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2.
Artigo em Inglês | MEDLINE | ID: mdl-31780193

RESUMO

OBJECTIVE: Patient selection of community pharmacy is based on a multitude of factors. With increasing competition and rapidly changing face of pharmacy, identification of these factors is critical for patient satisfaction and financial success. This systematic review summarizes patient preferences for different attributes of community pharmacy. DATA SOURCES: Systematic review of peer-reviewed studies conducted on U.S. population, published from 2005 to 2018 in EBSCO, PubMed, and EMBASE, was conducted to identify attributes of community pharmacy that determine patient patronage. STUDY SELECTION: Studies conducted between 2005 and 2018 on U.S. population that examined attributes in choosing a pharmacy were eligible for this systematic review. DATA EXTRACTION: Data were independently extracted, assessed, and evaluated by 2 reviewers. Any disagreements were resolved by the third reviewer. Data obtained included year, setting, number of patients, data-collection/evaluation methods, and relevant results and outcomes. RESULTS: Of the 713 papers identified, 10 articles met the inclusion criteria and were included in this systematic review. Majority of the studies used surveys to examine key attributes that influence patients' selection of a pharmacy. Pharmacist traits like friendly, helpful, trustworthy, professional, competent, caring, knowledgeable, responsive, and approachable are critical attributes that influence a patient's selection of pharmacy. Convenience (i.e., location, hours of operation, wait time, stock availability) also influenced patients' selection of pharmacy. Cost and contract with insurance were other important factors. Availability of auto-refills appeared consistently in the studies. Medication safety (detecting drug interactions) quality metrics also appeared high among patients' preferences. CONCLUSION: The results of this review found that a relationship with a respectful, friendly, competent pharmacist represents important pharmacist-related attributes in the process of pharmacy selection. Important pharmacy-related attributes include cost, convenience, and wait times. Availability of auto-refill service was also a frequently reported attribute in this review.

3.
JAMA Intern Med ; 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31710344

RESUMO

Importance: Regulatory and scientific guidelines stipulate that indirect, surrogate measures of patient benefit, such as a change in microbial culture status, should be used as primary end points only in pivotal trials of chronic conditions that are serious or life threatening and when the experimental therapy is expected to offer substantial benefit compared with available therapy. However, many recent US Food and Drug Administration (FDA) anti-infective drug approvals for acute and/or non-life-threatening diseases have been based on pivotal trials using surrogate measures as primary end points rather than clinical outcomes, such as symptom resolution or survival. Objectives: To review FDA recommendations for primary end points in pivotal trials of new anti-infective drugs and assess the concordance of those recommendations with the regulatory and scientific conditions for the appropriate use of surrogate measures as primary trial outcomes. Evidence Review: All guidance documents for antimicrobial drug development hosted on the FDA website were searched in November 2017; the search was updated in June 2018. For each document, 2 reviewers independently extracted data on the recommended primary end points for a pivotal or phase 3 trial. Findings: Twenty-two FDA guidance documents met the inclusion criteria, which included recommendations for primary end points in pivotal clinical trials in 27 infectious disease indications. Twenty-one of 27 indications recommended surrogate outcomes as either the sole primary end point or as components of composite end points. None of the recommendations for the use of surrogate measures matched the regulatory and scientific conditions favoring indirect outcomes in place of clinical outcomes. Conclusions and Relevance: The FDA guidance documents for developing new anti-infective agents frequently recommend indirect measures of patient benefit, rather than direct measures of patient benefit, as sole primary end points or components of primary end points. Existing guidance documents should be updated and revised to recommend appropriate clinical outcomes consistent with general scientific and regulatory parameters.

4.
Genome Res ; 29(4): 635-645, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30894395

RESUMO

Large-scale population analyses coupled with advances in technology have demonstrated that the human genome is more diverse than originally thought. To date, this diversity has largely been uncovered using short-read whole-genome sequencing. However, these short-read approaches fail to give a complete picture of a genome. They struggle to identify structural events, cannot access repetitive regions, and fail to resolve the human genome into haplotypes. Here, we describe an approach that retains long range information while maintaining the advantages of short reads. Starting from ∼1 ng of high molecular weight DNA, we produce barcoded short-read libraries. Novel informatic approaches allow for the barcoded short reads to be associated with their original long molecules producing a novel data type known as "Linked-Reads". This approach allows for simultaneous detection of small and large variants from a single library. In this manuscript, we show the advantages of Linked-Reads over standard short-read approaches for reference-based analysis. Linked-Reads allow mapping to 38 Mb of sequence not accessible to short reads, adding sequence in 423 difficult-to-sequence genes including disease-relevant genes STRC, SMN1, and SMN2 Both Linked-Read whole-genome and whole-exome sequencing identify complex structural variations, including balanced events and single exon deletions and duplications. Further, Linked-Reads extend the region of high-confidence calls by 68.9 Mb. The data presented here show that Linked-Reads provide a scalable approach for comprehensive genome analysis that is not possible using short reads alone.


