Navegando por Palavras-chave "risk"

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    Escore de avaliação de risco pré-transplante: metodologia e a importância das características socioeconômicas
    (Sociedade Brasileira de Nefrologia, 2014-09-01) Gusukuma, Luciana Wang; Tedesco-Silva Junior, Hélio [UNIFESP]; Pestana, Jose Osmar Medina [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Kidney transplantation is performed in emergency conditions in a population with high perioperative risk. Instruments for risk assessment before transplantation in this population are scarce. Objective: To develop a score with pretransplant variables to estimate the probability of success of kidney transplantation, defined as survival of the recipient and the graft with creatinine < 1.5 mg/dl at 6 months. Methods: Analysis of variables of patients from a unique kidney transplantation center in São Paulo. Logistic regression was used to construct an equation with variables able to estimate the probability of success. Integer points were assigned to variables for score construction. Results:Of the 305 patients analyzed, 176 (57.7%) achieved success. Of the 23 variables identified by univariate analysis, 21 were included in the logistic regression model and 10 that remained independently associated with success, were used in the score. Four of these 10 variables were socioeconomic. It was great (area under the ROC curve 0.817) the power of discrimination between groups success and not success and adequate (Hosmer and Lemeshow = 0.672) the agreement between frequencies of the probabilities estimated by equation and frequencies of probabilities actual observed. There were correlation (0.982) between the estimated probability via the scoring system and the estimated probabilities via logistic regression. Conclusion: Point score simplified risk stratification of transplant candidate according to their probability of success. Socioeconomic variables influence the success, demonstrating the need for creation of prognostic tools utilizing clinical and demographic variables of our population.
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    Escore para rastrear idosos (> 75 anos) de alto risco para doença arterial periférica
    (Sociedade Brasileira de Cardiologia - SBC, 2007-06-01) Makdisse, Marcia [UNIFESP]; Ramos, Luiz Roberto [UNIFESP]; Moreira, Frederico [UNIFESP]; Oliveira, Anderson [UNIFESP]; Berwanger, Otávio [UNIFESP]; Moscardi, Alcione [UNIFESP]; Junqueira, Virginia [UNIFESP]; Rodrigues, Evandro [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Israelita Albert Einstein
    BACKGROUND: The prevalence of peripheral arterial disease (PAD) in the elderly is high. Most are asymptomatic and the sensitivity of the physical exam is low. In Brazil, little is known in regard to PAD risk factors in the elderly. OBJECTIVES: To identify risk factors for PAD among elderly individuals (> 75 years) in the community and to develop a prediction score. METHODS: Cross-sectional, prospective, community-based study nested within a cohort study (Epidoso). A total of 176 individuals were assessed. PAD was defined as an ankle-brachial index <0.9. Risk factors associated with PAD were entered into a multivariate logistic regression model. Statistical modeling was used to formulate a score according to the likelihood of PAD. A p value <0.05 was significant. RESULTS: PAD was present in 36.4% of participants. Abnormal pedal pulses, hypertension, cigarette smoking, and complain of leg pain/discomfort in either leg on walking were predictors of PAD. Based on the coefficients of the logistic regression, these variables were given scores of 13, 9, 5 and 5, respectively. A cutoff point >18 points defined the high risk individuals and yielded sensitivity, specificity, positive predictive value and negative predictive value of 85.9%, 71.4%, 63.2% and 89.9%, respectively. Receiver-operator characteristic analysis yielded area under curve of 85%, indicating excellent discrimination and goodness-of-fit statistics indicated excellent calibration (p=0.639). CONCLUSION: Because of its good performance, the proposed score can become a simple and useful tool to identify elderly community residents at higher risk of PAD who should be considered for further investigation.
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    On the origin and timing of Zika virus introduction in Brazil
    (Cambridge Univ Press, 2017) Massad, E.; Burattini, Marcelo Nascimento [UNIFESP]; Khan, K.; Struchiner, C. J.; Coutinho, F. A. B.; Wilder-Smith, A.
    The timing and origin of Zika virus (ZIKV) introduction in Brazil has been the subject of controversy. Initially, it was assumed that the virus was introduced during the FIFA World Cup in June-July 2014. Then, it was speculated that ZIKV may have been introduced by athletes from French Polynesia (FP) who competed in a canoe race in Rio de Janeiro in August 2014. We attempted to apply mathematical models to determine the most likely time window of ZIKV introduction in Brazil. Given that the timing and origin of ZIKV introduction in Brazil may be a politically sensitive issue, its determination (or the provision of a plausible hypothesis) may help to prevent undeserved blame. We used a simple mathematical model to estimate the force of infection and the corresponding individual probability of being infected with ZIKV in FP. Taking into account the air travel volume from FP to Brazil between October 2013 and March 2014, we estimated the expected number of infected travellers arriving at Brazilian airports during that period. During the period between December 2013 and February 2014, 51 individuals travelled from FP airports to 11 Brazilian cities. Basing on the calculated force of ZIKV infection (the per capita rate of new infections per time unit) and risk of infection (probability of at least one new infection), we estimated that 18 (95% CI 12-22) individuals who arrived in seven of the evaluated cities were infected. When basic ZIKV reproduction numbers greater than one were assumed in the seven evaluated cities, ZIKV could have been introduced in any one of the cities. Based on the force of infection in FP, basic reproduction ZIKV number in selected Brazilian cities, and estimated travel volume, we concluded that ZIKV was most likely introduced and established in Brazil by infected travellers arriving from FP in the period between October 2013 and March 2014, which was prior to the two aforementioned sporting events.
