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1.
Ann Hematol ; 99(5): 1111-1119, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32253453

RESUMO

Acute graft-versus-host disease (aGVHD) of the lower gastrointestinal (GI) tract is the major cause of non-relapse mortality (NRM) in allogeneic hematopoietic stem cell transplantation (alloHSCT). This study aimed to identify variables associated with corticosteroid response and NRM in patients who developed lower GI aGVHD. We retrospectively analyzed the clinical data of patients treated at Yonsei University Severance Hospital between 2008 and 2017. Among 244 recipients of alloHSCT, 48 (19.7%) were diagnosed as lower GI aGVHD at a median of 22 days after alloHSCT. In these cases, 20 (41.6%) patients were resistant to corticosteroid therapy. Corticosteroid resistance was associated with advanced stage of lower GI aGVHD (P = 0.019), low serum albumin (P = 0.006), and elevated CRP (P = 0.030) on day 7 after corticosteroid therapy. NRM rate was significantly higher in the corticosteroid-resistant group compared with the sensitive group (HR 5.339, P = 0.003). Multivariate analysis revealed serum albumin (P = 0.046), and CRP levels (P = 0.032) were independent prognostic factors for NRM. When the patients were classified into 3 groups according to Glasgow prognostic score (GPS), the rate of corticosteroid resistance was significantly higher in the high GPS group compared with the intermediate or low GPS group (83.3 vs. 27.2 and 15.3%, respectively, P < 0.001). We demonstrated that low serum albumin and elevated CRP level on day 7 after corticosteroid therapy are objective biomarkers of corticosteroid resistance and a significant predictor for higher NRM. These simple and practical parameters could be valuable information predicting response and prognosis in lower GI aGVHD.


Assuntos
Proteína C-Reativa/metabolismo , Gastroenteropatias , Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Albumina Sérica Humana/metabolismo , Adolescente , Adulto , Aloenxertos , Biomarcadores/sangue , Feminino , Gastroenteropatias/sangue , Gastroenteropatias/etiologia , Gastroenteropatias/mortalidade , Doença Enxerto-Hospedeiro/sangue , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Estudos Retrospectivos
2.
Gastroenterology ; 158(1): 76-94.e2, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31593701

RESUMO

Since 2010, substantial progress has been made in artificial intelligence (AI) and its application to medicine. AI is explored in gastroenterology for endoscopic analysis of lesions, in detection of cancer, and to facilitate the analysis of inflammatory lesions or gastrointestinal bleeding during wireless capsule endoscopy. AI is also tested to assess liver fibrosis and to differentiate patients with pancreatic cancer from those with pancreatitis. AI might also be used to establish prognoses of patients or predict their response to treatments, based on multiple factors. We review the ways in which AI may help physicians make a diagnosis or establish a prognosis and discuss its limitations, knowing that further randomized controlled studies will be required before the approval of AI techniques by the health authorities.


Assuntos
Inteligência Artificial , Diagnóstico por Computador/métodos , Gastroenterologia/métodos , Gastroenteropatias/diagnóstico , Hepatopatias/diagnóstico , Tomada de Decisão Clínica/métodos , Sistemas de Apoio a Decisões Clínicas , Árvores de Decisões , Gastroenteropatias/mortalidade , Gastroenteropatias/terapia , Humanos , Hepatopatias/mortalidade , Hepatopatias/terapia , Prognóstico , Resultado do Tratamento
3.
Gastroenterology ; 158(1): 95-110, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31626754

RESUMO

Glycans are sequences of carbohydrates that are added to proteins or lipids to modulate their structure and function. Glycans modify proteins required for regulation of immune cells, and alterations have been associated with inflammatory conditions. For example, specific glycans regulate T-cell activation, structures, and functions of immunoglobulins; interactions between microbes and immune and epithelial cells; and malignant transformation in the intestine and liver. We review the effects of protein glycosylation in regulation of gastrointestinal and liver functions, and how alterations in glycosylation serve as diagnostic or prognostic factors, or as targets for therapy.


Assuntos
Gastroenteropatias/diagnóstico , Hepatopatias/diagnóstico , Biomarcadores/metabolismo , Gastroenteropatias/mortalidade , Gastroenteropatias/terapia , Trato Gastrointestinal/imunologia , Trato Gastrointestinal/metabolismo , Glicômica , Glicosilação/efeitos dos fármacos , Humanos , Fígado/imunologia , Fígado/metabolismo , Hepatopatias/mortalidade , Hepatopatias/terapia , Polissacarídeos/metabolismo , Prognóstico , Proteômica , Linfócitos T/efeitos dos fármacos , Linfócitos T/imunologia , Linfócitos T/metabolismo , Fatores de Tempo
4.
J Cardiothorac Surg ; 14(1): 181, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31661002

