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2.
Curr Pain Headache Rep ; 25(3): 19, 2021 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-33630183

RESUMO

PURPOSE OF REVIEW: This review provides an updated discussion on the clinical presentation, diagnosis and radiographic features, mechanisms, associations and epidemiology, treatment, and prognosis of posterior reversible encephalopathy syndrome (PRES). Headache is common in PRES, though headache associated with PRES was not identified as a separate entity in the 2018 International Classification of Headache Disorders. Here, we review the relevant literature and suggest criteria for consideration of its inclusion. RECENT FINDINGS: COVID-19 has been identified as a potential risk factor for PRES, with a prevalence of 1-4% in patients with SARS-CoV-2 infection undergoing neuroimaging, thus making a discussion of its identification and treatment particularly timely given the ongoing global pandemic at the time of this writing. PRES is a neuro-clinical syndrome with specific imaging findings. The clinical manifestations of PRES include headache, seizures, encephalopathy, visual disturbances, and focal neurologic deficits. Associations with PRES include renal failure, preeclampsia and eclampsia, autoimmune conditions, and immunosuppression. PRES is theorized to be a syndrome of disordered autoregulation and endothelial dysfunction resulting in preferential hyperperfusion of the posterior circulation. Treatment typically focuses on treating the underlying cause and removal of the offending agents.


Assuntos
Endotélio/fisiopatologia , Cefaleia/fisiopatologia , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Convulsões/fisiopatologia , Transtornos da Visão/fisiopatologia , Síndrome Torácica Aguda/epidemiologia , Ácido Aminolevulínico/análogos & derivados , Anemia Falciforme/epidemiologia , Doenças Autoimunes/epidemiologia , Barreira Hematoencefálica/metabolismo , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/fisiopatologia , Circulação Cerebrovascular/fisiologia , Citocinas/metabolismo , Eclampsia/epidemiologia , Feminino , Homeostase/fisiologia , Humanos , Hipertensão/fisiopatologia , Imagem por Ressonância Magnética , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/epidemiologia , Síndrome da Leucoencefalopatia Posterior/terapia , Pré-Eclâmpsia/epidemiologia , Gravidez , Prognóstico , Insuficiência Renal/epidemiologia , Vasoespasmo Intracraniano/fisiopatologia
3.
Medicine (Baltimore) ; 100(5): e23075, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592816

RESUMO

ABSTRACT: The aim of this study was to evaluate the effect of beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) after cardiac surgery in the liver cirrhosis (LC) patients. We conducted a population-based cohort study using data from the Taiwanese National Health Insurance Research Database (NHIRD) from 2001 to 2013. The outcomes of interest included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE) and liver and renal outcomes. Among 1470 LC patients, 35.6% (n = 524) received beta-blockers and 33.4% (n = 491) were prescribed ACEIs and/or ARBs after cardiac surgery. The risk of negative liver outcomes was significantly lower in the ARB group compared with the ACEI group (9.6% vs 22.7%, hazard ratio [HR] 0.50, 95% confidence interval [CI] 0.31-0.83). Furthermore, the risk of MACCE (44.2% vs 54.7%, HR 0.79, 95% CI 0.65-0.96), all-cause mortality (35.3% vs 46.4%, HR 0.74, 95% CI 0.60-0.92), composite liver outcomes (9.6% vs 16.5%, HR 0.56, 95% CI 0.38-0.85) and hepatic encephalopathy (2.7% vs 5.7%, HR 0.45, 95% CI 0.21-0.94) were lower in the ARB group than the control group. Our study demonstrated that ARBs provide a greater protective effect than ACEIs in regard to long-term outcomes following cardiac surgery in patients with LC.


Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Fármacos Cardiovasculares/administração & dosagem , Cirrose Hepática/epidemiologia , Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas Adrenérgicos beta/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Receptores de Angiotensina/administração & dosagem , Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Fármacos Cardiovasculares/efeitos adversos , Fármacos Cardiovasculares/classificação , Feminino , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/epidemiologia , Taiwan/epidemiologia
4.
Medicine (Baltimore) ; 100(5): e24553, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592909

