Mortality predictors in critically ill patients with acute kidney injury requiring continuous renal replacement therapy

Background@#Because of high cost of continuous renal replacement therapy (CRRT) and the high mortality rate among severe acute kidney injury patients, careful identification of patients who will benefit from CRRT is warranted. This study determined factors associated with mortality among critically ill patients requiring CRRT. @*Methods@#This was a retrospective observational study of 414 patients admitted to the intensive care unit of four hospitals in South Korea who received CRRT from June 2017 to September 2018. Patients were divided according to degree of fluid overload (FO) and disease severity. The Cox proportional hazards model was used to explore the effect of relevant variables on mortality. @*Results@#In-hospital mortality rate was 57.2%. Ninety-day mortality rate was 58.5%. Lower creatinine and blood pH were significant predictors of mortality. A one-unit increase in the Sequential Organ Failure Assessment (SOFA) score was associated with increased risk of and 90-day mortality (hazard ratio [HR], 1.07; p 10%, independent of disease severity. @*Conclusion@#FO increases the risk of mortality independent of other factors, including severity of acute illness. Prevention of FO should be a priority, especially when managing the critically ill.

Continuous renal replacement therapy in elderly with acute kidney injury

The objective of this article is to raise awareness among physicians of the increasing incidence of acute kidney injury in the elderly population and the utility of continuous renal replacement therapy (CRRT) in its management. While CRRT is frequently applied in younger patients, its use in elderly patients is less frequent, for various reasons, including resistance to such an aggressive intervention from the family and the healthcare team. However, predictors of prognosis have been identified and some studies have concluded that advanced age is not associated with poor outcomes. Decisions regarding management are more complex when dealing with the elderly but like very other patient, the approach should be patient- centered.

Simplified bronchiolitis severity score for health care providers

Background: Bronchiolitis is a viral lower respiratory infection of young infants. It requires monitoring by outpatient health care providers and rarely needs hospitalization. Scoring of severity in community helps in early referral. A simplified bronchiolitis scoring for rural health care providers with no facility for measurement of oxygen saturation (SpO2) and chest X-ray (CXR) is a long-felt need. This study proposes a simplified score.Methods: The proposed bronchiolitis severity score (PSS) has to be validated against the standard bronchiolitis severity score (SSS). The PSS was administered by a physician, nurse and researcher. The reliability was measured by the comportment of internal consistency and inter-observer agreement.Results: The physicians rating of severity by SSS and PSS was similar in 97% of cases. The internal consistency of 0.72 and the kappa index of 0.86 were obtained. The inter-rater agreements between physician, nurse, researcher was 0.94, 0.94 and 0.93 respectively.Conclusions: The PSS is reliable, valid and can be administered by nurses in peripheral health care settings.

Current approaches to immunotherapy in noncolorectal gastrointestinal malignancies

Noncolorectal gastrointestinal (GI) malignancies are among the most frequently diagnosed cancers. Despite the undeniable progress in systemic treatments in recent decades, further improvements using cytotoxic chemotherapy seem unlikely. In this setting, recent discoveries regarding the mechanism underlying immune evasion have prompted the study of molecules capable of inducing strong antitumor responses. Thus, according to early data, immunotherapy is a very promising tool for the treatment of patients with GI malignancies. Noncolorectal GI cancers are a major public health problem worldwide. Traditional treatment options, such as chemotherapy, surgery, radiation therapy, monoclonal antibodies and antiangiogenic agents, have been the backbone of treatment for various stages of GI cancers, but overall mortality remains a major problem. Thus, there is a substantial unmet need for new drugs and therapies to further improve the outcomes of treatment for noncolorectal GI malignancies. "Next-generation" immunotherapy is emerging as an effective and promising treatment option in several types of cancers. Therefore, encouraged by this recent success, many clinical trials evaluating the efficacy of immune checkpoint inhibitors and other strategies in treating noncolorectal GI malignancies are ongoing. This review will summarize the current clinical progress of modern immunotherapy in the field of noncolorectal GI tumors.

