RESUMEN
OBJECTIVES: Technical graft loss, usually thrombotic in nature, accounts for most of the pancreas grafts that are removed early after transplant. Although arterial and venous thrombosis can occur, the vein is predominantly affected, with estimated overall rate of thrombosis of 6% to 33%. In late diagnosis, the graft will need to be removed because thrombectomy will not restore its functionality. However, in early diagnosis, a salvage procedure should be attempted. MATERIALS AND METHODS: We conducted a retrospective, descriptive analysis of a prospective database of patients who underwent pancreas transplant from April 2008 to June 2020 at a single center. We evaluated post-transplant clinical glucose levels, imaging, treatment, and outcomes. We also performed a systematic review of publications for endovascular treatment of vascular graft thrombosis in pancreas transplant. RESULTS: In 67 pancreas transplants analyzed, 13 (19%) were diagnosed with venous thrombus. In 7 of 13 patients (54%), systemic anticoagulation was prescribed because of a non-occlusive thromboses, resulting in complete resolution for all 7 patients. Six patients (46%) required endovascular thrombectomy because of the presence of complete occlusive thrombosis; 4 of these patients (67%) needed a second procedure because of recurrence of the thrombosis. One of the 6 patients (17%) required a surgical approach, resulting in successful removal of the recurrent clot. Twelve of the 13 grafts (92%) were rescued. Graft survival at 1 year was 84%; graft survival at 3, 5, and 10 years remained at 70%. CONCLUSIONS: Pancreas vein thrombosis represents a frequent surgical complication and remains as a challenging problem. In our experience, early diagnoses and an endovascular approach combined with aggressive medical treatment and follow-up can be used for successful treatment and reduce graft loss.
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Procedimientos Endovasculares , Trasplante de Páncreas , Terapia Recuperativa , Vena Esplénica , Trombectomía , Trombosis de la Vena , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Bases de Datos Factuales/estadística & datos numéricos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/métodos , Trasplante de Páncreas/efectos adversos , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Terapia Recuperativa/efectos adversos , Terapia Recuperativa/métodos , Vena Esplénica/cirugía , Vena Esplénica/diagnóstico por imagen , Trombectomía/efectos adversos , Trombectomía/métodos , Factores de Tiempo , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/epidemiología , Trombosis de la Vena/etiología , Trombosis de la Vena/terapiaRESUMEN
OBJECTIVE: to analyze the trend of incompleteness of the maternal schooling and race/skin color variables held on the Brazilian Live Birth Information System (SINASC) between 2012 and 2020. METHODS: this was an ecological time series study of the incompleteness of maternal schooling and race/skin color data for Brazil, its regions and Federative Units, by means of joinpoint regression and calculation of annual percentage change (APC) and average annual percentage change. RESULTS: a total of 26,112,301 births were registered in Brazil in the period; incompleteness of maternal schooling data decreased for Brazil (APC = -8.1%) and the Southeast (APC = -19.5%) and Midwest (APC = -17.6%) regions; as for race/skin color, there was a downward trend for Brazil (APC = -8.2%) and all regions, except the Northeast region, while nine Federative Units and the Federal District showed a stationary trend. CONCLUSION: there was an improvement in filling out these variables on the SINASC, but with regional disparities, mainly for race/skin color.
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Escolaridad , Nacimiento Vivo , Femenino , Humanos , Embarazo , Brasil , Embarazo Múltiple , Pigmentación de la Piel , Bases de Datos Factuales/normas , Bases de Datos Factuales/estadística & datos numéricos , Sistemas de Información en Salud , Grupos RacialesRESUMEN
The prospective collection of clinical data can generate detailed information on heterogeneous populations. This article reviews the strengths and limitations of the collection of real-world data and provides insight into the feasibility of routine collection of high-quality evidence even in a resource-constrained setting. The acquisition of high-quality data to assess the clinical and psychosocial needs of young Mexican patients with breast cancer has been enhanced through the use of preplanned, standardized data definitions and instrumentation to provide internally and externally comparable results, optimization of data collection with web-based surveys, engagement of participants to minimize missing data, and routine review for data consistency. A similar approach by other research groups could improve the quality of real-world data and accomplish enhanced inference of information.
