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1.
Br J Haematol ; 2024 Jul 17.
Article in English | MEDLINE | ID: mdl-39021060

ABSTRACT

Uncertainty remains regarding the safety and tolerability of immunosuppressive therapy (IST) with anti-thymocyte globulin (ATG) and cyclosporine (CSA) in older patients. We retrospectively analysed two prospective clinical trials of IST in treatment-naïve severe aplastic anaemia (SAA) to assess safety in older compared to younger patients. Patients ≥18 years of age who had received IST with ATG and CSA +/- eltrombopag (EPAG) were included. Pre-treatment baseline characteristics and co-morbidities were assessed as predictors of therapy-related complications in younger (<60 years) versus older (≥60 years) patients. Out of 245 eligible patients, 54 were older and 191 were younger. Older patients had a similar frequency of SAEs, ICU admissions and hospital length of stay compared to younger patients. Older patients had a higher frequency of cardiac events related to IST, but none resulted in death. Older patients had worse long-term overall survival, and more relapse and clonal evolution post-IST. However, older patients who responded to IST had a similar survival at a median follow-up to younger patients. Disease-related factors and limited therapeutic options in refractory disease likely contribute to poorer outcomes in older patients, not complications of upfront IST. Therefore, IST should be considered first-line therapy for most older SAA patients.

2.
Braz J Infect Dis ; 27(5): 102810, 2023.
Article in English | MEDLINE | ID: mdl-37813358

ABSTRACT

Among individuals coinfected with HCV and HIV, studies of mortality from non-hepatic causes have shown inconsistent results. The aim of this study was to investigate the contribution of HCV and HIV co-infection to mortality from hepatic and non-hepatic causes in Brazil. This retrospective cohort study included blood donors from Fundação Pró-Sangue de São Paulo (FPS) who were followed from 1994 to 2016 to compare mortality and its causes between HIV-HCV coinfected individuals versus those seronegative for all tested infections. Records from the FPS database and the Mortality Information System were linked through a probabilistic record Relationship (RL). The Hazard Ratio (HR) was estimated using Cox multiple regression models. HCV-HIV coinfected individuals compared to seronegative individuals had a higher risk of death from all causes (HR = 14.54), non-liver neoplasms (HR = 2.55), infections (HR = 10.37) and liver disease (HR = 7.0). In addition, HCV mono-infected individuals compared to seronegative individuals had a higher risk of death from all causes (HR = 2.23), liver cancer (HR = 32.21), liver disease (HR = 14.92), infection (HR = 3.22), and trauma (HR = 1.68). Individuals coinfected with HCV and HIV have increased overall mortality and death due to infections, liver diseases and non-liver neoplasms as compared to those uninfected with HCV and HIV.


Subject(s)
Coinfection , HIV Infections , Hepatitis C , Liver Diseases , Neoplasms , Humans , HIV Infections/complications , Brazil/epidemiology , Retrospective Studies , Blood Donors , Survival Analysis , Hepatitis C/complications
3.
Article in Portuguese | Sec. Est. Saúde SP, SESSP-CTDPROD, Sec. Est. Saúde SP | ID: biblio-1392625

ABSTRACT

A pandemia de covid-19 tanto impactou a economia quanto foi impactada por ela. Objetivos ­ Este trabalho objetivou compreender a relação entre a vida profissional dos brasileiros e seu nível de adesão às medidas restritivas impostas pelo governo durante a pandemia, a fim de elucidar essa problemática e fornecer mais informações aos gestores. Material e métodos ­ Para isso, foram analisados os dados do questionário do projeto ICPCovid compartilhado virtualmente no primeiro semestre de 2020, sendo tal análise embasada na literatura publicada recentemente sobre o tema. Resultados: Ao todo, foram entrevistadas 23.896 pessoas, das quais 5.235 (21,9%) afirmaram ser trabalhadoras autônomas; 7.748 (32,4%) alegaram não estar trabalhando em casa no momento da entrevista e, quando questionadas sobre o motivo, 3.974 (16,6%) disseram que não podiam devido ao tipo de profissão. Discussão: Nesse sentido, observou-se uma elevada porcentagem de brasileiros entrevistados que não podiam exercer trabalho remoto, tanto pela alta taxa de informalidade do mercado de trabalho, em torno de 40%, segundo o IBGE (2021), quanto pela incapacidade dos menos qualificados de se adaptarem às exigências sanitárias trazidas pela crise pandêmica. Ademais, notou-se diferenças significativas nos números da covid-19 entre as diferentes regiões brasileiras, com destaque para o Norte e o Nordeste. Apesar de menos favorecidos socioeconomicamente, ambos apresentaram, no período analisado, melhor desempenho que as outras regiões. Conclusão: Uma parcela significativa da população brasileira expôs sua saúde a maiores riscos devido à profissão exercida.


Subject(s)
Women, Working , Job Market , COVID-19
4.
Rev. venez. cir ; 54(3): 146-152, sept. 2001. ilus
Article in Spanish | LILACS | ID: lil-344114

ABSTRACT

Presentar la utilidad de una nueva técnica de dilatación de estricturas biliares benignas, en los casos de biliodigestivas, utilizando el sistema de video laparoscopia con ópticas de 5 mm y 30º en una cirugía abdominal. Se presenta la experiencia de 2 casos con estricturas biliares benignas tipo Bistmuth IV, por causa de una anastomosis biliodigestiva. Se utilizó el laparoscopio de 5 mm y 30º, en una cirugía abierta, por vía transyeyunal pudiendo de esta manera: visualizar, dilatar, realizar colangiografías, estricturoplastias y colocar catéteres sobre una anastomosis bilioentérica en Y de Roux y Asa de Winckle. Además se realizó una modificación de la técnica del Asa de Winckle en uno de los casos, para la posibilidad de dilataciones en caso de recidivas. Servicio No 1 de Cirugía General Hospital Universitario de Maracaibo, Venezuela. En ambos casos se pudieron resolver las estricturas por vía endoscópica, con disminución de las enzimas hepáticas y fosfatasas alcalinas a niveles normales en un lapso no mayor de 72 horas, y alta médica a las 48 horas posterior al procedimiento. El seguimiento de los casos en promedio fue de 13 meses sin presentar recurrencia. El abordaje transyeyunal endoscópico nos ofrece la posibilidad de identificar la causa de estrictura, dilatar, realizar colangiografías, estricturoplastias, colocar catéteres, tutores y toma de biopsias sobre una anastomosis bilientérica en Y de Roux, Asa de Winckle o en Omega, sin deshacer la biliodigestiva, con la simple utilización del laparoscopio de 30º. Este sería un método viable, sencillo, seguro y de bajo costo para evitar procedimientos mayores en pacientes con anastomosis biliodisgestiva altas, que no serían buenos candidatos para una anastomosis


Subject(s)
Humans , Endoscopy , General Surgery , Gastric Dilatation , Biliary Tract Diseases , Venezuela , Medicine
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