Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 3.177
Filter
1.
Infectio ; 25(4): 270-275, oct.-dic. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1286721

ABSTRACT

Resumen Objetivo: Comparar la expresión de mRNA y proteínas de SFRP1, PTPRN, CDO1, EDNRB, CDX2, EPB41L3 y HAND1 en pacientes con lesión intra-epitelial cervical de bajo y alto grado, con posterior progresión o regresión. Material y Método: Se realizó análisis de expresión de genes mediante RT-PCR y análisis de expresión de proteínas por inmunohistoquímica. El análisis estadís tico fue realizado con las pruebas: Wilcoxon, coeficiente de correlación de Spearman e índice de concordancia. Las muestras fueron pareadas en momento 1 y momento 2. Resultados: SFRP1 mostró tendencia de mayor expresión de mRNA en lesión intra-epitelial de bajo grado (momento 2) Vs. alto grado (momento 1). La expresión de proteínas por inmunohistoquímica de SFRP1 en casos de progresión (83,3 %) mostró disminución en su graduación (p = 0,0313*); los demás genes en estudio no tuvieron cambios estadísticamente significativos. Discusión: SFRP1 mostró comportamiento ajustado a resultados de estudios previos donde se encontró hipermetilado en lesiones intra-epiteliales de alto grado; su subexpresión por hipermetilación se reportó en otros canceres, proceso que colabora con su silenciamiento y transición epitelial-mesenquimatosa del cáncer de cuello uterino. Conclusiones. SFRP1 es potencial biomarcador en lesiones preneoplásicas del cuello uterino asociadas al virus de papiloma humano.


Abstract Objective. The aim of this work was to compare the expression of mRNA and proteins of SFRP1, PTPRN, CDO1, EDNRB, CDX2, EPB41L3 and HAND1 in patients with low and high grade cervical intraepithelial lesion, with subsequent progression or regression. Material and Methods: Gene expression analysis was conducted through RT-PCR and protein expression analysis was performed by immunohistochemistry. The statistics analysis were Wilcoxon test, Spearman's correlation coefficient and concordance index. The samples were paired during moment 1 (initial patient diag nosis) and moment 2 (follow-up histological diagnosis). Results: SFRP1 showed a trend of higher mRNA expression in low-grade intra-epithelial lesions (moment 2) Vs. high-grade (moment 1). The expression of proteins by immunohistochemistry of SFRP1 in progression cases (83.3%) showed a decrease in its graduation (p = 0.0313*); the other genes under study had no statistically significant. Discussion: SFRP1 showed a biological behavior adjusted to the results of previous studies where hypermethylation was found in high-grade intra-epithelial lesions; its subexpression by hypermethylation has been reported in other cancers, a process that collaborates with its silencing and epithelial-mesenchymal tran sition of cervical. Conclusions. SFRP1 is a potential biomarker in preneoplastic lesions of the cervix associated with human papillomavirus.


Subject(s)
Humans , Female , Adult , Papilloma , DNA Probes, HPV , Viruses , Proteins , Uterine Cervical Neoplasms , Disease Progression , Alphapapillomavirus
2.
An. Fac. Cienc. Méd. (Asunción) ; 54(3): 113-118, Dec. 2021.
Article in Spanish | LILACS | ID: biblio-1352964

ABSTRACT

La esclerosis múltiple es una enfermedad desmielinizante crónica que produce discapacidad progresiva, por lo que el tratamiento se centra en retrasar la progresión, prevenir recaídas y disminuir los síntomas de manera efectiva. Realizamos un estudio observacional, descriptivo, longitudinal, de un solo centro, con los pacientes admitidos en la unidad de enfermedades desmielinizantes, desde diciembre 2017 hasta febrero 2020. Del total de pacientes, 62.5% recibieron tratamiento con ocrelizumab y completaron seguimiento por 12 meses, sin progresión de la enfermedad. Con este estudio, resaltamos la importancia y la efectividad de los tratamientos modificadores de la enfermedad.


Multiple sclerosis is a chronic demyelinating disease that causes progressive disability, so treatment focuses on slowing progression, preventing relapses, and effectively reducing symptoms. We conducted an observational, descriptive, longitudinal, single-center study with patients admitted to the demyelinating diseases unit from December 2017 to February 2020. Of the total number of patients, 62.5% received treatment with ocrelizumab and completed 12-month follow-up, without disease progression. With this study, we highlight the importance and effectiveness of disease-modifying treatments


Subject(s)
Multiple Sclerosis , Patients , Effectiveness , Demyelinating Diseases , Aftercare , Disease Progression
3.
Medicina (B.Aires) ; 81(3): 323-328, jun. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346466

ABSTRACT

Resumen La presencia de sarcopenia (pérdida de masa y función muscular) implica peor pronóstico. Sin embargo, su diagnóstico es complejo y no se realiza en la atención clínica habitual. Se ha propuesto un biomarcador como estimador subrogado de la masa muscular esquelética, el denominado índice de sarcopenia ([creatinina sérica/cistatina C] x100) que se asocia a características pronósticas en diversas enfermedades incluyendo pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable. El objetivo de nuestro estudio ha sido evaluar de forma prospectiva la potencial información clínica y pronóstica de este biomarcador en agudización de la EPOC. Se trata de un estudio prospectivo, durante un año, de los pacientes consecutivos que ingresan por agudización de su EPOC. Se incluyeron 89 pacientes, 70 varones (79%) y 19 mujeres (21%). Aquellos con valores disminuidos del índice de sarcopenia tenían más disnea y requerían una internación más prolongada. En el análisis de correlación se obtuvo valores con significación estadística del índice con FEV1 (r = 0.23), PaCO (r = -0.30) y bicarbonato (r = -0.31), y con la disnea (r = -0.25) y la duración del ingreso (r =0.30). En los ingresados por agudización de la EPOC el índice de sarcopenia se relacionó con características pronósticas, de modo que los valores inferiores se asociaron a mayor duración de la internación, más disnea y mayor afectación funcional. Al tratarse de un índice asociado a la masa muscular, su determinación podría identificar a pacientes a incluir en un plan terapéutico diferenciado.


