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1.
Wei Sheng Yan Jiu ; 49(5): 844-849, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33070834

RESUMO

OBJECTIVE: To study the status of chronic disease multimorbidity of middle-aged and elderly people over 45 years old in China, and to analyze the influencing factors. METHODS: Using the data of the"China Health and Nutrition Survey(CHNS)", this survey has been carried out in 10 rounds nationwide since 1989. Multi-stage cluster random sampling was used to investigate rural and urban areas in 9 provinces and cities in China. In this study, the general socio-demographic characteristics, disease history, living habits and other information in the 2009 database were used to analyze the subjects who were collected blood samples. The prevalence of 8 common chronic diseases and multimorbidity such as hypertension, mixed-hyperlipidemia and hyperuricemia were described respectively. The Venn diagram in the R software package was used to calculate the multimorbidity of the disease. The χ~2 test and multiple correspondence analysis were used to explore the influencing factors of chronic disease multimorbidity in the middle-aged and elderly people in China. RESULTS: Among the 5316 subjects, the highest prevalence among 8 chronic diseases was hypertension(2143, 40. 3%). The lowest prevalence was myocardial infarction(87, 1. 4%). There were all together 1498 patients who had two kinds or more than two kinds of chronic diseases with a detection rate of 28. 18%. The most common multimorbidity were hypertension+hyperuricemia(199, 13. 30%), followed by hypertension + mixed-hyperlipidemia(191, 12. 77%). Hypertension+hyperuricemia+mixed-hyperlipidemia was the most common combination of the three chronic diseases(103, 6. 89%). Age(Kendull=0. 158, P<0. 001), region(χ~2=30. 129, P<0. 001), BMI(Kendull=0. 344, P<0. 001) and marital status(χ~2=21. 923, P<0. 001) were associated with the number of multimorbidities. Correspondence analysis showed that subjects aged 65 to 74, living in cities and sleeping less than 7 hours were more likely to have multimorbidity. CONCLUSION: The prevalence of chronic disease multimorbidity among middle-aged and elderly residents in China is high. Older age, unmarried, overweight and obesity, too little or too much sleep may increase the risk of multimorbidity.


Assuntos
Hipertensão , Multimorbidade , Idoso , China/epidemiologia , Doença Crônica , Humanos , Hipertensão/epidemiologia , Pessoa de Meia-Idade , Prevalência
2.
Medicine (Baltimore) ; 99(40): e22310, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019406

RESUMO

Immunoglobulin A nephropathy (IgAN) is a major cause of secondary hypertension (HT) of renal origin - a significant prognostic factor of IgAN. In children, similar to HT, prehypertension (pre-HT) is becoming a significant health issue. However, the role of secondary HT and pre-HT (HT/pre-HT) in the progression of pediatric IgAN remains unclear. We investigated the effects of HT/pre-HT on prognosis and its determinants as well as their correlation with clinicopathological parameters to identify more effective therapeutic targets.This single-center retrospective study compared clinicopathological features and treatment outcomes between patients with and without HT/pre-HT in 108 children with IgAN. Independent risk factors for HT/pre-HT were evaluated; segmental glomerulosclerosis was a significant variable, whose relationship with clinicopathological parameters was analyzed.Clinical outcomes of patients with and without HT/pre-HT differed considerably (P = .006) on ≥6 months follow-up. Patients with HT/pre-HT reached complete remission less frequently than those without HT/pre-HT (P = .014). Age, serum creatinine, prothrombin time, and segmental glomerulosclerosis or adhesion were independent risk factors for HT/pre-HT in pediatric IgAN (P = .012, P = .017, P = .002, and P = .016, respectively). Segmental glomerulosclerosis or adhesion was most closely associated with glomerular crescents (r = 0.456, P < .01), followed by Lees grades (r = 0.454, P < .01), renal arteriolar wall thickening (r = 0.337, P < .01), and endocapillary hypercellularity (r = 0.306, P = .001). The intensity of IgA deposits, an important marker of pathogenetic activity in IgAN, was significantly associated with the intensity and location of fibrinogen deposits (intensity: r = 0.291, P = .002; location: r = 0.275, P = .004).HT/pre-HT in pediatric IgAN patients is an important modifiable factor. A relationship is observed between HT/pre-HT and its determinants, especially segmental glomerulosclerosis. Potential therapeutic approaches for IgAN with HT/pre-HT might be directed toward the management of coagulation status, active lesions, and hemodynamics for slowing disease progression.