RESUMO

ABSTRACT: Studies on predicting factors for adverse pregnancy outcomes (APOs) in Thai patients with systemic lupus erythematosus (SLE) are limited. This retrospective observation study determined APOs and their predictors in Thai patients with SLE.Medical records of pregnant SLE patients in a lupus cohort, seen from January 1993 to June 2017, were reviewed.Ninety pregnancies (1 twin pregnancy) from 77 patients were identified. The mean age at conception was 26.94 ±â€Š4.80 years. At conception, 33 patients (36.67%) had active disease, 23 (25.56%) hypertension, 20 (22.22%) renal involvement, and 6 of 43 (13.95%) positive anti-cardiolipin antibodies or lupus anti-coagulants, and 37 (41.11%) received hydroxychloroquine. Nineteen patients (21.11%) had pregnancy loss. Of 71 successful pregnancies, 28 (31.11%) infants were full-term, 42 (46.67%) pre-term and 1 (11.11%) post-term; 19 (26.39%) were small for gestational age (SGA), and 38 (52.58%) had low birth weight (LBW). Maternal complications occurred in 21 (23.33%) pregnancies [10 (11.11%) premature rupture of membrane (PROM), 8 (8.89%) pregnancy induced hypertension (PIH), 4 (4.44%) oligohydramnios, 2 (2.22%) post-partum hemorrhage, and 1 (1.11%) eclampsia]. Patients aged ≥ 25 years at pregnancy and those ever having renal involvement had predicted pregnancy loss with adjusted odds ratio (AOR) [95% CI] of 4.15 [1.10-15.72], P = .036 and 9.21 [1.03-82.51], P = .047, respectively. Renal involvement predicted prematurity (6.02 [1.77-20.52, P = .004), SGA (4.46 [1.44-13.78], P = .009), and LBW in infants (10.01 [3.07-32.62], P < .001). Prednisolone (>10 mg/day) and immunosuppressive drugs used at conception protected against prematurity (0.11 [0.02-0.85], P = .034). Flares and hematologic involvement predicted PROM (8.45 [1.58-45.30], P = .013) and PIH (9.24 [1.70-50.24], P = .010), respectively. Cutaneous vasculitis (33.87 [1.05-1,094.65], P = .047), and renal (31.89 [6.66-152.69], P < .001), mucocutaneous (9.17 [1.83-45.90], P = .007) and hematologic involvement (128.00 [4.60-3,564.46], P = .004) during pregnancy predicted flare; while prednisolone (>10 mg/day) and immunosuppressive drug use at conception reduced that risk (0.08 [0.01-0.68, P = .021).APOs remain a problem in Thai pregnant SLE patients. Renal involvement and SLE flares were associated with the risk of APOs.


Assuntos
Lúpus Eritematoso Sistêmico/epidemiologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adulto , Fatores Etários , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/fisiopatologia , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/fisiopatologia , Insuficiência Renal/epidemiologia , Estudos Retrospectivos , Tailândia/epidemiologia , Adulto Jovem
5.
Medicine (Baltimore) ; 100(4): e23990, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530196

RESUMO

ABSTRACT: The association between anemia and body mass index (BMI) in Koreans, considering kidney function, has not been clarified. Thus, we aimed to examine the association between anemia and BMI among Korean adults aged ≥19 years.This retrospective cross-sectional study evaluated male and female Korean adults aged ≥19 years who participated in the 5th, 6th, and 7th Korean National Health and Nutrition Examination Surveys (KNHANES) conducted between 2010 and 2017 were used. The participants were classified as underweight, normal weight, and overweight according to their BMI. Anemia was defined as hemoglobin levels of <13 g/dL for men and <12 g/dL for women according to the World Health Organization standards. Kidney function was evaluated according to the estimated glomerular filtration rate (eGFR), with abnormal kidney function in men defined as eGFR <60 mL/min/1.73 m2. Clinicodemographic variables were analyzed using logistic regression adjusted for weight. After propensity score matching (PSM), 6596 study participants were divided into 2 groups of 3298 participants each. Additionally, subgroup analysis by sex and kidney function was performed.On PSM, similar distribution patterns were obtained between the anemia and non-anemia groups; significant differences in BMI; kidney function; level of hemoglobin, hematocrit, and serum creatinine; iron intake; and eGFR were also observed between these groups. Anemia and BMI showed a significant association in both crude and adjusted logistic regression models. In model 2, which was adjusted for age, sex, education level, household income, alcohol consumption, smoking status, and exercise period, underweight men with abnormal kidney function showed a significantly higher risk of anemia than did normal weight men (odds ratio [OR]: 3.27; 95% confidence interval [CI]: 1.25-8.57; P = .016). Meanwhile, overweight men showed a significantly lower risk of anemia than did normal weight men (OR: 0.48; 95% CI: 0.33-0.70, P < .001).Anemia is associated with BMI according to sex. Compared with normal weight men, underweight men with abnormal kidney function had a significantly higher prevalence of anemia after adjusting for kidney function and sex, thus highlighting their need for careful management for anemia.


