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1.
Rev. enferm. UERJ ; 28: e45752, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1117683

RESUMO

Objetivo: estimar a prevalência do uso do preservativo e os fatores associados em trabalhadores da construção civil. Método: estudo transversal, analítico, com 370 trabalhadores da grande João Pessoa, Paraíba. Considerou como variável de desfecho o uso do preservativo na última relação sexual. Utilizou-se questionário estruturado. Análise de regressão logística bivariada e múltipla foi utilizada para identificar associação entre as variáveis sociodemográficas e o uso do preservativo. Resultados: a maioria dos participantes é do sexo masculino, adultos jovens, casados e com baixa escolaridade. A prevalência estimada de uso do preservativo foi de 23,5% (IC 95%: 19,2% - 27,8%). Indivíduos com menos de 39 anos possuem 1,82 vezes mais chances de usar o preservativo e ser casado diminui (RC=0,26) as chances de uso. Conclusão: há baixa prevalência de uso do preservativo em trabalhadores da construção civil. A prevenção combinada é uma alternativa para controle das infecções transmissíveis, sendo o preservativo o principal coadjuvante.


Objective: to estimate the prevalence of condom use and the associated factors in construction workers. Method: in this crosssectional, analytical study with 370 workers from greater João Pessoa, Paraíba, Brazil, the outcome variable was condom use at last sexual intercourse. A structured questionnaire was used. Bivariate and multiple logistic regression analysis was used to identify associations between sociodemographic variables and condom use. Results: most participants were young, male adults, married and with little education. Estimated prevalence of condom use was 23.5% (95% CI; 19.2% - 27.8%). Individuals under 39 years old were found to be 1.82 times more likely to use condoms than individuals aged 40 years or older (OR = 1.82; 95% CI), while being married reduced the likelihood (OR = 0.26). Conclusion: prevalence of condom use is low among construction workers. Combined prevention is one option for controlling communicable diseases, with condoms as the main support.


Objetivo: estimar la prevalencia del uso de condón y los factores asociados en trabajadores de la construcción. Método: en este estudio transversal y analítico con 370 trabajadores del área metropolitana de João Pessoa, Paraíba, Brazil, la variable de resultado fue el uso de condón en la última relación sexual. Se utilizó un cuestionario estructurado y análisis de regresión logística bivariada y múltiple para identificar asociaciones entre las variables sociodemográficas y el uso del condón. Resultados: la mayoría de los participantes fueron jóvenes, varones adultos, casados y con poca educación. La prevalencia estimada del uso de condones fue del 23,5% (IC del 95%; 19,2% - 27,8%). Se encontró que las personas menores de 39 años tenían 1,82 veces más probabilidades de usar condones que las personas de 40 años o más (OR = 1,82; IC del 95%), mientras que estar casado redujo la probabilidad (OR = 0,26). Conclusión: la prevalencia del uso de condones es baja entre los trabajadores de la construcción. La prevención combinada es una opción para controlar las enfermedades transmisibles, con el condón como principal apoyo.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Comportamento Sexual/estatística & dados numéricos , Saúde do Trabalhador , Preservativos/estatística & dados numéricos , Sexo sem Proteção/estatística & dados numéricos , Brasil , Indústria da Construção , Estudos Transversais , Prevenção de Doenças , Correlação de Dados , Enfermagem do Trabalho
2.
Medicine (Baltimore) ; 99(42): e22459, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080681

RESUMO

Major surgery due to traumatic injury can activate early systemic postoperative pro-inflammatory responses and postoperative immunosuppression. However, the interaction between them is complex and not entirely clear. This study was performed in postoperative patients admitted to the intensive care unit (ICU) to elucidate the correlation between the systemic cellular immunity function and circulating cytokines levels in the early postoperative period.Twenty-four cases of postoperative patients admitted to the ICU were enrolled in this study. Twelve hours after admission, blood routine examination and measurement of circulating cytokines (interleukin-2 [IL-2], IL-4, IL-6, IL-10, IL-17A, interferon-γ, tumor necrosis factor-alpha [TNF-α], TNF-ß, granulocyte-colony stimulating factor [G-CSF], and granulocyte-macrophage colony-stimulating factor [GM-CSF]) were performed. The correlation analysis between cytokines levels and absolute peripheral blood lymphocyte count or lymphocytes/neutrophils ratio was analyzed.The cytokines (IL-2, IL-4, IL-6, IL-10, IL-17A, TNF-α, G-CSF, and GM-CSF) levels were increased above the normal upper limit at 12 hours after surgery. The number of leukocytes and neutrophils were markedly increased. In contrast, the absolute count and relative ratio of lymphocytes decreased below the lower normal limit. Spearman correlation analysis showed a moderate negative correlation between absolute peripheral blood lymphocyte count and IL-2 or IL-4 level. A low-negative correlation between absolute peripheral blood lymphocyte count and GM-CSF levels was detected. We also found that lymphocytes/neutrophils ratio was also negatively correlated with plasma IL-2, IL-4, or GM-CSF level.In ICU patients with compromised immune function in the early postoperative period, the elevated levels of IL-2, IL-4, and GM-CSF may be the compensatory responses to systemic immunosuppression.


