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1.
Am Surg ; 85(7): 695-699, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405410

RESUMO

SSI is a leading cause of morbidity and increases health-care cost after colorectal operations. It is a key hospital-level patient safety indicator. Previous literature has identified perioperative risk factors associated with SSI and interventions to decrease rate of infection. The purpose of this study was to evaluate the impact of blowhole closure on the rate of superficial and deep SSI. The ACS-NSQIP database was queried for patients undergoing colectomy at the University of Kentucky from 2013 to 2016. Retrospective chart review was performed to gather demographic data and perioperative variables. Wounds left open and packed were excluded. Rates of postoperative SSI were measured between the groups. One thousand eighty-three patients undergoing elective and emergent colectomy were reviewed. Nine hundred and forty-five had closed incision and 138 had blowhole closure. Patient characteristics between the groups were well matched. Patients with a blowhole closure were more likely to have an open procedure (P = 0.037) and a higher wound class (P < 0.001). The rate of superficial and deep SSI was 9.1 per cent in patients with a closed incision and 5.1 per cent in patients with blowhole closure (P = 0.142). With adjustment for approach and wound class, blowhole closure decreased the incidence of SSI (P = 0.04). There was no significant difference in morbidity or mortality. Patients undergoing elective and emergent colectomy had decreased incidence of SSI when blowhole closure was used. Given that it does not increase resource usage and its technical ease, blowhole closure should become the standard method of surgical wound closure.


Assuntos
Colectomia/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Colectomia/efeitos adversos , Comorbidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Adulto Jovem
2.
West Afr J Med ; 36(2): 183-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385606

RESUMO

OBJECTIVE: There is paucity of information on delirium in sub-Saharan Africa (SSA) particularly in the older persons (>60 years of age), leaving questions about the burden of the disease in an environment with lower health care standards. In this article, we set out to determine the frequency, precipitants and symptomatology of delirium in elderly patients admitted into medical wards in a teaching hospital in South-West Nigeria. METHODS: This was a descriptive study involving a pre-planned sample of one hundred and fifty patients aged 60 years and over, assessed for cognitive impairment and delirium using the previously validated IDEA cognitive screen, and the Confusion Assessment Method (CAM) respectively. Diagnosis of delirium was made using the CAM and DSM-IV criteria. RESULTS: Delirium was diagnosed in 32 patients giving a frequency of 21.3% (95%CI: 14.7-30.0%). Patients with delirium were significantly older (p<0.05). A quarter of the patients had dementia. Hypertension was a notable co-morbid condition. All the patients had altered sleep wake cycle, inattention, disorientation, and altered consciousness. Neurological diseases were the most common precipitant. There was a good agreement between the DSM-IV and CAM diagnoses. CONCLUSION: Delirium is common in hospitalised elderly patients particularly those with neurological diseases. Co-morbidities like hypertension, dementia, and depression should be looked for in delirious elderly patients.


Assuntos
Disfunção Cognitiva/diagnóstico , Confusão/diagnóstico , Delírio/diagnóstico , Demência/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/epidemiologia , Comorbidade , Confusão/psicologia , Delírio/epidemiologia , Delírio/psicologia , Demência/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Hipertensão/epidemiologia , Entrevista Psiquiátrica Padronizada/estatística & dados numéricos , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Testes Neuropsicológicos/estatística & dados numéricos , Nigéria/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Centros de Atenção Terciária
3.
An Bras Dermatol ; 94(3): 298-303, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31365658

RESUMO

BACKGROUND: Hidradenitis suppurativa is a complex and infrequent autoinflammatory disease that impacts on quality of life. Its pathogenesis is not fully understood, which limits the development of curative treatments. OBJECTIVES: To evaluate clinical and quality of life aspects of hidradenitis suppurativa patients from a social group on the Internet. METHODS: A cross-sectional, Internet-based survey study among participants in a discussion group (Facebook) of individuals with hidradenitis suppurativa. Patients were asked to answer a questionnaire about clinical-demographic aspects and quality of life (DLQI-BRA). RESULTS: A total of 390 individuals agreed to participate in the study, 82% of them female, median age (p25-p75), of 31 (25-37) years old, disease onset at 15 (13-23) years, family member affected in 20% of cases, overweight (BMI 29 [25-33]) kg/m2 and severe impact on quality of life (DLQI 20 [13-25]). Regarding Hurley's classification, the participants provided information that enabled classification into: I (19%), II (52%) and III (29%). More severe cases were associated with males (OR = 1.69), higher weight (BMI: OR = 1.03) non-white color (OR = 1.43) and higher frequency of other autoinflammatory diseases (OR = 1.37). STUDY LIMITATIONS: Voluntary adherence survey with self-completion of the questionnaire by 390 from about 1600 group members. CONCLUSIONS: Hidradenitis suppurativa patients who participated in a social network group had onset of the disease after puberty, with a predominance in females and overweight people, with great impact on the quality of life.