Abstract Sarcopenia (loss of muscle mass and function) implies a worse prognosis. However, its diagnosis is complex and is not made in routine clinical care. A biomarker has been proposed as a surrogate estimator of skeletal muscle mass, the so-called sarcopenia index ([serum creatinine/cystatine C] x100) which is associated with prognostic features in various diseases including patients with stable chronic obstructive pulmonary disease (COPD). The aim of our study was to prospectively evaluate the potential clinical and prognostic information of this biomarker in COPD exacerbation. This is a one-year prospective study of consecutive patients admitted for COPD exacerbation. A total of 89 patients, 70 men (79%) and 19 women (21%) were included. Those with lower values of the sarcopenia index had a higher level of dyspnoea and a longer hospitalization. In the correlation analysis, the index had statistically significant values with FEV1 (r = 0.23), PaCO (r = -0.30), bicarbonate (r = -0.31), dyspnoea (r = -0.25) and length of admission (r = -0.30). In patients admitted for COPD exacerbation, the sarcopenia index was related to prognostic characteristics, so that lower values were associated with longer duration of hospital admission, more dyspnoea and greater functional impairment. As this is an index associated with muscle mass, its determination may identify patients who could be the subject of a differentiated therapeutic plan.


Subject(s)
Humans , Male , Female , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/diagnosis , Sarcopenia/diagnosis , Prognosis , Prospective Studies , Disease Progression , Hospitalization
5.
Arch. argent. pediatr ; 119(2): e117-e120, abril 2021. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1151875

ABSTRACT

La infección crónica con el virus B de la hepatitis es una de las enfermedades de mayor prevalencia mundial. Puede evolucionar a la cirrosis y carcinoma hepatocelular. La detección temprana, evitar la utilización de drogas intravenosas, la educación sexual y la vacunación son fundamentales para la prevención. La infección neonatal y durante el primer año de vida evoluciona hacia la cronicidad en más del 90 % de los niños. La transmisión vertical, de una madre con virus B de la hepatitis al recién nacido, es, actualmente, la forma más frecuente de infección. Su detección y la administración de inmunoglobulinas y vacuna disminuyen esta vía de infección. El tratamiento antiviral puede acelerar en dos o tres años el pasaje de la fase activa a la inactiva de la infección, sin influir en el proceso hacia la recuperación. El tratamiento oportuno de algunos casos elegidos puede evitar la progresión de la enfermedad


Chronic hepatitis B virus infection is one of the most prevalent diseases worldwide. It may progress to cirrhosis and hepatocellular carcinoma. An early detection, not using intravenous drugs, sex education, and immunization are critical for prevention. An infection in the neonatal period and in the first year of life becomes chronic in more than 90 % of children. Vertical transmission from a mother with hepatitis B virus to the newborn infant is currently the most common mode of transmission. Detection, immunoglobulin administration, and immunization help to reduce it. Antiviral therapy may accelerate the transition from the active to the inactive phase of infection by two or three years, without affecting the recovery process. A timely treatment of some selected cases may prevent hepatitis B progression.


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Hepatitis B, Chronic/therapy , Pediatrics , Disease Transmission, Infectious , Disease Progression , Hepatitis B, Chronic
6.
São Paulo; s.n; HSPM; 2021.
Thesis in Portuguese | LILACS, ColecionaSUS, SMS-SP, HSPM-Producao, SMS-SP | ID: biblio-1348626

ABSTRACT

RESUMO Diversas doenças têm grande impacto na vida das pessoas, assim como nos sistemas de saúde mundial como é a Doença Renal Crônica (DRC) e a Diabetes Mellitus (DM). Com o presente relato de caso, se expões as causas da progressão da doença renal crônica em um paciente diabético, hipertenso e obeso de longa data, que foi submetido a cirurgia bariátrica há 1 ano e meio com perda expressiva de peso nos últimos meses, que fez uso recente de multivitamínicos (por conta própria), antiinflamatórios associado a quadro de desidratação e consumo de carambola há 1 mês. A problemática principal foi a dificuldade diagnóstica para determinar a progressão da doença renal crônica, tendo diversas hipóteses. As Intervenções médicas para o diagnóstico, contaram entre outras o manejo de paciente DRC e a realização de biópsia renal devido à complexidade do caso e as múltiplas intercorrências no período, fazendo uso deste método para o diagnóstico definitivo. O modelo de estudo é observacional do tipo descritivo, sendo feito abordagem durante internação hospitalar e em consulta ambulatorial. Se coletaram dados do prontuário eletrônico e físico, exames de laboratório, exames de imagem e registros fotográficos, assim como laudo de biópsia de rim. A Conclusão principal a partir do relato de caso foi a evidência da progressão da DRC num paciente diabetico. Palavras-chave: Doença Renal Crônica. Diabetes Mellitus. Progressão.