Assuntos
Citocinas/sangue , Imunidade Celular , Hospedeiro Imunocomprometido , Contagem de Linfócitos , Idoso , Correlação de Dados , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório
3.
Sci Rep ; 10(1): 18377, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33110184

RESUMO

The Bacillus Calmette-Guerin (BCG) vaccine provides protection against tuberculosis (TB), and is thought to provide protection against non-TB infectious diseases. BCG vaccination has recently been proposed as a strategy to prevent infection with SARS-CoV-2 (CoV-2) to combat the COVID-19 outbreak, supported by its potential to boost innate immunity and initial epidemiological analyses which observed reduced severity of COVID-19 in countries with universal BCG vaccination policies. Seventeen clinical trials are currently registered to inform on the benefits of BCG vaccinations upon exposure to CoV-2. Numerous epidemiological analyses showed a correlation between incidence of COVID-19 and BCG vaccination policies. These studies were not systematically corrected for confounding variables. We observed that after correction for confounding variables, most notably testing rates, there was no association between BCG vaccination policy and COVD-19 spread rate or percent mortality. Moreover, we found variables describing co-morbidities, including cardiovascular death rate and smoking prevalence, were significantly associated COVID-19 spread rate and percent mortality, respectively. While reporting biases may confound our observations, our epidemiological findings do not provide evidence to correlate overall BCG vaccination policy with the spread of CoV-2 and its associated mortality.


Assuntos
Vacina BCG/administração & dosagem , Infecções por Coronavirus/epidemiologia , Vacinação em Massa/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Tuberculose/prevenção & controle , Vacina BCG/uso terapêutico , Correlação de Dados , Política de Saúde , Humanos , Pandemias
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5362-5368, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019194

RESUMO

A large amount of data including joint kinematics, joint kinetics, clinical and functional measurements constitutes the clinical gait analysis basis which is a process whereby quantitative gait information are collected to aid in clinical decision-making. Therefore, better understanding the relationship between the biomechanical and clinical data for the knee osteoarthritis (OA) patient is for a relevant importance. It's the purpose of this paper, which aims to analyze and visualize the correlation structure between biomechanical characteristics and clinical symptoms, and thus to provide an additional knowledge from the coupling of these parameters that will be useful for the pathology assessment of knee-joint disease in the end-staged knee OA patients. We perform two multivariate statistical approaches, first, a Canonical Correlation Analysis (CCA) to assess the multivariate association and, second, a graphical- based representation of the multivariate correlation to better understand the association between these multivariate data. Results show the usefulness of using such multivariate approaches to highlight association and specific correlation structure between the features and to extract meaningful information.


Assuntos
Correlação de Dados , Osteoartrite do Joelho , Fenômenos Biomecânicos , Humanos , Articulação do Joelho , Análise Multivariada
6.
Medicine (Baltimore) ; 99(44): e22892, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126340

RESUMO

T cell immunoglobulin and mucin domain-3 (TIM-3) is a surface molecule expressed on immune cells which play a role in immune regulation. The aims of the present study were to determine whether circulating soluble T cell immunoglobulin domain and mucin-3 (sTIM-3) are elevated in rheumatoid arthritis (RA) patients, and investigate the relationships between sTIM-3 and clinical features of RA.The study included 116 patients with established RA and 27 healthy control subjects. Serum levels of sTIM-3 were measured via the enzyme-linked immunosorbent assays (ELISA). Correlations between serum sTIM-3 and a range of parameters including anti-citrullinated peptide antibody (ACPA) titer, erythrocyte sedimentation rate (ESR), and matrix metalloproteinase-3 (MMP-3) were assessed.Serum sTIM-3 was significantly elevated in RA patients compared with those in healthy subjects, and it was positively correlated with ACPA titer (r = 0.27 P = .005), ESR (r = 0.27, P = .004) and MMP-3 (r = 0.35, P < .001). In RA patients with high ACPA titers (≥200 U/mL), sTIM-3 was not correlated with ESR or MMP-3. Whereas, sTIM-3 was significantly correlated with ESR and MMP-3 in RA patients with low ACPA titers (<200 U/mL).Serum sTIM-3 was increased in RA patients, and it was associated with proinflammatory markers and disease activity in RA patients under a particular ACPA status. Our data suggest that circulating sTIM-3 may be a useful biomarker for the determination of disease activity in RA patients.


