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2.
Acta otorrinolaringol. esp ; 70(6): 348-357, nov.-dic. 2019. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-184880

RESUMO

Antecedentes y objetivo: El objetivo del estudio ha sido describir los resultados del tratamiento de sinusitis fúngica invasiva con cirugía endoscópica nasal en una población oncológica pediátrica con inmunosupresión e informar sobre la seguridad, la eficacia y las complicaciones del procedimiento. Métodos: Se realizó un estudio retrospectivo de la totalidad de los pacientes con diagnóstico de sinusitis fúngica invasiva operados en la Unidad Nacional de Oncología Pediátrica entre los años 2012 y 2016. Los datos tomados de su historial médico incluyeron: características epidemiológicas, diagnóstico oncológico, datos hematológicos, síntomas, estudios tomográficos, intervenciones quirúrgicas, resultados de enfermedad y cultivos, medicamentos recibidos, complicaciones, evolución y supervivencia. Los datos fueron analizados utilizando estadística descriptiva, las variables continuas con medidas de tendencia central y las variables categóricas de forma porcentual. Resultados: Se identificó a 18 pacientes, 7 de sexo masculino y 11 de sexo femenino. El promedio de edad fue de 12 años, 13 tuvieron diagnóstico de leucemia linfoide aguda y 5 de leucemia mieloide aguda; 17 pacientes presentaron neutropenia severa en el momento del diagnóstico. El agente etiológico más frecuentemente identificado fue Aspergillus en 13 pacientes. En 16 pacientes (89%) se controló la enfermedad con cirugía endoscópica nasal. Diez pacientes fallecieron por causas no relacionadas a lo largo del estudio. Discusión y conclusiones: La sinusitis fúngica invasiva es una enfermedad cuya incidencia va en aumento entre pacientes con inmunosupresión y debe de considerarse una urgencia médica debido a su alta mortalidad. El diagnóstico se basa en un alto índice de sospecha en pacientes con factores predisponentes (leucemia, neutropenia, fiebre persistente, sonda nasogástrica) y la evaluación endoscópica nasal. El tratamiento médico antifúngico y cirugía endoscópica nasal agresiva está indicado independientemente del estado del paciente para disminuir la carga fúngica y la alta mortalidad asociada. El tratamiento debe de ser suministrado por un equipo multidisciplinario que incluye pediatría, hemato-oncología, infectología y otorrinolaringología


Background and objective: to describe the results of the treatment of invasive fungal sinusitis with nasal endoscopic surgery in an immunocompromised paediatric oncological population. Methods: retrospective study of all patients diagnosed with invasive fungal sinusitis operated in the National Paediatric Oncology Unit between 2012 and 2016. Data taken from their medical history included: epidemiological characteristics, oncological diagnosis, haematological data, symptoms, tomographic studies, surgical interventions, results of pathology and cultures, medications received, complications, evolution and survival. Results: 18 patients were identified, 7 male and 11 female. The average age was 12 years, 13 had a diagnosis of acute lymphocytic leukemia and 5 of acute myeloid leukemia. Seventeen patients presented severe neutropenia at the time of diagnosis. The most frequently identified aetiological agent was Aspergillus in 13 patients. In 16 patients (89%) the disease was controlled with nasal endoscopic surgery. Ten patients died due to unrelated causes throughout the study. Discussion and conclusions: Invasive fungal sinusitis should be considered a medical emergency due to its high mortality. The diagnosis is based on a high index of suspicion in patients with predisposing factors (leukaemia, neutropenia, persistent fever, nasogastric tube) and endoscopic nasal evaluation. Antifungal medical treatment and aggressive nasal endoscopic surgery is indicated regardless of the patient's condition to reduce the fungal burden and associated high mortality. The treatment must be provided by a multidisciplinary team that includes paediatrics, haemato-oncology, infectology and otorhinolaryngology


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Sinusite/diagnóstico , Sinusite/cirurgia , Imunossupressão , Endoscopia/métodos , Avaliação de Resultado de Intervenções Terapêuticas , Estudos Retrospectivos , Neutropenia/complicações , Aspergillus/isolamento & purificação , Micoses/complicações , Febre/etiologia , Seios Paranasais/diagnóstico por imagem , Complicações Pós-Operatórias
4.
Farm. hosp ; 43(5): 158-162, sept.-oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183928

