Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.612.122
Filtrar
1.
MMWR Morb Mortal Wkly Rep ; 68(35): 766-770, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31487277

RESUMO

Hepatitis A virus (HAV) is an RNA virus primarily transmitted via the fecal-oral route and, in rare cases, causes liver failure and death in infected persons. Although drinking water-associated hepatitis A outbreaks in the United States are rarely reported (1), HAV was the most commonly reported etiology for outbreaks associated with untreated ground water during 1971-2008 (2), and HAV can remain infectious in water for months (3). This report analyzes drinking water-associated hepatitis A outbreaks reported to the Waterborne Disease and Outbreak Surveillance System (WBDOSS) during 1971-2017. During that period, 32 outbreaks resulting in 857 cases were reported, all before 2010. Untreated ground water was associated with 23 (72%) outbreaks, resulting in 585 (68.3%) reported cases. Reported outbreaks significantly decreased after introduction of Advisory Committee on Immunization Practices (ACIP) hepatitis A vaccination recommendations* and U.S. Environmental Protection Agency's (USEPA) public ground water system regulations.† Individual water systems, which are not required to meet national drinking water standards,§ were the only contaminated drinking water systems to cause the last four reported hepatitis A outbreaks during 1995-2009. No waterborne outbreaks were reported during 2009-2017. Water testing and treatment are important considerations to protect persons who use these unregulated systems from HAV infection.


Assuntos
Surtos de Doenças/prevenção & controle , Água Potável/virologia , Hepatite A/epidemiologia , Hepatite A/prevenção & controle , Prática de Saúde Pública , Regulamentação Governamental , Vacinas contra Hepatite A/administração & dosagem , Humanos , Avaliação de Programas e Projetos de Saúde , Estados Unidos/epidemiologia , United States Environmental Protection Agency , Abastecimento de Água/legislação & jurisprudência
2.
Z Psychosom Med Psychother ; 65(3): 288-303, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31476999

RESUMO

Is the influence of religiousness on fearful, depressive and somatic symptoms and psychic traumatization overestimated? A representative cross-sectional study Objectives: The aim of this study is to prove if religious faith, spirituality and religious praxis are joined with lower depression, anxiety and physical pain-level and if subjects with traumatic experiences report more spirituality. Methods: In this consecutive study, 2508 adults of a representative sample in Germany were interviewed about religious faith and spirituality in relation to depression, anxiety, physical disorders as well as traumatic experiences. Results: Unlike our hypotheses people who are charged with mental (PHQ-4; Löwe et al. 2010) or physical disorders (GBB_8; Kliem et al. 2017) report more spirituality and more private religious/spiritual praxis than people without mental or physical problems. As expected people with traumatic experiences in their childhood (CTS; Grabe et al. 2012) describe significantly more spirituality than people without these experiences. Conclusions: Other than expected people with more mental or physical disorders report more spirituality and more private religious/spiritual praxis. It is to discuss if spirituality is less a protective factor for mental or physical disorders than disorders activate to look for spirituality and private religious/spiritual praxis.


Assuntos
Ansiedade/psicologia , Depressão/psicologia , Medo/psicologia , Sintomas Inexplicáveis , Trauma Psicológico/psicologia , Religião e Psicologia , Espiritualidade , Adulto , Ansiedade/epidemiologia , Criança , Estudos Transversais , Depressão/epidemiologia , Alemanha/epidemiologia , Humanos , Entrevistas como Assunto , Trauma Psicológico/epidemiologia
3.
Isr Med Assoc J ; 21(8): 512-515, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474008

RESUMO

BACKGROUND: Breast implant-associated anaplastic large cell lymphoma (ALCL) is a rare type of non-Hodgkin's lymphoma that is found around breast implants. ALCL was discovered only two decades ago. In Israel we currently have four diagnosed cases (as of 2018). Until recently, the estimated incidence was 1:300,000 women with breast implants, while recent reports range from 1:3817 to 1:30,000. OBJECTIVES: To determine the occurrence of breast implant-ALCL in Israel. METHODS: We conducted a retrospective analysis of the four patients diagnosed with ALCL in Israel. Cytology was confirmed and the clinical data was collected. Based on the estimated number of women with breast implants in Israel, a calculation of the true incidence was completed. RESULTS: The incidence in Israel is significantly higher than the older incidence reports indicate. We estimated that the lifetime prevalence of the disease is 4:60,000 women with a textured breast implant, or 1:15,000 women with a textured breast implant in Israel. CONCLUSIONS: ALCL is not common. We support the claim that the prevalence is significantly higher than what was initially described. This finding has clinical and medicolegal implications that should be addressed accordingly.


