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1.
Sci Rep ; 11(1): 13945, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34230563

RESUMO

Acute gastroenteritis associated with diarrhea is considered a serious disease in Africa and South Asia. In this study, we examined the trends in the causative pathogens of diarrhea and the corresponding gut microbiota in Ghana using microbiome analysis performed on diarrheic stools via 16S rRNA sequencing. In total, 80 patients with diarrhea and 34 healthy adults as controls, from 2017 to 2018, were enrolled in the study. Among the patients with diarrhea, 39 were norovirus-positive and 18 were rotavirus-positive. The analysis of species richness (Chao1) was lower in patients with diarrhea than that in controls. Beta-diversity analysis revealed significant differences between the two groups. Several diarrhea-related pathogens (e.g., Escherichia-Shigella, Klebsiella and Campylobacter) were detected in patients with diarrhea. Furthermore, co-infection with these pathogens and enteroviruses (e.g., norovirus and rotavirus) was observed in several cases. Levels of both Erysipelotrichaceae and Staphylococcaceae family markedly differed between norovirus-positive and -negative diarrheic stools, and the 10 predicted metabolic pathways, including the carbohydrate metabolism pathway, showed significant differences between rotavirus-positive patients with diarrhea and controls. This comparative study of diarrheal pathogens in Ghana revealed specific trends in the gut microbiota signature associated with diarrhea and that pathogen-dependent dysbiosis occurred in viral gastroenteritis.


Assuntos
Disbiose/microbiologia , Disbiose/virologia , Gastroenterite/microbiologia , Gastroenterite/virologia , Microbioma Gastrointestinal , Adolescente , Adulto , Bactérias/classificação , Biodiversidade , Estudos de Casos e Controles , Criança , Pré-Escolar , Diarreia/microbiologia , Diarreia/virologia , Fezes/microbiologia , Feminino , Gana , Humanos , Masculino , Filogenia , Rotavirus/fisiologia
2.
Front Cell Infect Microbiol ; 11: 646467, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34084754

RESUMO

HIV-1 infected individuals under antiretroviral therapy can control viremia but often develop non-AIDS diseases such as cardiovascular and metabolic disorders. Gut microbiome dysbiosis has been indicated to be associated with progression of these diseases. Analyses of gut/fecal microbiome in individual regions are important for our understanding of pathogenesis in HIV-1 infections. However, data on gut/fecal microbiome has not yet been accumulated in West Africa. In the present study, we examined fecal microbiome compositions in HIV-1 infected adults in Ghana, where approximately two-thirds of infected adults are females. In a cross-sectional case-control study, age- and gender-matched HIV-1 infected adults (HIV+; n = 55) and seronegative controls (HIV-; n = 55) were enrolled. Alpha diversity of fecal microbiome in HIV+ was significantly reduced compared to HIV- and associated with CD4 counts. HIV+ showed reduction in varieties of bacteria including Faecalibacterium, the most abundant in seronegative controls, but enrichment of Proteobacteria. Ghanaian HIV+ exhibited enrichment of Dorea and Blautia; bacteria groups whose depletion has been reported in HIV-1 infected individuals in several other cohorts. Furthermore, HIV+ in our cohort exhibited a depletion of Prevotella, a genus whose enrichment has recently been shown in men having sex with men (MSM) regardless of HIV-1 status. The present study revealed the characteristics of dysbiotic fecal microbiome in HIV-1 infected adults in Ghana, a representative of West African populations.


Assuntos
Infecções por HIV , HIV-1 , Microbiota , Adulto , Estudos de Casos e Controles , Estudos Transversais , Disbiose , Feminino , Gana , Humanos , Masculino
3.
Jpn J Infect Dis ; 74(1): 42-47, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-32611986

RESUMO

Recent studies have indicated an association between gut microbiome composition and various disorders, including infectious diseases. The composition of the microbiome differs among ethnicities and countries, possibly resulting in diversified interactions between host immunity and the gut microbiome. Characterization of baseline microbiome composition in healthy people is an essential step for better understanding of the biological interactions associated with individual populations. However, data on the gut/fecal microbiome have not been accumulated for individuals in West Africa. In the present study, we examined the fecal microbiome composition in healthy adults in Ghana. Toward this, 16S rRNA gene libraries were prepared using bacterial fractions derived from 55 Ghanaian adults, which were then subjected to next-generation sequencing. The fecal microbiome of the Ghanaian adults was dominated by Firmicutes (Faecalibacterium, Subdoligranulum, and Ruminococcaceae UCG-014), Proteobacteria (Escherichia-Shigella and Klebsiella), and Bacteroidetes (Prevotella 9 and Bacteroides), consistent with previous observations in African cohorts. Further, our analysis revealed differences in microbiome composition and a lower diversity of the fecal microbiome in the Ghanaian cohort compared with those reported in non-African countries. This is the first study to describe substantial fecal microbiome data obtained using high-throughput metagenomic tools on samples derived from a cohort in Ghana. The data may provide a valuable basis for determining the association between the fecal microbiome and progression of various diseases in West African populations.


