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1.
BMC Public Health ; 20(1): 1409, 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938411

RESUMO

BACKGROUND: Tuberculosis (TB) patients in Uganda incur large costs related to the illness, and while seeking and receiving health care. Such costs create access and adherence barriers which affect health outcomes and increase transmission of disease. The study ascertained the proportion of Ugandan TB affected households incurring catastrophic costs and the main cost drivers. METHODS: A cross-sectional survey with retrospective data collection and projections was conducted in 2017. A total of 1178 drug resistant (DR) TB (44) and drug sensitive (DS) TB patients (1134), 2 weeks into intensive or continuation phase of treatment were consecutively enrolled across 67 randomly selected TB treatment facilities. RESULTS: Of the 1178 respondents, 62.7% were male, 44.7% were aged 15-34 years and 55.5% were HIV positive. For each TB episode, patients on average incurred costs of USD 396 for a DS-TB episode and USD 3722 for a Multi drug resistant tuberculosis (MDR TB) episode. Up to 48.5% of households borrowed, used savings or sold assets to defray these costs. More than half (53.1%) of TB affected households experienced TB-related costs above 20% of their annual household expenditure, with the main cost drivers being non-medical expenditure such as travel, nutritional supplements and food. CONCLUSION: Despite free health care in public health facilities, over half of Ugandan TB affected households experience catastrophic costs. Roll out of social protection interventions like TB assistance programs, insurance schemes, and enforcement of legislation related to social protection through multi-sectoral action plans with central NTP involvement would palliate these costs.

3.
Int J Surg Case Rep ; 4(12): 1088-90, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24240074

RESUMO

INTRODUCTION: Giant anal condyloma also called Buschke-Löwenstein tumor is a rare sexually transmitted disease involving anogenital region with potential malignant degeneration into invasive squamous carcinoma. Complete surgical excision is the treatment of choice and often wide wounds are necessary to reach clear margins and prevent recurrence. PRESENTATION OF CASE: The authors present two cases treated with an S-plasty rotating and a bilateral house advancement flap respectively with good functional result. DISCUSSION: Giant anal condyloma also called Buschke-Löwenstein tumor is a large exophytic, cauliflower-like mass that is characterized by local aggressive behavior. Immunosuppression favors rapid growth of the condylomas and increases the risk of their malignant transformation. In limited lesions primary excision can be safely performed leaving wounds open to granulate while in more extensive lesions flap or skin graft coverage is preferable to decrease the length of recovery and minimize risk of severe anal stricture. Abdominoperineal resection should be performed for more extensive lesions with deep invasion, malignant transformation or tumor recurrence. CONCLUSION: Giant anal condyloma also called Buschke-Löwenstein is a rare pathology with mainly sporadic single center experience reported in literature. Surgical complete excision remains the best treatment although elevate should be eventual recurrence. No sufficient data are available to recommend any medical treatment such as interferon, radiotherapy or chemotherapy.

4.
Interact Cardiovasc Thorac Surg ; 15(1): 57-62, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22493100

RESUMO

Early graft failure (EGF) is a dreaded complication after heart transplantation (HT). Despite several improvements, no effective therapy has been developed and the prognosis is poor. We evaluated the risk factors and clinical impact of EGF. In a consecutive series of 317 HTs performed at a single institution between January 1999 and December 2008, variables associated significantly with EGF were sought in bivariate and multivariable discriminant analyses. The deriving propensity score was used to stratify the study sample in to three groups (low, intermediate and high risk for EGF). Comparisons were performed between the higher-risk group and the remaining population in terms of preoperative features and outcomes. EGF occurred in 10.1% of the overall population (2.9, 3.8 and 23.6%, respectively, in the three groups). Overall, EGF-related mortality was 56.3% (100, 75 and 48%, respectively, in the three groups). Determinants of EGF in the highest-risk group were: redo procedure, valvular cardiomyopathy, status one at transplant, recipient male sex, donor-recipient (D/R) weight mismatch, high inotropic donor support, ischaemic time and first day troponin I release. In conclusion, several donor and recipient features predicted EGF. Since such characteristics are not readily modifiable but synergistically determine the occurrence of EGF, optimization of D/R matching is crucial to prevent it.


