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1.
Anticancer Res ; 40(1): 299-304, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31892580

RESUMEN

BACKGROUND/AIM: To clarify whether renal dysfunction affects the incidence of adverse events associated with oxaliplatin, the present study was designed to investigate the relationship between creatinine clearance (Ccr) and the incidence of oxaliplatin-related adverse events. PATIENTS AND METHODS: A total of 287 CRC patients who received the first cycle of oxaliplatin-based chemotherapy were eligible. Adverse events, including nausea, vomiting, neutropenia and thrombocytopenia, were graded, and the relationship between Ccr and the incidence of adverse events was examined using multivariable logistic regression analysis. RESULTS: A multivariable analysis indicated that the incidence of grade ≥2 nausea increased, while the incidence of other adverse events tended to be higher, as the Ccr decreased. Particularly, renal dysfunction (Ccr <60 ml/min) was a significant risk factor for grade ≥2 nausea (p=0.042). CONCLUSION: Care should be taken to avoid adverse events associated with oxaliplatin in patients with renal dysfunction.


Asunto(s)
Neoplasias Colorrectales/tratamiento farmacológico , Riñón/fisiopatología , Oxaliplatino/efectos adversos , Oxaliplatino/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Creatinina/metabolismo , Femenino , Humanos , Incidencia , Riñón/efectos de los fármacos , Masculino , Persona de Mediana Edad , Náusea/inducido químicamente , Factores de Riesgo , Adulto Joven
2.
Anticancer Res ; 40(1): 305-313, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31892581

RESUMEN

BACKGROUND: Cancer-associated thrombosis (CAT), the second leading cause of death in patients with cancer can be treated with low molecular weight heparin (LMWH) according to guidelines. PATIENTS AND METHODS: A multicenter prospective observational study was carried out to record anti-thrombotic treatment practice, assess thrombosis recurrence and bleeding, and identify potential risk factors. Adult patients from 18 Oncology Departments throughout Greece were followed-up for 12 months. RESULTS: A total of 120 patients with CAT receiving anticoagulant treatment were enrolled (35% incidental); 85% were treated for more than 6 months, 95.8% were treated with tinzaparin and smaller percentages with other agents. Thrombosis recurred in three patients and there was minor bleeding in four patients. Bleeding was associated with high body mass index (>35 kg/m2), trauma history, renal insufficiency and bevacizumab use. CONCLUSION: Incidental thrombosis contributes significantly to CAT burden. Long-term use of LMWH seems to be effective and safe. Several risk factors associated with bleeding should be considered during anti-coagulation therapy planning.


Asunto(s)
Neoplasias/complicaciones , Trombosis/etiología , Trombosis/terapia , Femenino , Hemorragia/etiología , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Factores de Riesgo
3.
Adv Exp Med Biol ; 1232: 331-337, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893428

RESUMEN

Obesity, a risk factor of coronary artery disease, is known to cause peripheral microcirculatory disturbances. This study evaluated the relationship between the degree of obesity and peripheral microcirculatory disturbances, using peripheral near infrared spectroscopy (NIRS) with a vascular occlusion test (VOT). We compared correlations between the NIRS parameter changes induced by VOT and body mass index (BMI) in patients with and without statin therapy. A NIRS probe was set on the right thenar eminence, brachial artery blood flow was blocked for 3 min, and then released. Although total hemoglobin (ΔcHb), deoxyhemoglobin (ΔHHb) and tissue oxygenation index (ΔTOI) were not correlated with BMI, a significant negative correlation was found between oxyhemoglobin (ΔO2Hb) and BMI in the overall study population (r = -0.255, p-value 0.02). In addition, a significant negative correlation was found between ΔO2Hb and BMI in patients without statin therapy (r = -0.353, p-value 0.02) but not in patients with statin therapy (r = -0.181, p-value 0.27). These findings suggest that ΔO2Hb may be a useful indicator to assess peripheral microcirculation.