Assuntos
Fezes/microbiologia , Microbioma Gastrointestinal/genética , Adulto , Bacteroidetes/genética , Estudos Transversais , Feminino , Firmicutes/genética , Gana , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Metagenômica , Microbiota , Pessoa de Meia-Idade , Proteobactérias/genética , RNA Bacteriano/isolamento & purificação , RNA Ribossômico 16S/genética
4.
Jpn J Infect Dis ; 2021 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-34980705

RESUMO

Accurate monitoring of epidemics is a key strategy for the control of human immunodeficiency virus type-1 (HIV-1) infection. To delineate the characteristic of newly-diagnosed cases of HIV-1 infection, we assessed the proportion of recent HIV-1 infections using a recent infection testing algorithm (RITA). In 2015, 248 cases were newly diagnosed with HIV infection in Reginal Hospital Koforidua, Ghana. Of these, 234 cases (94.4%) were infected with HIV-1 only, four (1.6%) were infected with HIV-2 only, and 10 (4.0%) were co-infected with HIV-1 and HIV-2. All the HIV-1 single seropositive samples were applied to HIV-1 LAg avidity assay for RITA. Our analysis revealed that 18 cases (7.7%) were determined as recent infections, indicating that early diagnosis has not been achieved in Ghana. This is the first report assessing the proportion of recent infections in Ghana using a biomarker approach. Accumulation of these data would contribute to accurate estimation of HIV-1 incidence and prevalence in Ghana.

5.
Jpn J Infect Dis ; 72(6): 374-380, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31257246

RESUMO

In human immunodeficiency virus type-1 (HIV-1) infections, cytotoxic T-lymphocyte (CTL) responses targeting human leukocyte antigen (HLA)-restricted viral epitopes exert strong suppressive pressure on viral replication and frequently select for mutations resulting in viral escape from CTL recognition. Numerous data on these HLA-associated mutations in HIV-1 subtypes B and C have been amassed with few reports described in other subtypes. In the present study, we investigated the HLA-associated mutations in HIV-1 subtype CRF02_AG prevailing in Ghana, Western Africa. We determined viral gag sequences in 246 out of 324 HIV-1-infected Ghanaians. Phylogeny analysis revealed that 200 (81.3%) individuals were infected with HIV-1 CRF02_AG. Full gag and vif sequences were obtained from 199 and 138, respectively, out of the 200 individuals infected with CRF02_AG and subjected to determination of HLA-associated mutations. The analysis found HLA-associated HIV-1 CRF02_AG non-synonymous polymorphisms at 19 sites; 13 in gag and six in vif, including those that were newly determined. Generation of this data is an important contribution to our understanding of HIV-1 CRF02_AG and host T cell interaction.


Assuntos
Infecções por HIV/virologia , HIV-1/genética , Antígenos HLA/imunologia , Polimorfismo Genético , Produtos do Gene gag do Vírus da Imunodeficiência Humana/genética , Produtos do Gene vif do Vírus da Imunodeficiência Humana/genética , Adolescente , Adulto , Idoso , Criança , Feminino , Genótipo , Gana/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Filogenia , Adulto Jovem
6.
Medicine (Baltimore) ; 98(6): e14313, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30732150

