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1.
Pharm Dev Technol ; 26(1): 92-100, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33074769

RESUMO

Isradipine is a dihydropyridine calcium channel blocker (CCB) commonly used as vasodilator with antihypertensive properties. A remote-controlled release formulation for isradipine would substantially improve the clinical outcomes of the patients requiring chronic long-term treatment. In this work, sustained release (SR) tablets of isradipine, composed of hydroxypropylmethyl cellulose (HPMC), have been produced by wet granulation and their in vitro and in vivo characterization was compared to a conventional tablet dosage form of immediate release (IR) as preliminary assessment. Tablets composed of 15.0% (wt/wt) HPMC exhibited a SR profile over a period of 24 hours. The release of isradipine followed a Fickian diffusion pattern obeying to the first order kinetics and the extent of absorption was even higher in comparison to the developed conventional tablets, which showed immediate drug release. In vivo studies were carried out in rabbits, showing that the extent of isradipine absorption from the developed tablets was higher in comparison to IR tablets due to the modified release profile obtained for the former (p < 0.05). Our results suggest that SR tablets of isradipine are an efficient solid dosage form to overcome the limitations encountered in conventional IR tablets.

2.
Artigo em Espanhol | IBECS | ID: ibc-196557

RESUMO

Las emergencias de salud pública, como la que estamos viviendo con la pandemia originada por el coronavirus SARS-CoV-2, han originado trágicas limitaciones de recursos que impiden salvar vidas. Provocan tensiones en la atención sanitaria centrada en el paciente como eje del sistema en condiciones normales, y en la misma atención sanitaria en situaciones de emergencia originadas en la COVID-19. En esta revisión abordamos algunos de los problemas asistenciales, organizativos y éticos que este escenario ha provocado en la atención primaria, como: cancelación de actividades programadas; escasa atención domiciliaria y seguimiento de pacientes ancianos, enfermos crónicos e inmovilizados; desabastecimiento de EPI y exposición al riesgo de los profesionales sanitarios, y finalmente los problemas asociados a la telemedicina y a la atención telefónica a los pacientes


Public health emergencies, such as the current SARS-CoV-2 coronavirus pandemic, have led to tragic resource constraints that prevent lives from being saved. This has led to tensions in patient-centered care as the backbone of the system in normal conditions and the same care in emergencies originating in the COVID-19. In this review we address some of the healthcare, organizational and ethical problems that this scenario has caused in primary care such as: cancellation of programmed activities; scarce home care and follow-up of elderly, chronically ill and immobilized patients; shortage of PPE and the exposure to risk of healthcare professionals, and finally the problems associated with telemedicine and telephone attention to patients


Assuntos
Humanos , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Pandemias/ética , Atenção Primária à Saúde/ética , Atenção Primária à Saúde/métodos , Telemedicina/ética
3.
Semergen ; 2020 Nov 28.
Artigo em Espanhol | MEDLINE | ID: mdl-33358090

RESUMO

Public health emergencies, such as the current SARS-CoV-2 coronavirus pandemic, have led to tragic resource constraints that prevent lives from being saved. This has led to tensions in patient-centered care as the backbone of the system in normal conditions and the same care in emergencies originating in the COVID-19. In this review we address some of the healthcare, organizational and ethical problems that this scenario has caused in primary care such as: cancellation of programmed activities; scarce home care and follow-up of elderly, chronically ill and immobilized patients; shortage of PPE and the exposure to risk of healthcare professionals, and finally the problems associated with telemedicine and telephone attention to patients.

