RESUMO
Introducción y objetivo: En la actualidad, se ha demostrado que la psoriasis presenta una importante asociación con síndrome metabólico y sus componentes. El objetivo de este estudio es determinar la prevalencia de los factores de riesgo cardiovascular y el engrosamiento de la íntima media carotídea en pacientes con psoriasis que consultan al servicio de dermatología de un hospital de 4. nivel. Material y métodos: Se realizó un estudio descriptivo de corte transversal en pacientes mayores de 18 años con diagnóstico de psoriasis, atendidos en la consulta de dermatología en el Hospital de San José, en Bogotá, Colombia. Entre marzo y agosto del 2015, se realizó un interrogatorio y un examen físico dirigido a la identificación de factores de riesgo cardiovascular, pruebas de laboratorio para determinar la presencia de síndrome metabólico y se practicó medición del grosor de la íntima media carotídea por ecografía. Resultados: Fueron incluidos 40 pacientes con psoriasis. La prevalencia de factores de riesgo cardiovascular en este grupo de pacientes fue del 35% para hipertensión arterial, el 17,5% para dislipidemia, el 17,5% para tabaquismo y el 10% para diabetes mellitus tipo 2. El 12,5% de los sujetos tenía antecedente de infarto agudo de miocardio. Se encontró síndrome metabólico en 20 (50%) pacientes. La dislipidemia se reportó por bioquímica sanguínea en 32 (80%) pacientes. Según el score de Framingham, 11 pacientes (31,4%) tenían riesgo latente, 22 (62,8%) riesgo intermedio y 2 (5,7%) riesgo alto. En la evaluación de la carótida, se encontró una media del espesor intimal de 0,7 (DE 0,12) mm y engrosamiento en 6 pacientes (15,0%). Conclusiones: Este estudio aporta información sobre la prevalencia alta de factores de riesgo cardiovascular en pacientes con psoriasis y orienta a un estricto abordaje clínico para el control del riesgo cardiovascular en esta población (AU)
Background and objectives: Psoriasis is now known to have a clear association with metabolic syndrome and its components. The aim of our study was to determine the prevalence of cardiovascular risk factors (CVRFs) and increased carotid intima-media thickness in psoriasis patients seen in the dermatology department of a quaternary hospital. Material and methods: This was a descriptive cross-sectional study of psoriasis patients aged over 18 years seen in the dermatology department of Hospital de San José in Bogota, Colombia, between March and August, 2015. Directed medical history and physical examination were performed to detect CVRFs, laboratory studies to exclude metabolic syndrome, and ultrasound examination to measure carotid intima-media thickness. Results: Forty patients with psoriasis were included in the study. The prevalence of the distinct CVRFs was 35% for systemic hypertension, 17.5% for dyslipidemia, 17.5% for smoking, and 10% for type 2 diabetes mellitus. A history of acute myocardial infarction was detected in 12.5% of patients. Metabolic syndrome was found in 20 patients (50%), and blood biochemistry revealed dyslipidemia in 32 patients (80%). Based on the Framingham score, the cardiovascular risk was low in 11 patients (31.4%), intermediate in 22 (62.8%), and high in 2 (5.7%). Mean (SD) carotid intima-media thickness was 0.7 (0.12) mm, with thickening observed in 6 patients (15%). Conclusions: This study provides evidence of the high prevalence of CVRFs in psoriasis patients and indicates the need for strict clinical control to monitor cardiovascular risk in this population (AU)
Assuntos
Humanos , Doenças Cardiovasculares/epidemiologia , Espessura Intima-Media Carotídea/estatística & dados numéricos , Psoríase/complicações , Fatores de Risco , Colômbia/epidemiologia , Epidemiologia Descritiva , Síndrome Metabólica/epidemiologia , Dislipidemias/epidemiologiaRESUMO
BACKGROUND AND OBJECTIVES: Psoriasis is now known to have a clear association with metabolic syndrome and its components. The aim of our study was to determine the prevalence of cardiovascular risk factors (CVRFs) and increased carotid intima-media thickness in psoriasis patients seen in the dermatology department of a quaternary hospital. MATERIAL AND METHODS: This was a descriptive cross-sectional study of psoriasis patients aged over 18 years seen in the dermatology department of Hospital de San José in Bogota, Colombia, between March and August, 2015. Directed medical history and physical examination were performed to detect CVRFs, laboratory studies to exclude metabolic syndrome, and ultrasound examination to measure carotid intima-media thickness. RESULTS: Forty patients with psoriasis were included in the study. The prevalence of the distinct CVRFs was 35% for systemic hypertension, 17.5% for dyslipidemia, 17.5% for smoking, and 10% for type 2 diabetes mellitus. A history of acute myocardial infarction was detected in 12.5% of patients. Metabolic syndrome was found in 20 patients (50%), and blood biochemistry revealed dyslipidemia in 32 patients (80%). Based on the Framingham score, the cardiovascular risk was low in 11 patients (31.4%), intermediate in 22 (62.8%), and high in 2 (5.7%). Mean (SD) carotid intima-media thickness was 0.7 (0.12) mm, with thickening observed in 6 patients (15%). CONCLUSIONS: This study provides evidence of the high prevalence of CVRFs in psoriasis patients and indicates the need for strict clinical control to monitor cardiovascular risk in this population.