RESUMO

Objetivo: Analizar las reacciones adversas en pacientes con cáncer colorrectal no metastásico debidas al tratamiento con capecitabina innovadora o genérica, y/o al régimen quimioterápico empleado, capecitabina en monoterapia o en combinación con oxaliplatino (XELOX). Método: Estudio descriptivo retrospectivo llevado a cabo en un hospital de segundo nivel en dos periodos de estudio (noviembre de 2013-abril de 2014 y agosto de 2016-mayo de 2017). Las variables recogidas fueron variables de exposición (esquema quimioterápico y/o medicamento recibido), variables de control (datos demográficos, de enfermedad y de tratamiento) y variables de respuesta (reacciones adversas). El análisis estadístico de los datos se efectuó con el programa SPSS(R) 15.0. Resultados: Se incluyeron 50 pacientes. Según el esquema quimioterápico administrado, se encontraron diferencias estadísticamente significativas en la aparición de eritrodisestesia palmo-plantar, más frecuente con monoterapia (p < 0,05), y neurotoxicidad, trombopenia y neutropenia, más frecuentes con XELOX (p < 0,05). Según el medicamento de capecitabina administrado, no se observaron diferencias estadísticamente significativas en las reacciones adversas estudiadas. Conclusiones: El perfil de seguridad de dos formulaciones de capecitabina, innovadora y genérica, parece estar asociado al esquema quimioterápico empleado, y no al medicamento en cuestión. La mayor eritrodisestesia palmo-plantar para monoterapia se debe probablemente a la mayor dosis de capecitabina empleada en dicho esquema, y la mayor neurotoxicidad, trombopenia y neutropenia para XELOX se debe probablemente a la toxicidad acumulada de dos fármacos antineoplásicos


Objective: To analyze adverse reactions in patients with nonmetastatic colorectal cancer due to treatment with either innovative or generic capecitabine and/or to the chemotherapeutic regimen employed, to the capecitabine alone, or in combination with oxaliplatin (XELOX). Method: Descriptive retrospective study carried out in a secondary level hospital in two study periods (November 2013-April 2014 and August 2016-May 2017). The collected variables were: exposure (chemotherapy scheme and/or received medication), control (demographics, disease and treatment data), and response (adverse reactions). The statistical analysis of data was performed with the SPSS(R) 15.0 program. Results: Fifty patients were included. According to the administered chemotherapeutic scheme, statistically significant differences were found in the appearance of palmar-plantar erythrodysesthesia, which is more frequent with monotherapy (p < 0.05), and neurotoxicity, thrombocytopenia and neutropenia, which is more frequent with XELOX (p < 0.05). Concerning the capecitabine drug administered, no statistically significant differences were found in the studied adverse reactions. Conclusions: The safety profile of two capecitabine formulations -innovative and generic- appears to be associated with the chemotherapy scheme employed, and not the drug itself. Most palmar-plantar erythrodysesthesia for monotherapy is likely due to the higher dose of capecitabine used in said scheme. The increase in neurotoxicity, thrombocytopenia and neutropenia for XELOX is probably due to cumulative toxicity of two antineoplastic drugs


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Capecitabina/administração & dosagem , Neoplasias Colorretais/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Oxaliplatina/administração & dosagem , Estudos Retrospectivos , Análise Estatística , Síndromes Neurotóxicas/complicações , Trombocitopenia/complicações , Neutropenia/induzido quimicamente
5.
Pharm. pract. (Granada, Internet) ; 17(3): 0-0, jul.-sept. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-188126

RESUMO

Background: Studies examining relationships between patient-related factors and treatment outcome in patients with candidemia are limited and often based on all-cause mortality. Objective: Our purpose was to examine the impact of concurrent renal replacement therapy (RRT) and other pre-specified factors on treatment outcome among adults with candidemia. Methods: This Institutional Review Board (IRB)-approved, single-center, case-cohort study included patients over 18 years of age admitted to Duke University Hospital between Jun 1, 2013 and Jun 1, 2017 with a blood culture positive for Candida spp. Treatment-, patient-, and disease-specific data were collected, and outcome (success/failure) determined 90 days after the index culture. An odds ratio (OR) and 95% confidence interval (95%CI) were calculated for the following during therapy: receipt of RRT, fluconazole monotherapy regimen, intensive care unit (ICU) stay, and neutropenia. Results: Among the 112 encounters (from 110 unique patients) included, treatment failure occurred in 8/112 (7.1%). Demographics were comparable between outcome groups. Among 12 patients receiving concomitant RRT, only 1 patient failed therapy. With regard to treatment failure, no significant differences were observed with RRT (OR, 1.21; 95%CI, 0.14 - 10.75), fluconazole monotherapy regimen (OR, 1.59; 95%CI, 0.3-8.27), ICU stay (OR, 1.43; 95%CI, 0.32-6.29), and neutropenia (0 treatment failures). Conclusions: Treatment failure, receipt of concomitant RRT, and neutropenia were infrequent in patients undergoing treatment for candidemia. In our cohort, exposure to RRT, a fluconazole monotherapy regimen, ICU stay, or neutropenia during treatment did not impact treatment outcome


