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- ItemSomente MetadadadosBone Mass Outcomes in Patients With Osteoporosis Treated With Risedronate After Alendronate Failure: a 12-Month Follow-Up Study(Elsevier Science Inc, 2017) Mendonca, Leonardo Teixeira [UNIFESP]; Pinheiro, Marcelo Medeiros [UNIFESP]; Szejnfeld, Vera Lucia [UNIFESP]; Castro, Charlles Heldan de Moura [UNIFESP]Oral bisphosphonates are the drugs most frequently used for the treatment of osteoporosis. Clinicians usually switch between these drugs in clinical practice based on differences in efficacy. We aim to investigate the reasons associated with switching between oral bisphosphonates and to evaluate bone mass response and the incidence of fractures 12 mo after the exchange in a cohort of patients with osteoporosis seen at a tertiary hospital. Patients with osteoporosis who switched between oral bisphosphonates between January 2007 and December 2014 were included. Bone mass measured by dual-energy X-ray absorptiometry and the incidence of fracture were evaluated. A total of 112 patients (73.1 yr old on average, 95.5% women, 98% postmenopausal) were included. All patients were taking alendronate at the time of the switch to risedronate. In 91 patients (81.3%), the following reasons for the exchange of medication were identified: bone loss (59.8%), adverse events (11.6%), and recent fragility fracture (10.7%). One year after the switch, bone densitometry revealed bone loss in 51 patients (45.5%), bone mass maintenance in 34 (30.4%), and bone mass gain in 27 (24.1%). No new vertebral fracture was detected and no nonvertebral fracture was reported in 12 mo of follow-up. Bone mass outcomes (gain, loss, or maintenance) were not associated with the reason for switching between oral bisphosphonates. Similarly, none of the parameters evaluated could predict good densitometric response (gain or maintenance) in this scenario. Our findings suggest that the use of risedronate should not be recommended in the scenario of treatment failure or adverse events following the use of alendronate.
- ItemSomente MetadadadosLiver retransplantation: A model for determining long-term survival(Lippincott Williams & Wilkins, 2006-04-15) Linhares, M. M.; Azoulay, D.; Matos, D.; Castelo, A.; Trivino, T.; Goldenberg, A.; Castaing, D.; Adam, R.; Delvart, V; Ichai, P.; Saliba, F.; Lemoine, A.; Samuel, D.; Bismuth, H.; Universidade Federal de São Paulo (UNIFESP); Hop Paul Brousse; Univ Paris SudBackground. Because of the worse results from retransplantation in relation to the initial liver transplantation, there is a need to refine the indication for retransplantation, such that fair distribution of this benefit is obtained.Methods. This was a Study of 139 patients who underwent liver retransplantation. Thirty variables were studied: 18 relating to the recipient and 12 to the donor. All the independent variables were initially compared with the length of survival using univariate analyses. Variables presenting significance were compared with the dependent variable of length of survival, to determine which factors were related to longer survival among patients, when evaluated together.Results. A multivariate model for determining long-term survival among patients with retransplants was built up using the following variables: recipient's age, creatinine, urgency of retransplantation and early failure of the first graft. Through this multivariate model it was possible to determine a score that was categorized according to tertile distributions (below the 33rd percentile, score < 24; 33rd to 66th percentile, 24 <= score <= 32; above the 66th percentile, score > 32). One-year, 3-year, and 5-year patient survival rates following retransplantation were respectively 85%, 82%, and 77% for scores < 24; 69%, 66%, and 61% for scores between 24 and 32; and 21%, 19%, and 16% for scores > 32 (P < 0.0001).Conclusion. the variables of recipient's age, creatinine, urgency of retransplantation, and early failure of the initial transplantation were factors that were independently related to the long-term survival of patients with liver retransplants.