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1.
Medicina (B Aires) ; 85(1): 39-46, 2025.
Artigo em Espanhol | MEDLINE | ID: mdl-39900047

RESUMO

INTRODUCTION: The use of antidementia drugs near the end of life remains controversial. We evaluated the prevalence of and factors associated with antidementia drug use in the last 6 months of life in older adults with dementia. MATERIALS AND METHODS: Observational retrospective study of adults ≥60 years, affiliated to the Hospital Italiano de Buenos Aires health maintenance organization, who died with a dementia diagnosis, between 2017 and 2021. The main event was the use of antidementia drugs in the 6 months prior to death. We fit a logistic regression model to estimate odds ratios (OR) and 95% confidence intervals (CI) of baseline variables associated with antidementia drug use. RESULTS: A total of 540/1898 (28%) patients used antidementia drugs in the 6 months preceding death. Lewy body dementia (OR=1.97; 95%CI, 1.22-3.19) and Alzheimer's disease (OR=1.47; 95%CI, 1.12-1.92) were associated with higher odds of antidementia drug use. Heart failure (OR=0.65; 95%CI, 0.48-0.89), older age (OR=0.75; 95%CI, 0.68-0.81), and prior hospitalizations (OR=0.81; 95%CI, 0.70-0.93) were inversely associated with antidementia drug use. DISCUSSION: One out of three patients with dementia receive antidementia drugs in the 6 months prior to death despite limited evidence in such a scenario.


Introducción: El uso de medicaciones antidemenciales cerca del final de la vida es controvertido. Evaluamos la prevalencia de uso de drogas antidemenciales en los últimos 6 meses de vida en adultos mayores con demencia y sus factores asociados. Materiales y métodos: Estudio observacional retrospectivo de pacientes ≥60 años, afiliados al plan de salud del Hospital Italiano de Buenos Aires, que fallecieron con un diagnóstico de demencia presente entre 2017 y 2021. El evento principal fue el uso de drogas antidemenciales en los 6 meses previos a la muerte. Usamos un modelo de regresión logística para estimar odds ratio (OR) e intervalos de confianza (IC) del 95% de las variables basales asociadas al uso de antidemenciales. Resultados: Un total de 540/1898 (28%) pacientes utilizaron antidemenciales en los en los 6 meses previos a la muerte. La demencia con cuerpos de Lewy (OR=1.97; IC95%, 1.22-3.19) y la enfermedad de Alzheimer (OR=1.47; IC95%, 1.12-1.92) se asociaron con un mayor uso de drogas antidemenciales. La insuficiencia cardíaca (OR=0.65; IC95%, 0.48-0.89), la edad (OR=0.75; IC95%, 0.68-0.81) y hospitalizaciones previas (OR=0.81; IC95%, 0.70-0.93) se asociaron inversamente al uso de antidemenciales. Discusión: Uno de cada tres pacientes con demencia reciben drogas antidemenciales en los 6 meses previos a la muerte a pesar de la limitada evidencia que soporta su uso en este escenario.


Assuntos
Demência , Assistência Terminal , Humanos , Feminino , Masculino , Estudos Retrospectivos , Idoso , Idoso de 80 Anos ou mais , Demência/tratamento farmacológico , Assistência Terminal/estatística & dados numéricos , Pessoa de Meia-Idade , Argentina/epidemiologia , Modelos Logísticos , Doença por Corpos de Lewy/tratamento farmacológico , Doença de Alzheimer/tratamento farmacológico
2.
Medicina (B Aires) ; 85(1): 78-85, 2025.
Artigo em Espanhol | MEDLINE | ID: mdl-39900051

RESUMO

INTRODUCTION: Type 2 diabetes (T2DM) together (along) with age and the presence of atrial fibrillation, high blood pressure, smoking, dyslipidemia (DLP), carotid stenosis, and an unhealthy lifestyle are risk factors (RF) to develop an ischemic stroke. The objective of this work was to analyze and compare risk factors and evolution of inpatients with ischemic stroke with and without T2DM. MATERIALS AND METHODS: This study was a retrospective and observational analysis. Data on habits, comorbidities, medication and laboratory parameters were collected patients' medical records hospitalized for stroke between January 1, 2022 and December 31, 2022. The sample was divided into patients with and without T2DM. RESULTS: One hundred and ninety three patients experienced stroke. The average age: 73.6 ±11.8 years. Among them, 100 patients had T2DM, displaying a higher prevalence of obesity (p= 0.000), DLP (p=0.000), and chronic kidney disease (p= 0.045). Elevated levels of glycemia (p=0.001), HbA1C (p=0.001), triglycerides (TG) (p=<0.001) and TG/HDL index (p= <0.001) as well as and lower HDL (p=<0.001) were also observed. Patients with T2DM showed lower survival (p= 0.012). DISCUSSION: Patients hospitalized for stroke with T2DM had more risk factors and higher mortality than the population without T2DM.


Introducción: La diabetes tipo 2 (DM2) junto con la edad y la presencia de fibrilación auricular, hipertensión arterial, tabaquismo, dislipidemia (DLP), estenosis carotídea, y un estilo de vida no saludable, son factores de riesgo (FR) para el desarrollo de un accidente cerebrovascular isquémico (ACVi). El objetivo de este trabajo fue analizar y comparar factores de riesgo y evolución de pacientes internados con ACV isquémico con y sin DM2. Materiales y métodos: Estudio retrospectivo y longitudinal. Se recolectaron datos (hábitos, comorbilidades, medicación y laboratorio) de las historias clínicas de pacientes internados por ACVi desde el 1 de enero de 2022 al 31 de diciembre de 2022. Se dividióla muestra en pacientes con y sin DM2. Resultados: Ciento noventa y tres pacientes presentaron ACVi. La edad promedio: 73.6 ±11.8 años; 100 pacientes tenían DM2, quienes presentaron mayor obesidad (p=<0.001, DLP (p=<0.001), enfermedad renal crónica (p=0.045). También se observómayores niveles de glucemia (p=0.001), HbA1C (p=0.001), triglicéridos (TG) (p=<0.001) e índice TG/HDL (p=<0.001) y HDL más bajo (p=<0.001). Los pacientes con DM2 presentaron menor supervivencia (p=0.012). Discusión: Los enfermos hospitalizados por accidente cerebrovascular con DM2 tuvieron más factores de riesgo y mayor mortalidad que la población sin DM2.


