RESUMO
BACKGROUND: Diabetes is a very common metabolic condition during pregnancy. The number of cases increases with age and obesity. The prevalence of pre-gestational diabetes and gestational diabetes (GD) differs between different ethnic groups. OBJECTIVE: The aim of the study was to analyse the prevalence of pre-gestational diabetes and GD in the health region of Lleida. We also studied the GD risk factors during pregnancy according to the country of origin of the pregnant woman. METHODS: We performed a retrospective observational cohort study among pregnant women between 2012 and 2018 in the health region of Lleida. A multivariate model was performed with the different variables analysed by calculating the regression coefficient and its 95% confidence interval (CI). RESULTS: In our sample of 17,177 pregnant women, we observed a prevalence of pre-gestational diabetes and GD of 8.2% and 6.5%, respectively. We found a relationship of gestational diabetes with different factors: age, with 6.8% in 30-34 year-old women and 11.3% in women over 35 (OR 1.78 and 3.29, respectively); overweight, with 8.29% (OR 1.89); and obesity, with 12.9% (OR 3.15). Finally, women from Asia and the Middle East and the Maghreb had a higher risk of diabetes, with 12.2% (OR 2.1) and 9.91% (OR 1.3), respectively, and Sub-Saharan women had a lower risk of it 6.07% (OR 0.71). CONCLUSIONS: GD has different risk factors, such as age, overweight, and obesity. Non-related conditions include hypothyroidism, arterial hypertension, and dyslipidaemia. Finally, pregnant women from the Maghreb, and Asia and the Middle East, are at higher risk of developing diabetes during pregnancy; meanwhile, Sub-Saharan origin is protector factor.
Assuntos
Diabetes Gestacional , Feminino , Gravidez , Humanos , Adulto , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/etiologia , Sobrepeso/epidemiologia , Estudos Retrospectivos , Prevalência , Índice de Massa Corporal , Obesidade/complicações , Fatores de RiscoRESUMO
OBJECTIVES: The aim of the study was to investigate whether very low level viraemia (VLLV) (20-50 HIV-1 RNA copies/mL) was associated with increased risk of virological failure (VF) as compared with persistent full suppression (< 20 copies/mL). METHODS: From the VACH Cohort database, we selected those patients who started antiretroviral therapy (ART) after January 1997 and who achieved effective viral suppression [two consecutive viral loads (VLs) < 50 copies/mL] followed by full suppression (at least one VL <20 copies/mL). We carried out survival analyses to investigate whether the occurrence of VLLV rather than maintaining full suppression at < 20 copies/mL was associated with virological failure (two consecutive VLs > 200 copies/mL or one VL > 200 copies/mL followed by a change of ART regimen, administrative censoring or loss to follow-up), adjusted for nadir CD4 cell count, sex, age, ethnicity, transmission group, type of ART and time on effective suppression at < 50 copies/mL. RESULTS: Of 21 480 patients who started ART, 13 674 (63.7%) achieved effective suppression at < 50 copies/mL, of whom 4289 (31.4%) further achieved full suppression at < 20 copies/mL after May 2009. A total of 2623 patients (61.1%) remained fully suppressed thereafter, while 1666 had one or more episodes of VL detection > 20 copies/mL (excluding virological failure). A total of 824 patients had VLLV after suppression at < 20 copies/mL. VLLV was not associated with virological failure as compared with persistent full suppression [hazard ratio (HR) 0.67; 95% confidence interval (CI) 0.44-1.00], independently of the number of blips recorded (from one to 18). CONCLUSIONS: In our population of HIV-infected patients on ART who achieved viral suppression at < 20 copies/mL, the risk of virological failure was no different for patients who remained fully suppressed compared with those who experienced subsequent episodes of VLLV.
Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , HIV-1/isolamento & purificação , Resposta Viral Sustentada , Carga Viral , Viremia , Adolescente , Adulto , Estudos de Coortes , Feminino , Infecções por HIV/virologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Risco , Medição de Risco , Falha de Tratamento , Adulto JovemRESUMO
OBJECTIVES: The aim of this work was to provide a reference for the CD4 T-cell count response in the early months after the initiation of combination antiretroviral therapy (cART) in HIV-1-infected patients. METHODS: All patients in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) cohort who were aged ≥ 18 years and started cART for the first time between 1 January 2005 and 1 January 2010 and who had at least one available measurement of CD4 count and a viral load ≤ 50 HIV-1 RNA copies/mL at 6 months (± 3 months) after cART initiation were included in the study. Unadjusted and adjusted references curves and predictions were obtained using quantile regressions. RESULTS: A total of 28 992 patients were included in the study. The median CD4 T-cell count at treatment initiation was 249 [interquartile range (IQR) 150, 336] cells/µL. The median observed CD4 counts at 6, 9 and 12 months were 382 (IQR 256, 515), 402 (IQR 274, 543) and 420 (IQR 293, 565) cells/µL. The two main factors explaining the variation of CD4 count at 6 months were AIDS stage and CD4 count at cART initiation. A CD4 count increase of ≥ 100 cells/mL is generally required in order that patients stay 'on track' (i.e. with a CD4 count at the same percentile as when they started), with slightly higher gains required for those starting with CD4 counts in the higher percentiles. Individual predictions adjusted for factors influencing CD4 count were more precise. CONCLUSIONS: Reference curves aid the evaluation of the immune response early after antiretroviral therapy initiation that leads to viral control.
Assuntos
Antirretrovirais/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Linfócitos T CD4-Positivos/imunologia , Infecções por HIV/tratamento farmacológico , HIV-1/efeitos dos fármacos , Adolescente , Adulto , Idoso , Contagem de Linfócito CD4 , Estudos de Coortes , Monitoramento de Medicamentos , Europa (Continente) , Feminino , Infecções por HIV/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Carga Viral , Adulto JovemAssuntos
Vacinas contra COVID-19 , COVID-19/prevenção & controle , Linfadenopatia , Adulto , Vacina BNT162 , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/efeitos adversos , Feminino , Humanos , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/etiologia , Remissão Espontânea , SARS-CoV-2 , Ultrassonografia/métodosRESUMO
We report on a patient with longstanding multicentric Castleman's disease, hyaline-vascular type, who presented with nearly-fatal myocarditis associated with a 2009 pandemic H1N1 influenza virus infection. This is the first case of such an association described in the literature.
Assuntos
Hiperplasia do Linfonodo Gigante/complicações , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/complicações , Miocardite/complicações , Feminino , Humanos , Influenza Humana/epidemiologia , Pessoa de Meia-Idade , Miocardite/etiologia , Pandemias , EspanhaRESUMO
INTRODUCTION: Subjective memory complaints (SMCs) in elderly adults could express cognitive decline in the future. A consensus has been reached about how these SMC relate to mood variables, but further research is required to determine which socio-demographic, cognitive, functional and occupational factors will act as predictors in elderly adults. OBJETIVE: To analyze, through a descriptive observational study, the relationship between anxiety/depression and sex, age and occupation, with cognitive/functional performance in 367 older adults with SMC, but without objective cognitive impairment in a primary healthcare center. METHODS: The cognitive variables were measured by applying the Spanish version of Mini-Mental State Examination (MEC-35) and Set-test for verbal fluency. To measure functional level, the Barthel index and Lawton and Brody scales were employed. Physical occupational status and mental occupational status were measured based on three levels, low, medium and high, according to the American Occupational Therapy Association. RESULTS: Low educational and occupational physical and mental levels were related to anxiety and depression. In addition, differences by sex were found on anxiety and depression related to different factors. In men, anxiety was related to higher cognitive level, and in women to higher functional performance in IADLs. On the contrary, depression in men was related to lower cognitive level and higher performance in ADLs. CONCLUSIONS: It is important to maintain a sex-gender perspective on the study of anxiety and depression in elderly, taking into account social roles and the traints of the work environment, in order to avoid cognitive and functional impairment.
