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1.
Anticancer Res ; 40(1): 143-151, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892562

RESUMO

BACKGROUND/AIM: Adiponectin protects from metabolic disease and cancer. Accordingly, serum adiponectin was reduced in patients with colorectal cancer (CRC). This hepatoprotective factor was definitely increased in hepatocellular carcinoma (HCC). CRC metastases to the liver are common and the aim of the present study was to evaluate whether serum adiponectin discriminates primary from secondary liver cancers. MATERIALS AND METHODS: Adiponectin was measured by ELISA in the serum of 36 patients with colorectal liver metastases, 32 patients with HCC and 49 patients without cancer. RESULTS: Serum adiponectin levels were higher in cancer than non-tumor patients. Adiponectin was not related to TNM stage in HCC nor to the levels of serum tumor markers. Moreover, hepatic inflammation and liver fibrosis were not correlated with serum adiponectin levels. Metabolic diseases are associated with low adiponectin and a higher risk of cancer. In HCC, but not in CRC serum, adiponectin was increased in patients with hypertension and hyperuricemia. In this cohort, adiponectin positively correlated with chemerin, an adipokine supposed to contribute to metabolic disturbances. CONCLUSION: Serum adiponectin cannot discriminate primary from secondary liver tumors.


Assuntos
Adiponectina/sangue , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/diagnóstico , Biomarcadores , Comorbidade , Diagnóstico Diferencial , Feminino , Humanos , Cirrose Hepática/sangue , Cirrose Hepática/patologia , Testes de Função Hepática , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Masculino , Invasividade Neoplásica , Estadiamento de Neoplasias
2.
Medicine (Baltimore) ; 99(1): e18486, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895781

RESUMO

We have been examining the Comprehensive Health Check of the Fukushima Health Management Survey of residents of 13 municipalities who were forced by the government to evacuate due to the 2011 Great East Japan Earthquake (GEJE). Our findings showed that evacuation is a risk factor for polycythemia and suggested that experiencing an unprecedented disaster and exposure to chronic stress due to evacuation might be a cause of polycythemia.We analyzed the relationship between the prevalence of polycythemia and the following factors observed in the Mental Health and Lifestyle Survey in an observational study with a cross-sectional design: traumatic symptoms, depression status, socioeconomic factors such as residential environment, and working situation after the GEJE. Target population of the survey included men and women who were at least 15 years of age and who lived in the evacuation zones specified by the government. Participants analyzed consisted of 29,474 persons (12,379 men and 16,888 women) who had participated in both the 2011 Comprehensive Health Check and Mental Health and Lifestyle Survey from June 2011 through March 2012.The prevalence of polycythemia was not associated with mental states associated with traumatic symptoms (Post-Traumatic Stress Disorder Checklist Scale ≥ 44) and depression status (Kessler 6-item Scale ≥ 13). Furthermore, multivariate analysis showed that there was a tendency for males to develop polycythemia, with characteristics such as being aged 65 years and older, highly educated, obese (body mass index ≥ 25), hypertensive, diabetic, having liver dysfunction, and a smoker being significantly related to the prevalence of polycythemia.Our findings conclusively demonstrated that polycythemia was not significantly related to psychological factors, but was significantly related to the onset of lifestyle-related disease after the GEJE.


Assuntos
Acidente Nuclear de Fukushima , Policitemia/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Causalidade , Comorbidade , Terremotos , Feminino , Humanos , Japão/epidemiologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Policitemia/etiologia , Policitemia/psicologia , Prevalência , Tsunamis , Adulto Jovem
3.
Praxis (Bern 1994) ; 109(1): 9-12, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31910766

RESUMO

PsyCoLaus: A Prospective Study of the Links between Mental Health and Cardiovascular Diseases Abstract. PsyCoLaus, which includes an investigation of mental disorders and cognitive functioning, aims to determine the prevalence and the course of mental disorders in the general population and to study the mechanisms underlying the association between these disorders and cardiovascular diseases. This investigation revealed a very high lifetime prevalence rate of 43.6 % for major depressive disorder in Lausanne. We have also observed that the association between major depression and cardio-metabolic risk factors is essentially attributable to the atypical subtype, characterized by an increased appetite, heaviness in limbs, hypersomnia and conserved affective reactivity. Patients who suffer from this type of depression have an increased risk to develop overweight, diabetes and the metabolic syndrome and deserve particular clinical attention on the metabolic level.


