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1.
J Card Fail ; 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33038531

RESUMO

BACKGROUND: Identifying patients at risk of poor diuretic response in acute heart failure (AHF) is critical to make prompt adjustments in therapy. The objective of this study was to investigate whether the circulating levels of soluble ST2 predict the cumulative diuretic efficiency (DE) at 24 and 72 hours in patients with AHF and concomitant renal dysfunction. METHODS AND RESULTS: This is a post hoc analysis of the IMPROVE-HF trial, in which we enrolled 160 patients with AHF and renal dysfunction (estimated glomerular filtrate rate of <60 mL/min/1.73 m2). DE was calculated as the net fluid output produced per 40 mg of furosemide equivalents. The association between sST2 and DE was evaluated by using multivariate linear regression analysis. The median cumulative DE at 24 and 72 hour was 747 mL (interquartile range 490-1167 mL) and 1844 mL (interquartile range 1142-2625 mL), respectively. The median sST2 and mean estimated glomerular filtrate rate were 72 ng/mL (interquartile range 47-117 ng/mL), and 34.0 ± 8.5 mL/min/1.73 m2, respectively. In a multivariable setting, higher sST2 were significant and nonlinearly related to lower DE both at 24 and 72 hours (P = .002 and P = .019, respectively). CONCLUSIONS: In patients with AHF and renal dysfunction at presentation, circulating levels of sST2 were independently and negatively associated with a poor diuretic response, both at 24 and 72 hours.

2.
Cardiorenal Med ; 10(5): 362-372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32721973

RESUMO

OBJECTIVE: In acute heart failure (AHF), early assessment of spot urinary sodium (UNa) has emerged as a useful biomarker for risk stratification and monitoring. The objective of this study was to investigate (a) whether early spot UNa predicts 24-h diuretic efficiency and (b) the clinical factors associated with early spot UNa in patients with AHF and concomitant renal dysfunction (RD). METHODS: This is a post hoc analysis of the IMPROVE-HF trial, in which 160 patients with AHF and RD (estimated glomerular filtrate rate [eGFR] <60 mL/min/1.73 m2) were included. Diuretic efficiency was calculated as the net fluid output produced per 40 mg of furosemide equivalents in 24 h. The association between early spot UNa and diuretic efficiency and clinical variables associated with UNa were evaluated using multivariate linear regression analysis. The contribution of the exposures in the predictability of the models was assessed with the coefficient of determination (R2). RESULTS: The mean age of the study population was 78 ± 8 years. The median (interquartile range) diuretic efficiency, early spot UNa, aminoterminal pro-brain natriuretic peptide, and eGFR were 747 (490-1,167) mL, 90 mmol/L (65-111), 7,765 pg/mL (3,526-15,369), and 33.7 ± 11.3 mL/min/1.73 m2, respectively. In a multivariate setting, lower UNa was significantly and nonlinearly associated with lower diuretic efficiency (p = 0.001), explaining the 44.4% of the model predictability. Natremia and surrogates of congestion emerged as the main factors related to UNa. CONCLUSIONS: In patients with AHF and RD at presentation, early spot UNa was inversely related to 24-h diuretic efficiency.

3.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32624444

RESUMO

INTRODUCTION AND OBJECTIVES: Urinary sodium (UNa+) has emerged as a useful biomarker of poor clinical outcomes in acute heart failure (AHF). Here, we sought to evaluate: a) the usefulness of a single early determination of UNa+ for predicting adverse outcomes in patients with AHF and renal dysfunction, and b) whether the change in UNa+ at 24hours (ΔUNa24h) adds any additional prognostic information over baseline values. METHODS: This is a post-hoc analysis of a multicenter, open-label, randomized clinical trial (IMPROVE-HF) (ClinicalTrials.gov NCT02643147) that randomized 160 patients with AHF and renal dysfunction on admission to a) the standard diuretic strategy, or b) a carbohydrate antigen 125-guided diuretic strategy. The primary end point was all-cause mortality and total all-cause readmissions. RESULTS: The mean age was 78±8 years, and the mean glomerular filtration rate was 34.0±8.5mL/min/1.73 m2. The median UNa+ was 90 (65-111) mmol/L. At a median follow-up of 1.73 years [interquartile range, 0.48-2.35], 83 deaths (51.9%) were registered, as well as 263 all-cause readmissions in 110 patients. UNa+ was independently associated with mortality (HR, 0.75; 95%CI, 0.65-0.87; P <.001) and all-cause readmissions (HR, 0.92; 95%CI, 0.88-0.96; P <.001). The prognostic usefulness of the ΔUNa24h varied according to UNa+ at admission (P for interaction <.05). The ΔUNa24h was inversely associated with both end points only in the group with UNa+ ≤ 50 mmol/L. Conversely, no effect was found in the group with UNa+> 50 mmol/L. CONCLUSIONS: In patients with AHF and renal dysfunction, a single early determination of UNa+ ≤ 50 mmol/L identifies patients with a higher risk of all-cause mortality and readmission. The ΔUNa24h adds prognostic information over baseline values only when UNa+ at admission is ≤ 50 mmol/L.