RESUMO

BACKGROUND: Gastrointestinal complications after lung transplatation are associated with an increased risk of morbidity and mortality. This study aims to describe severe gastrointestinal complications (SGC) after lung transplantation. METHODS: We performed a prospective, observational study that included 136 lung transplant patients during a seven year period in a tertiary care universitary hospital. SGC were defined as any diagnosis related to the gastrointestinal or biliary tract leading to lower survival rates or an invasive therapeutic procedure. Early and late complications were defined as those occurring < 30 days and ≥ 30 days post-transplant. The survival function was calculated through the Kaplan-Meier estimator. Variables were analyzed using univariate and multivariate analysis. Statistical significance was defined as p < 0.05. RESULTS: There were 17 (12.5%) SGC in 17 patients. Five were defined as early. Twelve patients (70.6%) required surgical treatment. Mortality was 52.9% (n = 9). Patients with SGC had a lower overall survival rate compared to those who did not (14 vs 28 months, p = 0.0099). The development of arrhythmias in the first 48 h of transplantation was a risk factor for gastrointestinal complications (p = 0.0326). CONCLUSIONS: SGC are common after lung transplantation and are associated with a considerable increase in morbidity-mortality. Early recognition is necessary to avoid delays in treatment, since a clear predictor has not been found in order to forecast this relevant comorbidity.


Assuntos
Gastroenteropatias/mortalidade , Transplante de Pulmão/efeitos adversos , Transplante de Pulmão/mortalidade , Complicações Pós-Operatórias/mortalidade , Adulto , Idoso , Comorbidade , Feminino , Gastroenteropatias/etiologia , Humanos , Estimativa de Kaplan-Meier , Pneumopatias/complicações , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Morbidade , Análise Multivariada , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Fatores de Risco , Análise de Sobrevida , Taxa de Sobrevida
5.
Pregnancy Hypertens ; 17: 144-147, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31487632

RESUMO

OBJECTIVE: We aimed to study the long-term effect of preeclampsia on the risk for subsequent gastrointestinal morbidity of the offspring. STUDY DESIGN: A population based cohort analysis comparing total and different subtypes of gastrointestinal related pediatric hospitalizations among offspring of preeclamptic mothers versus offspring of mothers without preeclampsia. The analysis included all singletons born between the years 1999-2014 at a single tertiary regional medical center. Gastrointestinal related morbidities included hospitalizations involving a set of ICD-9 codes, as recorded in hospital files. Infants with congenital malformations, multiple gestations, and perinatal deaths were excluded from the analysis. A Kaplan-Meier survival curve was used to compare the cumulative morbidity, and a Cox proportional hazards model was constructed to adjust for confounders. RESULTS: The study population included 239,687 newborns who met inclusion criteria; among them 2222 (0.93%) were born to mothers with severe preeclampsia or eclampsia, and 7279 (3.03%) were born to mothers with mild preeclampsia. Offspring of mothers with severe preeclampsia had significantly higher rates of gastrointestinal-related hospitalizations in comparison to offspring of mothers with mild preeclampsia and offspring of non-preeclamptic mothers (7.7% vs. 5.5% vs. 5.3%, respectively; p < 0.001). The association between exposure to severe preeclampsia and eclampsia and long-term gastrointestinal morbidity of the offspring remained significant and independent while adjusting for confounders (Adjusted HR = 1.2, 95% CI 1.0-1.4; p = 0.019). CONCLUSION: Severe preeclampsia and eclampsia are independent risk factors for pediatric gastrointestinal morbidity of the offspring.


Assuntos
Gastroenteropatias/epidemiologia , Pré-Eclâmpsia , Efeitos Tardios da Exposição Pré-Natal , Adulto , Estudos de Coortes , Feminino , Gastroenteropatias/congênito , Gastroenteropatias/etiologia , Gastroenteropatias/mortalidade , Humanos , Recém-Nascido , Israel/epidemiologia , Masculino , Gravidez , Modelos de Riscos Proporcionais , Fatores de Risco , Análise de Sobrevida
6.
Medicine (Baltimore) ; 98(35): e17059, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464966

