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1.
J Am Coll Cardiol ; 83(23): 2262-2273, 2024 Jun 11.
Artículo en Inglés | MEDLINE | ID: mdl-38839200

RESUMEN

BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B (apoB) are highly correlated measures of atherogenic lipoproteins. OBJECTIVES: The study investigators hypothesized that excess apoB is associated with an increased risk of myocardial infarction (MI), atherosclerotic cardiovascular disease (ASCVD), and all-cause mortality. METHODS: The study included 53,484 women and 41,624 men not taking statins from the Copenhagen General Population Study. Associations of excess apoB with the risk of MI, ASCVD, and all-cause mortality were estimated by Cox proportional hazards regressions with 95% CIs. Excess apoB was defined as measured levels of apoB minus expected levels of apoB from LDL-C alone; expected levels were defined by linear regressions of LDL-C levels vs apoB levels in individuals with triglycerides ≤1 mmol/L (89 mg/dL). RESULTS: During a median follow-up of 9.6 years, 2,048 MIs, 4,282 ASCVD events, and 8,873 deaths occurred. There was a dose-dependent association between excess apoB and the risk of MI and ASCVD in both women and men, as well as an association with the risk of all-cause mortality in women. For ASCVD in women compared with those with excess apoB <11 mg/dL, the multivariable adjusted HR was 1.08 (95% CI: 0.97-1.21) for excess apoB 11 to 25 mg/dL, 1.30 (95% CI: 1.14-1.48) for 26 to 45 mg/dL, 1.34 (95% CI: 1.14-1.58) for 46 to 100 mg/dL, and 1.75 (95% CI: 1.08-2.83) for excess apoB >100 mg/dL. Corresponding HRs in men were 1.14 (95% CI: 1.02-1.26), 1.41 (95% CI: 1.26-1.57), 1.41 (95% CI: 1.25-1.60), and 1.52 (95% CI: 1.13-2.05), respectively. Results were robust across the entire LDL-C spectrum. CONCLUSIONS: Excess apoB (ie, the value of apoB above that contributed by LDL-C levels alone) is associated dose-dependently with an increased risk of MI and ASCVD in women and men. This finding demonstrates that apoB provides important predictive value beyond LDL-C across the entire LDL-C spectrum.


Asunto(s)
Apolipoproteínas B , Humanos , Femenino , Masculino , Persona de Mediana Edad , Apolipoproteínas B/sangre , Anciano , Dinamarca/epidemiología , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/mortalidad , Estudios de Seguimiento , Infarto del Miocardio/epidemiología , Infarto del Miocardio/sangre , LDL-Colesterol/sangre , Adulto , Factores de Riesgo de Enfermedad Cardiaca , Aterosclerosis/sangre , Aterosclerosis/epidemiología , Factores Sexuales
2.
Am J Clin Nutr ; 119(6): 1443-1454, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38839195

RESUMEN

BACKGROUND: The World Health Organization recommends calcium supplementation (1500-2000 mg/d) during pregnancy for women with a low-calcium intake. OBJECTIVES: The purpose of this study was to investigate whether pregnancy calcium supplementation affects offspring blood pressure and growth in The Gambia where calcium intakes are low (300-400 mg/d). METHODS: Follow-up of offspring born during a randomized controlled trial of pregnancy calcium supplementation (ISRCTN96502494, 1996-2000) in which mothers were randomly assigned to 1500 mg Ca/d (Ca) or placebo (P) from 20 wk pregnancy to delivery. Offspring were enrolled at age 3 y in studies where blood pressure and anthropometry were measured under standardized conditions at approximately 2-yearly intervals. Mean blood pressure and growth curves were fitted for females and males separately, using the longitudinal SuperImposition by Translation and Rotation (SITAR) mixed effects model. This generates 3 individual-specific random effects: size, timing, and intensity, reflecting differences in size, age at peak velocity, and peak velocity through puberty relative to the mean curve, respectively. RESULTS: Five hundred twenty-three singleton infants were born during the trial (maternal group assignment: Ca/P = 259/264). Four hundred ninety-one were enrolled as children (females: F-Ca/F-P = 122/129 and males: M-Ca/M-P = 119/121) and measured regularly from 3.0 y to mean age 18.4 y; 90% were measured on ≥8 occasions. SITAR revealed differences in the systolic blood pressure and height curves between pregnancy supplement groups in females, but not in males. F-Ca had lower systolic blood pressure than F-P at all ages (size = -2.1 ± SE 0.8 mmHg; P = 0.005) and lower peak height velocity (intensity = -2.9 ± SE 1.1%, P = 0.009). No significant pregnancy supplement effects were seen for other measures. CONCLUSIONS: This study showed, in female offspring, that pregnancy calcium supplementation may lower systolic blood pressure and slow linear growth in childhood and adolescence, adding to evidence of offspring sexual dimorphism in responses to maternal supplementation. Further research is warranted on the long-term and intergenerational effects of antenatal supplementations. This trial was registered at ISRCTN Registry as ISRCTN96502494.


