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1.
Nat Med ; 27(7): 1290-1297, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34108714

RESUMO

Reports of ChAdOx1 vaccine-associated thrombocytopenia and vascular adverse events have led to some countries restricting its use. Using a national prospective cohort, we estimated associations between exposure to first-dose ChAdOx1 or BNT162b2 vaccination and hematological and vascular adverse events using a nested incident-matched case-control study and a confirmatory self-controlled case series (SCCS) analysis. An association was found between ChAdOx1 vaccination and idiopathic thrombocytopenic purpura (ITP) (0-27 d after vaccination; adjusted rate ratio (aRR) = 5.77, 95% confidence interval (CI), 2.41-13.83), with an estimated incidence of 1.13 (0.62-1.63) cases per 100,000 doses. An SCCS analysis confirmed that this was unlikely due to bias (RR = 1.98 (1.29-3.02)). There was also an increased risk for arterial thromboembolic events (aRR = 1.22, 1.12-1.34) 0-27 d after vaccination, with an SCCS RR of 0.97 (0.93-1.02). For hemorrhagic events 0-27 d after vaccination, the aRR was 1.48 (1.12-1.96), with an SCCS RR of 0.95 (0.82-1.11). A first dose of ChAdOx1 was found to be associated with small increased risks of ITP, with suggestive evidence of an increased risk of arterial thromboembolic and hemorrhagic events. The attenuation of effect found in the SCCS analysis means that there is the potential for overestimation of the reported results, which might indicate the presence of some residual confounding or confounding by indication. Public health authorities should inform their jurisdictions of these relatively small increased risks associated with ChAdOx1. No positive associations were seen between BNT162b2 and thrombocytopenic, thromboembolic and hemorrhagic events.


Assuntos
Vacinas contra COVID-19/uso terapêutico , COVID-19/prevenção & controle , Hemorragia/epidemiologia , Púrpura Trombocitopênica Idiopática/epidemiologia , Trombocitopenia/epidemiologia , Tromboembolia/epidemiologia , Tromboembolia Venosa/epidemiologia , Adolescente , Adulto , Idoso , Vacina BNT162 , Estudos de Casos e Controles , ChAdOx1 nCoV-19 , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , SARS-CoV-2 , Escócia/epidemiologia , Trombose dos Seios Intracranianos/epidemiologia , Adulto Jovem
2.
BMC Infect Dis ; 21(1): 342, 2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33845766

RESUMO

BACKGROUND: Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2) has challenged public health agencies globally. In order to effectively target government responses, it is critical to identify the individuals most at risk of coronavirus disease-19 (COVID-19), developing severe clinical signs, and mortality. We undertook a systematic review of the literature to present the current status of scientific knowledge in these areas and describe the need for unified global approaches, moving forwards, as well as lessons learnt for future pandemics. METHODS: Medline, Embase and Global Health were searched to the end of April 2020, as well as the Web of Science. Search terms were specific to the SARS-CoV-2 virus and COVID-19. Comparative studies of risk factors from any setting, population group and in any language were included. Titles, abstracts and full texts were screened by two reviewers and extracted in duplicate into a standardised form. Data were extracted on risk factors for COVID-19 disease, severe disease, or death and were narratively and descriptively synthesised. RESULTS: One thousand two hundred and thirty-eight papers were identified post-deduplication. Thirty-three met our inclusion criteria, of which 26 were from China. Six assessed the risk of contracting the disease, 20 the risk of having severe disease and ten the risk of dying. Age, gender and co-morbidities were commonly assessed as risk factors. The weight of evidence showed increasing age to be associated with severe disease and mortality, and general comorbidities with mortality. Only seven studies presented multivariable analyses and power was generally limited. A wide range of definitions were used for disease severity. CONCLUSIONS: The volume of literature generated in the short time since the appearance of SARS-CoV-2 has been considerable. Many studies have sought to document the risk factors for COVID-19 disease, disease severity and mortality; age was the only risk factor based on robust studies and with a consistent body of evidence. Mechanistic studies are required to understand why age is such an important risk factor. At the start of pandemics, large, standardised, studies that use multivariable analyses are urgently needed so that the populations most at risk can be rapidly protected. REGISTRATION: This review was registered on PROSPERO as CRD42020177714 .