RESUMO

BACKGROUND: Delta neutrophil index (DNI) is the ratio of the number of immature granulocytes and the total neutrophil count in peripheral circulation. DNI precedes changes in white blood cell or neutrophil counts due to the course of granular leukocyte differentiation in infectious and inflammatory conditions, beginning with immature granulocyte formation. The role of DNI as a biomarker of various infectious or inflammatory conditions has been reported. However, no studies explored the potential role of DNI as an initial biomarker for predicting disease severity, surgical outcomes, and mortality rates of gastrointestinal diseases with pooled diagnostic test accuracy. This study aims to provide evidence that DNI is a predictor of disease severity, surgical outcomes, and mortality rates in patients with gastrointestinal diseases in emergency medical departments. METHODS: MEDLINE, EMBASE, and the Cochrane Library will be searched using common keywords (inception to July 2019) by 2 independent evaluators. Inclusion criteria will be patients with gastrointestinal diseases, DNI measurements performed in the emergency department, indices of diagnostic performance (sensitivity, specificity, predictive values, and likelihood ratios) of DNI for predicting severity, surgical outcomes, and mortality rate of gastrointestinal diseases. True and false positives and negatives will be calculated based on the diagnostic indices of each study. All types of study designs with full-text literature written in English will be included. Risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Descriptive data synthesis will be conducted and quantitative synthesis (bivariate and hierarchical summary receiver operating characteristic model) will be performed if the included studies are sufficiently homogenous. Meta-regression, sensitivity analysis, publication bias, and Fagan nomogram will be analyzed and described. RESULTS: The pooled synthesis of the diagnostic performance of various gastrointestinal diseases with different cut-off values for DNI may limit the interpretation of uniform diagnostic validity. The authors will contact the corresponding authors for the missing values, requesting the original data in each study. However, if there are no responses from these authors, these studies will be excluded. CONCLUSION: This study will provide diagnostic validity of DNI as an initial marker for the prediction of severity, surgery, and mortality of gastrointestinal diseases.


Assuntos
Gastroenteropatias/sangue , Gastroenteropatias/mortalidade , Neutrófilos/metabolismo , Biomarcadores , Gastroenteropatias/cirurgia , Humanos , Prognóstico , Projetos de Pesquisa , Sensibilidade e Especificidade , Índice de Gravidade de Doença
7.
Ann Hematol ; 98(10): 2407-2419, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31338570

RESUMO

Steroid-resistant acute graft-versus-host disease (GVHD) of the gastrointestinal tract associates with important morbidity and mortality. While high-dose steroids are the established first-line therapy in GVHD, no second-line therapy is generally accepted. In this analysis of 65 consecutive patients with severe, steroid-resistant, intestinal GVHD (92% stage 4), additional ileostomy surgery significantly reduced overall mortality (hazard ratio 0.54; 95% confidence interval, 0.36-0.81; p = 0.003) compared to conventional GVHD therapy. Median overall survival was 16 months in the ileostomy cohort compared to 4 months in the conventional therapy cohort. In the ileostomy cohort, both infectious- and GVHD-associated mortality were reduced (40% versus 77%). Significantly declined fecal volumes (p = 0.001) after surgery provide evidence of intestinal adaptation following ileostomy. Correlative studies indicated ileostomy-induced immune-modulation with a > 50% decrease of activated T cells (p = 0.04) and an increase in regulatory T cells. The observed alterations of the patients' gut microbiota may also contribute to ileostomy's therapeutic effect. These data show that ileostomy induced significant clinical responses in patients with steroid-resistant GVHD along with a reduction of pro-inflammatory immune cells and changes of the intestinal microbiota. Ileostomy is a treatment option for steroid-resistant acute GVHD of the gastrointestinal tract that needs further validation in a prospective clinical trial.


Assuntos
Resistência a Medicamentos , Microbioma Gastrointestinal , Doença Enxerto-Hospedeiro , Ileostomia , Doença Aguda , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Gastroenteropatias/microbiologia , Gastroenteropatias/mortalidade , Gastroenteropatias/cirurgia , Doença Enxerto-Hospedeiro/microbiologia , Doença Enxerto-Hospedeiro/mortalidade , Doença Enxerto-Hospedeiro/cirurgia , Neoplasias Hematológicas/microbiologia , Neoplasias Hematológicas/mortalidade , Neoplasias Hematológicas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esteroides/administração & dosagem
8.
PLoS One ; 14(3): e0214087, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30893383

RESUMO

Pediatric myocarditis symptoms can be mild or as extreme as sudden cardiac arrest. Early identification of the severity of illness and timely provision of critical care is helpful; however, the risk factors associated with mortality remain unclear and controversial. We undertook a retrospective review of the medical records of pediatric patients with myocarditis in a tertiary care referral hospital for over 12 years to identify the predictive factors of mortality. Demographics, presentation, laboratory test results, echocardiography findings, and treatment outcomes were obtained. Regression analyses revealed the clinical parameters for predicting mortality. During the 12-year period, 94 patients with myocarditis were included. Of these, 16 (17%) patients died, with 12 succumbing in the first 72 hours after admission. Fatal cases more commonly presented with arrhythmia, hypotension, acidosis, gastrointestinal symptoms, decreased left ventricular ejection fraction, and elevated isoenzyme of creatine kinase and troponin I levels than nonfatal cases. In multivariate analysis, troponin I > 45 ng/mL and left ventricular ejection fraction < 42% were significantly associated with mortality. Pediatric myocarditis had a high mortality rate, much of which was concentrated in the first 72 hours after hospitalization. Children with very high troponin levels or reduced ejection fraction in the first 24 hours were at higher risk of mortality, and targeting these individuals for more intensive therapies may be warranted.


