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1.
J. Health NPEPS ; 6(1)jun. 2021.
Artigo em Português | LILACS | ID: biblio-1147344

RESUMO

Objetivo: analisar a letalidade da COVID-19 por sexo e idade entre os profissionais de saúde do Estado Pará, Brasil. Método: estudo epidemiológico e observacional, com utilização de dados secundários públicos sobre casos e óbitos acumulados por COVID-19 e dados demográficos, entre março e outubro de 2020. O número de casos e óbitos por COVID-19 ocorridos entre profissionais de saúde foram comparados em relação à idade e ao sexo pelo teste qui-quadrado, seguido por regressão logística pelo método Backward Stepwise de Wald. Resultados: entre os 15.332 casos confirmados de COVID-19, 70,3% eram do sexo feminino e 61,3% com idade entre 30 a 49 anos (39,2±11,6 anos). Registraram-se 97 óbitos, com uma taxa de letalidade de 0,6%. A probabilidade de óbito foi 52,8 vezes (20,7-134,5) e 4,0 vezes (2,5-6,2) maior entre jovens e homens quando comparados às demais notificações. Conclusão: a taxa de letalidade entre os profissionais de saúde é alta, especialmente entre homens jovens. Este é um alerta sobre os impactos da doença entre os trabalhadores da saúde e suscita ao poder público, especificamente ao setor saúde melhores condições de trabalho e políticas de saúde do trabalhador.(AU)


Objective: to analyze the lethality of COVID-19 by sex and age among health professionals in the state of Pará, Brazil. Method: epidemiological and observational study, using public secondary data on cases and deaths accumulated by COVID-19 and demographic data, between March and October 2020. The number of cases and deaths by COVID-19 that occurred among health professionals were compared in relation to age and sex using the chi-square test, followed by logistic regression using Wald's Backward Stepwise method. Results: among the 15,332 confirmed cases of COVID-19, 70.3% were female and 61.3% aged between 30 and 49 years (39.2 ± 11.6 years). 97 deaths were recorded, with a fatality rate of 0.6%. The probability of death was 52.8 times (20.7-134.5) and 4.0 times (2.5-6.2) higher among young men and men when compared to other reports. Conclusion: the lethality rate among health professionals is high, especially among young men. This is an alert about the impacts of the disease among health workers and raises the public authorities, specifically the health sector, better working conditions and worker health policies.(AU)


Objetivo: analizar la letalidad de COVID-19 por sexo y edad en profesionales de la salud en el estado de Pará, Brasil. Método: estudio epidemiológico y observacional, utilizando datos secundarios públicos sobre casos y defunciones acumulados por COVID-19 y datos demográficos, entre marzo y octubre de 2020. Se comparó el número de casos y defunciones por COVID-19 ocurridos entre profesionales de la salud en relación con edad y sexo usando la prueba de chi-cuadrado, seguida de regresión logística usando el método de Wald Backward Stepwise. Resultados: entre los 15.332 casos confirmados de COVID-19, el 70,3% eran mujeres y el 61,3% tenían entre 30 y 49 años (39,2 ± 11,6 años). Se registraron 97 muertes, con una tasa de letalidad del 0,6%. La probabilidad de muerte fue 52,8 veces (20,7-134,5) y 4,0 veces (2,5-6,2) más grande entre hombres y jóvenes en comparación con otros informes. Conclusión: la tasa de letalidad entre los profesionales de la salud es alta, especialmente entre los hombres jóvenes. Se trata de una alerta sobre los impactos de la enfermedad entre los trabajadores de la salud y plantea a las autoridades públicas, específicamente al sector salud, mejores condiciones laborales y políticas de salud laboral.(AU)


Assuntos
Humanos , Saúde do Trabalhador , Pessoal de Saúde/estatística & dados numéricos , Infecções por Coronavirus/mortalidade , Política de Saúde , Brasil , Estudos Epidemiológicos
3.
Goiânia; S.n; Fev. 05,2021. 22 p. ilus, tab, graf, mapas.(Boletim Epidemiológico Covid-19, 44).
Monografia em Português | Coleciona SUS, CONASS, SES-GO | ID: biblio-1147539