Subject(s)
Humans , Male , Female , Disease Progression , Diabetes Mellitus , Renal Insufficiency, Chronic
7.
Article in English | WPRIM | ID: wpr-880338

ABSTRACT

Recent studies have revealed an inverse association between height and cardiovascular disease. However, the background mechanism of this association has not yet been clarified. Height has also been reported to be positively associated with cancer. Therefore, well-known cardiovascular risk factors, such as increased oxidative stress and chronic inflammation, are not the best explanations for this inverse association because these risk factors are also related to cancer. However, impaired blood flow is the main pathological problem in cardiovascular disease, while glowing feeding vessels (angiogenesis) are the main characteristic of cancer pathologies. Therefore, endothelial maintenance activity, especially for the productivity of hematopoietic stem cells such as CD34-positive cells, could be associated with the height of an individual because this cell contributes not only to the progression of atherosclerosis but also to the development of angiogenesis. In addition, recent studies have also revealed a close connection between bone marrow activity and endothelial maintenance; bone marrow-derived hematopoietic stem cells contribute towards endothelial maintenance. Since the absolute volume of bone marrow is positively associated with height, height could influence endothelial maintenance activity. Based on these hypotheses, we performed several studies. The aim of this review is not only to discuss the association between height and bone marrow activity, but also to describe the potential mechanism underlying endothelial maintenance. In addition, this review also aims to explain some of the reasons that implicate hypertension as a major risk factor for stroke among the Japanese population. The review also aims to clarify the anthropological reasons behind the high risk of atherosclerosis progression in Japanese individuals with acquired genetic characteristics.


Subject(s)
Aged , Atherosclerosis/physiopathology , Body Height/physiology , Bone Marrow/physiology , Disease Progression , Endothelium/physiology , Humans , Hypertension/physiopathology , Japan/epidemiology , Male , Middle Aged , Risk Factors , Stroke/physiopathology
8.
Article in Chinese | WPRIM | ID: wpr-879836

ABSTRACT

Kawasaki disease is the main cause of acquired heart disease in children. The cardiovascular sequelae of Kawasaki disease, such as coronary artery lesion and giant coronary aneurysm, have a great impact on children's physical and mental health. The Japanese Circulatory Society and the Japanese Society of Cardiac Surgery jointly released the JCS/JSCS 2020 guideline on diagnosis and management of cardiovascular sequelae in Kawasaki disease in July, 2020, which systematically introduces the advances in the diagnosis and management of cardiovascular sequelae of Kawasaki disease. The article gives an interpretation in the severity evaluation of Kawasaki disease and diagnosis, treatment and long-term management of cardiovascular sequelae in the guideline.


Subject(s)
Child , Coronary Aneurysm , Coronary Vessels , Disease Progression , Heart Diseases , Humans , Mucocutaneous Lymph Node Syndrome/therapy
9.
Article in Chinese | WPRIM | ID: wpr-879634

ABSTRACT

With the economic development and living standards improvement, various chronic viral liver diseases in children is decreasing year by year, and the liver diseases related to heredity, environment and living habits is increasing. Although liver disease in children is relatively rare and is not the main cause of childhood mortality, chronic liver disease cannot be ignored for its effect on children's growth and development, mental health, quality of life and the economic burden to family or society. Therefore, more attention should be paid to the early screening, diagnosis and treatment of pediatric liver diseases, in order to delay or prevent its progression efficiently.


Subject(s)
Child , Disease Progression , Heredity , Humans , Liver Diseases/epidemiology , Quality of Life
10.
Evid. actual. práct. ambul ; 24(2): e002072, 2021.
Article in Spanish | LILACS | ID: biblio-1254866

ABSTRACT

Los autores de este artículo abordan la evidencia disponible sobre la prevención de diabetes tipo 2 mediante la indicación de metformina en pacientes sin alteraciones de la glucemia, a partir de una consulta de la práctica ambulatoria. (AU)


The authors of this article discuss the available evidence on the prevention of type 2 diabetes through the prescription of metformin to patients without glycemic alterations, based on an outpatient practice consultation. (AU)


Subject(s)
Humans , Male , Adult , Primary Prevention , Diabetes Mellitus, Type 2/prevention & control , Metformin/therapeutic use , Blood Glucose/metabolism , Risk Factors , Disease Progression , Ambulatory Care , Life Style , Metformin/administration & dosage
11.
Rev. bras. oftalmol ; 80(4): e0014, 2021. tab, graf
Article in English | LILACS | ID: biblio-1280126

ABSTRACT

ABSTRACT Objective To assess the economic impact of reducing glaucoma progression by using the trabecular micro-bypass implant, iStent inject®, in the Reference Centers for glaucoma treatment within the Brazilian Public Unified Health System (SUS). Methods In a cost-effectiveness analysis, a Markov model was developed, and the costs were obtained from the SUS perspective (medical direct costs). Effectiveness was measured in progression-free life-years. The time horizon was the mean life expectancy of the Brazilian population. The model parameters were obtained through a review and a critical analysis of the literature. The base case comprised a hypothetical cohort of patients with open-angle glaucoma, using anti-glaucoma eye drops and followed up at Reference Centers of SUS. We tested whether the incorporation of iStent inject® as an alternative second-line therapy would be cost-effective. The outcome measure was the incremental cost-effectiveness ratio (R$/progression-free life-years). We tested the robustness of the model by univariate and probabilistic sensitivity analyses. Results The use of iStent inject® led to decreased progression rate of glaucoma, evidenced by the amount of progression-free life-years obtained with each treatment strategy (7.82 progression-free life-years with iStent inject® versus 6.33 progression-free life-years with medical treatment), thereby improving glaucoma control. There was also a reduction in future costs associated with eye drops, filtering surgeries, and treatment complications. Incremental cost-effectiveness ratio ranged from R$ 6,429.30 to R$ 7,550.97/progression-free life-years. The model proved to be robust in the sensitivity analyses. Conclusion This analysis showed that iStent inject®, when used after the failure of the first-line therapy, is able to reduce the rate of glaucoma progression at an acceptable cost.