Assuntos
Seleção do Doador , Transplante de Coração/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Distribuição de Qui-Quadrado , Análise Discriminante , Feminino , Transplante de Coração/mortalidade , Mortalidade Hospitalar , Humanos , Incidência , Itália , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Complicações Pós-Operatórias/mortalidade , Pontuação de Propensão , Medição de Risco , Fatores de Risco , Fatores de Tempo , Falha de Tratamento
5.
Heart Surg Forum ; 14(4): E242-4, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21859643

RESUMO

BACKGROUND: Papillary fibroelastomas (PFEs) are rare cardiac tumors usually treated by shave resection. Up to 20% of the patients are actually denied such a conservative surgical approach because atypical morphology is thought to preclude radical and effective outcomes. METHODS/RESULTS: Surgical tricks and tips of shave resection are elucidated, and a case series presentation of the morphology of atypical PFEs treated by shave resection is described. CONCLUSION: In experienced hands surgical shave resection is the gold standard for the treatment of PFE even in atypical presentations.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Fibroma/cirurgia , Neoplasias Cardíacas/cirurgia , Músculos Papilares/cirurgia , Idoso , Ecocardiografia Transesofagiana , Feminino , Fibroma/diagnóstico por imagem , Seguimentos , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Papilares/diagnóstico por imagem
6.
Am J Respir Crit Care Med ; 181(1): 80-6, 2010 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-19833824

RESUMO

RATIONALE: The multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) epidemics are rapidly expanding in South Africa. Our initial report of HIV-associated XDR TB in South Africa revealed rapid and near complete mortality. Lower mortality has been described in the literature, but few of these patients have been HIV coinfected. OBJECTIVES: To characterize mortality from MDR and XDR TB in a setting with high HIV-coinfection rates. METHODS: We conducted a retrospective observational study among 654 MDR and XDR TB cases diagnosed in Tugela Ferry, South Africa, from 2005 to 2007. Demographics and HIV status were abstracted from available medical records. MEASUREMENTS AND MAIN RESULTS: Survival was determined from the date of sputum collection until October 2008 and correlated with year of diagnosis and drug-susceptibility test results. From 2005 to 2007, 272 MDR TB and 382 XDR TB cases were diagnosed; HIV-coinfection rates were 90 and 98%, respectively. One-year mortality was 71% for MDR and 83% for XDR TB patients; 40% of MDR TB and 51% of XDR TB cases died within 30 days of sputum collection. One-year mortality among both MDR and XDR TB patients improved from 2005 to 2007; however, the majority of deaths still occurred within the first 30 days. One-year and 30-day mortality rates were worse with greater degree of drug resistance (P < 0.001). CONCLUSIONS: Mortality from MDR and XDR TB in this high HIV-prevalence region is extraordinarily high, particularly within the first 30 days. Efforts to reduce mortality must focus on earlier diagnosis and early initiation of second-line TB and antiretroviral therapy.


Assuntos
Tuberculose Extensivamente Resistente a Medicamentos/complicações , Infecções por HIV/complicações , Adulto , Tuberculose Extensivamente Resistente a Medicamentos/mortalidade , Feminino , Infecções por HIV/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , África do Sul/epidemiologia
7.
Clin Transplant ; 23(1): 101-7, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19200222

RESUMO

BACKGROUND: Obesity, dyslipidemia, hypertension, and diabetes mellitus are common features after heart transplantation and they lead to coronary artery disease and graft loss. AIM: To determine the effects of a dietary intervention on nutritional status and metabolic outcome of two groups enrolled during or after the first year from the transplant. METHODS: Forty two subjects (mean age 51.36+/-12.4 yr) were studied; 20 were enrolled during the first year by the transplant, 22 were enrolled after the first year from the transplant (7.9+/-3.86 and 56.86+/-38.6 months after surgery, respectively). According to diet compliance both groups were divided into two subgroups and they were prospectively followed for 4 years. Anthropometric measurements, biochemical nutritional markers, and dietary records were collected at baseline (T0) and after a 12-month follow-up period (T12) and a 48-month follow-up period (T48). Body composition was performed at T0 and T12. RESULTS: Diet compliance was associated with a decrease in total cholesterol, triglycerides and glucose plasma level and with a weight loss mainly due to a decrease in fat mass. CONCLUSION: Our study shows the efficacy of dietary intervention to obtain an early and late weight and metabolic control after heart transplant.


