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1.
Infectio ; 23(3): 271-304, July-Sept. 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-1002162

RESUMO

Abstract Invasive Candidiasis (IC) and candidemia (as its most frequent manifestation) have become the main cause of opportunistic mycosis at hospital settings. This study, made by members of the Colombian Association of Infectious Diseases (ACIN), was aimed at providing a set of recommendations for the management, follow-up and prevention of IC / candidemia and mucous membrane candida infection in adult, pediatric and neonatal patients in a hospital setting, including the hemato-oncological and critical care units. All the data obtained through an exhaustive search were reviewed and analyzed in a comprehensive manner by all the members of the group, and the recommendations issued are being made after a careful review of the scientific literature available and the consensus of all specialists involved; the emergence of Candida Spp. problem is highlighted and a correct orientation to health professionals regarding the management of patients with candidiasis is provided in a rational and practical way, emphasizing patient evaluation, diagnostic strategies, prophylaxis, empirical treatment, directed treatment and preventative therapy.


Resumen La Candidiasis Invasora (CI) y la candidemia, como su manifestación más frecuente, se ha convertido en la principal causa de micosis oportunista a nivel hospitalario. Este manuscrito realizado por miembros de la Asociación Colombiana de Infectología (ACIN), tuvo como objetivo proporcionar un conjunto de recomendaciones para manejo, seguimiento y prevención de la CI/candidemia y de la infección candidiásica de mucosas, en población adulta, pediátrica y neonatal, en un entorno hospitalario, incluyendo las unidades hemato-oncológicas y unidades de cuidado crítico. Todos los datos obtenidos mediante una búsqueda exhaustiva, fueron revisados y analizados de manera amplia por todos los miembros del grupo, y las recomendaciones emitidas se elaboraron luego de la evaluación de la literatura científica disponible, y el consenso de todos los especialistas involucrados, reconociendo el problema de la emergencia de las infecciones por Candida Spp. y brindando una correcta orientación a los profesionales de la salud sobre el manejo de pacientes con enfermedad candidiásica, de una forma racional y práctica, enfatizando en la evaluación del paciente, estrategias de diagnóstico, profilaxis, tratamiento empírico, tratamiento dirigido y terapia preventiva.

4.
Braz. j. infect. dis ; 18(6): 631-637, Nov-Dec/2014. tab
Artigo em Inglês | LILACS | ID: lil-730413

RESUMO

Background: Bloodstream infection by Candida species has a high mortality in Latin American countries. The aim of this study was to describe the characteristics of patients with documented bloodstream infections caused by Candida species in third level hospitals and determine the risk factors for in-hospital-mortality. Methods: Patients from seven tertiary-care hospitals in Bogotá, Colombia, with isolation of a Candida species from a blood culture were followed prospectively from March 2008 to March 2009. Epidemiologic information, risk factors, and mortality were prospectively collected. Isolates were sent to a reference center, and fluconazole susceptibility was tested by agar-based E-test. The results of susceptibility were compared by using 2008 and 2012 breakpoints. A multivariate analysis was used to determinate risk factors for mortality. Results: We identified 131 patients, with a median age of 41.2 years. Isolates were most frequently found in the intensive care unit (ICU). Candida albicans was the most prevalent species (66.4% of the isolates), followed by C. parapsilosis (14%). Fluconazole resistance was found in 3.2% and 17.6% of the isolates according to the 2008 and 2012 breakpoints, respectively. Fluconazole was used as empirical antifungal therapy in 68.8% of the cases, and amphotericin B in 22%. Hospital crude mortality rate was 35.9%. Mortality was associated with age and the presence of shock at the time of Candida detection. Fluconazole therapy was a protective factor for mortality. Conclusions: Candidemia is associated with a high mortality rate. Age and shock increase mortality, while the use of fluconazole was shown to be a protective factor. A higher resistance rate with new breakpoints was noted. .


Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Candida/classificação , Candidemia/mortalidade , Mortalidade Hospitalar , Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candidemia/microbiologia , Colômbia/epidemiologia , Testes de Sensibilidade Microbiana , Prevalência , Estudos Prospectivos , Fatores de Risco , Centros de Atenção Terciária/estatística & dados numéricos
5.
Braz J Infect Dis ; 18(6): 631-7, 2014 Nov-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25181401

RESUMO

BACKGROUND: Bloodstream infection by Candida species has a high mortality in Latin American countries. The aim of this study was to describe the characteristics of patients with documented bloodstream infections caused by Candida species in third level hospitals and determine the risk factors for in-hospital-mortality. METHODS: Patients from seven tertiary-care hospitals in Bogotá, Colombia, with isolation of a Candida species from a blood culture were followed prospectively from March 2008 to March 2009. Epidemiologic information, risk factors, and mortality were prospectively collected. Isolates were sent to a reference center, and fluconazole susceptibility was tested by agar-based E-test. The results of susceptibility were compared by using 2008 and 2012 breakpoints. A multivariate analysis was used to determinate risk factors for mortality. RESULTS: We identified 131 patients, with a median age of 41.2 years. Isolates were most frequently found in the intensive care unit (ICU). Candida albicans was the most prevalent species (66.4% of the isolates), followed by C. parapsilosis (14%). Fluconazole resistance was found in 3.2% and 17.6% of the isolates according to the 2008 and 2012 breakpoints, respectively. Fluconazole was used as empirical antifungal therapy in 68.8% of the cases, and amphotericin B in 22%. Hospital crude mortality rate was 35.9%. Mortality was associated with age and the presence of shock at the time of Candida detection. Fluconazole therapy was a protective factor for mortality. CONCLUSIONS: Candidemia is associated with a high mortality rate. Age and shock increase mortality, while the use of fluconazole was shown to be a protective factor. A higher resistance rate with new breakpoints was noted.


Assuntos
Candida/classificação , Candidemia/mortalidade , Mortalidade Hospitalar , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candidemia/microbiologia , Criança , Colômbia/epidemiologia , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
6.
Arch. bronconeumol. (Ed. impr.) ; 48(8): 267-273, ago. 2012. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-103787

RESUMO

Objetivo: Analizar los resultados conseguidos desde su creación hace 5 años en una consulta de diagnóstico rápido de cáncer de pulmón (CDR-CP) relacionados con el buen uso de la derivación, tiempos de demora diagnóstica y terapéutica, y días de estancia hospitalaria. Comparar las demoras diagnóstico-terapéuticas y estancias hospitalarias con las obtenidas en los pacientes evaluados mediante la sistemática habitual (NCDR-CP). Pacientes y método: Se ha incluido a todos los pacientes valorados en nuestra CDR-CP en los últimos 5 años. En los CP se han registrado las fechas de derivación al médico especialista, primera consulta, realización de pruebas diagnósticas, estadificación, inicio del tratamiento y días de hospitalización. Se han comparado estos mismos datos con los pacientes NCDR-CP diagnosticados en el periodo de octubre 2008 a octubre de 2010. Resultados: Se evaluaron 179 pacientes remitidos a CDR-CP que representan el 26,7% de las consultas ofertadas, siendo 166 (92,7%) las remisiones correctas, de las que el 44,5% correspondieron a un CP; en el 75,6% de ellos se realizó todo el estudio de forma ambulatoria y más del 85% de los casos cumplían con las recomendaciones existentes relacionadas con las demoras diagnóstico-terapéuticas. Al comparar estos datos con el grupo NCDR-CP (n=151), se encontraron diferencias relacionadas con los datos de hospitalización: menor porcentaje de ingresados (p<0,0001) y menos días de estancia (p<0,0001) en el grupo CDR-CP. No existieron diferencias entre ambos grupos en las demoras diagnósticas y terapéuticas. Conclusión: En nuestro medio la consulta de diagnóstico rápido de cáncer de pulmón permite realizar, en un gran porcentaje de casos, todos los estudios de forma ambulatoria y en plazos de tiempo acordes con las recomendaciones existentes. Pese a ello, hemos detectado una acusada infrautilización de las mismas(AU)


Objective: To analyze the results obtained in a lung cancer screening program since its inception five years ago regarding correct referrals, diagnostic and therapeutic delay times and days of hospitalization. To compare the diagnostic-therapeutic delays and hospital stays with those obtained in patients evaluated with the standard system. Patients and methods: Included for study were all those patients evaluated in our Lung Cancer Screening Program (LCSP) in the last five years. For the cases with LC, we recorded the dates the patients were referred to a specialist, the first consultation, diagnostic tests, stage, start of treatment and days of hospitalization. We compared these same data with lung cancer patients who did not partake in the LCSP and were diagnosed between October 2008 and October 2010. Results: We evaluated 179 patients remitted to the LCSP, which represented 26.7% of the consultations; 166 (92.7%) of the referrals were correct, out of which 44.5% were LC. In 75.6% of these, the entire study was completed in the outpatient setting, and more than 85% of the cases met the current recommendations related with diagnostic-therapeutic delays. When these results were compared with the non-LCSP group (n=151), differences were found in the data for hospitalizations: there was a lower percentage of hospitalizations (P<.0001) and shorter hospital stays (P<.0001) in the LCSP group. There were no differences between the two groups for diagnostic or therapeutic delays. Conclusion: In our setting, lung cancer screening programs allow for cancer studies to be carried out in the outpatient consultations in a large percentage of cases, and within the time periods recommended by current guidelines. In spite of this fact, we have detected that these programs are underused(AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Pulmonares , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/terapia , Estudos Observacionais como Assunto , Epidemiologia Descritiva , Neoplasias
7.
Arch Bronconeumol ; 48(8): 267-73, 2012 Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-22575811

