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RESUMEN El objetivo es proponer un esquema conceptual que sea útil para interpretar las implicaciones económicas y ambientales que tienen las organizaciones sociales basadas en un paradigma individualista o altruista. Tras una revisión de literatura y breve recuento histórico de estos paradigmas, se concluye que son las organizaciones complejas y equilibradas las que tienen mayor propensión a desarrollar intercambios de cooperación altruistas. La implicación para las políticas ambientales contemporáneas es que, además de los mecanismos de mercado, es posible complementarlas con otros esquemas basados en mecanismos comunitarios, siempre y cuando exista un contexto propicio para implementarlo.
ABSTRACT The objective is to propose a practical conceptual scheme to interpret social organizations' economic and ecological implications based on an individualistic or altruistic paradigm. After a literature review and a brief historical analysis of these paradigms, we conclude that complex and balanced organizations have the most remarkable propensity to develop altruistic cooperation exchanges. The implication for contemporary environmental policies is the possibility of complementing market mechanisms with community-based schemes in a favorable context.
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Background: Gaucher's disease (GD), a lysosomal storage disorder, poses significant treatment challenges. This 23-year study assesses survival rates and treatment efficacy in Brazilian GD patients, integrating data from a 16-year cohort (2000-2015) and the TABNET/DATASUS medicines distribution data (1999-2022). Objective: To investigate the survival of GD patients in Brazil, identifying key risk factors and evaluating the impact of treatments funded by the Brazilian National Health System (SUS). Methodology: A 16-year retrospective cohort study was conducted using the National Database of SUS. Patients diagnosed with GD and treated with Enzyme Replacement Therapy (ERT) or Substrate Synthesis Inhibition (SSI) from 2000 to 2015 were included. Survival analysis was performed using Kaplan-Meier method and Cox proportional hazards model. The data from TABNET/DATASUS system from 1999 to 2022 was used to assess the trend in drug distribution beyond the main cohort. Results: The study included 1,234 patients. Survival rates at 5 and 10 years were 93.2% and 88.5%, respectively, with age and comorbidities like diabetes, cardiovascular diseases, and Parkinson's disease significantly affecting survival. Patients who received doses lower than DDD (n = 880) demonstrated a survival probability of 91.8%. In contrast, those with doses equal to the DDD (n = 15) showed a 100% survival probability, as no events were observed in this group. The greater than DDD group (n = 339) exhibited a survival probability of 81%. A log-rank test indicated a borderline statistical significance (p = 0.058) in the survival distributions among the different DDD adherence, with the lower dose group showing a favorable trend. Conclusion: This study provides insights into the survival rates and associated risk factors for GD patients in Brazil, contributing to the global understanding of GD and its management. While we acknowledge the inherent limitations of relying largely on electronic medical records and categorical codes, our findings underscore the need for early diagnosis, timely initiation of treatment, effective management of comorbidities, and personalized dosing strategies to improve patient outcomes. Future studies should aim to incorporate clinical verification of electronic data to further enhance the reliability and applicability of these findings.
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OBJECTIVE: Describe the survival, sociodemographic and clinical characteristics of subjects with disorders of consciousness in a reference rehabilitation center, in a developing country. METHODS: Patients with disorders of consciousness (DoC) caused by acquired neurological injuries, admitted between the years 2002-2018 in a neurorehabilitation center. Extracted data covered demographics, clinical details, survival time, and discharge information. Cox proportional hazard model and Kaplan-Meier analysis were used to reveal, associations with survival. RESULT: Out of 5064 neurological cases, 159 patients were diagnosed with DoC. The demographic data showed a male dominance (65%), with an average injury age of 42 years. The most common causes were traumatic (41%), anoxic (36%), and vascular (10%), with traffic accidents accounting for 71% of traumatic injuries. The study found that 75% of patients remained in a vegetative state (VS), and 25% in a minimally conscious state (MCS), with an average survival of 2110 days. CONCLUSION: There were no significant differences in survival days between patients in MCS and VS. Patients with traumatic injuries showed a higher survival rate than those with non-traumatic injuries. Age and etiology were identified as factors associated with a higher risk of death.