No disponible


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Candida/patogenicidade , Candidíase/etiologia , Candidemia/epidemiologia , Terapia de Substituição Renal/efeitos adversos , Neutropenia/complicações , Fatores de Risco , Fluconazol/uso terapêutico , Antifúngicos/uso terapêutico , Unidades de Terapia Intensiva/estatística & dados numéricos , Estudos Retrospectivos
6.
Rev. esp. quimioter ; 32(supl.3): 34-36, sept. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-188977

RESUMO

Ceftobiprole is a fifth generation cephalosporin with a series of characteristics differentiating it from other beta-lactams, including its antibacterial activity, mainly against methicillin-resistant Staphylococcus aureus, resistant Streptococcus pneumoniae and also Gram-negative microorganisms such as Pseudomonas aeruginosa. This antibiotic has been subjected to various clinical trials and the results of these have led to its approval in Spain for the treatment of nosocomial pneumonia, excluding that associated with mechanical ventilation, and community-acquired pneumonia. The results of various ceftobiprole clinical studies provide consistent information on efficacy and tolerability. Ceftobiprole as monotherapy has been shown to be non-inferior to comparator antibiotics in different settings. Information is available on its compatibility with other drugs in Y-site administration, important from the point of view of the intravenous treatment of patients who present venous access limitation. On the other hand, and in contrast to other cephalosporins, ceftobiprole presents a low risk of infection due to Clostridium difficile and, in comparison with ceftaroline, neutropenia has not been reported to present any significant issues


No disponible


Assuntos
Humanos , Antibacterianos/efeitos adversos , Cefalosporinas/efeitos adversos , Administração Intravenosa , Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Ensaios Clínicos Fase I como Assunto , Ensaios Clínicos Fase III como Assunto , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Neutropenia/induzido quimicamente , Pneumonia Bacteriana/tratamento farmacológico , Pseudomonas aeruginosa/efeitos dos fármacos , Streptococcus pneumoniae/efeitos dos fármacos
8.
Rev. lab. clín ; 11(2): 97-100, abr.-jun. 2018. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-174362

RESUMO

El síndrome de Kabuki (SK) es una rara enfermedad genética que cursa con importantes alteraciones cardiacas e inmunológicas. La mayoría de los pacientes son diagnosticados en los primeros años de vida pese a que la edad de inicio no está bien definida. Los pacientes afectos presentan infecciones de repetición debido a su inmunosupresión pudiendo llegar a un estado de agranulocitosis. Aunque su pronóstico es bastante favorable, su esperanza de vida viene condicionada por este tipo de complicaciones. Por ello, conocer sus características analíticas particulares resulta interesante desde el punto de vista del laboratorio de hematología para contribuir en su orientación diagnóstica y en el seguimiento de los mismos. Presentamos el caso de un paciente diagnosticado de SK


Kabuki syndrome (KS) is a rare genetic disease that usually involves significant cardiac and immunological disorders. Most patients are diagnosed in the first years of life, despite the fact that the age of onset is not well-defined. Affected patients have recurrent infections due to their immunosuppression, and may reach a state of agranulocytosis. Although their prognosis is quite favourable, their life expectancy is determined by these types of complications. Therefore, to understand its particular analytical characteristics is interesting from the point of view of the Haematology Laboratory to contribute to their diagnosis and follow-up. The case is presented of a patient diagnosed with KS


Assuntos
Humanos , Feminino , Criança , Agranulocitose/diagnóstico , Agranulocitose/genética , Prognóstico , Neutropenia/genética , Mutagênese , Agranulocitose/complicações , Neutropenia/complicações , Otite/complicações , Otite/diagnóstico , Pseudomonas aeruginosa/isolamento & purificação , Deficiências do Desenvolvimento/complicações , Testes Hematológicos/métodos , Diagnóstico Diferencial
9.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 45(1): 36-39, ene.-mar. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-170103

