ESRD patients without co-morbid risk factors at the start of haemodialysis are ideal as survival comparison population.
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BACKGROUND: Our aim was to identify co-morbid risk factors in ESRD patients at the start of the treatment, to select patients in the low-risk group (LRG) and to compare overall survival, adjusted overall survival and LRG survival in three centres (A, B and C). METHODS: Population includes 531 patients entering haemodialysis from 1 January 1981 to 31 December 1996 (mean age 59.6 +/- 16.7 years). Demographics and co-morbidity data collected at the start of HD were independent variables for the analysis. Univariate and multivariate analysis of survival were used to identify significant prognostic factors (Kaplan-Meier and Cox hazard regression model respectively). According to this analysis the LRG was defined by the absence of the identified significant mortality risk factors except age. RESULTS: The overall median survival was 7.92 years, with 92.0% survival at 1 year, 65.2% at 5 years and 40.4% at 10 years. The median survival in centre C (10.83 years) was significantly higher than median survival in centre A (7.0 years) and in centre B (7.83 years). Centres A and B were afterwards analysed together (A-B). In the multivariate analysis, five variables (starting age, diabetes, cancer, smoking habit, and arteriosclerotic heart disease) were associated with survival. The variable centre (A-B or C) was not significant. The adjusted survival curve for centres A-B and C were not different. The LRG included patients of any age, without diabetes, cancer, smoking habit, and arteriosclerotic heart disease. The frequency of the patients in the LRG was 66.3% in centre C and 45.7% in centre A-B (P = 0.0004). Taking into account only the LRG, the survival comparison between centres A-B and C, did not show significant differences (P = 0.196). CONCLUSIONS: We conclude that for purposes of comparison of mortality in ESRD, low-risk population is better than overall ESRD population. (+info)
Evidence of increasing diversification of hepatitis C viruses.
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Hepatitis C virus (HCV) has high genomic variability and, since its discovery, at least six different types and an increasing number of sub-types have been reported. The HCV genotype may influence virus replication, the natural course of disease and the response to therapy. HCV has been described as a dynamic population of heterogeneous, closely related variants, designated quasispecies. In order to study the degree of genetic variability of strains isolated in Montevideo, Uruguay, sequence data obtained from the 5' non-coding region of type 1-infected patients were compared with published sequences from 53 different strains of all types isolated all over the world. The phylogenetic analysis revealed that type 1 strains isolated in Montevideo represent a different genetic lineage from major sub-types 1a and 1b strains and indicates an increasing diversification of HCV viruses. (+info)
Foods, nutrients and prostate cancer: a case-control study in Uruguay.
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A case-control study of diet and prostate cancer was conducted in Montevideo, Uruguay involving 175 cases and 233 controls. When the highest quartile of intake was compared with the lowest, positive findings were obtained for red meat intake (OR 2.0, 95% CI 1.1-3.8), desserts (OR 1.8, 95% CI 0.9-3.3), total energy (OR 1.9, 95% CI 1.0-3.4) and total fat intake (OR 1.8, 95% CI 0.9-3.4). On the other hand, vegetables and fruits (OR 0.5, 95% CI 0.3-0.9), vitamin C (OR 0.4, 95% 0.2-0.8) and vitamin E (OR 0.6, 95% CI 0.3-1.1) were associated with reduced risks of prostate cancer. Possible mechanisms are discussed. (+info)
New uses of legacy systems: examples in perinatal care.
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In this article, new uses of the Perinatal Information System at the Uruguayan Social Security health care facilities are described. The perinatal information system has been in place for over 13 years, with about 40 thousand clinical records on electronic files. A newly created Web interface allows a distributed access to existing perinatal information within the National Social Security Wide Area a Network. Perinatal data is also exported to a management information system, allowing to dynamically answer questions and make managerial decisions, and eventually link these data with other sources. Future steps regarding clinical information systems are outlined. (+info)
Comparison of survival for haemodialysis patients vs renal transplant recipients treated in Uruguay.
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BACKGROUND: Our aim was to compare survival among renal transplant recipients and haemodialysis patients treated in Uruguay. METHODS: All the patients transplanted in Uruguay (n=460) and all the patients who started haemodialysis (HD) in three centres in Uruguay (n=695) from 01 January 1981 to 31 December 1998 were included. Overall survival, adjusted survival and survival of the patients in the low-risk group were compared for HD patients and renal transplant recipients. Diabetic and non-diabetic patients were considered independently. The low-risk group was defined by the absence of any significant risk factor related to mortality on the Cox proportional hazard regression model (age more than 55 years at start of HD, previous history of diabetes, heart disease, cancer, and smoking habit). The significant variables were also used to adjust the survival curve. RESULTS: Overall survival was significantly greater in renal transplant recipients (P<0.0001). One-, five- and ten-year survival rates were 95.2, 88.0 and 78.8% for renal transplant recipients and 90.6, 62.7 and 39.8% for HD patients. In non-diabetic patients, adjusted survival rates (for age, heart disease, cancer, and smoking habit) were similar in renal transplant recipients and HD patients (P=0.8713). In the low-risk group as well, significant differences in survival between renal transplant recipients (n=289) and HD patients (n=134) were not observed (P=0.2312). Ten-year survival rates were 82.6 and 87.9% respectively. In diabetic patients 5-year survival rates adjusted for heart disease, smoking habit, and chronic pulmonary disease were 89.2% for renal transplant recipients and 40.9% for HD patients (P=0. 0168) The relative risk of haemodialysis patients related to renal graft recipients was 2.85 (1.21-6.75). CONCLUSIONS: We conclude that when the outcome is adjusted to co-morbid factors there is no difference between renal transplant recipients and haemodialysis patients survival in non-diabetic patients, while renal transplantation gives better survival rates than haemodialysis in diabetic patients. (+info)
Variance and covariance components for weaning weight for Herefords in three countries.
