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1.
Br J Nurs ; 29(2): S27-S34, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31972102

RESUMO

BACKGROUND: Difficult venous access (DVA) is common in liver patients requiring blood collection using traditional peripheral approaches. This study aimed to understand the experience of DVA for liver patients and the acceptability of peripheral venepuncture versus external jugular venepuncture (EJV). A secondary aim was to explore the impact of EJV on local resource utilization. METHODS: Semistructured interviews with liver outpatients with DVA (n = 10) requiring venepuncture were firstly themed inductively. We then deductively applied the acceptability framework of Sekhon et al. as a further analytic lens. Audit data from DVA encounters (n = 24) allowed analysis of issues from multiple perspectives. The Consolidated Criteria for Reporting Qualitative Research reporting checklist guides this report. RESULTS: Peripheral venepuncture had poor prospective, concurrent, and retrospective acceptability, requiring significant mental and physical preparation. Fear, stigma, pain and distress, poor continuity of care, and poor effectiveness led to service disengagement. While EJV caused initial trepidation, it had high concurrent and retrospective acceptability. The significant improvement in patient experience was corroborated by audit data for both procedure duration (5 versus 15 minutes) and first attempt success (100 versus 28.5%) for EJV versus peripheral venepuncture, respectively. While EJV required a recumbent position, it required less staff. CONCLUSIONS: EJV is highly acceptable to patients, using less time and staff resources. EJV protocols and staff training should be considered where DVA presentations are common. Individualized care plans and careful care coordination could divert DVA patients needing venepuncture to services that use EJV preferentially. HIGHLIGHTS Peripheral venepuncture results in fear, stigma, pain, & distress for those with DVA. This poor acceptability of traditional venepuncture leads to service disengagement. External jugular venepuncture is highly acceptable & improves resource utilization.


Assuntos
Veias Jugulares , Hepatopatias/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Flebotomia/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
2.
Medicine (Baltimore) ; 99(2): e18539, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914027

RESUMO

The purpose of this study was to determine the factors associated with parenteral nutrition-associated liver disease (PNALD) in infants who underwent surgery for necrotizing enterocolitis (NEC) and followed up the postoperative outcomes for long term parenteral nutrition (PN).This study included a retrospective review of 87 infants with NEC and managed surgically from July 2007 to May 2017 at the Children's Hospital, Chongqing Medical University. Clinical data and procedure information were collected and analyzed.Among the infants included, 16.1% of patients developed PNALD. Multivariable logistic regression analysis revealed progressive clinical deterioration (OR, 5.47; 95% CI, 1.10-26.96; P = .037) was independent risk factor for PNALD whereas congenital heart disease (OR, 0.068; 95% CI, 0.008-0.55; P = .012) presentation served as a protective factor.The current data suggested the distinct disease process for cardiac patients with NEC, which might help in the prevention and treatment of PNALD for patients with NEC.


Assuntos
Enterocolite Necrosante/complicações , Enterocolite Necrosante/cirurgia , Hepatopatias/etiologia , Nutrição Parenteral/efeitos adversos , Enterocolite Necrosante/dietoterapia , Enterocolite Necrosante/mortalidade , Feminino , Idade Gestacional , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/mortalidade , Humanos , Doença Iatrogênica/epidemiologia , Doença Iatrogênica/prevenção & controle , Incidência , Lactente , Recém-Nascido , Hepatopatias/diagnóstico , Hepatopatias/epidemiologia , Masculino , Estudos Retrospectivos , Fatores de Risco
3.
Medicine (Baltimore) ; 98(50): e18265, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852096

RESUMO

The purpose of this study was to investigate the association between triglyceride glucose (TyG) index and abnormal liver function both in urban and rural Chinese adult populations. The 5824 urban (Nanjing) and 20,269 rural (Hefei) Chinese adults, from random selected households provided clinical history, glucose, lipids, anthropometric, and blood pressure measurements. Liver functions were assessed using Alanine Aminotransferase (ALT). Linear regression was applied to examine the dose-response relationship between TyG index and ALT. Logistic regression was used to estimate the association between TyG index and abnormal liver and function. Cubic spline models were applied to investigate the dose-response association between TyG index and abnormal liver function. C-statistics was used to compare the discriminable capacity over triglyceride, glucose and TyG index. Linear dose-response relationship was identified between TyG index and ALT as 1.222 IU increase by 1 unit increase of TyG index (1.242 for urban population and 1.210 for rural population). The 6.0% of urban and 11.0% of rural Chinese adults were observed to have abnormal liver function. The linear association between TyG index and abnormal liver function was revealed as 2.044 (1.930 to 2.165) of odds ratio by in unit increase of TyG index (2.334 for urban population and 1.990 for rural population). Higher C-statistics was found for TyG index compared with fasting glucose and triglyceride both in Chinese urban and rural populations. This study suggested in both urban and rural Chinese adult populations, TyG index is associated with abnormal liver function. TyG index is a potential indicator to identify high-risk individuals with metabolic disorders, for example impaired liver function in Chinese population, especially in Chinese urban population.


