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1.
Rev. Nac. (Itauguá) ; 13(2): 5-17, DICIEMBRE, 2021.
Article in Spanish | LILACS-Express | LILACS, BDNPAR | ID: biblio-1348665

ABSTRACT

RESUMEN Introducción: en cirugía cardiovascular, el EuroSCORE I, EuroSCORE II y STS score son herramientas que brindan pronóstico e información para la toma de decisiones. Es imperativo evaluar el valor predictivo real de los mismos en nuestro medio. Objetivo: evaluar el valor predictivo de los citados scores en pacientes sometidos a cirugía cardíaca en el área de cardiología del Hospital Nacional. Metodología: estudio de cohortes, retrospectivo, con muestreo no probabilístico de casos consecutivos. La población estuvo constituida por pacientes sometidos a cirugía cardiaca en el periodo comprendido entre enero 2020 a julio 2021. Fueron evaluadas 60 historias clínicas, excluidas 6, quedando finalmente 54 expedientes. Resultado: predominó el sexo masculino 57,14 %, la edad media fue de 60 ± 12 años (rango 26 - 82 años). El EuroSCORE II presentó un riesgo relativo de 10 (IC 95 % 1,3 ­ 90), p=0,004, sensibilidad 80 %, especificidad 78,43 %, VPP 26,67 % (IC 95 % 0,95 a 52,38) y VPN 97,56 % (IC 95 % 91,62 a 100 %). El EuroSCORE I presentó riesgo relativo de 1,6 (IC 95 % 0,2 ­ 10,9) p=0,50, sensibilidad 60 %, especificidad 52,94 %, VPP 11,11 % (IC 95 % 0,00 a 24,82) y VPN 93,10 % (IC 95 % 82,16 a 100 %). El STS score arrojó un riesgo relativo de 3,5 (IC 95 % 0,07 ­ 35), p=0,10, sensibilidad del 20 %, especificidad 93,33 %, valor predictivo positivo del 25 % (IC 95 % 0,00 a 79,93) y valor predictivo negativo 91,30 % (IC 95 % 82,07 a 100 %). La mortalidad global fue 8,93 % y morbilidad 93 %. Conclusión: se demostró un alto valor predictivo negativo en los scores, lo que determinó que pacientes con riesgo bajo e intermedio tuvieran una mortalidad baja.


ABSTRACT Introduction: in cardiovascular surgery, the EuroSCORE I, EuroSCORE II and STS score are tools that provide prognosis and information for decision making. It is imperative to evaluate their real predictive value in our environment. Objective: to evaluate the predictive value of the aforementioned scores in patients undergoing cardiac surgery in the Hospital Nacional cardiology area. Methodology: retrospective cohort study, with non-probabilistic sampling of consecutive cases. The population consisted of patients undergoing cardiac surgery in the period from January 2020 to July 2021. 60 medical records were evaluated, 6 excluded, finally leaving 54 records. Result: male sex predominated 57,14 %, the mean age was 60 ± 12 years (range 26 - 82 years old). The EuroSCORE II presented a relative risk of 10 (95 % CI 1.3 - 90), p = 0.004, sensitivity 80 %, specificity 78,43 %, PPV 26,67 % (95 % CI 0,95 to 52,38) and NPV 97,56 % (95 % CI 91,62 to 100 %). The EuroSCORE I presented a relative risk of 1.6 (95 % CI 0.2 - 10.9) p = 0.50, sensitivity 60 %, specificity 52,94 %, PPV 11,11 % (95 % CI 0.00 a 24,82) and NPV 93,10 % (95 % CI 82.16 to 100 %). The STS score yielded a relative risk of 3,5 (95 % CI 0.07 - 35), p = 0.10, sensitivity of 20 %, specificity 93,33 %, positive predictive value of 25 % (CI 95 % 0 .00 to 79.93) and negative predictive value 91,30 % (95 % CI 82.07 to 100 %). Overall mortality was 8,93 % and morbidity 93 %. Conclusion: a high negative predictive value was demonstrated in the scores, which determined that patients with low and intermediate risk had a low mortality.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Prognosis , Proportional Hazards Models , Predictive Value of Tests , Cohort Studies , Heart Disease Risk Factors , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/mortality
2.
Medicina (B.Aires) ; 81(5): 774-779, oct. 2021. graf
Article in Spanish | LILACS | ID: biblio-1351050

ABSTRACT

Resumen El objetivo del trabajo fue evaluar la asociación entre el nivel de glutamato en el líquido cefalorraquídeo (LCR) al inicio de la enfermedad y la progresión de la enfermedad durante el seguimiento en una cohorte de pacientes con esclerosis múltiple (EM). Se determinaron niveles de glutamato (Glu) en LCR al inicio de la enfermedad. Se realizó una resonancia basal y durante el seguimiento cada 12 meses con el objeto de determinar el porcentaje de cambio de volumen cerebral (PCVC), grosor cortical (GC) y volumen le sional cerebral en secuencia T2 (VLT2). Los predictores primarios de interés fueron los niveles basales de Glu en LCR, PCVC Y GC, así como la progresión clínica de la enfermedad [medida por Expanded Disability Status Scale (EDSS) y tasa anual de recaídas]. Un total de 26 pacientes fueron incluidos. La concentración media de Glu fue de 5.3 ± 0.4 μM/l. Se encontró una asociación significativa entre concentraciones basales elevadas de Glu y la progresión del EDSS (b = 1.06, IC 95% 0.47-1.66, p = 0.003), así como también el PCVC (b = -0.71, IC 95% -0.56-1.38, p = 0.002) y CG (b = -0.15, IC 95% -0.06-0.33, p = 0.01). No se encontró asociación entre los niveles de Glu y la tasa anual de recaídas como tampoco el VLT2 (b = 0.08, IC 95% -0.11-0.43, p = 0.11 y b = 195, IC -39-330, p = 0.22, respectivamente). Los niveles aumentados de Glu se asociaron con un mayor cambio en el PCVC y progresión del EDSS durante el seguimiento.


Abstract. The objective of this study was to evaluate the association between glutamate (Glu) levels in cerebrospinal fluid (CSF) at disease onset and disease progression during follow up in a cohort of multiple sclerosis (MS) patients. Glu level was measured at disease onset (first relapse). MRI was obtained at baseline and follow-up (every 12 months) to determine the percent of brain volume change (PBVC), cortical thickness (CT), and T2 lesion volume (T2LV). The primary predictors of interest were baseline CSF Glu levels, PBVC and CT, as well as clinical disease progression [measured by Expanded Disability Status Scale (EDSS) and annualized relapse rate] during follow-up. A total of 26 MS patients were included. Mean concentration of Glu in CSF at diagnosis was 5.3 ± 0.4 μM/l. A significant association was observed between higher baseline levels of Glu and an increase in EDSS during follow up (b = 1.06, 95%CI 0.47-1.66, p = 0.003) as well as PBVC (b = -0.71 95%CI -0.56-1.38, p = 0.002) and CT (b = -0.15, 95%CI -0.06-0.33, p = 0.01). We did not observe an association between baseline Glu levels and relapse rate or T2LV during follow-up (b = 0.08, 95%CI -0.11-0.43, p = 0.11 and b = 195, 95%CI -39-330, p = 0.22, respectively). Higher Glu concentrations at disease onset were associated with an increase in PBVC and EDSS progression during follow-up in MS patients.


