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1.
Nature ; 575(7781): 130-136, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31695207

RESUMO

With rapidly changing ecology, urbanization, climate change, increased travel and fragile public health systems, epidemics will become more frequent, more complex and harder to prevent and contain. Here we argue that our concept of epidemics must evolve from crisis response during discrete outbreaks to an integrated cycle of preparation, response and recovery. This is an opportunity to combine knowledge and skills from all over the world-especially at-risk and affected communities. Many disciplines need to be integrated, including not only epidemiology but also social sciences, research and development, diplomacy, logistics and crisis management. This requires a new approach to training tomorrow's leaders in epidemic prevention and response.


Assuntos
Infecção/epidemiologia , Saúde Pública/tendências , Ciência/tendências , Métodos Epidemiológicos , História do Século XIX , História do Século XX , História do Século XXI , Infecção/diagnóstico , Infecção/microbiologia , Infecção/virologia , Controle de Infecções , Saúde Pública/história , Ciência/história
2.
Medicine (Baltimore) ; 98(31): e16665, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374040

RESUMO

BACKGROUND: The aim of this study was to summarize current evidence evaluating the association between antenatal infection and intraventricular hemorrhage (IVH) in preterm infants. MATERIALS AND METHODS: We searched for published articles on antenatal infection and IVH in 3 English (PubMed, the Cochrane Library, and EBSCO) and 3 Chinese (VEIPU, CNKI, and WANFANG) databases on May 19, 2019. In addition, the references of these articles were screened. The included studies had to meet all of the following criteria: preterm infants (<37 weeks); comparing antenatal infection with no infection; the outcomes included IVH (all grades), mild IVH, or sereve IVH; the type of study was randomized controlled trial or cohort study. RESULTS: A total of 23 cohort studies involving 13,605 preterm infants met our inclusion criteria. Antenatal infection increased the risk of IVH (odds ratios ([OR] 2.18, 95% confidence intervals [CI] 1.58-2.99), mild IVH (OR 1.95, 95% CI 1.09-3.49) and severe IVH (OR 2.65, 95% CI 1.52-4.61). For type of antenatal infection, the ORs and 95% CI were as follows: 2.21 (1.60-3.05) for chorioamnionitis, 2.26 (1.55-3.28) for histologic chorioamnionitis, 1.88 (1.22-2.92) for clinical chorioamnionitis, and 1.88 (1.14-3.10) for ureaplasma. CONCLUSIONS: Antenatal infection may increase the risk of developing IVH in the preterm infant. The evidence base is however of low quality and well-designed studies are needed.


Assuntos
Hemorragia Cerebral Intraventricular/epidemiologia , Recém-Nascido Prematuro , Infecção/epidemiologia , Resultado da Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Peso ao Nascer , Corioamnionite/epidemiologia , Feminino , Idade Gestacional , Humanos , Gravidez , Índice de Gravidade de Doença
3.
Medicine (Baltimore) ; 98(28): e16287, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305412

RESUMO

BACKGROUND: Blood transfusions are associated with many adverse outcomes among spine surgery patients, but it remains unclear whether perioperative blood transfusion during spine surgery and postoperative infection are related. Recently, many related cohort studies have been published on this topic. METHODS: This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The PubMed, Embase, and Cochrane Library databases were searched for eligible published studies. The Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of the studies, and a random-effects model was used to calculate the odds ratios (ORs) with 95% CIs. Sensitivity analyses were conducted to explore the source of heterogeneity. RESULTS: The final analysis included 8 cohort studies with a total of 34,185 spine surgery patients. These studies were considered to be of high or moderate quality based on their NOS scores, which ranged from 5 to 9. Pooled estimates indicated that blood transfusion increased the infection rate (OR, 2.99; 95% CI, 1.95 to 4.59; I = 86%), which was consistent with the sensitivity analyses. CONCLUSIONS: Our results suggest that perioperative blood transfusion is a risk factor for postoperative infection among spine surgery patients. Further study is necessary to identify other influencing factors and to establish the mechanism underlying this relationship. Additional measures may be needed to reduce unnecessary blood transfusions during spine surgery.


