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[PMID]:28468628
[Au] Autor:Nwaneri DU; Sadoh AE; Ibadin MO
[Ad] Endereço:Department of Child Health, University of Benin Teaching Hospital, P.M.B. 1111, Benin City, Nigeria. uchechukwu.nwaneri@uniben.edu.
[Ti] Título:Impact of home-based management on malaria outcome in under-fives presenting in a tertiary health institution in Nigeria.
[So] Source:Malar J;16(1):187, 2017 05 03.
[Is] ISSN:1475-2875
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Home-based management of malaria involves prompt delivery of effective malaria treatment at the community by untrained caregiver. The aim of this study was to document home-based treatment of suspected malaria by non-medical caregivers and to identify its health impact on malaria outcome (severe malaria prevalence, parasite load and mortality) in children (6-59 months). METHODS: A descriptive cross-sectional study carried out from June 2012-July 2013. Data was obtained by researcher-administered questionnaire and malaria was confirmed in each child by microscopy. Analysis was by Statistical Package for Scientific Solutions version 16. RESULTS: Of the 290 caregivers (31.2 ± 6.1 years)/child (21.3 ± 14.4 months) pairs recruited, 222 (76.6%) caregivers managed malaria at home before presenting their children to hospital. Majority (99.0%) practiced inappropriate home-based malaria treatment. While only 35 (15.8%) caregivers used the recommended artemisinin-based combination therapy, most others used paracetamol either solely or in combination with anti-malarial monotherapy [153 (69.0%)]. There was no significant difference in mean [±] parasites count (2055.71 ± 1655.06/µL) of children who received home-based treatment and those who did not (2405.27 ± 1905.77/µL) (t = 1.02, p = 0.31). Prevalence of severe malaria in this study was 111 (38.3%), which was statistically significantly higher in children who received home-based malaria treatment [90.0%] (χ = 18.4, OR 4.2, p = 0.00). The mortality rate was 62 per 1000 and all the children that died received home-based treatment (p < 0.001). While low socio-economic class was the significant predictor of prevalence of severe malaria (ß = 0.90, OR 2.5, p = 0.00), late presentation significantly predicted mortality (ß = 1.87, OR 6.5, p = 0.02). CONCLUSIONS: The expected benefits of home-based management of malaria in under-fives were undermined by inappropriate treatment practices by the caregivers leading to high incidence of severe malaria and mortality.
[Mh] Termos MeSH primário: Instalações de Saúde/utilização
Serviços de Assistência Domiciliar/estatística & dados numéricos
Malária/terapia
[Mh] Termos MeSH secundário: Antimaláricos/uso terapêutico
Cuidadores
Pré-Escolar
Competência Clínica
Estudos Transversais
Feminino
Instalações de Saúde/estatística & dados numéricos
Serviços de Assistência Domiciliar/normas
Seres Humanos
Lactente
Malária/tratamento farmacológico
Malária/epidemiologia
Malária/mortalidade
Masculino
Nigéria/epidemiologia
Carga Parasitária/estatística & dados numéricos
Prevalência
Atenção Terciária à Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antimalarials)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1186/s12936-017-1836-6


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[PMID]:28743261
[Au] Autor:Ghaffar R; Iqbal Q; Khalid A; Saleem F; Hassali MA; Baloch NS; Ahmad FUD; Bashir S; Haider S; Bashaar M
[Ad] Endereço:Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Pakistan.
[Ti] Título:Frequency and predictors of anxiety and depression among pregnant women attending tertiary healthcare institutes of Quetta City, Pakistan.
[So] Source:BMC Womens Health;17(1):51, 2017 07 25.