Assuntos
Pesquisa Participativa Baseada na Comunidade/métodos , Hidradenite Supurativa/psicologia , Qualidade de Vida , Mídias Sociais , Adulto , Idoso , Índice de Massa Corporal , Comorbidade , Estudos Transversais , Feminino , Hidradenite Supurativa/terapia , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Fatores Sexuais , Inquéritos e Questionários
4.
Medicine (Baltimore) ; 98(32): e16462, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393350

RESUMO

The outcome of patients with acute type B aortic dissection (BAAD) is largely dictated by whether or not the case is "complicated." The purpose of this study was to investigate the risk factors leading to in-hospital death among patients with BAAD and then to develop a predictive model to estimate individual risk of in-hospital death.A total of 188 patients with BAAD were enrolled. Risk factors for in-hospital death were investigated with univariate and multivariable logistic regression analysis. Significant risk factors were used to develop a predictive model.The in-hospital mortality rate was 9% (17 of 188 patients). Univariate analysis revealed 7 risk factors to be statistically significant predictors of in-hospital death (P < .1). In multivariable analysis, the following variables at admission were independently associated with increased in-hospital mortality: hypotension (odds ratio [OR], 4.85; 95% confidence interval [CI], 1.12-18.90; P = .04), ischemic complications (OR, 8.24; 95% CI, 1.25-33.85; P < .001), renal dysfunction (OR, 12.32; 95% CI, 10.63-76.66; P < .001), and neutrophil percentage ≥80% (OR, 5.76; 95% CI, 2.58-12.56; P = .03). Based on these multivariable results, a reliable and simple prediction model was developed, a total score of 4 offered the best point value.Independent risk factors associated with in-hospital death can be predicted in BAAD patients. The prediction model could be used to identify the prognosis for BAAD patients and assist physicians in their choice of management.


Assuntos
Aneurisma Dissecante/mortalidade , Aneurisma da Aorta Torácica/mortalidade , Mortalidade Hospitalar , Adulto , Idoso , Aneurisma Dissecante/classificação , Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/classificação , Aneurisma da Aorta Torácica/terapia , Comorbidade , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Neutrófilos/metabolismo , Razão de Chances , Fatores de Risco
5.
Medicine (Baltimore) ; 98(32): e16739, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393386

RESUMO

Surgical site infection (SSI) is a well-known complication in older adults. However, there have been no studies on SSI after gastrectomy in older adults. Therefore, we aimed to investigate the incidence, risk factors, and outcomes of SSIs after gastrectomy in older adults.We performed a retrospective cohort study of older adults, aged 65 years or older, who underwent gastrectomy between January 2015 and December 2015 at the Severance Hospital in Seoul, Korea. The incidence and outcomes of SSIs after gastrectomy were evaluated, and the risk factors for SSI were identified using multivariate analyses.We identified 353 older adults who underwent gastrectomy. Of these, 25 patients (7.1%) developed an SSI. Multivariate analysis indicated that open surgery (odds ratio, 2.71; 95% confidence interval, 1.13-6.51; P = .03) and a longer operation time (odds ratio, 1.01; 95% confidence interval, 1.00-1.01; P = .04) were independent risk factors for SSI after gastrectomy. In the SSI group, the incidence of postoperative fever (84.0% vs 51.8%; P < .001), length of postoperative hospital stay (13 days vs 6 days; P < .001), and re-admission rates within 30 days postoperatively (32.0% vs 3.4%; P < .001) were significantly higher than those in the non-SSI group.The risk factors for SSI in older adults after gastrectomy were open surgery and a longer operation time. When an SSI occurred, the postoperative hospital stay was prolonged and the chances of having a postoperative fever and being re-admitted within 30 days increased.


