RESUMO
INTRODUCTION: The prevalence of pathologies that generate chronic pain is high (10-40%), as is the use of opioids. In Colombia, these drugs rank among the first in terms of prescriptions and the number of deaths related to their consumption is rising (0.71/1,000,000 inhabitants). This study seeks to characterise opioid-related problems (ORP) and the variables associated with their resolution. MATERIALS AND METHODS: It is a study based on secondary information. Incidences were calculated using Ministry of Health data and characteristics related to non-recoverable adverse reactions (ADRs) were determined. RESULTS: Altogether 4,437 problems were identified in 3,063 patients (39.51%, male), adults (45 years old; IQR: 29-62). The most common opioids were tramadol (46.49%, 5 mg; IQR: 5-5) and morphine (19.65%, 3 mg; IQR: 2.6-5). The majority of ORP were ADRs (93.15%) and of these, 32.28% were severe. Women had proportionally more gastrointestinal and neurological disorders, while men had a higher frequency of vascular, psychiatric, urinary and haematological problems (p < 0.05). These reactions did not resolve in 8.39%, and prognosis was associated with oral administration - odds ratio (OR): 9.24; 95% confidence interval (CI 95%): 6.36-13.42; severity (OR: 3.96; CI 95%: 2.71-5.76); age (OR: 1.01; CI 95%: 1.001-1.01); weak opioids (OR: 0.57; CI 95%: 0.4-0.84); and neurological-cardiovascular reactions (OR: 0.36; CI 95%: 0.21-0.61). CONCLUSIONS: Interventions to optimise the prescription of opioids should be encouraged to prevent ADRs with poor prognosis. Studies should be conducted to further investigate the impact of gender and route of administration on the occurrence of ADRs, as well as the severity of skin and gastrointestinal problems, which may be underestimated.
TITLE: Problemas y reacciones adversas relacionadas con analgésicos opioides en Colombia.Introducción. Las patologías que generan dolor crónico tienen alta prevalencia (10-40%), así como el consumo de opioides. En Colombia, estos medicamentos ocupan los primeros lugares de prescripción y existe un incremento en las muertes relacionadas con su consumo (0,71/1.000.000 habitantes). Este estudio busca caracterizar los problemas relacionados con opioides (PRM) y las variables asociadas con su resolución. Materiales y métodos. Es un estudio basado en información secundaria. Se calcularon las incidencias con datos del Ministerio de Salud y se determinaron las características relacionadas con reacciones adversas (RAM) no recuperables. Resultados. Se identificaron 4.437 problemas en 3.063 pacientes (39,51%, hombres), adultos (45 años; RIC: 29-62). Los opioides más comunes fueron tramadol (46,49%, 5 mg; RIC: 5-5) y morfina (19,65%, 3 mg; RIC: 2,6-5). La mayoría de los PRM fueron RAM (93,15%), y de éstas, el 32,28% fueron graves. Las mujeres presentaron proporcionalmente más alteraciones gastrointestinales y neurológicas, mientras que los hombres tuvieron una mayor frecuencia de problemas vasculares, psiquiátricos, urinarios y hematológicos (p menor de 0,05). Estas reacciones no se resolvieron en el 8,39% y el pronóstico se asoció con la administración oral odds ratio (OR): 9,24; intervalo de confianza al 95% (IC 95%): 6,36-13,42, gravedad (OR: 3,96; IC 95%: 2,71-5,76), edad (OR: 1,01; IC 95%: 1,001-1,01), opioides débiles (OR: 0,57; IC 95%: 0,4-0,84) y reacciones neurológicas-cardiovasculares (OR: 0,36; IC 95%: 0,21-0,61). Conclusiones. Se sugiere fomentar intervenciones para optimizar la prescripción de opioides y así prevenir RAM con pobre pronóstico. Deben realizarse estudios que profundicen en el impacto del sexo y la vía de administración sobre la ocurrencia de RAM, así como la gravedad de los problemas cutáneos y gastrointestinales, que podría subestimarse.
