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1.
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
2.
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
3.
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
4.
Compend Contin Educ Dent ; 41(1): e1-e5, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31904245

RESUMEN

Implants used to replace molar teeth present issues of space distribution and crown contours that are unique to these sites. Because the diameter of the implant typically is smaller than that of the tooth being replaced, and the circular shape of the implant does not replicate the anatomy of the tooth, a large gingival embrasure area between the implant platform and adjacent tooth often results. Upon the review of radiographs of molar implants placed over an 11-year period in one private practice, the authors identified an unusually high incidence of approximal, cervical, and root caries on teeth adjacent to these implants. This retrospective radiographic study investigated the incidence of decay as related to: (1) the horizontal distance from the implant to the adjacent tooth (ie, the implant-tooth distance, or ITD) as measured at the alveolar crest, (2) the vertical distance from the apical portion of the prosthetic contact area to the implant platform, and (3) the presence of an existing restoration on the adjacent tooth. Of the three variables examined, both the horizontal distance of the implant to a natural tooth (ITD) and the presence of an existing restoration on an adjacent tooth proved to be significantly correlated with the incidence of decay. Results showed that incidence of decay ranges from 7.4% when the ITD is <2 mm to 40% when the ITD is ≥6 mm. The mean ITD in cases in which decay was found was 4.1 mm, and it was 3.5 mm in cases that showed no decay (P = .005). It is therefore suggested that the horizontal threshold of 4 mm be considered as the "critical ITD." The results also indicated that the presence of a previous restoration on an adjacent tooth increases the incidence of decay to a statistically significant degree with an odds ratio of 2.25 at a 95% confidence level. This information may prove useful in diagnosis and treatment planning for molar implant replacement.


Asunto(s)
Implantes Dentales de Diente Único , Diente , Incidencia , Diente Molar , Estudios Retrospectivos
5.
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
8.
MMWR Morb Mortal Wkly Rep ; 69(1): 10-13, 2020 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-31917781

RESUMEN

Tailoring communicable disease preparedness and response strategies to unique population movement patterns between an outbreak area and neighboring countries can help limit the international spread of disease. Global recognition of the value of addressing community connectivity in preparedness and response, through field work and visualizing the identified movement patterns, is reflected in the World Health Organization's declaration on July 17, 2019, that the 10th Ebola virus disease (Ebola) outbreak in the Democratic Republic of the Congo (DRC) was a Public Health Emergency of International Concern (1). In March 2019, the Infectious Diseases Institute (IDI), Uganda, in collaboration with the Ministry of Health (MOH) Uganda and CDC, had previously identified areas at increased risk for Ebola importation by facilitating community engagement with participatory mapping to characterize cross-border population connectivity patterns. Multisectoral participants identified 31 locations and associated movement pathways with high levels of connectivity to the Ebola outbreak areas. They described a major shift in the movement pattern between Goma (DRC) and Kisoro (Uganda), mainly through Rwanda, when Rwanda closed the Cyanika ground crossing with Uganda. This closure led some travelers to use a potentially less secure route within DRC. District and national leadership used these results to bolster preparedness at identified points of entry and health care facilities and prioritized locations at high risk further into Uganda, especially markets and transportation hubs, for enhanced preparedness. Strategies to forecast, identify, and rapidly respond to the international spread of disease require adapting to complex, dynamic, multisectoral cross-border population movement, which can be influenced by border control and public health measures of neighboring countries.


Asunto(s)
Brotes de Enfermedades , Fiebre Hemorrágica Ebola/epidemiología , Migración Humana/estadística & datos numéricos , Participación de la Comunidad , República Democrática del Congo/epidemiología , Brotes de Enfermedades/prevención & control , Fiebre Hemorrágica Ebola/prevención & control , Humanos , Rwanda/epidemiología , Uganda/epidemiología
9.
MMWR Morb Mortal Wkly Rep ; 69(1): 1-5, 2020 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-31917782

