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  1 / 20724 MEDLINE  
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[PMID]:29381721
[Au] Autor:von Babo M; Chmiel C; Müggler SA; Rakusa J; Schuppli C; Meier P; Fischler M; Urner M
[Ad] Endereço:Department of Internal Medicine, Waid City Hospital, Zurich, Switzerland.
[Ti] Título:Transfusion practice in anemic, non-bleeding patients: Cross-sectional survey of physicians working in general internal medicine teaching hospitals in Switzerland.
[So] Source:PLoS One;13(1):e0191752, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC) greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland. METHODS: In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed. RESULTS: 560 physicians of 71 hospitals (64%) responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin <130 g/L for men and by 57% at <120 g/L in non-pregnant women). 62% and 43% respectively, did not define anemia in men and in women according to the World Health Organization. Fifty percent reported not to transfuse RBC according to international guidelines. Following factors were indicated to influence the decision to transfuse: educational background of the physicians, geographical region of employment, severity of anemia, and presence of known coronary artery disease. 60% indicated that their knowledge on Transfusion-related Acute Lung Injury (TRALI) did not influence transfusion practice. 50% of physicians stated that no local transfusion guidelines exist and 84% supported the development of national recommendations on transfusion in non-acutely bleeding, anemic patients. CONCLUSION: This study highlights the lack of adherence to current transfusion guidelines in Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.
[Mh] Termos MeSH primário: Transfusão de Sangue/utilização
Medicina Geral
Hospitais de Ensino/organização & administração
Padrões de Prática Médica
[Mh] Termos MeSH secundário: Estudos Transversais
Seres Humanos
Medicina Interna
Suíça
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180131
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191752


  2 / 20724 MEDLINE  
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[PMID]:29381714
[Au] Autor:Walther B; Klein KS; Barton AK; Semmler T; Huber C; Wolf SA; Tedin K; Merle R; Mitrach F; Guenther S; Lübke-Becker A; Gehlen H
[Ad] Endereço:Institute of Microbiology and Epizootics, Freie Universität Berlin, Berlin, Germany.
[Ti] Título:Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Acinetobacter baumannii among horses entering a veterinary teaching hospital: The contemporary "Trojan Horse".
[So] Source:PLoS One;13(1):e0191873, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Pathogens frequently associated with multi-drug resistant (MDR) phenotypes, including extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) and Acinetobacter baumannii isolated from horses admitted to horse clinics, pose a risk for animal patients and personnel in horse clinics. To estimate current rates of colonization, a total of 341 equine patients were screened for carriage of zoonotic indicator pathogens at hospital admission. Horses showing clinical signs associated with colic (n = 233) or open wounds (n = 108) were selected for microbiological examination of nostril swabs, faecal samples and wound swabs taken from the open wound group. The results showed alarming carriage rates of Gram-negative MDR pathogens in equine patients: 10.7% (34 of 318) of validated faecal specimens were positive for ESBL-E (94%: ESBL-producing Escherichia coli), with recorded rates of 10.5% for the colic and 11% for the open wound group. 92.7% of the ESBL-producing E. coli were phenotypically resistant to three or more classes of antimicrobials. A. baumannii was rarely detected (0.9%), and all faecal samples investigated were negative for Salmonella, both directly and after two enrichment steps. Screening results for the equine nostril swabs showed detection rates for ESBL-E of 3.4% among colic patients and 0.9% in the open wound group, with an average rate of 2.6% (9/340) for both indications. For all 41 ESBL-producing E. coli isolated, a broad heterogeneity was revealed using pulsed-field gel electrophoresis (PFGE) patterns and whole genome sequencing (WGS) -analysis. However, a predominance of sequence type complex (STC)10 and STC1250 was observed, including several novel STs. The most common genes associated with ESBL-production were identified as blaCTX-M-1 (31/41; 75.6%) and blaSHV-12 (24.4%). The results of this study reveal a disturbingly large fraction of multi-drug resistant and ESBL-producing E. coli among equine patients, posing a clear threat to established hygiene management systems and work-place safety of veterinary staff in horse clinics.