Asunto(s)
Presión Sanguínea , Calcio de la Dieta , Suplementos Dietéticos , Humanos , Femenino , Embarazo , Masculino , Presión Sanguínea/efectos de los fármacos , Calcio de la Dieta/administración & dosificación , Estudios de Seguimiento , Preescolar , Adolescente , Gambia , Fenómenos Fisiologicos Nutricionales Maternos , Adulto , Niño , Desarrollo Infantil/efectos de los fármacos , Efectos Tardíos de la Exposición Prenatal , Estatura
3.
Int Ophthalmol ; 44(1): 231, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38822988

RESUMEN

PURPOSE: To analyze the intraoperative challenges of cataract surgery in children, following glaucoma filtering surgery. METHODS: This was a retrospective study to analyze intra-op challenges and outcomes of pediatric cataract surgery in post-glaucoma filtration surgery eyes, between January 2007 and December 2019. RESULTS: We included 20 eyes of 16 children. The most common glaucoma surgery performed was trabeculectomy and trabeculotomy (14 eyes). The median age at the time of cataract surgery was 74.5 months. The most common cataract surgery performed was lens aspiration with posterior chamber intraocular lens implantation (LA + PCIOL) (9/20). The most common intraoperative challenge faced was difficulty in capsulorrhexis (ten eyes), followed by extension of primary posterior capsulotomy (six eyes). At the final follow up eight eyes had improvement in visual acuity, five eyes had stable visual acuity and five eyes had a drop in visual acuity. In 12/20 eyes IOL was implanted, nine eyes in-the-bag and three eyes had in ciliary sulcus. None of the IOLs in the bag had decentration of IOL. The median postoperative IOP (p = 0.12) and median number of postoperative AGM (p = 0.13) at 2 years remained stable compared to the preoperative values. The IOP remained well controlled in 4 eyes without anti-glaucoma medications and in 14 eyes with anti-glaucoma medications and none needed additional surgery for IOP control. Two eyes developed retinal detachment postoperatively. CONCLUSION: Cataract surgery in pediatric eyes with prior glaucoma surgeries, have challenges with capsulorrhexis and IOL stability. The visual outcomes were reasonably good so was the IOP control.


Asunto(s)
Extracción de Catarata , Catarata , Glaucoma , Presión Intraocular , Agudeza Visual , Humanos , Estudios Retrospectivos , Masculino , Femenino , Extracción de Catarata/métodos , Extracción de Catarata/efectos adversos , Niño , Preescolar , Presión Intraocular/fisiología , Glaucoma/cirugía , Glaucoma/fisiopatología , Catarata/complicaciones , Cirugía Filtrante/métodos , Estudios de Seguimiento , Resultado del Tratamiento , Adolescente , Complicaciones Intraoperatorias , Lactante , Trabeculectomía/métodos , Implantación de Lentes Intraoculares/métodos
4.
Neurosurg Focus ; 56(6): E4, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38823050

RESUMEN

OBJECTIVE: The objective of this study was to evaluate the long-term effectiveness of selective tibial neurotomy (STN) for the treatment of the spastic foot using a goal-centered approach. METHODS: Between 2011 and 2018, adult patients with a spastic foot (regardless of etiology) who received STN followed by a rehabilitation program were included. The primary outcome was the achievement of individual goals defined preoperatively (T0) and compared at 1-year (T1) and 5-year (T5) follow-up by using the Goal Attainment Scaling methodology (T-score). The secondary outcomes were the presence of spastic deformities (equinus, varus, and claw toes), modified Ashworth scale (MAS) score for the targeted muscles, and modified Rankin Scale (mRS) score at T0, T1, and T5. RESULTS: Eighty-eight patients were included. At T5, 88.7% of patients had achieved their goals at least "as expected." The mean T-score was significantly higher at T1 (62.5 ± 9.5) and T5 (60.6 ± 11.3) than at T0 (37.9 ± 2.8) (p < 0.0001), and the difference between T1 and T5 was not significant (p = 0.2). Compared to T0, deformities (equinus, varus, and claw toes; all p < 0.0001), MAS score (p < 0.0001), and mRS score (p < 0.0001) were significantly improved at T1 and T5. Compared to T1, MAS score increased slightly only at T5 (p = 0.05) but remained largely below the preoperative value. There was no difference between T1 and T5 regarding other clinical parameters (e.g., deformities, walking abilities, mRS score). CONCLUSIONS: This study found that STN associated with a postoperative rehabilitation program can enable patients to successfully achieve personal goals that are sustained within a 5-year follow-up period.


Asunto(s)
Objetivos , Nervio Tibial , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Resultado del Tratamiento , Nervio Tibial/cirugía , Procedimientos Neuroquirúrgicos/métodos , Tibia/cirugía , Espasticidad Muscular/cirugía , Espasticidad Muscular/etiología , Anciano , Estudios de Seguimiento , Estudios Retrospectivos
5.
Neurosurg Focus ; 56(6): E16, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38823054

RESUMEN

OBJECTIVE: Craniocervical dystonia (CCD) is a common type of segmental dystonia, which is a disabling disease that has been frequently misdiagnosed. Blepharospasm or cervical dystonia is the most usual symptom initially. Although deep brain stimulation (DBS) of the globus pallidus internus (GPi) has been widely used for treating CCD, its clinical outcome has been primarily evaluated in small-scale studies. This research examines the sustained clinical effectiveness of DBS of the GPi in individuals diagnosed with CCD. METHODS: The authors report 24 patients (14 women, 10 men) with refractory CCD who underwent DBS of the GPi between 2016 and 2023. The severity and disability of the dystonia were evaluated using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). The BFMDRS scores were collected preoperatively, 6 months postoperatively, and at the most recent follow-up visit. RESULTS: The mean age at onset was 52.0 ± 11.0 years (range 33-71 years) and the mean disease duration was 63.3 ± 73.3 months (range 7-360 months) (values for continuous variables are expressed as the mean ± SD). The mean follow-up period was 37.5 ± 23.5 months (range 6-84 months). The mean total BFMDRS motor scores at the 3 different time points were 13.3 ± 9.4 preoperatively, 5.0 ± 4.7 (55.3% improvement, p < 0.001) at 6 months, and 4.5 ± 3.6 (56.6% improvement, p < 0.001) at last follow-up. The outcomes were deemed poor in 6 individuals. CONCLUSIONS: Inferences drawn from the findings suggest that DBS of the GPi has long-lasting effectiveness and certain limitations in managing refractory CCD. The expected stability of the clinical outcome is not achieved. Patients with specific types of dystonia might consider targets other than GPi for a more precise therapy.