4.
Epidemiol Psychiatr Sci ; 29: e182, 2020 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-33200977

RESUMO

AIMS: Psychosis spectrum disorder has a complex pathoetiology characterised by interacting environmental and genetic vulnerabilities. The present study aims to investigate the role of gene-environment interaction using aggregate scores of genetic (polygenic risk score for schizophrenia (PRS-SCZ)) and environment liability for schizophrenia (exposome score for schizophrenia (ES-SCZ)) across the psychosis continuum. METHODS: The sample consisted of 1699 patients, 1753 unaffected siblings, and 1542 healthy comparison participants. The Structured Interview for Schizotypy-Revised (SIS-R) was administered to analyse scores of total, positive, and negative schizotypy in siblings and healthy comparison participants. The PRS-SCZ was trained using the Psychiatric Genomics Consortiums results and the ES-SCZ was calculated guided by the approach validated in a previous report in the current data set. Regression models were applied to test the independent and joint effects of PRS-SCZ and ES-SCZ (adjusted for age, sex, and ancestry using 10 principal components). RESULTS: Both genetic and environmental vulnerability were associated with case-control status. Furthermore, there was evidence for additive interaction between binary modes of PRS-SCZ and ES-SCZ (above 75% of the control distribution) increasing the odds for schizophrenia spectrum diagnosis (relative excess risk due to interaction = 6.79, [95% confidential interval (CI) 3.32, 10.26], p < 0.001). Sensitivity analyses using continuous PRS-SCZ and ES-SCZ confirmed gene-environment interaction (relative excess risk due to interaction = 1.80 [95% CI 1.01, 3.32], p = 0.004). In siblings and healthy comparison participants, PRS-SCZ and ES-SCZ were associated with all SIS-R dimensions and evidence was found for an interaction between PRS-SCZ and ES-SCZ on the total (B = 0.006 [95% CI 0.003, 0.009], p < 0.001), positive (B = 0.006 [95% CI, 0.002, 0.009], p = 0.002), and negative (B = 0.006, [95% CI 0.004, 0.009], p < 0.001) schizotypy dimensions. CONCLUSIONS: The interplay between exposome load and schizophrenia genetic liability contributing to psychosis across the spectrum of expression provide further empirical support to the notion of aetiological continuity underlying an extended psychosis phenotype.


Assuntos
Herança Multifatorial , Transtornos Psicóticos/genética , Esquizofrenia/genética , Adulto , Feminino , Interação Gene-Ambiente , Predisposição Genética para Doença , Genômica , Humanos , Masculino , Transtornos Psicóticos/psicologia , Psicologia do Esquizofrênico
5.
Rev Esp Quimioter ; 33(6): 436-443, 2020 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-33045817

RESUMO

OBJECTIVE: Infective endocarditis has a high morbidity and mortality and requires a coordinated medical-surgical management. The objective was to analyse the impact of surgery on mortality in a hospital without cardiac surgery. METHODS: Evaluation of a prospective cohort of patients with infective endocarditis diagnosed between August 2011 and January 2016 according to modified Duke's criteria. RESULTS: Sixty-four patients were included, of whom seventeen patients were operated (26.6%). Mortality was 32.8% and it was associated with chronic obstructive pulmonary disease history, staphylococci coagulase-negative and the appearance of complications, as valvular insufficiency and embolisms in the central nervous system; cardiac surgery was not associated with mortality. Four patients (6,6%) were not operated despite indication of cardiac surgery. The main reason for not been intervened was the poor presurgical prognosis (44.7%). CONCLUSIONS: Mortality due to infective endocarditis in a hospital without cardiac surgery is high. The need for interhospital teams is strengthened.

6.
Environ Pollut ; 267: 115367, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32866862

RESUMO

Perfluoroalkyl substances (PFASs) are a class of organohalogenated compounds of environmental concern due to similar characteristics as the well-studied legacy persistent organic pollutants (POPs) that typically show environmental persistence, biomagnification and toxicity. Nevertheless, PFAS are still poorly regulated internationally and in many aspects poorly understood. Here, we studied liver and muscle concentrations in five cetacean species stranded at the southeastern coast of Spain during 2009-2018. Twelve of the fifteen targeted compounds were detected in >50% of the liver samples. Hepatic concentrations were significantly higher than those in muscle reflecting the particular toxicokinetics of these compounds. Bottlenose dolphins Tursiops truncatus showed the highest hepatic ΣPFAS (n = 5; 796.8 ± 709.0 ng g-1 ww) concentrations, followed by striped dolphin Stenella coeruleoalba (n = 29; 259.5 ± 136.2 ng g-1 ww), sperm whale Physeter macrocephalus (n = 1; 252.8 ng g-1 ww), short-beaked common dolphin Delphinus delphis (n = 2; 240.3 ± 218.6 ng g-1 ww) and Risso's dolphin Grampus griseus (n = 1; 78.7 ng g-1 ww). These interspecies differences could be partially explained by habitat preferences, although they could generally not be related to trophic position or food chain proxied by stable N (δ15N) and C (δ13C) isotope values, respectively. PFAS profiles in all species showed a similar pattern of concentration prevalence in the order PFOS>PFOSA>PFNA≈PFFUnA>PFDA. The higher number of samples available for striped dolphin allowed for evaluating their PFAS burden and profile in relation to the stranding year, stable isotope values, and biological variables including sex and length. However, we could only find links between δ15N and PFAS burdens in muscle tissue, and between stranding year and PFAS profile composition. Despite reductions in the manufacturing industry, these compounds still appear in high concentrations compared to more than two decades ago in the Mediterranean Sea and PFOS remains the dominating compound.