RESUMO

A Secretaria de Estado da Saúde de Goiás através da Superintendência de Vigilância em Saúde e Gerência de Vigilância Epidemiológica através deste Boletim informa que, Desde os primeiros registros de casos suspeitos de COVID-19 em Goiás em 04 de fevereiro de 2020 até 30 de janeiro de 2021 foram notificados à Vigilância Epidemiológica 1.008.969 casos. Nesta última semana epidemiológica analisada (SE 04/2021) houve a confirmação de 12.831 casos novos, representando um aumento de 40%, quando comparado ao número de casos confirmados na SE 03. Na última semana avaliada (SE 04/2021), 104 (42,3%) dos municípios goianos confirmaram novos casos de COVID-19. Goiânia, registrou o maior número, 85 casos, seguido por Catalão com 50, Morrinhos com 45 e Caldas Novas com 23. Do total de casos confirmados de COVID-19 até dia 30 de janeiro de 2021,10.819 (3,1%) eram trabalhadores da saúde. Ocorreu um aumento de 1,8% no registro de profissionais da saúde com relação a SE anterior. Na SE 04/2021 foi registrado 1 óbito de profissional de saúde. Na SE 04 foram registrados 295 novos casos que necessitaram de cuidados intensivos, um aumento de 0,6% em relação a SE 03 (293)


The State Department of Health of Goiás through the Superintendence of Health Surveillance and Management of Epidemiological Surveillance through this Bulletin informs that, Since the first records of suspected cases of COVID-19 in Goiás on February 4, 2020 to January 30, 2021 were notified to epidemiological surveillance 1,008,969 cases. In this last epidemiological week analyzed (SE 04/2021) there was confirmation of 12,831 new cases, representing an increase of 40%, when compared to the number of confirmed cases in SE 03. In the last week evaluated (SE 04/2021), 104 (42.3%) municipalities confirmed new cases of COVID-19. Goiânia, recorded the highest number, 85 cases, followed by Catalan with 50, Morrinhos with 45 and Caldas Novas with 23. Of the total number of confirmed cases of COVID-19 by January 30, 2021, 10.819 (3,1%) were health workers. There was a 1.8% increase in the registration of health professionals in relation to the previous SE. In SE 04/2021, 1 death of a health professional was recorded. In SE 04, 295 new cases requiring intensive care were recorded, an increase of 0.6% compared to SE 03 (293)


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias , Betacoronavirus , Brasil/epidemiologia , Incidência , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade
4.
Goiânia; S.n; Fev. 12, 2021. 23 p. ilus, tab, graf, mapas.(Boletim Epidemiológico Covid-19, 45).
Monografia em Português | Coleciona SUS, CONASS, SES-GO | ID: biblio-1147990

RESUMO

Secretaria de Estado da Saúde de Goiás através da Superintendência de Vigilância em Saúde e Gerência de Vigilância Epidemiológica apresenta as informações através deste Boletim, que desde os primeiros registros de casos suspeitos de COVID-19 em Goiás em 04 de fevereiro de 2020 até 06 de fevereiro de 2021 foram notificados à Vigilância Epidemiológica 1.037.296 casos. Desta data até 06 de fevereiro de 2021 foram confirmados 360.742 (34,8%) sendo 335.899 (93,1%) por critério laboratorial, 12.512 (3,5%) pelo critério clínico epidemiológico, 2.181 (0,6%) por critério clínico-imagem e 9.355 (2,6%) pelo critério clínico. Do total de notificados, 367.339 (35,4%) foram descartados e 309.215 (29,8%) continuam como suspeitos. Na última semana avaliada (SE 05/2021), 97 (39,4%) dos municípios goianos confirmaram novos casos de COVID-19. Goiânia registrou 200 casos, seguida por Inhumas com 46, Morrinhos com 31 e Rubiataba com 28. Na SE 05/2021 foram registrados 211 novos óbitos por COVID-19 distribuídos por 73 municípios (29,7% do total do estado). Um aumento de 2,9% em relação ao total de registros da SE anterior (205). Cento e noventa e quatro óbitos continuam em investigação. Na SE 05/2021 não foi registrado óbito de profissional de saúde. Na SE 05/2021 foram notificados 793 novos casos de SRAG por COVID-19, 3,7% a mais do que na SE 04 (765)


The State Department of Health of Goiás through the Superintendence of Health Surveillance and Management of Epidemiological Surveillance presents the information through this Bulletin, which from the first records of suspected cases of COVID-19 in Goiás on February 4, 2020 to February 6, 2021 were notified to epidemiological surveillance 1,037,296 cases. From this date until February 6, 2021 360,742 (34.8%) 335,899 (93.1%) by laboratory criterion, 12,512 (3.5%) by epidemiological clinical criterion, 2,181 (0.6%) by clinical-imaging criterion and 9,355 (2.6%) by clinical criterion. Of the total number of notified, 367,339 (35.4%) were discarded and 309,215 (29.8%) remain as suspects. In the last week evaluated (SE 05/2021), 97 (39.4%) municipalities confirmed new cases of COVID-19. Goiânia recorded 200 cases, followed by Inhumas with 46, Morrinhos with 31 and Rubiataba with 28. In SE 05/2021, 211 new deaths due to COVID-19 were recorded distributed in 73 municipalities (29.7% of the total state). An increase of 2.9% in relation to the total number of previous SE records (205). One hundred and ninety-four deaths are still under investigation. In SE 05/2021, no death of a health professional was recorded. In SE 05/2021, 793 new cases of SRAG were reported by COVID-19, 3.7% more than in SE 04 (765)