Carcinoid syndrome: update on the pathophysiology and treatment

Approximately 30-40% of patients with well-differentiated neuroendocrine tumors present with carcinoid syndrome, which is a paraneoplastic syndrome associated with the secretion of several humoral factors. Carcinoid syndrome significantly and negatively affects patients' quality of life; increases costs compared with the costs of nonfunctioning neuroendocrine tumors; and results in changes in patients' lifestyle, such as diet, work, physical activity and social life. For several decades, patients with neuroendocrine tumors and carcinoid syndrome have been treated with somatostatin analogues as the first-line treatment. While these agents provide significant relief from carcinoid syndrome symptoms, there is inevitable clinical progression, and new therapeutic interventions are needed. More than 40 substances have been identified as being potentially related to carcinoid syndrome; however, their individual contributions in triggering different carcinoid symptoms or complications, such as carcinoid heart disease, remain unclear. These substances include serotonin (5-HT), which appears to be the primary marker associated with the syndrome, as well as histamine, kallikrein, prostaglandins, and tachykinins. Given the complexity involving the origin, diagnosis and management of patients with carcinoid syndrome, we have undertaken a comprehensive review to update information about the pathophysiology, diagnostic tools and treatment sequence of this syndrome, which currently comprises a multidisciplinary approach.

Treatment of patients with metastatic colorectal cancer and poor performance status: current evidence and challenges

Patients with unresectable metastatic colorectal cancer live for a median of three years when treated with standard therapies. While the evidence guiding cancer-directed treatment of this disease comes from phase III trials that have mostly enrolled patients with good performance status, some patients present with poor clinical conditions. The best treatment for these patients remains to be determined. We performed a systematic review of the treatment outcomes of patients with metastatic colorectal cancer and poor performance status, defined as Eastern Cooperative Oncology Group performance status ≥2. Eligible articles were prospective or retrospective studies or case reports published in English, Portuguese or Spanish. We searched PubMed, EMBASE, LILACS and the Cochrane Library from onset until October 2017 using specific keywords for each search. We found a total of 18 publications, mostly case reports and retrospective studies (14 articles). One was an uncontrolled prospective trial, two were observational studies and one was an individual patient meta-analysis. Although some studies suggested benefits in terms of symptomatic response with standard chemotherapy, with good safety profiles when dose-reduced regimens were administered, a true survival gain could not be demonstrated. The scientific evidence for treating metastatic colorectal cancer patients with poor performance status is scarce, and more studies evaluating treatment for this population are necessary since this condition is not uncommon in clinical practice, particularly in the public healthcare system and developing countries and among destitute populations.

A "miracle" cancer drug in the era of social media: A survey of Brazilian oncologists' opinions and experience with phosphoethanolamine / Uma "milagrosa" droga contra o câncer na era da mídia social: uma pesquisa sobre a opinião e a experiência dos oncologistas brasileiros com a fosfoetanolamina

Summary Introduction: Patients who are treating cancer have often used alternative therapies. In the internet era, information can be broadcasted widely, and this happened with phosphoethanolamine in Brazil, where this substance was claimed by the population to be the "cure for cancer." Method: This is a cross-sectional study developed by the Brazilian Society of Clinical Oncology (SBOC). An objectively structured questionnaire was sent by e-mail and SMS to active MDs members of the SBOC. Descriptive statistics was used to evaluate the data. Statistical significance between the variables was tested by Pearson's Chi-squared test (p<0.05 was considered significance). Results: The survey was sent to 1,072 oncologists, and 398 (37.1%) answered at least part of it. One hundred and fifteen (28.9%) had followed patients who had used phosphoethanolamine. Among these, 14 (12.2%) observed adverse events and four (3.5%) attributed clinical benefit to the substance. Most of the oncologists (n=331; 83.2%) believe that it should only be used as part of a clinical trial protocol. Most physicians did not recommend this drug to their patients (n=311; 78.1%). Oncologists in Southeast, South and Midwest Brazil were more likely to have patients taking the drug compared to the Northern and Northeastern regions. Conclusion: This is the first survey to assess the opinion and experience of oncologists about this alternative therapy. Most oncologists in Brazil do not believe that synthetic phosphoethanolamine is active in cancer treatment, do not recommend its use without proper evaluation, and state that it should only be available to patients in the context of clinical trials.

