RESUMEN

OBJECTIVES: to evaluate the risk of postoperative complications in cardiac patients. METHODS: an evaluative study using the Tuman Score on medical records of 70 adult patients who underwent cardiac surgery at a University Hospital. The R for Windows software was used for the analyses. Descriptive statistics and bivariate analysis were employed to verify the association between the risk score and complications. The relative risk between the Tuman Score and postoperative complications was obtained through Quasi-Poisson regression, with a 95% confidence interval. RESULTS: the majority of the patients were male (58.57%), aged between 41-64 years (50%), who underwent myocardial revascularization (50%). These patients were associated with a lower risk of postoperative complications (p=0.003), (p=0.008), and (p=0.000), respectively. High-risk patients had pulmonary complications (RR=1.32, p=0.002) and neurological complications (RR=1.20, p=0.047). CONCLUSIONS: preoperative risk assessment promotes qualified care to reduce postoperative complications.

Asunto(s)

Procedimientos Quirúrgicos Cardíacos , Complicaciones Posoperatorias , Humanos , Masculino , Persona de Mediana Edad , Femenino , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Adulto , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Anciano , Factores de Riesgo

RESUMEN

AIMS: Left ventricular diastolic dysfunction (LVDD) and LV systolic dysfunction (LVSD) are prevalent in CKD, but their prognostic relevance is debatable. We intent to verify whether LVDD and LVSD are independently predictive of all-cause mortality and if they have comparable or different effects on outcomes. METHODS: A retrospective analysis was conducted of the echocardiographic data of 1285 haemodialysis patients followed up until death or transplantation. LVDD was classified into 4 grades of severity. Endpoint was all-cause mortality. RESULTS: During a follow-up of 30 months, 419/1285 (33%) patients died, 224 (53%) due to CV events. LVDD occurred in 75% of patients, grade 1 DD was the prevalent diastolic abnormality, and pseudonormal pattern was the predominant form of moderate-severe DD. Moderate-severe LVDD (HR 1.379, CI% 1.074-1.770) and LVSD (HR 1.814, CI% 1.265-2.576) independently predicted death; a graded, progressive association was found between LVDD categories and the risk of death; and the impact of isolated severe-moderate LVDD on the risk of death was comparable to that exercised by isolated compromised LV systolic function. CONCLUSION: Moderate-severe LVDD and LVSD were independently associated with a higher probability of death and had a similar impact on survival. A progressive association was observed between LVDD grades and mortality.

Asunto(s)

Insuficiencia Cardíaca Diastólica , Insuficiencia Cardíaca Sistólica , Diálisis Renal , Insuficiencia Renal Crónica , Disfunción Ventricular Izquierda , Anciano , Brasil/epidemiología , Ecocardiografía Doppler/métodos , Femenino , Insuficiencia Cardíaca Diastólica/diagnóstico , Insuficiencia Cardíaca Diastólica/epidemiología , Insuficiencia Cardíaca Diastólica/fisiopatología , Insuficiencia Cardíaca Sistólica/diagnóstico , Insuficiencia Cardíaca Sistólica/epidemiología , Insuficiencia Cardíaca Sistólica/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Diálisis Renal/métodos , Diálisis Renal/estadística & datos numéricos , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/terapia , Estudios Retrospectivos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/mortalidad , Disfunción Ventricular Izquierda/fisiopatología

RESUMEN

Objetivo: avaliar o risco para desenvolvimento de lesões relacionadas ao posicionamento cirúrgico. Método: estudo transversal com amostra (n=146) de adultos cirúrgicos eletivos do Paraná, Brasil. Aplicou-se a Escala de Avaliação de Risco para o Desenvolvimento de Lesões decorrentes do Posicionamento Cirúrgico e extração de variáveis sociodemográficas. Procedeu-se análise estatística descritiva e inferencial. Resultados: homens (49,3%) e mulheres (50,7%) tiveram distribuição equânime de atendimento majoritariamente pela ortopedia (39,7%). Pela escala aplicada, destacou-se: uso de colchão convencional+coxins de campo de algodão como superfície de suporte (100%); posição supina (78%); membros superiores com abertura inferior a 90º (70,5%); anestesia regional (54,1%) e tempo cirúrgico de 1-2h (46,6%). Constatou-se escore médio de 17,6±3,29 pontos e 75,3% da amostra apresentou baixo risco de desenvolver lesões do posicionamento cirúrgico. Conclusão: em torno de um quarto da amostra apresentou maior risco de lesão decorrente da posição cirúrgica.

