Orientador: Plinio Trabasso / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-05T09:39:08Z (GMT). No. of bitstreams: 1 Fagnani_Renata_M.pdf: 5349161 bytes, checksum: e6caf1cbb6ca03b1ded5646ba6d81269 (MD5) Previous issue date: 2005 / Resumo: Os avanços nas técnicas de diagnósticos e na terapêutica têm aumentado a sobrevida e o número de indivíduos com alterações imunológicas, sendo a neutropenia fator predisponente para IH. Este estudo avaliou a ocorrência de IH nos pacientes com DOH ou AA acompanhados consecutivamente no HC UNICAMP, tendo como objetivos determinar a densidade de incidência, as topografias, os agentes etiológicos das IH e identificar os fatores de risco para ocorrência de episódios febris. Foi realizado estudo observacional prospectivo de investigação epidemiológica, através da busca ativa de casos e coleta sistemática de dados no período de outubro de 2001 a outubro de 2003. No período foram acompanhados 352 pacientes que apresentaram 794 internações, sendo diagnosticados 245 episódios febris, onde foram identificados 87 (35,5%) casos de FOI e 158 (64,5%) de infecções clínicas ou microbiologicamente documentadas. A mediana de dias de internação hospitalar foi superior para os pacientes que apresentaram episódios febris. A taxa de utilização dos dispositivos invasivos foi de 4,18 e 8,9 para VM e SVD e 48,7/ 100 pacientes-dia para os CVC. Os dispositivos invasivos, VM, SVD, SH e HIC foram identificados no estudo como risco para IH. Ao realizarmos a análise bivariada entre os graus de neutropenia (NL, NM, NG) prévios aos diagnósticos dos episódios febris; o estudo demonstrou valores significativos em relação a FOI, ICS, PN, CSEP, PELE, GI e VASC. No estudo foram diagnosticadas: ICS (n=69), RESP (n=32), ITU (n=17), PELE (n=10), VASC (n=9), EENT (n=9) e CSEP (n=7). Ao realizarmos os cálculos de densidade de incidência das topografias estratificadas pelo grau de neutropenia, o índice de IH foi superior no período de neutropenia grave. Cento e dez agentes etiológicos foram isolados dentre as ICS e ITU, sendo 56,36% bactérias Gram-negativas, 37,27% bactérias Gram-positivas, 5,45% leveduras e 0,9% fungos filamentosos. A taxa de mortalidade da população estudada foi de 14,8/ 1000 pacientes-dias. ICS, CSEP e PN foram topografias de risco para o óbito. Este estudo demonstrou o risco dos dispositivos invasivos e da neutropenia para ocorrência da IH e identificou predominância de bactérias Gram-negativas na população do estudada / Abstract: Diagnostic and therapeutic advances have led to an increased number of individuals with immunological alterations being neutropenia one of the most important predisposing factor for infections. A prospective observational cohort study, from October 2001 to October 2003 was conducted for determine the incidence, sites and etiological agents and to verify if granulocytopenia or invasive devices are risk factors for nosocomial infections (NI) in patients with onco-hematologic diseases or aplastic anemia. There were 352 patients, corresponding to 794 hospitalizations. There were 245 febrile episodes, being 158 (64.5%) of clinically or microbiologically documented infections and 87 (35.5%) of fever of unknown origin (FUO). Infections were diagnosed as BSI (n=69); LRI (n=32); UTI (n=17); SST (n=10); VASC (n=9); EENT (n=9); CSEP (n=7) and GI (n=7). The median length of stay was superior among patients with febrile episodes. Microorganisms were recovered from 86 cases, accounting for 110 microorganisms, being 56.36% gram-negative bacteria; 37.27% gram-positive bacteria; 5.45% yeast and 0.9% filamentous fungi. Granulocytopenia was found to be risk factor in bivariate analysis for FUO (p<0.01); CSEP (p=0.019); SST (p=0.019); GI (p=0.01); PNEU (p=0.023); BSI (p<0.01) and VASC (p=0.046). The mortality rate was 14.8/1000 patients-day. It was concluded that neutropenia and invasive devices were risk factors for NI; gram-negative bacteria predominate / Mestrado / Ciencias Basicas / Mestre em Clinica Medica

Thesis (Ph. D.)--University of Washington, 2004. / Vita. Includes bibliographical references (leaves 74-80).