Assuntos
Transtorno Depressivo Maior , Síndrome Metabólica , Comorbidade , Depressão , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/epidemiologia , Humanos , Síndrome Metabólica/complicações , Estudos Prospectivos
4.
Klin Padiatr ; 232(1): 5-12, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31847010

RESUMO

INTRODUCTION: Gender dysphoria (GD) in childhood and adolescence is characterized by an incongruence between sex at birth and gender identity, which usually increases during puberty. Gender dysphoric children and adolescents often suffer from psychological comorbidities such as depression. The purpose of our study is to give an overview of the patients treated in our clinic. METHODS: We analyzed data of 66 patients who presented with GD at our outpatient clinic between 2005 and 2018. RESULTS: We noted a rise of presentations with one or no patient with GD per year between 2005 and 2008 up to 18 patients in 2018, although the percentage of all 14.339 endocrinological outpatients (2005-2018) is low. 54 patients were assigned as female and 12 as male at birth resulting in a ratio of 4.5:1. The mean age at their first appointment was 13.6 years. 49 patients (74%) had reached tanner stadium P3/B3 or P3/G3. 30 (45%) showed symptoms of a comorbidity related to GD. 48 (73%) showed symptoms of GD before puberty. 15 patients (23%) experienced a negative response regarding their outing and 17 (26%) were victims of mobbing in school. CONCLUSION: The number of patients increased in the last years. About half of the patients suffered from a psychological comorbidity. They often experienced negative response regarding their GD in the family. The variability of appearance and the comorbidities pose the challenge in the treatment of gender dysphoric children and adolescents.


Assuntos
Disforia de Gênero/psicologia , Disforia de Gênero/cirurgia , Cirurgia de Readequação Sexual , Pessoas Transgênero/psicologia , Adolescente , Criança , Comorbidade , Feminino , Disforia de Gênero/diagnóstico , Identidade de Gênero , Humanos , Masculino , Maturidade Sexual
5.
Angiology ; 71(1): 17-26, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31129986

RESUMO

The Middle East and North Africa (MENA) region has a high burden of morbidity and mortality due to premature (≤55 years in men; ≤65 years in women) myocardial infarction (MI) and acute coronary syndrome (ACS). Despite this, the prevalence of risk factors in patients presenting with premature MI or ACS is incompletely described. We compared lifestyle, clinical risk factors, and biomarkers associated with premature MI/ACS in the MENA region with selected non-MENA high-income countries. We identified English-language, peer-reviewed publications through PubMed (up to March 2018). We used the World Bank classification system to categorize countries. Patients with premature MI/ACS in the MENA region had a higher prevalence of smoking than older patients with MI/ACS but a lower prevalence of diabetes, hypertension, and dyslipidemia. Men with premature MI/ACS had a higher prevalence of smoking than women but a lower prevalence of diabetes and hypertension. The MENA region had sparse data on lifestyle, diet, psychological stress, and physical activity. To address these knowledge gaps, we initiated the ongoing Gulf Population Risks and Epidemiology of Vascular Events and Treatment (Gulf PREVENT) case-control study to improve primary and secondary prevention of premature MI in the United Arab Emirates, a high-income country in the MENA region.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Infarto do Miocárdio/epidemiologia , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/prevenção & controle , África do Norte/epidemiologia , Idade de Início , Idoso , Estudos de Casos e Controles , Comorbidade , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Oriente Médio/epidemiologia , Mortalidade Prematura , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/prevenção & controle , Prevalência , Prevenção Primária , Prognóstico , Projetos de Pesquisa , Fatores de Risco , Prevenção Secundária , Fatores Sexuais , Fumar/efeitos adversos , Fumar/epidemiologia
6.
Eur J Endocrinol ; 182(1): G1-G32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31855556

RESUMO

Obesity is an emerging condition, with a prevalence of ~20%. Although the simple measurement of BMI is likely a simplistic approach to obesity, BMI is easily calculated, and there are currently no data showing that more sophisticated methods are more useful to guide the endocrine work-up in obesity. An increased BMI leads to a number of hormonal changes. Additionally, concomitant hormonal diseases can be present in obesity and have to be properly diagnosed - which in turn might be more difficult due to alterations caused by body fatness itself. The present European Society of Endocrinology Clinical Guideline on the Endocrine Work-up in Obesity acknowledges the increased prevalence of many endocrine conditions in obesity. It is recommended to test all patients with obesity for thyroid function, given the high prevalence of hypothyroidism in obesity. For hypercortisolism, male hypogonadism and female gonadal dysfunction, hormonal testing is only recommended if case of clinical suspicion of an underlying endocrine disorder. The guideline underlines that weight loss in obesity should be emphasized as key to restoration of hormonal imbalances and that treatment and that the effect of treating endocrine disorders on weight loss is only modest.