RESUMO

Antiretroviral therapy (ART) and drug resistance studies worldwide have focused almost exclusively on human immunodeficiency virus type 1 (HIV-1). As a result, there is limited information on ART and drug resistance in HIV-2 patients. In Ghana, the HIV epidemic is characterized by the domination of HIV-1, with cocirculating HIV-2. We, therefore, sought to determine viral load and drug resistance mutations in HIV-2 patients to inform the clinical management of such individuals in Ghana.We used purposive sampling to collect blood from 16 consented patients, confirmed as HIV-2 or HIV-1/2 dual infections by serology. A 2-step real-time RT-PCR assay was used to determine plasma HIV-2 RNA viral loads. For drug resistance testing, nucleic acids were extracted from plasma and peripheral blood mononuclear cells. The reverse transcriptase and protease genes of HIV-2 were amplified, sequenced and analyzed for drug resistance mutations and HIV-2 group.HIV-2 viral load was detected in 9 of 16 patients. Six of these had quantifiable viral loads (range: 2.62-5.45 log IU/mL) while 3 had viral loads below the limit of quantification. Sequences were generated from 7 out of 16 samples. Five of these were classified as HIV-2 group B and 2 as HIV-2 group A. HIV-2 drug resistance mutations (M184V, K65R, Y115F) were identified in 1 patient.This study is the first to report HIV-2 viral load and drug resistance mutations in HIV-2 strains from Ghana. The results indicate the need for continuous monitoring of drug resistance among HIV-2- infected patients to improve their clinical management.


Assuntos
Farmacorresistência Viral/genética , Infecções por HIV/tratamento farmacológico , HIV-1/genética , HIV-2/genética , Mutação/genética , Carga Viral , Adulto , Idoso , Fármacos Anti-HIV/uso terapêutico , Estudos Transversais , Feminino , Gana , Infecções por HIV/complicações , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
Microbes Infect ; 21(2): 113-118, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30385305

RESUMO

Numbers of HLA-associated polymorphisms have been reported on HIV-1 subtypes B and C, but few on other subtypes. Here, we analyzed HLA-associated gag and nef polymorphisms in HIV-1 subtype A/E prevalent in Vietnam. We determined HLA-A, B and C genotypes in 179 HIV-1-infected Vietnamese by next generation sequencing and analyzed proviral genome sequences in 144 of them, showing that 142 of the 144 were subtype A/E. Analysis revealed HLA-associated subtype A/E gag and nef polymorphisms at nineteen residues including those newly determined. Accumulation of these data would contribute to our understanding of HIV-1 subtype A/E and host immune interaction.


Assuntos
HIV-1/genética , Antígenos HLA/genética , Polimorfismo Genético/genética , Produtos do Gene gag do Vírus da Imunodeficiência Humana/genética , Produtos do Gene nef do Vírus da Imunodeficiência Humana/genética , Adulto , Idoso , Estudos de Coortes , Feminino , Frequência do Gene , Genótipo , HIV-1/imunologia , Antígenos HLA-A/genética , Antígenos HLA-B/genética , Antígenos HLA-C/genética , Humanos , Leucócitos/virologia , Masculino , Pessoa de Meia-Idade , Vietnã , Adulto Jovem
8.
Jpn J Clin Oncol ; 48(10): 877-883, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30107588

RESUMO

Background: End-of-life (EOL) cancer care in Japanese acute care hospitals has not been well described. Methods: We aimed to assess the aggressiveness of EOL care and examine common treatments administered to cancer patients using a health administrative database. Subjects are adult cancer patients who died at acute care hospitals between April 2011 and March 2014. Data from the Japanese Diagnosis Procedure Combination database were analysed to measure the aggressiveness of care (chemotherapy, intensive care unit [ICU] admission and cardiopulmonary resuscitation [CPR]) and describe procedures and prescriptions administered in the last 14 and 30 days of life, disaggregated by hospital case volume: high, intermediate and low volumes. Results: Of 248,978 cancer decedents, 170,024 died in high-, 70,231 in intermediate- and 8,723 in low-volume hospitals. Aggressive treatment in the last 14 days of life included chemotherapy (9.4%, 7.3%, and 5.4%, respectively), ICU admission (3.0%, 2.0%, and 2.4%) and CPR (5.8%, 6.4%, and 8.3%). Opioids were administered to 66.0%, 59.0% and 49.4% patients, while Palliative Care Team intervention was performed for 8.5%, 2.2% and 2.0% of patients, respectively in the last 30 days. In high-volume hospitals, radiotherapy and certified outpatient chemotherapy fees were more frequent. Catecholamines and hyperalimentation were more frequently administered in low-volume hospitals. Conclusion: This is the first study to assess EOL care among Japanese acute care hospitals. More frequent use of chemotherapy at high-volume hospitals may reflect a well-established cancer treatment system. The approach for low-volume hospitals might improve the EOL care for all cancer patients in Japan.