Assuntos
Glomerulonefrite por IGA/epidemiologia , Hipertensão/epidemiologia , Pré-Hipertensão/epidemiologia , Adolescente , Fatores Etários , Anti-Hipertensivos/uso terapêutico , Biomarcadores , Criança , Creatinina/sangue , Progressão da Doença , Feminino , Fibrinolíticos/uso terapêutico , Taxa de Filtração Glomerular , Glomerulonefrite por IGA/tratamento farmacológico , Glomerulosclerose Segmentar e Focal/epidemiologia , Humanos , Hipertensão/tratamento farmacológico , Imunossupressores/uso terapêutico , Masculino , Pré-Hipertensão/tratamento farmacológico , Prognóstico , Tempo de Protrombina , Estudos Retrospectivos , Fatores de Risco
4.
JAMA ; 324(14): 1429-1438, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-33048153

RESUMO

Importance: The prevalence of leading risk factors for morbidity and mortality in the US significantly varies across regions, states, and neighborhoods, but the extent these differences are associated with a person's place of residence vs the characteristics of the people who live in different places remains unclear. Objective: To estimate the degree to which geographic differences in leading risk factors are associated with a person's place of residence by comparing trends in health outcomes among individuals who moved to different areas or did not move. Design, Setting, and Participants: This retrospective cohort study estimated the association between the differences in the prevalence of uncontrolled chronic conditions across movers' destination and origin zip codes and changes in individuals' likelihood of uncontrolled chronic conditions after moving, adjusting for person-specific fixed effects, the duration of time since the move, and secular trends among movers and those who did not move. Electronic health records from the Veterans Health Administration were analyzed. The primary analysis included 5 342 207 individuals with at least 1 Veterans Health Administration outpatient encounter between 2008 and 2018 who moved zip codes exactly once or never moved. Exposures: The difference in the prevalence of uncontrolled chronic conditions between a person's origin zip code and destination zip code (excluding the individual mover's outcomes). Main Outcomes and Measures: Prevalence of uncontrolled blood pressure (systolic blood pressure level >140 mm Hg or diastolic blood pressure level >90 mm Hg), uncontrolled diabetes (hemoglobin A1c level >8%), obesity (body mass index >30), and depressive symptoms (2-item Patient Health Questionnaire score ≥2) per quarter-year during the 3 years before and the 3 years after individuals moved. Results: The study population included 5 342 207 individuals (mean age, 57.6 [SD, 17.4] years, 93.9% men, 72.5% White individuals, and 12.7% Black individuals), of whom 1 095 608 moved exactly once and 4 246 599 never moved during the study period. Among the movers, the change after moving in the prevalence of uncontrolled blood pressure was 27.5% (95% CI, 23.8%-31.3%) of the between-area difference in the prevalence of uncontrolled blood pressure. Similarly, the change after moving in the prevalence of uncontrolled diabetes was 5.0% (95% CI, 2.7%-7.2%) of the between-area difference in the prevalence of uncontrolled diabetes; the change after moving in the prevalence of obesity was 3.1% (95% CI, 2.0%-4.2%) of the between-area difference in the prevalence of obesity; and the change after moving in the prevalence of depressive symptoms was 15.2% (95% CI, 13.1%-17.2%) of the between-area difference in the prevalence of depressive symptoms. Conclusions and Relevance: In this retrospective cohort study of individuals receiving care at Veterans Health Administration facilities, geographic differences in prevalence were associated with a substantial percentage of the change in individuals' likelihood of poor blood pressure control or depressive symptoms, and a smaller percentage of the change in individuals' likelihood of poor diabetes control and obesity. Further research is needed to understand the source of these associations with a person's place of residence.


Assuntos
Transtorno Depressivo/epidemiologia , Diabetes Mellitus/epidemiologia , Migração Humana/estatística & dados numéricos , Hipertensão/epidemiologia , Obesidade/epidemiologia , Características de Residência/estatística & dados numéricos , Doença Crônica/epidemiologia , Doença Crônica/etnologia , Transtorno Depressivo/etnologia , Diabetes Mellitus/etnologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Geografia Médica , Migração Humana/tendências , Humanos , Hipertensão/etnologia , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Incerteza , Estados Unidos/epidemiologia , Estados Unidos/etnologia , Serviços de Saúde para Veteranos Militares/estatística & dados numéricos
5.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(8): 923-928, 2020 Aug 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33053533

