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1.
Medicine (Baltimore) ; 99(2): e18727, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914089

RESUMEN

The current study aimed to analyze the clinical characteristics of severe fever with thrombocytopenia syndrome (SFTS) and to explore the risk factors of critical patients. From 2016 to 2018, we collected the hospitalized diagnosed cases with SFTS in Jinan infectious disease hospital of Shandong University and analyzed by the descriptive epidemiological method. According to the prognosis, they were divided into general group and severe group. The epidemiological characteristics, clinical features, and laboratory indexes of these 2 groups of patients were compared and analyzed at the first visit. The risk factors related to the severity of the disease were analyzed by univariate Logistic regression. In total, 189 cases of SFTS were treated during the period and 33 deaths occurred in the severe group, with the fatality rate of 17.46%. The patients' age (χ = 8.864, P < .01), ALT (Z = -2.304, P = .03), AST (Z = -3.361, P < .01), GLU (t = -4.115, P < .01), CK (Z = -3.964, P < .01), CK-MB (Z = -2.225, P = .03), LDH (Z = -3.655, P < .01), α-HBDH (Z = -2.040, P = .04), APTT (t = -3.355, P < .01), BUN (Z = -2.040, P = .04), Cr (Z = -3.071, P = .01), and D-dimer (Z = -2.026, P = .04) in the severe group were higher than that in the normal group, but the blood platelet (PLT) counts were significantly lower (Z = -2.778, P < .01) than that in the normal group. With the neuropsychiatric symptoms (OR = 24.083, 95% CI = 6.064-95.642), skin bleeding point (OR = 30.000, 95% CI = 6.936-129.764), multiple organ dysfunction (OR = 34.048, 95% CI = 7.740-149.782), past medical history (OR = 3.792, 95% CI = 1.284-11.200), and fasting glucose elevation (OR = 1.359, 95% CI = 1.106-1.668) could predict the severity of the SFTS. In summary, the abnormality of the laboratory index, the special clinical manifestations, and the past medical history of SFTS patients were the important basis for judging the patient's serious condition.


Asunto(s)
Fiebre/epidemiología , Fiebre/fisiopatología , Trombocitopenia/epidemiología , Trombocitopenia/fisiopatología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Glucemia , Comorbilidad , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/epidemiología , Recuento de Plaquetas , Pronóstico , Factores de Riesgo , Estaciones del Año , Índice de Severidad de la Enfermedad , Trombocitopenia/mortalidad , Adulto Joven
3.
Autoimmun Rev ; 18(11): 102395, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31520800

RESUMEN

BACKGROUND: According to criteria for the classification of Systemic Lupus Erythematosus (SLE), thrombocytopenia is one of the disease-defining hematologic disorders. Since the recognition of Antiphospholipid Syndrome (APS), thrombocytopenia was frequently reported but several studies yielded contradictory results on the association between aPL-positivity and thrombocytopenia. METHODS: We evaluated the role of antiphospholipid antibodies (aPL) and different aPL profiles on the risk of thrombocytopenia in SLE patients by conducting a systematic review and meta-analysis of available literature from 1987 to 2018. MEDLINE, EMBASE, Cochrane Library, congress abstracts, and reference lists of eligible studies were searched. Studies were selected if they included SLE patients with descriptions of the exposure to aPL and the outcomes (thrombocytopenia). Two reviewers extracted study characteristics and outcome data from published reports. Estimates were pooled using random effects models and sensitivity analyses. We followed the PRISMA guidelines for all stages of the meta-analysis. PROSPERO registration number: CRD42015027378. RESULTS: From 3278 articles identified, 53 studies met inclusion criteria amounting to 9019 SLE patients. Twenty-nine percent of aPL-positive SLE patients had thrombocytopenia compared to 15.1% in aPL-negative SLE patients. The overall pooled Odds Ratio (OR) for thrombocytopenia in aPL positive patients was 2.48 (95% CI; 2.10-2.93). Among aPL subtypes, the risk of thrombocytopenia was highest for lupus anticoagulant (OR = 3.56 [95% CI, 2.57-5.25]), IgM anti-ß2-GP1(OR = 2.87 [95% CI; 2.57-5.25]), IgG and IgM anticardiolipin antibodies (OR = 1.87 [95% CI; 1.52-2.31] and OR = 1.73 [95% CI; 1.36-2.19] respectively). CONCLUSIONS: The occurrence of thrombocytopenia was strongly determined by various aPL profiles in SLE patients. While the association between IgM antibodies and other APS manifestations including thrombosis is debated, IgM isotypes are helpful in the risk stratification of thrombocytopenia in SLE.


