Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 671
Article in Chinese | WPRIM | ID: wpr-907065


Objective @#To analyze the survival of patients with malignant mesothelioma, so as to provide insights into the management of malignant mesothelioma.@*Methods @#Totally 36 patients with malignant mesothelioma admitted to Cixi Third People’s Hospital from October 2012 to January 2021 were enrolled, and the demographic features, exposure to asbestos, and diagnosis and treatment were retrospectively reviewed. The survival rate and median survival time were calculated with the life-table method, and the factors affecting the survival rate of malignant mesothelioma were identified using the Kaplan-Meier estimate and log-rank test.@*Results @#The 36 patients with malignant mesothelioma included 6 men ( 16.67% ) and 30 women ( 83.33% ), and had a median age of 61 ( interquartile range, 14 ) years. There were 30 cases with pleural malignant mesothelioma ( 83.33% ) and 6 cases with peritoneal malignant mesothelioma ( 16.67% ), 32 cases ( 88.89% ) with a history of occupational exposure to asbestos, and 26 cases ( 72.22% ) receiving palliative treatment. The 1-, 2- and 3-year cumulative survival rates were 30%, 15% and 3%, respectively, and the median survival time was 0.71 years. In addition, there were no significant differences in the survival period among patients with malignant mesothelioma in terms of gender, age, route of asbestos exposure, duration of asbestos exposure, pathogenic site and treatment regimens ( P>0.05 ).@*Conclusion @#The 36 patients with malignant mesothelioma had a median survival period of 0.71 years, and no association was found between the survival period and asbestos exposure or pathogenic site.

Article in Chinese | WPRIM | ID: wpr-920824


@#Objective    To evaluate the diagnostic value of various severity assessment scoring systems for sepsis after cardiac surgery and the predictive value for long-term prognosis. Methods    The clinical data of patients who underwent cardiac sugeries including coronary artery bypass grafting (CABG) and (or) valve reconstruction/valve replacement were extracted from Medical Information Mark for Intensive Care-Ⅲ (MIMIC-Ⅲ). A total of 6 638 patients were enrolled in this study, including 4 558 males and 2 080 females, with an average age of 67.0±12.2 years. Discriminatory power was determined by comparing the area under the receiver operating characteristic (ROC) curve (AUC) for each scoring system individually using the method of DeLong. An X-tile analysis was used to determine the optimal cut-off point for each scoring system, and the patients were grouped by the cut-off point, and Kaplan-Meier curves and log-rank test were applied to analyze their long-term survival. Results    Compared with the sequential organ failure assessment (SOFA) score, acute physiology score-Ⅲ (APS-Ⅲ, P<0.001), the simplified acute physiology score-Ⅱ (SAPS-Ⅱ, P<0.001) and logistic organ dysfunction score (LODS, P<0.001) were more accurate in distinguishing sepsis. Compared with the non-septic group, the 10-year overall survival rate of the septic group was lower (P<0.001). Except for the systemic inflammation response score (SIRS) system, the 10-year overall survival rates of patients in the high risk layers of SOFA (HR=2.50, 95%CI 2.23-2.80, P<0.001), SAPS (HR=2.93, 95%CI 2.64-3.26, P<0.001), SAPS-Ⅱ (HR=2.77, 95%CI 2.51-3.04, P<0.001), APS-Ⅲ (HR=2.90, 95%CI 2.63-3.20, P<0.001), LODS (HR=2.17, 95%CI 1.97-2.38, P<0.001), modified logistic organ dysfunction score (MLODS, HR=2.04, 95%CI 1.86-2.25, P<0.001) and the Oxford acute severity of illness score (OASIS, HR=2.37, 95%CI 2.16-2.60, P<0.001) systems were lower than those in the low risk layers. Conclusion    Compared with SOFA score, APS-Ⅲ score may have higher value in the diagnosis of sepsis in patients who undergo isolated CABG, a valve procedure or a combination of both. Except for SIRS scoring system, SOFA, APS-Ⅲ, SAPS, SAPS-Ⅱ, LODS, MLODS and OASIS scoring systems can be applied to predict the long-term outcome of patients after cardiac surgery.

Article in Chinese | WPRIM | ID: wpr-920821


@#Objective    To provide clinical reference for the perioperative management of esophageal cancer patients with different stages of chronic obstructive pulmonary disease (COPD) through investigating the impact of COPD on postoperative complications and survival in esophageal cancer patients undergoing oesophagectomy. Methods    The clinical data of 163 patients who underwent radical resection of esophageal cancer in our department from January 2015 to January 2018 were retrospectively analyzed, including 124 males and 39 females, with a median age of 64 years (IQR: 23.8 years). They were divided into a COPD group (n=87) and a non-COPD group (n=76) according to the presence of COPD before operation. The clinical data were collected and the postoperative complications and 2-year survival between the two groups were compared and analyzed. Results    The incidence of major postoperative complications (pulmonary infection, respiratory failure, arrhythmia and anastomotic leakage) in the COPD group were higher than those in the non-COPD group (all P<0.05). Spearman correlation analysis showed that the severity of preoperative COPD was positively correlated with the incidence of postoperative complications in patients with esophageal cancer (r=0.437, P<0.001). The incidence of postoperative respiratory failure and mortality in patients with severe COPD were significantly higher than those in patients without COPD and those with mild or moderate COPD. The 2-year survival rate of patients with esophageal cancer in the COPD group was lower than that in the non-COPD group (56.1%vs. 78.5.%, P=0.001), and the severity of COPD was negatively correlated to the survival rate. Conclusion    COPD significantly increases the incidence of postoperative complications in patients with esophageal cancer, which is not conducive to the prognosis of patients, and the severity of COPD is correlated with postoperative complications and 2-year survival rate.