Assuntos
Anticorpos Anti-Proteína Citrulinada/sangue , Artrite Reumatoide , Receptor Celular 2 do Vírus da Hepatite A/sangue , Artrite Reumatoide/sangue , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/fisiopatologia , Biomarcadores/sangue , Sedimentação Sanguínea , Correlação de Dados , Progressão da Doença , Feminino , Humanos , Articulações/imunologia , Articulações/patologia , Masculino , Metaloproteinase 3 da Matriz/sangue , Pessoa de Meia-Idade , Monitorização Imunológica/métodos , Gravidade do Paciente
7.
BMJ ; 371: m3502, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028606

RESUMO

OBJECTIVE: To consolidate evidence from systematic reviews and meta-analyses investigating the association between reproductive factors in women of reproductive age and their subsequent risk of cardiovascular disease. DESIGN: Umbrella review. DATA SOURCES: Medline, Embase, and Cochrane databases for systematic reviews and meta-analyses from inception until 31 August 2019. REVIEW METHODS: Two independent reviewers undertook screening, data extraction, and quality appraisal. The population was women of reproductive age. Exposures were fertility related factors and adverse pregnancy outcomes. Outcome was cardiovascular diseases in women, including ischaemic heart disease, heart failure, peripheral arterial disease, and stroke. RESULTS: 32 reviews were included, evaluating multiple risk factors over an average follow-up period of 7-10 years. All except three reviews were of moderate quality. A narrative evidence synthesis with forest plots and tabular presentations was performed. Associations for composite cardiovascular disease were: twofold for pre-eclampsia, stillbirth, and preterm birth; 1.5-1.9-fold for gestational hypertension, placental abruption, gestational diabetes, and premature ovarian insufficiency; and less than 1.5-fold for early menarche, polycystic ovary syndrome, ever parity, and early menopause. A longer length of breastfeeding was associated with a reduced risk of cardiovascular disease. The associations for ischaemic heart disease were twofold or greater for pre-eclampsia, recurrent pre-eclampsia, gestational diabetes, and preterm birth; 1.5-1.9-fold for current use of combined oral contraceptives (oestrogen and progesterone), recurrent miscarriage, premature ovarian insufficiency, and early menopause; and less than 1.5-fold for miscarriage, polycystic ovary syndrome, and menopausal symptoms. For stroke outcomes, the associations were twofold or more for current use of any oral contraceptive (combined oral contraceptives or progesterone only pill), pre-eclampsia, and recurrent pre-eclampsia; 1.5-1.9-fold for current use of combined oral contraceptives, gestational diabetes, and preterm birth; and less than 1.5-fold for polycystic ovary syndrome. The association for heart failure was fourfold for pre-eclampsia. No association was found between cardiovascular disease outcomes and current use of progesterone only contraceptives, use of non-oral hormonal contraceptive agents, or fertility treatment. CONCLUSIONS: From menarche to menopause, reproductive factors were associated with cardiovascular disease in women. In this review, presenting absolute numbers on the scale of the problem was not feasible; however, if these associations are causal, they could account for a large proportion of unexplained risk of cardiovascular disease in women, and the risk might be modifiable. Identifying reproductive risk factors at an early stage in the life of women might facilitate the initiation of strategies to modify potential risks. Policy makers should consider incorporating reproductive risk factors as part of the assessment of cardiovascular risk in clinical guidelines. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019120076.


Assuntos
Doenças Cardiovasculares/epidemiologia , Fertilidade , Complicações na Gravidez/epidemiologia , Saúde Reprodutiva/estatística & dados numéricos , Medição de Risco , Correlação de Dados , Feminino , Humanos , Metanálise como Assunto , Gravidez , Fatores de Risco , Revisões Sistemáticas como Assunto
8.
Minerva Med ; 111(4): 337-343, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33032394

RESUMO

BACKGROUND: Programmed death-ligand 1 (PD-L1) expression and tumor-infiltrating lymphocytes (TILs) are considered have a prognostic value in several malignancies. This study investigated the correlation between PD-L1 expression of tumor cells with the degree of stromal TILs in colorectal adenocarcinoma. METHODS: A cross sectional study design performed by taking 52 colorectal adenocarcinoma samples. The specimens were stained by immunohistochemical procedure using PD-L1 rabbit monoclonal antibody and the degrees of TILs were assessed base on hematoxylin and eosin (H&E) staining. RESULTS: From a total of 52 samples, the positive PD-L1 expression of tumor cells were 44 (84.6%) samples with 22 (50.0%), 18 (40.9%) and 4 (9.1%) samples had low-, moderate-, and high-degree TILs, respectively. While the negative PD-L1 expression were eight (15.4%) samples with 1 (12.5%), three (37.5%) and four (50.0%) samples had low-, moderate-, and high-degree TILs, respectively. A value of P=0.017 (P<0.05) was obtained by the Chi-square test. CONCLUSIONS: This study concluded that there was a significant correlation between PD-L1 expression of tumor cells and the degree of TILs in colorectal adenocarcinoma. This result indicated that the degree of TILs had the potential to be used as a predictive factor for PD-L1 expression of tumor cells in colorectal adenocarcinoma.