Asunto(s)
Anticuerpos Antifosfolípidos/inmunología , Lupus Eritematoso Sistémico/epidemiología , Trombocitopenia/epidemiología , Estudios de Casos y Controles , Estudios de Cohortes , Estudios Transversales , Humanos , Lupus Eritematoso Sistémico/inmunología , Factores de Riesgo , Trombocitopenia/inmunología
4.
J Assoc Physicians India ; 67(7): 61-64, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31559771

RESUMEN

Objective: To study the incidence of thrombocytopenia in adults with Plasmodium vivax infection. Method: An observational study comprising 84 consenting individuals with Plasmodium vivax infection was undertaken. All the individuals belong to armed forces who are from different parts of the country. Everyone had normal platelet count prior to admission to the hospital. After admission, they were subjected to routine hematological and biochemical investigations comprising complete blood count including platelet counts, urine routine, liver function test, renal function test, serum electrolytes and Chest X-ray after ruling out Dengue, concomitant sepsis and possibility of recent viral infection. Grading of thrombocytopenia was done according to NCI common terminology criteria for adverse events Version 3.0. Results were analysed and tabulated. Result: A total of 84 patients were studied. 82 (97.6%) patients had thrombocytopenia. Majority (68.3%) of the patients had their lowest platelet count on the 5th and 6th day of fever. There was no associated increase in risk of complication with the increase in grade of thrombocytopenia. But with increase in severity of thrombocytopenia, it took more time for the platelets to recover to normal level. Conclusion: Thrombocytopenia is widely present in P. vivax malaria of adults. However, the severity of thrombocytopenia does not correlate with the likely progression to complication. The chance of progressing to complicated malaria is equal among all adults of P.vivax malaria irrespective of the platelet levels. Hence, in a resource limited rural Indian set-up where the expertise to diagnose and detect malaria microscopically or reliable antigen detection method is not available, thrombocytopenia in an acute febrile illness especially on Day 5 to Day 6 of fever onset could be considered as P. vivax malarial infection with good amount of diagnostic accuracy (sensitivity of 97.6%) and empirical anti-malarial therapy could be started as per the existing treatment guidelines.


Asunto(s)
Malaria Vivax/epidemiología , Trombocitopenia/epidemiología , Adulto , Plaquetas , Humanos , Malaria , Malaria Vivax/diagnóstico , Recuento de Plaquetas
5.
Clin Rev Allergy Immunol ; 57(2): 294-302, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31392657

RESUMEN

Streptococcus A infections have been associated with immune-mediated sequelae including acute glomerulonephritis, acute rheumatic fever, thrombocytopenia, hemolytic anemia, Henoch-Schönlein purpura, arthritis, uveitis, guttate psoriasis, and erythema nodosum. Available reviews do not report the occurrence of acute poststreptococcal glomerulonephritis in association with one of the mentioned conditions. We performed a systematic review of the literature on extrarenal immune-mediated disorders associated with acute poststreptococcal glomerulonephritis. The principles recommended by the Economic and Social Research Council guidance on the conduct of narrative synthesis and on the Preferred Reporting Items for Meta-Analyses and Systematic Reviews were used. We identified 41 original articles, published after 1965, which reported on 52 patients (34 males and 18 females aged from 1.7 to 57 years, median 9) affected by acute poststreptococcal glomerulonephritis associated with a further poststreptococcal disease: 29 cases with rheumatic fever (17 males and 12 females aged 3.0 to 57, median 17 years), 16 with hematologic diseases such as thrombocytopenia or hemolytic anemia (13 males and 3 females aged 1.8 to 13, median 6.0 years) and seven with Henoch-Schönlein syndrome, reactive arthritis or uveitis (4 males and 3 females aged 1.7 to 14, median 7.0 years). Patients affected by acute poststreptococcal glomerulonephritis associated with acute rheumatic fever were on the average older (P < 0.05) than patients with acute poststreptococcal glomerulonephritis associated with thrombocytopenia, hemolytic anemia, Henoch-Schönlein syndrome, reactive arthritis or uveitis. Five large case series describing 2058 patients affected by acute poststreptococcal glomerulonephritis did not mention its occurrence in association with further immune-mediated disorders. This systematic review points out that acute poststreptococcal glomerulonephritis can be associated, albeit rarely, with rheumatic fever, thrombocytopenia, hemolytic anemia, Henoch-Schönlein syndrome, reactive arthritis, or uveitis.


Asunto(s)
Anemia Hemolítica/epidemiología , Artritis Reactiva/epidemiología , Glomerulonefritis/epidemiología , Púrpura de Schoenlein-Henoch/epidemiología , Fiebre Reumática/epidemiología , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/aislamiento & purificación , Trombocitopenia/epidemiología , Uveítis/epidemiología , Enfermedad Aguda , Adolescente , Adulto , Niño , Preescolar , Comorbilidad , Femenino , Glomerulonefritis/microbiología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Adulto Joven
6.
Niger J Clin Pract ; 22(8): 1120-1125, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31417056

