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1.
Angiology ; 71(1): 17-26, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31129986

RESUMO

The Middle East and North Africa (MENA) region has a high burden of morbidity and mortality due to premature (≤55 years in men; ≤65 years in women) myocardial infarction (MI) and acute coronary syndrome (ACS). Despite this, the prevalence of risk factors in patients presenting with premature MI or ACS is incompletely described. We compared lifestyle, clinical risk factors, and biomarkers associated with premature MI/ACS in the MENA region with selected non-MENA high-income countries. We identified English-language, peer-reviewed publications through PubMed (up to March 2018). We used the World Bank classification system to categorize countries. Patients with premature MI/ACS in the MENA region had a higher prevalence of smoking than older patients with MI/ACS but a lower prevalence of diabetes, hypertension, and dyslipidemia. Men with premature MI/ACS had a higher prevalence of smoking than women but a lower prevalence of diabetes and hypertension. The MENA region had sparse data on lifestyle, diet, psychological stress, and physical activity. To address these knowledge gaps, we initiated the ongoing Gulf Population Risks and Epidemiology of Vascular Events and Treatment (Gulf PREVENT) case-control study to improve primary and secondary prevention of premature MI in the United Arab Emirates, a high-income country in the MENA region.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Infarto do Miocárdio/epidemiologia , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/prevenção & controle , África do Norte/epidemiologia , Idade de Início , Idoso , Estudos de Casos e Controles , Comorbidade , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Oriente Médio/epidemiologia , Mortalidade Prematura , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/prevenção & controle , Prevalência , Prevenção Primária , Prognóstico , Projetos de Pesquisa , Fatores de Risco , Prevenção Secundária , Fatores Sexuais , Fumar/efeitos adversos , Fumar/epidemiologia
3.
Medicine (Baltimore) ; 98(45): e17170, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702607

RESUMO

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare clinical syndrome accompanying with severe headache as its main symptom. Postpartum reversible cerebral vasoconstriction syndrome (PPRCVS) refers to RCVS occurring in the puerperium, in which it has a low incidence, and that is easily missed diagnosed and misdiagnosed in clinical practice.By searching in CNKI and Wanfang databases, 9 published articles reported PPRCVS were found, totally including 12 cases with PPRCVS. The clinical data of these 12 cases were accordingly analyzed and summarized. The characteristics of these cases were compared with those reported in other countries, and eventually the clinical characteristics of Chinese PPRCVS patients were summarized.The clinical characteristics of Chinese PPRCVS patients were basically as same as those found in other countries, while the onset age was earlier, PPRCVS often occurred earlier after delivery, with higher proportions of concomitant symptoms and abnormal laboratory and imaging examinations; moreover, and fewer patients were diagnosed by digital subtraction angiography (DSA).


Assuntos
Angiografia Digital/métodos , Quimioterapia Combinada/métodos , Vasoespasmo Intracraniano/diagnóstico por imagem , Vasoespasmo Intracraniano/tratamento farmacológico , Adulto , Idade de Início , China/epidemiologia , Feminino , Humanos , Incidência , Imagem por Ressonância Magnética , Período Pós-Parto , Vasoespasmo Intracraniano/epidemiologia
4.
Wiad Lek ; 72(9 cz 1): 1676-1682, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31586982

RESUMO

Rheumatoid arthritis (RA) is a chronic, systemic connective tissue disease, characterized by progressive, destructive polyarthritis with internal organs involvement due to active, systemic inflammation. The onset of disease occurs usually in 4th or 5th decade of life. Since the general population is ageing, beginning of RA in older age is more and more common. The term elderly onset of rheumatoid arthritis (EORA) describes the disease with onset at age over 60. Several observational studies indicated, that proportion of women and men is comparable in EORA. Clinical course of the disease is characterized by sudden onset with general constitutional symptoms, high disease activity and inflammatory parameters. Involvement of large joints is more common, specially shoulder joints. Antibodies typical for RA (rheumatoid factor, anti-citrullinated peptide) are usually negative. More advanced destructive changes of joints and functional impairment are also characteristic for EORA patients in comparison with younger onset of RA (YORA). In clinical practice the use of methotrexate and biological drugs is less common, and glucocorticosteroids more common in EORA. Due to high RA activity, patients with EORA should be treated in the same way as YORA, with careful monitoring due to higher risk of adverse events associated with treatment.