Assuntos
Ecocardiografia , Mortalidade Hospitalar , Miocardite/diagnóstico por imagem , Miocardite/mortalidade , Adolescente , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/mortalidade , Criança , Pré-Escolar , Feminino , Gastroenteropatias/diagnóstico por imagem , Gastroenteropatias/etiologia , Gastroenteropatias/mortalidade , Hospitalização , Humanos , Hipotensão/diagnóstico por imagem , Hipotensão/etiologia , Hipotensão/mortalidade , Masculino , Miocardite/complicações , Estudos Retrospectivos , Centros de Atenção Terciária , Fatores de Tempo
9.
Ann Hematol ; 98(3): 763-773, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30666433

RESUMO

Enterococcus species are commensals of the human gastrointestinal tract with the ability to cause invasive infections. For patients with hematological diseases, enterococcal bloodstream infections (BSI) constitute a serious clinical complication which may even be aggravated if the pathogen is vancomycin-resistant. Therefore, we analyzed the course of BSI due to vancomycin-susceptible enterococci (VSE) in comparison to vancomycin-resistant enterococci (VRE) on patient survival. In this retrospective single-center study, BSI were caused by VRE in 47 patients and by VSE in 43 patients. Baseline patient characteristics were similar in both groups. Concerning infection-related characteristics, an increased CRP value and an increased rate of prior colonization with multidrug-resistant organisms were detected in the VRE BSI group. More enterococcal invasive infections were found in the VSE group. The primary endpoint, overall survival (OS) at 30 days after BSI, was significantly lower in patients with VRE BSI compared to patients with VSE BSI (74.5% vs. 90.7%, p = 0.039). In a multivariate regression analysis, VRE BSI and a Charlson comorbidity index higher than 4 were independent factors associated with 30-day mortality. Moreover, we found that VRE with an additional teicoplanin resistance showed a trend towards an even lower OS.


Assuntos
Gastroenteropatias , Infecções por Bactérias Gram-Positivas , Doenças Hematológicas , Enterococos Resistentes à Vancomicina , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Gastroenteropatias/etiologia , Gastroenteropatias/mortalidade , Gastroenteropatias/terapia , Infecções por Bactérias Gram-Positivas/etiologia , Infecções por Bactérias Gram-Positivas/mortalidade , Infecções por Bactérias Gram-Positivas/terapia , Doenças Hematológicas/complicações , Doenças Hematológicas/mortalidade , Doenças Hematológicas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida
10.
Am J Trop Med Hyg ; 100(1): 202-208, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30479248

RESUMO

The quick sequential organ failure assessment (qSOFA) score has been proposed for risk stratification of emergency room patients with suspected infection. Its use of simple bedside observations makes qSOFA an attractive option for resource-limited regions. We prospectively assessed the predictive ability of qSOFA compared with systemic inflammatory response syndrome (SIRS), universal vital assessment (UVA), and modified early warning score (MEWS) in a resource-limited setting in Lambaréné, Gabon. In addition, we evaluated different adaptations of qSOFA and UVA in this cohort and an external validation cohort from Malawi. We included 279 cases, including 183 with an ad hoc (suspected) infectious disease diagnosis. Overall mortality was 5%. In patients with an infection, oxygen saturation, mental status, human immunodeficiency virus (HIV) status, and all four risk stratification score results differed significantly between survivors and non-survivors. The UVA score performed best in predicting mortality in patients with suspected infection, with an area under the receiving operator curve (AUROC) of 0.90 (95% confidence interval [CI]: 0.78-1.0, P < 0.0001), outperforming qSOFA (AUROC 0.77; 95% CI: 0.63-0.91, P = 0.0003), MEWS (AUROC 0.72; 95% CI: 0.58-0.87, P = 0.01), and SIRS (AUROC 0.70; 95% CI: 0.52-0.88, P = 0.03). An amalgamated qSOFA score applying the UVA thresholds for blood pressure and respiratory rate improved predictive ability in Gabon (AUROC 0.82; 95% CI: 0.68-0.96) but performed poorly in a different cohort from Malawi (AUROC 0.58; 95% CI: 0.51-0.64). In conclusion, UVA had the best predictive ability, but multicenter studies are needed to validate the qSOFA and UVA scores in various settings and assess their impact on patient outcome.


Assuntos
Doenças Transmissíveis/diagnóstico , Escores de Disfunção Orgânica , Sepse/diagnóstico , Sepse/mortalidade , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Adulto , Área Sob a Curva , Doenças Transmissíveis/epidemiologia , Feminino , Gastroenteropatias/diagnóstico , Gastroenteropatias/epidemiologia , Gastroenteropatias/mortalidade , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/mortalidade , Recursos em Saúde , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Malária/diagnóstico , Malária/epidemiologia , Malária/mortalidade , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Infecções Urinárias/mortalidade
11.
Rheumatology (Oxford) ; 58(4): 636-644, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30517716

