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1.
PLoS One ; 19(4): e0290632, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38626012

RESUMO

Psoriasis has been related to metabolic dysfunction-associated fatty liver disease and, liver fibrosis. This study aimed to evaluate the prevalence of liver fibrosis in psoriasis and identify predictors for fibrosis. This is a cross-sectional study conducted from December 2012 to June 2016 assessing psoriasis and psoriatic arthritis patients attended at four centers in Mexico City. Data regarding history of the skin disease, previous and current medication, and previously diagnosed liver disease was collected. Liver fibrosis was assessed with four different non-invasive methods (FIB4, APRI, NAFLD score and elastography). We compared data based on the presence of fibrosis. Adjusted-logistic regression models were performed to estimate OR and 95% CI. A total of 160 patients were included. The prevalence of significant fibrosis using elastography was 25% (n = 40), and 7.5% (n = 12) for advanced fibrosis. Patients with fibrosis had higher prevalence of obesity (60% vs 30.8%, P = 0.04), type 2 diabetes (40% vs 27.5%, P = 0.003), gamma-glutamyl transpeptidase levels (70.8±84.4 vs. 40.1±39.2, P = 0.002), and lower platelets (210.7±58.9 vs. 242.8±49.7, P = 0.0009). Multivariate analysis showed that body mass index (OR1.11, 95%CI 1.02-1.21), type 2 diabetes (OR 3.44, 95%CI 1.2-9.88), and gamma-glutamyl transpeptidase (OR 1.01, 95%CI1-1.02) were associated with the presence of fibrosis. The use of methotrexate was not associated. Patients with psoriasis are at higher risk of fibrosis. Metabolic dysfunction, rather than solely the use of hepatotoxic drugs, likely plays a major role; it may be beneficial to consider elastography regardless of the treatment used. Metabolic factors should be assessed, and lifestyle modification should be encouraged.


Assuntos
Diabetes Mellitus Tipo 2 , Técnicas de Imagem por Elasticidade , Hepatopatia Gordurosa não Alcoólica , Psoríase , Humanos , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , gama-Glutamiltransferase , Cirrose Hepática/complicações , Cirrose Hepática/epidemiologia , Cirrose Hepática/diagnóstico , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Psoríase/complicações , Psoríase/epidemiologia , Fibrose , Técnicas de Imagem por Elasticidade/métodos
2.
Diagnostics (Basel) ; 14(7)2024 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-38611675

RESUMO

BACKGROUND: The triglyceride-glucose index (TyG) and a combination of body mass index (BMI) and waist circumference (WC) have been proposed as predictive scores for liver steatosis (LS). The aim of this study was to determine the diagnostic accuracy of these indices compared with controlled attenuation parameters (CAPs) and other predictive scores of LS. METHODS: A retrospective analysis of patients who attended a check-up unit in 2021 was performed. LS was determined by CAP. Anthropometric and biochemical parameters for calculating TyG, TyG-BMI, TyG-WC, fatty liver index, and hepatic steatosis index were obtained. ROC curve was used to establish the best cut-off point of each TyG index for LS detection. The accuracy was determined for all patients, as well as for overweight and diabetic patients. RESULTS: Medical records of 855 patients with a median age of 48 [IQR, 44-54] years and a BMI of 25.7 [IQR 23.4-28.1] kg/m2 were included. According to CAP, LS prevalence was 31.8% (n = 272). TyG-BMI and TyG-WC show better AUCs compared with CAP (0.82, 0.81), FLI (0.96, both), and HSI (0.93, 0.85). For diabetic patients, TyG-WC shows an AUC of 0.70. Meanwhile, TyG-BMI shows better accuracy (0.75) compared with CAP. CONCLUSIONS: TyG-BMI and TyG-WC showed a superior predictive accuracy for detecting LS compared with the TyG index.