Subject(s)
Humans , Multiple Sclerosis, Chronic Progressive , Multiple Sclerosis, Relapsing-Remitting , Multiple Sclerosis/diagnostic imaging , Prognosis , Glutamic Acid
3.
Medicina (B.Aires) ; 81(5): 754-760, oct. 2021. graf
Article in Spanish | LILACS | ID: biblio-1351047

ABSTRACT

Resumen La infección respiratoria es uno de los diagnósticos más frecuentes en el ámbito sanitario asociado a una elevada mortalidad. Residir en una residencia de ancianos podría ser un factor de riesgo predictivo de mortalidad. El objetivo fue estudiar las características de los pacientes con infección respiratoria según procedieran de su domicilio o de residencias de ancianos, y analizar si la procedencia es un factor de riesgo de mortalidad. Se trata de un estudio de cohortes prospectivo. Participaron 208 pacientes con infección respiratoria ingresados en un Servicio de Medicina Interna. Se recogieron variables clínicas, analíticas, epidemio lógicas, pronosticas y terapéuticas realizándose un análisis multivariado. Los pacientes tuvieron una edad media 83 años y 135 (64.9%) procedían de su domicilio. El 44.7% presentaban insuficiencia cardiaca como antecedente clínico. La mayoría cumplían criterios de pluripatología, polifarmacia y tenían una dependencia moderada según índice de Barthel. La mortalidad durante el internamiento hospitalario fue de 16 pacientes (7.7%), y durante el seguimiento a seis meses de 37 (17.8%). Los procedentes de residencias de ancianos presentaron una mayor mortalidad, un 37%, que los que vivían en su propio domicilio, un 19,3% (p = 0.005). En el análisis multivariado los factores pronósticos de mortalidad fueron un mayor nivel de urea al ingreso (OR = 2.33, IC 95% = 1.06-5.11) y la no prescripción de oxígeno al alta (OR = 2.96, IC 95% = 1.29-6.82). En conclusión, se observó un mayor porcentaje de mortalidad en los pacientes procedentes de residencias de ancianos, sin embargo, es necesario realizar más investigaciones para clarificar si el residir en un centro geriátrico puede ser considerado un factor de riesgo independiente de mortalidad.


Abstract Respiratory infection is one of the most frequent diagnoses associated with high mortality. Living in a nursing home could be a predictive risk factor for mortality. The objective was to study the characteristics of patients with respi ratory infection according to whether they came from their home or nursing homes, and to analyze whether their origin is a risk factor for mortality. It was a prospective cohort study, that included 208 patients with respiratory infection admitted to the Internal Medicine Service, that participated in the study. Clinical, analytical, epidemiologi cal, prognostic and therapeutic variables were collected and a multivariate analysis was performed. Patients had an average age of 83 years and 64.9% came from their home. 44.7% had heart failure as a clinical history. Most of patients met criteria of pluripatology, polypharmacy and were moderately dependent according to Barthel's index. Mortality at admission was 16 patients (7.7%), and during the six-month follow-up of 37 patients (17.8%). Those coming from nursing homes had a higher mortality rate, 37%, than those who lived in their own home, 19.3% (p = 0.005). In the multivariate analysis, the prognostic factors for mortality were a higher level of urea at admission (OR = 2.33, IC 95% = 1.06-5.11) and the non-prescription of oxygen at discharge (OR = 2.96, IC 95% = 1.29-6.82). In conclusion, a higher percentage of mortality is observed in patients coming from nursing homes, however further research is needed to clarify whether living in a residence for elderly can be considered an independent risk factor for mortality.


Subject(s)
Humans , Aged , Aged, 80 and over , Respiratory Tract Infections , Nursing Homes , Prognosis , Prospective Studies , Hospitalization
4.
Femina ; 49(9): 556-571, 20211030. tab
Article in Portuguese | LILACS | ID: biblio-1342326

ABSTRACT

Objetivo: Determinar a correlação entre vias de parto, locais de parto e prognóstico neonatal por meio do índice de Apgar e a capacidade de diagnosticar malforma- ções. Métodos: A pesquisa foi realizada no Sistema de Informação de Nascidos Vivos para variáveis de parto e malformações. Também correlacionamos o Apgar com ou sem malformação fetal e local do parto. Resultados: Houve uma quantidade considerável de dados de Apgar indefinidos, especialmente em partos domiciliares. Os partos domiciliares com malformações fetais com Apgar 0-2 e 3-5 no primeiro minuto também apresentaram piores taxas de recuperação no quinto minuto em comparação a cesárea e parto vaginal intra-hospitalar. O registro do diagnóstico das malformações fetais ocorre em ambiente hospitalar e é mais frequente do que no domiciliar. Recém-nascidos com malformações fetais apresentaram maiores taxas de Apgar ao nascer em ambiente hospitalar. As anomalias associadas aos piores prognósticos foram neurológicas e cardiológicas, enquanto as menos associadas foram as de pés e quadris. Conclusão: Esta pesquisa sugere que a cesárea e o parto hospitalar estão correlacionados a um melhor prognóstico do recém-nascido com malformação, bem como a capacidade de diagnosticar doenças congênitas que potencialmente requerem intervenção médica imediata.(AU)


Objective: To determine the correlation between delivery routes, delivery sites and neonatal prognosis through Apgar score and the ability to diagnose malformations. Methods: Research was carried out in the Live Birth Information System for delivery variables and malformations. We also correlated Apgar with or without fetal malformation and delivery site. Results: There was a considerable amount of undefined Apgar data, especially in home births. Home births with fetal malformations with Apgar 0-2 and 3-5 in the first minute also showed worse recovery rates in the fifth minute compared to cesarean section and intra-hospital vaginal delivery. Registration of the diagnosis of fetal malformations occurs in a hospital environment and is more frequent than at home. Newborns with fetal malformations had higher Apgar rates when born in a hospital environment. The abnormalities associated with the worst prognoses were neurological and cardiological, while the least associated were those of the feet and hips. Conclusion: This research suggests that caesarean section and hospital births are correlated with a better prognosis of the newborn with malformation, as well as ability to diagnose congenital diseases that potentially require immediate medical intervention.(AU)


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Apgar Score , Congenital Abnormalities/diagnosis , Congenital Abnormalities/epidemiology , Parturition , Prognosis , Cesarean Section , Birth Setting , Home Childbirth , Natural Childbirth
5.
Rev. cuba. med ; 60(3): e1343, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1347508

ABSTRACT

Introducción: La hiperglucemia de ayuno es un factor pronóstico en cirugía. Encontrar el umbral de riesgo mayor en cirugía cardiovascular es una necesidad en la práctica médica actual. Objetivo: Estimar el umbral glucémico ideal de ayuno para un mejor pronóstico en la evolución clínica de los pacientes sometidos a cirugía cardiaca. Métodos: Se realizó un estudio descriptivo prospectivo en pacientes sometidos a cirugía cardíaca, en el Hospital Hermanos Ameijeiras durante el periodo de enero a junio del año 2017. La muestra quedó constituida por 191 pacientes, a todos los pacientes se les determinó glucemia de ayuno. Se empleó la prueba de independencia Ji-cuadrado (X2) para evaluar la asociación entre variables. Se realizó un análisis de regresión logística para identificar el efecto independiente de las variables estudiadas. Además, se construyó una curva Receiver Operating Characteristic Curve (por sus siglas en inglés) en la que se graficaron especificidad 1 y sensibilidad para cada punto de corte definido para los valores glucémicos. Resultados: La edad de los pacientes predominó entre 40-69 años, el sexo masculino representó 60,7 por ciento de la muestra, el 55,5 por ciento presentó glucemias normales y solo el 1,6 por ciento presentó glucemias mayores a 15 mmol/L. El 33,5 por ciento presentó algún tipo de complicación, los pacientes que presentaron complicaciones tenían la glucemia por encima de 9,9 mmol/L en el 84,4 por ciento. En el análisis multivariado solo hubo significación estadística para la aparición de complicaciones para la glucemia mayor a 10 mmol/L. Conclusiones: La hiperglucemia de ayuno se asoció a mayor riesgo de complicaciones(AU)