Asunto(s)
Estimulación Encefálica Profunda , Globo Pálido , Humanos , Estimulación Encefálica Profunda/métodos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Anciano , Estudios de Seguimiento , Resultado del Tratamiento , Tortícolis/terapia , Trastornos Distónicos/terapia
6.
Neurosurg Focus ; 56(6): E15, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38823057

RESUMEN

OBJECTIVE: Essential tremor (ET) is the most common movement disorder. Deep brain stimulation (DBS) targeting the ventral intermediate nucleus (VIM) is known to improve symptoms in patients with medication-resistant ET. However, the clinical effectiveness of VIM-DBS may vary, and other targets have been proposed. The authors aimed to investigate whether the same anatomical structure is responsible for tremor control both immediately after VIM-DBS and at later follow-up evaluations. METHODS: Of 68 electrodes from 41 patients with ET, the authors mapped the distances of the active contact from the VIM, the dentatorubrothalamic tract (DRTT), and the caudal zona incerta (cZI) and compared them using Friedman's ANOVA and the Wilcoxon signed-rank follow-up test. The same distances were also compared between the initially planned target and the final implantation site after intraoperative macrostimulation. Finally, the comparison among the three structures was repeated for 16 electrodes whose active contact was changed after a mean 37.5 months follow-up to improve tremor control. RESULTS: After lead implantation, the VIM was statistically significantly closer to the active contact than both the DRTT (p = 0.008) and cZI (p < 0.001). This result did not change if the target was moved based on intraoperative macrostimulation. At the last follow-up, the active contact distance from the VIM was always significantly less than that of the cZI (p < 0.001), but the distance from the DRTT was reduced and even less than the distance from the VIM. CONCLUSIONS: In patients receiving VIM-DBS, the VIM itself is the structure driving the anti-tremor effect and remains more effective than the cZI, even years after implantation. Nevertheless, the role of the DRTT may become more important over time and may help sustain the clinical efficacy when the habituation from the VIM stimulation ensues.


Asunto(s)
Estimulación Encefálica Profunda , Temblor Esencial , Núcleos Talámicos Ventrales , Zona Incerta , Humanos , Temblor Esencial/terapia , Temblor Esencial/cirugía , Estimulación Encefálica Profunda/métodos , Zona Incerta/cirugía , Femenino , Masculino , Persona de Mediana Edad , Anciano , Núcleos Talámicos Ventrales/cirugía , Resultado del Tratamiento , Adulto , Estudios de Seguimiento , Anciano de 80 o más Años
7.
Front Endocrinol (Lausanne) ; 15: 1344007, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38828412

RESUMEN

Aims: We aimed to describe and compare the incidence of the first cardiovascular event and its major subtypes, coronary heart disease (CHD), cerebrovascular disease, heart failure (HF), or peripheral artery disease (PAD), according to age and sex in a population-based cohort of individuals with type 2 diabetes (T2D) from a Mediterranean region. Material and methods: We used linked primary care electronic medical reports, pharmacy-invoicing data, and hospital admission disease registry records from the SIDIAP database, which contains linked data for 74% of the Catalonian population. We selected individuals with T2D aged 30 to 89 years free of cardiovascular disease (CVD). The primary outcome was the first presentation of CVD. Results: The study cohort included 247,751 individuals (48.6% women, 66.8 ± 11.9 years). During a 6.99-year follow-up, the cumulative incidence of the first cardiovascular event was 23.4%. Men were at higher risk for CVD (hazard ratio [HR]: 1.47 95%CI: 1.45-1.50), CHD (HR: 1.52 95%CI: 1.47-1.57), cerebrovascular disease (HR:1.07 95%CI: 1.03-1.10) and PAD (HR: 2.30 95%CI: 2.21-2.39) than women but at a lower risk for HF (HR:0.70 95%CI: 0.68-0.73). CHD and PAD were the most frequent CVD presentations among men (28.1% and 27.5%) and HF (40.1%) in women. CHD predominated among young participants of both sexes, while HF predominated among women older than 65 and men older than 75. Conclusions: In individuals with T2D, the overall risk and the type of first CVD manifestation largely varied by sex and age. This epidemiological evidence should be considered in clinical practice.


Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Masculino , Anciano , Persona de Mediana Edad , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Estudios de Cohortes , Adulto , Anciano de 80 o más Años , Incidencia , Factores Sexuales , Factores de Edad , Factores de Riesgo , Estudios de Seguimiento , España/epidemiología
8.
Int J Hyperthermia ; 41(1): 2345382, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38843894