Assuntos
Fluorcarbonetos , Stenella , Animais , Cetáceos , Mar Mediterrâneo , Espanha
7.
J Dairy Sci ; 103(11): 10161-10174, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981728

RESUMO

Four multiparous, lactating Holstein cows (average DIM 169.5 ± 20.5 d), fitted with ruminal and duodenal cannulas, were used in a 4 × 4 Latin square with a 2 × 2 factorial arrangement of treatments to investigate the effects of 2-hydroxy-4-methylthio-butanoic acid (HMTBA) when fed with diets differing in metabolizable protein (MP) supply and equal levels of crude protein on milk production and composition, rumen microbial activity, duodenal protein flow, and rumen bacterial community composition in vivo and in vitro. Experimental periods were 28 d in length. Cows were housed in individual tie stalls and were randomly assigned to 4 dietary treatments: low MP or high MP, supplemented with or without 25 g of HMTBA, which was top-dressed once daily at 0930 h. No interactions were observed between HMTBA and level of dietary MP, with the exception of ruminal acetate-to-propionate ratio. Milk yield was not affected by treatment and averaged 23.8 ± 2.06 kg/d. There was a tendency for increased milk protein percent in cows receiving low MP diets, averaging 3.30 ± 0.09% and 3.21 ± 0.09% for low MP and high MP, respectively. The total-tract apparent digestibility of organic matter, neutral detergent fiber, and nitrogen were greater in cows consuming the low MP diet. Rumen pH was lower in cows consuming high MP diets as well as in those consuming HMTBA. Rumen ammonia concentrations tended to be greater in cows consuming HMTBA, and volatile fatty acid concentrations were greater in cows consuming HMTBA. Duodenal dry matter flow, nitrogen flow, and microbial nitrogen flow did not differ between treatments. The bacterial community structure of cows receiving HMTBA was not affected at the phylum level. The relative abundance of bacterial phyla in vivo differed when compared with in vitro conditions for Firmicutes, Bacteroidetes, Proteobacteria, TM7, Tenericutes, Spirochaetes, SR1, and Verrucomicrobia.

8.
Eur J Radiol ; 131: 109236, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32932176

RESUMO

BACKGROUND: The outbreak of COVID-19 has become pandemic. Pediatric population has been less studied than adult population and prompt diagnosis is challenging due to asymptomatic or mild episodes. Radiology is an important complement to clinical and epidemiological features. OBJECTIVE: To establish the most common CXR patterns in children with COVID-19, evaluate interobserver correlation and to discuss the role of imaging techniques in the management of children. MATERIALS AND METHODS: Forty-four patients between 0 and 16 years of age with confirmed SARS-Cov-2 infection and CXR were selected. Two paediatric radiologists independently evaluated the images and assessed the type of abnormality, distribution and evolution when available. RESULTS: Median age was 79.8 months (ranging from 2 weeks to 16 years of age). Fever was the most common symptom (43.5 %). 90 % of CXR showed abnormalities. Peribronchial cuffing was the most common finding (86.3 %) followed by GGOs (50 %). In both cases central distribution was more common than peripheral. Consolidations accounted for 18.1 %. Normal CXR, pleural effusion, and altered cardiomediastinal contour were the least common. CONCLUSION: The vast majority of CXR showed abnormalities in children with COVID-19. However, findings are nonspecific. Interobserver correlation was good in describing consolidations, normal x-rays and GGOs. Imaging techniques have a role in the management of children with known or suspected COVID-19, especially in those with moderate or severe symptoms or with underlying risk factors.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Tórax/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Infecções por Coronavirus/complicações , Feminino , Febre/etiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pandemias , Pneumonia Viral/complicações , Fatores de Risco , Raios X
9.
Med Oral Patol Oral Cir Bucal ; 25(5): e668-e674, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32851984