Assuntos
Doenças Cardiovasculares/epidemiologia , Espessura Intima-Media Carotídea , Psoríase/epidemiologia , Adulto , Idoso , Colômbia/epidemiologia , Comorbidade , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Dislipidemias/epidemiologia , Saúde da Família , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prevalência , Medição de Risco , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
OBJECTIVES: This study aimed to characterize the chronically infected general hepatitis C virus (HCV) population in Barcelona using a highly sensitive subtyping method that can identify the 67 recognized HCV subtypes and diagnose mixed infection by various genotypes/subtypes in a single individual. The resulting information has implications for selecting optimal direct-acting antiviral (DAA) treatment for each patient and establishing public healthcare policies in our setting. METHODS: Consecutive HCV patients (treatment-naïve or interferon-based failures) attending Vall d'Hebron Hospital outpatient clinics from February 2015 to May 2016 (N=1473) were included in the study. Patient samples were characterized using HCV subtyping by next-generation ultra-deep pyrosequencing. RESULTS: The following genotypes (G) were found: G1 (1126/1473 (76.4%)), G4 (145/1473 (9.8%)), G3 (135/1473 (9.2%)), G2 (51/1473 (3.5%)), and G5 (1/1473 (0.1%)). Twenty-two subtypes were seen: 1b (790/1473 (53.6%)), 1a (332/1473 (22.5%)), 3a (133/1473 (9.0%)), 4d (105/1473 (7.1%)), 4a (29/1473 (2.0%)), and 2c (25/1473 (1.7%)), with 16 low-prevalence subtypes accounting for the remaining 3.0% (44/1473). There was a worrisome 1.0% (15/1473) of mixed infections. G2 (51/1473 (3.5%)) showed a high level of heterogeneity. Analyses by age groups showed a predominance of G1b over G1a (428/506 (84.6%) vs. 24/506 (4.7%)) in patients born before 1950 (N=506/1473), and similar percentages of these subtypes in those born between 1951 and 1975 (N=834/1473) (315/834, 37.8% vs. 266/834, 31.9%) and after 1976 (N=133/1473) (47/133, 35.3% vs. 42/133, 31.6%). CONCLUSIONS: Subtype distribution showed a higher level of heterogeneity than was expected, particularly for G2. Prevalence of mixed infections was around 1%. HCV subtype distribution related to patient age group suggested that patients born from 1936 to 1975 in our setting should undergo screening for the infection. Next-generation sequencing enabled better classification of candidates for DAA-based treatment.