Resumo Introdução: Alguns pacientes com diagnóstico de câncer utilizam terapias alternativas. Na era da internet, as informações podem se dissipar de forma rápida e abrangente, como foi o caso da fosfoetanolamina no Brasil, onde foi aclamada pela população como sendo a "cura para o câncer". Método: Trata-se de um estudo transversal desenvolvido pela Sociedade Brasileira de Oncologia Clínica (SBOC). Através de e-mail e SMS, enviou-se um questionário com perguntas objetivas para oncologistas membros ativos da SBOC. Os dados foram avaliados por meio de estatística descritiva. A significância estatística entre as variáveis ​​foi testada pelo teste Qui-quadrado de Pearson (p<0,05 foi considerado significativo). Resultados: O questionário foi enviado para 1.072 oncologistas, tendo 398 (37,1%) respondido pelo menos parte dele. Cento e quinze (28,9%) tinham pacientes que fizeram uso da fosfoetanolamina. Desses, 14 (12,2%) observaram eventos adversos e quatro (3,5%) atribuíram benefício clínico para a substância. A maioria (n=331; 83,2%) acreditava que ela só deveria ser utilizada dentro de um ensaio clínico. A principal recomendação dada aos pacientes foi contra o seu uso (n=311; 78,1%). Oncologistas das regiões Sudeste, Sul e Centro-Oeste tiveram mais pacientes que tomaram a substância quando comparados com as regiões Norte e Nordeste. Conclusão: Este é o primeiro estudo que avalia a opinião dos oncologistas sobre essa terapia alternativa e sua experiência. A maioria dos oncologistas brasileiros não acredita que a fosfoetanolamina sintética seja ativa no tratamento do câncer, não recomendando seu uso sem avaliação adequada, e afirmam que a substância só deve estar disponível no contexto de ensaios clínicos.

China Patient-centered Evaluative Assessment of Cardiac Events Prospective Study of Acute Myocardial Infarction: Study Design / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Despite the rapid growth in the incidence of acute myocardial infarction (AMI) in China, there is limited information about patients' experiences after AMI hospitalization, especially on long-term adverse events and patient-reported outcomes (PROs).</p><p><b>METHODS</b>The China Patient-centered Evaluative Assessment of Cardiac Events (PEACE)-Prospective AMI Study will enroll 4000 consecutive AMI patients from 53 diverse hospitals across China and follow them longitudinally for 12 months to document their treatment, recovery, and outcomes. Details of patients' medical history, treatment, and in-hospital outcomes are abstracted from medical charts. Comprehensive baseline interviews are being conducted to characterize patient demographics, risk factors, presentation, and healthcare utilization. As part of these interviews, validated instruments are administered to measure PROs, including quality of life, symptoms, mood, cognition, and sexual activity. Follow-up interviews, measuring PROs, medication adherence, risk factor control, and collecting hospitalization events are conducted at 1, 6, and 12 months after discharge. Supporting documents for potential outcomes are collected for adjudication by clinicians at the National Coordinating Center. Blood and urine samples are also obtained at baseline, 1- and 12-month follow-up. In addition, we are conducting a survey of participating hospitals to characterize their organizational characteristics.</p><p><b>CONCLUSION</b>The China PEACE-Prospective AMI study will be uniquely positioned to generate new information regarding patient's experiences and outcomes after AMI in China and serve as a foundation for quality improvement activities.</p>

Adherence to colonoscopy recommendations for first-degree relatives of young patients diagnosed with colorectal cancer

OBJECTIVES:Colorectal cancer is the third leading cause of cancer death in the United States. The American College of Gastroenterology recommends screening for first-degree relatives of patients diagnosed with colorectal cancer before the age of 50. A colonoscopy is one of the most commonly recommended exams due to its specificity and the possibility to resect pre-malignant lesions. Nevertheless, the rate of physician adherence to this recommendation is unknown.METHODS:This transversal study was performed at a major cancer center in Brazil with 62 patients, aged 18 to 50, who completed a questionnaire on information received from their physicians regarding screening their first-degree relatives. We used the answers from patients who provided explicit consent.RESULTS:Two hundred and three patients were eligible to participate and 93 (45.8%) agreed to complete the questionnaire. Twenty-three questionnaires (24.73%) were returned and 39 were completed by telephone. Of the patients who answered the questionnaire, 39 (62.9%) had received a colonoscopy recommendation for their first-degree relatives and 23 (37.1%) were not informed of the recommendation. Among the patients who received the recommendations, 20.51% affirmed that all relatives completed the exam and 51.28% stated that no relatives completed the exam.DISCUSSION:The adherence rate of our physicians to the ACG guideline recommendations was 62.9%. Considering that our study was performed at a leading center for cancer treatment in Latin America, we had expected better adherence. The results show that adherence to the colorectal cancer screening recommendations for high-risk patients must be improved.