4.
Med Mycol ; 61(12)2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-37944000

RESUMO

Fusarium species represent an opportunistic fungal pathogen. The data in Mexico about Fusarium infections in humans are scarce. Here, we present a retrospective series of patients with a confirmed diagnosis of fusariosis in eight different hospitals in Mexico from January 2010 to December 2019. The diagnosis of proven fusariosis was made according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORT/MSG) criteria. A total of 49 cases were identified in our series. Most patients had burn injuries (49%), and 37% had hematological malignancies. Most patients had fire injuries (40%), followed by electric injuries (8%), febrile neutropenia (10%), and pancytopenia (6%). Patients had skin and soft tissue involvement in 49%, followed by blood culture isolation and biopsies from different sites of the body (lung, sinuses, bone tissue, and eyes). Febrile neutropenia (10%) and fungemia (8%) were the most common clinical syndromes in immunosuppressed patients. Most patients received monotherapy (67%), where voriconazole was used in 30% of the cases, followed by conventional amphotericin B (16%), and lipidic formulations of amphotericin B in 10% (either liposomal amphotericin B or amphotericin B lipid complex). Combination therapy was used in 20% of the cases, and the most common combination therapy was triazole plus any lipidic formulation of amphotericin B (10%). Mortality related to Fusarium infection occurred in 22% of patients. Fusariosis is a serious threat. Burn injuries and hematologic malignancies represent the most common causes of infection in this small series from Mexico.


This study describes the epidemiological characteristics of patients with fusariosis from a multicenter cohort in Mexico. These findings provide information from this invasive fungal disease that threatens different countries in Latin America.


Assuntos
Queimaduras , Neutropenia Febril , Fusariose , Fusarium , Neoplasias Hematológicas , Humanos , Fusariose/tratamento farmacológico , Fusariose/epidemiologia , Fusariose/veterinária , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Estudos Retrospectivos , México/epidemiologia , Voriconazol/uso terapêutico , Neoplasias Hematológicas/veterinária , Queimaduras/complicações , Queimaduras/epidemiologia , Queimaduras/veterinária , Neutropenia Febril/tratamento farmacológico , Neutropenia Febril/veterinária
5.
Front Endocrinol (Lausanne) ; 14: 1213372, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37753211

RESUMO

Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent metabolic disease, although prevalence could change according to region, nowadays is considered a public health problem whose real impact on the health system is unknown. NAFLD has a multifactorial and complex pathophysiology, due to this, developing a unique and effective pharmacological treatment has not been successful in reverting or avoiding the progression of this liver disease. Even though NAFLD pathophysiology is known, all actual treatments are focused on modifying or regulating the metabolic pathways, some of which interplay with obesity. It has been known that impairments in hunger and satiety signals are associated with obesity, however, abnormalities in these signals in patients with NAFLD and obesity are not fully elucidated. To describe these mechanisms opens an additional option as a therapeutic target sharing metabolic pathways with NAFLD, therefore, this review aims to describe the hormones and peptides implicated in both hunger-satiety in NAFLD. It has been established that NAFLD pharmacological treatment cannot be focused on a single purpose; hence, identifying interplays that lead to adding or modifying current treatment options could also have an impact on another related outcome such as hunger or satiety signals.


Assuntos
Hepatopatia Gordurosa não Alcoólica , Humanos , Hepatopatia Gordurosa não Alcoólica/metabolismo , Fome , Obesidade/complicações , Saciação
6.
Curr Microbiol ; 80(11): 357, 2023 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-37768473

RESUMO

Clostridioides difficile infection is one of the most significant causes of nosocomial diarrhea associated with antibiotic use worldwide. In recent years, the incidence of Clostridioides difficile infection in Latin American countries has increased due to the emergence and spread of epidemic Clostridioides difficile strains, such as RT027/NAP1/ST1, RT078/ST11, and RT017/ST37; additionally, endemic multi-drug-resistant strains have recently appeared due to the lack of heterogeneous diagnostic algorithms and guidelines for antibiotic use in each country. The aim of this review is to present the latest information regarding Clostridioides difficile and emphasize the importance of epidemiological surveillance of this pathogen in Latin American countries.