RESUMO

El ectima gangrenoso es una manifestación dermatológica característica de una infección severa causada casi siempre por Pseudomonas aeruginosa (P. aeruginosa), con o sin bacteriemia. Las infecciones severas por P. aeruginosa se presentan habitualmente en pacientes con inmunodepresión u hospitalizados, en los pacientes sanos existe el antecedente de foliculitis y forunculosis. El diagnóstico es evidentemente clínico con confirmación en cultivos. El ectima es una manifestación cutánea de una infección severa que lleva a confusión diagnóstica y causa retraso en el inicio del tratamiento. El tratamiento quirúrgico precoz asociado a una cobertura antibiótica amplia y a un soporte metabólico y nutricional adecuados son la primera elección terapéutica. Se presenta el caso de una paciente joven inmunocompetente que presentó un shock séptico asociado a neutropenia, ectima gangrenoso e infección de vías urinarias causado por P. aeruginosa


Ecthyma gangrenosum is a dermatological manifestation characteristic of a severe infection almost always caused by P. aeruginosa, with or without bacteraemia. Severe infections by P. aeruginosa usually present in immunocompromised or hospitalised patients, or in healthy patients with a history of folliculitis and furunculosis. The diagnosis is clinical with culture confirmation. Ecthyma is a cutaneous manifestation of a severe infection that leads to misdiagnosis and delayed treatment. Early surgical treatment associated with a broad antibiotic coverage and adequate metabolic and nutritional support are the first therapeutic choice. We describe the case of a young immunocompetent patient who presented septic shock associated with neutropenia, ecthyma gangrenosum and urinary tract infection caused by P. aeruginosa


Assuntos
Humanos , Feminino , Adulto , Ectima Contagioso/diagnóstico , Ectima Contagioso/cirurgia , Pseudomonas aeruginosa/isolamento & purificação , Pseudomonas aeruginosa/patogenicidade , Neutropenia/complicações , Infecções Urinárias/complicações , Edema/complicações , Vulva/patologia , Glândulas Vestibulares Maiores/patologia , Sepse/complicações
11.
Rev. esp. quimioter ; 30(6): 397-406, dic. 2017. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-169392

RESUMO

Given the growing incidence of invasive candidiasis in critically ill and haemato-oncological patients and its poor outcomes, an early diagnosis and treatment are need for get a better prognosis. This document reviews the current approaches that help in diagnosis of invasive candidiasis based on culture-independent microbiological tests. The combination of clinical prediction scores with fungal serological markers could facilitate the approach in antifungal therapy, optimizing it. This article also reviews the epidemiology and primary risk factors for invasive candidiasis in these patients, updating the therapeutic approach algorithms in both clinical contexts based on the main evidence and international guidelines (AU)


Dada la creciente incidencia de candidiasis invasiva en pacientes críticos y hematooncológicos y sus malos resultados, es necesario un diagnóstico y tratamiento precoz para obtener un mejor pronóstico. Este documento revisa los enfoques actuales que ayudan en el diagnóstico de candidiasis invasiva basado en pruebas microbiológicas independientes del cultivo. La combinación de puntuaciones de predicción clínica con marcadores serológicos fúngicos podría facilitar el enfoque en la terapia antifúngica, optimizándola. Este artículo también revisa la epidemiología y los principales factores de riesgo de candidiasis invasiva en estos pacientes, actualizando los algoritmos de abordaje terapéutico en ambos contextos clínicos basados en la evidencia publicada y en las guías internacionales (AU)


Assuntos
Humanos , Candidíase Invasiva/tratamento farmacológico , Candida/patogenicidade , Neutropenia/complicações , Algoritmos , Prática Clínica Baseada em Evidências/tendências , Padrões de Prática Médica/tendências , Candidíase Invasiva/microbiologia
12.
Rev. esp. quimioter ; 30(supl.1): 22-25, sept. 2017. tab
Artigo em Inglês | IBECS | ID: ibc-165932

RESUMO

There are major differences in the epidemiology and prognosis of invasive candidiasis and candidemia in the neutropenic patient; however, a recent study performed in Spanish hospitals (Candipop) confirmed that mortality at 1 month is 30%, which is similar to that observed in the general population. Although Candida albicans is the most frequently isolated species, C. tropicalis, C. glabrata, and C. krusei are more prevalent than in non-neutropenic patients. The benefit of neutrophil transfusion is unclear, and catheter withdrawal must be tailored and based on confirmation of the diagnosis. Echinocandins are the first-line option for therapy and have a better safety profile than other agents (AU)


