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1.
Ann Hematol ; 98(5): 1177-1184, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30610278

RESUMO

Immunoparesis is defined as a reduction in the levels of one, two, or three uninvolved immunoglobulins. However, there are very limited data on the incidence and prognostic significance of immunoparesis recovery 1 year after autologous stem cell transplantation (ASCT) in MM. We reviewed medical records of de novo MM patients who received ASCT at Beijing Chao Yang hospital. One hundred eight MM patients were included in the study. Conventional chemotherapy was administered as induction regimen in 16 patients (14.8%), whereas novel agents were used in 92 patients (85.2%). Most patients had immunoparesis at diagnosis (89.1%) and at the moment of ASCT as well (75%). After a median follow-up of 49 months, in the group with immunoglobulin recovery 1 year after ASCT, there was a trend towards longer progression-free survival (PFS) than in the group with immunoparesis (P = 0.054). And overall survival (OS) was significantly longer in patients with immunoparesis recovery (P = 0.004). In multivariate analysis, immunoparesis recovery 1 year after ASCT was independently associated with improved OS (P = 0.016). In conclusion, lack of immunoparesis recovery 1 year after ASCT in MM patients is associated with significantly shorter OS and this group of patients needs new treatment strategy to improve the prognosis.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Doenças do Sistema Imunitário , Adulto , Idoso , Autoenxertos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Doenças do Sistema Imunitário/etiologia , Doenças do Sistema Imunitário/imunologia , Doenças do Sistema Imunitário/mortalidade , Doenças do Sistema Imunitário/terapia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/imunologia , Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/terapia , Taxa de Sobrevida
2.
Crit Care ; 22(1): 42, 2018 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-29467023

RESUMO

BACKGROUND: Sepsis is a leading cause of mortality and critical illness worldwide and is associated with an increased mortality rate in the months following hospital discharge. The occurrence of persistent or new organ dysfunction(s) after septic shock raises questions about the mechanisms involved in the post-sepsis status. The present study aimed to explore the immune profiles of patients one year after being discharged from the intensive care unit (ICU) following treatment for abdominal septic shock. METHODS: We conducted a prospective, single-center, observational study in the surgical ICU of a university hospital. Eighty-six consecutive patients admitted for septic shock of abdominal origin were included in this study. Fifteen different plasma biomarkers were measured at ICU admission, at ICU discharge and at one year after ICU discharge. Three different clusters of biomarkers were distinguished according to their functions, namely: (1) inflammatory response, (2) cell damage and apoptosis, (3) immunosuppression and resolution of inflammation. The primary objective was to characterize variations in the immune status of septic shock patients admitted to ICU up to one year after ICU discharge. The secondary objective was to evaluate the relationship between these biomarker variations and patient outcomes. RESULTS: At the onset of septic shock, we observed a cohesive pro-inflammatory profile and low levels of inflammation resolution markers. At ICU discharge, the immune status demonstrated decreased but persistent inflammation and increased immunosuppression, with elevated programmed cell death protein-1 (PD-1) levels, and a counterbalanced resolution process, with elevated levels of interleukin-10 (IL-10), resolvin D5 (RvD5), and IL-7. One year after hospital discharge, homeostasis was not completely restored with several markers of inflammation remaining elevated. Remarkably, IL-7 was persistently elevated, with levels comparable to those observed after ICU discharge, and PD-1, while lower, remained in the elevated abnormal range. CONCLUSIONS: In this study, protracted immune disturbances were observed one year after ICU discharge. The study results suggested the presence of long-lasting immune illness disorders following a long-term septic insult, indicating the need for long-term patient follow up after ICU discharge and questioning the use of immune intervention to restore immune homeostasis after abdominal septic shock.