[Is] ISSN:1472-6874
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Anxiety and depression (A&D) are commonly reported among pregnant women from all over the world; however, there is a paucity of workable data from the developing countries including Pakistan. The current study, therefore, aims to find out the frequency and predictors of A&D among pregnant women attending a tertiary healthcare institutes in the city of Quetta, in the Balochistan province, Pakistan. METHODS: A questionnaire based, cross-sectional survey was conducted. The pre-validated Hospital Anxiety and Depression Scale (HADS) were used to assess the frequency of A&D among study respondents. Anxiety and depression scores were calculated via standard scoring procedures while logistic regression was used to identify the predictors of A&D. SPSS v. 20 was used for data analysis and p < 0.05 was taken as significant. RESULTS: Seven hundred and fifty pregnant women responded to the survey. The majority of the respondents belonged to age group of 26-35 year (424, 56.4%) and had no formal education (283, 37.6%). Furthermore, 612 (81.4%) of the respondents were unemployed and had urban residencies (651, 86.6%). The mean anxiety score was 10.08 ± 2.52; the mean depression score was 9.51 ± 2.55 and the total HADS score was 19.23 ± 3.91 indicating moderate A&D among the current cohort. Logistic regression analysis reported significant goodness of fit (Chi square = 17.63, p = 0.030, DF = 3), indicating that the model was advisable. Among all variables, age had a significant association when compared with HADS scores [adjusted OR (odds ratios) = 1.23, 95% CI = 1.13-1.62, p < 0.001]. CONCLUSION: Moderate A&D was reported among the study respondents. Furthermore, age was highlighted as a predictor of A&D. The evidence from this study provides a motion of support programs for anxious and depressed pregnant women. The benefits of implementing good mental health in antenatal care have long-lasting benefits for both mother and infant. Therefore, there is a need to incorporate A&D screening in the existing antenatal programs.
[Mh] Termos MeSH primário: Ansiedade/epidemiologia
Depressão/epidemiologia
Complicações na Gravidez/epidemiologia
Gestantes/psicologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Fatores Etários
Ansiedade/psicologia
Estudos Transversais
Depressão/psicologia
Feminino
Seres Humanos
Modelos Logísticos
Meia-Idade
Razão de Chances
Paquistão/epidemiologia
Gravidez
Complicações na Gravidez/psicologia
Cuidado Pré-Natal/estatística & dados numéricos
Escalas de Graduação Psiquiátrica
Fatores de Risco
Inquéritos e Questionários
Atenção Terciária à Saúde
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.1186/s12905-017-0411-1


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[PMID]:28949246
[Au] Autor:de la Fuente J; Garrett CG; Ossoff R; Vinson K; Francis DO; Gelbard A
[Ad] Endereço:1 Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
[Ti] Título:A Case Series of the Probability Density and Cumulative Distribution of Laryngeal Disease in a Tertiary Care Voice Center.
[So] Source:Ann Otol Rhinol Laryngol;126(11):748-754, 2017 Nov.
[Is] ISSN:1943-572X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To examine the distribution of clinic and operative pathology in a tertiary care laryngology practice. METHODS: Probability density and cumulative distribution analyses (Pareto analysis) was used to rank order laryngeal conditions seen in an outpatient tertiary care laryngology practice and those requiring surgical intervention during a 3-year period. RESULTS: Among 3783 new clinic consultations and 1380 operative procedures, voice disorders were the most common primary diagnostic category seen in clinic (n = 3223), followed by airway (n = 374) and swallowing (n = 186) disorders. Within the voice strata, the most common primary ICD-9 code used was dysphonia (41%), followed by unilateral vocal fold paralysis (UVFP) (9%) and cough (7%). Among new voice patients, 45% were found to have a structural abnormality. The most common surgical indications were laryngotracheal stenosis (37%), followed by recurrent respiratory papillomatosis (18%) and UVFP (17%). CONCLUSIONS: Nearly 55% of patients presenting to a tertiary referral laryngology practice did not have an identifiable structural abnormality in the larynx on direct or indirect examination. The distribution of ICD-9 codes requiring surgical intervention was disparate from that seen in clinic. Application of the Pareto principle may improve resource allocation in laryngology, but these initial results require confirmation across multiple institutions.
[Mh] Termos MeSH primário: Doenças da Laringe/diagnóstico
Doenças da Laringe/cirurgia
Atenção Terciária à Saúde
[Mh] Termos MeSH secundário: Efeitos Psicossociais da Doença
Tosse/diagnóstico
Tosse/cirurgia
Disfonia/diagnóstico
Disfonia/cirurgia
Seres Humanos
Laringoestenose/diagnóstico
Laringoestenose/cirurgia
Papiloma/diagnóstico
Papiloma/cirurgia
Neoplasias do Sistema Respiratório/diagnóstico
Neoplasias do Sistema Respiratório/cirurgia
Tennessee
Centros de Atenção Terciária
Estenose Traqueal/diagnóstico
Estenose Traqueal/cirurgia
Paralisia das Pregas Vocais/diagnóstico
Paralisia das Pregas Vocais/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170927
[St] Status:MEDLINE
[do] DOI:10.1177/0003489417728945


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[PMID]:28860401
[Au] Autor:Fawi HMT; Saba K; Cunningham A; Masud S; Lewis M; Hossain M; Chopra I; Ahuja S
[Ad] Endereço:Welsh Centre for Spinal Trauma and Surgery, Cardiff and Vale LHB, Cardiff CF14 4XW, UK.