Assuntos
Artrite Reumatoide/diagnóstico , Idade de Início , Idoso , Artrite Reumatoide/terapia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Inflamação , Masculino , Metotrexato/uso terapêutico
5.
Wiad Lek ; 72(9 cz 1): 1687-1690, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31586984

RESUMO

Sjögren's syndrome is a systemic autoimmune disease characterized by exocrine glands damage, resulting in the development of dry eyes and dry mouth, as well as extraglandular manifestation. It usually starts between the ages of 30 and 50. Late-onset Sjögren's syndrome should be considered as a disease that appears after age 65, but the literature also reports of the age 50, 60, or even 70. The prevalence of late-onset Sjögren's syndrome is estimated about 20%. The course of late-onset Sjögren's syndrome may differ when compared with patients with a younger onset. Lack of sicca symptoms and marker antibodies may be associated with a delay in Sjögren's syndrome diagnosis. Particularly in the elderly, the occurrence of sicca symptoms may be considered as age-related and medication-related.


Assuntos
Síndrome de Sjogren/diagnóstico , Adulto , Idade de Início , Idoso , Diagnóstico Tardio , Humanos , Pessoa de Meia-Idade , Síndrome de Sjogren/fisiopatologia
7.
J Drugs Dermatol ; 18(10): 1020-1027, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31584781

RESUMO

Introduction: Atopic dermatitis (AD) is a chronic, relapsing skin disease starting typically in atopic-prone children between 3­6 months of age, with most children having developed AD by the age of 5 years. Intense itching leads to sleep disturbance, especially in younger children and toddlers. This review explores early intervention in infants and young children with AD by controlling skin barrier function and inflammation at the earliest time point using a moisturizer and a proactive treatment. Methods: A working group of experienced clinicians managing pediatric populations with AD convened for a meeting. The panel reviewed the literature surrounding early intervention in infants and young children with AD and developed and discussed clinical questions aimed at optimizing clinical outcomes. Results: Complex gene/immune system/environment interactions are involved in AD development. Epidermal barrier defects play a central role in the condition, with various studies showing impairment of skin barrier function at birth may precede clinical AD. Dynamic changes take place in the amounts of skin lipids during infancy. Studies confirm that daily use of a moisturizer from birth onwards may offer benefits in improving skin barrier function and possibly prevention of AD, especially in high-risk, atopic prone newborns. Plant-based moisturizers were shown to be safe and effective when applied in pediatric patients with AD and may provide a TCS-sparing effect while improving skin condition. Conclusion: Dry skin conditions during infancy may predict the subsequent development of AD. Consequently, emollient therapy from birth represents a feasible, safe, and effective approach for AD prevention. Therefore, parental education and the application of moisturizers are recommended as an integral part of AD prevention, treatment, and maintenance. J Drugs Dermatol. 2019;18(10):1020-1027.


Assuntos
Dermatite Atópica/tratamento farmacológico , Emolientes/administração & dosagem , Carga Global da Doença , Extratos Vegetais/administração & dosagem , Fatores Etários , Idade de Início , Pré-Escolar , Dermatite Atópica/epidemiologia , Dermatite Atópica/etiologia , Emolientes/efeitos adversos , Humanos , Incidência , Lactente , Recém-Nascido , Extratos Vegetais/efeitos adversos , Prevalência , Fatores de Risco
8.
BMC Infect Dis ; 19(1): 760, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470804

RESUMO

BACKGROUND: Early diagnosis of sepsis in pediatric patients is vital but remains a major challenge. Previous studies showed that presepsin is potentially a reliable diagnostic biomarker for sepsis in adult and neonates. However, there is no pooled analysis of its efficacy as a diagnostic biomarker for sepsis in children. The aims of the present meta-analysis were to assess the overall diagnostic accuracy of presepsin in pediatric sepsis and compare it to those for C-reactive protein (CRP) and procalcitonin (PCT). METHODS: A systematic literature search was performed in Medline/Pubmed, Embase, the Cochrane Library, and ISI Web of Science to identify relevant studies reporting the diagnostic accuracy of presepsin in patients with pediatric sepsis. Sensitivities and specificities were pooled by bivariate meta-analysis. Heterogeneity was evaluated by χ2 test. RESULTS: We identified 129 studies in total. Most were disqualified on the basis of their titles/abstracts and duplication. Four studies were included in the final analysis. They comprised 308 patients aged between 1 mo and 18 y. The pooled diagnostic sensitivity and specificity of presepsin were 0.94 (95% confidence interval [CI]: 0.74-0.99) and 0.71 (95% CI: 0.35-0.92), respectively. The pooled diagnostic odds ratio, positive likelihood ratio (LR), and negative LR of presepsin were 32.87 (95% CI: 2.12-510.09), 3.24 (95% CI, 1.14-12.38), and 0.08 (95% CI, 0.01-0.74), respectively. Heterogeneity was found in both sensitivity (χ2 = 11.17; P = 0.011) and specificity (χ2 = 65.78; P < 0.001). No threshold effect was identified among the studies (r = - 0.938). The pooled sensitivity of presepsin (0.94) was higher than that of CRP (0.51) and PCT (0.76), whereas the overall specificity of presepsin (0.71) was lower than that of CRP (0.81) and PCT (0.76). The AUC of presepsin (0.925) was higher than that of CRP (0.715) and PCT (0.820). CONCLUSION: Currently available evidence indicates that presepsin has higher sensitivity and diagnostic accuracy, but lower specificity, than PCT or CRP in detecting sepsis in children. However, these results must be carefully interpreted as the number of studies included was small and the studies were statistically heterogeneous.