Assuntos
Doenças do Sistema Imunitário/complicações , Choque Séptico/complicações , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Biomarcadores/sangue , Ácidos Docosa-Hexaenoicos/análise , Ácidos Docosa-Hexaenoicos/sangue , Feminino , Humanos , Doenças do Sistema Imunitário/sangue , Doenças do Sistema Imunitário/mortalidade , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Interleucina-10/análise , Interleucina-10/sangue , Interleucina-7/análise , Interleucina-7/sangue , Masculino , Pessoa de Meia-Idade , Paris , Prognóstico , Receptor de Morte Celular Programada 1/análise , Receptor de Morte Celular Programada 1/sangue , Estudos Prospectivos , Choque Séptico/mortalidade
3.
Clin Lung Cancer ; 19(2): e171-e176, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29133121

RESUMO

BACKGROUND: The increased risk for early death owing to anti-programmed cell death 1 inhibitors is a major disadvantage that requires special management. We evaluated the frequency, causes, and risk factors of early death during nivolumab treatment for non-small cell lung cancer (NSCLC) in a Japanese clinical setting. PATIENTS AND METHODS: The medical records of patients with NSCLC who started receiving nivolumab between December 17, 2015 and July 31, 2016 in 3 Japanese institutes were collected. Early death was defined as any death within 3 months from the start of nivolumab treatment, irrespective of its cause. Treatment response was evaluated using the Response Evaluation Criteria In Solid Tumors criteria, version 1.1. RESULTS: A total of 201 patients with NSCLC were enrolled, and 38 (18.9%) died within the first 3 months. Thirty-one (81.6%) patients who experienced early death developed progressive disease, whereas 14 (36.8%) patients who experienced early death demonstrated nivolumab-induced immune-related adverse events, which required corticosteroid intervention, including interstitial lung disease in 7 (18.4%) patients. Multivariate logistic regression demonstrated that an Eastern Cooperative Oncology Group performance status score ≥ 2 (odds ratio [OR], 5.66; 95% confidence interval [CI], 2.01-15.61; P < .001), C-reactive protein-to-albumin ratio > 0.3 (OR, 10.56; 95% CI, 3.61-30.86; P < .001), and the response to prior treatment (OR, 2.07; 95% CI, 1.03-4.14; P = .041) were independent predictors for early death. CONCLUSION: Disease progression and immune-related adverse events are 2 major causes of early death with nivolumab in patients with NSCLC. An Eastern Cooperative Oncology Group performance status score ≥ 2, pretreatment C-reactive protein-to-albumin ratio > 0.3, and poor response to prior treatment were associated with early death.


Assuntos
Antineoplásicos/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Doenças do Sistema Imunitário/epidemiologia , Imunoterapia/efeitos adversos , Neoplasias Pulmonares/epidemiologia , Nivolumabe/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/mortalidade , Feminino , Humanos , Doenças do Sistema Imunitário/etiologia , Doenças do Sistema Imunitário/mortalidade , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Mortalidade Prematura , Nivolumabe/uso terapêutico , Receptor de Morte Celular Programada 1/imunologia , Risco , Análise de Sobrevida
4.
J Allergy Clin Immunol ; 141(3): 1036-1049.e5, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29241729

RESUMO

BACKGROUND: Immunodysregulation polyendocrinopathy enteropathy x-linked (IPEX) syndrome is a monogenic autoimmune disease caused by FOXP3 mutations. Because it is a rare disease, the natural history and response to treatments, including allogeneic hematopoietic stem cell transplantation (HSCT) and immunosuppression (IS), have not been thoroughly examined. OBJECTIVE: This analysis sought to evaluate disease onset, progression, and long-term outcome of the 2 main treatments in long-term IPEX survivors. METHODS: Clinical histories of 96 patients with a genetically proven IPEX syndrome were collected from 38 institutions worldwide and retrospectively analyzed. To investigate possible factors suitable to predict the outcome, an organ involvement (OI) scoring system was developed. RESULTS: We confirm neonatal onset with enteropathy, type 1 diabetes, and eczema. In addition, we found less common manifestations in delayed onset patients or during disease evolution. There is no correlation between the site of mutation and the disease course or outcome, and the same genotype can present with variable phenotypes. HSCT patients (n = 58) had a median follow-up of 2.7 years (range, 1 week-15 years). Patients receiving chronic IS (n = 34) had a median follow-up of 4 years (range, 2 months-25 years). The overall survival after HSCT was 73.2% (95% CI, 59.4-83.0) and after IS was 65.1% (95% CI, 62.8-95.8). The pretreatment OI score was the only significant predictor of overall survival after transplant (P = .035) but not under IS. CONCLUSIONS: Patients receiving chronic IS were hampered by disease recurrence or complications, impacting long-term disease-free survival. When performed in patients with a low OI score, HSCT resulted in disease resolution with better quality of life, independent of age, donor source, or conditioning regimen.