RESUMO

OBJECTIVES: To investigate the prevalence of primary aldosteronism (PA) in newly diagnosed diabetic patients with hypertension and to compare clinical differences between newly diagnosed diabetes mellitus with essential hypertension (EH) and PA, and to explore the relationship between plasm aldosterone concentration (PAC) and clinical biochemical variables. METHODS: A total of 270 newly diagnosed diabetic patients with hypertension were prospectively enrolled in this study. All patients were screened for PA. The positive patients in the screening test were further confirmed by captopril challenge test (CCT) to determine the prevalence of PA. Clinical biochemical indexes were detected. RESULTS: The prevalence of PA in 270 newly diagnosed diabetic patients with hypertension was 18.5%. Compared with patients in the EH group, patients in the PA group had higher systolic blood pressure (SBP), PAC, aldosterone to renin ratio (ARR), and carbondioxide binding force, but lower plasma renin activity (PRA) and serum potassium. Correlation analysis showed that the PAC was positively correlated with homeostasis model assessment-insulin resistance (HOMA-IR) in the EH group (r=0.139, P<0.05), but the correlation was not found in the PA group. Compared with patients with SBP<140 mmHg, patients with SBP≥160 mmHg had the significantly decreased PRA and potassium (P<0.05, P<0.001, respectively), but increased ARR and proportion in the PA patients (P<0.05, P<0.01, respectively). CONCLUSIONS: The prevalence of PA is relatively high in newly diagnosed diabetic patients with hypertension. Patients with hypertension above grade 2 should be actively screened for aldosterone. Newly diagnosed diabetic patients with hypertension combined with PA has a higher hypertension compared with the patients without PA.In newly diagnosed diabetic patients with hypertension, PAC may be related to insulin resistance.


Assuntos
Diabetes Mellitus , Hiperaldosteronismo , Hipertensão , Aldosterona , Diabetes Mellitus/epidemiologia , Humanos , Hiperaldosteronismo/complicações , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/epidemiologia , Hipertensão/complicações , Hipertensão/epidemiologia , Renina
6.
Medicine (Baltimore) ; 99(35): e21468, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871869

RESUMO

Saline is a commonly used intravenous solvent, however, its excessive infusion may increase drug-induced sodium intake. To investigate the effects of saline infusion on blood pressure variability (BPV) in patients with hypertension, a retrospective study was performed in 1010 patients with hypertension. The patients who received saline infusion before surgery for continuous 3 to 5 days were divided into 2 groups according to the saline infusion volume during the hospitalization, which are >500 mL per day group and <500 mL per day group. The overall incidence of abnormal BPV was 11.58%. As for the incidence of abnormal BPV in the <500 mL per day group with 698 patients was 9.17%, while that in the >500 mL per day group with 312 patients was as high as 16.99%. Additionally, >500 mL of daily saline infusion for continuous 3 to 5 days (P for trend = .004, odds ratio [OR] = 1.911, 95% confidence interval [CI] for OR 1.226-2.977), medical history of diabetes mellitus (P < .001, OR = 4.856, 95% CI for OR 3.118-7.563) and cardiovascular diseases (P < .001, OR = 2.498, 95% CI for OR 1.549-4.029) may be risk factors of abnormal BPV; while anti-hypertensive therapy with diuretics (P < .001, OR = 0.055, 95% CI for OR 0.024-0.125) may be the protective factor. Our study suggests that >500 mL of daily saline infusion for continuous 3 to 5 days may have disadvantages in the blood pressure control for hypertensive patients, especially for the patients with diabetes mellitus and cardiovascular diseases.


Assuntos
Variação Biológica da População/fisiologia , Pressão Sanguínea/efeitos dos fármacos , Hipertensão/epidemiologia , Solução Salina/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/tendências , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , China/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/tratamento farmacológico , Incidência , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Solução Salina/administração & dosagem
7.
Medicine (Baltimore) ; 99(35): e21953, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871943

RESUMO

H-type hypertension, defined as a combination of hypertension and hyperhomocysteinemia (Hhcy), is associated with atherosclerosis and, therefore, increased stroke risk. However, the role of hypertension and Hhcy in high-risk stroke populations has not been studied. The present study investigated the prevalence of H-type hypertension in a high-risk stroke population of Hainan Province, China and to assess possible joint effects between hypertension and Hhcy for increased carotid intima-media thickness (CIMT). In this community-based cross-sectional study, 959 high-risk stroke subjects (age, 65.8 ±â€Š10.8 years; 46.6% men) were recruited from Hainan Province, China. The demographic and clinical characteristics were collected, and blood samples were obtained. Analysis of variance or chi-square tests were performed to compare variates among groups based on both homocysteine levels and blood pressure status. The associations of hypertension and Hhcy with increased CIMT were evaluated through logistic regression. The prevalence of H-type hypertension was 34.8% in this population, with a higher ratio of H-type hypertension in men than in women. Compared with the normotension and normal homocysteine subgroup, the risk of increased CIMT was significantly higher in the subgroup with hypertension and Hhcy (odds ratio [OR] = 2.639; 95% confidence interval [CI], 1.690-4.091) after adjusting for age and sex. Increased CIMT was affected by an additive synergetic interaction between Hhcy and hypertension (synergy index = 1.105). It emphasized the clinical importance of anti-hypertension and lowering Hhcy in the high-risk stroke population.