Assuntos
Analgésicos Opioides/efeitos adversos , Adulto , Idoso , Colômbia/epidemiologia , Feminino , Gastroenteropatias/induzido quimicamente , Gastroenteropatias/epidemiologia , Doenças Hematológicas/induzido quimicamente , Doenças Hematológicas/epidemiologia , Humanos , Incidência , Masculino , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/induzido quimicamente , Doenças do Sistema Nervoso/epidemiologia , Manejo da Dor , Estudos Retrospectivos , Transtornos Urinários/induzido quimicamente , Transtornos Urinários/epidemiologia , Doenças Vasculares/induzido quimicamente , Doenças Vasculares/epidemiologia , Adulto JovemRESUMO
BACKGROUND: The Texas/Chihuahua (US/Mexico) border is a medically underserved region with many reported barriers for health care access. Although Hispanic ethnicity is associated with health disparities for many different diseases, the population-based estimates of incidence and survival for patients with blood cancer along the border are unknown. The authors hypothesized that Hispanic ethnicity and border proximity is associated with poor blood cancer outcomes. METHODS: Data from the Texas Cancer Registry (1995-2016) were used to investigate the primary exposures of patient ethnicity (Hispanic vs non-Hispanic) and geographic location (border vs non-border). Other confounders and covariates included sex, age, year of diagnosis, rurality, insurance status, poverty indicators, and comorbidities. The Mantel-Haenszel method and Cox regression analyses were used to determine adjusted effects of ethnicity and border proximity on the relative risk (RR) and survival of patients with different blood cancer types. RESULTS: Hispanic patients were diagnosed at a younger age than non-Hispanic patients and presented with increased comorbidities. Whereas non-Hispanics had a higher incidence of developing blood cancer compared with Hispanics overall, Hispanics demonstrated a higher incidence of acute lymphoblastic leukemia (RR, 1.92; 95% CI, 1.79-2.08; P < .001) with worse outcomes. Hispanics from the Texas/Chihuahua border demonstrated a higher incidence of chronic myeloid leukemia (RR, 1.28; 95% CI, 1.07-1.51; P = .02) and acute myeloid leukemia (RR, 1.17; 95% CI, 1.04-1.33; P = .0009) compared with Hispanics living elsewhere in Texas. CONCLUSIONS: Hispanic ethnicity and border proximity were associated with a poor presentation and an adverse prognosis despite the younger age of diagnosis. Future studies should explore differences in disease biology and treatment strategies that could drive these regional disparities.
Assuntos
Doenças Hematológicas/etnologia , Hispânico ou Latino , Área Carente de Assistência Médica , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Acessibilidade aos Serviços de Saúde , Doenças Hematológicas/epidemiologia , Doenças Hematológicas/mortalidade , Humanos , Incidência , Cobertura do Seguro , Leucemia Mielogênica Crônica BCR-ABL Positiva/epidemiologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/etnologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/mortalidade , Leucemia Mieloide Aguda/epidemiologia , Leucemia Mieloide Aguda/etnologia , Leucemia Mieloide Aguda/mortalidade , Leucemia Promielocítica Aguda/epidemiologia , Leucemia Promielocítica Aguda/etnologia , Leucemia Promielocítica Aguda/mortalidade , Masculino , México/etnologia , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/epidemiologia , Síndromes Mielodisplásicas/etnologia , Síndromes Mielodisplásicas/mortalidade , Transtornos Mieloproliferativos/epidemiologia , Transtornos Mieloproliferativos/etnologia , Transtornos Mieloproliferativos/mortalidade , Pobreza , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/etnologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Sistema de Registros , Análise de Regressão , População Rural , Fatores Sexuais , Texas , Adulto JovemRESUMO
Since the first evidence of human parvovirus B19 (B19V) infection in late 80s, several studies have been conducted to clarify the spectrum of clinical diseases in Brazil. B19V infection is prevalent in the general population and has exhibited a cyclical pattern of occurrence every 4-5 years, with the predominance of genotype 1 over 3b. During epidemic periods the wide range of clinical conditions, such as ertythema infectiosum, arthropathy, transient aplastic crisis, nonimmune hydrops fetalis and B19V-hepatitis were diagnosed. However, many infections are likely asymptomatic or have a self-limiting clinical course and are not readly diagnosed. Besides, the similarity of the symptoms of ertythema infectiosum to other rash diseases and the broadly circulation of arboviruses makes differential diagnosis more difficult. In this article, we provide a historical comprehensive overview of the research on parvovirus B19 conducted in Brazil, with a focus on the clinical and epidemiological aspects of the infection.
