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1.
Medicine (Baltimore) ; 99(35): e21897, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871921

RESUMO

Allogeneic red blood cell transfusion (ABT) is 1 of the poor prognostic factors for morbidity and mortality in patients with hip fracture, particularly among elderly patients. This study aimed to investigate the risk factors for ABT and 1-year mortality in elderly patients undergoing surgery for femoral neck fracture.A total of 225 elderly patients who underwent femoral neck fracture surgery between May 2013 and November 2015 at a tertiary medical center were retrospectively recruited. Medical records were analyzed.The median patient age was 80 years and 28.4% were men. A total of 113 patients received ABT (50.2%). Multivariate logistic regression analysis showed that female sex (odds ratio [OR] 2.606, 95% confidence interval [CI] 1.283-5.295, P = .008), malignancy (OR 5.098, 95% CI 1.725-15.061, P = .003), chronic kidney disease stage ≥ 3 (OR 3.258, 95% CI 1.603-6.622, P = .001), and anemia (hemoglobin < 12 g/dL) (OR 4.684, 95% CI 2.230-9.837, P < .001) were significantly associated with ABT. The 1-year mortality rate after surgery was 15.1%. Male sex (OR 2.477, 95% CI 1.101-5.575, P = .028), ABT (OR 2.367, 95% CI 1.036-5.410, P = .041), and intensive care unit admission (OR 5.564, 95% CI 1.457-21.249, P = .012) were significantly associated with 1-year mortality.In this study, underlying comorbidities such as chronic kidney disease and malignancy were associated with ABT. Furthermore, ABT was a significant independent risk factor for 1-year mortality. These findings suggest that underlying comorbidities and the need for ABT should be considered in the risk assessment of elderly patients with femoral neck fracture to improve the outcomes after surgery.


Assuntos
Causas de Morte , Transfusão de Eritrócitos , Fraturas do Colo Femoral/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anemia/complicações , Feminino , Fraturas do Colo Femoral/complicações , Humanos , Masculino , Modelos Estatísticos , Neoplasias/complicações , Insuficiência Renal Crônica/complicações , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais
2.
PLoS One ; 15(8): e0238077, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822409

RESUMO

BACKGROUND: Malaria in pregnancy remains a major public health problem in Africa and Ghana and has been associated with a variety of pregnancy-related adverse complications. The development of effective and timely health policies for the prevention and control of malaria and anemia in pregnancy; requires current and consistent data on the prevalence and risk factors. We report the prevalence and risk factors of malaria and anemia from three major hospitals across three regions in Ghana. METHODS: This multicenter cross-sectional study comprising a total of 628 pregnant women was conducted at the antenatal care units of the Achimota Hospital in the Greater Accra Region (n = 199), St. Michael's Hospital in the Ashanti Region (n = 221), and Effia Nkwanta Regional Hospital in the Western Region (n = 211). Questionnaires were administered to obtain socio-demographic, obstetrics and clinical data. Venous blood, stool and urine samples were collected for hematological profile and parasite identification using microscopy. Risk factors were evaluated using logistic regression models. RESULTS: The overall prevalence of P. falciparum malaria was 8.9%. Factors independently associated with malaria were self-reported mosquito exposure (moderate exposure: aOR = 3.11, 95% CI (1.12-8.61) and severe exposure: aOR = 10.46, 95% CI (3.86-28.34)) and non-use mosquito repellents (aOR = 3.29, 95% CI (1.70-6.39)). Multiparty (parity of 2: aOR = 0.19, 95% CI (0.05-0.70) and parity ≥3: aOR = 0.11, 95% CI (0.03-0.45)) and age (20-30 years old: aOR = 0.22, 95% CI (0.09-0.56)) reduced the odds of infection. The overall prevalence of anemia was 42.4%. The prevalence of mild, moderate and severe anemia were 35.7%, 6.1% and 0.6%, respectively. The use of water other than purified water (tap water: aOR = 3.05, 95% CI (2.06-4.51) and well water: aOR = 2.45, 95% CI (1.35-4.44)), increasing gestational age (second trimester: aOR = 2.05, 95% CI (1.41-2.97) and third trimester: aOR = 7.20, 95% CI (3.06-16.92)) and malaria (aOR = 2.40, 95% CI (1.27-4.53)) were independent risk factors for anemia. CONCLUSIONS: Although the prevalence of malaria is relatively low, that of anemia remains high. We recommend increasing efforts to make ITNs more available to strengthen malaria prevention. Public health education programs could help improve uptake and proper use of ITNs. To help reduce anemia in pregnancy, women should be empowered economically and interventions that reduce malnutrition should be encouraged. Women should be educated on early initiation of antenatal care to enhance surveillance, identification and treatment of anemia.