Assuntos
Neoplasias/reabilitação , Assistência Terminal/métodos , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Hospitais , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Estudos Retrospectivos , Inquéritos e Questionários
9.
J Epidemiol ; 28(11): 470-475, 2018 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-29760321

RESUMO

BACKGROUND: There has been no nationwide analysis of travel time for hospital admission in Japan. Factors associated with travel time are also unknown. This study aimed to describe the distribution of travel time for hospital admission of cancer patients and identify underlying factors. METHODS: The individual data from the Patient Survey in 2011 were linked to those from the Survey of Medical Institutions in the same year, and GIS data were used to calculate driving travel time between the addresses of medical institutions and the population centers of municipalities where patients lived. Proportions of patients with travel time exceeding versus not exceeding 45 minutes were calculated. To analyze the data with consideration of both individual factors of patients and geographical characteristics of areas where patients lived, multilevel logistic model analysis was performed. RESULTS: The analysis included 50,845 cancer inpatients. The majority of the cancer patients (approximately 80%) were admitted to hospitals located less than a 45-minute drive from their residences. The travel time tended to be longer for younger patients. The proportion of patients with travel time ≥45 minutes was lower among those with stomach or colorectal cancer (approximately 15%) than those with cervical cancer or leukemia (approximately 30%). The lack of designated cancer care hospitals in the secondary healthcare service areas was significantly associated with travel time. CONCLUSIONS: Selection of hospitals by cancer inpatients is affected by age, cancer sites, and availability of designated cancer care hospitals in the secondary healthcare service areas where patients live.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Neoplasias/terapia , Características de Residência/estatística & dados numéricos , Viagem/estatística & dados numéricos , Adulto , Idoso , Conjuntos de Dados como Assunto , Feminino , Sistemas de Informação Geográfica , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Fatores de Tempo
10.
J Med Microbiol ; 66(11): 1663-1672, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29068286

RESUMO

PURPOSE: There have been hardly any reports on the human immunodeficiency virus type 1 (HIV-1) drug-resistance profile from northern Ghana since antiretroviral therapy (ART) was introduced over a decade ago. This study investigated prevailing HIV-1 subtypes and examined the occurrence of drug resistance in ART-experienced patients in Tamale, the capital of the Northern Region of Ghana. METHODOLOGY: A cross-sectional study was carried out on HIV-infected adult patients receiving first-line ART. HIV viral load (VL) and CD4+ T-cell counts were measured. The pol gene sequences were analysed for genotypic resistance by an in-house HIV-1 drug-resistance test; the prevailing HIV-1 subtypes were analysed in detail.Results/Key findings. A total of 33 subjects were studied. Participants comprised 11 males (33.3 %) and 22 (66.7 %) females, with a median age of 34.5 years [interquartile range (IQR) 30.0-40.3]. The median duration on ART was 12 months (IQR 8.0-24). Of the 24 subjects successfully genotyped, 10 (41.7 %) viruses possessed at least one mutation conferring resistance to nucleoside or non-nucleoside reverse-transcriptase inhibitors (NRTIs/NNRTIs). Two-class drug resistance to NRTI and NNRTI was mostly detected (25 %, 6/24). The most frequent mutations were lamivudine-resistance M184V and efavirenz/nevirapine-resistance K103N. HIV-1 subtype CRF02_AG was predominant (79.2 %). Other HIV-1 subtypes detected were G (8.3 %), A3 (4.2 %) and importantly two (8.3 %) unique HIV-1 recombinant forms with CRF02_AG/A3 mosaic. CONCLUSION: HIV-1 shows high genetic diversity and on-going viral genetic recombination in the study region. Nearly 42 % of the patients studied harboured a drug-resistant virus. The study underscores the need for continued surveillance of HIV-1 subtype diversity; and of drug-resistance patterns to guide selection of second-line regimens in northern Ghana.


Assuntos
Fármacos Anti-HIV/farmacologia , Farmacorresistência Viral/genética , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , HIV-1/genética , Adulto , Contagem de Linfócito CD4 , Estudos Transversais , Feminino , Genótipo , Gana/epidemiologia , Humanos , Masculino , Mutação , Filogenia , Prevalência , RNA Viral , Carga Viral
11.
Japan Med Assoc J ; 59(2-3): 110-124, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28299245

