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1.
Intern Med ; 59(14): 1741-1744, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32295999

RESUMO

TEMPI syndrome, a disease entity comprising telangiectasia, erythrocytosis with high erythropoietin, monoclonal gammopathy, perinephric fluid collection, and intrapulmonary shunting, was first described by Sykes et al. in 2011. To our knowledge, only 15 cases have been reported worldwide, none of which were in Japan. We herein report a 47-year-old man who had intractable ascites for 2 and a half years and was referred to our department for a peritoneovenous shunt. In addition to ascites, he had telangiectasia, high erythropoietin, monoclonal gammopathy, and perinephric fluid collection. Thus, this is the first case of TEMPI syndrome in Japan.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/uso terapêutico , Bortezomib/uso terapêutico , Gamopatia Monoclonal de Significância Indeterminada/tratamento farmacológico , Policitemia/tratamento farmacológico , Telangiectasia/tratamento farmacológico , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Gamopatia Monoclonal de Significância Indeterminada/diagnóstico , Gamopatia Monoclonal de Significância Indeterminada/epidemiologia , Policitemia/diagnóstico , Policitemia/epidemiologia , Telangiectasia/diagnóstico , Telangiectasia/epidemiologia , Resultado do Tratamento
2.
Transplant Proc ; 52(4): 1169-1172, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32164957

RESUMO

INTRODUCTION: Renal transplantation presents multiple complications after its completion, some of them related to the behavior of hemoglobin levels. The objective of this study is to determine the behavior and prevalence of anemia and erythrocytosis in the first year after renal transplantation. MATERIAL AND METHODS: A retrospective, observational study was conducted of a cohort of patients of the 21st Century National Medical Center in Mexico of transplants performed from January 1, 2013 to December 31, 2017. A total of 649 met the inclusion criteria. Pre-transplant hemoglobin (Hb) levels were determined, as well as levels 1 month, 3, 6, 9, and 12 months after transplantation, and the prevalence of anemia and erythrocytosis was determined in each month. Descriptive analysis was performed with measures of central tendency and measures of dispersion. The statistical program SPSS version 25 was used. RESULTS: The mean pre-transplant Hb was 10.69 g/dL (standard deviation [SD] 2.04). One year after the renal transplant, Hb averaged 14.45 g/dL (SD 2.30), which meant an increase over the first year after renal transplantation of 3.76 g/dL. Pre-transplant anemia occurred in 73.1% of patients, and erythrocytosis in 0.1%; 12.9% of patients and 5.9% in erythrocytosis continued with anemia for a year. CONCLUSIONS: Renal transplantation allows Hb levels to recover in a multifactorial way; however, the persistence of anemia and erythrocytes creates a study challenge in any transplant unit, due to their prevalence of 12.9 and 5.9% respectively.


Assuntos
Anemia/epidemiologia , Transplante de Rim/efeitos adversos , Policitemia/epidemiologia , Adulto , Anemia/etiologia , Estudos de Coortes , Feminino , Hemoglobinas/análise , Humanos , Masculino , México , Pessoa de Meia-Idade , Policitemia/etiologia , Prevalência , Estudos Retrospectivos , Adulto Jovem
3.
Transfusion ; 60(5): 947-954, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32176332

RESUMO

BACKGROUND: Blood donors receiving testosterone replacement therapy (TRT) often require therapeutic phlebotomy due to erythrocytosis. Red blood cells (RBCs) donated by eligible TRT donors are approved for collection and transfusion. This study was aimed at defining the prevalence and demographic determinants of TRT donors at a large USA blood service organization. STUDY DESIGN: Donation data from TRT donors and matched controls was collected from a de-identified electronic donor database across 16 blood centers in 2017-2018. Demographic determinants included race, sex, age, hemoglobin (Hb), body mass index (BMI), mean arterial pressure (MAP), and the frequency of donations in the 2-year period. RESULTS: TRT donors comprised 1.6% of the donor population and produced 2.2% of RBC units during 2018. TRT donors were likely to be middle-aged white or Hispanic men, with high prevalence of obesity (50.8% of TRT donors had BMI ≥30 kg/m2 compared with 36.2% in controls) and intensive donation frequency (1 to 29 donations in 2 years vs. 1 to 12 in controls). TRT donors had significantly (p < 0.0001) higher MAP and Hb compared with controls (MAP 99.9 ± 9.81 vs. 96.5 ± 10.1 mmHg; Hb 17.8 ± 1.44 vs. 15.6 ± 1.37 g/dL). One year of donations was associated with significant decreases in MAP and Hb for TRT donors. CONCLUSIONS: TRT is associated with high prevalence of erythrocytosis and obesity that may explain the intensive donation frequency, high MAP, and Hb. Frequent phlebotomies had a moderately positive effect on blood pressure and Hb levels. Potential implications of TRT on the quality of the RBC products require further evaluation.