Assuntos
Transfusão de Sangue , Infecção/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Coluna Vertebral/cirurgia , Humanos , Infecção/etiologia , Assistência Perioperatória , Fatores de Risco
4.
BMJ ; 366: l4151, 2019 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-31292120

RESUMO

OBJECTIVE: To determine whether any association exists between exposure to 2009 pandemic H1N1 (pH1N1) influenza vaccination during pregnancy and negative health outcomes in early childhood. DESIGN: Retrospective cohort study. SETTING: Population based birth registry linked with health administrative databases in the province of Ontario, Canada. PARTICIPANTS: All live births from November 2009 through October 2010 (n=104 249) were included, and children were followed until 5 years of age to ascertain study outcomes. MAIN OUTCOME MEASURES: Rates of immune related (infectious diseases, asthma), non-immune related (neoplasms, sensory disorders), and non-specific morbidity outcomes (urgent or inpatient health services use, pediatric complex chronic conditions) were evaluated from birth to 5 years of age; under-5 childhood mortality was also assessed. Propensity score weighting was used to adjust hazard ratios, incidence rate ratios, and risk ratios for potential confounding. RESULTS: Of 104 249 live births, 31 295 (30%) were exposed to pH1N1 influenza vaccination in utero. No significant associations were found with upper or lower respiratory infections, otitis media, any infectious diseases, neoplasms, sensory disorders, urgent and inpatient health services use, pediatric complex chronic conditions, or mortality. A weak association was observed between prenatal pH1N1 vaccination and increased risk of asthma (adjusted hazard ratio 1.05, 95% confidence interval 1.02 to 1.09) and decreased rates of gastrointestinal infections (adjusted incidence rate ratio 0.94, 0.91 to 0.98). These results were unchanged in sensitivity analyses accounting for any potential differential healthcare seeking behavior or access between exposure groups. CONCLUSIONS: No associations were observed between exposure to pH1N1 influenza vaccine during pregnancy and most five year pediatric health outcomes. Residual confounding may explain the small associations observed with increased asthma and reduced gastrointestinal infections. These outcomes should be assessed in future studies.


Assuntos
Saúde da Criança , Vírus da Influenza A Subtipo H1N1 , Vacinas contra Influenza/efeitos adversos , Influenza Humana/prevenção & controle , Pandemias/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Efeitos Tardios da Exposição Pré-Natal , Adulto , Asma/epidemiologia , Pré-Escolar , Feminino , Gastroenteropatias/epidemiologia , Humanos , Lactente , Recém-Nascido , Infecção/epidemiologia , Ontário/epidemiologia , Gravidez , Pontuação de Propensão , Sistema de Registros , Estudos Retrospectivos , Adulto Jovem
6.
Expert Opin Drug Saf ; 18(8): 733-744, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31173698

RESUMO

Objectives: To examine agreement between the FDA Adverse Event Reporting System (FAERS) and observational studies in common infections for tumor necrosis factor inhibitors (TNFi's). Methods: Using MedDRA® preferred terms, all infection cases in FAERS with each TNFi were retrieved using EvidexTM. Observational studies reporting TNFi-related infections were identified from PubMed (OS-PM) and ClinicalTrials.gov (OS-CT). Infections with a reporting rate of ≥2% (based on percentage of total number of infections) from each data source were compiled. Fleiss's kappa and Cohen's kappa (κ) were calculated to determine agreement across all three sources and between each two sources. Results: A total of 163,789 FAERS infection cases, 53 OS-PM studies and 52 OS-CT studies were identified. The Fleiss' kappa that comparing all 3 data sources demonstrated lack of agreement. Significant moderate agreements were found between FAERS and OS-CT for etanercept and adalimumab, respectively (κ = 0.53, p = 0.02; κ = 0.56, p = 0.02), but no agreements (κ < 0) when comparing FAERS vs. OS-PM or OS-CT vs. OS-PM. Conclusion: For common TNFi-related infections, passive (FAERS) and active (observational studies) pharmacovigilance results are similar between FAERS vs. OS-CT for etanercept and adalimumab but dissimilar across the 3 sources. Our findings suggest incorporating both active and passive pharmacovigilance methods in post-marketing drug safety assessment.