RESUMEN

Aim: Wilson's disease (WD) presents with different phenotypes. Neurologic and liver involvement in WD are well documented. Few reports demonstrated cardiac and vascular involvement. Several studies showed an association between serum copper levels and atherosclerosis. Although WD is the prototype disease of copper metabolism, atherosclerosis has not been studied yet. The aim of this study is to assess aortic stiffness in WD. Materials and Methods: Aortic pulse wave velocity (PWV), augmentation pressure (AP), augmentation index (AIx), central aortic systolic, diastolic, mean, and pulse pressures were measured using SphygmoCor (AtCor Medical) device in 32 patients with WD and 24 healthy controls. Results: Patients with WD and healthy controls were similar in terms of age sex, body mass index (BMI), and liver and kiney functions. However, patients with WD were anemic and thrombocytopenic. Echocardiographic parameters including left ventricular, atrial dimensions, and systolic and diastolic functions were similar between two groups. Patients with WD and healthy controls were compared. Baseline characteristics including age, sex, and BMI did not differ between groups. Central aortic systolic, diastolic, mean, and pulse pressures were similar between the groups. AP, AIx, and PWV did not differ between groups as well. Conclusion: Aortic stiffness in WD was similar in healthy controls.


Asunto(s)
Presión Sanguínea/fisiología , Cobre/metabolismo , Ecocardiografía/métodos , Degeneración Hepatolenticular/diagnóstico por imagen , Análisis de la Onda del Pulso , Rigidez Vascular/fisiología , Adulto , Anemia/epidemiología , Presión Arterial , Índice de Masa Corporal , Estudios de Casos y Controles , Femenino , Degeneración Hepatolenticular/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Trombocitopenia/epidemiología , Turquia/epidemiología
7.
Ann Hematol ; 98(10): 2299-2302, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31444663

RESUMEN

Iron deficiency anemia (IDA) is often associated with mild to moderate thrombocytosis, and iron deficiency-associated thrombocytopenia (IDAT) is much more uncommon and often misdiagnosed as immune thrombocytopenia (ITP). To better describe the features of IDAT, we conducted a retrospective multicenter case-control study. We identified 10 patients (9 women) with a definite diagnosis IDAT, with a median age of 43.5 [range, 16-72] years and a median platelet count of 30.5 × 109/L [range, 21-80], and 7 patients with a possible diagnosis of IDAT. Bleeding manifestations were absent in all patients but one. All the patients recovered (platelet count ≥ 150 × 109/L) upon iron therapy ± red blood cell transfusion after a median time of 6 [4-39] days. When compared with 30 randomly newly diagnosed ITP patients matched on age, the baseline platelet count was significantly lower in ITP (median = 7 × 109/L [4-59], p < 0.001) whereas MPV was higher (10.5 fL [9,4-13,8] vs 8.2 fL, for IDAT p < 0.001). The median platelet count on day 7 was 337 × 109/L [113-1000] for IDAT cases vs 72 × 109/L [13-212] for ITP controls (p < 0.001). IDAT is potentially an under-recognized cause of thrombocytopenia that may be easily managed with iron therapy.


Asunto(s)
Anemia Ferropénica , Trombocitopenia , Adolescente , Adulto , Factores de Edad , Anciano , Anemia Ferropénica/sangre , Anemia Ferropénica/complicaciones , Anemia Ferropénica/diagnóstico , Anemia Ferropénica/epidemiología , Errores Diagnósticos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Púrpura Trombocitopénica Idiopática/sangre , Púrpura Trombocitopénica Idiopática/diagnóstico , Púrpura Trombocitopénica Idiopática/epidemiología , Púrpura Trombocitopénica Idiopática/etiología , Estudios Retrospectivos , Trombocitopenia/sangre , Trombocitopenia/diagnóstico , Trombocitopenia/epidemiología , Trombocitopenia/etiología
8.
Alcohol Alcohol ; 54(5): 503-509, 2019 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-31403690

RESUMEN

BACKGROUND: The aim of this study was to assess the predictive value of thrombocytopenia (TP) in alcohol withdrawal syndrome (AWS) as a marker of evolution of non-complicated AWS (nAWS) to severe, complicated AWS (cAWS): delirium tremens (DTs) and withdrawal seizures (wS), and to broaden knowledge about differences between nAWS and cAWS groups in relation to severity of TP. METHODS: This study involved 300 people (236 males and 64 females), aged 19-65 years (M = 44.64, SD = 11.32), hospitalized in the detoxification ward with ICD-10 diagnosis of F10.3 (AWS) or F10.4 (DTs), divided into nAWS and cAWS groups, 150 cases each. AWS severity was measured by CIWA-Ar. Available clinical and laboratory data were analyzed. RESULTS: TP was found in 139 (46%) of all subjects (nAWS = 32, cAWS = 107). nAWS and cAWS did not differ according to age, gender, length and severity of the last binge. A relationship between the occurrence of TP and cAWS was found (P < 0.001). The lower was the number of PLT, the more AWS incidence was observed. In CIWA-Ar, TP subjects had at least moderate AWS (P < 0.001). nAWS had higher PLT values than cAWS cases (Mrang = 195.96 vs. 105.04, P < 0.001). The predictive value of TP in cAWS was confirmed. CONCLUSIONS: The study demonstrates that patients with AWS and TP (in particular <119k/mL) are at higher risk of developing cAWS.