[Mh] Termos MeSH primário: Acinetobacter baumannii/metabolismo
Escherichia coli/metabolismo
Cavalos/microbiologia
Hospitais Veterinários
Hospitais de Ensino
beta-Lactamases/biossíntese
[Mh] Termos MeSH secundário: Acinetobacter baumannii/genética
Animais
Eletroforese em Gel de Campo Pulsado
Escherichia coli/genética
Genes Bacterianos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
EC 3.5.2.6 (beta-Lactamases)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180131
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191873


  3 / 20724 MEDLINE  
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[PMID]:29262784
[Au] Autor:Kwon YS; Park SH; Kim MA; Kim HJ; Park JS; Lee MY; Lee CW; Dauti S; Choi WI
[Ad] Endereço:Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea.
[Ti] Título:Risk of mortality associated with respiratory syncytial virus and influenza infection in adults.
[So] Source:BMC Infect Dis;17(1):785, 2017 Dec 20.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Respiratory syncytial virus (RSV) infection constitutes a substantial disease burden in the general population. However, the risk of death for RSV infection has been rarely evaluated with confounders or comorbidities adjusted. We aimed to evaluate whether RSV infection is associated with higher mortality than seasonal influenza after adjusting for confounders and comorbidities and the effect of oseltamivir on the mortality in patients with influenza infection. METHODS: A retrospective cohort study was conducted on adult (≥18 years) patients admitted to the emergency department and ward of a university teaching hospital for suspected viral infection during 2013-2015 (N = 3743). RSV infection was diagnosed by multiplex PCR (N = 87). Adults hospitalized for seasonal influenza during the study period were enrolled as a comparison group (n = 312). The main outcome was 20-day all-cause mortality.We used Cox proportional hazard regression analyses to calculate the relative risk of death. RESULTS: Adult patients were less likely to be diagnosed with RSV than with influenza (2.3 vs 8.3%, respectively), were older and more likely to be diagnosed with pneumonia, chronic obstructive pulmonary disease, hypoxemia, and bacterial co-infection. In patients with RSV infection, the 20-day all-cause mortality was higher than that for influenza, (18.4 vs 6.7%, respectively). RSV infection showed significantly higher risk of death compared to the seasonal influenza group, with hazard ratio, 2.32 (95% CI, 1.17-4.58). Oseltamivir had no significant effect on mortality in patients with influenza. CONCLUSIONS: RSV infection was significantly associated with a higher risk of death than seasonal influenza, adjusted for potential confounders and comorbidities.
[Mh] Termos MeSH primário: Influenza Humana/mortalidade
Infecções por Vírus Respiratório Sincicial/mortalidade
[Mh] Termos MeSH secundário: Adulto
Hospitais de Ensino
Seres Humanos
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2897-4


  4 / 20724 MEDLINE  
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[PMID]:28460016
[Au] Autor:Kathirvel S; Tripathy JP; Tun ZM; Patro BK; Singh T; Bhalla A; Devnani M; Wilkinson E
[Ad] Endereço:Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
[Ti] Título:Physicians' compliance with the National Drug Policy on Malaria in a tertiary teaching hospital, India, from 2010 to 2015: a mixed method study.
[So] Source:Trans R Soc Trop Med Hyg;111(2):62-70, 2017 02 01.
[Is] ISSN:1878-3503
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background: National drug policies are formulated to encourage rational use of drugs and to reduce drug resistance. This study assessed physicians' compliance with the National Drug Policy on Malaria at a tertiary care hospital in north India. Methods: This mixed method study extracted data from adult malaria inpatient records of the hospital from 2010-2015, and assessed drug supply at pharmacies. Physicians' practices and perspectives were explored by in-depth interviews. Compliance was assessed by severity, type of species and pregnancy status. Thematic analysis was done for the qualitative data. Results: A total of 247 case files were reviewed. Vivax malaria (41.0%) was more common than falciparum malaria (37.2%). The majority (90.8%) of cases were severe malaria. Overall compliance for use of schizonticidal drug was 73.0% in severe malaria and was only 9.5% in uncomplicated malaria. Compliance for use of gametocidal drug (primaquine) was 15.3%. Schizonticidal drugs were available in all pharmacies except the public one. Primaquine was available in only one. The main themes emerging in the thematic network analysis were physicians' misconceptions, physician-related factors, and hospital-related and drug access factors. Conclusions: The degree of compliance for severe malaria treatment was reasonably good but low for radical cure. Raising knowledge and awareness among health care providers, by using written treatment protocols and continuing medical education would improve compliance.