Assuntos
Gastrectomia/efeitos adversos , Neoplasias Gástricas/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Idoso , Comorbidade , Feminino , Gastrectomia/métodos , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Excisão de Linfonodo , Masculino , Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco
6.
Medicine (Baltimore) ; 98(32): e16765, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393395

RESUMO

Primary septic arthritis of the hip is rare and potentially devastating in adults. Its optimal surgical treatment and clinical outcomes remain unclear.In this retrospective cohort study, we investigated mortality and reinfection rates after surgery of patients with septic hip arthritis. We reviewed patients treated for primary septic hip joints from October 2005 to December 2016. A total of 51 adult patients were identified, and 38 among them had destructive hip joints. A poor postoperative outcome was defined as mortality or recurrent infection within 2 years of surgery.After surgery, 7 (13.7%) patients died within 1 year and 5 (9.8%) patients developed a recurrent hip infection within 2 years. Therefore, poor outcomes occurred in 22% (n = 11) of the study cohort. Among the 38 patients with a destructive hip joint, 7 (18.4%) died within 1 year after surgery and 4 (10.5%) developed a recurrent hip infection within 2 years of surgery. Correlative infections other than infected hip joint and liver cirrhosis were identified as risk factors for poor outcomes.In conclusion, clinical physicians treating adult primary septic hip joints should be cognizant of the high failure rate of surgical treatment. In addition, the high mortality rate should be considered during the discussion of surgical treatment with these patients and their families.


Assuntos
Artrite Infecciosa/mortalidade , Artrite Infecciosa/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/complicações , Coinfecção/epidemiologia , Comorbidade , Desbridamento/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Análise de Sobrevida
7.
Medicine (Baltimore) ; 98(33): e16867, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415421

RESUMO

Acute kidney injury (AKI) is a complex syndrome with a variety of possible etiologies and symptoms. It is characterized by high mortality and poor recovery of renal function. The incidence and mortality rates of patients with AKI in intensive care units are extremely high. It is generally accepted that early identification and prompt treatment of AKI are essential to improve outcomes. This study aimed to develop a model based on risk stratification to identify and diagnose early stage AKI for improved prognosis in critically ill patients.This was a single-center, retrospective, observational study. Based on relevant literature, we selected 13 risk factors (age, sex, hypertension, diabetes, coronary heart disease, chronic kidney disease, total bilirubin, emergency surgery, mechanical ventilation, sepsis, heart failure, cancer, and hypoalbuminemia) for AKI assessment using the Kidney Disease Improving Global Outcomes (KDIGO) diagnostic criteria. Univariate and multivariate analyses were used to determine risk factors for eventual entry into the predictive model. The AKI predictive model was established using binary logistic regression, and the area under the receiver operating characteristic curve (AUROC or AUC) was used to evaluate the predictive ability of the model and to determine critical values.The AKI predictive model was established using binary logistic regression. The AUROC of the predictive model was 0.81, with a sensitivity of 69.8%, specificity of 83.4%, and positive likelihood ratio of 4.2.A predictive model for AKI in critically ill patients was established using 5 related risk factors: heart failure, chronic kidney disease, emergency surgery, sepsis, and total bilirubin; however, the predictive ability requires validation.


Assuntos
Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Estatísticos , Lesão Renal Aguda/diagnóstico , Adulto , Idoso , Bilirrubina/sangue , Comorbidade , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Sepse/epidemiologia
8.
Medicine (Baltimore) ; 98(33): e16871, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415425

RESUMO

Predicting long-term outcomes after sepsis is important when caring for patients with this condition. The purpose of the present study was to develop models predicting long-term mortality of patients with sepsis, including septic shock.Retrospective data from 446 patients with sepsis (60.8% men; median age, 71 years) treated at a single university-affiliated tertiary care hospital over 3 years were reviewed. Binary logistic regression was used to identify factors predicting mortality at 180 and 365 days after arrival at the emergency department. Long-term prognosis scores for the 180- and 365-day models were calculated by assigning points to variables according to their ß coefficients.The 180- and 365-day mortality rates were 40.6% and 47.8%, respectively. Multivariate analysis identified the following factors for inclusion in the 180- and 365-day models: age ≥65 years, body mass index ≤18.5 kg/m, hemato-oncologic diseases as comorbidities, and ventilator care. Patients with scores of 0 to ≥3 had 180-day survival rates of 83.8%, 70.8%, 42.3%, and 25.0%, respectively, and 365-day survival rates of 72.1%, 64.6%, 36.2%, and 15.9%, respectively (all differences P < .001; log-rank test). The areas under the receiver operating characteristic curves of the 180- and 365-day models were 0.713 (95% confidence interval [CI] 0.668-0.756, P < .001) and 0.697 (95% CI 0.650-0.740, P < .001), respectively.These long-term prognosis models based on baseline patient characteristics and treatments are useful for predicting the 6- and 12-month mortality rates of patients with sepsis.


Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Choque Séptico/mortalidade , Análise de Sobrevida , APACHE , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Comorbidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Respiração Artificial/efeitos adversos , Adulto Jovem
9.
Stud Health Technol Inform ; 266: 20-24, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31397296

RESUMO

We developed a machine learning model to predict 30-day readmissions using the model types; XGBoost, Random Forests and Adaboost with decision stumps as a base learner with different feature combinations and preprocessing procedures. The proposed model achieved the F1-score (0.386 ± 0.006), sensitivity (0.598 ± 0.013), positive predictive value (PPV) (0.285 ± 0.004) and negative predictive value (NPV) (0.932 ± 0.002). When compared with LACE and PARR (NZ) models, the proposed model achieved better F1-score by 12.5% compared to LACE and 22.9% compared to PARR (NZ). The mean sensitivity of the proposed model was 6.0% higher than LACE and 42.4% higher than PARR (NZ). The mean PPV was 15.9% and 13.5% higher than LACE and PARR (NZ) respectively.


Assuntos
Serviço Hospitalar de Emergência , Readmissão do Paciente , Comorbidade , Humanos , Tempo de Internação , Modelos Logísticos , Fatores de Risco
10.
Stud Health Technol Inform ; 264: 858-862, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438046

RESUMO

Clinical Decision Support Systems (CDSS) utilize computerized Clinical Practice Guidelines (CPG) to deliver evidence-based care recommendations. However, when dealing with comorbidity (i.e., patients with multiple conditions), disease-specific CPG often interact in adverse ways (e.g., drug-drug, drug-disease interactions), and may involve redundant elements as well (e.g., repeated care tasks). To avoid adverse interactions and optimize care, current options involve the static, a priori integration of comorbid CPG by replacing or removing therapeutic tasks. Nevertheless, many aspects are relevant to a clinically safe and efficient integration, and these may change over time-task delays, test outcomes, and health profiles-which are not taken into account by static integrations. Moreover, in case of comorbidity, clinical practice often demands nuanced solutions, based on current health profiles. We propose an execution-time approach to safely and efficiently cope with comorbid conditions, leveraging knowledge from medical Linked Open Datasets to aid during CIG integration.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Comorbidade , Humanos
11.
Rev Saude Publica ; 53: 64, 2019 Aug 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31432929

RESUMO

OBJECTIVE: To analyze the impact of the Hospital-Acquired Conditions (HAC) in women in the puerperal and pregnancy cycle during length of stay. METHODS: This cross-sectional study was conducted with 113,456 women, between July 2012 and July 2017, in Brazil's national hospitals of the supplementary healthcare networks and philanthropists accredited to the Unified Health System (SUS). Data on hospital discharges were collected using the Diagnosis-Related Groups (DRG Brasil®) system. All DRGs of the major diagnostic category 14 (MDC14), including pregnancy, childbirth and puerperium, were included. The impact of HAC on length of stay was estimated by Student's t-test, and the effect size by Cohen's d, which allows to assess clinical relevance. RESULTS: The most prevalent diagnostic categories related to MDC14 were vaginal and cesarean deliveries without complicating diagnoses, both at institutions accredited to SUS and those for supplementary health care. The prevalence of HAC was 3.8% in supplementary health and 2.5% in SUS. Hospitals providing services to supplementary health care providers had a longer length of stay considering HAC for patients classified as DRG: cesarean section with complications or comorbidities at admission (p < 0.001; Cohen's d = 0.74), cesarean section without complications or comorbidities at admission (p < 0.001, Cohen's d = 0.31), postpartum and post abortion without listed procedure (p < 0.001, Cohen's d = 1.05), and other antepartum diagnoses with medical complications (p < 0.001; Cohen's d = 0.77). CONCLUSIONS: This study showed that the prevalence of HAC was low both in the institutions accredited to attend by SUS and in those of supplementary health; however, its presence contributes to increasing the length of stay in cases of cesarean sections without complications or comorbidities in supplementary health institutions.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Doença Iatrogênica , Tempo de Internação/estatística & dados numéricos , Brasil , Cesárea , Comorbidade , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Alta do Paciente/estatística & dados numéricos , Período Pós-Parto , Gravidez
12.
Rev Fac Cien Med Univ Nac Cordoba ; 76(3): 154-158, 2019 08 29.
Artigo em Espanhol | MEDLINE | ID: mdl-31465182