RESUMO

OBJECTIVE: To analyze the results obtained in a lung cancer screening program since its inception five years ago regarding correct referrals, diagnostic and therapeutic delay times and days of hospitalization. To compare the diagnostic-therapeutic delays and hospital stays with those obtained in patients evaluated with the standard system. PATIENTS AND METHODS: Included for study were all those patients evaluated in our Lung Cancer Screening Program (LCSP) in the last five years. For the cases with LC, we recorded the dates the patients were referred to a specialist, the first consultation, diagnostic tests, stage, start of treatment and days of hospitalization. We compared these same data with lung cancer patients who did not partake in the LCSP and were diagnosed between October 2008 and October 2010. RESULTS: We evaluated 179 patients remitted to the LCSP, which represented 26.7% of the consultations; 166 (92.7%) of the referrals were correct, out of which 44.5% were LC. In 75.6% of these, the entire study was completed in the outpatient setting, and more than 85% of the cases met the current recommendations related with diagnostic-therapeutic delays. When these results were compared with the non-LCSP group (n=151), differences were found in the data for hospitalizations: there was a lower percentage of hospitalizations (P<.0001) and shorter hospital stays (P<.0001) in the LCSP group. There were no differences between the two groups for diagnostic or therapeutic delays. CONCLUSION: In our setting, lung cancer screening programs allow for cancer studies to be carried out in the outpatient consultations in a large percentage of cases, and within the time periods recommended by current guidelines. In spite of this fact, we have detected that these programs are underused.


Assuntos
Diagnóstico Tardio , Neoplasias Pulmonares/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Idoso , Assistência Ambulatorial/estatística & dados numéricos , Técnicas de Diagnóstico do Sistema Respiratório/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Pneumopatias/diagnóstico , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores Socioeconômicos , Espanha/epidemiologia , Fatores de Tempo
8.
Infectio ; 14(supl.2): s116-s126, oct.-dic. 2010. tab
Artigo em Espanhol | LILACS-Express | ID: lil-635661

RESUMO

Introducción: la sensibilidad antifúngica in vitro en hongos filamentosos no ha tenido el mismo desarrollo que en levaduras. Se dispone de limitada información sobre la susceptibilidad en este tipo de aislamientos en Colombia. Materiales y métodos: se determinó la actividad in vitro de fluconazol, voriconazol, itraconazol, anfotericina B y caspofungina mediante el método de E-Test, de los géneros Aspergillus (36 A. fumigatus, 12 A. flavus, 9 A. niger, 6 A. terreus, 4 A. nidulans y 1 A. versicolor) e hifomicetes hialinos (9 Fusarium sp., 2 Geotrichum sp. y 2 Paecilomyces sp.), provenientes en su mayoría de lavados broncoalveolares (30%) y biopsias pulmonares (36%); 9% provenían de hemocultivos. Resultados: el perfil de resistencia general fue 28% para itraconazol, 15% para caspofungina, 14% para anfotericina B y 5% para voriconazol. En general, todos los aislamientos presentaron una sensibilidad disminuida para fluconazol e itraconazol. La mejor actividad farmacológica la presentaron voriconazol, caspofungina y anfotericina B. Fusarium sp. presentó una mayor actividad con el voriconazol. Se encontraron diferencias entre el tipo de micelio (Aspergillus vs no Aspergillus) y la susceptibilidad a voriconazol, anfotericina B y caspofungina. Conclusión: en general, los antimicóticos disponibles para el tratamiento de infecciones por miceliales muestran una sensibilidad disminuida in vitro en relación con el género y la especie identificada.


