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1.
Epidemiol Infect ; 140(3): 407-16, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21676358

RESUMO

In Spain hepatitis A is a compulsory notifiable disease and individual cases are reported to the national epidemiological surveillance network. Incidence rates show variations in different regions. The aim of this study was to analyse the space-time pattern of hepatitis A risk at municipal level in Spain and at global and local levels during the period 1997-2007. At global level we used two estimates of risk: the standardized incidence ratio (SIR) and the posterior probability that the smoothed relative risk is >1 (PP). At local level we used the scan statistic method to analyse the space-time clusters. The SIR and significant PP (>0·8) showed the highest risk concentrated in areas of the Mediterranean coast. The most likely cluster gave a relative risk of 53·530. These spatial statistics methodologies can be complementary tools in the epidemiological surveillance of infectious diseases.


Assuntos
Hepatite A/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Geografia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Espanha/epidemiologia , Fatores de Tempo , Adulto Jovem
2.
Arch Soc Esp Oftalmol (Engl Ed) ; 97(9): 490-496, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35787379

RESUMO

OBJECTIVE: To investigate the efficacy and safety of an intense pulsed light (IPL) combined IPL treatment protocol for meibomian gland dysfunction (MGD)/dry eye disease (DED) with IPL applied directly to the eyelids, associated with meibomian gland (MG) expression for the treatment of chalazion. MATERIAL AND METHODS: Retrospective case series study. Patients presenting with chalazion received a combined IPL therapy treatment consisting of using the usual IPL protocol for DGM/EOS using a fluence according to skin type according to Fitzpatrick, followed by a second phase (in the same session) of IPL application directly on the eyelids of both eyes using a fluence of 10J/cm2. All patients then received GM expression, eyelid hygiene, topical antibiotic and topical ocular anti-inflammatory medication. Adverse effects related to this protocol were assessed at each IPL session. RESULTS: Twenty-six chalazions from nineteen patients (24 eyes) with a mean age of 49.89±20.43 years were included. An average of 2.07±0.97 IPL sessions were required for chalazion resolution. The combined treatment of IPL protocol and GM expression showed 96.15% efficacy and no adverse effects were observed. CONCLUSIONS: Combined IPL treatment for MGD/DED with IPL applied directly onto the eyelids and MGX could be effective and safe for the management of chalazions.


Assuntos
Calázio , Síndromes do Olho Seco , Disfunção da Glândula Tarsal , Adulto , Idoso , Calázio/terapia , Síndromes do Olho Seco/terapia , Humanos , Disfunção da Glândula Tarsal/terapia , Glândulas Tarsais , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Acta Neurol Scand ; 123(5): 316-24, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-20636450

RESUMO

OBJECTIVES: To estimate dementia prevalence in Spain. MATERIALS AND METHODS: Nine probabilistic and geographically defined samples participated. A screening design based on the MMSE was implemented. Positively screened individuals underwent clinical evaluation. The total number of cases in Spain was estimated. Prevalence was confronted to that of other European countries. RESULTS: Five hundred and forty-six persons aged ≥75 participated, 49 had dementia (35 with Alzheimer's disease [AD], 10 with vascular dementia [VD], 4 other; 25 first diagnosed in the study). Age- and sex-adjusted prevalence and estimated nationwide cases were 7.5% (95% CI 5.4-9.7), 5.6 (95% CI 3.7-7.5) and 1.4 (95% CI 0.5-2.3), and 290,000 (95% CI 208,000-372,000), 214,000 (95% CI 141,000-288,000) and 54,000 (95% CI 20,000-88,000) for dementia, AD and VD, respectively. CONCLUSIONS: Dementia prevalence in Spain is comparable to other European populations, while a high number of undiagnosed cases live in the community. The potential impact of Mediterranean diet, hypertension control and decreasing vascular risk factors is discussed.


Assuntos
Demência/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Demência/diagnóstico , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Programas de Rastreamento , Exame Neurológico , Prevalência , Fatores Sexuais , Espanha/epidemiologia
4.
Asia Pac J Ophthalmol (Phila) ; 9(6): 571-579, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33181549