RESUMO

Introduction: Aeromonas is a common cause of gastroenteritis but occasionally it can cause extraintestinal infections. The incidence of bacteremia by this genus is very low and in general the patients have associated base diseases. Materials and methods: Retrospective analysis of episodes of bacteremia by Aeromonas spp. during a period of eight years in the National Hospital of Clinics of the city of Córdoba, emphasizing age, sex, associated comorbidities, clinical presentation, focus, origin of the infection, clinical evolution, species prevalence and antimicrobial sensitivity of the same . Results: 10 episodes of bacteremia were recorded by Aeromonas spp. 60% corresponded to women and 40% to men. The average age was 65 years. In seven patients the origin of the infection was community and in three nosocomial. 70% of the patients presented predisposing base pathologies. The focus of bacteremia was abdominal in two cases. A. hydrophila complex was responsible for 50% of the cases. 80% of bacteremia were monomicrobial. The isolates generally showed high percentages of sensitivity. Conclusion: Bacteremia occurred in elderly patients of both sexes, most of whom had associated comorbidities. The majority of the infections originated in the community. While bacteremia by Aeromonas spp. it is rare, the mortality found in our study was relatively high despite the high percentage of sensitivity to antimicrobials.


Assuntos
Aeromonas/isolamento & purificação , Bacteriemia/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/classificação , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Comorbidade , Resistência a Medicamentos , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Stud Health Technol Inform ; 264: 920-924, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438058

RESUMO

Understanding the progression of chronic diseases, such as chronic obstructive pulmonary disease (COPD), is important to inform early diagnosis, personalized care, and health system management. Data from clinical and administrative systems have the potential to advance this understanding, but traditional methods for modelling disease progression are not well-suited to analyzing data collected at irregular intervals, such as when a patient interacts with a healthcare system. We applied a continuous-time hidden Markov model to irregularly-spaced healthcare utilization events and patient-level characteristics in order to analyze the progression through discrete states of 76,888 patients with COPD. A 4-state model allowed classification of patients into interpretable states of disease progression and generated insights about the role of comorbidities, such as cardiovascular diseases, in accelerating severe trajectories. These results can improve the understanding of the evolution of COPD and point to new hypotheses about chronic disease management and comorbidity.


Assuntos
Doenças Cardiovasculares , Doença Pulmonar Obstrutiva Crônica , Doença Crônica , Comorbidade , Progressão da Doença , Humanos
14.
Rev Assoc Med Bras (1992) ; 65(7): 1015-1020, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31389516

RESUMO

OBJECTIVE: To review systematically the influence of admission criteria on the mortality of elderly patients under intensive therapy. METHODS: We performed a search on the PUBMED and BIREME databases by using the MeSH and DeCS terms "intensive care units", "patient admission", and "aged" in Portuguese, English, and Spanish. Only prospective and retrospective cohort studies were included. We analyzed the severity score, type of hospital admission, quality of life, co-morbidities, functionality, and elderly institutionalization. RESULTS: Of the 1,276 articles found, thirteen were selected after evaluation of the inclusion and exclusion criteria. It was observed that the severity score, functionality, and co-morbidities had an impact on mortality. It was not possible to determine which severity score was more suitable. CONCLUSION: We suggest that analysis of functionality, co-morbidities, and severity scores should be conducted to estimate the elderly mortality in relation to the admission to intensive care units.