7.
Turk J Gastroenterol ; 34(8): 866-872, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37533278

RESUMO

BACKGROUND/AIMS: Digital chromoendoscopy has proven to be useful in the histological prediction of premalignant lesions in the colon. The aim of the study was to describe the diagnostic performance of Narrow-Band Imaging International Colorectal Endoscopic Classification in the histological differentiation of colonic lesions, applied by expert endoscopists and trainees. MATERIALS AND METHODS: Cross-sectional study that includes high-definition endoscopic images and histopathological reports of 94 patients over 50 years. Images were evaluated and classified as Narrow-Band Imaging International Colorectal Endoscopic 1, 2, or 3 by 2 experts and 2 trainee endoscopists, all of them blinded to histological results. Diagnostic accuracy for each Narrow-Band Imaging International Colorectal Endoscopic category was calculated for trainees and expert endoscopists. Intra-observer agreement was evaluated by means of Cohen's kappa coefficient; meanwhile, inter-observer agreement was calculated by means of Fleiss' kappa. RESULTS: Evaluations performed by expert and trainee endoscopists showed a performance for Narrow-Band Imaging International Colorectal Endoscopic category 1: sensitivity 62%, specificity 85%, area under receiver operator characteristic 0.73; Narrow-Band Imaging International Colorectal Endoscopic category 2: sensitivity 61%, specificity 73%, area under receiver operator characteristic 0.66; and Narrow-Band Imaging International Colorectal Endoscopic category 3: sensitivity 88%, specificity 91%, area under receiver operator characteristic 0.86. The total agreement of the evaluations was 72.5%, with an inter-observer variability of K 0.60 (95% CI 0.52-0.74). When the diagnostic performance for non-dysplastic lesions and dysplastic lesions (Narrow-Band Imaging International Colorectal Endoscopic 1 vs 2 and 3) was compared, we observed an increase in sensitivity for differentiated adenomas (Narrow-Band Imaging International Colorectal Endoscopic 2). CONCLUSION: Narrow-Band Imaging International Colorectal Endoscopic Classification applied in the histological prediction of static images of colonic lesions has a good diagnostic performance for Narrow-Band Imaging International Colorectal Endoscopic category 3, as well as an acceptable performance for Narrow-Band Imaging International Colorectal Endoscopic category 1, with a moderate agreement among observers.


Assuntos
Pólipos do Colo , Neoplasias Colorretais , Humanos , Colonoscopia/métodos , Estudos Transversais , Pólipos do Colo/diagnóstico por imagem , Pólipos do Colo/patologia , Imagem de Banda Estreita/métodos , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/patologia
8.
Life (Basel) ; 13(4)2023 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-37109577

RESUMO

BACKGROUND: The association of low-normal thyroid function (LNTF) with non-alcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated fatty liver disease (MAFLD) is controversial; thus, the aim of this study is to determine this association. METHODS: NAFLD was evaluated by controlled attenuation parameter of transient elastography. Patients were classified by MAFLD criteria. LNTF was defined as TSH levels of 2.5 to 4.5 mIU/L and were divided into three different cut-off points (>4.5 to 5.0, >3.1, and >2.5 mIU/L). Associations between LNTF, NAFLD, and MAFLD were evaluated by univariate and multivariate logistic regression analyses. RESULTS: A total of 3697 patients were included; 59% (n = 2179) were male, and median age and body mass index were 48 (43-55) years and 25.9 (23.6-28.5) kg/m2, respectively, and 44% (n = 1632) were diagnosed with NAFLD. THS levels of 2.5 and 3.1 showed significant associations with the presence of NAFLD and MAFLD; however, LNTF did not show an independent association with the presence of NAFLD or MAFLD in multivariate analysis. According to different cut-off points, patients with LNTF presented similar risks for NAFLD as the general population. CONCLUSION: LNTF is not associated with NAFLD or MAFLD. Patients with high LNTF are equally at risk for NAFLD as the general population.