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Neoplasias de la Mama/epidemiología , Bases de Datos Factuales/estadística & datos numéricos , Investigación sobre Servicios de Salud/métodos , Almacenamiento y Recuperación de la Información/estadística & datos numéricos , Adaptación Psicológica , Adulto , Estudios de Cohortes , Femenino , Humanos , México , Estudios ProspectivosRESUMEN
OBJECTIVES: The objective of this study was to create a composite measure, optimal oncologic surgery (OOS), for patients undergoing distal pancreatectomy for pancreatic adenocarcinoma and identify factors associated with OOS. METHODS: Adult patients undergoing distal pancreatectomy were identified from the National Cancer Database between 2010 and 2016. Patients were stratified based on receipt of OOS. Criteria for OOS included 90-day survival, no 30-day readmission, length of stay ≤7 days, negative resection margins, ≥12 lymph nodes harvested, and receipt of chemotherapy. Multivariate logistic regression was performed to identify predictors of OOS. Survival curves and a Cox proportional hazards model were created to compare survival and identify risk factors for mortality. RESULTS: Three thousand five hundred forty-six patients were identified. The rate of OOS was 22.3%. Diagnosis after 2012, treatment at an academic medical center, and a minimally invasive surgical approach (MIS) were associated with OOS. Survival was superior for patients undergoing OOS. Decreasing age at diagnosis, fewer comorbidities, surgery at an academic medical center, MIS, and lower pathologic stage were also associated with improved survival on multivariate analysis. CONCLUSIONS: Rates of OOS for distal pancreatectomy are low. Time trends show increasing rates of OOS that may be related to increasing MIS, adjuvant chemotherapy, and referrals to academic medical centers.
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Adenocarcinoma/cirugía , Bases de Datos Factuales/estadística & datos numéricos , Pancreatectomía/estadística & datos numéricos , Neoplasias Pancreáticas/cirugía , Anciano , Femenino , Humanos , Estimación de Kaplan-Meier , Tiempo de Internación/estadística & datos numéricos , Modelos Logísticos , Masculino , Análisis Multivariante , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Modelos de Riesgos Proporcionales , Estados UnidosRESUMEN
PURPOSE: The COVID-19 pandemic remains a public health emergency of global concern. Determinants of mortality in the general population are now clear, but specific data on patients with cancer remain limited, particularly in Latin America. MATERIALS AND METHODS: A longitudinal multicenter cohort study of patients with cancer and confirmed COVID-19 from Oncoclínicas community oncology practice in Brazil was conducted. The primary end point was all-cause mortality after isolation of the SARS-CoV-2 by Real-Time Polymerase Chain Reaction (RT-PCR) in patients initially diagnosed in an outpatient environment. We performed univariate and multivariable logistic regression analysis and recursive partitioning modeling to define the baseline clinical determinants of death in the overall population. RESULTS: From March 29 to July 4, 2020, 198 patients with COVID-19 were prospectively registered in the database, of which 167 (84%) had solid tumors and 31 (16%) had hematologic malignancies. Most patients were on active systemic therapy or radiotherapy (77%), largely for advanced or metastatic disease (64%). The overall mortality rate was 16.7% (95% CI, 11.9 to 22.7). In univariate models, factors associated with death after COVID-19 diagnosis were age ≥ 60 years, current or former smoking, coexisting comorbidities, respiratory tract cancer, and management in a noncurative setting (P < .05). In multivariable logistic regression and recursive partitioning modeling, only age, smoking history, and noncurative disease setting remained significant determinants of mortality, ranging from 1% in cancer survivors under surveillance or (neo)adjuvant therapy to 60% in elderly smokers with advanced or metastatic disease. CONCLUSION: Mortality after COVID-19 in patients with cancer is influenced by prognostic factors that also affect outcomes of the general population. Fragile patients and smokers are entitled to active preventive measures to reduce the risk of SARS-CoV-2 infection and close monitoring in the case of exposure or COVID-19-related symptoms.