Assuntos
Diabetes Mellitus Tipo 1/congênito , Diarreia , Fatores de Transcrição Forkhead , Doenças Genéticas Ligadas ao Cromossomo X , Transplante de Células-Tronco Hematopoéticas , Doenças do Sistema Imunitário/congênito , Imunossupressão , Mutação , Adolescente , Adulto , Aloenxertos , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/genética , Diabetes Mellitus Tipo 1/imunologia , Diabetes Mellitus Tipo 1/mortalidade , Diabetes Mellitus Tipo 1/terapia , Diarreia/genética , Diarreia/imunologia , Diarreia/mortalidade , Diarreia/terapia , Intervalo Livre de Doença , Feminino , Seguimentos , Fatores de Transcrição Forkhead/genética , Fatores de Transcrição Forkhead/imunologia , Doenças Genéticas Ligadas ao Cromossomo X/genética , Doenças Genéticas Ligadas ao Cromossomo X/imunologia , Doenças Genéticas Ligadas ao Cromossomo X/mortalidade , Doenças Genéticas Ligadas ao Cromossomo X/terapia , Humanos , Doenças do Sistema Imunitário/genética , Doenças do Sistema Imunitário/imunologia , Doenças do Sistema Imunitário/mortalidade , Doenças do Sistema Imunitário/terapia , Lactente , Masculino , Estudos Retrospectivos , Taxa de Sobrevida
5.
J Neuroimmunol ; 312: 4-7, 2017 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-28886954

RESUMO

There is no consensus approach to safety screening for immune intervention in clinical neuroimmunology. An immunosuppression risk evaluation checklist was used as an audit tool to assess real-world immunosuppression risk management and formulate recommendations for quality improvements in patient safety. Ninety-nine patients from two centres with 27 non-MS diagnoses were included. An average of 1.9 comorbidities with the potential to adversely impact morbidity and mortality associated with immunosuppression were identified. Diabetes and smoking were the most common, however a range of rarer but potentially life-threatening co-morbid disorders in the context of immunosuppression were identified. Inadequate documentation of risk mitigation tasks was common at 40.1% of total tasks across both cohorts. A routine, systematic immunosuppression checklist approach should be considered to improve immunosuppression risk management in clinical neuroimmunology practice.


Assuntos
Lista de Checagem , Auditoria Clínica , Doenças do Sistema Imunitário/epidemiologia , Doenças do Sistema Imunitário/fisiopatologia , Imunossupressão , Austrália , Auditoria Clínica/métodos , Auditoria Clínica/normas , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Doenças do Sistema Imunitário/mortalidade , Masculino , Gestão de Riscos , Reino Unido
7.
PLoS One ; 9(2): e88197, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24505428

RESUMO

PURPOSE: The clinical implications for patients who survive serious infections are not well understood. It has been hypothesized that the excess mortality for survivors of sepsis observed in epidemiological studies is due to increased vulnerability to subsequent infections. We undertook this study to identify characteristics of patients who are at high risk for death after surviving a common type of blood-stream infection. MATERIALS AND METHODS: At a single academic medical center, 237 patients with Staphylococcus aureus bacteremia admitted during a three-year period were retrospectively identified. The primary outcomes were 30-day and 31 to 90-day mortality after the first positive blood culture. The primary predictor variable of interest was clinical immune dysfunction prior to bacteremia. RESULTS: The 30-day mortality was not significantly different for patients with and without prior immune dysfunction. However, during days 31 to 90, 11 patients (20%) with prior immune dysfunction compared to 10 patients (8.6%) without prior immune dysfunction died (OR 2.59, 95% CI 1.03-6.53, p = 0.04). In a Cox-proportional hazard model controlling for age, there was a significant association between prior immune dysfunction and greater 31 to 90 day mortality (HR 2.44, 95% CI 1.01-5.90, p = 0.05) and a non-significant trend towards occurrence of subsequent infections and greater 31 to 90 day mortality (HR 2.12, 95% CI 0.89-5.07, p = 0.09). CONCLUSIONS: Patients with prior immune dysfunction are at high risk for death 31 to 90 days, but not <30 days, after S. aureus bacteremia. Further investigation is needed to determine if this finding is due to poor prognosis of chronic disease or increased vulnerability to subsequent infections.