Assuntos
COVID-19/diagnóstico , COVID-19/mortalidade , Fatores de Risco , COVID-19/patologia , China , Humanos , Pandemias , Saúde Pública
3.
J Small Anim Pract ; 61(10): 637-643, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32789893

RESUMO

OBJECTIVE: To explore the use of a modified pupillometry technique in dogs without chemical restraint. MATERIALS AND METHODS: Following dark adaptation, pupillary light reflexes were assessed in six dogs with sudden acquired retinal degeneration syndrome, in the unaffected eye of eight dogs with unilateral primary glaucoma ("predisposed"), and in 11 healthy dogs. Responses to red, blue and white lights were recorded and relative pupil sizes subsequently determined based on video recordings of each test. RESULTS: Mean testing time was 2.3 minutes (range 1.8 to 3.1 minutes), excluding time for dark adaptation. Baseline pupil size in dogs with sudden acquired retinal degeneration syndrome was greater than in normal and predisposed eyes. Pupil constriction was reduced in predisposed compared to normal and sudden acquired retinal degeneration syndrome eyes when stimulated with high-intensity blue light. Compared to normal eyes, those with sudden acquired retinal degeneration syndrome had reduced pupil constriction when stimulated with low- and high-intensity red light, low-intensity blue light and white light. CLINICAL SIGNIFICANCE: Quantitative measures of pupil function were obtained from healthy and diseased eyes without the need for chemical restraint. Further investigations are warranted to validate the technique and evaluate its use in the management of canine glaucoma.


Assuntos
Doenças do Cão , Glaucoma , Animais , Cães , Glaucoma/veterinária , Luz , Pupila , Reflexo Pupilar , Opsinas de Bastonetes
4.
J Hosp Infect ; 106(3): 554-561, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32717202

RESUMO

BACKGROUND: Clostridioides difficile infection (CDI) is associated with high healthcare demands and related costs. AIM: To evaluate the healthcare and economic burden of CDI in hospitalized patients with community- (HOCA-CDI) or hospital-associated CDI (HOHA-CDI) in the National Health Service in Scotland. METHODS: A retrospective cohort study was conducted, examining data between August 2010 and July 2013 from four patient-level Scottish datasets, linked to death data. Data examined included prior antimicrobial prescriptions in the community, hospitalizations, length of stay and mortality. Each CDI case was matched to three hospital-based controls on the basis of age, gender, hospital and date of admission. Descriptive economic evaluations were based on bed-day costs for different types of wards. FINDINGS: Overall, 3304 CDI cases were included in the study. CDI was associated with additional median lengths of stay of 7.2 days for HOCA-CDI and 12.0 days for HOHA-CDI compared with their respective, matched controls. The 30-day mortality rate was 6.8% for HOCA-CDI and 12.4% for HOHA-CDI. Overall, recurrence within 90 days of the first CDI episode occurred in 373/2740 (13.6%) survivors. The median additional expenditure for each initial CDI case compared with matched controls was £1713. In the 6 months after the index hospitalization, the cost associated with a CDI case was £5126 higher than for controls. CONCLUSION: Using routinely collected national data, we demonstrated the substantial burden of CDI on healthcare services, including lengthy hospital stays and readmissions, which increased the costs of managing patients with CDI compared with matched controls.


Assuntos
Infecções por Clostridium/economia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/epidemiologia , Infecção Hospitalar/economia , Infecção Hospitalar/microbiologia , Feminino , Hospitalização/economia , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Escócia/epidemiologia , Adulto Jovem
5.
Aust Vet J ; 97(10): 404-413, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31286478