Assuntos
Anemia/diagnóstico , Malária/diagnóstico , Adulto , Anemia/complicações , Anemia/epidemiologia , Anemia/patologia , Estudos Transversais , Feminino , Idade Gestacional , Gana/epidemiologia , Humanos , Modelos Logísticos , Malária/complicações , Malária/epidemiologia , Controle de Mosquitos/estatística & dados numéricos , Razão de Chances , Gravidez , Gestantes , Cuidado Pré-Natal , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
3.
PLoS One ; 15(7): e0236828, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735573

RESUMO

Idiopathic intracranial hypertension (IIH) mostly affects obese women in childbearing age, leading to frustrating headache and permanent visual impairment. The exact etiology of this condition is poorly understood, and the population at risk and clinical presentation seems to be homogeneous. However, little attention has been paid to the clinical features of IIH patients with anemia. We herein performed a retrospective observational study by using the data of patients with presumed IIH who were referred to the neurology department of Beijing Tongren Hospital from January 2014 to August 2019 to describe the clinical features and radiological findings in patients with IIH and anemia, and compared these with those without anemia. The patients were divided into two groups based on the presence of anemic diseases. Clinical data including demographic characteristics, clinical features, past medical history, laboratory and neuroradiological findings, diagnoses, treatments and prognosis of these patients were reviewed and compared in both the groups. A total of 153 patients with IIH were enrolled, which included 22 cases with anemia (mean age, 33.23±9.68 years; 19 [86.36%] female) and 131 cases without anemia (mean age 37.11±11.56 years; 97 [74.05%] female). In the anemia group, 19/22 cases had iron deficiency anemia and 3/22 had renal anemia. Compared with patients in the non-anemia group, IIH patients with anemia had a shorter disease course, and tended to present pulsatile tinnitus and transverse sinus stenosis (TSS), faster and better prognosis after treatments for correcting anemia and reducing intracranial pressure. Our findings highlighted the importance of obtaining full blood counts in IIH patients with subacute onset, and provided appropriate and prompt treatments if proven anemic in order to bring better outcomes.


Assuntos
Anemia/complicações , Hipertensão Intracraniana/complicações , Adulto , Anemia Ferropriva , Constrição Patológica , Feminino , Cefaleia , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Zumbido , Baixa Visão , Adulto Jovem
4.
PLoS Negl Trop Dis ; 14(7): e0008466, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32687495

RESUMO

Malaria caused by Plasmodium vivax is a highly prevalent infection world-wide, that was previously considered mild, but complications such as anemia have been highly reported in the past years. In mice models of malaria, anti-phosphatidylserine (anti-PS) autoantibodies, produced by atypical B-cells, bind to uninfected erythrocytes and contribute to anemia. In human patients with P. falciparum malaria, the levels of anti-PS, atypical B-cells and anemia are strongly correlated to each other. In this study, we focused on assessing the relationship between autoantibodies, different B-cell populations and hemoglobin levels in two different cohorts of P. vivax patients from Colombia, South America. In a first longitudinal cohort, our results show a strong inverse correlation between different IgG autoantibodies tested (anti-PS, anti-DNA and anti-erythrocyte) and atypical memory B-cells (atMBCs) with hemoglobin in both P. vivax and P. falciparum patients over time. In a second cross-sectional cohort, we observed a stronger relation between hemoglobin levels, atMBCs and autoantibodies in complicated P. vivax patients compared to uncomplicated ones. Altogether, these data constitute the first evidence of autoimmunity associating with anemia and complicated P. vivax infections, suggesting a role for its etiology through the expansion of autoantibody-secreting atMBCs.