Assuntos
Diabetes Mellitus Tipo 2 , AVC Isquêmico , Humanos , Estudos Retrospectivos , Diabetes Mellitus Tipo 2/complicações , Masculino , Idoso , Feminino , AVC Isquêmico/epidemiologia , Fatores de Risco , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Pacientes Internados/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Dislipidemias/epidemiologia
3.
Medicina (B Aires) ; 85(1): 86-95, 2025.
Artigo em Espanhol | MEDLINE | ID: mdl-39900052

RESUMO

INTRODUCTION: The main objective of this study was to evaluate the association between the baseline level of Histoplasma capsulatum urinary antigen (AgU) and the severity of histoplasmosis in the context of HIV, as well as its utility for treatment monitoring. Secondary objectives included determining the appropriate cutoff point for AgU detection for the diagnosis of proven histoplasmosis. MATERIALS AND METHODS: The study was an analytical, retrospective cohort study in adults diagnosed with HIV, with at least one determination of AgU using ELISA. Sociodemographic, clinical, and laboratory variables were collected. Statistical analysis was performed using R-project® software. RESULTS: A total of 452 individuals with AgU were included from March 2018 to July 2022, with 42 (9.3%) positive results (25 proven histoplasmosis and 17 probable cases). An statistically significant correlation was found between the baseline concentration of AgU and positive cultures. However, the utility of AgU as a followup tool could not be evaluated. The optimal cutoff point for detecting proven histoplasmosis was an AgU value ≥2.2 ng/mL (specificity: 96.3% and sensitivity: 100%). DISCUSSION: Further studies are needed to evaluate the utility of AgU as a tool for monitoring antifungal treatment. A value of AgU ≥2.2 ng/mL could potentially correspond to a diagnosis of proven histoplasmosis.


Introducción: El objetivo principal del estudio fue evaluar la asociación entre el valor basal del antígeno urinario de Histoplasma capsulatum (AgU) y la gravedad del cuadro de histoplasmosis en contexto de HIV, así como su utilidad para seguimiento de tratamiento antifúngico. En los objetivos secundarios se incluyódeterminar el punto de corte adecuado en la detección del AgU para el diagnóstico de histoplasmosis probada. Materiales y métodos: Estudio de cohorte analítico, retrospectivo en adultos con diagnóstico de HIV con una determinación del AgU, mediante ELISA. Se recolectaron variables sociodemográficas, clínicas y de laboratorio. Se realizóel análisis estadístico mediante software Rproject®. Resultados: Se incluyeron 452 individuos con determinación de AgU desde marzo 2018 a julio 2022, con 42 (9.3%) resultados positivos (25 histoplasmosis probadas y 17 probables). Se hallóuna correlación estadísticamente significativa entre la concentración basal del AgU y los cultivos positivos. No pudo evaluarse la utilidad del AgU como herramienta de seguimiento. El mejor punto de corte para detectar histoplasmosis probada fue un valor de AgU ≥2.2 ng/mL (especificidad: 96.3% y sensibilidad: 100%). Discusión: Se requieren mayores estudios para evaluar la utilidad del AgU como herramienta para seguimiento del tratamiento antifúngico. Un valor de AgU ≥2.2 ng/mL, podría equivaler a un diagnóstico de histoplasmosis probada.


Assuntos
Antígenos de Fungos , Histoplasma , Histoplasmose , Humanos , Histoplasmose/urina , Histoplasmose/diagnóstico , Estudos Retrospectivos , Masculino , Feminino , Adulto , Antígenos de Fungos/urina , Pessoa de Meia-Idade , Prognóstico , Infecções por HIV/complicações , Infecções por HIV/urina , Ensaio de Imunoadsorção Enzimática , Infecções Oportunistas Relacionadas com a AIDS/urina , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Sensibilidade e Especificidade
4.
Medicina (B Aires) ; 85(1): 47-55, 2025.
Artigo em Espanhol | MEDLINE | ID: mdl-39900048

RESUMO

INTRODUCTION: The CheckMate 816 study, a global phase III randomized trial, demonstrated that neoadjuvant treatment with nivolumab plus chemotherapy significantly improves event-free survival in patients with resectable non-small cell lung cancer (NSCLC). Additionally, the treatment significantly increases the rate of complete pathological response. We present the results of CheckMate 816 in an Argentine subpopulation to evaluate the efficacy and safety of the neoadjuvant treatment. MATERIALS AND METHODS: A retrospective observational and descriptive study was conducted at a high-volume single center in Argentina from January 2023 to March 2024. Patients received 360 mg of nivolumab plus chemotherapy and a platinum doublet every three weeks for three cycles before undergoing definitive surgery. The results were compared with the international trial and the Japanese population subgroup. RESULTS: Nine patients received neoadjuvant therapy, of whom eight underwent definitive surgery. All patients achieved complete (R0) resection, and in three cases, a complete pathological response was observed. Currently, all are alive and disease-free. DISCUSSION: The results obtained in the Argentine subpopulation were consistent with those observed in the global population and the Japanese subgroup. A high proportion of patients achieved a complete pathological response, an early indicator of therapeutic efficacy. Neoadjuvant therapy with nivolumab plus chemotherapy could be considered an effective treatment option for Argentine patients with resectable NSCLC.


Introducción: El estudio CheckMate 816, un ensayo global de fase III y aleatorizado, mostróque el tratamiento neoadyuvante con nivolumab más quimioterapia mejora significativamente la supervivencia libre de eventos y la tasa de respuesta patológica completa (RPC) en pacientes con cáncer de pulmón de células no pequeñas (CPCNP) resecable. Presentamos los resultados del CheckMate 816 en una subpoblación argentina para evaluar la eficacia y seguridad del tratamiento neoadyuvante. Materiales y métodos: Se realizóun estudio retrospectivo observacional y descriptivo en un único centro de alto volumen en Argentina en el periodo de enero 2023 hasta marzo 2024. Los pacientes recibieron 360 mg de nivolumab más quimioterapia con doblete de platino cada tres semanas durante tres ciclos, antes de someterse a cirugía definitiva. Se compararon los resultados con el ensayo internacional y el subgrupo de población japonesa. Resultados: Se reportóun total de nueve pacientes que recibieron neoadyuvancia de los cuales ocho fueron sometieron a cirugía definitiva. Todos alcanzaron una resección completa (R0) y en tres casos se logróuna RPC. Actualmente todos se encuentran vivos y libres de enfermedad. Discusión: Los resultados obtenidos en la subpoblación argentina fueron consistentes con los observados en la población global y en el subgrupo japonés. Una alta proporción de pacientes alcanzaron una RPC, indicador temprano de la eficacia terapéutica. El uso de neoadyuvancia con nivolumab más quimioterapia podría considerarse como una opción de tratamiento efectiva para pacientes argentinos con CPCNP resecable.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Terapia Neoadjuvante , Nivolumabe , Humanos , Neoplasias Pulmonares/terapia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologia , Terapia Neoadjuvante/métodos , Estudos Retrospectivos , Carcinoma Pulmonar de Células não Pequenas/terapia , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/patologia , Argentina , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Nivolumabe/uso terapêutico , Resultado do Tratamento , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Imunoterapia/métodos
5.
Medicina (B Aires) ; 85(1): 31-38, 2025.
Artigo em Espanhol | MEDLINE | ID: mdl-39900046