Assuntos
Espessura Intima-Media Carotídea , Hiper-Homocisteinemia/complicações , Hipertensão/complicações , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Hiper-Homocisteinemia/fisiopatologia , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos
8.
PLoS One ; 15(9): e0238905, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915872

RESUMO

BACKGROUND: Due to a high prevalence of chronic non-degenerative diseases, it is suspected that COVID 19 poses a high risk of fatal complications for the Mexican population. The present study aims to estimate the risk factors for hospitalization and death in the Mexican population infected by SARS-CoV-2. METHODS AND FINDINGS: We used the publicly available data released by the Epidemiological Surveillance System for Viral Respiratory Diseases of the Mexican Ministry of Health (Secretaría de Salud, SSA). All records of positive SARS-CoV-2 cases were included. Two multiple logistic regression models were fitted to estimate the association between hospitalization and mortality, with other covariables. Data on 10,544 individuals (57.68% men), with mean age 46.47±15.62, were analyzed. Men were about 1.54 times more likely to be hospitalized than women (p<0.001, 95% C.I. 1.37-1.74); individuals aged 50-74 and ≥74 were more likely to be hospitalized than people aged 25-49 (OR 2.05, p<0.001, 95% C.I. 1.81-2.32, and OR 3.84, p<0.001, 95% C.I. 2.90-5.15, respectively). People with hypertension, obesity, and diabetes were more likely to be hospitalized than people without these comorbidities (p<0.01). Men had more risk of death in comparison to women (OR = 1.53, p<0.001, 95% C.I. 1.30-1.81) and individuals aged 50-74 and ≥75 were more likely to die than people aged 25-49 (OR 1.96, p<0.001, 95% C.I. 1.63-2.34, and OR 3.74, p<0.001, 95% C.I. 2.80-4.98, respectively). Hypertension, obesity, and diabetes presented in combination conveyed a higher risk of dying in comparison to not having these diseases (OR = 2.10; p<0.001, 95% C.I. 1.50-2.93). Hospitalization, intubation and pneumonia entail a higher risk of dying (OR 5.02, p<0.001, 95% C.I. 3.88-6.50; OR 4.27, p<0.001, 95% C.I. 3.26-5.59, and OR = 2.57; p<0.001, 95% C.I. 2.11-3.13, respectively). Our study's main limitation is the lack of information on mild (asymptomatic) or moderate cases of COVID-19. CONCLUSIONS: The present study points out that in Mexico, where an important proportion of the population has two or more chronic conditions simultaneously, a high mortality rate is a serious risk for those infected by SARS-CoV-2.


Assuntos
Infecções por Coronavirus/mortalidade , Diabetes Mellitus/epidemiologia , Hospitalização/estatística & dados numéricos , Hipertensão/epidemiologia , Obesidade/epidemiologia , Pneumonia Viral/mortalidade , Adulto , Idoso , Comorbidade , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Taxa de Sobrevida
9.
BMJ Open ; 10(9): e041079, 2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938604

RESUMO

OBJECTIVES: Our research question was: what are the most frequent baseline clinical characteristics in adult patients with COVID-19? Our major aim was to identify common baseline clinical features that could help recognise adult patients at high risk of having COVID-19. DESIGN: We conducted a scoping review of all the evidence available at LitCovid, until 23 March 2020. SETTING: Studies conducted in any setting and any country were included. PARTICIPANTS: Studies had to report the prevalence of sociodemographic characteristics, symptoms and comorbidities specifically in adults with a diagnosis of infection by SARS-CoV-2. RESULTS: In total, 1572 publications were published on LitCovid. We have included 56 articles in our analysis, with 89% conducted in China and 75% containing inpatients. Three studies were conducted in North America and one in Europe. Participants' age ranged from 28 to 70 years, with balanced gender distribution. The proportion of asymptomatic cases were from 2% to 79%. The most common reported symptoms were fever (4%-99%), cough (4%-92%), dyspnoea/shortness of breath (1%-90%), fatigue (4%-89%), myalgia (3%-65%) and pharyngalgia (2%-61%), while regarding comorbidities, we found cardiovascular disease (1%-40%), hypertension (0%-40%) and cerebrovascular disease (1%-40%). Such heterogeneity impaired the conduction of meta-analysis. CONCLUSIONS: The infection by COVID-19 seems to affect people in a very diverse manner and with different characteristics. With the available data, it is not possible to clearly identify those at higher risk of being infected with this condition. Furthermore, the evidence from countries other than China is, at the moment, too scarce.