Assuntos
Estudo de Associação Genômica Ampla/métodos , Polimorfismo Genético , Sequenciamento Completo do Genoma/métodos , Linhagem Celular , Genoma Humano , Humanos , Proteínas de Membrana/genética , Proteína 1 de Sobrevivência do Neurônio Motor/genética , Proteína 2 de Sobrevivência do Neurônio Motor/genética
5.
Curr Med Res Opin ; 35(8): 1379-1385, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30793988

RESUMO

Purpose: The purpose of this study is to determine racial and ethnic disparities with the adherence to inhaled corticosteroids (ICSs) in adults with persistent asthma, and their association with healthcare expenditures. Methods: A retrospective, cross-sectional study using the Medical Expenditure Panel Survey (MEPS) 2013-2014 data included patients ≥18 years with persistent asthma. Median medication possession ratio (MPR) was used to dichotomize adherence levels. Multivariate regression analysis was conducted to ascertain the association between adherence and race/ethnicity. Total expenditures and association with adherence were analyzed using a generalized linear model with a log link function and gamma distribution. Unadjusted expenditures were compared after bootstrapping. Results: The average MPR of ICSs for the sample of 277 patients was 0.34. The average MPR level was 0.33 among whites, 0.37 among African-Americans and 0.35 among other minorities. The average MPR was 0.30 among Hispanics, and 0.35 among non-Hispanics. African-Americans were less likely to be adherent than whites (OR 0.95). Hispanics were less likely to be adherent (OR 0.4; CI 0.206-0.777). Higher adherence was associated with significantly higher total health expenditure than lower adherence ($19,223 vs. $12,840 respectively, p < .0001). African-Americans had slightly higher total expenditure compared to whites; however, other minorities had significantly lower health expenditures compared to whites (p = .01). Non-Hispanics spent significantly less on healthcare compared to Hispanics (p = .04). Conclusions: Valuable insight into the economic cost of the disparities as they relate to persistent asthma provides further evidence of possible ethnic inequities that warrant addressing.

6.
J Clin Gastroenterol ; 53(2): e68-e74, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29252684

RESUMO

GOALS: The purpose of our study was to evaluate trends of hospitalization, acute kidney injury (AKI) and mortality in cirrhotic patients with spontaneous bacterial peritonitis (SBP). BACKGROUND: SBP is a frequent bacterial infection in cirrhotic patients leading to increased morbidity and mortality. MATERIALS AND METHODS: A total of 4,840,643 patients hospitalized with cirrhosis from 2005 to 2014 were identified using the Nationwide Inpatient Sample database, of which 115,359 (2.4%) had SBP. We examined annual trends and used multivariable mixed-effects logistic regression analyses to obtain adjusted odds ratios by accounting for hospital level and patient level variables. RESULTS: We identified a striking increase in hospitalizations for SBP in cirrhotic patients (0.45% to 3.12%) and AKI in SBP patients (25.6% to 46.7%) from 2005 to 2014. Inpatient mortality decreased over the study period in patients with SBP (19.1% to 16.1%) and in patients with SBP plus AKI (40.9% to 27.6%). Patients with SBP had a higher inpatient mortality rate than those without SBP [15.5% vs. 6%, adjusted odd ratio (aOR): 2.02, P<0.001]. AKI was 2-fold more prevalent in cirrhotics with SBP than those without SBP (42.8% vs. 17.2%, aOR: 1.91, P<0.001) and concomitant AKI was associated with a 6-fold mortality increase (aOR: 5.84, P<0.001). Cirrhotic patients with SBP had higher hospitalization costs and longer length of stays than patients without SBP. CONCLUSIONS: Despite a higher hospitalization rate and prevalence of concomitant AKI, mortality in patients with SBP decreased during the study period. SBP is associated with high likelihood of development of AKI, which in turn, increases mortality.