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Objetivo: evaluar el riesgo de desarrollar lesiones relacionadas con la posición quirúrgica. Método: estudio transversal con una muestra (n=146) de adultos sometidos a cirugías electivas en Paraná, Brasil. Se aplicó la Escala de Evaluación del Riesgo de Desarrollar Lesiones a raíz de la Posición Quirúrgica y se extrajeron variables sociodemográficas. Se realizó un análisis estadístico descriptivo e inferencial. Resultados: hubo distribución igualitaria entre hombres (49,3%) y mujeres (50,7%), atendidos mayoritariamente en la especialidad de Ortopedia (39,7%). Al aplicar la escala se destacó lo siguiente: utilización de colchón convencional + almohadones de campo de algodón como superficie de apoyo (100%); posición supina (78%); extremidades superiores con abertura de menos de 90º (70,5%); anestesia regional (54,1%) y duración de la cirugía de 1 a 2 horas (46,6%). Se verificó una puntuación media de 17,6±3,29 puntos y el 75,3% de la muestra presentó bajo riesgo de desarrollar lesiones a raíz de la posición quirúrgica. Conclusión: aproximadamente el 25% de la muestra presentó un riesgo más elevado de lesiones resultantes de la posición quirúrgica.

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Objective: to assess the risk for the development of injuries related to surgical positioning. Method: a cross-sectional study with a sample comprised by adults undergoing elective surgeries (n=146) in Paraná, Brazil. The Risk Assessment Scale for the Development of Injuries arising from Surgical Positioning was applied, with extraction of sociodemographic variables. Descriptive and inferential analyses were performed. Results: men (49.3%) and women (50.7%) presented equal distribution of appointments, mostly in the Orthopedics specialty (39.7%). The following stood out as per the scale applied: use of conventional mattress + cotton field cushions as a support surface (100%); supine position (78%); upper limbs with opening less than 90º (70.5%); regional anesthesia (54.1%), and surgical time of 1h-2h (46.6%). A mean score of 17.6±3.29 points was found and 75.3% of the sample presented low risk for the development of injuries related to surgical positioning. Conclusion: around 25% of the sample presented a higher risk of injuries arising from surgical positioning.

Asunto(s)

Humanos , Masculino , Femenino , Medición de Riesgo/estadística & datos numéricos , Atención Perioperativa/enfermería , Úlcera por Presión/prevención & control , Posicionamiento del Paciente/efectos adversos , Estudios Transversales

RESUMEN

OBJECTIVES/HYPOTHESIS: Robin sequence (RS) consists of associated micrognathia, glossoptosis, and respiratory dysfunction, with or without cleft palate. Studies on how different patient characteristics impact the severity of respiratory dysfunction are scarce and contradictory; this study investigates how different features affect respiratory obstruction severity at diagnosis of RS in controlled analysis. STUDY DESIGN: Retrospective cohort study that enrolled 71 RS patients under 90 days old who received care in our institution from 2009 to 2020. METHODS: The primary outcome, respiratory dysfunction, was categorized into four severity groups and analyzed using a multinomial logistic regression model that considered age, sex, mandible length, cleft palate, syndromic diagnosis, other airway anomalies, and degree of glossoptosis. RESULTS: Mandible length, syndromic diagnosis, and Yellon grade 3 glossoptosis were related to poorer respiratory outcomes (need for respiratory support). In univariate analysis, for each additional 1 mm of mandible length at diagnosis, a mean reduction of 28% in the risk of needing respiratory support was observed (OR = 0.72; 0.58-0.89); syndromic diagnosis and grade 3 glossoptosis also raised the risk (OR = 6.50; 1.59-26.51 and OR = 12.75; 1.03-157.14, respectively). In multivariate analysis, only mandible length significantly maintained its effects (OR = 0.73; 0.56-0.96), a 27% reduction. CONCLUSIONS: Mandible length was an independent predictor for more severe respiratory dysfunction in RS patients, with larger mandibles showing protective effects. Syndromic diagnosis and Yellon grade 3 glossoptosis are also likely to be associated with poorer respiratory outcomes, although this was not demonstrated in multivariate analysis. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2811-2816, 2021.

Asunto(s)

Glosoptosis/complicaciones , Síndrome de Pierre Robin/complicaciones , Trastornos Respiratorios/epidemiología , Femenino , Glosoptosis/diagnóstico , Glosoptosis/patología , Humanos , Imagenología Tridimensional , Lactante , Recién Nacido , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/patología , Tamaño de los Órganos , Síndrome de Pierre Robin/diagnóstico , Síndrome de Pierre Robin/patología , Pronóstico , Factores Protectores , Trastornos Respiratorios/diagnóstico , Trastornos Respiratorios/etiología , Estudios Retrospectivos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X