Assuntos
Anemia/epidemiologia , Índice de Massa Corporal , Insuficiência Renal/epidemiologia , Adulto , Idoso , Peso Corporal , Creatinina/sangue , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Comportamentos Relacionados com a Saúde , Inquéritos Epidemiológicos , Hemoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , República da Coreia/epidemiologia , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
6.
BMJ ; 372: m4573, 2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33441402

RESUMO

OBJECTIVE: To evaluate sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes at varying cardiovascular and renal risk. DESIGN: Network meta-analysis. DATA SOURCES: Medline, Embase, and Cochrane CENTRAL up to 11 August 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials comparing SGLT-2 inhibitors or GLP-1 receptor agonists with placebo, standard care, or other glucose lowering treatment in adults with type 2 diabetes with follow up of 24 weeks or longer. Studies were screened independently by two reviewers for eligibility, extracted data, and assessed risk of bias. MAIN OUTCOME MEASURES: Frequentist random effects network meta-analysis was carried out and GRADE (grading of recommendations assessment, development, and evaluation) used to assess evidence certainty. Results included estimated absolute effects of treatment per 1000 patients treated for five years for patients at very low risk (no cardiovascular risk factors), low risk (three or more cardiovascular risk factors), moderate risk (cardiovascular disease), high risk (chronic kidney disease), and very high risk (cardiovascular disease and kidney disease). A guideline panel provided oversight of the systematic review. RESULTS: 764 trials including 421 346 patients proved eligible. All results refer to the addition of SGLT-2 inhibitors and GLP-1 receptor agonists to existing diabetes treatment. Both classes of drugs lowered all cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and kidney failure (high certainty evidence). Notable differences were found between the two agents: SGLT-2 inhibitors reduced mortality and admission to hospital for heart failure more than GLP-1 receptor agonists, and GLP-1 receptor agonists reduced non-fatal stroke more than SGLT-2 inhibitors (which appeared to have no effect). SGLT-2 inhibitors caused genital infection (high certainty), whereas GLP-1 receptor agonists might cause severe gastrointestinal events (low certainty). Low certainty evidence suggested that SGLT-2 inhibitors and GLP-1 receptor agonists might lower body weight. Little or no evidence was found for the effect of SGLT-2 inhibitors or GLP-1 receptor agonists on limb amputation, blindness, eye disease, neuropathic pain, or health related quality of life. The absolute benefits of these drugs vary substantially across patients from low to very high risk of cardiovascular and renal outcomes (eg, SGLT-2 inhibitors resulted in 5 to 48 fewer deaths in 1000 patients over five years; see interactive decision support tool (https://magicevidence.org/match-it/200820dist/#!/) for all outcomes. CONCLUSIONS: In patients with type 2 diabetes, SGLT-2 inhibitors and GLP-1 receptor agonists reduced cardiovascular and renal outcomes, with notable differences in benefits and harms. Absolute benefits are determined by individual risk profiles of patients, with clear implications for clinical practice, as reflected in the BMJ Rapid Recommendations directly informed by this systematic review. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019153180.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Hipoglicemiantes/uso terapêutico , Mortalidade , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Humanos , Hipoglicemiantes/efeitos adversos , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Insuficiência Renal/epidemiologia , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos
7.
Am J Cardiol ; 144: 131-136, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33383012

RESUMO

Renal dysfunction is a known risk of sudden cardiac death in patients with ischemic heart disease. However, the association between renal dysfunction and sudden death in hypertrophic cardiomyopathy (HC) patients remains unknown. This study investigated the significance of an impaired renal function for the sudden death risk in a cohort of patients with HC. We included 450 patients with HC (mean age 52.9 years, 65.1% men). The estimated glomerular filtration rate (eGFR) was evaluated at the time of the initial evaluation. Renal dysfunction was defined as an eGFR <60 ml/min/1.73 m2. Renal dysfunction was found in 171 patients (38.0%) at the time of enrollment. Over a median (IQR) follow-up period of 8.8 (5.0 to 12.5) years, 56 patients (12.4%) experienced the combined end point of sudden death or potentially lethal arrhythmic events, including 20 with sudden death (4.4%), 11 resuscitated after a cardiac arrest, and 25 with appropriate implantable defibrillator shocks. Patients with renal dysfunction were at a significantly higher risk of sudden death (Log-rank p = 0.034) and the combined end point (Log-rank p <0.001) than patients without renal dysfunction. After adjusting for the highly imbalanced baseline variables, the eGFR remained as an independent correlate of the combined end point (adjusted hazard ratio: 1.24 per 10 ml/min decline in the eGFR; 95% confidence interval 1.04 to 1.47; p = 0.013). In conclusion, an impaired renal function may be associated with an incremental risk of sudden death or potentially lethal arrhythmic events in patients with HC.


