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1.
Hosp Pediatr ; 10(2): 138-146, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31980442

RESUMO

OBJECTIVES: Suicide is the second leading cause of death in the adolescent population, presenting a public health crisis. The goal of this study was to evaluate adolescent intentional ingestions in a community hospital and to identify variables associated with the risk of admission to inpatient medical and psychiatric settings. METHODS: This study was a retrospective chart review from a hospital system in the Pacific Northwest over 2 years for patients aged 9 to 18 years. Variables examined include age, sex, type of ingestion, emergency department length of stay (LOS), admission to the inpatient setting, LOS of inpatient admission, admission to psychiatry, presence of a therapist, and insurance type. RESULTS: During the study period, 233 individual intentional ingestions occurred. The most commonly ingested substances were psychiatric medications (30.9%), prescription medications (28.3%), and ibuprofen (24.0%). One-third of patients (33.9%) required admission to a medical hospital, whereas one-quarter (24.9%) required admission to a psychiatric hospital. The following variables were associated with risk of admission to a medical hospital: female sex, shorter emergency department LOS, and ingestion of psychiatric medications, prescription medication, and/or salicylates. Risk of admission to a psychiatric hospital was associated with an inpatient medical admission, an increased duration of medical admission, and an ingestion of a psychiatric medication. CONCLUSIONS: In this study, we describe important epidemiology on adolescent intentional ingestions in a community setting, providing variables associated with a risk of admission to medical and psychiatric hospitals.

2.
ANZ J Surg ; 88(1-2): E16-E20, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27621179

RESUMO

BACKGROUND: Clinical risk scores (CRS) within the context of neoadjuvant chemotherapy for colorectal liver metastases (CRLM) has not been validated. The predictive value of clinical risk scoring in patients administered neoadjuvant chemotherapy prior to liver surgery for CRLM is evaluated. METHODS: A prospective database over a 15-year period (April 1999 to March 2014) was analysed. We identified two groups: A, neoadjuvant chemotherapy prior to CRLM surgery; and B, no neoadjuvant chemotherapy. RESULTS: Overall median survival in groups A and B were 36 (2-137) months and 33 (2-137) months. In group A, nodal status, size, number of metastases and carcinoembryonic antigen levels were not found to be independent predictors of overall survival (OS). However, patients with a shorter disease-free interval of less than 12 months had an increased OS (P = 0.0001). Multivariate analysis of high- and low-risk scores compared against survival in group B (P < 0.05) confirms the applicability of the scoring system in traditional settings. CONCLUSION: Traditional CRS are not a prognostic predictive tool when applied to patients receiving neoadjuvant chemotherapy for CRLM. Disease-free interval may be one independent variable for use in future risk score systems specifically developed for the neoadjuvant chemotherapy era.


Assuntos
Neoplasias Colorretais/patologia , Hepatectomia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Terapia Neoadjuvante , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Estudos de Coortes , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/terapia , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Taxa de Sobrevida , Resultado do Tratamento
3.
Langenbecks Arch Surg ; 402(5): 811-819, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28434059

RESUMO

PURPOSE: The aim of this study was to compare the prognostic value of established scoring systems with early warning scores in a large cohort of patients with acute pancreatitis. METHODS: In patients presenting with acute pancreatitis, age, sex, American Society of Anaesthesiologists (ASA) grade, Modified Glasgow Score, Ranson criteria, APACHE II scores and early warning score (EWS) were recorded for the first 72 h following admission. These variables were compared between survivors and non-survivors, between patients with mild/moderate and severe pancreatitis (based on the 2012 Atlanta Classification) and between patients with a favourable or adverse outcome. RESULTS: A total of 629 patients were identified. EWS was the best predictor of adverse outcome amongst all of the assessed variables (area under curve (AUC) values 0.81, 0.84 and 0.83 for days 1, 2 and 3, respectively) and was the most accurate predictor of mortality on both days 2 and 3 (AUC values of 0.88 and 0.89, respectively). Multivariable analysis revealed that an EWS ≥2 was independently associated with severity of pancreatitis, adverse outcome and mortality. CONCLUSION: This study confirms the usefulness of EWS in predicting the outcome of acute pancreatitis. It should become the mainstay of risk stratification in patients with acute pancreatitis.


Assuntos
Pancreatite/mortalidade , Pancreatite/cirurgia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
4.
Med Oncol ; 32(5): 144, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25807934

RESUMO

A range of prognostic cellular indices of the systemic inflammatory response, namely the neutrophil-lymphocyte ratio (NLR), derived NLR (dNLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), combination of platelet count and neutrophil-lymphocyte ratio (COP-NLR) and prognostic nutritional index (PNI), have been developed and found to have prognostic utility across varied malignancies. The current study is the first to examine the prognostic value of these six inflammatory scores in patients with resectable colorectal liver metastases (CRLM). Data from 302 consecutive patients undergoing surgery for resectable CRLM were evaluated. The prognostic influence of clinicopathological variables and the inflammatory scores NLR, dNLR, PLR, LMR, COP-NLR and PNI upon overall survival (OS) and cancer-specific survival (CSS) were determined by log-rank analysis and univariate and multivariate Cox regression analyses. High preoperative NLR was the only inflammatory variable independently associated with shortened OS (HR 1.769, 95 % CI 1.302-2.403, P < 0.001) or CSS (HR 1.927, 95 % CI 1.398-2.655, P < 0.001) following metastasectomy. When NLR was replaced by dNLR in analyses, high dNLR was independently associated with shortened OS (HR 1.932, 95 % CI 1.356-2.754, P < 0.001) and CSS (HR 1.807, 95 % CI 1.209-2.702, P = 0.004). The inflammatory scores PLR, LMR, COP-NLR and PNI demonstrated no independent association with either overall or cancer-specific survival in the study population. Our findings support high preoperative NLR and dNLR as independent prognostic factors for poor outcome in patients undergoing CRLM resection, with prognostic value superior to other cellular-based systemic inflammatory scores.