Asunto(s)
Índice de Masa Corporal , Enfermedad de la Arteria Coronaria , Espectroscopía Infrarroja Corta , Anciano , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Masculino , Microcirculación/fisiología , Oxígeno , Consumo de Oxígeno , Oxihemoglobinas/metabolismo , Factores de Riesgo , Espectroscopía Infrarroja Corta/normas
4.
Adv Exp Med Biol ; 1232: 355-360, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893431

RESUMEN

Epicardial adipose tissue (EAT) is associated with visceral fat and various cardiac disorders, such as atrial fibrillation and adverse cardiovascular events. Therefore, it is important to develop a simple and non-invasive inspection method to assess EAT, to prevent unfavorable cardiac events. This study assessed correlations between near-infrared spectroscopy (NIRS) changes induced by a vascular occlusion test (VOT) and EAT volume measured by cardiac computed tomography (CCT) in patients with suspected coronary artery disease. We also assessed correlations between body mass index (BMI) and EAT volume in the same population. In addition, these correlations were compared in patients treated with statin therapy and in those without statin therapy. A NIRS probe was set on the right thenar eminence, and brachial artery blood flow was blocked for 3 min before being released. A negative correlation was found between oxyhemoglobin (ΔO2Hb) and EAT volume in the overall study population (r = -0.236, p = 0.03). Interestingly, although a strong correlation was observed in patients without statin therapy (r = -0.488, p < 0.001), this correlation was not observed in patients with statin therapy (r = 0.157, p = 0.34). These findings suggest that NIRS measurements with VOT may be a useful method to identify patients with high EAT volume and high cardiovascular risks.


Asunto(s)
Enfermedad de la Arteria Coronaria , Espectroscopía Infrarroja Corta , Tejido Adiposo/metabolismo , Anciano , Índice de Masa Corporal , Angiografía por Tomografía Computarizada , Enfermedad de la Arteria Coronaria/diagnóstico , Femenino , Humanos , Masculino , Oxihemoglobinas/metabolismo , Factores de Riesgo
5.
Anticancer Res ; 40(1): 491-499, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31892604

RESUMEN

This article is a narrative review of recent epidemiological findings regarding ultraviolet-B (UVB) dose or exposure, serum 25-hydroxyvitamin D [25(OH)D] concentrations, vitamin D supplementation, and genetic variations in 25(OH)D concentration for incidence, survival, and mortality rates of overall and breast, colorectal, and prostate cancer. According to ecological studies, solar UVB doses are inversely correlated with incidence/mortality rates for about 20 cancer types. Observational studies support a role of higher 25(OH)D concentrations in reducing risk of breast and colorectal cancer incidence and mortality rates but, for prostate cancer, in increasing incidence rates while reducing mortality rates. Mendelian randomization studies offer little support for vitamin D in reducing cancer risk. Their primary limitation is that they only investigate small variations in genetically predicted 25(OH)D concentration near the population mean value. The secondary analyses from the VITAL clinical trial indicated significant reductions from 2000 IU/d of vitamin D3 supplementation in all-cancer incidence and mortality rates for selected subgroups. Thus, Hill's criteria for causality in a biological system are now largely satisfied for supporting the claim that vitamin D reduces the risk of cancer incidence and death.


Asunto(s)
Neoplasias/epidemiología , Vitamina D/metabolismo , Suplementos Dietéticos , Humanos , Neoplasias/sangre , Neoplasias/mortalidad , Estudios Observacionales como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Vitamina D/sangre
6.
Anticancer Res ; 40(1): 501-509, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31892605

RESUMEN

BACKGROUND: Intensive scientific debate is ongoing about whether moderate solarium use increases melanoma risk. The authors of some recent publications demand the debate be closed and propose "actions against solarium use for skin cancer prevention" because new studies have convincingly demonstrated causality. This minireview aims to investigate whether those demands are sufficiently supported by present scientific knowledge and comply with the principles of evidence-based medicine. MATERIALS AND METHODS: We performed a systematic literature search (through June 2019; PubMed, ISI Web of Science) to identify publications investigating how solarium use affects melanoma risk. RESULTS: We found no studies that demonstrate a causal relationship between moderate solarium use and melanoma risk. Results of cohort and case-control studies published to date, including recent investigations, do not prove causality, and randomized controlled trials providing unequivocal proof are still lacking. Moreover, the overall quality of observational studies is low as a result of severe limitations (including unobserved or unrecorded confounding), possibly leading to bias. We also disagree with recent claims that Hill's criteria for the epidemiological evidence of a causal relationship between a potential causal factor and an observed effect are fulfilled in regard to the conclusion that moderate solarium use per se would increase melanoma risk Conclusion: Current scientific knowledge does not demonstrate a causal relationship between moderate solarium use and melanoma risk. Therefore, the debate is not closed.