RESUMO

AIMS: The objectives of this study were to estimate the prevalence of digital dermatitis (DD) in Victoria, Australia, and to investigate which organisms are consistent with typical DD lesions. The prevalence and causative pathogens of DD are not clear yet in Australia and this paper is one of the first to explore these questions in this country. METHODS: Examination and sampling of limbs was undertaken at three knackeries in Victoria, Australia. Limbs were classified as normal (N), active DD-lesion (A), dried or chronic DD-lesion (D) or suspected case of DD (S). A total of 823 cows were examined. Six skin biopsies were taken at each knackery, from which DNA was extracted for diversity profiling. Histochemical staining of samples was performed on eight of the skin biopsies. RESULTS: DD was detected in 29.8% of all cows. The prevalence of DD was significantly higher in dairy cows (32.2%) than in beef cows (10.8%). The differential abundance of Treponema-species was significantly increased in dried lesions, compared with the normal skin biopsies. Actinobacteria, Proteobacteria, Firmicutes and Tenericutes were found to be significantly different in abundance in the DD lesions compared with normal skin biopsies. Silver staining of samples showed only mild inflammation and in two samples organisms with morphology consistent with Spirochaetes were detected. CONCLUSIONS: The calculated prevalence indicates that DD is present in Victoria, Australia. The results of diversity profiling showed that the presence of Treponema-species was significantly different between the samples of DD lesions and normal skin.


Assuntos
Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/microbiologia , Dermatite Digital/epidemiologia , Dermatite Digital/microbiologia , Animais , Bovinos , Doenças dos Bovinos/patologia , Dermatite Digital/patologia , Pele/microbiologia , Pele/patologia , Vitória/epidemiologia
6.
J Public Health (Oxf) ; 41(1): e84-e94, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29850883

RESUMO

BACKGROUND: Use of cardiovascular medication has increased over time, especially for primary and secondary prevention, with polypharmacy common. METHODS: Review of published systematic reviews of the factors and outcomes associated with adherence to cardiovascular medication using MEDLINE, Embase, CINAHL and PsycINFO databases. Quality was assessed using the AMSTAR tool. RESULTS: Of 789 systematic reviews identified, 45 met the inclusion criteria and passed the quality assessment; 34 focused on factors associated with adherence, and 11 on outcomes. High heterogeneity, both between and within reviews, precluded meta-analysis and so a pooled estimate of adherence levels could not be derived. Adherence was associated with disease factors, therapy factors, healthcare factors, patient factors and social factors, though with some inconsistencies. In total, 91% of reviews addressing outcomes reported that low adherence was associated with poorer clinical and economic endpoints. CONCLUSIONS: Factors from across five key domains relate to non-adherence to cardiovascular medications, and may contribute to poorer clinical outcomes. Interventions to improve adherence should be developed to address modifiable factors and targeted at those at highest risk of non-adherence. Adherence research is highly heterogeneous to-date and efforts to standardize this should be implemented to improve comparability.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Adesão à Medicação , Feminino , Humanos , Masculino , Polimedicação , Fatores Socioeconômicos , Resultado do Tratamento
7.
J Small Anim Pract ; 60(6): 340-347, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30474235

RESUMO

OBJECTIVES: To describe preliminary use of a forced-choice preferential looking task for the clinical assessment of vision in dogs. MATERIALS AND METHODS: The vision of 18 pet dogs was investigated in two separate studies using a forced-choice preferential looking task: multiple observers watched eye, head and body movements on video recordings to identify cues suggesting when a dog had seen the feature of interest. Human observer reliability was determined using eight dogs and computer-generated stimuli. Visual acuity was assessed using computer-generated grating stimuli: in real-time, an observer watched each dog's eye movement patterns and behaviour to decide whether each grating was seen. Stimuli were presented in a step-wise manner and were controlled by the observer. Acuity was estimated as the highest spatial frequency the dog was determined to have seen. RESULTS: Median estimated visual acuity was better at 1 m compared to that at 3 m. Average test time was longer at a 3-m distance than at 1 m. Inter- and intra-observer reliability was better from 1 m than from 3 m. CLINICAL SIGNIFICANCE: Preliminary use of a forced-choice preferential looking task for measurement of visual acuity in dogs has potential use as a clinical tool for the assessment of vision in dogs.


