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1.

Background

Influenza continues to drive seasonal morbidity, particularly in settings with low vaccine coverage.

Objectives

To describe the influenza cases and viral circulation among hospitalized patients.

Methods

A prospective study based on active surveillance of inpatients with influenza-like illness from a tertiary hospital in Bucharest, Romania, in the season 2016/17.

Results

A total of 446 patients were tested, with a balanced gender distribution. Overall, 192 (43%) patients tested positive for influenza, with the highest positivity rate in the age groups 3–13 years and >65 years. Peak activity occurred between weeks 1 and 16/2017, with biphasic distribution: A viruses were replaced by B viruses from week 9/2017; B viruses predominated (66.1%). Among the 133 (69.3%) subtyped samples, all influenza A were subtype H3 (n = 57) and all influenza B were B/Victoria (n = 76). Patients who tested positive for influenza presented fewer comorbidities (p = 0.012), except for the elderly, in whom influenza was more common in patients with comorbidities (p = 0.050). Disease evolution was generally favorable under antiviral treatment. The length of hospital stay was slightly longer in patients with influenza-like illness who tested patients negative for influenza (p = 0.031).

Conclusions

Distinctive co-circulation of A/H3 and B/Victoria in Bucharest, Romania in the 2016/17 influenza season was found. While the A/H3 subtype was predominant throughout Europe that season, B/Victoria appears to have circulated specifically in Romania and the Eastern European region, predominantly affecting preschoolers and school children.  相似文献   

2.

Aim

To evaluate the efficacy of the onabotulinum toxin type A in the treatment of HTLV-1 associated overactive bladder and its impact on quality of life (QoL).

Methods

Case series with 10 patients with overactive bladder refractory to conservative treatment with anticholinergic or physical therapy. They received 200Ui of onabotulinumtoxin type A intravesically and were evaluated by overactive bladder symptoms score (OABSS) and King's Health Questionnaire.

Results

The mean (SD) of the age was 52 + 14.5 years and 60% were female. All of them had confirmed detrusor overactivity on urodynamic study. Seven patients had HAM/TSP. The median and range of the OABSS was 13 (12–15) before therapy and decreased to 1.0 (0–12) on day 30 and to 03 (0–14) on day 90 (p < 0.0001). There was a significant improvement in 8 of the 9 domains of the King's Health Questionnaire after the intervention. Hematuria, urinary retention and urinary infection were the complications observed in 3 out of 10 patients. The mean time to request retreatment was 465 days.

Conclusion

Onabotulinum toxin type A intravesically reduced the OABSS with last long effect and improved the quality of life of HTLV-1 infected patients with severe overactive bladder.  相似文献   

3.

Aims

To assess whether an integrated hospital-community diabetes management program could improve major cardiovascular risk factor control among patients with diabetes in real-world clinical settings.

Methods

985 adults with diabetes in the Shanghai Taopu community health service center were enrolled at baseline and 907 subjects completed the follow-up. The follow-up levels of the metabolic profiles were assessed by their averages during the follow up period.

Results

After a mean 7-year follow-up period, heamoglobin A1c, systolic and diastolic blood pressure levels decreased by 0.6%, 5.7 mmHg, and 1.5 mmHg, respectively (all P < 0.001). There was a non-significant difference in low-density lipoprotein cholesterol, while high-density lipoprotein cholesterol increased 1.9 mg/dL and triglycerides decreased 28.3 mg/dL, respectively (all P < 0.001). The percentage of patients with diabetes who met any one of three Chinese Diabetes Society goals (heamoglobin A1c <7.0%, blood pressure <140/80 mmHg, and low-density lipoprotein cholesterol <100 mg/dL) increased from 58.2% to 70.1%. The chronic diabetes complication screening rates (diabetic retinopathy, diabetic neuropathy, diabetic nephropathy) have significantly increased, from almost zero to 12–78%.