Assuntos
Adenocarcinoma/patologia , Antígeno B7-H1/biossíntese , Neoplasias Colorretais/patologia , Linfócitos do Interstício Tumoral/metabolismo , Adulto , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Am J Prev Med ; 59(5): 630-638, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33011008

RESUMO

INTRODUCTION: Exposure to disaster-related media may be a risk factor for mental distress, but this has not been examined in the context of the COVID-19 pandemic. This study assesses whether exposure to social and traditional media during the rise of the COVID-19 pandemic was associated with mental distress among U.S. adults. METHODS: Data came from the Understanding America Study, conducted with a cross-sectional, nationally representative sample of adults who completed surveys online. Participants included 6,329 adults surveyed between March 10 and March 31, 2020. Regression analyses examined the associations of (1) self-reported average time spent on social media in a day (hours) and (2) number of traditional media sources (radio, TV, and newspaper) consulted to learn about COVID-19 with self-reported mental distress (4-item Patient Health Questionnaire). Data were analyzed in April 2020. RESULTS: Participants responding at later survey dates reported more time spent on social media (ß=0.02, 95% CI=0.01, 0.03), a greater number of traditional media sources consulted to learn about COVID-19 (ß=0.01, 95% CI=0.01, 0.02), and greater mental distress (ß=0.07, 95% CI=0.04, 0.09). Increased time spent on social media and consulting a greater number of traditional media sources to learn about COVID-19 were independently associated with increased mental distress, even after adjusting for potential confounders (social media: ß=0.14, 95% CI=0.05, 0.23; traditional media: ß=0.14, 95% CI=0.08, 0.20). CONCLUSIONS: Exposure to a greater number of traditional media sources and more hours on social media was modestly associated with mental distress during the rise of the COVID-19 pandemic in the U.S.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Angústia Psicológica , Meio Social , Mídias Sociais/estatística & dados numéricos , Adulto , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Disseminação de Informação/métodos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Psicologia , Fatores de Risco , Autorrelato/estatística & dados numéricos , Estados Unidos/epidemiologia
10.
Medicine (Baltimore) ; 99(43): e22752, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120777

RESUMO

BACKGROUND: Electroacupuncture (EA) treatment has antidepressant effect and when patients were treated with EA and antidepressants, the effect could be maintained for a longer time. However, the effect of EA combined with antidepressants based on metabolism is still in the initial observation stage, which requires further research. METHODS: A total of 60 patients with moderate depression were assigned into 2 groups at a ratio of 1:1, the EA group (receiving EA and antidepressants) and the control group (taking antidepressants only) in this randomized controlled pilot trial. The EA treatment was performed 3 times a week for 8 consecutive weeks and then follow up for 4 weeks. The patients' depressive mood was measured by the Hamilton Depression scale (HAMD) at baseline, week 4, week 8 and week 12. Before and after 8-week treatment, morning urine samples from all patients were analyzed by the gas chromatography-mass spectrometry (GC-MS) to find possible metabolic markers of depression and of EA treatment related changes. RESULTS: Compared with the control group, the EA group showed more significant improvements in depressive symptoms measured by HAMD at week 4 (16.89 ±â€Š5.74 vs 25.58 ±â€Š7.03, P < .001), week 8 (9.59 ±â€Š5.13 vs 25.04 ±â€Š7.49, P < .001) and week 12 (11.07 ±â€Š6.85 vs 27.25 ±â€Š7.14, P < .001). The significant differences in urinary specific metabolites before and after EA treatment were malonic acid (fatty acid biosynthesis), cysteine (glutamate metabolism), glutathione (glutamate metabolism), tryptophan (tryptophan metabolism), proline (glutamate metabolism), and N-acetyl-5-hydroxytryptamine. These metabolites are involved in tryptophan metabolism, glutamate metabolism, and fatty acid biosynthesis. CONCLUSION: EA treatment combined with antidepressants is more effective in improving depressive symptoms than antidepressants alone. EA may treat depression by acting on tryptophan metabolism, glutamate metabolism, and fatty acid biosynthesis. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR-2000030786.


Assuntos
Antidepressivos/uso terapêutico , Depressão/metabolismo , Depressão/terapia , Eletroacupuntura , Adulto , Correlação de Dados , Depressão/tratamento farmacológico , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
11.
PLoS One ; 15(9): e0238772, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32946454

RESUMO

CONTEXT: Metabolic syndrome (MetS) is a complex condition comprising a 'clustering' of components representing cardiometabolic risk factors for heart disease and diabetes; its prevalence rate is high and consequences serious. Evidence suggests that light exposure patterns and misalignment of circadian rhythms might contribute to MetS etiology by impacting energy metabolism and glucose regulation. OBJECTIVE: We hypothesised that individuals with MetS would show disrupted circadian and sleep parameters alongside differences in light exposure profiles. We investigated this using data from a cohort study in Brazil. METHODS: Data from 103 individuals from the Baependi Heart Cohort Study aged between 50 and 70 were analysed. Motor activity and light exposure were measured using wrist-worn actigraphy devices. Cardiometabolic data were used to calculate the number of MetS components present in each participant, and participants grouped as MetS/non-MetS according to standard guidelines. Between-group comparisons were made for the actigraphy measures; additionally, correlation analyses were conducted. RESULTS: Motor activity and circadian profiles showed no differences between groups. However, the MetS group presented lower light exposure during the day and higher light exposure at night. Correlation analyses, including all participants, showed that greater daytime light exposure and greater light exposure difference between day and night were associated with reduced MetS risk (a lower number of MetS components). Also, the light exposure difference between day and night correlated with body mass index across all participants. CONCLUSIONS: The observed results suggest a direct association between light exposure and MetS which appears to not be attributable to disruptions in circadian activity rhythm nor to sleep parameters. This link between light exposure patterns and MetS risk could inform possible prevention strategies.