Assuntos
Alanina Transaminase/sangue , Glicemia/metabolismo , Hepatopatias/sangue , Vigilância da População , População Rural , Triglicerídeos/sangue , População Urbana , Adulto , Biomarcadores/sangue , Índice de Massa Corporal , China/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Hepatopatias/epidemiologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Fatores de Risco , Adulto Jovem
4.
J Surg Oncol ; 120(8): 1371-1378, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31696512

RESUMO

BACKGROUND: Postoperative complications after gastric cancer resection vary in different series and they might have a significant impact in long-term outcomes. Our aim was to build a prediction rule on gastric cancer patients' overall and major morbidity risks. METHODS: This retrospective study included 1223 patients from a single center who were resected between 1992 and 2016. Overall and major morbidity predictors were identified through multiple logistic regression. Models' performances were assessed through discrimination, calibration, and cross-validation, and nomograms were constructed. RESULTS: The mean age was 61.3-year old and the male gender was more frequent (60%). The most common comorbidities were hypertension (HTN), diabetes, and chronic obstructive pulmonary disease (COPD). A D2-distal gastrectomy was the most frequent procedure and 87% of all lesions were located in the middle or distal third. Age, COPD, coronary heart disease, chronic liver disease, pancreatic resection, and operative time were independent predictors of overall and major morbidity. The extent of resection and splenectomy was associated with overall events and HTN with major ones. Both models were very effective in predicting events among patients at higher risk. CONCLUSIONS: The overall and major morbidity models and nomograms included clinical- and surgical-related data that were very effective in predicting events, especially for high-risk patients.


Assuntos
Gastrectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Neoplasias Gástricas/cirurgia , Fatores Etários , Brasil/epidemiologia , Estudos de Coortes , Doença das Coronárias/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Hepatopatias/epidemiologia , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pâncreas/cirurgia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Esplenectomia , Neoplasias Gástricas/epidemiologia
5.
BMC Public Health ; 19(1): 1291, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615542

RESUMO

BACKGROUND: Alcohol consumption is a known risk factor for liver disease in HIV-infected populations. Therefore, knowledge of alcohol consumption behaviour and risk of disease progression associated with hazardous drinking are important in the overall management of HIV disease. We aimed at assessing the usefulness of routine data collected on alcohol consumption in predicting risk of severe liver disease (SLD) among people living with HIV (PLWHIV) with or without hepatitis C infection seen for routine clinical care in Italy. METHODS: We included PLWHIV from two observational cohorts in Italy (ICONA and HepaICONA). Alcohol consumption was assessed by physician interview and categorized according to the National Institute for Food and Nutrition Italian guidelines into four categories: abstainer; moderate; hazardous and unknown. SLD was defined as presence of FIB4 > 3.25 or a clinical diagnosis of liver disease or liver-related death. Cox regression analysis was used to evaluate the association between level of alcohol consumption at baseline and risk of SLD. RESULTS: Among 9542 included PLWHIV the distribution of alcohol consumption categories was: abstainers 3422 (36%), moderate drinkers 2279 (23%), hazardous drinkers 637 (7%) and unknown 3204 (34%). Compared to moderate drinkers, hazardous drinking was associated with higher risk of SLD (adjusted hazard ratio, aHR = 1.45; 95% CI: 1.03-2.03). After additionally controlling for mode of HIV transmission, HCV infection and smoking, the association was attenuated (aHR = 1.32; 95% CI: 0.94-1.85). There was no evidence that the association was stronger when restricting to the HIV/HCV co-infected population. CONCLUSIONS: Using a brief physician interview, we found evidence for an association between hazardous alcohol consumption and subsequent risk of SLD among PLWHIV, but this was not independent of HIV mode of transmission, HCV-infection and smoking. More efforts should be made to improve quality and validity of data on alcohol consumption in cohorts of HIV/HCV-infected individuals.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Coinfecção , Infecções por HIV/epidemiologia , Hepatite C/epidemiologia , Hepatopatias/epidemiologia , Adulto , Estudos de Coortes , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Índice de Gravidade de Doença
6.
J Ayub Med Coll Abbottabad ; 31(3): 368-371, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31535508