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Records from the Hereford Associations of the United States (USA), Canada, and Uruguay were used to estimate genetic and phenotypic variances and covariances for weaning weight. Estimation was done using a complete animal model, relatively large data sets, and the same methodology for the three countries in order to determine whether genetic parameters for weaning weight were homogeneous across environments. Data were composed of 2,322,722, 487,661, and 102,986 edited weaning weight records for USA, Canada, and Uruguay, respectively. Ten samples were obtained from each country by eliminating data from small herds with fewer than 500 records, selecting herds at random from the entire data set after removing the small herds, and then retaining the direct-sire-connected contemporary groups within each sample. The final sample sizes ranged from 9,832 to 46,377 records. An accelerated EM-REML algorithm was used in estimating the (co)variance components in each sample. The estimates were pooled by calculating the arithmetic mean of the 10 samples from within each country. Direct and maternal (in parentheses) heritability estimates were .24 (.16), .20 (.16), and .23 (.18) for USA, Canada, and Uruguay, respectively. Maternal heritabilities reported here are nearly 50% smaller than the values currently used in national genetic evaluation for the breed, which were estimated using sire-maternal grandsire models. Covariance between direct and maternal was negative in all countries, accounting for 6, 8, and 10% of the total phenotypic variation, and the total dam effect was 32.5, 37.0, and 34.0% in USA, Canada, and Uruguay, respectively. Total heritabilities were similar among the countries, with values of .19, .19, and .17 for the three respective countries. The similarity of genetic and environmental parameters across the three countries suggests that joint genetic evaluation is feasible across environments provided that the genotype x environment interaction is negligible and can be ignored. (+info)
Ten-year review of invasive pneumococcal diseases in children and adults from Uruguay: clinical spectrum, serotypes, and antimicrobial resistance.
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OBJECTIVES: Since 1987, the Reference Laboratory of the Ministry of Health of Uruguay has been monitoring infections due to Streptococcus pneumoniae in patients under 5 years of age, in those between 5 to 14 years of age, and in adults. The purpose of the present study was to retrospectively analyze a 10-year collection of invasive S. pneumoniae isolates from children 5 to 14 years of age and adults. METHODS: The Reference Children's Hospital, Pasteur Hospital, and two private hospitals in Montevideo as well as four hospitals located in other representative areas of the country participated in the pneumococcal surveillance program. Based on the information available at the Microbiology Department of the Central Public Health Laboratory (demographic data, date and site of isolate, and clinical diagnosis), all patients with an invasive pneumococcal disease were recorded. Pneumonia was clinically and radiologically diagnosed and etiology was assessed by isolation of S. pneumoniae from blood or pleural fluid. All specimens were collected at the Emergency Service. Capsular serotyping and antimicrobial susceptibilities were determined for each isolate. RESULTS: During the 10-year period, 228 invasive S. pneumoniae were identified and included in the study (blood, n = 129; cerebrospinal fluid [CSF], n = 73; pleural fluid, n = 20; peritoneal fluid, n = 3; synovial fluid, n = 1; pericardic fluid, n = 1; abscess, n = 1). The most frequent clinical presentations were pneumonia (n = 71) and meningitis (n = 69). Thirty-five adults had an underlying condition including, four with malignancies, four with lupus, two with human immunodeficiency virus (HIV)-infected, and two patients in hemodialysis among others. Eighteen of the 228 patients died (7.9% fatality rate), but only four of these had an underlying condition. Eleven fatal cases were attributable to meningitis (2 children, 9 and 11 years old; 9 adults, mean age, 59 y). Four patients with pneumonia and three with sepsis died, including a splenectomized woman. Nine different capsular serotypes (1, 5, 7, 9, 12, 15, 19A, 20, and 23A) were identified among the 18 fatal cases. Resistance to penicillin, generally combined with trimethoprim-sulfamethoxazole, fluctuated annually, not surpassing 10%. CONCLUSIONS: The study results indicated that 96% of the serotypes involved in severe pneumococcal diseases were included in the 23-valent vaccine and that S. pneumoniae resistance to penicillin was moderate. (+info)
Alpha-linolenic acid and risk of prostate cancer: a case-control study in Uruguay.
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In the time period of 1994-1998, a case-control study on diet and prostate cancer was carried out in Uruguay to examine the risk associated with fat intake. Two hundred and seventeen (217) incident cases afflicted with advanced prostate cancer were frequency-matched with 431 controls on age, residence, and urban/rural status. The analysis was carried out using unconditional multiple logistic regression. Alpha-linolenic acid was associated with a strong positive association (fourth quartile of intake odds ratio, 3.91; 95% confidence interval, 1.50-10.1) after controlling for total calorie intake and for the other types of fat. The effect was similar when alpha-linolenic acid was analyzed by its sources of origin (odds ratio for vegetable linolenic acid, 2.03; 95% confidence interval, 1.01-4.07). Including this report, five of six studies that have examined the relationship between alpha-linolenic acid and prostate cancer yielded a positive association, which was significant in four studies. Thus, there appears to be evidence of a role of alpha-linolenic acid in prostate carcinogenesis. (+info)