Conclusions

This long-term program has increased the proportions of attaining major cardiovascular risk factors control goals and diabetic chronic complication screening rates among patients with diabetes.  相似文献   

4.

Aim

This study aimed to test the dose-response relationship between fasting blood glucose (FBG) levels and risk of prostate cancer.

Methods

A systematic search was done of PubMed and Scopus from their inception up to January 2017. Prospective and retrospective studies reporting risk estimates of prostate cancer for two or more categories of blood glucose levels were identified, and two independent authors extracted the information. Relative risk (RR) was calculated using random-effects models and pooled.

Results

Ten prospective cohort studies, one nested case-control study, one case-cohort study and three case-control studies (total n = 1,214,947) involving 12,494 cases of prostate cancer were reviewed. The pooled RR of prostate cancer for the highest vs. lowest category of FBG was 0.88 (95% CI: 0.78–0.98, I2 = 25.5%, n = 15 studies). A 10 mg/dL increment in FBG level was not associated with risk of prostate cancer (0.98, 95% CI: 0.96–1.00, I2 = 45.4%, n = 11 studies). Subgroup analyses yielded a significant inverse association only in the subgroup of cohort studies. Non-linear dose-response meta-analysis showed a very slight decrement in risk with increasing FBG levels. Sensitivity analyses using cohort studies showed a steep decrease in risk along with an increase in FBG from baseline levels of ≈ 70 mg/dL across prediabetes and diabetes ranges.

Conclusion

Higher FBG levels are associated with lower risk of prostate cancer in cohort studies, but not in case-control studies, findings that limit interpretation of our present results.  相似文献   

5.

Introduction

Despite the high prevalence of chronic pain in individuals infected with HTLV-1, predictive and protective factors for its development are still unclear.

Objective

To identify factors associated with chronic pain in individuals with HTLV-1.

Methods

This cross-sectional study was conducted in a reference center for treatment of patients infected with HTLV-1 in Salvador, Bahia, Brazil. The study included individuals infected with HTLV-1, over 18 years, and excluded those with difficulty to respond the pain protocol. Data on sociodemographic, health behavior, and clinical characteristics were collected in a standardized way. The prevalence ratio (PR) of pain is described, as well as the factors independently associated with the presence of pain, which were assessed by multiple logistic regression.

Results

A total of 142 individuals were included in the study, mostly female (62.7%), aged 20–64 years (73.2%), married (61.3%), with less than eight years of education (54.2%), and with a steady income (79.6%). Multivariate analysis showed that being symptomatic for HTLV-1 – sensory manifestations, erectile dysfunction, overactive bladder, and/or HAM/TSP (PR = 1.21, 95% CI: 1.05 to 1.38), self-medication (PR = 1.29, 95% CI: 1.08–1.53), physiotherapy (PR = 1.15, 95% CI: 1.02–1.28), and depression (PR = 1.14, 95% CI: 1.01–1.29) were associated with an increased likelihood of presenting pain. On the other hand, physical activity (PR = 0.79, 95% CI: 0.67–0.93) and religious practice (PR = 0.83, 95% CI: 0.72–0.95) were associated with a decreased likelihood of having pain.

Conclusion

The use of self-medication, physiotherapy and the presence of depression are independently associated with neurological symptoms in HTLV-1 infected patients. Religious practice and physical activity are both protective for the development of pain.  相似文献   

6.

Background

A progressive decrease in Helicobacter pylori eradication rates has been described over the years, driving the need for new antibiotic treatments.

Aim

To evaluate the efficacy and safety of the addition of rifaximin (Spiraxin®) to standard triple therapy (omeprazole, amoxicillin and clarithromycin) for the eradication of H. pylori.

Methods

Independent prospective clinical trial (EUDRACT no.: 2013-001080-23). Forty consecutive adult patients were included with H. pylori infection, dyspeptic symptoms and naive to eradication treatment. A full blood test was performed in the first five patients enrolled to evaluate the safety of the treatment. H. pylori eradication was confirmed with the 13C-urea breath test at least four weeks after the end of treatment with rifaximin 400 mg/8 h, clarithromycin 500 mg/12 h, amoxicillin 1 g/12 h and omeprazole 20 mg/12 h for 10 days.