RESUMO

Advances in the computerization of information and development of technology have mitigated restrictions on handling of a large amount of information. This has resulted in growth of expectations for the use of large-scale databases, or so-called "big data." This is also the case in the field of healthcare. Projects that involve building of the national receipt database (NDB) of medical fee bill (receipt) information and special health check-up information based on the Act on Assurance of Medical Care for Elderly People and the development of medical information databases have been pursued by the national government, and considerable attention has also been focused on researches conducted through the secondary uses of publicly collected data. Aside from these trends, there are numerous projects which collect diagnosis procedure combination (DPC) data to build large-scale databases for research purposes. Following to the ethics guidelines for epidemiologic studies, they collect and analyze anonymized DPC data from cooperating institutions. This communication concentrates on the use of DPC data, and outlines the scale of data currently available for research use. Examples on the use of DPC data will be shown for analysis on the current status of clinical practice from the microscopic perspective and macroscopic analysis of community medical care provision. Additionally, potential for extending studies to long-term outcomes research, limitations and issues related to the use of medical big data will also be discussed.

12.
Plant Dis ; 100(8): 1686-1691, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30686227

RESUMO

Resistance to the quinone outside inhibitor (QoI) fungicides in the tea gray blight-causing fungus Pestalotiopsis longiseta is a serious problem in Japanese tea cultivation. We conducted a population genetic analysis of QoI-resistant P. longiseta isolates on the Makinohara Plateau, Shizuoka Prefecture, Japan's largest tea-growing area, to elucidate the disease's epidemiology and the spread of QoI resistance. Inter simple sequence repeat (ISSR) analysis of 1,083 isolates from 395 fields collected from 2009 to 2012 detected 42 ISSR types, designated as PL01 to PL42. A total of 18, seven, and 38 ISSR types were detected in highly resistant, moderately resistant, and sensitive isolates, respectively. No distinct phylogenetic relationship corresponding to QoI sensitivity or sampling location was observed. No annual changes in the population genetic structure of highly resistant isolates were observed during the study period. A different ISSR type was predominant among QoI-resistant isolates in each region. Analysis of molecular variance revealed significant genetic differentiation in populations of highly resistant isolates among regions (FCT = 0.213) and farmers (FCT = 0.071). Consequently, we speculate that QoI-resistant P. longiseta strains occurred in a number of clonal lineages and spread by both natural and artificial transmission, such as rain splash and plucking machines, throughout each region on the Makinohara Plateau.

13.
J Am Heart Assoc ; 3(5): e001059, 2014 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-25336463

RESUMO

BACKGROUND: Poor outcomes have been reported for stroke patients admitted outside of regular working hours. However, few studies have adjusted for case severity. In this nationwide assessment, we examined relationships between hospital admission time and disabilities at discharge while considering case severity. METHODS AND RESULTS: We analyzed 35 685 acute stroke patients admitted to 262 hospitals between April 2010 and May 2011 for ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). The proportion of disabilities/death at discharge as measured by the modified Rankin Scale (mRS) was quantified. We constructed 2 hierarchical logistic regression models to estimate the effect of admission time, one adjusted for age, sex, comorbidities, and number of beds; and the second adjusted for the effect of consciousness levels and the above variables at admission. The percentage of severe disabilities/death at discharge increased for patients admitted outside of regular hours (22.8%, 27.2%, and 28.2% for working-hour, off-hour, and nighttime; P<0.001). These tendencies were significant in the bivariate and multivariable models without adjusting for consciousness level. However, the effects of off-hour or nighttime admissions were negated when adjusted for consciousness levels at admission (adjusted OR, 1.00 and 0.99; 95% CI, 1.00 to 1.13 and 0.89 to 1.10; P=0.067 and 0.851 for off-hour and nighttime, respectively, versus working-hour). The same trend was observed when each stroke subtype was stratified. CONCLUSIONS: The well-known off-hour effect might be attributed to the severely ill patient population. Thus, sustained stroke care that is sufficient to treat severely ill patients during off-hours is important.


Assuntos
Plantão Médico , Estado de Consciência/fisiologia , Mortalidade Hospitalar , Admissão do Paciente/estatística & dados numéricos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/terapia , Estudos de Coortes , Intervalos de Confiança , Feminino , Escala de Coma de Glasgow , Humanos , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Alta do Paciente/estatística & dados numéricos , Avaliação de Resultados da Assistência ao Paciente , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/terapia , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/mortalidade , Hemorragia Subaracnóidea/terapia , Análise de Sobrevida
14.
PLoS One ; 9(5): e96819, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24828409