Assuntos
Índice de Massa Corporal , Hipotireoidismo/diagnóstico , Obesidade/diagnóstico , Comorbidade , Endocrinologia , Humanos , Hipotireoidismo/epidemiologia , Obesidade/epidemiologia , Prevalência , Testes de Função Tireóidea
7.
Br J Anaesth ; 124(1): 73-83, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31860444

RESUMO

BACKGROUND: Socioeconomic circumstances can influence access to healthcare, the standard of care provided, and a variety of outcomes. This study aimed to determine the association between crude and risk-adjusted 30-day mortality and socioeconomic group after emergency laparotomy, measure differences in meeting relevant perioperative standards of care, and investigate whether variation in hospital structure or process could explain any difference in mortality between socioeconomic groups. METHODS: This was an observational study of 58 790 patients, with data prospectively collected for the National Emergency Laparotomy Audit in 178 National Health Service hospitals in England between December 1, 2013 and November 31, 2016, linked with national administrative databases. The socioeconomic group was determined according to the Index of Multiple Deprivation quintile of each patient's usual place of residence. RESULTS: Overall, the crude 30-day mortality was 10.3%, with differences between the most-deprived (11.2%) and least-deprived (9.8%) quintiles (P<0.001). The more-deprived patients were more likely to have multiple comorbidities, were more acutely unwell at the time of surgery, and required a more-urgent surgery. After risk adjustment, the patients in the most-deprived quintile were at significantly higher risk of death compared with all other quintiles (adjusted odds ratio [95% confidence interval]: Q1 [most deprived]: reference; Q2: 0.83 [0.76-0.92]; Q3: 0.84 [0.76-0.92]; Q4: 0.87 [0.79-0.96]; Q5 [least deprived]: 0.77 [0.70-0.86]). We found no evidence that differences in hospital-level structure or patient-level performance in standards of care explained this association. CONCLUSIONS: More-deprived patients have higher crude and risk-adjusted 30-day mortality after emergency laparotomy, but this is not explained by differences in the standards of care recorded within the National Emergency Laparotomy Audit.


Assuntos
Serviços Médicos de Emergência , Laparotomia/mortalidade , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/mortalidade , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Inglaterra/epidemiologia , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/economia , Assistência Perioperatória/normas , Pobreza , Risco Ajustado , Medicina Estatal , Adulto Jovem
8.
JAMA ; 322(23): 2292-2302, 2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31846016

RESUMO

Importance: Short-term infusions of single vasodilators, usually given in a fixed dose, have not improved outcomes in patients with acute heart failure (AHF). Objective: To evaluate the effect of a strategy that emphasized early intensive and sustained vasodilation using individualized up-titrated doses of established vasodilators in patients with AHF. Design, Setting, and Participants: Randomized, open-label blinded-end-point trial enrolling 788 patients hospitalized for AHF with dyspnea, increased plasma concentrations of natriuretic peptides, systolic blood pressure of at least 100 mm Hg, and plan for treatment in a general ward in 10 tertiary and secondary hospitals in Switzerland, Bulgaria, Germany, Brazil, and Spain. Enrollment began in December 2007 and follow-up was completed in February 2019. Interventions: Patients were randomized 1:1 to a strategy of early intensive and sustained vasodilation throughout the hospitalization (n = 386) or usual care (n = 402). Early intensive and sustained vasodilation was a comprehensive pragmatic approach of maximal and sustained vasodilation combining individualized doses of sublingual and transdermal nitrates, low-dose oral hydralazine for 48 hours, and rapid up-titration of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or sacubitril-valsartan. Main Outcomes and Measures: The primary end point was a composite of all-cause mortality or rehospitalization for AHF at 180 days. Results: Among 788 patients randomized, 781 (99.1%; median age, 78 years; 36.9% women) completed the trial and were eligible for primary end point analysis. Follow-up at 180 days was completed for 779 patients (99.7%). The primary end point, a composite of all-cause mortality or rehospitalization for AHF at 180 days, occurred in 117 patients (30.6%) in the intervention group (including 55 deaths [14.4%]) and in 111 patients (27.8%) in the usual care group (including 61 deaths [15.3%]) (absolute difference for the primary end point, 2.8% [95% CI, -3.7% to 9.3%]; adjusted hazard ratio, 1.07 [95% CI, 0.83-1.39]; P = .59). The most common clinically significant adverse events with early intensive and sustained vasodilation vs usual care were hypokalemia (23% vs 25%), worsening renal function (21% vs 20%), headache (26% vs 10%), dizziness (15% vs 10%), and hypotension (8% vs 2%). Conclusions and Relevance: Among patients with AHF, a strategy of early intensive and sustained vasodilation, compared with usual care, did not significantly improve a composite outcome of all-cause mortality and AHF rehospitalization at 180 days. Trial Registration: ClinicalTrials.gov Identifier: NCT00512759.


Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Vasodilatadores/administração & dosagem , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Comorbidade , Esquema de Medicação , Feminino , Insuficiência Cardíaca/mortalidade , Hospitalização , Humanos , Masculino , Readmissão do Paciente/estatística & dados numéricos , Vasodilatadores/efeitos adversos
9.
Gan To Kagaku Ryoho ; 46(12): 1855-1859, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31879403

RESUMO

BACKGROUND: Comorbidities among cancer patients are becoming more common. Comorbidity and relative dose intensity (RDI)are 2 major host-dependent prognostic factors for diffuse large B-cell lymphoma(DLBCL), but the clinical evidence demonstrating a relationship between those 2 factors is limited. METHODS: We retrospectively analyzed the clinical records of patients with de novo DLBCL treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone(R-CHOP) therapy at the Okitama Public General Hospital between January 2010 and October 2018 to evaluate the relationship between comorbidity and RDI. RESULTS: A total of 104 patients with a median age of 73 years(range, 36-90 years)were included. More than half of the patients(n=58, 55.8%)had at least one comorbidity. 3-year progression-free survival(p=0.043)and 3- year overall survival(p=0.049)were lower in the comorbidity group than in the no comorbidity group. The RDI was also lower in the comorbidity group than in the no comorbidity group(p=0.011). Univariate analysis of various factors influencing the RDI revealed that the presence of comorbidity was associated with insufficient RDI(p=0.016), but multivariate analysis revealed that only age ≥75(p<0.001)was independently associated with insufficient RDI. CONCLUSIONS: Our results demonstrated that the presence of comorbidity was associated with insufficient RDI and poor treatment outcome in DLBCL patients treated with R-CHOP. To optimize the RDI maintenance to achieve better outcomes for DLBCL patients, further investigation of comorbidities is required.


Assuntos
Linfoma Difuso de Grandes Células B , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Murinos , Protocolos de Quimioterapia Combinada Antineoplásica , Comorbidade , Ciclofosfamida , Doxorrubicina , Humanos , Linfoma Difuso de Grandes Células B/epidemiologia , Pessoa de Meia-Idade , Prednisona , Estudos Retrospectivos , Resultado do Tratamento , Vincristina
10.
Ther Adv Cardiovasc Dis ; 13: 1753944719894509, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31854243

RESUMO

BACKGROUND: It is known that once heart failure occurs in older patients with diabetes, the overall prognosis is extremely poor. We investigated whether early initiation of SGLT2 inhibitor therapy after admission was beneficial for diabetic patients requiring inpatient treatment for acute heart failure. METHODS: We retrospectively assessed consecutive patients with comorbid diabetes who were admitted to the Department of Cardiology in Tosei General Hospital for treatment of acute heart failure. Patients were divided into two groups: those who initiated SGLT2 inhibitor therapy (SGLT2 inhibitor group; mean age: 73 ± 9 years) and those who did not receive the inhibitors during hospitalization (conventional treatment group; mean age: 75 ± 10 years). RESULTS: No intergroup differences were observed in the distribution of either the severity or classes of heart failure on admission. Glycosylated hemoglobin levels were significantly higher in the SGLT2 inhibitor group (HbA1c: 8.1% ± 0.8%) than in the conventional treatment group (HbA1c: 7.1% ± 0.8%) (p = 0.003). After admission, patients in both groups recovered equally well, and in almost the same period of time, before discharge. The rate of diuretics use at the time of discharge in the SGLT2 inhibitor group (n = 8, 67%) was significantly lower than that in the conventional treatment group (n = 19, 100%) (p = 0.016). In particular, the dose of loop diuretics in the conventional treatment group was 34 ± 4 mg/day while that in the SGLT2 inhibitor group was significantly lower at 13 ± 5 mg/day (p = 0.008). During hospitalization, the incidence of acute kidney injury was significantly higher in the conventional treatment group (n = 11, 58%) than in the SGLT2 inhibitor group (n = 2, 16%) (p = 0.031). CONCLUSIONS: For the treatment and management of heart failure in patients with diabetes, early initiation of SGLT2 inhibitor therapy appears to be effective.


