RESUMO
INTRODUCTION: Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by precapillary pulmonary hypertension secondary to vaso-occlusive pulmonary vasculopathy and is classified as Pulmonary Hypertension Group 4. The aim of this study is to report the clinical experience of CTEPH in Mexico. METHODS: Consecutive patients diagnosed with CTEPH were identified from the Registro de Pacientes con Hipertension Pulmonar del Instituto de Seguridad y Servicio Social de los Trabajadores del Estado (REPHPISSSTE) registry between January 2009 and February 2014. Right heart catheterization was not routinely performed prior to August 2010 in the work-up of CTEPH. RESULTS: We identified 50 patients with CTEPH; their median age was 63 years and 58 % were female. Patients had multiple associated co-morbidities and moderate hemodynamic impairment. All patients were treated with anticoagulation. Despite surgical evaluation for pulmonary endarterectomy (PEA), only one patient underwent PEA given the lack of infrastructure for post-operative care and lack of insurance for this procedure. Most of the patients were treated with sildenafil, bosentan, or both, with increasing use of rivaroxaban and sildenafil in recent years. The overall survival of the cohort was similar to that reported in other international registries, despite the limitations of care imposed by drug availability and surgical feasibility. CONCLUSION: This is the first report on the CTEPH experience in Mexico. It highlights the similarity of patients in the REPHPISSSTE registry to those in international registries as well as the challenges that clinicians face in a resource-limited setting.
Assuntos
Hipertensão Pulmonar/epidemiologia , Artéria Pulmonar , Embolia Pulmonar/epidemiologia , Idoso , Anticoagulantes/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Cateterismo de Swan-Ganz , Doença Crônica , Comorbidade , Endarterectomia , Feminino , Hemodinâmica , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Estimativa de Kaplan-Meier , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Artéria Pulmonar/efeitos dos fármacos , Artéria Pulmonar/fisiopatologia , Artéria Pulmonar/cirurgia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/terapia , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
El asma es una enfermedad atópica caracterizada por un incremento de los eosinófilos y de la inmunoglobulina E (IgE) en la mucosa nasal y en la sangre periférica. Con los avances en el conocimiento de la fisiopatología y de las técnicas de laboratorio, en estos momentos se pueden determinar algunas proteínas de la superficie de los linfocitos T llamadas CD, por ejemplo CD62L, CD152, CD11a. Material y métodos: se reclutaron 15 sujetos distribuidos en tres grupos de cinco personas (control, asma leve y asma severa). Se determinaron CD11a, CD30, CD62L. Se efectuó un Análisis con métodos estadísticos no paramétricos. Resultados: se encontraron diferencias con respecto a CD62L (p = 0.009) relacion ndose con asma severa. Conclusión: se demuestra la existencia de un cambio en la expresión de los CD. Hace falta un número mayor de pacientes para apoyar aún más nuestros resultados.