RESUMO
To analyze the possible association between serum uric acid (SUA) and nocturnal hypertension and to evaluate the ability of these variables (alone or in combination) to predict preeclampsia (PE) we conducted a historical cohort study in 532 high-risk pregnancies. Women were divided according to SUA values and nocturnal blood pressure (BP) into four groups: 1- normal SUA and nocturnal normotension; 2- high SUA and nocturnal normotension; 3- normal SUA and nocturnal hypertension and 4- high SUA and nocturnal hypertension. High SUA was defined by the top quartile values and nocturnal hypertension as BP ≥ 120/70 mmHg, using ambulatory blood pressure monitoring (ABPM), during nocturnal rest. Risks for PE were compared using logistic regression. SUA had a weak but significant correlation with daytime systolic ABPM (r = 0.11, p = 0.014), daytime diastolic ABPM (r = 0.13, p = 0.004), nighttime systolic ABPM (r = 0.16, p < 0.001) and nighttime diastolic ABPM (r = 0.18, p < 0.001). Also, all ABPM values were higher in women with high SUA. The absolute risk of PE increased through groups: 6.5%, 13.1%, 31.2%, and 47.9% for groups 1, 2, 3, and 4, respectively, p < 0.001. Compared with Group 1, Group 3 (OR 6.29 95%CI 3.41-11.60), but not Group 2 (OR 2.15 95%CI 0.88-5.24), had statistically significant higher risk for PE. Group 4 (women with both, high SUA and nocturnal hypertension) had the highest risk (OR 13.11 95%CI 6.69-25.70). Risks remained statistically significant after the adjustment for relevant variables. In conclusion, the combination of SUA > 4 mg/dL and nocturnal BP > 120/70 mmHg implies a very high risk to developed PE.
Assuntos
Ritmo Circadiano , Pré-Eclâmpsia , Ácido Úrico , Humanos , Feminino , Ácido Úrico/sangue , Gravidez , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/fisiopatologia , Pré-Eclâmpsia/epidemiologia , Adulto , Fatores de Risco , Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Gravidez de Alto Risco/sangue , Biomarcadores/sangue , Hipertensão/sangue , Hipertensão/fisiopatologia , Hipertensão/diagnóstico , Adulto Jovem , Modelos Logísticos , Medição de RiscoRESUMO
Breast cancer (BC) is one of the most common cancers in women worldwide and in Chile. Due to the lack of a Chilean national cancer registry, there is partial information on the status of BC in the country. We aim to estimate BC incidence and mortality rates by health care providers and regions for Chilean women. We used two public anonymized databases provided by the Ministry of Health: the national death and hospital discharges datasets. We considered a cohort of 58,254 and 16,615 BC hospital discharges and deaths for the period 2007-2018. New BC cases increased by 43.6%, from 3,785 in 2007 to 5,435 in 2018. Total BC deaths increased by 33.6% from 1,158 to 1,547 during the same period. Age-adjusted incidence rates were stable over time, with an average rate of 44.0 cases/100,000 women (SD 2.2). There were considerable differences in age-adjusted incidence rates among regions, with no clear geographical trend. Women affiliated to a private provider (ISAPRE) have an average age-adjusted incidence rate of 60.6 compared to 38.8 (both cases/100,000 women) for women affiliated with the public provider (FONASA). Age-adjusted mortality rates have an average of 10.5 cases/100,000 women (SD 0.4). This study shows important differences in incidence rates between private and publicly insured women, with no significant differences in mortality rates. Such differences may be associated with women's lifestyles, dietary compositions, comorbidities, and differences in healthcare systems. These hypotheses should be studied in greater depth. Additionally, differences in BC incidence found in this study compared to incidences reported from other estimations reinforce the need of a national cancer registry that should lead to more accurate indicators regarding BC in Chile.
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To analyze the relationship between the level of BP achieved with treatment and the risk for development of preeclampsia/eclampsia (PE), we conducted a historical cohort study on 149 consecutive pregnant women with treated chronic hypertension, evaluated between January 1, 2016, and November 31, 2022. According to office BP readings and ambulatory blood pressure monitoring (ABPM) performed after 20 weeks of gestation, the cohort was classified in controlled hypertension, white-coat uncontrolled hypertension, masked uncontrolled hypertension and sustained hypertension. Risks for the development of PE were estimated using logistic regression. One hundred and twenty-four pregnant women with a control BP evaluation were included in this analysis. The rates of PE were 19.4%, 27.3%, 44.8% and 47.1% for controlled, white-coat uncontrolled, masked uncontrolled and sustained uncontrolled hypertension, respectively. Compared with women with controlled hypertension, the relative risk for PE increased markedly in women with sustained uncontrolled (OR 3.69, 95% CI, 1.19-11.45) and masked uncontrolled (OR 3.38, 95% CI, 1.30-11.45) hypertension, but not in those with white-coat uncontrolled (OR 1.56 95% CI, 0.36-6.70); adjustment for covariates did not modify the results. Each mmHg higher of systolic and diastolic daytime ABPM increased the relative risk for PE ~4% and ~5%, respectively. Each mmHg higher of systolic and diastolic nocturnal BP increased the risk ~5% and ~6%, respectively. When these risks were adjusted for ABPM values in opposite periods of the day, only nocturnal ABPM remained as a significant predictor. In conclusion, masked uncontrolled hypertension implies a substantial risk for the development of PE, comparable to those of sustained uncontrolled. The presence of nocturnal hypertension seems important.