Asunto(s)
Melanoma/epidemiología , Baño de Sol , Animales , Humanos , Factores de Riesgo , Rayos Ultravioleta
7.
Anticancer Res ; 40(1): 557-564, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31892612

RESUMEN

BACKGROUND/AIM: Ultraviolet radiation (UVR) causes solar lentigines (SL) and skin cancer (SC) in humans. The association between measured lifetime UVR dose and SC has not been investigated. This study investigated this relation through their common relationship to SL. MATERIALS AND METHODS: First we investigated the association between lifetime UVR dose and SL for 16,897 days in 38 healthy participants, and secondly, the relation between SL and SC was investigated in 2,898 participants, including 149 with SC. By combining both studies, SC risk related to lifetime UVR dose and skin phototype was estimated. RESULTS: A positive association was found between SL and lifetime UVR dose (p=0.060). Skin phototype (p=0.001) and SL (p<0.001) were associated with SC. Combined SC risk increased 1.23 by doubling the average lifetime UVR dose and was 34.9 times higher for those with very fair skin compared to dark Mediterranean skin. CONCLUSION: The estimate of SC risk shows that skin phototype is of greater relative importance than lifetime UVR dose.


Asunto(s)
Lentigo/epidemiología , Neoplasias Cutáneas/epidemiología , Rayos Ultravioleta , Adulto , Anciano , Relación Dosis-Respuesta en la Radiación , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Factores de Riesgo
8.
FP Essent ; 488: 25-34, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31894953

RESUMEN

Acute urinary tract infection (UTI) is among the most common bacterial infections in infants and children. Diagnosis requires evidence of infection and the presence of at least 50,000 colony-forming units (CFU)/mL of a pathogen cultured from an appropriately collected urine specimen. Febrile UTIs (ie, temperature 38°C [100.4°F] or greater) are most common during the first two years of life. Risk factors for UTI in febrile female infants are white race, age younger than 12 months, temperature 39°C (102.2°F) or greater, fever lasting 2 days or more, and absence of another source of infection. For febrile male infants, risk factors include being uncircumcised. If circumcised, risk factors include nonblack race, temperature 39°C (102.2°F) or greater, fever for more than 24 hours, and absence of another source of infection. Antibiotic treatment should be continued for 7 to 14 days. Renal and bladder ultrasonography is indicated for infants ages 2 to 24 months with a febrile UTI. If ultrasonography results are abnormal, a voiding cystourethrogram (VCUG) is indicated. VCUG also is indicated for children with recurrence of febrile UTI to identify vesicoureteral reflux and/or other anatomic findings associated with recurrent UTI. Recent studies have shown a statistically significant benefit of continuous antibiotic prophylaxis for prevention of recurrent UTI.


Asunto(s)
Infecciones Urinarias , Reflujo Vesicoureteral , Profilaxis Antibiótica , Niño , Preescolar , Femenino , Fiebre , Humanos , Lactante , Masculino , Factores de Riesgo
9.
Nursing ; 50(1): 39-43, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31855986

RESUMEN

Measles has re-emerged in the US for a variety of reasons, including misinformation spread by antivaccination advocates and imported cases from countries where infected children may be too young for immunization. Prompt diagnosis and isolation can help reduce measles transmission.


Asunto(s)
Enfermedades Transmisibles Emergentes/enfermería , Sarampión/enfermería , Enfermedades Transmisibles Emergentes/epidemiología , Humanos , Sarampión/epidemiología , Sarampión/fisiopatología , Vacuna contra el Sarampión-Parotiditis-Rubéola/administración & dosificación , Diagnóstico de Enfermería , Educación del Paciente como Asunto , Factores de Riesgo , Estados Unidos/epidemiología
10.
Gene ; 725: 144163, 2020 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-31639433

