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1.
Medicine (Baltimore) ; 99(8): e19173, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080098

RESUMO

Recent large observational studies of antineutrophil cytoplasmic autoantibody-associated vasculitis (AAV) show that severe infection is a major cause of death and that the majority of infections occur during the early phase of initiating remission-induction therapy. Many risk factors for severe infection have been suggested, but these have been inconsistent. Nevertheless, infectious risk factors in elderly patients with AAV have not been adequately investigated in previous studies.In this retrospective observational study, we examined potential predictors of severe infection within 90 days (early severe infections) after remission-induction therapy in patients with AAV aged 65 years or older. We included 167 consecutive elderly patients with AAV admitted to our hospital. Data from medical history and remission-induction therapy were analyzed for predictive risk factors associated with early severe infections. The relationship between initial doses of corticosteroids and cumulative incidence of severe infections was also analyzed. A multivariate analysis of risk factors for early severe infections was performed using logistic regression analysis. The Kaplan-Meier method was used to estimate the overall survival, and the log-rank test was used to evaluate the differences between patients with and without early severe infections. Gray method was used to compare the cumulative incidence of severe infections in patients who did and did not receive initial high-dose corticosteroids.Logistic regression analysis showed that initial high-dose corticosteroid administration (prednisolone ≥0.8 mg/kg/d) (odds ratio [OR] 3.86, P = .030) and serum creatinine levels at diagnosis ≥1.5 mg/dL (OR 5.13, P = .003) were independent predictors of early severe infection although administration of cyclophosphamide or rituximab was not. The cumulative incidence of severe infections was also significantly higher in patients who received initial high-dose corticosteroids (P = .042), and patients with early severe infections exhibited a high mortality rate within 6 months (P < .001).Our findings suggest that initial high-dose corticosteroids and renal impairment at diagnosis are associated with a higher risk of early severe infections and early death in elderly patients with AAV.


Assuntos
Corticosteroides/uso terapêutico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/epidemiologia , Infecções Bacterianas/epidemiologia , Insuficiência Renal/epidemiologia , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Creatinina/sangue , Relação Dose-Resposta a Droga , Feminino , Humanos , Imunossupressores/uso terapêutico , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
2.
Heart Surg Forum ; 22(5): E385-E389, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31596717

RESUMO

BACKGROUND: The aim of this study was to evaluate the frequency of postoperative complications in patients who underwent coronary artery bypass grafting (CABG) and simultaneous carotid endarterectomy (CEA) and find predictors of postoperative complications. METHODS: We retrospectively evaluated 86 patients after simultaneous CABG and CEA. Inclusion criteria were: patients with asymptomatic carotid stenosis with a reduction of the carotid lumen diameter of more than 70% detected with Doppler ultrasound and diagnosed with one, two, or three vessel coronary artery disease with coronary stenosis more than 75% and hemodynamic significant stenosis of the left main artery. Exclusion criteria were patients with urgent and previous cardiac surgery and patients with myocardial infarction and stroke in the past one month. We monitored preoperative (ejection fraction, coronarography status), operative (number of grafts, on-pump or off-pump technique) and postoperative (extubation, unit care and hospital stay, bleeding and reoperation) details and complications (myocardial infarction, neurological events, inotropic agents and transfusion requiry, infection, arrhythmic complication, renal failure, mortality). RESULTS: Postoperative complications were observed in 18 (29.9%) patients. Two patients (2.3%) had postoperative stroke and one patient (1.2%) had transient ischemic attack (TIA). Previous stroke was a predictor for increased postoperative neurological events (P < .05). Intrahospital mortality was 8.1%. CONCLUSION: Simultaneous CEA and CABG were performed with low rates of stroke and TIA. Previous stroke was identified as a predictor for increased postoperative neurological complications.


Assuntos
Estenose das Carótidas/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Estenose Coronária/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Complicações Pós-Operatórias/etiologia , Idoso , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etiologia , Doenças Assintomáticas , Estenose das Carótidas/complicações , Causas de Morte , Comorbidade , Estenose Coronária/complicações , Feminino , Humanos , Ataque Isquêmico Transitório/epidemiologia , Ataque Isquêmico Transitório/etiologia , Masculino , Mediastinite/epidemiologia , Mediastinite/etiologia , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Insuficiência Renal/epidemiologia , Insuficiência Renal/etiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
3.
Nutrients ; 11(9)2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31480674