Assuntos
Eclampsia , Hipertensão , Hipertensão Mascarada , Pré-Eclâmpsia , Hipertensão do Jaleco Branco , Humanos , Feminino , Gravidez , Pressão Sanguínea/fisiologia , Pré-Eclâmpsia/epidemiologia , Monitorização Ambulatorial da Pressão Arterial , Gestantes , Estudos de Coortes , Hipertensão do Jaleco Branco/complicações , Hipertensão Mascarada/epidemiologiaRESUMO
This paper studies the updated estimation method for estimating the transmission rate changes over time. The models for the population dynamics under SEIR epidemic models with stochastic perturbations are analysed the dynamics of the COVID-19 pandemic in Bogotá, Colombia. We performed computational experiments to interpret COVID-19 dynamics using actual data for the proposed models. We estimate the model parameters and updated their estimates for reported infected and recovered data.
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COVID-19 , Humanos , COVID-19/epidemiologia , Colômbia/epidemiologia , Pandemias , Dinâmica PopulacionalRESUMO
There are several determinants of a population's health, including meteorological factors and air pollution. For example, it is well known that low temperatures and air pollution increase mortality rates in infant and elderly populations. With the emergence of SARS-COV-2, it is important to understand what factors contribute to its mitigation and control. There is some research in this area which shows scientific evidence on the virus's behavior in the face of these variables. This research aims to quantify the impact of climatic factors and environmental pollution on SARS-COV-2 specifically the effect on the number of new infections in different areas of Chile. At the local level, historical information available from the Department of Statistics and Health Information, the Chilean National Air Quality Information System, the Chilean Meteorological Directorate, and other databases will allow the generation of panel data suitable for the analysis. The results show the significant effect of pollution and climate variables measured in lags and will allow us to explain the behavior of the pandemic by identifying the relevant factors affecting health, using heteroskedastic models, which in turn will serve as a contribution to the generation of more effective and timely public policies for the control of the pandemic.
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Poluentes Atmosféricos , Poluição do Ar , COVID-19 , Humanos , Idoso , SARS-CoV-2 , Poluentes Atmosféricos/análise , Chile/epidemiologia , COVID-19/epidemiologia , Poluição do Ar/análise , Material Particulado/análiseRESUMO
The objectives of this study were 1-to evaluate the prevalence of masked chronic hypertension in pregnant women classified as gestational hypertension 2-to compare the risks of developing preeclampsia in true gestational hypertension vs those women classified as having gestational hypertension but who had had masked hypertension in the first half of pregnancy. We conducted a cohort study in consecutive high-risk pregnancies who were evaluated before 20 weeks of gestation. Women who developed gestational hypertension (normotension in the office before 20 weeks of gestation and office BP ≥ 140/90 mmHg and/or antihypertensive treatment in the second half of gestation) were divided, according to an ABPM performed before 20 weeks of pregnancy, in two subgroups: subgroup 1-if their ABPM was normal, and subgroup 2-if they had masked chronic hypertension. Risks for preeclampsia (PE) were estimated and compared with normotensive women. Before 20 weeks of gestation, 227 women were evaluated (age 32 ± 6 years, median gestation age 15 weeks); 67 had chronic hypertension (29.5%). Of the remaining 160, 39 developed gestational hypertension (16 in subgroup 1 and 23 insubgroup 2. Compared with normotensive pregnant women, subgroup 1 of women with gestational hypertension did not increase the risk of developing PE (OR = 0.76, 95% CI = 0.16-6.65). Conversely, subgroup 2 of gestational hypertension increased the risk of PE more than 4 times (0R = 4.47 CI = 1.16-12.63). Risk estimation did not change substantially after the adjustment for multiple possible confounders. In conclusion, the59% of women initially diagnosed as gestational hypertensive according to current recommendations had masked chronic hypertension and a very high risk of developing PE.