Asunto(s)
Alcoholismo/diagnóstico , Alcoholismo/epidemiología , Síndrome de Abstinencia a Sustancias/diagnóstico , Síndrome de Abstinencia a Sustancias/epidemiología , Trombocitopenia/diagnóstico , Trombocitopenia/epidemiología , Adulto , Anciano , Alcoholismo/fisiopatología , Femenino , Hospitalización/tendencias , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Síndrome de Abstinencia a Sustancias/fisiopatología , Trombocitopenia/fisiopatología
9.
Lupus ; 28(9): 1158-1166, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31299879

RESUMEN

INTRODUCTION: Although extensively characterized in the outpatient setting, systemic lupus erythematosus (SLE) in the hospitalization wards is still scarcely portrayed, particularly in the perspective of its evolution over the years. METHODS: Retrospective analysis of SLE patients hospitalized in the Department of Autoimmune Diseases of a university hospital during a 20-year period (1995-2015), describing hospitalization characteristics, causes and predictors of outcome. RESULTS: A total of 814 hospitalizations concerning 339 patients were analysed. The main causes of admission were flare (40.2%), infection (19.2%), diagnostic procedures (18.8%) and thrombotic events (5.4%). Therapy with cyclophosphamide (odds ratio (OR) 1.908, p = 0.047) was associated with admission due to infection, while antimalarials displayed a protective effect (OR 0.649, p = 0.024). Nearly 3.9% of patients required admission to an intensive care unit, with associated antiphospholipid syndrome (OR 7.385, p = 0.04) standing as a predicting factor for this outcome. Readmission at 30 days occurred in 5.8% of patients, with thrombocytopenia (OR 6.007, p = 0.002) and renal involvement (OR 3.362, p = 0.032) featuring as predicting factors. Eight patients died, with antiphospholipid syndrome (OR 26.814, p = 0.02) and thrombocytopenia (OR 31.523, p = 0.01) being associated with mortality. There was no significant variation in patients' demographics or admission causes across the 20-year period, except for a decrease in admissions due to thrombotic and musculoskeletal causes. Recently, an increase in the use of mycophenolate mofetil and lower doses of glucocorticoids were noted. CONCLUSION: While demographics of SLE hospitalizations have not markedly changed over the past 20 years, changes in therapy patterns were observed. Thrombocytopenia, antiphospholipid syndrome and renal involvement featured as predictors of poor outcome.


Asunto(s)
Síndrome Antifosfolípido/epidemiología , Hospitalización/estadística & datos numéricos , Lupus Eritematoso Sistémico/terapia , Trombocitopenia/epidemiología , Adulto , Síndrome Antifosfolípido/etiología , Ciclofosfamida/administración & dosificación , Femenino , Humanos , Inmunosupresores/administración & dosificación , Lupus Eritematoso Sistémico/mortalidad , Lupus Eritematoso Sistémico/fisiopatología , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Estudios Retrospectivos , España , Trombocitopenia/etiología
10.
Acta Med Port ; 32(6): 453-458, 2019 Jun 28.
Artículo en Inglés | MEDLINE | ID: mdl-31292027

RESUMEN

INTRODUCTION: Skin and skin structure infections are an increasing cause of hospitalization. Although mortality is relatively low, skin and skin structure infections are associated with prolonged hospital length of stay and high costs. Oxazolidinones have been suggested as a tool to treat infected patients in the ambulatory setting in order to decrease hospital length of stay. We wanted to address the evidence associated with the use of oxazolidinones in the treatment of skin and skin structure infections. MATERIAL AND METHODS: In this observational retrospective study we analyzed the anonymized diagnosis related group coded information from the Portuguese database for hospital admissions, that included all adult patients with a diagnosis of oxazolidinone use and a SSSI, discharged between 2010 and 2015. RESULTS: During the study period, a total of 5518 patients had a diagnosis of oxazolidinone treatment. We selected 483 of those who were also diagnosed with a skin and skin structure infections. Their mean age was 64.9 years and 62.7% were male. The median hospital length of stay was 27 days (Inter quartile range 13 - 56) and the mortality rate was 12.6%. The prevalence of secondary anemia and of thrombocytopenia in the whole group treated with oxazolidinones was 2.5% and 3%, respectively. DISCUSSION: Despite the high bioavailability of oxazolidinones, we were not able to find evidence that its use was associated with a decrease of mortality or hospital length of stay (due to early discharge) of patients with skin and skin structure infections. CONCLUSION: In this study we were not able to find evidence that oxazolidinones had any clinically significant benefit. A structured approach, including antibiotics with favorable pharmacokinetic and safety profile as well as a carefully planned ambulatory follow up may be needed.