7.
BMC Infect Dis ; 18(1): 707, 2018 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-30594124

RESUMO

BACKGROUND: The emergence of different viral infections during the last decades like dengue, West Nile, SARS, chikungunya, MERS-CoV, Ebola, Zika and Yellow Fever raised some questions on quickness and reliability of laboratory diagnostic tests for verification of suspected cases. Since sampling of blood requires medically trained personal and comprises some risks for the patient as well as for the health care personal, the sampling by non-invasive methods (e.g. saliva and/ or urine) might be a very valuable alternative for investigating a diseased patient. MAIN BODY: To analyse the usefulness of alternative non-invasive samples for the diagnosis of emerging infectious viral diseases, a literature search was performed on PubMed for alternative sampling for these viral infections. In total, 711 papers of potential relevance were found, of which we have included 128 in this review. CONCLUSIONS: Considering the experience using non-invasive sampling for the diagnostic of emerging viral diseases, it seems important to perform an investigation using alternative samples for routine diagnostics. Moreover, during an outbreak situation, evaluation of appropriate sampling and further processing for laboratory analysis on various diagnostic platforms are very crucial. This will help to achieve optimal diagnostic results for a good and reliable case identification.


Assuntos
Doenças Transmissíveis Emergentes/diagnóstico , Saliva/virologia , Manejo de Espécimes , Coleta de Urina , Viroses/diagnóstico , Variação Biológica da População , Febre de Chikungunya/diagnóstico , Febre de Chikungunya/epidemiologia , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/virologia , Dengue/diagnóstico , Dengue/epidemiologia , Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/normas , Humanos , Reprodutibilidade dos Testes , Manejo de Espécimes/métodos , Manejo de Espécimes/normas , Manejo de Espécimes/estatística & dados numéricos , Coleta de Urina/métodos , Coleta de Urina/normas , Viroses/epidemiologia , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/epidemiologia
8.
Indian J Community Med ; 43(3): 185-189, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30294085

RESUMO

Background: Tuberculosis (TB) is first opportunistic infection and leading cause of death among human immunodeficiency virus (HIV)/AIDS. Certainly, the prevalence of TB is expected to differ between general population and HIV-infected persons. This study was conducted to determine the prevalence of TB among newly diagnosed HIV-infected adults attending antiretroviral therapy (ART) center in the state of Gujarat, India. Materials and Methods: Cross-sectional study was carried out among newly diagnosed HIV-infected persons attending ART center from July 2012 to September 2012. Screening of TB symptoms and chest X-ray was done for those who consented. Sputum samples were collected for microscopy with Ziehl-Neelsen method for all presumptive TB cases and those diagnosed as pulmonary TB, culture, and drug susceptibility test was done. Blood samples were collected for CD4+ T-cells count and hemoglobin. Results: Out of 2021 eligible HIV-infected persons, 63.5% were males and 68.2% were in the age group of 26-45 years. The prevalence of TB was 17.8%. Among 360 patients with TB, 102 (28%) had smear positive TB, 86 (24%) had smear-negative TB, and 172 (48%) were diagnosed as extrapulmonary TB. Two hundred and thirty-eight (27%) TB patients with CD4+ T-Cell count below 200 compared to 122 (11%) patients above 200. Conclusion: A high prevalence of TB was found among newly diagnosed HIV-infected adults attending ART center for care and treatment. The prevalence of pulmonary and extrapulmonary TB was almost equal. Chances of TB disease were more with depletion of CD4 counts. The study highlights urgent need of intensive case finding as well as periodic screening of newly diagnosed HIV-infected individuals.

9.
J Infect Dis ; 218(10): 1622-1630, 2018 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-29917112

RESUMO

Background: A mobile laboratory transportable on commercial flights was developed to enable local response to viral hemorrhagic fever outbreaks. Methods: The development progressed from use of mobile real-time reverse-transcription polymerase chain reaction to mobile real-time recombinase polymerase amplification. In this study, we describe various stages of the mobile laboratory development. Results: A brief overview of mobile laboratory deployments, which culminated in the first on-site detection of Ebola virus disease (EVD) in March 2014, and their successful use in a campaign to roll back EVD cases in Conakry in the West Africa Ebola virus outbreak are described. Conclusions: The developed mobile laboratory successfully enabled local teams to perform rapid disgnostic testing for viral hemorrhagic fever.