Assuntos
Infecções Assintomáticas/epidemiologia , Infecções por Coronavirus/fisiopatologia , Tosse/fisiopatologia , Dispneia/fisiopatologia , Fadiga/fisiopatologia , Febre/fisiopatologia , Pneumonia Viral/fisiopatologia , Betacoronavirus , Doenças Cardiovasculares/epidemiologia , Transtornos Cerebrovasculares/epidemiologia , Comorbidade , Infecções por Coronavirus/epidemiologia , Humanos , Hipertensão/epidemiologia , Mialgia/fisiopatologia , Pandemias , Faringite/fisiopatologia , Pneumonia Viral/epidemiologia
10.
Value Health ; 23(9): 1210-1217, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940239

RESUMO

OBJECTIVES: Significant literature exists on the effects of medication adherence on reducing healthcare costs, but less is known about the effect of medication adherence among Medicare low-income subsidy (LIS) recipients. This study examined the effects of medication adherence on healthcare costs among LIS recipients with diabetes, hypertension, and/or heart failure. METHODS: This retrospective study analyzed Medicare claims data (2012-2013) linked to the Area Health Resources Files. Using measures developed by the Pharmacy Quality Alliance, adherence to 11 medication classes was studied among patients with 7 possible combinations of the diseases mentioned. Adherence was measured in 8 categories of proportion of days covered (PDC): ≥95%, 90% to <95%, 85% to <90%, 80% to <85%, 75% to <80%, 50% to <75%, 25% to <50%, and <25%. Annual Medicare costs were compared across adherence categories. A generalized linear model was used to control for patient/community characteristics. RESULTS: Among patients with only one disease, such as diabetes, patients with the lowest adherence (PDC < 25%) had $3152/year higher Medicare costs than patients with the highest adherence (PDC ≥ 95%; $11 101 vs $7949; P < .05). The adjusted costs among patients with PDC < 25% was $1893 higher than patients with PDC ≥ 95% ($9919 vs $8026; P < .05). Among patients with multiple chronic conditions, patients' adherence to medications for fewer diseases had higher costs. CONCLUSIONS: Greater medication adherence is associated with lower Medicare costs in the Medicare LIS population. Future policy affecting the LIS program should encourage better medication adherence among patients with chronic diseases.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Insuficiência Cardíaca/epidemiologia , Hipertensão/epidemiologia , Medicare/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Diabetes Mellitus Tipo 2/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Hipertensão/tratamento farmacológico , Medicare/economia , Estudos Retrospectivos , Estados Unidos
11.
Am J Physiol Heart Circ Physiol ; 319(4): H793-H796, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32886002

RESUMO

The 60-kDa heat shock protein (HSP60) is a chaperone essential for mitochondrial proteostasis ensuring thus sufficient aerobic energy production. In pathological conditions, HSP60 can be translocated from the mitochondria and excreted from the cell. In turn, the extracellular HSP60 has a strong ability to trigger and enhance inflammatory response with marked proinflammatory cytokine induction, which is mainly mediated by Toll-like receptor binding. Previous studies have found increased circulating levels of HSP60 in hypertensive patients, as well as enhanced HSP60 expression and membrane translocation in the hypertrophic myocardium. These observations are of particular interest, since they could provide a possible pathophysiological explanation of the severe course and worse outcome of severe acute respiratory syndrome coronavirus 2 infection in hypertensive patients, repeatedly reported during the recent coronavirus disease 2019 (COVID-19) pandemic and related to hyperinflammatory response and cytokine storm development during the third phase of the disease. In this regard, pharmacological inhibition of HSP60 could attract attention to potentially ameliorate inappropriate inflammatory reaction in severe COVID-19 patients. Among HSP60 antagonizing drugs, mizoribine is the most intriguing, since it is clinically approved and exerts antiviral activity. However, this topic requires to be further scrutinized.