Assuntos
Doadores de Sangue/estatística & dados numéricos , Terapia de Reposição Hormonal/estatística & dados numéricos , Testosterona/uso terapêutico , Adulto , Idoso , Bancos de Sangue/organização & administração , Bancos de Sangue/estatística & dados numéricos , Doadores de Sangue/provisão & distribução , Estudos de Casos e Controles , Feminino , Humanos , Hipogonadismo/sangue , Hipogonadismo/tratamento farmacológico , Hipogonadismo/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/epidemiologia , Policitemia/sangue , Policitemia/epidemiologia , Prevalência , Fatores Socioeconômicos , Estados Unidos/epidemiologia
4.
Medicine (Baltimore) ; 99(1): e18486, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895781

RESUMO

We have been examining the Comprehensive Health Check of the Fukushima Health Management Survey of residents of 13 municipalities who were forced by the government to evacuate due to the 2011 Great East Japan Earthquake (GEJE). Our findings showed that evacuation is a risk factor for polycythemia and suggested that experiencing an unprecedented disaster and exposure to chronic stress due to evacuation might be a cause of polycythemia.We analyzed the relationship between the prevalence of polycythemia and the following factors observed in the Mental Health and Lifestyle Survey in an observational study with a cross-sectional design: traumatic symptoms, depression status, socioeconomic factors such as residential environment, and working situation after the GEJE. Target population of the survey included men and women who were at least 15 years of age and who lived in the evacuation zones specified by the government. Participants analyzed consisted of 29,474 persons (12,379 men and 16,888 women) who had participated in both the 2011 Comprehensive Health Check and Mental Health and Lifestyle Survey from June 2011 through March 2012.The prevalence of polycythemia was not associated with mental states associated with traumatic symptoms (Post-Traumatic Stress Disorder Checklist Scale ≥ 44) and depression status (Kessler 6-item Scale ≥ 13). Furthermore, multivariate analysis showed that there was a tendency for males to develop polycythemia, with characteristics such as being aged 65 years and older, highly educated, obese (body mass index ≥ 25), hypertensive, diabetic, having liver dysfunction, and a smoker being significantly related to the prevalence of polycythemia.Our findings conclusively demonstrated that polycythemia was not significantly related to psychological factors, but was significantly related to the onset of lifestyle-related disease after the GEJE.


Assuntos
Acidente Nuclear de Fukushima , Policitemia/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Causalidade , Comorbidade , Terremotos , Feminino , Humanos , Japão/epidemiologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Policitemia/etiologia , Policitemia/psicologia , Prevalência , Tsunamis , Adulto Jovem
5.
Dis Markers ; 2019: 5946461, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31827636

RESUMO

Background: The hypoxic conditions at high altitudes are great threats to survival, causing pressure for adaptation. More and more high-altitude denizens are not adapted with the condition known as high-altitude polycythemia (HAPC) that featured excessive erythrocytosis. As a high-altitude sickness, the etiology of HAPC is still unclear. Methods: In this study, we reported the whole-genome sequencing-based study of 10 native Tibetans with HAPC and 10 control subjects followed by genotyping of selected 21 variants from discovered single nucleotide variants (SNVs) in an independent cohort (232 cases and 266 controls). Results: We discovered the egl nine homologue 3 (egln3/phd3) (14q13.1, rs1346902, P = 1.91 × 10-5) and PPP1R2P1 (Protein Phosphatase 1 Regulatory Inhibitor Subunit 2) gene (6p21.32, rs521539, P = 0.012). Our results indicated an unbiased framework to identify etiological mechanisms of HAPC and showed that egln3/phd3 and PPP1R2P1 may be associated with the susceptibility to HAPC. Egln3/phd3b is associated with hypoxia-inducible factor subunit α (HIFα). Protein Phosphatase 1 Regulatory Inhibitor is associated with reactive oxygen species (ROS) and oxidative stress. Conclusions: Our genome sequencing conducted in Tibetan HAPC patients identified egln3/phd3 and PPP1R2P1 associated with HAPC.


Assuntos
Doença da Altitude/diagnóstico , Biomarcadores/análise , Prolina Dioxigenases do Fator Induzível por Hipóxia/genética , Policitemia/diagnóstico , Polimorfismo de Nucleotídeo Único , Proteína Fosfatase 1/genética , Sequenciamento Completo do Genoma/métodos , Adulto , Idoso , Doença da Altitude/epidemiologia , Doença da Altitude/genética , Estudos de Casos e Controles , Feminino , Seguimentos , Genoma Humano , Genótipo , Humanos , Hipóxia , Masculino , Pessoa de Meia-Idade , Policitemia/epidemiologia , Policitemia/genética , Prognóstico , Tibet/epidemiologia
6.
J Assoc Physicians India ; 67(10): 20-24, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31571446