Results

Forty patients were consecutively enrolled, 53% woman, mean age 44 years. Indication for eradication: 60% non-investigated dyspepsia, 38% functional dyspepsia and 2% gastric ulcer. Four patients did not attend the eradication confirmatory breath test. The eradication rate was 61% (95% CI: 45–77%) for the protocol and 55% (40–70%) for intention-to-treat. About 76% of the patients experienced adverse events (35% diarrhea, 14% nausea and 24% metallic taste), none of which was serious. The blood tests did not show significant alterations.

Conclusion

Acceptable H. pylori eradication rates are not achieved with rifaximin associated with standard triple therapy for 10 days.  相似文献   

7.

Introduction

Limited therapeutic options and high mortality make the management of OXA-48-like carbapenemase-producing Klebsiella pneumoniae (KPOXA-48) bacteraemia complicated. The aim of the study was to describe the clinical characteristics of KPOXA-48 bacteraemia between October 2013 and December 2016.

Material and methods

The variables to analyse were retrospectively collected from medical records. Carbapenemase production was confirmed by phenotypic and molecular methods.

Results

A total of 38 patients with bacteraemia were included, mainly classified as hospital-acquired (n = 31). The majority of cases were secondary bacteraemia (n = 26), most commonly arising from the urinary tract (n = 11). All isolates presented a multidrug-resistant profile with the extended spectrum beta-lactamase CTX-M-15 and the carbapenemase OXA-48-like production. The crude mortality rate with adequate targeted antibiotic therapy was 0%, rising to 55% with inadequate treatment (p = 0.0015).

Conclusions

This study highlights the importance of identifying this resistance mechanism, the patient factors, type of bacteraemia and adequacy of antibiotic therapy in the outcome of bacteraemia.  相似文献   

8.

Background

Antiretroviral therapy (ART) saved millions from HIV-1 infection and AIDS, but some patients do not experience adequate CD4+ T cells gain despite achieving viral suppression. The genetic component of this condition is not yet completely elucidated.

Objective

To identify predictive genetic markers of immune response to ART.

Methods

Case–control study. Out of 176 HIV-infected patients recruited in the city of Recife, Northeast Brazil, 67 patients with no immunologic response were the cases and the remaining 109 patients who responded were the controls. A set of 94 selected single nucleotide polymorphisms (SNPs) involved in antiretroviral drugs pharmacodynamic pathways and immune system homeostasis were genotyped, while the remaining 48 were ancestry informative markers (AIMs) for controlling for eventual hidden population structure.

Results

Male patients were overrepresented in non-responder group (p = 0.01). Non-responders also started with lower absolute CD4+ T cell counts (p < 0.001). We found five SNPs significantly associated with the outcome, being three more frequent in non-responders than responders: rs2243250 (IL4) A allele (p = 0.04), rs1128503 (ABCB1) A allele (p = 0.03) and rs707265 (CYP2B6) A allele (p = 0.02), whereas the other two were less frequent in non-responders: rs2069762 (IL2) C allele (p = 0.004) and rs4646437 (CYP3A4) A allele (p = 0.04).

Conclusion

Some significant univariate associations remained independently associated at multivariate survival analysis modeling, such as pre-treatment CD4+ T cells counts, IL2 and ABCB1 genotypes, and use of protease inhibitors, yielding a predictive model for the probability for immune response. More studies are needed to unravel the genetic basis of ART immunological non-response.  相似文献   

9.
10.

Aim

To compare steady state pharmacodynamic and pharmacokinetic profiles of insulin glargine 300 U/mL (Gla-300) with insulin degludec 100 U/mL (Deg-100) in people with type 1 diabetes.

