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1.
Respir Med Case Rep ; 47: 101957, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38223467

RESUMO

One of the most frequent diffuse interstitial lung diseases is hypersensitivity pneumonitis. It is related to exposure to diverse antigens, causing fibrosis in advanced stages, making the differential diagnosis with interstitial pulmonary fibrosis difficult as it overlaps with the usual interstitial pneumonia pattern. On the other hand, there are interstitial lung diseases associated with ANCA, such as microscopic polyangiitis, which is also related to the usual interstitial pneumonia pattern. We present the case of a 74-year-old male patient with chronic dyspnea, history of smoking and exposure to organic particles, in addition to a pattern suggestive of moderately severe restriction. The diagnosis was confirmed by histology of hypersensitivity pneumonitis by presenting granules, however, anti MPO and p-ANCA positivity was found, integrating the simultaneous diagnosis of microscopic polyangiitis. This is a case of difficult diagnosis since these pathologies have not been previously reported to coexist.

2.
Kidney Int ; 105(4): 824-834, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38280517

RESUMO

In Mexico, chronic kidney disease of unknown origin is highly prevalent. Screening studies in adolescents have shown persistent microalbuminuria (pACR), adaptive podocytopathy and decreased kidney volume (KV). Here, we sought to develop normality tables of kidney dimensions by ultrasound in the Mexican state of Aguascalientes pediatric population (0 to 18y) and evaluate the relationship between the KV and pACR among the region's adolescents in a cross-sectional study. Kidney length (KL) and KV were determined by ultrasound. Our findings were compared with those in international literature of different populations where tables and graphs of normal kidney dimensions by ultrasound were reported. We compared organ dimensions in individuals above the age of 11 without albuminuria with those in patients with pACR recruited through screening studies in adolescents in Aguascalientes. This included 1068 individuals to construct percentile tables and graphs of the KL. Kidney dimensions were significantly lower when compared with all international comparisons. From a total 14,805 screen individuals, we compared 218 adolescents with pACR and 377 individuals without significant albuminuria. The Total KV adjusted to body surface (TKVBS) was significantly associated with pACR (odds ratio 1.03, 95% confidence interval 1.02-1.03). The upper quartile of TKVBS was highly associated with pACR (7.57, 4.13-13.87), hypertension (2.53, 1.66-3.86), and hyperfiltration (26 vs 11.5%). Thus, TKVBS is directly associated with pACR while greater KV, arterial hypertension, and hyperfiltration in patients with pACR suggest that the increase in volume is secondary to kidney hypertrophy. Additionally, the adaptative podocytopathy with low fibrosis seen on kidney biopsy which was performed in a subset of patients, and the smaller kidney dimensions in our population point to prenatal oligonephronia as the primary cause of the detected kidney disease.


Assuntos
Hipertensão , Insuficiência Renal Crônica , Humanos , Criança , Adolescente , Albuminúria/diagnóstico , Albuminúria/epidemiologia , Albuminúria/etiologia , Estudos Transversais , México/epidemiologia , Taxa de Filtração Glomerular , Rim/patologia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/complicações , Hipertensão/patologia
3.
Clin Kidney J ; 15(7): 1300-1311, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35756733

RESUMO

Background: End-stage renal failure of unknown origin (ESRD-UO) is a public health problem in Mexico and many regions of the world. The prevalence of ESRD-UO in Aguascalientes, Mexico, is one of the highest worldwide, particularly in adults between 20 and 40 years of age. Our aim was to screen adolescents for chronic kidney disease (CKD) to identify risk factors and histologically characterize adolescents with persistent albuminuria. Methods: This was a cross-sectional, observational and comparative study of adolescents in whom serum creatinine and the albumin:creatinine ratio (ACR) were determined when screening for CKD. A clinical evaluation and risk factor survey were conducted. Patients with an abnormal ACR (≥30 mg/g) or a low glomerular filtration rate (GFR) (≤75 mL/min/1.73 m2) were re-evaluated and a renal ultrasound (US) was obtained. A kidney biopsy was performed in patients with persistent albuminuria. Results: A total of 513 students were included; 19 had persistent albuminuria and 494 were controls. The prevalence of persistent albuminuria was 3.7% [95% confidence interval (CI) 2.1-5.3]. Only one patient had a decreased GFR. None of the patients with persistent albuminuria had anatomical abnormalities of the urinary tract by renal US. Patients with persistent albuminuria had a decreased total renal volume compared with the control group (150 versus 195 mL/m2; P < 0.01). Eighteen kidney biopsies were performed; 72% had glomerulomegaly and only one patient had mild fibrosis. Podocyte abnormalities were evident on electron microscopy, including partial fusion (100%), microvillous degeneration (80%) and increased organelles (60%). Risk factors for persistent albuminuria were: homestead proximity to maize crops, the use of pesticides at the father's workplace, a family history of CKD and blood pressure abnormalities. The body mass index and breastfeeding were protective factors. Conclusions: The prevalence of persistent albuminuria in adolescents in Aguascalientes is high and histologic compromise is characterized by podocyte injury in the absence of fibrosis. The renal volume of persistent albuminuria patients was decreased, suggesting oligonephronia. Exposure to environmental toxins such as pesticides, even prenatally, may be responsible for this pathological entity. Screening programs in adolescents by determining ACR are necessary in this setting.