Assuntos
Disfunção Cognitiva , Depressão , Humanos , Masculino , Feminino , Idoso , Depressão/epidemiologia , Caracteres Sexuais , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Ansiedade/epidemiologia , Transtornos de AnsiedadeRESUMO
Transient elastography is a useful method to assess liver fibrosis, but uncertainties still exist regarding reliability and reproducibility of the technique. We aimed to improve knowledge on interobserver variability with the procedure and tried to find factors associated with such variability. This was a cross-sectional study to compare the results of transient elastography performed by two different operators, one test made just after the other. We assessed both results with correlation tests and with repeated parametric or nonparametric tests, as needed. We also carried out a multivariate analysis to find factors associated with discrepancy in the results obtained by the two operators. We included a total of 333 pairs of transient elastography tests, belonging to 274 different patients. A total of 325 pairs of tests (97.6%) were valid. Results of the first and the second tests were, respectively, median (and interquartile range) of direct measurement 6.2 (4.6-10.6) and 6.0 (4.4-10.1) kPa (P = 0.012), and mean ± standard deviation of log(10) of direct measurement 0.892 ± 0.316 and 0.871 ± 0.324 (P = 0.001). In 87 pairs of tests (26.7%), a discrepancy of at least 2 kPa between both results was found, and in 15 pairs of tests (4.6%), a discrepancy of at least 10 kPa was found. Discordance of at least one stage between both measurements was noted in 74 pairs of tests (22.8%). An association was found between higher stiffness and discrepancy between both operators (P < 0.001). Although transient elastography is a very convenient test to assess liver fibrosis in clinical practice, interobserver discrepancy in results is common and represents a significant problem with the technique. Discrepant results are more common in patients with higher values of stiffness.
Assuntos
Técnicas de Imagem por Elasticidade/métodos , Cirrose Hepática/diagnóstico , Adulto , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Variações Dependentes do ObservadorRESUMO
A 77-year-old woman presented with subacute respiratory symptoms which were demonstrated to be due to nocardiosis. After initial improvement with antimicrobial therapy, new symptoms appeared, consisting of persistent vomits, abdominal pain and hypotension, which led to the diagnosis of Addison's disease.
Assuntos
Doença de Addison/complicações , Nocardiose/complicações , Doença de Addison/diagnóstico , Idoso , Tosse/etiologia , Feminino , Humanos , Nocardiose/diagnósticoRESUMO
BACKGROUND: Reports have shown that the publication of practice guidelines does not guarantee their use in clinical practice. The objective of this study was to evaluate the agreement between antiretroviral treatments (ARTs) prescribed in clinical practice and the recommendations in published guidelines. METHODS: A retrospective cohort study was carried out in ART-naïve adults of the Spanish Asociacion Medica Vach de Estudios Multicentricos (VACH) Cohort for the period from 2003 to 2006. RESULTS: A total of 945 patients initiated ART. Of these patients, 12.3% had a CD4 cell count above 350 cells/microL. A 'nonrecommended' antiretroviral regimen was prescribed to 5.3, 5.1 and 7.8% of patients with CD4 counts <200, 200-350 and >350 cells/microL, respectively. Multivariate analyses demonstrated that only a higher viral load was associated with the selection of a combination treatment that was recommended by the guidelines. CONCLUSIONS: Most patients were prescribed initial treatments in agreement with the recommendations. Appropriate routine data collection in databases can be used to evaluate the level of antiretroviral guideline compliance. We propose that routine evaluations of the guidelines must be part of quality assessment to improve medical care.
Assuntos
Antirretrovirais/uso terapêutico , Fidelidade a Diretrizes/normas , Infecções por HIV/tratamento farmacológico , HIV-1 , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica , Adulto , Idoso , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Espanha , Fatores de Tempo , Carga ViralRESUMO
Q fever is a zoonosis caused by Coxiella burnetii. The infection is transmitted to humans mainly through aerosols generated from products of delivery of cows and other animals. Generally the disease presents acutely with fever, pneumonitis and hepatitis. But chronic endocarditis is also a possible occurrence. Diagnosis is usually made by serology. The acute form of the infection responds well to tetracyclines and other antibiotics. But endocarditis is difficult to treat, and its prognosis is grim.
Assuntos
Febre Q , Doença Aguda , Doença Crônica , Humanos , Febre Q/diagnóstico , Febre Q/tratamento farmacológicoRESUMO
Chlamydiae are a singular group of bacteria, with a vital cycle that is intracellular in part. These microorganisms adhere to epithelia, where they may provoke infection. There are three pathogenic species for humans: Chlamydia trachomatis, which produce infections mainly in the genital and urinary tracts, and C. psittaci and C. pneumoniae, which mostly produce respiratory infections. The last two microorganisms are now classified in a different genus, known as Chlamydophila.