Methods

This single-centre, randomized, double-blind crossover euglycaemic clamp study included two parallel cohorts with fixed once-daily morning dose regimens. For both insulins participants received 0.4 (n = 24) or 0.6 U/kg/day (n = 24), before breakfast, for 8 days prior to the clamp. The main endpoint was within-day variability (fluctuation) of the smoothed glucose infusion rate (GIR) over 24 hours (GIR-smFL0–24).

Results

Gla-300 provided 20% less fluctuation of steady state glucose infusion rate profiles than Deg-100 over 24 hours at 0.4 U/kg/day (GIR-smFL0–24 treatment ratio 0.80 [90% confidence interval: 0.66 to 0.96], P = 0.047), while at the dose of 0.6 U/kg/day the difference between insulins was not statistically significant (treatment ratio 0.96 [0.83 to 1.11], P = 0.603). Serum insulin concentrations appeared more evenly distributed with both dose levels of Gla-300 versus the same doses of Deg-100, as assessed by relative 6-hour fractions of the area under the curve within 24 hours. Both insulins provided exposure and activity until 30 hours (end of clamp).

Conclusion

Gla-300 provides less fluctuating steady state pharmacodynamic profiles (i.e. lower within-day variability) and more evenly distributed pharmacokinetic profiles, compared with Deg-100 in a once-daily morning dosing regimen of 0.4 U/kg/day.  相似文献   

11.

Introduction

The commonly held notion that a rural environment decreases the frequency of allergic diseases has proven to be inconsistent amongst children.

Objective

Our objective was to contrast the prevalence of bronchial asthma (BA), allergic rhinitis (AR), and atopic dermatitis (AD) between children that live in a rural environment and those that live in urban areas.

Methods

We carried out a cross-sectional study amongst children aged six to seven; they were selected through probabilistic, stratified and conglomerated sampling. The prevalence of BA, AR, and AD was identified with the use of the questionnaire provided by The International Study of Asthma and Allergies in Childhood, additionally, we inquired about each child's family history of atopy, their exposure to farm animals, the intake of unpasteurised cow's milk, and the number of siblings related to every child. We used logistic regression and multivariate analysis to determine the correlation between asthma, allergic diseases, and rural environment.

Results

We included 189/1003 (18.8%) children from a rural environment, and 814/1003 (81.2%) from an urban area. BA and AR were associated to a family history of atopy (OR = 2.15, p = 0.001; OR = 2.58, p = 0.002, respectively). BA was more prevalent in males (OR = 1.92, p = 0.007). Notably, a higher number of siblings seems to protect against AR (OR = 0.45, p = 0.008). A paternal history of allergies was associated to AD.

Conclusions

In our study, we were unable to find protective factors in a rural environment that might decrease the prevalence of asthma or allergic diseases.  相似文献   

12.

Aims

Determine the mortality experience among adults with diabetes in meeting and not meeting less intense control for glycated hemoglobin (HbA1c), blood pressure (BP), and cholesterol.

Methods

National Health and Nutrition Examination Survey 1999–2010 participants with self-report of diagnosed diabetes (N = 3335), measured HbA1c, BP and non-HDL cholesterol were linked to the National Death Index through December 31, 2011. Proportional hazards models were used to estimate hazard ratios (HR) of meeting HbA1c < 9% and BP < 160/110, and non-HDL cholesterol < 190 mg/dL. Models used age as the time scale and adjusted for demographics (sex, race/ethnicity, education), diabetes duration, history of cardiovascular and chronic kidney disease, and treatments for elevated glucose, BP, and cholesterol.

Results

Over a mean 5.4 person-years of follow-up, participants meeting all less intense control had a 37% lower mortality (HR = 0.63, 95% CI 0.54, 0.74) relative to those who did not meet the goals. Of approximately 306,000 deaths per year that occur among Americans with diabetes, we estimate 39,400 might have been averted by improving the care of those who have not met these less intense control goals.

Conclusions

Meeting the less intense control goals is associated with 37% reduction in mortality and could lead to 39,400 fewer deaths per year.  相似文献   

13.