Assuntos
Biomarcadores/sangue , Receptores de Lipopolissacarídeos/sangue , Fragmentos de Peptídeos/sangue , Sepse/diagnóstico , Adolescente , Idade de Início , Biomarcadores/análise , Proteína C-Reativa/análise , Criança , Pré-Escolar , Diagnóstico Precoce , Feminino , Humanos , Lactente , Recém-Nascido , Receptores de Lipopolissacarídeos/análise , Masculino , Fragmentos de Peptídeos/análise , Pró-Calcitonina/análise , Pró-Calcitonina/sangue , Prognóstico , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Sepse/epidemiologia
9.
BMC Infect Dis ; 19(1): 757, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470805

RESUMO

BACKGROUND: Human metapneumovirus (HMPV) is an important respiratory pathogen that causes seasonal epidemics of acute respiratory illness and contributes significantly to childhood pneumonia. Current knowledge and understanding on its patterns of spread, prevalence and persistence in communities in low resource settings is limited. METHODS: We present findings of a molecular-epidemiological analysis of nasal samples from children < 5 years of age admitted with syndromic pneumonia between 2007 and 2016 to Kilifi County Hospital, coastal Kenya. HMPV infection was detected using real-time RT-PCR and positives sequenced in the fusion (F) and attachment (G) genes followed by phylogenetic analysis. The association between disease severity and HMPV subgroup was assessed using Fisher's exact test. RESULTS: Over 10 years, 274/6756 (4.1%) samples screened were HMPV positive. Annual prevalence fluctuated between years ranging 1.2 to 8.7% and lowest in the recent years (2014-2016). HMPV detections were most frequent between October of one year to April of the following year. Genotyping was successful for 205/274 (74.8%) positives revealing clades A2b (41.0%) and A2c (10.7%), and subgroups B1 (23.4%) and B2 (24.9%). The dominance patterns were: clade A2b between 2007 and 11, subgroup B1 between 2012 and 14, and clade A2c in more recent epidemics. Subgroup B2 viruses were present in all the years. Temporal phylogenetic clustering within the subgroups for both local and global sequence data was seen. Subgroups occurring in each epidemic season were comprised of multiple variants. Pneumonia severity did not vary by subgroup (p = 0.264). In both the F and G gene, the sequenced regions were found to be predominantly under purifying selection. CONCLUSION: Subgroup patterns from this rural African setting temporally map with global strain distribution, suggesting a well-mixed global virus transmission pool of HMPV. Persistence in the local community is characterized by repeated introductions of HMPV variants from the global pool. The factors underlying the declining prevalence of HMPV in this population should be investigated.


Assuntos
Metapneumovirus/classificação , Metapneumovirus/isolamento & purificação , Infecções por Paramyxoviridae , Pneumonia , Idade de Início , Pré-Escolar , Epidemias , Feminino , Genótipo , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Masculino , Metapneumovirus/genética , Infecções por Paramyxoviridae/epidemiologia , Infecções por Paramyxoviridae/virologia , Admissão do Paciente/estatística & dados numéricos , Filogenia , Pneumonia/epidemiologia , Pneumonia/virologia , Vigilância da População , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Estações do Ano
10.
Harefuah ; 158(9): 563-567, 2019 Sep.
Artigo em Hebraico | MEDLINE | ID: mdl-31507104