RESUMEN

BACKGROUND: Previous studies have established that coronary artery disease is associated with excess inflammation. These studies have shown an elevation of both pro and anti-inflammatory cytokines in sufferers of coronary artery disease. There is increasing interest in the role played by the inflammasome Nod Like Receptor family pyrin domain containing 3 (NLRP3) in the aetiology of coronary artery disease. Increased severity of coronary artery disease correlates with higher levels of expression of NLRP3. Does NLRP3 polymorphisms play a role in the aetiology of coronary artery disease? METHOD: In a cohort of Vietnam War (n-299) veterans who have been previously exposed to trauma, NLRP3 polymorphisms were analysed for association with coronary calcium scores using analyses of variance. Independent t-test was used to analyse genotypes. In samples with a small representation of minor homozygotes, genotypes were combined and analysed using independent t-test. If any of the genotype analysis suggested the potential for a dominant or a recessive model the model was further explored. Hardy-Weinberg Equilibrium was calculated using Hardy-Weinberg equilibrium calculator including analysis for ascertainment bias. RESULTS: The NLRP3 polymorphism, rs10159239 was significantly associated (p = 0.001) with a higher raised coronary calcium score. The Single Nucleotide Polymorphism rs10159239 was examined by logistic regression with known risk factors for Coronary artery disease and remained significant (0.035). This is the first time rs10159239 A-allele has been associated with raised coronary calcium score. CONCLUSIONS: This is the first time rs10159239 A-allele has been associated with raised coronary calcium score. Further research is needed to replicate our results in larger well-characterised cohorts.


Asunto(s)
Enfermedad de la Arteria Coronaria/genética , Proteína con Dominio Pirina 3 de la Familia NLR/genética , Proteína con Dominio Pirina 3 de la Familia NLR/metabolismo , Anciano , Anciano de 80 o más Años , Alelos , Proteínas Portadoras/genética , Estudios de Cohortes , Enfermedad de la Arteria Coronaria/metabolismo , Citocinas/genética , Grupo de Ascendencia Continental Europea/genética , Femenino , Frecuencia de los Genes/genética , Predisposición Genética a la Enfermedad/genética , Genotipo , Humanos , Inflamación/genética , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple/genética , Factores de Riesgo , Veteranos , Guerra de Vietnam
12.
J Homosex ; 67(1): 104-126, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-30307803

RESUMEN

Malay-Muslim men who have sex with men (MSM) are marginalized and hidden in Malaysia, a predominantly Muslim country in southeast Asia. We explored the policy, network, community, and individual factors related to HIV infection among Malay-Muslim MSM through 26 in-depth interviews and one focus group discussion (n = 5) conducted in Kuala Lumpur and Kota Bharu between October 2013 and January 2014. As religion plays an important role in their lives, participants viewed homosexuality as a sin. Low risk perception and misconceptions about HIV/AIDS were common, and most participants expressed reluctance to consult a doctor unless they had symptoms. Additionally, buying condoms was embarrassing and anxiety-producing. Fear of discrimination by health care providers and community hindered participants from disclosing sexual behaviors and accessing health services. Homophobic comments and policies by the government and religious leaders were concerns of participants. A safe and enabling environment is needed to reduce HIV risks among Malay-Muslim MSM.


Asunto(s)
Revelación , Infecciones por VIH/psicología , Homofobia , Homosexualidad Masculina , Islamismo , Religión y Sexo , Minorías Sexuales y de Género/psicología , Adulto , Redes Comunitarias , Condones , Grupos Focales , Personal de Salud , Accesibilidad a los Servicios de Salud , Humanos , Malasia , Masculino , Factores de Riesgo
14.
Zhonghua Nei Ke Za Zhi ; 59(1): 5-17, 2020 Jan 01.
Artículo en Chino | MEDLINE | ID: mdl-31887830

RESUMEN

In this consensus we mainly present the etiology, epidemiology, risk factors, microbiology, clinical diagnosis and general principles of treatment, as well as the detailed diagnosis and treatment of common candidiasis. Though mucocutaneous candidiasis such as oral, esophageal and vulvovaginal infections are known as non-invasive diseases, they are included in this consensus, considering their high prevalence and the potential to be the source of systematic infections.In order to be accordant with the practical situation in China, new technologies and drugs that have not been well developed or routinely applied are not recommended in this consensus. As to the differences from foreign guidelines, we address the explanations. Individualized treatment and management should be administrated based on the specific underlying conditions, organism distribution and drug resistance profile of Candida species.