Article in English | LILACS-Express | LILACS | ID: biblio-1373326


Objectives: To understand the importance of hand grip strength (HGS) as a survival predictor in nonagenarians and centenarians. Methods: Longitudinal, observational and analytical study, using HGS measurements obtained during a first evaluation performed in 2016. Participants were nonagenarians and centenarians, randomly selected in various neighborhoods of Porto Alegre (RS) and evaluated in their homes. The time elapsed between the first evaluation and the date of death or last contact (for survivors) was used to calculate the hazard ratio (HR) using survival analysis on simple and adjusted Cox regression models. Results: The sample comprised 212 participants (155 women), of whom 83 (39%) died during follow-up (until August 30, 2019). Using the lowest quartile (25%) for HGS, participants with < 10 kgf for women and 17 kgf for men were considered to have poor HGS performance. In the simple regression model, participants with lower HGS presented a HR of 2.75 (1.76­4.30, p < 0.001) for death. Also in the simple model, participants aged between 90 and 94 years old presented an HR of 0.37 (0.16­0.85, p = 0.019) compared to those aged 100 or older. In the adjusted model, age lost its significance in the presence of HGS. The following were significant predictors in both simple and adjusted models: cognitive performance, calf circumference, ability to participate in social activities, shop, and prepare meals alone, performance in the Timed Up and Go test, and ease to perform activities requiring upper limb strength. Conclusions: HGS was an important independent and modifiable predictor of survival among nonagenarians and centenarians.

Objetivos: Compreender a importância da força de preensão palmar (FPP) como preditor em nonagenários e centenários. Metodologia: Estudo, longitudinal, observacional e analítico, utilizando os resultados da FPP medidos na primeira avaliação realizada em 2016. Os participantes eram nonagenários e centenários, selecionados aleatoriamente em vários bairros de Porto Alegre (RS) e avaliados em suas residências. Os participantes com 10 kgf para mulheres e 17 kgf para homens foram considerados com menor desempenho da FPP. O tempo entre a primeira avaliação e a data do óbito ou último contato (entre sobreviventes) foi calculado para avaliar a Razão de Dano (RD) usando análise de sobrevida por modelos simples e ajustados da Regressão de Cox. Resultados: A amostra foi composta por 212 participantes, 155 mulheres, 83 (39%) faleceram durante acompanhamento (até 30 de agosto de 2019). Na regressão simples, os participantes com menor desempenho na FPP apresentaram RD de 2,75 (1,76 ­ 4,30, p < 0,001). No modelo simples, participantes com idade entre 90 e 94 anos, apresentaram RD de 0,37 (0,16 ­ 0,85, p = 0,019) em relação aos centenários. No modelo ajustado, a idade perdeu sua significância na presença da FPP. Foram preditores significativos nos modelos simples e ajustados: desempenho cognitivo, circunferência da panturrilha, ser capaz de participar de atividades sociais e fazer compras e preparar refeições sozinho, desempenho no teste Timed Up and Go, e a facilidade para realizar atividades que exijam membros superiores. Conclusões: Concluímos que a FPP foi um importante preditor independente de sobrevida entre nonagenários e centenários, o que poderia ser melhorado por uma intervenção clínica.

Vaccimonitor (La Habana, Print) ; 30(3)2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1341783


Se realizó un estudio retrospectivo y observacional en pacientes con adenocarcinoma pancreático avanzado, tratados con Nimotuzumab combinado con un esquema de quimioterapia GEMOX, atendidos en el Servicio de Oncología Clínica del Hospital Clínico Quirúrgico Hermanos Ameijeiras entre 2013 y 2019 (n=118), cuyo objetivo fue evaluar la respuesta al tratamiento y la supervivencia global según variables clínicas, histopatológicas y tratamiento. Se utilizó método chi-cuadrado para la asociación de variables. Se evaluó la supervivencia global por el método de Kaplan Meier y se utilizó la prueba de Log-Rank y Breslow para la comparación de las curvas, con valor p<0.05. La tasa de control de la enfermedad fue 44,9. La mediana de supervivencia fue de 13,8 meses (IC95 por ciento:11,7-15,8). Las variables estadísticamente significativas asociadas con mayor respuesta al tratamiento y supervivencia fueron: no hábitos tabáquicos; índice plaquetas-linfocitos por debajo de 200; tumores primarios T2-T3, de localización predominantemente en cabeza pancreática; no presencia de metástasis al diagnóstico y más de seis dosis de quimioterapia o Nimotuzumab. Los pacientes con clasificación de bajo peso y albúmina sérica baja tuvieron peor supervivencia (p<0.05). En 42 pacientes se realizó una segunda línea de quimioterapia y se obtuvo supervivencia de 17,4 meses (IC95 por ciento:13,5-21,4). Las toxicidades clasificadas como grado 3-4 se reportaron en 27 pacientes (22,9 por ciento), las más frecuentemente observadas fueron: neuropatía (14,4 por ciento), neutropenia (10,2 por ciento) y trombopenia (9,3 por ciento). En condiciones de práctica clínica, con el Nimotuzumab combinado con quimioterapia GEMOX se obtuvieron óptimas tasas de control de la enfermedad y supervivencia con buen perfil de seguridad(AU)

A retrospective and observational study was carried out in patients with advanced pancreatic adenocarcinoma, treated with Nimotuzumab combined with a GEMOX chemotherapy scheme, in the Clinical Oncology Service at the Ameijeiras Hospital, between 2013 and 2019 (n =118), whose objective was to evaluate the response to the treatment and overall survival according to clinical, histopathological and treatment variables. The chi-square method was used for the association of variables. Overall survival was evaluated by the Kaplan Meier method and the Log-Rank and Breslow test for the comparison of the curves, with p <0.05. The disease control rate was 44.9. The median survival was 13.8 months (95 percent CI: 11.7-15.8). The statistically significant variables associated with greater response to treatment and survival were: no smoking habits; platelet-lymphocyte index below 200; T2-T3 primary tumors, predominantly located in the pancreatic head; no presence of metastases at diagnosis and greater than six doses of chemotherapy and Nimotuzumab. Patients classified as underweight and low serum albumin had worse survival (p <0.05). Second-line chemotherapy was performed in 42 patients and it was obtained SV of 17.4 months (95 percent CI: 13.5-21.4). Toxicities classified as grade 3-4 were reported in 27 patients (22.9 percent); the most frequently observed were: neuropathy (14.4 percent), neutropenia (10.2 perrcent) and thrombopenia (9.3 percent). Under clinical practice conditions, Nimotuzumab combined with GEMOX chemotherapy obtained optimal disease control and survival rates with a good safety profile(AU)