RESUMO

Corneal grafting is one of the most common forms of human tissue transplantation. The corneal stroma is responsible for many characteristics of the cornea. For these reasons, an important volume of research has been made to replicate the corneal stroma in the laboratory to find an alternative to classical corneal transplantation techniques.There is an increasing interest today in cell therapy of the corneal stroma using induced pluripotent stem cells or mesenchymal stem cells since these cells have shown to be capable of producing new collagen within the host stroma and even to improve its transparency.The first clinical experiment on corneal stroma regeneration in advanced keratoconus cases has been reported and included. Fourteen patients were randomized and enrolled into 3 experimental groups: (1) patients underwent implantation of autologous adipose-derived adult stem cells alone, (2) patients received decellularized donor corneal stroma laminas, and (3) patients received implantation of recellularized donor laminas with adipose-derived adult stem cells. Clinical improvement was detected with all cases in their visual, pachymetric, and topographic parameters of the operated corneas.Other recent studies have used allogenic SMILE implantation lenticule corneal inlays, showing also an improvement in different visual, topographic, and keratometric parameters.In the present report, we try to summarize the available preclinical and clinical evidence about the emerging topic of corneal stroma regeneration.


Assuntos
Substância Própria/patologia , Transplante de Córnea/métodos , Ceratocone/cirurgia , Acuidade Visual , Substância Própria/cirurgia , Topografia da Córnea , Humanos , Ceratocone/diagnóstico , Tomografia de Coerência Óptica
5.
Neuroepidemiology ; 28(4): 224-34, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17878737

RESUMO

BACKGROUND: Studies on dementia subtypes show a wide variation in the prevalence of Alzheimer's disease (AD) and vascular dementia (VD) worldwide. However, studies reporting on Lewy body dementia (LBD) and frontotemporal dementia (FTD) are sparse. AIMS: To describe the prevalence of dementia and subtypes. METHOD: A 34% sample of 5,150 subjects aged 70 years and over in El Prat de Llobregat (Barcelona) were screened by the Mini-Mental State Examination. When scoring <24, participants were assessed to establish a diagnosis. RESULTS: There were 165 subjects diagnosed with dementia (prevalence of 9.4%). Subtypes of dementia were: AD 69.1%, VD 12.7%, LBD 9.1%, FTD 3% and secondary dementia 1.8%. Prevalences were: AD 6.5%, VD 1.2%, LBD 0.9% and FTD 0.3%. CONCLUSIONS: AD and VD were the most common type of dementia. Prevalence of dementia, AD and FTD were similar to those reported, while prevalence of VD and LBD were lower.


Assuntos
Demência/classificação , Demência/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Coleta de Dados/métodos , Demência/psicologia , Feminino , Humanos , Masculino , Prevalência , Escalas de Graduação Psiquiátrica , Espanha/epidemiologia
6.
Arch Neurol ; 56(5): 609-12, 1999 May.
Artigo em Inglês | MEDLINE | ID: mdl-10328257

RESUMO

OBJECTIVE: To determine the frequency and etiologic and clinical aspects of new-onset seizures in patients with human immunodeficiency virus (HIV) infection. DESIGN: A prospective survey of an HIV-infected patient cohort. SETTING: Outpatients and inpatients in a university hospital in Barcelona, Spain. PATIENTS: Five hundred fifty HIV-infected patients recruited over 1 year. MAIN OUTCOME MEASURE: Analysis of new-onset seizures, with detailed medical history and appropriate workup. RESULTS: Seventeen HIV-infected patients (3%) had a new-onset seizure during the study period. Fourteen (82%) of 17 patients had acquired immunodeficiency syndrome diagnosed according to the 1993 CDC Expanded AIDS Definition. Mean latency (+/-SD) between diagnosis of HIV infection and the first seizure was 60.7+/-37.6 months. Seizure cause was drug toxicity in 8 patients (47%) and intracranial lesion in 6 patients (35.3%). Two patients had seizures related to metabolic derangements. No cause was found in 1 case. The first seizure was generalized in 12 patients (70.6%), simple partial motor seizure in 2 (11.8%), and simple partial seizure evolving to generalized seizure in 3 (17.6%). We found partial seizures in 66.6% of patients who had intracranial lesions. Most patients were treated with phenytoin, which was well tolerated and effective in controlling seizures. CONCLUSIONS: New-onset seizures are infrequent in patients with HIV. In most cases a definite or probable cause is identified, which is usually related to toxic and/or metabolic factors. Most seizures are generalized, and partial seizures suggest a focal cerebral lesion.