Introduction: Fasting hyperglycemia is a prognostic factor in surgery. Finding the highest risk threshold in cardiovascular surgery is a necessity in current medical practice. Objective: To estimate the ideal fasting glycemic threshold for a better prognosis in the clinical evolution of patients undergoing cardiac surgery. Methods: A prospective descriptive study was carried out in patients undergoing cardiac surgery, at Hermanos Ameijeiras Hospital from January to June 2017. The sample consisted of 191 patients; fasting blood glucose was determined in all patients. The Chi-square (X2) test of independence was used to evaluate the association between variables. A logistic regression analysis was performed to identify the independent effect of the variables studied. In addition, a Receiver Operating Characteristic Curve was constructed in which 1-specificity and sensitivity were plotted for each cut-off point defined for the glycemic values. Results: The 40-69 years age of the patients predominated, the male sex represented 60.7 percent of the sample, 55.5 percent had normal blood glucose levels and only 1.6 percent showed blood glucose levels higher than 15 mmol/L. Moreover, 33.5 percent had some type of complication; the patients with complications had blood glucose levels above 9.9 mmol/L in 84.4 percent. In the multivariate analysis, there was only statistical significance for the appearance of complications for glycaemia higher than 10 mmol/L. Conclusions: Fasting hyperglycemia was associated with higher risk of complications(AU)


Subject(s)
Humans , Prognosis , Thoracic Surgery/methods , Hyperglycemia , Epidemiology, Descriptive , Prospective Studies
6.
Rev. cuba. med ; 60(3): e2515, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1347507

ABSTRACT

Introducción: El trasplante autólogo de progenitores hematopoyéticos es una terapéutica aplicable en determinadas situaciones a pacientes con Linfoma de Hodgkin. Objetivo: Evaluar la influencia de factores pronósticos seleccionados en los resultados del trasplante autólogo de progenitores hematopoyéticos en pacientes con Linfoma de Hodgkin. Métodos: Se realizó un estudio retrospectivo de 57 pacientes con diagnóstico de Linfoma de Hodgkin trasplantados en el Hospital Clínico Quirúrgico Hermanos Ameijeiras entre 1991 y 2018. La influencia de varios factores desfavorables fue evaluada según sobrevida libre de enfermedad a los cinco años de forma univariada y multivariada. Resultados: Se comprobó una sobrevida libre de enfermedad menor para todos los grupos con las categorías desfavorables. El análisis univariado indicó que el haber recibido tres o más líneas de tratamiento previas, aumentó como promedio 3,48 veces la probabilidad de recaída. En la evaluación múltiple, aumentó de forma significativa la probabilidad de recaída la existencia de enfermedad activa al momento del trasplante (p= 0,023) y el no recibir radioterapia en el tratamiento acondicionante (p= 0,010). Conclusiones: Se demostró la importancia de conocer los factores desfavorables. Notable importancia tuvo evitar enfermedad activa al trasplante y realizar una correcta evaluación de riesgos y beneficios en cuanto a la posible inclusión de la radioterapia en el tratamiento acondicionante(AU)


Introduction: Autologous hematopoietic stem cell transplantation is a therapy used in certain situations to patients with Hodgkin's Lymphoma. Objective: To evaluate the influence of selected prognostic factors on the results of autologous hematopoietic stem cell transplantation in patients with Hodgkin's Lymphoma. Methods: A retrospective study of 57 patients with a diagnosis of Hodgkin Lymphoma transplanted at Hermanos Ameijeiras Clinical Surgical Hospital from 1991 to 2018 was carried out. The influence of several unfavorable factors was evaluated according to univariate and multivariate disease-free survival at five years. Results: A lower disease-free survival was found for all groups with unfavorable categories. Univariate analysis indicated that receiving three or more previous lines of treatment increased the probability of relapse on average 3.48 times. In the multiple evaluation, the probability of relapse was significantly increased by the existence of active disease at the time of transplantation (p = 0.023) and by not receiving radiotherapy in the conditioning treatment (p = 0.010). Conclusions: The importance of knowing the unfavorable factors was established. It was of noteworthy importance to avoid active disease at transplantation and to carry out a correct evaluation of risks and benefits regarding the possible inclusion of radiotherapy in the conditioning treatment(AU)


Subject(s)
Humans , Prognosis , Transplantation, Autologous/methods , Hodgkin Disease , Retrospective Studies
7.
Arq. gastroenterol ; 58(3): 344-352, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1345307

ABSTRACT

ABSTRACT BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a decompensation of cirrhosis with an in-hospital mortality ranging from 20% to 40%. OBJECTIVE: The purpose of this study is to analyze if EASL-CLIF definition of acute-on-chronic liver failure (ACLF) is able to predict mortality in cirrhotic patients with SBP. METHODS: Historical cohort study conducted in a public tertiary care teaching hospital. Data from medical records from January 2009 to July 2016 were obtained by searching the hospital electronic database for samples of ascites collected in the period. Electronic and physical medical records were analyzed and patients were included if they were over 18-years old, with cirrhosis and an ascites fluid compatible with SBP: 69 patients were included. Liver-specific scores were calculated and Kaplan-Meier survival analysis was used for univariate analysis and a stepwise approach to the Cox regression for multivariate analysis. RESULTS: All cause mortality was 44%, 56.5% and 74% for 28-, 90- and 365-day, respectively. The prevalence of ACLF was 58%. Of these, 65% grade 1, 17.5% grade 2 and 17.5% grade 3. In multivariate analysis, the use of proton-pump inhi­bitors, alanine transaminase lower than 40 U/L, hemoglobin higher than 9 g/dL, absence of ACLF and lower CLIF-SOFA and MELD scores were independently associated with higher survival for both 28- and 90-day interval. CONCLUSION: The presence of ACLF and higher CLIF-SOFA scores were independently associated with higher 28- and 90-day mortality in cirrhotic patients admitted due to SBP.


RESUMO CONTEXTO: A peritonite bacteriana espontânea (PBE) é uma descompensação da cirrose com uma mortalidade intra-hospitalar de 20% a 40%. OBJETIVO: O objetivo deste estudo é analisar se a definição de insuficiência hepática crônica agudizada (IHCA) como definido pelo consórcio EASL-CLIF é capaz de predizer mortalidade em pacientes cirróticos com PBE. MÉTODOS: Coorte histórica conduzida em um hospital de ensino público terciário. Foram obtidos dados de prontuários médicos de janeiro de 2009 até julho de 2016, buscando no banco de dados eletrônico do hospital por todas as amostras de ascite coletadas no período. Prontuários eletrônicos e físicos foram analisados e os pacientes com mais de 18 anos com cirrose e líquido de ascite compatível com PBE foram incluídos. Foram incluídos 69 pacientes. Escores específicos para o fígado foram calculados e a análise de sobrevida de Kaplan-Meier foi utilizada para a análise univariada, e uma abordagem progressiva para a regressão logística de Cox foi usada para a análise multivariada. RESULTADOS: A mortalidade por todas as causas foi 44%, 56,5% e 74% para 28-, 90- e 365-dias, respectivamente. A prevalência de IHCA foi de 58%. Desses, 65% grau 1, 17,5% grau 2 e 17,5% grau 3. Na análise multivariada, o uso de inibidores da bomba de prótons, alanina transaminase menor que 40 U/L, hemoglobina acima de 9 g/dL, ausência de IHCA e menores valores dos escores CLIF-SOFA e MELD foram independentemente associados com maior sobrevida para ambos intervalos de 28- e 90-dias. CONCLUSÃO: A presença de IHCA e maiores valores de CLIF-SOFA foram independentemente associados em maior mortalidade para pacientes cirróticos admitidos por PBE no intervalo de 28- e 90-dias.