Assuntos
Luz , Síndrome Metabólica/etiologia , Actigrafia/métodos , Idoso , Brasil/epidemiologia , Ritmo Circadiano , Estudos de Coortes , Correlação de Dados , Feminino , Glucose/metabolismo , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prevalência , Sono
12.
JCI Insight ; 5(20)2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-32937615

RESUMO

BACKGROUNDPatients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) differ in the severity of disease. We hypothesized that characteristics of SARS-CoV-2-specific immunity correlate with disease severity.METHODSIn this study, SARS-CoV-2-specific T cells and antibodies were characterized in uninfected controls and patients with different coronavirus disease 2019 (COVID-19) disease severity. SARS-CoV-2-specific T cells were flow cytometrically quantified after stimulation with SARS-CoV-2 peptide pools and analyzed for expression of cytokines (IFN-γ, IL-2, and TNF-α) and markers for activation, proliferation, and functional anergy. SARS-CoV-2-specific IgG and IgA antibodies were quantified using ELISA. Moreover, global characteristics of lymphocyte subpopulations were compared between patient groups and uninfected controls.RESULTSDespite severe lymphopenia affecting all major lymphocyte subpopulations, patients with severe disease mounted significantly higher levels of SARS-CoV-2-specific T cells as compared with convalescent individuals. SARS-CoV-2-specific CD4+ T cells dominated over CD8+ T cells and closely correlated with the number of plasmablasts and SARS-CoV-2-specific IgA and IgG levels. Unlike in convalescent patients, SARS-CoV-2-specific T cells in patients with severe disease showed marked alterations in phenotypical and functional properties, which also extended to CD4+ and CD8+ T cells in general.CONCLUSIONGiven the strong induction of specific immunity to control viral replication in patients with severe disease, the functionally altered characteristics may result from the need for contraction of specific and general immunity to counteract excessive immunopathology in the lung.FUNDINGThe study was supported by institutional funds to MS and in part by grants of Saarland University, the State of Saarland, and the Rolf M. Schwiete Stiftung.


Assuntos
Anticorpos Antivirais , Betacoronavirus , Infecções por Coronavirus , Citocinas/sangue , Contagem de Leucócitos , Pandemias , Pneumonia Viral , Linfócitos T , Adulto , Anticorpos Antivirais/sangue , Anticorpos Antivirais/classificação , Betacoronavirus/imunologia , Betacoronavirus/isolamento & purificação , Doenças Cardiovasculares/epidemiologia , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/virologia , Correlação de Dados , Cuidados Críticos/métodos , Cuidados Críticos/estatística & dados numéricos , Estado Terminal/terapia , Feminino , Alemanha/epidemiologia , Humanos , Contagem de Leucócitos/métodos , Contagem de Leucócitos/estatística & dados numéricos , Subpopulações de Linfócitos/classificação , Masculino , Doenças Metabólicas/epidemiologia , Pessoa de Meia-Idade , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , Índice de Gravidade de Doença , Linfócitos T/classificação , Linfócitos T/virologia
13.
Bone Joint J ; 102-B(9): 1200-1209, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862689

RESUMO

AIMS: We quantitatively compared the 3D bone density distributions on CT scans performed on scaphoid waist fractures subacutely that went on to union or nonunion, and assessed whether 2D CT evaluations correlate with 3D bone density evaluations. METHODS: We constructed 3D models from 17 scaphoid waist fracture CTs performed between four to 18 weeks after fracture that did not unite (nonunion group), 17 age-matched scaphoid waist fracture CTs that healed (union group), and 17 age-matched control CTs without injury (control group). We measured the 3D bone density for the distal and proximal fragments relative to the triquetrum bone density and compared findings among the three groups. We then performed bone density measurements using 2D CT and evaluated the correlation with 3D bone densities. We identified the optimal cutoff with diagnostic values of the 2D method to predict nonunion with receiver operating characteristic (ROC) curves. RESULTS: In the nonunion group, both the distal (100.2%) and proximal (126.6%) fragments had a significantly higher bone density compared to the union (distal: 85.7%; proximal: 108.3%) or control groups (distal: 91.6%; proximal: 109.1%) using the 3D bone density measurement, which were statistically significant for all comparisons. 2D measurements were highly correlated to 3D bone density measurements (Spearman's correlation coefficient (R) = 0.85 to 0.95). Using 2D measurements, ROC curve analysis revealed the optimal cutoffs of 90.8% and 116.3% for distal and proximal fragments. This led to a sensitivity of 1.00 if either cutoff is met and a specificity of 0.82 when both cutoffs are met. CONCLUSION: Using 3D modelling software, nonunions were found to exhibit bone density increases in both the distal and proximal fragments in CTs performed between four to 18 weeks after fracture during the course of treatment. 2D bone density measurements using standard CT scans correlate well with 3D models. In patients with scaphoid fractures, CT bone density measurements may be useful in predicting the likelihood of nonunion. Cite this article: Bone Joint J 2020;102-B(9):1200-1209.