RESUMO

BACKGROUND: Objectives of the study were to determine the clinical spectrum of presentation and various modalities helpful in the diagnosis of liver glycogenosis short of genetic analysis. METHODS: All patients under 18 years of age presenting to Paediatric Gastroenterology unit of Children's Hospital, Lahore with suspicion of hepatic glycogen storage disease (GSD) were enrolled over a period of 18 months. Demographic profile and various factors under observation were recorded. Collected data was analysed using SPSS version 22. RESULTS: Among 89 enrolled patients F:M ratio was (1.28:1). The most common GSD was type I (71, 79.7%) followed by III (13, 14.6%), II (3, 3.3%), IV (1, 1.1%) and IX (1, 1.1%). The Abdominal distension was the most common presentation in 89.5% followed by hepatomegaly in 86.5%, diarrhoea in 41.6%, doll's like appearance in 31.5% and vomiting, acidotic breathing with convulsions in about 20% of children in GSD I. Hepatomegaly (100%), failure to thrive (85%), developmental delay (69%) and splenomegaly (92.3%) were leading presentation in GSD III. Elevated triglycerides (77.5%) followed by transaminesemia (56%), hypercholesterolemia (63%), hyperuricemia (32%) and hypoglycaemia (14%) were significant biochemical findings in GSD I. Consistently raised liver enzymes (92%) and creatinine phosphokinase (100%) in addition to hypertriglyceridemia (69%) were seen in GSD III. The presence of enlarged hepatocytes with clearing of cells favour GSD1 showed in 79% of children while fibrosis and steatosis usually seen in GSD-III (14.6%). CONCLUSIONS: Hepatic glycogen storage diseases are serious health issues and should be excluded in any patient who present with hepatomegaly, short stature and hyperlipidaemia to decrease the disease mortality and morbidity.


Assuntos
Doença de Depósito de Glicogênio , Hepatopatias , Adolescente , Criança , Pré-Escolar , Feminino , Doença de Depósito de Glicogênio/diagnóstico , Doença de Depósito de Glicogênio/epidemiologia , Doença de Depósito de Glicogênio/patologia , Doença de Depósito de Glicogênio/fisiopatologia , Humanos , Lactente , Recém-Nascido , Fígado/patologia , Fígado/fisiopatologia , Hepatopatias/diagnóstico , Hepatopatias/epidemiologia , Hepatopatias/patologia , Hepatopatias/fisiopatologia , Testes de Função Hepática , Masculino , Paquistão , Estudos Prospectivos
8.
Wien Klin Wochenschr ; 131(17-18): 395-403, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31493100

RESUMO

BACKGROUND: Liver disease impacts on hepatic synthesis of lipoproteins and lipogenesis but data on dyslipidemia during disease progression are limited. We assessed the patterns of dyslipidemia in (i) different liver disease etiologies and discriminated (ii) non-advanced (non-ACLD) from advanced chronic liver disease (ACLD) as it is unclear how progression to ACLD impacts on dyslipidemia-associated cardiovascular risk. METHODS: Patients with alcoholic liver disease (n = 121), hepatitis C (n = 1438), hepatitis B (n = 384), metabolic/fatty liver disease (n = 532), cholestatic liver disease (n = 119), and autoimmune hepatitis (n = 114) were included. Liver stiffness ≥15 kPa defined ACLD. Dyslipidemia was defined as total cholesterol >200 mg/dL, low-density lipoprotein (LDL)-cholesterol >130 mg/dL and triglycerides >200 mg/dL. RESULTS: Across all etiologies, total cholesterol levels were significantly lower in ACLD, when compared to non-ACLD. Accordingly, LDL-cholesterol levels were significantly lower in ACLD due to hepatitis C, hepatitis B, metabolic/fatty liver disease and autoimmune hepatitis. Triglyceride levels did not differ due to disease severity in any etiology. Despite lower total and LDL cholesterol levels in ACLD, etiology-specific dyslipidemia patterns remained similar to non-ACLD. Contrary to this "improved" lipid status in ACLD, cardiovascular comorbidities were more prevalent in ACLD: arterial hypertension was present in 26.6% of non-ACLD and in 55.4% of ACLD patients (p < 0.001), and diabetes was present in 8.1% of non-ACLD and 25.6% of ACLD patients (p < 0.001). CONCLUSION: Liver disease etiology is a major determinant of dyslipidemia patterns and prevalence. Progression to ACLD "improves" serum lipid levels while arterial hypertension and diabetes mellitus are more prevalent. Future studies should evaluate cardiovascular events after ACLD-induced "improvement" of dyslipidemia.