Objectives

To determine the factors associated with Mycobacterium tuberculosis complex-positive blood culture.

Methods

Case-control study. Sociodemographic, clinical and laboratory data were collected from 2000 to 2015.

Results

We reviewed medical records of 533 patients with culture-proven tuberculosis, of whom 27.2% (145/533) had blood culture available. Patients with mycobacteremia presented more frequently with abdominal tuberculosis, body mass index <18 kg/m2, and had lower hemoglobin and albumin levels. No differences were observed regarding HIV status.

Conclusions

Few studies have reported on the characteristics associated with Mycobacterium tuberculosis complex bacteremia, especially among Human Immunodeficiency Virus-negative patients. Out of 145 tuberculosis-infected patients with blood culture results available, 21 turned out positive. Anemia, hypoalbuminemia, and a body mass index < 18 kg/m2 were associated with mycobacteremia.  相似文献   

14.
Tuberculosis (TB) may have a similar spirometry findings as a chronic obstructive pulmonary disease but the prevalence of TB-induced airflow obstruction (AO) is still unknown.

Objectives

To measure frequency of AO in new TB cases at the beginning of treatment and to evaluate factors associated with obstructive abnormalities following TB diagnosis.

Materials and Methods

317 patients that have no history of prior AO were recruited into the study with a median age of 39.0 years (IQR, 30.0–49.0). AO was defined using the FEV1/F(VC) < LLN.

Results

AO was detected in 29.97% (95/317) new TB cases. These patients had a more severe clinical manifestation of TB with a greater likelihood of cough, OR = 5.47 (95%CI 1.90–15.70) and wheezing, OR = 10.51 (95%CI 5.72–19.27), p < 0.001. The frequency of AO was positively associated with bronchoscopic evidence of narrowing of the main airways. Furthermore, from multiple logistic regression analysis we would assume that higher FEV1 value in TB patients with AO was related to greater BMI and inversely associated with older age, female sex and radiographic extent (p < 0.05).

Conclusions

Obstructive pattern on spirometry frequently occurs in new TB cases without previously detected AO. This category of patients should be targeted for detailed follow-up, particularly, in high TB burden countries.  相似文献   

15.
16.

Introduction

Treatment of type 2 diabetes with sodium–glucose cotransporter 2 (SGLT2) inhibitors may result in genital fungal infections. We investigated possible risk factors for developing such infections among patients treated with the SGLT2 inhibitor dapagliflozin.

Methods

The Association of British Clinical Diabetologists (ABCD) collected data on patients treated with dapagliflozin in routine clinical practice from 59 diabetes centres. We assessed possible associations of patient’s age, diabetes duration, body mass index, glycated haemoglobin, renal function, patient sex, ethnicity and prior genital fungal infection, urinary tract infection, urinary incontinence or nocturia, with the occurrence of ≥1 genital fungal infection within 26 weeks of treatment.

Results

1049 out of 1116 patients (476 women, 573 men) were analysed. Baseline characteristics were, mean ± SD, age 56.7 ± 10.2 years, BMI 35.5 ± 6.9 kg/m2 and HbA1c 9.4 ± 1.5%. Only patient sex (13.2% women vs 3.3% men) and prior history of genital fungal infection (21.6% vs 7.3%) were found to be associated with occurrence of genital fungal infections after dapagliflozin treatment, adjusted OR 4.22 [95%CI 2.48,7.19], P < 0.001 and adjusted OR 2.41 [95% CI 1.04,5.57], P = 0.039, respectively.

Conclusion

Women and patients with previous genital fungal infections had higher risks of developing genital fungal infections with dapagliflozin treatment.  相似文献   

17.

Background

Perinatally HIV-infected children are surviving into adulthood, and getting pregnant. There is a scarcity of information on health and pregnancy outcomes in these women.

Aim

To evaluate characteristics related to HIV disease and pregnancy outcomes in perinatally infected women, and to compare these women with a group of youth with behaviorally acquired HIV-infection, at a reference hospital in Rio de Janeiro, Brazil.