Assuntos
Anemia/complicações , Autoanticorpos/sangue , Linfócitos B/classificação , Malária Vivax/sangue , Malária Vivax/complicações , Anemia/sangue , Anemia/imunologia , Hemoglobinas/metabolismo , Humanos , Malária Falciparum/sangue , Malária Falciparum/complicações , Malária Falciparum/imunologia , Fosfatidilserinas/imunologia , Plasmodium falciparum , Plasmodium vivax
5.
PLoS One ; 15(7): e0236132, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687544

RESUMO

BACKGROUND: The Japan Chronic Kidney Disease Database (J-CKD-DB) is a nationwide clinical database of patients with chronic kidney disease (CKD) based on electronic health records. The objective of this study was to assess the prevalence of anemia and the utilization rate of erythropoiesis-stimulating agents (ESAs) in Japanese patients with CKD. METHODS: In total, 31,082 adult outpatients with estimated glomerular filtration rates of 5-60 ml/min/1.73 m2 in seven university hospitals were included this analysis. The proportions of patients with CKD stages G3b, G4, and G5 were 23.5%, 7.6%, and 3.1%, respectively. RESULTS: The mean (standard deviation) hemoglobin level of male patients was 13.6 (1.9) g/dl, which was significantly higher than the mean hemoglobin level of female patients (12.4 (1.6) g/dl). The mean (standard deviation) hemoglobin levels were 11.4 (2.1) g/dl in patients with CKD stage G4 and 11.2 (1.8) g/dl in patients with CKD stage G5. The prevalences of anemia were 40.1% in patients with CKD stage G4 and 60.3% in patients with CKD stage G5. Logistic regression analysis showed that diagnoses of CKD stage G3b (adjusted odds ratio [95% confidence interval]: 2.32 [2.09-2.58]), G4 (5.50 [4.80-6.31]), and G5 (9.75 [8.13-11.7]) were associated with increased prevalence of anemia. The utilization rates of ESAs were 7.9% in patients with CKD stage G4 and 22.4% in patients with CKD stage G5. CONCLUSIONS: We determined the prevalence of anemia and utilization rate of ESAs in Japanese patients with CKD using data from a nationwide cohort study.


Assuntos
Anemia/complicações , Anemia/epidemiologia , Bases de Dados Factuais , Insuficiência Renal Crônica/complicações , Anemia/metabolismo , Anemia/fisiopatologia , Estudos de Coortes , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Hemoglobinas/metabolismo , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Prevalência
6.
Anaesthesia ; 75(8): 1050-1058, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32500530

RESUMO

In the UK, tranexamic acid is recommended for all surgical procedures where expected blood loss exceeds 500 ml. However, the optimal dose, route and timing of administration are not known. This study aimed to evaluate current practice of peri-operative tranexamic acid administration. Patients undergoing primary total hip arthroplasty, total knee arthroplasty or unicompartmental knee arthroplasty during a 2-week period were eligible for inclusion in this prospective study. The primary outcome was the proportion of patients receiving tranexamic acid in the peri-operative period. Secondary outcomes included: dose, route and timing of tranexamic acid administration; prevalence of pre- and postoperative anaemia; estimated blood loss; and red blood cell transfusion rates. In total, we recruited 1701 patients from 56 NHS hospitals. Out of these, 1523 (89.5%) patients received tranexamic acid and of those, 1052 (69.1%) received a single dose of 1000 mg intravenously either pre- or intra-operatively. Out of the 1701 patients, 571 (33.6%) and 1386 (81.5%) patients were anaemic (haemoglobin < 130 g.l-1 ) in the pre- and postoperative period, respectively. Mean (SD) estimated blood loss for all included patients was 792 (453) ml and 54 patients (3.1%) received a red blood cell transfusion postoperatively. The transfusion rate for patients with pre-operative anaemia was 6.5%, compared with 1.5% in patients without anaemia. Current standard of care in the UK is to administer 1000 mg of tranexamic intravenously either pre- or intra-operatively. Approximately one-third of patients present for surgery with anaemia, although the overall red blood cell transfusion rate is low. These data provide useful comparators when assessing the efficacy of tranexamic acid and other patient blood management interventions in future studies.


