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María Victoria Rubio Rubio Luis Miguel Lou Arnal José Antonio Gimeno Orna Paula Munguía Navarro Alex Gutiérrez-Dalmau Elena Lambán Ibor Javier Paúl Ramos Raquel Pernaute Lavilla Belén Campos Gutiérrez Alberto San Juan Hernández-Franch 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2019,39(2):141-150
Introduction
Conservative Management (CM) has become a therapeutic option in Advanced Chronic Kidney Disease in the elderly. However, there is a lack of evidence about prognosis of these patients in terms of survival and health related quality of life (HRQoL).Objective
Establish predictive variables associated with mortality and analyse HRQoL in CM patients.Patients and methods
Prospective cohort study. An assessment of renal function parameters and a comprehensive geriatric assessment were made, including: analysis of comorbidity, functional, cognitive, fragility, nutritional, social and HRQoL status.Results
82 patients with a mean age of 84 years and significant pluripathology were studied: 56% had history of vascular event and Charlson > 8. The mortality rate was 23/1,000 patients per month, with a homogeneous mortality rate after 6 months.Survival differed significantly depending on whether they presented with a previous vascular event (36.7 vs. 14.8; p = 0.028), Charlson score ≥ 10 (42 vs. 17; p = 0.002), functional status (48.4 vs. 19; p = 0.002) and fragility (27 vs. 10; p = 0.05).Mortality predictors included eGFR and proteinuria, the presence of previous vascular events, Charlson comorbidity score, malnutrition-inflammation parameters (albumin and MNA score), degree of dependency, physical HRQoL and increase of PTH level. The presence of previous vascular event, comorbidity, decreased albumin and elevated PTH were independent predictors of mortality. HRQoL remained stable over time and no significant worsening occurred during treatment.Conclusions
Having knowledge of the factors associated with mortality and HRQoL assessment can be a useful tool to helping decision making during CM. Previous vascular events, comorbidity, decreased albumin and increased PTH were independent predictors of mortality. 相似文献3.
Monica Baumgardt Bay Marise Reis de Freitas Marcia Cavalcante Vinhas Lucas Elizabeth Cristina Fagundes de Souza Angelo Giuseppe Roncalli 《The Brazilian journal of infectious diseases》2019,23(1):2-7
Background
Men who have sex with men (MSM) account for the highest prevalence of HIV in Brazil. HIV testing allows to implement preventive measures, reduces transmission, morbidity, and mortality.Methods
We conducted a cross-sectional study to evaluate HIV testing during lifetime, factors associated with the decision to test, knowledge about HIV transmission, and use of condoms between MSM from the city of Natal, northeast Brazil.Results
Out of 99 participants, 62.6% had been tested for HIV during lifetime, 46.2% in the last year. The most frequent reported reason to be tested for HIV infection was curiosity (35.5%). Correct knowledge about HIV was observed in only 9.2% of participants. In multivariate analysis, age (PR 0.95; 95%CI, 0.91–0.99; p = 0.041) and previous syphilis test (PR 4.21; 95%CI, 1.52–11.70; p = 0.006) were associated with HIV testing.Conclusions
The frequency of HIV testing among MSM from Natal is rather low, especially in younger MSM, and knowledge about HIV transmission is inappropriate. 相似文献4.
T.A.A. Seghda N.V. Yaméogo G.R.C. Millogo L. Kagambega J. Kologo T. Boro A. Samadoulougou P. Zabsonré 《Annales de cardiologie et d'angeiologie》2019,68(2):65-70
Objective
To describe the management and evolution of high risk of death pulmonary embolism associated with right heart thrombi.Material and methods
We conducted a prospective cohort survey over a 54 month-period, from March 1st, 2012 to September 30th 2015. Were included all patients with pulmonary embolism and having high or intermediate-high risk of death. Patients were divided into two groups according to whether cardiac Doppler-echography found a thrombus in the right chambers or not (ICT+ vs. ICT?). The survival curves for the patients were obtained using the software STATA.Results
The prevalence of pulmonary embolism associated with right heart thrombi was 4% in our study. Thrombi were mobile, straight localization in all cases. The ICT + group was characterized by a significantly higher proportion of congestive heart and chronic lung disease. The proportion of patients’ thrombolysis was significantly higher in the ICT-group. In the ICT + group, thrombolysis significantly reduced mortality giving a 30-day survival of 80% against 20% among patients receiving only heparin.Conclusion
Pulmonary embolism associated with right heart thrombi including the atrium are not exceptional. These patients are at high risk of early death. Thrombolysis is significantly improving the mortality of pulmonary embolism associated with right-sided heart thrombi. 相似文献5.
