RESUMO
Objetivo. La hiperglucemia es una observación frecuente en el síndrome coronario agudo (SCA). Hemos analizado la relación existente entre la hiperglucemia al ingreso y el pronóstico de los pacientes que ha sufrido un SCA. Material y métodos. Estudio prospectivo de 455 pacientes con SCA con y sin elevación del segmento ST de alto riesgo (criterios de la ACA/AHA). Dividimos la muestra según la mediana de la glucemia al ingreso en < 139mg/dl y ≥ 139mg/dl, y observamos variables analíticas, electrocardiográficas, ecocardiográficas y epidemiológicas. Mediante un análisis de riesgos proporcionales de Cox se analizó su relación con la mortalidad como variable principal en los siguientes seis meses al evento. Resultados. La edad media fue de 64,3±12,7 años, el 80,4% eran varones y el 21,8% habían sido diagnosticados de diabetes. La glucemia media al ingreso fue de 163±72mg/dL. Un total de 47 pacientes fallecieron (10,3%). La glucemia media de los que fallecieron fue de 190±79mg/dl frente a 160±70mg/dl en los supervivientes (p=0,003). Aquellos que presentaban al ingreso hiperglucemia (≥ 139mg/dL) tuvieron una mayor mortalidad (Hazard ratio [HR]=2,98; intervalo de confianza [IC] 95%: 1,06-8,4; p=0,039). La edad avanzada, el sexo masculino, la disfunción ventricular y el descenso inicial de la presión arterial también mostraron relación independiente con la mortalidad. Conclusiones. La hiperglucemia al ingreso ≥ 139mg/dl en pacientes con SCA se asocia a un mayor riesgo de fallecer en los próximos seis meses, independientemente del antecedente de diabetes y otros factores de riesgo conocidos(AU)
Objective. Hyperglycemia is a frequent observation in the acute coronary syndrome. We analyzed the relationship between hyperglycemia on admission and patients with acute coronary syndrome. Material and methods. Prospective study of 455 patients with acute coronary syndrome with and without elevation of ST segment with high risk according to ACA/AHA criteria. We divided the sample according to the median glycemia on admission into <139mg/dl and ≥139mg/dl. We studied the analytic, electrocardiography, echocardiography and epidemiologic variables. Using the Cox Proportional Hazard Model, we analyzed their relationship with the mortality as principal variable during a six-month period after the acute coronary syndrome. Results. Mean age was 64.3±12.7 years, 80.4% were male and 21.8% had been diagnosed with diabetes. Mean glycemia on admission was 163.3±71.8mg/dl. Forty-seven patients died (10.3%), Mean glycemia of those who had died was 189.8±78.8mg/dl compared to 160.3±70.4mg/dl in the survival group (P=0.003). Patients with hyperglycemia on admission ≥139mg/dl had higher mortality, hazard ratio (HR)=2.98 (confidence interval [CI 95%]: 1.06-8.4; P=0.039). Elderly patients, being a male, having ventricular dysfunction and initial decrease of blood pressure also showed an independent relationship with mortality. Conclusions. Hyperglycemia on admission ≥139mg/dl in acute coronary syndrome patients is associated with a higher risk of death in the following six months, independently of diabetes or other risk factors known(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Hiperglicemia/complicações , Hiperglicemia/diagnóstico , Prognóstico , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Fatores de Risco , Síndrome do QT Longo/complicações , Síndrome Coronariana Aguda/fisiopatologia , Estudos Prospectivos , Glicemia/análise , Índice Glicêmico , Eletrocardiografia/métodos , Intervalos de Confiança , Indicadores de MorbimortalidadeRESUMO
OBJECTIVE: Hyperglycemia is a frequent observation in the acute coronary syndrome. We analyzed the relationship between hyperglycemia on admission and patients with acute coronary syndrome. MATERIAL AND METHODS: Prospective study of 455 patients with acute coronary syndrome with and without elevation of ST segment with high risk according to ACA/AHA criteria. We divided the sample according to the median glycemia on admission into < 139 mg/dl and ≥ 139 mg/dl. We studied the analytic, electrocardiography, echocardiography and epidemiologic variables. Using the Cox Proportional Hazard Model, we analyzed their relationship with the mortality as principal variable during a six-month period after the acute coronary syndrome. RESULTS: Mean age was 64.3 ± 12.7 years, 80.4% were male and 21.8% had been diagnosed with diabetes. Mean glycemia on admission was 163.3 ± 71.8 mg/dl. Forty-seven patients died (10.3%), Mean glycemia of those who had died was 189.8 ± 78.8 mg/dl compared to 160.3 ± 70.4 mg/dl in the survival group (P = 0.003). Patients with hyperglycemia on admission ≥ 139 mg/dl had higher mortality, hazard ratio (HR) =2.98 (confidence interval [CI 95%]: 1.06-8.4; P = 0.039). Elderly patients, being a male, having ventricular dysfunction and initial decrease of blood pressure also showed an independent relationship with mortality. CONCLUSIONS: Hyperglycemia on admission ≥ 139 mg/dl in acute coronary syndrome patients is associated with a higher risk of death in the following six months, independently of diabetes or other risk factors known.