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BACKGROUND: Chlorsulfuron resistance and genetic dominance was evaluated in Raphanus raphanistrum genotypes homozygous (122-RR, 376-RR), heterozygous (122-RS, 376-RS) and compound heterozygous (122-R/376-R) for the target-site resistance mutations Ala-122-Tyr and Asp-376-Glu in the AHAS (acetohydroxyacid synthase) gene. RESULTS: At the AHAS level, 122-RR and 122-RS plants exhibited significantly higher I50 values than 376-RR and 376-RS plants, respectively. However, plants of the compound heterozygous genotype (122-R/376-R), showed no difference in AHAS activity compared to the 122-RS genotype but lower activity than the 122-RR genotype, and showed a nearly 400-fold greater I50 value than both genotypes (376-RR and 376-RS) carrying the 376-Glu allele. At the whole-plant level, 100% survival was observed for 122-RR plants at the highest chlorsulfuron dose of 640 g ha-1, yet 376-RR plants showed no survival at 380 g ha-1. Thus, this survival difference resulted in different median lethal dose (LD50) estimates [>640 (122-RR) versus 330 g ha-1(376-RR)]. The effect of chlorsulfuron in reducing aboveground growth of surviving plants also was markedly lower for the homozygous 122-RR (GR50 = 566 g ha-1) than for 376-RR plants (GR50 = 66). Heterozygous plants carrying the 122-Tyr allele (122-RS) exhibited two- and five-fold higher LD50 values than both homozygous and heterozygous plants carrying the 376-Glu allele (376-RR, 376-RS), respectively. Along the difference in plant survival, 122-RS plants also showed four-fold higher GR50 than both 376-RR and 376-RS plants. Survival of plants with the compound heterozygous genotype (122-R/376-R) under increasing chlorsulfuron doses was similar to 122-RR or 122-RS genotypes. However, this compound heterozygous genotype showed two- and six-fold higher LD50 values than 376-RR or 376-RS genotypes, respectively. However, both resistance 122-Tyr and 376-Glu alleles were dominant or nearly dominant over the wild-type susceptible alleles (ALA-122 and ASP-376), and the resistance 122-Tyr allele was dominant over the 376-Glu allele. CONCLUSIONS: These results broaden our understanding of AHAS target-site resistance in R. raphanistrum and strengthens the hypothesis that the AHAS 122-Tyr allele corresponds to a stronger target-site resistance allele than the 376-Glu allele. © 2024 Society of Chemical Industry.
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Background: Survival in patients with sleep apnoea (SA) can be reduced by variables such as age, sex, and comorbidities. However, survival data in patients with SA in Colombia remains scarce. Methods: This is a retrospective cohort study of patients diagnosed with SA between 2005 and 2022. Five-year survival was assessed using the Kaplan-Meier method, and survival curves were stratified by age, sex, and cardiovascular disease. Risk factors associated with survival were evaluated using Hazard Ratio (HR) by adjusting for confounding variables with a Cox regression model. A minimum sample size of 1537 patients were estimated to be necessary to estimate a survival incidence rate with a 5% precision. Results: The five-year survival rate in the general population was 94.6%, with lower survival in patients over 65 years (88.5% vs 97.9%; p < 0.001) and in patients with cardiovascular disease (89% vs 95.2%; p < 0.001) compared to the control group. In the Cox regression, age showed an HR of 1.05 (95% CI: 1.02-1.07; p < 0.001). Male sex had an HR of 2.31 (95% CI: 1.25-4.25; p = 0.007), congestive heart failure an HR of 4.00 (95% CI: 2.31-6.94; p < 0.001), chronic obstructive pulmonary disease (COPD) an HR of 1.75 (95% CI: 1.04-2.96; p = 0.035), chronic kidney disease (CKD) an HR of 2.23 (95% CI: 1.31-3.78; p = 0.003), and metastatic cancer an HR of 4.96 (95% CI: 1.95-12.60; p = 0.001). Conclusion: The study showed a high five-year survival rate in patients with SA. The risk factors associated with decreased overall five-year survival were age, male sex, cardiovascular disease, COPD, CKD, and metastatic cancer.