Assuntos
Testes Visuais , Animais , Cães , Humanos , Projetos Piloto , Reprodutibilidade dos Testes , Gravação em Vídeo , Acuidade Visual
8.
Aust Vet J ; 95(4): 129-133, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28346666

RESUMO

CASE REPORT: A 4-year-old neutered male Rhodesian Ridgeback dog with right-sided Horner's syndrome, bilateral laryngeal paralysis, neck pain and bilateral hindlimb ataxia was euthanased following deterioration of its neurological status. Necropsy examination revealed an off-white retropharyngeal neoplastic mass (100 × 30 × 30 mm) attached to the base of the skull on the right side and macroscopic nodular metastases in the spleen and three vertebral bodies (C6, C7 and T6), including a nodule attached to the dura at C7. Histological evidence of neuroblastic tumour was detected in these macroscopic lesions, a regional lymph node, bone marrow of a femur and all 15 vertebral bodies (C1-T8) examined, including the three with macroscopic metastases, and in the lumens of small blood vessels in the lungs and liver. Ganglion cell differentiation was detected only in the primary retropharyngeal mass, one splenic nodule and the C7 dural nodule. Neoplastic cells were immunoreactive to neurofilament protein (ganglion cells only), vimentin and synaptophysin, and were negative for S100 protein, GFAP, CD3 and Pax5. CONCLUSION: The diagnosis was disseminated peripheral neuroblastoma, differentiating subtype (International Neuroblastoma Pathology Classification), with likely primary involvement of the right cranial cervical ganglion. This appears to be the first report of neuroblastoma in a dog with widespread occult haematogenous metastasis to bone marrow.


Assuntos
Doenças do Cão/patologia , Neuroblastoma/veterinária , Neoplasias do Sistema Nervoso Periférico/veterinária , Animais , Ataxia/etiologia , Ataxia/veterinária , Neoplasias da Medula Óssea/secundário , Neoplasias da Medula Óssea/veterinária , Neoplasias Ósseas/secundário , Neoplasias Ósseas/veterinária , Cães , Síndrome de Horner/etiologia , Síndrome de Horner/veterinária , Masculino , Neuroblastoma/complicações , Neuroblastoma/patologia , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/patologia , Neoplasias Esplênicas/secundário , Neoplasias Esplênicas/veterinária , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/veterinária
9.
Vet Pathol ; 54(2): 194-203, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27681326

RESUMO

In many health-related fields, there is great interest in the identification of biomarkers that distinguish diseased from healthy individuals. In addition to identifying the diseased state, biomarkers have potential use in predicting disease risk, monitoring disease progression, evaluating treatment efficacy, and informing pathogenesis. This review details the genetic and biochemical markers associated with canine primary glaucoma. While there are numerous molecular markers (biochemical and genetic) associated with glaucoma in dogs, there is no ideal biomarker that allows early diagnosis and/or identification of disease progression. Genetic mutations associated with canine glaucoma include those affecting ADAMTS10, ADAMTS17, Myocilin, Nebulin, COL1A2, RAB22A, and SRBD1. With the exception of Myocilin, there is very limited crossover in genetic biomarkers identified between human and canine glaucomas. Mutations associated with canine glaucoma vary between and within canine breeds, and gene discoveries therefore have limited overall effects as a screening tool in the general canine population. Biochemical markers of glaucoma include indicators of inflammation, oxidative stress, serum autoantibodies, matrix metalloproteinases, tumor necrosis factor-α, and transforming growth factor-ß. These markers include those that indicate an adaptive or protective response, as well as those that reflect the damage arising from oxidative stress.


Assuntos
Doenças do Cão/genética , Glaucoma/veterinária , Animais , Biomarcadores , Doenças do Cão/sangue , Cães , Glaucoma/sangue , Glaucoma/genética , Mutação
10.
J Clin Pharm Ther ; 41(5): 486-92, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27349795