Clinical predictors of cognitive impairment and psychiatric complications in Parkinson’s disease / Preditores clínicos de transtorno cognitivo e complicações psiquiátricas na doença de Parkinson

Objective To estimate the clinical and demographics aspects that may contribute to cognitive impairment and psychiatric symptoms in Parkinson’s disease (PD). Method All patients answered a structured standardized clinical questionnaire. Two movement disorders specialists performed the following scale: Unified Parkinson’s disease rating score (UPDRS), the modified Hoehn and Yahr staging, Schwab and England Scale, SCOPA cognition (SCOPA-COG), SCOPA-Psychiatric complications (SCOPA-PC) and Non-Motor Symptoms Scale (NMSS). We built a generalized linear model to assess predictors for the SCOPA-COG and SCOPA-PC scores. Results Almost 37% of our patients were demented as per SCOPA-COG scores. Level of education and the UPDRS-Subscale III were predictors of cognitive impairment. Higher scores in domain 3 of NMSS and male gender were associated with psychiatric complications as assessed per the SCOPA-PC. Conclusion Level of education and disease severity are predictors of dementia in PD. Psychiatric complications are more commonly observed in men. .

Objetivo Estimar aspectos clínicos e demográficos que podem contribuir para o comprometimento cognitivo e sintomas psiquiátricos na doença de Parkinson (DP). Método Todos pacientes responderam questionário clínico padrão. Duas especialistas em distúrbios do movimento aplicaram as seguintes escalas: Unified Parkinson’s disease rating score (UPDRS), Hoehn and Yahr estágios, Schwab and England Scale, SCOPA cognição (SCOPA-COG), SCOPA-Complicações psiquiátricas (SCOPA-CP) e Escala de sintomas não motores (NMSS). Utilizamos análise multivariada, para avaliar os preditores relacionados ao SCOPA-COG e SCOPA CP. Resultados Aproximadamente 37% dos nossos pacientes foram classificados como dementes utilizando-se os valores obtidos no SCOPA-COG. Nível educacional e a parte III do UPDRS foram preditores de comprometimento cognitivo. Escores elevados no domínio 3 do NMSS e sexo masculino associaram-se com complicações psiquiátricas quando acessadas pelo SCOPA-CP. Conclusão Nível educacional e gravidade de doença são preditores de demência na DP. Complicações psiquiátricas são mais comumente observadas em homens. .

Quality of life among people with epilepsy: A cross-sectional study from rural southern India.

Background. Epilepsy can be associated with profound physical, social and psychological consequences and it has an impact on a person’s quality of life. We assessed the quality of life and factors associated with a poor quality of life, among adults with epilepsy in a rural block of Tamil Nadu. Methods. We interviewed 91 epilepsy patients from 20 randomly selected villages using a structured questionnaire including World Health Organization Quality of Life BREF (WHOQOL-BREF), Patient Health Questionnaire 2 (PHQ-2) and Generalized Anxiety Disorder 7 (GAD-7) questionnaires. Results. The mean (SD) total score of the quality of life scale was 61.49 (12.56). Those who were single, separated or widowed (t statistic= –2.71, p<0.01), had not completed primary education (t statistic=–2.308, p<0.05), not currently going for work (t statistic=–2.748, p<0.01), had seizure in the past one year (t statistic=–4.068, p<0.01), had depressive symptoms (t statistic=–3.207, p<0.01), had higher anxiety scores (t statistic=–2.727, p<0.01), had low scores in the quality of life questionnaire. Multivariate analysis showed increasing age, education less than grade V, being unmarried, widowed or separated, lower per capita income, a high anxiety score and experiencing a seizure episode in the past one year to be significantly associated with a low score in the WHOQOL-BREF questionnaire (adjusted R2=0.378, SE 9.90). Conclusion. The presence of anxiety, lack of primary education, being single, separated or widowed, increasing age, low per capita income and having a seizure episode in the past year are associated with lower quality of life among people with epilepsy.