Assuntos
Antifibrinolíticos/uso terapêutico , Artroplastia de Substituição/métodos , Ácido Tranexâmico/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Anemia/complicações , Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Estudos de Coortes , Transfusão de Eritrócitos , Feminino , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos
8.
Rinsho Ketsueki ; 61(5): 455-461, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32507808

RESUMO

An 81-year-old female was referred to our hospital with progressive neutropenia and anemia of unknown etiology. We performed a bone marrow biopsy which was notable for hypercellularity, multinucleated megakaryocytes and hypo-granular neutrophils with 2.6% blasts. A diagnosis of myelodysplastic syndrome with multilineage dysplasia (MDS-MLD) was made. Karyotype analysis revealed a t (9;22)(q34;q11.2) BCR-ABL1 fusion with no additional chromosomal abnormalities. BCR-ABL1 was also detected in transcripts from peripheral blood cells as well as in polynuclear leukocytes via FISH. Within one year, her peripheral blood neutrophil count had declined to 403/µl; further analysis was notable for increasing dysplasia including enlarged platelets and hypo-granular neutrophils. Platelet counts gradually increased over time and reached 100×104/µl. A second bone marrow examination revealed similar cell morphology and the BCR-ABL1 translocation. Her condition deteriorated and blood transfusions were required. Treatment with low doses of the tyrosine kinase inhibitor (TKI), imatinib mesylate (100 mg), was initiated. Thereafter, both the neutropenia and anemia resolved gradually, platelet counts returned to normal levels, and dysplasia eventually disappeared. Detection of the BCR-ABL fusion in mRNA decreased to < 0.0007% (IS%) after 16 months of treatment. Several cases of BCR-ABL1-positive myelodysplastic syndrome treated with TKIs have been reported. Our results suggest that complete hematologic recovery in response to imatinib mesylate suggests a critical role for the BCR-ABL1 fusion in the pathogenesis of this disease.


Assuntos
Anemia , Síndromes Mielodisplásicas , Neutropenia , Idoso de 80 Anos ou mais , Anemia/complicações , Feminino , Proteínas de Fusão bcr-abl , Humanos , Mesilato de Imatinib , Síndromes Mielodisplásicas/complicações , Síndromes Mielodisplásicas/tratamento farmacológico , Neutropenia/complicações , Inibidores de Proteínas Quinases
10.
PLoS One ; 15(6): e0234768, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555694

RESUMO

BACKGROUND: There is a growing interest in the life course approach for the prevention, early detection and subsequent management of morbidity in women of reproductive age to ensure optimal health and nutrition when they enter pregnancy. Reliable estimates of such morbidities are lacking. We report the prevalence of health or nutrition-related morbidities, specifically, anemia, undernutrition, overweight and obesity, sexually transmitted infections (STIs) or reproductive tract infections (RTIs), diabetes or prediabetes, hypothyroidism, hypertension, and depressive symptoms, during the preconception period among women aged 18 to 30 years. METHODS: A cross-sectional study was conducted among 2000 nonpregnant married women aged 18 to 30 years with no or one child who wished to have more children in two low- to middle-income urban neighborhoods in Delhi, India, in the context of a randomized controlled trial. STIs and RTIs were measured by symptoms and signs, blood pressure by a digital device, height by stadiometer and weight by a digital weighing scale. A blood specimen was taken to screen for anemia, diabetes, thyroid disorders and syphilis. Maternal depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Multivariable logistic regression analysis was performed to identify sociodemographic factors associated with individual morbidity. RESULTS: Overall, 58.7% of women were anemic; 16.5%, undernourished; 26%, overweight or obese; 13.2%, hypothyroid; and 10.5% with both symptoms and signs of STIs/RTIs. There was an increased risk of RTI/STI symptoms and signs in undernourished women and an increased risk of diabetes or prediabetes in overweight or obese women. An increased risk of undernutrition was also observed in women from lower categories of wealth quintiles. A decreased risk of moderate to severe anemia was seen in overweight women and those who completed at least secondary education. CONCLUSIONS: Our findings show a high burden of undernutrition, anemia, RTIs, hypothyroidism and prediabetes among women in the study. This information will aid policymakers in planning special programs for women of reproductive age.


Assuntos
Infecções do Sistema Genital/patologia , Doenças Sexualmente Transmissíveis/patologia , Adolescente , Adulto , Anemia/complicações , Anemia/patologia , Estudos Transversais , Diabetes Mellitus Tipo 2/etiologia , Feminino , Humanos , Hipotireoidismo/patologia , Índia/epidemiologia , Morbidade , Obesidade/complicações , Obesidade/patologia , Prevalência , Infecções do Sistema Genital/epidemiologia , Fatores de Risco , Índice de Gravidade de Doença , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto Jovem
11.
Br J Haematol ; 189(4): 635-639, 2020 05.
Artigo em Inglês | MEDLINE | ID: covidwho-116400