RESUMO

WHAT IS KNOWN AND OBJECTIVES: Adverse clinical outcomes have been associated with cumulative anticholinergic burden (to which low-potency as well as high-potency anticholinergic medicines contribute). The clinical indications for which anticholinergic medicines are prescribed (and thus the 'phenotype' of patients with anticholinergic burden) have not been established. We sought to establish the overall prevalence of prescribing of anticholinergic medicines, the prevalence of prescribing of low-, medium- and high-potency anticholinergic medicines, and the clinical indications for which the medicines were prescribed in an older primary care population. METHODS: This was a cross-sectional analysis of a cohort study of Australian early-career general practitioners' (GPs') clinical consultations - the Registrar Clinical Encounters in Training (ReCEnT) study. In ReCEnT, GPs collect detailed data (including medicines prescribed and their clinical indication) for 60 consecutive patients, on up to three occasions 6 months apart. Anticholinergic medicines were categorized as levels 1 (low-potency) to 3 (high-potency) using the Anticholinergic Drug Scale (ADS). RESULTS: During 2010-2014, 879 early-career GPs (across five of Australia's six states) conducted 20 555 consultations with patients aged 65 years or older, representing 35 506 problems/diagnoses. Anticholinergic medicines were prescribed in 10·4% [95% CIs 9·5-10·5] of consultations. Of the total anticholinergic load of prescribed medicines ('community anticholinergic load') 72·7% [95% CIs 71·0-74·3] was contributed by Level 1 medicines, 0·8% [95% CIs 0·5-1·3] by Level 2 medicines and 26·5% [95% CIs 24·8-28·1] by Level 3 medicines. Cardiac (40·0%), Musculoskeletal (16·9%) and Respiratory (10·6%) were the most common indications associated with Level 1 anticholinergic prescription. For Level 2 and 3 medicines (combined data), Psychological (16·1%), Neurological (16·1%), Musculoskeletal (15·7%) and Urological (11·1%) indications were most common. WHAT IS NEW AND CONCLUSION: Anticholinergic medicines are frequently prescribed in Australian general practice, and the majority of the 'community' anticholinergic burden is contributed by 'low'-anticholinergic potency medicines whose anticholinergic effects may be largely 'invisible' to prescribing GPs. Furthermore, the clinical 'phenotype' of the patient with high anticholinergic burden may be very different to common stereotypes (patients with urological, psychological or neurological problems), potentially making recognition of risk of anticholinergic adverse effects additionally problematic for GPs.


Assuntos
Antagonistas Colinérgicos/uso terapêutico , Adulto , Austrália , Antagonistas Colinérgicos/efeitos adversos , Estudos de Coortes , Estudos Transversais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Medicina de Família e Comunidade , Feminino , Clínicos Gerais , Humanos , Masculino , Padrões de Prática Médica , Medicamentos sob Prescrição/efeitos adversos , Medicamentos sob Prescrição/uso terapêutico , Atenção Primária à Saúde , Encaminhamento e Consulta
11.
Br J Cancer ; 111(3): 623-7, 2014 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-24945997

RESUMO

BACKGROUND: Aspirin use has been associated with a reduced cancer incidence and fewer deaths from cancer. This study examined whether women with breast cancer prescribed aspirin postdiagnosis had improved survival. METHODS: An observational, population cohort study was undertaken using data linkage of cancer registry, dispensed prescriptions and death records in Tayside, Scotland. All community prescriptions for aspirin in women with breast cancer were extracted and use postdiagnosis for each individual examined using Cox's proportional hazard models. The main outcome measures were all-cause mortality and breast cancer-specific mortality. RESULTS: Four thousand six hundred and twenty-seven patients diagnosed with breast cancer between 1 January 1998 and 31 December 2008 were followed up until 28 February 2010. Median age at diagnosis was 62 (IQR 52-74). One thousand eight hundred and two (39%) deaths were recorded, with 815 (18%) attributed to breast cancer. One thousand and thirty-five (22%) patients were prescribed aspirin postdiagnosis. Such aspirin use was associated with lower risk of all-cause mortality (HR=0.53, 95% CI=0.45-0.63, P<0.001) and breast cancer-specific mortality (HR=0.42, 95% CI=0.31-0.55, P<0.001) after adjusting for age, socioeconomic status, TNM stage, tumour grade, oestrogen receptor status, surgery, radiotherapy, chemotherapy, adjuvant endocrine therapy and aspirin use prediagnosis. CONCLUSIONS: Aspirin use postdiagnosis of breast cancer may reduce both all-cause and breast cancer-specific mortality. Further investigation seeking a causal relationship and which subgroups of patients benefit most await ongoing randomised controlled trials.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Aspirina/uso terapêutico , Neoplasias da Mama/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/terapia , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Análise de Sobrevida , Resultado do Tratamento
12.
Br J Cancer ; 109(5): 1172-80, 2013 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-23949153