Assuntos
Bacteriemia/complicações , Doenças do Sistema Imunitário/complicações , Infecções Estafilocócicas/complicações , Staphylococcus aureus/isolamento & purificação , Adulto , Idoso , Bacteriemia/sangue , Bacteriemia/mortalidade , Feminino , Humanos , Doenças do Sistema Imunitário/mortalidade , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/sangue , Infecções Estafilocócicas/mortalidade
8.
BMC Nephrol ; 13: 97, 2012 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-22935561

RESUMO

BACKGROUND: The status of immunocompromised patients is well recognized in end stage renal disease (ESRD). As described recently, this acquired immune dysfunction in the uremic milieu may be one of the main pathogenic factors for mortality in ESRD. The aim of this study was to determine the relationship between the immune response following a hepatitis B vaccination (HBV vaccination) and the survival of maintenance dialysis patients. METHODS: A total of 156 patients (103 on hemodialysis and 53 on continuous ambulatory peritoneal dialysis) were recruited. After receiving a full dose of the HBV vaccination, all patients were followed up for to 5 years to evaluate the association of patient survival, cause of mortality, and immune response. RESULTS: The response rate to the hepatitis B vaccination was 70.5%. There was no significant association between the immune response and the 5-year survival rate (p =0.600) or between the post-vaccination anti-HBs titers and the 5-year survival rate (p = 0.201). The logistic prediction model with the coefficient as non-response following HBV vaccination, diabetes mellitus, old age, and low albumin level could significantly predict infection-cause mortality (sensitivity = 0.842, specificity = 0.937). CONCLUSION: There was no significant association between the immune response to HBV vaccination and the 5-year survival rate. However, non-response following HBV vaccination might be associated with infection-cause mortality in dialysis patients.


Assuntos
Vacinas contra Hepatite B/imunologia , Vacinas contra Hepatite B/uso terapêutico , Doenças do Sistema Imunitário/mortalidade , Diálise Renal/mortalidade , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/reabilitação , Vacinação/mortalidade , Causalidade , Comorbidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Análise de Sobrevida , Taxa de Sobrevida , Taiwan/epidemiologia , Resultado do Tratamento
9.
Am J Clin Nutr ; 96(1): 164-74, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22648726

RESUMO

BACKGROUND: Previous studies have shown that high fiber intake is associated with lower mortality. However, little is known about the association of dietary fiber with specific causes of death other than cardiovascular disease (CVD). OBJECTIVE: The aim of this study was to assess the relation between fiber intake, mortality, and cause-specific mortality in a large European prospective study of 452,717 men and women. DESIGN: HRs and 95% CIs were estimated by using Cox proportional hazards models, stratified by age, sex, and center and adjusted for education, smoking, alcohol consumption, BMI, physical activity, total energy intake, and, in women, ever use of menopausal hormone therapy. RESULTS: During a mean follow-up of 12.7 y, a total of 23,582 deaths were recorded. Fiber intake was inversely associated with total mortality (HR(per 10-g/d increase): 0.90; 95% CI: 0.88, 0.92); with mortality from circulatory (HR(per 10-g/d increase): 0.90 and 0.88 for men and women, respectively), digestive (HR: 0.61 and 0.64), respiratory (HR: 0.77 and 0.62), and non-CVD noncancer inflammatory (HR: 0.85 and 0.80) diseases; and with smoking-related cancers (HR: 0.86 and 0.89) but not with non-smoking-related cancers (HR: 1.05 and 0.97). The associations were more evident for fiber from cereals and vegetables than from fruit. The associations were similar across BMI and physical activity categories but were stronger in smokers and participants who consumed >18 g alcohol/d. CONCLUSIONS: Higher fiber intake is associated with lower mortality, particularly from circulatory, digestive, and non-CVD noncancer inflammatory diseases. Our results support current recommendations of high dietary fiber intake for health maintenance.