Assuntos
Infecções por Parvoviridae/virologia , Parvovirus B19 Humano/fisiologia , Brasil/epidemiologia , Doenças Hematológicas/diagnóstico , Doenças Hematológicas/epidemiologia , Doenças Hematológicas/virologia , Humanos , Artropatias/diagnóstico , Artropatias/epidemiologia , Artropatias/virologia , Infecções por Parvoviridae/diagnóstico , Infecções por Parvoviridae/epidemiologia , Parvovirus B19 Humano/classificação , Parvovirus B19 Humano/genética , Parvovirus B19 Humano/isolamento & purificaçãoRESUMO
Invasive fungal disease (IFD) is frequent in patients with haematologic malignancies and in recipients of haematopoietic cell transplantation (HCT). An epidemiologic study conducted in Brazil reported a high incidence of IFD in haematologic patients, and invasive fusariosis was the leading IFD. A limitation of that study was that galactomannan was not available for at least half of the study period. In order to characterise the epidemiology and burden of IFD in three cohorts, HCT, acute myeloid leukaemia (AML) or myelodysplasia (MDS), and acute lymphoid leukaemia (ALL), we conducted a prospective multicentre cohort study in four haematologic Brazilian centres. From August 2015 to July 2016, all patients receiving induction chemotherapy for newly diagnosed or relapsed AML, MDS or ALL, and all HCT recipients receiving conditioning regimen were followed during the period of neutropenia following chemotherapy or the conditioning regimen. During a 1-year period, 192 patients were enrolled: 122 HCT recipients (71 allogeneic, 51 autologous), 46 with AML, and 24 with ALL. The global incidence of IFD was 13.0% (25 cases, 11 proven and 14 probable). Invasive aspergillosis (14 cases) was the leading IFD, followed by candidemia (6 cases) and fusariosis (3 cases). The incidence of IFD was 26.1% in AML/MDS, 16.7% in ALL, 11.3% in allogeneic HCT, and 2.0% in autologous HCT. The burden of IFD in haematologic patients in Brazil is high, with a higher frequency in AML and ALL. Invasive aspergillosis is the leading IFD, followed by invasive candidiasis and fusariosis.
Assuntos
Doenças Hematológicas/complicações , Infecções Fúngicas Invasivas/epidemiologia , Adolescente , Adulto , Idoso , Antifúngicos/uso terapêutico , Brasil/epidemiologia , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Feminino , Doenças Hematológicas/epidemiologia , Doenças Hematológicas/microbiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Incidência , Lactente , Infecções Fúngicas Invasivas/classificação , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transplantados/estatística & dados numéricos , Transplante Autólogo/efeitos adversos , Adulto JovemRESUMO
Costa Rica undertakes continuous efforts to recover the native population of macaw species through rehabilitation programs for breeding and releasing birds in protected areas. In the summer of 2018, a total of 107 scarlet (Ara macao) and 93 great green (Ara ambigua) macaws were sampled in four wildlife rehabilitation centers in Costa Rica. Fecal samples representing 200 individuals were analyzed for intestinal parasites, and 23 individuals were sampled for hemoparasites. Ascaridia and Capillaria were found in fecal samples. No hemoparasites were found. The distribution of percentage of infection was analyzed by location, species, and housing type. As part of a health screening prior to release, parasitological examination is recommended.
Assuntos
Doenças das Aves/epidemiologia , Doenças Hematológicas/veterinária , Enteropatias Parasitárias/epidemiologia , Papagaios , Animais , Animais Selvagens , Doenças das Aves/parasitologia , Costa Rica/epidemiologia , Doenças Hematológicas/epidemiologia , Doenças Hematológicas/parasitologia , Incidência , Enteropatias Parasitárias/parasitologia , Prevalência , Especificidade da EspécieAssuntos
Anestesia em Procedimentos Cardíacos/normas , COVID-19/terapia , Procedimentos Cirúrgicos Cardíacos/normas , Doenças Hematológicas/terapia , Assistência Perioperatória/normas , Contagem de Células Sanguíneas/normas , Coagulação Sanguínea/fisiologia , COVID-19/epidemiologia , Doenças Hematológicas/sangue , Doenças Hematológicas/epidemiologia , HumanosRESUMO
Exposure to pesticides by the rural population is increasing worldwide. Pesticides can induce the development of different diseases such as cancer and diseases of the central nervous system. This study analysed the clinical symptoms and haematological changes of a rural population in Conceição do Castelo, Espirito Santo, Brazil. For evaluation of symptomatology exposure to pesticides, 142 rural workers were interviewed. Of these, 22 workers were selected for haematological tests randomly as to evaluate haematological changes during the period of exposure to pesticides. Haematological analyses showed that erythrocytes, haemoglobin, haematocrit, mean corpuscular (VCM) volume, mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) are in accordance with the reference intervals in haematology. Variations in the concentrations of rods and neutrophils indicates that exposure to pesticides increases the amount of those cells. Haematological disorders in rural workers exposed to pesticides can be correlated with reported symptoms. The results described in this study are relevant to the health public and reinforce the concern about the indiscriminate use of pesticides.