RESUMO

With the developing COVID-19 pandemic, patients with inherited anaemias require specific advice regarding isolation and changes to usual treatment schedules. The National Haemoglobinopathy Panel (NHP) has issued guidance on the care of patients with sickle cell disease, thalassaemia, Diamond Blackfan anaemia (DBA), congenital dyserythropoietic anaemia (CDA), sideroblastic anaemia, pyruvate kinase deficiency and other red cell enzyme and membrane disorders. Cascading of accurate information for clinicians and patients is paramount to preventing adverse outcomes, such as patients who are at increased risk of fulminant bacterial infection due to their condition or its treatment erroneously self-isolating if their fever is mistakenly attributed to a viral cause, delaying potentially life-saving antibiotic therapy. Outpatient visits should be minimised for most patients, however some, such as first transcranial dopplers for children with sickle cell anaemia should not be delayed as known risk of stroke will outweigh the unknown risk from COVID-19 infection. Blood transfusion programmes should be continued, but specific changes to usual clinical pathways can be instituted to reduce risk of patient exposure to COVID-19, as well as contingency planning for possible reductions in blood available for transfusions. Bone marrow transplants for these disorders should be postponed until further notice. With the current lack of evidence on the risk and complications of COVID-19 infection in these patients, national data collection is ongoing to record outcomes and eventually to identify predictors of disease severity, particularly important if further waves of infection travel through the population.


Assuntos
Anemia/complicações , Anemia/terapia , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Transfusão de Sangue , Transplante de Medula Óssea , Infecção Hospitalar/prevenção & controle , Humanos
12.
J Med Virol ; 92(7): 915-918, 2020 07.
Artigo em Inglês | MEDLINE | ID: covidwho-47259

RESUMO

An 80-year-old man with multiple comorbidities presented to the emergency department with tachypnea, tachycardia, fever, and critically low O2 saturation and definitive chest computerized tomography scan findings in favor of COVID-19 and positive PCR results in 48 hours. He received antiviral treatment plus recombinant human erythropoietin (rhEPO) due to his severe anemia. After 7 days of treatment, he was discharged with miraculous improvement in his symptoms and hemoglobin level. We concluded that rhEPO could attenuate respiratory distress syndrome and confront the severe acute respiratory syndrome coronavirus 2 virus through multiple mechanisms including cytokine modulation, antiapoptotic effects, leukocyte release from bone marrow, and iron redistribution away from the intracellular virus.


Assuntos
Anemia/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Eritropoetina/uso terapêutico , Febre/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Taquicardia/tratamento farmacológico , Taquipneia/tratamento farmacológico , Idoso de 80 Anos ou mais , Anemia/complicações , Anemia/diagnóstico , Anemia/virologia , Antivirais/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/genética , Betacoronavirus/patogenicidade , Biomarcadores/sangue , Técnicas de Laboratório Clínico/métodos , Convalescença , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Estado Terminal , Febre/complicações , Febre/diagnóstico , Febre/virologia , Humanos , Irã (Geográfico) , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , RNA Viral/sangue , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Taquicardia/complicações , Taquicardia/diagnóstico , Taquicardia/virologia , Taquipneia/complicações , Taquipneia/diagnóstico , Taquipneia/virologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
Bone Joint J ; 102-B(4): 485-494, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228085

RESUMO

AIMS: The aim of this study was to determine the impact of the severity of anaemia on postoperative complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: A retrospective cohort study was conducted using the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database. All patients who underwent primary TKA or THA between January 2012 and December 2017 were identified and stratified based upon hematocrit level. In this analysis, we defined anaemia as packed cell volume (Hct) < 36% for women and < 39% for men, and further stratified anaemia as mild anaemia (Hct 33% to 36% for women, Hct 33% to 39% for men), and moderate to severe (Hct < 33% for both men and women). Univariate and multivariate analyses were used to evaluate the incidence of multiple adverse events within 30 days of arthroplasty. RESULTS: Following adjustment, patients in the THA cohort with moderate to severe anaemia had an increased odds of 6.194 (95% confidence interval (CI) 5.679 to 6.756; p < 0.001) for developing any postoperative complication. Following adjustment, patients in the TKA cohort with moderate to severe anaemia had an increased odds of 5.186 (95% CI 4.811 to 5.590; p < 0.001) for developing any postoperative complication. Among both cohorts, as severity increased, there was an increased risk of postoperative complications. CONCLUSION: Preoperative anaemia is a risk factor for complications following primary arthroplasty. There is a significant relationship between the severity of anaemia and the odds of postoperative complications. Patients who had moderate to severe anaemia were at increased risk of developing postoperative complications relative to patients with mild anaemia. When considering elective primary THA or TKA in a moderately or severely anaemic patient, surgeons should strongly consider correcting anaemia prior to surgery if possible. Cite this article: Bone Joint J 2020;102-B(4):485-494.