RESUMO

BACKGROUND: The objective of this study was to describe the bacterial communities associated with pediatric patients with endodontic infections of temporal teeth by targeting the 16S rRNA gene using pyrosequencing. MATERIAL AND METHODS: Microbiological samples were obtained from the lower primary molars of thirteen 13 pediatric patients with dental infections. An aspiration method for microbiological sampling was used. The identification of microbiota employing the pyrosequencing method by targeting the 16S gene was performed. RESULTS: Ribosomal 16S RNA gene sequences were amplified, obtaining a total of 16,182 sequences from 13 primary infected molars (13 different individuals) by pyrosequencing. Bacteroidetes phyla (35.15%) were the most abundant followed by Firmicutes (33.3%) and Fusobacteria (10.05%); the presence of specific pathogenic bacteria was determined as well. CONCLUSIONS: The infected root canal of primary teeth contains a high diversity of anaerobic bacteria, and Bacteroidetes, Firmicutes, and Fusobacteria phyla were the most abundant; Prevotella and Streptococcus genera were the most prevalent.


Assuntos
Bactérias , Bacteroidetes/genética , Criança , Humanos , RNA Ribossômico 16S , Análise de Sequência de DNA , Dente Decíduo
11.
An. sist. sanit. Navar ; 43(2): 225-234, mayo-ago. 2020. tab
Artigo em Inglês | IBECS-Express | IBECS | ID: ibc-ET1-6513

RESUMO

The constant advances in the field of lung cancer immunotherapy have recently reached the treatment of locally advanced disease with the approval of durvalumab after concurrent chemoradiation. However, radiation therapy continues to be key for controlling the disease at this stage. Over the years, different strategies have been employed to try to optimize outcomes using radiotherapy, with cardiac and pulmonary toxicity as the main limitation on its success. The interest in the use of hypofractionation and stereotactic body radiation therapy for stage III non-small cell lung cancer has increased as knowledge regarding these kinds of treatments has been enhanced. Hypofractionation is a relatively frequent treatment, although the level of evidence that supports it is limited. For its part, stereotactic body radiation therapy has been particularly studied as a boost after chemoradiation, with encouraging results. In both cases, study of how to integrate these tools with chemotherapy and particularly with immunotherapy is essential, as they may have an immunomodulatory role


The constant advances in the field of lung cancer immunotherapy have recently reached the treatment of locally advanced disease with the approval of durvalumab after concurrent chemoradiation. However, radiation therapy continues to be key for controlling the disease at this stage. Over the years, different strategies have been employed to try to optimize outcomes using radiotherapy, with cardiac and pulmonary toxicity as the main limitation on its success. The interest in the use of hypofractionation and stereotactic body radiation therapy for stage III non-small cell lung cancer has increased as knowledge regarding these kinds of treatments has been enhanced. Hypofractionation is a relatively frequent treatment, although the level of evidence that supports it is limited. For its part, stereotactic body radiation therapy has been particularly studied as a boost after chemoradiation, with encouraging results. In both cases, study of how to integrate these tools with chemotherapy and particularly with immunotherapy is essential, as they may have an immunomodulatory role