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COVID-19/mortalidad , Supervivientes de Cáncer/estadística & datos numéricos , Neoplasias/mortalidad , SARS-CoV-2/aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , COVID-19/diagnóstico , COVID-19/virología , Prueba de Ácido Nucleico para COVID-19/estadística & datos numéricos , Causas de Muerte , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Fragilidad/epidemiología , Humanos , Estudios Longitudinales , Masculino , Oncología Médica/estadística & datos numéricos , Persona de Mediana Edad , Neoplasias/complicaciones , Pronóstico , Estudios Prospectivos , ARN Viral/aislamiento & purificación , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , SARS-CoV-2/genética , Fumar/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To test for an association between surgical delay and overall survival (OS) for patients with T2 renal masses. Many health care systems are balancing resources to manage the current COVID-19 pandemic, which may result in surgical delay for patients with large renal masses. METHODS: Using Cox proportional hazard models, we analyzed data from the National Cancer Database for patients undergoing extirpative surgery for clinical T2N0M0 renal masses between 2004 and 2015. Study outcomes were to assess for an association between surgical delay with OS and pathologic stage. RESULTS: We identified 11,848 patients who underwent extirpative surgery for clinical T2 renal masses. Compared with patients undergoing surgery within 2 months of diagnosis, we found worse OS for patients with a surgical delay of 3-4 months (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.00-1.25) or 5-6 months (HR 1.51, 95% CI 1.19-1.91). Considering only healthy patients with Charlson Comorbidity Index = 0, worse OS was associated with surgical delay of 5-6 months (HR 1.68, 95% CI 1.21-2.34, P= .002) but not 3-4 months (HR 1.08, 95% CI 0.93-1.26, P = 309). Pathologic stage (pT or pN) was not associated with surgical delay. CONCLUSION: Prolonged surgical delay (5-6 months) for patients with T2 renal tumors appears to have a negative impact on OS while shorter surgical delay (3-4 months) was not associated with worse OS in healthy patients. The data presented in this study may help patients and providers to weigh the risk of surgical delay versus the risk of iatrogenic SARS-CoV-2 exposure during resurgent waves of the COVID-19 pandemic.
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COVID-19/prevención & control , Toma de Decisiones Clínicas , Neoplasias Renales/mortalidad , Nefrectomía/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricos , Anciano , COVID-19/epidemiología , COVID-19/transmisión , Control de Enfermedades Transmisibles/normas , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Estadificación de Neoplasias , Nefrectomía/normas , Nefrectomía/tendencias , Pandemias/prevención & control , Modelos de Riesgos Proporcionales , Puerto Rico/epidemiología , Estudios Retrospectivos , SARS-CoV-2/patogenicidad , Factores de Tiempo , Tiempo de Tratamiento/tendencias , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Postoperative complications, length of index hospital stay, and unplanned hospital readmissions are important metrics reflecting surgical care quality. Postoperative infections represent a substantial proportion of all postoperative complications. We examined the relationships between identification of postoperative infection prehospital and posthospital discharge, length of stay, and unplanned readmissions in the American College of Surgeons National Surgical Quality Improvement Program database across nine surgical specialties. METHODS: The 30-day postoperative infectious complications including sepsis, surgical site infections, pneumonia, and urinary tract infection were analyzed in the American College of Surgeons National Surgical Quality Improvement Program inpatient data during the period from 2012 to 2017. General, gynecologic, vascular, orthopedic, otolaryngology, plastic, thoracic, urologic, and neurosurgical inpatient operations were selected. RESULTS: Postoperative infectious complications were identified in 5.2% (137,014/2,620,450) of cases; 81,929 (59.8%) were postdischarge. The percentage of specific complications identified postdischarge were 73.4% of surgical site infections (range across specialties 63.7-93.1%); 34.9% of sepsis cases (27.4-58.1%); 26.5% of pneumonia cases (18.9%-36.3%); and 53.2% of urinary tract infections (48.3%-88.0%). The relative risk of readmission among patients with postdischarge versus predischarge surgical site infection, sepsis, pneumonia, or urinary tract infection was 5.13 (95% confidence interval: 4.90-5.37), 9.63 (8.93-10.40), 10.79 (10.15-11.45), and 3.32 (3.07-3.60), respectively. Over time, mean length of stay decreased but postdischarge infections and readmission rates significantly increased. CONCLUSION: Most postoperative infectious complications were diagnosed postdischarge. These were associated with an increased risk of readmission. The trend toward shorter length of stay over time was observed along with an increase both in the percentage of infections detected after discharge and the rate of unplanned related postoperative readmissions over time. Postoperative surveillance of infections should extend beyond hospital discharge of surgical patients.