RESUMO

OBJECTIVES: To examine the incidence, predictors and outcomes associated with severe gastrointestinal (GI) disease in a large inception SSc cohort. METHODS: SSc subjects with <2 years of disease duration were identified from two multicentre cohorts. Severe GI disease was defined as: malabsorption, hyperalimentation, pseudo-obstruction and/or ⩾10% weight loss in association with the use of antibiotics for bacterial overgrowth or oesophageal stricture. Kaplan-Meier, multivariate logistic regression and Cox proportional hazard analyses were performed to determine the cumulative incidence rate, independent clinical correlates and mortality rate associated with severe GI disease. A longitudinal mixed model was used to assess the impact of severe GI disease on the Short Form Health Survey. RESULTS: In this inception SSc cohort, the probability of developing severe GI disease was estimated at 9.1% at 2 years and 16.0% at 4 years. In multivariate analysis, severe GI disease was associated with inflammatory myositis (odds ratio 4.68, 95% CI 1.65, 13.24), telangiectasias (odds ratio 2.45, 95% CI 1.19, 5.04) and modified Rodnan skin score (odds ratio 1.03, 95% CI 1.01, 1.07). Severe GI disease was associated with a >2-fold increase in the risk of death (hazard ratio 2.27, 95% CI 1.27, 4.09) and worse health-related quality of life [Short Form Health Survey physical (ß = -2.37, P = 0.02) and mental (ß = -2.86, P = 0.01) component summary scores]. CONCLUSION: Severe GI disease is common in early SSc and is associated with significant morbidity and increased mortality. More research is needed to understand, prevent and mitigate severe GI disease in SSc.


Assuntos
Gastroenteropatias/mortalidade , Escleroderma Sistêmico/mortalidade , Adulto , Feminino , Gastroenteropatias/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mortalidade Prematura , Análise Multivariada , Razão de Chances , Fatores de Risco , Escleroderma Sistêmico/complicações , Índice de Gravidade de Doença
12.
J Matern Fetal Neonatal Med ; 32(10): 1609-1614, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29183177

RESUMO

INTRODUCTION: Low Apgar scores (<7) measured at age 5 minutes can predict short-term infant morbidity and mortality. Although an association exists between low Apgar scores and neuropsychological disorders, other childhood disorders were not thoroughly studied. We aimed to study the possible association between low 5-minute Apgar scores in term newborns and their long-term childhood gastrointestinal (GI) morbidity. METHODS: A population-based cohort analysis was performed comparing total and different subtypes of GI-related pediatric hospitalizations among newborns with normal (≥7) and low (<7) 5-minute Apgar scores. The analysis included all term singletons born between the years 1999 and 2014 at a single tertiary regional medical center. Infants with congenital malformations, multiple gestations, and all perinatal deaths were excluded from the analysis. GI-related morbidities included hospitalizations involving a predefined set of ICD-9 codes, as recorded in the hospital computerized files. A Kaplan-Meier survival curve was constructed to compare the cumulative GI morbidity, and a Cox proportional hazards model was used to adjust for confounders. RESULTS: The study population, including 223 244 term singletons, was followed for an average of 10.02 ± 6.0 years (0-18 years, median 10.25) following discharge from birth hospitalization. Low 5-minute Apgar scores were recorded in 585 (0.3%) newborns. Incidence of GI-related hospitalizations was higher among the low versus the normal 5-minute Apgar score group (7.4 versus 5.2%; 8.6/1000 person years (PY) versus 5.2/1000 PY, respectively; p = .02; odds ratio =1.66, 95%CI 1.36-1.96). The association remained significant and independent while adjusting for gestational age, fetal weight, offspring gender, maternal age, maternal smoking, hypertension, and diabetes (Adjusted HR =1.57, 95%CI 1.16-2.12, p = .003). CONCLUSIONS: Low 5 minutes Apgar score is associated with an increased risk for long-term pediatric GI morbidity of the offspring. Our results suggest that Apgar scores can be used as a possible predictor for long-term pediatric morbidities and thus may necessitate appropriate surveillance in this vulnerable group of children.


Assuntos
Índice de Apgar , Gastroenteropatias/mortalidade , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Masculino , Gravidez , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Adulto Jovem
13.
Bone Marrow Transplant ; 54(2): 212-217, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29795429

