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2.
Rev. esp. enferm. dig ; 112(4): 249-257, abr. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-187502

RESUMO

INTRODUCTION: the aim of this study was to determine the risk factors for rebleeding following device-assisted enteroscopy therapy of small bowel vascular lesions. METHODS: this is a systematic review and meta-analysis. A literature search was performed from January 2003 to October 2019. All studies reporting on at least one risk factor for bleeding recurrence after endoscopic therapy of small bowel vascular lesions were included. A meta-analysis of those risk factors reported in at least three studies was performed to assess their association with rebleeding. The OR and 95 % CI were used for binary outcome data. Heterogeneity analysis was performed using the Tau and I2 index. If I2 > 20 %, potential sources of heterogeneity were identified by sensitivity analyses and a random-effect model was used. RESULTS: the search identified a total of 572 articles and 35 full-text records were assessed for eligibility after screening. Finally, eight studies that included 548 patients were selected. The overall median rebleeding rate was 38.5 % (range: 10.9-53.3 %) with a median follow-up of 24.5 months. Female sex (OR: 1.96, 95 % CI: 1.14-3.37, p = 0.01, I2 = 0 %), Osler-Weber syndrome (OR: 4.35, 95 % CI: 1.22-15.45, p = 0.02, I2 = 0 %) and cardiac disease (OR: 1.89, 95 % CI: 1.12-2.97, p = 0.005, I2: 0 %) were associated with rebleeding. According to the sensitivity analysis, overt bleeding (OR: 2.13, 95 % CI: 1.22-3.70, p = 0.007, I2 = 0 %), multiple lesions (OR: 4.57, 95 % CI: 2.04-10.22, p < 0.001, I2 = 0 %) and liver cirrhosis (OR: 2.61, 95 % CI: 1.11-6.13, p = 0.03, I2 = 0 %) were also predictors for rebleeding. CONCLUSIONS: patient characteristics and comorbidities should be considered for follow-up patient management after effective device-assisted endoscopic therapy, as they can predict rebleeding


No disponible


Assuntos
Humanos , Enteroscopia de Balão/métodos , Hemorragia Gastrointestinal/cirurgia , Enteropatias/cirurgia , Intestino Delgado/cirurgia , Intestino Delgado/irrigação sanguínea , Enteroscopia de Balão/efeitos adversos , Fatores de Risco , Recidiva
3.
Rev. esp. enferm. dig ; 112(4): 262-268, abr. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-187504

RESUMO

BACKGROUND: data on the long-term outcome of patients with obscure gastrointestinal bleeding (OGIB) with positive small bowel findings in capsule endoscopy but negative small bowel findings in device-assisted enteroscopy are scarce. OBJECTIVE: this study aimed to evaluate the rebleeding rate and time to rebleed in patients with no small bowel findings in enteroscopy, after a positive capsule endoscopy in the setting of OGIB. Baseline predictors for rebleeding were assessed. METHODS: a retrospective double-center study was performed, including patients with OGIB with positive findings by capsule endoscopy and negative small bowel findings by enteroscopy. RESULTS: thirty-five patients were included. Rebleeding occurred in 40 % of patients during a median follow-up of 27 months. Further evaluation in patients with a rebleed was performed in 85.7 %, leading to a final diagnosis in 78.6 %. The rebleeding rate increased progressively over time, from 17.2 % at one month to 54.4 % at four years. Overt bleeding at the time of the first episode was a predictor of rebleeding (p = 0.03) according to the multivariate analysis. This was 50 % at one year compared with 21.8 % in patients with occult bleeding on admission. CONCLUSIONS: in obscure gastrointestinal bleeding, long-term follow-up and further evaluation may be considered after a positive capsule endoscopy. Even if there are no small bowel findings by device-assisted enteroscopy. The rebleeding rate in our study was 40 %, mainly in the presence of an overt bleeding on admission


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/cirurgia , Enteroscopia de Balão , Recidiva , Endoscopia por Cápsula , Estudos Retrospectivos , Fatores de Risco
4.
Rev. esp. enferm. dig ; 112(4): 269-272, abr. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-187505