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias , Betacoronavirus , Brasil/epidemiologia , Incidência , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Monitoramento Epidemiológico
5.
Am J Epidemiol ; 190(2): 251-264, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33524120

RESUMO

Mortality assessment in cohorts with high numbers of persons lost to follow-up (LTFU) is challenging in settings with limited civil registration systems. We aimed to assess mortality in a clinical cohort (the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO)) of human immunodeficiency virus (HIV)-infected persons in rural Tanzania, accounting for unseen deaths among participants LTFU. We included adults enrolled in 2005-2015 and traced a nonrandom sample of those LTFU. We estimated mortality using Kaplan-Meier methods 1) with routinely captured data (method A), 2) crudely incorporating tracing data (method B), 3) weighting using tracing data to crudely correct for unobserved deaths among participants LTFU (method C), and 4) weighting using tracing data accounting for participant characteristics (method D). We investigated associated factors using proportional hazards models. Among 7,460 adults, 646 (9%) died, 883 (12%) transferred to other clinics, and 2,911 (39%) were LTFU. Of 2,010 (69%) traced participants, 325 (16%) were found: 131 (40%) had died and 130 (40%) had transferred. Five-year mortality estimates derived using the 4 methods were 13.1% (A), 16.2% (B), 36.8% (C), and 35.1% (D), respectively. Higher mortality was associated with male sex, referral as a hospital inpatient, living close to the index clinic, lower body mass index, more advanced World Health Organization HIV clinical stage, lower CD4 cell count, and less time since initiation of antiretroviral therapy. Adjusting for unseen deaths among participants LTFU approximately doubled the 5-year mortality estimates. Our approach is applicable to other cohort studies adopting targeted tracing.


Assuntos
Infecções por HIV/mortalidade , Perda de Seguimento , População Rural/estatística & dados numéricos , Adolescente , Adulto , Antirretrovirais/uso terapêutico , Índice de Massa Corporal , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Encaminhamento e Consulta , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Tanzânia/epidemiologia , Adulto Jovem
6.
JAMA ; 325(5): 445-453, 2021 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-33528535

RESUMO

Importance: After a decline in cardiovascular mortality for nonelderly US adults, recent stagnation has occurred alongside rising income inequality. Whether this is associated with underlying economic trends is unclear. Objective: To assess the association between changes in economic prosperity and trends in cardiovascular mortality in middle-aged US adults. Design, Setting, and Participants: Retrospective analysis of the association between change in 7 markers of economic prosperity in 3123 US counties and county-level cardiovascular mortality among 40- to 64-year-old adults (102 660 852 individuals in 2010). Exposures: Mean rank for change in 7 markers of economic prosperity between 2 time periods (baseline: 2007-2011 and follow-up: 2012-2016). A higher mean rank indicates a greater relative increase or lower relative decrease in prosperity (range, 5 to 92; mean [SD], 50 [14]). Main Outcomes and Measures: Mean annual percentage change (APC) in age-adjusted cardiovascular mortality rates. Generalized linear mixed-effects models were used to estimate the additional APC associated with a change in prosperity. Results: Among 102 660 852 residents aged 40 to 64 years living in these counties in 2010 (51% women), 979 228 cardiovascular deaths occurred between 2010 and 2017. Age-adjusted cardiovascular mortality rates did not change significantly between 2010 and 2017 in counties in the lowest tertile for change in economic prosperity (mean [SD], 114.1 [47.9] to 116.1 [52.7] deaths per 100 000 individuals; APC, 0.2% [95% CI, -0.3% to 0.7%]). Mortality decreased significantly in the intermediate tertile (mean [SD], 104.7 [38.8] to 101.9 [41.5] deaths per 100 000 individuals; APC, -0.4% [95% CI, -0.8% to -0.1%]) and highest tertile for change in prosperity (100.0 [37.9] to 95.1 [39.1] deaths per 100 000 individuals; APC, -0.5% [95% CI, -0.9% to -0.1%]). After accounting for baseline prosperity and demographic and health care-related variables, a 10-point higher mean rank for change in economic prosperity was associated with 0.4% (95% CI, 0.2% to 0.6%) additional decrease in mortality per year. Conclusions and Relevance: In this retrospective study of US county-level mortality data from 2010 to 2017, a relative increase in county-level economic prosperity was significantly associated with a small relative decrease in cardiovascular mortality among middle-aged adults. Individual-level inferences are limited by the ecological nature of the study.