RESUMO

Steroid-refractory (SR) acute gastrointestinal (GI) graft-versus-host disease (GVHD) is associated with significant mortality in allogeneic hematopoietic cell transplantation recipients. We retrospectively evaluated the efficacy of tocilizumab for the treatment of SR biopsy-proven acute lower GI GVHD in 16 consecutive adult transplant recipients between October 2015 and July 2016. Tocilizumab 8 mg/kg was administered every 2 weeks until achievement of complete response, defined as resolution of all manifestations of GI GVHD, or until patients had progression or initiation of other therapy. Ten of 16 patients (62.5%; 95% CI, 0.39-82) achieved a complete response after a median time of 11 days (range, 2-28 days) from tocilizumab initiation. The median time to response onset (improvement in stage by at least 1) was 1 day (range, 1-4 days). Tocilizumab was administered at a median of 9 days (range, 3-75 days) from GVHD diagnosis and 10 days (range, 3-75 days) from initiation of high-dose steroids. At a median follow-up of 7.6 months (range, 0.8-27.7 months) from initiation of tocilizumab, 6/16 (37.5%) patients are alive and free of their underlying hematologic malignancy. Tocilizumab appears to be a highly active agent for the treatment of severe SR lower GI acute GVHD.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Gastroenteropatias/tratamento farmacológico , Doença Enxerto-Hospedeiro/tratamento farmacológico , Esteroides/farmacologia , Adulto , Idoso , Anticorpos Monoclonais Humanizados/farmacologia , Feminino , Gastroenteropatias/mortalidade , Gastroenteropatias/patologia , Doença Enxerto-Hospedeiro/mortalidade , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/patologia , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Trato Gastrointestinal Inferior , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
14.
J Gastroenterol Hepatol ; 34(1): 124-131, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29995979

RESUMO

BACKGROUND AND AIM: Gastrointestinal (GI) diseases account for substantial morbidity, mortality, and health care utilization. This public hospital-based study assessed the incidence and time trend of hospitalization and mortality of major GI diseases over one decade. METHODS: We conducted an observational study using population-wide database managed by the Hong Kong Hospital Authority with a principal diagnosis of GI diseases defined by International Classification of Disease, 9th Revision, Clinical Modification coding. We measured age-standardized incidence of hospitalization, emergency admissions, multiple admissions, and in-hospital mortality from 2005 to 2014 using Poisson regression. RESULTS: The annual incidence of hospitalization for GI diseases increased from 4713 to 5241 per 100 000 discharges (incidence rate ratio [IRR] = 1.004; 95% confidence interval [CI]: 1.003-1.005). GI infections and cancers showed the highest rates of hospitalization in 2014. Hospitalization for GI cancers (IRR = 1.014; 95% CI: 1.013-1.016) and non-infectious enterocolitis (IRR = 1.058; 95% CI: 1.055-1.061) increased, whereas peptic ulcer disease has decreased. Hospitalization for Crohn's disease showed the most significant rise (126%). Annual incidence of hospitalization for Clostridium difficile infections increased by fivefold (IRR = 1.221; 95% CI: 1.178-1.266), while a 66% reduction was observed for peptic ulcer bleeding (IRR = 0.894; 95% CI: 0.889-0.899). GI cancers had the highest in-hospital mortality rate in 2014, especially colorectal cancer and gastric cancer. CONCLUSIONS: This study showed an increased hospitalization burden of GI cancers and Crohn's disease, and a reduction in overall mortality for GI diseases. These data provide insight into epidemiological changes of GI diseases in the 21st century and implications for hospital burden and need of resource re-allocation.


Assuntos
Clostridium difficile , Gastroenteropatias/epidemiologia , Mortalidade Hospitalar/tendências , Hospitalização/tendências , Hospitais Públicos/estatística & dados numéricos , China/epidemiologia , Doença de Crohn/epidemiologia , Serviço Hospitalar de Emergência/tendências , Enterocolite/epidemiologia , Enterocolite Pseudomembranosa/epidemiologia , Gastroenteropatias/mortalidade , Neoplasias Gastrointestinais/epidemiologia , Hospitais Públicos/tendências , Humanos , Incidência , Tempo de Internação/tendências , Readmissão do Paciente/tendências , Úlcera Péptica/epidemiologia , Úlcera Péptica Hemorrágica/epidemiologia , Estudos Retrospectivos
16.
BMC Gastroenterol ; 18(1): 145, 2018 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-30285652

RESUMO

BACKGROUND: This study aimed to quantify the effects of aging and urbanization on major gastrointestinal disease (liver cirrhosis, hepatitis B, diarrhea, liver cancer, stomach cancer, pancreas cancer, hepatitis C, esophagus cancer, colon/rectum cancer, gastrointestinal ulcers, diabetes, and appendicitis). METHODS: We accessed 2004 and 2011 mortality statistics from the most developed cities and least developed rural areas in China using a retrospective design. The relative risk of death associated with urbanization and age was quantified using Generalized linear model (the exp.(B) from model is interpreted as the risk ratio; the greater the B, the greater the impact of urbanized factors or aging factor or effect of aging factor with urbanization). The interaction between region (cities and rural areas) and age was considered as indicator to assess role of age in mortality with urbanization. RESULTS: Greater risk of disease with urbanization were, in ascending order, for diabetes, colon/rectum cancer, hepatitis C and pancreas cancer. Stronger the effect of aging with urbanization were, in ascending order, for stomach cancer, ulcer, liver cancer, colon/rectum cancer, pancreas cancer, diabetes, hepatitis C, appendicitis and diarrhea. When the effects of aging and urbanization on diseases were taken together as the dividing value, we were able to further divide the 12 gastrointestinal diseases into three groups to guide the development of medical strategies. CONCLUSIONS: It was suggested that mortality rate for most gastrointestinal diseases was sensitive to urbanization and control of external risk factors could lead to the conversion of most gastrointestinal disease.