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BACKGROUND: Liver transplantation is the treatment for many end-stage liver diseases and hepatocellular carcinoma but shortage of available organs poses significant challenge. Many centers have used grafts from donors with positive anti-HBc serology but concerns about potential hepatitis B virus reactivation and de novo hepatitis B infection have raised questions about the safety of this approach. This study aimed to evaluate the survival of liver transplant recipients from anti-HBc-positive-donors and assess the risk of hepatitis B reactivation and de novo hepatitis B. PATIENTS AND METHODS: A retrospective single-center cohort study was conducted from 2002 to 2018, comparing who received grafts from anti-HBc-positive-donors to those from anti-HBc-negative-donors. The primary outcome was survival and description cases of hepatitis B reactivation/de novo hepatitis B. RESULTS: We analyzed 1,111 liver transplants, in which 993 (89â¯%) received grafts from anti-HBc-negative-donors and 118 (11â¯%) from anti-HBc-positive-donors. Median age of recipients from anti-HBc-positive donors was 56 years and from anti-HBc-negative donors was of 53 years (pâ¯=â¯0.001). Male sex was predominant in both groups. Factors associated with death in multivariate analysis were retransplantation, early allograft dysfunction, high MELD, recipient over 60 years and female donor. The utilization of grafts from anti-HBc-positive-donors did not increase mortality. The majority of HBV reactivation and de novo hepatitis B occurred in anti-HBc positive recipients. The risk of hepatitis B reactivation/de novo hepatitis B was low and manageable. CONCLUSION: The study supports safety of liver grafts from anti-HBc-positive donors when employing antiviral prophylaxis. These findings contribute to expand donor options and improve patient outcomes.
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BACKGROUND: The coffee crop is prominent in Brazilian agriculture, making the country a global power in this area. One of the main concerns in the coffee sector is disease, which can affect coffee productivity and quality. Thus, it is important to evaluate the factors that may affect coffee quality and thus enhance the development of strategies to reduce coffee losses and costs and optimize production. This study evaluated the influence of the type of irrigation (self-propelled, drip, and center pivot) on the time until the occurrence of phoma leaf spot on Arabica coffee plants, considering the intensity of the disease. Additionally, the association between longitudinal incidence and the time until an event of interest was assessed based on the joint modeling of longitudinal and survival data. RESULTS: The results of this study identify the effectiveness of drip irrigation system compared with other systems; the use of such systems was associated with an ~46.5% reduction in the risk of leaf spot disease compared with the use of a self-propelled irrigation system. The use of a center pivot system increased the risk of disease progression compared with a self-propelled system. An association between the longitudinal and survival processes was also observed. CONCLUSION: The findings demonstrate the superior performance of the drip irrigation system in controlling phoma leaf spot disease in Arabica coffee plants compared with self-propelled and center pivot systems. This research highlights the potential of using drip irrigation to establish more effective agricultural practices in coffee cultivation, contributing to better disease management and improved crop quality. © 2024 Society of Chemical Industry.
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Toxoplasma gondii is a zoonotic parasite with global distribution capable of infecting homeothermic animals. Transmission of protozoan to humans includes ingestion of water and raw food contaminated with sporulated oocysts, ingestion of raw or undercooked meat with tissue cysts, and tachyzoites' transplacental transmission. Fresh goat milk intake has already been linked to human toxoplasmosis outbreaks, but little is known about the infectious potential of this biological sample. Accordingly, the aim of the present study is to assess the survival and infectivity of T. gondii tachyzoites in fresh goat milk samples through an experimental protocol to detect this parasite via bioassay carried out with a murine model, DNA amplification, and serology. Swiss Webster mice were inoculated with fresh goat milk samples contaminated with different T. gondii RH strain tachyzoite concentrations per milliliter and stored for different refrigeration times. Animals showing clinical signs compatible to toxoplasmosis were euthanized. Milk samples contaminated with high parasitic loads and kept for a shorter refrigeration time were the most lethal ones. No significant differences were observed between mean death rates recorded for different goat milk contamination concentrations (p = 0.1888), and for the refrigeration time, contaminated milk samples were kept under (p = 0.9440). T. gondii DNA was amplified in all contaminated milk samples, but only one of the surviving mice was serologically positive. Results of the present study have shown T. gondii survival and infectivity in fresh goat milk samples, and it highlights its significant risk for public health. Therefore, molecular methods must be the tests of choice when milk samples are used to assess infection caused by protozoan in goats' dairy products.