RESUMEN

ABSTRACT: The aim of this study was to evaluate the association between sociodemographic factors and noncavitated and cavitated caries lesions in Mexican schoolchildren.This cross-sectional study was conducted in 2020 on 8-to-12-year-old schoolchildren of different socioeconomic status (SES). The caries was evaluated using ICDAS II, SES was evaluated using three categories---a high, middle, or low-income level---of the CONAPO. Multinomial logistic regression analyses were performed in order to ascertain the associations between socioeconomic factors and noncavitated and cavitated caries lesions.The prevalence of noncavitated lesions was 38.0% and cavitated lesions was 43.4% in permanent dentition. In all the samples, 50.6% of schoolchildren had poor oral hygiene. About 52.5% of the mothers and 64.7% of the fathers had less than 9 years of education. Schoolchildren with a low-income level have more cavitated lesions (ICDAS II 4-6) than schoolchildren with high-income level (56.3% vs 15.8%, P = .009). The multinomial logistic regression models showed that mother's level of education <9 years and low-income level were significantly associated with cavitated caries lesions (ICDAS II 4-6), [odds ratio = 1.79 (1.17 - 2.75); P = .007], [OR = 2.21 (1.23 - 3.97); P = .008], respectively. The socioeconomic level was not associated with noncavitated caries lesions (ICDAS II 1-3).An association was found between the presence of cavitated caries lesions and the subject's mother's level of education and a low-income level. Socioeconomic factors were found to be associated with inequalities in caries distribution in the age group studied.

Asunto(s)

Caries Dental/epidemiología , Exposición de la Pulpa Dental/epidemiología , Niño , Estudios Transversales , Caries Dental/complicaciones , Caries Dental/diagnóstico , Exposición de la Pulpa Dental/diagnóstico , Exposición de la Pulpa Dental/etiología , Escolaridad , Femenino , Humanos , Renta , Masculino , México/epidemiología , Madres/educación , Madres/estadística & datos numéricos , Prevalencia , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Clase Social

RESUMEN

Little is known about the long-term neurological development of children diagnosed with congenital Zika infection at birth. Here, we report the imaging and clinical outcomes up to three years of life of a cohort of 129 children exposed to Zika virus in utero. Eighteen of them (14%) had a laboratory confirmed congenital Zika infection at birth. Infected neonates have a higher risk of adverse neonatal and early infantile outcomes (death, structural brain anomalies or neurologic symptoms) than those who tested negative: 8/18 (44%) vs 4/111 (4%), aRR 10.1 [3.5-29.0]. Neurological impairment, neurosensory alterations or delays in motor acquisition are more common in infants with a congenital Zika infection at birth: 6/15 (40%) vs 5/96 (5%), aRR 6.7 [2.2-20.0]. Finally, infected children also have an increased risk of subspecialty referral for suspected neurodevelopmental delay by three years of life: 7/11 (64%) vs 7/51 (14%), aRR 4.4 [1.9-10.1]. Infected infants without structural brain anomalies also appear to have an increased risk, although to a lesser extent, of neurological abnormalities. It seems paramount to offer systematic testing for congenital ZIKV infection in cases of in utero exposure and adapt counseling based on these results.

Asunto(s)

Desarrollo Infantil , Malformaciones del Sistema Nervioso/epidemiología , Complicaciones Infecciosas del Embarazo/virología , Efectos Tardíos de la Exposición Prenatal/epidemiología , Infección por el Virus Zika/complicaciones , Adolescente , Adulto , Preescolar , Femenino , Guyana Francesa/epidemiología , Humanos , Lactante , Recién Nacido , Masculino , Edad Materna , Malformaciones del Sistema Nervioso/etiología , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Efectos Tardíos de la Exposición Prenatal/etiología , Medición de Riesgo/estadística & datos numéricos , Adulto Joven , Virus Zika/aislamiento & purificación , Infección por el Virus Zika/congénito , Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/virología

RESUMEN

BACKGROUND: Few trials have evaluated the utility of liquid biopsies to detect epidermal growth factor receptor mutations (EGFRm) at the time of response evaluation and its association with the clinical characteristics and outcomes of non-small-cell lung cancer (NSCLC) patients. OBJECTIVE: This study aimed to evaluate, in a real-world clinical setting, the prevalence of plasma EGFRm and its association with the clinical characteristics, response and survival outcomes of NSCLC patients under treatment with EGFR-tyrosine kinase inhibitors (EGFR-TKIs). METHODS: This observational study enrolled advanced or metastatic NSCLC patients, with confirmed tumor EGFRm, receiving treatment with first- or second-generation EGFR-TKIs. Blood samples for the detection of plasma EGFRm were collected at the time of response evaluation and processed using the Target Selector™ assay. The main outcomes were the detection rate of plasma EGFRm, median Progression-Free Survival (PFS) and Overall Survival (OS) according to plasma EGFR mutational status. RESULTS: Of 84 patients, 50 (59.5%) had an EGFRm detected in plasma. After a median follow-up of 21.1 months, 63 patients (75%) had disease progression. The detection rate of plasma EGFRm was significantly higher in patients with disease progression than in patients with partial response or stable disease (68.3% versus 33.3%; P< 0.01). PFS and OS were significantly longer in patients without plasma EGFRm than among patients with plasma EGFRm (14.3 months [95% CI, 9.25-19.39] vs 11.0 months [95% CI, 8.61-13.46]; P= 0.034) and (67.8 months [95% CI, 39.80-95.94] vs 32.0 months [95% CI, 17.12-46.93]; P= 0.006), respectively. A positive finding in LB was associated with the presence of ⩾ 3 more metastatic sites (P= 0.028), elevated serum carcinoembryonic (CEA) at disease progression (P= 0.015), and an increase in CEA with respect to baseline levels (P= 0.038). CONCLUSIONS: In NSCLC patients receiving EGFR-TKIs, the detection of plasma EGFRm at the time of tumor response evaluation is associated with poor clinical outcomes.