Assuntos
Implantes de Mama/efeitos adversos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Linfoma Anaplásico de Células Grandes/diagnóstico , Linfoma Anaplásico de Células Grandes/epidemiologia , Adulto , Mama/cirurgia , Neoplasias da Mama/cirurgia , Remoção de Dispositivo , Feminino , Humanos , Israel/epidemiologia , Linfoma Anaplásico de Células Grandes/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
Isr Med Assoc J ; 21(8): 538-541, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474016

RESUMO

BACKGROUND: Travelers' diarrhea (TD) is frequently encountered in people traveling from high-income to low-income countries; however, its epidemiology in those traveling between high-income countries is not known. OBJECTIVES: To evaluate the incidence of diarrhea in North American students relocating to Israel. METHODS: A retrospective cohort study involving medical students from the United States and Canada relocating to Israel was conducted. Students who relocated to Israel during 2010-2016 were contacted by email to participate in an anonymous survey. Data included demographic information as well as occurrence, timing, duration, and outcome of diarrhea after relocation. RESULTS: Ninety-seven students participated in the survey. Most (93.7%) students relocated from the United States or Canada. The period-prevalence of diarrhea was 69.1%. The incidence of diarrhea declined from 34.8 cases per 100 student-months during the first month after relocation to 1.3 cases per 100 student-months after 1 year. The duration of diarrhea was up to 1 week in 72.7%. Students who reported diarrhea were younger than students who did not (mean age 24.0 ± 2.2 and 28.4 ± 1.8 years, respectively, P < 0.001). No other demographic parameter was significantly associated with a higher likelihood of diarrhea. CONCLUSIONS: A high proportion of North American medical students relocating to Israel reported diarrhea with clinical and epidemiological features similar to classic TD. Further studies are needed to elucidate the causative agents of TD in Israel.


Assuntos
Diarreia/epidemiologia , Inquéritos Epidemiológicos/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Doença Relacionada a Viagens , Doença Aguda , Adulto , Canadá/etnologia , Estudos de Coortes , Diarreia/etnologia , Feminino , Humanos , Incidência , Israel/epidemiologia , Masculino , Projetos Piloto , Estudos Retrospectivos , Viagem , Estados Unidos/etnologia , Adulto Jovem
5.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(9): 694-699, 2019 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-31484244

RESUMO

Objective: To investigate the incidence of venous thromboembolism (VTE) in lung transplant (LT) recipients. Methods: The clinical data on 124 consecutive patients who underwent lung transplant at Lung Transplantation Center of China-Japan Friendship Hospital from March 2017 to September 2018 were retrospectively collected. Deep venous thrombosis (DVT) was ascertained by vascular ultrasound. Pulmonary embolism (PE) was diagnosed by either chest computed tomography pulmonary angiogram or ventilation/perfusion scan. The risk factors in those patients with postoperative VTE were studied. Results: A total of 124 lung transplant recipients including 78 single lung transplant recipients (62.9%) and 46 bilateral lung transplant recipients(37.1%) were enrolled. Preoperative and postoperative prophylactic anticoagulant was used in 52 patients(52/124, 41.9%) and 69 patients(69/124, 55.6%) respectively. Thirty-two patients developed postoperative VTE among 124 consecutive patients. The overall incidence rate of VTE among 124 LT recipients was 25.8%. The median time to VTE episode following lung transplant was 22.5 days (range 4-295 days). The percentage of DVT in VTE was 93.8%(30/32), involving 1-8 (2.83±1.86) veins. And 60.0% of DVT was from lower extremities and 56.7% located in upper extremities (P>0.05). Four patients (4/32,12.5%) had PE episodes, and half of them suffered from only PE without DVT. The use of extracorporeal membrane oxygenation (ECMO) in 32 patients with VTE was 90.6% (29/32), which was significantly higher than that without VTE (64/92,69.6%, P=0.033). However, there was no difference in the use of peripherally inserted central catheter (PICC) between two groups (96.9% vs 81.5%, P=0.067). Resolution of VTE was successfully accomplished by anticoagulant therapy with long-term use of low molecular weight heparin in 30 patients (93.7%) and followed by oral warfarin in 2 patients (6.3%). Three months follow-up data after anticoagulant therapy showed that total and partial vascular recanalization rate was 65.6%(21/32) and 34.4%(11/32), respectively. Despite anticoagulation-related bleeding complications in three patients, no serious consequences occurred. Conclusions: VTE was frequent in LT recipients. It was speculated that ECMO utilization may be a major risk factor for high incidence of VTE in LT recipients. Aggressive VTE screening/treatment protocols were suggested to be implemented in LT recipients.