Assuntos
Doença pelo Vírus Ebola/diagnóstico , Laboratórios , Unidades Móveis de Saúde , Sistemas Automatizados de Assistência Junto ao Leito , África Ocidental , Ebolavirus/genética , Doença pelo Vírus Ebola/virologia , Humanos , Tipagem Molecular/instrumentação , RNA Viral/sangue , Reação em Cadeia da Polimerase em Tempo Real/instrumentação
12.
PLoS Negl Trop Dis ; 12(5): e0006381, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29813062

RESUMO

BACKGROUND: 4 one-step, real-time, reverse transcription loop-mediated isothermal amplification (RT-LAMP) assays were developed for the detection of dengue virus (DENV) serotypes by considering 2,056 full genome DENV sequences. DENV1 and DENV2 RT-LAMP assays were validated with 31 blood and 11 serum samples from Tanzania, Senegal, Sudan and Mauritania. DENV3 and DENV4 RT-LAMP assays were validated with 25 serum samples from Cambodia. METHODOLOGY/PRINCIPAL FINDINGS: 4 final reaction primer mixes were obtained by using a combination of Principal Component Analysis of the full DENV genome sequences, and LAMP primer design based on sequence alignments using the LAVA software. These mixes contained 14 (DENV1), 12 (DENV2), 8 (DENV3) and 3 (DENV4) LAMP primer sets. The assays were evaluated with an External Quality Assessment panel from Quality Control for Molecular Diagnostics. The assays were serotype-specific and did not cross-detect with other flaviviruses. The limits of detection, with 95% probability, were 22 (DENV1), 542 (DENV2), 197 (DENV3) and 641 (DENV4) RNA molecules, and 100% reproducibility in the assays was obtained with up to 102 (DENV1) and 103 RNA molecules (DENV2, DENV3 and DENV4). Validation of the DENV2 assay with blood samples from Tanzania resulted in 23 samples detected by RT-LAMP, demonstrating that the assay is 100% specific and 95.8% sensitive (positive predictive value of 100% and a negative predictive value of 85.7%). All serum samples from Senegal, Sudan and Mauritania were detected and 3 untyped as DENV1. The sensitivity of RT-LAMP for DENV4 samples from Cambodia did not quite match qRT-PCR. CONCLUSIONS/SIGNIFICANCE: We have shown a novel approach to design LAMP primers that makes use of fast growing sequence databases. The DENV1 and DENV2 assays were validated with viral RNA extracted clinical samples, showing very good performance parameters.


Assuntos
Vírus da Dengue/genética , Vírus da Dengue/isolamento & purificação , Dengue/virologia , Técnicas de Amplificação de Ácido Nucleico/métodos , Primers do DNA/genética , Vírus da Dengue/classificação , Vírus da Dengue/metabolismo , Humanos , Técnicas de Amplificação de Ácido Nucleico/instrumentação , Filogenia , RNA Viral/genética , Transcrição Reversa , Tanzânia
13.
Children (Basel) ; 5(4)2018 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-29642612

RESUMO

Congenital talipes equinovarus (CTEV), also known as clubfoot, is a complex congenital deformity of the foot that, left untreated, can limit a person's mobility by making it difficult and painful to walk. Worldwide, 80% of children born with clubfoot are in low- and middle-income countries. The management of clubfoot has a long history. Non-operative management did not become popular, as an increasing number of orthopaedists started leaning towards surgical treatment. The late Dr. Ignacio Ponseti developed a method of clubfoot correction that successfully realigns clubfoot in infants without extensive and major surgery. The aim of the study was to assess the functional outcome of CTEV management by the Ponseti technique, to study the severity of CTEV deformity using the Pirani score, and to evaluate the cost-effectiveness of the technique. A total of 356 cases with 402 feet with CTEV were treated by the Ponseti method. The average age of the children and the number of casts applied before full correction were 4.03 months and 6.91, respectively. There was a good functional outcome in 95.45% of cases (score > 30) at the last follow up. The management of CTEV by the Ponseti technique provides a good functional and cosmetic outcome. In a developing country like India, this technique is a safe, easy, economical method of clubfoot management.