RESUMO

Dyslipidemia, anemia, and inflammation are associated with declined kidney function. This study investigated the association of inflammatory dietary pattern with dyslipidemia, anemia, and kidney function biomarkers among middle-aged and older Taiwanese adults with declined kidney function. Biochemical data and food frequency questionnaire were obtained from 41,128 participants with estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2 and positive urinary protein. Inflammatory dietary pattern was identified by reduced rank regression with C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (N/L) as response variables. Males had higher prevalence of dyslipidemia and higher inflammatory markers, but lower prevalence of anemia and lower eGFR levels compared to females. Inflammatory dietary pattern characterized with low intakes of seafood, grains, vegetables, and fruits but high intakes of meat, eggs, preserved/processed foods, and sugary drinks was associated with an increased risk of dyslipidemia by 21% in males and an increased risk of anemia by 28-47% in both genders. Furthermore, high consumption of inflammatory dietary pattern was associated with reduced eGFR (males ß = -0.85, 95% CI -1.26 to -0.43, females ß = -0.53, 95% CI -0.98 to -0.08) and increased N/L and/or CRP in both genders. In conclusion, inflammatory dietary pattern is positively associated with dyslipidemia, anemia, and decreased kidney function in middle-aged and older adults with declined kidney function.


Assuntos
Anemia/etiologia , Dieta/efeitos adversos , Dislipidemias/etiologia , Inflamação/induzido quimicamente , Insuficiência Renal/complicações , Idoso , Anemia/epidemiologia , Grupo com Ancestrais do Continente Asiático , Biomarcadores/sangue , Estudos Transversais , Dislipidemias/epidemiologia , Comportamento Alimentar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/epidemiologia , Estudos Retrospectivos , Taiwan
4.
World Neurosurg ; 131: e543-e549, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31398520

RESUMO

OBJECTIVE: To test whether robot-assisted surgery can improve prognosis of small-volume thalamic hemorrhage and to provide a surgical basis for treatment of small-volume thalamic hemorrhage. METHODS: This retrospective study included patients with thalamic hemorrhage and hematoma volume of 5-15 mL treated from December 2015 to December 2018. Patients were divided into an operation group and a nonoperation group. General data, types of hematoma, incidence of complications, Scandinavian Stroke Scale score, and modified Rankin Scale score were recorded and analyzed. RESULTS: Retrospectively, 84 cases met inclusion criteria: 35 cases in operation group and 49 cases in nonoperation group. At 90 days after onset, mortality was 11.4% in the operation group and 4.1% in the nonoperation group (P > 0.05). The Scandinavian Stroke Scale score in the operation group (43.3 ± 8.5) was higher than in the nonoperation group (36.1 ± 10.0) (P < 0.05). The modified Rankin Scale score in the operation group (2.9 ± 0.3) was lower than in the nonoperation group (3.7 ± 0.2) (P < 0.05). The incidence of pneumonia (8.6%) and renal dysfunction (14.3%) was lower in the operation group than in the nonoperation group (28.6% and 34.7%, respectively) (P < 0.05). There was no significant difference between the 2 groups in the incidence of central fever (5.7% vs. 12.2%), stress ulcer (11.4% vs. 16.3%), and ion balance disturbance (20.0% vs. 26.5%) (P > 0.05). CONCLUSIONS: Robot-assisted drainage of thalamic hemorrhage can improve prognosis and reduce the incidence of pneumonia and renal dysfunction.


Assuntos
Hematoma/cirurgia , Hemorragias Intracranianas/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Doenças Talâmicas/cirurgia , Idoso , Drenagem/métodos , Feminino , Hematoma/diagnóstico por imagem , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Mortalidade , Pneumonia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Insuficiência Renal/epidemiologia , Doenças Talâmicas/diagnóstico por imagem , Resultado do Tratamento
5.
Transplant Proc ; 51(6): 1920-1922, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399176

RESUMO

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


Assuntos
Inibidores de Calcineurina/administração & dosagem , Transplante de Fígado , Complicações Pós-Operatórias/epidemiologia , Tacrolimo/administração & dosagem , Fatores de Tempo , Adulto , Esquema de Medicação , Quimioterapia Combinada , Feminino , Seguimentos , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/etiologia , Humanos , Hepatopatias/epidemiologia , Hepatopatias/etiologia , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/administração & dosagem , Complicações Pós-Operatórias/etiologia , Insuficiência Renal/epidemiologia , Insuficiência Renal/etiologia , Estudos Retrospectivos
6.
Ren Fail ; 41(1): 600-606, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31282239

RESUMO

Background: The presence of simple renal cyst (SRC) has been associated to renal dysfunction, but the results were inconsistent. Accordingly, we conducted a longitudinal cohort study to explore the association between SRC and kidney damage. Methods: A total of 4274 adults (aged 45.4 ± 13.6 years) without chronic kidney disease at baseline were enrolled in 2008. SRC was assessed by ultrasonography. Logistic regression analysis were applied to explore the relationships between SRC and indicators of kidney damage (proteinuria and renal insufficiency), and also with relatively rapid decline in renal function (defined as the lowest quartile of △eGFR). Results: During 5 years of follow-up, participants in the SRC group had higher incidence of proteinuria (5.2% versus 2.4%, p = 0.004) and renal insufficiency (3.8% versus 0.97%, p < 0.001) compared with control group. SRC was correlated with proteinuria (OR 2.24; 95% CI 1.34-3.75) and renal insufficiency (OR 4.0; 95% CI 2.11-7.58) in univariable analysis, despite that the correlation was not significant after adjusted for traditional kidney disease risk factors. Furthermore, after adjusted for potential confounders, maximum diameter of the cyst (≥2.2 cm) was significantly associated with rapid decline in renal function (OR 2.19; 95% CI 1.24-3.87). Conclusions: Participants with SRC may be associated with higher incidence of proteinuria and renal insufficiency. This relationship may be obscured by age and other traditional risk factors. Higher diameter of the cysts contributed to more rapid decline in renal function of SRC participants.