[Mh] Termos MeSH primário: Antimaláricos/uso terapêutico
Fidelidade a Diretrizes/estatística & dados numéricos
Malária/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Antimaláricos/provisão & distribuição
Atitude do Pessoal de Saúde
Feminino
Hospitais de Ensino/estatística & dados numéricos
Seres Humanos
Índia
Masculino
Meia-Idade
Farmácias/estatística & dados numéricos
Padrões de Prática Médica
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Antimalarials)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1093/trstmh/trx020


  5 / 20724 MEDLINE  
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[PMID]:29422752
[Au] Autor:Ackuaku-Dogbe EM; Akpalu J; Abaidoo B
[Ad] Endereço:Department of Surgery, Eye Unit, School of Medicine and Dentistry, University of Ghana, Accra, Ghana.
[Ti] Título:Epidemiology and Clinical Features of Thyroid-associated Orbitopathy in Accra.
[So] Source:Middle East Afr J Ophthalmol;24(4):183-189, 2017 Oct-Dec.
[Is] ISSN:0975-1599
[Cp] País de publicação:India
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Thyroid-associated orbitopathy (TAO), a clinical manifestation of Graves' disease, is an autoimmune disorder of the orbital and periorbital tissue. Data on the epidemiology and clinical presentation of TAO in Africa are generally scarce and unavailable in Ghana. We investigated the epidemiology and clinical features of TAO among patients with thyroid disorders attending the Korle Bu Teaching Hospital, Accra. SUBJECTS AND METHODS: This was a descriptive cross-sectional study of patients diagnosed with thyroid disorders which was conducted at the endocrine and orbital clinics of the Korle Bu Teaching Hospital. Diagnosis was based on clinical features and confirmed by a thyroid function test. Data collected and analyzed included demography, systemic and ocular features of thyroid disorder, and thyroid function tests. RESULTS: Of the 194 patients with thyroid disorders recruited, 117 (60.30%) had TAO. The mean age was 45.22 years (standard deviation: 13.90). The male:female ratio was 1:4.45. The most common ocular symptoms were "bulging eyes" (76/65.00%) and "puffy eyelid" (62/53.00%), and the common signs were eyelid retraction (97/82.91%) and proptosis (80/68.38%). Mild TAO was diagnosed in 64.96% of patients with only 6.84% having the severe form. The outcomes of the thyroid function test, thyroid disorder, and severity of TAO did not record any statistically significant differences. CONCLUSIONS: The epidemiology is similar to those reported from other parts of the world, but the ocular presentation seems to be milder than in Caucasians.
[Mh] Termos MeSH primário: Oftalmopatia de Graves/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Distribuição por Idade
Estudos Transversais
Feminino
Gana/epidemiologia
Oftalmopatia de Graves/diagnóstico
Hospitais de Ensino
Seres Humanos
Masculino
Meia-Idade
Prevalência
Distribuição por Sexo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180210
[St] Status:MEDLINE
[do] DOI:10.4103/meajo.MEAJO_91_17


  6 / 20724 MEDLINE  
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[PMID]:29394929
[Au] Autor:Vasquez-Perez A; Simpson A; Nanavaty MA
[Ad] Endereço:Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BF, UK.
[Ti] Título:Femtosecond laser-assisted cataract surgery in a public teaching hospital setting.
[So] Source:BMC Ophthalmol;18(1):26, 2018 Feb 02.