No description available.

Aim: Biosimilar medicines offer significant cost-savings potential over their reference products, which can be re-allocated to provide access to other cancer treatments on a budget-neutral basis. Methods: Simulation study using cost data for the USA under consideration of several prophylaxis patterns. Results: Potential savings from conversion from reference filgrastim to biosimilar filgrastim-sndz are significant. These savings expand budget-neutral access to novel immunotherapies (obinutuzumab; pembrolizumab) or supportive care (filgrastim-sndz). Conclusion: The combination of biosimilar savings and expanded access increases the value of cancer care as the same supportive care is provided at lower cost, additional cancer care is enabled at no additional cost, and more patients will have access to cancer care.

Orientador: Satoshi Kitamura / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T19:15:33Z (GMT). No. of bitstreams: 1 Gonzalez_LuizRicardo_D.pdf: 1852973 bytes, checksum: fe261b80338f57f34b13efff35148a9f (MD5) Previous issue date: 2012 / Resumo: Justificativa e Objetivos: Neutropenia étnica benigna é uma condição caracterizada por uma redução da contagem dos neutrófilos abaixo de 1.500/mm³ na circulação sanguínea, estando ausentes as causas secundárias, adquiridas ou congênitas.Ocorre, principalmente, em populações negras e seus descendentes, não apresentando problemas recorrentes de infecção. Diversos trabalhos realizados, ao redor do tema em outros Países, em que a etnia negra é importante na composição populacional, como no Brasil, mostra à importância do conhecimento da neutropenia étnica.A proposta do presente estudo foi investigar a prevalência de neutropenia étnica benigna,no meio de uma população trabalhadora, aparentemente saudável, sendo realizado em um Hospital de grande porte na cidade de São Paulo-Brasil. Método: Trata-se de um estudo transversal, envolvendo 347 voluntários, que estavam dentro dos critérios de inclusão do estudo. Resultados: Os dados deste trabalho demonstram que entre os trabalhadores estudados, 9 (2,59%) apresentaram critérios diagnósticos para neutropenia étnica benigna. Relativamente em relação aos brancos participantes, os negros, pardos e amarelos apresentaram menor contagem de neutrófilos.Conclusão: Levando-se em consideração o aspecto racial, este estudo mostra que pessoas negras e seus descendentes podem apresentar uma diminuição na contagem de neutrófilos, sem predisposição a infecções / Abstract: Background and Objectives: Benign ethnic neutropenia is a condition characterized by a neutrophil count reduction under 1.500/mm³ in blood circulation, with absence of acquired or congenital secondary causes. It occurs mainly among afro populations or their descendants not presenting problems with recurrent infections. Different papers performed in other countries, in which the Black ethnicity is important in the population composition, such as in Brazil, discuss the importance of knowing about ethnic neutropenia. The aim of this study was to investigate the prevalence of benign ethnic neutropenia in an apparently healthy working population of a large hospital in the city of Sao Paulo, Brazil. Method: This transversal study comprised 347 volunteers who met the inclusion criteria. Results: According to this study, nine (2.59%) among the studied employees met the diagnostic criteria for benign ethnic neutropenia. Compared to Caucasian participants, Black, Brown and Yellow people presented a lower neutrophil count. Conclusion: Considering the racial aspect, this study showed that afro people and their descendants may present a neutrophil count reduction, without predisposition to infections / Doutorado / Epidemiologia / Doutor em Saude Coletiva

No description available.

No description available.