RESUMEN

In May 2018, a study of birth defects in infants born to women with diagnosed human immunodeficiency virus (HIV) infection in Botswana reported an eightfold increased risk for neural tube defects (NTDs) among births with periconceptional exposure to antiretroviral therapy (ART) that included the integrase inhibitor dolutegravir (DTG) compared with other ART regimens (1). The World Health Organization* (WHO) and the U.S. Department of Health and Human Services† (HHS) promptly issued interim guidance limiting the initiation of DTG during early pregnancy and in women of childbearing age with HIV who desire pregnancy or are sexually active and not using effective contraception. On the basis of additional data, WHO now recommends DTG as a preferred treatment option for all populations, including women of childbearing age and pregnant women. Similarly, the U.S. recommendations currently state that DTG is a preferred antiretroviral drug throughout pregnancy (with provider-patient counseling) and as an alternative antiretroviral drug in women who are trying to conceive.§ Since 1981 and 1994, CDC has supported separate surveillance programs for HIV/acquired immunodeficiency syndrome (AIDS) (2) and birth defects (3) in state health departments. These two surveillance programs can inform public health programs and policy, linkage to care, and research activities. Because birth defects surveillance programs do not collect HIV status, and HIV surveillance programs do not routinely collect data on occurrence of birth defects, the related data have not been used by CDC to characterize birth defects in births to women with HIV. Data from these two programs were linked to estimate overall prevalence of NTDs and prevalence of NTDs in HIV-exposed pregnancies during 2013-2017 for 15 participating jurisdictions. Prevalence of NTDs in pregnancies among women with diagnosed HIV infection was 7.0 per 10,000 live births, similar to that among the general population in these 15 jurisdictions, and the U.S. estimate based on data from 24 states. Successful linking of data from birth defects and HIV/AIDS surveillance programs for pregnancies among women with diagnosed HIV infection suggests that similar data linkages might be used to characterize possible associations between maternal diseases or maternal use of medications, such as integrase strand transfer inhibitors used to manage HIV, and pregnancy outcomes. Although no difference in NTD prevalence in HIV-exposed pregnancies was found, data on the use of integrase strand transfer inhibitors in pregnancy are needed to understand the safety and risks of these drugs during pregnancy.


Asunto(s)
Infecciones por VIH/diagnóstico , Defectos del Tubo Neural/epidemiología , Complicaciones Infecciosas del Embarazo/diagnóstico , Adolescente , Adulto , Antirretrovirales/efectos adversos , Antirretrovirales/uso terapéutico , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Recién Nacido , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Estados Unidos/epidemiología , Adulto Joven
10.
MMWR Morb Mortal Wkly Rep ; 69(1): 14-19, 2020 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-31917783

RESUMEN

On August 1, 2018, the Democratic Republic of the Congo (DRC) declared its 10th Ebola virus disease (Ebola) outbreak in an area with a high volume of cross-border population movement to and from neighboring countries. The World Health Organization (WHO) designated Rwanda, South Sudan, and Uganda as the highest priority countries for Ebola preparedness because of the high risk for cross-border spread from DRC (1). Countries might base their disease case definitions on global standards; however, historical context and perceived risk often affect why countries modify and adapt definitions over time, moving toward or away from regional harmonization. Discordance in case definitions among countries might reduce the effectiveness of cross-border initiatives during outbreaks with high risk for regional spread. CDC worked with the ministries of health (MOHs) in DRC, Rwanda, South Sudan, and Uganda to collect MOH-approved Ebola case definitions used during the first 6 months of the outbreak to assess concordance (i.e., commonality in category case definitions) among countries. Changes in MOH-approved Ebola case definitions were analyzed, referencing the WHO standard case definition, and concordance among the four countries for Ebola case categories (i.e., community alert, suspected, probable, confirmed, and case contact) was assessed at three dates (2). The number of country-level revisions ranged from two to four, with all countries revising Ebola definitions by February 2019 after a December 2018 peak in incidence in DRC. Case definition complexity increased over time; all countries included more criteria per category than the WHO standard definition did, except for the "case contact" and "confirmed" categories. Low case definition concordance and lack of awareness of regional differences by national-level health officials could reduce effectiveness of cross-border communication and collaboration. Working toward regional harmonization or considering systematic approaches to addressing country-level differences might increase efficiency in cross-border information sharing.