RESUMEN

PURPOSE: The objective was to describe the technique and clinical outcome of microwave thermal ablation (MWA) and perfusion combined with synthetic bone substitutes in treating unicameral bone cysts (UBCs) in adolescents. MATERIALS AND METHODS: A total of 14 consecutive patients were enrolled by percutaneous MWA and saline irrigation combined with synthetic bone substitutes. Clinical follow-up included the assessment of pain, swelling, and functional mobility. Radiological parameters included tumor volume, physis-cyst distance, cortical thickness of the thinnest cortical bone, and the Modified Neer classification system. RESULTS: The mean follow-up was 28.9 months (26-52 months). All UBCs were primary, and all patients underwent the MWA, saline perfusion, and reconstruction combined with a synthetic bone substitute session, except for one patient (7.1%) who required a second session. All patients had good clinical results at the final follow-up. Satisfactory cyst healing was achieved in 13 cases according to radiological parameters. Tumor volume decreased from a mean of 49.7 cm3 before surgery treatment to 13.9 cm3 at the final follow-up (p < 0.01). The physis-cyst distance increased from a mean of 3.17-4.83 cm at the final follow-up (p < 0.01). Cortical thickness improved from a mean of 1.1 mm to 2.0 mm at the final follow-up (p < 0.01). According to the proposed radiological criteria, our results were considered successful (Grading I and II) in 13 patients (92.9%) at the final follow-up. CONCLUSION: Percutaneous microwave ablation combined with a bone graft substitute is a minimally invasive, effective, safe, and cost-effective approach to treating primary bone cysts in the limbs of adolescents.


Asunto(s)
Quistes Óseos , Sustitutos de Huesos , Microondas , Humanos , Masculino , Femenino , Adolescente , Quistes Óseos/cirugía , Quistes Óseos/diagnóstico por imagen , Sustitutos de Huesos/uso terapéutico , Microondas/uso terapéutico , Estudios de Seguimiento , Niño , Procedimientos de Cirugía Plástica/métodos , Adulto Joven , Técnicas de Ablación/métodos
9.
Ann Oncol ; 35(6): 537-548, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38844309

RESUMEN

BACKGROUND: Nivolumab plus ipilimumab demonstrated promising clinical activity and durable responses in sorafenib-treated patients with advanced hepatocellular carcinoma (HCC) in the CheckMate 040 study at 30.7-month median follow-up. Here, we present 5-year results from this cohort. PATIENTS AND METHODS: Patients were randomized 1 : 1 : 1 to arm A [nivolumab 1 mg/kg plus ipilimumab 3 mg/kg Q3W (four doses)] or arm B [nivolumab 3 mg/kg plus ipilimumab 1 mg/kg Q3W (four doses)], each followed by nivolumab 240 mg Q2W, or arm C (nivolumab 3 mg/kg Q2W plus ipilimumab 1 mg/kg Q6W). The primary objectives were safety, tolerability, investigator-assessed objective response rate (ORR), and duration of response (DOR) per RECIST version 1.1. RESULTS: A total of 148 patients were randomized across treatment arms. At 60-month minimum follow-up (62.6-month median follow-up), the ORR was 34% (n = 17), 27% (n = 13), and 29% (n = 14) in arms A, B, and C, respectively. The median DOR was 51.2 months [95% confidence interval (CI) 12.6 months-not estimable (NE)], 15.2 months (95% CI 7.1 months-NE), and 21.7 months (95% CI 4.2 months-NE), respectively. The median overall survival (OS) was 22.2 months (34/50; 95% CI 9.4-54.8 months) in arm A, 12.5 months (38/49; 95% CI 7.6-16.4 months) in arm B, and 12.7 months (40/49; 95% CI 7.4-30.5 months) in arm C; 60-month OS rates were 29%, 19%, and 21%, respectively. In an exploratory analysis of OS by response (6-month landmark), the median OS was meaningfully longer for responders versus nonresponders for all arms. No new safety signals were identified with longer follow-up. There were no new discontinuations due to immune-mediated adverse events since the primary analysis. CONCLUSIONS: Consistent with the primary analysis, the arm A regimen of nivolumab plus ipilimumab continued to demonstrate clinically meaningful responses and long-term survival benefit, with no new safety signals in patients with advanced HCC following sorafenib treatment, further supporting its use as a second-line treatment in these patients.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Carcinoma Hepatocelular , Ipilimumab , Neoplasias Hepáticas , Nivolumab , Sorafenib , Humanos , Carcinoma Hepatocelular/tratamiento farmacológico , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/mortalidad , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/mortalidad , Ipilimumab/administración & dosificación , Ipilimumab/efectos adversos , Nivolumab/administración & dosificación , Nivolumab/efectos adversos , Sorafenib/administración & dosificación , Sorafenib/efectos adversos , Sorafenib/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Adulto , Estudios de Seguimiento , Anciano de 80 o más Años
10.
Blood Press ; 33(1): 2353836, 2024 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38847517

RESUMEN

Objectives: Evidence suggests that renal function increasingly deteriorates in patients with apparently treatment-resistant hypertension (ATRH) in comparison with those who have non-resistant arterial hypertension (NAH). We aimed to assess the long-term decline in renal function between these patient groups and identify specific risk factors contributing to the progression of renal dysfunction. Methods: Data for 265 patients with ATRH and NAH in a hypertension excellence centre were retrospectively evaluated. Demographic characteristics, co-morbidities, laboratory findings, secondary causes of hypertension, medication and exposure to contrast agents were assessed. To address differences between groups, adjustment with linear mixed-effect models was used. Results: Data from the first 4 years of follow-up were evaluated. After adjustment for age and diabetes, which were identified as independent risk factors for renal dysfunction progression in the study cohort, the mean decrease in estimated glomerular filtration rate per year was steeper with ATRH than with NAH (-1.49 vs. -0.65 mL/min/1.73 m2 per year; difference in slope, 0.83 mL/min/1.73 m2 per year; 95% confidence interval [CI]: 0.25-1.41, p = 0.005). In subgroup analyses, without Holm-Bonferroni correction, the prescription of MRA indicated a faster decline in renal function in ATRH. Following correction, no specific therapeutic risk factor was associated with faster progression of renal dysfunction. Conclusions: Renal function declines twice as fast with ATRH compared with NAH, independently of age and diabetes. Larger studies are needed to reveal risk factors for renal dysfunction in patients with hypertension.