4.
Am J Med ; 133(3): 370-380.e4, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31422111

RESUMO

BACKGROUND: The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation. METHODS: This multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into 2 groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-guided group (n = 79) and in clinical evaluation in the usual-care group (n = 81). Changes in estimated glomerular filtration rate (eGFR) at 72 and 24 hours were the co-primary endpoints, respectively. RESULTS: The mean age was 78 ± 8 years, the median amino-terminal pro-brain natriuretic peptide was 7765 pg/mL, and the mean eGFR was 33.7 ± 11.3 mL/min/1.73m2. Over 72 hours, the CA125-guided group received higher furosemide equivalent dose compared to usual care (P = 0.011), which translated into higher urine volume (P = 0.042). Moreover, patients in the active arm with CA125 >35 U/mL received the highest furosemide equivalent dose (P <0.001) and had higher diuresis (P = 0.013). At 72 hours, eGFR (mL/min/1.73m2) significantly improved in the CA125-guided group (37.5 vs 34.8, P = 0.036), with no significant changes at 24 hours (35.8 vs 39.5, P = 0.391). CONCLUSION: A CA125-guided diuretic strategy significantly improved eGFR and other renal function parameters at 72 hours in patients with acute heart failure and renal dysfunction.


Assuntos
Antígeno Ca-125/sangue , Furosemida/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Proteínas de Membrana/sangue , Insuficiência Renal/tratamento farmacológico , Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/urina , Humanos , Testes de Função Renal , Masculino , Medicina de Precisão , Insuficiência Renal/complicações , Insuficiência Renal/urina , Urina
5.
BMC Pregnancy Childbirth ; 18(1): 424, 2018 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-30373541

RESUMO

BACKGROUND: The reference intervals for hemoglobin A1c (HbA1c) in pregnant Mexican women without diabetes are not well defined. The study aims to determine the reference intervals for HbA1c at each trimester in healthy Mexican pregnant women. METHODS: This cross-sectional study included healthy Mexican pregnant women in trimester 1 (T1), 6-13.6 weeks of gestation (WG), trimester 2 (T2), 14-27 WG, and trimester 3 (T3), ≥27-36 WG, with a maternal age > 18 years, and pregestational body mass index (BMI) ranging between 18.5-24.9 kg/m2. Women with gestational diabetes mellitus, pregestational diabetes, anemia, a pregestational BMI < 18.5 or ≥ 25 kg/m2, and any hematologic, hepatic, immunological, renal, or cardiac disease were excluded. HbA1c was measured using high-performance liquid chromatography based on the National Glycohemoglobin Standardization Program-certified PDQ Primus guidelines. The HbA1c reference intervals were calculated in terms of the 2.5th to the 97.5th percentiles. RESULTS: We analyzed the HbA1c values of 725 women (T1 n = 84, T2 n = 448, and T3 n = 193). The characteristics of the participants were expressed as mean ± standard deviation and included: maternal age (28.2 ± 6.7 years), pregestational weight (54.8 ± 5.9 Kg), pregestational BMI (22.2 ± 1.7 Kg/m2), and glucose values using a 75 g-2 h oral glucose tolerance test; fasting 4.5 ± 0.3 mmol/L (81.5 ± 5.5 mg/dL), 1 h 6.4 ± 1.5 mmol/L (115.3 ± 26.6 mg/dL), and 2 h 5.7 ± 1.1 mmol/L (103.5 ± 19.6 mg/dL). Reference intervals for HbA1c, expressed as median and 2.5th to 97.5th percentile for each trimester were: T1: 5.1 (4.5-5.6%), T2: 5.0 (4.4-5.5%), and T3: 5.1 (4.5-5.6%). CONCLUSIONS: The reference range of HbA1C in healthy Mexican pregnant women during pregnancy was 4.4% to 5.6%. We suggest as upper limits of HbA1c value ≤5.6%, 5.5%, and 5.7% for T1, T2, and T3, respectively among Mexican pregnant women.