Assuntos
Betacoronavirus/patogenicidade , Chaperonina 60/metabolismo , Infecções por Coronavirus/metabolismo , Hipertensão/metabolismo , Mediadores da Inflamação/metabolismo , Pneumonia Viral/metabolismo , Animais , Chaperonina 60/antagonistas & inibidores , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Interações Hospedeiro-Patógeno , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Imunossupressores/uso terapêutico , Mediadores da Inflamação/antagonistas & inibidores , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico , Ribonucleosídeos/uso terapêutico , Transdução de Sinais
12.
Psychiatr Danub ; 32(Suppl 2): 221-225, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32970639

RESUMO

A study of COVID-19 infected patients was conducted regarding to organic and psychological characteristics. The findings of the study indicate that in the period of the pandemic in 2020, a total of 78 infection cases were confirmed in West Herzegovina Canton. Of the total number of infected, 55.1% are women and 44.9% are men. Of the infected population, 16.7% were hospitalized. By monitoring the COVID-19 disease in West Herzegovina Canton, we conclude how all manifestations of the disease were represented, from asymptomatic, through mild respiratory to the most severe clinical picture with fatal outcomes. The mortality rate in West Herzegovina Canton is 5.1%. The study showed that a total of 28.2% of COVID-19 positive patients before infecting with virus, were most likely to suffer from hypertension, diabetes and malignancies. Furthermore, it is important to emphasize that a total of 71.9% of those infected are without underlying diseases. Also, the results indicate that people with COVID-19 in addition to the characteristic symptoms of the disease (fever, fatigue, cough, etc.) had certain mental ailments such as decreased general mood, increased anxiety, panic attacks, acute stress disorder and others.


Assuntos
Infecções por Coronavirus/epidemiologia , Saúde Mental/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Betacoronavirus , Bósnia e Herzegóvina/epidemiologia , Comorbidade , Infecções por Coronavirus/psicologia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Neoplasias/epidemiologia , Pneumonia Viral/psicologia
13.
Hypertension ; 76(5): 1350-1367, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32981369

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic is associated with significant morbidity and mortality throughout the world, predominantly due to lung and cardiovascular injury. The virus responsible for COVID-19-severe acute respiratory syndrome coronavirus 2-gains entry into host cells via ACE2 (angiotensin-converting enzyme 2). ACE2 is a primary enzyme within the key counter-regulatory pathway of the renin-angiotensin system (RAS), which acts to oppose the actions of Ang (angiotensin) II by generating Ang-(1-7) to reduce inflammation and fibrosis and mitigate end organ damage. As COVID-19 spans multiple organ systems linked to the cardiovascular system, it is imperative to understand clearly how severe acute respiratory syndrome coronavirus 2 may affect the multifaceted RAS. In addition, recognition of the role of ACE2 and the RAS in COVID-19 has renewed interest in its role in the pathophysiology of cardiovascular disease in general. We provide researchers with a framework of best practices in basic and clinical research to interrogate the RAS using appropriate methodology, especially those who are relatively new to the field. This is crucial, as there are many limitations inherent in investigating the RAS in experimental models and in humans. We discuss sound methodological approaches to quantifying enzyme content and activity (ACE, ACE2), peptides (Ang II, Ang-[1-7]), and receptors (types 1 and 2 Ang II receptors, Mas receptor). Our goal is to ensure appropriate research methodology for investigations of the RAS in patients with severe acute respiratory syndrome coronavirus 2 and COVID-19 to ensure optimal rigor and reproducibility and appropriate interpretation of results from these investigations.


Assuntos
Infecções por Coronavirus/epidemiologia , Hipertensão/epidemiologia , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/epidemiologia , Sistema Renina-Angiotensina/fisiologia , Síndrome Respiratória Aguda Grave/metabolismo , Determinação da Pressão Arterial/métodos , China/epidemiologia , Feminino , Humanos , Hipertensão/fisiopatologia , Incidência , Masculino , Pandemias/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Prognóstico , Projetos de Pesquisa , Medição de Risco , Síndrome Respiratória Aguda Grave/epidemiologia
14.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32948657