Assuntos
Infecções por HIV/complicações , Convulsões/epidemiologia , Adulto , Anticonvulsivantes/uso terapêutico , Antivirais/efeitos adversos , Córtex Cerebral/patologia , Feminino , Humanos , Masculino , Doenças Metabólicas/complicações , Pessoa de Meia-Idade , Fenitoína/uso terapêutico , Prevalência , Estudos Prospectivos , Convulsões/tratamento farmacológico , Convulsões/etiologia
7.
Chest ; 90(6): 912-4, 1986 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-3536345

RESUMO

A patient with the acquired immunodeficiency syndrome (AIDS) presented with Pneumocystis carinii pneumonia and pulmonary nocardiosis. The nocardial lesions appeared small and localized on chest radiograph. On two separate occasions, nocardial organisms were absent in transbronchial lung biopsy specimens, but were identified in bronchoalveolar lavage fluid probably because the latter specimen sampled a larger area of lung. The patient was initially treated with trimethoprim-sulfamethoxazole (TMP/SMX) for both infections. When TMP/SMX was discontinued because of an adverse reaction, the nocardiosis promptly exacerbated but was then easily controlled with minocycline and amikacin followed by minocycline and cycloserine. Among patients with AIDS who have sulfamethoxazole hypersensitivity during treatment for nocardiosis, alternative drugs may be efficacious and may be particularly important in this setting because they have a lower incidence of toxicity.


Assuntos
Síndrome da Imunodeficiência Adquirida/microbiologia , Nocardiose/microbiologia , Alvéolos Pulmonares/microbiologia , Infecções Respiratórias/microbiologia , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Adulto , Amicacina/uso terapêutico , Ciclosserina/uso terapêutico , Quimioterapia Combinada , Humanos , Masculino , Minociclina/uso terapêutico , Nocardiose/diagnóstico por imagem , Nocardiose/tratamento farmacológico , Nocardia asteroides , Pneumonia por Pneumocystis/diagnóstico por imagem , Radiografia , Infecções Respiratórias/diagnóstico por imagem , Infecções Respiratórias/tratamento farmacológico , Irrigação Terapêutica
8.
Eur J Clin Nutr ; 56(2): 141-8, 2002 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11857047

RESUMO

OBJECTIVE: Classic cardiovascular risk factors, such as smoking, arterial hypertension and hypercholesterolaemia, cannot explain a substantial part of the geographic differences in cardiovascular mortality. Anthropometric and nutritional factors in early stages of life may contribute to adult cardiovascular disease. Therefore, this work examines certain anthropometric variables and diet among children aged 6-7 y, living in four Spanish cities with widely differing ischaemic heart disease (IHD) mortality. DESIGN AND SETTING: Cross-sectional anthropometric and dietary survey in four cities in Spain. SUBJECTS: A total of 1112 children (50.1% males, 49.9% females) attending public and private schools in Cadiz and Murcia, cities with a relatively high IHD mortality, and Madrid and Orense, cities with a relatively low IHD mortality. A standardized method was used to measure anthropometric variables, and a food-frequency questionnaire completed by subjects' mothers, to measure diet. OUTCOME MEASURES: Body mass index (BMI), overweight (BMI>17.6 kg/m(2)), obesity (BMI>20.1 kg/m(2)) and intake of food and nutrients. RESULTS: Children in the four cities showed a high prevalence of overweight (range across cities, 28.9-34.5%) and obesity (8.5-15.7%). They also had a moderately hypercaloric diet (range, 2078-2218 kcal/day), marked by an excessive intake of lipids (45.0-47.3% kcal), particularly saturated fats (16.6-16.9% kcal), proteins (17.0-17.3% kcal), sugars (20.0-21.9% kcal) and cholesterol (161.6-182.9 mg/1000 kcal/day), and a low intake of complex carbohydrates (17.5-18.1% kcal) and fibre (19.6-19.9 g/day). Compared with children in the two low-IHD-mortality cities, those in the two high-IHD-mortality cities had a greater BMI (mean difference, 0.61 kg/m(2); P=0.0001) and ponderal index (0.58 kg/m(3); P=0.0001) and a higher intake of energy (104 kcal/day; P=0.007), cholesterol (16.00 mg/1000 kcal/day; P=0.0001) and sodium (321 mg/day; P=0.0001). Inter-city differences in anthropometric variables remained after adjustment for birthweight. CONCLUSIONS: Intake of fats, especially saturated fats, and cholesterol should be reduced among Spanish children. It could contribute to a needed reduction of the high prevalence of overweight and obesity in children. If the differences in anthropometric variables and diet between children from the cities with high and low coronary mortality are maintained in future or continue into adulthood, this could contribute to consolidate or even increase the IHD mortality gradient across cities. The finding that differences in anthropometric variables are independent of birthweight suggests that the childhood, rather than intrauterine environment, is involved in the development of such differences. SPONSORSHIP: This study was partly funded by grants from the International Olive Oil Board (Consejo Oleícola Internacional), Comunidad Autónoma de Madrid, Fundación Pedro Barrié de la Maza, and Fundación Eugenio Rodríguez Pascual.