Subject(s)
Humans , Peritonitis , Acute-On-Chronic Liver Failure/complications , Prognosis , Retrospective Studies , Cohort Studies , Liver Cirrhosis/complications
8.
Rev. cuba. hematol. inmunol. hemoter ; 37(3): e1455, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1341398

ABSTRACT

Introducción: La leucemia mieloide aguda es una enfermedad clonal, reconocida como una de las hemopatías malignas más heterogénea en la que determinados biomarcadores clínicos, inmunológicos, citogenéticos y moleculares influyen en la respuesta de los pacientes al tratamiento. Objetivo: Describir la influencia pronóstico de biomarcadores inmunológicos, citogenéticos y moleculares en la respuesta terapéutica en los pacientes adultos menores de 60 años con leucemia mieloide aguda. Métodos: Se realizó una revisión exhaustiva del tema en bases de datos como: Pubmed, Scielo, ScienceDirect, Medline y el motor de búsqueda Google académico; se utilizaron como referencia artículos actualizados publicados principalmente en los últimos cinco años. Análisis y síntesis de la información: La heterogeneidad inmunológica, citogenética y molecular de los pacientes adultos menores de 60 años con leucemia mieloide aguda se relaciona con la variabilidad en la respuesta al tratamiento que tienen los enfermos y repercute en la supervivencia global y libre de enfermedad. Conclusión: Sobre la base a características inmunológicas, citogenéticas y moleculares es posible establecer el pronóstico de los pacientes con leucemia mieloide aguda, lo cual permite seleccionar la terapéutica adecuada para disminuir en lo posible las complicaciones, las recaídas y aumentar la supervivencia global(AU)


Introduction: Acute myeloid leukemia is a clonal disease, recognized as one of the most heterogeneous malignant hemopathy in which certain clinical, immunological, cytogenetic and molecular biomarkers influence the response of patients to treatment. Objective: Describe the prognostic influence of immunological, cytogenetic and molecular biomarkers on the therapeutic response in adult patients under 60 years of age with acute myeloid leukemia. Methods: An exhaustive review was conducted about the topic in the databases as Pubmed, Scielo, ScienceDirect, Medline and Scholar Google, for which papers mainly published in the last five years were used as reference. Analysis and synthesis of the information: The immunological, cytogenetic and molecular heterogeneity of adult patients under 60 years of age with acute myeloid leukemia is related to the variability in the response to treatment that patients have and affects their overall and disease-free survival. Conclusions: Based on the immunological, cytogenetic and molecular characteristics, it is possible to establish the prognosis of patients with acute myeloid leukemia, which allows selecting the appropriate therapy to reduce complications, relapses as much as possible and increase overall survival(AU)


Subject(s)
Humans , Adult , Biomarkers/analysis , Leukemia, Myeloid, Acute , Disease-Free Survival , Cytogenetics , Prognosis
9.
Arq. bras. med. vet. zootec. (Online) ; 73(4): 812-820, Jul.-Aug. 2021. tab, graf
Article in English | ID: biblio-1285272

ABSTRACT

The objective of this study was to describe the prevalence, survival time, and risk factors of myxomatous mitral valve disease (MMVD) in dogs by a retrospective observational cohort study design of a Brazilian veterinary center, admitted from 2012 to 2018 (2.585 days). Considering the 105 dog files confirmed as MMVD, the prevalence of the disease was higher in small-breed dogs with ages from 10 to 19 years (30.3%). The survival time of the dogs at B1 stage (1.854 ± 145 days) was higher than the B2 (1.508+209) and C/D (930 ± 209). Higher risks of death (hazard ratio) were detected in the presence of syncope (2.5), pulmonary crackling (2.0), dyspnea (1.9), and higher values of vertebral heart scale (1.7), radiographic left atrium dimension (1.8), the ACVIM staging (1.7), and the duration of QRS complex (1.05). The results achieved demonstrated higher prevalence of MMVD in old small-breed dogs, associated with longer survival time in the B1 stage of the disease, and higher risk of death related to the presence of clinical signs, such as dyspnea, syncope, and pulmonary crackling, beyond some radiographic, echocardiographic, and electrocardiographic variables of heart or atrial enlargement.(AU)


O objetivo deste estudo foi descrever a prevalência, o tempo de sobrevivência e os fatores de risco da doença mixomatosa valvar mitral (DMVM) em cães, por meio de estudo de coorte observacional retrospectivo, os quais foram atendidos em um centro veterinário de 2012 a 2018 (2.585 dias). Considerando os 105 arquivos de cães com confirmação da DMVM, maior prevalência foi observada em raças pequenas com idades entre 10 e 19 anos (30,3%). O tempo de sobrevivência de cães em estágio B1 (1.854+145 dias) foi superior ao B2 (1.508+209) e ao C/D (930+209). Maior risco de morte (hazard ratio) foi observado na presença de síncope (2,5), crepitação pulmonar (2,0), dispneia (1,9), bem como de valores superiores de VHS (1,7), dimensão radiográfica do átrio esquerdo (1,8), estadiamento ACVIM (1,7) e duração do complexo QRS (1,05). Os resultados obtidos demonstraram maior prevalência de DMVM em cães idosos de raças pequenas, associada a maior tempo de sobrevida no estágio B1 da doença e a maior risco de morte relacionado à presença de sinais clínicos como dispneia, síncope e crepitação pulmonar, além de algumas variáveis radiográficas, ecocardiográficas e eletrocardiográficas de cardiomegalia ou aumento atrial esquerdo.(AU)


Subject(s)
Animals , Dogs , Fibrosis/veterinary , Endocardium/pathology , Heart Disease Risk Factors , Heart Valve Diseases/veterinary , Prognosis , Echocardiography/veterinary , Radiography, Thoracic/veterinary , Electrocardiography/veterinary
10.
Rev. ecuat. pediatr ; 22(2): 1-8, 31 de agosto del 2021.
Article in Spanish | LILACS | ID: biblio-1284503

ABSTRACT

Introducción: El objetivo del presente estudio fue realizar un estudio de pruebas diagnósticas entre la escala PRISM III vs la escala PELOD para predecir mortalidad en pacientes que ingresan a la Unidad de Cuidados Intensivos (UCIP) del Hospital Pediátrico Baca Ortiz en el periodo de junio-diciembre 2019. Métodos: En el presente estudio observacional, retrospectivo, se registró la mortalidad y las variables que conforman cada una de las escalas predictivas. Se aplicó estadística descriptiva e inferencial, cálculo del área bajo la curva de ROC. La calibración, se calculó usando el chi2 de Hosmer Lemeshow y la tasa de mortalidad estandarizada mediante le paquete estadístico STATA v16. Resultados: Ingresaron al estudio 150 pacientes. 99 pacientes (66%) fueron hombres, tuvieron una media de edad de 3 años (P25 a P75) de 1 mes a 14 años. La patología de ingreso más frecuente fue la enfermedad posquirúrgica en 43 pacientes (28.6%), y la insuficiencia respiratoria en 31 pacientes (21.6%). La mortalidad fue 12.7%, con una media de estancia hospitalaria de 5 días (1 a 60). La escala de PRIMS III con área bajo la curva de 0.80 (IC 95% de 0.70 a 0.90), sensibilidad 79 % y especificidad 63 % con un puntaje PRISM III de 13 puntos. La escala de PELOD con área bajo la curva de 0.7 (IC 95% de 0.5 a 0.80), sensibilidad de 79 % y especificidad de 60 % con un puntaje PELOD de 21 puntos. Conclusiones: La escala de PRISM III predice la mortalidad mejor que la escala PELOD en este grupo de pacientes pediátricos en las primeras 24 horas.