RESUMO

OBJECTIVES: To determine the natural history of pediatric hypertension. METHODS: We conducted a 72-month retrospective cohort study among 165 primary care sites. Blood pressure measurements from two consecutive 36 month periods were compared. RESULTS: Among 398 079 primary care pediatric patients ages 3 to 18, 89 347 had ≥3 blood pressure levels recorded during a 36-month period, and 43 825 children had ≥3 blood pressure levels for 2 consecutive 36-month periods. Among these 43 825 children, 4.3% (1881) met criteria for hypertension (3.5% [1515] stage 1, 0.8% [366] stage 2) and 4.9% (2144) met criteria for elevated blood pressure in the first 36 months. During the second 36 months, 50% (933) of hypertensive patients had no abnormal blood pressure levels, 22% (406) had elevated blood pressure levels or <3 hypertensive blood pressure levels, and 29% (542) had ≥3 hypertensive blood pressure levels. Of 2144 patients with elevated blood pressure in the first 36 months, 70% (1492) had no abnormal blood pressure levels, 18% (378) had persistent elevated blood pressure levels, and 13% (274) developed hypertension in the second 36-months. Among the 7775 patients with abnormal blood pressure levels in the first 36-months, only 52% (4025) had ≥3 blood pressure levels recorded during the second 36-months. CONCLUSIONS: In a primary care cohort, most children initially meeting criteria for hypertension or elevated blood pressure had subsequent normal blood pressure levels or did not receive recommended follow-up measurements. These results highlight the need for more nuanced initial blood pressure assessment and systems to promote follow-up of abnormal results.


Assuntos
Determinação da Pressão Arterial/estatística & dados numéricos , Hipertensão/diagnóstico , Adolescente , Fatores Etários , Estatura , Criança , Pré-Escolar , Intervalos de Confiança , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Valores de Referência , Análise de Regressão , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo
15.
Bratisl Lek Listy ; 121(9): 628-633, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32990010

RESUMO

AIMS: The aim of this study was to explain the demographic data, comorbidity and laboratory findings of our first cases in COVID-19 pneumonia in our country. METHODS: We gathered the data of COVID-19 pneumonia participants from our electronic medical system, including daily medical knowledge and laboratory, radiological, and microbiological results between March 10 to April 7, 2020. RESULTS: Totally, 125 patients, whose findings were compatible with COVID-19, were included in the study, 42 patients were excluded from the study. The distribution of genders was, 39 females (46.9 %), 44 males (53.01 %), the average age was 56.36 ± 16.25 (19-85). Hypertension above 60 years of age and diabetes mellitus under 60 years of age were the most common comorbidities. Neutrophils/ Lymphocyte percent(% NLR) was noted in 44 (53.01 %) patients, average: 3 (range 1.78-4.63). There was a statistically significant and positive relationship between D-dimer and C Reactive Protein (CRP) and ferritin. CONCLUSION: We detected that comorbidities, which were seen at COVID-19 disease differ according to the patients age. Besides that D-dimer, ferritin and CRP outcomes were particularly high and had a significant correlation with COVID-19 severity (Tab. 3, Fig. 2, Ref. 25). Text in PDF www.elis.sk Keywords: COVID-19, prognosis, acute phase reactan.


Assuntos
Proteínas da Fase Aguda/análise , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Adulto , Idoso , Betacoronavirus , Comorbidade , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Prognóstico , Eslováquia/epidemiologia , Adulto Jovem
16.
BMC Public Health ; 20(1): 1364, 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32891134

RESUMO

BACKGROUND: The co-morbidity of cardiometabolic diseases in patients with Tuberculosis adds a significant burden in current health systems in developing countries including Nepal. The main objective of this study was to explore cardiometabolic risk factors among patients with Tuberculosis. METHODS: This was a cross-sectional study conducted among patients with tuberculosis in 12 tuberculosis treatment centers from eight districts of Nepal between May and July 2017. Interviews with participants were conducted using a structured questionnaire and were supplemented by anthropometric measurements and on-site blood glucose tests. Data were analyzed using descriptive and inferential statistics. RESULTS: Among 221 study participants, 138 (62.4%) had new smear-positive pulmonary tuberculosis, 24 (10.9%) had new smear-negative pulmonary tuberculosis and 34 (15.4%) had new extra- pulmonary tuberculosis. Overall, 43.1% of the patients with tuberculosis had at least one cardiometabolic risk factor. The prevalence of at least one cardiometabolic risk factor was more in male than female (47.8% versus 33.8%). Prevalence of tobacco (18.9% versus 4.8%), and alcohol (12.6% versus 6.5%) use was proportionately higher in male compared to female. The prevalence of hypertension (17% vs. 21%) and obesity (11.9% vs. 12.9%) was lower in male compared to females. Female (AOR = 0.47; CI: 0.23-0.94), those from Gandaki Province (AOR = 0.32; CI: 0.13-0.79) and literate (AOR = 0.49; CI: 0.25-0.96) had reduced risk of cardiometabolic disease risk factors. CONCLUSIONS: This study highlights the role of gender and socio-demographic characteristics associated with the risk of cardiometabolic diseases in patients with Tuberculosis. The findings from this study can guide medical practitioners and policy makers to consider clinical suspicion, diagnosis and treatment. National treatment guideline can benefit by integrating the management of non-communicable diseases in Tuberculosis treatment centers.