High blood pressure (arterial hypertension) is a significant risk factor for kidney function decline. Resistant hypertension represents a subtype of hypertension that is difficult to treat and requires multiple antihypertensive agents to achieve effective blood pressure control. Recent research suggests that individuals with resistant hypertension are at greater risk of kidney dysfunction.This study analyses data from adult patients with arterial hypertension and resistant hypertension followed-up for a mean duration of 6.4 years.A faster decline in kidney function was observed in patients with resistant hypertension. This suggests that renal function in these patients should be closely monitored.After statistical evaluation, no medication was found to be associated with an increased risk of kidney failure progression. However, two specific medications, spironolactone and eplerenone, raised suspicion and require further exploration in larger prospective studies.


Asunto(s)
Tasa de Filtración Glomerular , Hipertensión , Humanos , Masculino , Hipertensión/fisiopatología , Hipertensión/tratamiento farmacológico , Hipertensión/complicaciones , Femenino , Persona de Mediana Edad , Factores de Riesgo , Anciano , Estudios Retrospectivos , Progresión de la Enfermedad , Antihipertensivos/uso terapéutico , Riñón/fisiopatología , Estudios de Seguimiento
11.
J Refract Surg ; 40(6): e381-e391, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38848059

RESUMEN

PURPOSE: To investigate the long-term visual quality and rotational stability after the implantation of Implantable Collamer Lens (ICL) and toric ICL (TICL) (STAAR Surgical) in patients with myopia older than 40 years. METHODS: This study included 82 eyes of 41 patients older than 40 years with myopia who underwent ICL/TICL V4c implantation. The refraction sphere, refraction cylinder, spherical equivalent (SE), uncorrected and corrected distance visual acuity, and anterior segmental parameters were measured preoperatively and at the 1-month, 3-month, and last follow-up visits at 33 to 58 months postoperatively (mean follow-up: 42.56 ± 7.17 months). Wavefront aberrations and TICL rotation were measured using OPD-Scan III (Nidek Co Ltd) at the last follow-up visit. RESULTS: At the last follow-up visit, the overall safety and efficacy index were 1.22 ± 0.26 and 0.88 ± 0.34, respectively, without significant differences between the ICL and TICL groups. Postoperative refraction cylinder was -0.95 ± 0.64 and -0.71 ± 0.54 diopters in the ICL and TICL groups, respectively. The average vault was 467.44 ± 231.98 µm. The average TICL rotation was 5.45 ± 6.61 degrees, positively correlated with the preoperative anterior chamber volume (R2 = 0.1118, P = .026) and clockwise TICL alignment degree (R2 = 0.3110, P = .007) and negatively correlated with the 1-month vault (R2 = 0.1218, P = .008). There were no significant differences in the total, corneal, or internal aberrations and modulation transfer function AreaRatio between the ICL and TICL groups. CONCLUSIONS: Both ICL and TICL presented satisfactory long-term safety, efficacy, and visual quality in patients older than 40 years. Postoperative TICL spontaneous rotation was within the manageable range in the long term. [J Refract Surg. 2024;40(6):e381-e391.].


Asunto(s)
Implantación de Lentes Intraoculares , Miopía Degenerativa , Lentes Intraoculares Fáquicas , Refracción Ocular , Agudeza Visual , Humanos , Agudeza Visual/fisiología , Refracción Ocular/fisiología , Masculino , Femenino , Persona de Mediana Edad , Adulto , Estudios de Seguimiento , Miopía Degenerativa/fisiopatología , Miopía Degenerativa/cirugía , Estudios Retrospectivos , Aberración de Frente de Onda Corneal/fisiopatología , Rotación
12.
World J Surg Oncol ; 22(1): 146, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38822349

RESUMEN

BACKGROUND: Delayed epistaxis after endoscopic transnasal pituitary tumor resection (ETPTR) is a critical complication, tending to cause aspiration or hemorrhagic shock. This study assessed clinical characteristics, risk factors, and provide treatment and prevention advice of this complication. METHODS: This was a retrospective monocentric analysis of 862 patients who underwent ETPTR. Statistical analyses of clinical data revealed the incidence, sources and onset time of delayed epistaxis. Univariate analysis and binary logistic regression were used to identify risk factors. RESULTS: The incidence of delayed epistaxis was 2.78% (24/862), with an average onset time of 20.71 ± 7.39 days. The bleeding sources were: posterior nasal septal artery branch of sphenopalatine artery (12/24), multiple inflammatory mucosae (8/24), sphenopalatine artery trunk (3/24) and sphenoid sinus bone (1/24). Univariate analysis and binary logistic regression analysis confirmed that hypertension, nasal septum deviation, chronic rhinosinusitis and growth hormone pituitary tumor subtype were independent risk factors for delayed epistaxis. Sex, age, history of diabetes, tumor size, tumor invasion and operation time were not associated with delayed epistaxis. All patients with delayed epistaxis were successfully managed through endoscopic transnasal hemostasis without recurrence. CONCLUSIONS: Delayed epistaxis after ETPTR tends to have specific onset periods and risk factors. Prevention of these characteristics may reduce the occurrence of delayed epistaxis. Endoscopic transnasal hemostasis is recommended as the preferred treatment for delayed epistaxis.