[Is] ISSN:1471-2415
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: To evaluate the efficiency and practicality of femtosecond laser assisted cataract surgery (FLACS) in a public teaching hospital setting using a mobile FLACS system compared to conventional phacoemulsification cataract surgery (CPCS). METHODS: Ninety eyes from 90 patients underwent either FLACS or CPCS (45 in each group). Cataracts were graded using the Lens Opacities Classification System III system. Outcome measures included total surgery duration, femtosecond laser treatment time, vacuum time (VT), total phacoemulsification time (TPT) and total phacoemulsification power (TPP). RESULTS: No differences were observed in the preoperative mean cataract grades and co-morbidities. FLACS took longer than CPCS with a mean difference of 5.2 ± 4.5 min (range: 0-18.8 min). The average femtosecond laser treatment time was 4.3 ± 3.4 min (range: 1-15.5 min). The VT was 2.51 ± 0.45 min (range: 1.59-4.10 min). Although not significant, TPT in FLACS showed a trend towards improvement (mean 1.0 ± 0.6 s; range: 0.1-2.4 s) compared to CPCS (mean 1.2 ± 0.6 min; range: 0.5-2.5 min). Whereas, TPP was significantly less in FLACS (mean 17.9 ± 5.0%; range: 5-27%) compared to CPCS (mean 20.3 ± 4.1%; range: 12.0-28.7%)(p = 0.031). CONCLUSIONS: The mobile FLACS system housed in the same operating room increased the surgical duration by 5.2 min. The average VT was 2.51 min, which was lower in comparison to published experience using non-mobile FLACS systems.
[Mh] Termos MeSH primário: Extração de Catarata/métodos
Terapia a Laser/métodos
Implante de Lente Intraocular
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Hospitais Públicos
Hospitais de Ensino
Seres Humanos
Complicações Intraoperatórias
Masculino
Meia-Idade
Duração da Cirurgia
Facoemulsificação
Estudos Prospectivos
Pseudofacia/fisiopatologia
Acuidade Visual/fisiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[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:180204
[St] Status:MEDLINE
[do] DOI:10.1186/s12886-018-0693-6


  7 / 20724 MEDLINE  
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Texto completo SciELO Saúde Pública
[PMID]:28453158
[Au] Autor:Rodríguez-Burbano L; Pio De La Hoz F; Leal-Castro AL
[Ad] Endereço:Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia.
[Ti] Título:[Costs of infection associated with urinary bladder probes in a teaching hospital in Santander, Colombia].
[Ti] Título:Costo de infección de vías urinaria universitario de Santander, Colombia..
[So] Source:Rev Salud Publica (Bogota);18(1):104-116, 2016 Feb.
[Is] ISSN:0124-0064
[Cp] País de publicação:Colombia
[La] Idioma:spa
[Ab] Resumo:Objective To estimate the excess costs of urinary tract infection associated with catheter use and clinical interventions that influence costs the most. Methods A study of cohorts paired by the time of occurrence of the nosocomial event was carried out. Those exposed were patients with urinary tract infection associated with catheters and those unexposed were patients without nosocomial infection, admitted with a similar diagnosis. In both cohorts the direct costs of hospital care were evaluated. Results Excess total cost of care for a urinary tract infection associated with catheter was 2 460 168 (Colombian pesos in 2009). The highest percentage (71.8 %) was attributed to the days of hospitalization in the general ward; daily valuations contributed 19.1%, followed by antibiotics (6%), blood cultures (5 %), arterial blood gases (2 %). The remaining cost categories contributed less than 1 % each. Discussion This study tried to get closer to the actual cost, using variables such as ultrasound, arterial blood gases and others unused in previous studies in addition to the common variables such as length of hospital stay, and consumption of antibiotics. To our knowledge this is the first study of micro costs of nosocomial infections that has been done in the country, using a cohort as a design. Conclusion It was found that urinary tract infection associated with catheter use had a direct excess of costs of 2 460 168 Colombian pesos (US$ 1 329 dollars in 2009) It was found that urinary tract infection associated with catheter had a direct excess of costs of 2 460 168 Colombian pesos (US$ 1 329 dollars in 2009).
[Mh] Termos MeSH primário: Infecções Relacionadas a Cateter/economia
Infecção Hospitalar/economia
Cateteres Urinários/efeitos adversos
Infecções Urinárias/economia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Estudos de Casos e Controles
Infecções Relacionadas a Cateter/terapia
Colômbia
Custos e Análise de Custo
Infecção Hospitalar/etiologia
Feminino
Hospitais de Ensino
Seres Humanos
Masculino
Meia-Idade
Infecções Urinárias/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE


  8 / 20724 MEDLINE  
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[PMID]:29391088
[Au] Autor:Spence LH; Schwartz S; Kaji AH; Plurad D; Kim D
[Ad] Endereço:Department of Surgery, Harbor UCLA Medical Center, Torrance, California, USA.