9.
Front Endocrinol (Lausanne) ; 13: 1026444, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36523596

RESUMO

Nowadays, non-alcoholic fatty liver disease is one of the first causes of liver transplant worldwide; many efforts have been done to find the perfect drug for this multifactorial disease. Presently we just have a few drugs that could be used in specific and limited clinical scenarios. Current evidence suggests that bariatric endoscopic and surgical therapies could be strategies with optimal outcomes, with high impact in quality of life, decrease of cardiovascular risk, and improvement in metabolic profile, despite being considered expensive procedures. This review proposes to consider these therapies early together with liver fibrosis evaluation, with long term cost-effectiveness benefits in the absence of response to lifestyle modifications and pharmacological treatments.


Assuntos
Cirurgia Bariátrica , Bariatria , Hepatopatia Gordurosa não Alcoólica , Obesidade Mórbida , Humanos , Hepatopatia Gordurosa não Alcoólica/cirurgia , Obesidade Mórbida/cirurgia , Qualidade de Vida
10.
Artigo em Inglês | MEDLINE | ID: mdl-36231529

RESUMO

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of metabolic syndrome. Recently, the term metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed and adapted to body mass index (BMI). This study describes the impact on prevalence of the application of both criteria in overweight and lean patients. METHODS: Patients who were evaluated for liver steatosis by transient elastography were included and divided according to BMI (≥25 kg/m2 and <25 kg/m2) and classified as NAFLD or MAFLD, according to metabolic abnormalities. Differences in prevalence were evaluated applying both criteria. A multivariate analysis was performed to evaluate independent associations of metabolic abnormalities and liver steatosis in lean patients. RESULTS: 3847 patients were included. In overweight patients (61%), the prevalence NAFLD was 63.6% and 65.3% for MAFLD (p = 0.22). In contrast, the prevalence of MAFLD was lower (7.9% vs. 18.3%, p ≤ 0.001) in lean patients. In this group, higher age, fasting glucose, triglycerides, and waist circumference showed independent association with liver steatosis. CONCLUSION: The application of NAFLD/MAFLD criteria did not show prevalence differences in overweight patients. With MAFLD criteria, the prevalence is lower in lean patients, but patients with high risk of progression of liver disease for steatosis were identified, according to their metabolic abnormalities.


Assuntos
Hepatopatia Gordurosa não Alcoólica , Glucose , Humanos , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Sobrepeso/complicações , Sobrepeso/epidemiologia , Prevalência , Triglicerídeos
11.
Sci Rep ; 12(1): 8272, 2022 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-35585153

RESUMO

Patients with chronic disorders like non-alcoholic fatty liver disease (NAFLD) face important challenges adhering to diagnostic and treatment tracks. As NAFLD increases, the need to incentivize health-seeking behaviors grows. No evidence-based interventions to address this gap exist. The aim of the study was to estimate the effect of providing increasing levels of diagnostic information on medical care-seeking in adults newly diagnosed with NAFLD. We randomly assigned adults with a sonographic diagnosis of NAFLD at a check-up unit in Mexico to one of five groups. All groups received medical consultation. A: no further interventions; B: received multimedia educational material (MEM); C: MEM + NAFLD-fibrosis-score (NFS); D: MEM + transient elastography (TE); E: MEM + NFS + TE. 1209 participants were randomized, follow-up rate 91%; 82% male, BMI 30.5 ± 4 kg/m2. There were no differences in the proportion of patients undergoing further diagnostic evaluation of liver fibrosis (A 0.4%, E 0.4%, P-for-trend = 0.269). Groups who received more information sought specialized medical care more frequently: A 22%, E 30% (P-for-trend = 0.047). A trend to receive treatment was also observed at higher levels of information: A 26.7%, E 36.3% (P-for-trend = 0.134). Increasing the amount of diagnostic information seemed to increase patient's health-seeking. Tailoring the communication of information obtained for diagnosis could help to increase health-seeking in chronic disease patients.Trial registration: NCT01874249 (full date of first registration 11-06-2013).