Introduction: The aim of the present study was a study of diagnostic tests between the PRISM III scale vs the PELOD scale to predict mortality in patients admitted to the Intensive Care Unit (PICU) of the Baca Ortiz Pediatric Hospital in the period of June-December 2019. Methods: In this retrospective, observational study, mortality and the variables that make up each of the predictive scales were recorded. Descriptive and inferential statistics were ap-plied, calculation of the area under the ROC curve. The calibration was calculated using the Hosmer Lemeshow chi2 and the mortality rate standardized using the statistical package STATA v16. Results: 150 patients entered the study. 99 patients (66%) were men, had a mean age of 3 years (P25 to P75) from 1 month to 14 years. The most frequent admission pathology was postoperative disease in 43 patients (28.6%), and respiratory failure in 31 patients (21.6%). Mortality was 12.7%, with a mean hospital stay of 5 days (1 to 60). The PRIMS III scale with area under the curve of 0.80 (95% CI from 0.70 to 0.90), sensitivity 79% and specificity 63% with a PRISM III score of 13 points. The PELOD scale with area under the curve of 0.7 (95% CI from 0.5 to 0.80), sensitivity of 79% and specificity of 60% with a PELOD score of 21 points. Conclusions: the PRISM III scale predicts mortality better than the PELOD scale in this group of pediatric patients in the first 24 hours.


introdução: O objetivo do presente estudo foi realizar um estudo de testes diagnósticos entre a escala PRISM III vs a escala PELOD para predizer mortalidade em pacientes internados na Unidade de Terapia Intensiva (UTIP) do Hospital Pediátrico Baca Ortiz no período de junho a dezembro 2019. Métodos: Nesse estudo retrospectivo e observacional, foram registradas a mortalidade e as variáveis ​​que compõem cada uma das escalas preditivas. Foi aplicada estatística descritiva e inferencial, cálculo da área sob a curva ROC. A calibração foi calculada usando o Hosmer Lemeshow chi2 e a taxa de mortalidade padronizada usando o pacote estatístico STATA v16. Resultados: 150 pacientes entraram no estudo. 99 pacientes (66%) eram homens, com idade média de 3 anos (P25 a P75) de 1 mês a 14 anos. A patologia de admissão mais frequente foi doença pós-operatória em 43 pacientes (28,6%) e insuficiência respiratória em 31 pacientes (21,6%). A mortalidade foi de 12,7%, com tempo médio de internação de 5 dias (1 a 60). Escala PRIMS III com área sob a curva de 0,80 (IC 95% de 0,70 a 0,90), sensibilidade 79% e especificidade 63% com escore PRISM III de 13 pontos. A escala PELOD com área sob a curva de 0,7 (IC 95% de 0,5 a 0,80), sensibilidade de 79% e especificidade de 60% com escore PELOD de 21 pontos. Conclusões: A escala PRISM III prediz mortalidade melhor do que a escala PELOD neste grupo de pacientes pediátricos nas primeiras 24 horas.


Subject(s)
Humans , Child, Preschool , Child , Prognosis , Cause of Death , Critical Care , Child Mortality , Child
11.
Rev. ecuat. pediatr ; 22(2): 1-7, 31 de agosto del 2021.
Article in Spanish | LILACS | ID: biblio-1284504

ABSTRACT

Introducción: El trasplante renal en pediatría constituye el tratamiento de elección para la enfermedad renal crónica terminal (ERCT) con ventajas ampliamente comprobadas sobre los tratamientos dialíticos. El objetivo del presente estudio fue determinar los factores de riesgo relacionados con la sobrevida global y del injerto en un grupo de pacientes pediátricos con trasplante renal atendidos en un hospital de referencia nacional con observación de factores asociados al hiperparatiroidismo secundario. Métodos: En el presente estudio observacional, retrospectivo, se realizó en el Hospital Metropolitano de Quito - Ecuador desde el primero de enero del 2010 al treinta de junio del 2013. Se registró la mortalidad y la supervivencia del injerto, presencia de hiperparatiroidismo pre trasplante, variables demográficas, clínicas (compatibilidad). Se usa el método de Kaplan Meier para el análisis y se presentan riesgos relativos. Resultados: Ingresaron al estudio 33 pacientes, de edad 12±3.8 años. Donante cadavérico 21 casos (63.6%), donante vivo 12 pacientes 36.4%. 18 hombres (54.5%). La etiología de la ERCT fue indeterminada en 63.6%; nefropatías en 24.2% y uropatías en 12.1%. Rechazo agudo 1 paciente, rechazo tardío 10 pacientes. Las variables con significancia en la sobrevida del injerto fueron: hiperparatiroidismo RR= 6.0 (IC95%= 1.078-45.902) P=0.032. No recibir inmunosupresión completa RR=14.5 (IC95%= 3.807-55.225) P<0.001. La necesidad de diálisis pos trasplante la primera semana y biopsia temprana tuvieron RR=15 (IC95%= 3.9-57.2). Conclusiones: Este estudio demostró que el hiperparatiroidismo secundario es un factor de riesgo negativo para la sobrevida del injerto renal en pacientes pediátricos trasplantados


Introduction: Kidney transplantation in pediatrics is the treatment of choice for end-stage renal disease (ESRD) with widely proven advantages over dialysis treatments. The aim of the present study was to determine the risk factors related to global and graft survival in a group of pediatric kidney transplant patients treated at a national referral hospital with observation of factors associated with secondary hyperparathyroidism. Methods: In the present observational, retrospective study, it was carried out in the Hospital Metropolitano de Quito - Ecuador from January 1, 2010 to June 30, 2013. Mortality and graft survival, presence of hyperparathyroidism pre transplantation, demographic and clinical variables (compatibility). The Kaplan Meier method is used for analysis and relative risks are presented. Results: 33 patients, aged 12 ± 3.8 years, entered the study. Cadaveric donor 21 cases (63.6%), living donor 12 patients 36.4%. 18 men (54.5%). The etiology of ESRD was indeterminate in 63.6%; nephropathies in 24.2% and uropathies in 12.1%. Acute rejection 1 patient, late rejection 10 patients. Variables with significance in graft survival were: hyperparathyroidism RR = 6.0 (95% CI = 1.078-45.902) P = 0.032. Not receiving complete immunosuppression RR = 14.5 (95% CI = 3.807-55.225) P <0.001. The need for post-transplant dialysis the first week and early biopsy had RR = 15 (95% CI = 3.9-57.2). Conclusions: This study demonstrated that secondary hyperparathyroidism is a negative risk factor for kidney graft survival in pediatric transplant patients.