Assuntos
Dislipidemias , Hepatopatias , Adulto , LDL-Colesterol/sangue , Dislipidemias/epidemiologia , Feminino , Humanos , Hepatopatias/epidemiologia , Hepatopatias/etiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Triglicerídeos/sangue
9.
Transplant Proc ; 51(6): 1920-1922, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399176

RESUMO

INTRODUCTION: Following liver transplantation (LT), the majority of patients are treated with reduced-dose calcineurin inhibitors (CNIs) in combination with mycophenolate mofetil. The optimal timing for subsequent conversion to CNI monotherapy is not clearly defined. This study aims to evaluate the safety of conversion to CNI monotherapy after LT. METHODS: This was a single-center retrospective study of 100 consecutive patients who received CNI and mycophenolate mofetil combination regimen after LT at Singapore General Hospital from 2006 to 2018. Patient demographics, clinical parameters, and posttransplant complications (ie, rates of graft rejection, de novo malignancy, cytomegalovirus infection and renal impairment) were recorded. RESULTS: One hundred patients were recruited and mean follow-up time in months ± standard deviation was 60.36 ± 41.73. Patients were divided into 2 groups based on institution of CNI monotherapy within (group 1) or beyond (group 2) 6 months. Twenty-five (25%) patients were on CNI monotherapy within 6 months post-LT. Overall patient survival was 83.7% at 5-years posttransplant. There was no statistical difference in the rates of posttransplant complications including liver graft rejection (4.0% vs 18.7%, P = .11); de novo malignancy (0.0% vs 8.0%, P = .33); cytomegalovirus infection (4.0% vs 1.3%, P = .44); and renal impairment (20.0% vs 40.0%, P = .069) between the 2 groups. CONCLUSIONS: Successful institution of CNI monotherapy within 6 months is safe, and does not increase the risk of rejection.


Assuntos
Inibidores de Calcineurina/administração & dosagem , Transplante de Fígado , Complicações Pós-Operatórias/epidemiologia , Tacrolimo/administração & dosagem , Fatores de Tempo , Adulto , Esquema de Medicação , Quimioterapia Combinada , Feminino , Seguimentos , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/etiologia , Humanos , Hepatopatias/epidemiologia , Hepatopatias/etiologia , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/administração & dosagem , Complicações Pós-Operatórias/etiologia , Insuficiência Renal/epidemiologia , Insuficiência Renal/etiologia , Estudos Retrospectivos
11.
Am J Med Sci ; 358(2): 127-133, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31331450

RESUMO

BACKGROUND: Many guidelines addressing the approach to abnormal liver chemistries, including bilirubin, transaminases and alkaline phosphatase, recommend repeating the tests. However, when clinicians repeat testing is unknown. MATERIAL AND METHODS: This retrospective study followed adult patients with abnormal liver chemistries in a patient-centered medical home (PCMH) from 2007 to 2016. All PCMH patients possessing at least 1 abnormal liver test (total bilirubin, aminotransferases and alkaline phosphatase) were included. Patients were followed from the index abnormal liver chemistry until the next liver test result, or the end of the study period. The primary predictor variable of interest was the number of abnormal chemistries (out of 4) on index testing. Demographic and clinical variables served as other potential predictors of outcome. A Cox proportional hazards model was applied to investigate associations between the predictor variables and the time to repeat liver chemistry testing. RESULTS: Of 9,545 patients with at least 2 PCMH visits and 1 liver test abnormality, 6,489 (68%) obtained repeat testing within 1 year, and 80% of patients had follow-up tests within 2 years. Patients with multiple abnormal liver tests and those with higher degrees of abnormality were associated with shorter time to repeat testing. CONCLUSIONS: A large proportion of patients with abnormal liver tests still lack repeat testing at 1 year. The number of liver abnormal liver tests and degree of elevation were inversely associated with the time to repeat testing.