Assuntos
Gorduras na Dieta/administração & dosagem , Comportamento Alimentar , Isquemia Miocárdica/mortalidade , Obesidade/epidemiologia , Antropometria , Criança , Estudos Transversais , Inquéritos sobre Dietas , Gorduras na Dieta/efeitos adversos , Ingestão de Energia , Feminino , Preferências Alimentares , Humanos , Masculino , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/etiologia , Prevalência , Espanha/epidemiologia , Inquéritos e Questionários
9.
J Infect ; 38(2): 120-3, 1999 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10342653

RESUMO

OBJECTIVE: This study aimed to examine the prevalence of antibodies against hepatitis A (anti-HAV) in a population of institutionalized mentally retarded persons compared with that of institutionalized non-mentally retarded persons in an area with moderate endemicity of HAV infection. METHODS: The study population was a group of mentally retarded persons aged between 10 and 30 years, institutionalized in one residence in Madrid, Spain. A group of non-mentally retarded subjects in the same age range was chosen as controls. Information about demography and duration of institutionalization was obtained by the investigator. Four drops of whole blood were obtained from each person by finger-stick, collected on filter paper, air-dried and stored at +4 degrees C until antibody determination. Eluates were tested by an ELISA method. RESULTS: A total of 314 institutionalized subjects were included: 157 mentally retarded (mean age and mean duration of institutionalization were 24.4+/-3 and 9.7+/-5 years respectively) and 157 non-mentally retarded (mean age and mean duration of institutionalization were 19.2+/-5 and 4.6+/-3 years respectively). The prevalence of anti-HAV antibody was 54% (95% confidence interval (CI) 50-58) in mentally retarded and 22% (95% CI 19-25) in non-mentally retarded [P<0.001; odds ratio (OR): 4.2 (95% CI 2.5-7)]. In both groups, these differences were not statistically significant for anti-HAV antibody prevalence between persons institutionalized for >5 years compared with those institutionalized for < or = 5 years. CONCLUSIONS: There results indicate that in an area of moderate endemicity the institutionalized mentally retarded are at increased risk of having acquired hepatitis A infection compared to the non-mentally retarded. In these institutionalized persons, regardless whether they are mentally retarded or not, prevalence is not influenced by age or length of stay in institutions.


Assuntos
Anticorpos Antivirais/sangue , Hepatite A/epidemiologia , Hepatovirus/imunologia , Deficiência Intelectual/complicações , Adolescente , Adulto , Fatores Etários , Estudos de Casos e Controles , Criança , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Institucionalização , Tempo de Internação , Masculino , Estudos Soroepidemiológicos , Espanha/epidemiologia
10.
Med Clin (Barc) ; 96(5): 161-4, 1991 Feb 09.
Artigo em Espanhol | MEDLINE | ID: mdl-2033984

RESUMO

BACKGROUND: The aim of the study was to assess the number of urinary tract infections, the time between catheterization and the development of bacteriuria, the route taken by the microorganisms and the clinical relevance of infection in patients with bladder catheterization during a short time. METHODS: 83 patients were evaluated by urine culture from the bladder, urethra, the connection of the catheter and the collecting system, and the collecting bag, on a daily basis during the 5 initial days, with clinical and microbiological follow up to 7 days after the removal of the catheter. RESULTS: 32% of patients developed bacteriuria. The mean interval between catheterization and the development of bacteriuria was 4.1 days. 45% of them were detected within 48 hours after catheter insertion. In 50% the causative organisms were detected in the urethra at least 24 hours previously. In no case the microorganism isolated from the connection between the catheter and the collecting system was subsequently isolated form bladder urine. Bacteriuria disappeared spontaneously in 27% of cases. Antibiotic therapy was necessary in 42%. CONCLUSIONS: In the study population most urinary infections were due to previous urethral colonization and subsequent dragging into the bladder, in many cases at the same time of catheterization. A non-negligible number of bacteriurias disappeared spontaneously.