Asunto(s)
Epistaxis , Neoplasias Hipofisarias , Humanos , Epistaxis/etiología , Epistaxis/prevención & control , Epistaxis/epidemiología , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Neoplasias Hipofisarias/cirugía , Factores de Riesgo , Adulto , Anciano , Estudios de Seguimiento , Pronóstico , Incidencia , Endoscopía/métodos , Endoscopía/efectos adversos , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Adulto Joven , Factores de Tiempo , Adolescente , Cirugía Endoscópica por Orificios Naturales/efectos adversos , Cirugía Endoscópica por Orificios Naturales/métodos
13.
Trials ; 25(1): 353, 2024 May 31.
Artículo en Inglés | MEDLINE | ID: mdl-38822392

RESUMEN

BACKGROUND: The SAVVY project aims to improve the analyses of adverse events (AEs) in clinical trials through the use of survival techniques appropriately dealing with varying follow-up times and competing events (CEs). This paper summarizes key features and conclusions from the various SAVVY papers. METHODS: Summarizing several papers reporting theoretical investigations using simulations and an empirical study including randomized clinical trials from several sponsor organizations, biases from ignoring varying follow-up times or CEs are investigated. The bias of commonly used estimators of the absolute (incidence proportion and one minus Kaplan-Meier) and relative (risk and hazard ratio) AE risk is quantified. Furthermore, we provide a cursory assessment of how pertinent guidelines for the analysis of safety data deal with the features of varying follow-up time and CEs. RESULTS: SAVVY finds that for both, avoiding bias and categorization of evidence with respect to treatment effect on AE risk into categories, the choice of the estimator is key and more important than features of the underlying data such as percentage of censoring, CEs, amount of follow-up, or value of the gold-standard. CONCLUSIONS: The choice of the estimator of the cumulative AE probability and the definition of CEs are crucial. Whenever varying follow-up times and/or CEs are present in the assessment of AEs, SAVVY recommends using the Aalen-Johansen estimator (AJE) with an appropriate definition of CEs to quantify AE risk. There is an urgent need to improve pertinent clinical trial reporting guidelines for reporting AEs so that incidence proportions or one minus Kaplan-Meier estimators are finally replaced by the AJE with appropriate definition of CEs.


Asunto(s)
Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Factores de Tiempo , Ensayos Clínicos Controlados Aleatorios como Asunto/normas , Guías de Práctica Clínica como Asunto , Interpretación Estadística de Datos , Medición de Riesgo , Proyectos de Investigación/normas , Factores de Riesgo , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Sesgo , Análisis de Supervivencia , Estudios de Seguimiento , Resultado del Tratamiento , Simulación por Computador , Estimación de Kaplan-Meier
14.
Reprod Health ; 21(1): 73, 2024 May 31.
Artículo en Inglés | MEDLINE | ID: mdl-38822390

RESUMEN

BACKGROUND: Early antenatal care visit is important for optimal care and health outcomes for women and children. In the study area, there is a lack of information about the time to initiation of antenatal care. So, this study aimed to determine the time to initiation of antenatal care visits and its predictors among pregnant women who delivered in Arba Minch town public health facilities. METHODS: An institution-based retrospective follow-up study was performed among 432 women. A systematic random sampling technique was employed to select the study participants. The Kaplan-Meier survival curve was used to estimate the survival time. A Multivariable Cox proportional hazard regression model was fitted to identify predictors of the time to initiation of antenatal care. An adjusted hazard ratio with a 95% confidence interval was used to assess statistical significance. RESULTS: The median survival time to antenatal care initiation was 18 weeks (95% CI = (17, 19)). Urban residence (AHR = 2.67; 95% CI = 1.52, 4.71), Tertiary and above level of education of the women (AHR = 1.90; 95% CI = 1.28, 2.81), having pregnancy-related complications in a previous pregnancy (AHR = 1.53; 95% CI = 1.08, 2.16), not having antenatal care for previous pregnancy (AHR = 0.39; 95% CI = 0.21, 0.71) and unplanned pregnancy (AHR = 0.66; 95% CI = 0.48, 0.91) were statistically significant predictors. CONCLUSION: Half of the women initiate their antenatal care visit after 18 weeks of their pregnancy which is not in line with the recommendation of the World Health Organization. Urban residence, tertiary and above level of education of the women, having pregnancy-related complications in a previous pregnancy, not having previous antenatal care visits and unplanned pregnancy were predictors of the time to initiation of antenatal care. Therefore, targeted community outreach programs including educational campaigns regarding antenatal care for women who live in rural areas, who are less educated, and who have no previous antenatal care experience should be provided, and comprehensive family planning services to prevent unplanned pregnancy are needed.


Asunto(s)
Atención Prenatal , Humanos , Femenino , Embarazo , Atención Prenatal/estadística & datos numéricos , Etiopía , Adulto , Estudios Retrospectivos , Estudios de Seguimiento , Adulto Joven , Mujeres Embarazadas/psicología , Adolescente , Aceptación de la Atención de Salud/estadística & datos numéricos , Instituciones de Salud/estadística & datos numéricos , Factores de Tiempo
15.
Int Heart J ; 65(3): 433-443, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38825492

RESUMEN

Late kidney injury (LKI) in patients with acute heart failure (AHF) requiring intensive care is poorly understood.We analyzed 821 patients with AHF who required intensive care. We defined LKI based on the ratio of the creatinine level 1 year after admission for AHF to the baseline creatinine level. The patients were categorized into 4 groups based on this ratio: no-LKI (< 1.5, n = 509), Class R (risk; ≥ 1.5, n = 214), Class I (injury; ≥ 2.0, n = 78), and Class F (failure; ≥ 3.0, n = 20). Median follow-up after admission for AHF was 385 (346-426) days. Multivariate logistic regression analysis revealed that acute kidney injury (AKI) during hospitalization (Class R, odds ratio [OR]: 1.710, 95% confidence interval [CI]: 1.138-2.571, P = 0.010; Class I, OR: 6.744, 95% CI: 3.739-12.163, P < 0.001; and Class F, OR: 9.259, 95% CI: 4.078-18.400, P < 0.001) was independently associated with LKI. Multivariate Cox regression analysis showed that LKI was an independent predictor of 3-year all-cause death after final follow-up (hazard ratio: 1.545, 95% CI: 1.099-2.172, P = 0.012). The rate of all-cause death was significantly lower in the no-AKI/no-LKI group than in the no-AKI/LKI group (P = 0.048) and in the AKI/no-LKI group than in the AKI/LKI group (P = 0.017).The incidence of LKI was influenced by the presence of AKI during hospitalization, and was associated with poor outcomes within 3 years of final follow-up. In the absence of LKI, AKI during hospitalization for AHF was not associated with a poor outcome.