RESUMO

INTRODUCCIÓN: la lesión de Dieulafoy en intestino delgado es una causa infrecuente de hemorragia digestiva que recidiva frecuentemente tras su tratamiento endoscópico. MATERIAL Y MÉTODOS: se presenta un estudio observacional, descriptivo, retrospectivo y unicéntrico de 15 pacientes con hemorragia de intestino delgado, diagnosticados de lesión de Dieulafoy con cápsula endoscópica o enteroscopia doble balón, en los que se realizó tratamiento endoscópico combinado. Resultados y conclusiones: durante una mediana de seguimiento de 33,5 meses (rango 2-145), recidivaron tres de los 12 casos que se pudieron seguir (25 %) y todos ocurrieron precozmente en las primeras 48 horas tras la terapéutica. Se retrataron con éxito dos de ellos con una nueva enteroscopia


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Intestino Delgado/irrigação sanguínea , Intestino Delgado/cirurgia , Hemorragia Gastrointestinal/cirurgia , Recidiva , Estudos Retrospectivos , Enteroscopia de Duplo Balão , Endoscopia por Cápsula , Seguimentos
5.
Cir. plást. ibero-latinoam ; 46(1): 57-64, ene.-mar. 2020. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-190863

RESUMO

INTRODUCCIÓN Y OBJETIVO: La formación de queloides condiciona un deterioro en la calidad de vida de los pacientes por causar desfiguración cosmética, dolor y prurito. A pesar de que existe una amplia gama de opciones terapéuticas e incluso combinación de estas, aún existen tasas de recurrencia elevadas que hacen del tratamiento de los queloides un desafío complejo. Recogemos nuestra tasa de recurrencia de queloides en diferentes áreas corporales tras cirugía asociada a radioterapia con haz de electrones en el postoperatorio inmediato mediante un protocolo de radioterapia definido. MATERIAL Y MÉTODO: Estudio de tipo ambispectivo en los centros de Cirugía Plástica del Hospital del Salvador y Clínica Santa María en Santiago (Chile) entre 2010 y 2017 sobre pacientes intervenidos por queloides mediante cirugía y tratamiento protocolizado con radioterapia de electrones. Excluimos pacientes que no asistieron al tratamiento con radioterapia, o se realizó después de 24 horas, o no se les realizó seguimiento durante al menos 3 meses. Evaluamos datos demográficos, clínicos, antecedentes de procedimientos anteriores frustrados, número de queloides y recurrencia. Utilizamos como prueba estadística chi-cuadrado con significancia estadística p ≤ 0.05. RESULTADOS: Estudiamos un total de 15 pacientes con un total de 32 queloides intervenidos en distintas áreas corporales con seguimiento promedio de 862 días. En todos realizamos el procedimiento sin inconvenientes y con buena tolerancia. El promedio de recidiva total fue del 34%, siendo la zona de mayor recurrencia la dorsal (83%) y la de menor la auricular donde no hubo recidivas. CONCLUSIONES: En nuestra experiencia, el tratamiento quirúrgico escisional de los queloides, seguido de radioterapia con haz de electrones según el protocolo expuesto, resultó sin recidivas en la zona auricular


BACKGROUND AND OBJECTIVE: Keloids cause deterioration in the quality of life of patients due to cosmetic disfigurement, pain and pruritus. Although there is a wide range of therapeutic options and even a combination of these, there are still high recurrence rates that make keloids treatment a challenge. We report our rate of recurrence of keloid in different body areas after surgery associated with radiotherapy electron beam in the immediate postoperative period using a defined radiotherapy protocol. METHODS: An ambispective study was carried out in the Plastic Surgery Unit at Salvador Hospital and Santa María Clinic in Santiago (Chile) between 2010 and 2017, colleting patients operated on by keloids with surgery and protocolized treatment of electron radiation therapy. Patients who did not attend the radiotherapy treatment, it was performed after 24 hours, or they were not followed up for at least 3 months, were excluded. We evaluated demographic, clinical data, past history of frustrated procedures, keloid number and keloid recurrence. Chi-square statistical test was used using statistical significance p ≤ 0.05. RESULTS: A total of 15 patients with 321 keloids in different body areas were treated, with an average follow-up time of 862 days. All patients underwent surgical and radiotherapy treatment without inconveniences and good tolerance. The average total recurrence was 34%, with the greatest recurrence in the dorsal area (83%) and with no recurrences in the auricular one. CONCLUSIONS: Excisional surgical treatment of keloids, followed by beam radiation therapy according to the protocol described, results in no recurrence in the auricular área


