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  1 / 2622 MEDLINE  
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[PMID]:28452910
[Au] Autor:Sacdalan C; Crowell T; Colby D; Kroon E; Chan P; Pinyakorn S; Chomchey N; Prueksakaew P; Puttamaswin S; Chintanaphol M; Cheng T; Phanuphak N; Ananworanich J
[Ad] Endereço:*SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand; †Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA; ‡US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; §Yale University, New Haven, CT, USA; ‖Mayo Medical School, Rochester, MN, USA; and ¶University of Amsterdam, Amsterdam, The Netherlands.
[Ti] Título:Brief Report: Safety of Frequent Blood Sampling in Research Participants in an Acute HIV Infection Cohort in Thailand.
[So] Source:J Acquir Immune Defic Syndr;76(1):98-101, 2017 09 01.
[Is] ISSN:1944-7884
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Anemia is a potential adverse effect of phlebotomy during participation in research. Clinical studies of acute HIV infection (AHI) require frequent phlebotomy to maximize scientific yield, but this participant population may also be at increased risk for anemia and other adverse events. OBJECTIVE: The objective of this study was to describe baseline and longitudinal hemoglobin changes among participants with AHI. METHODS: Participants with AHI (n = 202) were enrolled in a prospective cohort study in Thailand. AHI was diagnosed using pooled nucleic acid testing and sequential HIV antibody immunoassays. Antiretroviral therapy was initiated on enrollment. During 48 weeks of study participation, a total of 629 mL of blood was drawn over 14 visits. Hemoglobin levels were measured serially, and abnormalities were graded using the Division of AIDS (National Institute of Allergy and Infectious Diseases) adverse event table. RESULTS: AHI was diagnosed at a median of 18 days after infection. Mean hemoglobin at enrollment of male participants was 14.8 g/dL, and for females, it was 13.0 g/dL. Over 48 weeks, there was a mean increase of 0.2 g/dL among men (P = 0.01) and a decrease of 0.7 g/dL among women (P = 0.03). The overall prevalence of anemia was low, with 7 (3.5%) of 202 fulfilling grade 1 or 2 anemia criteria. CONCLUSIONS: Anemia was rare after frequent phlebotomy in research participants with AHI, before and after antiretroviral therapy. Given that the blood volume drawn from this study did not pose substantial clinical risk, increasing the volume of blood drawn for research purposes in acute HIV-infected research participants could be considered for future studies.
[Mh] Termos MeSH primário: Coleta de Amostras Sanguíneas/efeitos adversos
Infecções por HIV/sangue
Segurança do Paciente/normas
Sujeitos da Pesquisa
[Mh] Termos MeSH secundário: Adolescente
Adulto
Anemia/etiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Flebotomia/efeitos adversos
Prevalência
Estudos Prospectivos
Tailândia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1097/QAI.0000000000001436


  2 / 2622 MEDLINE  
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[PMID]:29174110
[Au] Autor:Walter-Nicolet E; Chary-Tardy AC; Tourniaire B; le groupe Pédiadol
[Ad] Endereço:Service de néonatologie-maternité, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France. Electronic address: ewalter@hpsj.fr.
[Ti] Título:[Do analgesic sweet solutions in neonates influence glycemia? A literature review].
[Ti] Título:Les solutions sucrées à visée antalgique chez le nouveau-né modifient-elles la glycémie ? Synthèse de la littérature..
[So] Source:Arch Pediatr;24(12):1281-1286, 2017 Dec.
[Is] ISSN:1769-664X
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:Sweet solutions are one of the most widely used nonpharmacologic analgesics used for newborns. They alleviate mild to moderate pain induced by painful procedures. They are used daily in neonatal intensive care units before a venepuncture or a heel stick, especially for a blood-sugar measurement. It is agreed that analgesic sweet solutions do not modify glycemia results. This nevertheless remains a recurrent question that the present review attempts to answer.
[Mh] Termos MeSH primário: Analgésicos/administração & dosagem
Glicemia/efeitos dos fármacos
Coleta de Amostras Sanguíneas/efeitos adversos
Dor Processual/prevenção & controle
Edulcorantes/farmacologia
[Mh] Termos MeSH secundário: Seres Humanos
Recém-Nascido
Dor Processual/etiologia
Flebotomia/efeitos adversos
Soluções
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Analgesics); 0 (Blood Glucose); 0 (Solutions); 0 (Sweetening Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE


  3 / 2622 MEDLINE  
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[PMID]:29390505
[Au] Autor:Lee JA; Hong M; Lee MS; Yoon SH; Choi JY
[Ad] Endereço:Department of Korean Internal Medicine, College of Korean Medicine, Gachon University.
[Ti] Título:Blood-letting therapy for the common cold: A protocol for a systematic review of controlled trials.
[So] Source:Medicine (Baltimore);96(51):e9315, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Many people experience the common cold, but there is currently no special treatment. For this reason, complementary and alternative medicine (CAM) therapies are used to improve the symptoms of the common cold. Blood-letting therapy (BL) is a CAM therapy that has been used for over 2000 years to treat various diseases. However, few studies have provided evidence for the efficacy and safety of BL for the common cold. This study aims to assess the effectiveness and safety of BL for the common cold. METHODS AND ANALYSIS: A total of 11 databases will be searched for studies conducted through June 2017. We will include randomized controlled trials assessing BL for the common cold. All randomized controlled trials on BL or related interventions will be included. Risk of bias will be assessed using the Cochrane Risk of Bias Assessment Tool, while confidence in the accumulated evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation instrument. ETHICS AND DISSEMINATION: This systematic review will be published in a peer-reviewed journal and will also be disseminated electronically and in print. The review will be updated to inform and guide healthcare practices.
[Mh] Termos MeSH primário: Resfriado Comum/terapia
Flebotomia
[Mh] Termos MeSH secundário: Seres Humanos
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009315


  4 / 2622 MEDLINE  
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[PMID]:29384977
[Au] Autor:Zou DM; Rong DD; Zhao H; Su L; Sun WL
[Ad] Endereço:Department of Hematology.
[Ti] Título:Improvement of chronic hepatitis B by iron chelation therapy in a patient with iron overload: A case report.
[So] Source:Medicine (Baltimore);96(52):e9566, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: This report describes seroconversion of hepatitis B surface antigen (HBsAg) in a patient with marked iron overload caused by chronic hepatitis B (CHB) after receiving iron chelation therapy and discusses the role of iron chelation therapy in CHB. PATIENT CONCERNS: Increased serum ferritin level for 2 months. DIAGNOSIS: Secondary iron overload and CHB. INTERVENTION: To relieve iron load of the body, the patient underwent regular phlebotomy therapy and deferoxamine (DFO) therapy. During the therapy, serum ferritin and hepatitis B virus (HBV) were monitored and the iron concentration of the liver and heart were followed by T2* of magnetic resonance imaging (MRI) scan. OUTCOMES: Serum ferritin gradually decreased. Approximately 1 year after the therapy, HBsAg turned persistently negative. LESSONS: Iron chelation therapy may attenuate HBV infection.
[Mh] Termos MeSH primário: Terapia por Quelação/métodos
Desferroxamina/uso terapêutico
Hepatite B Crônica/complicações
Sobrecarga de Ferro/complicações
Sobrecarga de Ferro/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Ferritinas/sangue
Antígenos de Superfície da Hepatite B/imunologia
Seres Humanos
Sobrecarga de Ferro/terapia
Masculino
Flebotomia/métodos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hepatitis B Surface Antigens); 9007-73-2 (Ferritins); J06Y7MXW4D (Deferoxamine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009566


  5 / 2622 MEDLINE  
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[PMID]:29193587
[Au] Autor:Ohara Y; Chew SH; Shibata T; Okazaki Y; Yamashita K; Toyokuni S
[Ad] Endereço:Department of Pathology and Biological Responses, Nagoya University Graduate School of Medicine, Nagoya, Japan.
[Ti] Título:Phlebotomy as a preventive measure for crocidolite-induced mesothelioma in male rats.
[So] Source:Cancer Sci;109(2):330-339, 2018 Feb.
[Is] ISSN:1349-7006
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Malignant mesothelioma (MM) is a rare but socially important neoplasm due to its association with asbestos exposure. Malignant mesothelioma is difficult to diagnose at an early stage, yet there are no particularly effective treatments available at the advanced stage, thus necessitating efficient strategies to prevent MM in individuals already exposed to asbestos. We previously showed that persistent oxidative damage caused by foreign body reaction and affinity of asbestos both to hemoglobin and histones is one of the major pathogeneses. Accordingly, as an effective strategy to prevent asbestos-induced MM, we undertook the use of an iron chelator, deferasirox, which decreased the epithelial-mesenchymal transition in a crocidolite-induced rat MM model. However, this agent may show adverse effects. Here, we studied the effects of iron removal by phlebotomy as a realistic measure on the same rat model. We injected a total of 5 mg crocidolite i.p. to F1 hybrid rats between the Fischer-344 and Brown-Norway strains at the age of 6 weeks. We repeated weekly or biweekly phlebotomy of 6-8 mL/kg/time from 10 to 60 weeks of age. The animals were observed until 120 weeks. In male rats, phlebotomy significantly decreased the weight and nuclear grade of MM, and modestly reduced the associated ascites and the fraction of more malignant sarcomatoid subtype. Weekly phlebotomy prolonged long-term survival. Our results indicate that appropriate phlebotomy may be a practical preventive measure to attenuate the initiation and promotion capacity of asbestos towards MM by reducing iron in individuals exposed to asbestos.
[Mh] Termos MeSH primário: Asbesto Crocidolita/toxicidade
Neoplasias Pulmonares/induzido quimicamente
Neoplasias Pulmonares/prevenção & controle
Mesotelioma/induzido quimicamente
Mesotelioma/prevenção & controle
Flebotomia/métodos
[Mh] Termos MeSH secundário: Animais
Modelos Animais de Doenças
Ferro/sangue
Neoplasias Pulmonares/sangue
Neoplasias Pulmonares/patologia
Masculino
Mesotelioma/sangue
Mesotelioma/patologia
Ratos
Análise de Sobrevida
Resultado do Tratamento
Carga Tumoral
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
12001-28-4 (Asbestos, Crocidolite); E1UOL152H7 (Iron)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE
[do] DOI:10.1111/cas.13460