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BACKGROUND: Cervical cancer (CC) is a serious public health concern, being the fourth most common cancer among women and a leading cause of cancer mortality. In Brazil, many women are diagnosed late, and in Mato Grosso, with its geographical diversity, there are specific challenges. This study analyzed hospital survival and its predictors using data from the Hospital Information System (SIH) of the Unified Health System (SUS) in Mato Grosso from 2011 to 2023. METHODS: Cox regression and Kaplan-Meier models were applied to determine survival time and identify mortality predictors. The adjusted Hazard Ratio (AHR) with a 95% Confidence Interval (CI) was used to measure the association between the factors analyzed. RESULTS: The hospital mortality rate was 9.88%. The median duration of hospitalization was 33 days (interquartile range [IQR]: 12-36), with a median survival of 43.7%. Patients were followed up for up to 70 days. In the multivariable Cox model, after adjusting for potential confounders, the risk of death during hospitalization was higher in patients aged 40-59 years (AHR = 1.39, p = 0.027) and 60-74 years (AHR = 1.54, p = 0.007), in the absence of surgical procedures (AHR = 4.48, p < 0.001), in patients with medium service complexity (AHR = 2.40, p = 0.037), and in the use of ICU (AHR = 4.97, p < 0.001). On the other hand, patients with hospital expenses above the median (152.971 USD) showed a reduced risk of death (AHR = 0.21, p < 0.001). CONCLUSION: This study highlights that hospitalized CC patients have reduced survival, underscoring the need for interventions to improve care, including strategies for early diagnosis and expanded access to adequately resourced health services.
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Mortalidade Hospitalar , Hospitalização , Neoplasias do Colo do Útero , Humanos , Feminino , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia , Pessoa de Meia-Idade , Adulto , Brasil/epidemiologia , Idoso , Hospitalização/estatística & dados numéricos , Taxa de Sobrevida , Prognóstico , Seguimentos , Estudos Retrospectivos , Fatores de TempoRESUMO
INTRODUCTION: The COVID-19 pandemic is a great burden worldwide, but its impact on patients with genitourinary cancer (GUC) is poorly characterized. This study aimed to characterize the clinical features and evolution of GUC patients affected by COVID-19 in Spain. PATIENTS AND METHODS: SOGUG-COVID-19 was an observational ambispective non-interventional study that recruited patients with SARS-CoV-2 infection who had been treated for GUC in 32 Spanish hospitals. Data were collected from patients' medical records in a short period of time, coinciding with the first waves of COVID-19, when the mortality was also higher in the general population. RESULTS: From November 2020 to April 2021, 408 patients were enrolled in the study. The median age was 70 years, and 357 patients (87.5%) were male. Most frequent Cancer Origin was: prostate (40.7%), urothelial (31.4%) and kidney (22.1%). Most patients (71.3%) were diagnosed at the metastatic stage, and 33.3% had poorly differentiated histology. Anticancer treatment during the infection was reported in 58.3% of patients, and 21.3% had received immunotherapy prior to or concurrent with the infection. The most frequent COVID-19 symptoms were pyrexia (49.0%), cough (38.2%) and dyspnea (31.9%). Median age was higher for patients with pneumonia (p < 0.001), patchy infiltrates (p = 0.005), ICU admission (p < 0.001) and death (p < 0.001). Tumor stage was associated with complications (p = 0.006). The fatality rate was 19.9% and the 6-month COVID-19-specific survival rate was 79.7%. CONCLUSION: Patients with genitourinary cancers seem exceptionally vulnerable to COVID-19 regardless of tumor type or anticancer therapy. Age and tumor stage were the only identified risk factors for severe COVID-19.