Asunto(s)
Lesión Renal Aguda , Insuficiencia Cardíaca , Unidades de Cuidados Intensivos , Humanos , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/complicaciones , Masculino , Femenino , Anciano , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Lesión Renal Aguda/terapia , Unidades de Cuidados Intensivos/estadística & datos numéricos , Estudios Retrospectivos , Creatinina/sangre , Persona de Mediana Edad , Enfermedad Aguda , Anciano de 80 o más Años , Hospitalización/estadística & datos numéricos , Factores de Riesgo , Estudios de Seguimiento , Factores de Tiempo
16.
Pediatr Surg Int ; 40(1): 148, 2024 Jun 02.
Artículo en Inglés | MEDLINE | ID: mdl-38825635

RESUMEN

BACKGROUND: Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by hamartomatous gastrointestinal polyps along with the characteristic mucocutaneous freckling. Multiple surgeries for recurrent intussusception in these children may lead to short bowel syndrome. Here we present our experience of management in such patients. METHODS: From January 2015 to December 2023, we reviewed children of PJS, presented with recurrent intussusceptions. Data were collected regarding presentation, management, and follow-up with attention on management dilemma. Diagnosis of PJS was based on criteria laid by World Health Organization (WHO). RESULTS: A total of nine patients were presented with age ranging from 4 to 17 years (median 9 years). A total of eighteen laparotomies were performed (7 outside, 11 at our centre). Among 11 laparotomies done at our centre, resection and anastomosis of bowel was done 3 times while 8 times enterotomy and polypectomy was done after reduction of intussusception. Upper and lower gastrointestinal endoscopy (UGIE & LGIE) was done in all cases while intraoperative enteroscopy (IOE) performed when required. Follow-up ranged from 2 months to 7 years. CONCLUSION: Children with PJS have a high risk of multiple laparotomies due to polyps' complications. Considering the diffuse involvement of the gut, early decision of surgery and extensive bowel resection should not be done. Conservative treatment must be tried under close observation whenever there is surgical dilemma. The treatment should be directed in the form of limited resection or polypectomy after reduction of intussusception.


Asunto(s)
Intususcepción , Síndrome de Peutz-Jeghers , Recurrencia , Humanos , Síndrome de Peutz-Jeghers/complicaciones , Síndrome de Peutz-Jeghers/cirugía , Intususcepción/cirugía , Intususcepción/terapia , Niño , Preescolar , Adolescente , Femenino , Masculino , Estudios Retrospectivos , Laparotomía/métodos , Estudios de Seguimiento
17.
Diabetes Metab Res Rev ; 40(5): e3826, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38824455

RESUMEN

INTRODUCTION: Early and tight glycaemic control is crucial to prevent long-term complications of Type 1 Diabetes (T1D). The aim of our study was to compare glucose metrics, including Time In Tight Range (TITR), in a real-world setting. METHODS: We performed a single-centre cross-sectional study in 534 children and adolescents with T1D. Participants were divided into four groups (multiple daily injections + real-time Continuous glucose monitoring (CGM), multiple daily injections + intermittently scanned CGM, sensor augmented pump (SAP), and Advanced Hybrid Closed-Loop (AHCL). Demographical and clinical data were collected and analysed. RESULTS: The group with AHCL showed significantly higher Time In Range (TIR) (71.31% ± 10.88) than SAP (57.82% ± 14.98; p < 0.001), MDI + rtCGM (54.56% ± 17.04; p < 0.001) and MDI + isCGM (52.17% ± 19.36; p < 0.001) groups with a lower Time Above Range (p < 0.001). The group with AHCL also showed lower Time Below Range than MDI + isCGM and SAP groups (p < 0.01). The overall TITR was 37% ± 14 with 19% of participants who reached a TITR ≥50% with a mean TIR of 81%. AHCL had significantly higher TITR (45.46% ± 11.77) than SAP (36.25% ± 13.53; p < 0.001), MDI + rtCGM (34.03% ± 13.89; p < 0.001) and MDI + isCGM (33.37% ± 15.84; p < 0.001) groups with a lower Coefficient of Variation (p < 0.001). CONCLUSIONS: Our study indicates that AHCL ensures a better glycaemic control with an improvement in both TIR and TITR, along with a reduction in CV. Implementation of automated insulin delivery systems should be considered in the treatment of children and adolescents with T1D.