Assuntos
Hemoglobina A Glicada/análise , Adulto , Glicemia/análise , Cromatografia Líquida de Alta Pressão , Estudos Transversais , Feminino , Idade Gestacional , Humanos , México , Gravidez , Trimestres da Gravidez , Valores de Referência
6.
Cient. dent. (Ed. impr.) ; 15(1): 15-18, ene.-abr. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-172855

RESUMO

La sialolitiasis es la segunda patología más prevalente de las glándulas salivares, representando el 30% de la patología salival. La localización más frecuente es en la glándula submandibular, con alrededor del 80% de los casos de litiasis, mientras que la afectación de las glándulas salivares menores es de aproximadamente un 2%. La etiopatogenia de esta entidad sigue siendo un tema controvertido, sin embargo se atribuyen factores bioquímicos, infecciosos y mecánicos como los causantes de su formación. Una adecuada exploración física acompañada de la realización de pruebas complementarias de imagen, como la ecografía, resonancia magnética (RM) o tomografía computerizada (TC), serán fundamentales para el diagnóstico de la lesión. Se presenta el caso clínico de una paciente con diagnóstico de sialolitiasis de glándula salival menor labial tratada quirúrgicamente así como los resultados de la revisión científica bibliográfica hecha al respecto


Sialolithiasis is the second most frequent disease of the salivary glands, representing the 30% of whole salivary pathology. The most prevalent localization occurs in the submandibular gland, affected in 80% of cases of lithiasis, whereas minor salivary glands are concerned only in 2%. The etiology of this entity is still controversial, however different biochemical, infectious and mechanics factors have been attributed as the source of its formation. A correct physic examination along with supplementary images tests, as ultrasound, MRI or CT scan, will be essential for the right diagnosis. A case of a female diagnosed with sialolithiasis of minor salivary gland and surgically treated within a review of the literature is described


Assuntos
Humanos , Feminino , Idoso , Cálculos das Glândulas Salivares/diagnóstico , Glândulas Salivares Menores/patologia , Diagnóstico Diferencial , Mucosa Bucal/patologia , Neoplasias Labiais/patologia
7.
Gac Med Mex ; 154(1): 47-53, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-29420530

RESUMO

Objective: Identify percutaneous catheter-related complications in preterm and term newborns. Methods: Comparative cross-section. Were included newborns whit percutaneous catheter insertion, blood culture results and distal catheter segment. Were formed two groups: Preterm and term. Results: Were analyzed the data of preterm (n = 50) and term (n = 50) newborn, the gestational age was 30 ± 3 and 40 ± 2 (p = 0.01). The frecuency in preterm and term newborn was respectively, sepsis catheter 36 and 18% (p = 0.02; OR: 2.56; 95% CI: 1.02-7.17), infected catheter 50 and 22% (p = 0.01; OR: 5.92; 95% CI: 1.66-23.12), colonized catheter of 24 and 14% (p = 0.01; OR: 3.58; 95% CI: 1.32-9.90), local infection 14 and 8% (p = 0.03; OR: 1.87; 95% CI: 1.45-8.29), infiltration 18 and 4% (p = 0.02; OR: 5.27; 95% CI: 1.17-59), accidental removal 6 and 22% (p = 0.02; OR: 0.23; 95% CI: 0.05-0.87) and catheter rupture 10 and 28% (p = 0.02; OR: 0.29; 95% CI: 0.08-0.98). Conclusions: We found a higher association of infections and infiltrations by percutaneous catheter in preterm and term prevailed in accidental removal and catheter rupture.