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Cuidados Posteriores/organización & administración , Complicaciones Posoperatorias/epidemiología , Mejoramiento de la Calidad/estadística & datos numéricos , Servicio de Cirugía en Hospital/organización & administración , Procedimientos Quirúrgicos Operativos/efectos adversos , Adulto , Cuidados Posteriores/estadística & datos numéricos , Anciano , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Neumonía/epidemiología , Neumonía/etiología , Complicaciones Posoperatorias/etiología , Factores de Riesgo , Sepsis/epidemiología , Sepsis/etiología , Servicio de Cirugía en Hospital/estadística & datos numéricos , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Estados Unidos/epidemiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiologíaRESUMEN
OBJECTIVE: The characteristics of surgical patients were examined according to type of health insurance to determine whether differences existed between these groups. METHODS: We evaluated the characteristics of cases in the UPR General Surgery Department's database (entered from January 1, 2018 through December 31, 2018) by insurance type. The variables examined included age, gender, inpatient/outpatient status, wound classification, type of surgery, American Society of Anesthesiology (ASA) scores and whether a given patient had diabetes, was a smoker, or suffered from hypertension. This database had no trauma cases. RESULTS: Information was available for 5,097 cases during the study period. The mean age of the group was 51 (±22) years. The gender distribution indicated that 56% were women and 44% were men. The insurance types were distributed as follows: government/no insurance, 40%; Medicare, 12%; and private insurance, 48%. The government-insured/uninsured patients were younger (mean age, 41 ±24) and had had emergency surgery more frequently (18%) than had privately insured patients (10%). Medicare patients were significantly older (mean age, 72 ±12), and had had higher incidences of diabetes (46%) and hypertension (81%), presenting with ASA scores greater than or equal to 3 in 73% of cases. More privately insured individuals than those in other groups had had elective surgery (90%); 48% had been outpatients when they had their surgery, 58% had had clean wounds, and 61% of the patients having elective surgery were women. CONCLUSION: There were significant differences (P<.05) in the characteristics of patients with different types of health insurance. The frequency of emergency surgery was found to be significantly higher in the government-insured/uninsured group than in the privately insured group.
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Seguro de Salud/clasificación , Adulto , Factores de Edad , Anciano , Bases de Datos Factuales/estadística & datos numéricos , Diabetes Mellitus/epidemiología , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Urgencias Médicas/epidemiología , Femenino , Hospitales Universitarios , Humanos , Hipertensión/epidemiología , Seguro de Salud/estadística & datos numéricos , Masculino , Pacientes no Asegurados/estadística & datos numéricos , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Sector Privado/estadística & datos numéricos , Sector Público/estadística & datos numéricos , Puerto Rico/epidemiología , Factores Sexuales , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Estados UnidosRESUMEN
Pooled data analysis in the field of maternal and child nutrition rarely incorporates data from low- and middle-income countries and existing studies lack a description of the methods used to harmonize the data and to assess heterogeneity. We describe the creation of the Brazilian Maternal and Child Nutrition Consortium dataset, from multiple pooled longitudinal studies, having gestational weight gain (GWG) as an example. Investigators of the eligible studies published from 1990 to 2018 were invited to participate. We conducted consistency analysis, identified outliers, and assessed heterogeneity for GWG. Outliers identification considered the longitudinal nature of the data. Heterogeneity was performed adjusting multilevel models. We identified 68 studies and invited 59 for this initiative. Data from 29 studies were received, 21 were retained for analysis, resulting in a final sample of 17,344 women with 72,616 weight measurements. Fewer than 1% of all weight measurements were flagged as outliers. Women with pre-pregnancy obesity had lower values for GWG throughout pregnancy. GWG, birth length and weight were similar across the studies and remarkably similar to a Brazilian nationwide study. Pooled data analyses can increase the potential of addressing important questions regarding maternal and child health, especially in countries where research investment is limited.
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Salud Infantil/estadística & datos numéricos , Fenómenos Fisiológicos Nutricionales Infantiles , Bases de Datos Factuales/estadística & datos numéricos , Bases de Datos Factuales/normas , Salud Materna/estadística & datos numéricos , Fenómenos Fisiologicos Nutricionales Maternos , Peso al Nacer , Índice de Masa Corporal , Brasil , Niño , Estudios Transversales , Análisis de Datos , Femenino , Ganancia de Peso Gestacional , Humanos , Estudios Longitudinales , Obesidad , Embarazo , Complicaciones del Embarazo/fisiopatología , Literatura de Revisión como AsuntoRESUMEN
The objective was to determine the pharmacological treatment patterns of headache disorders in a Colombian population. Cross-sectional study. The dispensations of drugs for the management of tension-type headache, migraine, and cluster headache in the first trimester of 2019 were reviewed from a national medication dispensing database. Sociodemographic, diagnostic, and treatment variables (acute or prophylactic; concomitant drugs) were analyzed. During the study period, 7450 patients were identified: 68.5% with migraine, 25.1% with tension-type headache, and 6.4% with cluster headache. A total of 79.7% (n = 5937) were women, and the mean age was 38.6 ± 14.7 years. The 87.8% (n = 6539) were prescribed drugs for acute pain management, mainly nonsteroidal anti-inflammatory drugs (n = 3559; 47.8%), acetaminophen (n = 3390; 45.5%), ergotamine (n = 2158; 29.0%), and opioids (n = 1750; 23.5%). The 50.3% (n = 3750) received at least one drug used for prophylaxis, mainly antidepressants (n = 1769, 23.7%), flunarizine (n = 927; 12.4%), and ß-blockers (n = 764; 10.3%). The main comedication was proton pump inhibitors (n = 921; 12.4%). Patients with tension-type headache, migraine, and cluster headache receive mainly medications for acute management, some with low therapeutic value or not recommended, such as opioids or ergotamine. Prophylactic management is mainly directed to migraines, although patients with other kinds of headache also used it, even though it was not indicated.