Assuntos
Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem , Inibidores do Transportador 2 de Sódio-Glicose/administração & dosagem , Doença Aguda , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Glicemia/metabolismo , Comorbidade , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Hemoglobina A Glicada/metabolismo , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Intervalo Livre de Progressão , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Inibidores de Simportadores de Cloreto de Sódio e Potássio/efeitos adversos , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Fatores de Tempo
11.
Zhonghua Gan Zang Bing Za Zhi ; 27(10): 748-753, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31734987

RESUMO

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in China. To provide evidence-based and updated practical recommendations for clinician, this expert recommendations have updated the diagnosis and treatment of NAFLD in five aspects as follows: (1) the framework of NAFLD treatment centre or clinic; (2) screening and evaluation: who should be screened, initial evaluation items, non-invasive assessment of steatohepatitis and advanced fibrosis, when to obtain a liver biopsy in patients with NAFLD, and other metabolic disorders and cardiovascular risk assessment; (3) managements of patient with NAFLD: lifestyle intervention (dietary, exercise and weight loss), drug treating metabolic co-morbidities such as hyperlipidemia, type 2 diabetes mellitus and hypertension, and steatohepatitis and fibrosis; (4) management of special populations with NAFLD: children, pregnant or lactating women, patients co-existence with alcoholic liver disease, chronic HBV and/or HCV infection, and autoimmune disorders; (5) monitoring and follow-up. This consensus aims to modify the optimizing management process and guide physicians make correct and reasonable decisions in the diagnosis and treatment for patients with NAFLD.


Assuntos
Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/terapia , Biópsia , Criança , China , Comorbidade , Diabetes Mellitus Tipo 2 , Feminino , Humanos , Hiperlipidemias , Hipertensão , Lactação , Estilo de Vida , Guias de Prática Clínica como Assunto
12.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(11): 832-837, 2019 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-31694093

RESUMO

Objective: To compare clinical characteristics between patients with chronic obstructive pulmonary disease (COPD) and COPD -OSA overlap, and to analyze the risk factors for OSA in patients with COPD. Methods: A total of 431 patients with COPD were divided into a COPD-OSA group with AHI>15 events/h or a COPD group with AHI ≤ 15 events/h according to the results of polysomnography, and their clinical characteristics were summarized. Risk factors for OSA overlap in COPD patients were identified by univariate and multivariate logistic regression analyses. Results: There were no significant differences in gender composition, dyspnea scale (mMRC) score, the numbers of acute exacerbations and hospitalizations in the last year, prevalence of coronary heart disease, or cor pulmonale or diabetes mellitus in the two groups (all P>0.05). Age, BMI, neck circumference, smoking index, COPD assessment test (CAT) score, the values of FEV(1) or FEV(1)%, FEV(1)/FVC ratios, and the prevalence of hypertension in the COPD-OSA group with AHI>15 events/h were significantly higher than in the COPD group with AHI ≤15 events/h, while the duration of COPD and the proportion of severe COPD were lower than the COPD group with AHI≤ 15 (P<0.05). The scores of Charlson Comorbidity Index, Epworth Sleepiness Scale (ESS) and Sleep Apnea Clinical Score (SACS) in the COPD-OSA group were significantly higher than in the COPD group with AHI≤ 15, with all P values<0.05. Risk factors for AHI>15 OSA coinciding in patients with COPD included BMI, neck circumference, ESS, SACS and CAT (P<0.05). Furthermore, BMI, ESS and CAT were independent risk factors for OSA in COPD patients (P<0.05). Compared with mild or moderate COPD cases, patients with severe COPD (FEV(1)%<50%) had a lower risk of having OSA (ß=-0.459, OR=0.632, 95% CI 0.401-0.997, P=0.048). Conclusions: Compared to COPD patients with AHI ≤ 15 events/h, OSA-COPD overlap patients (AHI>15 events/h) had a worse quality of life, more daytime sleepiness and higher prevalence of hypertension. BMI, ESS and CAT were independent risk factors for AHI>15 OSA in patients with COPD. The risk of having OSA in severe COPD patients was lower than cases with mild or moderate COPD.