Assuntos
Cateterismo Urinário/efeitos adversos , Infecções Urinárias/etiologia , Adulto , Bactérias/isolamento & purificação , Bacteriúria/epidemiologia , Bacteriúria/etiologia , Bacteriúria/microbiologia , Candida/isolamento & purificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Tempo , Uretra/microbiologia , Bexiga Urinária/microbiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia
11.
An Med Interna ; 18(6): 312-6, 2001 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-11503578

RESUMO

BACKGROUND: In the adult, the primary infection by the varicella-zoster virus acquires an unusual severity due to several complications, the most frequent of them being pneumonia. We study the main characteristics of nine patients diagnosed of pneumonia varicellosa. METHODS: Clinical, therapeutic and evolutive features of 9 adult patients, both immunocompetents and immunodepressed, diagnosed of pneumonia varicellosa are retrospectively reviewed, in the last ten years, at Hospital de Sant Pau, Barcelona. Diagnosis of varicella was established on the basis of the typical rash in the context of a feverish illness. The antecedents of smoking habit, pregnancy and underlying disease, evaluating especially arterial blood and platelet count at entrance, are assessed. RESULTS: Nine patients (4 males and 5 women; mean age 38 years) were included in the study. Seventy-eight percent of patients were smokers of more than 20 cigarettes a day; one met criteria of simple chronic bronchitis, another suffered ankylosing spondylitis and three were known carriers of human immunodeficiency virus. None of the female patients was pregnant. Respiratory symptoms began from the third and fifth day after the skin rash, and the most common symptoms were cough (89%), dyspnea (67%) and hemoptysis (22%). Arterial blood gas determination showed hypoxemia in four patients (45%). Chest X-ray revealed an interstitial pattern predominantly at both bases, with a case of right pleural effusion. Intravenous acyclovir was started in 6 patients, foscarnet in one and symptomatic therapy in two patients. All patients had a favourable clinical course, none of them requiring entrance to the Intensive Care Unit. CONCLUSIONS: Adult patients with varicella pneumonia that suffer respiratory insufficiency, thrombocytopenia or are carriers of base illnesses must be early treated with intravenous acyclovir. However, despite clinical, biological and radiological recovery is earlier with such treatment, the evolution seems equally favourable if it is only conducted, for instance, symptomatic therapy with antithermic and antihistaminic compounds.


Assuntos
Varicela , Pneumonia Viral , Aciclovir/uso terapêutico , Adulto , Fatores Etários , Antivirais/uso terapêutico , Varicela/diagnóstico , Varicela/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/tratamento farmacológico , Radiografia Torácica , Tomografia Computadorizada por Raios X
12.
An Med Interna ; 13(1): 4-8, 1996 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-8679824

RESUMO

We have retrospectively reviewed 63 cases of encephalic toxoplasmosis (ET) in HIV-infected patients in order to determine clinical and radiological characteristics, the diagnostic value of serologic determinations, and the response to antioxoplasmic therapy. ET was the AIDS-defining condition in 44% of the patients. Eighty of the patients had a CD4 cell count < 100/microliters when ET was diagnosed. Only 4.8% of the patients had been taking anti-Pneumocytis carinii prophylaxis with cotrimoxazol. The most frequent clinical presentation was focal neurologic signs in 80.9% of the patients, with headache and fever in 53.3% and 42.4%, respectively. The most frequent cerebral CT finding was hipodense lesions (92%) with ring enhancement (68.9%). They were most frequently had a hemisferic location. Seroconversion was detected in two patients (6%), whereas 55 patients had serologic evidence of latent infection by Toxoplasma gondii (87.3%). Ninety eight percent of the patients were treated with sulphadiazine plus pyrimethamine. However, such therapy should be discontinued in 22% of them and switched to clindamycin plus pyrimethamine. The overall mortality rate during the acute phase of the disease was 7.9%, but 41.4% of the survivors exhibited neurologic sequelae. Relapsing ET was detected in 33.3% of the patients, and it was usually due to discontinuation of treatment. The mean survival time after the diagnosis of ET was 11.5 months. ET is the most common opportunistic infection of the central nervous system among our AIDS patients. Primary prophylaxis for toxoplasmic infection seems advisable in our epidemiologic environment, when CD4 cell count is less than 200/microliters and there is serologic evidence of latent infection. Acute ET usually has a good response to therapy, and the acute mortality rate is low. However, most of the survivors will remain with neurologic sequelae. The high frequency of adverse effects to sulphamide therapy with clindamycin make the need of alternative treatment strategies urgent.


Assuntos
Infecções por HIV/complicações , Toxoplasmose Cerebral/diagnóstico , Toxoplasmose Cerebral/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/complicações , Adulto , Idoso , Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Clindamicina/uso terapêutico , Coccidiostáticos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pirimetamina/uso terapêutico , Radiografia , Estudos Retrospectivos , Sulfadiazina/uso terapêutico , Toxoplasmose Cerebral/diagnóstico por imagem
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