Assuntos
Transplante de Pulmão/efeitos adversos , Complicações Pós-Operatórias , Tromboembolia Venosa/epidemiologia , Adulto , Anticoagulantes/administração & dosagem , China/epidemiologia , Humanos , Incidência , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia
6.
Medicina (B Aires) ; 79(4): 257-264, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31487244

RESUMO

The epidemiology of infectious endocarditis (IE) has undergone changes due to a series of factors such as aging, comorbidities and medical procedures. The aim of this study was to evaluate the main clinical, epidemiological and etiological changes of the IE in the last 25 years in Argentina. A comparative analysis of three observational prospective registries was performed in which cases of definite and possible IE were consecutively included according to the Duke criteria: two multicentre studies (EIRA-1 [1992-1994] and EIRA-2 [2001-2002]) and one study in a reference cardiology center (CRC [2007-2017]). In the 1065 episodes of EI evaluated, there were no differences regarding sex, and the patients were older in each period (p < 0.001). Intracardiac device-associated IE was more frequent in the last decade: pacemaker (5.4 vs. 23% p < 0.0001) and prosthetic valve IE (8.5% vs. 19.2% vs. 47.5% p < 0.0001). On the other hand, IE associated with intravenous drugs (P < 0.0001) and congenital heart diseases (p = 0.001) was significantly less frequent. The etiology changed substantially: Streptococcus viridans group decreased (30.8% vs. 26.8% vs. 15.9%, p < 0.001) and IE by Staphylococcus spp. predominated over other microorganisms, with a statistically significant increase in IE due to coagulase-negative Staphylococcus. Surgical treatment was more frequently implemented in the last decade and was accompanied by a trend towards lower mortality in the CRC (23.5%, 24.3% vs. 17.2% p = 0.058).


Assuntos
Endocardite Bacteriana/epidemiologia , Adulto , Idoso , Argentina/epidemiologia , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/microbiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência
7.
J Registry Manag ; 46(1): 4-14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31490916

RESUMO

PURPOSE: As survival rates for individuals with HIV/AIDS diagnoses increase, cancer is becoming a more prevalent disease in this population. Data regarding the concurrent diagnoses of HIV/AIDS and cancer has not previously been examined and analyzed in the state of Iowa. METHODS: The Iowa Cancer Registry and Iowa Department of Public Health's HIV/AIDS surveillance databases were linked, and matches were identified. Characteristics of Iowans with HIV/AIDS later diagnosed with cancer between 1991 and 2015 were compared to Iowans without HIV/AIDS using proportional incidence ratios (PIRs). RESULTS: 490 patients met inclusion criteria; 91% had AIDS and 9% had HIV only. Compared to individuals without HIV/AIDS, significantly higher PIRs for cancer were found in younger persons, males, African Americans, metropolitan (metro) residents, and Iowans with Medicaid or the uninsured. Specifically, PIRs associated with the following cancers were higher in the population with HIV/AIDS: Kaposi sarcoma, non-Hodgkin lymphomas (NHLs), and squamous cell neoplasms of the anus. When stratified by AIDS-defining cancers and non-AIDS-defining cancers, the main differences were individuals with AIDS-defining cancers had elevated PIRs among those diagnosed between 1991-1998 and had Kaposi sarcoma or Burkitt lymphoma, while those with non-AIDS-defining cancers were diagnosed between 2007-2015 and were diagnosed with anal, male or female genital, lymphoma other than NHL, liver, lung, or other squamous cell neoplasm cancers. When comparing nonmetropolitan (nonmetro) vs metro Iowans with HIV/AIDS, PIRs for nonmetro patients were elevated in those diagnosed with cancer between 50-59 years old, whites, and individuals diagnosed with squamous cell neoplasms. CONCLUSION: Our results indicate Iowans with HIV/AIDS have higher proportions of certain types of cancers compared to the general population and provide baseline information for future initiatives aimed at preventing or detecting cancer among those living with HIV/AIDS.


Assuntos
Infecções por HIV/epidemiologia , Neoplasias/epidemiologia , Sistema de Registros/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Infecções por HIV/complicações , Humanos , Incidência , Lactente , Recém-Nascido , Iowa/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Adulto Jovem
8.
MMWR Morb Mortal Wkly Rep ; 68(35): 762-765, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31487273