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BACKGROUND: Intra-operative cardiac arrest is a rare but life-threatening event. Over the past two decades, various initiatives have improved the care of patients undergoing surgery at our quaternary teaching hospital in Brazil. We aimed to evaluate the epidemiology of intra-operative cardiac arrest and associated 30-day mortality over an 18-year period. A secondary aim was to identify associated risk factors. METHODS: We conducted a retrospective observational study using data collected from 1 January 2005 to 31 December 2022. Factors associated with cardiac arrest and mortality were identified using multivariable logistic regression analysis. RESULTS: Among the 154,178 cases, the overall rates of intra-operative cardiac arrest (n = 297) and associated 30-day mortality (n = 248) were 19.3 (95%CI (16.6-21.9)) and 16.1 (95% CI 13.9-18.3) per 10,000 anaesthetics, respectively. These decreased over time (2005-2010 vs. 2017-2022) from 26.3 (95%CI 21.0-31.6) to 15.4 (95%CI 12.0-18.7) per 10,000 anaesthetics, and from 23.4 (95%CI 18.8-28.1) to 13.7 (95%CI 10.8-16.7) per 10,000 anaesthetics, respectively. Factors associated with intra-operative cardiac arrest included children aged < 1 year (adjusted OR (95%CI) 3.51 (1.87-6.57)); ASA physical status 3-5 (adjusted OR (95%CI) 13.85 (8.86-21.65)); emergency surgery (adjusted OR (95%CI) 10.06 (7.85-12.89)); general anaesthesia (adjusted OR (95%CI) 8.79 (4.60-19.64)); surgical procedure involving multiple specialities (adjusted OR (95%CI) 9.13 (4.24-19.64)); cardiac surgery (adjusted OR (95%CI) 7.69 (5.05-11.71)); vascular surgery (adjusted OR (95%CI) 6.21 (4.05-9.51)); and gastrointestinal surgery (adjusted OR (95%CI) 2.98 (1.91-4.65)). DISCUSSION: We have shown an important reduction in intra-operative cardiac arrest and associated 30-day mortality over an 18-year period. Identification of relative risk factors associated with intra-operative cardiac arrest can be used to improve the safety and quality of patient care, especially in a resource-limited setting.
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BACKGROUND: Neoadjuvant chemotherapy (NAC), traditionally used for locally advanced disease, is now applied for operable disease, particularly to treat aggressive breast cancer (BC). This study aimed to characterize the pathological complete response (pCR) and its relationship with overall survival (OS) and disease-free survival (DFS) among BC patients receiving NAC in a Brazilian public reference center, as well as the association between pCR and BC subtypes. METHODS: A retrospective cohort study used a comprehensive BC database from a Brazilian women's health reference center, including patients diagnosed between 2011 and 2020 who underwent NAC. We collected demographic, cancer-specific, and treatment-related data, analyzing OS and DFS based on pCR status using the semiparametric Kaplan-Meier method, with the date of BC diagnosis as the starting point. RESULTS: The study included 1,601 patients, with an average age of 49 years and a majority presenting stage IIIa disease (35%). Most had invasive nonspecial type (NST) BC (94%), and a significant portion (86.7%) exhibited a Ki-67 index <14. The overall pCR rate was 22.7%, with higher frequencies observed in the triple negative and luminal B subtypes. Patients who achieved pCR had significantly higher survival rates (89% alive vs. 61%, P<0.001) and better DFS (90% vs. 66%, P<0.001), except in the luminal A subtype, where pCR did not correlate with improved OS or DFS. CONCLUSIONS: These updated real-world data (RWD) from BC patients who underwent NAC in Brazil revealed a pCR rate of 22.7% in all cancer subtypes and stages. pCR was not associated with better outcomes in patients with luminal A, contrasting with other subtypes.
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Liver cirrhosis is a pathology of varied etiology with a high prevalence and mortality, resulting in >1 million mortalities per year. Patients with liver cirrhosis typically have a survival time of 12 years following diagnosis. The treatment for this disease is directed at the complications of cirrhosis; however, to the best of our knowledge, the long-term management of patients with cirrhosis has been scarcely studied. Pentoxifylline (PTX) is a non-selective phosphodiesterase inhibitor with rheological activity and antioxidant, anti-inflammatory and antifibrotic properties. PTX has been used in the treatment of peripheral arterial disease, inflammatory liver diseases and hepatocellular carcinoma with encouraging results. The aim of the present study was to evaluate the effect of PTX use on the survival of patients with compensated cirrhosis. For this purpose, a cross-sectional study was performed at the Gastroenterology and Hepatitis C Department of Dr. Valentín Gómez Farias Hospital (Institute for Security and Social Services for State Workers, Zapopan, Mexico) from June, 1996 to December, 2019. The follow-up time for these patients was 22.6 years (up to the end of the study period). In the present study, 326 patient files were analyzed and 118 patients with the disease were identified, 81 of whom (68.64%) died within 12 years after diagnosis. Of the included patients, 26 received PTX combined with PEG IFN-α-2a plus ribavirin, and 11 received PTX plus propranolol, with a median treatment duration of 20.6±0.8 years. Furthermore, 16 patients (43%) did not develop co-morbidities within this time, and the transition to decompensated cirrhosis was 16.6 years, with a survival time of 20 years. Therefore, the results of the present study suggest that PTX may improve the long-term survival of patients with compensated cirrhosis, rendering PTX a candidate for repurposing in the treatment of hepatic cirrhosis.