Assuntos
Cardiomiopatia Hipertrófica/epidemiologia , Morte Súbita Cardíaca/epidemiologia , Cardioversão Elétrica/estatística & dados numéricos , Taxa de Filtração Glomerular , Insuficiência Renal Crônica/epidemiologia , Taquicardia Ventricular/epidemiologia , Fibrilação Ventricular/epidemiologia , Adulto , Idoso , Reanimação Cardiopulmonar , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Feminino , Parada Cardíaca/epidemiologia , Parada Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Insuficiência Renal/epidemiologia , Insuficiência Renal/metabolismo , Insuficiência Renal Crônica/metabolismo , Fatores de Risco , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapia
8.
Am J Cardiol ; 143: 29-36, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33359202

RESUMO

Data regarding the potential influence of gender on outcomes of rotational atherectomy (RA) percutaneous coronary intervention (PCI) are scarce and conflicting. Using the Euro4C registry, an international prospective multicentric registry of RA PCI, we evaluated the influence of gender on clinical outcomes of RA PCI. Between October 2016 and July 2018, 966 patients were included. In them, 267 (27.6%) were females. Female patients were older than males (77.7 years old ± 9.8 vs 73.3 ± 9.5 years old respectively, p < 0.001) had a poorer renal function (43,1% of females had a GFR < 60 ml/min:1.73m² vs 30.4% of males, p < 0.001) and were more frequently admitted for an acute coronary syndrome (32.2% vs 22.3% p = 0.002). During RA procedure, women were less likely to be treated by radial approach (65.0% vs 74.4%, p = 0.004). In-hospital major adverse cardiac event rate-defined as cardiovascular death, myocardial infarction, stroke/transient ischemic attack, target lesion revascularization, and coronary artery bypass grafting surgery-was higher in the female group (7.1% vs 3.7%, p = 0.043). However, coronary perforation, dissection, slow/low flow and tamponade did not significantly differ in gender, neither did cardiovascular medications at discharge. At 1 year follow-up, rate of major adverse cardiac event was 18.4% in the female group vs 11.2% in the male group (adjusted Hazard Ratio 1.82 [1.24 to 2.67], p = 0.002). No significant bleeding differences were observed in gender, neither in hospital, nor during follow-up. In conclusion women had worse clinical outcomes following RA PCI during hospitalization and at 1 year follow-up than did men.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Aterectomia Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Calcificação Vascular/cirurgia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Tamponamento Cardíaco/epidemiologia , Doenças Cardiovasculares/mortalidade , Ponte de Artéria Coronária/estatística & dados numéricos , Doença da Artéria Coronariana/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Artéria Radial , Sistema de Registros , Insuficiência Renal/epidemiologia , Fatores Sexuais , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento , Calcificação Vascular/epidemiologia , Lesões do Sistema Vascular/epidemiologia
9.
BMJ Open ; 10(9): e038976, 2020 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-32948572