Introduction: fungal susceptibility against micelial fungi has not been developed at the same pace as susceptibility against yeasts. Scarce information is available about that kind of isolates in Colombia. Materials and methods: in vitro susceptibility against micelial isolates from patients with cancer was determined. The E-test method was used to find out susceptibility against fluconazole, voriconazole, itraconazole, amphotericin B, and caspofungin. Isolates of the genera Aspergillus (36 A. fumigatus, 12 A. flavus, 9 A. niger, 6 A. terreus, 4 A. nidulans and one A. versicolor isolate), Fusarium (n=9), Geotrichum and Paecilomyces (n=2 each one) obtained from patients with cancer were tested. These isolates were obtained from bronchoalveolar lavage (30%), pulmonary biopsies (36%) and bloodstream infections (9%). Results: The general pattern of resistance was 28% against intraconazole, 15% against caspofungin, 14% against amphotericin B, and 5% against voriconazole. In general, susceptibility against fluconazole and itraconazole showed a diminishing trend. Voriconazole, caspofungin, and amphotericin B showed the best pharmacologic potency. Fusarium sp. presented a higher activity level against voriconazole. There were differences in the susceptibility against voriconazole, anphotericin B, and caspofungin depending on the type of micelial isolate (Aspergillus vs. Non- Aspergillus). Conclusion: In general, the available antifungal treatments against mycelial fungi identified in the cancer center show diminished susceptibility.

9.
Infectio ; 14(supl.2): s131-s144, oct.-dic. 2010. ilus, tab
Artigo em Espanhol | LILACS-Express | ID: lil-635662

RESUMO

El género Aspergillus es ubicuo en la naturaleza y de distribución universal. Por esta razón, el contacto con este hongo incluye hospederos inmunocompetentes e inmunosuprimidos. La vía aérea es la forma más frecuente de adquirir este hongo y sus manifestaciones clínicas y localización topográfica se relacionan con la interacción del hongo y la capacidad inmunológica del hospedero. La principal manifestación clínica de este hongo es a nivel respiratorio, con un impacto muy importante en mortalidad y morbilidad, especialmente en el paciente inmunosuprimido. Los pacientes con tumores hematológicos, trasplantes de corazón, pulmón y con sida son más susceptibles de presentar invasión tisular y vascular por este hongo, que en tales casos se manifiesta como Aspergilosis Invasora (AI). La AI ofrece dificultades diagnósticas en el hospedero inmunosuprimido por lo que en este grupo de pacientes el uso de métodos de diagnóstico no invasores permite guiar el abordaje terapéutico. En la actualidad se dispone de medicamentos antifúngicos del grupo de los azoles (voriconazol) y de las equinocandinas (caspofungina) que han mejorado el resultado de la AI. En este artículo se actualiza la literatura en cuanto al diagnóstico y tratamiento de la AI.


The genus Aspergillus is ubiquitous in nature and has universal distribution; for this reason contact with this fungus includes immunocompetent and non-immunocompetent hosts. The most common form of acquiring this fungus is through air, and its clinical manifestations and topographic location correspond to the interaction of the fungus and its host's immune capacity. The main clinical manifestation of this fungus is a breathing condition and has a very significant impact on mortality and morbidity, especially in non-immunocompetent patients. Patients with haematological malignancies, heart or lung transplant surgeries, and AIDS are the most susceptible to present tissue and vascular invasion by this fungus in the form of invasive aspergillosis (IA). The IA presents diagnostic difficulties in non-immunocompetent hosts; therefore using non-invasive diagnosis methods for this group of patients offers therapeutic approach guidance. Antifungal drugs such as azoles (voriconazole) and echinocandins (caspofungin), that have improved the AI group results, are available nowadays. This article updates the literature on AI diagnosis and treatment.

10.
Infectio ; 14(supl.2): s107-s115, oct.-dic. 2010. tab
Artigo em Espanhol | LILACS-Express | ID: lil-635667

RESUMO

Objetivo: comparar los métodos de referencia de microdilución en caldo de la CLSI M27-A2 y EUCAST, identificando la utilidad y las principales diferencias de cada uno de ellos para los agentes antifúngicos anfotericina B (1), fluconazol (FCZ) e itraconazol (ITZ), contra aislamientos clínicos de Candidaspp. de pacientes con cáncer. Materiales y métodos: se estudiaron 136 aislamientos de C. albicans, 36 de C. tropicalis y 17 de Candidaspp. Se utilizó el índice Kappa ponderado para medir el grado de acuerdo entre los dos métodos. Resultados: se estableció que el grado de concordancia entre los dos métodos para el total de los aislamientos fue alto con AB (κ: 1) y FCZ (κ: 0.74) y bajo al utilizar ITZ (κ: 0.49). La concordancia fue variable y especie-específica: para ITZ y FCZ en C. albicans fue de 0,45 y 0,64; en C. tropicalis, de 0,48 y 0,91; y en Candidaspp. de 0,73 y 0,87, respectivamente. Discusión: este estudio sugiere que las pruebas de sensibilidad antifúngica para los dos métodos son equivalentes en lo esencial. Deben considerarse las diferencias y discrepancias asociadas a la especie implicada, el tipo de antifúngico utilizado y los tiempos de incubación, que puede producir variaciones al interpretar los resultados obtenidos de acuerdo con la metodología empleada.