RESUMO

BACKGROUND: Low adherence to adjuvant tamoxifen is associated with worse health outcomes but little is known about the cost-effectiveness of high adherence. METHODS: We conducted an economic evaluation using data for all women with incident breast cancer between 1993 and 2000 who were subsequently prescribed tamoxifen in the Tayside region of Scotland. Patient-level, lifetime Markov models evaluated the impact of high vs low adherence to tamoxifen using linked prescribing, cancer registry, clinical cancer audit, hospital discharge and death records. Direct medical costs were estimated for each patient and quality-of-life weights were assigned. Recurrence information was collected by case note review and adherence calculated from prescribing records with low adherence classed below 80%. RESULTS: A total of 354 (28%) patients had a recorded recurrence and 504 (39%) died. Four hundred and seventy-five (38%) patients had low adherence over the treatment period, which was associated with reduced time to recurrence of 52% (P<0.001). Time to other cause mortality was also reduced by 23% (P=0.055) but this was not statistically significant. For an average patient over her lifetime, low adherence was associated with a loss of 1.43 (95% CI: 1.15-1.71) discounted life years or 1.12 (95% CI: 0.91-1.34) discounted quality-adjusted life years (QALYs) and increased discounted medical costs of £5970 (95% CI: £4644-£7372). Assuming a willingness to pay threshold of £25,000 per QALY, the expected value of changing a patient from low to high adherence is £33,897 (95% CI: £28,322-£39,652). CONCLUSION: Patients with low adherence have shorter time to recurrence, increased medical costs and worse quality of life. Interventions that encourage patients to continue taking their treatment on a daily basis for the recommended 5-year period may be highly cost-effective.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/economia , Adesão à Medicação , Recidiva Local de Neoplasia/economia , Tamoxifeno/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Hormonais/efeitos adversos , Antineoplásicos Hormonais/economia , Neoplasias da Mama/mortalidade , Estudos de Coortes , Análise Custo-Benefício , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Sistema de Registros , Tamoxifeno/efeitos adversos , Tamoxifeno/economia
13.
Aust Vet J ; 91(7): 296-300, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23782024

RESUMO

BACKGROUND: An ulcerative dermopathy caused by Mycobacterium ulcerans is described in two alpacas (Vicugna pacos) domiciled in endemic areas of Victoria, Australia. RESULTS: The diagnosis was confirmed in both cases by PCR targeting the M. ulcerans-specific insertion sequence, IS2404. Extensive wound debridement and bandaging was effective in controlling local disease in one alpaca, although the animal was eventually euthanased because of suspected disease recurrence at other anatomical sites. Treatment was not undertaken in the second animal, but the results of a complete necropsy are described. Investigation of the environs of the second animal yielded low levels of M. ulcerans DNA associated with a variety of samples. The potential use of adjunctive antibiotic therapies directed against M. ulcerans infection in this species is discussed. CONCLUSION: Mycobacterium ulcerans infection should be suspected in alpacas domiciled in endemic areas and presented with ulcerative skin disease.


Assuntos
Úlcera de Buruli/veterinária , Camelídeos Americanos/microbiologia , Mycobacterium ulcerans/isolamento & purificação , Úlcera Cutânea/veterinária , Animais , Úlcera de Buruli/microbiologia , Úlcera de Buruli/terapia , Elementos de DNA Transponíveis/genética , DNA Bacteriano/química , DNA Bacteriano/genética , Evolução Fatal , Feminino , Histocitoquímica/veterinária , Mycobacterium ulcerans/genética , Reação em Cadeia da Polimerase/veterinária , Úlcera Cutânea/microbiologia , Úlcera Cutânea/terapia , Vitória
14.
Avian Pathol ; 42(2): 147-50, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23581441

RESUMO

Poxviral infection was identified in a crimson rosella presented to the Australian Wildlife Health Centre (Victoria) in 2002, and from a second crimson rosella in 2008. Both cases were characterized by proliferative lesions on non-feathered skin. Routine histopathology identified intra-lesional epidermal changes consistent with those caused by poxvirus. Electron microscopy confirmed the presence of poxvirus in inclusions in the first case, and genetic analysis of DNA extracted from both cases found an identical viral genome that differs from all other known poxviruses. We conclude that this infection in crimson rosellas is caused by a previously unrecognized avian poxvirus endemic to this region of Australia, and with low virulence.