Assuntos
Densidade Óssea , Consolidação da Fratura , Fraturas não Consolidadas/diagnóstico por imagem , Imageamento Tridimensional , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/lesões , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Correlação de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Adulto Jovem
14.
BMJ Open ; 10(9): e039338, 2020 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-32973066

RESUMO

OBJECTIVES: A number of studies have shown that the airborne transmission route could spread some viruses over a distance of 2 meters from an infected person. An epidemic model based only on respiratory droplets and close contact could not fully explain the regional differences in the spread of COVID-19 in Italy. On March 16th 2020, we presented a position paper proposing a research hypothesis concerning the association between higher mortality rates due to COVID-19 observed in Northern Italy and average concentrations of PM10 exceeding a daily limit of 50 µg/m3. METHODS: To monitor the spreading of COVID-19 in Italy from February 24th to March 13th (the date of the Italian lockdown), official daily data for PM10 levels were collected from all Italian provinces between February 9th and February 29th, taking into account the maximum lag period (14 days) between the infection and diagnosis. In addition to the number of exceedances of the daily limit value of PM10, we also considered population data and daily travelling information for each province. RESULTS: Exceedance of the daily limit value of PM10 appears to be a significant predictor of infection in univariate analyses (p<0.001). Less polluted provinces had a median of 0.03 infections over 1000 residents, while the most polluted provinces showed a median of 0.26 cases. Thirty-nine out of 41 Northern Italian provinces resulted in the category with the highest PM10 levels, while 62 out of 66 Southern provinces presented low PM10 concentrations (p<0.001). In Milan, the average growth rate before the lockdown was significantly higher than in Rome (0.34 vs 0.27 per day, with a doubling time of 2.0 days vs 2.6, respectively), thus suggesting a basic reproductive number R0>6.0, comparable with the highest values estimated for China. CONCLUSION: A significant association has been found between the geographical distribution of daily PM10 exceedances and the initial spreading of COVID-19 in the 110 Italian provinces.


Assuntos
Poluição do Ar , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Transmissão de Doença Infecciosa , Pandemias , Material Particulado/análise , Pneumonia Viral , Poluição do Ar/análise , Poluição do Ar/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Correlação de Dados , Transmissão de Doença Infecciosa/prevenção & controle , Transmissão de Doença Infecciosa/estatística & dados numéricos , Humanos , Itália/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Medição de Risco/métodos
15.
BMJ Open ; 10(9): e040569, 2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-32994260

RESUMO

INTRODUCTION: This protocol describes an observational study which set out to assess whether frailty and/or multimorbidity correlates with short-term and medium-term outcomes in patients diagnosed with COVID-19 in a European, multicentre setting. METHODS AND ANALYSIS: Over a 3-month period we aim to recruit a minimum of 500 patients across 10 hospital sites, collecting baseline data including: patient demographics; presence of comorbidities; relevant blood tests on admission; prescription of ACE inhibitors/angiotensin receptor blockers/non-steroidal anti-inflammatory drugs/immunosuppressants; smoking status; Clinical Frailty Score (CFS); length of hospital stay; mortality and readmission. All patients receiving inpatient hospital care >18 years who receive a diagnosis of COVID-19 are eligible for inclusion. Long-term follow-up at 6 and 12 months is planned. This will assess frailty, quality of life and medical complications.Our primary analysis will be short-term and long-term mortality by CFS, adjusted for age (18-64, 65-80 and >80) and gender. We will carry out a secondary analysis of the primary outcome by including additional clinical mediators which are determined statistically important using a likelihood ratio test. All analyses will be presented as crude and adjusted HR and OR with associated 95% CIs and p values. ETHICS AND DISSEMINATION: This study has been registered, reviewed and approved by the following: Health Research Authority (20/HRA1898); Ethics Committee of Hospital Policlinico Modena, Italy (369/2020/OSS/AOUMO); Health and Care Research Permissions Service, Wales; and NHS Research Scotland Permissions Co-ordinating Centre, Scotland. All participating units obtained approval from their local Research and Development department consistent with the guidance from their relevant national organisation.Data will be reported as a whole cohort. This project will be submitted for presentation at a national or international surgical and geriatric conference. Manuscript(s) will be prepared following the close of the project.