Assuntos
Fatores Etários , Gastroenteropatias/mortalidade , Urbanização , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Estado Nutricional , Qualidade de Vida , Estudos Retrospectivos , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , População Urbana/estatística & dados numéricos , Adulto Jovem
17.
Haematologica ; 103(10): 1708-1719, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30076185

RESUMO

Upper gastrointestinal acute graft-versus-host disease is reported in approximately 30% of hematopoietic stem cell transplant recipients developing acute graft-versus-host disease. Currently classified as Grade II in consensus criteria, upper gastrointestinal acute graft-versus-host disease is often treated with systemic immunosuppression. We reviewed the Center for International Blood and Marrow Transplant Research database to assess the prognostic implications of upper gastrointestinal acute graft-versus-host disease in isolation or with other acute graft-versus-host disease manifestations. 8567 adult recipients of myeloablative allogeneic hematopoietic stem cell transplant receiving T-cell replete grafts for acute leukemia, chronic myeloid leukemia or myelodysplastic syndrome between 2000 and 2012 were analyzed. 51% of transplants were from unrelated donors. Reported upper gastrointestinal acute graft-versus-host disease incidence was 12.1%; 2.7% of recipients had isolated upper gastrointestinal acute graft-versus-host disease, of whom 95% received systemic steroids. Patients with isolated upper gastrointestinal involvement had similar survival, disease-free survival, transplant-related mortality, and relapse as patients with Grades 0, I, or II acute graft-versus-host disease. Unrelated donor recipients with isolated upper gastrointestinal acute graft-versus-host disease had less subsequent chronic graft-versus-host disease than those with Grades I or II disease (P=0.016 and P=0.0004, respectively). Upper gastrointestinal involvement added no significant prognostic information when present in addition to other manifestations of Grades I or II acute graft-versus-host disease. If upper gastrointestinal symptoms were reclassified as Grade 0 or I, 425 of 2083 patients (20.4%) with Grade II disease would be downgraded, potentially impacting the interpretation of clinical trial outcomes. Defining upper gastrointestinal acute graft-versus-host disease as a Grade II entity, as it is currently diagnosed and treated, is not strongly supported by this analysis. The general approach to diagnosis, treatment and grading of upper gastrointestinal symptoms and their impact on subsequent acute graft-versus-host disease therapy warrants reevaluation.


Assuntos
Gastroenteropatias , Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Imunossupressão , Leucemia Mielogênica Crônica BCR-ABL Positiva , Síndromes Mielodisplásicas , Adolescente , Adulto , Idoso , Aloenxertos , Intervalo Livre de Doença , Feminino , Gastroenteropatias/diagnóstico , Gastroenteropatias/mortalidade , Gastroenteropatias/terapia , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/mortalidade , Doença Enxerto-Hospedeiro/terapia , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/diagnóstico , Leucemia Mielogênica Crônica BCR-ABL Positiva/mortalidade , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/diagnóstico , Síndromes Mielodisplásicas/mortalidade , Síndromes Mielodisplásicas/terapia , Taxa de Sobrevida
18.
Am J Trop Med Hyg ; 99(4): 833-839, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30105965

RESUMO

Epidemiologic data indicate a global distribution of anthrax outbreaks associated with certain ecosystems that promote survival and viability of Bacillus anthracis spores. Here, we characterized three anthrax outbreaks involving humans, livestock, and wildlife that occurred in the same locality in Kenya between 2014 and 2017. Clinical and epidemiologic data on the outbreaks were collected using active case finding and review of human, livestock, and wildlife health records. Information on temporal and spatial distribution of prior outbreaks in the area was collected using participatory epidemiology. The 2014-2017 outbreaks in Nakuru West subcounty affected 15 of 71 people who had contact with infected cattle (attack rate = 21.1%), including seven with gastrointestinal, six with cutaneous, and two with oropharyngeal forms of the disease. Two (13.3%) gastrointestinal human anthrax cases died. No human cases were associated with infected wildlife. Of the 54 cattle owned in 11 households affected, 20 died (attack rate = 37%). The 2015 outbreak resulted in death of 10.5% of the affected herbivorous wildlife at Lake Nakuru National Park, including 745 of 4,500 African buffaloes (species-specific mortality rate = 17%) and three of 18 endangered white rhinos (species-specific mortality rate = 16%). The species mortality rate ranged from 1% to 5% for the other affected wildlife species. Participatory epidemiology identified prior outbreaks between 1973 and 2011 in the same area. The frequency and severity of outbreaks in this area suggests that it is an anthrax hotspot ideal for investigating risk factors associated with long-term survival of anthrax spores and outbreak occurrence.