Asunto(s)
Antiinfecciosos/uso terapéutico , Tiempo de Internación/estadística & datos numéricos , Oxazolidinonas/uso terapéutico , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/estadística & datos numéricos , Anemia/inducido químicamente , Anemia/epidemiología , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Portugal/epidemiología , Estudios Retrospectivos , Enfermedades Cutáneas Bacterianas/microbiología , Enfermedades Cutáneas Bacterianas/mortalidad , Trombocitopenia/inducido químicamente , Trombocitopenia/epidemiología
11.
BMC Pregnancy Childbirth ; 19(1): 269, 2019 Jul 29.
Artículo en Inglés | MEDLINE | ID: mdl-31357932

RESUMEN

BACKGROUND: The occurrence of thrombocytopenia is as high as 7-12% in pregnancy, yet minimum platelet count safe for cesarean section remains unknown. METHODS: In this retrospective noninferior cohort study, we consecutively included patients undergoing cesarean section for a period of 6 years in a tertiary hospital and excluded patients at very high risk for excessive hemorrhage. The included patients with preoperative platelet count of 50-100 × 109/L were defined as the thrombocytopenic group. The control group were eligible patients with preoperative platelet count>150 × 109/L, matched to the thrombocytopenic group by age and operation timing in a 1:2 ratio. Mixed effect model was used to analyze the effect of thrombocytopenia based on a noninferiority assumption. The predefined noninferiority delta of bleeding was 50 mL. RESULTS: There was no significant difference of the calculated blood loss between the thrombocytopenic and the control group (mean difference = 8.94, 95% CI - 28.34 mL to 46.09 mL). No statistical difference was observed in the requirement for blood transfusion, visually estimated blood loss, or the incidence of adverse events between groups. Although there were more patients admitted to intensive care unit (odds ratio = 12, 95% CI 2.69-53.62, p = 0.001) in the thrombocytopenic group, most of them required critical care for reasons other than hemorrhage. The thrombocytopenic group had longer length of hospital stay (mean difference = 0.40 days, 95% CI 0.09-0.71, p = 0.011), but the difference was considered as clinically insignificant. CONCLUSIONS: Preoperative moderate thrombocytopenia is not associated with increased blood loss, blood transfusion, or occurrence of adverse events in patients undergoing cesarean section in absence of additional bleeding risk.


Asunto(s)
Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Cesárea/estadística & datos numéricos , Complicaciones Hematológicas del Embarazo/epidemiología , Resultado del Embarazo/epidemiología , Trombocitopenia/epidemiología , Adulto , Pérdida de Sangre Quirúrgica/prevención & control , Estudios de Cohortes , Femenino , Humanos , Transfusión de Plaquetas , Embarazo , Estudios Retrospectivos , Trombocitopenia/complicaciones , Adulto Joven
12.
Cancer Sci ; 110(9): 2875-2883, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31254422

RESUMEN

Previous studies have shown sex-related differences in the incidence of adverse events following treatment with fluoropyrimidines, however the mechanism of this difference is unknown. We examined sex-related differences in the safety of S-1 plus oxaliplatin (SOX) and S-1 plus cisplatin (CS) in 663 metastatic gastric cancer patients taking part in a phase III study. The incidences of leukopenia (odds ratio [OR] 1.9; P = .015), neutropenia (OR 2.2; P = .002), nausea (OR 2.0; P = .009), and vomiting (OR 2.8; P < .001) were increased in women versus men treated with SOX, while vomiting (OR 2.9; P < .001) and stomatitis (OR 1.8; P = .043) were increased in women versus men treated with CS. In contrast, male patients treated with CS experienced thrombocytopenia more often (OR 0.51; P = .009). The mean relative dose intensity of S-1 in SOX was 75.4% in women and 81.4% in men (P = .032). No difference in efficacy was observed between women and men undergoing either regimen. Sex-related differences in adverse reactions during SOX and CS treatment were confirmed in this phase III study. Further translational research studies are warranted to pursue the cause of this difference.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Cisplatino/efectos adversos , Oxaliplatino/efectos adversos , Ácido Oxónico/efectos adversos , Neoplasias Gástricas/tratamiento farmacológico , Tegafur/efectos adversos , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Cisplatino/administración & dosificación , Supervivencia sin Enfermedad , Relación Dosis-Respuesta a Droga , Combinación de Medicamentos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Náusea/inducido químicamente , Náusea/epidemiología , Neutropenia/inducido químicamente , Neutropenia/epidemiología , Oxaliplatino/administración & dosificación , Ácido Oxónico/administración & dosificación , Factores Sexuales , Neoplasias Gástricas/sangre , Neoplasias Gástricas/patología , Estomatitis/inducido químicamente , Estomatitis/epidemiología , Tegafur/administración & dosificación , Trombocitopenia/inducido químicamente , Trombocitopenia/epidemiología , Vómitos/inducido químicamente , Vómitos/epidemiología
13.
BMC Infect Dis ; 19(1): 498, 2019 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-31174484