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Queloide/cirurgia , Queloide/radioterapia , Terapia Combinada , Seguimentos , Resultado do Tratamento , Recidiva
6.
Actas dermo-sifiliogr. (Ed. impr.) ; 111(2): 149-156, mar. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-ET2-5428

RESUMO

ANTECEDENTES: La micosis fungoide (MF) es el tipo más común de linfoma cutáneo de células T tanto en adultos como en niños. En algunos países se ha observado un aumento de la prevalencia de MF en niños. Hasta la fecha, no existen estudios descriptivos de MF en la población pediátrica colombiana. MÉTODOS: En una revisión ambispectiva de 128 pacientes con el diagnóstico confirmado de MF en la Sección de Dermatología y del Laboratorio de Dermatopatología de la Universidad de Antioquia entre los años 2008-2017, se describen las variantes clínicas e histopatológicas, la respuesta al tratamiento y la progresión de la enfermedad de 23 pacientes menores de 18 años de edad. RESULTADOS: Los casos de MF en niños constituyeron el 18% del total. La mediana de edad de inicio de las lesiones fue de 9 años; la mediana de edad al momento del diagnóstico fue de 11 años y la mediana del tiempo promedio entre el inicio de las lesiones y el diagnóstico fue de 2 años. Todos los pacientes se encontraban en estadios tempranos de la enfermedad. La MF hipopigmentada fue la presentación clínica más frecuente (52,2%), seguida por la MF clásica (30,4%). La MF foliculotropa se presentó en el 17,4%. Todos los pacientes recibieron terapias dirigidas a la piel con esteroides tópicos y fototerapia, uno recibió quimioterapia, aún en estadio temprano. El 59,1% obtuvieron remisión completa y el 40,9% respuesta parcial. Solo 2 casos permanecieron asintomáticos durante 5 años. CONCLUSIÓN: En nuestra experiencia, la MF hipopigmentada fue la presentación clínica más común en pacientes menores de 18 años. No se presentaron progresiones a estadios avanzados. Sin embargo, las recurrencias después de la interrupción del tratamiento fueron comunes


BACKGROUND: Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma in adults and children. The prevalence has increased in some countries, but no descriptive studies of MF in the pediatric population have been done in Colombia to date. METHODS: A combined prospective-retrospective study of 128 patients with a diagnosis of MF confirmed by the dermatology department and dermatopathology laboratory of Universidad de Antioquia between 2008 and 2017. We describe the clinical and histopathologic variants, response to treatment, and progression of the disease in 23 patients under 18 years of age. RESULTS: The pediatric cases of MF accounted for 18% of all the cases on record. The median age of onset of lesions was 9 years, the median age at diagnosis was 11 years, and the median time between onset of lesions and diagnosis was 2 years. All patients were in early stages of the disease. Hypopigmented MF was the most common clinical presentation (in 52.2%), followed by classical MF (in 30.4%). Folliculotropic MF was identified in 17.4%. All patients were treated with topical corticosteroids and phototherapy. One patient received chemotherapy while still in the early stage of disease.complete remission was achieved in 59.1% and a partial response in 40.9%. Only 2 patients remained asymptomatic for 5 years. CONCLUSIÓN: We found hypopigmented MF to be the most common clinical presentation in patients under 18 years of age. The disease did not progress to advanced stages in any of the patients, although recurrence after treatment interruption was common


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Micose Fungoide/diagnóstico , Micose Fungoide/terapia , Progressão da Doença , Fototerapia , Recidiva , Citometria de Fluxo , Imuno-Histoquímica , Terapia PUVA
8.
Rev. patol. respir ; 23(supl.1): S1-S4, feb. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-188028