RESUMO

INTRODUCTION: The prevalence of polycystic ovary syndrome (PCOS) in transgender and non-binary genders assigned female at birth (TMNBG) men is controversial. Our objectives were to investigate the prevalence, phenotypic characteristics of PCOS, and cardiometabolic risk of TMNBG with and without PCOS prior to hormone therapy. MATERIALS AND METHODS: This was a retrospective study of 346 TMNBG adults presenting to our service for gender-affirming hormone therapy. PCOS was diagnosed according to the evidence-based international guideline for the evaluation and treatment of PCOS 2018 and the Rotterdam consensus of 2003. RESULTS: The described transgender population had a prevalence of PCOS of 23.8%. Phenotype B was the most common one (39.1%), followed by phenotype A (33.7%). Transgender people with PCOS had statistically higher body mass index (BMI), systolic and diastolic blood pressure, plasma insulin levels, HOMA-IR, and HOMA-B than those who did not meet PCOS criteria. However, blood pressure and markers of insulin resistance were similar for both groups after controlling for BMI. DISCUSSION: PCOS appears to be prevalent among TMNBG. Transgender people with PCOS may exhibit an unfavorable cardiometabolic risk profile compared to those without PCOS, especially due to a higher BMI. It is necessary to evaluate the specific components of PCOS before starting hormonal therapy due to the long-term implications it could have.


Introducción: La prevalencia del síndrome de ovario poliquístico (SOP) en hombres trans y géneros no binarios asignados mujer al nacer (HTGNB) es controvertida. Nuestros objetivos fueron investigar la prevalencia, características fenotípicas del SOP y riesgo cardiometabólico de HTGNB con y sin SOP previo a la terapia hormonal (TH). Materiales y métodos: Este fue un estudio retrospectivo de 346 HTGNB adultos que acudieron a nuestro servicio para recibir TH de afirmación de género. El SOP se diagnosticósegún la guía internacional basada en evidencia para la evaluación y el tratamiento del SOP de 2018 y el consenso de Rotterdam de 2003. Resultados: En nuestra cohorte, el 26.6% de los HTGNB presentóSOP. El fenotipo B fue el más común (39.1%), seguido del fenotipo A (33.7%). Las personas transgénero con SOP tuvieron un índice de masa corporal (IMC), presión arterial (PA) sistólica y diastólica, niveles plasmáticos de insulina, HOMA-IR y HOMA-B, estadísticamente más altos que aquellos que no cumplían con los criterios de SOP. Sin embargo, la PA y marcadores de resistencia insulínica fueron similares para ambos grupos luego de controlar por IMC. Discusión: El SOP parece ser prevalente entre los HTGNB. Los mismos pueden exhibir un perfil de riesgo cardiometabólico desfavorable en comparación con aquellos sin SOP, sobre todo debido a un mayor IMC. Se hace necesaria la evaluación de los componentes específicos del SOP antes del inicio de la terapia hormonal por las implicancias que la misma podría tener a largo plazo.


Assuntos
Fenótipo , Síndrome do Ovário Policístico , Pessoas Transgênero , Humanos , Síndrome do Ovário Policístico/epidemiologia , Síndrome do Ovário Policístico/complicações , Feminino , Adulto , Estudos Retrospectivos , Prevalência , Pessoas Transgênero/estatística & dados numéricos , Masculino , Índice de Massa Corporal , Fatores de Risco Cardiometabólico , Resistência à Insulina , Adulto Jovem , Fatores de Risco
6.
Medicina (B Aires) ; 85(1): 126-134, 2025.
Artigo em Espanhol | MEDLINE | ID: mdl-39900056

RESUMO

INTRODUCTION: Cranioencephalic traumatism (CET) is a serious public health problem worldwide. Advances in treatment have reduced mortality, increasing the demand for rehabilitation. The objective was to describe the demographic characteristics and functional outcomes in adult patients with traumatic brain injury (TBI) treated in a rehabilitation center. MATERIALS AND METHODS: Retrospective study between 2002 and 2022. Patients received 4 hours of rehabilitation daily. The level of functional independence was assessed with the Functional Independence Measure (FIM) at admission and discharge. RESULTS: 229 patients were included, the median (25-75 percentiles) time from injury to admission to rehabilitation was 56 (36-98) days; 76% were men. Mean age (standard deviation) 42 (17) years. The most frequent etiologies were car accidents and falls; 46.8% were under 40 years of age and the median length of stay was 82 days (14-132). At discharge, 79.9% of patients over 65 years of age had low to severe disability (GOS-E) and 79.5% returned home. The median (p 25-75) FIM at admission was 30 (20-55) and at discharge was 90 (58-106); a statistically significant difference was observed (p = 0.001). Differences in functional outcomes were found based on age and place of residence. DISCUSSION: In Argentina, patients admitted to rehabilitation for TBI are predominantly young men, the main cause being car accidents. The implementation of an early and intensive rehabilitation program has shown significant improvements in functional outcomes. At discharge, most patients required home supervision and assistance in daily activities.


Introducción: El traumatismo craneoencefálico (TCE) es un grave problema de salud pública a nivel global. Los avances en el tratamiento han reducido la mortalidad, incrementando la demanda en rehabilitación. El objetivo fue describir las características demográficas y resultados funcionales en pacientes adultos con lesión cerebral traumática (LCT) tratados en un centro de rehabilitación. Materiales y métodos: Estudio retrospectivo entre 2002 y 2022. Los pacientes recibieron 4 horas diarias de rehabilitación. El nivel de independencia funcional fue evaluado con la Medida de Independencia Funcional (FIM) al ingreso y al alta. Resultados: Se incluyeron 229 pacientes, la mediana (percentilos 25-75) del tiempo de lesión al ingreso a rehabilitación fue de 56 (36-98) días; 76% eran hombres. Edad media (desvío estándar) 42 (17) años. Las etiologías más frecuentes fueron accidentes automovilísticos y caídas; 46.8% tenía menos de 40 años y la mediana de estadía fue de 82 días (14-132). Al alta, el 79.9% de los pacientes mayores de 65 años presentaba discapacidad baja a grave (GOS-E) y el 79.5% regresóa su domicilio. La mediana (p 25-75) de FIM al ingreso fue 30 (20-55) y al alta fue 90 (58-106); observándose una diferencia estadísticamente significativa (p = 0.001). Se encontraron diferencias en los resultados funcionales entre la edad y lugar de residencia. Discusión: En Argentina los pacientes ingresados en rehabilitación por LCT son predominantemente hombres jóvenes, la causa principal son los accidentes automovilísticos. La implementación de un programa de rehabilitación temprano e intensivo ha demostrado mejoras significativas en los resultados funcionales. Al alta, la mayoría de los pacientes requirieron supervisión domiciliaria y asistencia en las actividades diarias.