Assuntos
Neoplasias Colorretais/patologia , Inflamação/patologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Plaquetas/patologia , Feminino , Humanos , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Monócitos/patologia , Neutrófilos/patologia , Avaliação Nutricional , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos
5.
Br J Sports Med ; 41(6): 385-91, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17272311

RESUMO

OBJECTIVE: To determine whether moderate water loss (approximately 1.5-2% of body mass (BM)) represents a significant impairment to soccer match-play and the related fitness variables. METHODS: 11 moderately active male soccer players (mean (SD) age 24.4 (3) years, BM 74.03 (10.5) kg, peak oxygen consumption 50.91 (4.0) ml/kg/min) volunteered to participate. The experimental procedure comprised: (1) a 45 min pre-match period of cycle ergometry exercise (90% of individual ventilatory threshold); (2) the completion of a 45 min soccer match; and (3) the immediate post-match performance of sport-specific and mental concentration tests. The subjects completed the procedure on three occasions each in a different experimental condition (fluid intake (FL), no fluid (NF) and mouth rinse (MR)) in an individually randomised order. Core temperature (Tc), heart rates, plasma and urine osmolalities, BM, sweat rates and heat storage were all measured. RESULTS: The only condition-dependent difference during the match-play element of the protocol was a significantly increased Tc in the NF condition compared with the FL condition (39.28 degrees C (0.35 degrees C) and 38.8 degrees C (0.47 degrees C), respectively; p<0.05). The immediate post-match performance of a sport-specific fitness test was significantly impaired where FL had been denied (p<0.01). The post-test evaluation of rating of perceived exertion and thirst indicated that the NF condition was perceived to be the most challenging (p<0.05). CONCLUSIONS: The condition-dependent differences in match-play and post-match tests demonstrate that moderate dehydration is detrimental to soccer performance. However, it remains unclear whether this could be attributable to water loss in itself or the negative psychological associations derived from a greater perception of effort in that condition.


Assuntos
Atenção/fisiologia , Exercício/fisiologia , Futebol/fisiologia , Perda Insensível de Água/fisiologia , Adulto , Temperatura Corporal , Peso Corporal/fisiologia , Estudos Cross-Over , Ingestão de Líquidos , Frequência Cardíaca , Humanos , Masculino , Concentração Osmolar , Plasma/química , Análise e Desempenho de Tarefas , Fatores de Tempo , Urina/química
6.
Am J Hum Biol ; 15(3): 428-32, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12704718

RESUMO

The waist-to-hip ratio (WHR) reflects the relative distribution of adipose tissue in the human body. However, whether this is due to the musculoskeletal structures of the waist and hip or the overlying subcutaneous adipose tissue has been disputed. We measured waist and hip girths in 11 male and 11 female cadavers, aged 55-94 years, before and after complete removal of skin and subcutaneous adipose tissue. Girths measured following removal of subcutaneous adipose tissue were termed "waist gx" and "hip gx", and their ratio "WHRx". Masses of regional adipose tissue segments were obtained by complete dissection, and the adipose mass ratios "trunk/arm-plus-leg", "trunk/leg", "internal/arm-plus-leg", and "internal/leg" were derived. As assessed by analysis of variance, WHR accounted for significant (P < 0.05) portions of the variance in all adipose mass ratios; adjustment for internal adipose mass increased the significance of all these relationships (P < 0.005). The ratio WHRx was not related to any ratio of regional adipose masses. Waist girth was related to trunk (P < 0.001) and internal (P < 0.05) adipose masses, and hip girth was related to arm-plus-leg adipose mass (P < 0.0001) and leg adipose mass (P < 0.0001), but waist gx and hip gx were not related to dependent variables. The results indicate that the ability of WHR and waist and hip girths to reflect the regional distribution of adipose tissue in the body is dependent upon the subcutaneous adipose tissue mass of the waist hip area, not its musculoskeletal constituency.


Assuntos
Tecido Adiposo , Antropometria , Composição Corporal , Cadáver , Dissecação , Feminino , Humanos , Masculino , Valores de Referência
7.
Am J Hum Biol ; 11(2): 167-174, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-11533940

RESUMO

Although body composition analysis is popular, dissection data are sparse and sometimes difficult to access. Published data that include the weights of skin, adipose tissue, muscle, and bone, along with body weight, are reviewed. The 31 men and 20 women include 34 cadavers from three separate dissection studies in Brussels, 12 from 19th century reports, and 5 from the United States. The age range was 16-94y. Men differed from women in that they had less adipose tissue and more muscle in both absolute and relative terms. The body mass index (BMI) did not differ between the sexes, because lower weights of muscle and bone compensated for the greater adiposity in women. The relationship between the BMI and relative adiposity was significant, but the BMI explained only about one-third of the variance in adiposity, indicating that in this sample it is a poor predictor of fatness. The composition of the fat-free weight (FFW) and adipose tissue free weight (ATFW), though less variable than body weight, showed enough variability that the assumption of constancy of the fat-free body required for densitometry and other indirect methods of fat estimation, could not be supported. In the few dissections that did fat extraction, essential on non-adipose fat, varied from 4-14% of the FFW, thus undermining the concept of lean body weight. More dissection data are needed, especially in children and adolescents, and especially in conjunction with in vivo body composition methods to help in their validation. Am. J. Hum. Biol. 11:167-174, 1999. Copyright 1999 Wiley-Liss, Inc.

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