Assuntos
Hepatopatias/diagnóstico , Fígado , Médicos de Atenção Primária/normas , Atenção Primária à Saúde/métodos , Registros Eletrônicos de Saúde , Feminino , Seguimentos , Humanos , Fígado/metabolismo , Hepatopatias/epidemiologia , Hepatopatias/metabolismo , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Atenção Primária à Saúde/estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , South Carolina , Fatores de Tempo
12.
Respir Res ; 20(1): 137, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272464

RESUMO

BACKGROUND: The severity of Hereditary Hemorrhagic Telangiectasia (HHT) disease is generally related to vascular visceral involvement represented by arteriovenous malformations (AVMs). Pulmonary function tests (PFTs) remain normal in HHT patients without Pulmonary AVMs (PAVMs) and respiratory comorbidity. The aim of our study was to compare the diffusing capacity of the lung for carbon monoxide (DLCO) and nitric oxide (DLNO) and its 2 components: the pulmonary capillary blood volume (Vc) and the alveolar-capillary membrane conductance (Dm), in HHT patients with PAVMs, PAVMs and liver AVMs (LAVMs), LAVMs without PAVM, no PAVM and LAVM, and controls. METHODS: Sixty one consecutive adult patients (HHT without PAVM and LAVM: n = 7; HHT with PAVMs: n = 8; HHT with PAVMs and LAVMs: n = 25; HHT with LAVMs: n = 21) and controls matched for age and sex ratio without respiratory, heart and liver pathology (n = 15) were non-invasively evaluated using PFTs, combined DLCO/DLNO, arterial blood gas at rest, contrast echocardiography and enhanced computed tomography scan of the liver and chest the day of pulmonary function testing. RESULTS: We found that patients with LAVMs but without PAVMs exhibited increased Vc/Dm ratio. Interestingly, HHT patients with hepatic artery enlargement showed higher Vc/Dm ratio than HHT patients with normal hepatic artery diameter. CONCLUSION: Vc/Dm ratio may have practical impact in HHT patients' management to detect precociously the occurrence of LVAMs. However, further studies are needed to assess the accuracy and potential prognostic value of pulmonary gas exchange measurements in HHT patients with LVAMs.


Assuntos
Malformações Arteriovenosas/fisiopatologia , Volume Sanguíneo/fisiologia , Hepatopatias/fisiopatologia , Troca Gasosa Pulmonar/fisiologia , Telangiectasia Hemorrágica Hereditária/fisiopatologia , Adolescente , Adulto , Idoso , Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/epidemiologia , Feminino , Humanos , Hepatopatias/diagnóstico , Hepatopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Telangiectasia Hemorrágica Hereditária/diagnóstico , Telangiectasia Hemorrágica Hereditária/epidemiologia , Adulto Jovem
13.
Res Vet Sci ; 125: 136-140, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31226571

RESUMO

Periodontal disease (PD) is one of the most frequent and widespread inflammatory diseases in dogs. The onset of PD pathogenesis is prompted by the dental microbial biofilm combined with the animal immune-inflammatory response. Along with local effects, systemic consequences can occur secondary to dental plaque-associated bacteraemia, affecting distant tissues and organs. The main goal of this retrospective study was to access and evaluate the association between PD and systemic consequences (renal, hepatic and cardiac) in a group of 136 dogs. Clinical records of all animals were assessed for general and systemic information, further analysed by general linear model and Odds-Ratio. Animals were organized in two groups, PD group and control group, formed by animals without PD. In this population, increasing age was proven to be a risk factor (OR = 1.04, p < .01) for PD establishment. Small breeds (<10 Kg) were the most prevalent in the PD group, being more susceptible to this disease. On the other hand, no influence of gender or reproductive status in PD progression was observed. Regarding systemic diseases, a statistically significant association (p = .026) was obtained between PD and cardiac disease. Results show that PD can have a significant adverse impact on animals' health, being related with systemic consequences, which may increase morbidity and mortality rates of these animals. PD prevention, with focus on owner's information about this disease and its management, are essential points for an active PD control program.


Assuntos
Doenças do Cão/epidemiologia , Cardiopatias/veterinária , Nefropatias/veterinária , Hepatopatias/veterinária , Doenças Periodontais/veterinária , Animais , Cães , Feminino , Cardiopatias/complicações , Cardiopatias/epidemiologia , Nefropatias/complicações , Nefropatias/epidemiologia , Hepatopatias/complicações , Hepatopatias/epidemiologia , Masculino , Doenças Periodontais/complicações , Doenças Periodontais/epidemiologia , Portugal/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco
14.
Transplant Proc ; 51(4): 1143-1146, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31101188