Assuntos
Síndrome Coronariana Aguda/complicações , Hiperglicemia/complicações , Síndrome Coronariana Aguda/mortalidade , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos ProspectivosRESUMO
No disponible
No disponible
Assuntos
Idoso de 80 Anos ou mais , Humanos , Masculino , Baclofeno/uso terapêutico , Tétano/tratamento farmacológico , Baclofeno/administração & dosagem , Injeções EspinhaisRESUMO
Presence of central nervous system by extrapulmonary tuberculosis is an infrequent disease specially among non HIV infected patients, and it is associated with poor prognosis and high mortality rates. We report a case with a middle cerebral artery ischemic strocke as a first symptom of miliar tuberculosis.
Assuntos
Isquemia Encefálica/microbiologia , Infarto da Artéria Cerebral Média/microbiologia , Tuberculose Miliar/complicações , Adulto , Feminino , HumanosRESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto , Tuberculose Miliar/complicações , Tuberculose Miliar/diagnóstico , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/diagnóstico , Infarto da Artéria Cerebral Média/mortalidade , Lúpus Eritematoso Sistêmico/complicações , Infarto Cerebral/mortalidade , Infarto da Artéria Cerebral Média/tratamento farmacológico , Infarto da Artéria Cerebral Média/epidemiologiaAssuntos
Quadriplegia/etiologia , Neoplasias da Medula Espinal/complicações , Vértebras Cervicais , Humanos , Laminectomia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/cirurgia , Resultado do TratamentoRESUMO
La endocarditis infecciosa (EI) es una de las complicaciones más severas en la población adicta a drogas por vía parenteral (ADVP). La infección por el VIH incrementa el riesgo de aparición en los pacientes que además son ADVP. La EI en ambas poblaciones posee una especial tendencia a infectar las válvulas del hemicardio derecho, siendo infrecuente la afectación aórtica. Se expone el caso un paciente VIH y ADVP, que ingresa por síndrome febril, con Rx de tórax inicial normal y hemocultivos negativos. CD490 mm3. Imposible realizar ecocardiograma transesofágico (ETE), revelando el transtorácico (ETT) una insuficiencia aórtica moderada con función sistólica conservada. A pesar de antibioterpia de amplio espectro,antifúngico y tratamiento antirretroviral (TAR) presentó SDRA por lo que es intubado. Se realizó ETT apreciando una gran desestructuración aórtica y una fístula aorto-pulmonar secundaria a una EI izquierda. Posteriormente solo un hemocultivo fue positivo para S. aureus. Fue desestimado el tratamiento quirúrgico. El paciente falleció tras 3 semanas de evolución
Infective endocarditis (IE) is the most severe complication in intravenous drug abusers (IVDAs). HIV infection increases the risk of IE in IVDAs too. IE in both population are special tendency to infect the rigthsided heart, but unusual infective aortic valve. We report a case of HIVand IVDA patient admitted in hospital due to fever syndrome, with X-ray test normal and the first blood cultures negatives. CD4 count cell 90 mm3. It was impossible doing a transesophageal echocardiography (TEE) and transtoracic echocardiogramma (TTE) only showed a moderate aortic insufficiency with conserved systolic function. Despite using antibiotics, antifungals and highly active antirretroviral therapy, he developed ARDS, and mechanical ventilation should be performed. At that moment, TEE showed an aorto pulmonary fistula due to left-sided IE. Further cultures was undergone and only one blood culture was positive to Staphylococcus aureus. Cardiac surgery was not indicated. The patient died 3 weeks later
Assuntos
Humanos , Adulto , Fístula Arteriovenosa/etiologia , Endocardite Bacteriana/etiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Endocardite Bacteriana/diagnóstico , Transtornos Relacionados ao Uso de Substâncias , Staphylococcus aureus/patogenicidadeRESUMO
No disponible
Assuntos
Pessoa de Meia-Idade , Humanos , Paresia/complicações , Paresia/diagnóstico , Laminectomia/métodos , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico , Hemiatrofia Facial/complicações , Tomografia Computadorizada de Emissão/métodos , Paresia/radioterapiaRESUMO
No disponible
Assuntos
Masculino , Pessoa de Meia-Idade , Humanos , Hérnia Diafragmática/complicações , Hérnia Diafragmática/diagnóstico , Choque/complicações , Dopaminérgicos/uso terapêutico , Dopamina/uso terapêutico , Tomografia Computadorizada de Emissão/métodos , Taquicardia Ventricular/complicações , Taquicardia Ventricular/diagnóstico , Dispneia/complicações , Hipotensão/complicações , Taquicardia Ventricular/fisiopatologia , Taquicardia VentricularRESUMO
Infective endocarditis (IE) is the most severe complication in intravenous drug abusers (IVDAs). HIV infection increases the risk of IE in IVDAs too. IE in both population are special tendency to infect the right-sided heart, but unusual infective aortic valve. We report a case of HIV and IVDA patient admitted in hospital due to fever syndrome, with X-ray test normal and the first blood cultures negatives. CD4 count cell 90 mm3. It was impossible doing a transesophageal echocardiography (TEE) and transtoracic echocardiogramma (TTE) only showed a moderate aortic insufficiency with conserved systolic function. Despite using antibiotics, antifungals and highly active antiretroviral therapy, he developed ARDS, and mechanical ventilation should be performed. At that moment, TEE showed an aorto pulmonary fistula due to left-sided IE. Further cultures was undergone and only one blood culture was positive to Staphylococcus aureus. Cardiac surgery was not indicated. The patient died 3 weeks later.