13.
Int J Drug Policy ; 84: 102854, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32717703

RESUMO

Background Previous research found inconsistent associations between alcohol control policies and socioeconomic inequality with adolescent drinking outcomes. This study expands the focus beyond individual associations to examine whether a combination of policies is related to socioeconomic inequality in adolescent drinking outcomes and whether this relationship varies across survey years. Methods Multilevel modelling of 4 waves of repeat cross-sectional survey data (2001/02, 2005/06, 2009/10, and 2013/14) from the Health Behaviour in School-aged Children (HBSC) study was carried out. The sample was composed of 671,084 adolescents (51% girls) aged 11, 13, and 15 (mean age=13.58; SD=1.65) from 33 European and North American countries/regions. The dependent variables were lifetime alcohol consumption, weekly alcohol consumption, and lifetime drunkenness. Independent variables were of three types: individual-level variables (age, sex, Family Affluence Scale, and the Perceived Family Wealth), time-level variable (survey year), and context-level variables (minimum legal drinking age, physical availability, advertising restrictions, a total alcohol policy index, and affordability of alcohol). Results The total alcohol policy index showed a negative relationship with both lifetime and weekly consumption. Higher affordability of alcohol was related to higher lifetime and weekly consumption and higher lifetime drunkenness. Family Affluence Scale was positively related to all three alcohol measures and Perceived Family Wealth was negatively related to lifetime drunkenness, with these associations increasing across survey years. The total alcohol policy index buffered the associations of Family Affluence Scale and Perceived Family Wealth with adolescent drinking outcomes. Conclusion A combination of alcohol control policies is more effective in reducing adolescent drinking outcomes than single policy measures. Reducing the affordability of alcohol stood out as the most successful single measure. Socioeconomic inequalities (i.e. higher alcohol consumption and drunkenness in adolescents with higher family affluence and higher drunkenness in adolescents perceiving their families to be poor) have persisted and even increased across survey years. A combined alcohol control policy can help in tackling them.

14.
Bioresour Technol ; 313: 123518, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32512427

RESUMO

The extraction of three families of compounds (carotenoids, fatty acids and amphidinols) from the biomass of two strains of Amphidinium carterae (ACRN03 and Dn241EHU) was improved by tuning cell disruption and solvent extraction operations. The extraction of carotenoids was evaluated using alkaline saponification (0%-60% KOH d.w.) at different temperatures (25-80 °C). High levels of carotenoids were obtained at 60 °C using freeze-dried biomass, not subjected to cell disruption methods. The ACRN03 strain required 20% KOH whereas the Dn241EHU strain did not require saponification since carotenoid degradation was observed. The extraction efficiencies were determined with a wide range of pure solvents and mixtures thereof. Two empirical non-linear equations were used to correlate extraction percentages for each family of compounds with the Hildebrand solubility parameter (δT) and the polarity index of the solvents (PI). Thresholds of δT and PI of around 20 MPa1/2 and 6, respectively, were determined for the extraction of amphidinols, consistent with antiproliferative activity measurements.


Assuntos
Dinoflagelados , Microalgas , Biomassa , Carotenoides , Ácidos Graxos , Solventes
16.
Appl Microbiol Biotechnol ; 104(14): 6101-6113, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32440707

RESUMO

Microbial physiology is an essential characteristic to be considered in the research and industrial use of microorganisms. Conventionally, the study of microbial physiology has been limited to carrying out qualitative and quantitative analysis of the role of individual components in global cell behaviour at a specific time and under certain growth conditions. In this framework, groups of observable cell physiological variables that remain over time define the physiological states. Recently, with advances in omics techniques, it has been possible to demonstrate that microbial physiology is a dynamic process and that, even with low variations in environmental culture conditions, physiological changes in the cell are provoked. However, the changes cannot be detected at a macroscopic level, and it is not possible to observe these changes in real time. As an alternative to solve this inconvenience, dielectric spectroscopy has been used as a complementary technique to monitor on-line cell physiology variations to avoid long waiting times during measurements. In this review, we discuss the state-of-the-art application of dielectric spectroscopy to unravel the physiological state of microorganisms, its current state, prospects and limitations during fermentation processes. Key points • Summary of the state of the art of several issues of dielectric spectroscopy. • Discussion of correlation among dielectric properties and cell physiological states. • View of the potential use of dielectric spectroscopy in monitoring bioprocesses.