Existen diferencias significativas en la epidemiología y pronóstico de la candidemia y candidiasis invasiva en el paciente neutropénico, aunque una similar mortalidad a la observada en la población general (30% al mes) ha sido notificada en un reciente estudio nacional (Candipop). Candida albicans es la especie más frecuente pero C. tropicalis, C. glabrata y C. krusei tienen una mayor prevalencia que en los pacientes no neutropénicos. No está claro el beneficio de la transfusión de neutrófilos y la retirada de catéter debe ser individualizada. Las equinocandinas suponen el tratamiento de elección dada su eficacia y perfil de toxicidad en relación a otros antifúngicos (AU)


Assuntos
Humanos , Candidíase Invasiva/diagnóstico , Candidíase Invasiva/tratamento farmacológico , Neutropenia/complicações , Candidemia/tratamento farmacológico , Antifúngicos/uso terapêutico , Candida albicans , Candida albicans/isolamento & purificação , Candida tropicalis , Candida glabrata , Neutrófilos , Equinocandinas/uso terapêutico
13.
Bol. pediatr ; 57(239): 9-19, 2017. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-168526

RESUMO

Objetivos: Analizar las formas clínicas de presentación, hallazgos al diagnóstico, caracterización etiológica y evolución de los diferentes tipos de neutropenia en la infancia, excluida la asociada a diagnóstico o tratamiento oncológico. Material y métodos: Estudio retrospectivo descriptivo sobre una serie de casos clínicos consecutivos en niños diagnosticados de neutropenia, durante los años 2000-2015. Estudio analítico por grupos etiológicos agrupando formas congénitas y adquiridas y grupos de edad. Resultados: Se incluyeron 43 casos predominando las formas adquiridas (35, 81,4%). Las neutropenias congénitas (8, 18,6%) se asociaron a neutropenia benigna familiar (3), anemia de Fanconi (2) y neutropenia cíclica (3), sin otros casos de neutropenia congénita grave. El diagnóstico de la neutropenia se realizó por hallazgo analítico casual en 20 casos (46,5%) y en 17 (39,5%) por analítica por infección. La mediana de neutrófilos al diagnóstico fue significativamente menor en el grupo de neutropenias autoinmune primaria que en el grupo postinfecciosa. En 23 casos (53,5%) la neutropenia fue persistente. En las formas congénitas se apreció mayor duración de la neutropenia y mayor porcentaje de infecciones de repetición. En las adquiridas el porcentaje de neutropenia moderada y grave o muy grave fue mayor en el grupo de menores de dos años. Las pruebas de mayor rentabilidad diagnóstica fueron los anticuerpos antineutrófilos (63,3%) y el estudio de médula ósea (41,6%). Conclusiones: Debido a la excepcionalidad de las formas congénitas graves, en la infancia predominan las formas adquiridas de neutropenia y en éstas se asocia la mayor severidad al diagnóstico de neutropenia autoinmune primaria


Objectives: To analyze the clinical forms of presentation, findings at diagnosis, etiological characterization and clinical evolution of different types of neutropenia in childhood, excluding those associated with diagnosis or oncological treatment. Material and methods: A retrospective descriptive study of a series of consecutive clinical cases in children diagnosed with neutropenia during the years 2000-2015. Etiological form grouping congenital and acquired types and age groups, were investigated. Results: Forty-five cases were included, predominantly acquired forms (35, 81.4%). Congenital neutropenia (8, 18.6%) were associated with ethnic neutropenia (3), Fanconi anemia (2) and cyclic neutropenia (3), without other cases of severe congenital neutropenia. The diagnosis of neutropenia was made by casual analytical finding in 20 cases (46.5%) and in 17 (39.5%) by analytic coincidence with infection. The median neutrophils at diagnosis were significantly lower in the primary autoimmune neutropenia group than in the postinfectious group. In 23 cases (53.5%), neutropenia was persistent. In the congenital forms, the duration of neutropenia and a higher percentage of recurrent infections were observed. In the acquired cases, the percentage of moderate and severe or very severe neutropenia was higher in the group of children under two years. The most diagnostic tests were neutrophil antibodies assay (63.3%) and the bone marrow study (41.6%). Conclusions: Due of the exceptional nature of severe congenital forms, acquired forms of neutropenia predominate in childhood. In these, the greatest severity is associated with the diagnosis of primary autoimmune neutropenia