RESUMO

Las guías de práctica clínica (GPC) aparecieron con el fin de homogenizar el diagnóstico y tratamiento del asma; inicialmente como un consenso de expertos, y posteriormente incluyendo para sus afirmaciones y recomendaciones técnicas de medicina basada en la evidencia, e incorporar en sus actualizaciones frecuentes, los cambios en el conocimiento fisiopatológico y en el manejo de la enfermedad. En el 2019 se han realizado actualizaciones de las tres principales GPC incluyendo el tratamiento del paciente con asma grave no controlada, el uso de fármacos biológicos y otros procedimientos


The clinical practice guidelines (CPG) appeared with the intention to homogenize the asthma diagnosis and treatment, initially as an expert consensus, and afterwards including evidence based medicine data for its affirmations and technical recommendations incorporating advances in knowledge and management of the disease in their frequent updates. In 2019 the 3 principal CPG, have updates including the management of non-controlled severe asthma patients, biological treatments use and other procedures


Assuntos
Humanos , Asma/terapia , Guias de Prática Clínica como Assunto , Consenso , Recidiva , Produtos Biológicos/uso terapêutico , Glucocorticoides/administração & dosagem , Anticorpos Monoclonais/uso terapêutico , Imunoglobulina E/uso terapêutico , Interleucina-5/uso terapêutico , Interleucina-4/uso terapêutico , Azitromicina/uso terapêutico , Termoplastia Brônquica/métodos
9.
Gastroenterol. hepatol. (Ed. impr.) ; 43(1): 14-21, ene. 2020. ilus, graf, tab
Artigo em Inglês | IBECS | ID: ibc-188286

RESUMO

Introduction: Diagnosis of severe hepatitis C recurrence is based on analytical and histological criteria but there is little information about their correlation. Aim: To assess the accuracy of laboratory criteria for the diagnosis of fibrosing cholestatic hepatitis (FCH). Patients and methods: Retrospective analysis of prospectively collected data form HCV positive patients who underwent liver transplantation (LT) between 2000 and 2014 in two European university hospitals. Patients were classified according to laboratory criteria such as FCH, cholestatic hepatitis (CH) and non-cholestatic acute hepatitis (NCAH). Histological characteristics were also evaluated. Results: Seventy patients with acute HCV recurrence within the first year after LT with an available liver biopsy were included in the study. Most patients were male (70%) with a median age of 58 years (50-64) and infected with genotype 1b (71.4%). Median time from LT to diagnosis of recurrence was 2.96 months (2.1-5.3). Thirty-nine patients were classified as FCH, 21 as CH and 10 as NCAH. Marked hepatocyte ballooning and ductular reaction were associated with the presence of FCH with an OR of 4.66 (p=0.047) and 20.58 (p=0.025), respectively. Considering liver biopsy as the gold standard, the sensitivity, specificity, positive and negative predictive values of the analytical criteria were 0.8, 0.5, 0.3 and 0.9, respectively. However, correlation between histological and analytical criteria was poor (k=0.033). Discussion: Analytical criteria may be used to rule out the presence of FCH, but a biopsy is mandatory to confirm the diagnosis. Ductular reaction and hepatocyte ballooning were independent predictors of FCH