Assuntos
Doença Pulmonar Obstrutiva Crônica/epidemiologia , Qualidade de Vida , Apneia Obstrutiva do Sono/epidemiologia , Comorbidade , Humanos , Hipertensão/epidemiologia , Polissonografia , Prevalência , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/psicologia , Fatores de Risco , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/psicologia , Sonolência
13.
Medicine (Baltimore) ; 98(45): e17869, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702652

RESUMO

Nontuberculous mycobacteria (NTM) are important pathogens in humans, and hospital-based studies have shown an increased incidence of NTM infection. However, little is known about the treatment pattern of NTM infection with respect to the number of cases per population in South Korea. This study evaluated the trends in the incidence of NTM infection, respiratory comorbidities, and treatment patterns in South Korea.National claims data from the Health Insurance Review and Assessment service database for the years 2009 to 2015 were reviewed, and codes related to NTM infection, respiratory comorbidities occurring from one year before NTM infection and associated treatments were identified.In total, 52,551 patients were included in the study and the average annual incidence per 100,000 person-years was 12.8. The annual incidence was found to have increased from 6.6 to 26.6 per 100,000 persons. Accompanied comorbidities were tuberculosis (33.7%), followed by bronchial asthma (33.2%), chronic obstructive pulmonary disease (25.6%), and lung cancer (5.8%). A total of 76.6% of patients did not receive any combination treatment within one year after the diagnosis of NTM infection. Macrolide-based treatment was administered to 18.8% of patients.A dramatic increase in the incidence of NTM infection was noted in the population of South Korea. Approximately three-fourth of the patients with NTM infection were clinically observed without treatment for at least 1 year after the identification of NTM infection and most patients who treated NTM infection received macrolide-based combination therapy.


Assuntos
Antibióticos Antituberculose/uso terapêutico , Infecções por Micobactéria não Tuberculosa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Comorbidade , Bases de Dados Factuais , Quimioterapia Combinada , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa/epidemiologia , Infecções por Micobactéria não Tuberculosa/terapia , República da Coreia/epidemiologia , Adulto Jovem
14.
Medicine (Baltimore) ; 98(45): e17914, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702670

RESUMO

There are very few reports of eczema and other prosthetic-related allergic skin complications following arthroplasty. We aimed to assess the risk of eczema after joint replacement.We performed a retrospective population-based cohort study in 2024 joint replacement patients using the Longitudinal Health Insurance Database. For comparison, 8096 controls were selected, with 4 control subjects for each joint replacement patient matched for age, sex, and index year, to assess eczema risk. We examined 14-year cumulative eczema incidence associated with age, sex, immunity, disease history, and joint replacement location.Eczema rates in the joint replacement patients were 38% higher than in the control group (57.90 vs 41.84 per 1000 person-years, respectively). Compared with the control group, joint replacement patients showed a 1.35-fold increased risk of eczema according to the multivariable Cox model (95% Confidence interval [CI] = 1.23-1.49). Knee replacement patients had higher eczema risk compared with the control group (Hazard ratio [HR] = 1.45, 95% CI = 1.33-1.70). Stratified by study period, the joint replacement cohort had a higher eczema risk after the 3-month follow-up.Our study revealed that joint arthroplasty increased risk of eczema in this 14-year follow-up study, and this was not related to personal atopic history or gender.


Assuntos
Artroplastia de Substituição/efeitos adversos , Eczema/epidemiologia , Prótese Articular/efeitos adversos , Idoso , Artroplastia de Substituição/estatística & dados numéricos , Estudos de Casos e Controles , Comorbidade , Dermatite Alérgica de Contato/epidemiologia , Eczema/etiologia , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Metais/efeitos adversos , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco
15.
Anticancer Res ; 39(11): 6325-6332, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704863

RESUMO

BACKGROUND/AIM: We aimed to assess surgical outcome and long-term survival after elective hepatic resection for hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM) in patients aged 80 years or older. PATIENTS AND METHODS: This study included 100 patients aged 70 years or older, who underwent hepatic resection for HCC or CRLM between January 2000 and December 2012. Outcomes and clinicopathological data were compared between the elderly (aged 70-79 years; n=84) and extremely elderly groups (aged 80 years or older; n=16). RESULTS: Incidence of postoperative complications, in-hospital mortality, and postoperative OS in the extremely elderly group were comparable with those of the elderly group. In patients with HCC, the extremely elderly group was associated with shorter DFS (p=0.030) in univariate analysis, while multivariate analysis showed significant and independent factors of cancer recurrence. CONCLUSION: Hepatic resection for HCC and CRLM in patients aged 80 years and older may be safe and acceptable with appropriate selection. For HCC in patients aged 80 years and older, hepatic resection may be effective when negative surgical margins can be achieved.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Colorretais/patologia , Hepatectomia , Neoplasias Hepáticas/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Comorbidade , Intervalo Livre de Doença , Feminino , Hepatectomia/mortalidade , Hepatectomia/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Masculino , Margens de Excisão , Complicações Pós-Operatórias , Análise de Sobrevida , Resultado do Tratamento
16.
Anticancer Res ; 39(11): 6347-6353, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704866