Assuntos
Variação Genética , Genótipo , Técnicas de Genotipagem/métodos , Hepacivirus/classificação , Hepacivirus/genética , Hepatite C Crônica/virologia , Adolescente , Adulto , Idoso , Coinfecção/epidemiologia , Coinfecção/virologia , Feminino , Hepacivirus/isolamento & purificação , Hepatite C Crônica/epidemiologia , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Prevalência , Espanha/epidemiologia , Adulto JovemRESUMO
El balón intragástrico bioenteric (BIB) es un procedimiento endoscópico, no quirúrgico indicado para el tratamiento temporal de la obesidad, que favorece la disminución de la capacidad gástrica, ocupando gran parte del fundus. Analizar la eficacia a corto plazo, seguridad y tolerabilidad del balón intragástrico en el tratamiento de la obesidad. Estudio retrospectivo, descriptivo y longitudinal, de abril 2005 hasta abril 2009, 141 pacientes, 121 mujeres, 20 hombres, 5 fueron segundo balón, 4 mujeres y 1 hombre, con un total de 146 balones colocados; con edad promedio de 37.2 en mujeres y 35,23 en hombres, con un rango desde 16 hasta 69 años y un tiempo promedio de duración del balón 6,94 meses. El peso promedio al inicio fue de 96.34 y al final de 82.01 kg, con una diferencia de 14.33 kg. En cuanto al Índice de Masa Corporal (IMC), el cambio observado fue un grado de diferencia, pasando de obesidad grado II a obesidad grado I. El valor promedio al inicio fue de 36.37 kg/m2 y al final 30.95 kg/m2. El promedio de grasa al inicio 40,97 Kg (42.55%) y al final 30.82 kg (36.63%). La co-morbilidad más frecuente fue: hiperinsulinismo 67(45.89%) dislipidemia 37(25.34%), hipertensión arterial 19 (13.01%). No hubo complicaciones severas. El BIB es un método endoscópico seguro y eficaz en el tratamiento de la obesidad...
The bioenterics intragastric balloon (BIB) is a non-surgical endoscopic procedure indicated for the temporary treatment of obesity, which subserves the reduction of gastric capacity, occupying most of the fundus. To analyze the short-term effi ciency, safety and tolerability of the intragastric balloon in the treatment of obesity. Retrospective, descriptive and longitudinal study, from April, 2005 to April, 2009. 141 patients, 121 women, 20 men; 146 BIB, 5 were second BIB, 4 women and 1 man; with an average age of 37.2 forwomen and 35,23 formen, with a range from 16-69 years and an average period of 6.94 months duration of the balloon. The average weight at the beginning was 96.34 kg and at the end 82.01 kg, with a difference of 14.33 kg. As for the Body mass index (BMI), the observed change was a 1 degree difference, passing from obesity degree II to obesity degree I. The average value at the beginning was 36.37 kg/m2 and at the end 30.95 kg/m2. The average of body fat at the beginning was 40,97 Kg (42.55%) and at the end of our study was 30.82 kg (36.63%). The most frequent comorbidity was: hyperinsulinism 67 (46.89%), dyslipidemia 37 (25.34%), hypertension 19 (13.01). There were no severe complications. BIB is a safe and effective endoscopic method in the treatment of obesity...
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Índice de Massa Corporal , Balão Gástrico , Endossonografia/instrumentação , Obesidade/diagnóstico , Obesidade/terapia , GastroenterologiaRESUMO
La enfermedad coronaria es una de las primeras causas de morbilidad y mortalidad cardiovascular. Para su prevención es necesario diagnosticar y corregir con medidas farmacológicas y no farmacológicas los factores de riesgo cardivascular modificables. Nosotros hemos desarrollado un programa de diagnóstico precoz y tratamiento de factores que incrementan a desarrollar enfermedades cardiovasculares y metabólicas, en sujetos "sanos", asintomáticos. Hasta el presente hemos evaluado 153 sujetos. En este trabajo evaluamos la asociación a la sensibilidad a la sal con otros factores de riesgo cardiovascular silente e investigamos los posibles factores predictores de sensibilidad a la sal. La comparación de los sujetos sensibles a la sal (SS), con los sujetos sal resistentes (SR) demostró que los sujetos SS tienen mayor edad, peso corporal, cifras tensionales, niveles elevados de triglicéridos, niveles bajos de HDL-colesterol y de actividad físico. Adicionalmente estudiamos el papel de la hiperinsulinemia y de la hiperglicemia en la sensibilidad a la sal, a través de la medición de la incidencia (porcentaje de individuos SS y SR) y severidad de la sensibilidad a la sal en sujetos hiperinsulinémicos e intolerantes