Asunto(s)

Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Neoplasias Pulmonares/mortalidad , Inhibidores de Proteínas Quinasas/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/sangre , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/genética , Análisis Mutacional de ADN , Progresión de la Enfermedad , Receptores ErbB/sangre , Receptores ErbB/genética , Femenino , Humanos , Biopsia Líquida , Neoplasias Pulmonares/sangre , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/genética , Masculino , Persona de Mediana Edad , Supervivencia sin Progresión , Inhibidores de Proteínas Quinasas/farmacología , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos

RESUMEN

BACKGROUND: No biomarker is available for identifying cancer patients at risk of developing nephrotoxicity when treated with cisplatin. METHODS: We performed microRNA (miRNA) sequencing using plasma collected 5 days after cisplatin treatment (D5) from twelve patients with head and neck cancer with and without nephrotoxicity (grade ≥ 2 increased serum creatinine). The most differentially expressed miRNAs between the two groups were selected for quantification at baseline and D5 in a larger cohort of patients. The association between miRNAs and nephrotoxicity was evaluated by calculating the odds ratio (OR) from univariate logistic regression. Receiver operating characteristic curves (ROC) were used to estimate the area under the curve (AUC), sensitivity, and specificity. RESULTS: MiR-3168 (p = 1.98 × 10- 8), miR-4718 (p = 4.24 × 10- 5), and miR-6125 (p = 6.60 × 10- 5) were the most differentially expressed miRNAs and were further quantified in 43, 48, and 53 patients, respectively. The baseline expression of miR-3168 (p = 0.0456, OR = 1.03, 95% CI: 1.00-1.06) and miR-4718 (p = 0.0388, OR = 1.56, 95% CI: 1.03-2.46) were associated with an increased risk of nephrotoxicity, whereas miR-6125 showed a trend (p = 0.0618, OR = 1.73, 95% CI: 0.98-3.29). MiR-4718 showed the highest AUC (0.77, 95% CI: 0.61-0.93) with sensitivity of 66.76 and specificity of 79.49. CONCLUSIONS: We have provided evidence of baseline plasmatic expression of miR-3168, miR-6125, and miR-4718 as potential predictors of cisplatin-induced nephrotoxicity.

Asunto(s)

Lesión Renal Aguda/epidemiología , Biomarcadores de Tumor/metabolismo , Cisplatino/efectos adversos , Neoplasias de Cabeza y Cuello/terapia , MicroARNs/metabolismo , Carcinoma de Células Escamosas de Cabeza y Cuello/terapia , Lesión Renal Aguda/sangre , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/genética , Anciano , Biomarcadores de Tumor/sangre , Estudios de Casos y Controles , Quimioradioterapia/efectos adversos , Quimioradioterapia/métodos , Creatinina/sangre , Femenino , Perfilación de la Expresión Génica , Predisposición Genética a la Enfermedad , Neoplasias de Cabeza y Cuello/sangre , Neoplasias de Cabeza y Cuello/genética , Humanos , Masculino , MicroARNs/sangre , Persona de Mediana Edad , Curva ROC , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Análisis de Secuencia de ARN , Carcinoma de Células Escamosas de Cabeza y Cuello/sangre , Carcinoma de Células Escamosas de Cabeza y Cuello/genética