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    Risk of symptomatic dengue for foreign visitors to the 2014 FIFA World Cup in Brazil
    (Fundaco Oswaldo Cruz, 2014-05-01) Massad, Eduardo; Wilder-Smith, Annelies; Ximenes, Raphael; Amaku, Marcos; Lopez, Luis Fernandez; Bezerra Coutinho, Francisco Antonio; Coelho, Giovanini Evelim; Silva, Jarbas Barbosa da; Struchiner, Claudio Jose; Burattini, Marcelo Nascimento [UNIFESP]; Universidade de São Paulo (USP); London Sch Hyg & Trop Med; Nanyang Univ; Florida Int Univ; Minist Saude; Fiocruz MS; Universidade Federal de São Paulo (UNIFESP)
    Brazil will host the FIFA World Cup T, the biggest single-event competition in the world, from June 12-July 13 2014 in 12 cities. This event will draw an estimated 600,000 international visitors. Brazil is endemic for dengue. Hence, attendees of the 2014 event are theoretically at risk for dengue. We calculated the risk of dengue acquisition to non-immune international travellers to Brazil, depending on the football match schedules, considering locations and dates of such matches for June and July 2014. We estimated the average per-capita risk and expected number of dengue cases for each host-city and each game schedule chosen based on reported dengue cases to the Brazilian Ministry of Health for the period between 2010-2013. On the average, the expected number of cases among the 600,000 foreigner tourists during the World Cup is 33, varying from 3-59. Such risk estimates will not only benefit individual travellers for adequate pre-travel preparations, but also provide valuable information for public health professionals and policy makers worldwide. Furthermore, estimates of dengue cases in international travellers during the World Cup can help to anticipate the theoretical risk for exportation of dengue into currently non-infected areas.
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    Spironolactone Versus Clonidine as a Fourth-Drug Therapy for Resistant Hypertension: The ReHOT Randomized Study (Resistant Hypertension Optimal Treatment)
    (Lippincott Williams & Wilkins, 2018) Krieger, Eduardo M.; Drager, Luciano F.; Giorgi, Dante M. A.; Pereira, Alexandre C.; Soares Barreto-Filho, Jose Augusto; Nogueira, Armando R.; Mill, Jose Geraldo; Lotufo, Paulo A.; Amodeo, Celso; Batista, Marcelo Costa [UNIFESP]; Bodanese, Luiz C.; Carvalho, Antonio Carlos [UNIFESP]; Castro, Iran; Chaves, Hilton; Costa, Eduardo A. S.; Feitosa, Gilson S.; Franco, Roberto J. S.; Fuchs, Flavio D.; Guimaraes, Armenio C.; Jardim, Paulo C.; Machado, Carlos Alberto [UNIFESP]; Magalhaes, Maria E.; Mion, Decio, Jr.; Nascimento, Raimundo M.; Nobre, Fernando; Nobrega, Antonio C.; Ribeiro, Antonio L. P.; Rodrigues-Sobrinho, Carlos R.; Sanjuliani, Antonio F.; Teixeira, Maria do Carmo B.; Krieger, Jose E.
    The aim of this study is to compare spironolactone versus clonidine as the fourth drug in patients with resistant hypertension in a multicenter, randomized trial. Medical therapy adherence was checked by pill counting. Patients with resistant hypertension (no office and ambulatory blood pressure [BP] monitoring control, despite treatment with 3 drugs, including a diuretic, for 12 weeks) were randomized to an additional 12-week treatment with spironolactone (12.5-50 mg QD) or clonidine (0.1-0.3 mg BID). The primary end point was BP control during office (<140/90 mmHg) and 24-h ambulatory (<130/80 mmHg) BP monitoring. Secondary end points included BP control from each method and absolute BP reduction. From 1597 patients recruited, 11.7% (187 patients) fulfilled the resistant hypertension criteria. Compared with the spironolactone group (n=95), the clonidine group (n=92) presented similar rates of achieving the primary end point (20.5% versus 20.8%, respectively
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    An Updated Systematic Review and Meta-analysis of the Predictive Value of Serum Biomarkers in the Assessment of Fever During Neutropenia in Children With Cancer
    (Lippincott Williams & Wilkins, 2013-10-01) Haeusler, Gabrielle M.; Carlesse, Fabianne [UNIFESP]; Phillips, Robert S.; Royal Childrens Hosp Melbourne; Peter MacCallum Canc Ctr; Universidade Federal de São Paulo (UNIFESP); Univ York; Leeds Teaching Hosp Trust
    Background: Fever during neutropenia (FN) is a frequent and potentially life-threatening complication of the treatment of childhood cancer. the role of biomarkers in predicting morbidity and mortality associated with FN in children has been explored with varying results. This systematic review identified, critically appraised and synthesized information on the use of biomarkers for the prediction of outcome of FN in children/young adults, updating a review of initial assessment and adding further analysis of their value at reassessment.Methods: This review was conducted in accordance with the Centre for Reviews and Dissemination Methods, using 3 different random effects meta-analysis models.Results: Thirty-seven studies involving over 4689 episodes of FN in children were assessed, including an additional 13 studies investigating 18 biomarkers in 1670 FN episodes since the original review. Meta-analysis was possible for admission C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 and interleukin-8 in their ability to detect significant infection. Marked heterogeneity exists, precluding clear clinical interpretation of the results. Qualitative synthesis of the role of serial biomarkers suggests their predictive ability may be more pronounced at 24 to 48 hours compared with admission. Direct comparisons of the discriminatory power of admission values of PCT and CRP showed PCT generally had a better discriminatory estimate of serious infection than CRP.Conclusions: There remains a paucity of robust and reproducible data on the use of biomarkers in prediction of serious infection in children with FN. Available evidence suggests PCT has better discriminatory ability than CRP and that the role of serial biomarkers warrants further study.