Objective
To assess the impact of providing integrated psycho-socio-economic support to drug resistant tuberculosis (DRTB) patients on the treatment outcome under programmatic conditions.Study design
Retrospective cohort study.Setting
An urban district TB centre in India under the Revised National Tuberculosis Control Programme.Participants
A cohort of 123 patients who started DRTB treatment between June 2010 and May 2013.Methods
Patients started on treatment for DRTB between June 2010 and May 2013 who were provided with the integrated support package for at least 3 months formed the supported group while the other patients of the cohort formed the non-supported group. The treatment outcomes and sputum culture conversion rates were compared between the two groups.Results
The supported group consisted of 60 patients and the non-supported group of 63 patients. The treatment success rate was found to be significantly higher in the supported group (65% vs 46.03%; p = 0.0349). Support duration was significantly associated with lower incidence of death [HR 0.876, 95% CI 0.811–0.947; p = 0.0009] and loss to follow up [OR: 0.752, 95% CI 0.597–0.873; p = 0.0023]. The treatment failure rate was higher in the supported group (16.66% vs 4.76%) with 60% of the failures in the supported group occurring after 24 months of compliant treatment. There was no significant association found between support duration and treatment failure or sputum culture conversion.Conclusion
Integrated support seems to significantly increase the treatment success rate and improve survival and treatment adherence of DRTB patients. However, early diagnosis and effective pharmacotherapy are crucial for reducing treatment failures. 相似文献6.
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O. Ben Rejeb W. Brahim H. Ghali S. Ernez A. Mahdhaoui G. Jeridi 《Annales de cardiologie et d'angeiologie》2019,68(2):80-86
Aim
To assess the quality of long-term anticoagulation therapy with antivitamin-K in patients with atrial fibrillation by measuring the TTR and to determine the factors associated with a good TTR.Patients and methods
This is an observational study conducted over a period of three years (from January 2013 until December 2015) in the outpatient clinic of cardiology of Farhat Hached hospital of Sousse, Tunisia. Pre-established individual plugs were used for data collection. The data analysis was performed using the SPSS Software, version 20.Results
Overall, 200 patients were eligible. Half of the patients did not know the risks of AVK and 29.1% were unaware of their interest. The average TTR was 57.3 ± 18.2%. Good control of anticoagulation was obtained in 24.5% of patients. Those with a ≥ 70% were more autonomous, observant, of urban origin, living in Sousse and Kairouan, with good knowledge about AVK and having a small left atrium. The factors associated negatively with TTR were hypertension, diabetes, old AF, hematological diseases, high number of medications taken daily and the presence of mitral insufficiency, mitral valve replacement, a tricuspid insufficiency or a tricuspid plasty.Conclusion
The quality of AVK anticoagulation in AF patients is insufficient. Improving this indicator would reduce the morbidity and mortality associated with AVK treatment. 相似文献9.