[Ti] Título:Venous thromboembolism in adult elective spinal surgery: a tertiary centre review of 2181 patients.
[So] Source:Bone Joint J;99-B(9):1204-1209, 2017 Sep.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: To evaluate the incidence of primary venous thromboembolism (VTE), epidural haematoma, surgical site infection (SSI), and 90-day mortality after elective spinal surgery, and the effect of two protocols for prophylaxis. PATIENTS AND METHODS: A total of 2181 adults underwent 2366 elective spinal procedures between January 2007 and January 2012. All patients wore anti-embolic stockings, mobilised early and were kept adequately hydrated. In addition, 29% (689) of these were given low molecular weight heparin (LMWH) while in hospital. SSI surveillance was undertaken using the Centers for Disease Control and Prevention criteria. RESULTS: In patients who only received mechanical prophylaxis, the incidence of VTE was 0.59% and that of SSI 2.1%. In patients who were additionally given LMWH, the incidence of VTE was 0% and that of SSI 0.7%. The unadjusted p-value was 0.04 for VTE and 0.01 for SSI. There were no cases of epidural haematoma or 90-day mortality in either group. When adjusted for case-mix, LMWH remained a significant factor (p = 0.006) for VTE, but not for SSI. CONCLUSION: A peri-operative protocol involving mechanical anti-embolism stockings, adequate hydration, and early post-operative mobilisation is effective in significantly reducing the incidence of VTE. The addition of LMWH is safe in patients at higher risk of developing VTE. Cite this article: 2017;99-B:1204-9.
[Mh] Termos MeSH primário: Doenças da Coluna Vertebral/cirurgia
Tromboembolia Venosa/etiologia
Tromboembolia Venosa/prevenção & controle
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Deambulação Precoce
Procedimentos Cirúrgicos Eletivos
Feminino
Hidratação
Hematoma/epidemiologia
Hematoma/etiologia
Hematoma/prevenção & controle
Heparina de Baixo Peso Molecular/uso terapêutico
Mortalidade Hospitalar
Seres Humanos
Incidência
Masculino
Meia-Idade
Fatores de Risco
Meias de Compressão
Infecção da Ferida Cirúrgica/epidemiologia
Infecção da Ferida Cirúrgica/etiologia
Infecção da Ferida Cirúrgica/prevenção & controle
Atenção Terciária à Saúde
Tromboembolia Venosa/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Heparin, Low-Molecular-Weight)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170902
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.99B9.BJJ-2016-1193.R2


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[PMID]:28778450
[Au] Autor:Kumar MM; Venkataswamy MM; Sathyanarayanan G; Thippeswamy H; Chandra PS; Mani RS
[Ad] Endereço:Department of Neurovirology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India.
[Ti] Título:Immune system aberrations in postpartum psychosis: An immunophenotyping study from a tertiary care neuropsychiatric hospital in India.
[So] Source:J Neuroimmunol;310:8-13, 2017 Sep 15.
[Is] ISSN:1872-8421
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Postpartum psychosis (PP) is associated with significant morbidity to both mother and infant. Immune system dysregulation during PP is reported in recent studies. This study attempted to determine immune signatures associated with first-onset PP by flow cytometry. Peripheral blood showed decreased naive CD4 and CD8 T cells, while activated CD8 and memory regulatory T cells (Tregs) were increased in women with PP as against healthy controls. The CD14 CD16 non-classical monocytes, CD11c+myeloid DCs and cytotoxic CD56 CD16 were reduced, while CD56 CD16 regulatory NK cells were elevated in women with PP. The variations in immune cell subsets highlight the generalized immune dysregulation in PP.
[Mh] Termos MeSH primário: Citocinas/metabolismo
Doenças do Sistema Imune/etiologia
Imunofenotipagem
Período Pós-Parto/imunologia
Transtornos Psicóticos/complicações
[Mh] Termos MeSH secundário: Adulto
Células Dendríticas/metabolismo
Células Dendríticas/patologia
Feminino
Citometria de Fluxo
Hospitais Psiquiátricos/estatística & dados numéricos
Seres Humanos
Doenças do Sistema Imune/patologia
Índia/epidemiologia
Células Matadoras Naturais/metabolismo
Células Matadoras Naturais/patologia
Monócitos/metabolismo
Monócitos/patologia
Subpopulações de Linfócitos T/metabolismo
Subpopulações de Linfócitos T/patologia
Atenção Terciária à Saúde
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cytokines)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170822
[Lr] Data última revisão:
170822
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170806
[St] Status:MEDLINE


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[PMID]:28591184
[Au] Autor:Saha D; Pal A; Sarkar N; Das D; Blackard JT; Guha SK; Saha B; Chakravarty R
[Ad] Endereço:ICMR Virus Unit, Kolkata, ID & BG Hospital Campus, Kolkata, West Bengal, India.