Asunto(s)
Brotes de Enfermedades , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/epidemiología , Vigilancia en Salud Pública/métodos , República Democrática del Congo/epidemiología , Humanos , Rwanda/epidemiología , Sudán del Sur/epidemiología , Factores de Tiempo , Uganda/epidemiología
11.
J Urol ; 203(1): 108-114, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31430233

RESUMEN

PURPOSE: Compared to urban populations, rural populations rank poorly on numerous health indicators, including cancer outcomes. We examined the relationship of rural residence with stage and treatment among patients with prostate cancer, the second most common malignancy in men. MATERIALS AND METHODS: Using the Pennsylvania Cancer Registry we identified all men diagnosed with prostate cancer between 2009 and 2015. Patients were classified as residing in a rural area, a large town or an urban area using the Rural-Urban Commuting Area classification. Our primary outcomes included indicators of prostate cancer treatment and treatment types but we also examined disease stage and mortality. We used the chi-square tests to assess differences between groups and estimated multivariable logistic regression models to assess the association between rural residence and treatment. RESULTS: We identified 51,024 men diagnosed with localized or metastatic prostate cancer between 2009 and 2015. The overall incidence of prostate cancer decreased during the study period from 416 to 304/100,000 men while the incidence of metastatic disease increased from 336 to 538/100,000. Rural residents were less likely to undergo treatment than urban residents even when stratified by low, intermediate and high risk disease (aOR 0.77, 95% CI 0.64-0.91; aOR 0.71, 95% CI 0.58-0.89; and aOR 0.68, 95% CI 0.53-0.89, respectively). Rural status did not affect the receipt of radiation therapy compared to other treatment types. CONCLUSIONS: Prostate cancer treatment differs between urban and rural residents. Rural residents are less likely to receive treatment even when stratified by disease risk.


Asunto(s)
Neoplasias de la Próstata/terapia , Población Rural , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pennsylvania/epidemiología , Neoplasias de la Próstata/epidemiología , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/patología , Sistema de Registros
12.
J Urol ; 203(1): 194-199, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31479395

RESUMEN

PURPOSE: In utero myelomeningocele closure is a valid alternative to postnatal repair with unclear benefits to bladder function. We compared bladder status in patients who underwent fetal myelomeningocele surgery versus postnatal repair. MATERIALS AND METHODS: We retrospectively reviewed our database, with group 1 consisting of in utero surgery and group 2 consisting of postnatal repair. Group 3 was a subgroup of group 2, including patients initially presenting at age less than 12 months. We recorded medical history, radiological investigation with renal ultrasonography, voiding cystourethrography, urodynamic evaluation and clinical outcome of the bladder pattern after treatment. RESULTS: We identified 88 patients in group 1, 86 in group 2 and 38 in group 3. The incidence of urinary tract infection was higher in the postnatal period (45% vs 20%). Hydronephrosis occurred in 20.7%, 22.6% and 28.9% of patients in groups 1, 2 and 3, respectively. Vesicoureteral reflux was diagnosed in 15% in all groups. Urodynamic data showed a higher prevalence of detrusor overactivity in group 1 and no difference in other urodynamic parameters. The high risk bladder pattern at initial evaluation occurred in 56%, 50% and 46% of patients in groups 1, 2 and 3, respectively. There was a trend to decrease the percentages of the high risk bladder pattern and to increase the normal pattern after treatment in all groups. CONCLUSIONS: In utero repair did not improve urological parameters compared to repair in the postnatal period.


Asunto(s)
Feto/cirugía , Meningomielocele/cirugía , Complicaciones Posoperatorias/epidemiología , Femenino , Humanos , Hidronefrosis/epidemiología , Lactante , Recién Nacido , Masculino , Embarazo , Estudios Retrospectivos , Infecciones Urinarias/epidemiología , Reflujo Vesicoureteral/epidemiología
13.
J Urol ; 203(1): 145-150, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31584849

RESUMEN

PURPOSE: North American studies have revealed that about 3% to 7% of opioid naïve surgical patients transition to chronic opioid use after a single prescription. We examined the risk of chronic opioid use following radical prostatectomy using nationwide Swedish data. MATERIALS AND METHODS: A total of 25,703 men in the National Prostate Cancer Register of Sweden who underwent radical prostatectomy were linked to the Prescribed Drug Register. Opioid use was assessed at 3 times, including baseline (13 months to 1 month preoperatively), perioperatively (1 month before and after) and postoperatively (1 to 12 months). Multivariable logistic regression was done to identify predictors of new late use (1 or more opioid prescriptions in 3 consecutive months more than 2 months after surgery). RESULTS: Overall 16,368 men (64%) filled an opioid prescription during the 13 months before or after surgery. The use of strong opioids increased with time and the use of weak opioids decreased. Of the men 1.9% had opioid prescriptions during the baseline period, followed by a spike to 59% around the time surgery, which sharply decreased in month 2 postoperatively. However, thereafter the proportion of men with opioid prescriptions remained slightly higher at 2.2% compared to the baseline before radical prostatectomy. Of chronic late users 57% were previous users and 43% were new chronic users. Higher cancer risk category, greater comorbidity, unmarried status and low educational level were associated with the risk of new chronic opioid use. CONCLUSIONS: Slightly more than half of male Swedish patients filled an opioid prescription after radical prostatectomy and less than 1% became chronic opioid users. These rates are lower than in previous studies of postoperative opioid use from North America.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Prostatectomía , Neoplasias de la Próstata/cirugía , Anciano , Humanos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Opioides/epidemiología , Sistema de Registros , Suecia/epidemiología
14.
Eur J Endocrinol ; 182(1): G1-G32, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31855556