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Cefalalgia Histamínica/tratamiento farmacológico , Trastornos Migrañosos/tratamiento farmacológico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Cefalea de Tipo Tensional/tratamiento farmacológico , Adulto , Colombia , Estudios Transversales , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
PURPOSE: To assess the use of external beam radiotherapy in Catalonia (Spain), overall and by health management area. METHODS: We assessed radiotherapy treatments in a cohort of patients diagnosed with cancer from 2009 to 2011, using the population-based cancer registries in Girona and Tarragona. Participants had to have a minimum follow-up of 5 years from the time the cancer registry database was linked to the catalan health service database for financing radiation oncology. Outcomes included the proportion of patients receiving radiotherapy within 1 and 5 years of diagnosis. A log-binomial model was used to assess age-related trends in the use of radiotherapy by tumour site. Finally, we calculated the standardized utilization rate and 95% confidence intervals by health management area covered by the radiation oncology services, using indirect methods. RESULTS: At 1 and 5 years from diagnosis, 21.4 and 24.4% of patients, respectively, had received external beam radiotherapy. Patients aged 40-64 years had the most indications for the treatment, and there was a negative correlation between the patients' age and the use of radiotherapy for most tumour sites (exceptions were cervical, thyroid, and uterine cancers). There were no statistically significant differences in the use of radiotherapy according to th health management area. CONCLUSIONS: Population-based data show that external beam radiotherapy is underutilized in Catalonia. This situation requires a careful analysis to understand the causes, as well as an improvement of the available resources, oriented toward achieving realistic targets for the optimal use of external beam radiotherapy in our country.
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Neoplasias/radioterapia , Adulto , Factores de Edad , Anciano , Estudios de Cohortes , Intervalos de Confianza , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Radioterapia/estadística & datos numéricos , España/epidemiología , Tiempo de TratamientoRESUMEN
OBJECTIVE: to evaluate the application of a deterministic routine for identifying multiple pregnancies on the Brazilian Live Birth Information System (SINASC). METHODS: SINASC data deduplication and linkage with the mortality database (fetal deaths) for Rio de Janeiro state for the period 2007-2008; we used a deterministic routine, using a key based on SINASC maternal and birth information, complemented by manual review. RESULTS: of the 433,874 SINASC records, 9,036 (2.1%) were classified as multiple pregnancy newborns; after implementing the routine, we reclassified 385 records as twins, and 286 as singletons; accuracy of multiple pregnancy information on the SINASC database was high (sensitivity=95.8%; specificity=99.9%); applying the routine without the manual review process increased sensitivity by 4.2%, with no significant change of specificity. CONCLUSION: despite the accuracy of information regarding multiple pregnancy held on SINASC, we suggest the use of this routine as an option for improving classification of twins.
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Sistemas de Información/estadística & datos numéricos , Nacimiento Vivo , Embarazo Múltiple/estadística & datos numéricos , Embarazo Gemelar/estadística & datos numéricos , Brasil , Exactitud de los Datos , Bases de Datos Factuales/normas , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Sistemas de Información/normas , EmbarazoRESUMEN
PURPOSE: To develop a database with social, demographic and professional information of all graduates of the two post-graduate programs in Ophthalmology of EPM-UNIFESP, including their opinions on quality, application, and contribution of the courses received in their professional careers. METHODS: The survey was conducted in the digital and physical archives of the University and by telephone contact. When the graduates' e-mails were all collected, the electronic questionnaire was applied. The responses were compiled. Descriptive analysis of the results obtained in this cross-sectional study was performed, and analyzed by the authors and by statistical professionals, through Excel graphs. RESULTS: The database suggests that most graduates were born and work in the state of São Paulo. A significant fraction of 66.77% is dedicated to academic work, but only 36.2% hold management positions. Most of them receive amounts of one to 56 minimum wages monthly. The main motivation was to improve their professional careers. CONCLUSION: For post-graduate programs, a database with information of its graduates can elucidate whether the goals were achieved based on the proposed teaching, as well as can generate reflections to improve the quality, the courses expectations and the vision that students have of the University.