RESUMEN

INTRODUCTION: Several studies in developed and developing countries have analyzed the health risk factors associated with COVID-19 mortality. Comorbid diseases are a key explanatory factor behind COVID-19 mortality, but current studies treat comorbidities in isolation, at average-population values, and rarely assess how death risk varies for different health profiles across institutions. Estimating death risk variations for different interactions between comorbid diseases and across healthcare institutions is crucial to gaining a significant depth of understanding in relation to mortality during the pandemic. METHODS: This study relies on data from approximately half a million people in Mexico (of all recorded cases through August 15, 2020) and on Bayesian estimation to provide a more robust estimate of the combined effect of several comorbidities and institutional inequalities on COVID-19 mortality. RESULTS: The findings of the study illustrate the additive effects of several comorbid diseases, with the presence of obesity, diabetes, hypertension, and chronic kidney disease increasing the mortality risk of COVID-19. There are also variations in the risk of death across the heterogeneous Mexican health system. CONCLUSIONS: This study shows that COVID-19 mortality risk sharply increases in patients with 2 or more comorbid diseases (obesity, diabetes, hypertension, and cardiovascular diseases) in Mexico. However, death risk varied significantly across institutions for patients with the same comorbidity profile.

Asunto(s)

COVID-19/mortalidad , Hospitales/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Teorema de Bayes , Comorbilidad , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Masculino , México , Persona de Mediana Edad , Modelos Estadísticos , Obesidad/epidemiología , Insuficiencia Renal Crónica/epidemiología , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo

RESUMEN

Previous studies have suggested that COVID-19 pneumonia is associated with an increased risk of venous thromboembolism (VTE). This study aimed to investigate the incidence of VTE among mechanically ventilated adults with COVID-19 pneumonia, compared to patients with respiratory failure related to other causes. Prospective study that enrolled critically ill adults with suspected COVID-19 pneumonia between June 2, 2020 and August 11, 2020. Critically ill adults with suspected COVID-19 pneumonia who required mechanical ventilation within 24 h after hospital admission were followed until death or hospital discharge. Sequential ultrasonography screening of the lower extremities and catheter insertion sites, as well as testing for plasma biochemical markers, were performed at the intensive care unit admission, day 3, day 7, and day 14. The primary outcome was a composite of deep venous thrombosis, pulmonary embolism, and thrombosis at the central catheter insertion sites. We enrolled 70 patients, including 57 patients with COVID-19 and 13 patients without COVID-19, and all patients completed follow-up. The incidence of the primary outcome was higher among patients with COVID-19 than among patients with respiratory failure related to other etiologies (36.8% vs. 0%, p = 0.023). Multivariate regression analysis revealed that VTE was independently associated with a COVID-19 diagnosis (odds ratio: 6.28, 95% confidence interval: 1.19-68.07) and D-dimer concentration (1-ng/mL increase, odds ratio: 1.15, 95% confidence interval: 1.05-1.30). The incidence of VTE was higher among critically ill mechanically ventilated patients, relative to among patients with respiratory failure related to other causes.

Asunto(s)

COVID-19 , Enfermedad Crítica , Neumonía Viral , Embolia Pulmonar , Insuficiencia Respiratoria , Medición de Riesgo , Tromboembolia Venosa , Brasil/epidemiología , COVID-19/diagnóstico , COVID-19/fisiopatología , COVID-19/terapia , Prueba de COVID-19/métodos , Catéteres Venosos Centrales/efectos adversos , Enfermedad Crítica/epidemiología , Enfermedad Crítica/terapia , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Incidencia , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Neumonía Viral/etiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Estudios Prospectivos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiología , Respiración Artificial/métodos , Respiración Artificial/estadística & datos numéricos , Insuficiencia Respiratoria/epidemiología , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Tromboembolia Venosa/sangre , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etiología , Tromboembolia Venosa/terapia

RESUMEN

BACKGROUND: Despite the prevalence of hypocoagulability after injury, the majority of trauma patients paradoxically present with elevated thrombin generation (TG). Although several studies have examined plasma TG post injury, this has not been assessed in whole blood. We hypothesize that whole blood TG is lower in hypocoagulopathy, and TG effectively predicts massive transfusion (MT). STUDY DESIGN: Blood was collected from trauma activation patients at an urban Level I trauma center. Whole blood TG was performed with a prototype point-of-care device. Whole blood TG values in healthy volunteers were compared with trauma patients, and TG values were examined in trauma patients with shock and MT requirement. RESULTS: Overall, 118 patients were included. Compared with healthy volunteers, trauma patients overall presented with more robust TG; however, those arriving in shock (n = 23) had a depressed TG, with significantly lower peak thrombin (88.3 vs 133.0 nM; p = 0.01) and slower maximum rate of TG (27.4 vs 48.3 nM/min; p = 0.04). Patients who required MT (n = 26) had significantly decreased TG, with a longer lag time (median 4.8 vs 3.9 minutes, p = 0.04), decreased peak thrombin (median 71.4 vs 124.2 nM; p = 0.0003), and lower maximum rate of TG (median 15.8 vs 39.4 nM/min; p = 0.01). Area under the receiver operating characteristics (AUROC) analysis revealed lag time (AUROC 0.6), peak thrombin (AUROC 0.7), and maximum rate of TG (AUROC 0.7) predict early MT. CONCLUSIONS: These data challenge the prevailing bias that all trauma patients present with elevated TG and highlight that deficient thrombin contributes to the hypocoagulopathic phenotype of trauma-induced coagulopathy. In addition, whole blood TG predicts MT, suggesting point-of-care whole blood TG can be a useful tool for diagnostic and therapeutic strategies in trauma.