RESUMO Objetivo Avaliar o impacto econômico da redução da progressão do glaucoma pelo uso do implante de by-pass trabecular iStent inject® no ambiente dos Centros de Referência para tratamento do Sistema Único de Saúde (SUS). Métodos Em uma análise de custo-efetividade, elaborou-se um modelo de Markov, cujos custos foram obtidos a partir da perspectiva do SUS financiador (custos médicos diretos). A efetividade foi medida em anos de vida livres de progressão. O horizonte temporal foi a expectativa de vida média da população brasileira. Os parâmetros do modelo foram obtidos pela revisão e pela análise crítica da literatura. O caso base foi composto de uma coorte hipotética de portadores de glaucoma de ângulo aberto em uso de colírios antiglaucomatosos e em acompanhamento nos Centros de Referência do SUS. Testou-se se a incorporação do iStent inject® como alternativa à segunda linha de tratamento seria custo-efetiva. A medida de desfecho foi a razão de custo-efetividade incremental (R$/anos de vida livres de progressão). A robustez do modelo foi testada por meio de análises de sensibilidade univariada e probabilística. Resultados A utilização do iStent inject® proporcionou uma diminuição da velocidade de progressão do glaucoma, evidenciada pela quantidade de anos de vida livres de progressão obtida com cada estratégia de tratamento (7,82 anos de vida livres de progressão com iStent inject® versus 6,33 anos de vida livres de progressão com tratamento com colírios), melhorando, dessa forma, o controle do glaucoma. Houve ainda redução nos custos futuros associados aos colírios, às cirurgias filtrantes e às complicações do tratamento. A razão de custo-efetividade incremental variou de R$6.429,30 a R$7.550,97/anos de vida livres de progressão. O modelo mostrou-se robusto nas análises de sensibilidade. Conclusão O iStent inject®, quando usado após a falha do primeiro medicamento, é capaz de reduzir a taxa de progressão do glaucoma a um custo aceitável.


Subject(s)
Humans , Prostheses and Implants/economics , Trabecular Meshwork/surgery , Unified Health System , Glaucoma, Open-Angle/surgery , Cost-Benefit Analysis , Disease Progression
12.
Autops. Case Rep ; 11: e2021246, 2021. graf
Article in English | LILACS | ID: biblio-1153187

ABSTRACT

Extranodal NK/T-cell lymphoma, nasal type (ENKTL-NT) is a rare type of Non-Hodgkin's lymphoma, which usually presents with extranodal involvement and affects the nasal/upper aerodigestive tract in the classical presentation. Herein, we report the case of a 31-year-old, previously healthy, male patient diagnosed with ENKTL-NT with the involvement of the lung parenchyma and heart. Unfortunately, due to the rapid disease progression, the diagnosis was performed only at the autopsy. The authors highlight the rare clinical presentation of this type of lymphoma, as well as the challenging anatomopathological diagnosis in necrotic samples.


Subject(s)
Humans , Male , Adult , Nose Neoplasms/pathology , Lymphoma, Extranodal NK-T-Cell/pathology , Nasal Cavity/pathology , Autopsy , Lymphoma, T-Cell , Fatal Outcome , Herpesvirus 4, Human , Disease Progression , Heart , Lung/pathology
13.
Adv Rheumatol ; 61: 9, 2021. tab, graf
Article in English | LILACS | ID: biblio-1152744

ABSTRACT

Abstract Background: In the past 20 years, hematopoietic stem cell transplantation (HSCT) has been investigated as treatment for systemic sclerosis (SSc). The goal of HSCT is to eradicate the autoreactive immune system, which is replaced by a new immune repertoire with long-lasting regulation and tolerance to autoantigens. Here, we describe the clinical outcomes of severe and refractory SSc patients that underwent HSCT at a single Brazilian center. Patients and methods: This is a longitudinal and retrospective study, including 70 adult SSc patients, with an established diagnosis of SSc, and who underwent autologous HSCT from 2009 to 2016. The procedure included harvesting and cryopreservation of autologous hematopoietic progenitor cells, followed by administration of an immunoablative regimen and subsequent infusion of the previously collected cells. Patients were evaluated immediately before transplantation, at 6 months and then yearly until at least 5-years of post-transplantation follow-up. At each evaluation time point, patients underwent clinical examination, including modified Rodnan's skin score (mRSS) assessment, echocardiography, high-resolution computed tomography of the lungs and pulmonary function. Results: Median (range) age was 35.9 (19-59), with 57 (81.4%) female and median (range) non-Raynaud's disease duration of 2 (1-7) years. Before transplantation, 96% of the patients had diffuse skin involvement, 84.2%, interstitial lung disease and 67%, positive anti-topoisomerase I antibodies. Skin involvement significantly improved, with a decline in mRSS at all post-transplantation time points until at least 5-years of follow-up. When patients with pre-HSCT interstitial lung disease were analyzed, there was an improvement in pulmonary function (forced vital capacity and diffusing capacity of lung for carbon monoxide) over the 5-year follow-up. Overall survival was 81% and progression-free survival was 70.5% at 8-years after HSCT. Three patients died due to transplant-related toxicity, 9 patients died over follow-up due to disease reactivation and one patient died due to thrombotic thrombocytopenic purpura. Conclusions: Autologous hematopoietic progenitor cell transplantation improves skin and interstitial lung involvement. These results are in line with the international experience and support HSCT as a viable therapeutic alternative for patients with severe and progressive systemic sclerosis.(AU)