Humans , Pancreatic Neoplasms/drug therapy , Reference Drugs , Retrospective Studies , Observational Study , Antineoplastic Agents/therapeutic use
Infectio ; 25(4): 276-283, oct.-dic. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1286722


Resumen Objetivo: Describir la supervivencia a siete años y los principales factores asociados a esta, en las personas con VIH que fueron atendidas en el sistema de salud colombiano entre 2011 a 2018. Métodos: Análisis de supervivencia de una cohorte de 64 039 personas diagnosticadas con VIH en Colombia. Se aplicó el método de Kaplan-Meier para estimar la probabilidad de supervivencia a partir de la fecha del diagnóstico. Se ajustó un modelo de supervivencia paramétrico flexible de Royston Parmar. Resultados: La estimación de la supervivencia global a 7 años fue de 94,8% (IC 95%: 94,5-95,2). El mayor riesgo de muerte se presentó en los hombres (HR: 1,2; IC 95%: 1,1-1,4; p: 0,010); en personas ≥50 años de edad (HR: 3,1; IC 95%: 1,6-6,3; p: 0,002); en el régimen subsidiado (HR: 2,2; IC 95%: 1,9-2,5; p: <0,001); en la etapa sida (HR: 2,8; IC 95%: 2,1-3,7; p: <0,001); en quienes presentaron la última carga viral detectable (HR: 7,1; IC 95%: 6,0-8,3; p: <0,001); y en quienes mostraron conteo de linfocitos T CD4+ <350 células/μL (HR: 1,9; IC 95%: 1,4-2,4; p: <0,001). Conclusión: La probabilidad de la supervivencia de las personas que viven con VIH aumenta al ser diagnosticados en edades jóvenes, en quienes presenten un recuento de linfocitos T CD4+ ≥350 células/μL, una carga viral indetectable (< 50 copias/mL) y no se encuentren en etapa sida.

Summary Objective: to describe the seven-year survival and predictors of mortality among people with HIV who were treated in the Colombian health system between 2011 and 2018. Methods: 64 039 people diagnosed with HIV in Colombia were included. Kaplan-Meier analysis estimated the probability of survival from the date of diagnosis. A Royston Parmar flexible parametric survival model was fitted. Results: The overall survival at 7 years was 94.8% (95% CI: 94.5-95.2). Survival was related to sex (men, HR: 1.2; 95% CI: 1.1-1.4; p: 0.010); people ≥50 years of age (HR: 3.1; 95% CI: 1.6-6.3; p: 0.002); subsidized regime (HR: 2.2; 95% CI: 1.9-2.5; p: <0.001); AIDS stage (HR: 2.8; 95% CI: 2.1-3.7; p: <0.001); a detectable viral load (HR: 7.1; 95% CI: 6.0-8.3; p: <0.001); and a CD4+ Lymphocyte count <350 cells/μL (HR: 1.9; 95% CI: 1.4-2.4; p: <0.001). Conclusion: The probability of survival of people living with HIV increases when they are diagnosed at a young age, in those with a CD4+ T Lymphocyte count ≥350 cells/μL, an undetectable viral load (<50 copies/mL) and are not in the AIDS stage.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Survival Analysis , Acquired Immunodeficiency Syndrome , Sex , T-Lymphocytes , Probability , HIV , Colombia , Lymphocyte Count , Viral Load , Survivorship
Enferm. foco (Brasília) ; 12(6): 1196-1203, dez. 2021. ilus, tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1369274


Objetivo: construir um modelo preditivo de avaliação do tempo entre o diagnóstico do Vírus da imunodeficiência humana e primeira hospitalização. Método: estudo epidemiológico, descritivo, retrospectivo, com amostra de 200 prontuários de pessoas com Síndrome da imunodeficiência adquirida, acompanhadas em serviço especializado. Realizada análise da sobrevida através do estimador Kaplan-Meier, modelo paramétrico de Weibull e semi paramétrico de Cox. Resultados: houve diferenças significativas no tempo entre diagnóstico e hospitalização, no que se refere à faixa etária, orientação sexual, registro de descontinuidade da terapia e ao número de consultas médicas e multidisciplinar. O modelo de Weibull apresentou como covariável significativa o registro de descontinuidade da terapia. No modelo de Cox, as variáveis ocupação, uso de álcool e psicotrópicos, contagem de linfócitos T-CD4+, carga viral e antecedentes psiquiátricos foram significativas para explicar o risco de hospitalização. Conclusão: foi possível identificar os fatores de risco e de proteção para o desfecho hospitalização. Os modelos também apontaram fatores que influenciam no tempo entre o diagnóstico do Vírus da Imunodeficiência humana e primeira hospitalização, e possibilitaram uma discussão enriquecedora acerca dos aspectos intrínsecos aos cuidados em saúde das pessoas vivendo com o vírus e a doença. (AU)

Objective: To build an evaluation predictive model of time between Human Immunodeficiency Virus diagnosis and first hospitalization. Methods: An epidemiological, descriptive, and retrospective study, with a sample of 200 medical records of people with Acquired Immunodeficiency Syndrome, monitored in a specialized service. Survival analysis was performed using the Kaplan-Meier estimator, the Weibull parametric model, and the Cox semi-parametric model. Results: There were significant differences in time between diagnosis and hospitalization regarding age, sexual orientation, therapy discontinuation records, and the number of medical and multidisciplinary consultations. The Weibull model presented the record of therapy discontinuity as a significant co-variable. In the Cox model, the occupation, alcohol and psychotropic use, T-CD4+ lymphocyte count, viral load, and psychiatric history variables were significant to explain the risk of hospitalization. Conclusion: It was possible to identify the risk and protection factors for the outcome hospitalization. The models also pointed out factors that influence the time between human immunodeficiency virus diagnosis and first hospitalization, and enabled an enriching discussion about the intrinsic aspects of health care for people living with the virus and the disease. (AU)