Assuntos
Mortalidade Hospitalar , Unidades de Terapia Intensiva/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Admissão do Paciente/normas , Fatores Etários , Comorbidade , Humanos , Qualidade de Vida , Índice de Gravidade de Doença
15.
Minerva Med ; 110(5): 464-470, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31368293

RESUMO

INTRODUCTION: Helicobacter pylori is a gram-negative bacterium that is colonized in the stomach. H. pylori infection can lead to a series of stomach diseases. However, the relationship between H. pylori infection and colorectal cancer is currently controversial. Therefore, we performed this meta-analysis to further understand the relationship between H. pylori infection and colorectal cancer. EVIDENCE ACQUISITION: We conducted a comprehensive retrieval from electronic databases, included the PubMed, Medline, China National Knowledge Infrastructure (CNKI), and China Wanfang Data Knowledge Service Platform databases (Wanfang Databases) through May 1st, 2018. We used the search terms H. pylori and colorectal cancer or colorectal carcinoma and collected all relevant studies to explore the association between H. pylori infection and colorectal cancer. EVIDENCE SYNTHESIS: Twenty-seven studies including 14357 cases were included. H. pylori infection was associated with an increased risk of colorectal cancer. A pooled odds ratio (OR) of 1.27 with a 95% CI of 1.17-1.37 (P<0.001) was calculated by using a fixed-effects model (I2=45.5%, P=0.006). The subgroup analysis revealed that H. pylori infection was associated with an increased risk of colorectal cancer in the subgroups of Western countries (OR=1.34, 95% CI: 1.14-1.57) (P<0.001), serological testing (OR=1.20, 95% CI: 1.08-1.34) (P=0.001), multiple methods of testing (OR=2.63, 95% CI: 1.09-6.31) (P=0.031), cross-sectional studies (OR=1.92, 95% CI: 1.17-3.16) (P=0.010) and case-control studies (OR 1.26, 95% CI: 1.16-1.36) (P<0.001). CONCLUSIONS: The present meta-analysis provides evidence suggests that a positive association between H. pylori infection and the risk of colorectal cancer.


Assuntos
Neoplasias Colorretais/etiologia , Gastrite/epidemiologia , Infecções por Helicobacter/complicações , Helicobacter pylori/patogenicidade , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/microbiologia , Comorbidade , Suscetibilidade a Doenças , Estudos Epidemiológicos , Gastrite/microbiologia , Infecções por Helicobacter/epidemiologia , Humanos , Razão de Chances , Viés de Publicação , Fatores de Risco , Sensibilidade e Especificidade
16.
Medicine (Baltimore) ; 98(34): e16927, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441878

RESUMO

Coronary artery disease (CAD) is a life-threatening medical emergency which needs urgent medical attention. Percutaneous coronary intervention (PCI) is common and necessary for patients with CAD. The effect of hypercholesterolemia and diabetes on long-term outcomes in patients with stable CAD receiving PCI is unclear.In this study, patients with stable CAD who underwent PCI were prospectively divided into 4 groups according to the presence or absence of diabetes or hypercholesterolemia. Clinical characteristics, risk factors, medications, angiographic findings, and outcome predictors were analyzed and long-term outcomes compared between groups.Of the 1676 patients studied, those with hypercholesterolemia and diabetes had the highest all-cause mortality rate after PCI (P < .01); those with diabetes only had the highest cardiovascular (CV) mortality (P < .01). However, the 4 groups did not differ in rates of myocardial infarction (MI) or repeated PCI. In Kaplan-Meier survival analysis, patients with diabetes only had the highest rates of all-cause mortality and CV mortality (both P < .001). In the Cox proportional hazard model, patients with both hypercholesterolemia and diabetes had the highest risk of all-cause mortality (hazard ratio: 1.70), but groups did not differ in rates of MI, CV mortality, and repeated PCI.With or without hypercholesterolemia, diabetes adversely impacts long-term outcomes in patients receiving PCI. Diabetes mellitus seemed to be a more hazardous outcome predictor than hypercholesterolemia. Hypercholesterolemia and diabetes seemed to have an additive effect on all-cause mortality in patients after receiving PCI.