Assuntos
Avipoxvirus/patogenicidade , Doenças das Aves/patologia , Doenças das Aves/virologia , Papagaios , Infecções por Poxviridae/veterinária , Animais , Avipoxvirus/genética , Eletroforese/veterinária , Microscopia Eletrônica/veterinária , Reação em Cadeia da Polimerase/veterinária , Infecções por Poxviridae/patologia , Vitória , Proteínas do Core Viral/genética , Virulência
15.
Br J Cancer ; 108(7): 1515-24, 2013 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-23519057

RESUMO

BACKGROUND: Adjuvant endocrine therapy is recommended for women with oestrogen receptor-positive breast cancer, but many women do not take the medication as directed and they stop treatment before completing the standard 5-year duration. METHODS: This retrospective cohort study conducted between 1993 and 2008 of all women with incident breast cancer, who are residing in the Tayside region of Scotland, examined adherence to prescribed adjuvant tamoxifen or aromatase inhibitors (AIs). Survival analysis examined the effect of adherence on all-cause mortality, breast cancer death and recurrence, using linked prescribing, cancer registry, clinical cancer audit, hospital discharge and death records. RESULTS: A total of 3361 women with breast cancer were followed for a median 4.47 years (interquartile range (IQR)=2.04-8.55). The median overall adherence was 90% (IQR=90-100%), but the annual adherence reduced after a longer period from diagnosis. Low adherence of <80% was associated with poorer survival (hazard ratios=1.20; 95% confidence interval=1.03-1.40, P=0.019). There was no significant difference for low adherence over the treatment period and recurrence, or breast cancer death, but patients with high annual adherence for 5 years had better outcomes than those with 3 or less. CONCLUSION: Low adherence to all adjuvant endocrine therapy for women with breast cancer, whether tamoxifen or AI, increases the risk of death.


Assuntos
Antineoplásicos Hormonais/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Inibidores da Aromatase/administração & dosagem , Neoplasias da Mama/mortalidade , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Estudos Retrospectivos , Escócia/epidemiologia , Análise de Sobrevida , Tamoxifeno/administração & dosagem
16.
Phys Rev Lett ; 110(20): 203003, 2013 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-25167403

RESUMO

We investigate forward scattering of ionization from neon, argon, and xenon in ultrahigh intensities of 2 × 10(19) W/cm(2). Comparisons between the gases reveal the energy of the outgoing photoelectron determines its momentum, which can be scattered as far forward as 45° from the laser wave vector k(laser) for energies greater than 1 MeV. The shell structure in the atom manifests itself as modulations in the photoelectron yield and the width of the angular distributions. We arrive at an agreement with theory by using an independent electron model for the atom, a dipole approximation for the bound state interaction, and a relativistic, three-dimensional, classical radiation field including the laser magnetic field. The studies provide the atomic physics within plasmas, radiation, and particle acceleration in ultrastrong fields.

17.
Eur J Cancer ; 49(5): 1049-57, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23182687

RESUMO

OBJECTIVE: Aspirin is associated with a reduced risk of developing colorectal cancer. This study examined whether patients with colorectal cancer prescribed aspirin had improved survival. DESIGN: An observational population cohort study was undertaken using data linkage of cancer registry, dispensed prescriptions and death certificate records in Tayside, Scotland. All community prescribed aspirin pre- and post-diagnosis was extracted and periods of aspirin use post-diagnosis for each individual were analysed using Cox proportional hazard models. Main outcome measures were all-cause and colorectal mortality from death certificates. RESULTS: Two thousand nine hundred ninety patients were identified with colorectal cancer between 1st January 1997 and 30th December 2006 and followed up until 28th February 2010. Median age at diagnosis was 73 (interquartile range [IQR] 65-80) with 52% male. One thousand nine hundred ninety-eight (67%) deaths were recorded with 1021 (34%) attributed to colorectal cancer. One thousand three hundred forty (45%) patients used aspirin at some stage of the study period. Aspirin use post-diagnosis was associated with lower risk of all cause mortality (hazard ratio [HR]=0.67, 95% confidence interval [CI]=0.57-0.79, p<0.001) and colorectal cancer specific mortality after allowing for age, Dukes' stage, gender, socio-economic status and aspirin use pre-diagnosis. Increasing age and stage at diagnosis were associated with increased risk, with more affluent patients at reduced risk. CONCLUSIONS: Our study suggests that aspirin use post-diagnosis of colorectal cancer may reduce both all cause and colorectal cancer specific mortality. However further work is required to ensure this is a causal relationship and to identify whether it is best used in specific groups of patients.