Asunto(s)
Antifúngicos/uso terapéutico , Candidiasis/diagnóstico , Candidiasis/tratamiento farmacológico , Adulto , Antifúngicos/administración & dosificación , Candida/efectos de los fármacos , China , Consenso , Humanos , Prevalencia , Factores de Riesgo
15.
Zhonghua Nei Ke Za Zhi ; 59(1): 18-22, 2020 Jan 01.
Artículo en Chino | MEDLINE | ID: mdl-31887831

RESUMEN

The prevalence of dyslipidemia in Chinese adult is increasing dramatically, which poses a severe challenge to the prevention and treatment of atherosclerotic cardiovascular diseases. In recent years, a series of new research results have been published, providing a lot of new information for the management strategy of dyslipidemia. In order to apply these new research results to clinical practice for the further prevention and treatment of dyslipidemia more reasonably and effectively, the China Cholesterol Education Program (CCEP) Working Committee organized joint expert meeting and revised the "Expert Advice on Prevention and Treatment of Dyslipidemia in China Cholesterol Education Program 2014", in which a new classification standard for cardiovascular risk stratification has been proposed, and the target value of lipid-lowering therapy has been updated.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Colesterol/sangre , Dislipidemias , Guías de Práctica Clínica como Asunto , Adulto , China , Dislipidemias/prevención & control , Dislipidemias/terapia , Humanos , Factores de Riesgo
16.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 281-287, jan.-dez. 2020. tab
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1047844

RESUMEN

Objetivo: investigar os fatores maternos e perinatais associados aos extremos da idade reprodutiva da mulher em São Luís, Maranhão. Método: trata-se de um estudo transversal, realizado em São Luís/MA, com população de 16.474 mães. Os dados foram coletados no Sinasc disponibilizado pela Secretaria Municipal. Utilizou-se o Teste Qui-quadrado de Pearson e calculou-se a Odds Ratio com nível de significância de α = 0.05. Resultados: verificou-se que as adolescentes apresentaram maior chance de nascimentos prematuros (OR=1,37; p< 0,001 mulheres com idade avançada apresentaram maior risco para baixo peso ao nascer (OR=1,22; p=0,022). Tanto as adolescentes (OR=2,09; p< 0,001) quanto as mães com idade avançada (OR=1,85; p<0,0011) possuem chances aumentadas para realizarem menos que seis consultas de pré-natal. Conclusão: os resultados perinatais, nascimento prematuro, baixo peso ao nascer e a realização de menos de seis consultas pré-natais são elevados nas gestações de adolescentes e mulheres em idade avançada


Objective: to investigate maternal and perinatal factors associated with extremes of women's reproductive age in São Luís, Maranhão. Method: this is a cross-sectional study conducted in São Luís/MA, with a population of 16,474 mothers. The data were collected in the Sinasc provided by the Municipal Health Secretariat. We used the Pearson Chi-square test and calculated the odds ratio with a significance level of α=0.05. Results: it was verified that the adolescents had a higher chance of preterm birth (OR=1.37; p<0,001); Women aged 35 years or older were at increased risk for low birth weight (OR=1.22; p=0.022). Both adolescents (OR=2.09; p<0,001) and older mothers (OR=1.85; p<0,001) have an increased chance to perform less than six prenatal visits. Conclusion: perinatal outcomes, preterm birth, low birth weight and fewer than six prenatal visits are frequent in the pregnancies of adolescents and women of advanced age


Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Persona de Mediana Edad , Complicaciones del Embarazo/epidemiología , Atención Prenatal , Edad Materna , Salud Materno-Infantil , Factores de Riesgo , Embarazo de Alto Riesgo , Atención Perinatal
17.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 221-225, jan.-dez. 2020. tab
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1048046