Guilherme Bricks Jorge Figueiredo Senise Henrique Pott-Jr Giuliano Grandi Dimas Carnaúba-Jr Hamilton Antonio Bonilha de Moraes Celso Franscisco Hernandes Granato Adauto Castelo 《The Brazilian journal of infectious diseases》2019,23(1):45-52
Background
Hepatitis E virus (HEV) infection in patients with pre-existing liver disease has shown high morbidity and lethality. The consequences of HEV superinfection in patients with chronic hepatitis C virus (HCV) infection are not fully understood. This study aimed to evaluate the association between the presence of anti-HEV antibodies, liver cirrhosis, and insulin resistance.Methods
A total of 618 patients chronically infected with HCV were included from three reference centers for viral hepatitis in São Paulo, Brazil. Presence of anti-HEV IgG was assessed by enzyme-linked immunosorbent assay (WANTAI HEV-IgG ELISA).Results
The seroprevalence of anti-HEV in patients with cirrhosis was significantly higher than in patients without cirrhosis (13.2% vs 8%, OR = 1.74, p = 0.04). Seropositivity for anti-HEV, adjusted for sex, age, and HCV genotype showed an association trend with hepatic cirrhosis (aOR = 1.75, p = 0.059). Presence of HEV antibodies, adjusted for age, body mass index and cirrhosis, was shown to be independently associated with insulin resistance (aOR: 4.39; p = 0.045).Conclusion
Patients with chronic hepatitis C are under risk of hepatitis E virus superinfection in Brazil. The trend toward association between cirrhosis and previous HEV infection suggests that it may accelerate liver fibrosis in patients with chronic hepatitis C. In addition, previous infection by HEV is independently associated with insulin resistance in the studied population, which may be an extra-hepatic manifestation of hepatitis E that persists after resolution of the active infection, and may contribute to fibrosis progression. 相似文献10.
Sumal Nandasena Chaminda Senavirathna Champa Munasinghe Chapa Wijesena Ridmi Sucharitharathna 《The Indian journal of tuberculosis》2019,66(1):76-80
Background
Tuberculosis (TB) is an infectious bacterial disease; remains as one of the important public health problem affecting every part of the world. Substantial number of TB cases are reported from Sri Lanka every year irrespective of its strong preventive health system. The aim of this analysis is to describe the characteristics of TB patients and to assess the factors associated with sputum conversion. This analysis was based on the data from the District Chest Clinic of Kalutara district, Sri Lanka.Methods
Information of all newly diagnosed and registered patients in the District Chest Clinic, Kalutara in year 2013 were ascertained. Out of 687 newly reported TB patients, 669 records were included in final analysis.Results
Majority of patients were males (n = 451, 67.4%), in the age group of 36–60 years (n = 306, 45.7%) and underweight (n = 359, 61.7%). Substantial proportion of normal weight or overweight adult patients (92.1%) had sputum conversion at 2–3 months as compared to underweight adult patients (82.5%) (p = 0.034). Those who smoke tobacco is less likely to have sputum conversion at 2–3 months as compared to non-smokers (90.2% vs. 82.1%, p = 0.045).Conclusion
Provision of good nutrition, maintaining of appropriate body mass index (i.e., BMI), and abstinence from smoking and alcohol consumption are important for sputum conversion among smear-positive pulmonary TB patients. 相似文献11.
M.C. Mboup J. Mingou D.M. Ba K. Dia P.D. Fall 《Annales de cardiologie et d'angeiologie》2019,68(2):115-119
Introduction
Acute coronary syndromes have been rarely studied in the female population in Sub-Saharan Africa. This Sub-Saharan serie has shown an increase in the prevalence of acute coronary syndromes among the female population, compared to previous studies. Through this retrospective study, we evaluated the epidemiological, clinical, paraclinical, therapeutic and evolutionary features of acute coronary syndromes on women at the Principal Hospital of Dakar.Methodology
This was a retrospective study of patients hospitalized for acute coronary syndrome over a period of 5 years from January 1st, 2010 to December 31st, 2014, at the Cardiology Department of the Principal Hospital of Dakar.Results
The prevalence of diabetes and obesity was statistically higher for women than for men. Atypical symptomatology was much more apparent (P = 0.0000), admission times at the emergency department for acute coronary syndromes were relatively longer ( = 0.005). Therapeutically, medical care was almost identical regardless of gender.Conclusion
In Senegal, acute coronary syndrome in women is characterized by the atypical symptomatology with delayed diagnosis and management. The fight against this reputedly masculine pathology requires a good awareness campaign. 相似文献12.