RESUMO

Background: Polycythemia is characterized by rise in hemoglobin and hematocrit, either as a result of hematopoietic clonal expansion (Vera) or secondary to hypoxic stimuli (secondary polycythemia).It is of great importance to detect early and identify the type of polycythemia and also asses the thrombotic risk so that timely and appropriate treatment can be given. The present study aims to characterize the different presentations and complications of polycythemia, evaluate genetic factors and differences between the two categories of polycythemia in ethnic Goan subjects. Aims and objectives: 1. To identify common presentations and etiologies of polycythemia 2. To evaluate and compare the differences in clinical features, hematological parameters and complications of polycythemia in primary (vera) and secondary polycythemia 3. To study the profile of JAK 2 V617F mutation in Goan patients with polycythemia Vera. Materials and Methods: This was a retrospective observational cohort study, conducted at the Department of Internal Medicine, Goa Medical College, a tertiary care, teaching institute in the state of Goa. We analysed clinical and laboratory data of patients of polycythemia due to all causes (polycythemia Vera and secondary causes) previously admitted or following up at the hospital from January 2014 to December 2017. In each of these 2 groups, we studied the various clinical parameters including the age at presentation,sex,residence, symptomatology and clinical findings,presence of hypertension, as well as complications arising due to polycythemia (past and at present) hematological data including Hb,HCT, total WBC count, absolute neutrophil count, RBC and platelet count, ESR, rouleaux formation, EPO levels and JAK 2 V617F mutation analysis (done by real time PCR technique) and requirement of phlebotomies in the last 4 years. Commonest clinical presentations and complications arising due to polycythemia, in each group were analysed and compared. Results: A total of 44 patients were included in the study out of which 33 were males. Polycythemia Vera was seen in 43.18% while secondary causes were seen in 56.8 % patients. Patients with Vera were found to be more symptomatic with higher levels of mean Hb, HCT, cell counts and with a higher requirement of phlebotomy and more thrombotic complications. Amongst Vera group, patients having high WBC count, increased Rouleau formation, and JAK2 positivity were found to be more prone for thrombosis. Hypertension was frequently seen to be associated with both groups. Obstructive sleep apnea followed by COPD was found to be the commonest causes of secondary polycythemia. Conclusion: Our study revealed that patients with polycythemia Vera are more symptomatic and have a higher requirement of phlebotomy and a higher thrombotic tendency (arterial being more common than venous) as compared to the secondary polycythemia owing to a higher hyperviscocity in the former. Leukocytosis and JAK 2 617F positivity were found to be important predictors of thrombotic risk. Hypertension was found to be frequently associated with Vera as well as in secondary causes due to OSA.


Assuntos
Policitemia/epidemiologia , Estudos de Coortes , Humanos , Índia , Masculino , Policitemia Vera , Estudos Retrospectivos , Centros de Atenção Terciária
7.
Fetal Diagn Ther ; 45(1): 13-20, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29332067

RESUMO

OBJECTIVES: To evaluate the incidence of residual anastomoses (RA) after laser therapy for twin-twin transfusion syndrome (TTS) and investigate risk factors for incomplete laser surgery. MATERIAL AND METHODS: All available TTS placentas treated with laser at our center between 2002 and 2016 were injected with color dye to assess the presence of RA. We evaluated the incidence of RA over the past 15 years by dividing the cohort into three time periods, and studied the association with risk factors and neonatal outcome. RESULTS: Overall, RA were detected in 21.0% (78/371) of placentas. The incidence of RA decreased from 38.8% (26/67) in the initial period to 11.7% (16/137) in the most recent period (p < 0.001). On multivariate analysis, several risk factors were independently associated with the risk of RA, including Solomon laser technique (odds ratio [OR] 0.17, 95% CI 0.09-0.33) and estimation of surgical success (OR 19.28, 95% CI 8.17-45.49). Premature delivery and neonatal morbidity occurred more often in TTS cases with RA. CONCLUSIONS: The incidence of RA after laser therapy for TTS decreased significantly in the past 15 years and is now below 15% due to the use of the Solomon technique.


Assuntos
Anastomose Arteriovenosa/cirurgia , Doenças em Gêmeos/cirurgia , Transfusão Feto-Fetal/cirurgia , Fetoscopia/efeitos adversos , Fotocoagulação a Laser/efeitos adversos , Placenta/irrigação sanguínea , Placenta/cirurgia , Circulação Placentária , Complicações Pós-Operatórias/epidemiologia , Anastomose Arteriovenosa/fisiopatologia , Doenças em Gêmeos/diagnóstico , Doenças em Gêmeos/epidemiologia , Doenças em Gêmeos/fisiopatologia , Feminino , Transfusão Feto-Fetal/diagnóstico , Transfusão Feto-Fetal/epidemiologia , Transfusão Feto-Fetal/fisiopatologia , Humanos , Incidência , Masculino , Países Baixos/epidemiologia , Policitemia/epidemiologia , Policitemia/fisiopatologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Gravidez , Recidiva , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
High Alt Med Biol ; 19(4): 398-403, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30251888