Objetivo: Construir un modelo predictivo para evaluar el tiempo entre el diagnóstico de Virus da Inmunodeficiencia humana y la primera hospitalización. Métodos: Estudio epidemiológico, descriptivo, retrospectivo, con una muestra de 200 historias clínicas de personas con Síndrome de Inmunodeficiencia Adquirida, seguido de un servicio especializado. El análisis de supervivencia se realizó mediante el estimador de Kaplan Meier, el modelo paramétrico de Weibull y el modelo semiparamétrico de Cox. Resultados: Hubo diferencias significativas en el tiempo entre el diagnóstico y la hospitalización, en cuanto al grupo de edad, orientación sexual, historial de discontinuidad de la terapia y número de consultas médicas y multidisciplinarias. El modelo de Weibull presentó la discontinuidad de la terapia como una covariable significativa. En el modelo de Cox, las variables ocupación, consumo de alcohol y psicofármacos, recuento de linfocitos T-CD4 +, carga viral e historia psiquiátrica fueron significativas para explicar el riesgo de hospitalización. Conclusión: Fue posible identificar los factores de riesgo y de protección para el resultado de la hospitalización. Los modelos también señalaron los factores que influyen en el tiempo que transcurre entre el diagnóstico del virus de la inmunodeficiencia humana y la primera hospitalización, y permitieron un debate enriquecedor sobre los aspectos intrínsecos de la atención sanitaria a las personas que viven con el virus y la enfermedad. (AU)

HIV , Survival Analysis , Acquired Immunodeficiency Syndrome , Hospitalization
Biomédica (Bogotá) ; 41(supl.2): 21-28, oct. 2021.
Article in English | LILACS | ID: biblio-1355756


Abstract | Non-parametric survival analysis has become a very popular statistical method in current medical research. However, resorting to survival analysis when its fundamental assumptions are not fulfilled can severely bias the results. Currently, hundreds of clinical studies are using survival methods to investigate factors potentially associated with the prognosis of coronavirus disease 2019 (COVID-19) and test new preventive and therapeutic strategies. In the pandemic era, it is more critical than ever to base decision-making on evidence and rely on solid statistical methods, but this is not always the case. Serious methodological errors have been identified in recent seminal studies about COVID-19: One reporting outcomes of patients treated with remdesivir and another one on the epidemiology, clinical course, and outcomes of critically ill patients. High-quality evidence is essential to inform clinicians about optimal COVID-19 therapies and policymakers about the true effect of preventive measures aiming to tackle the pandemic. Though timely evidence is needed, we should encourage the appropriate application of survival analysis methods and careful peer-review to avoid publishing flawed results, which could affect decision-making. In this paper, we recapitulate the basic assumptions underlying non-parametric survival analysis and frequent errors in its application and discuss how to handle data on COVID-19.

Resumen | El análisis de supervivencia es un método estadístico muy popular en la investigación médica actual. Sin embargo, el recurrir al análisis de supervivencia cuando no se cumplen sus supuestos fundamentales puede sesgar gravemente los resultados. Actualmente, cientos de estudios clínicos están utilizando esta metodología para estudiar los factores potencialmente asociados con el pronóstico de la COVID-19 y probar nuevas estrategias preventivas y terapéuticas. En la pandemia actual es más importante que nunca que las decisiones se basen en pruebas y en métodos estadísticos sólidos. Sin embargo, este no es siempre el caso. Se han detectado errores metodológicos graves en estudios seminales recientes sobre COVID-19: uno que informa los resultados de los pacientes tratados con remdesivir y otro sobre la epidemiología, el curso clínico y los resultados de los pacientes críticamente enfermos. La evidencia de calidad es esencial para informar a los médicos sobre las terapias óptimas contra la enfermedad y, a los legisladores, sobre el verdadero efecto de las medidas preventivas destinadas a abordar la pandemia. Aunque se necesitan pruebas oportunas, debemos fomentar la aplicación adecuada de los métodos de análisis de supervivencia y una cuidadosa revisión por pares para evitar la publicación de resultados defectuosos que pueden afectar la adopción de decisiones. En este artículo, recapitulamos los supuestos básicos que subyacen al análisis de supervivencia y los errores frecuentes en su aplicación, y discutimos cómo manejar los datos sobre la COVID-19.

Survival Analysis , Coronavirus Infections , Data Interpretation, Statistical , Severe Acute Respiratory Syndrome , Betacoronavirus
Medicina (B.Aires) ; 81(5): 800-807, oct. 2021. graf
Article in Spanish | LILACS | ID: biblio-1351054


Resumen El adenocarcinoma ductal de páncreas es una enfermedad agresiva asociada con pobres resultados de supervivencia a largo plazo. La resección quirúrgica y los nuevos tratamientos oncológicos pe rioperatorios han logrado mejorar la supervivencia de estos pacientes en la experiencia internacional. En este estudio retrospectivo se analiza la supervivencia global y la libre de enfermedad de todos los pacientes operados por cáncer de páncreas en el Hospital Italiano de Buenos Aires de enero 2010 a enero 2020. Se identificaron 242 pacientes con resecciones pancreáticas por adenocarcinoma de páncreas o carcinoma indiferenciado. La supervivencia global mediana fue de 22.8 meses (IC 95%: 19.5-29) y la tasa de supervivencia global a 1, 3 y 5 años fue de 72%, 32.5% y 20.8% respectivamente. La supervivencia libre de enfermedad mediana fue de 13.8 meses (IC 95%: 12-17.6) y la tasa de supervivencia libre de enfermedad a 1, 3 y 5 años fueron de 56.1%, 21.8% y 19.4% respectivamente. El grupo de pacientes que logró completar el tratamiento adyuvante mostró una mayor supervivencia global (p<0.0001).