Assuntos
Lesões Encefálicas Traumáticas , Recuperação de Função Fisiológica , Centros de Reabilitação , Humanos , Masculino , Feminino , Estudos Retrospectivos , Argentina/epidemiologia , Adulto , Pessoa de Meia-Idade , Centros de Reabilitação/estatística & dados numéricos , Lesões Encefálicas Traumáticas/reabilitação , Lesões Encefálicas Traumáticas/mortalidade , Idoso , Adulto Jovem , Resultado do Tratamento , Avaliação da Deficiência , Tempo de Internação/estatística & dados numéricos , Adolescente
7.
Medicina (B Aires) ; 85(1): 112-125, 2025.
Artigo em Espanhol | MEDLINE | ID: mdl-39900055

RESUMO

INTRODUCTION: Low back pain is one of the main causes of medical consultation worldwide, with heterogeneous management in the request for complementary methods. This study sought to determine the frequency and clinical and imaging characteristics of patients with low back pain in a tertiary hospital, considering the presence or absence of red flags. MATERIALS AND METHODS: A retrospective analytical study was carried out at the Private University Hospital of Córdoba. Patients over 18 years of age who consulted for the first time for low back pain between January and June 2021 were included, excluding pregnant and those without complete records. RESULTS: A total of 880 patients were included. Of these, 589 (67%) presented acute low back pain, 112 (13%) subacute and 179 (20%) chronic. Simple low back pain was the most common cause (n=652, 74%), followed by herniated disc (n=179, 20%) and spondylolisthesis (n=33, 4%). Red flags were identified in 190 (22%) patients according to American College of Radiology (ACR) criteria and in 420 (48%) according to the Agency for Health Care Policy and Research (AHCPR). Imaging studies were performed in 314 (75%) patients with AHCPR criteria and 255 (55%) with ACR criteria. Neoplasia/infection and vertebral fracture were diagnosed in 2 (2%) and 5 (9%) patients with red flags, respectively. DISCUSSION: The first consultation for low back pain represented 1.8% of consultations, with acute low back pain being more frequent. Obesity was the most common comorbidity. About half of the patients had red flags according to AHCPR and 21% according to ACR.


Introducción: La lumbalgia es una de las principales causas de consulta médica a nivel mundial, con un manejo heterogéneo en la solicitud de métodos complementarios. Este estudio buscódeterminar la frecuencia y características clínicas e imagenológicas de los pacientes con lumbalgia en un hospital de tercer nivel, considerando la presencia o ausencia de signos de alerta o banderas rojas. Meteriales y métodos: Se realizóun estudio analítico retrospectivo en el Hospital Privado Universitario de Córdoba. Se incluyeron pacientes mayores de 18 años que consultaron por primera vez por lumbalgia entre enero y junio de 2021, excluyendo embarazadas y aquellos sin registros completos. Resultados: Se incluyeron 880 pacientes. De éstos, 589 (67%) presentaron lumbalgia aguda, 112 (13%) subaguda y 179 (20%) crónica. La lumbalgia simple fue la causa más común (n=652, 74%), seguida de hernia discal (n=179, 20%) y espondilolistesis (n=33, 4%). Se identificaron banderas rojas en 190 (22%) pacientes según criterios del American College of Radiology (ACR) y en 420 (48%) según la Agency for Health Care Policy and Research (AHCPR). Se realizaron estudios de imágenes en 314 (75%) pacientes con criterios de AHCPR y en 255 (55%) con criterios de ACR. Neoplasia/infección y fractura vertebral se diagnosticaron en 2 (2%) y 5 (9%) pacientes con banderas rojas, respectivamente. Discusión: La primera consulta por lumbalgia representóel 1.8% de las consultas, siendo más frecuente la lumbalgia aguda. La obesidad fue la comorbilidad más común. Cerca de la mitad de los pacientes tenían banderas rojas según AHCPR y el 21% según ACR.


Assuntos
Dor Lombar , Humanos , Dor Lombar/diagnóstico por imagem , Feminino , Estudos Retrospectivos , Masculino , Pessoa de Meia-Idade , Adulto , Idoso , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/epidemiologia , Espondilolistese/diagnóstico por imagem
8.
Medicina (B Aires) ; 85(1): 101-111, 2025.
Artigo em Inglês | MEDLINE | ID: mdl-39900054

RESUMO

INTRODUCTION: Malignant rhabdoid tumor (MRT) is a highly aggressive disease, mainly affecting infants and small children. MATERIAL AND METHODS: Between January 2007 and May 2021 a retrospective study was conducted at the Hospital de Pediatría J. P. Garrahan in Buenos Aires, Argentina, including 13 patients diagnosed with ERNC-MRT (extra-renal non-cerebral malignant rhabdoid tumor). Event-free survival (EFS) and overall survival (OS) were assessed using the Kaplan-Meier method and compared using the log-rank test. RESULTS: Seven patients were less than 1 year old, all of them died. Four of 13 had metastatic disease, all of them in the lungs, 2 had locoregional lymph node involvement. Six achieved complete remission, 4 of them remained alive. Five received maintenance therapy (MT) with cyclophosphamide/vinorelbine, 4 were alive at last follow-up. Only one was studied for germline mutations, the result was negative. With a median follow-up of 126 months (range: 72-161), 3 and 5-year EFS and OS were 30.7% and 38.4%, respectively. DISCUSSION: Although the sample size is small, survival rates are similar or slightly lower than other series. Age was the main prognostic factor. All but one patient that received MT are alive, suggesting that MT might have a role in ERNC-MRT; however, the prognostic significance is not entirely clear since there are multiple confounding factors.


Introducción: El tumor rabdoide maligno (TRM) es una enfermedad altamente agresiva que afecta principalmente a lactantes y niños pequeños. Materiales y métodos: Entre enero de 2007 y mayo de 2021 se realizóun estudio retrospectivo en el Hospital de Pediatría J. P. Garrahan de Buenos Aires, Argentina, incluyendo 13 pacientes diagnosticados con tumor rabdoide maligno extrarrenal extra-cerebral. La sobrevida libre de eventos (SLE) y la sobrevida global (SG) se evaluaron mediante el método de Kaplan-Meier y se compararon mediante la prueba de rango logarítmico. Resultados: Siete pacientes tenían menos de 1 año al diagnóstico y todos fallecieron. Cuatro de 13 tenían enfermedad metastásica, todos ellos en los pulmones, 2 tenían afectación ganglionar loco-regional. Seis alcanzaron la remisión completa, 4 de ellos sobrevivieron. Cinco recibieron terapia de mantenimiento (TM) con ciclofosfamida/vinorelbine, 4 estaban vivos en el último control. Solo uno fue estudiado para mutaciones de línea germinal, el resultado fue negativo. Con una mediana de seguimiento de 126 meses (rango: 72-161), la SLE y la SG a 3 y 5 años fue de 30.7 % y 38.4 %, respectivamente. Discusión: Aunque el tamaño muestral es pequeño, las tasas de sobrevida son similares o ligeramente inferiores a otras series. La edad fue el principal factor pronóstico. El uso de TM prolongósignificativamente la sobrevida; sin embargo, la importancia pronóstica no está del todo clara ya que existen múltiples factores confundidores.