Assuntos
Dieta , Transplante de Coração , Doenças Metabólicas/dietoterapia , Avaliação Nutricional , Índice de Massa Corporal , Colesterol/sangue , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Estudos Prospectivos , Triglicerídeos/sangue , Perda de Peso
8.
Heart Vessels ; 21(2): 89-94, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16550309

RESUMO

Celsior solution has already proved effective in heart graft preservation because it reduces myocardial edema, prevents free radical damage, and limits calcium overload. The aim of this study was to evaluate the effectiveness of Celsior solution as myocardial protection in high-risk transplantation. Hospital charts and follow-up data of 200 consecutive heart recipients (162 males, 38 females, mean age 47.4 +/- 12.6 years) were reviewed. Patients were divided into two groups: group A (73 patients) included recipients of high-risk grafts (at least two of the following: age >45; female sex; high preretrieval inotropic support, viz. dobutamine or dopamine >10 microg/kg per minute and/or infusion of norepinephrine regardless of its dosage; size mismatch >20%; ischemia time >180 min) and group B (127 patients) included recipients of standard grafts. Quality of preservation was assessed through enzyme release, echocardiographic evaluation, the need for inotropic support or pacemaker, and histology of biopsy samples. Hospital and 1-year mortality were also evaluated. Comparisons between the two groups were made through univariate analysis. Study groups proved homogeneous as to recipient age, pretransplant cardiomyopathy, status at transplantation, mean panel reactive antibodies, and redo cardiac surgery. Hospital mortality was 8% (11% vs 6.3%, P = 0.18) while 1-year mortality reached 12% (15.1% vs 10.2%, P = 0.6) without significant difference between groups. Graft performance as described by the need for inotropic support and/or pacemaker as well as echocardiography (left and right ventricular ejection fraction) proved comparable. There were no significant differences as to histology findings and patterns of enzyme release. Celsior provides optimal myocardial preservation in both standard and high-risk procedures. Such advances help to enhance donor pool expansion.


Assuntos
Transplante de Coração , Soluções para Preservação de Órgãos , Adolescente , Adulto , Idoso , Criança , Dissacarídeos , Eletrólitos , Feminino , Glutamatos , Glutationa , Histidina , Humanos , Masculino , Manitol , Pessoa de Meia-Idade , Controle de Qualidade , Estatísticas não Paramétricas , Resultado do Tratamento
9.
J Am Coll Cardiol ; 46(5): 827-34, 2005 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-16139132

RESUMO

OBJECTIVES: The aim of the present study was to evaluate the expression and the activity of vascular endothelial growth factor (VEGF) in the hearts of diabetic patients with chronic coronary heart disease (CHD). BACKGROUND: Diabetes is characterized by a decreased collateral vessel formation in response to coronary ischemic events, although the role of VEGF in human diabetic macroangiopathy has not been fully investigated. METHODS: Biopsies of left ventricular (LV) myocardium were obtained from 10 patients with type 2 diabetes and 10 non-diabetic patients with chronic CHD, all undergoing surgical coronary revascularization. Right ventricle myocardial samples taken from normal hearts were used as control specimens. Vascular endothelial growth factor and VEGF-receptors (flt-1 and flk-1) were evaluated by Western blot, reverse transcriptase-polymerase chain reaction (RT-PCR) and real-time RT-PCR. Akt and endothelial nitric oxide synthase (eNOS) protein expression and their phosphorylated forms were also evaluated by Western blot. RESULTS: Vascular endothelial growth factor, flt-1, and flk-1 messenger ribonucleic acid (mRNA) and protein expressions were increased in non-diabetic patients with CHD compared with control subjects. Remarkably, in diabetic patients, VEGF mRNA and protein levels were significantly higher, whereas flt-1, flk-1 mRNA, and protein were lower when compared with non-diabetic patients. Interestingly, phospho-flk-1 was reduced in diabetic patients compared with non-diabetic patients. As a consequence, Akt phosphorylation, eNOS protein and its phosphorylated form were significantly higher in the samples from non-diabetic patients compared with diabetic patients. CONCLUSIONS: Chronic CHD in diabetic patients is characterized by an increased VEGF myocardial expression and a decreased expression of its receptors along with a down-regulation of its signal transduction. The latter could be partially responsible for the reduced neoangiogenesis in diabetic patients with ischemic cardiomyopathy.