Assuntos
Doenças Cardiovasculares/mortalidade , Emprego/tendências , Renda/tendências , Adulto , Emprego/economia , Emprego/estatística & dados numéricos , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Estudos Retrospectivos , Estados Unidos/epidemiologia
7.
JAMA Netw Open ; 4(2): e2037053, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33566109

RESUMO

Importance: Alpha 1-adrenergic receptor blocking agents (α1-blockers) have been reported to have protective benefits against hyperinflammation and cytokine storm syndrome, conditions that are associated with mortality in patients with coronavirus disease 2019 and other severe respiratory tract infections. However, studies of the association of α1-blockers with outcomes among human participants with respiratory tract infections are scarce. Objective: To examine the association between the receipt of α1-blockers and outcomes among adult patients hospitalized with influenza or pneumonia. Design, Setting, and Participants: This population-based cohort study used data from Danish national registries to identify individuals 40 years and older who were hospitalized with influenza or pneumonia between January 1, 2005, and November 30, 2018, with follow-up through December 31, 2018. In the main analyses, patients currently receiving α1-blockers were compared with those not receiving α1-blockers (defined as patients with no prescription for an α1-blocker filled within 365 days before the index date) and those currently receiving 5α-reductase inhibitors. Propensity scores were used to address confounding factors and to compute weighted risks, absolute risk differences, and risk ratios. Data were analyzed from April 21 to December 21, 2020. Exposures: Current receipt of α1-blockers compared with nonreceipt of α1-blockers and with current receipt of 5α-reductase inhibitors. Main Outcomes and Measures: Death within 30 days of hospital admission and risk of intensive care unit (ICU) admission. Results: A total of 528 467 adult patients (median age, 75.0 years; interquartile range, 64.4-83.6 years; 273 005 men [51.7%]) were hospitalized with influenza or pneumonia in Denmark between 2005 and 2018. Of those, 21 772 patients (4.1%) were currently receiving α1-blockers compared with a population of 22 117 patients not receiving α1-blockers who were weighted to the propensity score distribution of those receiving α1-blockers. In the propensity score-weighted analyses, patients receiving α1-blockers had lower 30-day mortality (15.9%) compared with patients not receiving α1-blockers (18.5%), with a corresponding risk difference of -2.7% (95% CI, -3.2% to -2.2%) and a risk ratio (RR) of 0.85 (95% CI, 0.83-0.88). The risk of ICU admission was 7.3% among patients receiving α1-blockers and 7.7% among those not receiving α1-blockers (risk difference, -0.4% [95% CI, -0.8% to 0%]; RR, 0.95 [95% CI, 0.90-1.00]). A comparison between 18 280 male patients currently receiving α1-blockers and 18 228 propensity score-weighted male patients currently receiving 5α-reductase inhibitors indicated that those receiving α1-blockers had lower 30-day mortality (risk difference, -2.0% [95% CI, -3.4% to -0.6%]; RR, 0.89 [95% CI, 0.82-0.96]) and a similar risk of ICU admission (risk difference, -0.3% [95% CI, -1.4% to 0.7%]; RR, 0.96 [95% CI, 0.83-1.10]). Conclusions and Relevance: This cohort study's findings suggest that the receipt of α1-blockers is associated with protective benefits among adult patients hospitalized with influenza or pneumonia.


Assuntos
Antagonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Mortalidade Hospitalar , Hospitalização , Inflamação/tratamento farmacológico , Influenza Humana/tratamento farmacológico , Unidades de Terapia Intensiva , Pneumonia/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , /patologia , Estudos de Coortes , Dinamarca , Feminino , Humanos , Inflamação/etiologia , Influenza Humana/mortalidade , Influenza Humana/patologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Pneumonia/mortalidade , Pneumonia/patologia , Pontuação de Propensão , Índice de Gravidade de Doença
8.
MMWR Morb Mortal Wkly Rep ; 70(6): 202-207, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33571180