RESUMO

BACKGROUND: The effectiveness of comprehensive stroke center (CSC) capabilities on stroke mortality remains uncertain. We performed a nationwide study to examine whether CSC capabilities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke. METHODS AND RESULTS: Of the 1,369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding CSC capabilities that queried the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2010 and March 31, 2011 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, comorbidities, and the number of fulfilled CSC items in each component and in total. Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Mortality rates were 7.8% for patients with ischemic stroke, 16.8% for patients with intracerebral hemorrhage (ICH), and 28.1% for patients with subarachnoid hemorrhage (SAH). Mortality adjusted for age, sex, and level of consciousness was significantly correlated with personnel, infrastructural, educational, and total CSC scores in patients with ischemic stroke. Mortality was significantly correlated with diagnostic, educational, and total CSC scores in patients with ICH and with specific expertise, infrastructural, educational, and total CSC scores in patients with SAH. CONCLUSIONS: CSC capabilities were associated with reduced in-hospital mortality rates, and relevant aspects of care were found to be dependent on stroke type.


Assuntos
Isquemia Encefálica/mortalidade , Hemorragia Cerebral/mortalidade , Assistência Integral à Saúde/organização & administração , Acidente Vascular Cerebral/mortalidade , Hemorragia Subaracnóidea/mortalidade , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/patologia , Isquemia Encefálica/terapia , Hemorragia Cerebral/patologia , Hemorragia Cerebral/terapia , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Hospitalização , Hospitais , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/terapia , Hemorragia Subaracnóidea/patologia , Hemorragia Subaracnóidea/terapia
15.
J Stroke Cerebrovasc Dis ; 23(5): 1001-18, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24103675

RESUMO

BACKGROUND: The association between comprehensive stroke care capacity and hospital volume of stroke interventions remains uncertain. We performed a nationwide survey in Japan to examine the impact of comprehensive stroke care capacity on the hospital volume of stroke interventions. METHODS: A questionnaire on hospital characteristics, having tissue plasminogen activator (t-PA) protocols, and 25 items regarding personnel, diagnostic, specific expertise, infrastructure, and educational components recommended for comprehensive stroke centers (CSCs) was sent to 1369 professional training institutions. We examined the effect of hospital characteristics, having a t-PA protocol, and the number of fulfilled CSC items (total CSC score) on the hospital volume of t-PA infusion, removal of intracerebral hemorrhage, and coiling and clipping of intracranial aneurysms performed in 2009. RESULTS: Approximately 55% of hospitals responded to the survey. Facilities with t-PA protocols (85%) had a significantly higher likelihood of having 23 CSC items, for example, personnel (eg, neurosurgeons: 97.3% versus 66.1% and neurologists: 51.3% versus 27.7%), diagnostic (eg, digital cerebral angiography: 87.4% versus 43.2%), specific expertise (eg, clipping and coiling: 97.2% and 54% versus 58.9% and 14.3%, respectively), infrastructure (eg, intensive care unit: 63.9% versus 33.9%), and education (eg, professional education: 65.2% versus 20.7%). On multivariate analysis adjusted for hospital characteristics, total CSC score, but not having a t-PA protocol, was associated with the volume of all types of interventions with a clear increasing trend (P for trend < .001). CONCLUSION: We demonstrated a significant association between comprehensive stroke care capacity and the hospital volume of stroke interventions in Japan.


Assuntos
Assistência Integral à Saúde/tendências , Hospitais com Alto Volume de Atendimentos/tendências , Hospitais com Baixo Volume de Atendimentos/tendências , Avaliação de Processos e Resultados em Cuidados de Saúde/tendências , Acidente Vascular Cerebral/terapia , Prestação Integrada de Cuidados de Saúde/tendências , Embolização Terapêutica/tendências , Fibrinolíticos/administração & dosagem , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/tendências , Disparidades em Assistência à Saúde/tendências , Humanos , Japão , Modelos Lineares , Análise Multivariada , Procedimentos Neurocirúrgicos/tendências , Equipe de Assistência ao Paciente/tendências , Acidente Vascular Cerebral/diagnóstico , Inquéritos e Questionários , Terapia Trombolítica/tendências , Ativador de Plasminogênio Tecidual/administração & dosagem , Resultado do Tratamento
16.
J Am Heart Assoc ; 2(5): e000336, 2013 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-24045119