Assuntos
Doença da Artéria Coronariana/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Miocárdio , Receptores de Fatores de Crescimento do Endotélio Vascular/fisiologia , Fatores de Crescimento do Endotélio Vascular/biossíntese , Idoso , Estudos de Casos e Controles , Doença Crônica , Doença da Artéria Coronariana/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Angiopatias Diabéticas , Endotélio Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Transdução de Sinais , Fatores de Crescimento do Endotélio Vascular/fisiologia
10.
Ital Heart J ; 3(7): 419-23, 2002 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12189971

RESUMO

BACKGROUND: According to the data of the Registry of the International Society for Heart and Lung Transplantation, donor and recipient female gender is a significant risk factor for mortality after heart transplantation. It has also been reported that donor-recipient gender mismatch is a determinant of post-transplant morbidity and mortality. To examine the effect of gender on the early and mid-term outcomes, we retrospectively reviewed data of a consecutive group of heart transplant recipients at our Institution. METHODS: The study population comprised 99 patients undergoing heart transplantation between 1996 and 1998. This population was divided into four groups on the basis of donor and recipient matching. Group A consisted of 61 men who received male donor hearts, group B of 12 women who received female donor hearts, group C of 9 women who received male donor hearts, and group D of 17 men who received female donor hearts. Standard heart transplantation protocols were applied to all patient groups [graft preservation with Celsior solution, Shumway surgical technique, donor-recipient size matching > or = 1.0, induction therapy with polyclonal antithymocyte globulins, triple immunosuppressive therapy (neoral, azathioprine, steroids)]. RESULTS: The study groups were found to be homogeneous with regard to the major preoperative risk factors (etiology, status at transplantation, donor and recipient age, total ischemic time). Donor gender, recipient gender and donor-recipient gender mismatching did not significantly modify the short and mid-term survivals, functional recovery and freedom from rejection. CONCLUSIONS: Even though previous reports suggest that gender negatively affects survival, this factor proved to have no influence on the outcomes of the present series. These results can be explained by a correct donor-recipient size matching. The well-documented female recipients tendency to more frequent and fatal rejection was not confirmed in our experience. The patient's age at transplantation, the routine use of induction therapy and an aggressive immunosuppressive regimen may be the substrate of these findings.


Assuntos
Transplante de Coração/efeitos adversos , Transplante de Coração/métodos , Adulto , Feminino , Rejeição de Enxerto/epidemiologia , Transplante de Coração/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Fatores Sexuais , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
11.
Dis Colon Rectum ; 45(7): 875-9, 2002 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12130873

RESUMO

OBJECTIVES: Local recurrence after transanal excision of rectal cancer is often amenable to salvage radical proctectomy, but the long-term results remain unknown. This study was designed to determine the outcome of salvage radical surgery after failed local excision in patients with early rectal cancer. METHODS: We retrospectively reviewed the charts of 29 patients who underwent salvage radical surgery for local recurrence after a full-thickness transanal excision for Stage I rectal cancer. End points included local and distant recurrences and disease-free survival after salvage radical surgery. Comparisons between groups were performed by chi-squared test. RESULTS: Recurrence involved the rectal wall in 26 patients (90 percent) and was purely extrarectal in only 3 (10 percent). Mean time between local excision and radical operation was 26 months. The resection was considered curative in 23 patients (79 percent). The stage of the recurrent tumor was more advanced than the primary tumor in 27 patients (93 percent). At a mean follow-up of 39 (range, 2-147) months after radical surgery, 17 patients (59 percent) remained free of disease. The disease-free survival rate was 68 percent for patients with tumors with favorable histology vs. 29 percent for patients with tumors with unfavorable histology. CONCLUSION: Salvage surgery for recurrence after local excision of rectal cancers may not provide results equivalent to those of initial radical treatment. In the present study the poor results of salvage surgery emphasize the importance of appropriate selection of the initial treatment of Stage I rectal cancer.


Assuntos
Colectomia/métodos , Recidiva Local de Neoplasia , Neoplasias Retais/cirurgia , Terapia de Salvação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Reoperação , Estudos Retrospectivos , Falha de Tratamento
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