Introducción: El diagnóstico de la recurrencia grave de la hepatitis C se basa en criterios histológicos y analíticos. Sin embargo, existe poca información respecto su correlación. Objetivo: Evaluar la precisión de los criterios analíticos el diagnóstico de la hepatitis colestásica fibrosante (HCF). Pacientes y métodos: Análisis retrospectivo de pacientes con una recidiva grave precoz del virus de la hepatitis C (VHC) tras el trasplante hepático (TH) en 2 hospitales universitarios europeos entre 2000-2014. Los pacientes se clasificaron según criterios analíticos en HCF, hepatitis colestásica (HC) y hepatitis aguda no colestásica (HANC). Las características histológicas también fueron evaluadas. Resultados: Se incluyeron 70 pacientes que desarrollaron una recurrencia grave del VHC en el primer año tras TH con una biopsia hepática disponible. La mayoría eran varones (70%) con mediana de edad de 58 años (50-64) y genotipo 1b (71,4%). La mediana de tiempo desde el TH hasta el diagnóstico de la recurrencia fue de 2,96 meses (2,1-5,3). Treinta y nueve pacientes fueron clasificados como HCF, 21 como HC y 10 como HANC. La balonización intensa y reacción ductular se asociaron con HCF con una OR de 4,66 (p=0,047) y 20,58 (p=0,025), respectivamente. Considerando la biopsia hepática como gold standard, la sensibilidad, especificidad y valores predictivos positivo y negativo de los criterios analíticos fueron 0,8, 0,5, 0,3 y 0,9, respectivamente. Sin embargo, la correlación entre ambos fue escasa (k=0,033). Discusión: Los criterios analíticos podrían utilizarse para descartar la presencia de HCF, pero la biopsia sigue siendo obligatoria para el diagnóstico. La reacción ductular y la balonización son predictores de HCF


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Hepatite C/patologia , Transplante de Fígado/efeitos adversos , Hepatócitos/patologia , Hepatite C/diagnóstico , Hepatite C/etiologia , Estudos Retrospectivos , Recidiva , Biópsia , Fígado/patologia , Sensibilidade e Especificidade , Análise Multivariada
12.
Actas esp. psiquiatr ; 47(6): 229-235, nov.-dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-188260

RESUMO

INTRODUCCIÓN: Este estudio evalúa el grado de cumplimiento y efectividad del programa ARSUIC de Atención al Riesgo Suicida, cuyo objetivo es reducir el riesgo posterior al intento de suicidio facilitando una cita ambulatoria de alta prioridad después del alta hospitalaria. METODOLOGÍA: Estudio retrospectivo de base hospitalaria conducido, entre 2012 y 2015, en todos los casos de intento de suicidio atendidos en la red de recursos de psiquiatría del Hospital Universitario La Paz. Se obtienen estimadores del tiempo hasta la primera consulta después del alta, de la proporción de citas que cumple el objetivo del programa de ser atendidos en un máximo de 7 días, de la tasa de intento de suicidio y del porcentaje de intentos que corresponde con un reintento, en cada año de estudio. RESULTADOS: Después de la implementación del programa, la mediana de tiempo entre el alta y la primera consulta baja de 8,5 a 6 días y el porcentaje de citas que cumplen el objetivo aumenta de 32 a 48,5%. Entre 2012 y 2015, la tasa de intentos de suicidio por paciente y año se reduce de 1,20 a 1,08, y el porcentaje de intentos que corresponde con reintentos de 26,6 a 12,8%. CONCLUSIÓN: La implementación del Programa ARSUIC ha reducido el tiempo entre el alta después de un intento de suicidio y la primera cita ambulatoria. Han disminuido los intentos de suicidio debidos a reintentos y la tasa de intentos por paciente y año. El porcentaje de cumplimiento menor al 50% sugiere diferencias interindividuales en el acceso efectivo al programa


INTRODUCTION: This study evaluates the degree of com-pliance and effectiveness of the ARSUIC Suicide Risk Care Program. ARSUIC seeks to reduce the relapse risk that follows a suicide attempt by scheduling a high priority outpatient visit following hospital discharge. METHOD: Hospital-based retrospective study conducted between years 2012 and 2015. We included every suicide attempt treated at the La Paz University Hospital's mental healthcare resources network. We estimated the time between hospital discharge and the first outpatient visit; the proportion of visits that fulfill the program's objective-a follow-up within a maximum of 7 days; the suicide attempt rate; and the percentage of attempts corresponding to re-lapses, by study year. RESULTS: After program deployment, median time be-tween discharge and the first visit decreased from 8.5 to 6 days, and the percentage of visits that fulfill the program's objective increased from 32 to 48.5%. Between years 2012 and 2015, the suicide attempt rate per person and year de-creased from 1.20 to 1.08 and the proportion of attempts corresponding to relapses from 26.6% to 12.8%. CONCLUSION: Implementing the ARSUIC Program lowered the time between discharge and the first outpatient visit following a suicide attempt. The proportion of suicide attempts due to relapses and the suicide attempt rate per person decreased progressively. The program fulfilment proportion was under 50%, suggesting between-user differences regarding their effective access to the program


