether to reconstruct the deltoid ligament remains in debate in the treatment of logsplitter injury, whether and when to remove the syndesmotic screws were still debated. Correct surgical intervention is successful in the treatment of "logsplitter injury", however, the optimal fixation of syndesmosis and repair of deltoid ligaments need further investigate.


Asunto(s)
Fracturas de Tobillo/cirugía , Procedimientos Ortopédicos/normas , Accidentes por Caídas , Adolescente , Humanos , Fijadores Internos , Masculino , Procedimientos Ortopédicos/métodos , Procedimientos Ortopédicos/estadística & datos numéricos , Radiografía/métodos
20.
Medicine (Baltimore) ; 99(9): e19393, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118791

RESUMEN

BACKGROUND: Due to advances in technology and medical devices, intra-thoracic left ventricular assisted devices such as the fully magnetically levitated centrifugal-flow pump may now prolong the life of patients with advanced heart failure. However, several concerns have been raised about pump thrombosis and durability of the device. We aimed to systematically compare the two year outcomes of magnetic levitated centrifugal continuous flow circulatory pump versus the axial continuous flow pump for advanced heart failure. METHODS: Following the PRISMA guideline, online databases were searched for relevant trials based on centrifugal continuous flow circulatory pump and axial continuous flow pump in patients with advanced heart failure. The adverse clinical outcomes reported at 2 years follow-up were considered as the endpoints. This analysis was carried out by the RevMan 5.3 software whereby odds ratios (OR) and 95% confidence intervals (CI) were generated. RESULTS: A total number of 1011 patients with advanced heart failure was included. At 2 years, pump thrombosis was not significantly different between the two groups, with OR: 0.43, 95% CI: 0.06-3.29; P = .42. However, pump replacement was significantly higher with the axial continuous-flow pump with OR: 0.36, 95% CI: 0.15-0.84; P = .02. Stroke, sepsis and bleeding events were not significantly different. In addition, outcomes such as right heart failure, cardiac arrhythmia, the need for right ventricular assisted device, respiratory failure, renal failure and hepatic dysfunction were also not significantly different. CONCLUSIONS: At a follow-up time period of 2 years, pump replacement was significantly higher with the axial continuous-flow pump in comparison to the magnetic levitated centrifugal continuous flow circulatory pump. However, no significant difference was observed with the other adverse outcomes.


Asunto(s)
Diseño de Equipo/normas , Insuficiencia Cardíaca/cirugía , Corazón Auxiliar/normas , Resultado del Tratamiento , Insuficiencia Cardíaca/fisiopatología , Corazón Auxiliar/tendencias , Humanos , Oportunidad Relativa , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos
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