Assuntos
Cistos/epidemiologia , Nefropatias/epidemiologia , Rim/fisiopatologia , Proteinúria/epidemiologia , Insuficiência Renal/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Taxa de Filtração Glomerular , Humanos , Incidência , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Ultrassonografia , Adulto Jovem
7.
Injury ; 50(8): 1429-1432, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31279477

RESUMO

INTRODUCTION: Opioid-related compartment syndrome (ORCS) is an understudied complication related to opioid overdose. We hypothesized that ORCS would be associated with worse clinical outcomes, including higher amputation rates, need for multiple surgical procedures, and rhabdomyolysis on admission, compared with nonopioid-related compartment syndrome (NORCS). METHODS: We used Current Procedural Terminology codes for fasciotomy as a proxy marker for cases of compartment syndrome treated at 1 health system from January 1, 2016, to December 21, 2018. We excluded patients younger than 18 years, those treated for exertional compartment syndrome, and those who underwent elective fasciotomies. Seventy-four patients met our inclusion criteria. Data reviewed included patient characteristics, cause of compartment syndrome, time until evaluation for compartment syndrome, peak creatinine kinase levels, number of surgical procedures required, duration of hospital stay, and postoperative inpatient morbidity and death. Patients were categorized as having ORCS (n = 8) or NORCS (n = 66). Alpha = .05. RESULTS: All cases of ORCS occurred in men. Opioid use was the third most common cause of compartment syndrome. Two patients underwent amputation, both in the ORCS group (p <  0.01). The median number of debridements was significantly higher for the ORCS group (median, 4; interquartile range [IQR]: 3-6) than for the NORCS group (median, 3; IQR 2-4) (p =  0.03). Duration of hospital stay was longer for the ORCS group (median, 27 days; IQR 16-38) compared with the NORCS group (median, 9 days; IQR: 5-13) (p <  0.001). Mean (± standard deviation) peak creatinine kinase level was significantly higher in the ORCS group (224,000 ± 225,052 U/L) compared with the NORCS group (7550 ± 32,500) (p <  0.001). The proportion of patients who underwent hemodialysis was higher in the ORCS group (88%) than in the NORCS group (35%) (p <  0.001). All ORCS patients presented >8 h after immobilization in a dependent position. CONCLUSION: Patients in the ORCS group had delayed presentations and significantly more morbidity compared with patients in the NORCS group.


Assuntos
Síndromes Compartimentais/etiologia , Fáscia/lesões , Dependência de Heroína/complicações , Transtornos Relacionados ao Uso de Opioides/complicações , Insuficiência Renal/epidemiologia , Rabdomiólise/epidemiologia , Lesões do Sistema Vascular/complicações , Adulto , Síndromes Compartimentais/epidemiologia , Síndromes Compartimentais/fisiopatologia , Síndromes Compartimentais/terapia , Fáscia/irrigação sanguínea , Fasciotomia , Feminino , Dependência de Heroína/epidemiologia , Dependência de Heroína/fisiopatologia , Dependência de Heroína/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/fisiopatologia , Transtornos Relacionados ao Uso de Opioides/terapia , Estudos Retrospectivos , Estados Unidos/epidemiologia , Lesões do Sistema Vascular/epidemiologia , Lesões do Sistema Vascular/fisiopatologia , Lesões do Sistema Vascular/terapia
8.
Diabetes Res Clin Pract ; 155: 107781, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31279959

RESUMO

AIMS: To analyze the factors associated with non-albuminuric reduced estimated glomerular filtration rate (NAeGFR-) phenotype in young people with type 1 diabetes (T1DM). METHODS: In this cross-sectional study were enrolled 140 outpatient diabetic children (age 7-18 years), consecutively observed in the period 2016-2017. Eighteen subjects with microalbuminuria (defined as albumin excretion rate ≥ 30 mg/24 h) were excluded. Fasting HbA1c, uric acid (UA), neutrophils and lymphocytes count were recorded. Estimated glomerular filtration rate (eGFR) was calculated using the Schwartz's bed-side formula and reduced eGFR was defined by a value <90 mL/min/1.73 m2. RESULTS: Out of 122 subjects analyzed, 76 (62%) showed normal eGFR and 46 (38%) showed NAeGFR- phenotype. They were characterized by higher prevalence of male sex (57% vs 33%, p = 0.010), autoimmune diseases (26% vs 12%, p = 0.043), high UA levels (4.0 ±â€¯0.9 vs 3.3 ±â€¯0.9 mg/dl, p < 0.0001) and high Neutrophils/Lymphocytes ratio (1.5 [1.2-2.0] vs 1.3 [1.0-1.8], p = 0.023). CONCLUSIONS: In our population, the prevalence on NAeGFR- phenotype is 38% and it is associated with male sex, high levels of UA, presence of other autoimmune diseases and low-grade inflammation. It should encourage pediatricians to monitor early both eGFR and UA in order to intercept diabetic youth more likely prone to develop progressive renal impairment.