Asunto(s)

Trastornos de la Coagulación Sanguínea/epidemiología , Transfusión Sanguínea/estadística & datos numéricos , Trombina/análisis , Heridas y Lesiones/complicaciones , Adulto , Trastornos de la Coagulación Sanguínea/sangre , Trastornos de la Coagulación Sanguínea/diagnóstico , Estudios de Factibilidad , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Tromboelastografía , Centros Traumatológicos/estadística & datos numéricos , Heridas y Lesiones/sangre , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/terapia

RESUMEN

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.

Asunto(s)

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 Joven

RESUMEN

Aim: The aim of this study was to evaluate the frequency and median time for the development of metastases and prognosis by metastatic site after the diagnosis of non-small-cell lung cancer (NSCLC). Patients & methods: This cohort study was conducted with 1096 patients diagnosed with NSCLC between 2006 and 2014. Results: The most prevalent site of NSCLC metastases was the respiratory system. The nervous and adrenal systems presented the longest median time for the development of metastases. The 6-month survival varied from 68.2% for liver to 79.9% for the nervous system. Bone metastases were associated with a higher risk of death. Conclusion: The respiratory system was the most prevalent site of metastases. OS and risk of death varied according to the metastatic site.

Asunto(s)

Adenocarcinoma del Pulmón/epidemiología , Carcinoma de Células Grandes/epidemiología , Carcinoma de Pulmón de Células no Pequeñas/epidemiología , Carcinoma de Células Escamosas/epidemiología , Neoplasias Pulmonares/patología , Adenocarcinoma del Pulmón/secundario , Brasil/epidemiología , Carcinoma de Células Grandes/secundario , Carcinoma de Pulmón de Células no Pequeñas/secundario , Carcinoma de Células Escamosas/secundario , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Factores de Tiempo

RESUMEN

BACKGROUND & AIMS: Systemic inflammation has been reported as a new predictor for cancer outcomes. This study aimed i) to identify the neutrophil to lymphocytes ratio (NLR) cut-off point that best predicts sarcopenia and ii) to verify the association between NLR and sarcopenia risk in hospitalized cancer patients. METHODS: A cross-sectional study enrolled a total of 123 hospitalized cancer patients receiving chemotherapy and/or undergoing surgery. Systemic inflammation was assessed as revealed by circulating levels of C-reactive protein, neutrophils, platelet, and by calculating platelet-lymphocytes ratio (PLR) and NLR. Sarcopenia risk was assessed using the Strength, Assistance for walking, Rise from a chair, Climb stairs, and Falls (SARC-F; score≥4 identifies sarcopenia risk). ROC curve were used to identify the best NLR cut-off value which predicts sarcopenia risk. Differences between groups were tested using the T Student, Mann-Whitney, or Chi-Square tests. Logistic regression analyses were done to assess the association between NLR and sarcopenia risk. RESULTS: ROC curve revealed that the best cut-off point to predict sarcopenia risk was NLR ≥6.5 (sensitivity of 45% and specificity of 81%). Those with NLR ≥6.5 presented higher C-reactive protein, neutrophils, platelet-lymphocytes ratio (PLR), and SARC-F than NLR <6.5 group. A negative correlation was found between NLR and gait speed (r = -0.48, p = 0.0001), handgrip strength (r = -0.29, p = 0.002), arm circumference (r = -0.29, p = 0.002) and calf circumference (r = -0.28, p = 0.003). Those with increased NLR values were associated with high sarcopenia risk in crude model, as well as if adjusted by smoking, alcohol intake, and sex (OR:1.19 [95%CI:1.03-1.37], p = 0.013) or by BMI (OR:1.20 [95%CI:1.05-1.38], p = 0.006). CONCLUSION: In hospitalized cancer patients, systemic inflammation measured by NLR was associated with increased sarcopenia risk.