RESUMO

INTRODUCTION: The aging process of rheumatoid arthritis (RA) requires re-assessment of diagnostic and treatment approaches in patients who developed RA at 60-69 years (EORA-Elderly-Onset RA), 70 years and older (LORA-Late Onset RA) compared with CORA patients - Common Onset RA (35 - 50 years). METHODS: Comparing data of CORA, EORA and LORA patients: gender, nationality; swollen and tender joints (out of 28 joints), Disease Activity Score (DAS28), inflammatory markers, rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (ACPA); treatment with corticosteroids and disease modifying anti rheumatic drugs (DMARDs). RESULTS: Patients' files were examined: CORA (39, 33.5%), EORA (37, 30.8%) and LORA (44, 36.7%). No differences were observed between swollen and tender joints, inflammatory markers, DAS28, RF, and ACPA. Methotrexate was introduced in 94.9% of CORA patients versus EORA (77.3%) and LORA (78.4%); 88.6% LORA-patients received corticosteroids versus 69.2% CORA; 43.2% of LORA patients and 92.3% CORA received synthetic disease-modifying antirheumatic drugs (DMARDs); 43.6% CORA versus 16.2% EORA and 9.3% LORA patients received biologics. CONCLUSIONS: No clinical and laboratory differences were found between CORA, EORA, and LORA groups. EORA and LORA patients received less synthetic and biological DMARDs. It is necessary to change the attitude to EORA and LORA and to promote advanced optimal treatments. Prospective studies on the efficacy and safety of novel drugs in EORA and LORA patients are needed.


Assuntos
Antirreumáticos , Artrite Reumatoide , Idade de Início , Idoso , Acesso aos Serviços de Saúde , Humanos , Estudos Prospectivos
11.
DNA Cell Biol ; 38(11): 1249-1256, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31553233

RESUMO

Transmembrane protein 39A (TMEM39A) gene polymorphisms have been related to various autoimmune diseases, but the relationship between TMEM39A polymorphisms and autoimmune thyroid disease (AITD) remains unknown. This study was aimed at investigating whether the polymorphisms of the TMEM39A were associated with AITD in the Chinese Han population. A case-control study was performed in a total of 906 AITD patients and 744 healthy controls. Four single nucleotide polymorphisms, including rs1132200, rs12492609, rs2282175, and rs7629750, in TMEM39A were examined by polymerase chain reaction-ligase detection reaction. We found that the allele T of rs12492609 in TMEM39A was associated with AITD and Hashimoto's thyroiditis (HT) (p = 0.023; p = 0.028 respectively). Compared with controls, the frequency of haplotype CCA in AITD patients was higher than that in controls (p = 0.036), but the frequency of haplotype CTA in AITD and HT patients was lower than that in controls (p = 0.046; p = 0.047 respectively). In addition, the frequency of allele A at rs7629750 in AITD patients with onset age ≤18 years old was higher than that in AITD patients with onset age ≥19 (p = 0.046). Further, there was an obvious difference in the genotype distributions of rs12492609 and rs7629750 between HT patients with hypothyroidism and those without hypothyroidism (p = 0.034 and p = 0.023, respectively). Our study first reveals that the polymorphisms of the TMEM39A gene are associated with the susceptibility to AITD, especially for early-onset AITD and HT with hypothyroidism.


Assuntos
Proteínas de Membrana/genética , Polimorfismo de Nucleotídeo Único , Tireoidite Autoimune/genética , Adolescente , Adulto , Idade de Início , Grupo com Ancestrais do Continente Asiático/genética , Estudos de Casos e Controles , China/epidemiologia , Feminino , Frequência do Gene , Predisposição Genética para Doença , Doença de Hashimoto/epidemiologia , Doença de Hashimoto/genética , Humanos , Hipotireoidismo/epidemiologia , Hipotireoidismo/genética , Desequilíbrio de Ligação , Masculino , Pessoa de Meia-Idade , Tireoidite Autoimune/epidemiologia , Adulto Jovem
12.
BMJ ; 366: l5214, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554611