[Ti] Título:Occult hepatitis B virus infection in HIV positive patients at a tertiary healthcare unit in eastern India.
[So] Source:PLoS One;12(6):e0179035, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Occult HBV infection (OBI), defined by the presence of HBV DNA in absence of hepatitis B surface antigen (HBsAg), is a significant concern in the HIV-infected population. Of 441 HIV+/HBsAg- patients analyzed, the overall prevalence of OBI was 6.3% (28/441). OBI was identified in 21 anti-HBc positives (17.8%), as well as among those who lacked any HBV-specific serological markers (2.2%). Comparison with HIV/HBV co-infection revealed that the levels of CD4, ALT, and HBV DNA were significantly lower during occult infection. Discrete differences were also observed with respect to quasispecies divergence. Additionally, subgenotype D1 was most frequent in occult infection, while D2 was widespread during chronic infection. The majority (~90%) of occult D1 sequences had the sQ129R mutation in the surface gene. This study highlights several distinct features of OBI in India and underscores the need for additional HBV DNA screening in HIV-positive individuals.
[Mh] Termos MeSH primário: Doenças Transmissíveis/sangue
Infecções por HIV/sangue
Antígenos de Superfície da Hepatite B/sangue
Hepatite B/sangue
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Antígenos CD4/sangue
Doenças Transmissíveis/epidemiologia
Doenças Transmissíveis/virologia
DNA Viral/sangue
Feminino
HIV/patogenicidade
Infecções por HIV/epidemiologia
Infecções por HIV/virologia
Hepatite B/epidemiologia
Hepatite B/virologia
Anticorpos Anti-Hepatite B/sangue
Vírus da Hepatite B/patogenicidade
Seres Humanos
Índia/epidemiologia
Masculino
Meia-Idade
Sangue Oculto
Atenção Terciária à Saúde
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (CD4 Antigens); 0 (DNA, Viral); 0 (Hepatitis B Antibodies); 0 (Hepatitis B Surface Antigens)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170608
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0179035


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[PMID]:28547646
[Au] Autor:Zullow S; Jambaulikar G; Rustgi A; Quezada S; Cross RK
[Ad] Endereço:Department of Internal Medicine, Boston Medical Center, Boston University School of Medicine, 72 East Concord Street, Evans 124, Boston, MA, 02118, USA. Samantha.Zullow@bmc.org.
[Ti] Título:Risk Factors for Vitamin D Deficiency and Impact of Repletion in a Tertiary Care Inflammatory Bowel Disease Population.
[So] Source:Dig Dis Sci;62(8):2072-2078, 2017 Aug.
[Is] ISSN:1573-2568
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Many patients with inflammatory bowel disease (IBD) are vitamin D deficient. The purpose of our study was to identify risk factors for vitamin D deficiency in IBD and to assess the impact of vitamin D repletion on disease activity and quality of life (QOL). METHODS: Patients with at least one 25-OH vitamin D level measured between 2004 and 2011 were included. Patients with a level <30 ng/ml at baseline were followed until the time of repletion. QOL and disease activity scores were measured at baseline and repletion. RESULTS: A total of 255 patients were identified. 33, 29, and 39% had a vitamin D level of ≥30, 20-29, and <20 ng/ml, respectively. When adjusting for disease type and duration, gender, smoking, and race, non-Caucasians had 5.3 (2.3-12.3) and UC patients had a 0.59 (0.33-1.03) odds of having a vitamin D <30 ng/ml. Women were 1.7 times more likely to have a 25-OH vitamin D level <20 ng/ml than men. 55 patients underwent repletion. In CD patients, the HBI and SIBDQ prior to repletion was 5.5 ± 4.9 and 44.3 ± 16.4, respectively; these improved to 3.6 ± 3.4 and 48.6 ± 14.2 after repletion (p = 0.0154 and p = 0.0684). CONCLUSIONS: In this tertiary care IBD cohort, the majority of patients have low vitamin D levels. Non-Caucasian race and female gender are associated with low vitamin D. UC was associated with lower risk of vitamin D insufficiency. In CD, vitamin D repletion is associated with decreased disease activity and increased QOL.