Assuntos
Antraz/veterinária , Bacillus anthracis/fisiologia , Doenças dos Bovinos/epidemiologia , Surtos de Doenças , Gastroenteropatias/veterinária , Dermatopatias Bacterianas/veterinária , Esporos Bacterianos/fisiologia , Animais , Animais Selvagens/microbiologia , Antraz/epidemiologia , Antraz/microbiologia , Antraz/mortalidade , Bacillus anthracis/patogenicidade , Búfalos/microbiologia , Bovinos , Doenças dos Bovinos/microbiologia , Doenças dos Bovinos/mortalidade , Gastroenteropatias/epidemiologia , Gastroenteropatias/microbiologia , Gastroenteropatias/mortalidade , Humanos , Quênia/epidemiologia , Gado/microbiologia , Fatores de Risco , Dermatopatias Bacterianas/epidemiologia , Dermatopatias Bacterianas/microbiologia , Dermatopatias Bacterianas/mortalidade , Esporos Bacterianos/patogenicidade , Análise de Sobrevida
19.
Rev Assoc Med Bras (1992) ; 64(4): 374-378, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30133618

RESUMO

OBJECTIVE: To evaluate the incidence, mortality and cost of non-traumatic abdominal emergencies treated in Brazilian emergency departments. METHODS: This paper used DataSus information from 2008 to 2016 (http://www.tabnet.datasus.gov.br). The number of hospitalizations, costs - AIH length of stay and mortality rates were described in acute appendicitis, acute cholecystitis, acute pancreatitis, acute diverticulitis, gastric and duodenal ulcer, and inflammatory intestinal disease. RESULTS: The disease that had the highest growth in hospitalization was diverticular bowel disease with an increase of 68.2%. For the period of nine years, there were no significant changes in the average length of hospital stay, with the highest increase in gastric and duodenal ulcer with a growth of 15.9%. The mortality rate of gastric and duodenal ulcer disease increased by 95.63%, which is significantly high when compared to the other diseases. All had their costs increased but the one that proportionally had the highest increase in the last nine years was the duodenal and gastric ulcer, with an increase of 85.4%. CONCLUSION: Non-traumatic abdominal emergencies are extremely prevalent. Hence, the importance of having updated and comparative data on the mortality rate, number of hospitalization and cost generated by these diseases to provide better healthcare services in public hospitals.


Assuntos
Colecistite Aguda/economia , Colecistite Aguda/mortalidade , Gastroenteropatias/economia , Gastroenteropatias/mortalidade , Pancreatite/economia , Pancreatite/mortalidade , Dor Abdominal/economia , Dor Abdominal/mortalidade , Doença Aguda/economia , Doença Aguda/mortalidade , Brasil/epidemiologia , Colecistite Aguda/epidemiologia , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Gastroenteropatias/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Humanos , Incidência , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Admissão do Paciente/economia , Admissão do Paciente/estatística & dados numéricos , Fatores de Tempo
20.
J Neuromuscul Dis ; 5(3): 331-340, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30010141

RESUMO

BACKGROUND: Congenital myotonic dystrophy (CDM) is the neonatal onset and most severe presentation of Myotonic Dystrophy type 1. Since it first description, perinatal complications have been detailed including prolonged hospital stay, respiratory and feeding therapy during the neonatal period, although long-term complications are less documented. OBJECTIVE: Present a prospective cohort of CDM and compare it to the literature of other CDM case series, to adequately describe and contrast the prenatal, neonatal and infancy features of CDM. METHODS: A 5-year cohort of CDM eligible cases was conducted via the Canadian Pediatric Surveillance Program. 38 patients met the inclusion criteria. Comparison to other CDM case series published in the literature between 1992 and 2016 about perinatal and infancy morbidity. RESULT: From a total of 118 cases, the most frequent features were Polyhydramnios (58%), feeding therapy (77%), intubation and ventilation (58%); neonatal death was reported in 16% of the cases; the most frequent long-term morbidity were respiratory tract infections. CONCLUSIONS: We performed a detailed description of the main perinatal features of CDM and precise documentation of the mortality and morbidity during the first five years of life. This is an essential step in the knowledge of the natural history of CDM.


Assuntos
Distrofia Miotônica/patologia , Adulto , Canadá/epidemiologia , Ventrículos Cerebrais/patologia , Pré-Escolar , Estudos de Coortes , Criptorquidismo/etiologia , Criptorquidismo/patologia , Nutrição Enteral , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/etiologia , Gastroenteropatias/mortalidade , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Intubação Intratraqueal , Tempo de Internação , Masculino , Anormalidades Musculoesqueléticas/epidemiologia , Distrofia Miotônica/complicações , Distrofia Miotônica/mortalidade , Poli-Hidrâmnios/etiologia , Gravidez , Estudos Prospectivos , Respiração Artificial , Terapia Respiratória/estatística & dados numéricos , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Infecções Respiratórias/mortalidade
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