Assuntos
Infecções por Coronavirus , Idoso Fragilizado , Fragilidade , Multimorbidade , Pandemias , Pneumonia Viral , Saúde Pública/métodos , Qualidade de Vida , Adulto , Idoso , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Correlação de Dados , Europa (Continente)/epidemiologia , Feminino , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Avaliação Geriátrica/métodos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Análise de Sobrevida
16.
BMC Pulm Med ; 20(1): 237, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894108

RESUMO

BACKGROUND: This study aimed to evaluate whether the Homocysteine (Hcy) level was elevated in chronic obstructive pulmonary disease (COPD) patients and its correlation with the occurrence and acute progression of COPD. METHODS: From November 2014 to November 2015, COPD patients were enrolled from Beijing Chao-yang Hospital, and the the biological and clinical data were collected. These patients were tested in the non-acute exacerbation period and the acute exacerbation period, so they were defined as AECOPD group and Non-AECOPD group. Besides, 50 healthy subjects were recruited and defined as control group. Total plasma Hcy levels (antibodies-online, USA) were determined by enzyme-linked immunosorbent assay. Correlation analysis was used to analyze the correlation between serum Hcy level and ventilatory function. Using ROC curve, the diagnostic value of Hcy for the occurrence and acute progression of COPD was explored. RESULTS: In this study, we found that Hcy levels in the Non-AECOPD group or the AECOPD group were significantly higher than those in the control group (P < 0.001). Meanwhile, compared with the Non-AECOPD group, the Hcy level in the AECOPD group was significantly higher (P < 0.001). In addition, according to the classification of GOLD grade, there was significant difference in the Hcy level among different GOLD grade groups (P < 0.001). The correlation analysis showed that in the AECOPD group and the Non-AECOPD group, Hcy levels presented a negative correlation with FEV1(r < 0). Meanwhile, FEV1% was also negatively correlated with Hcy level (r < 0). ROC curve analysis showed that when the cutoff value was set to 10.8 µg/ml, the specificity, sensitivity and AUC were the best, which were 0.980, 0.800, and 0.945, respectively. Besides, our results showed that when the cutoff value was set to 14.0 µg / ml, the specificity, sensitivity and AUC were the best, which were 0.846, 0.680, and 0.802, respectively. In addition, compared with the prediction of acute progression of COPD, when Hcy level predicted the occurrence of COPD, its specificity (0.980 vs. 0.846, P < 0.001) and sensitivity (0.800 vs. 0.680, P < 0.001) were significantly higher. CONCLUSION: Hcy level is positively correlated with the severity of COPD patients, which has predictive value for the occurrence of COPD and acute progression.


Assuntos
Progressão da Doença , Homocisteína/sangue , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Aguda , Idoso , Correlação de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos
17.
Respir Med ; 172: 106135, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32947171

RESUMO

PURPOSE: Patients hospitalized for infection with SARS-CoV-2 typically present with pneumonia. The respiratory failure is frequently complicated by pulmonary embolism in segmental pulmonary arteries. The distribution of pulmonary embolism in regard to lung parenchymal opacifications has not been investigated yet. METHODS: All patients with COVID-19 treated at a medical intensive care unit between March 8th and April 15th, 2020 undergoing computed tomography pulmonary angiography (CTPA) were included. All CTPA were assessed by two radiologists independently in respect to parenchymal changes and pulmonary embolism on a lung segment basis. RESULTS: Out of 22 patients with severe COVID-19 treated within the observed time period, 16 (age 60.4 ± 10.2 years, 6 female SAPS2 score 49.2 ± 13.9) underwent CT. A total of 288 lung segment were analyzed. Thrombi were detectable in 9/16 (56.3%) patients, with 4.4 ± 2.9 segments occluded per patient and 40/288 (13.9%) segments affected in the whole cohort. Patients with thrombi had significantly worse segmental opacifications in CT (p < 0.05) and all thrombi were located in opacitated segments. There was no correlation between d-dimer level and number of occluded segmental arteries. CONCLUSIONS: Thrombi in segmental pulmonary arteries are common in COVID-19 and are located in opacitated lung segments. This might suggest local clot formation.


Assuntos
Angiografia por Tomografia Computadorizada , Infecções por Coronavirus , Pulmão/diagnóstico por imagem , Pandemias , Pneumonia Viral , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar , Síndrome do Desconforto Respiratório do Adulto , Trombose , Betacoronavirus/isolamento & purificação , Coagulação Sanguínea , Angiografia por Tomografia Computadorizada/métodos , Angiografia por Tomografia Computadorizada/estatística & dados numéricos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Correlação de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Radiografia Torácica/métodos , Radiografia Torácica/estatística & dados numéricos , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/virologia , Estudos Retrospectivos , Trombose/diagnóstico por imagem , Trombose/etiologia
18.
Medicine (Baltimore) ; 99(32): e21052, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769865