Subject(s)
Humans , Adult , Scleroderma, Systemic/surgery , Hematopoietic Stem Cells , Cryopreservation/instrumentation , Hematopoietic Stem Cell Transplantation/instrumentation , Disease Progression , Retrospective Studies , Longitudinal Studies
14.
Medicina (B.Aires) ; 80(6): 606-610, dic. 2020. graf
Article in Spanish | LILACS | ID: biblio-1250282

ABSTRACT

Resumen El objetivo del estudio fue evaluar los aspectos clínicos y demográficos de los pacientes con esclerosis múltiple (EM) secundaria progresiva (EMSP) en los pacientes incluidos en el Registro Argentino de EM (RelevarEM, número de registro de Clinical Trials 03375177). RelevarEM es un registro longitudinal, estrictamente observacional, de pacientes con EM y trastornos del espectro de neuromielitis óptica. Los aspectos clínicos y demográficos fueron descriptos en pacientes con EMSP respecto a aquellos con EM recaída en remisión (EMRR). Se incluyeron 1723 pacientes con EM (1605, 93.2% EMRR y 118, 6.8%, EMSP). En el grupo con EMSP la mediana de edad fue de 53 (intervalo inter-cuartil [IIQ] 47-62) años, 67% eran mujeres, mediana de tiempo de evolución de enfermedad 19.5 (IIQ 14-26) años, EDSS (expanded disability status scale), 6.5 y 48.3% estaban en tratamiento para su EM. Solo el 23.7% con EMSP estaban trabajando activamente y el 86% tenía certificado de discapacidad. Un 35.6% con EMSP presentaron nuevas lesiones en resonancia magnética y 5% tuvo recaídas clínicas en los 12 meses previos al análisis, mostrando una actividad de la enfermedad significativamente menor respecto a la forma EMRR (p < 0.01).


Abstract The objective of the study was to describe the clinical and demographic aspects of patients with secondary progressive multiple sclerosis (SPMS) included in the Argentine MS Registry (RelevarEM, Clinical Trials registry number 03375177). RelevarEM is a longitudinal, strictly observational registry of patients with MS and neuromyelitis optica spectrum disorders. Clinical and demographic aspects were described in patients with SPMS and compared with relapsing remitting MS patients (RRMS). A total of 1723 patients with MS were included (1605, 93.2% RRMS and 118, 6.8%, SPMS). In SPMS, the median age was 53 (inter quartile range [IQR] 47-62) years, 67% were women, median disease duration of 19.5 (IQR 14-26) years, median EDSS (expanded disability status scale) 6.5 and 48.3% were under treatment for their MS. Only 23.7% of patients with SPMS were actively working and 86% had a disability certificate; 35.6% of patients with SPMS presented new lesions in MRI and 5% had clinical relapses during the past 12 months of the registry entry showing a significantly lower disease activity compared with RRMS (p < 0.01).


Subject(s)
Humans , Male , Female , Middle Aged , Multiple Sclerosis, Chronic Progressive/drug therapy , Multiple Sclerosis, Chronic Progressive/epidemiology , Argentina/epidemiology , Registries , Demography , Disease Progression
15.
Rev. med. Risaralda ; 26(2): 97-109, jul.-dic. 2020. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1150017

ABSTRACT

Resumen Introducción: La Enfermedad Renal Crónica es una patología de gran impacto en salud pública a nivel mundial, su progresión está determinada por limitaciones en el control de sus factores de riesgo y pronóstico. Los programas de nefroprotección hacen seguimiento y control de los pacientes con la enfermedad, intentando llevarlos a cumplir las metas específicas de nefroprotección para limitar la progresión de la Enfermedad Renal Crónica. Objetivo: Determinar los factores explicativos de la progresión de la Enfermedad Renal Crónica en pacientes atendidos en un programa de nefroprotección. Materiales y métodos: Estudio analítico observacional de cohorte retrospectivo en 5872 pacientes con Enfermedad Renal Crónica en diferentes estadios, participantes de un programa de nefroprotección en el departamento de Nariño durante el período 2016-2018. La progresión de la ERC, correspondió a la disminución de la Tasa de Filtración Glomerular en 5mL/min/1.73 m2 o más. La información se obtuvo de la base de datos del programa. Se construyó un modelo explicativo ajustado por variables demográficas y clínicas. Acorde al diseño se utilizó un modelo binomial con función de enlace logarítmica para estimar los coeficientes de regresión de las variables de interés. Las medidas de asociación fueron los Riesgos Relativos. Resultados: el 72,2% fueron mujeres, el 75,1% tenían 60 años o más, el 12,4% eran afrocolombinos, y el 85% mestizos, se presentó progresión el 49,2% (IC 95% 47,9-50,4) de los casos. Los factores que mejor explicaron la relación la progresión de ERC, fueron: ser hombre con un RR ajustado de 1,04 (IC95%:1,00-1,15), y tener un estadio de la ERC, de 4, 5 y 3a-b, con RR ajustado 1,62 (IC1,36-1,94) y 1,41 (IC1,21-1,63) respectivamente. Conclusiones: En la población nariñense de Colombia afiliada a un programa de nefroprotección, la progresión de la ERC fue del 49,2%, siendo explicada de forma significativa por el sexo masculino, y los estadios avanzados de la enfermedad.