Assuntos
Fatores Imunológicos/efeitos adversos , Infecção/epidemiologia , Farmacovigilância , Vigilância de Produtos Comercializados/métodos , Adalimumab/administração & dosagem , Adalimumab/efeitos adversos , Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Doenças Autoimunes/tratamento farmacológico , Etanercepte/administração & dosagem , Etanercepte/efeitos adversos , Humanos , Fatores Imunológicos/administração & dosagem , Infecção/induzido quimicamente , Vigilância de Produtos Comercializados/estatística & dados numéricos , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Estados Unidos , United States Food and Drug Administration
7.
Afr Health Sci ; 19(1): 1449-1459, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31148972

RESUMO

Background: Primary immunodeficiency diseases (PID) comprise a group of more than 300 diseases that affect development and /or function of the immune system. Objectives: The aim of this study was diagnosis of PID among a suspected group of neonates and infants within the first six months of life as well as identifying the warning signs of PID characteristic to this period. Method: Fifty neonates presenting with warning signs of PID were enrolled in the study. Results: The study revealed that twenty six patients (52%) were diagnosed with Primary Immunodeficiency, T cell/combined immunodeficiency were noted as the most common PID class (88.5%) with fourteen T-B-SCID patients (70%) and six T-B+ SCID patients (30%), phagocytic disorders were estimated to be 7.7% while 3.8% were unclassified immunodeficiency. The mean age of presentation for PID group was 1.42±1.38 months with a diagnostic lag of 3.08±1.78 months. Consanguinity was positive in 76.9% of the PID group. Lower respiratory tract infections, persistent fungal infections and lymphopenia were the most significant warning signs for diagnosing PID with a p value of (0.01). Combined, lower respiratory tract infections, fungal infections and lymphopenia were 12.3 times more likely to be associated with PID. Conclusion: Focused screening in high risk neonates proved to be a valuable tool for diagnosis of PID disorders.


Assuntos
Síndromes de Imunodeficiência/diagnóstico , Síndromes de Imunodeficiência/epidemiologia , Infecção/epidemiologia , Triagem Neonatal , Imunodeficiência Combinada Severa/epidemiologia , Infecções Bacterianas/diagnóstico , Consanguinidade , Egito/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Prevalência , Imunodeficiência Combinada Severa/diagnóstico
8.
Expert Opin Drug Metab Toxicol ; 15(7): 565-575, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31211608

RESUMO

Introduction: There are concerns that opioids may be associated with an increased risk of infection. This safety issue is alarming given the widespread use of opioids in pain management. Areas covered: In this review, we summarize the pharmacologic aspects of opioids related to the immune system and to the assumed pathophysiology of opioid-related infections. We also synthesize and critically appraise the available clinical evidence on the potential association between the use of opioids and the risk of infection. PubMed was searched from inception to 1 February 2019 for all articles published in English with terms corresponding to 'opioids' and 'infections'. Expert opinion: Morphine appears to suppress the immune system via affecting cells of the innate and the adaptive immunity as well as via modulating the hypothalamic-pituitary-adrenal axis. However, knowledge gaps exist regarding the immune-related pharmacology of non-morphine opioids. Observational studies have suggested an increased risk of infections associated with the use of opioids. However, methodological limitations such as confounding by indication due to the choice of non-use as comparator render the interpretation of most of these studies difficult. Thus, further efforts in preclinical research and well-conducted observational studies are needed to provide more robust evidence in this regard.


Assuntos
Analgésicos Opioides/efeitos adversos , Sistema Imunitário/efeitos dos fármacos , Infecção/etiologia , Imunidade Adaptativa/efeitos dos fármacos , Analgésicos Opioides/administração & dosagem , Animais , Humanos , Imunidade Inata/efeitos dos fármacos , Infecção/epidemiologia , Infecção/imunologia , Morfina/administração & dosagem , Morfina/efeitos adversos , Dor/tratamento farmacológico , Risco
10.
BMC Health Serv Res ; 19(1): 324, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31117997