RESUMO

OBJECTIVE: Evaluate the risk of pre-existing comorbidities on COVID-19 mortality, and provide clinical suggestions accordingly. SETTING: A nested case-control design using confirmed case reports released from the news or the national/provincial/municipal health commissions of China between 18 December 2019 and 8 March 2020. PARTICIPANTS: Patients with confirmed SARS-CoV-2 infection, excluding asymptomatic patients, in mainland China outside of Hubei Province. OUTCOME MEASURES: Patient demographics, survival time and status, and history of comorbidities. METHOD: A total of 94 publicly reported deaths in locations outside of Hubei Province, mainland China, were included as cases. Each case was matched with up to three controls, based on gender and age ±1 year old (94 cases and 181 controls). The inverse probability-weighted Cox proportional hazard model was performed, controlling for age, gender and the early period of the outbreak. RESULTS: Of the 94 cases, the median age was 72.5 years old (IQR=16), and 59.6% were men, while in the control group the median age was 67 years old (IQR=22), and 64.6% were men. Adjusting for age, gender and the early period of the outbreak, poor health conditions were associated with a higher risk of COVID-19 mortality (HR of comorbidity score, 1.31 [95% CI 1.11 to 1.54]; p=0.001). The estimated mortality risk in patients with pre-existing coronary heart disease (CHD) was three times that of those without CHD (p<0.001). The estimated 30-day survival probability for a profile patient with pre-existing CHD (65-year-old woman with no other comorbidities) was 0.53 (95% CI 0.34 to 0.82), while it was 0.85 (95% CI 0.79 to 0.91) for those without CHD. Older age was also associated with increased mortality risk: every 1-year increase in age was associated with a 4% increased risk of mortality (p<0.001). CONCLUSION: Extra care and early medical interventions are needed for patients with pre-existing comorbidities, especially CHD.


Assuntos
Doença das Coronárias/epidemiologia , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Bronquite Crônica/epidemiologia , Estudos de Casos e Controles , Infarto Cerebral/epidemiologia , China/epidemiologia , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Falência Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Insuficiência Renal/epidemiologia , Adulto Jovem
10.
J Clin Lab Anal ; 34(10): e23535, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32840917

RESUMO

BACKGROUND: This objective of this study was to identify a sensitive indicator of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: Samples were collected from 136 patients with Coronavirus disease 2019 (COVID-19) pneumonia admitted to the Shanghai public health clinical center (116 mild, 20 severe). The concentrations of serum urea, Uric Acid (UA), Creatinine (CREA), Erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), and urine protein (Pro) have been tested in this study. RESULTS: Higher levels of urea (female 7.00 ± 3.31, male 8.87 ± 5.18) Pro (female7/7, male 12/13), hs-CRP (female 2/7, male 5/13) ESR (female 94.43 ± 33.26, male 67.85 ± 22.77) were found in severe patients compared with the mild (urea: female 3.71 ± 1.00, male 4.42 ± 1.14; Pro: female 3/46, male 12/70; hs-CRP: female 1/46, male 3/70; ESR: female 43.32 ± 33.24, male 21.64 ± 21.82). UA is lower in the severe group (female 146.90 ± 54.01, male 139.34 ± 66.95) than in mild group (female 251.99 ± 64.35, male 339.81 ± 71.32). CREA and PCT did not show a significant difference between mild and severe patients, but the difference among the five biological markers (urea, Pro, hs-CRP, ESR, and UA) between mild and severe patients we tested was small (P < .05). CONCLUSION: Severe COVID-19 patients had higher levels of urea and Pro, while their UA levels were lower, reflecting poor kidney function in severe patients. However, higher levels of hs-CRP, ESR indicated that inflammatory responses were more active in severe patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Insuficiência Renal , Adulto , Idoso , Idoso de 80 Anos ou mais , Sedimentação Sanguínea , Proteína C-Reativa/análise , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Creatinina/sangue , Estado Terminal , Feminino , Humanos , Inflamação , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Insuficiência Renal/epidemiologia , Insuficiência Renal/virologia , Adulto Jovem
11.
J Vet Diagn Invest ; 32(4): 549-555, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32687010

RESUMO

Polycystic kidney disease (PKD) is one of the most common hereditary diseases in cats, with high prevalence in Persian and Persian-related cats. PKD is caused mainly by an inherited autosomal dominant (AD) mutation, and animals may be asymptomatic for years. We screened 16 cats from various breeds exhibiting a renal abnormality by ultrasound examination and genotyped them for the c.10063C>A transversion on exon 29 of the polycystin-1 (PKD1) gene, by PCR-restriction fragment length polymorphism (PCR-RFLP). Among these cats, a Siamese nuclear family of 4 cats with ancestral hereditary renal failure were screened by whole-genome sequencing (WGS) to determine novel variations in genes associated with both AD and autosomal recessive PKD in humans. During the study period, one cat died as a result of renal failure and was forwarded for autopsy. Additionally, we screened 294 cats asymptomatic for renal disease (Angora, Van, Persian, Siamese, Scottish Fold, Exotic Shorthair, British Shorthair, and mixed breeds) to determine the prevalence of the mutation in cats in Turkey. Ten of the symptomatic and 2 of the asymptomatic cats carried the heterozygous C → A transversion, indicating a prevalence of 62.5% and 0.68%, respectively. In the WGS analysis of 4 cats in the Siamese nuclear family, novel variations were determined in the fibrocystin gene (PKHD1), which was not compatible with dominant inheritance of PKD.