Abstract Introduction: Chronic Kidney Disease is a pathology of great impact on public health worldwide, its progression is determined by limitations in the control of its risk factors and prognosis. Nephroprotection programs monitor, control, and limit the progression of this disease in the patients while trying to lead them to meet the specific program goals. Objective: To determine the factors that boost the progression of Chronic Kidney Disease in patients treated in a nephroprotection program. Materials and methods: This retrospective analytical observational cohort study was carried out in 5872 patients from a nephroprotection program with different stages of Chronic Kidney Disease, in the department of Nariño between 2016 and 2018. The progression of CKD corresponded to a decrease in the Glomerular Filtration Rate by 5mL / min / 1.73 m2 or more; this information was obtained from the program's database. An explanatory model was built and adjusted taking into consideration demographic and clinical variables. According to the design, a binomial model with a logarithmic link function was used to estimate the regression coefficients of the variables of interest. The association measures were the Relative risks. Results: In the final results it was found that 72.2% were women, 75.1% were 60 years old or older, 12.4% were afro-colombian, 85% were mixed race, and 49.2% presented progression (95% CI 47 , 9-50.4) of the cases. The factors that best explained the relationship between CKD progression were: being a man with an adjusted RR of 1.04 (95% CI: 1.00-1.15), and having a CKD stage of 4, 5 and 3a-b, with adjusted RR 1.62 (CI1.36-1.94) and 1.41 (CI1.21-1.63) respectively. Conclusions: In the Nariño population of Colombia that is affiliated to a nephroprotection program the progression of CKD was 49.2% according to the male sex and the advanced stages of the condition.


Subject(s)
Humans , Female , Middle Aged , Demography , Disease Progression , Renal Insufficiency, Chronic , Control , Glomerular Filtration Rate , Health Programs and Plans , Risk , Risk Factors , Cohort Studies , Models, Statistical , Colombia , Aftercare
16.
Rev. cuba. reumatol ; 22(3): e856,
Article in Spanish | LILACS, CUMED | ID: biblio-1144533

ABSTRACT

El diagnóstico y el tratamiento de la artritis reumatoide temprana en el curso de la enfermedad proporcionan alivio de los síntomas y también previene el daño estructural a largo plazo y el deterioro funcional, con una mejora concomitante en la calidad de vida. El propósito de este estudio es exponer algunos enfoques de la artritis reumatoide en cuanto al tratamiento y comportamiento de la actividad de la enfermedad. El reconocimiento de los pacientes de que su enfermedad progresa rápidamente es fundamental para identificar candidatos en los cuales la terapia intensiva puede tener el mayor impacto, en términos de prevenir la progresión de la enfermedad. Los datos acumulados muestran que las estrategias de tratamiento intensivo con agentes biológicos, especialmente los inhibidores del factor de necrosis tumoral, son más eficaces que la monoterapia secuencial o la terapia de combinación progresiva. Estos muestran una eficacia sustancial en combinación con el metotrexato, ya que proporcionan beneficios y mejoras rápidas y sustanciales a los pacientes(AU)


The diagnosis and treatment of rheumatoid arthritis early in the course of the disease provides relief of symptoms and also prevents long-term structural damage and functional deterioration, with a concomitant improvement in quality of life. To expose approaches to rheumatoid arthritis in terms of the treatment and behavior of the activity of said disease. Recognition of patients with rapidly progressing disease is essential to identify candidates in whom intensive therapy can have the greatest impact, in terms of preventing disease progression. The accumulated data shows that intensive treatment strategies with biological agents, especially TNF inhibitors, are more effective than sequential monotherapy or progressive combination therapy. These show substantial efficacy in combination with methotrexate, providing rapid and substantial benefits and improvements in patient outcomes(AU)


Subject(s)
Humans , Male , Female , Arthritis, Rheumatoid/diagnosis , Methotrexate/therapeutic use , Disease Progression , Early Diagnosis , Arthritis, Rheumatoid/drug therapy , Quality of Life
17.
Rev. Méd. Clín. Condes ; 31(5/6): 417-422, sept.-dic. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1223803

ABSTRACT

La escoliosis idiopática del adolescente (eia) es la forma de escoliosis más frecuente, afecta al 1 a 3% de los adolescentes. Su etiología aún no está totalmente definida siendo la causa genética la más probable. El objetivo principal del tratamiento es evitar la progresión de la curva y por ende prescindir del tratamiento quirúrgico. Tratamiento en curvas no severas dependerá de la madurez esquelética del paciente y de la magnitud de la curva, siendo la observación en curvas leves y el uso de corsé en las moderadas los tratamientos más aceptados.