4.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 43(5): 494-503, Sept.-Oct. 2021. tab
Artigo em Inglês | LILACS | ID: biblio-1345466

RESUMO

Objective: The mental health problems and perceived needs of healthcare workers involved with coronavirus disease (COVID-19) may vary due to individual and contextual characteristics. The objective of this study was to evaluate healthcare workers' mental health problems during the common COVID-19 exposure scenario in Mexico, comparing those on the frontline with other healthcare workers according to gender and profession, determining the main risk factors for the most frequent mental health problems. Methods: A cross-sectional online study was conducted with a non-probabilistic sample of 5,938 Mexican healthcare workers who completed brief screening measures of mental health problems and ad hoc questions about sociodemographic professional characteristics, conditions related to increased risk of COVID-19 infection, life stressors during the COVID-19 emergency, and perceived need to cope with COVID-19. Results: The identified mental health problems were insomnia, depression, and posttraumatic stress disorder (PTSD), all of which were more frequent in frontline healthcare workers (52.1, 37.7, and 37.5%, respectively) and women (47.1, 33.0 %, and 16.3%, respectively). A lack of rest time was the main risk factor for insomnia (OR = 3.1, 95%CI 2.6-3.7, p ≤ 0.0001). Mourning the death of friends or loved ones due to COVID-19 was the main risk factor for depression (OR = 2.2, 95%CI 1.8-2.7, p ≤ 0.0001), and personal COVID-19 status was the main risk factor for PTSD (OR = 2.2, 95%CI 1.7-2.9, p ≤ 0.0001). Conclusion: The most frequent mental health problems during the common exposure scenario for COVID-19 in Mexico included the short-term psychological consequences of intense adversity. A comprehensive strategy for preventing mental health problems should focus on individuals with cumulative vulnerability and specific risk factors.


Assuntos
Humanos , Feminino , Saúde Mental , COVID-19 , Ansiedade , Surtos de Doenças , Estudos Transversais , Pessoal de Saúde , Depressão/epidemiologia , SARS-CoV-2
5.
Clin Kidney J ; 14(4): 1197-1206, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34094519

RESUMO

BACKGROUND: Chronic kidney disease (CKD) is one of the pathologies with the greatest impact on the public health system. Over the last few decades, the relevance of CKD in Mexico has increased, with associated overwhelming costs for care of renal disease. There are no reliable CKD statistics in Mexico. METHODOLOGY: In June 2018, the government of Aguascalientes called on all Health Institutions to create a state registry of treated end-stage renal disease (ESRD). In the same system, a renal biopsy result registry included all the native kidney biopsies obtained in the state of Aguascalientes since 2012. We herein describe the prevalence, incidence and characteristics of the patients included in the CKD and renal biopsy registry in the state of Aguascalientes. RESULTS: As of April 2020, the state has documented 2827 patients on renal replacement therapy (RRT), 1877 on dialysis and 950 that have been transplanted. The prevalence of patients on dialysis is 1326 per million population (p.m.p.), and if transplanted individuals are included, it is 1997 p.m.p. The incidence of treated ESRD in 2019 was 336 p.m.p. (n = 474) in individuals with an average age of 45.6 years (standard deviation ±18), and in a higher proportion of men (61%). There is a bimodal distribution of the age at which RRT was initiated. The first and the most significant peaks are between the ages of 20 and 40 years and are usually the result of CKD of unknown cause (73%). The second peak is between 50 and 70 years of age, and CKD is usually the result of diabetes mellitus and systemic arterial hypertension (59.6%). Since January 2012, 423 biopsies have been recorded. The patient's ages were between 20 and 30 years (n = 112), and the most frequent diagnosis was focal segmental glomerulosclerosis (FSGS) (54%). CONCLUSIONS: The prevalence of treated ESRD in the state of Aguascalientes is high. The disease mostly afflicts young people between 20 and 40 years of age, and there is a clear male predominance. In this age group, the main clinical diagnosis is CKD of unknown origin, and the most frequent biopsy diagnosis was FSGS.