Assuntos
Hipertensão Induzida pela Gravidez , Hipertensão , Hipertensão Mascarada , Pré-Eclâmpsia , Feminino , Gravidez , Humanos , Adulto , Lactente , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/epidemiologia , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/epidemiologia , Hipertensão Mascarada/diagnóstico , Hipertensão Mascarada/epidemiologia , Estudos de Coortes , Hipertensão/diagnóstico , Pressão SanguíneaRESUMO
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a group of viruses that provoke illnesses ranging from the common cold to more serious illnesses such as pneumonia. COVID-19 started in China and spread rapidly from a single city to an entire country in just 30 days and to the rest of the world in no more than 3 months. Several studies have tried to model the behavior of COVID-19 in diverse regions, based on differential equations of the SIR and stochastic SIR type, and their extensions. In this article, a statistical analysis of daily confirmed COVID-19 cases reported in eleven different cities in Europe and America is conducted. Log-linear models are proposed to model the rise or drop in the number of positive cases reported daily. A classification analysis of the estimated slopes is performed, allowing a comparison of the eleven cities at different epidemic peaks. By rescaling the curves, similar behaviors among rises and drops in different cities are found, independent of socioeconomic conditions, type of quarantine measures taken, whether more or less restrictive. The log-linear model appears to be suitable for modeling the incidence of COVID-19 both in rises and drops.
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COVID-19 , Humanos , COVID-19/epidemiologia , SARS-CoV-2 , Cidades/epidemiologia , Quarentena , Europa (Continente)/epidemiologia , China/epidemiologiaRESUMO
Seriously ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and hospitalized in intensive care units (ICUs) are commonly given a combination of drugs, a process known as multi-drug treatment. After extracting data on drug-drug interactions with clinical relevance from available online platforms, we hypothesize that an overall interaction map can be generated for all drugs administered. Furthermore, by combining this approach with simulations of cellular biochemical pathways, we may be able to explain the general clinical outcome. Finally, we postulate that by applying this strategy retrospectively to a cohort of patients hospitalized in ICU, a prediction of the timing of developing acute kidney injury (AKI) could be made. Whether or not this approach can be extended to other diseases is uncertain. Still, we believe it represents a valuable pharmacological insight to help improve clinical outcomes for severely ill patients.
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Injúria Renal Aguda , Tratamento Farmacológico da COVID-19 , Injúria Renal Aguda/tratamento farmacológico , Interações Medicamentosas , Humanos , Unidades de Terapia Intensiva , Estudos Retrospectivos , SARS-CoV-2RESUMO
To test the hypothesis that nocturnal hypertension identifies risk for early-onset preeclampsia/eclampsia (PE), we conducted an historical cohort study of consecutive high-risk pregnancies between 1st January 2016 and 31st March 2020. Office blood pressure (BP) measurements and ambulatory blood pressure monitoring (ABPM) were performed. The cohort was divided into patients without PE or with early- or late-onset PE (<34 and ≥34 weeks of gestation, respectively). The relative risks of office and ABPM hypertension for the development of late- or early-onset PE were estimated with multinomial logistic regression using no PE as a reference category. Four hundred and seventy-seven women (mean age 30 ± 7 years, with 23 ± 7 weeks of gestation at the time of the BP measurements) were analyzed; 113 (23.7%) developed PE, 69 (14.5%) developed late-onset PE, 44 (9.2%) developed early-onset PE. Office and ambulatory BP increased between the groups, and women who developed early-onset PE had significantly higher office and ambulatory BP values than those with late-onset PE or without PE. Hypertension prevalence increased across groups, with the highest values in early-onset PE. Nocturnal hypertension was the most prevalent finding and was highly prevalent in women who developed early-onset PE (88.6%); only 1.6% of women without nocturnal hypertension developed early-onset PE. Additionally, nocturnal hypertension was a stronger predictor for early-onset PE than for late-onset PE (adjusted OR, 5.26 95%CI 1.67-16.60) vs. 2.06, 95%CI 1.26-4.55, respectively). In conclusion, nocturnal hypertension was the most frequent BP abnormality and a significant predictor of early-onset PE in high-risk pregnancies.
Assuntos
Hipertensão , Pré-Eclâmpsia , Adulto , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Estudos de Coortes , Feminino , Humanos , Hipertensão/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Gravidez de Alto Risco , Adulto JovemRESUMO
In this paper, we discuss the basic reproduction number of stochastic epidemic models with random perturbations. We define the basic reproduction number in epidemic models by using the integral of a function or survival function. We study the systems of stochastic differential equations for SIR, SIS, and SEIR models and their stability analysis. Some results on deterministic epidemic models are also obtained. We give the numerical conditions for which the disease-free equilibrium point is asymptotically stable.