Asunto(s)

Recuento de Células Sanguíneas/estadística & datos numéricos , Linfocitos/metabolismo , Neoplasias/sangre , Neutrófilos/metabolismo , Medición de Riesgo/estadística & datos numéricos , Sarcopenia/etiología , Anciano , Plaquetas/metabolismo , Proteína C-Reactiva/metabolismo , Estudios Transversales , Femenino , Estado Funcional , Hospitalización , Humanos , Inflamación , Estado de Ejecución de Karnofsky , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Valor Predictivo de las Pruebas , Curva ROC , Valores de Referencia

RESUMEN

PURPOSE: Brazil is the largest country in South America. Although a developing nation, birth rates have been decreasing in the last few decades, while its overall population is undergoing lifestyle changes and ageing significantly. Moreover, Brazil has had increasingly high mortality rates related to colorectal cancer (CRC). Herein, we investigated whether the Brazilian population is exhibiting increasing mortality rates related to colon cancer (CC) or rectal cancer (RC) in recent years. METHODS: We examined data from the Brazilian Federal Government from 1979 to 2015 to determine whether CRC mortality and the population ageing process may be associated. RESULTS: Our mathematical modelling suggests that mortality rates related to CC and RC events in the Brazilian population may increase by 79% and 66% in the next 24 years, respectively. This finding led us to explore the mortality rates for both diseases in the country, and we observed that the highest levels were in the south and southeast regions from the year 2000 onwards. CC events appear to decrease life expectancy among people during their second decade of life in recent years, whereas RC events induced decreases in life expectancy in those aged >30 years. Additionally, both CC and RC events seem to promote significant mortality rates in the male population aged > 60 years and living in the southern states. CONCLUSION: Our dataset suggests that both CC and RC events may lead to a significantly increasing number of deaths in the Brazilian male population in coming years.

Asunto(s)

Neoplasias del Colon/mortalidad , Neoplasias del Recto/mortalidad , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Estudios Prospectivos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Distribución por Sexo , Factores Sexuales , Adulto Joven

Asunto(s)

Dermoscopía/estadística & datos numéricos , Melanoma/epidemiología , Nevo/patología , Neoplasias Cutáneas/epidemiología , Piel/diagnóstico por imagen , Adulto , Biopsia , Femenino , Humanos , Masculino , Melanoma/diagnóstico , Melanoma/patología , Persona de Mediana Edad , Nevo/congénito , Pronóstico , Estudios Retrospectivos , Medición de Riesgo/estadística & datos numéricos , Piel/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , Adulto Joven

RESUMEN

BACKGROUND: The high mortality rate of decompensated cirrhosis underlines the need for new treatments. Experimental models of cirrhosis and its reported relationship with atherosclerotic cardiovascular disease have provided data supporting the rational use of statins in these patients. However, little is known about the safety of statins in this setting. AIM: We evaluate the safety of chronic simvastatin treatment in patients with decompensated cirrhosis. METHODS: We conducted a prospective, open, uncontrolled, phase 2a trial in 30 patients with Child-Pugh class A (n = 6), B (n = 22), and C (n = 2) decompensated cirrhosis. The patients received standard treatment throughout the trial plus simvastatin 20 mg/day for 2 weeks and thereafter simvastatin 40 mg/day up to 1 year. RESULTS: Sixteen out of 30 patients (53.3%) showed adverse events, including gastrointestinal toxicity (36.7%), muscle injury (MI) (36.7%), and headache (13.3%). No liver injury was registered. Due to MI alone, simvastatin dosage was reduced in 23.4% of cases and transiently interrupted in 13.3%. Once these adverse events were overcome, simvastatin was resumed until the end of the trial. MI was associated with baseline MELD score > 12 (p = 0.035) and with baseline Child-Pugh class C. No MI was associated with final Child-Pugh score ≤ 6 (p = 0.030) or final Child-Pugh class A (p = 0.020). CONCLUSIONS: Chronic treatment with simvastatin 40 mg/day in patients with decompensated cirrhosis was associated with several adverse events, being MI the only clinically significant one, which appears to be related to the simvastatin dosage and the degree of cirrhosis severity. Noticeably, no liver injury was recorded.

Asunto(s)

Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Cirrosis Hepática , Hígado/efectos de los fármacos , Simvastatina , Argentina/epidemiología , Enfermedades Cardiovasculares/prevención & control , Progresión de la Enfermedad , Relación Dosis-Respuesta a Droga , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/diagnóstico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Femenino , Enfermedades Gastrointestinales/inducido químicamente , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/epidemiología , Cefalea/inducido químicamente , Cefalea/diagnóstico , Cefalea/epidemiología , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/epidemiología , Masculino , Persona de Mediana Edad , Mialgia/inducido químicamente , Mialgia/diagnóstico , Mialgia/epidemiología , Evaluación de Procesos y Resultados en Atención de Salud , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Simvastatina/administración & dosificación , Simvastatina/efectos adversos