RESUMO

AIM: This study aims to evaluate survival rates in elderly patients after liver transplantation (LT) and to analyze the factors associated with mortality. PATIENTS AND METHODS: Our study includes 535 patients over the age of 18 who had undergone LT in our clinic between June 2004 and January 2018. Data were collected prospectively and scanned retrospectively. Data concerning the patients' age, sex, LT indication, Child-Turcotte-Pugh score, Model for End-Stage Liver Disease score, presence of hepatocellular cancer (HCC), coexisting disease, LT types, and post-transplant survival were investigated. The patients were grouped under 2 categories (18-59 years of age and 60 years of age and over) and were compared in terms of their characteristics. In patients aged 60 and over, the causes of mortality and related factors were investigated. RESULTS: The study included 535 patients, 458 (85.6%) of whom were between 18 and 59 years of age and 77 (14.4%) were over 60 years of age. The median follow-up period was 86.7 (1 to 247) months. The elderly group's survival rate was significantly lower than that of the younger group (P = .002). In elderly patients, survival rates of 1, 3, 5, and 10 years were 67.4%, 56.4%, 53.8%, and 46.1%, respectively. CONCLUSION: In elderly patients, factors that increase post-LT mortality require thorough consideration. Equally important is the physiological status of the candidates for transplantation. Correct patient selection in the preoperative stage and good postoperative care can provide successful survival results in elderly patients.


Assuntos
Fatores Etários , Transplante de Fígado/mortalidade , Adulto , Idoso , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/cirurgia , Feminino , Sobrevivência de Enxerto , Humanos , Incidência , Hepatopatias/epidemiologia , Hepatopatias/cirurgia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
15.
PLoS One ; 14(4): e0215026, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30978214

RESUMO

The Estonian Biobank, governed by the Institute of Genomics at the University of Tartu (Biobank), has stored genetic material/DNA and continuously collected data since 2002 on a total of 52,274 individuals representing ~5% of the Estonian adult population and is increasing. To explore the utility of data available in the Biobank, we conducted a phenome-wide association study (PheWAS) in two areas of interest to healthcare researchers; asthma and liver disease. We used 11 asthma and 13 liver disease-associated single nucleotide polymorphisms (SNPs), identified from published genome-wide association studies, to test our ability to detect established associations. We confirmed 2 asthma and 5 liver disease associated variants at nominal significance and directionally consistent with published results. We found 2 associations that were opposite to what was published before (rs4374383:AA increases risk of NASH/NAFLD, rs11597086 increases ALT level). Three SNP-diagnosis pairs passed the phenome-wide significance threshold: rs9273349 and E06 (thyroiditis, p = 5.50x10-8); rs9273349 and E10 (type-1 diabetes, p = 2.60x10-7); and rs2281135 and K76 (non-alcoholic liver diseases, including NAFLD, p = 4.10x10-7). We have validated our approach and confirmed the quality of the data for these conditions. Importantly, we demonstrate that the extensive amount of genetic and medical information from the Estonian Biobank can be successfully utilized for scientific research.


Assuntos
Asma/genética , Bancos de Espécimes Biológicos/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Hepatopatias/genética , Polimorfismo de Nucleotídeo Único , Adulto , Asma/complicações , Asma/epidemiologia , Estônia/epidemiologia , Feminino , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Genótipo , Humanos , Hepatopatias/complicações , Hepatopatias/epidemiologia , Masculino , Fenótipo
16.
PLoS One ; 14(4): e0212737, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30973940

RESUMO

This study sought to determine the prevalence of significant liver disease in those subjects with serum alanine aminotransferase levels in the range between the current and the newly suggested upper limit of normal (termed the delta range). The files of the previous study subjects (who underwent at least one alanine aminotransferase measurement in 2002 and followed to 2012) were reviewed for a diagnosis of chronic liver disease; aspartate aminotransferase/platelet ratio index, FIB-4 and alanine aminotransferase/aspartate aminotransferase ratio were used to evaluate liver fibrosis. The prevalence of significant liver disease, by diagnoses and fibrosis scores was compared between subjects with alanine aminotransferase levels in the delta range (men, 42-45 IU/L; women, 26-34 IU/L) and in the newly suggested normal range (men, 15-42 IU/L; women, 10-26 IU/L). The cohort included 49,634 subjects (41% male, mean age 83±6 years) of whom 2022 were diagnosed with chronic liver disease including 366 with cirrhosis. Compared to subjects with alanine aminotransferase levels in the newly suggested normal range, subjects with alanine aminotransferase levels in the delta range had a significantly higher rate of chronic liver disease (men, 15.3% vs. 4.9%; women, 7.8% vs. 3.3%) and of cirrhosis specifically (men, 4.2% vs. 0.9%; women, 1.5% vs. 0.4%) and also had higher mean fibrosis scores (P <0.001 for all). Lowering the current upper limit of normal of serum alanine aminotransferase may help to identify elderly patients at risk of significant liver disease.