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Bases de Datos Factuales , Oftalmología/educación , Estudiantes de Medicina , Adulto , Anciano , Estudios Transversales , Bases de Datos Factuales/normas , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oftalmología/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Factores Socioeconómicos , Estudiantes de Medicina/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Although systemic therapy is the standard treatment for metastatic breast cancer, the value of locoregional treatment (LRT) of the primary tumor and its impact on survival is controversial. This study evaluates survival outcomes in patients with metastatic breast cancer after receiving LRT (surgery and/or radiation therapy) of the primary tumor. MATERIALS AND METHODS: The National Cancer Database was used to identify 16,128 qualifying cases of metastatic breast cancer who received systemic therapy with or without LRT from 2004 to 2013. Treatment modality was divided into surgery (Sx), radiation therapy (RT), surgery followed by RT (Sx + RT), and no LRT. The median survival and 3-year actuarial survival rates (OS) were analyzed for each treatment group. On multivariate analyses, adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using Cox regression modeling to adjust for patient and clinicopathologic characteristics. RESULTS: Overall, the median follow-up was 28.3 months, and the median survival for all patients was 37.2 months. With 9761 deaths reported, the estimated 3-year OS was 51.3%. The Sx + RT group (n = 2166) had the highest 3-year OS of 69.4%, followed by the Sx group (n = 4293) with 57.6%, the no LRT group (n = 8955) with 44.3%, and the RT group (n = 714) with 41.5% (P < .0001). On multivariate analysis, compared with the no LRT group, a decreased HR was noted in patients receiving Sx (adjusted HR, 0.68; 95% CI, 0.65-0.71; P < .0001) and Sx + RT (adjusted HR, 0.46; 95% CI, 0.43-0.49; P < .0001). CONCLUSION: LRT, especially surgery followed by RT, in addition to systemic therapy, was associated with improved survival in patients with metastatic breast cancer.
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Antineoplásicos/uso terapéutico , Neoplasias de la Mama/terapia , Mastectomía/estadística & datos numéricos , Adolescente , Adulto , Anciano , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Quimioterapia Adyuvante/estadística & datos numéricos , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Radioterapia Adyuvante/estadística & datos numéricos , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND: The Surveillance, Epidemiology, and End Results (SEER) database and National Cancer Database (NCDB) show improved overall survival (OS) in patients with multiple myeloma (MM) over the last 15 years. This analysis evaluated the validity of the largely community-based Connect MM Registry as a national reference for MM. METHODS: Baseline disease characteristics and survival in US newly diagnosed MM patients were examined using the Connect MM Registry as well as SEER and NCDB databases. Baseline characteristics predictive of longer survival in Connect MM were also identified. RESULTS: As of February 2017, 3011 patients were enrolled in the Connect MM Registry; 2912 were treated. Median age at time of MM diagnosis and age range were numerically similar from 2010 to 2015 across all 3 registries; SEER had a higher representation of nonwhite racial groups than that in the other 2 registries. OS rates suggest proportionate improvement with year of diagnosis among the 3 registries. A Cox proportional hazards model suggests that younger age (<65 years) is associated with longer survival (vs ≥75; HR, 0.39; 95% confidence interval, 0.34-0.46) in the Connect MM Registry. However, sex (HR, 0.91; P = .15) and race (black vs white; HR, 0.88; P = .21) were not associated with longer OS. CONCLUSIONS: Data from the Connect MM Registry appear to be largely representative of national trends, comprehensive, and reliable representations of the national MM population. Baseline characteristics were comparable, and survival similarly improved over time among the 3 registries. CLINICALTRIALS. GOV, IDENTIFIER: NCT01081028.