Assuntos
Quimioterapia de Manutenção , Tumor Rabdoide , Humanos , Tumor Rabdoide/mortalidade , Tumor Rabdoide/tratamento farmacológico , Estudos Retrospectivos , Masculino , Feminino , Lactente , Pré-Escolar , Quimioterapia de Manutenção/métodos , Criança , Argentina/epidemiologia , Estimativa de Kaplan-Meier , Taxa de Sobrevida
9.
Clinics (Sao Paulo) ; 80: 100580, 2025.
Artigo em Inglês | MEDLINE | ID: mdl-39893830

RESUMO

BACKGROUND: Although emergency Percutaneous Coronary Intervention (PCI) has been shown to reduce mortality in patients with Acute Myocardial Infarction (AMI), the risk of in-hospital death remains high. In this study, the authors aimed to identify risk factors associated with in-hospital mortality in AMI patients who underwent PCI, develop a nomogram prediction model, and evaluate its effectiveness. METHODS: The authors retrospectively analyzed data from 1260 patients who underwent emergency PCI at Dongyang People's Hospital between June 1, 2013, and December 31, 2021. Patients were divided into two groups based on in-hospital mortality: the death group (n = 61) and the survival group (n = 1199). Clinical data between the two groups were compared. The Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to select non-zero coefficients of predictive factors. Multivariable logistic regression analysis was then performed to identify independent risk factors for in-hospital mortality in AMI patients after emergency PCI. A nomogram model for predicting the risk of in-hospital mortality in AMI patients after PCI was constructed, and its predictive performance was evaluated using the c-index. Internal validation was performed using the bootstrap method with 1000 resamples. The Hosmer-Lemeshow test was used to assess the goodness of fit, and a calibration curve was plotted to evaluate the model's calibration. RESULTS: LASSO regression identified d-dimer, B-type natriuretic peptide, white blood cell count, heart rate, aspartate aminotransferase, systolic blood pressure, and the presence of postoperative respiratory failure as important predictive factors for in-hospital mortality in AMI patients after PCI. Multivariable logistic regression analysis showed that d-dimer, B-type natriuretic peptide, white blood cell count, systolic blood pressure, and the presence of postoperative respiratory failure were independent factors for in-hospital mortality. A nomogram model for predicting the risk of in-hospital mortality in AMI patients after PCI was constructed using these independent predictive factors. The Hosmer-Lemeshow test yielded a Chi-Square value of 9.43 (p = 0.331), indicating a good fit for the model, and the calibration curve closely approximated the ideal model. The c-index for internal validation was 0.700 (0.560‒0.834), further confirming the predictive performance of the model. Clinical decision analysis demonstrated that the nomogram model had good clinical utility, with an area under the ROC curve of 0.944 (95 % CI 0.903‒0.963), indicating excellent discriminative ability. CONCLUSION: This study identified B-type natriuretic peptide, white blood cell count, systolic blood pressure, d-dimer, and the presence of respiratory failure as independent factors for in-hospital mortality in AMI patients undergoing emergency PCI. The nomogram model based on these factors showed high predictive accuracy and feasibility.


Assuntos
Mortalidade Hospitalar , Infarto do Miocárdio , Nomogramas , Intervenção Coronária Percutânea , Humanos , Intervenção Coronária Percutânea/mortalidade , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Medição de Risco/métodos , Fatores de Risco , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/sangue , Modelos Logísticos
10.
Cancer Med ; 14(3): e70541, 2025 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-39891416

RESUMO

BACKGROUND: Dual sources of cells (DSC) with peripheral blood stem cell apheresis (PBSC) and surgical bone marrow (BM) for haploidentical hematopoietic cell transplantation (Hid-HCT) are used in China and some Asian countries. The experience of the Baltimore group for haploidentical transplant with post-transplant cyclophosphamide (PT-Cy) and reduced-intensity-conditioning (RIC) regimen used BM as a source of hematopoietic stem cells. METHODS: We retrospectively analyzed 64 Hid-HCT with DSC and PT-Cy, RIC (n = 57), or myeloablative-conditioning (MAC) (n = 7), from two public health Brazilian centers, with a median follow-up of 23.3 months (6.7-45.4). RESULTS: The 49 malignant patients were 27/46 (58.7%) beyond the first remission or with no complete response, and three patients did not complete disease status evaluation before transplant. Eight of 62 patients (12.9%) had grade 2 or more Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI), and two patients had no HCT-CI classified. Cytomegalovirus (CMV) viremia occurred in 26 of 57 (45.6%). The cumulative incidence of 100-day grade III-IV acute GVHD was 12.3% (7/57), with a 95% confidence interval (CI) of 3.8% and 20.8%, and 2-year moderate or severe chronic GVHD was 21.1% (11/52; 95% CI, 10.1%-32.3%). The 2-year relapses were 24.5% for malignant disease (12/49; 95% CI, 12.4%-36.5%). The 2-year overall survival (OS) probability was 54.7% (35/64; 95% CI, 42.5%-66.9%). Benign diseases achieve 2-year OS in 73.3% (11/15; 95% CI, 51%-95.7%) of the patients. The HCT-CI were significant in multivariate analyses for DFS (p = 0.002) and OS in uni- and multivariate analyses (both p < 0.001). The number of CD34+ cells by apheresis collection was significant in multivariate analysis for DFS (p = 0.039). CONCLUSION: Hid-HCT using PT-Cy, DSC, and RIC is a safe option for benign and malignant diseases.


Assuntos
Ciclofosfamida , Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Condicionamento Pré-Transplante , Transplante Haploidêntico , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Ciclofosfamida/uso terapêutico , Transplante de Células-Tronco Hematopoéticas/métodos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Doença Enxerto-Hospedeiro/etiologia , Adulto Jovem , Estudos Retrospectivos , Adolescente , Condicionamento Pré-Transplante/métodos , Transplante Haploidêntico/métodos , Criança , Resultado do Tratamento
11.
Arch. argent. pediatr ; 123(1): e202310222, feb. 2025. tab
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1585637

RESUMO

Los tumores hepáticos primarios son indicación creciente de trasplante hepático pediátrico. Reportamos los 10 pacientes con trasplantes hepáticos por tumores hepáticos primarios en nuestro centro desde 2001 hasta la actualidad. Hasta el año 2011, se realizó un trasplante por hepatoblastoma de 117 trasplantes hepáticos (0,8 %). Desde 2012, fueron 9 pacientes de 141 (6,4 %) (5 hepatoblastomas, 2 hepatocarcinomas, 1 hemangioendotelioma epitelioide hepático y 1 hamartoma mesenquimático hepático). Seguimiento 13,2 meses (media), edad al trasplante 4,7 años (media), peso 17,6 kg (mediana). El 80 % recibió injertos desde donantes relacionados. No hubo recurrencia tumoral y la sobrevida fue del 100 % en el período de seguimiento. En nuestra serie, los pacientes con tumores hepáticos primarios que requirieron trasplante presentaron buena evolución, aun en hepatocarcinoma. El trasplante hepático con donante relacionado acortó los tiempos entre la indicación y la realización.