Assuntos
Doenças do Gato/epidemiologia , Mutação , Doenças Renais Policísticas/veterinária , Canais de Cátion TRPP/genética , Animais , Doenças do Gato/etiologia , Doenças do Gato/genética , Gatos , Doenças Renais Policísticas/epidemiologia , Doenças Renais Policísticas/etiologia , Doenças Renais Policísticas/genética , Reação em Cadeia da Polimerase/veterinária , Polimorfismo de Fragmento de Restrição , Prevalência , Insuficiência Renal/epidemiologia , Insuficiência Renal/etiologia , Insuficiência Renal/genética , Insuficiência Renal/veterinária , Canais de Cátion TRPP/metabolismo , Turquia/epidemiologia , Sequenciamento Completo do Genoma/veterinária
14.
Int J Clin Oncol ; 25(10): 1786-1792, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32617752

RESUMO

BACKGROUND: Our aim is to assess whether the poor breast cancer specific survival (BCSS) seen in women with breast cancer and impaired renal function can be explained by associations with other prognostic factors. METHODS: The study group was a consecutive series of patients undergoing breast ultrasound (US) who had invasive breast cancer (n = 1171). All women had their US diameter and mean stiffness (kPa) at shear wave elastography (SWE) recorded. The core biopsy grade and receptor status were noted. Core biopsy of abnormal axillary nodes and the patient referral source was also noted. Survival including cause of death was ascertained. Comorbidities at diagnosis were recorded. Patients were divided into those with a GFR<60 ("renal group"), those with other comorbidities and those with none. BCSS was assessed using Kaplan-Meier survival curves and Cox proportional hazards regression. RESULTS: One thousand, one hundred and forty-one patients constituted the study group. 107 (9%) patients had impaired renal function, 182 (16%) had other comorbidities while 852 (75%) had no comorbidities. Mean follow-up was 5.8 years. 109 breast cancer and 122 non-breast cancer deaths occurred. BCSS in the renal group was significantly worse than the other groups. Women with renal comorbidity were older, more likely to present symptomatically, have a pre-operative diagnosis of axillary metastases, and have larger and stiffer cancers. Cox proportional hazards regression showed that renal impairment maintained independent significance. CONCLUSION: The poor BCSS in women with impaired renal function is partially explained by advanced tumour stage at presentation. However, impaired renal function maintains an independent prognostic effect.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/mortalidade , Insuficiência Renal/epidemiologia , Idoso , Axila/patologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Comorbidade , Técnicas de Imagem por Elasticidade , Feminino , Barreira de Filtração Glomerular , Humanos , Estimativa de Kaplan-Meier , Linfonodos/patologia , Pessoa de Meia-Idade , Prognóstico , Ultrassonografia Mamária
15.
South Med J ; 113(6): 305-310, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32483641

RESUMO

OBJECTIVE: White blood cells (WBCs) play a major role in inflammation, with effects on the vascular wall, the microvascular blood flow, and endothelial cells and endothelial function. Previous studies have shown that a high WBC count may increase the risk of cardiovascular complication rate and mortality after coronary artery bypass graft (CABG) surgery. The aim of the study was to evaluate the association between preoperative WBC count and the post-CABG clinical outcome. METHODS: A retrospective study that was based on 239 patients who underwent CABG surgery in our medical center. Statistical analysis estimated the effect of WBC count in postoperative clinical outcomes, including atrial fibrillation, length of stay, readmission rate, and death. RESULTS: The preoperative WBC count was associated with longer hospitalization length (B = 0.392, P < 0.01). A preoperative WBC count >8150/µL predicted a longer stay (Z = 2.090, P = 0.03). A low lymphocyte count was associated with atrial fibrillation (B = -0.543, P = 0.03). Female patients were older (Z = 2.920, P < 0.01), had impaired renal function (Z = -3.340, P < 0.01), and had a higher rate of postoperative atrial fibrillation (df 2 = 3.780, P = 0.05) and readmission (df 2 = 5.320, P = 0.02). CONCLUSIONS: Preoperative WBC count may have an effect on the postoperative clinical outcome in patients undergoing CABG. Surgeons should pay more attention to patients' WBC count and sex and plan surgery and postoperative management accordingly.