RESUMO

Deaths involving synthetic opioids other than methadone (synthetic opioids), which largely consist of illicitly manufactured fentanyl; psychostimulants with abuse potential (e.g., methamphetamine); and cocaine have increased in recent years, particularly since 2013 (1,2). In 2019, a total of 70,630 drug overdose deaths occurred, corresponding to an age-adjusted rate of 21.6 per 100,000 population and a 4.3% increase from the 2018 rate (20.7) (3). CDC analyzed trends in age-adjusted overdose death rates involving synthetic opioids, psychostimulants, cocaine, heroin, and prescription opioids during 2013-2019, as well as geographic patterns in synthetic opioid- and psychostimulant-involved deaths during 2018-2019. From 2013 to 2019, the synthetic opioid-involved death rate increased 1,040%, from 1.0 to 11.4 per 100,000 age-adjusted (3,105 to 36,359). The psychostimulant-involved death rate increased 317%, from 1.2 (3,627) in 2013 to 5.0 (16,167) in 2019. In the presence of synthetic opioid coinvolvement, death rates for prescription opioids, heroin, psychostimulants, and cocaine increased. In the absence of synthetic opioid coinvolvement, death rates increased only for psychostimulants and cocaine. From 2018 to 2019, the largest relative increase in the synthetic opioid-involved death rate occurred in the West (67.9%), and the largest relative increase in the psychostimulant-involved death rate occurred in the Northeast (43.8%); these increases represent important changes in the geographic distribution of drug overdose deaths. Evidence-based prevention and response strategies including substance use disorder treatment and overdose prevention and response efforts focused on polysubstance use must be adapted to address the evolving drug overdose epidemic.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/mortalidade , Medicamentos Sintéticos/envenenamento , Geografia , Humanos , Mortalidade/tendências , Estados Unidos/epidemiologia
9.
Medicine (Baltimore) ; 100(6): e24613, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578570

RESUMO

ABSTRACT: Complete mesocolic excision (CME) is being performed more frequently and has recently become an established oncologic surgical method for right hemicolectomy. Despite its advantages, such as its association with early mobilization, a short hospital stay, early bowel movement, mild postoperative pain, and good cosmesis, CME is technically demanding and carries the risk of severe complications. This study aims to compare the clinical, pathological, and oncological results of open and laparoscopic right hemicolectomy with CME.The data of 76 patients who underwent right hemicolectomy with CME and high vascular ligation were reviewed retrospectively. The patients were divided into 2 groups according to whether the open or laparoscopic technique was used.Thirty-two patients underwent open right hemicolectomy, and 44 patients underwent laparoscopic right hemicolectomy. The 2 groups were similar in age, sex, American Society of Anesthesiologists class, abdominal surgical history, tumor localization, and operation time. No significant differences were found regarding the specimen length, tumor size, harvested lymph nodes, number of metastatic lymph nodes, or tumor grade. According to the Clavien-Dindo classification system, the laparoscopic group had significantly fewer complications than did the open group (11.4% vs 31.2%; P = .04). The open group had a longer postoperative hospital stay than did the laparoscopic hemicolectomy group (9.9 ±â€Š4.7 vs 7.2 ±â€Š3.1 days; P = .002). In addition, the groups were similar with respect to disease-free survival (P = .14) and overall survival (P = .06).The data in this study demonstrated that no differences exist between the open and laparoscopic techniques concerning pathological and oncological results. However, significantly fewer complications and a shorter length of hospital stay were observed in the laparoscopic group than in the open group. Laparoscopic right hemicolectomy with CME and central vascular ligation is a safe and feasible surgical procedure and should be considered the standard technique for right-sided colon cancer.


Assuntos
Colectomia/métodos , Neoplasias do Colo/cirurgia , Mesocolo/cirurgia , Idoso , Neoplasias do Colo/mortalidade , Feminino , Humanos , Laparoscopia , Ligadura , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Análise de Sobrevida , Turquia
10.
Medicine (Baltimore) ; 100(6): e24640, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578585

RESUMO

ABSTRACT: Lung cancer is the most common type of cancer worldwide with a high mortality rate. The specific tyrosine kinase inhibitors of epidermal growth factor receptor (EGFR) have made enormous strides in non-small-cell lung cancer (NSCLC) treatment. The novel systemic immune-inflammation index (SII), a parameter that integrates lymphocytes, neutrophils, and platelets, has been found to play the vital role of a marker for predicting survival and recrudescence in various tumors.We retrospectively examined 102 patients with different EGFR-mutant lung adenocarcinomas. Survival analysis was performed using the Kaplan-Meier method with the log-rank test. Cut-off points were identified using the receiver operating characteristic curves with the maximum log-rank values. The Cox proportional hazards regression, expressed as p value, hazards regression, and 95% confidence interval, was conducted to assess the prognostic values of variables in overall survival (OS)/ progression-free survival (PFS).Lower SII was associated with prolonged survival in patients with different EGFR mutant lung adenocarcinomas in both variable and multivariable analyses.SII before treatment was a powerful indicator for the PFS and OS of patients who received the first-generation EGFR-TKI.