[Ti] Título:Concurrent Biliary Disease Increases the Risk for Conversion and Bile Duct Injury in Laparoscopic Cholecystectomy: A Retrospective Analysis at a County Teaching Hospital.
[So] Source:Am Surg;83(10):1024-1028, 2017 Oct 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Biliary tract disease remains a common indication for operative intervention. The incidence of concurrent biliary tract disease (>2 biliary tract disease processes) is unknown and the impact of more than one biliary tract diagnosis on outcomes remains to be defined. The objective of this study was to determine the effect of concurrent biliary tract disease on conversion rate and outcomes after laparoscopic cholecystectomy. A 5-year retrospective analysis of all patients who underwent a laparoscopic cholecystectomy was performed comparing those with a single biliary diagnosis to patients with concurrent biliary tract disease. Variables analyzed were conversion to open cholecystectomy, incidence of bile duct injury, use of endoscopic retrograde cholangiopancreatography and/or intraoperative cholangiogram, length of surgery, and duration of hospitalization. The incidence of concurrent biliary tract disease was 9 per cent and a conversion to open cholecystectomy was performed in 16 per cent of patients. After adjusting for confounding factors, concurrent biliary tract disease was predictive of conversion (odds ratio 1.6, 95% confidence interval 1.1-2.3, P = 0.03) and bile duct injury (odds ratio 2.5, 95% confidence interval 0.8-5, P = 0.01). Concurrent biliary tract disease patients were more likely to undergo intraoperative cholangiogram or endoscopic retrograde cholangiopancreatography, as well as longer operation and length of stay.
[Mh] Termos MeSH primário: Ductos Biliares/lesões
Doenças Biliares/cirurgia
Colecistectomia Laparoscópica/efeitos adversos
Conversão para Cirurgia Aberta/estatística & dados numéricos
Complicações Intraoperatórias/etiologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Ductos Biliares/cirurgia
Feminino
Hospitais de Condado
Hospitais de Ensino
Seres Humanos
Incidência
Complicações Intraoperatórias/epidemiologia
Modelos Logísticos
Masculino
Meia-Idade
Razão de Chances
Estudos Retrospectivos
Fatores de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE


  9 / 20724 MEDLINE  
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[PMID]:29371493
[Au] Autor:Luitel BR; Chalise PR; Nathani S; Gupta DK; Subedi P; Chapagain S; Sharma UK; Gyawali PR; Shrestha GK; Joshi BR
[Ad] Endereço:Department of Surgery, Urology Unit, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
[Ti] Título:Risk-based Management of Non-muscle Invasive Bladder Cancer: Experience from Tribhuvan University Teaching Hospital.
[So] Source:Kathmandu Univ Med J (KUMJ);14(56):352-356, 2016 Oct.-Dec..
[Is] ISSN:1812-2078
[Cp] País de publicação:Nepal
[La] Idioma:eng
[Ab] Resumo:Background Most of the recent evidences suggest for risk-based management of non muscle invasive bladder cancer (NMIBC) to reduce the risk of recurrence and progression. Objective This study was conducted to assess the recurrence and progression of non muscle invasive bladder cancer in Nepalese patients using European Organization for Research and Treatment of Cancer (EORTC) risk tables and to assess the effectiveness of intravesical therapy to reduce the risk of recurrence. Method A prospective observational single centre study was conducted at Tribhuvan University Teaching Hospital from January 2010- December 2012. Forty six patients with non muscle invasive bladder cancer who underwent transurethral resection of bladder tumor and completed two years follow up were included. According to the European Organization for Research and Treatment of Cancer (EORTC) risk table, the patients were divided into low, intermediate and high risk groups. The patients received postoperative adjuvant therapy and surveillance as per the European Association of Urology guidelines. Result Among the 46 patients, the overall two year recurrence and progression rate was 8 (17%) and 1 (2%) respectively. Out of seven patients in low risk category, none of them developed recurrence or progression of disease. Out of 15 patients in intermediate risk category the one year and two year recurrence rate was 13% and 20% respectively. Out of 24 patients in high risk category the one and two year recurrence rate was 17% and 21% respectively. The risk reduction by use of intravesical Bacillus Calmette Guerin (BCG) for recurrence in high risk category was 58% and 60% in first and second year respectively. In our study, the overall and individual risk group, the one and two year recurrence rate was lower than that predicted by European Organization for Research and Treatment of Cancer risk table. Conclusion Risk-based management of non muscle invasive bladder cancer by using the European Organization for Research and Treatment of Cancer risk table is a useful method of management, though its prediction rates are lower in Nepalese population.