RESUMO

OBJECTIVE: To compare the risk and severity of prostate cancer between men achieving fatherhood by assisted reproduction and men conceiving naturally. DESIGN: National register based cohort study. SETTING: Sweden from January 1994 to December 2014. PARTICIPANTS: 1 181 490 children born alive in Sweden during 1994-2014 to the same number of fathers. Fathers were grouped according to fertility status by mode of conception: 20 618 by in vitro fertilisation (IVF), 14 882 by intra-cytoplasmic sperm injection (ICSI), and 1 145 990 by natural conception. MAIN OUTCOME MEASURES: Prostate cancer diagnosis, age of onset, and androgen deprivation therapy (serving as proxy for advanced or metastatic malignancy). RESULTS: Among men achieving fatherhood by IVF, by ICSI, and by non-assisted means, 77 (0.37%), 63 (0.42%), and 3244 (0.28%), respectively, were diagnosed as having prostate cancer. Mean age at onset was 55.9, 55.1, and 57.1 years, respectively. Men who became fathers through assisted reproduction had a statistically significantly increased risk of prostate cancer compared with men who conceived naturally (hazard ratio 1.64, 95% confidence interval 1.25 to 2.15, for ICSI; 1.33, 1.06 to 1.66, for IVF). They also had an increased risk of early onset disease (that is, diagnosis before age 55 years) (hazard ratio 1.86, 1.25 to 2.77, for ICSI; 1.51, 1.09 to 2.08, for IVF). Fathers who conceived through ICSI and developed prostate cancer received androgen deprivation therapy to at least the same extent as the reference group (odds ratio 1.91; P=0.07). CONCLUSIONS: Men who achieved fatherhood through assisted reproduction techniques, particularly through ICSI, are at increased risk for early onset prostate cancer and thus constitute a risk group in which testing and careful long term follow-up for prostate cancer may be beneficial.


Assuntos
Antagonistas de Androgênios/uso terapêutico , Fertilização In Vitro/estatística & dados numéricos , Infertilidade Masculina/epidemiologia , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/epidemiologia , Adulto , Idade de Início , Estudos de Coortes , Fertilização , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Risco , Injeções de Esperma Intracitoplásmicas/estatística & dados numéricos , Análise de Sobrevida , Suécia/epidemiologia
13.
J Med Vasc ; 44(5): 311-317, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31474340

RESUMO

INTRODUCTION: Chronic inflammatory diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), are accompanied by high cardiovascular morbidity and mortality secondary to accelerated and premature atherosclerosis. Atherosclerosis is correlated with chronic systemic inflammation independently of the factors for cardiovascular risk. Vasculitis of large arteries such as Takayasu's disease, are characterized both by chronic systemic inflammation and local parietal vascular inflammation. METHODS: We prospectively analyzed in a case-control study, a group of 64 carriers of Takayasu's arteritis patients with a mean age of 41 years [±11.94], a group of 50 RA female patients aged 45 years [±10.27], and a control group with an average age of 44 years [±12.63]. We recorded classic cardiovascular risk factors and used the Framingham equation to calculate the risk. We measured the intima-media thickness (IMT) in the carotids and noted the presence of carotid, aortic and femoral atheroma. RESULTS: The mean calculated cardiovascular risk was 3.5 % in the Takayasu's group. It was 4.4 % in the RA group, and 4.5 % in controls with no significant difference between the three groups (P=0.153). Subclinical atherosclerosis defined by IMT> 0.70mm and/or the presence of atheroma plaque was found in 87 % of Takayasu's patients versus 76 % of RA patients, (P=0.088) and 48 % of controls (P<0.001). Most atherosclerotic plaques were found in the Takayasu group. Compared to the control group the carotid intima-media thickness was significantly higher in the Takayasu group. The average IMT in the Takayasu group was 0.91mm [±0.368], 0.76mm [±0.151] for the PR group, and 0.71mm [±0.141] for controls. DISCUSSION: Atherosclerosis observed in Takayasu's disease was accelerated and premature, occurring in young patients with a low overall cardiovascular risk. Recent data support the central role of inflammation in all stages of atherogenesis from endothelial dysfunction to plaque rupture. Systemic inflammation associated with local parietal inflammation observed in Takayasu's arteritis, appears to be responsible for accelerated and premature atherosclerosis. The results of our study and the literature review favor an active strategy for cardiovascular prevention in Takayasu's disease.


