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1.
Rev. Méd. Inst. Mex. Seguro Soc ; 60(2): 142-148, abr. 2022. tab, graf
Article in Spanish | LILACS | ID: biblio-1367399

ABSTRACT

Introducción: la mortalidad asociada a infarto del miocardio (IM) no solo se debe a complicaciones cardiovasculares, sino también a complicaciones intrahospitalarias no cardiovasculares (CIHNC). El índice leuco-glucémico (ILG) se ha utilizado como un marcador pronóstico para el desarrollo de complicaciones cardiovasculares en el IM. Centramos este estudio en identificar el punto de corte de ILG para el desarrollo de CIHNC en pacientes con infarto de miocardio con elevación del segmento ST (IAMCEST). Material y métodos: en este diseño de un solo centro y transversal, incluimos pacientes con IAMCEST. El análisis bioquímico incluyó glucosa y leucocitos; se calculó ILG. Se realizaron análisis univariados y bivariados, curva ROC y análisis multivariado para el desarrollo de IAMCEST. Resultados: incluimos 1294 pacientes, 79.8% hombres y 20.2% mujeres. Las principales comorbilidades fueron: hipertensión arterial sistémica, diabetes mellitus y dislipidemia. Seiscientos cuarenta y cuatro pacientes (49.8%) presentaron CIHNC. El ILG > 1200 con área bajo la curva (AUC) 0.817 predice el desarrollo de CIHNC en pacientes con IAMCEST. Las variables que aumentaron el desarrollo de CIHNC fueron: ILG > 1200, creatinina > 0.91 mg/dL, diabetes mellitus y edad > 65 años. La neumonía intrahospitalaria y las complicaciones cardiovasculares aumentaron el riesgo de muerte entre los pacientes con IAMCEST. Conclusión: un LGI > 1200 aumentó más de nueve veces el riesgo de desarrollo de CIHNC en pacientes con IAMCEST.


Background: The myocardial infarction-associated (MI) mortality is not only due cardiovascular complications, but intrahospital non-cardiovascular complications (IHnCVCs). The leuko-glycemic index (LGI) has been used as a prognostic marker for the development of cardiovascular complications in MI. We focused this study on identifying the cut-off point of LGI for the IHnCVCs development in patients with ST-segment elevation myocardial infarction (STEMI).Material and methods: In this single-center and cross-sectional design, we included patients with STEMI. The biochemical analysis included glucose and leucocytes; with them we calculated the LGI. Receiver operating characteristic curve, univariate and bivariate analysis, and multivariate analysis for IHnCVCs development were performed. A p < 0.05 was considered statistically significant. Results: We included 1294 patients, 79.8% were men and 20.2% women. The main comorbidities were hypertension, diabetes mellitus and dyslipidemia. Six hundred forty-four (49.8%) patients presented IHNCVCs. The LGI > 1200 (AUC 0.817) predict the IHNCVCs development in STEMI patients. The variables that increased the IHNCVCs development were LGI > 1200, creatinine > 0.91 mg/dL, diabetes mellitus and age > 65 years. Hospital acquired pneumonia and cardiovascular complications increase the risk of death among STEMI patients. Conclusion: A LGI > 1200 increased, just over nine times, the risk of IHnCVC development in STEMI patients.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Glycemic Index , ST Elevation Myocardial Infarction/blood , Prognosis , Biomarkers/blood , Cross-Sectional Studies , Multivariate Analysis , Retrospective Studies , Hospital Mortality , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/mortality , Heart Disease Risk Factors , Nonagenarians , Mexico/epidemiology
2.
Dermatol. argent ; 27(2): 53-58, abr-jun 2021. il, graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1363911

ABSTRACT

El granuloma anular maculoso es una variante rara de granuloma anular, que representa un desafío diagnóstico. Su incidencia se desconoce y se presenta con mayor frecuencia en las mujeres de entre 40 y 70 años. Se asocia a las mismas entidades y responde a los mismos tratamientos que las otras variantes clínicas de granuloma anular. Se presentan los casos de 5 mujeres con diagnóstico de granuloma anular maculoso, que recibieron diferentes tratamientos tópicos y sistémicos, con respuestas clínicas variables.


Patch-type granuloma annulare is a rare variant of granuloma annulare, thus which represents diagnostic challenge. It has an unknown incidence and occurs most often in women between 40 and 70 years of age. It presents similar associations and responds to treatment as the clinical variants. We present 5 emale patients with patch-type granuloma annulare, who received different topical and systemic treatments, with variable clinical responses.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged, 80 and over , Granuloma Annulare/diagnosis , Phototherapy , Granuloma Annulare/pathology , Granuloma Annulare/drug therapy , Octogenarians , Nonagenarians
3.
J. vasc. bras ; 20: e20200156, 2021. graf
Article in English | LILACS | ID: biblio-1340173

ABSTRACT

Abstract The kidneys and ureters are retroperitoneal structures in the upper part of the paravertebral gutters, tilted against the structures on the sides of the lowest two thoracic and upper three lumbar vertebrae, so that their anterior and posterior surfaces face antero-laterally and postero-medially, respectively. Congenital anomalies of the urinary tract are often the underlying cause of renal pathologies; 40% of these pathological conditions are due to variations in location, shape, and size of the kidney(s), calyces, ureter, or bladder. This case report describes the presence of a unilateral non-rotated left kidney with vascular and ureter variations found during routine cadaveric dissection for medical graduates. Alterations in rotation of the kidney and its relation to structures at the hilum have great clinical significance when conducting surgical procedures like partial nephrectomy, nephron sparing surgery, and renal transplantation.