14.
Future Cardiol ; 14(2): 125-130, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29355029

RESUMO

AIM: Postmyocardial infarction ventricular septal defect (VSD) is a rare complication that can lead to rapid hemodynamic patient decompensation. The type of VSD repair relies on several factors including: size, location, timing and surgical expertise. CASE: A 63-year-old man with a ST-elevation myocardial infarction underwent percutaneous coronary intervention of the right coronary artery. A holosystolic murmur was notable postcatheterization, and transthoracic echocardiogram confirmed a VSD. To characterize the VSD, a cardiac MRI demonstrated a large, serpiginous VSD and longitudinal septal tear. Given the anatomic complexity and stable hemodynamics, a surgical trans-left ventricular patch repair was performed. CONCLUSION: We emphasize the importance of cardiac magnetic resonance as a decision-making tool, utilizing imaging to ascertain the anatomy combined with hemodynamics to determine optimal individualized therapy.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Dispositivo para Oclusão Septal , Ecocardiografia , Comunicação Interventricular/etiologia , Comunicação Interventricular/cirurgia , Ventrículos do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
15.
J Orthop Case Rep ; 8(4): 29-31, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30687657

RESUMO

Introduction: Giant cell tumors are common in proximal tibia and distal end radius and have a low tendency to recur. They have been treated successfully with excision and cementing or sandwich bone grafting without recurrence. Here, we present a rare case of giant cell tumor (GCT) of the distal tibia treated successfully with no recurrence at the end of 2 years. Case Report: A 28-year-old female presented with complaints of pain and restricted movement of the right ankle joint since 1 month. There was no history of trauma. On examination, tenderness on the anterior aspect of the right ankle joint with restricted range of motion was found. X-rays revealed a well-defined expansile predominantly lytic lesion in the distal epi-metaphyseal region of the right tibia with minimal periosteal reaction seen along the medial margin. Magnetic resonance imaging revealed an ill-defined expansile lesion involving the epi-metaphyseal end of the lower end of tibia causing cortical breach and having extra-osseous tissue component with the abnormal signal in flexor and extensor group of muscles with the possibility of GCT. Surgery by excision, curettage, and cementation was performed to fill the defect. Histopathology of the tissue showed multinucleated giant cells with a uniform vesicular nucleus and mononuclear cells which were spindle shaped with uniform vesicular nucleus suggestive of GCT. Conclusion: The patient at 2-year follow-up is doing well, walking without any pain, comfortably and with a full range of motion of the ankle joint with no signs of recurrence.

16.
Anal Biochem ; 544: 29-33, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29258829

RESUMO

Rickettsioses are zoonotic vector-transmitted bacterial infections leading to flu-like symptoms and can progress to severe illness in humans. The gold standard for diagnosis of rickettsial infections is the indirect immunofluorescence assay, a serological method which is not suitable for pathogen identification during the acute phase of the disease. Therefore, several real-time PCR assays were developed. These assays are very sensitive, but require high-equipped laboratories and well-trained personnel. Hence, in this study, a rapid point-of-need detection method was developed to detect all Rickettsia species. The 23S and 16S rRNA genes were targeted to develop a recombinase polymerase amplification (RPA) assay. Both 23S and 16S_RPA assays required between seven to ten minutes to amplify and detect one or ten DNA molecules/reaction, respectively. The 16S_RPA assay detected all tested species, whereas the 23S_RPA assay identified only species of the spotted fever and transitional rickettsial groups. All results were compared with real-time PCR assays directed against the same rickettsial genes. The RPA assays are easy to handle and produced quicker results in comparison to real-time PCRs. Both RPA assays were implemented in a mobile suitcase laboratory to ease the use in rural areas. This method can help to provide rapid management of rickettsial infections.


Assuntos
Técnicas de Amplificação de Ácido Nucleico , RNA Ribossômico 16S/genética , RNA Ribossômico 23S/genética , Reação em Cadeia da Polimerase em Tempo Real , Rickettsia/genética , Humanos , Rickettsia/isolamento & purificação
17.
Rev Cardiovasc Med ; 18(2): 73-77, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29038415

RESUMO

The appropriate use criteria (AUC) has become an integral part of the cardiologist's daily practice and have evolved greatly since their inception over a decade ago. However, as health care costs continue to rise, the AUC has come to play an even more pivotal role in the way medicine-specifically cardiology-is practiced today. This editorial describes two opposing viewpoints commonly held by practicing clinicians of the AUC. Written from the perspective of two fellows-in-training looking ahead at the challenges and opportunities of clinical practice (under the auspices of several experienced clinicians and leaders of the American College of Cardiology), this article provides a fresh perspective on the impact AUC has on our patients, clinicians, and the health care system.