Assuntos
Hipertensão/epidemiologia , Obesidade/epidemiologia , Tuberculose Pulmonar/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Comorbidade , Estudos Transversais , Assistência à Saúde , Feminino , Instalações de Saúde , Humanos , Hipertensão/etiologia , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Doenças não Transmissíveis/epidemiologia , Obesidade/etiologia , Obesidade/terapia , Prevalência , Fatores de Risco , Fatores Sexuais , Uso de Tabaco/efeitos adversos , Tuberculose/epidemiologia , Tuberculose Pulmonar/terapia
17.
Medicine (Baltimore) ; 99(38): e21786, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957307

RESUMO

The present study is a retrospective cohort study. Metabolic syndrome (MetS) is a clustering of clinical findings that has been shown to increase the risk of the surgical outcomes. Our study aimed to evaluate whether MetS was a risk factor for increased perioperative outcomes in patients undergoing posterior lumbar interbody fusion (PLIF).We retrospectively analyzed patients over 18 years following elective posterior lumbar spine fusion from January 2014 to December 2018. Emergency procedures, infections, tumor, fracture, and revision surgeries were excluded. Patients were divided into 2 groups with and without MetS. The MetS was defined by having 3 of the following 4 criteria: obesity (body mass index ≥30 kg/m), dyslipidemia, hypertension, and diabetes. The follow-up period lasted up to 30 days after surgery. The outcomes of demographics, comorbidities, perioperative complications, and length of stay were compared between the 2 groups. Multivariate logistic regression analysis was used to identify perioperative outcomes that were independently associated with MetS.The overall prevalence of MetS was 12.5% (360/2880). Patients with MetS was a significantly higher risk factor for perioperative complications, and longer length of stay cmpared with patients without MetS (P < .05). The MetS group had a higher rate of cardiac complications (P = .019), pulmonary complication (P = .035), pneumonia (P = .026), cerebrovascular event (P = .023), urinary tract infection (P = .018), postoperative ICU admission (P = .02), and deep vein thrombosis (P = .029) than non-MetS group. The patients with MetS had longer hospital stays than the patients without MetS (22.16 vs 19.99 days, P < .001). Logistic regression analysis revealed that patients with MetS were more likely to experience perioperative complications (odds ratio [OR] 1.31; 95% confidence interval [CI]: 1.06-2.07; P < .001), and extend the length of stay (OR: 1.69; 95% CI: 1.25-2028; P = .001).The MetS is a significant risk factor for increased perioperative complications, and extend length of stay after PLIF. Strategies to minimize the adverse effect of MetS should be considered for these patients.


Assuntos
Vértebras Lombares/cirurgia , Síndrome Metabólica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/efeitos adversos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Comorbidade , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Hipertensão/epidemiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fumar/epidemiologia , Fatores Socioeconômicos , Adulto Jovem
20.
Neurol Sci ; 41(10): 2675-2679, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32761396

RESUMO

Corona virus disease 2019 (COVID-19) pandemic has become a globally challenging issue after its emergence in December 2019 from Wuhan, China. Despite its common presentation as respiratory distress, patients with COVID-19 have also shown neurological manifestation especially stroke. Therefore, the authors sought to determine the etiology, underlying risk factors, and outcomes among patients with COVID-19 presenting with stroke. We conducted a systematic review of the electronic database (PubMed, Google Scholar, Scopus, Medline, EMBASE, and Cochrane library) using different MeSH terms from November 2019 to June 2020. A total of 39 patients with stroke from 6 studies were included. The mean age of our included patients was 61.4 ± 14.2 years. Majority of the patients (n = 36, 92.3%) with COVID-19 had ischemic stroke, 5.1% (n = 2) had hemorrhagic stroke, and 2.6% (n = 1) had cerebral venous thrombosis at the time of initial clinical presentation. Almost all of the patients presented had underlying risk factors predisposing to stroke which included diabetes mellitus, hyperlipidemia, hypertension, and previous history of cerebrovascular disease. 51.2% (n = 20) of the included patients infected with COVID-19 with stroke died, while remaining patients were either discharged home or transferred to a rehabilitation unit. Exploring the neurological manifestation in terms of stroke among patients with COVID-19 is a step towards better understanding of the virus, preventing further spread, and treating the patients affected by this pandemic.


Assuntos
Betacoronavirus , Isquemia Encefálica/diagnóstico , Infecções por Coronavirus/diagnóstico , Doenças do Sistema Nervoso/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Isquemia Encefálica/epidemiologia , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Pneumonia Viral/epidemiologia , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
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