Assuntos
Cateterismo/efeitos adversos , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Pele , Nascimento a Termo
8.
Rev. esp. cardiol. (Ed. impr.) ; 70(12): 1067-1073, dic. 2017. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-169305

RESUMO

Introducción y objetivos: El tratamiento óptimo de pacientes con insuficiencia cardiaca aguda (ICA) y síndrome cardiorrenal tipo 1 (SCR-1) no está bien definido. La hipoperfusión arterial y la congestión venosa tienen un papel fundamental en la fisiopatología del SCR-1. El antígeno carbohidrato 125 (CA125) ha emergido como marcador indirecto de sobrecarga de volumen en la ICA. El objetivo de este estudio es evaluar la utilidad del CA125 para el ajuste del tratamiento diurético de pacientes con SCR-1. Métodos: Ensayo clínico multicéntrico, abierto y paralelo, que incluye a pacientes con ICA y creatinina ≥ 1,4 mg/dl al ingreso, aleatorizados a: a) estrategia convencional: titulación basada en la evaluación clínica y bioquímica habitual, o b) estrategia basada en CA125: dosis altas de diuréticos si CA125 > 35 U/ml y bajas en caso contrario. El objetivo principal es el cambio en la función renal a las 24 y las 72 h tras el comienzo del tratamiento. Como objetivos secundarios: a) cambios clínicos y bioquímicos a las 24 y las 72 h, y b) cambios en la función renal y eventos clínicos mayores a 30 días. Resultados: Los resultados de este estudio aportarán datos relevantes sobre la utilidad del CA125 para guiar el tratamiento diurético en el SCR-1. Además, permitirá ampliar el conocimiento de la fisiopatología de esta compleja entidad clínica. Conclusiones: La hipótesis del presente estudio es que las concentraciones de CA125 aumentadas pueden identificar a una población de pacientes con SCR-1 para quienes una estrategia diurética más intensa puede ser beneficiosa. Por el contrario, las concentraciones bajas de esta glucoproteína seleccionarían a los pacientes para los que serían perjudiciales las dosis altas de diuréticos (AU)


Introduction and objectives: The optimal treatment of patients with acute heart failure (AHF) and cardiorenal syndrome type 1 (CRS-1) is far from being well-defined. Arterial hypoperfusion in concert with venous congestion plays a crucial role in the pathophysiology of CRS-I. Plasma carbohydrate antigen 125 (CA125) has emerged as a surrogate of fluid overload in AHF. The aim of this study was to evaluate the clinical usefulness of CA125 for tailoring the intensity of diuretic therapy in patients with CRS-1. Methods: Multicenter, open-label, parallel clinical trial, in which patients with AHF and serum creatinine ≥ 1.4 mg/dL on admission will be randomized to: a) standard diuretic strategy: titration-based on conventional clinical and biochemical evaluation, or b) diuretic strategy based on CA125: high dose if CA125 > 35 U/mL, and low doses otherwise. The main endpoint will be renal function changes at 24 and 72 hours after therapy initiation. Secondary endpoints will include: a) clinical and biochemical changes at 24 and 72 hours, and b) renal function changes and major clinical events at 30 days. Results: The results of this study will add important knowledge on the usefulness of CA125 for guiding diuretic treatment in CRS-1. In addition, it will pave the way toward a better knowledge of the pathophysiology of this challenging situation. Conclusions: We hypothesize that higher levels of CA125 will identify a patient population with CRS-1 who could benefit from the use of a more intense diuretic strategy. Conversely, low levels of this glycoprotein could select those patients who would be harmed by high diuretic doses (AU)


Assuntos
Humanos , Insuficiência Cardíaca/terapia , Nefropatias/complicações , Biomarcadores , Diuréticos/uso terapêutico , Insuficiência Cardíaca/complicações , Análise Estatística
9.
Rev Esp Cardiol (Engl Ed) ; 70(12): 1067-1073, 2017 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28341415

RESUMO

INTRODUCTION AND OBJECTIVES: The optimal treatment of patients with acute heart failure (AHF) and cardiorenal syndrome type 1 (CRS-1) is far from being well-defined. Arterial hypoperfusion in concert with venous congestion plays a crucial role in the pathophysiology of CRS-I. Plasma carbohydrate antigen 125 (CA125) has emerged as a surrogate of fluid overload in AHF. The aim of this study was to evaluate the clinical usefulness of CA125 for tailoring the intensity of diuretic therapy in patients with CRS-1. METHODS: Multicenter, open-label, parallel clinical trial, in which patients with AHF and serum creatinine ≥ 1.4mg/dL on admission will be randomized to: a) standard diuretic strategy: titration-based on conventional clinical and biochemical evaluation, or b) diuretic strategy based on CA125: high dose if CA125 > 35 U/mL, and low doses otherwise. The main endpoint will be renal function changes at 24 and 72hours after therapy initiation. Secondary endpoints will include: a) clinical and biochemical changes at 24 and 72hours, and b) renal function changes and major clinical events at 30 days. RESULTS: The results of this study will add important knowledge on the usefulness of CA125 for guiding diuretic treatment in CRS-1. In addition, it will pave the way toward a better knowledge of the pathophysiology of this challenging situation. CONCLUSIONS: We hypothesize that higher levels of CA125 will identify a patient population with CRS-1 who could benefit from the use of a more intense diuretic strategy. Conversely, low levels of this glycoprotein could select those patients who would be harmed by high diuretic doses.