RESUMO

Approximately 700 women die in the United States each year as a result of pregnancy or its complications, and significant racial/ethnic disparities in pregnancy-related mortality exist (1). Data from CDC's Pregnancy Mortality Surveillance System (PMSS) for 2007-2016 were analyzed. Pregnancy-related mortality ratios (PRMRs) (i.e., pregnancy-related deaths per 100,000 live births) were analyzed by demographic characteristics and state PRMR tertiles (i.e., states with lowest, middle, and highest PRMR); cause-specific proportionate mortality by race/ethnicity also was calculated. Over the period analyzed, the U.S. overall PRMR was 16.7 pregnancy-related deaths per 100,000 births. Non-Hispanic black (black) and non-Hispanic American Indian/Alaska Native (AI/AN) women experienced higher PRMRs (40.8 and 29.7, respectively) than did all other racial/ethnic groups. This disparity persisted over time and across age groups. The PRMR for black and AI/AN women aged ≥30 years was approximately four to five times that for their white counterparts. PRMRs for black and AI/AN women with at least some college education were higher than those for all other racial/ethnic groups with less than a high school diploma. Among state PRMR tertiles, the PRMRs for black and AI/AN women were 2.8-3.3 and 1.7-3.3 times as high, respectively, as those for non-Hispanic white (white) women. Significant differences in cause-specific proportionate mortality were observed among racial/ethnic populations. Strategies to address racial/ethnic disparities in pregnancy-related deaths, including improving women's health and access to quality care in the preconception, pregnancy, and postpartum periods, can be implemented through coordination at the community, health facility, patient, provider, and system levels.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Complicações na Gravidez/etnologia , Complicações na Gravidez/mortalidade , Adulto , Feminino , Humanos , Gravidez , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
9.
J Glob Health ; 9(2): 020403, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31489186

RESUMO

Background: There is a need to develop sustainable emergency health care systems in low-resource settings, but data that analyses emergency health care needs in these settings are scarce. We aimed at assessing presenting complaints (PCs) and post-discharge mortality in a large emergency department population in Nepal. Methods: Characteristics of adult patients who entered the emergency department (ED) in a hospital in Nepal were prospectively recorded in the local emergency registry from September 2013 until December 2016. To assess post-ED mortality, patient households were followed-up by telephone interviews at 90 days. Results: In 21892 included adults, the major PC categories were injuries (29%), abdominal complaints (23%), and infections (16%). Median age was 40 years and sex distribution was balanced. Among 3793 patients followed at 90 days, 8% had died. For respiratory and cardiovascular PCs, 90-day mortality were 25% and 23%. The highest mortality was in individuals with known chronic lung disease, in this group 32% had died by 90 days of ED discharge, regardless of PC. In women, illiteracy compared to literacy (adjusted odds ratio (aOR) = 7.0, 95% confidence interval (CI) = 2.1-23.6) and being both exposed to tobacco-smoking and traditional cooking stove compared to no smoke (aOR = 2.8, 95% CI = 1.6-4.9) were associated with mortality. The mortality was much higher among family-initiated discharged patients (17%, aOR = 5.4, 95% CI = 3.3-8.9) compared to doctor-initiated discharged (3%). Conclusions: Our report suggests that nearly one in ten patients seeking emergency health care died within 90 days. This finding is alarming and novel. Post-discharge studies need to be replicated and appropriate follow-up programs in low-resource settings where primary health care is underdeveloped are urgently needed.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Mortalidade/tendências , Adulto , Idoso , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Estudos Prospectivos
10.
N Engl J Med ; 381(5): 407-419, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31365799

RESUMO

BACKGROUND: The World Health Organization recommends not performing transfusions in African children hospitalized for uncomplicated severe anemia (hemoglobin level of 4 to 6 g per deciliter and no signs of clinical severity). However, high mortality and readmission rates suggest that less restrictive transfusion strategies might improve outcomes. METHODS: In this factorial, open-label, randomized, controlled trial, we assigned Ugandan and Malawian children 2 months to 12 years of age with uncomplicated severe anemia to immediate transfusion with 20 ml or 30 ml of whole-blood equivalent per kilogram of body weight, as determined in a second simultaneous randomization, or no immediate transfusion (control group), in which transfusion with 20 ml of whole-blood equivalent per kilogram was triggered by new signs of clinical severity or a drop in hemoglobin to below 4 g per deciliter. The primary outcome was 28-day mortality. Three other randomizations investigated transfusion volume, postdischarge supplementation with micronutrients, and postdischarge prophylaxis with trimethoprim-sulfamethoxazole. RESULTS: A total of 1565 children (median age, 26 months) underwent randomization, with 778 assigned to the immediate-transfusion group and 787 to the control group; 984 children (62.9%) had malaria. The children were followed for 180 days, and 71 (4.5%) were lost to follow-up. During the primary hospitalization, transfusion was performed in all the children in the immediate-transfusion group and in 386 (49.0%) in the control group (median time to transfusion, 1.3 hours vs. 24.9 hours after randomization). The mean (±SD) total blood volume transfused per child was 314±228 ml in the immediate-transfusion group and 142±224 ml in the control group. Death had occurred by 28 days in 7 children (0.9%) in the immediate-transfusion group and in 13 (1.7%) in the control group (hazard ratio, 0.54; 95% confidence interval [CI], 0.22 to 1.36; P = 0.19) and by 180 days in 35 (4.5%) and 47 (6.0%), respectively (hazard ratio, 0.75; 95% CI, 0.48 to 1.15), without evidence of interaction with other randomizations (P>0.20) or evidence of between-group differences in readmissions, serious adverse events, or hemoglobin recovery at 180 days. The mean length of hospital stay was 0.9 days longer in the control group. CONCLUSIONS: There was no evidence of differences in clinical outcomes over 6 months between the children who received immediate transfusion and those who did not. The triggered-transfusion strategy in the control group resulted in lower blood use; however, the length of hospital stay was longer, and this strategy required clinical and hemoglobin monitoring. (Funded by the Medical Research Council and Department for International Development; TRACT Current Controlled Trials number, ISRCTN84086586.).