Assuntos
Albuminas/análise , Diabetes Mellitus Tipo 1/fisiopatologia , Taxa de Filtração Glomerular , Insuficiência Renal/epidemiologia , Adolescente , Criança , Estudos Transversais , Diabetes Mellitus Tipo 1/metabolismo , Feminino , Hemoglobina A Glicada/análise , Humanos , Incidência , Itália/epidemiologia , Masculino , Fenótipo , Prevalência , Ácido Úrico/análise
10.
BMC Res Notes ; 12(1): 462, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31358035

RESUMO

OBJECTIVE: The aim of this study was to estimate the prevalence of renal insufficiency using estimated glomerular filtration rate (eGFR) among adult outpatients with normal SCr. RESULTS: A total of 414 patients with normal SCr were included in the study. Mean GFR (ml/min/1.73 m2) was 116.8 ± 43.5 using the MDRD equation and 90.5 ± 33.1 by the C-G formula. According to the MDRD formula, mild renal insufficiency (i.e. eGFR 60-89.9 ml/min/1.73 m2) was found in 21.5% of the patients and moderate renal insufficiency (i.e. eGFR 30-59.9 ml/min/1.73 m2) was found in 7.7%. According to the Cockcroft-Gault (C-G) formula, mild renal insufficiency was found in 38.2% and moderate renal insufficiency in 16.9% of the patients with normal SCr. In multivariate analysis, older age, female sex, a family history of kidney disease or other chronic diseases and high systolic blood pressure were associated with prevalent renal insufficiency depending on the formula used to estimate GFR. This study demonstrates the substantial prevalence of impaired renal function among Ethiopian adult outpatients with normal SCr. Including calculated estimates of GFR in routine laboratory reporting may help to facilitate the identification and thus optimal management of patients with renal insufficiency.


Assuntos
Rim/fisiopatologia , Insuficiência Renal/epidemiologia , Insuficiência Renal/fisiopatologia , Adulto , Fatores Etários , Idoso , Creatinina/sangue , Estudos Transversais , Etiópia/epidemiologia , Feminino , Taxa de Filtração Glomerular , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pacientes Ambulatoriais , Prevalência , Insuficiência Renal/sangue , Insuficiência Renal/diagnóstico , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
11.
PLoS One ; 14(6): e0218024, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31211789

RESUMO

BACKGROUND: Little is known on how the interaction between Sickle Cell Disease (SCD) and renal insults caused by other coexisting conditions in Sub Saharan Africa such as urinary schistosomiasis, malnutrition and HIV affect the prevalence of renal dysfunction in children with SCD. OBJECTIVES: To determine the prevalence and factors associated with renal dysfunction among children with SCD aged 6 months to 12 years attended at a tertiary hospital in Northwestern Tanzania. METHODS: A cross sectional hospital-based study with a short follow up component of 3 months for 153 children with SCD was done to document demographics, clinical characteristics and features of renal dysfunction including urine dipstick albuminuria (>20mg/l) and eGFR (<60ml/ml/min/1.73m2). Other potential renal insults such as HIV infection and Schistosomiasis were also evaluated. RESULTS: At enrollment, 48/153(31.37%) children had renal dysfunction declining to 31(20.3%) at 3 months follow up. Acute chest syndrome (OR 3.04, 95% CI [1.08-8.96], p = 0.044), severe anemia (OR 0.44, 95% CI [0.26-0.76],p = 0.003), urinary schistosomiasis (OR 7.43, 95% CI [2.10-26.32] p<0.002) and acute malnutrition (OR 4.92, 95% CI [1.29-18.84], p = 0.020). were associated with renal dysfunction. CONCLUSION: Where prevalent, urinary schistosomiasis and acute malnutrition increase the risk for renal dysfunction in children with SCD. We recommend albuminuria routine screening in children with SCD especially those presenting with acute chest syndrome, severe anemia and features of acute malnutrition for early detection of renal dysfunction among children with SCD.