Resumo Os rins e o ureter são estruturas retroperitoneais localizadas na parte superior do sulco paravertebral, inclinados contra as estruturas laterais das duas vértebras torácicas inferiores e das três vértebras lombares superiores. Assim, as superfícies anteriores e posteriores estão nas porções anterolateral e posteromedial, respectivamente. As anomalias congênitas do trato urinário frequentemente são causas subjacentes de patologias renais, e 40% delas ocorrem devido a variações no local, formato e tamanho dos rins, cálices, ureter ou bexiga. Este relato de caso descreve a presença de rim esquerdo unilateral sem rotação com variações vasculares e de ureter encontradas durante uma dissecção de cadáver rotineira com graduandos de Medicina. As alterações na rotação do rim e a sua relação com as estruturas no hilo têm grande importância clínica durante procedimentos cirúrgicos como a nefrectomia parcial, a cirurgia poupadora de néfrons e o transplante renal.


Subject(s)
Humans , Male , Aged, 80 and over , Congenital Abnormalities , Kidney/abnormalities , Torsion Abnormality , Urinary Tract/abnormalities , Nonagenarians , Nephrectomy
4.
J. vasc. bras ; 19: e20200031, 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1135121

ABSTRACT

Resumo Contexto As oclusões arteriais agudas (OAA) de membros vêm crescendo paralelemente com a longevidade da população. Objetivos O objetivo deste estudo foi avaliar fatores de risco, salvamento de membros e sobrevida dos pacientes com OAA tratados em instituição universitária. Métodos Este é um estudo coorte retrospectivo de pacientes consecutivos. Os desfechos incluíram: sucesso técnico, sintomas, comorbidades, categoria Rutherford, artérias acometidas, complicações pós-operatórias, taxa de salvamento de membros em 30 dias e óbitos. Resultados Avaliou-se 105 prontuários, havendo predomínio do sexo masculino (65,7%) e idade entre 46 a 91 anos. As etiologias identificadas foram trombóticas (54,3%), embólicas (35,2%) e indefinidas (10,5%). Cerca de dois terços apresentavam-se nas Categorias II e III de Rutherford. Os sintomas associados encontrados foram dor (97,1%), esfriamento (89,5%), palidez (64,7%), parestesias (44,7%), paralisias (30,5%), anestesias (21,9%), edema (21,9%) e cianose (15,2%); e as comorbidades associadas observadas foram hipertensão (65,0%), tabagismo (59,0%), arritmias (26,6%), dislipidemias (24,0%) e diabetes (23,8%). O segmento femoral superficial-poplíteo-distal foi o mais acometido (80%). A tromboembolectomia com cateter Fogarty foi realizada em 73,3% dos casos (81,0% nas embolias, 71,9% nas tromboses e 54,5% nos indefinidos), sendo isoladamente em 41 pacientes (39,05%), nos quais ocorreram 11 reoclusões, 20 amputações e 14 óbitos. A reoclusão arterial foi mais frequente nas tromboses (12,9%; p = 0,054). Até 30 dias após tratamento, o óbito total foi de 14,6% e a amputação maior foi de 19,8%, sendo menos frequente na Classe I Rutherford (p = 0,0179). Conclusão O tratamento da OAA feito prioritariamente por meio de tromboembolectomia com cateter Fogarty, isolado e/ou associado, proporcionou taxas de amputação e complicações compatíveis com as apresentadas na literatura e progressivamente menores nas categorias Rutherford menos avançadas.


Abstract Background Acute arterial occlusions (AAO) in limbs have been increasing in parallel with population longevity. Objective To assess risk factors, limb salvage rates, and survival of patients with AAO treated at a University Hospital. Methods Retrospective cohort study of consecutive patients. Outcomes included: patency, symptoms, comorbidities, Rutherford category, arteries occluded, postoperative complications, and 30-day limb salvage and mortality rates. Results Medical records were evaluated from 105 patients, predominantly males (65.7%), with ages ranging from 46 to 91 years. Etiology: thrombotic (54.3%), embolic (35.2%), and undefined (10.5%). About 2/3 of the patients were assessed as Rutherford category II or III. Associated symptoms: pain (97.1%), coldness (89.5%), pallor (64.7%), sensory loss (44.7%), paralysis (30.5%), anesthesia (21.9%), edema (21.9%), and cyanosis (15.2%). Associated comorbidities: hypertension (65.0%), smoking (59.0%), arrhythmias (26.6%), dyslipidemia (24.0%), and diabetes (23.8%). The distal superficial femoral-popliteal segment was the most affected (80%). Thromboembolectomy with a Fogarty catheter was performed in 73.3% of cases (81.0% of embolic cases, 71.9% of thrombotic cases, and 54.5% of cases with undefined etiology) and was the only treatment used in 41 cases (39.05%), among which there were 11 reocclusion, 20 amputations, and 14 deaths. Arterial reocclusion was more frequent in thrombosis cases (12.9%, p = 0.054). Within 30 days of treatment, total mortality was 14.6%, and 19.8% of cases underwent major amputation, which was less frequent among Rutherford Class I patients (p = 0.0179). Conclusion Treatment of AAO was primarily performed by thromboembolectomy with a Fogarty catheter, either alone or in combination with other treatments, achieving amputation and complication rates compatible with the best results in the literature and were progressively lower in less advanced Rutherford categories.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Hospitals, University/statistics & numerical data , Ischemia/prevention & control , Ischemia/therapy , Survival , Retrospective Studies , Limb Salvage , Extremities , Balloon Embolectomy , Heart Disease Risk Factors , Nonagenarians
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