[Mh] Termos MeSH primário: Neoplasias da Bexiga Urinária/patologia
Neoplasias da Bexiga Urinária/cirurgia
[Mh] Termos MeSH secundário: Administração Intravesical
Idoso
Progressão da Doença
Feminino
Hospitais de Ensino
Seres Humanos
Masculino
Meia-Idade
Recidiva Local de Neoplasia
Nepal/epidemiologia
Estudos Prospectivos
Medição de Risco
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180127
[St] Status:MEDLINE


  10 / 20724 MEDLINE  
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[PMID]:28465654
[Au] Autor:Fekade D; Weldegebreal T; Teklu AM; Damen M; Abdella S; Baraki N; Belayhun B; Berhan E; Kebede A; Assefa Y
[Ad] Endereço:Addis Ababa University.
[Ti] Título:Predictors of Survival among Adult Ethiopian Patients in the National ART Program at Seven University Teaching Hospitals: A Prospective Cohort Study.
[So] Source:Ethiop J Health Sci;27(Suppl 1):63-71, 2017 Feb.
[Is] ISSN:2413-7170
[Cp] País de publicação:Ethiopia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In Ethiopia, the publicly funded antiretroviral treatment (ART) program was started in 2005. Two hundred seventy-five thousand patients were enrolled in the national ART program by 2012. However, there is limited data on mortality and predictors of death among adult patients in the ART program. The study aimed to estimate mortality and risk factors for death among adult, ART-naïve patients, started in the national ART program from January 2009 to July 2013. METHODS: Multi-site, prospective, observational cohort study of adult, age > 18 years, ART-naïve patients, started in the national ART program at seven university-affiliated hospitals from January 2009 - July 2013. Kaplan-Meier and Cox regression analyses were used to estimate survival and determine risk factors for death. RESULTS: A total of 976 patients, 594 females (60.9 %), were enrolled into the study. Median age of the cohort was 33years. The median CD4 count at start of ART was 144 cells/µl (interquartile range (IQR) 78-205), and 34.2% (330/965) had CD4 < 100. Sixty-three percent (536/851) had viral load greater than 5 log copies/ml (IQR 4.7-5.7) at base line. One hundred and one deaths were recorded during follow-up period, all-cause mortality rate 10.3%; 5.4 deaths/100 person years of observation, 95% confidence interval 4.4-6.5. Seventy percent of the deaths occurred within six months of starting ART. Cox regression analyses showed that the following measures independently predicted mortality: age >51 years, (Adjusted Hazard Ratio (AHR) 4.01, P=0.003), WHO stages III&IV, (AHR 1.76, p = 0.025), CD4 count, <100, (AHR 2.36, p =0.006), and viral load >5 log copies /ml (CHR 1.71, p = 0.037). CONCLUSION: There is high early on- ART mortality in patients presenting with advanced immunodeficiency. Detecting cases and initiating ART before onset of advanced immunodeficiency might improve survival.
[Mh] Termos MeSH primário: Fármacos Anti-HIV/uso terapêutico
Terapia Antirretroviral de Alta Atividade/mortalidade
Programas Governamentais/estatística & dados numéricos
Infecções por HIV/mortalidade
[Mh] Termos MeSH secundário: Adulto
Contagem de Linfócito CD4
Etiópia
Feminino
Infecções por HIV/sangue
Infecções por HIV/tratamento farmacológico
Hospitais de Ensino
Hospitais Universitários
Seres Humanos
Masculino
Modelos de Riscos Proporcionais
Estudos Prospectivos
Fatores de Risco
Carga Viral
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Anti-HIV Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE



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