Assuntos
Adenocarcinoma/mortalidade , Inflamação , Neoplasias Pulmonares/mortalidade , Recidiva Local de Neoplasia/mortalidade , Índice de Gravidade de Doença , Adenocarcinoma/sangue , Adenocarcinoma/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , China , Receptores ErbB/genética , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/genética , Masculino , Pessoa de Meia-Idade , Mutação , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/genética , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos
11.
Isr Med Assoc J ; 23(2): 116-120, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33595218

RESUMO

BACKGROUND: Extremely preterm infants are at high risk for mortality and morbidity including neurodevelopmental impairment from invasive Candida infections. Prophylactic antifungal therapy has been shown to reduce both colonization and invasive candidemia in high-risk preterm infants. Prophylactic treatment should be started in the first 48 to 72 hours after birth to extremely low birth weight (ELBW) infants (weighing ≤ 1000 grams at birth) or below 27 weeks gestation age with risk factors, or in any NICU with moderate (5-10%) or high (≥ 10%) rates of invasive candidiasis. Studies demonstrated the benefits of fluconazole prophylaxis regarding its safety of the short-term and long-term without the development of fungal resistance. Empiric antifungal therapy may lower mortality and improve outcomes.


Assuntos
Antifúngicos/administração & dosagem , Candidíase Invasiva/prevenção & controle , Doenças do Prematuro/prevenção & controle , Antifúngicos/efeitos adversos , Candidíase Invasiva/mortalidade , Farmacorresistência Fúngica , Fluconazol/administração & dosagem , Fluconazol/efeitos adversos , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/microbiologia , Doenças do Prematuro/mortalidade , Unidades de Terapia Intensiva Neonatal , Seleção de Pacientes
13.
Virol J ; 18(1): 33, 2021 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-33568204

RESUMO

PURPOSE: To investigate the predictive significance of different pneumonia scoring systems in clinical severity and mortality risk of patients with severe novel coronavirus pneumonia. MATERIALS AND METHODS: A total of 53 cases of severe novel coronavirus pneumonia were confirmed. The APACHE II, MuLBSTA and CURB-65 scores of different treatment methods were calculated, and the predictive power of each score on clinical respiratory support treatment and mortality risk was compared. RESULTS: The APACHE II score showed the largest area under ROC curve in both noninvasive and invasive respiratory support treatment assessments, which is significantly different from that of CURB-65. Further, the MuLBSTA score had the largest area under ROC curve in terms of death risk assessment, which is also significantly different from that of CURB-65; however, no difference was noted with the APACHE II score. CONCLUSION: For patients with COVID, the APACHE II score is an effective predictor of the disease severity and mortality risk. Further, the MuLBSTA score is a good predictor only in terms of mortality risk.


Assuntos
/diagnóstico , Pneumonia/diagnóstico , APACHE , Adulto , Idoso , Idoso de 80 Anos ou mais , /terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/mortalidade , Pneumonia/terapia , Pneumonia/virologia , Prognóstico , Curva ROC , Medição de Risco , Índice de Gravidade de Doença , Adulto Jovem
14.
Nat Commun ; 12(1): 1022, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33589584

RESUMO

Development of chemoresistance is the main reason for failure of clinical management of multiple myeloma (MM), but the genetic and epigenetic aberrations that interact to confer such chemoresistance remains unknown. In the present study, we find that high steroid receptor coactivator-3 (SRC-3) expression is correlated with relapse/refractory and poor outcomes in MM patients treated with bortezomib (BTZ)-based regimens. Furthermore, in immortalized cell lines, high SRC-3 enhances resistance to proteasome inhibitor (PI)-induced apoptosis. Overexpressed histone methyltransferase NSD2 in patients bearing a t(4;14) translocation or in BTZ-resistant MM cells coordinates elevated SRC-3 by enhancing its liquid-liquid phase separation to supranormally modify histone H3 lysine 36 dimethylation (H3K36me2) modifications on promoters of anti-apoptotic genes. Targeting SRC-3 or interference of its interactions with NSD2 using a newly developed inhibitor, SI-2, sensitizes BTZ treatment and overcomes drug resistance both in vitro and in vivo. Taken together, our findings elucidate a previously unrecognized orchestration of SRC-3 and NSD2 in acquired drug resistance of MM and suggest that SI-2 may be efficacious for overcoming drug resistance in MM patients.