Abstract Pancreatic cancer is an aggressive disease associated with poor results regarding long term survival. Surgical treatment along with new onco logic treatments have improved the survival of these patients in international experience reports. The aim of this study was to describe overall survival and disease-free survival after pancreatectomy for pancreatic ductal adenocarcinoma. A retrospective study of consecutive patients undergoing pancreatic resection due to PDAC or undifferentiated carcinoma from January 2010 to January 2020 in a single tertiary center was performed. Overall, 242 patients underwent complete pancreatic resections for pancreatic ductal adenocarcinoma or undifferentiated carcinoma. Median overall survival was 22.8 months (95% CI: 19.5-29) and survival at 1, 3 and 5 years were 72%, 32.5% and 20.8% respectively. The median disease-free survival was 13.8 months (95% CI: 12-17.6) and 1, 3- and 5-years disease-free survival were 56.1%, 21.8% and 19.4% respectively. The groups of patients that completed adjuvant treatment showed a better overall survival (p < 0.0001).

Humans , Pancreatic Neoplasms/surgery , Carcinoma, Pancreatic Ductal/surgery , Pancreas , Pancreatectomy , Retrospective Studies
Saude e pesqui. (Impr.) ; 14(4): e8802, out-dez. 2021.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1357893


Com o envelhecimento ocorrem complicações que afetam a funcionalidade e a independência dos indivíduos, muitas vezes sendo necessário o acompanhamento contínuo por profissionais da saúde, entre eles o fisioterapeuta. Diante disso, objetivou-se verificar a sobrevida, a funcionalidade e a ocorrência de comorbidades em indivíduos idosos acompanhados pelo serviço de Fisioterapia domiciliar. Um estudo com delineamento transversal foi realizado com 121participantes de um Serviço de Atenção Domiciliar, utilizando a Karnofsky Performance Scale para verificar a funcionalidade, e o Índice de Comorbidades de Charlson para avaliar as multimorbidades. Constatou-se que aproximadamente metade dos participantes apresentou cronicidade funcional, com condição potencialmente incapacitante, com piora dos índices de funcionalidade em indivíduos que sofreram alguma intercorrência. Os resultados demonstraram também que o acesso à Fisioterapia aumentou a taxa de sobrevida dos idosos e que o acompanhamento fisioterapêutico mais frequente possibilitou que a funcionalidade se mantivesse.

With aging, there are complications affecting the functionality and independence of individuals, often requiring continuous monitoring by health professionals, including the physical therapist. The objective was to analyze survival, functionality and the occurrence of comorbidities in elderly individuals monitored by the home physical therapy service. A cross-sectional study was carried out with 121 participants from a home care service, using the Karnofsky Performance Scale to check functionality, and the Charlson Comorbidity Index to assess multimorbidity. It was found that approximately half of the participants evaluated had functional chronicity, with potentially disabling condition, with worsening of functionality indices in individuals who have suffered some complication. The results also demonstrated that access to physical therapy increased the survival rate of the elderly and that the more frequent physical therapy follow-up enabled the functionality to be maintained.

Ciênc. Saúde Colet ; 26(8): 3065-3076, ago. 2021. tab, graf
Article in English | LILACS | ID: biblio-1285965


Abstract Cigarette consumption is a worldwide epidemic and its reduction is one of the major public health concerns. In Brazil, although there is a wide literature on smoking cessation it is restricted to experimental studies. Based on data from the 2013 National Health Survey (PNS), this study uses the survival methodology and use population data and consumer's profile to investigate which characteristics will affect smoking cessation hazard. The results showed that the people who are less likely to quit smoking are older, single men, with low income and fewer education years. They also do not practice physical exercise. The findings of cigarette cessation hazard to Brazilian population are similar of experimental studies with smokers and ex-smokers in country. Therefore, in order to decrease public health spending, Brazilian health policies regarding tobacco cessation could focus on those groups who will likely smoke for a long time.

Resumo O consumo de cigarro é uma epidemia mundial e sua redução é uma das principais preocupações de saúde pública. No Brasil, embora exista uma ampla literatura sobre a cessação do tabagismo, ela se restringe a estudos experimentais. Com base nos dados da Pesquisa Nacional de Saúde de 2013 (PNS), este estudo usa a metodologia de sobrevivência e usa dados da população e os perfis dos consumidores para investigar quais características afetarão as chances de cessação do tabagismo. Os resultados mostraram que as pessoas com menor probabilidade de parar de fumar são homens mais velhos e solteiros, com baixa renda e menos anos de estudo, que não praticam exercícios físicos. Os achados do risco de cessação do cigarro para a população brasileira são semelhantes a estudos experimentais com fumantes e ex-fumantes no país. Portanto, para diminuir os gastos em saúde pública, as políticas de saúde brasileiras em relação à cessação do tabaco poderiam se concentrar nos grupos que fumarão por mais tempo.

Humans , Male , Smoking Cessation , Tobacco Products , Brazil/epidemiology , Smoking/epidemiology , Survival Analysis
Rev. Assoc. Med. Bras. (1992) ; 67(7): 950-957, July 2021. tab, graf
Article in English | LILACS | ID: biblio-1346933


SUMMARY OBJECTIVE: Triple-negative breast cancer (TNBC) is characterized by lack of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) expression and accounts for 15-20% of all breast cancers. This study aims to analyze prognostic factors related to a reduction in overall survival (OS), disease-free survival (DFS), and risk of mortality and recurrence in TNBC. METHODS: This is a retrospective observational cohort study. Medical records of 532 patients with breast cancer diagnosed from 2007 to 2020 were analyzed. Of these patients, 93 (17%) were women with TNBC. Ten medical records were excluded, and the final sample was composed of 83 women with TNBC. OS and DFS were estimated by the Kaplan-Meier model. Univariate analysis (log-rank test) and multivariate analysis (Cox regression) were used to examine prognostic factors related to a statistically significant reduction (p<0.05) in OS and DFS and increased risk of mortality and tumor recurrence. RESULTS: Smoking, advanced clinical stage, larger tumor size, angiolymphatic invasion, positive sentinel lymph node, axillary node involvement, higher cancer burden, surgical treatment with mastectomy, and recurrence were related to a significant decrease in OS and/or DFS and increased risk of mortality and/or recurrence in TNBC. The 10-year OS and DFS was around 61 and 65%, respectively. CONCLUSIONS: Advanced clinical stage, positive sentinel lymph node, axillary node involvement, surgical treatment with mastectomy, and higher residual cancer burden were related to a significant reduction in OS and DFS and increased risk of mortality and recurrence in TNBC.