Subject(s)
Humans , Child, Preschool , Child , Adolescent , Parathyroid Diseases , Prognosis , Kidney Transplantation , Child , Cause of Death , Critical Care
12.
Medicina (B.Aires) ; 81(3): 329-336, jun. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346467

ABSTRACT

Resumen El índice PROFUND se desarrolló y validó para predecir mortalidad a 12 meses en pacientes pluripatológicos. Sin embargo, su valor potencial para predecir mortalidad intrahospitalaria no ha sido suficientemente estudiado. Se evaluó la capacidad del índice PROFUND en comparación con la proteína C re activa (PCR), la albúmina, y el ancho de distribución eritrocitaria (ADE) para predecir mortalidad intrahospitalaria, mediante el análisis posterior de una cohorte prospectiva de 111 pacientes pluripatológicos internados en clínica médica. La edad promedio fue 75.8 ± 9.3 años. La mortalidad intrahospitalaria fue de 17% (19 pacientes). La mediana (RIQ) del índice PROFUND, albúmina, PCR y ADE en los fallecidos y sobrevivientes fue 12 (4) y 6 (7) p< 0.0001, 2.5 (0.4) y 2.6 (0.8) p 0.295, 58 (64) y 40 (60) p 0.176, 14.5 (2) y 14.6 (3) p 0.523, respectivamente. El análisis logístico multivariado mostró que el índice PROFUND se asocia con mortalidad intrahospitalaria (p 0.0003). El riesgo de fallecer durante la internación es 20% mayor por cada punto que se incrementa el índice PROFUND (OR 1.2, IC95% 1.1-1.4). El área bajo la curva de las características operativas del receptor (AUC-ROC) del índice PROFUND para predecir mortalidad durante la internación (0.760, IC95% 0.628-0.891) fue mayor a la del ADE, PCR y albúmina (0.494 IC95% 0.364-0.624 p 0.012; 0.583 IC95% 0.437-0.728 p 0.028; 0.621 0.494-0.748 p 0.109, respectivamente). El índice PROFUND se asocia a mortalidad intrahospitalaria, con una mayor capacidad predictiva que los biomarcadores estudiados, lo cual se sumaría a su valor pronóstico a largo plazo en pacientes pluripatológicos.


Abstract The PROFUND index was developed and valid to predict mortality at 12 months in polypathological patients (PP). However, its potential value for predicting in-hospital mortality has not been sufficiently studied. The ability of the PROFUND index in comparison with C-reactive protein (CRP), albumin, and red blood cell distribu tion width (RDW) to predict in-hospital mortality was evaluated through the subsequent analysis of a prospective cohort of 111 multiple pathological patients admitted to the clinic medical. The mean age was 75.8 ± 9.3 years. In-hospital mortality was 17% (19 patients). The median (IQR) of the PROFUND index, albumin, CRP and ADE in the deceased and survivors was 12 (4) and 6 (7) p < 0.0001, 2.5 (0.4) and 2.6 (0.8) p 0.295, 58 (64) and 40 (60) p 0.176, 14.5 (2) and 14.6 (3) p 0.523, respectively. The multivariate logistic analysis showed that the PROFUND index is associated with in-hospital mortality (p 0.0003). The risk of dying during hospitalization is 20% higher for each point that the PROFUND index increases (OR 1.2, 95% CI 1.1-1.4). The area under the curve the receiver operating characteristic (AUC-ROC) of the PROFUND index to predict mortality during hospitalization (0.760, 95% CI 0.628-0.891) was higher than that of the RDW, CRP and albumin (0.494 95% CI 0.364-0.624 p 0.012; 0.583 95% CI 0.437-0.728 p 0.028; 0.621 0.494-0.748 p 0.109, respectively). The PROFUND index is associated with in-hospital mortality, with a greater predictive capacity than the biomarkers studied, which would add to its long-term prognostic value in multiple pathological patients.


Subject(s)
Humans , Aged , Aged, 80 and over , Erythrocyte Indices , Hospitalization , Prognosis , Prospective Studies , Retrospective Studies , ROC Curve , Cohort Studies , Hospital Mortality
13.
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
14.
Medicina (B.Aires) ; 81(2): 198-207, June 2021. graf
Article in English | LILACS | ID: biblio-1287271

ABSTRACT

Abstract ANCA-associated vasculitis is a heterogeneous group of rare autoimmune conditions of unknown cause. Clinical characteristics and prognostic factors were analyzed in 47 patients: 20 (42.5%) with granulomatosis with polyangiitis, 17 (36.2%) with microscopic polyangiitis, 6 (12.8%) with renal-limited vasculitis, and 4 (8.5%) with eosinophilic granulomatosis with polyangiitis. Mean age at diagnosis was 53.5 ± 16.5 years and the median of BVAS (Birmingham Vasculitis Activity Score) was 14 (4-42). The most frequent clinical manifesta tions were: general in 44 (93.6%), renal in 30 (63.8%) and respiratory in 28 (59.6%). All received corticosteroids at the beginning of treatment. Intravenous cyclophosphamide was associated in 20 (42.5%) and oral route in 14 (29.8%); azathioprine in 3 (6.4%) and rituximab in 2 (4.2%). At a median follow-up of 35.5 months (range 0.14- 234), 21 relapses were recorded in 14 patients. Overall mortality was 3.5 deaths per 100 patient-year in the whole group. Those over 55 years old, the presence of alveolar hemorrhage, those with FFS (Five Factor Score) of 2, and patients with MPA had poor prognosis. Renal involvement, ANCA pattern and BVAS were not associated to a poorer prognosis.


Resumen Las vasculitis asociadas a ANCA son un grupo heterogéneo de entidades autoinmunes, poco frecuentes, de etiología desconocida. Analizamos las características clínicas y factores pronóstico en 47 pacientes: 20 (42.5%) granulomatosis con poliangeítis, 17 (36.2%) poliangeítis microscópica, 6 (12.8%) vasculitis limitada al riñón y 4 (8.5%) granulomatosis eosinofílica con poliangeítis. La edad promedio al diagnóstico fue 53.5 ± 16.5 años y la mediana de BVAS (Birmingham Vasculitis Activity Score) 14 (4-42). Las manifestaciones clínicas más frecuentes fueron: generales en 44 (93.6%), renales 30 (63.8%) y respiratorias en 28 (59.6%). Todos recibieron corticoides al inicio del tratamiento. Se asoció ciclofosfamida endovenosa en 20 (42.5%) y oral en 14 (29.8%); azatioprina en 3 (6.4%) y rituximab en 2 (4.2%). En una mediana de seguimiento de 35.5 meses (rango 0.14-234), se registraron 21 recaídas en 14 pacientes. La mortalidad fue 3.5 por cien pacientes-año en todo el grupo. Los mayores de 55 años, con presencia de hemorragia alveolar, FFS (Five Factor Score) de 2, y los casos con poliangeítis microscópica tuvieron peor pronóstico. El compromiso renal, el patrón de ANCA y el BVAS no se asociaron a peor pronóstico.