Objective: compare the broth microdilution testing reference standards CLSI M27-A2 and EUCAST, identifying the usefulness of each one of them and their main differences, against the antifungal agents amphotericin B (1), fluconazole (FCZ), and itraconazole (ITZ) using clinical isolates of Candidaspp. in cancer patients. Methods: isolates of C. albicans (n=136), C. tropicalis (n=36), and Candidaspp. (n=17) were tested by the two methods. The Kappa index was used to establish the degree of agreement between the methods. Results: the degree of agreement between the two methods was high for AB (κ: 1) and FCZ (κ: 0.74) and was low for ITZ (κ: 0.49). Agreement was variable and specific for the various species: for ITZ and FCZ in C. albicans, it was 0.45 and 0.64, respectively. In C. tropicalis, it was of 0.48 and 0.91, and in Candidaspp., it was 0.73 and 0.87 respectively. Discussion: this study suggests that antifungal susceptibility testing using both methods is equivalent. Attention should be focused on differences and discrepancies associated with the species tested, the type of antifungal agent, and the incubation times, which can cause variations at the moment of interpreting the results obtained.

11.
Cancer Epidemiol Biomarkers Prev ; 18(2): 646-50, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19190155

RESUMO

BACKGROUND: Malignant pleural mesothelioma (MPM) results from malignant transformation of mesothelial cells. Past asbestos exposure represents a major risk factor for MPM and other benign pleural disease. Soluble mesothelin-related peptides (SMRP) have been regarded as a promising serum biomarker for MPM. The aim of this study was to investigate serum levels of SMRP in malignant and nonmalignant asbestos-related pleural disease. PATIENTS: Four groups of patients were investigated: group 1 composed of 48 healthy subjects, group 2 composed of 177 patients with previous asbestos exposure and no pleural disease, group 3 composed of 36 patients with MPM, and group 4 composed of 101 patients with previous asbestos exposure and benign pleural disease. Serum SMRP levels were determined by ELISA. RESULTS: Serum SMRP levels were significantly higher among group 3 than the other three groups. There were no differences in SMRP concentrations between groups 2 and 4. Subjects exposed to asbestos had higher SMRP concentrations than normal control subjects regardless of the presence of pleural disease. The area under the receiver operating characteristic curve for SMRP values was 0.75 (95% confidence interval, 0.68-0.83). The SMRP level at 0.55 nmol/L/L was determined as the most optimal cutoff value with resulting sensitivity and specificity of 72% and 72% for the diagnosis of MPM. CONCLUSIONS: These data attest to good diagnostic sensitivity and specificity of SMRP for the diagnosis of malignant mesothelioma. We have also shown that serum SMRP levels might serve as a marker of asbestos exposure.


Assuntos
Asbestose/sangue , Biomarcadores Tumorais/sangue , Glicoproteínas de Membrana/sangue , Mesotelioma/sangue , Neoplasias Pleurais/sangue , Adulto , Área Sob a Curva , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Proteínas Ligadas por GPI , Humanos , Masculino , Mesotelioma/induzido quimicamente , Pessoa de Meia-Idade , Neoplasias Pleurais/induzido quimicamente , Estudos Prospectivos , Curva ROC , Estatísticas não Paramétricas
12.
Drug Saf ; 32(1): 33-42, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19132803