Assuntos
Anemia/complicações , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Bases de Dados Factuais , Feminino , Hematócrito , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
14.
BMC Infect Dis ; 20(1): 280, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32295546

RESUMO

BACKGROUND: Fatigue is one of the most common and devastating Human Immuno-deficiency Virus (HIV) - related symptoms, with a varying prevalence in different study areas. In Ethiopia, there is a paucity of information on the magnitude and factors associated with fatigue among HIV/Acquired Immune Deficiency Syndrome (AIDS) patients. This may lead to under-diagnosis and eventually under-management of the symptom. METHODS: Institution based cross-sectional study design was conducted among 609 HIV/AIDS patients who were selected by using a systematic random sampling method. Data were collected by using interviewer administered structured questionnaire. Level of fatigue was measured by Fatigue Severity Scale. RESULTS: The prevalence of fatigue was found to be 51.7%. The factors associated with fatigue were: Parity [AOR = 2.01; 95% CI: 1.09-3.71], CD4 count 200-499 cells/mm3 [AOR = 2.81; 95% CI: 1.58-4.99], anemia [AOR = 4.90 95% CI: 2.40-9.97], co-morbidities [AOR = 3.65; 95% CI: 1.71-7.78], depression [AOR = 3.68 95% CI: 1.99-6.79], not being physically active [AOR = 3.20 95% CI: 1.50-6.81], clinical stage II or IV HIV [AOR = 3.11; 95% CI: 1.51-6.40] and [AOR = 4.08; 95% CI: 1.37-12.14], respectively. CONCLUSION: The finding of this study revealed that fatigue is a common health problem among adult People Living with HIV (PLHIV). Factors associated with fatigue included: Parity, CD4 count 200-499 cells/mm3, Clinical Stage II or IV HIV, anemia, co-morbidities, depression, and not being physically active. The health care service needs to address the predisposing factors by provision integrated care including timely detection and treatment of comorbidities, mental health problems, and promote physical activity to slow down disease progression and then reduce exposure to fatigue.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/epidemiologia , Antirretrovirais/uso terapêutico , Fadiga/epidemiologia , Síndrome de Imunodeficiência Adquirida/patologia , Adulto , Anemia/complicações , Contagem de Linfócito CD4 , Comorbidade , Estudos Transversais , Depressão/complicações , Etiópia/epidemiologia , Fadiga/etiologia , Fadiga/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paridade , Gravidez , Prevalência , Comportamento Sedentário , Índice de Gravidade de Doença , Inquéritos e Questionários
15.
Br J Haematol ; 189(4): 635-639, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32330288

RESUMO

With the developing COVID-19 pandemic, patients with inherited anaemias require specific advice regarding isolation and changes to usual treatment schedules. The National Haemoglobinopathy Panel (NHP) has issued guidance on the care of patients with sickle cell disease, thalassaemia, Diamond Blackfan anaemia (DBA), congenital dyserythropoietic anaemia (CDA), sideroblastic anaemia, pyruvate kinase deficiency and other red cell enzyme and membrane disorders. Cascading of accurate information for clinicians and patients is paramount to preventing adverse outcomes, such as patients who are at increased risk of fulminant bacterial infection due to their condition or its treatment erroneously self-isolating if their fever is mistakenly attributed to a viral cause, delaying potentially life-saving antibiotic therapy. Outpatient visits should be minimised for most patients, however some, such as first transcranial dopplers for children with sickle cell anaemia should not be delayed as known risk of stroke will outweigh the unknown risk from COVID-19 infection. Blood transfusion programmes should be continued, but specific changes to usual clinical pathways can be instituted to reduce risk of patient exposure to COVID-19, as well as contingency planning for possible reductions in blood available for transfusions. Bone marrow transplants for these disorders should be postponed until further notice. With the current lack of evidence on the risk and complications of COVID-19 infection in these patients, national data collection is ongoing to record outcomes and eventually to identify predictors of disease severity, particularly important if further waves of infection travel through the population.