Assuntos
Anemia Falciforme/epidemiologia , Rim/fisiopatologia , Insuficiência Renal/epidemiologia , Esquistossomose/epidemiologia , Albuminúria/complicações , Albuminúria/epidemiologia , Albuminúria/fisiopatologia , Instituições de Assistência Ambulatorial , Anemia Falciforme/complicações , Anemia Falciforme/fisiopatologia , Criança , Pré-Escolar , Feminino , Taxa de Filtração Glomerular , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Infecções por HIV/fisiopatologia , Humanos , Lactente , Masculino , Insuficiência Renal/complicações , Insuficiência Renal/fisiopatologia , Esquistossomose/complicações , Esquistossomose/fisiopatologia , Tanzânia/epidemiologia , Centros de Atenção Terciária
12.
Saudi J Kidney Dis Transpl ; 30(3): 560-563, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31249218

RESUMO

Rabies is an important neurological infection that is prevalent in tropical countries. The rabid animals can bring rabies to humans by biting. The disease can result in serious neurological problem and death is the end result. The best way is prevention of disease by postexposure prophylaxis against rabies. The effect of rabies on the renal system is little mentioned in the literature. In the previous literature, acute kidney injury was observable in half of the rabies patients. Rabies is also transmittable by organ transplantation. Although it is rare and <10 cases had ever been reported in literature, it is proven that kidney transplant patients are at risk of getting rabies if the donor come from endemic country or with a history of travel to endemic country and has unclear cause of death. Regarding rabies immunization, the use of vaccination for patients with the underlying renal failure is interesting. In this short article, the authors summarize on those important clinical issues of rabies and renal failure.


Assuntos
Lesão Renal Aguda/virologia , Rim/virologia , Vacinas Antirrábicas/administração & dosagem , Vírus da Raiva/patogenicidade , Raiva/prevenção & controle , Insuficiência Renal/virologia , Lesão Renal Aguda/epidemiologia , Animais , Humanos , Imunização , Transplante de Rim/efeitos adversos , Raiva/epidemiologia , Raiva/transmissão , Raiva/virologia , Vacinas Antirrábicas/efeitos adversos , Vírus da Raiva/imunologia , Insuficiência Renal/epidemiologia , Fatores de Risco , Doadores de Tecidos
13.
Innovations (Phila) ; 14(4): 291-298, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31185776

RESUMO

OBJECTIVE: The management of concomitant mild-to-moderate aortic stenosis (AS) at the time of coronary artery bypass graft (CABG) is controversial. Here we perform a systematic review and meta-analysis of CABG and aortic valve replacement (AVR) versus CABG alone in patients with mild-moderate AS. METHODS: We searched MEDLINE and EMBASE databases until July 2018 for studies comparing CABG & AVR versus CABG in patients with mild-moderate AS undergoing coronary bypass. Data were extracted by 2 independent investigators. The main outcomes were operative mortality, long-term survival, and reintervention for AS. RESULTS: There were 6 unmatched retrospective observational studies with 1,172 patients (median follow-up 4.7 [interquartile range: 4.3 to 5.3] years). Patients undergoing CABG & AVR had less severe coronary artery disease. There were no differences in operative mortality (relative risk [RR]: 1.07; 95% CI, 0.59 to 1.94; P = 0.8). CABG & AVR was associated with greater incidence of stroke, bleeding, renal failure, and mediastinitis. At median follow-up of 5 years, there was no difference in long-term mortality (incidence rate ratio [IRR]:1.44; 95% CI, 0.83 to 2.51; P = 0.19), but CABG & AVR was associated with 73% lower risk of reoperation for AS (n = 13/485 versus n = 71/702; IRR: 0.27; 95% CI, 0.14 to 0.51; P < 0.001). CONCLUSIONS: In patients undergoing CABG with mild-moderate AS, combining AVR with CABG was associated with no difference in operative mortality but with increased risk of stroke, bleeding, renal failure, and mediastinitis. Long-term mortality was not different, but a risk of reoperation for AS at 5 years was 73% lower. Given the increasingly wide availability and safety of transcatheter aortic valve replacement (TAVR), one may consider a conservative approach toward concomitant mild-moderate AS.


Assuntos
Estenose da Valva Aórtica/cirurgia , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Estenose da Valva Aórtica/complicações , Doença da Artéria Coronariana/complicações , Humanos , Mediastinite/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Insuficiência Renal/epidemiologia , Índice de Gravidade de Doença , Acidente Vascular Cerebral/epidemiologia
14.
Am J Cardiol ; 124(4): 545-553, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31208702