17.
Braz J Microbiol ; 51(3): 1289-1296, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32232745

RESUMO

The interest in lactic acid bacteria, including Lactobacillus plantarum NRRL B-4496, has increased in recent years as bio-preservatives, due to the production of secondary metabolites capable of inhibiting pathogenic bacteria. The objectives of this study were to evaluate the antimicrobial activity, cytotoxicity and the anti-inflammatory response of L. plantarum NRRL B-4496 cell-free supernatant (CFS). Furthermore, the CFS was fractionated by size exclusion chromatography using Sephadex G-25, and a minimal inhibitory volume test was determined against a panel of pathogenic bacteria. The cytotoxicity and the inflammatory activities of the fractions were evaluated using the human-derived THP-1 cell line. Results of this study indicates that CFS of L. plantarum NRRL B-4496 possesses antimicrobial protein compounds against the pathogen Listeria monocytogenes and showed no toxicity nor a pro-inflammatory response to human macrophages. The obtained results contribute to the development of novel bio-preservatives, L. plantarum cell-free supernatant or its fractions, with a potential use in the food industry.

18.
An Sist Sanit Navar ; 43(1): 57-67, 2020 Apr 20.
Artigo em Espanhol | MEDLINE | ID: mdl-32242548

RESUMO

BACKGROUND: Heart failure (HF) is the leading cause of hospitalization for aging populations in Western countries, and is showing an increasing mortality. The aim of this study was to assess the probable long-term mortality risk factors for patients admitted because of HF. METHODS: Retrospective study of a cohort of 202 patients consecutively hospitalized because of HF and followed up for a maximum period of 5 years. Clinical and epidemiological factors and their relationship to in-hospital and long-term mortality were analyzed. RESULTS: In-hospital mortality was 16%.The independent predictors were: age >75 years (HR?=?2.68, 95%?IC: 1.65-4.36, p?=?0.001); cognitive impairment (HR?=?2.77, 95%?IC: 1.40-5.48, p?=?0.004); Barthel index =60 (HR?=?0.54, 95%?IC: 0.37-0.78, p?=?0,009); creatinine levels >1.16 mg/dl at admission (HR?=?1.57, 95%?IC: 1.12-2.20, p?=?0.009); and number of diagnostics >10 on discharge (HR?=?1. 64, 95%?IC: 1.14-2.36, p?=?0.007). Accumulated mortality at 12, 24, 36 and 48 months after hospital discharge were 43%, 51%, 67% and 70%, respectively; the independent predictors for this were: age >75 years (HR?=?2.55, 95%?IC: 1.56-4.15, p?<0.001); cognitive impairment (HR?=?2.45, 95%?IC: 1.22-4.90, p?=?0.011); creatinine levels >1.16 mg/dl on admission (HR?=?1.59, 95%?IC: 1.12-2.24, p?=?0.009); systolic blood pressure >140 mm Hg on admission (HR?=?0.56, 95%?IC: 0.40-0.80, p?<0.001); and number of diagnostics >10 on discharge (HR?=?1. 49, 95%?IC: 1.03-2.16, p?=?0.033). CONCLUSIONS: Clinical and epidemiological factors related to in-hospital and long-term mortality could help to improve the management of patients with HF.

19.
An. sist. sanit. Navar ; 43(1): 57-67, ene.-abr. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193678

RESUMO

FUNDAMENTO: La insuficiencia cardíaca (IC) es la primera causa de hospitalización en países occidentales, con una mortalidad creciente. El objetivo fue describir los posibles factores pronósticos de mortalidad en pacientes hospitalizados por IC. MATERIAL Y MÉTODOS: Estudio retrospectivo de una cohorte de 202 pacientes consecutivos hospitalizados por IC, y seguidos durante un período máximo de 5 años. Se analizaron variables basales epidemiológicas y clínicas y su relación con la mortalidad hospitalaria y a largo plazo. RESULTADOS: La mortalidad durante el episodio índice de hospitalización fue del 16%. Las variables predictoras independientes de la mortalidad hospitalaria fueron: edad >75 años (HR = 2,68; IC 95%: 1,65-4,36; p = 0,001), presencia de deterioro cognitivo (HR = 2,77; IC 95%: 1,40-5,48; p = 0,004), índice de Barthel >60 (HR = 0,54; IC 95%: 0,37-0,78; p = 0,009), creatinina >1,16 mg/dL al ingreso (HR = 1,57; IC 95%: 1,12-2,20; p = 0,009) y >10 diagnósticos al alta (HR = 1,64; IC 95%: 1,14-2,36; p = 0,007). La mortalidad global acumulada a los 12, 24, 36 y 48 meses fue del 43%, 51%, 67% y 70%, respectivamente, y sus predictores independientes fueron: edad >75 años (HR = 2,55; IC 95%: 1,56-4,15; p <0,001), deterioro cognitivo al ingreso (HR = 2,45; IC 95%: 1,22-4,90; p = 0,011), creatinina >1,16 mg/dL al ingreso (HR = 1,59; IC 95%: 1,12-2,24; p = 0,009), presión arterial sistólica <140 mm Hg al ingreso (HR = 0,56; IC 95%: 0,40-0,80; p <0,001) y >10 diagnósticos al alta (HR = 1,49; IC 95%: 1,03-2,16; p = 0,033). CONCLUSIONES: Existen variables relacionadas con la mortalidad hospitalaria y a largo plazo que podrían ayudar a un mejor manejo de estos pacientes