RESUMO

BACKGROUND: Technological advances in health care currently provide better care conditions and have increased survival rates of premature infants, along with increasing the life expectancy of chronically ill children. In this context, the home care service has emerged as an effective tool for the treatment of this group of children. Thus, this preliminary study aimed at evaluating the effectiveness of the Home Care Service (HCS) with regard to pediatric care. METHODS: A cross-sectional study was performed through a medical record analysis of a tertiary hospital in Minas Gerais/Brazil. Two groups were compared: 36 patients from the HCS (home group) and 13 patients hospitalized with an indication for home care (hospital group). To analyze the effectiveness of HCS, we evaluated the number of readmissions, infection rate, number of procedures, and optimization of beds. RESULTS: The hospital group presented 6.04 times more infections and was submitted to 6.43 times more procedures. The home group presented lower readmission rates; with 41.66% of children studied not being readmitted and 76.19% of those who needed readmissions did so after more than 30 days from hospital discharge. HCS optimized hospital beds and allowed, over five (5) years, the hospitalization of around 102 patients in the hospital studied. CONCLUSION: In this preliminary study, HCS reduced the number of procedures and infections compared to hospitalized patients. Moreover, HCS presented lower readmission rates and optimized hospital beds, which could be considered an indication of effectiveness.


Assuntos
Serviços de Assistência Domiciliar/normas , Hospitalização/estatística & dados numéricos , Infecção/terapia , Brasil/epidemiologia , Criança , Serviços de Saúde da Criança/estatística & dados numéricos , Doença Crônica , Estudos Transversais , Testes Diagnósticos de Rotina/estatística & dados numéricos , Feminino , Humanos , Lactente , Infecção/epidemiologia , Masculino , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos
11.
Z Rheumatol ; 78(5): 422-428, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31049664

RESUMO

Treat to target (T2T) strategies and comorbidities are closely related. Strong evidence exists for reducing the risk and extent of comorbidities, such as cardiovascular (CV) diseases, depression and infections by implementing T2T concepts and inducing good disease control of rheumatoid arthritis (RA) in this way. On the other hand existing comorbidities may hinder implementation of T2T concepts by aggravating RA or influencing rheumatologists to overcautiously use DMARD treatment. Among a long list of potentially relevant comorbidities with RA, in this review two particularly relevant accompanying diseases with respect to T2T, CV diseases and infections, are selected for discussion in detail. The CV comorbidities are the main cause of death for RA patients and are triggered by RA-associated inflammatory mechanisms. Their negative influence on implementation of T2T strategies can be stopped or at least reduced by optimal control of RA activity with the help of selecting drugs with cardioprotective properties (such as biologicals, methotrexate and hydroxychloroquine) as well as assessing and treating traditional CV risk factors. Infections are among most important adverse events of DMARD treatment and can disturb the optimal use of these drugs and so hinder the success of the T2T strategy. Optimal infection prophylaxis and identification of high risk patients are particularly important and minimization of glucocorticoid use is critical to reduce the risk of infections. In summary, comorbidities are important potential risk factors for the success of T2T strategies.


Assuntos
Antirreumáticos , Artrite Reumatoide , Produtos Biológicos , Doenças Cardiovasculares/epidemiologia , Infecção/epidemiologia , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/prevenção & controle , Produtos Biológicos/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Comorbidade , Humanos , Controle de Infecções , Metotrexato , Indução de Remissão
13.
Cancer Radiother ; 23(4): 273-280, 2019 Jul.
Artigo em Francês | MEDLINE | ID: mdl-31138520