RESUMO

Congestion is associated with adverse outcomes in heart failure (HF) patients. We characterized congestion in patients hospitalized for HF and examined the association between congestion severity at admission and postdischarge outcomes. Using the OPTIMIZE-HF registry linked to Medicare claims, we analyzed patients ≥65 years old hospitalized for HF from 2003 to 2004. Congestion severity was measured using a 15-point scale that scores dyspnea, orthopnea, fatigue, jugular venous pressure, rales, and edema. Patient characteristics and outcomes were described by congestion strata. Proportional hazards models were fit to examine associations between congestion and 1-year outcomes. Congestion scores for the 24,724 patients ranged from 0 to 14, with a median of 5 (Q1, Q3: 3, 7). At baseline, patients with the highest scores (≥7) had the highest rates of recent HF hospitalizations, EF ≤40%, and co-morbidities, including arrhythmias, diabetes mellitus, and renal insufficiency. Adjusting for patient characteristics, a 3-point congestion score increase was positively associated with mortality (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03, 1.09), all-cause rehospitalization (HR 1.02, 95% CI 1.00, 1.04), and HF rehospitalization (HR 1.09, 95% CI 1.06, 1.12), but not emergency department visits (HR 0.99, 95% CI 0.97, 1.01). In conclusion, for patients hospitalized with HF, congestion was associated with rehospitalization and mortality.


Assuntos
Dispneia/epidemiologia , Edema/epidemiologia , Fadiga/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/epidemiologia , Comorbidade , Diabetes Mellitus/epidemiologia , Dispneia/etiologia , Edema/etiologia , Serviço Hospitalar de Emergência , Fadiga/etiologia , Feminino , Insuficiência Cardíaca/complicações , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Veias Jugulares , Masculino , Mortalidade , Postura , Prognóstico , Modelos de Riscos Proporcionais , Insuficiência Renal/epidemiologia , Sons Respiratórios/etiologia , Índice de Gravidade de Doença , Pressão Venosa
15.
Clin Nephrol ; 92(2): 73-80, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31198168

RESUMO

BACKGROUND: Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease (ESRD) worldwide. Clinical manifestations of DKD consist of a progressive increase in albuminuria and a decline in estimated glomerular filtration rate (eGFR). Hence, the diagnosis of DKD in patients with declining renal function without albuminuria is more difficult. Although there are several reports of such patients in other geographic regions, the data in this regard are limited. OBJECTIVE: To determine the prevalence of normoalbuminuria with renal impairment and the decline in eGFR relative to their albuminuric status in type 2 diabetes mellitus (T2DM) among Thai patients. MATERIALS AND METHODS: Retrospective review was conducted on medical records of T2DM patients at a tertiary referral hospital dated from January 1, 2013, until June 30, 2016. Based on study inclusion criteria, T2DM patients with renal impairment identified by an eGFR of less than 60 mL/min/1.73m2 were eligible. Albumin excretion rate was determined by urine albumin-to-creatinine ratio from a single random urine collection. RESULTS: Of the 4,597 patients with T2DM, 16.5% had an eGFR below 60 mL/min/1.73m2. The overall prevalence rates of normoalbuminuria, moderate proteinuria, and severe proteinuria were 45.4, 30.9, and 23.7%, respectively. In the normoalbuminuria group, the incidences of chronic kidney disease at stage 3a, 3b, and 4 were 67.5, 27, and 5.5%, respectively. None of the patients with stage 5 chronic kidney disease had normoalbuminuria. The decline in eGFR with normoalbuminuria was less significant than in positive albuminuria. CONCLUSION: The association of normoalbuminuria is common in DKD. The decline of renal function is slower in normoalbuminuria; however, the risk factors, clinical progression, and renal pathology in these patients need to be further explored.


Assuntos
Albuminúria/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/epidemiologia , Insuficiência Renal/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Albuminúria/diagnóstico , Nefropatias Diabéticas/diagnóstico , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal/diagnóstico , Estudos Retrospectivos
16.
Arthritis Rheumatol ; 71(10): 1691-1700, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31066998

RESUMO

OBJECTIVE: A prognostic equation and risk score calculator derived from the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL) are being used to predict 1-year survival in patients with pulmonary arterial hypertension (PAH), but little is known about the performance of these REVEAL survival prediction tools in systemic sclerosis (SSc)-associated PAH (SSc-PAH). METHODS: Prospectively gathered data from the Johns Hopkins Pulmonary Hypertension Program and Pulmonary Hypertension Assessment and Recognition of Outcome in Scleroderma Registries were used to evaluate the predictive accuracy of the REVEAL models for predicting the probability of 1-year survival in patients with SSc-PAH. Model discrimination was assessed by comparison of the Harrell's C-index, model fit was assessed using multivariable regression techniques, and model calibration was assessed by comparing predicted to observed survival estimates. RESULTS: The validation cohort consisted of 292 SSc-PAH patients with a 1-year survival rate of 87.4%. The C-index for predictive accuracy of the REVEAL prognostic equation (0.734, 95% confidence interval [95% CI] 0.652-0.816) and for the risk score (0.743, 95% CI 0.663-0.823) demonstrated good discrimination, comparable to that in the model development cohort. The calibration slope was 0.707 (95% CI 0.400-1.014), indicating that the overall model fit was marginal (P = 0.06). The magnitude of risk assigned to low distance on the 6-minute walk test (6MWD) and elevated serum levels of brain natriuretic peptide (BNP) was lower in the validation cohort than was originally seen in the REVEAL derivation cohort. Model calibration was poor, particularly for the highest risk groups. CONCLUSION: In predicting 1-year survival in patients newly diagnosed as having SSc-PAH, the REVEAL prognostic equation and risk score provide very good discrimination but poor calibration. REVEAL prediction scores should be interpreted with caution in newly diagnosed SSc-PAH patients, particularly those with higher predicted risk of poor 1-year survival resulting from a low 6MWD or a high BNP serum level.