Introduction: There is uncertainty whether low-risk febrile neutropenia (FN) episodes in children with cancer are best managed in the inpatient or outpatient setting. Methods: A cost-utility model was created to compare four different treatment strategies for low-risk FN in pediatric cancer patients. Outcome measures were quality-adjusted FN episodes (QAFNE), costs (Canadian dollar), and incremental cost-effectiveness ratios (ICER). Results: The most cost-effective strategy was outpatient treatment with intravenous antibiotics. It was cost saving ($2,732 versus $2,757) and more effective (0.66 QAFNE versus 0.55 QAFNE) as compared to outpatient treatment with oral antibiotics. An early discharge strategy after 48 hours in hospital was slightly more effective but significantly more expensive than outpatient treatment with intravenous antibiotics resulting in an unacceptably high ICER of more than $130,000 per QAFNE. Inpatient care was the least cost-effective strategy. Conclusions: Outpatient strategies for treatment of low-risk FN in children are more cost-effective than traditional inpatient care.

Introduction: There is uncertainty whether low-risk febrile neutropenia (FN) episodes in children with cancer are best managed in the inpatient or outpatient setting. Methods: A cost-utility model was created to compare four different treatment strategies for low-risk FN in pediatric cancer patients. Outcome measures were quality-adjusted FN episodes (QAFNE), costs (Canadian dollar), and incremental cost-effectiveness ratios (ICER). Results: The most cost-effective strategy was outpatient treatment with intravenous antibiotics. It was cost saving ($2,732 versus $2,757) and more effective (0.66 QAFNE versus 0.55 QAFNE) as compared to outpatient treatment with oral antibiotics. An early discharge strategy after 48 hours in hospital was slightly more effective but significantly more expensive than outpatient treatment with intravenous antibiotics resulting in an unacceptably high ICER of more than $130,000 per QAFNE. Inpatient care was the least cost-effective strategy. Conclusions: Outpatient strategies for treatment of low-risk FN in children are more cost-effective than traditional inpatient care.

Memoria para optar al título de Bioquímico / La incidencia de infecciones nosocomiales en pacientes oncológicos inmunodeprimidos es entre 2 y 10 veces superior al de otros grupos de pacientes. Entre las infecciones nosocomiales, las bacterias y hongos oportunistas son de particular interés debido a su influencia en la morbilidad, mortalidad y costos terapéuticos asociados a este grupo de pacientes. El tiempo que demora el laboratorio en determinar el agente que causa el cuadro infeccioso es crítico dado que permite un tratamiento específico, y por ende una mayor tasa de éxito. Usando técnicas microbiológicas tradicionales, se detecta el agente infeccioso sólo en el 20- 40% de los casos con procedimientos que requieren de al menos 3 días. Esta memoria propone utilizar la técnica de biología molecular Múltiplex PCR para obtener un diagnóstico concluyente en 5 horas. Nuestro sistema de diagnóstico permite la detección in vitro simultánea y rápida de los patógenos oportunistas que frecuentemente causan estados de neutropenia febril en pacientes oncológicos, por lo que esta memoria evaluará la capacidad del sistema montado para detectar estos patógenos en muestras clínicas. De resultar exitoso este estudio, impactaremos beneficiosamente la rapidez con la que se podrá tomar una decisión terapéutica informada y mejoraremos la expectativa de vida de pacientes inmunodeprimidos / The incidence of nosocomial infections in immunocompromised cancer patients is between 2 and 10 times higher than other groups of patients. Among the nosocomial infections, opportunistic bacteria and fungi are of particular interest because of their impact on morbidity, mortality and treatment costs associated with this group of patients. The time taken for the laboratory to determine the agent causing the infection is critical because it allows a specific treatment and therefore a higher rate of success. Using traditional microbiological techniques, the infectious agent is detected only in 20- 40% of patients with procedures that require at least three days. This thesis proposes to use the technique of molecular biology technique of Multiplex PCR to obtain a conclusive diagnosis in 5 hours. Our diagnostic system allows simultaneous detection and rapid in vitro detection of opportunistic pathogens that frequently cause states of febrile neutropenia in cancer patients. In this work will evaluate the ability of our Multiplex PCR system to detect these pathogens in clinical samples. If this results successful, we will produce a positive impact on the speed with which physicians may take informed treatment decisions and improve the life expectancy of immunosuppressed patients