Subject(s)
Humans , Middle Aged , Churg-Strauss Syndrome/diagnosis , Churg-Strauss Syndrome/drug therapy , Churg-Strauss Syndrome/epidemiology , Granulomatosis with Polyangiitis , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy , Prognosis , Antibodies, Antineutrophil Cytoplasmic , Microscopic Polyangiitis
15.
Rev. ADM ; 78(3): 149-154, mayo-jun. 2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1254699

ABSTRACT

Introducción: Las alternativas de tratamiento de órganos dentales con gran destrucción en su estructura varían, no sólo por el material de restauración, sino también por el valor económico y estético. Dentro de las alternativas existe: corona convencional, endocorona cuyo objetivo principal es la elaboración de una restauradora que evita la colocación de postes intraconducto y endocorona con ausencia de una pared axial (EPA) que se realiza cuando una pared, mesial, distal, vestibular o palatina está ausente. Objetivo: Verificar si la endocorona EPA se comporta de igual manera que las coronas convencionales y endocoronas al medir su resistencia ante fuerzas de tracción. Material y métodos: Treinta premolares fueron tratados endodóncicamente, 10 fueron preparados para recibir una corona convencional (grupo A), 10 para endocorona (grupo B) y 10 para endocorona EPA (grupo C). Se realizaron fuerzas de tracción para obtener el valor máximo en el cual las coronas fallaron. Se realizó una prueba ANOVA para comparar los resultados. Resultados: Al someter a los tres tipos de coronas a fuerzas de tracción los resultados obtenidos fueron: 3.04 ± 0.55 MPa para la corona, 7.08 ± 1.6 MPa para la endocorona y 6.17 ± 1.12 MPa para la endocorona EPA. Conclusiones: No existió diferencia significativa entre la endocorona (7.08 MPa) y la EPA (6.17 MPa), convirtiéndose en una alternativa de tratamiento con buen pronóstico en la práctica diaria (AU)


Introduction: The alternatives of treatment of tooth with excessive wear vary not only by the restoration material but also by the economic and aesthetic value. Among the alternatives there is: conventional crown, endocrown whose main objective is the elaboration of a restorative that avoids the placement of intraconducting posts and endocrown without one axial wall (EPA) that is done when a wall; mesial, distal, vestibular or palatal is absent. Objective: To verify if the (EPA) behaves in the same way as the conventional crown and endocrown when measuring its resistance to tensile strength. Material and methods: 30 premolars were treated endodontically, ten were prepared to receive a conventional crown, 10 for endocrown and 10 for EPA. Tensile strength were performed to obtain the maximum value at which the crowns failed, an ANOVA test was performed to compare the results. Results: When the three types of crowns were subjected to tensile strength, the results obtained were; 3.04 ± 0.55 MPa for the crown, 7.08 ± 1.6 MPa for the endocrown and 6.17 ± 1.12 MPa for the EPA endocrown. Conclusions: There was no significant difference between the endocrown (7.08 MPa) and EPA endocrown (6.17 MPa) becoming an alternative treatment with good prognosis in daily practice (AU)


Subject(s)
Humans , Tensile Strength , Tooth, Nonvital/therapy , Crowns , Prognosis , Bicuspid , Ceramics , Statistical Analysis , Analysis of Variance , Cementation/methods
16.
Rev. ADM ; 78(3): 176-180, mayo-jun. 2021.
Article in Spanish | LILACS | ID: biblio-1255021

ABSTRACT

La microendodoncia involucra la visualización a través de un microscopio operatorio de todas las fases del tratamiento de conductos y procedimientos de cirugía apical y correctiva por parte del endodoncista. Existe sobrada evidencia acerca de las mejoras que puede aportar la magnificación al tratamiento; la literatura demuestra que la capacidad del operador mejora si su visión del campo gana claridad y precisión, ambos recursos pueden ser proporcionados por el microscopio operatorio, aunado a que posibilita diagnósticos más certeros junto con mejoras en el pronóstico, lo que permite evitar posibles complicaciones. La calidad de los tratamientos endodóncicos involucra infinidad de factores, cada uno relevante en sí mismo pero, en determinados casos, el microscopio puede significar la diferencia entre un tratamiento exitoso o un fracaso clínico. En la actualidad, se ha convertido en un tema de lo más relevante, por lo que el objetivo del presente trabajo es revisar la literatura con el fin de ayudar al entendimiento basado en evidencia científica de los criterios que determinan la relevancia del uso del microscopio en el ámbito endodóncico (AU)


Microendodontics involves the visualization through an operating microscope of all phases of root canal treatment and apical and corrective surgery procedures by the endodontist. There is plenty of evidence about the improvements that magnification can provide, the literature shows that the operator's ability improves if his vision of the field gains clarity and precision, both resources can be provided by the operating microscope, added to the fact that it enables more accurate diagnoses together with improvements in the prognosis allowing to avoid possible complications. The quality of endodontic treatments involves countless factors, each relevant in itself, but in certain cases the microscope can mean the difference between a successful treatment or a clinical failure. At present, it has become a very relevant topic, so the objective of this work is to review the literature in order to help understand the criteria that determine the relevance of the use of the microscope in the endodontic field based on scientific evidence (AU)


Subject(s)
Humans , Root Canal Therapy/trends , Image Enhancement/instrumentation , Microscopy/methods , Periapical Diseases/diagnosis , Prognosis , Treatment Outcome , Dental Instruments , Dental Pulp Diseases/diagnosis
17.
Int. braz. j. urol ; 47(3): 566-573, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1154486

ABSTRACT

ABSTRACT Background: Tyrosine kinase inhibitors (TKI) and immunotherapy improved survival in metastatic renal cell carcinoma (mRCC). Disparities in treatment access are present in healthcare systems globally. The aim of this study was to analyze survival outcomes of mRCC patients treated with first-line TKIs in the public (PHS) and private (PrS) health system in a Brazilian Cancer Center. Materials and Methods: Records from all mRCC patients treated with first-line TKIs from 2007-2018 were reviewed retrospectively. Categorial variables were compared by Fisher's exact test. Survival was estimated by Kaplan-Maier method and survival curves were compared using the log-rank test. Prognostic factors were adjusted by Cox regression model. Results: Of the 171 eligible patients, 37 (21.6%) were PHS patients and 134 (78.4%) were PrS patients. There were no difference in age, gender, or sites of metastasis. PHS patients had worse performance status (ECOG ≥2, 35.1% vs. 13.5%, p=0.007), poorer risk score (IMDC poor risk, 32.4% vs. 16.4%, p=0.09), and less nephrectomies (73% vs. 92.5%, p=0.003) than PrS patients. Median lines of therapy was one for PHS versus two for PrS patients (p=0.03). Median overall survival (OS) was 16.5 versus 26.5 months (p=0.002) and progression-free survival (PFS), 8.4 versus 11 months (p=0.01) for PHS and PrS patients, respectively. After adjusting for known prognostic factors on multivariate analysis, PHS patients still had a higher risk of death (HR: 1.61, 95% CI: 1.01-2.56, p=0.047). Conclusion: Patients with mRCC treated via the PHS had worse overall survival, possibly due to poorer prognosis at presentation and less drug access.