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The determination of the cancer prognosis is paramount for patients and medical personnel so that they can devise treatment strategies. Transcriptional-based signatures and subtypes derived from cancer biopsy material have been used in clinical practice for several cancer types to aid in setting the patient prognosis and forming treatment strategies. Other genomic features in cancer biopsies, such as copy number alterations (CNAs), have been underused in clinical practice, and yet they represent a complementary source of molecular information that can add detail to the prognosis, which is supported by recent work in breast, ovarian, and lung cancers. Here, through a systematic strategy, we explored the prognostic power of CNAs in 37 cancer types. In this analysis, we defined two modes of informative features, deep and soft, depending on the number of alleles gained or lost. These informative modes were grouped by amplifications or deletions to form four single-data prognostic models. Finally, the single-data models were summed or combined to generate four additional multidata prognostic models. First, we show that the modes of features are cancer-type dependent, where deep alterations generate better models. Nevertheless, some cancers require soft alterations to generate a feasible model due to the lack of significant deep alterations. Then, we show that the models generated by summing coefficients from amplifications and deletions appear to be more practical for many but not all cancer types. We show that the CNA-derived risk group is independent of other clinical factors. Furthermore, overall, we show that CNA-derived models can define clinically relevant risk groups in 33 of the 37 (90%) cancer types analyzed. Our study highlights the use of CNAs as biomarkers that are potentially clinically relevant to survival in cancer patients.
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Variações do Número de Cópias de DNA , Neoplasias , Humanos , Neoplasias/genética , Neoplasias/patologia , Prognóstico , Biomarcadores Tumorais/genéticaRESUMO
The results of in vitro and in vivo studies have shown the pro-tumor effects of TNF-α, and this cytokine's increased expression is associated with poor prognosis in patients with some types of cancer. Our study objective was to evaluate the possible association of TNF-α genetic polymorphisms and serum levels with susceptibility and prognosis in a cohort of Mexican patients with NB. We performed PCR-RFLP and ELISA methods to analyze the genetics of these SNPs and determine serum concentrations, respectively. The distribution of the -308 G>A and -238 G>A polymorphisms TNFα genotypes was considerably different between patients with NB and the control group. The SNP rs1800629 GG/GA genotypes were associated with a decreased risk of NB (OR = 0.1, 95% CI = 0.03-0.393, p = 0.001) compared with the AA genotype, which was associated with susceptibility to NB (OR = 2.89, 95% CI = 1.45-5.76, p = 0.003) and related to unfavorable histology and high-risk NB. The rs361525 polymorphism GG genotype was associated with a lower risk of developing NB compared with the GA and AA genotypes (OR = 0.2, 95% CI = 0.068-0.63, p = 0.006). Circulating TNF-α serum concentrations were significantly different (p < 0.001) between patients with NB and healthy controls; however, we found no relationship between the analyzed TNF-α serum levels and SNP genotypes. We found associations between the rs1800629AA genotype and lower event-free survival (p = 0.026); SNP rs361525 and TNF-α levels were not associated with survival in patients with NB. Our results suggest the TNF-α SNP rs1800629 as a probable factor of NB susceptibility. The -308 G/A polymorphism AA genotype has a probable role in promoting NB development and poor prognosis associated with unfavorable histology, high-risk tumors, and lower EFS in Mexican patients with NB. It should be noted that it is important to conduct research on a larger scale, through inter-institutional studies, to further evaluate the contribution of TNF-α genetic polymorphisms to the risk and prognosis of NB.