RESUMO

PURPOSE: The objective of this study was to identify predictive factors of toxicity of docetaxel, platin, 5-fluorouracil (TPF) induction chemotherapy for locally advanced head and neck cancers. PATIENTS AND METHODS: From July 2009 to March 2015, 57 patients treated consecutively with TPF were included retrospectively. There were 47 males (83%), the median age was 56 years [40-71 years]. Thirty-eight patients (67%) were treated for inoperable cancer (highly symptomatic and/or high tumor burden) and 19 (33%) were treated for laryngeal preservation. There were 47% stage IVa, 32% stage III and 21% stage IVb. At diagnosis, there were 53% stable weight, 28% grade 1 weight loss, 17% grade 2 weight loss and 2% grade 3 weight loss. RESULTS: Forty-seven percent of patients were in partial response after TPF, 28% in complete response, 7% stable, 2% progressing and 2% discordant response. The possibility of oral feeding without a feeding tube was predictive of a better response (P=0.02). Thirty-nine percent of patients increased weight during TPF, 35% were stable, 18% in grade 1 weight loss, 6% in grade 2 and 2% in grade 3. Six of the patients (10.5%) died during chemotherapy: four from febrile neutropenia, one from pneumopathy and one of unknown cause. Age 57years and older was associated with a higher risk of grade≥3 anemia and thrombocytopenia. There was a higher risk of grade≥3 infection for weight loss at diagnosis (P=0.04) and feeding tube (P=0.05). There was a higher risk of grade≥3 neutropenia for weight loss during TPF (P=0.03). CONCLUSION: Induction chemotherapy by TPF has an strong anti-tumor efficacy (75.5% objective response) but an important morbidity with 10% toxic deaths in our very symptomatic population with a very important tumor burden. Age and nutritional status are important factors to consider.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Cisplatino/efeitos adversos , Docetaxel/efeitos adversos , Fluoruracila/efeitos adversos , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Estado Nutricional , Adulto , Fatores Etários , Idoso , Anemia/induzido quimicamente , Cisplatino/administração & dosagem , Docetaxel/administração & dosagem , Nutrição Enteral , Neutropenia Febril/induzido quimicamente , Feminino , Fluoruracila/administração & dosagem , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Infecção/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trombocitopenia/induzido quimicamente , Carga Tumoral , Perda de Peso
15.
Phys Rev E ; 99(3-1): 032309, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30999425

RESUMO

For a reliable prediction of an epidemic or information spreading pattern in complex systems, well-defined measures are essential. In the susceptible-infected model on heterogeneous networks, the cluster of infected nodes in the intermediate-time regime exhibits too large fluctuation in size to use its mean size as a representative value. The cluster size follows quite a broad distribution, which is shown to be derived from the variation of the cluster size with the time when a hub node was first infected. On the contrary, the distribution of the time taken to infect a given number of nodes is well concentrated at its mean, suggesting the mean infection time is a better measure. We show that the mean infection time can be evaluated by using the scaling behaviors of the boundary area of the infected cluster and use it to find a nonexponential but algebraic spreading phase in the intermediate stage on strongly heterogeneous networks. Such slow spreading originates in only small-degree nodes left susceptible, while most hub nodes are already infected in the early exponential-spreading stage. Our results offer a way to detour around large statistical fluctuations and quantify reliably the temporal pattern of spread under structural heterogeneity.


Assuntos
Modelos Teóricos , Análise por Conglomerados , Simulação por Computador , Epidemias , Infecção/epidemiologia , Teoria da Informação , Tempo
16.
Saudi Med J ; 40(4): 401-404, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30957136

RESUMO

OBJECTIVES: To highlight the causes of hospitalization among sickle cell diseased (SCD) children in Al-Madinah Al-Munawarah, Saudi Arabia. METHODS: A retrospective study conducted at the Maternity and Children's Hospital, Al-Madinah Al-Munawarah, Saudi Arabia. A data of 739 SCD children admitted to the hematology/oncology unit between October 2010 and September 2015 were collected. The collected data were analyzed using an independent t test and a Chi square test as appropriate. RESULTS: Approximately 49% of the studied children were presented by acute painful crisis. Acute chest syndrome was reported in 20.9%. Infection was the cause of admission in 17.5%, and acute anemia was reported in 8.1% of the studied patients. No significant difference of the reported clinical manifestations by patients' gender. Children aged <12 years showed significantly high frequency of acute chest syndrome (ACS) (26.5%), while acute painful crisis (66.4%) was significantly more frequent among children aged ≥12 years. CONCLUSION: This study revealed high rate of hospitalization of SCD children because of acute painful crisis, ACS, infection, and anemia. These admissions causes could potentially be continuously assessed to minimize the rate of hospitalization.