Adolescent idiopathic scoliosis (ais) is the most frequent form of scoliosis, affecting 1 to 3% of adolescent. Its etiology is not yet fully defined, being the genetic factor the most important. The main objective of the treatment is to avoid the progression of the curve and therefore dispense with surgical treatment. Treatment in non-severe curves will depend of the skeletal maturity of the patient and the magnitude of the curve, being the observation in slight curves and the use of corset in the moderate ones the most accepted treatments.


Subject(s)
Humans , Adolescent , Scoliosis/diagnosis , Scoliosis/therapy , Risk Factors , Disease Progression
18.
Arq. neuropsiquiatr ; 78(11): 713-723, Nov. 2020. tab, graf
Article in English | LILACS | ID: biblio-1142366

ABSTRACT

Abstract Spatial disorientation has been observed in mild cognitive impairment (MCI) and is associated with a higher risk of progression to Alzheimer's disease (AD). However, there is no gold standard assessment for spatial orientation and paper-and-pencil tests lack ecological validity. Recently, there has been an increasing number of studies demonstrating the role of spatial disorientation as a cognitive marker of pathological decline, shedding new light on its importance for MCI. This systematic review aimed to investigate the accuracy of spatial orientation tasks for the diagnosis of MCI by comparison with cognitively healthy elderly. The search was conducted in the databases Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Web of Science, Scopus, Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Scientific Electronic Library Online (SciELO). Only original studies reporting spatial orientation assessment in MCI patients compared to a healthy control group were included. Studies were excluded if the MCI classification did not follow well described criteria and/or if accuracy results of spatial orientation assessment were not provided. Seven studies met the eligibility criteria, describing a variety of spatial orientation assessments including questionnaires, paper-and-pencil, office-based route learning, and computer-based and virtual reality tasks. Spatial orientation tasks demonstrated moderate to high accuracy in detecting elderly with MCI compared to cognitively healthy elderly, with areas under the curve (AUC) ranging from 0.77 to 0.99. However, important methodological issues were found in the selected studies which should be considered when interpreting results. Although the inclusion of spatial orientation assessments in MCI evaluations seems to have significant value, further studies are needed to clarify their true capacity to distinguish pathological from non-pathological aging.


RESUMO A ocorrência de desorientação espacial foi observada no comprometimento cognitivo leve (CCL) e está associada a um maior risco de progressão para a doença de Alzheimer (DA). No entanto, não há um padrão ouro para avaliação da orientação espacial e os testes em papel e caneta não apresentam validade ecológica. Recentemente, um número cada vez maior de estudos têm apontado o papel da desorientação espacial como um marcador cognitivo do declínio patológico, lançando uma nova luz sobre sua importância para o CCL. Esta revisão sistemática teve como objetivo investigar a acurácia de tarefas de orientação espacial para se estabelecer o diagnóstico de CCL entre idosos cognitivamente saudáveis. A pesquisa foi realizada através das bases de dados Medline/PubMed, Web of Science, Scopus, Embase, Lilacs e Scielo. Apenas artigos originais que reportassem avaliação da orientação espacial em idosos CCL comparados a um grupo controle saudável foram incluídos. Foram excluídos os estudos que não utilizassem a classificação de CCL segundo critérios bem descritos e/ou que não reportassem resultados de acurácia da avaliação da orientação espacial. Sete estudos atenderam aos critérios de elegibilidade, descrevendo uma variedade de formas de avaliação da orientação espacial, incluindo questionários, tarefas em papel e lápis, tarefas de aprendizado de rotas no escritório, tarefas baseadas em computador e com realidade virtual. As tarefas de orientação espacial demonstraram acurácia moderada a alta na detecção de CCL em comparação com idosos cognitivamente saudáveis, com áreas sob a curva (area under the curve — AUC) variando de 0,77 a 0,99. No entanto, um viés metodológico importante foi identificado nos estudos selecionados, o que deve ser levado em consideração na interpretação dos resultados. Apesar da inclusão da orientação espacial na avaliação cognitiva em CCL parecer ter um valor significativo, mais estudos são necessários para esclarecer sua verdadeira capacidade de distinguir o envelhecimento patológico do não patológico.


Subject(s)
Humans , Aged , Alzheimer Disease/diagnosis , Cognitive Dysfunction/diagnosis , Sensitivity and Specificity , Disease Progression , Orientation, Spatial
19.
Rev. bras. neurol ; 56(3): 25-28, jul.-set. 2020. ilus
Article in English | LILACS | ID: biblio-1120513

ABSTRACT

Creutzfeldt and Jakob's disease (CJD) has its initial milestone in the publication issued 100 years ago that precipitated its better clinical-pathological and etiological understanding. Now, it is established that it belongs to the group of the prion diseases or transmissible spongiform encephalopathies family. CJD is itself divided into several types, the most common being sporadic that is further subdivided according to the anatomoclinical expression, but mainly due to its aetiology regarding prionic protein or genotype.


A doença de Creutzfeldt e Jakob (CJD) tem seu marco inicial na publicação emitida há 100 anos que precipitou seu melhor entendimento clínico- patológico e etiológico. Agora, está estabelecido que pertence ao grupo da família das doenças de príons ou encefalopatias espongiformes transmissíveis. A própria CJD se divide em vários tipos, sendo o mais comum o esporádico que também se subdivide de acordo com a expressão anatomoclínica, mas principalmente devido à sua etiologia em relação à proteína priônica ou genótipo.