Humans , Female , Triple Negative Breast Neoplasms/surgery , Prognosis , Retrospective Studies , Cohort Studies , Mastectomy
Arq. bras. cardiol ; 116(6): 1059-1069, Jun. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1278328


Resumo Fundamento A regurgitação mitral (RM) é prevalente em pacientes submetidos a implante transcateter de válvula aórtica (TAVI). Há algumas controvérsias sobre o impacto prognóstico da RM na sobrevida de pacientes submetidos a TAVI. Objetivo Examinar a relação entre TAVI e RM em uma população de pacientes do Registro Brasileiro de TAVI. Métodos Setecentos e noventa e cinco pacientes do Registro Brasileiro de TAVI foram divididos na linha de base, alta e acompanhamento de acordo com o grau da RM da maneira seguinte: ausente/leve (RMAL) ou moderado/grave (RMMG). Eles foram subsequentemente reagrupados de acordo com as mudanças imediatas e tardias na gravidade da RM após TAVI da maneira seguinte: RM sem mudança, melhora ou piora. Foram analisados os preditores e o impacto prognóstico na linha de base, bem como as mudanças na gravidade da RM. A significância estatística foi estabelecida em p < 0,05. Resultados RMMG basal estava presente em 19,3% dos pacientes e foi um preditor de aumento da mortalidade tardia. Imediatamente após o TAVI, 47,4% dos casos melhoraram para RMAL, previsto por uma pontuação mais alta da Society of Thoracic Surgeons e um grau mais alto de regurgitação aórtica basal. No acompanhamento, 9,2% dos casos de RMAL pioraram para RMMG, enquanto 36,8% dos casos de RMMG melhoraram para RMAL. Fração de ejeção do ventrículo esquerdo (FEVE) mais baixa na linha de base e melhora na FEVE durante o acompanhamento foram preditores de melhora da RM. Piora progressiva da RM no acompanhamento foi um preditor independente de maior mortalidade tardia após TAVI (p = 0,005). Conclusões A RMMG na linha de base é um preditor de mortalidade tardia após TAVI. FEVE mais baixa e melhora na FEVE durante o acompanhamento são preditores de melhora da RM após TAVI. A pior progressiva da gravidade da RM durante o acompanhamento é um preditor independente de mortalidade tardia; isto é um achado raro na literatura.

Abstract Background Mitral regurgitation (MR) is prevalent in patients undergoing transcatheter aortic valve implantation (TAVI). There are some controversies about the prognostic impact of MR in survival of TAVI patients. Objective To examine the relationship between TAVI and MR in a patient population from the Brazilian TAVI Registry. Methods Seven hundred and ninety-five patients from the Brazilian TAVI Registry were divided at baseline, discharge, and follow-up according to their MR grade as follows: absent/mild (AMMR) or moderate/severe (MSMR). They were subsequently regrouped according to their immediate and late changes in MR severity after TAVI as follows: no change, improved, or worsened MR. Predictors and prognostic impact on baseline as well as changes in MR severity were analyzed. Statistical significance was set at p < 0.05. Results Baseline MSMR was present in 19.3% of patients and was a predictor of increased late mortality. Immediately after TAVI, 47.4 % of cases improved to AMMR, predicted by a higher Society of Thoracic Surgeons score and a higher grade of baseline aortic regurgitation. Upon follow-up, 9.2% of cases of AMMR worsened to MSMR, whereas 36.8% of cases of MSMR improved to AMMR. Lower baseline left ventricular ejection fraction (LVEF) and improvement in LVEF at follow-up were predictors of MR improvement. Progressive worsening of MR upon follow-up was an independent predictor of higher late mortality after TAVI (p = 0.005). Conclusions Baseline MSMR predicts late mortality after TAVI. Lower LVEF and improved LVEF at follow-up predict MR improvement after TAVI. Progressive worsening of MR severity at follow-up is an independent predictor of late mortality, which is a rare finding in the literature.

Humans , Aortic Valve Stenosis/surgery , Prosthesis Implantation , Transcatheter Aortic Valve Replacement , Mitral Valve Insufficiency/surgery , Aortic Valve/surgery , Stroke Volume , Severity of Illness Index , Brazil , Follow-Up Studies , Ventricular Function, Left , Treatment Outcome
Rev. Soc. Bras. Clín. Méd ; 19(1): 2-6, março 2021.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1361676


Objetivo: Estimar a taxa de sobrevida por câncer de pâncreas. Métodos: Trata-se de estudo com delineamento de coorte retrospectiva, realizado no período de 2007 a 2018, em um hospital terciário no Sul do Brasil. A amostra foi composta de 66 indivíduos que realizaram acompanhamento no Hospital Nossa Senhora da Conceição, em Tubarão (SC), cujo sítio primário da doença tenha sido o pâncreas. Resultados: Dos 66 prontuários avaliados, 35 pertenciam a pessoas do sexo masculino (53%), com média de idade de diagnóstico de 64,3 anos. O estádio mais prevalente foi o IV (46 pacientes, correspondente a 69,7%). O tempo médio de sobrevida global foi de 462,02 dias (desvio-padrão de 90,76), e a mediana foi de 320 dias. Conclusão: Identificou-se uma prevalência maior em pessoas do sexo masculino, idosos e caucasianos e em indivíduos no estadiamento IV.