RESUMEN

BACKGROUND: Cases of severe fever with thrombocytopenia syndrome (SFTS) have increasingly been observed in Miyazaki, southwest Japan. It is critical to identify and elucidate the risk factors of infection at community level. In the present study, we aimed to identify areas with a high risk of SFTS virus infection using a geospatial dataset of SFTS cases in Miyazaki. METHODS: Using 10 × 10-km mesh data and a geographically weighted logistic regression (GWLR) model, we examined the statistical associations between environmental variables and spatial variation in the risk of SFTS. We collected geospatial and population census data as well as forest and agriculture mesh information. Altitude and farmland were selected as two specific variables for predicting the presence of SFTS cases in a given mesh area. RESULTS: Using GWLR, the area under the receiver operating characteristic curve (AUC) was estimated at 73.9%, outperforming the classical logistic regression model (72.4%). The sensitivity and specificity of the GWLR model were estimated at 90.9 and 58.7%, respectively. We identified altitude (odds ratio (OR) = 0.996, 95% confidence interval (CI): 0.994-0.999 per one-meter elevation) and farmland (OR = 0.999, 95% CI: 0.998-1.000 per % increase) as useful negative predictors of SFTS cases in Miyazaki. CONCLUSIONS: Our study findings revealed that the risk of SFTS is high in geographic areas where farmland area begins to diminish and at mid-level altitudes. Our findings can help to improve the efficiency of ecological and animal surveillance in high-risk areas. Using finer geographic resolution, such surveillance can help raise awareness among local residents in areas with a high risk of SFTS.


Asunto(s)
Fiebre/etiología , Modelos Teóricos , Trombocitopenia/diagnóstico , Animales , Área Bajo la Curva , Humanos , Japón/epidemiología , Modelos Logísticos , Oportunidad Relativa , Curva ROC , Trombocitopenia/epidemiología
14.
BMC Infect Dis ; 19(1): 476, 2019 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-31138131

RESUMEN

BACKGROUND: Severe fever with thrombocytopenia syndrome (SFTS) is a newly identified severe infectious disease caused by SFTS phlebovirus (SFTSV). SFTS monitoring has been carried out since 2010 in mainland China. We analysed the detection results of SFTSV RNA and antibody in SFTS surveillance cases to provide basic data for SFTS diagnosis. METHODS: This study was conducted in Shandong Province. Sera of SFTS surveillance cases were collected to detect SFTSV RNA and antibody by real-time RT-PCR and enzyme-linked immunosorbent assay, respectively. Detection rates were calculated. SPSS 18.0 (Chicago, IL, USA) was used for statistical analysis to compare the detection rates of SFTSV RNA and antibodies among different sera groups. RESULTS: A total of 374 SFTS surveillance cases were enrolled. Overall, 93.3% (349/374) of the sera samples were collected within 2 weeks after onset, and 6.7% (25/374) were collected between 15 days and 45 days. Of these, 183 (48.9%) were positive for SFTSV RNA. The SFTSV RNA-positive rate peaked (52.2%) in samples collected ≤7 days after onset and then showed a decreasing trend. The detection rate of SFTSV-specific IgM antibody was 30.5% (46/151) and was highest in samples collected between 8 and 14 days (43.3%, 26/60). The positive rate of SFTSV-specific IgG antibody (17.9%, 27/151) showed an increasing trend with the specimen collection time. In total, 74.8% (113/151) of sera samples had the same SFTSV RNA and IgM antibody detection results. However, 23.2% (29/125) of SFTSV RNA-negative cases were IgM antibody-positive, and 8.6% (9/105) of IgM antibody-negative cases were SFTSV RNA-positive. CONCLUSIONS: SFTSV RNA detection was preferred for SFTSV infection during disease surveillance. For highly suspected SFTS cases, IgM antibody is suggested to make a comprehensive judgement.


Asunto(s)
Anticuerpos Antivirales/sangre , Infecciones por Bunyaviridae/epidemiología , Infecciones por Bunyaviridae/virología , Phlebovirus/genética , ARN Viral/sangre , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , China/epidemiología , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Fiebre/virología , Humanos , Inmunoglobulina M/sangre , Masculino , Persona de Mediana Edad , Phlebovirus/inmunología , Reacción en Cadena en Tiempo Real de la Polimerasa , Trombocitopenia/epidemiología , Trombocitopenia/virología
15.
Am J Med ; 132(8): 942-948.e5, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31034804