RESUMO

BACKGROUND: Intravenous tissue plasminogen activator (tPA) is an effective treatment for acute ischemic stroke if administered within a few hours of stroke onset. Because of this time restriction, tPA administration remains infrequent. Ambulance use is an effective strategy for increasing tPA administration but may be influenced by geographical factors. The objectives of this study are to investigate the relationship between tPA administration and ambulance use and to examine how patient travel distance and population density affect tPA utilization. METHODS AND RESULTS: We analyzed administrative claims data from 114,194 acute ischemic stroke cases admitted to 603 hospitals between July 2010 and March 2012. Mixed-effects logistic regression models of patients nested within hospitals with a random intercept were generated to analyze possible predictive factors (including patient characteristics, ambulance use, and driving time from home to hospital) of tPA administration for different population density categories to investigate differences in these factors in various regional backgrounds. Approximately 5.1% (5797/114,194) of patients received tPA. The composition of baseline characteristics varied among the population density categories, but adjustment for covariates resulted in all factors having similar associations with tPA administration in every category. The administration of tPA was associated with patient age and severity of stroke symptoms, but driving time showed no association. Ambulance use was significantly associated with tPA administration even after adjustment for covariates. CONCLUSION: The association between ambulance use and tPA administration suggests the importance of calling an ambulance for suspected stroke. Promoting ambulance use for acute ischemic stroke patients may increase tPA use.


Assuntos
Fibrinolíticos/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Ativador de Plasminogênio Tecidual/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ambulâncias/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Tratamento de Emergência , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Densidade Demográfica , Adulto Jovem
17.
Int J Surg Case Rep ; 4(10): 898-900, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23978533

RESUMO

INTRODUCTION: Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease characterized by a low platelet count and normal bone marrow. Patients with ITP undergoing surgery are thought to have increased risk for postoperative complications because of their thrombocytopenia. PRESENTATION OF CASE: we report the case of a 66-year-old woman with ITP who required an emergency operation for acute appendicitis associated with disseminated intravascular coagulation. Preoperative therapy consisted of platelet transfusions only, and intraoperative hemostasis was achieved. Postoperatively, high-dose intravenous immunoglobulin (IVIg) therapy led to an increased, stable, and adequate platelet count and good hemostasis. DISCUSSION: The outcome of this case suggests that IVIg therapy is not always required for preoperative management of patients with. CONCLUSION: IVIg therapy may be useful for postoperative management after emergency surgery.

18.
PLoS One ; 8(8): e71972, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23977189

RESUMO

BACKGROUND: Limited HIV-1 drug-resistance surveillance has been carried out in Ghana since the implementation of antiretroviral therapy (ART). This study sought to provide data on the profile of HIV-1 drug resistance in ART-experienced and newly diagnosed individuals in Ghana. METHODS: Samples were collected from 101 HIV-1-infected patients (32 ART-experienced cases with virological failure and 69 newly diagnosed ART-naïve cases, including 11 children), in Koforidua, Eastern region of Ghana, from February 2009 to January 2010. The pol gene sequences were analyzed by in-house HIV-1 drug-resistance testing. RESULTS: The most prevalent HIV-1 subtype was CRF02_AG (66.3%, 67/101) followed by unique recombinant forms (25.7%, 26/101). Among 31 ART-experienced adults, 22 (71.0%) possessed at least one drug-resistance mutation, and 14 (45.2%) had two-class-resistance to nucleoside and non-nucleoside reverse-transcriptase inhibitors used in their first ART regimen. Importantly, the number of accumulated mutations clearly correlated with the duration of ART. The most prevalent mutation was lamivudine-resistance M184V (n = 12, 38.7%) followed by efavirenz/nevirapine-resistance K103N (n = 9, 29.0%), and zidovudine/stavudine-resistance T215Y/F (n = 6, 19.4%). Within the viral protease, the major nelfinavir-resistance mutation L90M was found in one case. No transmitted HIV-1 drug-resistance mutation was found in 59 ART-naïve adults, but K103N and G190S mutations were observed in one ART-naïve child. CONCLUSIONS: Despite expanding accessibility to ART in Eastern Ghana, the prevalence of transmitted HIV-1 drug resistance presently appears to be low. As ART provision with limited options is scaled up nationwide in Ghana, careful monitoring of transmitted HIV-1 drug resistance is necessary.


