RESUMO
BACKGROUND: Cytomegalovirus (CMV) is a frequent infectious complication following solid organ transplantation (SOT). Considering significant differences in healthcare systems, a systematic review was conducted to describe the epidemiology, management, and burden of CMV post-SOT in selected countries outside of Europe and North America. METHODS: MEDLINE, Embase, and Cochrane databases were searched for observational studies in SOT recipients across 15 countries in the regions of Asia, Pacific, and Latin America (search period: January 1, 2011 to September 17, 2021). Outcomes included incidence of CMV infection/disease, recurrence, risk factors, CMV-related mortality, treatment patterns and guidelines, refractory and/or resistant CMV, patient-reported outcomes, and economic burden. RESULTS: Of 2708 studies identified, 49 were eligible (n = 43/49; 87.8% in adults; n = 34/49, 69.4% in kidney recipients). Across studies, selection of CMV preventive strategy was based on CMV serostatus. Overall, rates of CMV infection (within 1 year) and CMV disease post-SOT were respectively, 10.3%-63.2% (9 studies) and 0%-19.0% (17 studies). Recurrence occurred in 35.4%-41.0% cases (3 studies) and up to 5.3% recipients died of CMV-associated causes (11 studies). Conventional treatments for CMV infection/disease included ganciclovir (GCV) or valganciclovir. Up to 4.4% patients were resistant to treatment (3 studies); no studies reported on refractory CMV. Treatment-related adverse events with GCV included neutropenia (2%-29%), anemia (13%-48%), leukopenia (11%-37%), and thrombocytopenia (13%-24%). Data on economic burden were scarce. CONCLUSION: Outside of North America and Europe, rates of CMV infection/disease post-SOT are highly variable and CMV recurrence is frequent. CMV resistance and treatment-associated adverse events, including myelosuppression, highlight unmet needs with conventional therapy.
Assuntos
Infecções por Citomegalovirus , Leucopenia , Transplante de Órgãos , Adulto , Humanos , Citomegalovirus , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/epidemiologia , Europa (Continente)/epidemiologia , América do Norte/epidemiologia , Ganciclovir , Transplante de Órgãos/efeitos adversosRESUMO
The increasing world buffalo population, of which over 97% is concentrated in Asia, reflect the prominent role it plays in rural economy of the region through providing milk, meat and the draft work-force. In recent decades, buffalo farming has attracted increased attention in Mediterranean and Latin American countries as well as in the US and traditionally non-buffalo rearing European countries too. The increasing interest in buffalo rearing is primarily due to more desirable composition of buffalo milk in comparison to cow milk w.r.t. high milk fat content but low in cholesterol; higher total solids, SNF, proteins, calcium, phosphorus and calories per unit. Similarly, buffalo meat is also relished more due to its lean and low cholesterol properties. India is increasingly exporting buffalo meat with no scare of transmitting the dreaded mad-cow disease. Indian buffaloes account for more than half of the world buffalo population. With their population of over 98 millions, buffaloes contribute over 56% to Indias milk pool, much higher than the contribution of almost double the population of cattle. (AU)
Assuntos
Animais , Búfalos/crescimento & desenvolvimento , Controle da População , ÍndiaRESUMO
The increasing world buffalo population, of which over 97% is concentrated in Asia, reflect the prominent role it plays in rural economy of the region through providing milk, meat and the draft work-force. In recent decades, buffalo farming has attracted increased attention in Mediterranean and Latin American countries as well as in the US and traditionally non-buffalo rearing European countries too. The increasing interest in buffalo rearing is primarily due to more desirable composition of buffalo milk in comparison to cow milk w.r.t. high milk fat content but low in cholesterol; higher total solids, SNF, proteins, calcium, phosphorus and calories per unit. Similarly, buffalo meat is also relished more due to its lean and low cholesterol properties. India is increasingly exporting buffalo meat with no scare of transmitting the dreaded mad-cow disease. Indian buffaloes account for more than half of the world buffalo population. With their population of over 98 millions, buffaloes contribute over 56% to Indias milk pool, much higher than the contribution of almost double the population of cattle.