RESUMEN

BACKGROUND: The impact of thrombocytopenia on revascularization and outcomes in patients presenting with acute myocardial infarction remains poorly understood. We sought to evaluate associations between thrombocytopenia, in-hospital management, bleeding, and cardiovascular outcomes in patients hospitalized for acute myocardial infarction in the United States. METHODS: Patients hospitalized from 2004 to 2014 with a primary diagnosis of acute myocardial infarction were identified from the National Inpatient Sample. Management of acute myocardial infarction was compared between patients with and without thrombocytopenia. Multivariable logistic regression models were used to estimate odds of in-hospital adverse events stratified by thrombocytopenia and adjusted for demographics, cardiovascular risk factors, comorbidities, and treatment. RESULTS: A total of 6,717,769 patients were hospitalized with a primary diagnosis of acute myocardial infarction, and thrombocytopenia was reported in 219,351 (3.3%). Patients with thrombocytopenia were older, more likely to have other medical comorbidities, were more likely to undergo coronary artery bypass grafting (28.8% vs 8.2%, P < .001), and were less likely to receive a drug-eluting stent (15.5% vs 29.5%, P < .001). After multivariable adjustment, thrombocytopenia was independently associated with nearly twofold increased odds of in-hospital mortality (adjusted odds ratio 1.91; 95% confidence interval, 1.86-1.97). Thrombocytopenia was also independently associated with ischemic stroke, cardiogenic shock, cardiac arrest, and bleeding complications. CONCLUSIONS: Patients with thrombocytopenia in the setting of acute myocardial infarction had increased odds of bleeding, cardiovascular outcomes, and mortality compared with patients without thrombocytopenia. Future investigations to mitigate the poor prognosis of patients with acute myocardial infarction and thrombocytopenia are warranted.


Asunto(s)
Infarto del Miocardio/fisiopatología , Revascularización Miocárdica/efectos adversos , Trombocitopenia/fisiopatología , Anciano , Anciano de 80 o más Años , Femenino , Mortalidad Hospitalaria/tendencias , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Revascularización Miocárdica/métodos , Oportunidad Relativa , Factores de Riesgo , Trombocitopenia/epidemiología , Resultado del Tratamiento , Estados Unidos/epidemiología
17.
Transpl Immunol ; 55: 101206, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31009686

RESUMEN

BACKGROUND: Hematological abnormalities after transplantation are complications that may arise after renal transplantation, of which thrombocytopenia is associated with increased risk of bleeding and other complications. The development of thrombocytopenia is affected by various clinical conditions, and the stromal-derived factor 1 (SDF1) and platelet factor 4 (PF4) genes are known to be involved in the production or destruction of platelets. The purpose of this study was to investigate the prevalence of posttransplant thrombocytopenia and its association with other clinical conditions and genetic polymorphisms of SDF1 and PF4 genes a long time after transplantation. METHODS: This is a retrospective study that includes a total of 305 kidney transplant (KT) recipients between 2008 and 2012 at St. Vincent Medical Center, Los Angeles, CA. In this study, posttransplant thrombocytopenia was defined as a 30% reduction in platelet count from the baseline in the first week or a decrease of <100 (×103/µL) within 1 year after KT. The subjects were divided into posttransplant thrombocytopenia and control groups. The chi-square test, t-test, and logistic regression were used for the analyses. RESULTS: In the first week, 65 patients had a 30% reduction in platelet count (21.3%). Gender, simultaneous kidney-pancreas transplantation, induction therapy (IT), and only alleles of rs2297630 of SDF1, among the SDF1 and PF4 genes, showed statistically significant differences. The rs2297630 alleles were consistently significant risk factors (non G vs. G: odds ratio = 0.445; 95% confidence interval, 0.224-0.884; p = .021) in the multiple logistic regression. In the 1-year study, 61 patients (20.0%) had platelet counts of <100 × 103/µL and had statistically significant differences in patients who had delayed graft function and induction therapy. CONCLUSIONS: In this study, non-G group of rs2297630 in SDF1 significantly increased the risk of post-transplant thrombocytopenia in the first week of kidney transplantation.


Asunto(s)
Alelos , Quimiocina CXCL12/genética , Trasplante de Riñón , Factor Plaquetario 4/genética , Polimorfismo Genético , Trombocitopenia/genética , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Trombocitopenia/epidemiología , Trombocitopenia/etiología , Factores de Tiempo
18.
BMC Res Notes ; 12(1): 202, 2019 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-30940190

RESUMEN

OBJECTIVE: To assess the clinical presentation and hematological profile among young (≤ 55 years) and old (> 55 years) chronic lymphocytic leukemia patients in Sudan. RESULT: In the present cross-sectional descriptive study, out of 110 cases studied, among them 31 (28.2%) were young (≤ 55 years) patients with mean age 48 years, and 79 (71.8%) were elder patients (> 55 years) with mean age 66 years, the overall mean age was 62.97 ± 12.06 with range (22-85 years), and 79 (71.8%) were males and 31 (28.2%) were females (M:F = 2.6:1) (P = 0.000). (7.3%) were asymptomatic, 61 (55.5%) presented with nonspecific complains. Generalized lymphadenopathy was seen in 52 (47.27%) with elder predominance (P = 0.03). Splenomegaly, hepatomegaly, thrombocytopenia and anemia were seen in 54 (49.1%), 14 (12.7%), 43 (39.1%) and 38 (34.5%) of patients respectively with male predominance. 54 (49.1%) and 42 (38.18%) of patients presented at Rai high risk and Binet C stages respectively with nearly same age and sex distribution. CLL in Sudan is a disease of elders, same as seen in literature, with high male to female ratio. In general hematological parameters means were noted to be distributed equally according to age and sex groups. Majority of patients were presented with nonspecific symptoms and nearly half of patients presented at late stages as reported in most developing countries.