Assuntos
Técnicas de Imagem por Elasticidade , Hepatopatia Gordurosa não Alcoólica , Adulto , Biópsia , Feminino , Humanos , Fígado/patologia , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/patologia , Masculino , México , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/patologia
12.
Int J Mol Sci ; 23(2)2022 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-35055177

RESUMO

Hepatic steatosis is characterized by triglyceride accumulation within hepatocytes in response to a high calorie intake, and it may be related to intestinal microbiota disturbances. The prebiotic inulin is a naturally occurring polysaccharide with a high dietary fiber content. Here, we evaluate the effect of inulin on the intestinal microbiota in a non-alcoholic fatty liver disease model. Mice exposed to a standard rodent diet or a fat-enriched diet, were supplemented or not, with inulin. Liver histology was evaluated with oil red O and H&E staining and the intestinal microbiota was determined in mice fecal samples by 16S rRNA sequencing. Inulin treatment effectively prevents liver steatosis in the fat-enriched diet group. We also observed that inulin re-shaped the intestinal microbiota at the phylum level, were Verrucomicrobia genus significantly increased in the fat-diet group; specifically, we observed that Akkermansia muciniphila increased by 5-fold with inulin supplementation. The family Prevotellaceae was also significantly increased in the fat-diet group. Overall, we propose that inulin supplementation in liver steatosis-affected animals, promotes a remodeling in the intestinal microbiota composition, which might regulate lipid metabolism, thus contributing to tackling liver steatosis.


Assuntos
Akkermansia/classificação , Dieta Hiperlipídica/efeitos adversos , Inulina/administração & dosagem , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Análise de Sequência de DNA/métodos , Akkermansia/genética , Akkermansia/isolamento & purificação , Animais , DNA Bacteriano/genética , DNA Ribossômico/genética , Microbioma Gastrointestinal/efeitos dos fármacos , Sequenciamento de Nucleotídeos em Larga Escala , Inulina/farmacologia , Metabolismo dos Lipídeos/efeitos dos fármacos , Masculino , Camundongos , Hepatopatia Gordurosa não Alcoólica/induzido quimicamente , Hepatopatia Gordurosa não Alcoólica/microbiologia , Filogenia , RNA Ribossômico 16S/genética
13.
Nutr Res ; 87: 70-79, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33601216

RESUMO

Metabolic associated fatty liver disease (MAFLD) is a range of hepatic disorders with progression to steatohepatitis with risk of development of fibrosis, cirrhosis, and hepatocellular carcinoma. MAFLD is strongly related to metabolic disorders of active fatty acids, which seem to be selective according to their specific ligand of G protein-coupled receptors (GPRs) located in immune response cells. An approach to study the pathophysiological mechanisms of MAFLD could be through the expression of active fatty acids ligands. The expression of GPRs is associated with obesity, microbiota environment, and dietary characteristics in patients with MAFLD. More specifically, GPR41, GPR43, GPR20, and GPR120 have been associated with alteration of lipid metabolism in hepatic and intestinal cells, and consequently they have a key role in metabolic diseases. We observed that GPR120 is not expressed in nonoverweight/obese patients, regardless of the presence of MAFLD; meanwhile the expression of GPR41 is increased in patients with lean MAFLD. GPRs role in liver disease is intriguing and a field of research opportunity. More studies are necessary to define the role of active fatty acids in the development of metabolic diseases.