Prevalence of isolated systolic hypertension in Chinese adult population / 中华预防医学杂志

<p><b>OBJECTIVE</b>To evaluate prevalence of isolated systolic hypertension and other subtypes of hypertension, as well as their distribution in Chinese adults.</p><p><b>METHODS</b>A cross-sectional survey was conducted in the mainland China during 2000-2001 with a multistage cluster sampling to select a nationally representative sample of 15,540 Chinese adults aged 35-74, by InterASIA project. Hypertension subtypes were defined among individuals not receiving antihypertensive therapy as follows: isolated systolic hypertension as a systolic blood pressure > or = 140 mm Hg and a diastolic blood pressure < 90 mm Hg, isolated diastolic hypertension as a systolic pressure < 140 mm Hg and a diastolic pressure > or = 90 mm Hg, and combined systolic/diastolic hypertension as a systolic pressure > or = 140 mm Hg and a diastolic pressure > or = 90 mm Hg. Blood pressure for each subject was measured for three readings at sitting position after rest for at least five minutes and an average reading was recorded. A standardized structured questionnaire was used to collect history of hypertension and antihypertensive treatment.</p><p><b>RESULTS</b>Overall, 7.6% (1,181 cases) of adults had isolated systolic hypertension, 7.4% (1,150 cases) combined systolic/diastolic hypertension and 4.4% (683 cases) isolated diastolic hypertension in the sample of 15,540 adults at age 35-74. Prevalence of systolic hypertension increased with age, and was more common in the older women than in the older men. There was no significant difference in prevalence of isolated systolic hypertension between north and south China, but, rural residents had a higher prevalence than urban residents.</p><p><b>CONCLUSION</b>There existed a higher prevalence of systolic hypertension in China, to which enough attention should be paid.</p>

Obesidade: hábitos nutricionais, sedentarismo e resistência à insulina / Obesity: dietary Intake, sedentarism and insulin resistance

A obesidade já é considerada uma epidemia mundial independente de condiçöes econômicas e sociais. O risco aumentado de mortalidade e morbidade associado à obesidade tem sido alvo de muitos estudos que tentam elucidar os aspectos da síndrome X como conseqüência da obesidade. Esta síndrome é caracterizada por algumas doenças metabólicas, como resistência à insulina, hipertensäo, dislipidemia. Está bem estabelecido que fatores genéticos têm influência neste aumento dos casos de obesidade. No entanto, o aumento significativo nos casos de obesidade nos últimos 20 anos dificilmente poderia ser explicado por mudanças genéticas que tenham ocorrido neste espaço de tempo. Sendo assim, os principais fatores envolvidos no desenvolvimento da obesidade têm sido relacionados com fatores ambientais, como ingestäo alimentar inadequada e reduçäo no gasto calórico diário. Na tentativa de desencadear obesidade em animais e permitir o estudo desta doença de maneira mais completa, diversos modelos experimentais de obesidade têm sido desenvolvidos. Ainda que näo possam ser considerados exatamente iguais aos modelos de obesidade humana, säo de grande valor no estudo dos diversos aspectos que contribuem para este excessivo acúmulo de adiposidade e suas conseqüências

Biodegradation of acetonitrile by cells of Candifa Guillermondii UFMG-Y65 immobilized in alginate, kcarrageenan and citric pectin

Different encapsulation matrices were tested for immobilized cells of Candida guillermondii UFMG-Y65 used for acetonitrile degradation. Acetonitrile degradation by free cells and cells immobilized in Ba-alginate, k-carrageenan and citric pectin was studied. The rate of acetonitrile degradation was monitored for 120h by measuring yeast growth and ammonia concentration. Different alginate concentrations did not affect cell viability, but the period of incubation in BaCl(2) solution reduced the number of viable cells. Likewise, the gel nature and the matrix structure of the support resulting from the cell immobilization conditions were of fundamental importance for biocatalyst activity and performance, affecting substantially the patterns of microbial growth and enzymatic activity. Alginate-immobilized cells degraded acetonitrile more efficiently than k-carrageenan or citric pectin-immobilized cells.