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Predisposição Genética para Doença , Neuroblastoma , Polimorfismo de Nucleotídeo Único , Fator de Necrose Tumoral alfa , Humanos , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/sangue , Neuroblastoma/genética , Neuroblastoma/sangue , Neuroblastoma/mortalidade , Neuroblastoma/patologia , Masculino , Feminino , México , Pré-Escolar , Lactente , Criança , Prognóstico , Genótipo , Estudos de Coortes , Estudos de Casos e ControlesRESUMO
Introdução: A taxa de mortalidade em pacientes queimados diminuiu significativamente, tornando importante avaliar outros desfechos, como o tempo de internação, que aumenta a morbidade física e psicológica, o risco de infecção hospitalar e os custos financeiros. O objetivo deste estudo é analisar a relevância de vários fatores no tempo de internação na Unidade de Queimados. Método: Foram incluídos neste estudo 711 pacientes admitidos entre 2011 e 2020 na Unidade de Queimados do Hospital de São José, Centro Hospitalar Lisboa Central, Lisboa, Portugal. Os dados coletados foram analisados utilizando o PSPP para Windows. Resultados: Os pacientes eram predominantemente do sexo masculino, com idade média de 54 anos. O tempo médio de permanência hospitalar foi de 29 dias. Os fatores que prolongaram a estadia hospitalar foram relacionados à gravidade da queimadura, ao número de cirurgias e ao tempo decorrido até a primeira cirurgia, valores laboratoriais alterados tanto no perfil hematológico quanto químico durante a hospitalização, e a presença e o número de infecções documentadas. Conclusão: Existem fatores potencialmente modificáveis que infiuenciam o tempo de permanência hospitalar. Nosso estudo nos permite concluir que o tempo decorrido até a primeira intervenção cirúrgica e a presença e o número de infecções documentadas prolongam significativamente esse desfecho, e ênfase deve ser dada à implementação de medidas que favoreçam a intervenção cirúrgica precoce e o controle rigoroso de infecções.
Introduction: Burn patients' mortality rate has decreased significantly, making it important to evaluate other outcomes, such as length-of-stay, which increases physical and psychological morbidity, risk of nosocomial infection, and financial costs. The objective of this study is to analyze the relevance of several factors in the Burn Unit length-of-stay. Material and Methods: 711 patients were included in this study, admitted between 2011 and 2020 to the Burn Unit at São José Hospital, Centro Hospitalar Lisboa Central, Lisbon, Portugal. Collected data was analyzed using PSPP for Windows. Results: Patients included in the study were predominantly males, with a mean age of 54 years. The mean length of stay was 29 days. The factors that prolonged in-hospital stay were those related to the severity of the burn, the number of surgeries and the time elapsed until the first one, altered laboratory values in both hematologic and chemistry profile during the hospitalization, and the presence and number of documented infections. Conclusion: There are potentially modifiable factors that influence length-of-stay. Our study allows us to conclude that the time elapsed until the first surgical intervention and the presence and number of documented infections significantly prolong this outcome, and emphasis should be given to the implementation of measures that favor early surgical intervention and strict infection control.
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RESUMEN El propósito del estudio fue describir las características clínicas, anatomopatológicas, tratamiento y supervivencia de los pacientes con cáncer de tiroides diferenciado. Se realizó un estudio de cohorte retrospectiva con datos de 150 pacientes de un hospital peruano entre los años 2010 al 2020. Se describieron las características y supervivencia (método de Kaplan-Meier). La media de edad fue 48,3 años, 130 (86,7%) fueron mujeres y el tipo histológico más frecuente fue el papilar 94,6%. El 74,2% tenían estadio TNM I, 70,7% tiroidectomía total y 68,7% recibió yodo radiactivo. La supervivencia global a los 5 años fue 89,3%, siendo menor en aquellos con estadio TNM IV y mayor en los que usaron yodo radiactivo. En conclusión, en un hospital de Cusco, el cáncer diferenciado de tiroides fue más frecuente en mujeres y la supervivencia fue menor en comparación con reportes de otros países.