Assuntos
Fibras na Dieta/administração & dosagem , Doenças do Sistema Digestório/mortalidade , Promoção da Saúde , Doenças do Sistema Imunitário/mortalidade , Política Nutricional , Adulto , Idoso , Estudos de Coortes , Doenças do Sistema Digestório/prevenção & controle , Grão Comestível/química , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Frutas/química , Humanos , Doenças do Sistema Imunitário/prevenção & controle , Masculino , Pessoa de Meia-Idade , Mortalidade , Estudos Prospectivos , Risco , Verduras/química
11.
Crit Care Resusc ; 14(1): 25-32, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22404058

RESUMO

OBJECTIVE: To define the relationship between worsening oxygenation status (worst PaO(2)/FiO(2) ratio in the first 24 hours after intensive care unit admission) and mortality in immunosuppressed and immunocompetent ICU patients in the presence and absence of mechanical ventilation. DESIGN: Retrospective cohort study. SETTING: Data were extracted from the Australian and New Zealand Intensive Care Society Adult Patient Database. PARTICIPANTS: Adult patients admitted to 129 ICUs in Australasia, 2000-2010. MAIN OUTCOME MEASURES: In hospital and ICU mortality; relationship between mortality and declining PaO(2)/FiO(2) ratio by ventilation status and immune status. RESULTS: 457 750 patient records were analysed. Worsening oxygenation status was associated with increasing mortality in all groups. Higher mortality was seen in immunosuppressed patients than immunocompetent patients. After multivariate analysis, in mechanically ventilated patients, declining PaO(2)/FiO(2) ratio in the first 24 hours of ICU admission was associated with a more rapidly rising mortality rate in immunosuppressed patients than non-immunosuppressed patients. Immunosuppression did not affect the relationship between oxygenation status and mortality in non-ventilated patients. CONCLUSION: Immunosuppression increases the risk of mortality with progressively worsening oxygenation status, but only in the presence of mechanical ventilation. Further research into the impact of mechanical ventilation in immunosuppressed patients is required.


Assuntos
Doenças do Sistema Imunitário/sangue , Doenças do Sistema Imunitário/mortalidade , Oxigênio/sangue , Respiração Artificial/estatística & dados numéricos , Idoso , Austrália/epidemiologia , Estudos de Coortes , Feminino , Hong Kong , Mortalidade Hospitalar , Humanos , Doenças do Sistema Imunitário/fisiopatologia , Doenças do Sistema Imunitário/terapia , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Pressão Parcial , Estudos Retrospectivos
12.
Blood ; 118(15): 4041-52, 2011 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-21828139

RESUMO

Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of pathologic immune activation, occurring as either a familial disorder or a sporadic condition, in association with a variety of triggers. This immune dysregulatory disorder is prominently associated with cytopenias and a unique combination of clinical signs and symptoms of extreme inflammation. Prompt initiation of immunochemotherapy is essential for survival, but timely diagnosis may be challenging because of the rarity of HLH, its variable presentation, and the time required to perform diagnostic testing. Therapy is complicated by dynamic clinical course, high risk of treatment-related morbidity, and disease recurrence. Here, we review the clinical manifestations and patterns of HLH and describe our approach to the diagnosis and therapy for this elusive and potentially lethal condition.


Assuntos
Doenças do Sistema Imunitário/diagnóstico , Doenças do Sistema Imunitário/terapia , Imunoterapia/métodos , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/terapia , Humanos , Doenças do Sistema Imunitário/sangue , Doenças do Sistema Imunitário/imunologia , Doenças do Sistema Imunitário/mortalidade , Inflamação/sangue , Inflamação/diagnóstico , Inflamação/imunologia , Inflamação/mortalidade , Inflamação/terapia , Linfo-Histiocitose Hemofagocítica/sangue , Linfo-Histiocitose Hemofagocítica/imunologia , Linfo-Histiocitose Hemofagocítica/mortalidade
13.
Biol Blood Marrow Transplant ; 17(10): 1520-7, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21396476