Assuntos
Hepatopatia Gordurosa não Alcoólica/metabolismo , Receptores Acoplados a Proteínas G/metabolismo , Animais , Peso Corporal , Ácidos Graxos/metabolismo , Microbioma Gastrointestinal , Hepatócitos/metabolismo , Humanos , Leucócitos Mononucleares/metabolismo , Metabolismo dos Lipídeos , Hepatopatia Gordurosa não Alcoólica/complicações , Obesidade/complicações , Obesidade/metabolismo
14.
Ann Hepatol ; 20: 100271, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33099028

RESUMO

INTRODUCTION AND OBJECTIVES: Liver function tests (LFT) abnormalities are reported in up to 50% of COVID-19 patients, and metabolic comorbidities are associated with poorer outcomes. The aim of the study was to determine the prevalence of liver steatosis and fibrosis in patients with COVID-19 and their association with clinical outcomes. MATERIAL AND METHODS: Retrospective study in hospitalized COVID-19 patients was conducted. The risk for liver steatosis was estimated by HSI > 36, and risk for advanced liver fibrosis with APRI > 1.0, NAFLD FS > 0.675 and/or FIB-4 > 3.25. Clinical outcomes were admission to Intensive Care Unit (ICU) and mortality. RESULTS: Of 155 patients, 71.6% were male (n = 111), and 28.4% (n = 44) were obese. Abnormal LFT were present in 96.8% (n = 150), prevalence of steatosis was 42.6% (n = 66) and of significative liver fibrosis was 44.5% (n = 69). Liver fibrosis by FIB-4 was associated with risk of ICU admission (OR 1.74 [95%CI 1.74-2.68; p = 0.023]) and mortality (OR 6.45 [95%CI 2.01-20.83, p = 0.002]); no independent associations were found. CONCLUSIONS: The prevalence of steatosis and significant liver fibrosis was high in COVID-19 patients but was not associated with clinical outcomes.


Assuntos
COVID-19/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Cirrose Hepática/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Adulto , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Comorbidade , Estudos Transversais , Feminino , Seguimentos , Humanos , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Estudos Retrospectivos , SARS-CoV-2 , Índice de Gravidade de Doença
15.
Cir Cir ; 2020 Dec 09.
Artigo em Esperanto | MEDLINE | ID: mdl-33296911

RESUMO

Objetivo: Describir las variables ecocardiográficas de los pacientes con COVID-19 y su correlación con biomarcadores y mortalidad. Método: Estudio observacional, descriptivo, longitudinal y retrospectivo. Resultados: El 70% (n = 21) eran de sexo masculino, el promedio de edad fue de 59 (46-67) años y el índice de masa corporal fue de 30.1 (27.3-32.4) kg/m2. En la evaluación de la función sistólica del ventrículo izquierdo se observó una adecuada correlación entre la excursión sistólica del plano del anillo mitral (MAPSE) y la fracción de eyección del ventrículo izquierdo (r2 = 0.508, p = 0.004). La evaluación de la función sistólica del ventrículo derecho indicó una óptima correlación entre la excursión sistólica del plano del anillo tricuspídeo (TAPSE) y la fracción de acortamiento del ventrículo derecho (r2 = 0.649, p = ≤ 0.0001). No hubo correlación de los biomarcadores y las variables ecocardiográficas entre los pacientes sobrevivientes y no sobrevivientes, a excepción del MAPSE y las concentraciones séricas de deshidrogenasa láctica (r2 = -0.427, p = 0.019). La tasa de mortalidad fue del 16% (n = 5). Conclusión: Existe una adecuada correlación entre las variables ecocardiográficas de la función sistólica del ventrículo izquierdo y del ventrículo derecho, así como también entre la MAPSE y los valores séricos de DHL.

16.
Cir Cir ; 88(5): 569-575, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33064694

RESUMO

OBJECTIVE: To describe the clinical characteristics and management of severe COVID-19 patients. METHOD: Observational, descriptive, longitudinal, and retrospective study. RESULTS: 56 patients were admitted, of whom 80.3% (n = 45) were males with a mean age of 58 years [46-67]. The main comorbidities were obesity, high blood pressure, and diabetes. Symptoms onset time at admittance to the ICU was 9 [7-14] days, of which the most frequent were dyspnea, fever, and dry cough. Laboratory data were lymphopenia; elevation of LDH, fibrinogen, D-dimer, ferritin and CRP. 100% of the patients required mechanical ventilation, the median mechanical ventilation time was 12 [6-17] days, and 66% (n= 37) required a prone position. The pharmacological treatment was mainly based on azithromycin, hydroxychloroquine, tocilizumab and steroids. The most frequent complications were acute kidney injury, venous thromboembolism and acute myocardial infarction. Mortality rate was 17.8% (n = 10). CONCLUSION: The characteristics of the critically ill patients in our hospital were mostly elderly and obese, with the variables of higher SOFA score and acute kidney injury associated with higher mortality.