Assuntos
Infecções por Chlamydiaceae , Adulto , Criança , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/microbiologia , Infecções por Chlamydia/transmissão , Chlamydia trachomatis/classificação , Infecções por Chlamydiaceae/tratamento farmacológico , Infecções por Chlamydiaceae/epidemiologia , Infecções por Chlamydiaceae/microbiologia , Infecções por Chlamydiaceae/transmissão , Infecções por Chlamydophila/diagnóstico , Infecções por Chlamydophila/tratamento farmacológico , Infecções por Chlamydophila/epidemiologia , Infecções por Chlamydophila/microbiologia , Infecções por Chlamydophila/transmissão , Feminino , Doenças dos Genitais Femininos/tratamento farmacológico , Doenças dos Genitais Femininos/epidemiologia , Doenças dos Genitais Femininos/microbiologia , Doenças dos Genitais Masculinos/tratamento farmacológico , Doenças dos Genitais Masculinos/epidemiologia , Doenças dos Genitais Masculinos/microbiologia , Humanos , Masculino , Tracoma/tratamento farmacológico , Tracoma/epidemiologia , Tracoma/microbiologia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologiaRESUMO
CASE REPORT: Punctate inner choroidopathy (PIC) is a variant of multifocal choroiditis that principally affects young and healthy women. A case of this condition is described in a woman who presented with a scotoma as the main complaint. Four months after the diagnosis of PIC, she developed an exudative neurosensory detachment associated with an active focus of juxtafoveal choroiditis. Finally, with systemic corticosteroids and intravitreal ranibizumab, she made excellent progress. DISCUSSION: Intravitreal ranibizumab, associated with systemic corticosteroids, may be an effective treatment for exudative neurosensory detachment complicating PIC.
Assuntos
Corioidite/tratamento farmacológico , Glucocorticoides/administração & dosagem , Prednisona/administração & dosagem , Ranibizumab/administração & dosagem , Descolamento Retiniano/tratamento farmacológico , Administração Oral , Corioidite/complicações , Feminino , Humanos , Injeções Intravítreas , Coroidite Multifocal , Indução de Remissão , Descolamento Retiniano/complicações , Adulto JovemRESUMO
We report a rare case of meningitis caused by Enterococcus gallinarum, a bacterium characterized by its ability to express low-level resistance to vancomycin. As in the three other previously reported cases, this one occurred in a patient with a cerebrospinal fluid drainage catheter and properly responded to antimicrobial therapy and removal of the drain.
RESUMO
With the objective to value the degree of fulfillment of the pharmacological processing in patients with heart failure was designed the study of therapeutic adherence in heart failure (ATICA). During the period of inclusion educational, social, demographic data have been obtained, personal antecedents, analytic and physical exploration of the patients. These data mentioned are the ones that are reflected in the present pilot study. The total of patients included is 554, the majority of which are women, the middle ages is advanced and they present a fraction of eyección conserved in more than the half. In the therapeutic plan only was collected information of groups with neurohormonal action and of great recognition in the processing of the heart failure. The most utilized pharmacological group are the IECA, nevertheless medicines as the espirolactona or the betablocker continue showing a worrying degree of infrautilización, although they present a greater prescription that in other series.
Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Feminino , Humanos , Masculino , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Cooperação do Paciente , Projetos Piloto , Estudos ProspectivosRESUMO
Leptospirosis is the most common zoonosis worldwide, although most cases occur in tropical countries. Leptospira interrogans, a spirochete, is the causative agent. Rats are the main reservoir. Most patients present a mild clinical form of the disease, which consists of a self-limited febrile process, without jaundice. Nevertheless, about 10% of patients suffer severe infections, with intense jaundice. Typically the disease manifests in two phases: acute or leptospiremic and immune or leptospiuric, although in many patients the two phases are indistinguishable, and in mild cases the second one is frequently absent. Diagnosis is carried out by serology or culture of the microorganism. Treatment consists of antibiotics such as penicillin G, ceftriaxone, doxycycline or amoxicillin.