K. Douros D. Kotzia C. Kottaridi A. Giotas B. Boutopoulou E. Bozas V. Matziou K. Priftis V. Papaevangelou 《Allergologia et immunopathologia》2019,47(3):260-264
Aim
To prospectively evaluate interferences between viruses of the upper respiratory tract in asymptomatic preschool children.Methods
Nasal-pharyngeal swabs from 233 preschool aged children were prospectively collected over four consecutive time periods, during one school year. The samples were tested using a RT-PCR DNA/RNA microarray system for nine respiratory viruses.Results
Respiratory syncytial virus (RSV) was a predictor of the presence of influenza virus (INFL) (OR: 9.12, CI: 1.52–54.75, p = 0.016), and similarly, INFL predicted the presence of RSV (OR: 4.01, CI: 1.14–14.16, p = 0.030). Also, rhinovirus (RV) was a predictor of adenovirus (ADV) presence (OR: 3.66, CI: 1.10–12.14, p = 0.034), and similarly, ADV predicted the presence of RV (OR: 4.05, CI: 1.02–16.05, p = 0.046). No other significant associations between viruses were observed.Conclusion
Our results indicate that respiratory viruses found in carrier stage in asymptomatic children may interact with other viruses and even facilitate their settling in the upper respiratory tract. The pathophysiological role of these interactions is not yet clear. 相似文献13.
Background
Quality of life, which is impaired in patients with chronic spontaneous urticaria (CSU), is influenced by comorbid mental disorders. Headaches could be another comorbid mental disorder that affects quality of life in children with CSU.Objectives
To investigate the effect of headaches on urticaria symptoms, disease activity and quality of life in children with CSU.Methods
A total of 83 patients with CSU were enrolled in the study and were separated into two groups as those with or without headache. Demographic and clinical characteristics were studied with the Urticaria Activity Score (UAS7), Urticaria Control test (UCT) and Chronic Urticaria Quality of Life Questionnaire (CU-Q2QoL). The headache questionnaire designed according to the Department of International Classification of Headache Disorders, second edition (ICHD-II) was used and VAS (Visual Analogue Scale) and NRS (Numerical Rating Scale) were used to assess the pain measurement. In patients diagnosed with migraine, the paediatric Migraine Disability Assessment Scale (PedMIDAS) was applied.Results
CU-QoL total scores were significantly higher in patients with CSU with headache than in those without headache (p = 0.015). In the five domains of CU-QoL, impact of daily life activities domain and sleep problems domain had higher scores in CSU with headache (p = 0.008, 0.028, respectively). There was no significant relationship between UCT, UAS and CU-QoL and headache severity (p < 0.05). No differences were found between the groups in respect of duration of urticaria, UAS7 and UCT.Conclusion
Headache may be an important factor that affects and impairs quality of life in children with chronic urticaria. 相似文献14.
N.F. Benatta D.D. Batouche S. Benouaz M.A. Djazouli 《Annales de cardiologie et d'angeiologie》2019,68(2):94-97
Introduction
Infectious endocarditis (IE) is a serious disease that has continued to evolve in diagnostic and therapeutic terms.Aim
To analyze the diagnostic and out come profile.Methods
We collected 57 (IE) cases with a definite diagnosis according to the modified Duke criteria. Patients were admitted consecutively to the Cardiology Department of the Oran university hospital from January 2011 to June 2017. Among the variables studied: clinical data, paraclinic data, therapeutic management and hospital outcome.Results
The mean age was 40.5 ± 15 years (extreme 16–67 years), with a male predominance (sex-ratio = 1.5). This was a native valve IE in 70% of cases, on valve prosthesis in 15.5% of patients, on congenital heart disease in 2% and on pacemaker probe in 4% of cases. The entrance door was dominated by oral origin. Blood cultures were positive only in 51% of cases. The most commonly implicated organism in staphylococci in 22.6%, streptococcus in 18.9% and brucellosis in 3.8%. Ultrasound data revealed vegetation (83%), cardiac abscess (19%), valvular perforation (15.1%) and prosthesis disintegration (7.5%). Complications were mainly neurological complications (27%) and hemodynamics (26%). Cardiac surgery occurred in 29% of patients. Hospital mortality was 26%, predictive factors were staphylococcal AI (P < 0.001), cardiac insufficiency (P < 0.001) and neurological complications (P = 0.04).Conclusion
Infectious endocarditis is a serious disease in the absence of surgery. The diagnosis is based on echocardiography in the first place and blood cultures. The population is often young revealing the EI by complications; its prevention is the best way to improve its prognosis. 相似文献15.