Assuntos
Cardiologia/normas , Tomada de Decisão Clínica , Fidelidade a Diretrizes/normas , Segurança do Paciente/normas , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Cardiologia/economia , Redução de Custos , Análise Custo-Benefício , Fidelidade a Diretrizes/economia , Custos de Cuidados de Saúde , Humanos , Segurança do Paciente/economia , Padrões de Prática Médica/economia , Medição de Risco , Procedimentos Desnecessários/normas
18.
Cancer ; 123(23): 4594-4607, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-28881377

RESUMO

BACKGROUND: The authors hypothesized that unilateral intensity-modulated radiotherapy (IMRT) would decrease toxicity compared with bilateral IMRT for patients with lateralized palatine tonsillar cancer and a neck classification of N0 to N2b, with similar oncological outcomes. METHODS: A total of 154 patients were treated with postoperative IMRT from 1997 through 2013. Data were collected prospectively from 2005 to 2013 and retrospectively collected before 2005. Of those patients with lateralized primary and N0 to N2b disease, 48 received unilateral IMRT (group 1) and 59 received bilateral IMRT (group 2); a total of 47 patients had nonlateralized primary or N2c to N3 disease and received bilateral IMRT (group 3). RESULTS: The median follow-up was 5.5 years. The 5-year locoregional control rates were similar in group 1, group 2, and group 3 (100%, 96%, and 94%, respectively; pooled comparison: P = .39 and group 1 vs group 2 comparison: P = .19). The 5-year overall survival rates were similar in group 1, group 2, and group 3 (85%, 79%, and 76%, respectively; pooled comparison: P = .60 and group 1 vs group 2 comparison: P = .25). There were no contralateral neck recurrences noted among unilaterally treated patients. Unilateral IMRT reduced acute toxicity and improved patient-reported quality of life compared with bilateral IMRT. CONCLUSIONS: Unilateral IMRT appears to reduce acute toxicity and achieves oncological outcomes similar to those of bilateral IMRT in selected patients with lateralized palatine tonsillar cancer with a neck classification of N0 to N2b. Cancer 2017;123:4594-4607. © 2017 American Cancer Society.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Recidiva Local de Neoplasia/radioterapia , Tonsila Palatina/efeitos da radiação , Qualidade de Vida , Radioterapia de Intensidade Modulada/métodos , Neoplasias Tonsilares/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Tonsila Palatina/patologia , Tonsila Palatina/cirurgia , Prognóstico , Estudos Prospectivos , Dosagem Radioterapêutica , Radioterapia Adjuvante , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias Tonsilares/patologia , Neoplasias Tonsilares/cirurgia
19.
Int J Angiol ; 26(3): 191-195, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28924344

RESUMO

Although the use of drug-eluting stents (DES) has dramatically decreased the incidence of in-stent restenosis (ISR), concerns regarding the late manifestations of ISR remain. Optical coherence tomography (OCT) imaging provides unique insights into characteristics and patterns of ISR. We report a case of late DES ISR with unusual heterogeneous intracoronary luminal characteristics suggestive of vulnerable atherosclerotic plaque activity by OCT imaging. This case demonstrates that late ISR after DES may involve more than mere neointimal hyperplasia with lesion-associated craters, septae, and neoatherosclerosis. The use of OCT provides novel insights into the mechanisms and potential biology of the late DES ISR.

20.
Emerg Infect Dis ; 23(11)2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28949285

RESUMO

The current yellow fever outbreak in Brazil prompted widespread yellow fever virus (YFV) vaccination campaigns, imposing a responsibility to distinguish between vaccine- and wild-type YFV-associated disease. We developed novel multiplex real-time reverse transcription PCRs that differentiate between vaccine and American wild-type YFV. We validated these highly specific and sensitive assays in an outbreak setting.


Assuntos
Reação em Cadeia da Polimerase em Tempo Real/métodos , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Vacina contra Febre Amarela/isolamento & purificação , Febre Amarela/virologia , Vírus da Febre Amarela/isolamento & purificação , Brasil/epidemiologia , Surtos de Doenças , Humanos , Especificidade da Espécie , Febre Amarela/epidemiologia
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