Assuntos
Alanina Transaminase/sangue , Fígado Gorduroso/sangue , Fibrose/sangue , Hepatopatias/sangue , Idoso , Alanina/metabolismo , Aspartato Aminotransferases/sangue , Fígado Gorduroso/epidemiologia , Fígado Gorduroso/patologia , Feminino , Fibrose/epidemiologia , Fibrose/patologia , Geriatria , Humanos , Hepatopatias/epidemiologia , Hepatopatias/patologia , Testes de Função Hepática , Masculino
17.
Clin Liver Dis ; 23(2): 191-208, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30947871

RESUMO

Hepatobiliary disorders are commonly encountered in patients with inflammatory bowel disease (IBD). Although primary sclerosing cholangitis is the stereotypical hepatobiliary disorder associated with IBD, other diseases, including autoimmune hepatitis and nonalcoholic fatty liver disease, also are encountered in this population. Several agents used for treatment of IBD may cause drug-induced liver injury, although severe hepatotoxicity occurs infrequently. Furthermore, reactivation of hepatitis B virus infection may occur in patients with IBD treated with systemic corticosteroids and biologic agents.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/etiologia , Colangite Esclerosante/etiologia , Doenças Inflamatórias Intestinais/complicações , Hepatopatias/epidemiologia , Hepatopatias/etiologia , Neoplasias dos Ductos Biliares/epidemiologia , Colangiocarcinoma/epidemiologia , Colangite Esclerosante/diagnóstico , Colangite Esclerosante/terapia , Hepatite Autoimune/etiologia , Hepatite Viral Humana/epidemiologia , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico
18.
Surgery ; 165(6): 1128-1135, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30981416

RESUMO

BACKGROUND: Data on predictors of nonroutine discharge among patients undergoing hepatopancreatic surgery remain poorly defined. We sought to define factors associated with nonroutine discharge to home with home health care or to a skilled nursing facility or intermediate care facility and determine the impact of discharge destination on outcomes after hepatopancreatic surgery. METHODS: The Nationwide Readmissions Database was queried for individuals who underwent hepatopancreatic surgeries 2010-2014 and were discharged home with home health care or to a skilled nursing facility/intermediate care facility. RESULTS: A total of 42,189 patients underwent hepatopancreatic surgery. Of those, 2,825 (6.70%) were discharged to a skilled nursing facility or intermediate care facility, whereas 10,925 (25.9%) were discharged with home health care. A majority of patients underwent major hepatectomy (N = 14,516, 34.4%) or minor pancreatectomy (N = 13,824, 32.8%). Compared with patients discharged home, patients discharged to a skilled nursing facility or intermediate care facility were older (median age: 60 years, interquartile range: 50-68 vs 73, 67-79) and had more comorbidities (median score: 3, interquartile range: 1-8 vs 4, interquartile range: 2-8; P < .001). Type of operative procedure was not associated with discharge to a skilled nursing facility versus with home health care. Rather, patients with extreme loss of function, based on preoperative assessment, had 2.76 times higher odds of discharge to a skilled nursing facility or intermediate care facility versus with home health care (odds ratio 2.76, 95% confidence interval 1.98-3.85). Similarly, older (odds ratio 1.06, 95% confidence interval 1.06-1.07) and female patients (odds ratio 1.37, 95% confidence interval 1.25-1.51) were more likely to be discharged to a skilled nursing facility or intermediate care facility versus with home health care. CONCLUSION: One in four patients undergoing hepatopancreatic surgery were readmitted within 90 days of surgery. Age, severity of comorbidities, and perioperative course, including incidence of complications, were associated with nonroutine discharge.