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Neutropenia/epidemiologia , Anticorpos Anticitoplasma de Neutrófilos/análise , Agranulocitose/tratamento farmacológico , Neutropenia/congênito , Estudos Retrospectivos , Imunofluorescência/métodos , Algoritmos
15.
Acta pediatr. esp ; 74(10): e222-e225, nov. 2016. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-158374

RESUMO

La neutropenia aloinmune neonatal (NAN) es una patología poco frecuente, que se debe a la producción materna de anticuerpos IgG frente a antígenos específicos de los neutrófilos fetales (HNA), de herencia paterna y no presentes en los neutrófilos de la madre. Estos anticuerpos maternos pasan al feto a través de la placenta, provocando la eliminación de los neutrófilos fetales e incrementando el riesgo de infección durante el periodo neonatal. Existen siete subtipos de HNA, pero los que más a menudo se relacionan con la NAN son el HNA-1a, el HNA-1b y el HNA-2a. El tratamiento de elección es el factor estimulante de colonias granulocíticas (G-CSF) y, en casos refractarios, otras opciones terapéuticas son la gammaglobulina intravenosa o los corticoides. La sepsis neonatal y la trombopenia persistente son dos complicaciones frecuentemente asociadas a la NAN. La trombopenia en la NAN se produce comúnmente por tres mecanismos: la propia sepsis, el efecto yatrogénico del G-CSF, y por reacción cruzada entre los anticuerpos anti-HNA y las plaquetas. En este caso clínico presentamos un cuarto mecanismo que, de forma multifactorial y asociado a los tres mecanismos previos, explica la trombopenia persistente en nuestro caso de NAN (AU)


The alloimmune neonatal neutropenia (NAN) is a rare condition that affects newborn maternal IgG antibody production against specific antigens of neutrophils (HNA) of paternal inheritance and not present on neutrophils from the mother and in antigens present in the fetus. These maternal antibodies pass the fetus through the placenta causing the elimination of the fetal neutrophils, increasing the risk of infection during the neonatal period. There are seven subtypes of HNA, but the most often related to NAN are the HNA-1a, HNA-1b and HNA-2a. The treatment of choice is G-CSF and refractory cases, intravenous immunoglobulin or corticosteroids, are other treatment options. Neonatal sepsis and persistent thrombocytopenia are two complications frequently associated with NAN. Thrombocytopenia in NAN, commonly occurs by three mechanisms: sepsis own, iatrogenic effect of G-CSF and cross-reactivity between antibodies and platelets anti-HNA. In our case report we present a fourth mechanism, so multifactorial and associated with the previous three mechanisms explains the persistent thrombocytopenia in our case NAN (AU)


Assuntos
Humanos , Masculino , Recém-Nascido , Neutropenia/etiologia , Trombose Venosa/complicações , Veia Porta/patologia , Trombocitopenia/etiologia , Sepse Neonatal/etiologia , Fator Estimulador de Colônias de Granulócitos/uso terapêutico
16.
Rev. esp. quimioter ; 29(supl.1): 56-58, sept. 2016.
Artigo em Espanhol | IBECS | ID: ibc-155923

RESUMO

La incidencia de la aspergilosis pulmonar invasora (API) está aumentando entre los pacientes no neutropénicos en los últimos años. La dificultad del diagnóstico precoz en estos pacientes implica un retraso en el inicio del tratamiento adecuado y una mayor mortalidad (AU)


The incidence of invasive pulmonary aspergillosis (IPA) is increasing among non-neutropenic patients in recent years. The difficulty of early diagnosis in these patients involves a delay in the onset of adequate treatment and higher mortality (AU)


Assuntos
Humanos , Aspergilose Pulmonar/epidemiologia , Infecções Respiratórias/epidemiologia , Aspergillus/patogenicidade , Neutropenia/epidemiologia , Tempo para o Tratamento/estatística & dados numéricos , Fatores de Risco , Pneumopatias Fúngicas/epidemiologia
17.
Rev. iberoam. micol ; 33(3): 170-175, jul.-sept. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-154692