Assuntos
Doenças da Aorta/epidemiologia , Doenças das Artérias Carótidas/epidemiologia , Doença Arterial Periférica/epidemiologia , Arterite de Takayasu/epidemiologia , Adulto , Idade de Início , Doenças da Aorta/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Placa Aterosclerótica , Prevalência , Estudos Prospectivos , Fatores de Risco , Arterite de Takayasu/diagnóstico , Fatores de Tempo
14.
BMC Infect Dis ; 19(1): 769, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481123

RESUMO

BACKGROUND: Health-workers in developing countries rely on clinical algorithms, such as the Integrated Management of Childhood Illnesses (IMCI), for the management of patients, including diagnosis of serious bacterial infections (SBI). The diagnostic accuracy of IMCI in detecting children with SBI is unknown. Prediction rules and guidelines for SBI from well-resourced countries at outpatient level may help to improve current guidelines; however, their diagnostic performance has not been evaluated in resource-limited countries, where clinical conditions, access to care, and diagnostic capacity differ. The aim of this study was to estimate the diagnostic accuracy of existing prediction rules and clinical guidelines in identifying children with SBI in a cohort of febrile children attending outpatient health facilities in Tanzania. METHODS: Structured literature review to identify available prediction rules and guidelines aimed at detecting SBI and retrospective, external validation on a dataset containing 1005 febrile Tanzanian children with acute infections. The reference standard, SBI, was established based on rigorous clinical and microbiological criteria. RESULTS: Four prediction rules and five guidelines, including IMCI, could be validated. All examined rules and guidelines had insufficient diagnostic accuracy for ruling-in or ruling-out SBI with positive and negative likelihood ratios ranging from 1.04-1.87 to 0.47-0.92, respectively. IMCI had a sensitivity of 36.7% (95% CI 29.4-44.6%) at a specificity of 70.3% (67.1-73.4%). Rules that use a combination of clinical and laboratory testing had better performance compared to rules and guidelines using only clinical and or laboratory elements. CONCLUSIONS: Currently applied guidelines for managing children with febrile illness have insufficient diagnostic accuracy in detecting children with SBI. Revised clinical algorithms including simple point-of-care tests with improved accuracy for detecting SBI targeting in tropical resource-poor settings are needed. They should undergo careful external validation against clinical outcome before implementation, given the inherent limitations of gold standards for SBI.


Assuntos
Infecções Bacterianas/diagnóstico , Febre/diagnóstico , Técnicas Microbiológicas/normas , Testes Imediatos/normas , Guias de Prática Clínica como Assunto , Idade de Início , Algoritmos , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Criança , Pré-Escolar , Feminino , Febre/microbiologia , Humanos , Lactente , Masculino , Técnicas Microbiológicas/métodos , Técnicas Microbiológicas/estatística & dados numéricos , Testes Imediatos/estatística & dados numéricos , Guias de Prática Clínica como Assunto/normas , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Tanzânia/epidemiologia
15.
Hypertension ; 74(5): e45-e51, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31522617

RESUMO

Hypertension and obesity are known risk factors for atrial fibrillation (AF). However, it is unclear whether uncontrolled, long-standing hypertension has a particularly profound effect on AF. Because they have a similar underlying pathophysiology, hypertension and obesity could act synergistically in the context of AF. We evaluated how various stages of hypertension and body weight status affect new-onset AF. We analyzed a total of 9 797 418 participants who underwent a national health checkup. Hypertension was classified into 5 stages: nonhypertension, prehypertension, hypertension without medication, hypertension with medication <5 years, and hypertension with medication ≥5 years. The participants were also stratified based on body mass index and waist circumference. During the 80 130 161 person×years follow-up, a total of 196 136 new-onset AF cases occurred. The incidence of new-onset AF gradually increased among the 5 stages of hypertension: the adjusted hazard ratio for each group was 1 (reference), 1.145, 1.390, 1.853, and 2.344 for each stage of hypertension. A graded escalation in the risk of new-onset AF was also observed in response to increased systolic and diastolic blood pressure. The incidence of new-onset AF correlated with body mass index and waist circumference, with obese people having a higher risk than others. Hypertension and obesity acted synergistically: obese people with hypertension on medication ≥5 years had the highest risk of AF. In conclusion, the degree and duration of hypertension, as well as the presence of hypertension, were important factors for new-onset AF. Body weight status was significantly associated with new-onset AF and acted synergistically with hypertension.