OBJETIVO: Describir las características clínicas y el manejo de pacientes graves con COVID-19. MÉTODO: Estudio observacional, descriptivo, longitudinal y restrospectivo. RESULTADOS: Ingresaron 56 pacientes, el 80.3% (n = 45) de sexo masculino, con un promedio de edad de 58 [46-67] años. Las principales condiciones de comorbilidad fueron obesidad, hipertensión y diabetes. El tiempo de inicio de los síntomas al ingreso fue de 9 [7-14] días, siendo los más frecuentes disnea, fiebre y tos seca. Los datos de laboratorio fueron linfopenia y elevación de deshidrogenasa láctica, fibrinógeno, dímero D, ferritina y proteína C reactiva. El 100% de los pacientes requirieron ventilación mecánica, con una mediana de tiempo de ventilación de 12 [6-17] días, y el 66% (n = 37) requirieron posición en prono. El tratamiento farmacólogico fue a base de azitromicina, hidroxicloroquina, tocilizumab y esteroides, principalmente. Las complicaciones más frecuentes fueron lesión renal aguda, enfermedad tromboembólica venosa e infarto agudo al miocardio. La tasa de mortalidad fue del 17.8% (n = 10). CONCLUSIÓN: Los pacientes graves en nuestro hospital fueron en su mayoría personas de la tercera edad y con obesidad, siendo las variables de mayor puntaje SOFA y lesión renal aguda las asociadas con mayor mortalidad.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Unidades de Terapia Intensiva , Pandemias , Pneumonia Viral/terapia , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Corticosteroides/uso terapêutico , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Antivirais/uso terapêutico , Azitromicina/uso terapêutico , COVID-19 , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Terapia Combinada , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Feminino , Mortalidade Hospitalar , Hospitais Universitários/organização & administração , Humanos , Hidroxicloroquina/uso terapêutico , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Respiração Artificial , SARS-CoV-2 , Avaliação de Sintomas , Tratamento Farmacológico da COVID-19
17.
Ann Hepatol ; 19(5): 482-488, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32717363

RESUMO

INTRODUCTION AND OBJECTIVES: Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome. Some dietary fatty acids have showed different bioactive functions in metabolic syndrome. The aim of this study is to determine the dietary consumption patterns and serum percentage of bioactive fatty acids in NAFLD patients. PATIENTS AND METHODS: Cross-sectional study with NAFLD patients and non-NAFLD patients. Dietary consumption of bioactive fatty acids was assessed by a food frequency questionnaire. NAFLD and liver fibrosis were diagnosed by transient elastography. The identification of serum bioactive fatty acids was achieved by gas chromatography-mass spectrometry (%). Bioactive fatty acids consumption was correlated with NAFLD clinical characteristics with the Spearman correlation analysis. RESULTS: A total of 299 patients were included, whose mean of age and body mass index were 44.2±9.9 years and 25.9±3.8kg/m2, respectively. The consumption of bioactive fatty acids was no different regarding the presence of NAFLD; however, the consumption of stearic and linoleic fatty acids was higher in relation with NAFLD severity (p≤0.05). The consumption of myristic acid was higher in patients with fibrosis (p=0.02). Serum percentage and dietary consumption did not show correlations. CONCLUSION: Dietary consumption of bioactive fatty acids is different according to NAFLD severity. Individualized diets according to NAFLD severity could be successful in order to prevent liver injury-related outcomes.