Assuntos
Leptospirose , Humanos , Leptospirose/diagnóstico , Leptospirose/tratamento farmacológico , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Hypertension is a major cardiovascular risk factor, but knowledge about the real magnitude of the problem and its determinants is lacking. AIM: To assess control of hypertension and evaluate medical resource use, in patients at high risk of cardiovascular disease. DESIGN: Multicentric cross-sectional study. METHODS: We collected data for 2205 adult patients from 36 centres, representative of all regions of Spain. Patients had attended out-patient clinics from July 2002 to August 2003, had an absolute cardiovascular risk > or =20% at 10 years (according to the Framingham guidelines), and had a diagnosis of hypertension. Pregnant and terminally ill patients were excluded. RESULTS: Hypertension was inadequately controlled in 1384 patients (62.8%). LDL cholesterol was higher in patients with uncontrolled hypertension (median 130.2 vs. 120.0 mg/dl, p < 0.001). Haemoglobin A(1c) in diabetic patients was also greater in those with uncontrolled hypertension (median 7.10% vs. 6.90%, p = 0.010). Uncontrolled hypertension was associated with the following variables, in descending strength of association: higher LDL cholesterol, taking antihypertensive medication, living in non-metropolitan areas, and higher body mass index. DISCUSSION: Hypertension is poorly controlled in most patients with a high risk of cardiovascular disease. Uncontrolled hypertension is frequently associated with poor control of other risk factors.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Hipertensão/terapia , Idoso , Anti-Hipertensivos/uso terapêutico , Estudos Transversais , Feminino , Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , EspanhaRESUMO
We report a unique case of acute bacterial prostatitis probably caused by Listeria monocytogenes in an HIV-infected patient. For the best of our knowledge, this is the first case reported of a patient with this association. Our case illustrates the protean clinical presentations that L. monocytogenes infections may adopt, particularly in immunocompromised patients.
Assuntos
Antibacterianos/uso terapêutico , Infecções por HIV/complicações , Listeria monocytogenes/isolamento & purificação , Prostatite/tratamento farmacológico , Prostatite/microbiologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Doença Aguda , Adulto , Humanos , Listeriose/sangue , Listeriose/tratamento farmacológico , Masculino , Prostatite/diagnóstico , Resultado do TratamentoRESUMO
OBJECTIVE: To compare adherence and clinical outcome with two modalities of highly active antiretroviral therapy (HAART), in HIV-infected patients. DESIGN: Randomized, open-label, prospective study. SETTING: Tertiary care centre in Spain. PATIENTS: A total of 112 non-naive HIV-infected patients, recruited from March 1998 through August 1998, were studied. INTERVENTIONS: Triple drug therapy with stavudine and lamivudine, plus indinavir or nelfinavir. MAIN OUTCOME MEASURES: Adherence, side-effects, and immunological, virological, and clinical efficacy of treatment were assessed at 3-month intervals. RESULTS: After a median follow-up of 9 months, 32% of patients in the indinavir group versus 50% of those in the nelfinavir group showed adequate adherence in all clinical appointments (P= 0.0559). Adherence was superior in the nelfinavir group in every visit. After 6 months of treatment 48% of subjects in the indinavir group and 70% of those in the nelfinavir group exhibited adequate adherence (P= 0.0311). After 9 months 35% of patients in the indinavir group and 59% of those in the nelfinavir group showed adequate adherence (P= 0.0291). Side-effects provoked discontinuation of treatment in 34% of patients in the indinavir group and 12% of patients in the nelfinavir group (P= 0.0073). Immunological and virological efficacy were similar in both groups. CONCLUSIONS: Adherence to a HAART regimen with stavudine plus lamivudine plus nelfinavir was superior to a regimen with stavudine plus lamivudine plus indinavir. Side-effects provoked more discontinuation of treatment in the indinavir group than in the nelfinavir group.
Assuntos
Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/uso terapêutico , Lamivudina/uso terapêutico , Inibidores da Transcriptase Reversa/uso terapêutico , Estavudina/uso terapêutico , Adulto , Quimioterapia Combinada , Feminino , Humanos , Indinavir/efeitos adversos , Indinavir/uso terapêutico , Nefropatias/induzido quimicamente , Masculino , Nelfinavir/efeitos adversos , Nelfinavir/uso terapêutico , Cooperação do Paciente , Estudos Prospectivos , Resultado do TratamentoRESUMO
Specific binding sites for somatostatin have been characterized in cytosolic fraction of rabbit renal papilla. The interaction of 125I-Tyr11-somatostatin with cytosolic fraction was rapid, reversible, specific, saturable and dependent on temperature. At 25 degrees C the binding data were compatible with the existence of two classes of binding sites: a high-affinity class with a Kd = 57.7 nM and a low-affinity class with a Kd = 217.4 nM. Somatostatin binding sites exhibited a high degree of specificity since neuropeptides such as Leu-enkephalin, neurotensin, substance P, vasopressin and vasoactive intestinal peptide behaved as ligands with null or very low affinity.