Assuntos
Fibrilação Atrial/epidemiologia , Índice de Massa Corporal , Hipertensão/epidemiologia , Pré-Hipertensão/epidemiologia , Adulto , Distribuição por Idade , Idade de Início , Idoso , Fibrilação Atrial/diagnóstico , Determinação da Pressão Arterial/métodos , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Pré-Hipertensão/diagnóstico , Prevalência , Prognóstico , Modelos de Riscos Proporcionais , Curva ROC , República da Coreia , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Fatores de Tempo , Circunferência da Cintura
16.
Gut ; 68(12): 2179-2185, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31488504

RESUMO

OBJECTIVE: Early-onset colorectal cancer (CRC) is increasing in the USA despite rapid declines in older ages. Similar patterns are reported in Australia and Canada, but a comprehensive global analysis of contemporary data is lacking. DESIGN: We extracted long-term data from Cancer Incidence in Five Continents and supplemental sources to report on worldwide CRC incidence rates and trends by age (20-49 years and ≥50 years) through diagnosis year 2012 or beyond (Australia, Finland, New Zealand, Norway, Sweden, USA). RESULTS: During 2008-2012, age-standardised CRC incidence rates in adults <50 ranged from 3.5 per 100 000 (95% CI 3.2 to 3.9) in India (Chennai) to 12.9 (95% CI 12.6 to 13.3) in Korea. During the most recent decade of available data, incidence in adults <50 was stable in 14 of 36 countries; declined in Austria, Italy and Lithuania; and increased in 19 countries, nine of which had stable or declining trends in older adults (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, UK and USA). In Cyprus, Netherlands and Norway, inclines in incidence in young adults were twice as rapid as those in older adults (eg, Norway average annual per cent change (AAPC), 1.9 (95% CI 1.4 to 2.5) vs 0.5 (95% CI 0.3 to 0.7)). Among most high-income countries with long-term data, the uptick in early-onset disease began in the mid-1990s. The steepest increases in young adults were in Korea (AAPC, 4.2 (95% CI 3.4 to 5.0)) and New Zealand (AAPC, 4.0 (95% CI 2.1 to 6.0)). CONCLUSION: CRC incidence increased exclusively in young adults in nine high-income countries spanning three continents, potentially signalling changes in early-life exposures that influence large bowel carcinogenesis.


Assuntos
Neoplasias Colorretais/epidemiologia , Previsões , Adulto , Distribuição por Idade , Idade de Início , Feminino , Seguimentos , Saúde Global , Humanos , Incidência , Masculino , Estudos Retrospectivos , Adulto Jovem
17.
Presse Med ; 48(7-8 Pt 1): 832-841, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31444019

RESUMO

Lymphoplasmocytic lymphona with monoclonal lgM, rare. Median age at diagnosis 70 years old, frail population. Heterogenous clinic presentation. Molecular diagnosis with MYD88. Treatment required for symptomatic WM patients only. 1st line therapy: DRC. Input of targeted therapies (ibrutinib) for frail patients, maintenance effect.


Assuntos
Macroglobulinemia de Waldenstrom , Idade de Início , Idoso , Análise Mutacional de DNA/métodos , Idoso Fragilizado , Humanos , Técnicas de Diagnóstico Molecular/métodos , Terapia de Alvo Molecular/métodos , Terapia de Alvo Molecular/tendências , Fator 88 de Diferenciação Mieloide/genética , Pirazóis/uso terapêutico , Pirimidinas/uso terapêutico , Macroglobulinemia de Waldenstrom/diagnóstico , Macroglobulinemia de Waldenstrom/epidemiologia , Macroglobulinemia de Waldenstrom/genética , Macroglobulinemia de Waldenstrom/terapia
18.
Presse Med ; 48(7-8 Pt 1): 859-870, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31447331

RESUMO

Non-follicular small cell lymphomas include several entities whose clinical and pathological descriptions have been refined in the last 20 years. MALT lymphoma, developed at the expense of lymphoid tissue associated with the mucosa, is usually localized to a given organ, but can also disseminate. Some patients with MALT lymphoma can be treated by eradicating the associated infectious agent, whereas local treatment should be preferred for other cases ; disseminated forms and relapsed patients are eligible for anti-CD20 antibodies associated with cytotoxic agents. Patients with mantle cell lymphoma have benefited from many advances, including the use of cytarabine and bendamustine, anti-CD20 antibodies, intensive treatments (autograft) and recently targeted therapy (ibrutinib, inhibitor or the Bruton tyrosine kinase). Patients with splenic nodal marginal zone lymphomas should be evaluated for different options, of which immunochemotherapy remains important. For all these entities, the implementation of treatments may be delayed by several years for certain groups of patients. Although considered as incurable, the prognosis of these pathologies has improved significantly and the majority of patients will be able to live for many years with often treatment-free intervals.