Assuntos
/mortalidade , Escleroderma Sistêmico/complicações , Idoso , Pressão Atrial , Pressão Sanguínea , Comorbidade , Feminino , Frequência Cardíaca , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Prognóstico , Insuficiência Renal/epidemiologia , Reprodutibilidade dos Testes , Medição de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Resistência Vascular , Teste de Caminhada
17.
Am J Cardiol ; 124(1): 85-89, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31027658

RESUMO

The study aims to investigate the incidence of immediate renal function improvement in renal dysfunction patients who had transcatheter aortic valve implantation (TAVI). TAVI patients with ≥ moderate reduced renal function [estimated GFR ≤ 60 ml/min/1.73 m2] at baseline were identified from a prospectively maintained database. Patients were divided into 3 groups based on percent change [(discharge eGFR - baseline eGFR/baseline GFR) × 100] in eGFR post-TAVR. Improvement ≥ 10%, no change, Decline ≥ 10%. Multivariable logistic regression was performed to identify factors that predicted improvement/decline in GFR postprocedure. Out of 677 patients, 359 (53%) had eGFR ≤ 60 ml/min/1.73 m2. Of these, 188 (52%) had an improvement in eGFR ≥ 10%, 125 (34%) had no change and 48 (14%) observed decline ≥ 10%. All groups had similar proportions of females and age was comparable in patient groups. Patients in whom a decline in eGFR was observed had significantly higher Society of thoracic Surgeons scores (10.7 vs 8.2 vs 8.2; p = 0.007) and incidence of liver disease (6% vs, 0% vs 2%; p = 0.014) than the no-change or improved groups respectively. On multivariable analysis, independent predictors of decline/improvement in eGFR were being female, low left ventricular ejection fraction and baseline liver dysfunction. In conclusion, over half of patients with compromised renal function who underwent TAVI experience an immediate improvement in kidney function post-TAVI. Being female, baseline liver dysfunction and a low left ventricular ejection fraction is associated with an immediate decline in eGFR.


Assuntos
Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Insuficiência Renal/complicações , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/fisiopatologia , Estudos de Coortes , Feminino , Taxa de Filtração Glomerular , Humanos , Incidência , Modelos Logísticos , Masculino , Insuficiência Renal/epidemiologia , Insuficiência Renal/prevenção & controle , Fatores de Risco , Volume Sistólico , Resultado do Tratamento
18.
PLoS One ; 14(4): e0215757, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31022233

RESUMO

Nephrotoxicity is a well-known side effect of cisplatin for cancer treatment. Various regimens have been developed to treat cancer based on the type and severity of the tumor. We focus on the docetaxel, cisplatin, and 5-fluorouracil regimen, which is called the TPF regimen, where the standard dose of cisplatin is 60 mg/m2. The aim of this study is to examine the relationship of the dosage of cisplatin that causes nephrotoxicity and back ground factors of patients using information about the dose of cisplatin actually administered to patients. It is shown that nephrotoxicity may be caused by a substantially smaller dosage than the standard dose of cisplatin in the TPF regimen, indicating the need for dose adjustment, taking into account the patient's background factors in the treatment of a cancer.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Cisplatino/efeitos adversos , Neoplasias/tratamento farmacológico , Insuficiência Renal/induzido quimicamente , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Cisplatino/administração & dosagem , Docetaxel/administração & dosagem , Docetaxel/efeitos adversos , Relação Dose-Resposta a Droga , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/epidemiologia , Estudos Retrospectivos
19.
Lipids Health Dis ; 18(1): 90, 2019 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-30954084