  6 / 2622 MEDLINE  
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[PMID]:28466619
[Au] Autor:Rimon A; Shalom S; Wolyniez I; Gruber A; Schachter-Davidov A; Glatstein M
[Ad] Endereço:Pediatric Emergency Medicine, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
[Ti] Título:Medical Clowns and Cortisol levels in Children Undergoing Venipuncture in the Emergency Department: A Pilot Study.
[So] Source:Isr Med Assoc J;18(11):680-683, 2016 Nov.
[Is] ISSN:1565-1088
[Cp] País de publicação:Israel
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Medical clowns are increasingly used for diminishing pain and anxiety during painful procedures being performed on children in the hospital setting. Cortisol levels rise as a response to emotional distress. OBJECTIVES: To investigate whether medical clown-assisted interventions to reduce child's distress during venipuncture have an effect on cortisol levels. METHODS: During a 1 year period, children requiring blood work or intravenous access in the pediatric emergency department were prospectively randomized to either the presence or absence of a medical clown during the procedure. The child's distress was evaluated using the Faces Pain Scale - revised (FPS-R) for the 4-7 year age group and the visual analog scales (VAS) for those aged 8-15 years. Serum cortisol levels were measured in blood samples obtained by venipuncture. RESULTS: Fifty-three children aged 2-15 years were randomly assigned to the study group (with medical clown, n=29) or to the control group (without medical clown, n=24). Combined pain scores of the study group and control group were 2.2 and 7.5 respectively (P < 0.001). No difference in mean cortisol levels was found between the study group and the control group at all ages (16.4 µg/dl vs. 18.3 µg/dl, P = 0.65). CONCLUSIONS: In this pilot study, medical clowns reduced the distress from venipuncture in children. No effect on cortisol levels was observed.
[Mh] Termos MeSH primário: Hidrocortisona/sangue
Terapia do Riso/métodos
Manejo da Dor/métodos
Flebotomia/métodos
Estresse Psicológico/prevenção & controle
[Mh] Termos MeSH secundário: Adolescente
Ansiedade/prevenção & controle
Criança
Pré-Escolar
Serviço Hospitalar de Emergência
Feminino
Seres Humanos
Israel
Masculino
Dor/psicologia
Medição da Dor
Projetos Piloto
Estudos Prospectivos
Estresse Psicológico/sangue
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
WI4X0X7BPJ (Hydrocortisone)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE


  7 / 2622 MEDLINE  
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[PMID]:28854095
[Au] Autor:Bissell DM; Anderson KE; Bonkovsky HL
[Ad] Endereço:From the Department of Medicine, Division of Gastroenterology and Porphyria Center, University of California, San Francisco, San Francisco (D.M.B.); the Departments of Preventive Medicine and Community Health and Internal Medicine, Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston (K.E.A.); and the Department of Gastroenterology, Wake Forest School of Medicine, Winston-Salem, NC (H.L.B.).
[Ti] Título:Porphyria.
[So] Source:N Engl J Med;377(9):862-872, 2017 Aug 31.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Porfiria Cutânea Tardia
Porfiria Aguda Intermitente
Protoporfiria Eritropoética
[Mh] Termos MeSH secundário: Feminino
Heme/biossíntese
Hemina/uso terapêutico
Seres Humanos
Masculino
Flebotomia
Porfobilinogênio/sangue
Porfiria Cutânea Tardia/complicações
Porfiria Cutânea Tardia/diagnóstico
Porfiria Cutânea Tardia/terapia
Porfiria Aguda Intermitente/complicações
Porfiria Aguda Intermitente/diagnóstico
Porfiria Aguda Intermitente/terapia
Porfirinas/análise
Prognóstico
Protoporfiria Eritropoética/complicações
Protoporfiria Eritropoética/diagnóstico
Protoporfiria Eritropoética/terapia
RNA Interferente Pequeno/uso terapêutico
Luz Solar/efeitos adversos
Avaliação de Sintomas
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Porphyrins); 0 (RNA, Small Interfering); 42VZT0U6YR (Heme); 743LRP9S7N (Hemin); 74KHC72QXK (Porphobilinogen)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170831
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMra1608634