ABSTRACT This study aimed at studying the clinical and anatomopathological characteristics, treatment and survival of patients with differentiated thyroid cancer. A retrospective cohort study was conducted with data from 150 patients from a Peruvian hospital between the years 2010 to 2020. Characteristics and survival (Kaplan-Meier method) were described. The mean age was 48.3 years, 130 participants (86.7%) were women and the most frequent histologic type was papillary 94.6%. Of the participants, 74.2% had TNM stage I, 70.7% had total thyroidectomy and 68.7% received radioactive iodine. Overall survival at 5 years was 89.3%, being lower in those with TNM stage IV and higher in those who used radioactive iodine. In conclusion, in a hospital in Cusco, differentiated thyroid cancer was more frequent in women and survival was lower compared to reports from other countries.
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INTRODUCTION AND OBJECTIVES: There are limited recent data on the burden of chronic hepatitis B (CHB) in the North American general population. We aimed to identify the CHB burden from a Canadian population-based perspective. PATIENTS AND METHODS: Using a retrospective cohort design, we searched Alberta Analytics administrative databases including the Provincial Laboratory database, to describe CHB epidemiology and natural history in Alberta, Canada between fiscal years 2012-2020. We analyzed incidence and prevalence trends using a Poisson regression model and conducted Kaplan-Meier analyses to examine the incident cohort's survival. RESULTS: The age/sex-adjusted incidence of CHB between 2015-2020 was 27.1/100,000 person/years (29.6/100,000 in males and 24.5/100,000 in females) and was highest among individuals aged 45-64 years. Despite a decrease in annual incidence of CHB from 36.4 to 13.4/100,000 between 2015-2020, prevalence increased from 98.9 to 210.3/100,000 in the same period. Of 6,860 incident cases, 2.1% died, and 0.2% underwent liver transplantation during a median follow-up of 3.6 years (interquartile range 2.0-4.9 years). CHB patients had significantly lower survival rates compared to age/sex-matched Canadians, with a standardized mortality ratio of 3.9 (95% confidence interval [CI] 3.3-4.6). Male sex (hazard ratio [HR] 1.7; 95% CI 1.2-2.5), older age at diagnosis (HR, 1.08; 95% CI 1.07-1.09) independently predicted mortality. CONCLUSIONS: CHB incidence decreased in Alberta, which is consistent with nationwide trends. Males and individuals aged 45-64 had higher CHB incidence and prevalence. CHB patients' lower survival rates emphasize the need to address barriers to guideline recommended HBV care linkage.
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OBJECTIVE: This study investigated the significance of serum hypoxia-inducible factor (HIF)-1α/HIF-2 α and Chitinase 3-Like protein 1 (YKL-40) levels in the assessment of vascular invasion and prognostic outcomes in patients with Follicular Thyroid Cancer (FTC). METHODS: This prospective study comprised 83 patients diagnosed with FTC, who were subsequently categorized into a recurrence group (17 cases) and a non-recurrence group (66 cases). The pathological features of tumor vascular invasion were classified. Serum HIF-1α/HIF-2α and YKL-40 were quantified using a dual antibody sandwich enzyme-linked immunosorbent assay, while serum Thyroglobulin (Tg) levels were measured using an electrochemiluminescence immunoassay method. The Spearman test was employed to assess the correlation between serum factors, and the predictive value of diagnostic factors was determined using receiver operating characteristic curve analysis. A Cox proportional hazards regression model was utilized to analyze independent factors influencing prognosis. RESULTS: Serum HIF-1α, HIF-2α, YKL-40, and Tg were elevated in patients exhibiting higher vascular invasion. A significant positive correlation was observed between Tg and HIF-1α, as well as between HIF-1α and YKL-40. The cut-off values for HIF-1α and YKL-40 in predicting recurrence were 48.25 pg/mL and 60.15 ng/mL, respectively. Patients exceeding these cut-off values experienced a lower recurrence-free survival rate. Furthermore, serum levels surpassing the cut-off value, in conjunction with vascular invasion (v2+), were identified as independent risk factors for recurrence in patients with FTC. CONCLUSION: Serum HIF-1α/HIF-2α and YKL-40 levels correlate with vascular invasion in FTC, and the combination of HIF-1α and YKL-40 predicts recurrence in patients with FTC.