Primary liver tumors are an increasing indication for pediatric liver transplantation. Here we report the cases of 10 patients who underwent liver transplantation for primary liver tumors in our hospital, from 2001 to date. Up to 2011, 1 transplant due to hepatoblastoma was done out of 117 liver transplants (0.8%). Since 2012, there were 9 patients out of 141 (6.4%) (5 due to hepatoblastoma, 2 due to hepatocellular carcinoma, 1 due to hepatic epithelioid hemangioendothelioma, and 1 due to hepatic mesenchymal hamartoma). Follow-up: 13.2 months (median); age at transplantation: living 4.7 years (median); weight: 17.6 kg (median). Eighty percent of patients received grafts from living donors. No tumor recurrence was observed. Survival was 100% in the follow-up period. In our series, patients with primary liver tumors requiring transplantation showed an adequate course, even in the case of hepatocellular carcinoma, Related living donors liver transplantation shortened the time between the indication and the surgery.


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Transplante de Fígado/métodos , Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Estudos Retrospectivos , Hepatoblastoma/cirurgia
12.
Arch. argent. pediatr ; 123(1): e202410399, feb. 2025. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1585132

RESUMO

Introducción. La prueba de ventilación espontánea (PVE) en el proceso de liberación de la asistencia ventilatoria mecánica invasiva (AVMi) pediátrica es una práctica avalada; su positividad se sustenta en parámetros clínicos. Sin embargo, sus resultados están escasamente documentados. Objetivo. Describir los resultados de la PVE en el proceso de liberación de la AVMi. Población y métodos. Análisis retrospectivo. Pacientes con ≥ 48 h en AVMi del 1 de marzo de 2022 al 31 de enero de 2024. Resultados. Se analizaron 493 PVE en 304 pacientes; el 71 % (348) fueron positivas y el 87 % (302) redundó en extubaciones exitosas. Las causas de las PVE negativas fueron mayor trabajo respiratorio (70 %), frecuencia respiratoria (57 %) y frecuencia cardíaca (27 %). En el análisis univariado, la dificultad respiratoria como motivo de ingreso, la presión inspiratoria máxima previo a la PVE y el uso de tubo en T fueron predictores de PVE negativa. En el análisis multivariado, esta asociación persistió para el ingreso por causa respiratoria, la mayor frecuencia respiratoria programada en la AVM y la modalidad tubo en T. Quienes presentaron PVE negativas permanecieron más días en AVMi [9 (7-12) vs. 7 (4-10)] y en UCIP [11 (9-15) vs. 9 (7-12)]. Conclusión. La PVE positiva predijo la extubación exitosa en un alto porcentaje. La dificultad respiratoria al ingreso, la mayor frecuencia respiratoria programada y la mayor proporción de la modalidad tubo en T fueron predictores negativos para la prueba. La PVE negativa se asoció a mayor estadía en AVMi y UCIP.


Introduction. spontaneous breathing trial (SBT) in weaning from pediatric invasive mechanical ventilation (IMV) is an endorsed practice, its positivity is based on clinical parameters; however, its results could be better documented. Objective. To describe the results of the SBT in the IMV weaning process. Population and methods. Retrospective analysis. Patients with ≥48 h in IMV from March 1, 2022 to January 31, 2024. Results. A total of 493 SBT were analyzed in 304 patients; 71% (348) were positive, and 87% (302) resulted in successful extubations. The causes of negative SBT were increased work of breathing (70%), respiratory rate (57%), and heart rate (27%). In univariate analysis, respiratory distress as the reason for admission, peak inspiratory pressure before SBT and T-tube use, were predictors of negative SBT. In multivariate analysis, this association persisted for admission for respiratory cause, the higher programmed respiratory rate in IMV, as the T-tube modality. Those with negative SBT stayed more days in IMV (9 [712] vs. 7 [4-10]) and in PICU (11 [9-15] vs. 9 [7-12]). Conclusion. Positive SBT predicted successful extubation in a high percentage of cases. Respiratory distress on admission, higher programmed respiratory rate, and a higher proportion of T-tube mode were negative predictors of the test. Negative SBT was associated with more extended stays in IMV and PICU.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Respiração Artificial/métodos , Desmame do Respirador/métodos , Respiração , Unidades de Terapia Intensiva Pediátrica , Trabalho Respiratório/fisiologia , Estudos Retrospectivos , Resultado do Tratamento , Taxa Respiratória , Extubação/métodos , Tempo de Internação
13.
Cancer Control ; 32: 10732748251318386, 2025.
Artigo em Inglês | MEDLINE | ID: mdl-39901358

RESUMO

INTRODUCTION: Human papillomavirus (HPV) infection is a common sexually transmitted infection often associated with cancer development. This study aimed to estimate the prevalence of HPV in women receiving care at the AUNA healthcare network in Peru. METHODS: We conducted an observational, descriptive, cross-sectional, retrospective study. A de-identified database of HPV-positive women who underwent the BD Onclarity™ HPV Assay between December 2018 and December 2021 at Auna clinics was analyzed. The database contained information regarding age, city, and HPV type. High-risk HPV types were analyzed individually (16, 18, 31, 45, 51, 52) and pooled [P1 (33, 58), P2 (56,59,66), and P3 (35,39,68)]. The study was approved by an independent research ethics committee in Peru. RESULTS: Of 68,714 women included in the study, the HPV prevalence was 14.21% (N = 9765, 95%CI:13.95%-14.47%). The highest prevalence was detected in Piura (16.85%, 95%CI:15.40%-18.38%), where HPV-51, HPV-52, HPV-P1, HPV-P2, and HPV-P3 were most common compared to other Peruvian cities included in the study. In Arequipa, the prevalence was the lowest (13.58%, 95%CI:12.38%-14.85%), but the percentage prevalence of HPV-16 was the highest compared to other cities. The prevalence of multiple HPV infections was 2.88% (N = 1981, 95%CI:2.76%-3.01%), with most of them co-presenting two types of HPV (N = 1522). The most frequent co-occurrences were P2 and P3, P2 and 52, and P2 and 16. Among HPV-positive women, the mean age was 41.31 years (±9.48) and 25.29% were in the 31-35 years group. HPV-P2 was the most frequent in all age groups except in the 65-72 years group, where HPV-P3 was the most common. CONCLUSION: HPV prevalence was shown to be highest in Piura, with the most prevalent types being HPV-16, HPV-52, and HPV-P2 (HPV-56, -59, -66). HPV infection was found to be more frequent among women in the 31-35 years age group.