Assuntos
Anemia/terapia , Transfusão de Sangue , Hemoglobinas/análise , Tempo para o Tratamento , Anemia/complicações , Anemia/mortalidade , Transfusão de Sangue/economia , Criança , Pré-Escolar , Análise Custo-Benefício , Feminino , Seguimentos , Custos de Cuidados de Saúde , Humanos , Lactente , Tempo de Internação/economia , Malária/complicações , Malaui/epidemiologia , Masculino , Readmissão do Paciente/estatística & dados numéricos , Reação Transfusional/epidemiologia , Uganda/epidemiologia
11.
N Engl J Med ; 381(5): 420-431, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31365800

RESUMO

BACKGROUND: Severe anemia (hemoglobin level, <6 g per deciliter) is a leading cause of hospital admission and death in children in sub-Saharan Africa. The World Health Organization recommends transfusion of 20 ml of whole-blood equivalent per kilogram of body weight for anemia, regardless of hemoglobin level. METHODS: In this factorial, open-label trial, we randomly assigned Ugandan and Malawian children 2 months to 12 years of age with a hemoglobin level of less than 6 g per deciliter and severity features (e.g., respiratory distress or reduced consciousness) to receive immediate blood transfusion with 20 ml per kilogram or 30 ml per kilogram. Three other randomized analyses investigated immediate as compared with no immediate transfusion, the administration of postdischarge micronutrients, and postdischarge prophylaxis with trimethoprim-sulfamethoxazole. The primary outcome was 28-day mortality. RESULTS: A total of 3196 eligible children (median age, 37 months; 2050 [64.1%] with malaria) were assigned to receive a transfusion of 30 ml per kilogram (1598 children) or 20 ml per kilogram (1598 children) and were followed for 180 days. A total of 1592 children (99.6%) in the higher-volume group and 1596 (99.9%) in the lower-volume group started transfusion (median, 1.2 hours after randomization). The mean (±SD) volume of total blood transfused per child was 475±385 ml and 353±348 ml, respectively; 197 children (12.3%) and 300 children (18.8%) in the respective groups received additional transfusions. Overall, 55 children (3.4%) in the higher-volume group and 72 (4.5%) in the lower-volume group died before 28 days (hazard ratio, 0.76; 95% confidence interval [CI], 0.54 to 1.08; P = 0.12 by log-rank test). This finding masked significant heterogeneity in 28-day mortality according to the presence or absence of fever (>37.5°C) at screening (P=0.001 after Sidak correction). Among the 1943 children (60.8%) without fever, mortality was lower with a transfusion volume of 30 ml per kilogram than with a volume of 20 ml per kilogram (hazard ratio, 0.43; 95% CI, 0.27 to 0.69). Among the 1253 children (39.2%) with fever, mortality was higher with 30 ml per kilogram than with 20 ml per kilogram (hazard ratio, 1.91; 95% CI, 1.04 to 3.49). There was no evidence of differences between the randomized groups in readmissions, serious adverse events, or hemoglobin recovery at 180 days. CONCLUSIONS: Overall mortality did not differ between the two transfusion strategies. (Funded by the Medical Research Council and Department for International Development, United Kingdom; TRACT Current Controlled Trials number, ISRCTN84086586.).


Assuntos
Anemia/terapia , Transfusão de Sangue , Hemoglobinas/análise , Anemia/complicações , Anemia/mortalidade , Transfusão de Sangue/economia , Criança , Pré-Escolar , Análise Custo-Benefício , Feminino , Febre/complicações , Seguimentos , Custos de Cuidados de Saúde , Humanos , Lactente , Tempo de Internação/economia , Malária/complicações , Malaui/epidemiologia , Masculino , Readmissão do Paciente/estatística & dados numéricos , Reação Transfusional/epidemiologia , Uganda/epidemiologia
12.
Anticancer Res ; 39(8): 4265-4271, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366516