Alessandra Zilli Federica Cavalcoli Clorinda Ciafardini Sara Massironi 《Digestive and liver disease》2019,51(4):505-509
Background
Chronic atrophic autoimmune gastritis (CAAG) leads to vitamin B12 deficiency, but other micronutrient deficiencies are largely understudied.Aims
To investigate the prevalence of micronutrient deficiencies in CAAG patients and their potential relationship with the grading of gastric atrophy or entero-chromaffin-like cells hyperplasia or body mass index (BMI).Methods
From 2005 to 2016 a number of CAAG patients underwent regular follow-up with annual blood testing and upper gastrointestinal tract endoscopy every years.Results
Out of the 122 CAAG patients checked (100?F; median age 65 years), 76 presented nutritional deficiencies, single in 24 and multiple in 52 cases: a deficiency of B12 and iron showed in 42 patients, 25-OH vitamin D lacked in 76 and folic acid in 6 cases. 25-OH vitamin D levels directly correlated with B12 levels and were significantly lower in patients with macronodular than in those with linear or micronodular hyperplasia. No significant correlation was observed between B12, folic acid or ferritin levels and BMI, blood gastrin levels, the grading of gastric atrophy or ECL cells hyperplasia.Conclusions
25-OH vitamin D deficiency was the main one in CAAG patients: its correlation with B12 deficiency may indicate underlying shared pathogenic mechanisms, although further studies are needed to confirm this hypothesis. 相似文献16.
Konstantinos Douros Maria-Ioanna Thanopoulou Barbara Boutopoulou Anna Papadopoulou Anastassios Papadimitriou Andrew Fretzayas Kostas N. Priftis 《Allergologia et immunopathologia》2019,47(3):209-213
Introduction
There is accumulated evidence supporting a beneficial role of Mediterranean diet (MD) in the control of asthma symptoms. The aim of this study was to investigate the relationships between adherence to MD and serum levels of certain cytokines namely, interleukin (IL)-4, and IL-17 known to have a pathogenetic role in the airway changes associated with asthma.Methods
We measured serum IL-4, IL-33, and IL-17, in 44 asthmatic and 26 healthy children, 5–15 years old. Their adherence to MD was estimated with the Mediterranean Diet Quality Index for children and adolescents (KIDMED) score.Results
KIDMED score did not differ between the two groups (P = 0.59) and was not correlated with any of the three measured cytokines. However, when the analysis was restricted only to asthmatic children, the KIDMED score was correlated with IL-4, IL-33, and IL-17 (Beta: ?0.56, P = 0.007; Beta: 0.57, P = 0.010; Beta: ?0.62, P = 0.017, respectively).Conclusion
Our results indicate that MD can modulate the production of some of the main inflammatory mediators of asthma, in asthmatic children. 相似文献17.