Asunto(s)
Anemia , Hepatomegalia , Leucemia Linfocítica Crónica de Células B , Linfadenopatía , Esplenomegalia , Trombocitopenia , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Anemia/sangre , Anemia/epidemiología , Anemia/etiología , Femenino , Hepatomegalia/sangre , Hepatomegalia/epidemiología , Hepatomegalia/etiología , Humanos , Leucemia Linfocítica Crónica de Células B/sangre , Leucemia Linfocítica Crónica de Células B/complicaciones , Leucemia Linfocítica Crónica de Células B/epidemiología , Linfadenopatía/sangre , Linfadenopatía/epidemiología , Linfadenopatía/etiología , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Esplenomegalia/sangre , Esplenomegalia/epidemiología , Esplenomegalia/etiología , Sudán/epidemiología , Trombocitopenia/sangre , Trombocitopenia/epidemiología , Trombocitopenia/etiología , Adulto Joven
19.
J Bronchology Interv Pulmonol ; 26(4): 280-286, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30973520

RESUMEN

BACKGROUND: Bronchoscopy is a safe procedure, but current guidelines recommend transfusion for platelets <20 K/µL. Studies of bronchoscopy in thrombocytopenia are limited. OBJECTIVES: Our objective was to evaluate the incidence of bleeding with flexible bronchoscopy in those with thrombocytopenia especially those <20 K/µL. METHOD: We performed a retrospective review of all flexible bronchoscopies between June 1, 2008 and December 31, 2010. Biopsies and therapeutic procedures were excluded. The χ, Fisher exact, and Rank-sum test were conducted to evaluate associations of clinically significant bleeding. RESULTS: There were 1711 patients who underwent 2053 flexible bronchoscopies. Cancer diagnosis included hematologic (61.3%) and solid organ malignancy (34.9%). Half of the bronchoscopies had moderate to severe thrombocytopenia (<100 K/µL) with the following ranges: 14.7% with 50 to <100 K/µL, 20.6% with 20 to <50 K/µL, 10.6% with 10 to <20 K/µL, 4.1% with <10 K/µL. Platelet transfusion was given in 90.6% of those with platelets <10 K/µL and 55.5% of those with platelets 10 to <20 K/µL. The nasal route for bronchoscopy was used in 92.4%. Bleeding complication rate however was 1.1% (0.2% major) and not affected by platelets. CONCLUSION: Bronchoscopy with lavage can be safely performed without platelet transfusion in those with platelets of ≥10 K/µL. In the absence of nasal bleeding, trauma, or deformity, the nasal route can be used for bronchoscopy.


Asunto(s)
Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Broncoscopía , Neoplasias/epidemiología , Trombocitopenia/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Transfusión de Plaquetas , Estudios Retrospectivos , Factores de Riesgo , Trombocitopenia/sangre , Adulto Joven
20.
Joint Bone Spine ; 86(2): 165-171, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30837156

RESUMEN

Several conditions have clinical and laboratory features that can mimic those present in Systemic Lupus Erythematosus (SLE). Some of these "SLE mimickers" are very common, such as rosacea which can be mistaken for the butterfly rash, while others such as Kikuchi disease, type-1 interferonopathies, Castleman's disease, prolidase deficiency, angioimmunoblastic T-cell lymphoma, Evans' syndrome in the context of primary immune deficiencies and the autoimmune lymphoproliferative syndrome are exceptionally uncommon. A proper diagnosis of SLE must therefore be based upon a complete medical history as well as on the adequate constellation of clinical or laboratory findings. While there is no single test that determines whether a patient has lupus or not, the search for auto-antibodies towards nuclear antigens is a key step in the diagnosis strategy, keeping in mind that ANAs are not specific for SLE. In case of persistent doubt, patients should be referred to reference centers with experience in the management of the disease.


Asunto(s)
Anemia Hemolítica Autoinmune/diagnóstico , Anticuerpos Antinucleares/análisis , Enfermedades Autoinmunes/diagnóstico , Enfermedad de Castleman/diagnóstico , Lupus Eritematoso Sistémico/diagnóstico , Enfermedades Raras/diagnóstico , Trombocitopenia/diagnóstico , Anemia Hemolítica Autoinmune/epidemiología , Anticuerpos Antinucleares/inmunología , Enfermedades Autoinmunes/epidemiología , Enfermedad de Castleman/epidemiología , Diagnóstico Diferencial , Femenino , Linfadenitis Necrotizante Histiocítica/diagnóstico , Linfadenitis Necrotizante Histiocítica/epidemiología , Humanos , Incidencia , Lupus Eritematoso Sistémico/epidemiología , Lupus Eritematoso Sistémico/inmunología , Masculino , Enfermedades Raras/epidemiología , Medición de Riesgo , Trombocitopenia/epidemiología
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