RESUMEN

BACKGROUND: Frontal fibrosing alopecia (FFA) is a chronic cicatricial alopecia with unknown etiology and a worldwide rising incidence. OBJECTIVE: The objective of this study was to evaluate the association of FFA with demographic and exposure factors in a Brazilian multiracial population. METHODS: A multicenter case-control study was conducted in 11 referral centers throughout Brazil. The study was a case-control study that prospectively recruited 902 participants (451 patients with FFA and 451 sex-matched control individuals). Study participants completed a thorough questionnaire comprising variables grouped as baseline demographics, environmental exposure, diet, hormonal factors, allergies, and hair and skin care. RESULTS: When adjusted by sex, age, menopause, and skin color, FFA was associated with hair straightening with formalin (odds ratio [OR], 3.18), use of ordinary (nondermatologic) facial soap (OR, 2.09) and facial moisturizer (OR, 1.99), thyroid disorders (OR, 1.69), and rosacea (OR, 2.08). Smokers (OR, 0.33) and users of antiresidue/clarifying shampoo (OR, 0.35) presented a negative association with FFA. There was no association with the use of sunscreen. LIMITATIONS: Recall bias. CONCLUSIONS: The association with moisturizers, ordinary facial soap, and hair straightening with formalin and the negative association with antiresidue/clarifying shampoo reinforce the possibility of an exogenous particle triggering FFA.

Asunto(s)

Alopecia/epidemiología , Cicatriz/epidemiología , Rosácea/epidemiología , Fumar/epidemiología , Enfermedades de la Tiroides/epidemiología , Adulto , Anciano , Alopecia/etiología , Alopecia/patología , Brasil/epidemiología , Estudios de Casos y Controles , Cicatriz/etiología , Cicatriz/patología , Femenino , Frente , Formaldehído/efectos adversos , Preparaciones para el Cabello/efectos adversos , Preparaciones para el Cabello/química , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores Protectores , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Piel/patología , Jabones/efectos adversos , Encuestas y Cuestionarios/estadística & datos numéricos

RESUMEN

Chronic kidney disease (CKD) is a recognized public health problem and key determinant of poor health outcomes. In Mexico, this condition has been associated with high and significant risk of death in COVID-19 patients; however, not enough attention has been given to the vulnerable population as the increasing numbers and fatality rates suggest. This study evaluated the effect of interaction between CKD condition and other risk factors (sex, diabetes, hypertension and obesity) on the survival rate of positive patients for COVID-19 in Mexico. The results from this study support that CKD patients is a population at high risk for mortality for COVID-19 and that COVID-19 positive inpatients with CKD and diabetes are highly vulnerable to death.

Asunto(s)

COVID-19 , Mortalidad , Insuficiencia Renal Crónica , COVID-19/diagnóstico , COVID-19/epidemiología , Prueba de COVID-19/estadística & datos numéricos , Comorbilidad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Pronóstico , Diálisis Renal/métodos , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/terapia , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , SARS-CoV-2/aislamiento & purificación , Tasa de Supervivencia

RESUMEN

Children of Hispanic origin bear a high risk of obesity. Child weight gain trajectories are influenced by the family environment, including parent feeding practices. Excessive body fat can result in unhealthful metabolic and lipid profiles and increased risk of metabolic diseases. The objective was to estimate criterion validity of an obesity risk assessment tool targeting Spanish-speaking families of Mexican origin using anthropometric measures and blood values of their young children. A cross-sectional study design with five data collection sessions was conducted over an eight-week period and involved 206 parent/child dyads recruited at Head Start and the Special Supplemental Nutrition Program for Women, Infants and Children in Northern California. Main outcome measures were criterion validity of Niños Sanos, a pediatric obesity risk assessment tool, using anthropometric measures and blood biomarkers. Niños Sanos scores were inversely related to child BMI-for-age percentiles (p = 0.02), waist-for-height ratios (p = 0.05) and inversely related to blood biomarkers for the metabolic index (p = 0.03) and lipid index (p = 0.05) and positively related to anti-inflammatory index (p = 0.047). Overall, children with higher Niños Sanos scores had more healthful lipid, metabolic and inflammatory profiles, as well as lower BMI-for-age percentiles and waist-to height ratios, providing evidence for the criterion validity of the tool. Niños Sanos can be used by child obesity researchers, by counselors and medical professionals during clinic visits as a screening tool and by educators as a tool to set goals for behavior change.

Asunto(s)

Biomarcadores/sangre , Índice de Masa Corporal , Hispánicos o Latinos/estadística & datos numéricos , Obesidad Infantil/diagnóstico , Pobreza/estadística & datos numéricos , Medición de Riesgo/estadística & datos numéricos , Adulto , Glucemia/análisis , California/epidemiología , Preescolar , Estudios Transversales , Emigrantes e Inmigrantes , Femenino , Conductas Relacionadas con la Salud , Humanos , Inflamación/sangre , Insulina/sangre , Lípidos/sangre , Masculino , México/etnología , Obesidad Infantil/epidemiología , Relación Cintura-Estatura