RESUMO

BACKGROUND/AIM: The aim of this study was to determine the significance of immunonutritional and physical index in the assessment of risk associated with pancreaticoduodenectomy (PD) in the elderly. PATIENTS AND METHODS: This study enrolled 92 patients who underwent PD. They were divided into 2 groups: Group A included patients 79 years and younger (n=79) and Group B patients 80 years and older (n=13). Among 37 patients, physical function and body composition were also evaluated. RESULTS: Significantly higher neutrophil-lymphocyte ratio, lower prognostic nutritional index (PNI), and controlling nutritional score were observed in Group B. Muscle strength and walking ability were significantly impaired in Group B, although there was no significant difference in body composition. Age was not correlated with the incidence of postoperative complications, overall survival or recurrence-free survival by univariate and multivariate analysis. CONCLUSION: PD is justified for the elderly, with acceptable morbidity and prognosis. However, immunonutritional status and physical function are significantly impaired; thus, appropriate case selection and active nutritional support are required for the elderly.


Assuntos
Limitação da Mobilidade , Força Muscular , Estado Nutricional , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Neoplasias dos Ductos Biliares/cirurgia , Composição Corporal , Comorbidade , Neoplasias Duodenais/cirurgia , Feminino , Humanos , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos/citologia , Avaliação Nutricional , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/mortalidade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Medição de Risco , Albumina Sérica/análise
17.
Acta Chir Orthop Traumatol Cech ; 86(5): 320-323, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31748105

RESUMO

PURPOSE OF THE STUDY Osteoporotic hip fractures commonly associated with comorbid diseases and use of multiple drugs. Polypharmacy status and the comorbidity-polypharmacy score (CPS) are the most common two grading system to predict mortality risk for the trauma patients older than 45 years. The purpose of the study was to determine whether the CPS or polypharmacy can predict the mortality risk in the older patients had a surgery due to an osteoporotic hip fracture. MATERIAL AND METHODS Consecutive patients aged > 65 years had an osteoporotic hip fracture due to a simple trauma were enrolled in the study. Detailed data were collected included comorbid conditions, medications, T-scores and additional fractures. Patients were divided into four groups according to CPS classification and polypharmacy status was indicated in case of using five or more drugs before admission. Overall mortality was assessed using Kaplan-Meier survival testing. Factors influencing 1-year, 2-year and 5-year mortality were evaluated using a multivariate logistic regression model with adjusted odds ratios (AORs) and a threshold significance at p < 0.05. RESULTS A total of 109 patients (65% women) with a mean age 80 ± 8.06 were included in the study. The mean time to death from the surgery was 42.06 ± 34.9 months. The Kaplan-Meier survival curves showed a significant difference in mortality among CPS groups. (Log-Rank test < 0.001). CPS presented a significant prediction in 1-year (AOR: 4.2; p < 0.05) and 2-year mortality (AOR: 2.9; p < 0.05) after adjustment for several covariates (including age, gender, surgical procedure) whereas 5-year mortality did not reveal a significant prediction (p = 0.46) Polypharmacy existence did not independently predict both overall or year-based mortality (p > 0.05) . CONCLUSIONS CPS is a better predictor for mortality risk than polypharmacy existence in the first two years in the patients underwent surgery for an osteoporotic hip fracture. Key words:osteoporotic hip fracture, mortality, polypharmacy, comorbidity.


Assuntos
Fraturas do Quadril/mortalidade , Fraturas por Osteoporose/mortalidade , Polimedicação , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Indicadores Básicos de Saúde , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/etiologia , Humanos , Masculino , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Fatores de Risco
18.
Surg Clin North Am ; 99(6): 1111-1121, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676051

RESUMO

Patients with inflammatory bowel disease are at an increased risk of cancer secondary to long-standing intestinal inflammation. Surgical options must take into account the significant risk of synchronous disease at other colonic sites. Ileal pouch anal anastomosis is a viable option for patients with ulcerative colitis, but this should be restricted to early cancers that are unlikely to require preoperative or postoperative radiation treatment.