Assuntos
Anemia/complicações , Anemia/terapia , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Transfusão de Sangue , Transplante de Medula Óssea , Infecção Hospitalar/prevenção & controle , Humanos
16.
J Clin Psychiatry ; 81(2)2020 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-32237297

RESUMO

Many observational studies have found an association between antidepressant drug prescription during pregnancy and neurodevelopmental disorders such as autism spectrum disorder, attention-deficit/hyperactivity disorder, and intellectual disability. The results of such studies cannot be considered conclusive because of the possible presence of inadequately measured, unmeasured, and unknown confounds. In this context, maternal anemia before or at but not after 30 weeks of gestation was recently associated with an increased risk of all 3 of these neurodevelopmental disorders. Additionally, meta-analysis has shown that maternal anemia during pregnancy is associated with other adverse gestational outcomes, as well. Given that anemia is common during pregnancy, and that iron deficiency during pregnancy can compromise neurodevelopment in the offspring, it is clear that maternal anemia during pregnancy should be included as a confound that is adjusted for in analyses in studies of psychotropic drugs in pregnancy. However, many studies that significantly associated gestational exposure to antidepressants with adverse pregnancy outcomes did not adjust for maternal anemia during pregnancy. This issue is not merely academic because studies with such "significant" findings discourage depressed pregnant women from accepting antidepressants; therefore, women and their unborn children may risk experiencing the known harms associated with untreated depression during pregnancy. Additionally, such "significant" findings may provoke unjustified guilt in women who do use antidepressants during pregnancy, especially if the pregnancy is associated with an adverse outcome. Whereas this is not an endorsement of the unquestioning use of antidepressants during pregnancy, it does imply that those who argue against medication use during pregnancy should re-examine the science on which their views are based.


Assuntos
Anemia/complicações , Antidepressivos/efeitos adversos , Transtorno Depressivo/tratamento farmacológico , Transtornos do Neurodesenvolvimento/etiologia , Complicações Hematológicas na Gravidez/sangue , Efeitos Tardios da Exposição Pré-Natal/etiologia , Adolescente , Adulto , Anemia/epidemiologia , Criança , Transtorno Depressivo/epidemiologia , Feminino , Idade Gestacional , Humanos , Masculino , Transtornos do Neurodesenvolvimento/induzido quimicamente , Transtornos do Neurodesenvolvimento/epidemiologia , Gravidez , Complicações Hematológicas na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adulto Jovem
17.
Anaesthesia ; 75(7): 904-912, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32315080

RESUMO

Pre-operative anaemia is associated with poor outcomes after elective surgery but its relationship with outcomes after emergency surgery is unclear. We analysed National Emergency Laparotomy Audit data from 1 December 2013 to 30 November 2017, excluding laparotomy for haemorrhage. Anaemia was classified as 'mild' 129-110 g.l-1; 'moderate' 109-80 g.l-1; or 'severe' ≤ 79 g.l-1. The primary outcome was 90-day mortality. Secondary outcomes were 30-day mortality, return to theatre and postoperative hospital stay. The primary outcome was available for 86,763 patients, of whom 45,306 (52%) were anaemic. There were 12,667 (15%) deaths at 90 postoperative days and 9246 (11%) deaths at 30 postoperative days. Anaemia was associated with increased 90-day and 30-day mortality, odds ratio (95%CI): mild, 1.15 (1.09-1.21); moderate, 1.44 (1.36-1.52); and severe, 1.42 (1.24-1.63), p < 0.001 for all; mild, 1.07 (1.00-1.12), p = 0.030; moderate, 1.30 (1.21-1.38), p < 0.001; and severe, 1.22 (1.05-1.43), p = 0.010, respectively. All categories of anaemia were associated with prolonged hospital stay, adjusted coefficient (95%CI): mild, 1.31 (1.01-1.62); moderate, 3.41 (3.04-3.77); severe, 2.80 (1.83-3.77), p < 0.001 for all. Moderate and severe anaemia were associated with increased risk of return to the operating theatre, odds ratio (95%CI): moderate 1.13 (1.06-1.21), p < 0.001; and severe 1.23 (1.06-1.43), p = 0.006. Pre-operative anaemia is common in patients undergoing emergency laparotomy and is associated with increased postoperative mortality and morbidity.