RESUMO

Parainfluenza virus (PIV) infections cause significant mortality in adults undergoing hematopoietic stem cell transplantation (HSCT). Children are more prone to PIV infections than adults; however, data on the epidemiology of these infections in children undergoing HSCT are limited. This study examined the incidence of symptomatic PIV infections, risk factors for lower respiratory tract infection (LRTI), and the impact on mortality after pediatric HSCT. A total of 1028 children who underwent HSCT between 1995 and 2009 were studied. PIV infections were detected in 46 of the 738 patients tested for respiratory infection (6.2%). PIV infection was the most common symptomatic respiratory viral infection in this population. On multivariate logistic regression analysis, receipt of an allogeneic transplant (P < .0001) and total body irradiation-based conditioning (P < .0001) were associated with increased risk of acquiring symptomatic PIV infection. Of the 46 HSCT patients with PIV infection, 18 (39%) had an LRTI. LRTI was associated with PIV infection in the first 100 days post-HSCT (P = .006), use of steroids (P = .035), and absolute leukocyte count (ALC) <100 cells/µL at the onset of infection (P < .0001). An ALC of <500 cells/µL was associated with prolonged viral shedding (P = .045). Six (13%) HSCT patients died of PIV infection. Mortality was associated with African-American ethnicity (P = .013), LRTI (P = .002), use of steroids (P < .0001), mechanical ventilation (P < .0001), and ALC <100 cells/µL at the onset of infection (P = .01). PIV infection causes significant morbidity and mortality in children undergoing HSCT.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Infecções por Paramyxoviridae/metabolismo , Infecções Respiratórias/mortalidade , Condicionamento Pré-Transplante , Adolescente , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Doenças do Sistema Imunitário/mortalidade , Doenças do Sistema Imunitário/terapia , Masculino , Doenças Metabólicas/mortalidade , Doenças Metabólicas/terapia , Neoplasias/mortalidade , Neoplasias/terapia , Infecções por Paramyxoviridae/etnologia , Infecções por Paramyxoviridae/terapia , Infecções Respiratórias/etnologia , Infecções Respiratórias/terapia , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , Transplante Autólogo , Transplante Homólogo , Irradiação Corporal Total
14.
Semin Hematol ; 46(2): 176-89, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19389501

RESUMO

Multiple myeloma (MM) is characterized by the presence of osteolytic bone disease, renal impairment, anemia, and immune dysfunction. Adequate supportive care is considered an essential part of anti-myeloma therapy. The administration of bisphosphonates has been shown to reduce skeletal related events and hypercalcemia. Bisphosphonates are well tolerated, but preventive steps should be taken to avoid renal impairment and osteonecrosis of the jaw (ONJ). Adequate pain control is of crucial importance for the quality of life of MM patients. Local radiotherapy may rapidly ameliorate symptoms of painful MM bone lesions, and vertebroplasty and kyphoplasty are able to control symptoms and restore the original height of vertebral fractures. Symptomatic chemotherapy-induced anemia should preferentially be treated with erythropoietic growth factors, but further studies are required to confirm the long-term safety of this approach. Light-chain-induced renal impairment should be treated without delay with a highly effective anti-myeloma regimen consisting of novel drugs. Prophylaxis of infections should be considered particularly in patients with poorly controlled disease and documented infections should be treated aggressively as they contribute significantly to morbidity and mortality. The concerted action of these supportive therapies can significantly improve the quality of life of MM patients during the different phases of their disease.


Assuntos
Anemia/terapia , Doenças do Sistema Imunitário/terapia , Controle de Infecções , Nefropatias/terapia , Mieloma Múltiplo/complicações , Osteólise/terapia , Anemia/etiologia , Anemia/mortalidade , Doenças do Sistema Imunitário/etiologia , Doenças do Sistema Imunitário/mortalidade , Nefropatias/etiologia , Nefropatias/mortalidade , Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/terapia , Osteólise/etiologia , Osteólise/mortalidade
15.
J Acquir Immune Defic Syndr ; 49(1): 26-31, 2008 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-18667930

RESUMO

BACKGROUND: The aim of this study was to analyze the incidence of new cases, survival of HIV-1-infected patients with progressive multifocal leukoencephalopathy (PML), and the characteristics of PML-associated immune reconstitution inflammatory syndrome (IRIS). METHODS: Multicenter observational cohort study of all HIV-1-infected patients newly diagnosed of PML in 7 hospitals in Barcelona (Spain) from 2002 to 2006. The annual incidence of PML was calculated. Survival was estimated using the Kaplan-Meier method. IRIS was defined as new onset or rapid worsening of PML shortly after initiation of highly active antiretroviral therapy together with a decline in HIV-1 viral load and rising of CD4 lymphocytes. RESULTS: Sixty-one new cases of PML were diagnosed. The mean survival time was 15 months [95% confidence interval (CI), 11 to 19]. The Kaplan-Meier estimates of the probability of survival were 47.7% (95% CI, 35 to 59) at 6 months, 38.6% (95% CI, 25 to 51) at 12 months, 35.1% (95% CI, 22 to 48) at 24 months, and 25.1% (95% CI, 10 to 40) at 36 months. IRIS was diagnosed in 14 (23%) cases. Mortality was similar in patients with and without IRIS. CONCLUSIONS: PML continues to be one of the deadliest opportunistic infections in acquired immunodeficiency syndrome patients. The development of PML-associated IRIS has no influence on prognosis.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , HIV-1 , Leucoencefalopatia Multifocal Progressiva/complicações , Adulto , Estudos de Coortes , Feminino , Infecções por HIV/mortalidade , Humanos , Doenças do Sistema Imunitário/complicações , Doenças do Sistema Imunitário/mortalidade , Leucoencefalopatia Multifocal Progressiva/mortalidade , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida
16.
Eur J Cancer ; 44(10): 1390-403, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18329264