RESUMEN

Objetivo: identificar os tipos de medicamentos mais utilizados por idosos hospitalizados e relacioná-los com o risco de desenvolvimento de lesão por pressão. Método: estudo descritivo e documental, realizado em um hospital de referência em traumas de Fortaleza, Ceará. A amostra constituiu-se por 48 prontuários e a coleta de dados ocorreu no período de agosto de 2015 a fevereiro de 2016. Resultados: ocorreu a análise dos 48 prontuários de pacientes idosos acamados que se encontravam internados na Unidade de Terapia Intensiva e enfermaria. A média de idade desses idosos foi de 75 anos com presença de 54,2% do sexo masculino e 45,8% do sexo feminino. Desse total, os fármacos que mais apareceram e tem relação com o desenvolvimento da lesão são: os anti-hipertensivos, analgésicos, diuréticos, drogas vasoativas e antibiótico. Conclusão: os tipos de medicamentos mais utilizados nos idosos deste estudo estavam diretamente relacionados às alterações no sistema circulatório do idoso


Objective: the study's main purpose has been to identify the types of medication most used by hospitalized-elderly people, while relating them to the risk of developing pressure injury. Method: it is a descriptive and documental study, which was performed in a trauma referral hospital from the Fortaleza city, Ceará State. The sample consisted of 48 medical records and the data collection took place from August 2015 to February 2016. Results: through the analysis of 48 medical records from elderly patients hospitalized in both Intensive Care Unit and ward, the following results were found: the average age of those elderly individuals was 75 years old, with 54.2% being males and 45.8% being females. Bearing in mind the total, the drugs that appeared the most and were also related to the development of pressure injury were as follows: antihypertensives, analgesics, diuretics, vasoactive drugs and antibiotics. Conclusion: the types of medication most used by the elderly patients addressed in this study were directly related to alterations in their circulatory system


Objetivo: identificar los tipos de medicamentos más utilizados por ancianos hospitalizados y relacionarlos con el riesgo de desarrollo de lesión por presión. Método: estudio descriptivo y documental, realizado en un hospital de referencia en traumas de Fortaleza, Ceará. La muestra se constituyó por 48 prontuarios y la recolección de datos ocurrió en el período de agosto de 2015 a febrero de 2016. Resultados: ocurrió el análisis de los 48 prontuarios de pacientes ancianos acamados que se encontraban internados en la Unidad de Terapia Intensiva y enfermería. El promedio de edad de estos ancianos fue de 75 años con presencia de 54,2% del sexo masculino y el 45,8% del sexo femenino. De ese total, los fármacos que más aparecieron y tienen relación con el desarrollo de la lesión son: los antihipertensivos, analgésicos, diuréticos, drogas vasoactivas y antibiótico. Conclusión: los tipos de medicamentos más utilizados en los ancianos de este estudio estaban directamente relacionados a las alteraciones en el sistema circulatorio del anciano


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Úlcera por Presión , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/complicaciones , Pacientes Internos , Salud del Anciano , Factores de Riesgo
18.
Angiology ; 71(1): 10-16, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-30966756

RESUMEN

Cardiovascular disease (CVD) remains the major cause of death and disability worldwide, and residual risk after implementing all current therapies is still high. In this context, the latest (2016) European Cardiology Society/European Atherosclerosis Society guidelines recommend that triglyceride (TG)-lowering drugs should be used in high-risk patients with TGs levels >2.3 mmol/L (200 mg/dL), after lifestyle measures fail to lower them. After several neutral CVD outcome trials with n-3 fatty acids, the Reduction of Cardiovascular Events with EPA-Intervention Trial met its primary end point, that is, among patients with elevated TGs levels despite the use of statins, the risk of ischemic events, including cardiovascular death, was significantly lower in those who received 4 g of icosapent ethyl daily. In this review, we comment on the findings of previous and recently published randomized controlled CVD outcome trials assessing n-3 fatty acids supplementation. Both efficacy and safety, as well as future perspectives, are discussed.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Suplementos Dietéticos , Dislipidemias/tratamiento farmacológico , Ácido Eicosapentaenoico/análogos & derivados , Ácidos Grasos Insaturados/uso terapéutico , Lípidos/sangre , Biomarcadores/sangre , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/epidemiología , Suplementos Dietéticos/efectos adversos , Dislipidemias/sangre , Dislipidemias/epidemiología , Ácido Eicosapentaenoico/efectos adversos , Ácido Eicosapentaenoico/uso terapéutico , Ácidos Grasos Insaturados/efectos adversos , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Resultado del Tratamiento
19.
Gut ; 69(1): 112-121, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-30981990