  8 / 2622 MEDLINE  
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[PMID]:28712478
[Au] Autor:Pour PS; Ameri GF; Kazemi M; Jahani Y
[Ad] Endereço:Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
[Ti] Título:Comparison of Effects of Local Anesthesia and Two-Point Acupressure on the Severity of Venipuncture Pain Among Hospitalized 6-12-Year-Old Children.
[So] Source:J Acupunct Meridian Stud;10(3):187-192, 2017 Jun.
[Is] ISSN:2093-8152
[Cp] País de publicação:Korea (South)
[La] Idioma:eng
[Ab] Resumo:The aim of the present study was to compare the effects of topical anesthesia and acupressure at the Yintang (Extra 1) and the Laogong (P-8) points on the severity of venipuncture pain among hospitalized 6-12-year-old children. A sample (n = 120) of 6-12-year-old hospitalized children was recruited from two teaching hospitals located in Rafsanjan, Iran. The children were allocated to the topical anesthesia, acupressure, and control groups. For children in the topical anesthesia and the acupressure groups, eutectic mixture of local anesthetic (EMLA) cream and two-point acupressure were used, respectively, prior to performing venipuncture, whereas children in the control group only received routine prevenipuncture care. The severity of venipuncture pain was evaluated 5 minutes after performing venipuncture by using the Face, Leg, Activity, Cry, and Consolability behavioral pain assessment scale. The findings revealed that pain severity in both experimental groups was significantly lower than that in the control group, whereas there was no significant difference between the experimental groups regarding pain severity. Although acupressure was as effective as topical anesthesia cream in alleviating children's venipuncture pain, nurses are recommending to use acupressure instead of pharmacological pain management agents because of its greater safety, cost-effectiveness, and applicability.
[Mh] Termos MeSH primário: Analgesia por Acupuntura/métodos
Anestesia Local/métodos
Manejo da Dor/métodos
Flebotomia/efeitos adversos
[Mh] Termos MeSH secundário: Administração Tópica
Anestésicos Locais/administração & dosagem
Criança
Método Duplo-Cego
Feminino
Seres Humanos
Masculino
Dor/etiologia
Flebotomia/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anesthetics, Local)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170830
[Lr] Data última revisão:
170830
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170718
[St] Status:MEDLINE