RESUMO

The rising cancer burden in Europe, mainly due to a rapidly ageing population, demands a clear and coordinated response from researchers, oncologists and other physicians, public health professionals and policy-makers. Primary and secondary prevention is the front line in the complex battle against cancer in Europe. To formulate the best strategies in this fight, the major determinants of cancer are summarised in the order of their relative importance in Europe, including tobacco smoking, alcohol, diet, physical activity, occupational factors, environmental factors, infectious agents and genetic and hormonal factors. Furthermore, this paper offers explicit recommendations on individual behaviour modification and possible public policies. It also details the numerous examples of European policies and programmes already in effect which aim to reduce the impact of these risk factors on cancer. Although there are still pending questions, which need further epidemiologic research, it is also true that we have more operational knowledge for cancer prevention than ever before. The prompt implementation of prevention programmes such as those detailed here should be applied with determination to maximise the prevention results.


Assuntos
Neoplasias/etiologia , Neoplasias/prevenção & controle , Adulto , Consumo de Bebidas Alcoólicas/mortalidade , Consumo de Bebidas Alcoólicas/prevenção & controle , Dieta , Exposição Ambiental , Europa (Continente)/epidemiologia , Exercício , Feminino , Humanos , Doenças do Sistema Imunitário/mortalidade , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Neoplasias/mortalidade , Sobrepeso/mortalidade , Sobrepeso/prevenção & controle , Prevenção Primária/métodos , Fumar/mortalidade , Prevenção do Hábito de Fumar
18.
Surg Endosc ; 20(8): 1208-13, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16865623

RESUMO

BACKGROUND: Laparoscopic splenectomy (LS) offers better short-term results than open surgery for the treatment of immune thrombocytopenic purpura (ITP), but long-term follow-up is required to ensure its efficacy. The remission rate after splenectomy ranges from 49 to 86% and the factors that predict a successful response to surgical management have not been clearly defined. The goal of this study was to determine the preoperative factors that predict a successful outcome following LS. METHODS: From February 1993 to December 2003, LS was consecutively performed in a series of 119 nonselected patients diagnosed with ITP (34 men and 85 women; mean age, 41 years), and clinical results were prospectively recorded. Postoperative follow-up was based on clinical records, follow-up data provided by the referring hematologist, and a phone interview with the patient and/or relative. Univariate and multivariate analyses were performed for clinical preoperative variables to identify predictive factors of success following LS. RESULTS: Over a mean period of 33 months, 103 patients (84%) were available for follow-up with a remission rate of 89% (92 patients, 77 with complete remission with platelet count > 150,000). Eleven patients did not respond to surgery (platelet count < 50,000). Mortality during follow-up was 2.5% (two cases not related to hematological pathology and one case without response to splenectomy). Preoperative clinical variables evaluated to identify predictive factors of response to surgery were sex, age, treatment (corticoids alone or associated with Ig or chemotherapy), other immune pathology, duration of disease, and preoperative platelet count. In a subgroup of 52 patients, we also evaluated the type of autoantibodies and corticoid doses required to maintain a platelet count > 50,000. Multivariate analysis showed that none of the variables evaluated could be considered as predictive factors of response to LS due to the high standard error. CONCLUSION: Long-term clinical results show that LS is a safe and effective therapy for ITP. However, a higher number of nonresponders is needed to determine which variables predict response to LS for ITP.