Assuntos
Infecções por Papillomavirus , Humanos , Feminino , Estudos Transversais , Peru/epidemiologia , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Prevalência , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem , Adolescente , Idoso , Papillomaviridae/isolamento & purificação
14.
Am J Hum Biol ; 37(2): e70004, 2025 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-39905640

RESUMO

INTRODUCTION: Interpersonal violence against women is a major global health problem that may have intergenerational effects. This study investigated associations between maternal experiences of interpersonal violence and other traumatic events and maternal and infant salivary diurnal cortisol in a cohort of adolescent mothers in São Paulo, Brazil. METHOD: Adolescent mothers (14-19 years) participating in a home-visiting intervention were interviewed retrospectively about lifetime and pregnancy violence and trauma exposure. Mothers collected saliva at waking and before bedtime from themselves (n = 23) and their infants (n = 32) at 12 months postpartum. Multivariable regression models were used to examine associations between trauma history variables and salivary diurnal cortisol. RESULTS: Adjusting for the intervention group, infant sex, maternal age, non-supplement medication use, and sample collection time, we found that higher-than-average lifetime trauma exposure was associated with maternal evening cortisol (b = 0.472, p-value = 0.028). Lifetime assaultive violence exposure was also associated with maternal evening cortisol (b = 0.196, p-value = 0.02). Maternal exposure to traumatic events in pregnancy was positively associated with bedtime cortisol levels of infants (b = 0.21, p = 0.01). Trauma variables were not associated with maternal or infant morning cortisol levels. CONCLUSION: Results suggest that maternal trauma history influences both maternal and infant postnatal cortisol regulation as indexed by evening cortisol levels. These results are consistent with models of fetal programming; however, future studies should investigate potential postnatal psychobiological pathways. Lifetime trauma exposure may also become embedded in the maternal hypothalamic-adrenal-pituitary axis regulation. Future studies are needed to consider other biological pathways in the intergenerational transmission of trauma.


Assuntos
Hidrocortisona , Saliva , Humanos , Feminino , Adolescente , Saliva/química , Hidrocortisona/metabolismo , Hidrocortisona/análise , Brasil , Gravidez , Adulto Jovem , Lactente , Mães/psicologia , Mães/estatística & dados numéricos , Masculino , Gravidez na Adolescência/estatística & dados numéricos , Gravidez na Adolescência/psicologia , Estudos Retrospectivos , Ritmo Circadiano/fisiologia
15.
Arq Bras Cir Dig ; 37: e1867, 2025.
Artigo em Inglês | MEDLINE | ID: mdl-39907326

RESUMO

BACKGROUND: Patients undergoing Crohn's disease (CD) surgery may develop a higher rate of postoperative complications (POC) than other patients. AIMS: The aim of this study was to investigate factors determining POC in patients with CD undergoing urgent laparotomy. METHODS: This is a retrospective cohort study conducted on adult patients undergoing urgent laparotomy for CD. Clinical and surgical variables, medication history, American Society of Anesthesiologists classification, and POC were investigated. Data collection and management were carried out using the REDCap software (REDCap electronic data capture tools) hosted at the hospital institution. For statistical analysis, the χ2 (or Fisher's exact) test, Student's t-test, Mann-Whitney test, and simple and multiple multilevel logistic regression analyses were used. RESULTS: There was an association regarding the history of adalimumab use (p=0.04, OR 2.8, 95%CI 1.03-7.65), previous use of prednisone (p<0.01, OR 2.03, 95%CI 2.00-2.05), urgent surgery indications (p<0.01, OR=4.32, 95% CI=1.58-11.82), mechanical anastomosis (p=0.02, OR=0.22, 95%CI 0.06-0.80), unexpected intraoperative findings (p=0.02, OR 10.46, 95%CI 1.50-72.99), length of hospital stay greater than 10 days (p<0.01, OR 16.86, 95%CI 2.99-94.96), unplanned intensive care unit (ICU) admission (p=0.01, OR 15.06, 95%CI 1.96-115.70), and planned ICU admission (p<0.01, OR 18.46, 95%CI 3.60-94.51). On multivariate analysis, there was an association between the indication of urgent surgery (or emergency) (p=0.01, OR 4.38, 95%CI 1.43-13.37) and unexpected intraoperative findings (p=0.03, OR 8.11, 95%CI 1.21-54.50). CONCLUSIONS: Unexpected changes and urgent surgical indications are considered risk factors for POC in patients with CD.


Assuntos
Doença de Crohn , Laparotomia , Complicações Pós-Operatórias , Humanos , Doença de Crohn/cirurgia , Estudos Retrospectivos , Feminino , Masculino , Adulto , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem , Estudos de Coortes , Emergências
16.
BMJ Health Care Inform ; 32(1)2025 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-39904550

RESUMO

BACKGROUND: Type 2 diabetes is the fastest-growing global health concern, and its global prevalence is projected to affect 643 million individuals by 2030. Social media platforms, like Facebook, have become crucial channels for healthcare organisations to engage with the public to promote prevention and disease management, especially in low-resource settings like Honduras. This study aims to perform a retrospective analysis of Honduran healthcare organisations' Facebook posts to understand how effectively they engage diabetes-related content with their followers. METHODS: The top 10 followed healthcare organisations' Facebook pages were taken as a sample. Data were retrieved from October 2023 to March 2024. Diabetic-related posts were identified using keywords and categorised based on their contents and features. RESULTS: Findings reveal significant disparities in the frequencies of posts and public engagement among different types of organisations. The majority of posts were classified under the miscellaneous category and text+image feature. Recipes and food-related posts were liked and shared the most among the followers. CONCLUSION: The results of the study found that patients' engagement with diabetes-related content was low in social media. The gap between patients' participation and engagement highlights the need for reassessment and refinement of social media communication strategies for healthcare organisations to empower patients with diabetes through social media and increase public engagement.