RESUMO

BACKGROUND/AIM: Brain metastases are an additional challenge in patients with non-small-cell lung cancer (NSCLC) because most chemotherapy agents cannot cross the blood-brain barrier. Nivolumab has demonstrated efficacy in patients with advanced squamous NSCLC, but because patients with central nervous system (CNS) metastases are typically excluded from registration trials, 'field-practice' data are needed. PATIENTS AND METHODS: Patients in the Italian cohort of the Expanded Access Program (EAP) who had CNS metastases at baseline were analyzed. RESULTS: Thirty-seven patients with CNS metastases received a median of six doses of nivolumab. Three patients (8%) had grade 3-4 adverse events and one patient discontinued due to an adverse event. The objective response rate was 19%. Median overall survival was 5.8 (95% confidence interval=1.9-9.8) months and median progression-free survival was 4.9 (95% confidence interval=2.7-7.1) months. CONCLUSION: The safety and efficacy of nivolumab in patients with CNS metastases appear to be similar to those seen in the overall EAP cohort in Italy.


Assuntos
Neoplasias Encefálicas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias do Sistema Nervoso Central/tratamento farmacológico , Nivolumabe/administração & dosagem , Adulto , Idoso , Barreira Hematoencefálica/efeitos dos fármacos , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias do Sistema Nervoso Central/patologia , Neoplasias do Sistema Nervoso Central/secundário , Estudos de Coortes , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias
13.
Anticancer Res ; 39(8): 4305-4314, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366522

RESUMO

BACKGROUND/AIM: Risk factors for chemotherapy-induced nausea and vomiting (CINV) with anthracycline-containing regimen for breast cancer patients remain unknown. The risk factors for CINV with FEC100 were investigated. PATIENTS AND METHODS: Data on CINV events and patient backgrounds of 180 patients were collected from the first cycle of FEC100 treatment. In this regimen, patients were administered various antiemetics (ADs). The combinations of ADs were classified into four categories, while body mass index (BMI) was stratified into three categories. Risk factors were selected based on patient characteristics and combination of ADs. Risks for CINV were analyzed by univariate and multivariate analyses. RESULTS: In the univariate analysis of nausea, BMI was a significant factor, while BMI and combination of ADs were significant in vomiting. In the multivariate analysis concerning nausea, BMI was a significant factor. In the analysis concerning vomiting, the combination of ADs and BMI were significant. CONCLUSION: BMI was the most important risk factor for nausea and vomiting, while the combination of ADs was for vomiting.


Assuntos
Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Náusea/epidemiologia , Vômito/epidemiologia , Adulto , Fatores Etários , Idoso , Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Quimioterapia Combinada/efeitos adversos , Feminino , Humanos , Quimioterapia de Indução/efeitos adversos , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Náusea/patologia , Fatores de Risco , Vômito/induzido quimicamente , Vômito/patologia
14.
Anticancer Res ; 39(8): 4363-4370, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366531

RESUMO

BACKGROUND/AIM: The aim of this study was to determine the clinical impact of low tie ligation (LT) of the inferior mesenteric artery (IMA) below the left colic artery versus high tie ligation (HT) at the origin of the IMA in patients undergoing rectal cancer surgery. PATIENTS AND METHODS: Between January 2005 and December 2017, all consecutive patients who underwent rectal resection for non-metastatic cancer were retrospectively included. Patients who had LT were compared to those who had HT. RESULTS: Overall, 200 patients were identified (101 HT and 99 LT). Postoperative 30-day mortality rate was nil in both groups. There were significantly higher severe postoperative complications in HT versus LT patients (Clavien-Dindo III-IV) (18.8% vs. 9.1%, p=0.048). Median follow-up was 38.5 months and overall survival at 5 years was 91.5% and there was no difference between the two groups (90.1% vs. 92.9%; HT vs. LT p=0.640). CONCLUSION: LT ligation of IMA significantly decreased the severe postoperative complication rate without affecting recurrence-free or overall survival.


Assuntos
Artéria Mesentérica Inferior/cirurgia , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias/patologia , Neoplasias Retais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Ligadura/métodos , Excisão de Linfonodo , Masculino , Artéria Mesentérica Inferior/patologia , Artéria Mesentérica Inferior/efeitos da radiação , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Recidiva Local de Neoplasia/radioterapia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/radioterapia , Neoplasias Retais/patologia , Neoplasias Retais/radioterapia , Reto/patologia , Reto/efeitos da radiação , Reto/cirurgia
15.
Anticancer Res ; 39(8): 4385-4391, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366534

RESUMO

BACKGROUND/AIM: To identify the reason for age and gender differences in cancer risk. PATIENTS AND METHODS: Age-standardized incidence rates for 17 cancer types were compared between genders in 50 populations. For each cancer type, the female/male rate ratio was listed in fixed order of population. Correlation coefficients were calculated between these lists in all pairwise combinations. For each population, the female/male rate ratio was listed in fixed order of cancer. Correlation coefficients were calculated between lists in all pairwise combinations. RESULTS: Only four pairwise combinations for cancer type gave a correlation coefficient greater than 0.700. For each population, the lowest correlation coefficient was 0.950. CONCLUSION: The reason for the differences in risk of cancer varies with each type of cancer, but remains fixed in all populations. It is suspected that species-specific genes control stem cell telomere dynamics in a fixed strategy at rates that vary among tissues and between genders.


