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1.
AIDS Res Ther ; 20(1): 85, 2023 11 27.
Artículo en Inglés | MEDLINE | ID: mdl-38012656

RESUMEN

BACKGROUND: This case series of 5 patients with severely necrotic mpox highlights the predominantly necrotic nature of lesions seen in cases of severe mpox as shown by skin and lung biopsy, as well as the extensive dissemination of the infection, as shown by polymerase chain reaction (PCR) assessment in different body sites. CASE PRESENTATIONS: Patients were male, the median age was 37, all lived with HIV (2 previously undiagnosed), the median CD4+ cell count was 106 cells/mm3, and 2/5 were not receiving antiretroviral treatment. The most common complication was soft tissue infection. Skin and lung biopsies showed extensive areas of necrosis. Mpox PCR was positive in various sites, including skin, urine, serum, and cerebrospinal fluid. The initiation of antiretroviral treatment, worsened the disease, like that seen in immune reconstitution syndrome. Three patients died due to multiple organ failure, presumably associated with mpox since coinfections and opportunistic pathogens were ruled out. CONCLUSIONS: Severely necrotic manifestations of mpox in people living with advanced and untreated HIV are related to adverse outcomes.


Asunto(s)
Infecciones por VIH , Mpox , Humanos , Masculino , Adulto , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Mpox/complicaciones , Mpox/tratamiento farmacológico , Antirretrovirales/uso terapéutico , Recuento de Linfocito CD4 , Necrosis/inducido químicamente , Necrosis/complicaciones , Necrosis/tratamiento farmacológico
2.
Rev Invest Clin ; 72(3): 165-177, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32584326

RESUMEN

BACKGROUND: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. OBJECTIVE: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). METHODS: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. RESULTS: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. CONCLUSIONS: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , Dolor Abdominal/epidemiología , Adulto , Anciano , Atención Ambulatoria , Biomarcadores/sangre , Índice de Masa Corporal , COVID-19 , Comorbilidad , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Cuidados Críticos , Disnea/etiología , Femenino , Enfermedades Gastrointestinales/epidemiología , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , México , Persona de Mediana Edad , Obesidad/epidemiología , Pacientes Ambulatorios/estadística & datos numéricos , Neumonía Viral/complicaciones , Neumonía Viral/terapia , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Centros de Atención Terciaria/estadística & datos numéricos , Resultado del Tratamiento
4.
Rev. invest. clín ; 72(3): 165-177, May.-Jun. 2020. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1251851

RESUMEN

ABSTRACT Background: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. Objective: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). Methods: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. Results: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. Conclusions: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Neumonía Viral/epidemiología , Infecciones por Coronavirus/epidemiología , Pandemias , Betacoronavirus , Índice de Severidad de la Enfermedad , Biomarcadores/sangre , Dolor Abdominal/epidemiología , Índice de Masa Corporal , Comorbilidad , Resultado del Tratamiento , Cuidados Críticos , Disnea/etiología , Centros de Atención Terciaria/estadística & datos numéricos , Atención Ambulatoria , Enfermedades Gastrointestinales/epidemiología , SARS-CoV-2 , COVID-19 , Pacientes Internos/estadística & datos numéricos , México , Obesidad/epidemiología
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