RESUMO

Las enfermedades fúngicas invasoras por levaduras todavía tienen un importante papel en la morbimortalidad de los pacientes neutropénicos con neoplasias hematológicas. Aunque la incidencia global de la candidiasis invasora ha disminuido debido al amplio uso de profilaxis antifúngica, la incidencia de especies de Candida no-Candida albicans está aumentando y la mortalidad de la candidiasis invasora continúa siendo elevada. Además, se ha producido un incremento de infecciones invasoras por diversas levaduras poco comunes que incluyen especies de los géneros Malassezia, Rhodotorula, Trichosporon y Saprochaete, caracterizadas por su resistencia a las equinocandinas y un mal pronóstico de la enfermedad (AU)


Invasive fungal diseases caused by yeasts still play an important role in the morbidity and mortality in neutropenic patients with haematological malignancies. Although the overall incidence of invasive candidiasis has decreased due to widespread use of antifungal prophylaxis, the incidence of non-Candida albicans Candida species is increasing compared with that of C.albicans, and mortality of invasive candidiasis continues to be high. In addition, there has been an increase in invasive infections caused by an array of uncommon yeasts, including species of the genus Malassezia, Rhodotorula, Trichosporon and Saprochaete, characterised by their resistance to echinocandins and poor prognosis (AU)


Assuntos
Humanos , Masculino , Feminino , Micoses/complicações , Micoses/diagnóstico , Micoses/microbiologia , Neutropenia/complicações , Neutropenia/diagnóstico , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/diagnóstico , Antibioticoprofilaxia/métodos , Prognóstico , Candidíase/epidemiologia , Leveduras/isolamento & purificação , Candidíase/complicações , Candidíase/patologia , Malassezia/isolamento & purificação , Rhodotorula/isolamento & purificação , Trichosporon/isolamento & purificação , Indicadores de Morbimortalidade , Antifúngicos/uso terapêutico
18.
Med. clín (Ed. impr.) ; 146(supl.1): 30-35, abr. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-155625

RESUMO

Afatinib es un inhibidor irreversible de la tirosincinasa de la familia ErbB, aprobado para el tratamiento de pacientes con cáncer de pulmón no microcítico y mutaciones sensibilizadoras del gen EGFR. Como otros inhibidores de EGFR, afatinib puede provocar efectos adversos de clase como la diarrea, el exantema, la paroniquia o la mucositis. El manejo adecuado de estos efectos adversos es clave para mantener la calidad de vida de los pacientes y obtener el máximo beneficio del tratamiento con afatinib. El objetivo de este trabajo es revisar la toxicidad y resumir las recomendaciones de prevención y tratamiento de los efectos adversos más significativos de afatinib (AU)


Afatinib is an irreversible tyrosine kinase inhibitor of the ErbB family, approved for the treatment of patients with non-small cell lung cancer with EGFR-sensitizing mutations. Like other EGFR inhibitors, afatinib can provoke adverse events such as diarrhoea, rash, paronychia or mucositis. The correct management of these adverse events is essential to maintain quality of life in these patients and obtain the maximum benefit from afatinib therapy. This study aimed to review the toxicity of the drug and summarize recommendations for the prevention and treatment of the most significant adverse events associated with afatinib (AU)


Assuntos
Humanos , Masculino , Feminino , Genes erbB-1 , Receptores ErbB/toxicidade , Receptores ErbB/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/tratamento farmacológico , Proteínas Tirosina Quinases/efeitos adversos , Proteínas Tirosina Quinases/toxicidade , Diarreia/induzido quimicamente , Diarreia/complicações , Exantema/complicações , Estomatite/induzido quimicamente , Estomatite/complicações , Paroniquia/induzido quimicamente , Paroniquia/complicações , Vômito/complicações , Neutropenia/complicações
19.
Med. intensiva (Madr., Ed. impr.) ; 40(3): 139-144, abr. 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-151559

RESUMO

OBJETIVOS: Determinar los factores de riesgo asociados a candidemia en pacientes críticos de 7 unidades de cuidados intensivos de Colombia. MATERIALES Y MÉTODOS: Estudio de casos y controles pareado, multicéntrico, retrospectivo, en 7 unidades de cuidados intensivos de 3 hospitales universitarios. Se tomaron datos de duración de la estancia hospitalaria global (incluyendo salas generales) y en la unidad de cuidados intensivos. RESULTADOS: Se incluyeron 243 participantes (81 casos y 162 controles) entre enero de 2008 y diciembre de 2012. Se aislaron en orden de frecuencia C. albicans, C. tropicalis y C. parapsilosis. Los principales factores de riesgo identificados fueron: tiempo de estancia hospitalaria global>25 días (OR 5,33; IC 95% 2,6-10,9), uso de meropenem (OR 3,75; IC 95% 1,86-7,5), cirugía abdominal (OR 2,9; IC 95% 1,39-6,06) y hemodiálisis (OR 3,35; IC 95% 1,5-7,7). No se encontraron diferencias en mortalidad entre los grupos de pacientes con candidemia y el grupo control (39,5 frente a 36,5%; p = 0,66). CONCLUSIONES: Se identificaron como factores de riesgo para candidemia en Colombia la larga estancia hospitalaria, la cirugía abdominal, el uso de meropenem y la hemodiálisis