Assuntos
Doenças Hematológicas/epidemiologia , Exposição Ocupacional/efeitos adversos , Praguicidas/toxicidade , População Rural , Adolescente , Adulto , Brasil/epidemiologia , Índices de Eritrócitos , Feminino , Doenças Hematológicas/etiologia , Testes Hematológicos , Hemoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Abstract Exposure to pesticides by the rural population is increasing worldwide. Pesticides can induce the development of different diseases such as cancer and diseases of the central nervous system. This study analysed the clinical symptoms and haematological changes of a rural population in Conceição do Castelo, Espirito Santo, Brazil. For evaluation of symptomatology exposure to pesticides, 142 rural workers were interviewed. Of these, 22 workers were selected for haematological tests randomly as to evaluate haematological changes during the period of exposure to pesticides. Haematological analyses showed that erythrocytes, haemoglobin, haematocrit, mean corpuscular (VCM) volume, mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) are in accordance with the reference intervals in haematology. Variations in the concentrations of rods and neutrophils indicates that exposure to pesticides increases the amount of those cells. Haematological disorders in rural workers exposed to pesticides can be correlated with reported symptoms. The results described in this study are relevant to the health public and reinforce the concern about the indiscriminate use of pesticides.
Resumo A exposição a pesticidas pela população rural está crescendo em todo o mundo. Os pesticidas podem induzir o desenvolvimento de diferentes doenças, como o cancer e as do sistema nervoso central. Este estudo analisou os sintomas clínicos e alterações hematológicas de uma população rural em Conceição do Castelo, Espírito Santo, Brasil. Para a avaliação da exposição a pesticidas e sintomatologias, 142 trabalhadores rurais foram entrevistados. Destes, 22 trabalhadores foram selecionados de randomicamente para testes hematológicos e avaliação de alterações hematológicas durante o período de exposição a pesticidas. Análises hematológicas mostraram que eritrócitos, hemoglobina, hematócrito, volume corpuscular médio (VCM), hemoglobina corpuscular média (HCM), concentração de hemoglobina corpuscular média (CHCM) estão em conformidade com os intervalos de referência. As variações nas concentrações de bastonetes e neutrófilos indicam que a exposição a pesticidas aumenta a quantidade dessas células. Alterações hematológicas em trabalhadores rurais expostos a pesticidas podem ser correlacionados com alguns sintomas relatados. Os resultados descritos neste estudo são relevantes para a saúde pública e para reforçar a preocupação com o uso indiscriminado de pesticidas.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Praguicidas/toxicidade , População Rural , Exposição Ocupacional/efeitos adversos , Doenças Hematológicas/epidemiologia , Brasil/epidemiologia , Hemoglobinas/análise , Índices de Eritrócitos , Doenças Hematológicas/etiologia , Testes Hematológicos , Pessoa de Meia-IdadeRESUMO
AIMS: Despite their overall favourable safety profile, tyrosine kinase inhibitors (TKIs) are related to severe adverse events including haematological toxicities such as anaemia, leucopenia, neutropenia and thrombocytopenia. We designed a systematic review and network meta-analysis of randomised controlled trials to compare safety among TKIs (bosutinib, dasatinib, imatinib, nilotinib, ponatinib and radotinib) used by patients diagnosed with chronic myeloid leukaemia. METHODS: We obtained data from the PubMed, Scopus, Web of Science, and SciELO databases. The Bayesian approach was used for direct and indirect comparisons, and the treatments were ranked by the surface under the cumulative ranking curve (SUCRA). RESULTS: Seventeen studies were included in the network meta-analysis. Our data show that dasatinib was generally considered worse than the other TKIs, with SUCRA values ââfor 140 mg dasatinib of 90.3% for anaemia, 87.4% for leucopenia, 90.6% for neutropenia and 97.2% for thrombocytopenia. In addition, nilotinib was shown to be safer, with SUCRA values ââfor 600 and 800 mg doses of 21.9 and 35.8% for anaemia, 23.8 and 14.6% for leucopenia, 33.0 and 17.7% for neutropenia, and 28.7 and 32.6% for thrombocytopenia, respectively. CONCLUSION: Dasatinib appeared as the least safe drug for chronic myeloid leukaemia, probably because it binds to multiple key kinase targets, being more prone to cause serious haematological adverse events. Nilotinib demonstrated a safer profile, mostly due to its selective binding capacity.