RESUMO

The present study was designed to define the hemoglobin [Hb] increase with altitude in Peruvian children. We suggest the normal range of [Hb] as means ±2 standard deviations (SD), with a value less than - 2 SD as a possible threshold to detect anemia. The prevalence of anemia was calculated. These values were compared to the World Health Organization (WHO) altitude correction parameter and the threshold for anemia of 11 g/dL. Likewise, polycythemia is suggested as [Hb] greater than 2 SD. 2,028,701 children aged 6-59 months were analyzed. The quadratic regression analysis shows that [Hb] is constant between sea level and 999 m. Thereafter, [Hb] increases from 11.32 g/dL (1000 m) up to ∼14.54 g/dL at 4000 m. Applying the threshold for anemia defined by WHO (11 g/dL) results in a prevalence of ∼35% for children living at altitudes <1000 m, and prevalence decreases to ∼4.5% at >4000 m. After [Hb] altitude correction, the prevalence was ∼36% (1000 m) and increases to ∼66% above 4000 m. With our proposed threshold for anemia, the prevalence was ∼15% below 1000 m and ∼5% above 4000 m. For polycythemia ([Hb] >14.5 g/dL), increases were from 1.2% at <1000 m to 39.4% at 4000 m. After [Hb] correction for altitude, the prevalence of polycythemia decreases with altitude. Excessive erythrocytosis defined as [Hb] >19 g/dL shows the highest values at 4000 m, while polycythemia defined as [Hb] greater than 2 SD was reduced at high altitude (HA). In conclusion, using WHO thresholds for anemia and [Hb] correction by altitude most likely overestimates the prevalence of anemia and may underestimate polycythemia in Peruvian children living at HA. Therefore, new threshold values for anemia and polycythemia as mean [Hb] less than 2 SD and greater than 2 SD for populations living at a specific altitude are suggested.


Assuntos
Altitude , Anemia/diagnóstico , Hemoglobinas/normas , Policitemia/diagnóstico , Anemia/epidemiologia , Pré-Escolar , Feminino , Hemoglobinas/análise , Humanos , Lactente , Masculino , Peru/epidemiologia , Policitemia/epidemiologia , Prevalência , Padrões de Referência , Valores de Referência , Análise de Regressão , Organização Mundial da Saúde
9.
J Hypertens ; 36(12): 2420-2424, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29847483

RESUMO

BACKGROUND: Polycythemia is characterized by increased blood viscosity and a chronic inflammatory state possibly giving rise to excessive thromboembolic events and hypertensive cardiovascular disease. We aimed to study the relationship between polycythemia and cardiac risk factors using a large national registry. METHODS: Patients more than 18 years with a diagnosis of polycythemia were identified from the National Inpatient Sample 2009-2010 database using International Classification of Diseases; Ninth Edition (ICD-9) code 238.4. Demographics, cardiac risk factors, and cardiovascular events were identified. RESULTS: Polycythemia was present in 0.1% (n = 37 922) of hospital-discharged patients. Patients with polycythemia had a significantly increased prevalence of all cardiac risk factors and events, except for diabetes mellitus and chronic kidney disease. Hypertension was more prevalent in polycythemia compared to controls (61 vs. 46%; P < 0.0001). After adjusting for age, sex, race, diabetes mellitus, hyperlipidemia, tobacco use, obesity, coronary artery disease, heart failure, and chronic kidney disease, polycythemia was still a determinant of hypertension [1.37 (1.28-1.45); P < 0.001]. CONCLUSION: Polycythemia had high prevalence of all cardiac risk factors and was independently associated with increased prevalence of hypertension even after adjusting. Our findings from the National Inpatient Sample provide an epidemiological correlate of Gaisböck's original observation of the association of polycythemia and hypertension more than a century ago.


Assuntos
Hipertensão/epidemiologia , Policitemia/epidemiologia , Idoso , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Síndrome , Estados Unidos/epidemiologia
10.
High Alt Med Biol ; 19(3): 221-231, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29782186

RESUMO

Corante, Noemí, Cecilia Anza-Ramírez, Rómulo Figueroa-Mujíca, José Luis Macarlupú, Gustavo Vizcardo-Galindo, Grzegorz Bilo, Gianfranco Parati, Jorge L. Gamboa, Fabiola León-Velarde, and Francisco C. Villafuerte. Excessive erythrocytosis and cardiovascular risk in Andean highlanders. High Alt Med Biol. 19:221-231, 2018.-Cardiovascular diseases are the main cause of death worldwide. Life under high-altitude (HA) hypoxic conditions is believed to provide highlanders with a natural protection against cardiovascular and metabolic diseases compared with sea-level inhabitants. However, some HA dwellers become intolerant to chronic hypoxia and develop a progressive incapacitating syndrome known as chronic mountain sickness (CMS), characterized by excessive erythrocytosis (EE; Hb ≥21 g/dL in men, Hb ≥19 g/dL in women). Evidence from HA studies suggests that, in addition to CMS typical signs and symptoms, these highlanders may also suffer from metabolic and cardiovascular disorders. Thus, we hypothesize that this syndrome is also associated to the loss of the cardiometabolic protection observed in healthy highlanders (HH), and therefore to a higher cardiovascular risk (CVR). The aim of the present work was to evaluate the association between EE and CVR calculated using the Framingham General CVR Score and between EE and CVR factors in male highlanders. This cross-sectional study included 342 males from Cerro de Pasco, Peru at 4340 m (HH = 209, CMS = 133). Associations were assessed by multiple logistic regressions adjusted for potential confounders (BMI, pulse oxygen saturation and age). The adjusted models show that the odds of high CVR (>20%) in highlanders with EE was 3.63 times the odds in HH (CI 95%:1.22-10.78; p = 0.020), and that EE is associated to hypertension, elevated fasting serum glucose, insulin resistance, and elevated fasting serum triglycerides. Our results suggest that individuals who suffer from EE are at increased risk of developing cardiovascular events compared with their healthy counterparts.


Assuntos
Altitude , Pressão Sanguínea , Doenças Cardiovasculares/epidemiologia , Policitemia/epidemiologia , Adolescente , Adulto , Idoso , Glicemia/metabolismo , Doenças Cardiovasculares/fisiopatologia , Estudos Transversais , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Policitemia/fisiopatologia , Fatores de Risco , Triglicerídeos/sangue , Adulto Jovem
11.
Nutr. hosp ; 35(1): 123-130, ene.-feb. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-172099

RESUMO

Objective: To evaluate the prevalence of anaemia and the risk of haemoconcentration and its risk factors during all 3 trimesters of pregnancy in women in a Mediterranean area in the south of Europe. Material and methods: Longitudinal study of 11,259 women whose pregnancies were monitored at primary care centres between 2007 and 2012. The computerised clinical histories of all the pregnancies were used to collect haemoglobin (Hb) data for each trimester. The histories also provided information on the age of the mother, her socioeconomic status, the presence of obesity, tobacco use, type of pregnancy, and number of previous pregnancies and births. Anaemia was defined as Hb < 110 g/L in the 1st and 3rd trimesters of pregnancy and Hb < 105 g/L in the second. The risk of haemoconcentration was defined as Hb > 130 g/L in the 2nd and 3rd trimesters of pregnancy. Results: The prevalence of anaemia increased from 3.8% in the first trimester to 21.5% in the 3rd trimester. Around 10% of the women had Hb > 130 g/L during the 3rd trimester. Having children previously and/or being younger than 20 increased the chances of anaemia (Adj. OR: 1.4; 95% CI: 1.1-1.9), but being older than 34 increased the chances of Hb > 130 g/L (Adj. OR: 1.3; 95% CI: 1.1-1.5). Conclusion: The increased prevalence of anaemia is a moderate public health problem. Understanding the factors that influence these problems may help improve the guidelines regarding the use of iron supplements (AU)


Objetivo: valorar la prevalencia de anemia y de riesgo de hemoconcentración y sus factores de riesgo durante los 3 trimestres de embarazo en las mujeres de una zona mediterránea del sur de Europa. Material y métodos: estudio longitudinal con 11.259 mujeres que realizaron el seguimiento de su embarazo en centros de atención primaria entre el 2007 y 2012. A partir de la historia clínica informatizada se recogieron datos de hemoglobina (Hb) de cada trimestre de gestación, edad de la madre, bajo nivel socioeconómico, presencia de obesidad, hábito tabáquico, tipo de embarazo, número de embarazos y partos previos. Se definió anemia como Hb < 110 g/L para el 1er y 3er trimestre de gestación y como Hb < 105 g/L para el 2º trimestre. Se definió riesgo de hemoconcentración a Hb > 130 g/L en el 2º y 3er trimestre. Resultados: la prevalencia de anemia aumentó del 3.8% en el primer trimestre al 21.5% en el 3er trimestre. Alrededor de un 10% de las mujeres tuvieron Hb > 130 g/L en el 3er trimestre. Tener hijos previos y/o ser menor de 20 años predispone a tener anemia (adj. OR: 1.4; 95% CI: 1.1-1.9), pero tener más de 34 años predispone a Hb > 130 g/L (adj. OR: 1.3; 95% CI: 1.1-1.5). Conclusión: la elevada prevalencia de anemia supone un problema moderado de salud pública. El conocimiento de los factores que pueden influir en dichas prevalencias puede ayudar a adaptar mejor la pauta de suplementación con hierro (AU)


Assuntos
Humanos , Feminino , Gravidez , Anemia/epidemiologia , Policitemia/epidemiologia , Anemia Ferropriva/epidemiologia , Deficiência de Ferro , Complicações na Gravidez/diagnóstico , Fatores de Risco , Estudos Longitudinais , Terceiro Trimestre da Gravidez
12.
Wilderness Environ Med ; 29(1): 18-28, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29338990

RESUMO

INTRODUCTION: The Kham Tibetans are one of several Tibetan ethnic subgroups living in the Kham area of China. Because studies on the high-altitude adaptation of the Kham people are scant, the main aim of this study is to investigate whether the response to hypoxia, especially polycythemia status, in the Kham Tibetans is different from other Tibetan ethnic subgroups. METHODS: The primary investigation was conducted on 346 native Kham Tibetan adults (268 men and 78 women) from 3 herdsmen villages located in Hongyuan County situated at an altitude of greater than 3600 m. The participants were aged 46.2±14.1 (21-82; mean±SD with range) years. Anthropometric measurements such as weight, height, waist circumference, body mass index, and blood pressure, as well as laboratory blood tests such as glycosylated hemoglobin, hemoglobin, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and uric acid were analyzed. RESULTS: The concentrations of hemoglobin were 171.3±12.9 (66-229) mg·L-1 and 151.4±16.4 (86-190) mg·L-1 in men and women, respectively. The frequency of polycythemia was found to be 25.5 and 21.8% in men and women, respectively. Polycythemia was found to be significantly associated with glycosylated hemoglobin concentrations, hypertension, and hyperuricemia (P=0.002, 0.023, and 0.009, respectively). CONCLUSIONS: There is a higher frequency of polycythemia in the Kham Tibetans when compared with reported studies from other Tibetan ethnic subgroups living on the Qinghai-Tibet plateau.


Assuntos
Dislipidemias/epidemiologia , Hiperglicemia/epidemiologia , Hipertensão/epidemiologia , Hiperuricemia/epidemiologia , Sobrepeso/epidemiologia , Policitemia/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Altitude , China/epidemiologia , Dislipidemias/etiologia , Feminino , Humanos , Hiperglicemia/etiologia , Hipertensão/etiologia , Hiperuricemia/etiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/etiologia , Sobrepeso/etiologia , Policitemia/etiologia , Tibet/etnologia , Adulto Jovem
13.
Am J Obstet Gynecol ; 218(1): 1-18, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29097178

RESUMO

BACKGROUND: The effects of delayed cord clamping of the umbilical cord in preterm infants are unclear. OBJECTIVE: We sought to compare the effects of delayed vs early cord clamping on hospital mortality (primary outcome) and morbidity in preterm infants using Cochrane Collaboration neonatal review group methodology. STUDY DESIGN: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Chinese articles, cross-referencing citations, expert informants, and trial registries to July 31, 2017, for randomized controlled trials of delayed (≥30 seconds) vs early (<30 seconds) clamping in infants born <37 weeks' gestation. Before searching the literature, we specified that trials estimated to have cord milking in >20% of infants in any arm would be ineligible. Two reviewers independently selected studies, assessed bias, and extracted data. Relative risk (ie, risk ratio), risk difference, and mean difference with 95% confidence intervals were assessed by fixed effects models, heterogeneity by I2 statistics, and the quality of evidence by Grading of Recommendations, Assessment, Development, and Evaluations. RESULTS: Eighteen randomized controlled trials compared delayed vs early clamping in 2834 infants. Most infants allocated to have delayed clamping were assigned a delay of ≥60 seconds. Delayed clamping reduced hospital mortality (risk ratio, 0.68; 95% confidence interval, 0.52-0.90; risk difference, -0.03; 95% confidence interval, -0.05 to -0.01; P = .005; number needed to benefit, 33; 95% confidence interval, 20-100; Grading of Recommendations, Assessment, Development, and Evaluations = high, with I2 = 0 indicating no heterogeneity). In 3 trials in 996 infants ≤28 weeks' gestation, delayed clamping reduced hospital mortality (risk ratio, 0.70; 95% confidence interval, 0.51-0.95; risk difference, -0.05; 95% confidence interval, -0.09 to -0.01; P = .02, number needed to benefit, 20; 95% confidence interval, 11-100; I2 = 0). In subgroup analyses, delayed clamping reduced the incidence of low Apgar score at 1 minute, but not at 5 minutes, and did not reduce the incidence of intubation for resuscitation, admission temperature, mechanical ventilation, intraventricular hemorrhage, brain injury, chronic lung disease, patent ductus arteriosus, necrotizing enterocolitis, late onset sepsis or retinopathy of prematurity. Delayed clamping increased peak hematocrit by 2.73 percentage points (95% confidence interval, 1.94-3.52; P < .00001) and reduced the proportion of infants having blood transfusion by 10% (95% confidence interval, 6-13%; P < .00001). Potential harms of delayed clamping included polycythemia and hyperbilirubinemia. CONCLUSION: This systematic review provides high-quality evidence that delayed clamping reduced hospital mortality, which supports current guidelines recommending delayed clamping in preterm infants. This review does not evaluate cord milking, which may also be of benefit. Analyses of individual patient data in these and other randomized controlled trials will be critically important in reliably evaluating important secondary outcomes.


Assuntos
Constrição , Recém-Nascido Prematuro , Cordão Umbilical , Índice de Apgar , Transfusão de Sangue , Feminino , Hematócrito , Mortalidade Hospitalar , Humanos , Hiperbilirrubinemia/epidemiologia , Recém-Nascido , Policitemia/epidemiologia , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
14.
Asian J Androl ; 20(2): 195-199, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29205178

RESUMO

A variety of methods for testosterone replacement therapy (TRT) exist, and the major potential risks of TRT have been well established. The risk of developing polycythemia secondary to exogenous testosterone (T) has been reported to range from 0.4% to 40%. Implantable T pellets have been used since 1972, and secondary polycythemia has been reported to be as low as 0.4% with this administration modality. However, our experience has suggested a higher rate. We conducted an institutional review board-approved, single-institution, retrospective chart review (2009-2013) to determine the rate of secondary polycythemia in 228 men treated with subcutaneously implanted testosterone pellets. Kaplan-Meyer failure curves were used to estimate time until the development of polycythemia (hematocrit >50%). The mean number of pellets administered was 12 (range: 6-16). The mean follow-up was 566 days. The median time to development of polycythemia whereby 50% of patients developed polycythemia was 50 months. The estimated rate of polycythemia at 6 months was 10.4%, 12 months was 17.3%, and 24 months was 30.2%. We concluded that the incidence of secondary polycythemia while on T pellet therapy may be higher than previously established.


Assuntos
Androgênios/administração & dosagem , Hipogonadismo/tratamento farmacológico , Policitemia/induzido quimicamente , Testosterona/administração & dosagem , Adulto , Idoso , Androgênios/efeitos adversos , Implantes de Medicamento , Hematócrito , Terapia de Reposição Hormonal/métodos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Policitemia/epidemiologia , Estudos Retrospectivos , Testosterona/efeitos adversos
15.
J Neonatal Perinatal Med ; 10(4): 387-392, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29286929

RESUMO

OBJECTIVES: To compare the incidence of polycythemia in newborns of women with hypertensive disorders in pregnancy (HDP) with those of normotensive mothers, to determine the incidence of perinatal stress using Apgar scores and to correlate hematocrit with Apgar scores in these newborn. STUDY DESIGN: This was a hospital-based comparative study conducted in the University of Port Harcourt Teaching Hospital, Nigeria. MAIN OUTCOME MEASURES: Apgar scores of 200 newborns- 100 from mothers with HDP (case group) and 100 from normotensive mothers (control group)- were taken at 1st and 5th minute of birth and cord blood samples collected to determine hematocrit. The subjects were categorized into polycythemic and non polycythemic using a hematocrit ≥65%. RESULTS: Eight percent of newborns of women with HDP had polycythemia while none of the controls did. Apgar scores in the case group with and without polycythemia at one-minute were 4.1±1.8 and 6.6±2.1, respectively and at 5 minutes were 6.9±1.7 and 8.5±1.4 respectively. Hematocrit correlated positively with Apgar scores (both at one and five minutes) in cases without polycythemia (r = 0.221, p = 0.034 and r = 0.255, p = 0.014). Hematocrit of polycythemic newborns did not correlate with Apgar scores (r = -0.287, p = 0.491 and r = -0.436, p = 0.281). CONCLUSION: The incidence of polycythemia is significantly higher in newborns of women with HDP and these polycythemic neonates had a significantly higher incidence of birth asphyxia. Therefore, birth outcome as determined by Apgar score is influenced by hematocrit.


Assuntos
Índice de Apgar , Asfixia Neonatal/epidemiologia , Hematócrito , Hipertensão/fisiopatologia , Policitemia/epidemiologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Adulto , Pressão Sanguínea , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Incidência , Recém-Nascido , Gravidez
18.
Eur Respir J ; 49(6)2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28619952

RESUMO

Associations between sleep disordered breathing (SDB) and cardiometabolic outcomes have not been examined in highlanders.We performed nocturnal polygraphy in Peruvian highlanders (3825 m). Multivariable linear regression models examined associations between SDB metrics and haemoglobin, glucose tolerance (haemoglobin A1c (HbA1c)), fasting glucose, homeostatic model-based assessments of insulin resistance and ß-cell function (HOMA-IR and HOMA-ß, respectively), blood pressure, and lipids, while adjusting for age, sex, body mass index (BMI) and wake oxygenation.Participants (n=187; 91 men) were (median (interquartile range)) 52 (45-62) years old, and had a BMI of 27.0 (24.3-29.5) kg·m-2 and 87% (85-88%) oxyhaemoglobin (arterial oxygen) saturation during wakefulness. In fully adjusted models, worsening nocturnal hypoxaemia was associated with haemoglobin elevations in men (p=0.03), independent of wake oxygenation and apnoea-hypopnoea index (AHI), whereas worsening wake oxygenation was associated with haemoglobin elevations in older women (p=0.02). In contrast, AHI was independently associated with HbA1c elevations (p<0.05). In single-variable models, nocturnal hypoxaemia was associated with higher HbA1c, HOMA-IR and HOMA-ß (p<0.001, p=0.02 and p=0.04, respectively), whereas AHI was associated with HOMA-IR, systolic blood pressure and triglyceride elevations (p=0.02, p=0.01 and p<0.01, respectively). These associations were not significant in fully adjusted models.In highlanders, nocturnal hypoxaemia and sleep apnoea were associated with distinct cardiometabolic outcomes, conferring differential risk for excessive erythrocytosis and glucose intolerance, respectively.


Assuntos
Altitude , Intolerância à Glucose , Hemoglobina A Glicada/análise , Oximetria , Policitemia , Síndromes da Apneia do Sono , Idoso , Determinação da Pressão Arterial/estatística & dados numéricos , Índice de Massa Corporal , Meio Ambiente , Feminino , Intolerância à Glucose/diagnóstico , Intolerância à Glucose/epidemiologia , Humanos , Resistência à Insulina/fisiologia , Lipídeos/análise , Masculino , Pessoa de Meia-Idade , Oximetria/métodos , Oximetria/estatística & dados numéricos , Peru/epidemiologia , Policitemia/diagnóstico , Policitemia/epidemiologia , Polissonografia/métodos , Fatores de Risco , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/metabolismo , Síndromes da Apneia do Sono/fisiopatologia
19.
Ter Arkh ; 89(1): 72-77, 2017.
Artigo em Russo | MEDLINE | ID: mdl-28252631

RESUMO

Concurrences of multiple myeloma with myeloproliferative diseases or secondary myeloid leukemoid reactions are rather rare. The paper describes 3 cases of multiple myeloma: the first case concurrent with neutrophilic leukocytosis; the second case with secondary erythropoetin-dependent erythrocytosis, and the third case with chronic myeloid leukemia. In such cases, an accurate diagnosis requires molecular testing, besides routine clinical and laboratory studies. The paper discusses therapeutic strategy in cases of a concurrence of 2 competing tumors of the blood system: to treat them simultaneously or the most aggressive tumor now, as well as a relationship between multiple myeloma and chronic myeloid leukemia, other myeloproliferative disorders, and secondary myeloid leukemoid reactions.


Assuntos
Leucemia Mieloide/diagnóstico , Leucocitose/diagnóstico , Mieloma Múltiplo/diagnóstico , Transtornos Mieloproliferativos/diagnóstico , Policitemia/diagnóstico , Adulto , Comorbidade , Feminino , Humanos , Leucemia Mieloide/epidemiologia , Leucemia Mieloide/terapia , Leucocitose/epidemiologia , Leucocitose/terapia , Pessoa de Meia-Idade , Mieloma Múltiplo/epidemiologia , Mieloma Múltiplo/terapia , Transtornos Mieloproliferativos/epidemiologia , Transtornos Mieloproliferativos/terapia , Policitemia/epidemiologia , Policitemia/terapia
20.
J Urol ; 196(6): 1715-1720, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27287525

RESUMO

PURPOSE: We studied the incidence and risk factors for the development of erythrocytosis with implantable testosterone pellets. MATERIALS AND METHODS: A multi-institutional retrospective database analysis was used to evaluate men treated with testosterone pellets between 2009 and 2014. Inclusion criteria consisted of adult, hypogonadal males who had a full complement of pretreatment and posttreatment surveillance studies. Pretreatment and posttreatment values were compared with Wilcoxon signed rank tests. Multiple linear regression was used to identify potential risk factors for significant hematocrit elevation. RESULTS: A total of 97 patients were included in the study. The average age of the cohort was 52 years (range 24 to 80). Mean hematocrit before and after pellet implantation was 43.9% and 46.1%, respectively, corresponding to an increase of 2.2% (CI 1.4-2.9, p <0.001). The average increase in testosterone was 145.3 ng/dl from an initial mean of 278.9 ng/dl (CI 105.7-184.9, p <0.001). Multiple linear regression demonstrated that pretreatment hematocrit was inversely related to the expected change in hematocrit. Pretreatment comorbidity status (ie the presence of hypertension, hyperlipidemia, obesity or diabetes) was not associated with a significant increase in posttreatment hematocrit. CONCLUSIONS: Although the data demonstrate a statistically significant increase in hematocrit, an increment of 2.2% is unlikely to translate into clinical relevance. Thus, for this cohort of patients implantable testosterone pellets appear safe in terms of the risk of polycythemia. Pretreatment hematocrit may serve as a predictor of a significant hematocrit increase after the initiation of therapy.


Assuntos
Hematócrito , Hipogonadismo/tratamento farmacológico , Policitemia/induzido quimicamente , Policitemia/epidemiologia , Testosterona/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Implantes de Medicamento , Humanos , Masculino , Pessoa de Meia-Idade , Policitemia/sangue , Estudos Retrospectivos , Fatores de Risco , Testosterona/administração & dosagem
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