Assuntos
Fatores Etários , Neoplasias/epidemiologia , Fatores Sexuais , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinogênese/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/classificação , Neoplasias/genética , Neoplasias/patologia , Fatores de Risco
16.
Ann Parasitol ; 65(2): 125-128, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31375025

RESUMO

The emergence of drug resistance among parasites is a side effect of the common use of chemotherapeutic agents in horses. Combating parasites typically involves routine deworming treatments twice a year (before and after the grazing season). However, in grazing farming this treatment may be insufficient. The aim of the study was to evaluate the effectiveness of programs to combat the invasion of strongyles (Strongylidae) in horses in the selected stables of Western Pomerania. Coprological examination was conducted in 85 horses from three stables located in Western Pomerania. Horses from all three stables remained in the pastures in the period from spring to late autumn, and deworming treatment was performed twice. The examination of horses has found nematodes of the family Strongylidae. The average prevalence of infection in horses in the studs tested was 36.16% for Strongylinae, and 58.49% for Cyathostominae. Administration of the medication twice did not eradicate the invasion of strongyles in the horses investigated. A significant reduction of strongyle invasion was observed directly after treatment, followed by rapid reinvasion. It appears necessary to monitor the effectiveness of deworming treatments by performing parasitological examination of feces. The participating stables should develop and implement new strategies to combat parasitic invasions in horses that will be adapted to the environmental conditions (the life cycle of parasites).


Assuntos
Anti-Helmínticos , Infecções Equinas por Strongyloidea , Animais , Anti-Helmínticos/administração & dosagem , Gerenciamento Clínico , Fezes/parasitologia , Cavalos , Contagem de Ovos de Parasitas , Prevalência , Infecções Equinas por Strongyloidea/tratamento farmacológico , Infecções Equinas por Strongyloidea/epidemiologia , Infecções Equinas por Strongyloidea/prevenção & controle , Strongyloidea , Resultado do Tratamento
17.
Ann Parasitol ; 65(2): 151-158, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31378013

RESUMO

Dogs which spend their lives in rural areas are primarily "sentinels" of animal herds. The dogs' close contact with humans and other animals obligates their caregivers to systematic deworming. The goal is to eliminate potential contamination with parasites which is mostly caused by direct contact or food and water contaminated with dogs' excretions. The aim of this study was to assess internal parasitic invasions on dogs from rural areas which spend most of their lives on farms. In total, 69 samples of fresh stools were collected for the analysis, including 26 from females and 43 from males. Coprological analysis of stool samples was accompanied with a survey where pet owners gave information on the number of visits to the veterinarian in suspicion of their dogs being infected with the parasites, the number of deworming treatments in the previous year and the dogs' behavior towards strangers. Also, the age, sex and body weight of dogs were recorded. Statistical analysis of the obtained results was performed using Statistica 12.5 with a medical set by Statsoft. In total, 29 (46,03%) out of 69 fecal samples contained developmental forms of parasites. Research has shown that animals most vulnerable to invasion were in the 6­10 years old age group, mostly males. In addition, the invasion of Toxocara canis roundworms occurred most frequently, as it was found in 12 (41.37%) animals (6 females and 6 males). The analysis of the questionnaires showed that the dog owners' knowledge of the risk of infection and parasites is unsatisfactory. This corresponded with a small number of deworming treatments. It is significant that nearly half of the owners never dewormed their dogs.


Assuntos
Doenças do Cão , Parasitos , Animais , Doenças do Cão/epidemiologia , Doenças do Cão/parasitologia , Cães , Fezes/parasitologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Parasitos/isolamento & purificação , População Rural/estatística & dados numéricos , Inquéritos e Questionários , Toxocara canis , Toxocaríase/epidemiologia
18.
BMJ ; 366: l4485, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31383632

RESUMO

Essential tremor is one of the most common movement disorders in adults and can affect both children and adults. An updated consensus statement in 2018 redefined essential tremor as an isolated action tremor present in bilateral upper extremities for at least three years. Tremor may also be present in other locations, commonly the neck or the vocal cords. Patients with additional neurologic symptoms are now categorized as "essential tremor plus." Additional clinical features associated with the condition include but are not limited to cognitive impairment, psychiatric disorders, and hearing loss. When treatment is needed, propranolol and primidone are considered first line treatments. Patients who are severely affected are often offered deep brain stimulation. Although the ventral intermediate nucleus of the thalamus is the traditional surgical target, the caudal zona incerta is also being studied as a possible superior alternative. Magnetic resonance imaging guided high intensity focused ultrasound is a newer surgical alternative that may be ideal for patients with substantial medical comorbidities. Current research explores novel oral treatments, chemodenervation, and noninvasive neuromodulation for treatment of essential tremor.