6.
Acta pediátr. Méx ; 18(6): 282-4, nov.-dic. 1997. ilus
Artigo em Espanhol | LILACS | ID: lil-217347

RESUMO

Introducción: El neumoencéfalo es el atrapamiento de aire dentro de la cavidad craneal; puede comportarse como una lesión ocupativa, incrementar la presión intracraneana, provocar herniación cerebral e incluso la muerte. En ocasiones el tratamiento debe ser urgente. Si las manifestaciones son menos graves, pueden resolverse utilizando oxígeno (O2) normobárico. Caso clínico. Se presenta una niña de nueve años con traumatismo craneoencefálico grave y fístula transitoria de líquido cefalorraquídeo (LCR); desarrolló estado de estupor, síndrome de hipertensión intracraneana y meningitis secundaría a la fístula de LCR. La tomografía axial computada (TAC) mostró neumoencéfalo bifrontal de predominio izquierdo. Se trató antibióticos por 15 días y O2 nomobárico al 40 por ciento durante siete días. El control tomográfico mostró resolución del neumoencéfalo. Conclusión: El uso de O2 normobárico en concentraciones del 40 al 100 por ciento es útil en el tratamiento del neumoencéfalo de causa diversa. Es una modalidad de tratamiento de bajo costo, no invasiva y con excelentes resultados en pacientes seleccionados


Assuntos
Humanos , Feminino , Lesões Encefálicas/terapia , Meningite/fisiopatologia , Pneumocefalia/fisiopatologia , Pneumocefalia/terapia , Penicilina G , Punções , Punções/estatística & dados numéricos , Radiografia/estatística & dados numéricos , Tomografia , Tomografia/estatística & dados numéricos , Compostos de Oxigênio
8.
Acta pediátr. Méx ; 16(1): 9-14, ene.-feb. 1995. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-173783

RESUMO

Objetivo: Establecer indicadores tempranos para decidir intervención quirúrgica más oportuna. Material y métodos. Se estudiaron en forma retrospectiva los expedientes clínicos de 42 niños con enterocolitis necrosante (ECN) que por esta causa requirieron intervención quirúrgica. Se analizaron variables clínicas, radiológicas y de laboratorio. Resultados. El 57 por ciento de los pacientes fueron lactantes y 35 por ciento recién nacidos, de los cuales 21 por ciento eran prematuros; en el grupo de neonatos los factores de riesgo más importantes fueron enfermedad pulmonar grave, asfixia perinatal, prematurez y sepsis; en los lactantes la desnutrición, gastroenteritis y sepsis fueron los más sobresalientes. Los datos clínicos más frecuentes fueron: distensión abdominal, "aspecto séptico", evacuaciones con sangrado y dolor abdominal; el 72 por ciento tuvo hallazgos radiológicos de ECN demostrada, con neumatosis intestinal, porta o ambas, y neumoperitoneo. Los datos cardinales de laboratorio más destacados incluyen acidosis metabólica persistente, anemia, hipoprotrombinemia e hipoxemia persistente. Los estados clínico-radiológico fueron IIB y III en el 95 por ciento de los casos, es decir, con manifestaciones clínicas de falla orgánica múltiple; la mortalidad fué de 78.5 por ciento. Se considera la posibilidad de establecer nuevos criterios quirúrgicos para intervenir en forma más oportuna. Conclusiones. La enterocolitis complicada es una entidad de elevada morbimortalidad; se considera la posibilidad de establecer nuevos criterios quirúrgicos para intervenir en forma más oportuna


Assuntos
Recém-Nascido , Lactente , Humanos , Masculino , Feminino , Bactérias/isolamento & purificação , Enterocolite Pseudomembranosa/fisiopatologia , Hipóxia/complicações , Mucosa Intestinal/lesões , Distúrbios Nutricionais/complicações , Recém-Nascido Pequeno para a Idade Gestacional/fisiologia , Recém-Nascido/crescimento & desenvolvimento , Fatores de Risco
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