OBJECTIVES: Due to the increase in isolation of Candida spp. in critically ill patients, and the high mortality and economic costs which this infection entails, a study was made of the risk factors associated to candidemia in critically ill patients from 7 intensive care units in Colombia. MATERIALS AND METHODS: A multicenter matched case-control study was conducted in 7 intensive care units of 3 university hospitals. Data on overall length of hospital stay (including both general wards and the intensive care unit) were recorded. RESULTS: A total of 243 subjects (81 cases and 162 controls) between January 2008 and December 2012 were included. In order of frequency, C. albicans, C. tropicalis and C. parapsilosis were isolated. The main identified risk factors were: overall length of hospital stay>25 days (OR 5.33, 95% CI 2.6-10.9), use of meropenem (OR 3.75, 95% CI 1.86-7.5), abdominal surgery (OR 2.9, 95% CI 1.39-6.06) and hemodialysis (OR 3.35, 95% CI 1.5-7.7). No differences in mortality between patients with candidemia and controls were found (39.5 vs. 36.5%, respectively, P=.66) were found. CONCLUSIONS: In Colombia, a long hospital stay, abdominal surgery, the use of meropenem and hemodialysis were identified as risk factors for candidemia


Assuntos
Humanos , Candidemia/epidemiologia , Candida/patogenicidade , Cuidados Críticos/estatística & dados numéricos , Fatores de Risco , Colômbia/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Neutropenia/epidemiologia , Estudos de Casos e Controles
20.
Rev. lab. clín ; 8(4): 188-191, oct.-dic. 2015. ilus
Artigo em Espanhol | IBECS | ID: ibc-146405

RESUMO

La leishmaniasis es una enfermedad parasitaria ocasionada por protozoos del género Leishmania, cuya forma de transmisión habitual es vectorial. Actualmente está clasificada como enfermedad tropical desatendida. A pesar de esto, se ha visto un aumento de casos en los últimos años en relación con 3 hechos: falta de medidas de control, movimientos de población y presencia de inmunosupresión. A continuación, exponemos el caso de un varón de 26 años sin antecedentes previos, que presentaba un cuadro de 2 meses de evolución inespecífico con predominio de sensación de distermia, astenia, diaforesis e hiperoxia. En la exploración se evidenció hepatoesplenomegalia y en la analítica inicial se objetivó una marcada neutropenia y anemia. Se procedió al estudio citomorfológico de sangre periférica y aspirado de médula ósea donde se evidenció parasitación por Leishmania, a pesar de no presentar ningún factor de inmunosupresión; característica habitual de esta dolencia (AU)


Leishmaniasis is a parasitic disease caused by protozoa of the genus Leishmania. Its usual transmission form is vectorial. It is currently classified as a neglected tropical disease. Despite this, cases have been increasing in recent years due to three factors: lack of control measures, population movements, and presence of immunosuppression. The case is presented of a 26 year-old male with no previous history, who had a clinical profile of two months non-specific evolution with dysthermic feeling, asthenia, diaphoresis and hyperoxia. On physical examination he had hepatosplenomegaly and the initial laboratory results showed a marked anaemia and neutropenia. A cyto-morphological study of peripheral blood and bone marrow aspirate were performed that reported a Leishmania parasite infestation, but no evidence of any immunosuppressive factor, which is a regular feature of this disease (AU)


Assuntos
Adulto , Humanos , Masculino , Leishmaniose Visceral/diagnóstico , Imunossupressão/métodos , Neutropenia/diagnóstico , Trombocitopenia/sangue , Trombocitopenia/diagnóstico , Análise Química do Sangue/métodos , Análise Química do Sangue , Testes de Química Clínica , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/isolamento & purificação , Leishmaniose Visceral , Leucopenia/diagnóstico , Bilirrubina/análise , Radiografia Abdominal/métodos , Radiografia Abdominal , Esplenomegalia , Anfotericina B/uso terapêutico
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