RESUMO

BACKGROUND: Rupatadine (Rupafin), a novel antihistamine approved recently in Europe for the treatment of allergic rhinitis (AR) and chronic idiopathic urticaria in patients aged>or=12 years, has been shown to be highly efficacious, and as safe and well tolerated as other commonly employed antihistamines in the treatment of allergic disease. There are, however, few data on the long-term safety of these antihistamines derived in accordance with the clinical safety recommendations of the European Agency for the Evaluation of Medicinal Products (EMEA) and the International Conference on Harmonisation (ICH) of Technical Requirements for Registration of Pharmaceuticals for Human Use Guideline. OBJECTIVE: To assess the safety and tolerability of treatment with rupatadine 10 mg/day for 12 months in subjects with persistent AR (PER). METHODS: A multicentre, open-label, phase IV study in patients recruited from 33 centres in Spain, from September 2002 to November 2005. The study enrolled 324 male and female patients (aged 12-70 years) with a medical history of PER for at least 12 months and a documented positive skin-prick test to an appropriate allergen. On 4 of the 7 days prior to start of treatment, the patients were required to have a minimum total nasal symptom score (TNSS [for sneezing, rhinorrhoea, nasal obstruction/congestion and nasal itching]) of >or=5. Of the 324 eligible patients starting treatment, 120 needed to be treated for more than 6 months and were followed up until the end of 12 months. All patients received rupatadine 10 mg/day and were allowed to continue their normal concomitant medication for all conditions, other than rhinitis, for up to 6 or 12 months. Safety was assessed by means of adverse events (AEs) reported by patients or detected by investigators, scheduled centralized ECG with special attention to Bazzet corrected QT interval (QTcB) and standard laboratory investigations. RESULTS: Assessment of treatment compliance rates indicated 90% and 83% of patients to be compliant during the 1-6 months and 1-12 months treatment periods, respectively, with compliance rates>80% being associated with the majority of the study population reporting at least one AE. Overall, 74.1% and 65.8% of the patients reported at least one AE during the 1-6 months and 1-12 months treatment periods, respectively, compared with 20.4% and 10.8% of patients reporting at least one treatment-related AE during these periods. Disorders of the nervous system and respiratory thoracic and mediastinal system, in particular headache, somnolence and catarrh, were the three most common AEs reported by >5% of the patients during both treatment periods. Detailed ECG assessments demonstrated no clinically relevant abnormal ECG findings, nor any QTcB increases >60 msec or QTcB values>470 msec for any patient at any time during treatment. Serious AEs were reported in seven patients, of whom six were considered as unlikely to be related to rupatadine treatment, whereas one involving increased blood enzyme levels was considered as possibly related to rupatadine treatment. CONCLUSION: This study confirmed the good long-term safety and tolerability of rupatadine at the therapeutic dose of 10 mg/day in patients with PER.


Assuntos
Ciproeptadina/análogos & derivados , Antagonistas dos Receptores Histamínicos H1/efeitos adversos , Adesão à Medicação/estatística & dados numéricos , Rinite Alérgica Perene/tratamento farmacológico , Adolescente , Adulto , Idoso , Criança , Ciproeptadina/efeitos adversos , Ciproeptadina/uso terapêutico , Eletrocardiografia , Feminino , Seguimentos , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia , Fatores de Tempo , Adulto Jovem
13.
Rev. colomb. cancerol ; 10(3): 207-211, sept. 2006. ilus
Artigo em Espanhol | LILACS | ID: lil-484486

RESUMO

Se han identificado más de dos millones de especies de hongos, de los cuales más de 400 son patógenos para humanos: causan infecciones conocidas como micosis. Los hongos tienen un gran poder de adaptación y pueden causar procesos infecciosos que van desde cuadros clínicos benignos o asintomáticos hasta cuadros graves y fatales.En las últimas décadas, las infecciones micóticas han comenzado a ser un problema creciente en el campo de la salud y han adquirido importancia en la patología médica, especialmente en lo relacionado con las micosis oportunistas. Los factores que favorecen la infección micótica son los cambios en el estado inmune del individuo, los avances médicos en trasplantes de órganos, las quimioterapias antimicrobianas e inmunosupresoras, las cirugías reconstructivas, la expansión de la drogadicción endovenosa y las enfermedades como el cáncer o el sida, entre otros


More than two millions of fungi species have been identified and more than 400 are human pathogens. The funguses have great ability for adaptation and can cause infectious in a range from benign or asymptomatic disease to serious and fatal clinical events. In the last decades, mycotic infections have been a growing problem for health systems, and have acquired importance in medical pathology (mainly the opportunistic mycosis). Factors that favor mycotic infections are: natural inmunological changes, organ transplantation, antimicrobial and immunosuppressive chemotherapies, reconstructive surgery, intravenous drugs, and inmunosuppressive diseases such as cancer and AIDS among others.