Assuntos
Humanos , Masculino , Feminino , Adulto , Desenvolvimento de Programas , Tentativa de Suicídio/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Recidiva , Estudos Retrospectivos , Fatores de Risco , Espanha , Tentativa de Suicídio/estatística & dados numéricos , Fatores de Tempo
15.
Arch. Soc. Esp. Oftalmol ; 94(12): 614-618, dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-190015

RESUMO

Mujer de 36 años diagnosticada de hipertensión intracraneal idiopática tratada con acetazolamida y topiramato, que presenta desprendimientos neurosensoriales retinianos. La paciente fue seguida durante 2 años estableciéndose una relación entre los desprendimientos neurosensoriales y el topiramato, con recurrencias tras la introducción del topiramato y mejoría tras la retirada del mismo. Estos hechos señalan al topiramato como posible responsable del cuadro. El topiramato podría ser responsable de la aparición de desprendimientos neurosensoriales de la retina y mácula. Aunque los casos de efusión cilio coroidea producidos por este fármaco son bien conocidos, sus efectos secundarios sobre la retina son menos frecuentes. Ya que se trata de un fármaco de amplio uso, tanto neurólogos como oftalmólogos deberían ser conscientes de sus posibles efectos secundarios


A 36 year-old woman with idiopathic intracranial hypertension was treated with topiramate and acetazolamide. The patient was followed-up for 2 years, with a relationship between neurosensory detachments and topiramate being established, with recurrences after the introduction of topiramato and improvement after its withdrawal. These findings point topiramate as a possible cause of the clinical picture. Topiramate may cause retinal and macular neurosensory detachments. Although the ciliochoroidal effusion cases caused by this drug are well-known, its retinal side effects are less common. As it is a widely used drug, neurologists and ophthalmologists should be aware of its possible ocular side effects


Assuntos
Humanos , Feminino , Adulto , Anti-Hipertensivos/efeitos adversos , Macula Lutea , Descolamento Retiniano/induzido quimicamente , Topiramato/efeitos adversos , Acetazolamida/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Fundo de Olho , Hipertensão Intracraniana/tratamento farmacológico , Recidiva , Tomografia de Coerência Óptica
16.
Allergol. immunopatol ; 47(6): 591-597, nov.-dic. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-186553

RESUMO

Introduction and Objectives: Vitamin D deficiency is associated with increased susceptibility to infections and wheezing. We aimed to evaluate the relation between vitamin D levels, viral infections and severity of attacks in children with recurrent wheezing. Materials and methods: A total of 52 patients who applied with wheezing, at the ages of 12-60 months with a history of three or more wheezing attacks in the last year and 54 healthy children were included. Sociodemographic data, risk factors for recurrent wheezing, and the severity of the wheezing attacks were recorded. 25(OH)D3, calcium, phosphor, alkaline phosphatase and parathormone levels of all children were measured. Nasopharyngeal samples of the patients for viruses were studied by multiplex polymerase chain reaction. Results: For the patient group, being breastfed for six months or less, history of cesarean section, cigarette exposure, humid home environment, and family history of allergic disease were significantly higher compared with the control group. Serum vitamin D levels in the patient group were significantly lower compared to the control group. There was no significant relationship between vitamin D levels and hospitalization, oxygen or steroid therapy. Virus was detected in 38 patients (73%). Rhinovirus (63.2%) was the most frequently detected virus. Coinfection was found in 14 (36.8%) patients. There was no statistically significant difference between detection of virus and vitamin D levels. Conclusions: Cigarette exposure, being breastfed six months or less, humid home environment, history of cesarean section, family history of allergic disease and vitamin D deficiency might be risk factors for recurrent wheezing