Assuntos
Transformação Celular Neoplásica/patologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/cirurgia , Lesões Pré-Cancerosas/patologia , Anastomose Cirúrgica , Colectomia/métodos , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/patologia , Colite Ulcerativa/cirurgia , Neoplasias Colorretais/cirurgia , Comorbidade , Doença de Crohn/epidemiologia , Doença de Crohn/patologia , Doença de Crohn/cirurgia , Feminino , Humanos , Incidência , Doenças Inflamatórias Intestinais/patologia , Masculino , Lesões Pré-Cancerosas/epidemiologia , Prognóstico , Medição de Risco , Estomas Cirúrgicos , Análise de Sobrevida
19.
Undersea Hyperb Med ; 46(5): 603-610, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683357

RESUMO

Aim: To review incidents of immersion pulmonary edema (IPE) from Oceania, to determine the demographics, diving parameters, and comorbidities that may be related to this disorder. Method: Incidents of IPE, most of which were documented by Divers Alert Network Asia-Pacific (DAN AP) or reported in our medical literature, were analyzed. They included interviews with the survivors and a review of available medical records. Only incidents diagnosed as IPE by specialist diving physicians or pathologists with experience in the investigation of diving accidents were included. Results: Thirty-one IPE incidents in divers from Oceania were documented. There were two surface snorkelers, 22 scuba air divers and seven nitrox divers, which included three closed-circuit rebreathers (CCR). The mean (SD) age was 53 (12) years, 58% of victims were females, and the average dive profile was to a maximum depth of 19 msw for 25 minutes. Six victims (19%) had previous episodes of IPE. There were nine recorded fatalities in this cohort. Medical comorbidities were recorded in 68%, with 42% being cardiac. The latter included valvular disease in 29%, transient cardiomyopathies in 26% and dysrhythmias in 16%. Conclusion: IPE was more likely in middle-aged females, in experienced divers, and during ascent or after surfacing. Commonly reported associations such as exertion, stress, cold exposure, negative inspiratory pressure, hypertension, overhydration, tight wetsuit, aspiration and certain medications were identified. This series supports the hypothesis that the elderly IPE subjects are likely to have comorbidities and be susceptible to IPE recurrences and fatalities unless the contributing factors can be identified and addressed.


Assuntos
Mergulho/efeitos adversos , Edema Pulmonar/etiologia , Adulto , Fatores Etários , Idoso , Autopsia , Temperatura Baixa/efeitos adversos , Comorbidade , Mergulho/estatística & dados numéricos , Feminino , Cardiopatias/complicações , Humanos , Imersão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Oceania , Edema Pulmonar/diagnóstico , Edema Pulmonar/mortalidade , Edema Pulmonar/patologia , Fatores de Risco , Água do Mar , Adulto Jovem
20.
Georgian Med News ; (294): 72-76, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687953

RESUMO

Dysbacteriosis of the oral cavity is known to complicate the course of chronic catarrhal gingivitis resulting from functional disorders of the macroorganism ecosystem, decreased amount of probiotic and increased amount of opportunistic and pathogenic microflora. And natural immune response is activated first in this case. It differentiates pathogens by TLR. The aim - to enhance the efficacy of treatment of chronic catarrhal gingivitis in children suffering from type 1 diabetes mellitus by means of improving the methods of pharmacological correction on the basis of investigation of the indices of local natural immune response and microbiological properties of the disease. We formed 2 group of the study. Children received basic insulin therapy. The treatment of chronic catarrhal gingivitis in children from the main group were suggested the antiseptic solution "Decasan"; pill of a probiotic action "BioGaia ProDentis" and the immune modulator "Imupret". Children from the comparative group were treated according to the common scheme. Oral microflora of children after treatment was decreased by 69,42% of general microbial number in children from the main group. Natural immunity state was also indicative of the improved protective mechanisms of the oral cavity in children from the main subgroup in the dynamics of treatment: twice as less level of mRNA TLR-2 expression was found in the main subgroup and mRNA TLR-4 - 45,44%. Therefore, the initiated course of treatment concerning chronic catarrhal gingivitis promoted a considerable improvement of the periodontal tissue state in children.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Gengivite/imunologia , Gengivite/microbiologia , Doenças Periodontais/patologia , Anti-Infecciosos Locais/uso terapêutico , Criança , Comorbidade , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/epidemiologia , Ecossistema , Gengivite/tratamento farmacológico , Gengivite/epidemiologia , Humanos , Insulina/administração & dosagem , Doenças Periodontais/complicações , Doenças Periodontais/epidemiologia , Probióticos/administração & dosagem
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