[Mh] Termos MeSH primário: Colite Ulcerativa/complicações
Doença de Crohn/complicações
Suplementos Nutricionais
Deficiência de Vitamina D/etiologia
Vitamina D/administração & dosagem
Vitaminas/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Colite Ulcerativa/sangue
Grupos de Populações Continentais
Doença de Crohn/sangue
Feminino
Seres Humanos
Masculino
Meia-Idade
Qualidade de Vida
Estudos Retrospectivos
Fatores de Risco
Fatores Sexuais
Atenção Terciária à Saúde
Resultado do Tratamento
Vitamina D/análogos & derivados
Vitamina D/sangue
Deficiência de Vitamina D/sangue
Deficiência de Vitamina D/tratamento farmacológico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Vitamins); 1406-16-2 (Vitamin D); 64719-49-9 (25-hydroxyvitamin D)
[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:170527
[St] Status:MEDLINE
[do] DOI:10.1007/s10620-017-4614-y


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[PMID]:28500780
[Au] Autor:Khan T; Laul P; Laul A; Ramzan M
[Ad] Endereço:Department of Obstetrics and Gynaecology, Deen Dayal Upadhyay Hospital, New Delhi, India.
[Ti] Título:Prognostic factors of maternal near miss events and maternal deaths in a tertiary healthcare facility in India.
[So] Source:Int J Gynaecol Obstet;138(2):171-176, 2017 Aug.
[Is] ISSN:1879-3479
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To study maternal near miss (MNM) and maternal mortality to identify rectifiable risk factors. METHODS: The present cross-sectional retrospective study included pregnant women who experienced acute life-threatening pregnancy-related adverse events at Deen Dayal Upadhyay hospital, New Delhi, India, between September 1, 2009, and August 31, 2011. Patient data were analyzed to investigate factors associated with MNM events and maternal deaths. RESULTS: There were 369 patients included, and 302 MNM events and 67 maternal deaths were recorded. The recorded causes of MNM events included hemorrhage, hypertensive disorders, severe anemia with cardiac failure, organ failure, and infection in 192 (63.6%), 62 (20.5%), 13 (4.3%), 8 (2.6%), and 8 (2.6%) patients, respectively. Higher rates of anemia (P=0.007) and infection (P=0.007) were recorded among patients in the maternal death group than the MNMN group. CONCLUSION: Hemorrhage and hypertension were major causes of MNM events and are likely major barriers to reducing maternal mortality in low-income countries. Anemia and infection were significant prognostic factors of maternal death in the present study. MNM could be used as surrogate for maternal death in the provision of standard obstetric care.
[Mh] Termos MeSH primário: Morte Materna/estatística & dados numéricos
Mortalidade Materna
Near Miss/estatística & dados numéricos
Complicações na Gravidez/mortalidade
Atenção Terciária à Saúde/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estudos Transversais
Feminino
Seres Humanos
Índia/epidemiologia
Gravidez
Complicações na Gravidez/epidemiologia
Prognóstico
Estudos Retrospectivos
Fatores de Risco
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170514
[St] Status:MEDLINE
[do] DOI:10.1002/ijgo.12208


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[PMID]:28315666
[Au] Autor:Kozlowski AJ; Fabian M; Lad D; Delgado AD
[Ad] Endereço:Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY. Electronic address: allan.kozlowski@maryfreebed.com.
[Ti] Título:Feasibility and Safety of a Powered Exoskeleton for Assisted Walking for Persons With Multiple Sclerosis: A Single-Group Preliminary Study.
[So] Source:Arch Phys Med Rehabil;98(7):1300-1307, 2017 Jul.