No disponible


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Viroses/imunologia , Vitamina D/uso terapêutico , Índice de Gravidade de Doença , Fatores de Risco , Coinfecção/imunologia , Infecções Respiratórias/imunologia , Sons Respiratórios/imunologia , Recidiva , Reação em Cadeia da Polimerase , Anormalidades Congênitas/imunologia , Pulmão/anormalidades , Pulmão/imunologia , Espectrofotometria/métodos , Sons Respiratórios/etiologia , Deficiência de Vitamina D
20.
Arch. bronconeumol. (Ed. impr.) ; 55(11): 559-564, nov. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186323

RESUMO

Introducción: En los últimos años se observa un aumento de la prevalencia de colonización e infección por Scedosporium spp. en pacientes con fibrosis quística (FQ). En el presente estudio se registra la frecuencia de aislamiento de Scedosporium spp. en una Unidad de FQ de adultos, analizándose las características de los pacientes y los factores predisponentes. Métodos: Se realizó un estudio observacional retrospectivo en 87 pacientes adultos con FQ en los que se valoró la presencia de cultivo positivo para Scedosporium spp. durante 5 años (enero de 2012-julio de 2017). Se recogieron las siguientes variables clínicas: edad, sexo, índice de masa corporal, genotipo, presencia de insuficiencia pancreática, colonizaciones bacterianas, función pulmonar, complicaciones, exacerbaciones y tratamiento, así como puntuación Bhalla modificada de la última tomografía computarizada axial de alta resolución. Los resultados se analizaron con el paquete estadístico IBM SPSS Statistics Version 22.0. Resultados: En un 25,3% de los pacientes se aisló Scedosporium spp. En el análisis bivariante se observó en estos enfermos más frecuencia de Pseudomonas aeruginosa, peor puntuación en la clasificación de Bhalla (destacando los ítems presencia de bronquiectasias, tapones mucosos y generaciones bronquiales), un descenso leve en la capacidad de difusión pulmonar (DLCO) y que recibían con más frecuencia antibioterapia inhalada. En el análisis multivariante de regresión logística únicamente el ítem generaciones bronquiales fue significativo. Conclusiones: Scedosporium spp. debe considerarse un patógeno oportunista emergente en pacientes con FQ del que se desconoce su implicación clínica, factores de riesgo o necesidad de tratamiento


Introduction: In recent years an increase in the prevalence of colonization and infection by Scedosporium spp. in patients with cystic fibrosis (CF) has been observed. In this article, we study the frequency of isolation of Scedosporium spp. in an adult CF Unit, analyzing characteristics of the patients and predisposing factors. Methods: A retrospective observational study was conducted in 87 adult CF patients in whom the presence of positive culture for Scedosporium spp. was tested for a 5-year period (January 2012-July 2017). We recorded the following clinical variables: age, sex, body mass index, genotype, presence of pancreatic insufficiency, bacterial colonization, lung function, other complications, exacerbations and treatment, and the modified Bhalla score from the last high-resolution computed tomography. Results were analyzed with IBM SPSS Statistics Version 22.0 software. Results: Scedosporium spp. was isolated in 25.3% of patients. In the bivariate analysis, these patients showed a higher rate of Pseudomonas aeruginosa infection, worse score in the Bhalla classification (highlighting the following items: bronchiectasis, mucus plugs and bronchial generations), a slight decrease in the lung diffusion capacity and more frequently received inhaled antibiotics. In the logistic regression multivariate analysis, only the bronchial generations item was significant. Conclusion: Scedosporium spp. must be considered an emerging opportunistic pathogen in patients with CF whose clinical involvement, risk factors or need for treatment is unknown


Assuntos
Humanos , Masculino , Feminino , Adulto , Fibrose Cística/diagnóstico , Scedosporium/isolamento & purificação , Estudos de Coortes , Pneumopatias Fúngicas/diagnóstico , Estudos Retrospectivos , Índice de Massa Corporal , Recidiva , Tomografia Computadorizada de Emissão , Bronquiectasia/complicações , Capacidade de Difusão Pulmonar , Fatores de Risco
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