Assuntos
Resistencia a Medicamentos Antineoplásicos/efeitos dos fármacos , Inibidores Enzimáticos/farmacologia , Regulação Neoplásica da Expressão Gênica , Histona-Lisina N-Metiltransferase/genética , Mieloma Múltiplo/tratamento farmacológico , Coativador 3 de Receptor Nuclear/genética , Proteínas Repressoras/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/farmacologia , Apoptose/efeitos dos fármacos , Apoptose/genética , Osso e Ossos/efeitos dos fármacos , Osso e Ossos/metabolismo , Osso e Ossos/patologia , Bortezomib/farmacologia , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Cromossomos Humanos Par 14 , Cromossomos Humanos Par 4 , Resistencia a Medicamentos Antineoplásicos/genética , Feminino , Histona-Lisina N-Metiltransferase/metabolismo , Histonas/genética , Histonas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/genética , Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/patologia , Coativador 3 de Receptor Nuclear/antagonistas & inibidores , Coativador 3 de Receptor Nuclear/metabolismo , Inibidores de Proteassoma/farmacologia , Recidiva , Proteínas Repressoras/metabolismo , Transdução de Sinais , Análise de Sobrevida , Translocação Genética , Ensaios Antitumorais Modelo de Xenoenxerto
15.
Nat Commun ; 12(1): 1039, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33589602

RESUMO

Recent studies have reported a variety of health consequences of climate change. However, the vulnerability of individuals and cities to climate change remains to be evaluated. We project the excess cause-, age-, region-, and education-specific mortality attributable to future high temperatures in 161 Chinese districts/counties using 28 global climate models (GCMs) under two representative concentration pathways (RCPs). To assess the influence of population ageing on the projection of future heat-related mortality, we further project the age-specific effect estimates under five shared socioeconomic pathways (SSPs). Heat-related excess mortality is projected to increase from 1.9% (95% eCI: 0.2-3.3%) in the 2010s to 2.4% (0.4-4.1%) in the 2030 s and 5.5% (0.5-9.9%) in the 2090 s under RCP8.5, with corresponding relative changes of 0.5% (0.0-1.2%) and 3.6% (-0.5-7.5%). The projected slopes are steeper in southern, eastern, central and northern China. People with cardiorespiratory diseases, females, the elderly and those with low educational attainment could be more affected. Population ageing amplifies future heat-related excess deaths 2.3- to 5.8-fold under different SSPs, particularly for the northeast region. Our findings can help guide public health responses to ameliorate the risk of climate change.


Assuntos
Doenças Cardiovasculares/mortalidade , Mudança Climática/mortalidade , Pneumopatias/mortalidade , Modelos Estatísticos , Saúde Pública/tendências , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Criança , Pré-Escolar , China/epidemiologia , Simulação por Computador , Escolaridade , Feminino , Temperatura Alta , Humanos , Lactente , Recém-Nascido , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida
16.
Medicine (Baltimore) ; 100(7): e24474, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607778

RESUMO

ABSTRACT: Sepsis is a life-threatening condition, and serum lactate levels have been used to predict patient prognosis. Studies on serum lactate levels in patients undergoing regular hemodialysis who have sepsis are limited. This study aimed to determine the predictive value of serum lactate levels for sepsis-related mortality among patients who underwent last hemodialysis at three different times before admission to the emergency department (ED).This retrospective cohort study was conducted from January 2007 to December 2013 in southern Taiwan. All hemodialysis patients with sepsis, receiving antibiotics within 24 hours of sepsis confirmation, admitted for at least 3 days, and whose serum lactate levels were known were examined to determine the difference in the serum lactate levels of patients who underwent last hemodialysis within 4 hours (Groups A), in 4-12 hours (Group B), and beyond 12 hours (Group C) before visited to the ED. All the continuous variables, categorical variables and mortality were compared by using Kruskal-Wallis test or Mann-Whitney test, the χ2 or Fisher exact tests, and multiple logistic regression model, respectively.A total of 490 patients were enrolled in the study, and 8.0% (39), 21.5% (84), and 74.9% (367) of the patients were in Group A, Group B and Group C, respectively; the serum lactate levels (2.91 vs 2.13 vs 2.79 mmol/L, respectively; P = .175) and 28-day in-hospital mortality (17.9% vs 14.6% vs 22.9%) showed no statistically significant difference between 3 groups. The association between serum lactate levels and 28-day in-hospital mortality was reliable in Group B (P = .002) and Group C (P < .001), but it was unreliable in Group A (P = .629).Serum lactate level has acceptable sensitivity in predicting 28-day in-hospital mortality among patients with sepsis who undergo last hemodialysis after 4 hours, but is not reliable when the last hemodialysis takes place within 4 hours.