Asunto(s)
Bases de Datos Factuales/estadística & datos numéricos , Mieloma Múltiple/mortalidad , Sistema de Registros/estadística & datos numéricos , Programa de VERF/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Puerto Rico/epidemiología , Reproducibilidad de los Resultados , Tasa de Supervivencia , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Hepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular tumor with a high mortality rate. HEHE is now a formally recognized indication for exception point priority in the United States under the new National Liver Review Board. The role of liver transplantation (LT) and exception point waitlist priority in the United States for patients with HEHE remains understudied. METHODS: This was a retrospective cohort study using the United Network for Organ Sharing transplant database. From February 27, 2002 to January 31, 2018, 131 adults waitlisted for LT with HEHE were identified by free-text entry. RESULTS: Exception point applications were submitted for 91.6% (120/131) of patients. All patients with fully reviewed applications received exception points at least once during waitlisting, and 85% (103/120) upon first submission. Among the 88 patients transplanted, median model for end-stage liver disease score at LT was 7 ((interquartile range [IQR]: 6-11) and waiting time 78.5 days (IQR: 29.5-237.5). Unadjusted post-LT survival of HEHE recipients at 1-, 3-, and 5-years from LT was 88.6%, 78.9%, and 77.2%. Unadjusted post-LT patient and graft survival of HEHE patients was not different from patients with hepatocellular carcinoma within Milan receiving exception point priority (P = 0.08). An increased rate of graft failure due to hepatic artery thrombosis ≤14 days from initial LT was observed in HEHE versus non-HEHE patients (4.6% versus 0.5%). CONCLUSIONS: The majority of HEHE recipients receive exception points at a universal approval rate allowing prompt access to deceased donor LT.
Asunto(s)
Carcinoma Hepatocelular/cirugía , Enfermedad Hepática en Estado Terminal/cirugía , Hemangioendotelioma Epitelioide/cirugía , Neoplasias Hepáticas/cirugía , Trasplante de Hígado/estadística & datos numéricos , Adulto , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/patología , Bases de Datos Factuales/estadística & datos numéricos , Enfermedad Hepática en Estado Terminal/diagnóstico , Enfermedad Hepática en Estado Terminal/mortalidad , Enfermedad Hepática en Estado Terminal/patología , Femenino , Rechazo de Injerto/epidemiología , Rechazo de Injerto/etiología , Supervivencia de Injerto , Hemangioendotelioma Epitelioide/diagnóstico , Hemangioendotelioma Epitelioide/mortalidad , Hemangioendotelioma Epitelioide/patología , Arteria Hepática/patología , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Trasplante de Hígado/efectos adversos , Masculino , Persona de Mediana Edad , Selección de Paciente , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Trombosis/epidemiología , Trombosis/etiología , Trombosis/patología , Resultado del Tratamiento , Estados Unidos , Listas de Espera/mortalidadRESUMEN
Abstract Purpose To develop a database with social, demographic and professional information of all graduates of the two post-graduate programs in Ophthalmology of EPM-UNIFESP, including their opinions on quality, application, and contribution of the courses received in their professional careers. Methods The survey was conducted in the digital and physical archives of the University and by telephone contact. When the graduates' e-mails were all collected, the electronic questionnaire was applied. The responses were compiled. Descriptive analysis of the results obtained in this cross-sectional study was performed, and analyzed by the authors and by statistical professionals, through Excel graphs. Results The database suggests that most graduates were born and work in the state of São Paulo. A significant fraction of 66.77% is dedicated to academic work, but only 36.2% hold management positions. Most of them receive amounts of one to 56 minimum wages monthly. The main motivation was to improve their professional careers. Conclusion For post-graduate programs, a database with information of its graduates can elucidate whether the goals were achieved based on the proposed teaching, as well as can generate reflections to improve the quality, the courses expectations and the vision that students have of the University.