Assuntos
Síndrome Torácica Aguda/epidemiologia , Dor Aguda/epidemiologia , Anemia Falciforme/complicações , Anemia Falciforme/epidemiologia , Criança Hospitalizada/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Infecção/epidemiologia , Síndrome Torácica Aguda/etiologia , Dor Aguda/etiologia , Adolescente , Distribuição de Qui-Quadrado , Criança , Feminino , Humanos , Infecção/etiologia , Masculino , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Fatores de Tempo
17.
Acta Neurol Scand ; 140(1): 9-16, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30939222

RESUMO

OBJECTIVES: Correct identification of inflammatory etiologies of stroke is of outmost importance as they require treatment of the underlying disease. Aim of this study was to determine the prevalence of inflammatory changes in cerebrospinal fluid (CSF) observed in young cryptogenic stroke patients. MATERIALS AND METHODS: Of 6476 records of patients diagnosed with ischemic stroke, 278 had confirmed ischemia in brain imaging and received lumbar puncture. A total of 122 were classified as young stroke (≤55 years), and 156 were classified as older stroke patients; lumbar puncture in this cohort was indicated due to atypical clinical presentation. RESULTS: An infectious etiology was detected in 2.5% of young stroke patients (n = 3: vasculitis due to opportunistic infection, vasculitis due to neuroborreliosis, secondary vasospasm after viral meningitis) and in 1.9% (n = 3) in the older stroke cohort (vasculitis due to neurotuberculosis, septic embolic ischemia, vasculitis post-haemophilus influenza meningoencephalitis). Isolated vasculitis was evident in one patient of the older stroke cohort (0.6%). Non-specific alterations in CSF included increased cell count in 10% in young and in 9.3% in the older stroke cohort. Intrathecal Ig synthesis was present in 3.4% of the younger and in 4% of the older stroke cohort. CONCLUSIONS: The prevalence of an infectious etiology in young stroke is modest but slightly higher in comparison with older stroke patients. As brain imaging is not always sufficient for suspecting vasculitis, we recommend implementation of lumbar puncture in young cryptogenic stroke patients. If an infectious disease is present in ischemic stroke, it is of high therapeutic relevance.


Assuntos
Infecção/complicações , Inflamação/complicações , Acidente Vascular Cerebral/etiologia , Vasculite/complicações , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Infecção/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Vasculite/epidemiologia
18.
Int Immunopharmacol ; 70: 354-361, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30852290

RESUMO

INTRODUCTION: Idiopathic membranous nephropathy (IMN) is a common cause of nephrotic syndrome in adults and one of the leading causes of end-stage renal disease (ESRD). During recent years, the incidence of IMN has been increasing. The main treatment option for IMN is the use of immunosuppressive (IS) drugs combined with glucocorticoids (GC). However, the infection risk with different IS drug treatments has not been systematically compared. Therefore, a network meta-analysis was performed to compare the risk of infection of different IS drug treatments for IMN. METHODS: Randomized controlled trials (RCTs) that assessed the risk of infection in patients with IMN treated with different IS drugs combined with GC were included in the network meta-analysis. Risk ratios for dichotomous data with 95% confidence intervals (CI) were calculated and the data were pooled with a random-effects model. The surface under the cumulative ranking area (SUCRA) was calculated to rank the risk of infection with different interventions. RESULTS: A total of 38 RCTs with 2066 participants were included for comparison of nine interventions. Tacrolimus combined with GC (TAC + GC) was associated with a significantly lower risk of infection than that with intravenous cyclophosphamide (IVCTX) + GC with a risk ratio (95% CI) of 0.52 (0.34-0.79). IVCTX + GC was associated with a significantly higher risk of infection than that with TAC + GC, cyclosporin (CSA) + GC, and oral cyclophosphamide (POCTX) + GC. A sensitivity analysis, excluding studies with a very long follow-up period, revealed minimal differences in the estimates. The SUCRA showed that CSA + GC had the lowest risk of infection (SUCRA 86.0%), and the second best treatment was POCTX + GC (SUCRA 78.6%). Conversely, IVCTX + GC (SUCRA 16.2%) had a higher risk of infection than that with the other IS drugs. CONCLUSIONS: CSA + GC and POCTX+ GC were associated with a lower risk of infection than that with other IS drugs combined with GC for IMN. Combined with comparative efficacy data, these results can help patients make informed decisions about treatment options for IMN. PROSPERO registration: CRD42018104849.