Objective: To estimate the survival rate for pancreatic cancer. Methods: This is aretrospective cohort study conducted from 2007 to 2018 in a tertiary hospital in Southern Brazil. The sample consisted of 66 individuals followed up at Hospital Nossa Senhora da Conceição, in Tubarão (SC), whose primary site of the disease was the pancreas. Results: Of the 66 medical records assessed, 35 were of male (53%) individuals, with a mean age at diagnosis of 64.3 years. The most prevalent stage was IV (46 patients, corresponding to 69.7%). The mean overall survival time was 462.02 days (standard deviation of 90.76) and the median was 320 days. Conclusion: Higher prevalence of males, elderly people, and Caucasians was observed, as well as IV staging.

Rev. bras. ginecol. obstet ; 43(2): 137-144, Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1156096


Abstract Objective The present study aims to evaluate the profile of endometrial carcinomas and uterine sarcomas attended in a Brazilian cancer center in the period from 2001 to 2016 and to analyze the impact of time elapsed fromsymptoms to diagnoses or treatment in cancer stage and survival. Methods This observational study with 1,190 cases evaluated the year of diagnosis, age-group, cancer stage and histological type. A subgroup of 185 women with endometrioid histology attended in the period from 2012 to 2017 was selected to assess information about initial symptoms, diagnosticmethods, overall survival, and to evaluate the influence of the time elapsed from symptoms to diagnosis and treatment on staging and survival. The statistics used were descriptive, trend test, and the Kaplan- Meier method, with p-values < 0.05 for significance. Results A total of 1,068 (89.7%) carcinomas (77.2% endometrioid and 22.8% nonendometrioid) and 122 (10.3%) sarcomas were analyzed, with an increasing trend in the period (p < 0.05). Histologies of non-endometrioid carcinomas, G3 endometrioid, and carcinosarcomas constituted 30% of the cases. Non-endometrioid carcinomas and sarcomas weremore frequently diagnosed in patients over 70 years of age and those on stage IV (p < 0.05). The endometrioid subgroup with 185 women reported 92% of abnormal uterine bleeding and 43% diagnosis after curettage. The average time elapsed between symptoms to diagnosis was 244 days, and between symptoms to treatment was 376 days, all without association with staging (p = 0.976) and survival (p = 0.160). Only 12% of the patients started treatment up to 60 days after diagnosis. Conclusion The number of uterine carcinoma and sarcoma cases increased over the period of 2001 to 2016. Aggressive histology comprised 30% of the patients and, for endometrioid carcinomas, the time elapsed between symptoms and diagnosis or treatment was long, although without association with staging or survival.

Resumo Objetivo O presente estudo avaliou o perfil dos carcinomas endometriais e sarcomas uterinos atendidos em um centro brasileiro de câncer no período de 2001 a 2016, e avaliou o impacto do tempo decorrido entre os sintomas até o diagnóstico ou tratamento no estadiamento e sobrevida pelo câncer. Métodos Estudo observacional com 1.190 casos que analisou o ano do diagnóstico, faixa etária, estágio e tipo histológico do câncer. Um subgrupo de 185 mulheres com histologia endometrioide e atendidas no período de 2012 a 2017 foi selecionado para avaliar informações sobre sintomas iniciais, métodos de diagnóstico, sobrevida global e para analisar a relação entre o tempo decorrido a partir dos sintomas até o diagnóstico e tratamento no estadiamento e sobrevida. Foram realizadas análises estatísticas descritiva, de tendência linear e de sobrevida pelo método de Kaplan-Meier, com valores de p < 0,05 para significância. Resultados Os casos estudados de acordo com a histologia foram 1.068 (89,7%) carcinomas (77,2% endometrioides e 22,8% não endometrioides) e 122 (10,3%) sarcomas, com tendência crescente no período (p < 0,05). Histologias de carcinomas não endometrioides, G3 endometrioides e carcinossarcomas consistiram em 30% dos casos. Carcinomas não endometrioides e sarcomas forammais frequentemente diagnosticados em pacientes acima de 70 anos de idade e em estágio IV (p < 0,05). O subgrupo com185 mulheres com carcinoma endometrioide apresentou 92% de sangramento uterino anormal e 43% de diagnóstico após curetagem. O tempo médio decorrido entre os sintomas e o diagnóstico foi de 244 dias e entre os sintomas e o tratamento, 376 dias, todos sem associação com estadiamento (p = 0,976) e sobrevida (p = 0,160). Apenas 12% das pacientes iniciaram o tratamento em até 60 dias após o diagnóstico. Conclusão O número de casos de carcinomas e sarcomas uterinos aumentaram no período de 2001 a 2016. A histologia agressiva compreendeu 30% dos pacientes e, no caso dos carcinomas endometrioides, o tempo decorrido entre os sintomas e o diagnóstico ou tratamento foi longo, embora sem associação com estadiamento ou sobrevida.

Humans , Female , Aged , Sarcoma/diagnosis , Uterine Neoplasms/diagnosis , Carcinoma, Endometrioid/diagnosis , Sarcoma/surgery , Sarcoma/pathology , Time Factors , Uterine Neoplasms/surgery , Uterine Neoplasms/pathology , Brazil/epidemiology , Retrospective Studies , Risk Factors , Age Factors , Carcinoma, Endometrioid/surgery , Carcinoma, Endometrioid/pathology , Middle Aged , Neoplasm Staging
International Journal of Surgery ; (12): 531-537,F3, 2021.
Article in Chinese | WPRIM | ID: wpr-907476


Objective:To further understand the clinical characteristics of scirrhous gastric cancer (SGC)and clear it definitions. Analyzed the clinicopathologic features and prognosis of patients with SGC and Non SGC(NSGC).Methods:The study included 342 gastric cancer patients who had undergone gastrectomy in the Second Hospital University of South China between May 2011 and May 2018. The SGC was diagnosed by endoscopic, CT, tumor stroma ratio and appearance of surgical specimen clinicopathological characteristics were summarized and compared between SGC patients and NSGC using pearson′s χ2 test or student′s t test. Survival curves were estimated with the Kaplan-Meier method. Patients were matched 1∶1 using propensity score matching, and their overall survival rates were compared. Results:A total of 342 patients with gastrectomy were collected, 49 (14.3%) were diagnosed as SGC. Patients with SGC were younger, later pathological stage lymph node metastases tend to occur than those(NSGC). SGC had a higher total gastric resection rate, easier prone to nerve/vascular invasion and omental metastasis ( P<0.01). The median survival of SGC patients and overall survival at 1, 3, and 5 years after surgery were shorter than NSGC patients, which were independent risk factors affecting the prognosis of patients. Conclusions:SGC can be well defined by endoscopy, CT, TSR and tumor appearance. It is a peculiar solid tumor with poor differentiated, advanced stage and poor prognosis. Future research should focus on how to diagnose SGC earlier and intervene in time.