Subject(s)
Humans , History, 20th Century , Creutzfeldt-Jakob Syndrome/history , Prion Diseases/diagnosis , Creutzfeldt-Jakob Syndrome/genetics , Disease Progression , Prion Proteins
20.
Acta bioquím. clín. latinoam ; 54(4): 383-393, jul. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1149028

ABSTRACT

Resumen La enfermedad renal crónica (ERC) se define como la pérdida progresiva de la estructura y función renal. Es asintomática en etapas iniciales, pero lleva a insuficiencia renal y mortalidad cardiovascular prematura. La investigación e marcadores de lesión y función renal permite su detección precoz y la evaluación del riesgo de progresión. Se estudiaron 73 voluntarios aparentemente sanos con factores de riesgo, de ambos sexos, asintomáticos y con edades entre 20 y 70 años, y se los comparó con una población control sin factores de riesgo. Fueron evaluadas las historias clínicas, los parámetros antropométricos y la presión arterial. Se analizó la creatinina sérica por métodos enzimático y cinético, se estimó la filtración glomerular con las ecuaciones CKD-EPI, MDRD-IDMS y MDRD-4 y la creatinina urinaria y la albuminuria por métodos cinético e inmunoturbidimétrico, respectivamente. La lipocalina asociada a gelatinasa de neutrófilos (NGAL) sérica y urinaria se determinó por ELISA. El 66% de la población estudiada presentaba sobrepeso, el 34% hipertensión arterial y el 31% tabaquismo. El riesgo de progresión de ERC se estadificó con el filtrado glomerular estimado y la albuminuria y se evidenció un 87% con bajo riesgo, 12% con riesgo moderado y 1% con riesgo alto. La NGAL sérica mostró diferencias significativas respecto al grupo control 11,65 vs. 5,4 ng/mL (p<0,05), e incrementos en las distintas categorías conforme aumentaba el riesgo de progresión. La detección de ERC temprana, en pacientes asintomáticos con factores de riesgo considerados modificables, permitirá la implementación de acciones que retrasen la progresión a estadios avanzados y las complicaciones cardiovasculares asociadas a la enfermedad.


Abstract Progressive loss of renal structure and function define chronic kidney disease (CKD). It is silent in early stages but leads to renal failure and premature cardiovascular mortality. Investigation of renal function and injury markers allows CKD early detection and progression risk evaluation. A total of 73 apparently healthy volunteers, both sexes, asymptomatic with risk factors, from 20 to 70 years old were studied compared to the control population without risk factors. Clinical histories, anthropometric parameters and blood pressure were evaluated. Serum creatinine was analyzed with enzymatic and kinetic methods. Estimated glomerular filtration was calculated with CKD-EPI, MDRD-IDMS and MDRD-4 equations, urinary creatinine by kinetics method and albuminuria by immunoturbidimetry. Serum and urinary neutrophil gelatinase-associated lipocalin (NGAL) were investigated by ELISA. Population risk factors analyzed showed 66% overweight, 34% hypertensive and 31% smoking patients. CKD risk progression was staged with estimated glomerular filtration and albuminuria, according to KDIGO 2012. Population showed 87% patients in low CKD risk, 12% with moderate risk, and only 1% with high risk progression. Serum NGAL showed significant differences with respect to the control group, 11.65 vs 5.4 ng/mL (p<0,05), and increases in different categories as progression risk increases. CKD detection of asymptomatic patients with modifiable risk factors, in reversible early stages, will allow implementing actions that delay associated cardiovascular complications and disease progression to advanced stages.


Resumo A doença renal crônica (DRC) é definida como a perda progressiva da estrutura e função dos rins. Assintomático nos estágios iniciais, leva à insuficiência renal e à mortalidade cardiovascular prematura. A pesquisa de marcadores de lesão e função renal permite sua detecção precoce e avaliação do risco de progressão. Foram estudados 73 voluntários aparentemente saudáveis com fatores de risco, de ambos os sexos, assintomáticos e idades entre 20 e 70 anos, comparados à população controle sem fatores de risco. Prontuários, parâmetros antropométricos e pressão arterial foram avaliados. A creatinina sérica foi analisada pelo método enzimático e cinético, estimando a filtração glomerular com as equações CKD-EPI, MDRD-IDMS e MDRD-4, e a creatinina urinária e albuminúria, pelos métodos cinético e imunoturbidimétrico, respectivamente. Lipocalina associada à gelatinase de neutrófílos (NGAL), sérica e urinária foi determinada pelo método ELISA. 66% da população estudada apresentavam sobrepeso, 34% pressão arterial alta e 31% tabagismo. O risco de progressão da DRC foi classificado com a filtração glomerular estimada e albuminúria, mostrando 87% com baixo risco, 12% com risco moderado e apenas 1% com alto risco. A NGAL sérica mostrou diferenças significativas em relação ao grupo controle 11,65 vs 5,4 ng/mL (p<0,05) e incrementos nas diferentes categorias à medida que o risco de progressão aumentava. A detecção da DRC precoce, em pacientes assintomáticos com fatores de risco considerados modificáveis, permitirá a implementação de ações que atrasem a progressão para estágios avançados e complicações cardiovasculares associadas à doença.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Biomarkers/analysis , Disease Progression , Renal Insufficiency, Chronic/diagnosis , Cross-Sectional Studies , Risk Factors , Early Diagnosis , Glomerular Filtration Rate
SELECTION OF CITATIONS
SEARCH DETAIL