Subject(s)
Humans , Carcinoma, Renal Cell/drug therapy , Kidney Neoplasms/drug therapy , Prognosis , Brazil , Retrospective Studies , Treatment Outcome , Disease-Free Survival , Sunitinib
18.
Arq. gastroenterol ; 58(2): 131-138, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1285331

ABSTRACT

ABSTRACT BACKGROUND: Individuals with cirrhosis have a chronic systemic inflammation associated with an immune dysfunction, affecting the progression of the liver disease. The neutrophil-lymphocyte ratio (NLR) was proposed as a marker of systemic inflammatory response and survival in patients with cirrhosis. OBJECTIVE: Evaluate the prognostic role of NLR in cirrhotic patients and its relation with inflammatory cytokines(IL-6, IL-10 and IL-17). METHODS: In this prospective study two groups were evaluated: 1) Stable cirrhotic in outpatient follow-up (n=193); 2) Hospitalized cirrhotic for acute decompensation for at least 48 hours (n=334) with admission and 48 hours tests evaluation. Circulating inflammatory cytokines were available for 130 hospitalized patients. RESULTS: In outpatients with stable cirrhosis, NLR correlated with MELD score and other variables associated with severity of disease. However, after a median of 32 months of follow up NLR was not associated with mortality (HR 1.058, 95%CI 0.900-1.243; P=0.495). In hospitalized patients, NLR at 48-hour after admission was independently associated with 90-day survival (HR 1.061, 95%CI 1.020-1.103; P=0.003) in multivariate Cox-regression analysis. The 90-day Kaplan-Meier survival probability was 87% for patients with a 48-hour NLR <3.6 and 62% for NLR ≥3.6 (P<0.001). Elevation of NLR in the first 48 hours was also independently associated with mortality (HR 2.038, 95%CI 1295-3207; P=0.002). The 90-day Kaplan-Meier survival probability was 83% when NLR did not increase and 62% when NLR increased (P<0.001). IL-6, IL-10 and IL-17 at admission were positively correlated with both admission and 48-hour NLR. Lower levels of baseline IL-10 were associated with NLR increase during first 48-hour. CONCLUSION: NLR evaluated at 48 hours of hospitalization and its early increase after admission were independently associated with short-term mortality in patients hospitalized for acute decompensation of cirrhosis.


RESUMO CONTEXTO: Na cirrose há um quadro crônico de inflamação sistêmica associada a disfunção imune, que impactam na progressão da doença hepática. A razão neutrófilo-linfócito (RNL) foi proposta como um marcador de resposta inflamatória sistêmica e sobrevida em pacientes com cirrose hepática. OBJETIVO: Avaliar o papel de RNL como marcador prognóstico em portadores de cirrose hepática e sua relação com citocinas inflamatórias (IL-6, IL-10 e IL-17). MÉTODOS: É um estudo prospectivo com duas coortes: 1) pacientes cirróticos estáveis em acompanhamento ambulatorial (n=193); 2) pacientes cirróticos hospitalizados por descompensação aguda por no mínimo 48 horas (n=334) com avaliação de exames de admissão de 48 horas. Citocinas inflamatórias séricas estavam disponíveis em 130 pacientes hospitalizados. RESULTADOS: Nos pacientes ambulatoriais com cirrose estável, RNL se correlacionou com MELD e outras variáveis associadas com gravidade da doença. Entretanto, após uma mediana de 32 meses de seguimento, RNL não apresentou associação com mortalidade (HR 1.058, 95%CI 0.900-1.243; P=0.495). Nos pacientes hospitalizados, RNL de 48 horas após a admissão apresentou associação independente com sobrevida em 90 dias (HR 1.061, 95%CI 1.020-1.103; P=0.003) na regressão multivariada de Cox. A probabilidade de sobrevivência pela curva de Kaplan-Meier em 90 dias foi de 87% em pacientes com RNL de 48 horas <3.6 e 62% nos pacientes com RNL ≥3.6 (P<0.001). A elevação de RNL nas primeiras 48 horas também foi um fator independente associado a mortalidade (HR 2.038, 95%CI 1295-3207; P=0.002). A avaliação de sobrevida em 90 dias pela curva de Kaplan-Meier foi de 83% nos pacientes em que RNL não apresentou elevação e 62% nos que apresentaram elevação de RNL (P<0.001). IL-6, IL-10 e IL-17 na admissão se correlacionaram positivamente com RNL de admissão e de 48 horas. Níveis mais baixos de IL-10 basal foram associados com elevação de RNL nas primeiras 48 horas. CONCLUSÃO: RNL avaliada em 48 horas de hospitalização e sua elevação precoce após a admissão foram fatores independentemente associados a mortalidade em curto prazo nos pacientes hospitalizados com descompensação aguda da cirrose.


Subject(s)
Humans , Lymphocytes , Neutrophils/pathology , Prognosis , Prospective Studies , Retrospective Studies , Liver Cirrhosis/complications , Liver Cirrhosis/pathology
19.
Arq. bras. med. vet. zootec. (Online) ; 73(3): 747-751, May-June 2021. tab
Article in English | ID: biblio-1278348

ABSTRACT

Marcadores sorológicos são rotineiramente utilizados na prática clínica para o estadiamento de linfomas e para a determinação de seu prognóstico em humanos. No entanto, pouco se sabe sobre sua utilização em cães, mesmo os linfomas sendo neoplasias com alta prevalência nessa espécie. No presente estudo, as concentrações séricas do receptor solúvel de interleucina-2 (sIL-2R) e do antígeno do câncer 125 (CA 125) foram mensurados em 10 cães saudáveis e em 15 cães com linfoma cutâneo, utilizando-se o kit ELISA canino e a leitura em um Stat Fax modelo 2100 (sIL-2R), bem como o kit ELISA humano e a leitura pelo ELISYS UNO humano (CA 125). Os resultados mostraram que não houve diferença significativa (P<0,05) nas concentrações dos marcadores entre os grupos. Além disso, os resultados não apontaram significância clínica no estadiamento tumoral e estabelecimento do prognóstico em cães diagnosticados com linfoma cutâneo.(AU)


Subject(s)
Animals , Dogs , Biomarkers/blood , Receptors, Interleukin-2/blood , CA-125 Antigen/blood , Lymphoma/veterinary , Prognosis , Skin Neoplasms/veterinary
20.
Arch. argent. pediatr ; 119(5): e526-e530, oct. 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1292776

ABSTRACT

La hidrocefalia es una condición clínica que consiste en un cúmulo de líquido cefalorraquídeo a nivel encefálico. Una de las causas, poco frecuente, es el síndrome de Dandy-Walker. Se presenta el caso de un recién nacido con diagnóstico prenatal de hidrocefalia secundaria a una malformación de Dandy-Walker y sospecha de genitales ambiguos. Tras el nacimiento, se confirma el diagnóstico prenatal de malformación de Dandy-Walker asociado a manifestaciones extracraneales poco frecuentes como hipospadias interescrotal y dilatación del seno coronario secundario a persistencia de la vena cava superior izquierda. Con este caso clínico queremos exponer la complejidad del síndrome de Dandy-Walker debido a sus múltiples asociaciones, que marcarán el pronóstico del paciente y la necesidad de tratamiento multidisciplinar.


Hydrocephalus is a clinical condition that consists of an accumulation of cerebrospinal fluid around the brain; Dandy-Walker syndrome is a rare cause of it. We present the case of a newborn with prenatal diagnose of hydrocephalus due to a Dandy-Walker malformation, as well as ambiguous genitalia. After birth, diagnosis of Dandy-Walker malformation associated with uncommon extracranial manifestations is confirmed. Specifically, the baby presents interscrotal hypospadias and coronary sinus dilatation due to the persistence of the left superior vena cava. With the exposition of this case, we bring out the complexity of the Dandy-Walker syndrome due to the malformations associated with it; the ones that will determine the prognosis and the need of a multidisciplinary treatment


Subject(s)
Humans , Male , Pregnancy , Infant, Newborn , Dandy-Walker Syndrome/complications , Dandy-Walker Syndrome/diagnosis , Hydrocephalus/diagnosis , Hydrocephalus/etiology , Prognosis , Vena Cava, Superior , Brain
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