Assuntos
Aspirina/uso terapêutico , Carcinoma/tratamento farmacológico , Carcinoma/mortalidade , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Aspirina/administração & dosagem , Carcinoma/epidemiologia , Causas de Morte , Estudos de Coortes , Neoplasias Colorretais/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/prevenção & controle , Escócia/epidemiologia , Análise de Sobrevida , Sobreviventes/estatística & dados numéricos
18.
Aust Vet J ; 90(7): 269-71, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22731947

RESUMO

The ingestion of scarlet pimpernel (Lysimachia arvensis L.), also known as red chickweed, has been reported as a cause of death of cattle in Uruguay, and as the suspected cause of deaths of sheep in Australia. It has not previously been reported in association with deaths of cattle in Australia. We report the clinical and pathological findings from four cattle in western Victoria that died with a nephrosis suspected to be secondary to intoxication with scarlet pimpernel.


Assuntos
Anagallis/intoxicação , Doenças dos Bovinos/patologia , Nefrose/veterinária , Intoxicação por Plantas/veterinária , Animais , Austrália , Bovinos , Doenças dos Bovinos/etiologia , Surtos de Doenças/veterinária , Nefrose/etiologia , Nefrose/patologia , Intoxicação por Plantas/complicações , Intoxicação por Plantas/patologia , Ovinos , Doenças dos Ovinos/etiologia , Doenças dos Ovinos/patologia , Especificidade da Espécie
19.
Aust Vet J ; 90(4): 151-4, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22443332

RESUMO

Nigropallidal encephalomalacia was diagnosed in two horses in northern Victoria that had a history of long-term pasture access to a dense growth of Rhaponticum repens. The region in which the affected horses lived had received well above average rainfall for several months preceding the poisoning. Affected horses had sudden onset of subcutaneous oedema of the head, impaired prehension and mastication, dullness, lethargy and repeated chewing-like jaw movements. Diagnosis was confirmed at necropsy, with characteristic malacic lesions in the substantia nigra and globus pallidus of the brain. This is the first documented case of nigropallidal encephalomalacia in Australian horses associated with R. repens.


Assuntos
Encefalomalacia/veterinária , Doenças dos Cavalos/diagnóstico , Leuzea , Intoxicação por Plantas/veterinária , Animais , Encefalomalacia/diagnóstico , Evolução Fatal , Globo Pálido/patologia , Cavalos , Imageamento por Ressonância Magnética/veterinária , Masculino , Intoxicação por Plantas/complicações , Substância Negra/patologia , Vitória
20.
Anim Genet ; 42(6): 675-8, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22035013

RESUMO

An autosomal recessive form of cerebellar abiotrophy occurs in Australian Kelpie dogs. Clinical signs range from mild ataxia with intention tremor to severe ataxia with seizures. A whole-genome mapping analysis was performed using Affymetrix Canine SNP array v2 on 11 affected and 19 control dogs, but there was no significant association with disease. A homozygosity analysis identified a three megabase region likely to contain the disease mutation. The region spans 29.8-33 Mb on chromosome 3, for which all affected dogs were homozygous for a common haplotype. Microsatellite markers were developed in the candidate region for linkage analysis that resulted in a logarithm of odds score suggestive of linkage. The candidate region contains 29 genes, none of which are known to cause ataxia.


Assuntos
Doenças Cerebelares/veterinária , Doenças do Cão/genética , Animais , Ataxia Cerebelar/genética , Ataxia Cerebelar/veterinária , Doenças Cerebelares/genética , Mapeamento Cromossômico , Cães , Estudo de Associação Genômica Ampla , Polimorfismo de Nucleotídeo Único
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