Assuntos
Fármacos Anti-HIV/farmacologia , Farmacorresistência Viral , Infecções por HIV/tratamento farmacológico , Protease de HIV/genética , HIV-1/efeitos dos fármacos , Adulto , Alcinos , Fármacos Anti-HIV/uso terapêutico , Benzoxazinas/farmacologia , Benzoxazinas/uso terapêutico , Criança , Pré-Escolar , Ciclopropanos , Monitoramento Epidemiológico , Feminino , Gana/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , HIV-1/genética , Humanos , Lactente , Lamivudina/farmacologia , Lamivudina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Tipagem Molecular , Mutação de Sentido Incorreto , Nevirapina/farmacologia , Nevirapina/uso terapêutico , Prevalência , Análise de Sequência de DNA , Estavudina/farmacologia , Estavudina/uso terapêutico , Zidovudina/farmacologia , Zidovudina/uso terapêutico
19.
Viral Immunol ; 26(2): 133-42, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23509985

RESUMO

Intranasal immunization is currently used to deliver live virus vaccines such as influenza. However, to develop an intranasal vaccine to deliver inactivated virus, a safe and effective adjuvant is necessary to enhance the mucosal immune response. Here, we demonstrate the effectiveness of a chitosan microparticle (1-20 µm, 50 kDa, degree of deacetylation=85%) and a cationized chitosan (1000 kDa, degree of deacetylation=85%) derived from natural crab shells as adjuvants for an intranasal vaccine candidate. We examined the effectiveness of chitosan derivatives as an adjuvant by co-administering them with ovalbumin (OVA) intranasally in BALB/c mice, polymeric Ig receptor knockout (pIgR-KO) mice, and cynomolgus monkeys (Macaca fascicularis). pIgR-KO mice were used to evaluate S-IgA production on the mucosal surface without nasal swab collection. Administration of OVA with chitosan microparticles or cationized chitosan induced a high OVA-specific IgA response in the serum of pIgR-KO mice and a high IgG response in the serum of BALB/c mice and cynomolgus monkeys. We also found that administration of chitosan derivatives did not have a detrimental effect on cynomolgus monkeys as determined by complete blood count, blood chemistries, and gross pathology results. These results suggest that chitosan derivatives are safe and effective mucosal adjuvants for intranasal vaccination.


Assuntos
Adjuvantes Imunológicos/administração & dosagem , Adjuvantes Imunológicos/efeitos adversos , Quitosana/administração & dosagem , Quitosana/efeitos adversos , Administração Intranasal , Animais , Quitosana/química , Feminino , Imunoglobulina A Secretora/análise , Imunoglobulina A Secretora/sangue , Imunoglobulina G/sangue , Macaca fascicularis , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Knockout , Peso Molecular , Ovalbumina/administração & dosagem , Ovalbumina/imunologia , Receptores de Imunoglobulina Polimérica/deficiência
20.
Am J Emerg Med ; 31(1): 206-14, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23000326

RESUMO

PURPOSE: Ringer's lactate is used for patient resuscitation. Lactate naturally occurs in 2 stereoisometric forms, D- and L-lactate, that are added to fluid in equal amounts. Animal studies have demonstrated potentially deleterious effects of d-lactate on vital organs. Using an administrative database, we examined whether D- or L-lactate volume was associated with mortality in patients with trauma. BASIC PROCEDURES: The Trauma and Injury Severity Score could be calculated in 24,616 of 528,219 patients admitted in 2006 to 2009. Demographic characteristics, the use of blood products, mechanical ventilation, and mortality were compared among the following 3 groups of patients administered Ringer's lactate: group 1, fluids other than Ringer's lactate; group 2, fluids including Ringer's DL-lactate; and group 3, no D-lactate. The mean volume (in millimoles per day) of D- and L-lactate administered was calculated. Multivariate analyses were used to measure the impact of lactate volume on mortality, and mechanical ventilation started more than 48 hours after admission. MAIN FINDINGS: Groups 2 and 3 consisted of 2,827 (11.5%) patients (88 hospitals) and 12,036 (48.9%) patients (145 hospitals), respectively. The use of mechanical ventilation best explained the variation in mortality. Greater d-lactate volume, but not fluid management category or L-lactate volume, was associated with mortality. L-Lactate decreased and D-lactate increased the use of mechanical ventilation more than 48 hours after admission. CONCLUSIONS: Because early administration of D-lactate was associated with mortality and ventilation, physicians and policy makers should recognize the advantages of L-lactate and encourage research on the quality of d- and l-lactate in case mixes beyond trauma.


Assuntos
Soluções Isotônicas/química , Soluções Isotônicas/uso terapêutico , Ressuscitação/métodos , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/terapia , Adolescente , Adulto , Idoso , Transfusão de Sangue/estatística & dados numéricos , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Respiração Artificial/estatística & dados numéricos , Lactato de Ringer , Índices de Gravidade do Trauma , Resultado do Tratamento
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