Assuntos
Linfoma de Zona Marginal Tipo Células B , Fatores Etários , Idade de Início , Anticorpos Monoclonais/uso terapêutico , Diagnóstico Diferencial , Humanos , Imunoterapia/métodos , Imunoterapia/tendências , Linfoma de Zona Marginal Tipo Células B/classificação , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Linfoma de Zona Marginal Tipo Células B/epidemiologia , Linfoma de Zona Marginal Tipo Células B/terapia , Terapia de Alvo Molecular/métodos , Terapia de Alvo Molecular/tendências , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/terapia , Medicina de Precisão/métodos , Medicina de Precisão/tendências , Prognóstico , Neoplasias Esplênicas/diagnóstico , Neoplasias Esplênicas/epidemiologia , Neoplasias Esplênicas/patologia , Neoplasias Esplênicas/terapia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapia
19.
Rev Esp Salud Publica ; 932019 Aug 26.
Artigo em Espanhol | MEDLINE | ID: mdl-31447482

RESUMO

OBJECTIVE: People on methadone treatment have increased their life expectancy, aging prematurely with comorbidities. The objective of this study was to know the sociodemographic and clinical profile of these people in the Center for Addiction Care in the district of Latina (belonging to Madrid Salud), as well as the perception of the influence of the treatment on their aging. The Social Determinants of Health Model was used as a framework. METHODS: A mixed methodology was used in two phases: a quantitative one, to describe the sociodemographic and clinical characteristics of the study population; and another qualitative one, through semi-structured interviews to an intentional sample, to explore the history of life and the perception of future needs regarding the health of the participants. RESULTS: The results highlighted that the average age of the sample was 48.28 years, that they were mostly men (81.25%), of Spanish origin, with a low level of education and economics and with a medium stay in treatment with methadone of ± 13 years. An increase in mental pathologies was found the more years they had been in the program, as well as, at a lower age of onset in consumption, the presence of HIV and Hepatitis C virus increased. In their speeches it was found that the social determinants of Health have conditioned its vital history. CONCLUSIONS: Both consumption and methadone contribute to its stigmatization, not favoring its normalized inclusion in society and determining a high state of vulnerability. This increases as age does, not receive adequate resources to meet their future needs.


Assuntos
Envelhecimento , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Determinantes Sociais da Saúde , Estereotipagem , Adulto , Idade de Início , Comorbidade , Feminino , Infecções por HIV/complicações , Hepatite C/complicações , Humanos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia
20.
Cancer Sci ; 110(10): 3368-3374, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31432574

RESUMO

BRCA1/2 genes are the most frequently germline mutated DNA-repair genes, and the survival of BRCA1/2 carriers has been extensively explored in breast cancer. However, the prevalence of germline mutations in non-BRCA1/2 DNA-repair genes and the survival of carriers are largely unknown in a large cohort of unselected breast cancer patients. Germline mutations in 16 DNA-repair genes were determined using a multigene panel in 7657 BRCA1/2-negative breast cancer patients who were unselected for family history of cancer or age at diagnosis. Among the 7657 BRCA1/2-negative breast cancer patients, 257 (3.4%) carried at least 1 pathogenic germline mutation in the 16 DNA-repair genes. The prevalence of DNA-repair gene mutations was significantly higher in familial breast cancers (5.2%, P = 0.002) and early-onset breast cancers (diagnosed at and before the age of 40) (4.5%, P = 0.003) than that of sporadic breast cancers (2.9%) (diagnosed above age of 40), respectively. The DNA-repair gene mutation carriers were significantly more likely to have a larger tumor (P = 0.04) and axillary lymph node metastasis (P = 0.03). Moreover, DNA-repair gene mutation was an independent unfavorable factor for recurrence-free survival (adjusted hazard ratio [HR] = 1.38, 95% CI: 1.00-1.91, P = 0.05) and disease-specific survival (adjusted HR=1.63, 95% CI: 1.04-2.57, P = 0.03) in this cohort. Overall, 3.4% of BRCA1/2-negative breast cancer patients carried germline mutations in the 16 DNA-repair genes, and the DNA-repair gene mutation carriers exhibited an aggressive phenotype and had poor survival compared with noncarriers.


Assuntos
Neoplasias da Mama/patologia , Reparo do DNA , Mutação em Linhagem Germinativa , Metástase Linfática/patologia , Análise de Sequência de DNA/métodos , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Proteína BRCA1/genética , Proteína BRCA2/genética , Neoplasias da Mama/genética , Neoplasias da Mama/mortalidade , Feminino , Predisposição Genética para Doença , Humanos , Metástase Linfática/genética , Pessoa de Meia-Idade , Análise de Sobrevida , Carga Tumoral , Adulto Jovem
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