Article in English | WPRIM | ID: wpr-904596


@#Introduction: We aimed to compare the Barcelona Clinic Liver Cancer (BCLC) and Hong Kong Liver Cancer (HKLC) staging systems. Materials and Methods: This is a retrospective study on patients with newly diagnosed hepatocellular carcinoma (HCC) at the University Malaya Medical Centre between 2011 and 2014. Survival times were analysed using the KaplanMeier procedure and comparison between groups was done using the log rank test. Results: The data of 190 patients was analysed. Chronic hepatitis B was the most common aetiology for HCC (43.7%), but a large proportion was cryptogenic or non-alcoholic steatohepatitis-related (41.6%). Only 11.1% were diagnosed early (BCLC Stage 0-A) while majority were diagnosed at an intermediate stage (BCLC Stage B, 53.7%). The median survival rate was significantly different between the different groups when either of the staging systems was used (p<0.05 for all comparisons). However, the two staging systems lacked agreement (weighted kappa 0.519, 95%CI: 0.449, 0.589) with significant difference in median survival rates between BCLC Stage A and HKLC Stage 2, and between BCLC Stage C and HKLC Stage 4. Conclusion: Both staging systems were able to stratify patients according to survival, but they only had moderate agreement with significant differences observed in two groups of the staging systems.

Article in English | WPRIM | ID: wpr-922747


@#Introduction: Mortality following traumatic femoral neck fractures in the elderly (age >60 years) is influenced by many factors. Addressing some of them may reduce the mortality rate thus improving patient survival and quality of life. Materials and methods: This study was a retrospective research using data collected from Hospital Sultanah Bahiyah, Kedah between the years 2008-2018. We measured outcomes such as age, gender, hospital stay, default rate, ambulation post-surgery, American Society of Anaesthesiologists score (ASA) and surgical timing in correlation with mortality rate and 10-year survival of elderly patients treated with Total Hip Arthroplasty for femoral neck fractures in this centre. Results: A total of 291 traumatic femoral neck fractures aged above 60 years post total hip arthroplasty performed were included. There was higher number of female (n =233) compared to male (n=53) Estimated 10 years survival from Kaplan Meier was 42.88% (95% CI: 33.15, 52.54). One year mortality rate in our study was found to be 18.9%. The average time to event was 7.1 years (95% CI:33.15, 52.24) with a mean age group of 75. Discussion: Total hip arthroplasty patients not ambulating after surgery had a 4.2 times higher hazard ratio compared to ambulators. Those with pre-existing systemic disease (ASA III and IV) were found to have the highest hazard ratio, almost five times that of healthy patients, after adjusting for confounding factors. Delay of more than seven days to surgery was found to be a significant factor in 10-year survival with a hazard ratio of 3.8, compared to surgery performed earlier. Conclusion: Delay of more than 7 days to surgery in 10 years survival was significant with high hazard ratio. It is a predictor factor for survival in 10 years. A larger sample size with a prospective design is required to confirm our findings regarding “unacceptable surgical timing” for femoral neck fractures in patients above 60 years of age.

Article in English | WPRIM | ID: wpr-922388


OBJECTIVES@#To study the natural history of spinal muscular atrophy (SMA) in Chongqing and surrounding areas, China, and to provide a clinical basis for comprehensive management and gene modification therapy for SMA.@*METHODS@#A retrospective analysis was performed on the medical data and survival status of 117 children with SMA.@*RESULTS@#Of the 117 children, 62 (53.0%) had type 1 SMA, 45 (38.5%) had type 2 SMA, and 10 (8.5%) had type 3 SMA, with a median age of onset of 2 months, 10 months, and 15 months, respectively. Compared with the children with type 2 SMA or type 3 SMA, the children with type 1 SMA had significantly shorter time to onset, consultation, and confirmed diagnosis (@*CONCLUSIONS@#There are differences in clinical manifestations and survival rates among children with different types of SMA. The children with type 1 SMA have a low survival rate, and those with type 2 SMA may have non-linear regression of motor ability. Early identification and management of SMA should be performed in clinical practice.

Child , Homozygote , Humans , Infant , Muscular Atrophy, Spinal/genetics , Retrospective Studies , Sequence Deletion , Spinal Muscular Atrophies of Childhood/genetics
Article in English | WPRIM | ID: wpr-921394


OBJECTIVES@#To evaluate the efficacy and health economics of the comprehensive therapy for the children with severe early child caries (S-ECC) under dental general anesthesia (DGA) and conventional outpatient treatment to provide references for dentists and parents in the choice of clinical treatment.@*METHODS@#A retrospective cohort study was conducted on S-ECC children aged 36-71 months and who received dental treatment under general anesthesia or routine outpatient situation. The filled tooth survival rate, treatment cost, and cost-filled tooth survival time of the two groups were compared, and the curative effect and health economics was evaluated.@*RESULTS@#The filled tooth survival rate of the DGA group was higher than that of the routine outpatient group (@*CONCLUSIONS@#Compared with the conventional outpatient treatment group, the treatment outcomes of S-ECC under general anesthesia were better, and the costs were higher. However, no significant difference was observed in the total medical cost-filled tooth survival time between these two groups, and the conventional outpatient treatment did not have evident economic advantages.

Anesthesia, Dental , Anesthesia, General , Child , Dental Care , Dental Caries , Dental Caries Susceptibility , Humans , Outpatients , Retrospective Studies