Assuntos
Anemia/complicações , Procedimentos Cirúrgicos do Sistema Digestório/mortalidade , Idoso , Anemia/sangue , Anemia/mortalidade , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Emergências , Feminino , Hemoglobinas/metabolismo , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Auditoria Médica/métodos , Pessoa de Meia-Idade , Morbidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Período Pré-Operatório , Curva ROC , Reoperação/estatística & dados numéricos , Índice de Gravidade de Doença , Reino Unido/epidemiologia
18.
Klin Lab Diagn ; 65(5): 275-280, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32298542

RESUMO

Anemic syndrome is detected in 10-25% of geriatric patients, and with increasing age, there is a tendency to increase the incidence of the disease. Among the diseases that lead to the development of anemia, kidney pathology plays an important role. Progressive deterioration of kidney function in old age is associated with an increased risk of fractures, sarcopenia, and the development of cognitive impairment. Also, nephrogenic anemia aggravates the prognosis in patients with cardiovascular diseases, which is associated with an increase in myocardial ischemia, an increase in tissue hypoxia, a progression of left ventricular hypertrophy, and a decrease in left ventricular systolic function.


Assuntos
Anemia/complicações , Insuficiência Renal Crônica/complicações , Idoso , Doenças Cardiovasculares/complicações , Humanos , Hipertrofia Ventricular Esquerda , Hipóxia , Isquemia Miocárdica/complicações , Prognóstico , Disfunção Ventricular Esquerda
19.
Anaesthesia ; 75(8): 1105-1113, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32339260

RESUMO

As COVID-19 disease escalates globally, optimising patient outcome during this catastrophic healthcare crisis is the number one priority. The principles of patient blood management are fundamental strategies to improve patient outcomes and should be given high priority in this crisis situation. The aim of this expert review is to provide clinicians and healthcare authorities with information regarding how to apply established principles of patient blood management during the COVID-19 pandemic. In particular, this review considers the impact of the COVID-19 pandemic on blood supply and specifies important aspects of donor management. We discuss how preventative and control measures implemented during the COVID-19 crisis could affect the prevalence of anaemia, and highlight issues regarding the diagnosis and treatment of anaemia in patients requiring elective or emergency surgery. In addition, we review aspects related to patient blood management of critically ill patients with known or suspected COVID-19, and discuss important alterations of the coagulation system in patients hospitalised due to COVID-19. Finally, we address special considerations pertaining to supply-demand and cost-benefit issues of patient blood management during the COVID-19 pandemic.


Assuntos
Betacoronavirus , Doadores de Sangue/provisão & distribução , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Anemia/complicações , Anemia/diagnóstico , Anemia/terapia , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Procedimentos Cirúrgicos Eletivos , Emergências , Humanos , Recuperação de Sangue Operatório , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Cuidados Pré-Operatórios/métodos
20.
J Med Virol ; 92(7): 915-918, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32270515

RESUMO

An 80-year-old man with multiple comorbidities presented to the emergency department with tachypnea, tachycardia, fever, and critically low O2 saturation and definitive chest computerized tomography scan findings in favor of COVID-19 and positive PCR results in 48 hours. He received antiviral treatment plus recombinant human erythropoietin (rhEPO) due to his severe anemia. After 7 days of treatment, he was discharged with miraculous improvement in his symptoms and hemoglobin level. We concluded that rhEPO could attenuate respiratory distress syndrome and confront the severe acute respiratory syndrome coronavirus 2 virus through multiple mechanisms including cytokine modulation, antiapoptotic effects, leukocyte release from bone marrow, and iron redistribution away from the intracellular virus.


Assuntos
Anemia/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Eritropoetina/uso terapêutico , Febre/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Taquicardia/tratamento farmacológico , Taquipneia/tratamento farmacológico , Idoso de 80 Anos ou mais , Anemia/complicações , Anemia/diagnóstico , Anemia/virologia , Antivirais/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/genética , Betacoronavirus/patogenicidade , Biomarcadores/sangue , Técnicas de Laboratório Clínico/métodos , Convalescença , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Estado Terminal , Febre/complicações , Febre/diagnóstico , Febre/virologia , Humanos , Irã (Geográfico) , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , RNA Viral/sangue , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Taquicardia/complicações , Taquicardia/diagnóstico , Taquicardia/virologia , Taquipneia/complicações , Taquipneia/diagnóstico , Taquipneia/virologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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