RESUMO

BACKGROUND: Dyslipidemia is an important modifiable risk factor for cardiovascular disease. It is diagnosed by the presence of an abnormal lipid profile, primarily with elevated levels of plasma cholesterol, triglyceride, or both, or reduced levels of high-density lipoprotein cholesterol. However, some studies have reported increased risk of ischemic stroke with elevated low-density lipoprotein cholesterol (LDL-C) levels and increased risk of cardiovascular mortality independent of LDL-C levels in type 2 diabetes mellitus (T2DM) patients. METHODS: In this cross-sectional study, data were included for Thai adults with diabetes from the Diabetes Mellitus/ Hypertension (DM/HT) study, 2010-2014 (data was collected by the Medical Research Network of the Consortium of Thai Medical Schools). The target population comprised T2DM patients who were treated at a hospital for more than 12 months. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated to determine factors associated with dyslipidemia. RESULTS: In total, 140,557 participants (average age, 60 years) were enrolled, with a dyslipidemia prevalence of 88.9% in the cohort. The factors associated with dyslipidemia included female sex (aOR: 1.47, 95% CI: 1.38-1.56); age < 50 years (aOR: 1.16, 95% CI: 1.10-1.22); waist circumference ≥ 90 cm in males and ≥ 80 cm in females (aOR: 1.23, 95% CI: 1.16-1.31); treatment at a primary care unit (aOR: 1.28, 95% CI: 1.23-1.33); and a history of unknown stroke (aOR: 1.10, 95% CI: 1.02-1.19), coronary revascularization (aOR: 0.85, 95% CI: 0.79-0.91), diabetic nephropathy (aOR: 1.06, 95% CI: 1.01-1.12), or renal insufficiency (aOR: 1.08, 95% CI: 1.02-1.13). CONCLUSIONS: Dyslipidemia is prevalent among Thai T2DMpatients and is associated with gender; age; obesity; central obesity; treatment at a primary care unit; and a history of unknown stroke, coronary revascularization, diabetic nephropathy, and renal insufficiency. Our study results will help increase the awareness of healthcare providers regarding dyslipidemia in diabetic patients. To reduce cardiovascular risk, healthcare professionals should provide regular follow-up and proper advice and ensure primary prevention of vascular complications. Improved education and increased self-awareness regarding the need to change behaviors and regular intake of medication would help decrease dyslipidemia prevalence among diabetic patients.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/epidemiologia , Dislipidemias/epidemiologia , Insuficiência Renal/epidemiologia , Adulto , Idoso , Colesterol/sangue , LDL-Colesterol/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/etiologia , Dislipidemias/sangue , Dislipidemias/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/sangue , Obesidade Abdominal/epidemiologia , Obesidade Abdominal/etiologia , Intervenção Coronária Percutânea , Insuficiência Renal/sangue , Insuficiência Renal/etiologia , Fatores de Risco , População Rural , Tailândia/epidemiologia , Triglicerídeos/sangue
20.
World Neurosurg ; 128: e129-e147, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30981800

RESUMO

BACKGROUND: Traumatic brain injury (TBI) remains a life-threatening condition characterized by growing incidence worldwide, particularly in the aging population, in which the primary goal of treatment appears to be avoidance of chronic institutionalization. METHODS: To identify independent predictors of 30-day mortality or vegetative state in a geriatric population and calculate an intuitive scoring system, we screened 480 patients after TBI treated at a single department of neurosurgery over a 2-year period. We analyzed data of 214 consecutive patients aged ≥65 years, including demographics, medical history, cause and time of injury, neurologic state, radiologic reports, and laboratory results. A predictive model was developed using logistic regression modeling with a backward stepwise feature selection. RESULTS: The median Glasgow Coma Scale (GCS) score on admission was 14 (interquartile range, 12-15), whereas the 30-day mortality or vegetative state rate amounted to 23.4%. Starting with 20 predefined features, the final prediction model highlighted the importance of GCS motor score (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.09-0.32); presence of comorbid cardiac, pulmonary, or renal dysfunction or malignancy (OR, 2.86; 9 5% CI, 1.08-7.61); platelets ≤100 × 109 cells/L (OR, 13.60; 95% CI, 3.33-55.49); and red blood cell distribution width coefficient of variation ≥14.5% (OR, 2.91; 95% CI, 1.09-7.78). The discovered coefficients were used for nomogram development. It was further simplified to facilitate clinical use. The proposed scoring system, Elderly Traumatic Brain Injury Score (eTBI Score), yielded similar performance metrics. CONCLUSIONS: The eTBI Score is the first scoring system designed specifically for older adults. It could constitute a framework for clinical decision-making and serve as an outcome predictor. Its capability to stratify risk provides reliable criteria for assessing efficacy of TBI management.


Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Hemorragia Intracraniana Traumática/epidemiologia , Estado Vegetativo Persistente/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Contusão Encefálica/epidemiologia , Contusão Encefálica/mortalidade , Contusão Encefálica/terapia , Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/terapia , Tomada de Decisão Clínica , Comorbidade , Tratamento Conservador , Craniotomia , Descompressão Cirúrgica , Índices de Eritrócitos , Feminino , Escala de Coma de Glasgow , Cardiopatias/epidemiologia , Humanos , Hemorragia Intracraniana Traumática/mortalidade , Hemorragia Intracraniana Traumática/terapia , Modelos Logísticos , Pneumopatias/epidemiologia , Masculino , Mortalidade , Neoplasias/epidemiologia , Nomogramas , Inibidores da Agregação de Plaquetas/uso terapêutico , Contagem de Plaquetas , Prognóstico , Insuficiência Renal/epidemiologia , Medição de Risco , Ventriculostomia
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