  9 / 2622 MEDLINE  
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[PMID]:28701427
[Au] Autor:Steffen K; Doctor A; Hoerr J; Gill J; Markham C; Brown SM; Cohen D; Hansen R; Kryzer E; Richards J; Small S; Valentine S; York JL; Proctor EK; Spinella PC
[Ad] Endereço:Division of Pediatric Critical Care Medicine, Department of Pediatrics, St Louis Children's Hospital, Washington University School of Medicine in St Louis, St Louis, Missouri; steffen.kate@gmail.com.
[Ti] Título:Controlling Phlebotomy Volume Diminishes PICU Transfusion: Implementation Processes and Impact.
[So] Source:Pediatrics;140(2), 2017 Aug.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVES: Phlebotomy excess contributes to anemia in PICU patients and increases the likelihood of red blood cell transfusion, which is associated with risk of adverse outcomes. Excessive phlebotomy reduction (EPR) strategies may reduce the need for transfusion, but have not been evaluated in a PICU population. We hypothesized that EPR strategies, facilitated by implementation science methods, would decrease excess blood drawn and reduce transfusion frequency. METHODS: Quantitative and qualitative methods were used. Patient and blood draw data were collected with survey and focus group data to evaluate knowledge and attitudes before and after EPR intervention. The Consolidated Framework for Implementation Research was used to interpret qualitative data. Multivariate regression was employed to adjust for potential confounders for blood overdraw volume and transfusion incidence. RESULTS: Populations were similar pre- and postintervention. EPR strategies decreased blood overdraw volumes 62% from 5.5 mL (interquartile range 1-23) preintervention to 2.1 mL (interquartile range 0-7.9 mL) postintervention ( < .001). Fewer patients received red blood cell transfusions postintervention (32.1% preintervention versus 20.7% postintervention, = .04). Regression analyses showed that EPR strategies reduced blood overdraw volume ( < .001) and lowered transfusion frequency ( = .05). Postintervention surveys reflected a high degree of satisfaction (93%) with EPR strategies, and 97% agreed EPR was a priority postintervention. CONCLUSIONS: Implementation science methods aided in the selection of EPR strategies and enhanced acceptance which, in this cohort, reduced excessive overdraw volumes and transfusion frequency. Larger trials are needed to determine if this approach can be applied in broader PICU populations.
[Mh] Termos MeSH primário: Anemia/etiologia
Anemia/prevenção & controle
Transfusão de Eritrócitos/estatística & dados numéricos
Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos
Flebotomia/utilização
Procedimentos Desnecessários
[Mh] Termos MeSH secundário: Anemia/sangue
Anemia/enfermagem
Volume Sanguíneo
Criança
Pré-Escolar
Feminino
Implementação de Plano de Saúde/organização & administração
Hematócrito/enfermagem
Hemoglobinometria/enfermagem
Seres Humanos
Lactente
Capacitação em Serviço
Masculino
Missouri
Enfermagem Pediátrica/educação
Estudos Prospectivos
Revisão da Utilização de Recursos de Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171015
[Lr] Data última revisão:
171015
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170714
[St] Status:MEDLINE


  10 / 2622 MEDLINE  
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[PMID]:28699191
[Au] Autor:Barbui T; Vannucchi AM; Finazzi G; Finazzi MC; Masciulli A; Carobbio A; Ghirardi A; Tognoni G
[Ad] Endereço:F.R.O.M. Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
[Ti] Título:A reappraisal of the benefit-risk profile of hydroxyurea in polycythemia vera: A propensity-matched study.
[So] Source:Am J Hematol;92(11):1131-1136, 2017 Nov.
[Is] ISSN:1096-8652
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The use of hydroxyurea (HU) as first line therapy in polycythemia vera (PV) has been criticized because no solid demonstration that this drug prevents thrombosis or prolongs survival has been so far produced. Here we present the outcomes of a large cohort of patients with PV included in the European Collaborative Low-dose Aspirin (ECLAP) study. We selected 1,042 patients who, during the follow-up, had received only phlebotomy (PHL) or HU to maintain the hematocrit level < 45%. To assure comparability, we conducted a propensity score matching analysis. The two groups (PHL n = 342 and HU n = 681) were well balanced for the parameters included in the propensity score (overall balance: χ = 2.44, P = 0.964). Over a comparable period of follow-up (PHL = 29.9 vs. HU = 34.7 months), we documented an advantage of HU over PHL consistently significant with respect to the incidence of fatal/non-fatal cardiovascular (CV) events (5.8 vs. 3.0 per 100 person-years in PHL vs. HU group, P = 0.002) and myelofibrosis transformation that was only experienced by patients of PHL group. Evolution to acute leukemia was registered in three patients (two in PHL and one in HU group). The excess of mortality and total CV events in the PHL patients was restricted to the high-risk group, and, compared with HU cases, was significant higher in the PHL patients who failed to reach the hematocrit target < 0.45% (P = 0.000). In conclusion, this analysis provides reliable and qualified estimates of the therapeutic profile of HU and PHL treatments for future experimental studies and for the management of PV in clinical practice.
[Mh] Termos MeSH primário: Antineoplásicos/uso terapêutico
Hidroxiureia/uso terapêutico
Policitemia Vera/tratamento farmacológico
[Mh] Termos MeSH secundário: Antineoplásicos/administração & dosagem
Antineoplásicos/efeitos adversos
Biomarcadores
Terapia Combinada
Comorbidade
Feminino
Seguimentos
Hematócrito
Seres Humanos
Hidroxiureia/administração & dosagem
Hidroxiureia/efeitos adversos
Masculino
Flebotomia/métodos
Policitemia Vera/diagnóstico
Policitemia Vera/mortalidade
Pontuação de Propensão
Fatores de Risco
Análise de Sobrevida
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antineoplastic Agents); 0 (Biomarkers); X6Q56QN5QC (Hydroxyurea)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171024
[Lr] Data última revisão:
171024
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170713
[St] Status:MEDLINE
[do] DOI:10.1002/ajh.24851



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