Assuntos
Doença da Artéria Coronariana/mortalidade , Diabetes Mellitus/mortalidade , Hipercolesterolemia/mortalidade , Intervenção Coronária Percutânea/efeitos adversos , Estudos de Casos e Controles , Comorbidade , Doença da Artéria Coronariana/cirurgia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
17.
Medicine (Baltimore) ; 98(34): e16931, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441882

RESUMO

Several studies have shown that statin users have a lower risk of new-onset dementia (NOD) compared nonusers. However, other studies have shown opposite results. In this study, we investigated the association between the use of statins and the development of NOD.This was a longitudinal cohort study using data from claim forms submitted to the Taiwanese Bureau of National Health Insurance. The study included patients with NOD and non-NOD subjects from January 2002 to December 2013. We estimated the hazard ratios (HRs) of NOD associated with statin use, whereas nonuser subjects were used as a reference group.A total of 19,522 NOD cases were identified in 100,610 hyperlipidemic patients during the study period. The risk of NOD, after adjusting for sex, age, comorbidities, and concurrent medication, was lower among statin users than nonusers (HR 0.95, 95% CI [confidence interval] 0.94-0.96; P < .001). The adjusted HRs for NOD were 1.53 (95% CI, 1.45-1.62), 0.63 (95% CI, 0.57-0.71), and 0.34 (95% CI, 0.30-0.38) when the cumulative defined daily doses ranged from 28 to 365, 366 to 730, and more than 730 relative to nonusers, respectively.We concluded that statin use is associated with a decreased NOD risk. The protective effect of statins for NOD seemed to be related to high exposure to statins. This study also highlights that high exposure to statins has a dose-response effect on lowering NOD risk.


Assuntos
Cognição/efeitos dos fármacos , Demência/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hiperlipidemias/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Comorbidade , Demência/epidemiologia , Relação Dose-Resposta a Droga , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taiwan/epidemiologia
19.
Psychiatr Prax ; 46(5): 281-286, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31269520

RESUMO

OBJECTIVE: Patients from opioid maintenance treatment (OMT) may taper off from opioids during rehab treatment. It is investigated whether this option improves treatment outcomes in particular for those patients who are affected by psychiatric or somatic comorbidity, or by social problems. METHODS: Multicenter study with 4 rehab units. Patient characteristics and treatment outcomes were collected retrospectively. There were n = 227 patients who were admitted to treatment while still receiving OMT, and n = 156 who were opioid free. RESULTS: With regard to regular completion of rehab treatment, an interaction was observed between status at admission and diagnosis of affective, neurotic and anxiety disorders, and between status and previous rehab treatment experience. If admitted in an abstinent status, patients who had never entered rehab, and patients with affective or anxiety disorders showed decreased regular completion rates, while they showed increased completion rates if tapered off during treatment. There was no interaction between initial status and acute life crisis (release from prison, homelessness), somatic diagnoses, or number of stabilizing social factors. CONCLUSION: Admission while still receiving opiate maintenance could be helpful for patients with psychiatric comorbidity and for patients who had previously been reluctant to enter rehab treatment.


Assuntos
Analgésicos Opioides , Pacientes Internados , Transtornos Mentais/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Comorbidade , Alemanha , Humanos , Transtornos Mentais/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estudos Retrospectivos
20.
J Assoc Physicians India ; 67(4): 29-32, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31309792

RESUMO

Background: Hyperhomocystienemia is a plausible common link between psoriasis and associated co-morbidities. Aim: To assess and compare serum homocystiene levels in 160(M:F 94:66) patients aged 18-70 years with chronic plaque psoriasis of varying severity with or without metabolic syndrome, cardiovascular and thyroid disorders and controls. The 155 controls (M:F 97:58) were healthy volunteers aged between 18 and 66 years. Results: Overall, 123 (76.9%) psoriasis patients with or without co-morbidities and 87 (56.1%) controls had elevated serum homocystiene levels; 23.48±14.37 and 18.74±12.59 (mean±SD) µmol/L, respectively. Eighty-one (58%) patients had associated co-morbidities with mean serum homocystiene levels of 22.65±13.70 µmol/L.The difference between psoriasis patients with or without comorbidities and controls was statistically significant. Conclusions: Hyperhomocystienemia in psoriasis patients with or without comorbidities versus healthy controls suggests its possible dysregulation in psoriasis. The significance of hyperhomocystienemia as an independent risk factor for cardiovascular or other comorbidities in psoriasis patients remains tenuous at best. Well-designed studies will perhaps resolve this issue.


Assuntos
Hiper-Homocisteinemia/epidemiologia , Psoríase/complicações , Psoríase/epidemiologia , Adolescente , Adulto , Idoso , Doenças Cardiovasculares , Comorbidade , Humanos , Síndrome Metabólica , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
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