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Oftalmología/educación , Estudiantes de Medicina/estadística & datos numéricos , Bases de Datos Factuales/normas , Bases de Datos Factuales/estadística & datos numéricos , Oftalmología/estadística & datos numéricos , Factores Socioeconómicos , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Estudios Transversales , Encuestas y Cuestionarios , Persona de Mediana EdadAsunto(s)
Humanos , Antivirales/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Neumonía Viral/virología , Respiración Artificial/estadística & datos numéricos , Estados Unidos , Índice de Severidad de la Enfermedad , Ensayos Clínicos Controlados Aleatorios como Asunto , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , China , Bases de Datos Factuales/estadística & datos numéricos , Resultado del Tratamiento , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/virología , Ritonavir/uso terapéutico , Medicina Basada en la Evidencia/métodos , Medicina Basada en la Evidencia/estadística & datos numéricos , Alanina/análogos & derivados , Alanina/uso terapéutico , Combinación de Medicamentos , Nivel de Atención , Pandemias , Lopinavir/uso terapéutico , Metaanálisis en Red , Betacoronavirus/aislamiento & purificación , Betacoronavirus/patogenicidad , Revisiones Sistemáticas como Asunto , Glucocorticoides/uso terapéutico , Hidroxicloroquina/uso terapéuticoRESUMEN
ABSTRACT Objective: To assess spontaneous reports of suspected adverse drug reactions in children aged 0-12 years from the Brazilian Health Regulatory Agency between 2008 and 2013. Methods: A cross-sectional study on suspected adverse drug reactions reports related to medicines and health products in children was carried out for a six-year period (2008-2013). Year of report, origin of report by Brazilian state, gender, age, suspected drug, adverse reaction description and seriousness were included in the analysis. The data obtained was compared to the number of pediatric beds in health services and to global data from the VigiBase (World Health Organization). Results: A total of 3330 adverse drug reactions were reported in children in Brazil in the investigated period (54% were in boys). About 28% of suspected adverse drug reactions reports involved 0 to 1-year-old children. Almost 40% of reports came from the Southeast region. Approximately 60% were classified as serious events. There was death in 75 cases. Nearly 30% of deaths involved off-label use; 3875 medicines (465 active substances) were considered suspected drugs. Anti-infective (vancomycin, ceftriaxone, oxacillin, and amphotericin), nervous system (metamizole) and alimentary tract and metabolism medicines were more frequent in reports. Conclusions: The distribution of suspected adverse drug reactions reports by sex and age group corresponded to the profile of children hospitalized in Brazil. Data about seriousness and medicines reported may be useful to encourage regulatory actions and improve the safe use of medicines in children.
RESUMO Objetivo: Analisar relatos espontâneos de suspeitas de Reação Adversa a Medicamento (RAM) em crianças de 0 a 12 anos notificadas pela Agência Nacional de Vigilância Sanitária entre 2008 e 2013. Métodos: Um estudo transversal a partir de notificações de suspeitas de RAM relacionadas a medicamentos e produtos para a saúde em crianças foi realizado por um período de seis anos (2008-2013). O ano da notificação, a origem do relato por estado brasileiro, sexo, idade, o medicamento suspeito, a descrição da reação adversa e a gravidade foram incluídos na análise, bem como o número de leitos nos serviços de saúde e dados global da VigiBase. Resultados: Um total de 3330 reações adversas foram relatadas em crianças no Brasil no período investigado (54% em meninos). Cerca de 28% dos relatos de suspeitas de RAM envolveram crianças de 0 a 1 ano de idade. Quase 40% dos relatos vieram da região Sudeste. Aproximadamente 60% foram classificados como eventos graves. Houve ocorrência de morte em 75 casos. Quase 30% das mortes envolveram o uso off-label dos medicamentos. Um total de 3875 medicamentos (465 substâncias ativas) foram considerados fármacos suspeitos. Medicamentos anti-infecciosos (vancomicina, ceftriaxona, oxacilina e anfotericina), com ação no sistema nervoso (dipirona) e no trato digestivo foram os mais frequentemente notificados. Conclusões: As notificações de suspeitas de RAM por sexo e faixa etária corresponderam ao perfil de crianças hospitalizadas no Brasil. Os dados sobre gravidade e medicamentos relatados podem ser úteis para encorajar ações reguladoras e melhorar o uso seguro de medicamentos em crianças.
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Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Bases de Datos Factuales/estadística & datos numéricos , Sistemas de Registro de Reacción Adversa a Medicamentos/estadística & datos numéricos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Brasil/epidemiología , Preparaciones Farmacéuticas/administración & dosificación , Preparaciones Farmacéuticas/clasificación , Factores Sexuales , Estudios Transversales , Factores de Edad , Distribución por EdadRESUMEN
To investigate the global incidence of prostate cancer with special attention to the changing age structures. Data regarding the cancer incidence and population statistics were retrieved from the International Agency for Research on Cancer in World Health Organization. Eight developing and developed jurisdictions in Asia and the Western countries were selected for global comparison. Time series were constructed based on the cancer incidence rates from 1988 to 2007. The incidence rate of the population aged ≥ 65 was adjusted by the increasing proportion of elderly population, and was defined as the "aging-adjusted incidence rate". Cancer incidence and population were then projected to 2030. The aging-adjusted incidence rates of prostate cancer in Asia (Hong Kong, Japan and China) and the developing Western countries (Costa Rica and Croatia) had increased progressively with time. In the developed Western countries (the United States, the United Kingdom and Sweden), we observed initial increases in the aging-adjusted incidence rates of prostate cancer, which then gradually plateaued and even decreased with time. Projections showed that the aging-adjusted incidence rates of prostate cancer in Asia and the developing Western countries were expected to increase in much larger extents than the developed Western countries.