Assuntos
Fibrilação Atrial/epidemiologia , Ponte de Artéria Coronária , Tempo de Internação/estatística & dados numéricos , Leucocitose/epidemiologia , Mortalidade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Fatores Etários , Idoso , Feminino , Humanos , Contagem de Leucócitos , Modelos Lineares , Modelos Logísticos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Prognóstico , Insuficiência Renal/epidemiologia , Estudos Retrospectivos , Fatores Sexuais
16.
Kaohsiung J Med Sci ; 36(6): 393-398, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32492290

RESUMO

The COVID-19 has swept the world causing suffering, death, loss, and massive economy damage. The dialysis population is vulnerable and the dialysis facility is critical in maintaining operations and avoiding disease transmission. The present information regarding the clinical features of COVID-19 infection in the dialysis population was collected, and the useful measures of COVID-19 infection prevention and infection control in the dialysis facilities were summarized. Leadership, education, preparedness, management, and recovery phase were determined to be the critical procedures. It is hoped this updated interim review might provide information for medical professionals to take proactive action to best prepare and mitigate damage when facing the COVID-19 pandemic challenge.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Diálise Renal , Instituições de Assistência Ambulatorial , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Educação em Saúde , Humanos , Controle de Infecções/organização & administração , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Insuficiência Renal/epidemiologia , Insuficiência Renal/terapia , Taiwan/epidemiologia , Triagem
17.
Int J STD AIDS ; 31(7): 689-693, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32538332

RESUMO

Renal monitoring is recommended for Pre-Exposure Prophylaxis (PrEP) users. We aimed to explore follow-up and outcomes among PrEP users with renal impairment (defined as estimated glomerular filtration rate <65 mL/min/1.73 m2) attending Sydney Sexual Health Centre. Time to follow-up was analysed for impairment results over a 12-month period (January-December 2018); 48/2504 (1.9%) tests among 1700 attendees showed impairment. Follow-up occurred in 39/48 (81.3%) impairment results after a median of 42 days. PrEP was ceased in 3/6 cases of non-resolving/persisting impairment, with one case of subsequent human immunodeficiency virus infection. Maintaining engagement and follow-up of those with renal impairment are important aspects of PrEP service provision.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Rim/fisiopatologia , Profilaxia Pré-Exposição/métodos , Insuficiência Renal/epidemiologia , Adulto , Fatores Etários , Idoso , Instituições de Assistência Ambulatorial , Fármacos Anti-HIV/administração & dosagem , Austrália/epidemiologia , Feminino , Seguimentos , Taxa de Filtração Glomerular/efeitos dos fármacos , Infecções por HIV/prevenção & controle , Humanos , Rim/efeitos dos fármacos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Insuficiência Renal/induzido quimicamente , Insuficiência Renal/fisiopatologia , Fatores de Risco , Resultado do Tratamento
18.
Clin Interv Aging ; 15: 733-742, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32546991

RESUMO

Purpose: Reduced kidney function has been associated with an increased risk for adverse outcomes. Accurate assessment of glomerular filtration rate (GFR) is key to diagnosis and management of kidney disfunction. Debate exists on the best GFR estimation equation for elderly people. This study aimed to compare the predictive validity and discriminative ability of four GFR equations in relation to 2-year and 6-year mortality in exceptional longevity (EL) (those over 95 years old with intact health) individuals and is an ideal model to address factors relating to life span and age-related diseases. Patients and Methods: This study used 6 years' data of 278 EL from the Rugao longevity cohort. Baseline GFR was estimated using four equations: Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, Modification of Diet in Renal Disease Study (MDRD) equation, Berlin Initiative Study-1 (BIS) equation, and modified MDRD equation. Predictive validity was tested using Cox proportional hazards analysis. Overall improvement in reclassification based on estimated GFR (eGFR) was assessed applying net reclassification improvement (NRI). Results: Mean age of participants was 97±2 years with median follow-up of 2.6 years. Median (IQR) eGFR by CKD-EPI, MDRD, BIS, and modified MDRD equations were 73.9 (62.2-77.6), 82.3 (67.4-98.6), 56.4 (47.9-63.9), and 101.5 (83.1-121.6) mL/min per 1.73 m2, respectively. Higher eGFREPI was associated with lower mortality after multivariate adjustment (for continuous eGFREPI, HRtwo-year 1.018, 95% CI 1.002-1.033, P=0.023; HRsix-year 1.013, 95% CI 1.002-1.025, P=0.022), while eGFR from other equations did not show any associations with mortality. NRI for two-year mortality was 0.14 and approximately significant, which may favor the CKD-EPI when compared to BIS equation (P=0.052). Conclusion: The CKD-EPI equation showed more accurate estimation of kidney function in the elderly with respect to GFR distribution and predictability of mortality risk.