BACKGROUND: Heart failure (HF) is the leading cause of hospitalization for aging populations in Western countries, and is showing an increasing mortality. The aim of this study was to assess the probable long-term mortality risk factors for patients admitted because of HF. METHODS: Retrospective study of a cohort of 202 patients consecutively hospitalized because of HF and followed up for a maximum period of 5 years. Clinical and epidemiological factors and their relationship to in-hospital and long-term mortality were analyzed. RESULTS: In-hospital mortality was 16%.The independent predictors were: age >75 years (HR = 2.68, 95% IC: 1.65-4.36, p = 0.001); cognitive impairment (HR = 2.77, 95% IC: 1.40-5.48, p = 0.004); Barthel index ≥60 (HR = 0.54, 95% IC: 0.37-0.78, p = 0,009); creatinine levels >1.16 mg/dl at admission (HR = 1.57, 95% IC: 1.12-2.20, p = 0.009); and number of diagnostics >10 on discharge (HR = 1. 64, 95% IC: 1.14-2.36, p = 0.007). Accumulated mortality at 12, 24, 36 and 48 months after hospital discharge were 43%, 51%, 67% and 70%, respectively; the independent predictors for this were: age >75 years (HR = 2.55, 95% IC: 1.56-4.15, p <0.001); cognitive impairment (HR = 2.45, 95% IC: 1.22-4.90, p = 0.011); creatinine levels >1.16 mg/dl on admission (HR = 1.59, 95% IC: 1.12-2.24, p = 0.009); systolic blood pressure >140 mm Hg on admission (HR = 0.56, 95% IC: 0.40-0.80, p <0.001); and number of diagnostics >10 on discharge (HR = 1. 49, 95% IC: 1.03-2.16, p = 0.033). CONCLUSIONS: Clinical and epidemiological factors related to in-hospital and long-term mortality could help to improve the management of patients with HF


Assuntos
Humanos , Idoso , Insuficiência Cardíaca/mortalidade , Hospitalização , Prognóstico , Estudos de Coortes , Estudos Retrospectivos , Tempo de Internação , Análise de Sobrevida , Fatores de Risco , Intervalos de Confiança
20.
An Sist Sanit Navar ; 43(2): 225-234, 2020 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-32141442

RESUMO

The constant advances in the field of lung cancer immunotherapy have recently reached the treatment of locally advanced disease with the approval of durvalumab after concurrent chemoradiation. However, radiation therapy continues to be key for controlling the disease at this stage. Over the years, different strategies have been employed to try to optimize outcomes using radiotherapy, with cardiac and pulmonary toxicity as the main limitation on its success. The interest in the use of hypofractionation and stereotactic body radiation therapy for stage III non-small cell lung cancer has increased as knowledge regarding these kinds of treatments has been enhanced. Hypofractionation is a relatively frequent treatment, although the level of evidence that supports it is limited. For its part, stereotactic body radiation therapy has been particularly studied as a boost after chemoradiation, with encouraging results. In both cases, study of how to integrate these tools with chemotherapy and particularly with immunotherapy is essential, as they may have an immunomodulatory role.

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