Assuntos
Doenças do Sistema Imunitário/cirurgia , Laparoscopia , Púrpura Trombocitopênica/cirurgia , Esplenectomia , Adolescente , Adulto , Idoso , Feminino , Humanos , Doenças do Sistema Imunitário/sangue , Doenças do Sistema Imunitário/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Contagem de Plaquetas , Prognóstico , Estudos Prospectivos , Púrpura Trombocitopênica/sangue , Púrpura Trombocitopênica/mortalidade , Indução de Remissão , Resultado do Tratamento
19.
Eur Respir J ; 28(2): 364-9, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16571614

RESUMO

Lymphoid interstitial pneumonia (LIP) is rare and its clinical course incompletely described. The aim of this study was to examine the clinical features, associations and prognosis of surgical lung biopsy-proven LIP. The study group consisted of 15 subjects encountered over a 14-yr period. The majority of subjects were females (n = 11) and the mean age was 47 yrs (range 17-78 yrs). Underlying systemic immune disorders were frequent, including Sjögren's syndrome (n = 8), rheumatoid arthritis, systemic lupus erythematosus, polymyositis, common variable immunodeficiency and dysproteinaemia. Only three patients were classified as "idiopathic". Presenting symptoms were dominated by dyspnoea and cough. Restrictive physiology, reduced diffusion capacity (62.5+/-18.4% predicted) and bronchoalveolar lavage lymphocytosis (30.5+/-29.1% pred) were noted. Thirteen patients received corticosteroid therapy. Of the nine whose response could be assessed, four showed clinical improvement and four were stable. Overall, median survival was 11.5 yrs. Of the seven patients who died, respiratory problems were the primary cause of death in three. Conversion to lymphoma was not identified. In conclusion, histopathological lymphoid interstitial pneumonia is commonly associated with immune system dysregulation, with idiopathic lymphoid interstitial pneumonia being extremely rare. Clinical stability or improvement with corticosteroids can be expected; however, survival remains impaired.


Assuntos
Doenças Autoimunes , Doenças do Sistema Imunitário , Doenças Pulmonares Intersticiais , Linfocitose , Adolescente , Adulto , Doenças Autoimunes/complicações , Doenças Autoimunes/tratamento farmacológico , Doenças Autoimunes/mortalidade , Doenças Autoimunes/patologia , Feminino , Humanos , Doenças do Sistema Imunitário/complicações , Doenças do Sistema Imunitário/tratamento farmacológico , Doenças do Sistema Imunitário/mortalidade , Doenças do Sistema Imunitário/patologia , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/tratamento farmacológico , Doenças Pulmonares Intersticiais/mortalidade , Doenças Pulmonares Intersticiais/patologia , Linfocitose/complicações , Linfocitose/tratamento farmacológico , Linfocitose/mortalidade , Linfocitose/patologia , Masculino , Pessoa de Meia-Idade , Doenças Raras/tratamento farmacológico , Doenças Raras/mortalidade , Doenças Raras/patologia
20.
J Gerontol B Psychol Sci Soc Sci ; 60 Spec No 2: 40-7, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16251589

RESUMO

The complexity of gender differences in health (i.e., men's lower life expectancy and women's greater morbidity) extends beyond notions of either social or biological disadvantage. Gaps remain in understanding the antecedents of such differences and the issues this paradox raises regarding the connections between social and biological processes. Our goals in this analytic essay are to make the case that gender differences in health matter and that understanding these differences requires an explanation of why rational people are not effective in making health a priority in their everyday lives. We describe some salient gender health differences in cardiovascular disease, immune function and disorders, and depression and indicate why neither social nor biological perspectives alone are sufficient to account for them. We consider the limitations of current models of socioeconomic and racial/ethnic health disparities to explain the puzzling gender differences in health. Finally, we discuss constrained choice, a key issue that is missing in the current understanding of these gender differences, and call on the social science community to work with biomedical researchers on the interdisciplinary work required to address the paradoxical differences in men's and women's health.


Assuntos
Suscetibilidade a Doenças , Comportamentos Relacionados com a Saúde , Nível de Saúde , Sexo , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Comportamento de Escolha , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/mortalidade , Feminino , Humanos , Doenças do Sistema Imunitário/epidemiologia , Doenças do Sistema Imunitário/mortalidade , Masculino , Risco , Distribuição por Sexo , Medicina Social , Estados Unidos/epidemiologia
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