RESUMEN

Obesity is an emerging condition, with a prevalence of ~20%. Although the simple measurement of BMI is likely a simplistic approach to obesity, BMI is easily calculated, and there are currently no data showing that more sophisticated methods are more useful to guide the endocrine work-up in obesity. An increased BMI leads to a number of hormonal changes. Additionally, concomitant hormonal diseases can be present in obesity and have to be properly diagnosed - which in turn might be more difficult due to alterations caused by body fatness itself. The present European Society of Endocrinology Clinical Guideline on the Endocrine Work-up in Obesity acknowledges the increased prevalence of many endocrine conditions in obesity. It is recommended to test all patients with obesity for thyroid function, given the high prevalence of hypothyroidism in obesity. For hypercortisolism, male hypogonadism and female gonadal dysfunction, hormonal testing is only recommended if case of clinical suspicion of an underlying endocrine disorder. The guideline underlines that weight loss in obesity should be emphasized as key to restoration of hormonal imbalances and that treatment and that the effect of treating endocrine disorders on weight loss is only modest.


Asunto(s)
Índice de Masa Corporal , Hipotiroidismo/diagnóstico , Obesidad/diagnóstico , Comorbilidad , Endocrinología , Humanos , Hipotiroidismo/epidemiología , Obesidad/epidemiología , Prevalencia , Pruebas de Función de la Tiroides
15.
Chemosphere ; 238: 124528, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31425869

RESUMEN

A dendrochemical study of cottonwood trees (Populus deltoides) was conducted across a childhood cancer cluster in eastern Sandusky County (Ohio, USA). The justification for this study was that no satisfactory explanation has yet been put forward, despite extensive local surveys of aerosols, groundwater, and soil. Concentrations of eight trace metals were measured by ICP-MS in microwave-digested 5-year sections of increment cores, collected during 2012 and 2013. To determine whether the onset of the first cancer cases could be connected to an emergence of any of these contaminants, cores spanning the period 1970-2009 were taken from 51 trees of similar age, inside the cluster and in a control area to the west. The abundance of metals in cottonwood tree annual rings served as a proxy for their long-term, low-level accumulation from the same sources whereby exposure of the children may have occurred. A spatial analysis of cumulative metal burdens (lifetime accumulation in the tree) was performed to search for significant 'hotspots', employing a scan statistic with a mask of variable radius and center. For Cd, Cr, and Ni, circular hotspots were found that nearly coincide with the cancer cluster and are similar in size. No hotspots were found for Co, Cu, and Pb, while As and V were largely below method detection limits. Whereas our results do not implicate exposure to metals as a causative factor, we conclude that, after 1970, cottonwood trees have accumulated more Cd, Cr, and Ni, inside the childhood cancer cluster than elsewhere in Sandusky County.


Asunto(s)
Monitoreo del Ambiente , Neoplasias/epidemiología , Populus/química , Oligoelementos/análisis , Niño , Humanos , Ohio/epidemiología , Suelo/química , Análisis Espacial , Encuestas y Cuestionarios , Árboles/química
16.
Einstein (Sao Paulo) ; 18: eAO4739, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31553355

RESUMEN

OBJECTIVE: To use magnetic resonance imaging to assess the prevalence of foot and ankle ligament injuries and fractures associated with ankle sprain and not diagnosed by x-ray. METHODS: We included 180 consecutive patients with a history of ankle sprain, assessed at a primary care service in a 12-month period. Magnetic resonance imaging findings were recorded and described. RESULTS: Approximately 92% of patients had some type of injury shown on the magnetic resonance imaging. We found 379 ligament injuries, 9 osteochondral injuries, 19 tendinous injuries and 51 fractures. Only 14 magnetic resonance imaging tests (7.8%) did not show any sort of injury. We observed a positive relation between injuries of the lateral complex, syndesmosis and medial ligaments. However, there was a negative correlation between ankle ligament injuries and midfoot injuries. CONCLUSION: There was a high rate of injuries secondary to ankle sprains. We found correlation between lateral ligament injuries and syndesmosis and deltoid injuries. We did not observe a relation between deltoid and syndesmosis injuries or between lateral ligamentous and subtalar injuries. Similarly, no relation was found between ankle and midfoot injuries.