Assuntos
Hepatectomia/efeitos adversos , Pancreatectomia/efeitos adversos , Alta do Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Fatores Etários , Idoso , Comorbidade , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Hepatopatias/epidemiologia , Hepatopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Pancreatopatias/epidemiologia , Pancreatopatias/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Período Perioperatório/estatística & dados numéricos , Prognóstico , Melhoria de Qualidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos
19.
Pediatr Hematol Oncol ; 36(2): 86-102, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30978121

RESUMO

This study consists of a retrospective study including 71 childhood leukemia survivors (36 females) treated with allo-HSCT 12 Gy fractionated total body irradiation (fTBI) conditioning, with a median age of 25.0 y at time of follow-up and a median delay of 14.8 y since the graft. The recovery ratio was 90%. The number of severe late-effects was specified for each patient: 21 with growth deficiency (final height <162.5 cm for 12/35 men and <152.0 cm for 9/36 women - Growth deficiency was correlated to young age at the time of the allograft); 5 with sclerodermic chronic graft vs. host disease; 9 with osteonecrosis; risk of impaired fertility for 25 women and 28 men (only 2 women had a child); 8 with diabetes; 5 with pulmonary late-effects including 1 death; 5 with chronic renal insufficiency including 1 death; 2 with cardiac late-effects; 2 with arterial high blood pressure; 11 (8 women) declared 14 subsequent cancers (7 with thyroid carcinomas, 3 with multiple squamous cell carcinomas, 2 with epidermoïdis carcinomas of the tongue or the lip, 1 with bone sarcoma, and 1 with carcinoma of the breast); 6 with chelating treatments of hemochromatosis; 14 with important educational underachievement; 11 with depression at adult age; 1 with hepatitis B virus infection; 4 with other severe late-effects, including 2 with blindness. The average number of severe late-effects was 2.3 with a positive correlation according to delay from fTBI (p < 0.0002). Two-thirds had at least 2 late-effects. These results emphasize the urgent abandonment of conditioning by TBI in children.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Leucemia/terapia , Síndromes Mielodisplásicas/terapia , Lesões por Radiação/etiologia , Condicionamento Pré-Transplante/efeitos adversos , Irradiação Corporal Total/efeitos adversos , Adolescente , Aloenxertos , Criança , Pré-Escolar , Fracionamento da Dose de Radiação , Doenças do Sistema Endócrino/epidemiologia , Doenças do Sistema Endócrino/etiologia , Feminino , Seguimentos , Doença Enxerto-Hospedeiro/epidemiologia , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Lactente , Infertilidade/epidemiologia , Infertilidade/etiologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/etiologia , /etiologia , Hepatopatias/epidemiologia , Hepatopatias/etiologia , Pneumopatias/epidemiologia , Pneumopatias/etiologia , Masculino , Lesões por Radiação/epidemiologia , Indução de Remissão , Estudos Retrospectivos , Sobreviventes
20.
PLoS One ; 14(4): e0212779, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947265

RESUMO

OBJECTIVE: Cystic fibrosis associated liver disease (CFLD) is the third largest cause of mortality in CF. Our aim was to define the burden of CFLD in the UK using national registry data and identify risk factors for progressive disease. METHODS: A longitudinal population-based cohort study was conducted. Cases were defined as all patients with CFLD identified from the UK CF Registry, 2008-2013 (n = 3417). Denominator data were derived from the entire UK CF Registry. The burden of CFLD was characterised. Regression analysis was undertaken to identify risk factors for cirrhosis and progression. RESULTS: Prevalence of CFLD increased from 203.4 to 228.3 per 1000 patients during 2008-2013. Mortality in CF patients with CFLD was more than double those without; cirrhotic patients had higher all-cause mortality (HR 1.54, 95% CI 1.09 to 2.18, p = 0.015). Median recorded age of cirrhosis diagnosis was 19 (range 5-53) years. Male sex, Pseudomonas airway infection and CF related diabetes were independent risk factors for cirrhosis. Ursodeoxycholic acid use was associated with prolonged survival in patients without cirrhosis. CONCLUSIONS: This study highlights an important changing disease burden of CFLD. The prevalence is slowly increasing and, importantly, the disease is not just being diagnosed in childhood. Although the role of ursodeoxycholic acid remains controversial, this study identified a positive association with survival.


Assuntos
Fibrose Cística/epidemiologia , Cistos/epidemiologia , Doenças do Sistema Digestório/epidemiologia , Cirrose Hepática/epidemiologia , Hepatopatias/epidemiologia , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Fibrose Cística/complicações , Fibrose Cística/patologia , Cistos/complicações , Cistos/patologia , Doenças do Sistema Digestório/complicações , Doenças do Sistema Digestório/patologia , Feminino , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/patologia , Hepatopatias/complicações , Hepatopatias/patologia , Masculino , Fatores de Risco , Índice de Gravidade de Doença , Reino Unido/epidemiologia , Adulto Jovem
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