glucosados y/o diabéticos comparándolos con su respectivos controles. No hubo diferencias en la distribución de sensibilidad a la sal entre los diferentes grupos (hiper y normo insulinémicos (insulina en ayunas < 15uUL/ml), glucotolerantes (glicemia en ayunas <110;2 horas post carga < 140 mg/d) y en los intolerantes glucosados y/o diabéticos. La severidad de la sensibilidad a la sal también fue similar entre grupos, de hecho, la reducción de la ingesta de sal de 316ñ13 a 26ñ3 mmol/día, produjo cambios similares en la presión arterial en sujetos hiperinsulinémicos o en sujetos con niveles normoinsulinémicos y en sujetos tolerantes e intolerantes glucosados y/o diabéticos. Adicionalmente no se encontró correlación entre la magnitud de los cambios de la presión arterial inducidos por la sal y los niveles de insulina y glucosa en ayunas, 2 horas después de la carga oral de glucosa o el área bajo la curva de insulina. En conclusión, nuestros resultados sugieren los niveles de glicemia y de insulina del paciente, no determinan su reactividad vascular a los cambios en ingesta de sal
Assuntos
Humanos , Doenças Cardiovasculares , Doença das Coronárias , Hiperinsulinismo , Doenças Metabólicas , Fatores de Risco , VenezuelaRESUMO
Se presenta el caso de un paciente de 50 años, quien consultó por dolor abdominal, vómito y náuseas, al examen físico; el abdomen era doloroso al palpar mesogastrio. Se confirmó el diagnóstico de pancreatitis aguda de origen biliar mediante amilasemia, tomografía abdominal y colangiografía endoscópica retrógrada. Durante la hospitalización, el paciente presentó cambios mentales dados por desorientación, agresividad y alucinaciones. Se descartaron otras patologías como causa de su síndrome mental orgánico, confirmándose el diagnóstico de Encefalopatía Pancreática
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Encefalopatias/etiologia , Pancreatite/complicaçõesRESUMO
The effects of in vivo hyperoxia and hypoxia on the intravascular survival of 51Cr-labeled human sickle erythrocytes (SS RBS's) were studied after transfusion into rats and guinea pigs. The function of these animals' reticuloendothelial and complement systems had been previously inhibited by ethyl palmitate and cobra venom factor, thus allowing extension of the survival of the heterologous human RBC's. In the blood of rats breathing ambient air the 51Cr half-life survival of RBC's from 11 patients with sickle-cell anemia (mean, 7.1 hours; range, 2.0 to 16.5 hours) was significantly shorter (p less than 0.001) than that of five control subjects (mean, 17.5 hours; range, 12.0 to 26.5 hours). When rats transfused with sickle RBC's were exposed to 100 per cent O2, a mean increment of 16.5 per cent blood 51Cr activity was observed within the first 15 to 60 minutes of hyperoxia. Subsequent oxygen deprivation (7 to 8 per cent O2) resulted in an equally rapid decrease (mean, 35.6 per cent) in blood 51Cr activity. Continuation of hypoxia for up to 17 hours did not cause further acceleration of 51Cr activity. Continuation of hypoxia for up to 17 hours did not cause further acceleration of 51 Cr RBC clearance. Under these conditions the slope of the sickle RBC survival curve was similar to that in animals kept in ambient air. After hypoxic rats were allowed to breate room air again, mean 51Cr blood activity increased by 41.7 per cent. Sickle RBC's transfused to guinea pigs exhibited similar oxygen-dependent survival characteristics. The survival of 51Cr RBC's from four adult control subjects and of unlabeled fetal RBC's from three human cord blood samples was unaffected by oxygen changes. When rats that had been transfused with sickle reticulocytes labeled in vitro with 59Fe were made hypoxic, a decrease in blood 59Fe activity was observed. The extent of this decrease was comparable to that in rats transfused with 51Cr labeled RBC's from the same patients. There was increased liver and spleen 51Cr activity in animals transfused with 51Cr SS RBC's and killed during hypoxia when compared to that of hyperoxic animals. These studies suggest that a minor population of sickle cells is removed from circulation during hypoxia and circulates again upon reoxygenation of the animals. Erythrocyte aging does not appear to be responsible for this phenomenon. The oxygen-depdendent circulation of a population of SS RBC's in this animal system is probably due to reversible sickling and trapping of sickled cells in the microcirculation.