Assuntos
Diabetes Mellitus Tipo 2 , Mídias Sociais , Humanos , Estudos Retrospectivos , Diabetes Mellitus Tipo 2/terapia , Honduras , Pobreza , Participação do Paciente
17.
J Bras Nefrol ; 47(2): e20240127, 2025.
Artigo em Inglês, Português | MEDLINE | ID: mdl-39907321

RESUMO

INTRODUCTION: In the northwest of Portugal, AA amyloidosis was reported as the most frequent amyloid nephropathy, but it is unclear if the disease's incidence and outcomes have changed. The authors studied the changing epidemiology, aetiologies, and outcomes of patients with renal AA amyloidosis over the last 40 years. METHODS: This is a retrospective single-center cohort study involving patients with renal biopsy-proven AA amyloidosis diagnosed in the northwest of Portugal between 1978 and 2019. The patients were grouped into 14-year cohorts based on the year of diagnosis (CA 1978-1991; CB 1992-2005; CC 2006-2019), and clinical course and outcomes were analyzed. RESULTS: Sixty-nine AA amyloidosis patients were included. The incidence of the disease remained stable in CA (64%) and CB (62.7%) as opposed to the significant decrease in the most recent cohort (44%, p = 0.027). The mean age at presentation increased by ten years from CA to CC. Overall, infections were the leading cause of death, with a significant rise over time (9.1% in CA to 76.9% at CC, p = 0.002). There were no significant global and renal survival differences between the three cohorts. However, the CC patients died at an older age (61.4 years) than the CA (52.3 years). CONCLUSION: The incidence of AA amyloidosis has been declining over the last 40 years. In contrast, the age at presentation of amyloid nephropathy has been increasing. Global and renal outcomes did not improve, but the average life expectancy increased, suggesting progress in general management and supportive care of renal and underlying pathology.


Assuntos
Amiloidose , Nefropatias , Humanos , Masculino , Estudos Retrospectivos , Feminino , Pessoa de Meia-Idade , Amiloidose/epidemiologia , Portugal/epidemiologia , Idoso , Nefropatias/epidemiologia , Nefropatias/etiologia , Adulto , Incidência , Proteína Amiloide A Sérica
18.
Einstein (Sao Paulo) ; 23: eAO0951, 2025.
Artigo em Inglês | MEDLINE | ID: mdl-39907382

RESUMO

BACKGROUND: This is a pioneering study on the assessment of a Brazilian municipality entire, comparing alcohol-based hand sanitizer consumption before and during the COVID-19 pandemic. Vilas-Boas et al reported a rise from 24.2mL/PD in 2018 to 46.6 in 2020, being for adult intensive care units the municipality exceeded most of the Brazilian states. However, observed a decline in some hospitals in 2021. OBJECTIVE: Compare alcohol-based hand sanitizer use in intensive care units in a municipality in São Paulo state, before and during the coronavirus pandemic. METHODS: Analytical retrospective study using indirect documentation, with data obtained from a notification spreadsheet for epidemiological indicators of healthcare-associated infection in the state. Data on monthly alcohol-based sanitizer use were collected from the intensive care units of public and private general hospitals of the municipality. Analysis was conducted using descriptive statistics and graphically with run charts. The Mann-Whitney test was applied to compare the median consumption of public and private hospitals, at a 5% significance level. RESULTS: Adult, neonatal and pediatric intensive care units showed median increases in hand sanitizer use of 34.03 to 57.64, 31.53 to 48.66 and 34.38 to 60.35mL/patient-day, respectively. Private hospitals showed greater hand sanitizer use in the adult and pediatric intensive care units compared to public institutions. CONCLUSION: The pandemic contributed to increasing hand sanitizer use in municipal intensive care units, but there is still room for improvement. More effort is needed to ensure that hand sanitizer use remains high.


Assuntos
COVID-19 , Higiene das Mãos , Higienizadores de Mão , Unidades de Terapia Intensiva , Pandemias , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Brasil/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Estudos Retrospectivos , Higiene das Mãos/estatística & dados numéricos , Pandemias/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , SARS-CoV-2 , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/epidemiologia , Desinfecção das Mãos , Adulto
19.
Pediatr Transplant ; 29(1): e70028, 2025 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-39837770

RESUMO

BACKGROUND: When a family decides to donate the organs or tissues of their child with brain death, it is necessary to consider which organs or tissues will be donated. This phenomenon presents an ethical dilemma that is underexplored in the scientific literature, making it essential to examine this context to understand how refusals occur within donations. OBJECTIVE: To analyze the rates and trends of specific refusals for each organ and tissue from pediatric donors with brain death occurring between 2001 and 2020 in an Organ Procurement Organization in the State of São Paulo, Brazil. METHODS: This was a cross-sectional, exploratory, retrospective, quantitative study. Data were derived from a database consisting of copies of organ and tissue donation authorization forms, organized, and subjected to descriptive and inferential analyses. This study adhered to international ethical guidelines. RESULTS: Data from 109 real donors were analyzed. The bones, skin, and blood vessels had the highest refusal rates among tissues, as well as the pancreas and lungs for solid organs. Most organs and tissues showed a decreasing refusal trend except for the corneas, liver, and kidneys, which exhibited a stationary trend. CONCLUSIONS: This study illustrates the refusals within real donations, with high refusal rates for tissues compared to solid organs.


Assuntos
Morte Encefálica , Família , Obtenção de Tecidos e Órgãos , Humanos , Estudos Transversais , Obtenção de Tecidos e Órgãos/ética , Estudos Retrospectivos , Brasil , Criança , Masculino , Feminino , Pré-Escolar , Adolescente , Lactente , Doadores de Tecidos
20.
Pediatr Transplant ; 29(1): e70033, 2025 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-39837777

RESUMO

INTRODUCTION: Cytomegalovirus (CMV) infection is a frequent complication among hematopoietic stem cell transplant (HSCT) recipients. Data regarding CMV reactivation in children in underdeveloped countries is scarce. This is especially notable considering the increasing utilization of haploidentical-related HSCT with the post-transplant cyclophosphamide platform. This study aimed to describe the incidence, clinical characteristics, and evolution of children with CMV reactivation after HSCT and the possible impact of unmanipulated stem cells with PTCy for GvHD prophylaxis. METHODS: Retrospective cohort study of children undergoing hematopoietic stem cell transplantation from January 2012 to June 2022. Baseline characteristics and the clinical course were described. Duration of treatment, initial viral load, and time to clearance of DNAemia by type of transplant were compared using the Kruskal-Wallis test. Survival analysis was performed with the Kaplan-Meier method and log-rank test. All statistical analysis was performed using SPSS software, version 20.0. RESULTS: One hundred sixty-six children were included. Among them, 87% of recipients and 88% of donors were CMV positive. The cumulative incidence of cytomegalovirus DNAemia was 28% at 100 days post-transplantation. There were no differences between different donor types. Overall survival at 1 year was 60%, and non-relapse mortality was observed in 28%. CMV reactivation did not appear to negatively impact 1-year overall survival (OS). CONCLUSIONS: Our study found no differences in CMV reactivation rates, treatment duration, viral clearance times, co-infections, or 1-year overall survival across different HSCT donor types. Studies are needed to establish more precise criteria for monitoring recipients, particularly in regions where unmanipulated stem cells with PTCy for GvHD prophylaxis are increasing.


Assuntos
Infecções por Citomegalovirus , Citomegalovirus , Transplante de Células-Tronco Hematopoéticas , Ativação Viral , Humanos , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/etiologia , Estudos Retrospectivos , Feminino , Masculino , Criança , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Pré-Escolar , Colômbia/epidemiologia , Adolescente , Lactente , Incidência , Transplante Homólogo , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/epidemiologia
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