RESUMEN

BACKGROUND AND AIMS: Serrated polyposis syndrome (SPS) is associated with an increased risk of colorectal cancer (CRC). International guidelines recommend surveillance intervals of 1-2 years. However, yearly surveillance likely leads to overtreatment for many. We prospectively assessed a surveillance protocol aiming to safely reduce the burden of colonoscopies. METHODS: Between 2013 and 2018, we enrolled SPS patients from nine Dutch and Spanish hospitals. Patients were surveilled using a protocol appointing either a 1-year or 2-year interval after each surveillance colonoscopy, based on polyp burden. Primary endpoint was the 5-year cumulative incidence of CRC and advanced neoplasia (AN) during surveillance. RESULTS: We followed 271 SPS patients for a median of 3.6 years. During surveillance, two patients developed CRC (cumulative 5-year incidence 1.3%[95% CI 0% to 3.2%]). The 5-year AN incidence was 44% (95% CI 37% to 52%), and was lower for patients with SPS type III (26%) than for patients diagnosed with type I (53%) or type I and III (59%, p<0.001). Most patients were recommended a 2-year interval, and those recommended a 2-year interval were not at increased risk of AN: AN incidence after a 2-year recommendation was 15.6% compared with 24.4% after a 1-year recommendation (OR 0.57, p=0.08). CONCLUSION: Risk stratification substantially reduced colonoscopy burden while achieving CRC incidence similar to previous studies. AN incidence is considerable in SPS patients, but extension of surveillance intervals was not associated with increased AN in those identified as low-risk by the protocol. We identified SPS type III patients as low-risk group that might benefit from even less frequent surveillance. TRIAL REGISTRATION NUMBER: The study was registered on http://www.trialregister.nl; trial-ID NTR4609.


Asunto(s)
Poliposis Adenomatosa del Colon/diagnóstico , Neoplasias Colorrectales/diagnóstico , Poliposis Adenomatosa del Colon/epidemiología , Poliposis Adenomatosa del Colon/cirugía , Anciano , Estudios de Cohortes , Colonoscopía/métodos , Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Uso Excesivo de los Servicios de Salud/prevención & control , Uso Excesivo de los Servicios de Salud/estadística & datos numéricos , Persona de Mediana Edad , Países Bajos/epidemiología , Vigilancia de la Población/métodos , Prevalencia , Estudios Prospectivos , Factores de Riesgo , España/epidemiología
20.
Angiology ; 71(1): 77-82, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31018673

RESUMEN

Nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of the metabolic syndrome and is associated with cardiovascular disease (CVD). The NAFLD Fibrosis Score (NFS) is an index used for the detection of liver fibrosis. We investigated the relationship between NFS and complexity of coronary artery disease (CAD). In this cross-sectional study, 109 patients with CAD and 50 patients without CAD were enrolled. Demographic data, laboratory parameters, epicardial fat thickness (EFT), NFS, and Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score were recorded. Waist circumference, fasting glucose, low-density lipoprotein cholesterol (LDL-C), EFT, and NFS were significantly higher in the CAD group (P < .05). High-density lipoprotein cholesterol (HDL-C) and ejection fraction were significantly lower in the CAD group (P < .05). The SYNTAX score was positively correlated with fasting glucose, LDL-C, EFT, and NFS and negatively correlated with HDL-C (P < .05). The NFS was positively correlated with EFT (P = .019). Multivariate linear regression analysis revealed that NFS (P = .012), EFT (P < .001), and LDL-C (P = .001) were independently associated with the SYNTAX score. In conclusion, NFS, as a marker of NAFLD, could identify patients at higher risk of CVD.


Asunto(s)
Tejido Adiposo/diagnóstico por imagen , Adiposidad , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Ecocardiografía , Cirrosis Hepática/diagnóstico , Pruebas de Función Hepática , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Pericardio/diagnóstico por imagen , Tejido Adiposo/fisiopatología , Anciano , Biomarcadores/sangre , Índice de Masa Corporal , Enfermedad de la Arteria Coronaria/fisiopatología , Estudios Transversales , Femenino , Humanos , Cirrosis Hepática/sangre , Masculino , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/sangre , Pericardio/fisiopatología , Valor Predictivo de las Pruebas , Pronóstico , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad
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