Assuntos
Falência Renal Crônica/sangue , Falência Renal Crônica/mortalidade , Ácido Láctico/sangue , Diálise Renal/estatística & dados numéricos , Sepse/sangue , Sepse/mortalidade , Idoso , Serviço Hospitalar de Emergência , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Fatores de Tempo
17.
Hepatol Int ; 15(1): 202-212, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33548030

RESUMO

BACKGROUND: Infection with SARS-CoV-2 has been associated with liver dysfunction, aggravation of liver burden, and liver injury. This study aimed to assess the effects of liver injuries on the clinical outcomes of patients with COVID-19. METHODS: A total of 1520 patients with severe or critical COVID-19 from Huoshenshan Hospital, Wuhan, were enrolled. Chronic liver disease (CLD) was confirmed by consensus diagnostic criteria. Laboratory test results were compared between different groups. scRNA-seq data and bulk gene expression profiles were used to identify cell types associated with liver injury. RESULTS: A total of 10.98% of patients with severe or critical COVID-19 developed liver injury after admission that was associated with significantly higher rates of mortality (21.74%, p < 0.001) and intensive care unit admission (26.71%, p < 0.001). Pre-existing CLDs were not associated with a higher risk. However, fatty liver disease and cirrhosis were associated with higher risks, supported by evidences from single cell and bulk transcriptome analysis that showed more TMPRSS2+ cells in these tissues. By generating a model, we were able to predict the risk and severity of liver injury during hospitalization. CONCLUSION: We demonstrate that liver injury occurring during therapy as well as pre-existing CLDs like fatty liver disease and cirrhosis in patients with COVID-19 is significantly associated with the severity of disease and mortality, but the presence of other CLD is not associated. We provide a risk-score model that can predict whether patients with COVID-19 will develop liver injury or proceed to higher-risk stages during subsequent hospitalizations.


Assuntos
/complicações , Hepatopatias/diagnóstico , Hepatopatias/virologia , Adulto , Idoso , China , Cuidados Críticos , Oxigenação por Membrana Extracorpórea , Feminino , Hospitalização , Humanos , Hepatopatias/mortalidade , Masculino , Pessoa de Meia-Idade , Oxigenoterapia , Respiração Artificial , Fatores de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida
18.
Am J Public Health ; 111(3): 430-437, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33566641

RESUMO

The global influenza pandemic that emerged in 1918 has become the event of reference for a broad spectrum of policymakers seeking to learn from the past. This article sheds light on multiple waves of excess mortality that occurred in the US state of Michigan at the time with insights into how epidemics might evolve and propagate across space and time. We analyzed original monthly data on all-cause deaths by county for the 83 counties of Michigan and interpreted the results in the context of what is known about the pandemic. Counties in Michigan experienced up to four waves of excess mortality over a span of two years, including a severe one in early 1920. Some counties experienced two waves in late 1918 while others had only one. The 1920 wave propagated across the state in a different manner than the fall and winter 1918 waves. The twin waves in late 1918 were likely related to the timing of the statewide imposition of a three-week social distancing order. Michigan's experience holds sobering lessons for those who wish to understand how immunologically naïve populations encounter novel viral pathogens.


Assuntos
/epidemiologia , Influenza Pandêmica, 1918-1919/história , Influenza Pandêmica, 1918-1919/mortalidade , Causas de Morte , História do Século XX , História do Século XXI , Humanos , Michigan/epidemiologia , Pandemias
20.
Khirurgiia (Mosk) ; (2): 27-31, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570351

RESUMO

OBJECTIVE: To compare the most common prognostic systems in patients with peritonitis. MATERIAL AND METHODS: The study included 352 patients with secondary peritonitis. At admission, sepsis was diagnosed in 15 (4.3%) patients, septic shock - in 4 (1.1%) cases. Mortality was associated with the following main causes: purulent intoxication and/or sepsis - 51 cases (87.9%), cancer-induced intoxication - 4 (6.9%) cases, acute cardiovascular failure - 3 cases (5.2%). We analyzed the efficacy of Manheim Peritoneal Index (MPI), WSES prognostic score, APACHE-II scale, gSOFA score and Peritonitis Prediction System (PPS) developed by the authors. RESULTS: Age of a patient, malignant tumor, exudate nature, sepsis (septic shock) and organ failure not associated with peritonitis are the most important criteria in predicting fatal outcome. ROC analysis was used to assess prognostic value of various prediction systems. Standard error was less than 0.05 for all scales. Therefore, all prediction systems can be considered accurate for prediction of mortality in patients with peritonitis. CONCLUSION: PPS (AUC 0.942) has the greatest accuracy in predicting fatal outcome in patients with advanced secondary peritonitis, APACHE II (AUC 0.840) - minimum accuracy. MPI had predictive accuracy > 90% too.


Assuntos
Peritonite , Sepse , Índice de Gravidade de Doença , APACHE , Humanos , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/mortalidade , Prognóstico , Curva ROC , Medição de Risco , Sepse/diagnóstico , Sepse/etiologia , Sepse/mortalidade , Choque Séptico/diagnóstico , Choque Séptico/etiologia , Choque Séptico/mortalidade
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