Methods

A cohort study. Epidemiological, clinical, and laboratory data were compared between perinatally (PHIV) and behaviorally HIV-infected (BHIV) pregnant youth with the primary aim to study pregnancy outcomes in the PHIV group and compare with outcomes to BHIV group.

Results

Thirty-two pregnancies occurred in PHIV group, and 595 in BHIV group. A total of seven (22%) PHIV women and 64 (11%) BHIV women had a premature delivery (p = 0.04), however, when adjusting for younger age at pregnancy, and antiretroviral therapy initiation in 1st trimester of pregnancy (OR = 18.66, 95%CI = 5.52–63.14), the difference was no longer significant. No cases of mother-to-child HIV transmission (MTCT) were observed in the PHIV group while there was a 2% MTCT rate in BHIV group.

Conclusion

Pregnancy among PHIV was as safe as among BHIV. The differences between those groups were probably related to treatment and prolonged care in the first group.  相似文献   

18.
19.

Background

Cytokines are fundamental elements in mediating and stimulating the immune response against tuberculosis (TB). Growing evidence indicated that polymorphisms in the interleukin-17 (IL-17) A and F genes are implicated in TB.

Objectives

This meta-analysis was aimed to re-evaluate and update the relationship between IL-17A rs2275913 G/A and IL17F rs763780 T/C polymorphisms and TB risk.

Methods

Using inclusive searches of the PubMed, MEDLINE, EMBASE, Web of Science and Elsevier Science Direct, we identified outcome data from all articles estimating the association between IL-17 A and F polymorphisms and TB risk.

Results

A total of 15 studies comprising 7130 patients and 7540 controls were included. Our pooled analysis demonstrated that the IL-17A rs2275913 G/A SNP was not associated with the risk of TB in overall, or in Asians and Caucasians, but it conferred resistance to TB in Latin Americans using allele (OR = 0.53), codominant (OR = 0.53 and 0.38), dominant (OR = 0.49) and recessive (OR = 0.46) inheritance models. For IL-17F rs763780 T/C, the pooled evidence indicated that this variation was a risk factor for TB in allele (C vs T) and dominant (TC+CC vs TT) models in overall (OR of 1.35) and among Asians (OR = 1.40), but not in Caucasians.

Conclusion

In summary, our meta-analysis suggested that the IL-17A rs2275913 was a protective factor against TB, but ?17F rs763780 T/C was a risk factor for TB.  相似文献   

20.

Introduction

The etiology of pulmonary infections in HIV patients is determined by several variables including geographic region and availability of antiretroviral therapy.

Materials and methods

A cross-sectional prospective study was conducted from 2012 to 2016 to evaluate the occurrence of pulmonary fungal infection in HIV-patients hospitalized due to pulmonary infections. Patients’ serums were tested for (1–3)-β-D-Glugan, galactomannan, and lactate dehydrogenase. The association among the variables was analyzed by univariate and multivariate regression analysis.

Results

60 patients were included in the study. The patients were classified in three groups: Pneumocystis jirovecii pneumonia (19 patients), community-acquired pneumonia (18 patients), and other infections (23 patients). The overall mortality was 13.3%. The time since diagnosis of HIV infection was shorter in the pneumocystosis group (4.94 years; p = 0.001) than for the other two groups of patients. The multivariate analysis showed that higher (1-3)-β-D-Glucan level (mean: 241 pg/mL) and lactate dehydrogenase (mean: 762 U/L) were associated with the diagnosis of pneumocystosis. Pneumocystosis was the aids-defining illness in 11 out of 16 newly diagnosed HIV-infected patients.

Conclusion

In the era of antiretroviral therapy, PJP was still the most prevalent pulmonary infection and (1-3)-β-D-Glucan and lactate dehydrogenase may be suitable markers to help diagnosing pneumocystosis in our HIV population.  相似文献   

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