Assuntos
Infecções Bacterianas , Micose Fungoide , Neoplasias , Imunossupressão
14.
Rev. colomb. cancerol ; 10(1): 67-70, mar. 2006. ilus
Artigo em Espanhol | LILACS | ID: lil-446665

RESUMO

La epidemiología de la infección fúngica invasiva ha cambiado durante los últimos 20 años, la incidencia ha aumentado y la etiología de estas infecciones se ha diversificado. Aunque siguen siendo las levaduras el agente causal más frecuente, en años recientes los hongos han llegado a ser más habituales en ciertos grupos de pacientes. De la misma manera, la población de pacientes en riesgo se ha ampliado hasta incluir un amplio grupo de condiciones médicas, tales como: cáncer, transplante de médula ósea y órganos sólidos, terapia inmunosupresora, SIDA, nacimiento prematuro, edad avanzada y cirugía extensa. Se presenta una serie de imágenes de aislamientos micóticos provenientes de sangre, líquidos corporales y lavado brocoalveolar, tomados a partir de hemocultivos.


Assuntos
Regulação Fúngica da Expressão Gênica , Infecção/microbiologia , Meios de Cultura , Fungos , Neoplasias
16.
Nephrol Dial Transplant ; 19(11): 2874-82, 2004 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-15316100

RESUMO

OBJECTIVES: Our aim was to determine public attitudes towards living donation compared with cadaveric donation, and to analyse psycho-social factors that may influence this attitude. MATERIALS AND METHODS: An opinion poll was used to study a random sample in two geographical areas (urban and rural). Assessment was made of attitudes towards donation of one's own organs as a living donor to an unknown person, as a living donor to a relative and/or close acquaintance and, as a cadaveric donor, and of the different psycho-social variables that may influence this attitude. RESULTS: In the urban setting, 60% had a favourable response towards cadaveric donation; 29% were in favour of living kidney donation to an unknown person, a percentage which increased to 89% for donation to a relative or a friend. These rates were lower for liver (21 and 74%, respectively). When asked if they would accept an organ donated by a relative or a friend, 67% would accept a kidney and 60% a liver. Attitude towards living donation to an unknown person is more positive among those in favour of cadaveric donation and those who have had previous experience of donation. With respect to level of education, university students are more undecided about living donation to an unknown person than the other groups. In terms of attitude towards donation to relatives and/or friends, there is also the influence of social factors (sex, marital status). However, if the living donation is intended for oneself, there is no variable with which to associate this attitude. In the rural setting, 56% of the respondents refused to complete the survey due to fear of living donation. No statistical study was conducted due to the bias of the rural sample. CONCLUSIONS: There is great fear and ignorance of living donation among the rural population, and uncertainties in the urban population, although attitudes are more positive towards living donation to relatives and/or friends than towards cadaveric donation. These positive attitudes towards living donation are very strongly related to attitudes towards cadaveric donation, previous experience of donation and level of education.


Assuntos
Atitude , Transplante de Órgãos , Adulto , Escolaridade , Família , Feminino , Humanos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/psicologia , População Rural , Espanha , População Urbana
17.
Rev. colomb. cancerol ; 8(1): 23-28, mar. 2004. tab, graf
Artigo em Espanhol | LILACS | ID: lil-388737

RESUMO

Objetivo:determiar la sensibilidad antimicótica de aislamientos clínicos de Candida ssp.provenientes de pacientes oncológicos con uno o más episodios de infección y establecer los perfiles de sensibilidad y resistencia a los diferentes antimicóticos.Materiales y métodos:entre marzo de 1999 y febrero de 2002 se aislaron y clasificaron 181 cepas de levaduras partir de muestras clínicas de 67 pacientes. Se determinó la sensibilidad anfotericina B, fluconazol, itraconazol y ketoconazol mediante pruebas de microdilución en caldo, según la metodología recomendada en el documento M27-A del comité Nacional para los Estándares en el laboratorio clínico de Estados Unidos (NCCLS) Resultados: el agente fúngico más frecuente fue C albicans (51,6 por ciento, 95/181), seguido de C.tropicalis (34,2 por ciento, 62/181) Un 15,2 por ciento de los aislamientos presentó resistencia a la anfotericina B (MICmayor1mg/L)y un 19,6 por ciento mostroó resistencia al fluconazol. No se encontraron diferenc de sensibilidad entre los aislamientos de C. glabrata presentaron mayor resistencia a anfotericina B, en comparación con los demás especies de cándida (p=0.006). Discusión las frecuencias de aislamientos de C. albicans y de las otras especies de Candidad fueron similares a las reportadas en la bibliografía para pacientes oncológicos. La prevalencia de resistencia in vitro a la anfotericina B fue muy superior a la encontrada en otros reportes, lo que amerita estudios complementarios de confirmación. No es posible comparar los datos de sensibilidad in vitro a los azoles, debido a la ausencia de trabajos similares. las pruebas de sensibilidad antimicótica in vitro y la identificación del patógeno fúngico a nivel de especie constituyen herramientas de uyilidad en lo epidemiológico y lo clínico para detectar cepas de Candida spp. potencialmente resistentes.