Assuntos
Tremor Essencial/complicações , Tremor Essencial/terapia , Antagonistas Adrenérgicos beta/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antipsicóticos/uso terapêutico , Estimulação Encefálica Profunda , Tremor Essencial/diagnóstico , Tremor Essencial/epidemiologia , Tratamento por Ondas de Choque Extracorpóreas , Humanos , Bloqueio Nervoso
19.
Zhonghua Fu Chan Ke Za Zhi ; 54(7): 445-451, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31365956

RESUMO

Objective: To assess the five-year effect of the transvaginal high uterosacral ligament suspension (HUS) with or without additional concomitant native-tissue anterior and (or) posterior repair in women suffering from middle compartment defect. Methods: A retrospective review of records identified 79 women who underwent transvaginal HUS with or without additional concomitant native-tissue anterior and (or) posterior repair from January 2007 to January 2018 in Fourth Medical Center, General Hospital of People's Liberation Army. The middle compartment defects were predominant in these patients with point C no less than point Ba or Bp if accompanied with anterior or posterior vaginal wall prolapse. Follow-up visits were performed 2,6 and 12 months after surgery and then annually. Anatomic results of pelvic organ prolapse (POP) was established by pelvic examination using pelvic organ prolapse quantitation system (POP-Q) staging. Funtional results were obtained by patient global impression of improvement (PGI-I) scale in POP, pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7). Surgical success required the fulfillment of all 3 criteria: (1) anterior or posterior vaginal wall prolapsed leading edge of 0 cm or less and apex of 1/2 total vaginal length or less; (2) the absence of POP symptoms as reported on the PFDI-20 question No.3 ( "Do you usually have a bulge or something falling out that you can see or feel in your vaginal area?" ); and (3) no prolapse reoperations or pessary use during the study period. Results: Of 79 women, 51(65%, 51/79) women completed the five-year follow-up during the study period. The median follow-up time was 5.2 years (2.8-8.3 years). The overall surgery success rate was 86% (44/51) according to above all 3 criteria. Prolapse recurrence rates were isolated anterior 8% (4/51), isolated apical 0, isolated posterior 2% (1/51) and multiple compartments 4% (2/51). Seven women (14%,7/51) developed anterior or posterior prolapse beyond the hymen with the leading edge≤1 cm. No apical prolapsed occurred. None of recurrent women underwent retreatment,including either surgery or pessary usage at last follow-up. The subjective satisfaction rate was 90% (46/51). There was a 1% (1/79) rate of intraoperative ureteral kinking and 3% (2/79) rate of postoperative morbidity. Conclusions: The transvaginal HUS for middle compartment defect offers good long-term anatomical results with excellent vault suspension. With additional concomitant native-tissue anterior and (or) posterior repair, it will be a reconstructive surgery for the majority of moderate-to-severe POP. It is minimal traumatic and worthy of being popularized for clinical application.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Ligamentos/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Vagina/cirurgia , China , Feminino , Humanos , Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico/patologia , Pessários , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Sacro/cirurgia , Slings Suburetrais , Resultado do Tratamento
20.
Anticancer Res ; 39(8): 4415-4421, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366539

RESUMO

BACKGROUND/AIM: The aim of this study was to evaluate the association between the frequency of daily tooth brushing and the development of any type of malignancy. PATIENTS AND METHODS: We conducted a retrospective longitudinal study, including all adult participants who underwent health check-ups. Primary outcome was the development of any type of malignancy, compared to the frequency of daily tooth brushing, adjusting for potential confounders. RESULTS: A total of 71,449 participants were included and 5,025 participants developed a certain type of malignancy. Not brushing everyday (Odds Ratio (OR)=1.52, 95% Confidence Interval (CI)=1.03-2.25) and brushing once a day (OR=1.25, 95%CI=1.16-1.35) had significantly higher ORs for the outcome than brushing after every meal, although those who brushed once to twice a day had significantly lower OR (OR=0.78, 95%CI=0.72-0.83). CONCLUSION: As the frequency of daily tooth brushing increased, except for brushing after every meal, the development of all types of malignancies decreased.


Assuntos
Neoplasias/epidemiologia , Escovação Dentária , Feminino , Humanos , Masculino , Neoplasias/classificação , Neoplasias/patologia , Estudos Retrospectivos , Inquéritos e Questionários
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA