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1.
J Surg Res ; 257: 56-68, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32818785

RESUMO

BACKGROUND: Burn injuries (BIs) due to scalding are one of the most common accidents among children. BIs greater than 40% of total body surface area are considered extensive and result in local and systemic response. We sought to assess morphological and myogenic mechanisms through both short- and long-term intensive insulin therapies that affect the skeletal muscle after extensive skin BI in young rats. MATERIALS AND METHODS: Wistar rats aged 21 d were distributed into four groups: control (C), control with insulin (C + I), scald burn injury (SI), and SI with insulin (SI + I). The SI groups were submitted to a 45% total body surface area burn, and the C + I and SI + I groups received insulin (5 UI/Kg/d) for 4 or 14 d. Glucose tolerance and the homeostatic model assessment of insulin resistance index were determined. Gastrocnemius muscles were analyzed for histopathological, morphometric, and immunohistochemical myogenic parameters (Pax7, MyoD, and MyoG); in addition, the expression of genes related to muscle atrophy (MuRF1 and MAFbx) and its regulation (IGF-1) were also assessed. RESULTS: Short-term treatment with insulin favored muscle regeneration by primary myogenesis and decreased muscle atrophy in animals with BIs, whereas the long-term treatment modulated myogenesis by increasing the MyoD protein. Both treatments improved histopathological parameters and secondary myogenesis by increasing the MyoG protein. CONCLUSIONS: Treatment with insulin benefits myogenic parameters during regeneration and modulates MuRF1, an important mediator of muscle atrophy.


Assuntos
Queimaduras/complicações , Insulina/administração & dosagem , Desenvolvimento Muscular/efeitos dos fármacos , Atrofia Muscular/prevenção & controle , Animais , Glicemia/análise , Superfície Corporal , Queimaduras/patologia , Queimaduras/fisiopatologia , Expressão Gênica/efeitos dos fármacos , Fator de Crescimento Insulin-Like I/genética , Masculino , Proteínas Musculares/genética , Músculo Esquelético/química , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Atrofia Muscular/etiologia , Atrofia Muscular/genética , Proteína MyoD/análise , Miogenina/análise , Fatores de Transcrição Box Pareados/análise , Ratos , Ratos Wistar , Proteínas Ligases SKP Culina F-Box/genética , Proteínas com Motivo Tripartido/genética , Ubiquitina-Proteína Ligases/genética
2.
Am J Cardiol ; 143: 145-153, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33352210

RESUMO

Aortic Z-score (Z-score) is utilized in clinical trials to monitor the effect of medications on aortic dilation rate in Marfan (MFS) patients. Z-scores are reported in relation to body surface area and therefore are a function of height and weight. However, an information void exists regarding natural, non-pharmacological changes in Z-scores as children age. We had concerns that Z-score decrease attributed to "therapeutic" effects of investigational drugs for Marfan disease connective tissue diseases might simply reflect normal changes ("filling out" of body contour) as children age. This investigation studies natural changes with age in Z-score in normal and untreated MFS children, teasing out normal effects that might erroneously be attributed to drug benefit. (1) We first compared body mass index (BMI) and Z-scores (Boston Children's Hospital calculator) in 361 children with "normal" single echo exams in four age ranges (0 to 1, 5 to 7, 10 to 12, 15 to 18 years). Regression analysis revealed that aging itself decreases ascending Z-score, but not root Z-score, and that increase in BMI with aging underlies the decreased Z-scores. (2) Next, we examined Z-score findings in both "normal" and Marfan children (all pharmacologically untreated) as determined on sequential echo exams over time. Of 27 children without aortic disease with sequential echos, 19 (70%) showed a natural decrease in root Z-score and 24 (89%) showed a natural decrease in ascending Z- score, over time. Of 25 untreated MFS children with sequential echos, 12 (40%) showed a natural decrease in root Z-score and 10 (33%) showed a natural decrease in ascending Z-score. Thus, Z-score is over time affected by natural factors even in the absence of any aneurysmal pathology or medical intervention. Specifically, Z-score decreases spontaneously as a natural phenomenon as children age and with fill out their BMI. Untreated Marfan patients often showed a spontaneous decrease in Z-score. In clinical drug trials in aneurysm disease, decreasing Z-score has been interpreted as a sign of beneficial drug effect. These data put such conclusions into doubt.


Assuntos
Aorta/crescimento & desenvolvimento , Aneurisma Aórtico/diagnóstico por imagem , Síndrome de Marfan/diagnóstico por imagem , Adolescente , Aorta/diagnóstico por imagem , Aneurisma Aórtico/tratamento farmacológico , Aneurisma Aórtico/etiologia , Índice de Massa Corporal , Superfície Corporal , Estudos de Casos e Controles , Criança , Pré-Escolar , Ensaios Clínicos como Assunto , Ecocardiografia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Síndrome de Marfan/complicações , Síndrome de Marfan/tratamento farmacológico , Avaliação de Resultados em Cuidados de Saúde
3.
Med. infant ; 27(2): 120-124, Diciembre 2020. ilus, Tab
Artigo em Espanhol | LILACS, BINACIS, UNISALUD | ID: biblio-1148111

RESUMO

La correcta evaluación de la extensión de las quemaduras influye directamente en la terapéutica inicial instituida y la referencia al centro especializado. El objetivo de este trabajo ha sido cuantificar las diferencias de los porcentajes de superficie corporal quemada (%SCQ) estimados entre los hospitales de derivación y la Unidad de Quemados del Hospital de Pediatría Juan P. Garrahan, correspondientes a los niños internados entre los años 2014 y 2019. Se realizó una revisión retrospectiva de 221 historias clínicas digitalizadas, siendo que 154 de ellas contaban con estimaciones de %SCQ de los hospitales de derivación. Se compararon dichas estimaciones con las reales de la Unidad de Quemados con un nivel de exactitud del 100% y, además, las diferencias se expresaron como un porcentual del %SCQ real como subestimado (<20%), satisfactorio (<20 a 20%) y sobrestimado (>20%). Las variables secundarias (edad, mortalidad y estancia hospitalaria) fueron evaluadas en cada grupo. De los 154 pacientes estudiados, 36 fueron subestimados, 32 estimados satisfactoriamente y 86 fueron sobrestimados, al considerar un nivel de exactitud del 100%. La relación entre sobrestimación y estimación satisfactoria fue de 2.6:1 mientras que la subestimación y estimación satisfactoria fue 1.1:1. La relación entre sobrestimación y subestimación fue de 2.4:1. Se constató una diferencia global significativa de 5% ±10.87 DS (IC95% 3.06­6.96) entre las estimaciones de los hospitales de derivación y la Unidad de Quemados (p<0.00001), con notable inclinación a la sobrestimación. No hubo diferencias estadísticas entre las variables secundarias según los grupos (AU)


Adequate evaluation of the extent of burn wounds directly influences the initial management of the patient and the referral to a specialized center. The aim of this study was to quantify the differences in the estimated percent total body surface area (%TBSA) affected by the burns between the referring hospitals and the Burn Unit at Hospital de Pediatría Juan P. Garrahan of children admitted between 2014 and 2019. A retrospective review of 221 electronic records was conducted, in 154 of whom %TBSA was estimated at the referring hospitals. These estimates were compared with those performed at the Burn Unit with an accuracy level of 100%. In addition, the differences were expressed as a percentage of the actual %TBSA as underestimated (<20%), satisfactory (<20 to 20%), overestimated (>20%). Secondary variables (age, mortality, and hospital stay) were evaluated in each group. Of the 154 patients, %TBSA was underestimated in 36, estimated satisfactorily in 32, and overestimated in 86, considering a 100% level of accuracy. The ratio of overestimation to satisfactory estimation was 2.6:1, while the ratio of underestimation to satisfactory estimation was 1.1:1. The ratio of overestimation to underestimation was 2.4:1. A significant overall difference of 5% ±10.87 SD (95% CI 3.06­6.96) was found between the estimates of referring hospitals and the Burn Unit (p<0.00001), with a marked proclivity to overestimation. No statistical differences were found in secondary variables between the groups (AU)


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Superfície Corporal , Unidades de Queimados , Queimaduras , Escala de Gravidade do Ferimento , Estudos Retrospectivos , Estudos Longitudinais , Serviço Hospitalar de Emergência
4.
PLoS One ; 15(10): e0239212, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031479

RESUMO

BACKGROUND: Estimation of total body water (TBW) is essential for clinical care. OBJECTIVE: Evaluation of changes in TBW by bioelectrical impedance analysis (BIA) in children and young adults with excessive weight. DESIGN: Data was collected in individuals aged 3-21 years with normal (n = 202) or excessive body weight (n = 133). The BIA results from individuals with normal weight were compared with two previously published studies in children by isotope dilution methods. RESULTS: Individuals with excessive weight had a higher mean TBW (27.87 L, SE 0.368) for height and age as compared to individuals with normal weight (23.95 L, SE 0.298), P<0.001. However, individuals with excessive weight had lower mean TBW (24.93 L, SE 0.37) for weight and body surface area (BSA) as compared to individuals with normal weight (26.94 L, SE 0.287), P<0.001. Comparison with two previously published studies showed no significant differences in mean TBW with one ((p = 1.00) but a significant difference with another study (p = 0.001). CONCLUSIONS: Individuals with excessive weight had 16.5% higher mean TBW for height and age and 7.4% lower TBW for weight and BSA as compared to normal weight individuals. Our study validates the feasibility of data collection in pediatric outpatient setting by BIA.


Assuntos
Água Corporal/química , Peso Corporal , Adolescente , Índice de Massa Corporal , Superfície Corporal , Criança , Pré-Escolar , Impedância Elétrica , Feminino , Humanos , Masculino , Adulto Jovem
5.
Medicine (Baltimore) ; 99(35): e21891, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871919

RESUMO

To analyze the relationship between aortic measures and biometric parameters in a large cohort of consecutive patients undergoing computed tomography coronary angiography.1170 patients (717 men/453 women) performing computed tomography coronary angiography for coronary evaluation were retrospectively evaluated. Aortic diameters and areas were measured at reproducible anatomic landmarks, perpendicular to the axis of vessel, at the level of the aortic root (AoR), the sinotubular junction (STJ), and the tubular ascending aorta (TAo). Biometric parameters and cardiovascular risk factors were recorded.The average values of AoR, STJ, and TAo were 35.63 ±â€Š5.00 mm, 30.56 ±â€Š4.82 mm, 35.07 ±â€Š5.84 mm. Hypertension was significantly associated with aortic dimensions.Aortic measures were significantly different between men and women (37.56 ±â€Š4.77 mm vs 32.58 ±â€Š3.68 mm for AoR, 31.88 ±â€Š4.84 mm vs 28.47 ±â€Š3.98 mm for STJ and 35.93 ±â€Š5.86 mm vs 33.70 ±â€Š5.54 mm for TAo) (P < .001) and linearly increased with age. Low Spearman correlation coefficients were found and the correlation of TAo diameters with age displayed the highest values (ρ = 0.372 for male and ρ = 0.373 for female, P < .001). Multiple linear regression analysis models were compared by R. The best model used body surface area (BSA) and age as independent variables and TAo diameter as dependent variable (R = 0.29 for AoR; R = 0.21 for STJ, and R = 0.20 for TAo).In conclusion, in our population low correlation between aortic dimensions and biometric parameters highlights the difficulty of identifying normal ranges, as well as issues related to normalization using conventional biometric parameters.


Assuntos
Aorta/anatomia & histologia , Aorta/diagnóstico por imagem , Biometria , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/patologia , Angiografia Coronária , Tomografia Computadorizada por Raios X , Fatores Etários , Idoso , Superfície Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
6.
Medicine (Baltimore) ; 99(31): e21486, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756177

RESUMO

The diameter of femoral vessels was angiographically explored in pediatric patients with congenital heart disease (CHD) and compared with anthropometric and demographic indexes.A total of 153 pediatric patients younger than 3 years old were recruited. The sex, age, weight, and height of patients were recorded daily, and the body surface area (BSA) was calculated with the Mosteller formula.The values of mean left-right diameters were 3.13 (0.32) mm for the femoral artery (FA) and 5.14 (0.68) mm for the femoral vein (FV). The FA diameter (FA-Dm) and FV diameter (FV-Dm) were clearly related (R = 0.84, P < .001), and the FA-Dm/FV-Dm ratio ranged from 0.61 to 0.622. The diameters of femoral vessels were significantly correlated with age, height, weight and BSA (R = 0.63 to 0.73, P < .001). The FA-Dm and FV-Dm were most closely associated with the height of patients (FA-Dm: R = 0.73, P < .001; FV-Dm: R = 0.69, P < .001).The FV-Dm and FA-Dm were consistent with the weight, height, age and BSA in the surveyed pediatric patients. The FA-Dm and FV-Dm were closely associated with the height of pediatric patients. Furthermore, the FA-Dm/FV-Dm ratio was stable in these patients. Such estimations could help clinicians select the appropriate diameter of cannulation needles and catheters for interventional therapy pediatric patients with CHD.


Assuntos
Angiografia/estatística & dados numéricos , Artéria Femoral/diagnóstico por imagem , Veia Femoral/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Angiografia/métodos , Antropometria , Superfície Corporal , Feminino , Cardiopatias Congênitas/patologia , Humanos , Lactente , Masculino , Valores de Referência
7.
Zhonghua Shao Shang Za Zhi ; 36(7): 600-602, 2020 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-32842409

RESUMO

On February 6, 2017, one male patient aged 25 years with total burn area of 99% total body surface area (TBSA) and full-thickness burn area of 95% TBSA was transferred from a primary hospital to the Second Affiliated Hospital of Zhejiang University School of Medicine one day post injury. On admission, the patient was clearly conscious, with tracheotomy ventilator assisted ventilation, and received rehydration, antishock, anti-infection, nutritional support, debridement, skin grafting, and negative pressure treatment. During the hospitalization, the patient was in critical condition and 28 central venous catheterizations and 1 peripherally inserted central catheter were performed.Based on multidisciplinary cooperation and on the premise of full risk assessment, nurses focused on strengthening the nursing of central venous catheter related infection. The measures for central venous catheter care were improved after detection of carbapenems resistant Klebsiella pneumoniae from catheter tip attachment, wound exudate, and blood culture, active prevention measure targeted at thrombosis around central venous catheter was performed, and prevention of unplanned extubation was emphasized during the use of rotating bed, soaking bath, and agitation of patient. On the 171st day of admission, peripherally inserted central venous catheter was performed by intravenous therapy nurse specialist on the scar formation site of the right upper arm. The catheter was withdrawn after indwelling for 55 days and the patient recovered and was discharged. During follow-up of 18 months, the patient recovered well.


Assuntos
Queimaduras , Cateterismo Venoso Central , Adulto , Superfície Corporal , Cateterismo Periférico , Humanos , Masculino , Estudos Retrospectivos
8.
Am J Physiol Endocrinol Metab ; 319(2): E438-E446, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32691633

RESUMO

Understanding mouse thermal physiology informs the usefulness of mice as models of human disease. It is widely assumed that the mouse tail contributes greatly to heat loss (as it does in rat), but this has not been quantitated. We studied C57BL/6J mice after tail amputation. Tailless mice housed at 22°C did not differ from littermate controls in body weight, lean or fat content, or energy expenditure. With acute changes in ambient temperature from 19 to 39°C, tailless and control mice demonstrated similar body temperatures (Tb), metabolic rates, and heat conductances and no difference in thermoneutral point. Treatment with prazosin, an α1-adrenergic antagonist and vasodilator, increased tail temperature in control mice by up to 4.8 ± 0.8°C. Comparing prazosin treatment in tailless and control mice suggested that the tail's contribution to total heat loss was a nonsignificant 3.4%. Major heat stress produced by treatment at 30°C with CL316243, a ß3-adrenergic agonist, increased metabolic rate and Tb and, at a matched increase in metabolic rate, the tailless mice showed a 0.72 ± 0.14°C greater Tb increase and 7.6% lower whole body heat conductance. Thus, the mouse tail is a useful biomarker of vasodilation and thermoregulation, but in our experiments contributes only 5-8% of whole body heat dissipation, less than the 17% reported for rat. Heat dissipation through the tail is important under extreme scenarios such as pharmacological activation of brown adipose tissue; however, non-tail contributions to heat loss may have been underestimated in the mouse.


Assuntos
Regulação da Temperatura Corporal/fisiologia , Modelos Animais , Cauda/fisiologia , Antagonistas de Receptores Adrenérgicos alfa 1 , Amputação , Animais , Composição Corporal/fisiologia , Superfície Corporal , Regulação da Temperatura Corporal/efeitos dos fármacos , Peso Corporal/fisiologia , Metabolismo Energético/fisiologia , Resposta ao Choque Térmico , Camundongos , Camundongos Endogâmicos C57BL , Prazosina/farmacologia , Ratos , Cauda/cirurgia , Vasodilatação/fisiologia
9.
Circ Arrhythm Electrophysiol ; 13(8): e008253, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32634327

RESUMO

BACKGROUND: Normative ECG values for children are based on relatively few subjects and are not standardized, resulting in interpersonal variability of interpretation. Recent advances in digital technology allow a more quantitative, reproducible assessment of ECG variables. Our objective was to create the foundation of normative ECG standards in the young utilizing Z-scores. METHODS: One hundred two ECG variables were collected from a retrospective cohort of 27 085 study subjects with no known heart condition, ages 0 to 39 years. The cohort was divided into 16 age groups by sex. Median, interquartile range, and range were calculated for each variable adjusted to body surface area. RESULTS: Normative standards were developed for all 102 ECG variables including heart rate; P, R, and T axis; R-T axis deviation; PR interval, QRS duration, QT, and QTc interval; P, Q, R, S, and T amplitudes in 12 leads; as well as QRS and T wave integrals. Incremental Z-score values between -2.5 and 2.5 were calculated to establish upper and lower limits of normal. Historical ECG interpretative concepts were reassessed and new concepts observed. CONCLUSIONS: Electronically acquired ECG values based on the largest pediatric and young adult cohort ever compiled provide the first detailed, standardized, quantitative foundation of traditional and novel ECG variables. Expression of ECG variables by Z-scores lends an objective and reproducible evaluation without interpreter bias that can lead to more confident establishment of ECG-disease correlations and improved automated ECG readings in high-volume cardiac screening efforts in the young. Graphic Abstract: A graphic abstract is available for this article.


Assuntos
Potenciais de Ação , Eletrocardiografia/normas , Sistema de Condução Cardíaco/fisiologia , Frequência Cardíaca , Adolescente , Adulto , Fatores Etários , Superfície Corporal , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Valor Preditivo dos Testes , Valores de Referência , Estudos Retrospectivos , Adulto Jovem
10.
Am J Physiol Heart Circ Physiol ; 319(2): H432-H442, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32618514

RESUMO

Pulmonary artery (PA) morphometry has been extensively explored in adults, with particular focus on intra-acinar arteries. However, scaling law relationships for length and diameter of extensive preacinar PAs by age have not been previously reported for in vivo human data. To understand preacinar PA growth spanning children to adults, we performed morphometric analyses of all PAs visible in the computed tomography (CT) and magnetic resonance (MR) images from a healthy subject cohort [n = 16; age: 1-51 yr; body surface area (BSA): 0.49-2.01 m2]. Subject-specific anatomic PA models were constructed from CT and MR images, and morphometric information-diameter, length, tortuosity, bifurcation angle, and connectivity-was extracted and sorted into diameter-defined Strahler orders. Validation of Murray's law, describing optimal scaling exponents of radii for branching vessels, was performed to determine how closely PAs conform to this classical relationship. Using regression analyses of vessel diameters and lengths against orders and patient metrics (BSA, age, height), we found that diameters increased exponentially with order and allometrically with patient metrics. Length increased allometrically with patient metrics, albeit weakly. The average tortuosity index of all vessels was 0.026 ± 0.024, average bifurcation angle was 28.2 ± 15.1°, and average Murray's law exponent was 2.92 ± 1.07. We report a set of scaling laws for vessel diameter and length, along with other morphometric information. These provide an initial understanding of healthy structural preacinar PA development with age, which can be used for computational modeling studies and comparison with diseased PA anatomy.NEW & NOTEWORTHY Pulmonary artery (PA) morphometry studies to date have focused primarily on large arteries and intra-acinar arteries in either adults or children, neglecting preacinar arteries in both populations. Our study is the first to quantify in vivo preacinar PA morphometry changes spanning infants to adults. For preacinar arteries > 1 mm in diameter, we identify scaling laws for vessel diameters and lengths with patient metrics of growth and establish a healthy PA morphometry baseline for most preacinar PAs.


Assuntos
Envelhecimento , Angiografia por Tomografia Computadorizada , Angiografia por Ressonância Magnética , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/crescimento & desenvolvimento , Adolescente , Adulto , Fatores Etários , Estatura , Superfície Corporal , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Adulto Jovem
14.
Int J Hematol ; 112(3): 369-376, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32529585

RESUMO

Rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) is one of the standard regimens for indolent B-cell non-Hodgkin's lymphoma (NHL). It is unclear whether the prednisolone (PSL) dosage affects the therapeutic effect or the adverse event profile. We retrospectively examined 48 patients with indolent B-cell NHL who were treated with R-CHOP (PSL 50 mg/m2/day for 5 days) at our institute between 2006 and 2016. We compared them with 149 patients with indolent B-cell lymphoma who were treated with R-CHOP (PSL 100 mg for 5 days) in the JCOG 0203 trial. The proportions of patients with bulky disease, extranodal involvement, and increased nodal sites were higher at our institute. Nevertheless, there was no difference in the CR rate, PFS, OS or the frequency of adverse events, except for peripheral neuropathy, between the two treatment groups. In our institute, there was no difference in the CR rate, PFS, OS or adverse event profile between patients who received PSL at 60-80 mg/day and at 81-100 mg/day. Patients who received PSL at 60-80 mg/day included many female and light-weight patients. In conclusion, the PSL dose adjusted based on body surface area appeared to be appropriate in terms of efficacy and safety.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma Folicular/tratamento farmacológico , Prednisolona/administração & dosagem , Rituximab/administração & dosagem , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Superfície Corporal , Ciclofosfamida/efeitos adversos , Ciclofosfamida/uso terapêutico , Intervalo Livre de Doença , Doxorrubicina/efeitos adversos , Doxorrubicina/uso terapêutico , Cálculos da Dosagem de Medicamento , Feminino , Humanos , Linfoma Folicular/mortalidade , Linfoma não Hodgkin/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prednisolona/efeitos adversos , Prednisona/efeitos adversos , Prednisona/uso terapêutico , Indução de Remissão , Estudos Retrospectivos , Rituximab/efeitos adversos , Rituximab/uso terapêutico , Resultado do Tratamento , Vincristina/efeitos adversos , Vincristina/uso terapêutico
17.
PLoS One ; 15(5): e0233310, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32428014

RESUMO

BACKGROUND: No study has compared the clinical impact of indexation of left ventricular mass (LVM) on adverse clinical outcomes in pre-dialysis patients with chronic kidney disease (CKD). METHODS: We reviewed 2,101 patients from a large-scale multi-center prospective study that gathered anthropometric and echocardiographic measurements and clinical outcomes. The LVM was indexed as body surface area (LVMI-BSA) and height raised to the power of 2.7 (LVMI-H2.7). The main outcomes were composite renal and cardiovascular events and all-cause mortality. Left ventricular hypertrophy (LVH) was defined as the highest sex-specific quartile of LVMI-BSA or LVMI-H2.7. RESULTS: During a mean period of 3.5 years, 692 patients developed composite outcomes (32.9%). The area under the curve at 5 year of LVM (60.6%) for composite outcome was smaller than that for LVMI-BSA (63.2%, P <0.001) and LVMI-H2.7 (63.4%, P <0.001). The hazard ratio (HR) and 95% confidence interval (CI) per one unit increase in LVM (g), LVMI-BSA (g/m2), and LVMI-H2.7 (g/m2.7) for composite outcomes were 1.004 (1.002-1.005, P <0.001), 1.011 (1.006-1.016, P <0.001), and 1.023 (1.012-1.035, P <0.001), respectively. Patients with LVH determined by LVMI-BSA and LVMI-H2.7 (HR 1.352, 95% CI 1.123-1.626, P = 0.001) and LVH determined by only LVMI-BSA (HR 1.908, 95% CI 1.233-2.953, P = 0.004) showed an independent increase in the risk of composite-outcome development, when compared with patients without LVH, according to LVMI-BSA and LVMI-H2.7. CONCLUSION: Indexation of LVM improved the prediction of adverse outcomes. BSA may be as useful as height2.7 in indexing of LVM for predicting adverse outcomes in pre-dialysis patients with CKD.


Assuntos
Ventrículos do Coração/patologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Insuficiência Renal Crônica/metabolismo , Adulto , Pressão Sanguínea , Superfície Corporal , Estudos de Coortes , Diálise , Ecocardiografia/métodos , Feminino , Humanos , Hipertrofia Ventricular Esquerda/metabolismo , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Prospectivos , Insuficiência Renal Crônica/complicações , República da Coreia
18.
J Surg Res ; 253: 86-91, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32335395

RESUMO

INTRODUCTION: Burns are one of the most common injuries sustained globally. Low- and middle-income countries (LMICs) are disproportionately affected by burn injury morbidity and mortality; African children have the highest burn mortality globally. In high-income countries, early surgical intervention has shown to improve survival. However, when applied to burn victims in LMICs, improved survival in the early excision cohort (≤5 d) was not seen. Therefore, we aimed to determine the magnitude of the effect of surgical intervention on burn injury survival. METHODS: A retrospective analysis of a prospectively collected data, utilizing the Kamuzu Central Hospital Burn Database from May 2011 to July 2019, was performed. Pediatric patients (≤12 y) were included. Patients were excluded if they underwent surgical intervention for nonacute burn care management. Bivariate analyses stratifying by type of surgical intervention was performed, comparing demographics, burn characteristics, surgical intervention, and patient mortality. Standardized estimates were adjusted using the inverse-probability of treatment weights to account for confounding. Weighted logistic regression modeling was performed to determine the odds of mortality based on if a patient underwent surgical intervention. RESULTS: During the study, 2364 patients were seen at the Kamuzu Central Hospital, 1785 (75.5%) were children ≤12 y who met inclusion criteria. In the overall cohort, 342 (19.2%) underwent operations, including split-thickness skin graft (n = 196, 57.3%), debridement (n = 116, 33.9%), escharotomy (n = 19, 5.6%), and amputation (n = 1, 0.3%). The surgery cohort was older (4.2 ± 3.1 versus 3.1 ± 2.6 y, P < 0.001) with larger percent total body surface area burns (16%, interquartile range: 10-24 versus 13%, interquartile range: 8-20, P < 0.001) than those who did not have surgery. In the propensity score-weighted logistic regression predicting survival, patients undergoing surgery after burn injury had an increased odds of survival (odds ratio: 5.24, 95% confidence interval: 2.40-11.44, P = 0.003) when compared with patients not undergoing surgery. CONCLUSIONS: In this propensity-weighted analysis, surgical intervention following burn injury increases the odds of survival by a factor of 5.24 when compared with patients not undergoing surgical intervention. Efforts to enhance burn infrastructure to deliver surgical care is imperative to attenuate burn mortality in resource-poor settings.


Assuntos
Unidades de Queimados/economia , Queimaduras/cirurgia , Recursos em Saúde/provisão & distribução , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Fatores Etários , Superfície Corporal , Unidades de Queimados/estatística & dados numéricos , Unidades de Queimados/provisão & distribução , Queimaduras/diagnóstico , Queimaduras/economia , Queimaduras/mortalidade , Criança , Pré-Escolar , Países em Desenvolvimento/economia , Feminino , Recursos em Saúde/economia , Humanos , Lactente , Escala de Gravidade do Ferimento , Malaui/epidemiologia , Masculino , Pontuação de Propensão , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/economia , Análise de Sobrevida , Resultado do Tratamento
19.
Cancer Chemother Pharmacol ; 85(5): 881-897, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32246190