Assuntos
Gorduras na Dieta/sangue , Ácidos Graxos/sangue , Cirrose Hepática/sangue , Hepatopatia Gordurosa não Alcoólica/sangue , Adulto , Estudos de Casos e Controles , Estudos Transversais , Registros de Dieta , Gorduras na Dieta/efeitos adversos , Técnicas de Imagem por Elasticidade , Ácidos Graxos/efeitos adversos , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/etiologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/etiologia , Valor Nutritivo , Índice de Gravidade de Doença
18.
Expert Rev Gastroenterol Hepatol ; 14(5): 355-366, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32299261

RESUMO

INTRODUCTION: Sarcopenia refers to a progressive and generalized muscle mass and strength loss. In liver diseases, it has been related to worse outcomes and high risk of decompensations. AREAS COVERED: Sarcopenia is caused by a set of cellular processes in the muscle such as denervation, mitochondrial dysfunction, endotoxemia and inflammation; which are manifested through the alteration of several proteolytic pathways such as lysosomal, proteasomal and caspase systems. In autophagy, myostatin and oxidative stress; such as hyperammonemia, contributes importantly to liver sarcopenia through loss of muscle mass already demonstrated in in vitro and in vivo models. In addition, hormones and the regulation of the intestinal microbiota, influence in a not less important magnitude. In the clinical setting, early identification of sarcopenia has been established as a mandatory item to prevent progression of muscle mass loss; however, diagnostic methods have extreme variation according to methodology, population, etiology and severity of liver disease. Reversing sarcopenia should be an integral therapeutic strategy. EXPERT OPINION: Clinical and nutritional interventions should be adapted to liver injury etiology and stage of disease, each of them shares a similar sarcopenia development pathway. There are specific biomarkers that condition or exacerbate loss of skeletal muscle.


Assuntos
Microbioma Gastrointestinal/fisiologia , Hepatopatias/fisiopatologia , Sarcopenia/fisiopatologia , Carcinoma Hepatocelular/fisiopatologia , Doença Crônica , Humanos , Hepatopatias/etiologia , Neoplasias Hepáticas/fisiopatologia , Transplante de Fígado , Músculo Esquelético/fisiopatologia , Sarcopenia/diagnóstico , Sarcopenia/etiologia , Sarcopenia/terapia
19.
Nutr Cancer ; 72(2): 194-201, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31259622

RESUMO

Purpose: Dysgeusia can be found in 50% of cancer patients undergoing chemotherapy. Nonetheless, dysgeusia can be present in treatment-naïve patients, and may negatively impact nutrition and quality of life.Methods: Treatment-naïve non-small cell lung cancer (NSCLC) was assessed for dysgeusia using a self-reporting questionnaire and a rinse stimuli technique. Patients were evaluated in terms of health-related quality of life (HRQL) using the EORTC-QLQ-C30 questionnaire and in terms of nutrition using the subjective global assessment (SGA), energy consumption and body composition.Results: Among 65 treatment-naïve patients, dysgeusia was self-reported in 35%. Using the rinse stimuli technique, most of the patients perceived taste stimuli with a minimal concentration, but could not recognize the taste. Patients with dysgeusia presented significantly less lean-body mass (P = 0.027), and higher fat mass (P = 0.027). Additionally, these patients had significantly more gastrointestinal symptoms including nausea (P = 0.042), anorexia (P = 0.004), and early satiety (P < 0.0001). Dysgeusia was also associated with less food consumption (P = 0.010). Last, patients with dysgeusia had clinically-significant alterations in HRQL scales.Conclusion: Presence of dysgeusia in NSCLC patients before undergoing chemotherapy is associated with worse nutritional outcomes. The routine assessment of dysgeusia in treatment-naïve patients should be encouraged to timely assess and follow nutritional parameters.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Disgeusia/epidemiologia , Neoplasias Pulmonares/patologia , Estado Nutricional , Qualidade de Vida , Anorexia/fisiopatologia , Feminino , Humanos , Incidência , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Náusea/fisiopatologia , Autorrelato , Inquéritos e Questionários
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