RESUMO

Fatigue is a universal and challenging problem in a nurse's career, particularly for those working in the emergency department. Through analyzing the current status of emergency department nurses' fatigue, the purpose of this study is to provide guidance for occupational health promotion strategies making and fatigue relief.Cross-sectional study was conducted among nurses working in emergency department in 6 grade III A hospitals in Xi'an, China. Convenience sample of 346 nurses agreed to participate in this study. Data collection was based on the questionnaires. Descriptive statistics, hypothesis tests and correlation analysis were used to describe the samples' characteristics and identify associations amongst participants' characteristics.The fatigue score of those emergency nurses from grade III A hospitals in Xian was 8.71 ±â€Š3.01, a high fatigue level. Moreover, there were significant differences in fatigue scores of different age groups, sleep qualities, work stress levels and physical states (P < .01). Further, the dimension of physical fatigue in various age groups, job title, marital status, sleep qualities, work stress levels and physical states was significantly different (P < .05) and the dimension of mental fatigue with different sleep qualities, work stress levels and physical states was significantly different (P < .01). The results of correlation analysis showed that fatigue was positively correlated with perceived stress while negatively correlated with social support and self-efficacy (P < .01). The multiple stepwise linear regression analysis indicated that the independent variables in the fatigue regression equation were perceived stress, physical condition and work stress in turn (P < .01), and the independent variables in the the dimensions of physical fatigue regression equation were perceived stress, physical condition,work stress and job title in turn (P < .05); the independent variables in the the dimensions of mental fatigue regression equation were perceived stress,subjective support and physical condition in turn (P < .05).The current status of high fatigue level of emergency nurses should be taken seriously. It is imperative to take effective measures to help emergency nurses reduce stress, improve social support, promote the self-efficacy, and thus relieve fatigue.


Assuntos
Serviço Hospitalar de Emergência , Fadiga/epidemiologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Estresse Ocupacional/epidemiologia , Autoeficácia , Apoio Social , Adulto , China , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
19.
Medicine (Baltimore) ; 99(34): e21645, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846774

RESUMO

This study assessed the association of sirtuin type 1 (SIRT1) and survivin expression with the clinicopathological features and survival of esophageal squamous cell carcinoma (ESCC) patients after concurrent chemoradiotherapy.SIRT1 and survivin proteins were immunohistochemically stained in 93 ESCC tissue specimens.SIRT1 was expressed in ESCC (80.6% vs 25.8% in normal mucosae) and survivin was expressed in 67.7% of ESCC vs 19.4% normal tissues (P < .01), and SIRT1 expression was associated with survivin expression (r = 0.39, P < .05). Furthermore, expression of both SIRT1 and survivin was associated with tumor size, depth of tumor invasion, tumor differentiation, lymph node metastasis, advanced clinical stage, and chemoradiotherapy (P < .05) as well as poor progression-free survival (PFS; P < .05) of ESCC patients after concurrent chemoradiotherapy (P < .05). Patient age, chemotherapy, tumor size, clinical stage, lymph node metastasis, and SIRT1 and survivin expression were independent PFS predictors (P < .05).Expression of both SIRT1 and survivin was associated with poor ESCC PFS.


Assuntos
Carcinoma de Células Escamosas do Esôfago/metabolismo , Carcinoma de Células Escamosas do Esôfago/mortalidade , Sirtuína 1/biossíntese , Survivina/biossíntese , Adulto , Idoso , Quimiorradioterapia , Correlação de Dados , Carcinoma de Células Escamosas do Esôfago/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
20.
Medicine (Baltimore) ; 99(34): e21693, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846785

RESUMO

The role of immune cell infiltration in the prognosis of clear cell renal cell carcinoma (ccRCC) has received increasing attention. However, immune scores have not yet been introduced into routine clinical practice of ccRCC patients. The principal objective of our research was to study the correlation between immune scores and overall survival (OS) of ccRCC.In this study, Cox regression analyses were used to identify risk factors associated with OS of ccRCC based on the Cancer Genome Atlas datasets. Furthermore, an integrated nomogram combining immune scores and clinicopathologic factors was built for predicting 3- and 5-year OS of ccRCC patients. The receiver operating characteristic curve, concordance index, and calibration curves were used for the evaluation of our nomogram. Also, Kaplan-Meier (KM) survival analysis of immune scores, stromal scores, and different clinicopathological factors was performed.A total of 514 patients were divided into the low- or high-immune scores group. KM and multivariate Cox regression analyses demonstrated that ccRCC patients with high-immune scores had significantly poor OS compared with those with low-immune scores. Calibration curves showed good consistency between the predicted OS and the actual OS probability. Areas under the receiver operating characteristic curves for 3- and 5-year OS were 0.816 and 0.769, and the concordance index was 0.775, indicating that our nomogram had good accuracy for predicting OS of ccRCC patients. Additionally, KM analysis showed that older age, later T stage, distant metastasis, advanced tumor lymph node metastasis stage, higher tumor grade, left site, and low stromal scores were associated with worse OS in ccRCC patients.High-immune scores show a significant correlation with unsatisfactory prognosis in ccRCC patients. Furthermore, the immune scores-based nomogram may be helpful in predicting ccRCC prognosis.


Assuntos
Carcinoma de Células Renais/imunologia , Carcinoma de Células Renais/mortalidade , Neoplasias Renais/imunologia , Neoplasias Renais/mortalidade , Nomogramas , Idoso , Idoso de 80 Anos ou mais , Correlação de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Taxa de Sobrevida
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