Assuntos
Creatinina/sangue , Taxa de Filtração Glomerular/fisiologia , Longevidade/fisiologia , Insuficiência Renal/diagnóstico , Idoso de 80 Anos ou mais , Feminino , Humanos , Testes de Função Renal/métodos , Masculino , Mortalidade , Valor Preditivo dos Testes , Insuficiência Renal/epidemiologia , Reprodutibilidade dos Testes , Fatores de Risco
19.
Cardiovasc Diabetol ; 19(1): 98, 2020 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590982

RESUMO

Sodium/glucose cotransporter-2 inhibitors (SGLT2i) are a new type of glucose-lowering drug that can reduce blood glucose by inhibiting its reabsorption in proximal tubules and by promoting urinary glucose excretion. SGLT2i are widely used in the clinical treatment of type 2 diabetes mellitus (T2DM). In recent studies, SGLT2i were found to not only reduce blood glucose but also protect the heart and kidney, which can significantly reduce cardiovascular events, delay the progression of renal failure, greatly improve the quality of life of patients, and reduce medical expenses for families and society. As adverse cardiac and renal events are the most common and serious complications of T2DM, it is very important to understand the cardio- and renoprotective mechanisms of SGLT2i. This article reviews the historical development, pharmacological mechanism, heart and kidney protection and safety of SGLT2i. The information presented provides a theoretical basis for the clinical prevention and treatment of diabetes and its complications and for the development of new glucose-lowering drugs.


Assuntos
Glicemia/efeitos dos fármacos , Doenças Cardiovasculares/prevenção & controle , Sistema Cardiovascular/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Nefropatias Diabéticas/prevenção & controle , Rim/efeitos dos fármacos , Insuficiência Renal/prevenção & controle , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Animais , Biomarcadores/sangue , Glicemia/metabolismo , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Sistema Cardiovascular/fisiopatologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/fisiopatologia , Regulação para Baixo , Humanos , Rim/fisiopatologia , Insuficiência Renal/diagnóstico , Insuficiência Renal/epidemiologia , Insuficiência Renal/fisiopatologia , Medição de Risco , Fatores de Risco , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Resultado do Tratamento
20.
Am J Kidney Dis ; 76(3): 392-400, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32505811

RESUMO

With the exponential surge in patients with coronavirus disease 2019 (COVID-19) worldwide, the resources needed to provide continuous kidney replacement therapy (CKRT) for patients with acute kidney injury or kidney failure may be threatened. This article summarizes subsisting strategies that can be implemented immediately. Pre-emptive weekly multicenter projections of CKRT demand based on evolving COVID-19 epidemiology and routine workload should be made. Corresponding consumables should be quantified and acquired, with diversification of sources from multiple vendors. Supply procurement should be stepped up accordingly so that a several-week stock is amassed, with administrative oversight to prevent disproportionate hoarding by institutions. Consumption of CKRT resources can be made more efficient by optimizing circuit anticoagulation to preserve filters, extending use of each vascular access, lowering blood flows to reduce citrate consumption, moderating the CKRT intensity to conserve fluids, or running accelerated KRT at higher clearance to treat more patients per machine. If logistically feasible, earlier transition to intermittent hemodialysis with online-generated dialysate, or urgent peritoneal dialysis in selected patients, may help reduce CKRT dependency. These measures, coupled to multicenter collaboration and a corresponding increase in trained medical and nursing staffing levels, may avoid downstream rationing of care and save lives during the peak of the pandemic.


Assuntos
Betacoronavirus , Terapia de Substituição Renal Contínua/tendências , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde/tendências , Pandemias , Pneumonia Viral/terapia , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/terapia , Anticoagulantes/administração & dosagem , Anticoagulantes/provisão & distribução , Terapia de Substituição Renal Contínua/instrumentação , Infecções por Coronavirus/epidemiologia , Soluções para Diálise/administração & dosagem , Soluções para Diálise/provisão & distribução , Humanos , Pneumonia Viral/epidemiologia , Insuficiência Renal/epidemiologia , Insuficiência Renal/terapia
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