Asunto(s)
Automonitorización de la Glucosa Sanguínea , Glucemia , Diabetes Mellitus Tipo 1 , Hipoglucemiantes , Sistemas de Infusión de Insulina , Insulina , Humanos , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Estudios Transversales , Niño , Adolescente , Femenino , Masculino , Automonitorización de la Glucosa Sanguínea/métodos , Glucemia/análisis , Insulina/administración & dosificación , Insulina/uso terapéutico , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/uso terapéutico , Control Glucémico/métodos , Hemoglobina Glucada/análisis , Estudios de Seguimiento , Pronóstico , Biomarcadores/análisis , Hipoglucemia/prevención & control
18.
Pediatr Dent ; 46(3): 186-191, 2024 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-38822498

RESUMEN

Purpose: The purpose of this study was to longitudinally evaluate follow-up treatment on primary teeth initially treated with silver diammine fluoride (SDF). Methods: This retrospective cohort evaluated private insurance (not Medicaid) claims data from 2018 to 2019 for children no older than 12 years with at least one primary tooth initially treated with SDF. Additional treatment per tooth was recorded over a follow-up of at least 24 months. Results: The mean and standard deviation (±SD) age of 46,884 patients was 5.7±2.3 and for SDF-treated teeth per patient was 2.6±2.1. Forty percent (95 percent confidence interval [95% CI] equals 39 to 40.7 percent) of teeth initially treated with SDF received additional treatment. The odds of SDF-treated teeth receiving future treatment significantly decreased with patient age by 22 percent per year (odds ratio equals 0.78; 95% CI equals 0.077 to 0.79; P<0.001). Pediatric dentists had only slightly lower odds than general dentists for providing additional treatment (0.91, P<0.001). Posterior teeth and teeth expected to exfoliate in two or more years had significantly higher odds of receiving additional treatment (2.47 and 1.27, respectively, P<0.001). Conclusions: Beginning at age four, patient age at placement of silver diammine fluoride was inversely proportional to future treatment provided. Posterior teeth and teeth expected to exfoliate in two or more years were more likely to receive additional treatment.


Asunto(s)
Fluoruros Tópicos , Revisión de Utilización de Seguros , Compuestos de Plata , Diente Primario , Humanos , Niño , Fluoruros Tópicos/uso terapéutico , Estudios Retrospectivos , Femenino , Masculino , Preescolar , Estudios Longitudinales , Compuestos de Plata/uso terapéutico , Estudios de Seguimiento , Cariostáticos/uso terapéutico , Caries Dental/prevención & control , Atención Dental para Niños , Seguro Odontológico , Compuestos de Amonio Cuaternario
19.
Neurology ; 103(1): e209397, 2024 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-38833656

RESUMEN

BACKGROUND AND OBJECTIVES: Individuals with epilepsy have increased risk of suicidal ideation (SI) and behaviors when compared with the general population. This relationship has remained largely unexplored in adolescents. We investigated the prevalence of suicidality in adolescents with newly diagnosed focal epilepsy within 4 months of treatment initiation and over the following 36 months. METHODS: This was a post hoc analysis of the enrollment and follow-up data from the Human Epilepsy Project, an international, multi-institutional study that enrolled participants between 2012 and 2017. Participants enrolled were 11-17 years of age within 4 months of treatment initiation for focal epilepsy. We used data from the Columbia Suicide Severity Rating Scale (C-SSRS), administered at enrollment and over the 36-month follow-up period, along with data from medical records. RESULTS: A total of 66 adolescent participants were enrolled and completed the C-SSRS. At enrollment, 14 (21%) had any lifetime SI and 5 (8%) had any lifetime suicidal behaviors (SBs). Over the following 36 months, 6 adolescents reported new onset SI and 5 adolescents reported new onset SB. Thus, the lifetime prevalence of SI within this population increased from 21% to 30% (14-20 adolescents), and the lifetime prevalence of SB increased from 8% to 15% (5-10). DISCUSSION: The prevalence of suicidality in adolescents with newly diagnosed focal epilepsy reported in our study is consistent with previous findings of significant suicidality observed in epilepsy. We identify adolescents as an at-risk population at the time of epilepsy diagnosis and in the following years.


Asunto(s)
Epilepsias Parciales , Ideación Suicida , Humanos , Adolescente , Masculino , Femenino , Epilepsias Parciales/epidemiología , Epilepsias Parciales/psicología , Epilepsias Parciales/diagnóstico , Prevalencia , Niño , Estudios de Seguimiento , Suicidio/estadística & datos numéricos , Suicidio/psicología
20.
J Pediatr Orthop ; 44(6): e560-e565, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38835290

RESUMEN

BACKGROUND: Anterolateral tibial bowing associated with congenital tibial pseudarthrosis occurs often in patients with neurofibromatosis type 1 and results from the inability of the fractured bone to unite, leading to persistent nonunion, abnormal bone growth, and further bowing of the tibia. Current surgical and nonsurgical approaches demonstrate persistent nonunion or refracture, often resulting in amputation. METHODS: This report describes the management of 3 patients with anterolateral tibial bowing and NF1 who underwent distal tibia-guided growth. RESULTS: The patients had an average age of 1.6 years at initial operation, with a total of 3 to 4 surgeries over an average of 2.1 years. The latest follow-up on all patients is included, at a mean of 5.1 years after the initial operation. All 3 patients experienced substantial functional improvement and improved alignment of the mechanical axis of the tibia. One patient has experienced refracture. CONCLUSIONS: Our study indicates that guided growth can serve as an additional surgical option to improve ALTB and potentially reduce the risk of fracture and pseudarthrosis by restoring normal mechanical alignment. LEVEL OF EVIDENCE: Level-IV, Case Series.


Asunto(s)
Neurofibromatosis 1 , Seudoartrosis , Tibia , Humanos , Seudoartrosis/congénito , Seudoartrosis/cirugía , Neurofibromatosis 1/complicaciones , Tibia/cirugía , Tibia/anomalías , Masculino , Femenino , Lactante , Estudios de Seguimiento , Preescolar , Fracturas de la Tibia/cirugía , Resultado del Tratamiento
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