[Is] ISSN:1532-821X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To examine the feasibility, safety, and secondary benefit potential of exoskeleton-assisted walking with one device for persons with multiple sclerosis (MS). DESIGN: Single-group longitudinal preliminary study with 8-week baseline, 8-week intervention, and 4-week follow-up. SETTING: Outpatient MS clinic, tertiary care hospital. PARTICIPANTS: Participants (N=13; age range, 38-62y) were mostly women with Expanded Disability Status Scale scores ranging from 5.5 to 7.0. INTERVENTION: Exoskeleton-assisted walk training. MAIN OUTCOME MEASURES: Primary outcomes were accessibility (enrollment/screen pass), tolerability (completion/dropout), learnability (time to event for standing, walking, and sitting with little or no assistance), acceptability (satisfaction on the device subscale of the Quebec User Evaluation of Satisfaction with Assistive Technology version 2), and safety (event rates standardized to person-time exposure in the powered exoskeleton). Secondary outcomes were walking without the device (timed 25-foot walk test and 6-minute walk test distance), spasticity (Modified Ashworth Scale), and health-related quality of life (Patient-Reported Outcomes Measurement and Information System pain interference and Quality of Life in Neurological Conditions fatigue, sleep disturbance, depression, and positive affect and well-being). RESULTS: The device was accessible to 11 and tolerated by 5 participants. Learnability was moderate, with 5 to 15 sessions required to walk with minimal assistance. Safety was good; the highest adverse event rate was for skin issues at 151 per 1000 hours' exposure. Acceptability ranged from not very satisfied to very satisfied. Participants who walked routinely improved qualitatively on sitting, standing, or walking posture. Two participants improved and 2 worsened on ≥1 quality of life domain. The pattern of spasticity scores may indicate potential benefit. CONCLUSIONS: The device appeared feasible and safe for about a third of our sample, for whom routine exoskeleton-assisted walking may offer secondary benefits.
[Mh] Termos MeSH primário: Exoesqueleto Energizado
Transtornos Neurológicos da Marcha/reabilitação
Esclerose Múltipla/reabilitação
Modalidades de Fisioterapia
Caminhada
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
Segurança
Atenção Terciária à Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170809
[Lr] Data última revisão:
170809
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170320
[St] Status:MEDLINE


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[PMID]:28253286
[Au] Autor:Prieto I; Del Puerto-Nevado L; Gonzalez N; Portal-Nuñez S; Zazo S; Corton M; Minguez P; Gomez-Guerrero C; Arce JM; Sanz AB; Mas S; Aguilera O; Alvarez-Llamas G; Esbrit P; Ortiz A; Ayuso C; Egido J; Rojo F; Garcia-Foncillas J; DiabetesCancerConnect Consortium
[Ad] Endereço:Radiation Oncology, Oncohealth Institute, IIS-Fundacion Jimenez Diaz- UAM, Madrid, Spain.
[Ti] Título:Colon cancer modulation by a diabetic environment: A single institutional experience.
[So] Source:PLoS One;12(3):e0172300, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Multiple observational studies suggest an increased risk of colon cancer in patients with diabetes mellitus (DM). This can theoretically be the result of an influence of the diabetic environment on carcinogenesis or the tumor biologic behavior. AIM: To gain insight into the influence of a diabetic environment on colon cancer characteristics and outcomes. MATERIAL AND METHODS: Retrospective analysis of clinical records in an academic tertiary care hospital with detailed analysis of 81 diabetic patients diagnosed of colon cancer matched with 79 non-diabetic colon cancer patients. The impact of streptozotocin-induced diabetes on the growth of colon cancer xenografts was studied in mice. RESULTS: The incidence of DM in 1,137 patients with colorectal cancer was 16%. The diabetic colon cancer cases and non-diabetic colon cancer controls were well matched for demographic and clinical variables. The ECOG Scale Performance Status was higher (worse) in diabetics (ECOG ≥1, 29.1% of controls vs 46.9% of diabetics, p = 0.02), but no significant differences were observed in tumor grade, adjuvant therapy, tumor site, lymphovascular invasion, stage, recurrence, death or cancer-related death. Moreover, no differences in tumor variables were observed between patients treated or not with metformin. In the xenograft model, tumor growth and histopathological characteristics did not differ between diabetic and nondiabetic animals. CONCLUSION: Our findings point towards a mild or negligible effect of the diabetes environment on colon cancer behavior, once cancer has already developed.
[Mh] Termos MeSH primário: Neoplasias do Colo/patologia
Complicações do Diabetes/patologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Animais
Carcinogênese
Proliferação Celular
Transformação Celular Neoplásica
Neoplasias do Colo/complicações
Neoplasias do Colo/epidemiologia
Complicações do Diabetes/epidemiologia
Progressão da Doença
Seres Humanos
Hiperglicemia/complicações
Masculino
Camundongos
Meia-Idade
Estudos Retrospectivos
Atenção Terciária à Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170824
[Lr] Data última revisão:
170824
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170303
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0172300



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