RESUMO

PURPOSE: High-dose methotrexate (HD-MTX) is widely used in the treatment of non-Hodgkin lymphoma (NHL), but the pharmacokinetic properties of HD-MTX in Chinese adult patients with NHL have not yet been established through an approach that integrates genetic covariates. The purposes of this study were to identify both physiological and pharmacogenomic covariates that can explain the inter- and intraindividual pharmacokinetic variability of MTX in Chinese adult patients with NHL and to explore a new sampling strategy for predicting delayed MTX elimination. METHODS: A total of 852 MTX concentrations from 91 adult patients with NHL were analyzed using the nonlinear mixed-effects modeling method. FPGS, GGH, SLCO1B1, ABCB1 and MTHFR were genotyped using the Sequenom MassARRAY technology platform and were screened as covariates. The ability of different sampling strategies to predict the MTX concentration at 72 h was assessed through maximum a posteriori Bayesian forecasting using a validation dataset (18 patients). RESULTS: A two-compartment model adequately described the data, and the estimated mean MTX clearance (CL) was 6.03 L/h (9%). Creatinine clearance (CrCL) was identified as a covariate for CL, whereas the intercompartmental clearance (Q) was significantly affected by the body surface area (BSA). However, none of the genotypes exerted a significant effect on the pharmacokinetic properties of MTX. The percentage of patients with concentrations below 0.2 µmol/L at 72 h decreased from 65.6 to 42.6% when the CrCL decreased from 90 to 60 ml/min/1.73 m2 with a scheduled dosing of 3 g/m2, and the same trend was observed with dose regimens of 1 g/m2 and 2 g/m2. Bayesian forecasting using the MTX concentrations at 24 and 42 h provided the best predictive performance for estimating the MTX concentration at 72 h after dosing. CONCLUSIONS: The MTX population pharmacokinetic model developed in this study might provide useful information for establishing personalized therapy involving MTX for the treatment of adult patients with NHL.


Assuntos
Técnicas de Genotipagem/métodos , Linfoma não Hodgkin , Taxa de Depuração Metabólica/genética , Metotrexato/farmacocinética , Subfamília B de Transportador de Cassetes de Ligação de ATP/genética , Antimetabólitos Antineoplásicos/farmacocinética , Teorema de Bayes , Superfície Corporal , China/epidemiologia , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/métodos , Feminino , Humanos , Transportador 1 de Ânion Orgânico Específico do Fígado/genética , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/epidemiologia , Linfoma não Hodgkin/metabolismo , Masculino , Pessoa de Meia-Idade , Farmacogenética/métodos
20.
BMC Infect Dis ; 20(1): 193, 2020 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-32131752

RESUMO

BACKGROUND: Microbial infection is the main cause of increased morbidity and mortality in burn patients, especially infections caused by multiple drug-resistant organisms (MDRO). The purpose of this study was to explore major microbial trends in burn patients. METHODS: This retrospective study was conducted at burn wards and intensive care units, where burn patients were admitted following an event of dust explosion. Data were collected for a number of variables including severity of burns, demographic and clinical characteristics, laboratory data, and therapeutic devices. RESULTS: A total of 1132 specimens were collected from 37 hospitalized burn patients with mean TBSA of 46.1%.The most commonly isolated species were Staphylococcus spp. (22.4%). The highest rate of antibiotic resistance was observed in carbapenem-resistant A. baumannii (14.6%), followed by methicillin-resistant S. aureus (11.3%). For each additional 10% TBSA, the isolation of MDRO increased 2.58-17.57 times (p < 0.05); for each additional 10% of the third-degree burn severity, the risk of MDRO significantly decreased by 47% (95% CI, 0.38-0.73, p < 0.001) by Cox model. CONCLUSIONS: The proportion of overall microbial isolates increased with the increase in TBSA and duration of time after burns. The extent of TBSA was the most important factor affecting MDRO.


Assuntos
Traumatismos por Explosões/microbiologia , Queimaduras por Inalação/microbiologia , Poeira , Explosões , Centros de Atenção Terciária , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/isolamento & purificação , Adolescente , Adulto , Antibacterianos/uso terapêutico , Superfície Corporal , Carbapenêmicos/efeitos adversos , Carbapenêmicos/uso terapêutico , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Estudos Retrospectivos , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Fatores de Tempo , Adulto Jovem
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