Assuntos
Ciclosporina/uso terapêutico , Quimioterapia Combinada/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Glomerulonefrite Membranosa/epidemiologia , Glucocorticoides/uso terapêutico , Imunossupressores/uso terapêutico , Infecção/epidemiologia , Falência Renal Crônica/epidemiologia , China/epidemiologia , Ciclofosfamida/uso terapêutico , Glomerulonefrite Membranosa/tratamento farmacológico , Humanos , Infecção/etiologia , Falência Renal Crônica/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco , Tacrolimo/uso terapêutico
19.
Eur J Clin Microbiol Infect Dis ; 38(6): 1059-1070, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30834996

RESUMO

Recent advancements in next-generation sequencing (NGS) have provided the foundation for modern studies into the composition of microbial communities. The use of these NGS methods allows for the detection and identification of ('difficult-to-culture') microorganisms using a culture-independent strategy. In the field of routine clinical diagnostics however, the application of NGS is currently limited to microbial strain typing for epidemiological purposes only, even though the implementation of NGS for microbial community analysis may yield clinically important information. This lack of NGS implementation is due to many different factors, including issues relating to NGS method standardization and result reproducibility. In this review article, the authors provide a general introduction to the most widely used NGS methods currently available (i.e., targeted amplicon sequencing and shotgun metagenomics) and the strengths and weaknesses of each method is discussed. The focus of the publication then shifts toward 16S rRNA gene NGS methods, which are currently the most cost-effective and widely used NGS methods for research purposes, and are therefore more likely to be successfully implemented into routine clinical diagnostics in the short term. In this respect, the experimental pitfalls and biases created at each step of the 16S rRNA gene NGS workflow are explained, as well as their potential solutions. Finally, a novel diagnostic microbiota profiling platform ('MYcrobiota') is introduced, which was developed by the authors by taking into consideration the pitfalls, biases, and solutions explained in this article. The development of the MYcrobiota, and future NGS methodologies, will help pave the way toward the successful implementation of NGS methodologies into routine clinical diagnostics.


Assuntos
Testes Diagnósticos de Rotina/normas , Sequenciamento de Nucleotídeos em Larga Escala/normas , Infecção/diagnóstico , Microbiota/genética , DNA Bacteriano/genética , DNA Bacteriano/normas , Humanos , Infecção/epidemiologia , Infecção/microbiologia , Metagenômica/normas , Técnicas Microbiológicas/normas , RNA Ribossômico 16S/genética , RNA Ribossômico 16S/normas , Análise de Sequência de DNA/normas
20.
Cir Esp ; 97(4): 213-221, 2019 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30851871

RESUMO

INTRODUCTION: The main objective was the description and analysis of suspended surgeries and their causes for suspension at our hospital from the year 2010 to the present. As a secondary objective, we evaluated the effectiveness of a series of measures for improvement. METHODS: A retrospective study was conducted to analyze patients who were scheduled to undergo surgery that was finally suspended. A Failure Mode and Effects Analysis (FMEA) was carried out to analyze the causes of the suspensions and their consequences, any existing barriers and possible measures that have been implemented over time. The causes were classified as attributable to the patient, administrative causes and medical causes. RESULTS: 105,403 surgeries were scheduled, 3,867 of which were suspended (3.66%). Factors that influenced the suspensions included: surgical specialty, ASA 4 patients, elderly patients, ambulatory patients and surgeries scheduled during the winter. The most frequent medical cause was infection or fever (17.6%), while the most frequent administrative and patient causes were lack of time (26.8%) and no-show (6.3%), respectively. The avoidable causes were 64.8% versus 35.2% unavoidable causes. In the multivariate analysis, risk factors included age, shift, season and surgical service. CONCLUSIONS: Surgical cancellations have repercussions on the consumption of material and human resources. Any means to reduce their incidence should be our future priority in order improve the quality of care.


Assuntos
Análise do Modo e do Efeito de Falhas na Assistência à Saúde/métodos , Cooperação do Paciente/estatística & dados numéricos , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adulto , Idoso , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Febre/epidemiologia , Humanos , Incidência , Infecção/epidemiologia , Masculino , Pessoa de Meia-Idade , Pacientes não Comparecentes/estatística & dados numéricos , Participação do Paciente , Estudos Retrospectivos , Fatores de Risco , Estações do Ano
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