Asunto(s)
Traumatismos del Tobillo/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Adolescente , Adulto , Anciano , Traumatismos del Tobillo/diagnóstico por imagen , Brasil/epidemiología , Cartílago Articular/lesiones , Niño , Femenino , Humanos , Ligamentos Laterales del Tobillo/lesiones , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Prevalencia , Adulto Joven
17.
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
18.
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
19.
Angiology ; 71(1): 17-26, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31129986

RESUMEN

The Middle East and North Africa (MENA) region has a high burden of morbidity and mortality due to premature (≤55 years in men; ≤65 years in women) myocardial infarction (MI) and acute coronary syndrome (ACS). Despite this, the prevalence of risk factors in patients presenting with premature MI or ACS is incompletely described. We compared lifestyle, clinical risk factors, and biomarkers associated with premature MI/ACS in the MENA region with selected non-MENA high-income countries. We identified English-language, peer-reviewed publications through PubMed (up to March 2018). We used the World Bank classification system to categorize countries. Patients with premature MI/ACS in the MENA region had a higher prevalence of smoking than older patients with MI/ACS but a lower prevalence of diabetes, hypertension, and dyslipidemia. Men with premature MI/ACS had a higher prevalence of smoking than women but a lower prevalence of diabetes and hypertension. The MENA region had sparse data on lifestyle, diet, psychological stress, and physical activity. To address these knowledge gaps, we initiated the ongoing Gulf Population Risks and Epidemiology of Vascular Events and Treatment (Gulf PREVENT) case-control study to improve primary and secondary prevention of premature MI in the United Arab Emirates, a high-income country in the MENA region.


Asunto(s)
Síndrome Coronario Agudo/epidemiología , Infarto del Miocardio/epidemiología , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/prevención & control , África del Norte/epidemiología , Edad de Inicio , Anciano , Estudios de Casos y Controles , Comorbilidad , Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Medio Oriente/epidemiología , Mortalidad Prematura , Infarto del Miocardio/mortalidad , Infarto del Miocardio/prevención & control , Prevalencia , Prevención Primaria , Pronóstico , Proyectos de Investigación , Factores de Riesgo , Prevención Secundaria , Factores Sexuales , Fumar/efectos adversos , Fumar/epidemiología
20.
J Oral Rehabil ; 47(1): 53-60, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31299094

RESUMEN

BACKGROUND: Food boluses in the pharynx without enough bolus formation sometimes cause aspiration among older adults; however, the relationship between food bolus-forming ability and incidence of aspiration pneumonia is unclear. OBJECTIVE: To investigate the relationship between food bolus-forming ability and incidence of aspiration pneumonia by evaluating the condition of chew-swallow managing food transported into the pharynx. METHODS: A prospective observational study conducted in a nursing home for the elderly between April 2016 and February 2018. Seventy-three residents who swallowed thickened liquids and consistent boluses without aspiration were included. Food boluses were graded into three categories in the pharynx using videoendoscopic evaluation. Boluses that retained their original shape were defined as Grade 1. A mixture of large and small boluses was defined as Grade 2. Boluses that had completely transformed into a paste were defined as Grade 3. The relationship between the bolus formation grade and incidence of aspiration pneumonia over 6-month follow-up was investigated. RESULTS: Seventeen residents developed aspiration pneumonia. The incidence rate of aspiration pneumonia was highest among residents with Grade 1 boluses, at an incidence rate of .187 cases per person-month (95% confidence interval (CI): 0.097-0.359). Cox regression showed residents with Grade 1 boluses had a hazard ratio of 4.548 (1.393-14.85) for incidence of aspiration pneumonia compared with residents who had Grade 2 or 3 boluses. CONCLUSION: Insufficient food bolus-forming ability predicted high incidence of aspiration pneumonia. Healthcare professionals should evaluate the food bolus-forming ability, as well as swallowing function, to prevent aspiration pneumonia.


Asunto(s)
Trastornos de Deglución , Neumonía por Aspiración , Anciano , Deglución , Humanos , Incidencia , Casas de Salud , Estudios Prospectivos
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