Assuntos
Antifúngicos , Candida , Testes de Sensibilidade Microbiana , Neoplasias
18.
Rev. colomb. cancerol ; 7(2): 34-42, jun. 2003. tab
Artigo em Espanhol | LILACS | ID: lil-363824

RESUMO

El objetivo primario de virtualmente todas las pruebas de susceptibilidad antimicrobiana in vitro es ayudar a predecir el efecto del agente antimicrobiano de interés en el resultado terapéutico de la infección que es causada por un patógeno especifíco. Esto es válido para cualquiera de las pruebas de susceptibilidad in vitro llevadas a cabo taanto para el cuidado de pacientes, como para el desarrollo o ensayo de nuevos fármacos o para el de estudios epidemiológicos. Los resultados obtenidos de una prueba in vitro es un simple, bien definido y altamente artificial sistema con limitaciones intrísecas útil para predicir el resultado en un proceso biológico complejo representado por una infección clínica; sólo se ha logrado una correlación modesta entre el resultado de la prueba in vitro y el resultado clínico, a pesar de décadas de experiencia con la estandarización de estos métodos.


Assuntos
Antifúngicos , Técnicas de Laboratório Clínico , Resistência a Medicamentos
19.
Rev. colomb. neumol ; 10(1): 16-21, abr. 1998. tab
Artigo em Espanhol | LILACS | ID: lil-221010

RESUMO

Objetivo: Determinar la utilidad de los estudios fibrobroncoscopicos realizados en pacientes con cáncer de esófago (CE), como confirmación de posible compromiso tráqueo-bronquial. Materiales y métodos: Se realizó un estudio descriptivo, en 226 pacientes con CE, en el INC entre 1991-1996, excluyendo los pacientes previamente radiotratados, con cirugía previa esofágica y con cáncer primario diferente al esofágico. Se analizaron los síntomas gastrointestinales, pulmonares y /o generales, antecendentes de fumador, localización del cáncer primario esofágico, tipo hitológico del tumor, hallazgos radiológicos (Rx), hallazgos fibrobroncoscópicos macroscópicos (FBC) y los resultados de las técnicas de biopsias endobronquiales o endotraqueal, lavado bronquial o broncoalveolar y/o cepillado bronquial. Resultados: Se incluyeron en el estudio 158 pacientes, 110 hombres y 48 mujeres, entre 32 y 83 años, con sintomatología promedio de 5.2 meses, siendo los más significativos tos, disfonía y expectoración. En cuanto a la ubicación del primario y la posibilidad de compromiso traqueobronquial se estableció que tenía significación estadística únicamente para los tumores del tercio superior incluyendo región cercival (OR=6.45) y el tipo histológico escamocelular (OR=6.41). En relación con la apariencia radiológica, que podría dar una orientación diagnóstica del compromiso, se encontró alguna relación con los nódulos parenquimatosos (OR=5.12) e infiltrados instersticiales (OR=4.48). Los hallazgos FBC más frecuentes fueron: apariencia normal, seguidos por hallazgos macroscópicos de la fístula (OR=25.09), infiltrado endobronquial (OR=4.48), masa intrínseca (OR=10.54), parálisis de cuerdas vocales (OR=5.46). Las regiones más afectadas fueron tráquea, grandes bronquios y cuerda vocales. Fueron positivos histopatológicamente sólo 17 pacientes (10.7 por ciento). Al analizar la utilidad de la FBC para diagnosticar compromiso traqueobronquial por CE se encontró una sensibilidad: 100 por ciento, especificidad 34.8 por ciento, valor predictivo positivo: 15.6 por ciento y valor predictivo negativo: 100 por ciento. Conclusiones: La FBC es un método muy sensible para detectar compromiso traqueobronquial infiltrativo por CE. La sintomatología, las alteraciones radiológicas y la ubicación del CE, tienen relación pero tienen menor sensibilidad


Assuntos
Humanos , Masculino , Feminino , Broncoscopia , Neoplasias Esofágicas/patologia , Broncoscopia/instrumentação , Valor Preditivo dos Testes
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