C.-H. Tseng 《Diabetes & metabolism》2019,45(2):184-190
Purpose
This study aimed to investigate whether metformin can affect risk of chronic obstructive pulmonary disease (COPD) in type 2 diabetes (T2D) patients.Methods
T2D patients newly diagnosed during 1999–2005 were enrolled from the reimbursement database of Taiwan's National Health Insurance system and followed up to 31 December 2011. Analyses were conducted in an unmatched cohort (92,272 ever-users and 10,697 never-users of metformin) and a propensity score (PS) matched pair cohort (10,697 ever-users and 10,697 never-users). Cox regression incorporated into the inverse probability of treatment weighting using the PS was used to estimate hazard ratios (HRs).Results
In the unmatched cohort, 2573 never-users and 13,840 ever-users developed COPD with respective incidences of 5994.64 and 3393.19 per 100,000 person-years. The overall HR was 0.560 (95% confidence interval [CI]: 0.537–0.584). HRs for the first (< 25.27 months), second (25.27–55.97 months) and third (> 55.97 months) tertiles of cumulative duration were 1.021 (0.975–1.070), 0.575 (0.548–0.603) and 0.265 (0.252–0.280), respectively. Analyses of the matched cohort showed an overall HR of 0.643 (0.605–0.682), with HRs of 1.212 (1.122–1.309), 0.631 (0.578–0.689) and 0.305 (0.273–0.340) for the respective tertiles.Conclusion
A reduced risk of COPD is observed in metformin users with T2D. 相似文献18.
Iskandar Idris Kunal Gulati Magaly Perez-Nieves Irene Hadjiyianni Dachuang Cao Arash Tahbaz Jasmina Ivanova Syed Wasi Hassan 《Primary Care Diabetes》2019,13(2):106-112
Aim
Real-world effectiveness of insulin therapy is affected by poor treatment persistence, often occurring soon after initiation. An international cross-sectional survey of people with type 2 diabetes mellitus (T2DM) has been conducted to describe reasons for non-persistence with insulin therapy.Methods
Responders to an online survey in 7 countries were classified as continuers (no gap of ≥7 days), interrupters (interrupted therapy for ≥7 days within first 6 months, then restarted), and discontinuers (terminated therapy for ≥7 days within first 6 months, no restart before survey). We present the results from the United Kingdom (UK) cohort.Results
Of 942 global respondents, 131 were from the UK, having a mean age of 37 years and a mean of 7 years since first T2DM diagnosis. Reasons contributing to insulin continuation (n = 50) were improved physical feeling (52.0%) and improved glycemic control (48.0%). Common reasons for interruption (n = 50) or discontinuation (n = 31), respectively were weight gain (50.0%, 48.4%) and hypoglycemia (38.0%, 25.8%). Most important reason for possible re-initiation for interrupters and discontinuers, respectively was persuasion by physician/healthcare professional (74.0%, 64.5%).Conclusion
The benefits of basal insulin therapy motivated continuers to persist with the treatment; experienced or anticipated side effects contributed to interruption and discontinuation. 相似文献19.
Aim
To investigate the demographic and clinico-radiological characteristic of patients of tuberculosis presented with pneumothorax in relation to the patients of active pulmonary tuberculosis.Material and Methods
The retrospective study was conducted between January 2013 to June 2014 and records of 78 patients of pulmonary tuberculosis with pneumothorax (TP) and 156 patients of pulmonary tuberculosis without pneumothorax (NPT) were analyzed. Demographic, etiologic, clinical, radiographic, and outcome data were collected.Results
The mean age of tuberculous pneumothorax patients was 38.0 ± 14.3 years and that of non-pneumothorax was 39.5 ± 12.3 years. Most common presenting clinical feature was cough (76.9%) followed by dyspnoea (74.4%), chest pain (64.0%) and fever (56.4%) in TP patients. Chest radiograph showed cavity in 38 (48.7%) TP patients followed by consolidation in 32 (41.0%) patients and infiltration in 33 (42.3%) patients. All the TP patients had undergone underwater seal intercostal tube drainage procedure for the management of pneumothorax. The mean duration between chest drain insertion and removal was 17.14 ± 6.37 days. Twenty-five (32.1%) of the cases developed chest tube drainage related complications.Conclusion
Patients of tuberculous pneumothorax required prolonged period of chest tube drainage and usually showed good response to the treatment. 相似文献20.
S. Miceli Sopo G. Gurnari S. Monaco A. Romano L. Liotti B. Cuomo I. Dello Iacono L. Badina G. Longo M. Calvani A. Giannone C. Calabrò G. Scala M.C. Verga 《Allergologia et immunopathologia》2019,47(3):277-281