Assuntos
Acetazolamida/uso terapêutico , Antígeno Ca-125/sangue , Síndrome Cardiorrenal/tratamento farmacológico , Clortalidona/uso terapêutico , Diuréticos/uso terapêutico , Furosemida/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Proteínas de Membrana/sangue , Desequilíbrio Hidroeletrolítico/tratamento farmacológico , Doença Aguda , Síndrome Cardiorrenal/sangue , Síndrome Cardiorrenal/complicações , Creatinina/sangue , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Humanos , Planejamento de Assistência ao Paciente , Desequilíbrio Hidroeletrolítico/sangue , Desequilíbrio Hidroeletrolítico/etiologia
10.
Craniomaxillofac Trauma Reconstr ; 8(2): 136-40, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26000086

RESUMO

Osteochondroma is frequently found in the general skeleton but is rare in the condylar region of the mandible. We report a case of an osteochondroma of large size and rapid growth in the mandibular condyle, which was treated with total condylectomy and condylar replacement with a costochondral graft and preservation of the articular disc. In cases with a healthy and well-positioned articular disc, it may be preserved with no need of disc repositioning.

11.
Gac Med Mex ; 151(2): 192-6, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-25946530

RESUMO

OBJECTIVE: To determine the usefulness of the Clinical Risk Index for Babies II (CRIB II) and weight to predict mortality in preterm infants < 32 weeks treated with exogenous surfactant. MATERIAL AND METHODS: Design: cohort for diagnostic test. Preterm babies < 32 weeks who received exogenous surfactant in a third level of care were included. The cutoff for CRIB II was evaluated and considered as score > 10 and weight < 750 grams; monitoring was performed until discharge or death. RESULTS: RNP data analyzed 105 babies; 55/105 (52%) were female, the mean value ± 1.4 weight 2 grams and 29 + 2 weeks gestational age. Mortality was found in 16/105, of which 15/16 had a score > 10 on the CRIB II index. Survival was found in 89/105 and index > 10 points in 2/89. Based on these results we found: sensitivity 93%, specificity 98%, positive predictive value 88 "/o, negative predictive value 98"/o . With weight < 750 grams, mortality occurred in 10/16 and survival in 17189; sensitivity 62 "/o, specificity 81 "/o, positive predictive value 37%, and negative predictive value 92%. CONCLUSIONS: The CRIB II index is more useful than weight for predicting mortality in preterm infants less than 32 weeks treated with surfactant.


Assuntos
Doenças do Recém-Nascido/tratamento farmacológico , Doenças do Recém-Nascido/mortalidade , Surfactantes Pulmonares/uso terapêutico , Peso ao Nascer , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Prognóstico , Medição de Risco
12.
Cient. dent. (Ed. impr.) ; 11(3): 211-215, sept.-dic. 2014. ilus
Artigo em Espanhol | IBECS | ID: ibc-131985

RESUMO

La ránula sublingual es un pseudoquiste de retención salivar localizado en el suelo de la boca que se produce tras un fenómeno de extravasación y acúmulo del contenido mucoide de la glándula sublingual en el tejido blando adyacente. Etiológicamente se relaciona con episodios traumáticos u obstructivos en alguno de los conductos excretores de la glándula. A la exploración física se observa una tumoración ovalada, fluctuante, de consistencia blanda y coloración azulada. Clínicamente suele ser asintomática pero su crecimiento progresivo puede llegar a comprometer la deglución y fonación del paciente, siendo este el principal motivo por el cual se indica el tratamiento quirúrgico. Se requiere de pruebas diagnósticas complementarias como la Resonancia Magnética cervicofacial, la Tomografía Computerizada o la Punción Aspiración con Aguja Fina para confirmar el diagnóstico clínico de presunción. Las principales opciones terapéuticas incluyen la marsupialización y la exéresis de la ránula junto con la glándula sublingual (sublingualectomía). Factores como la edad del paciente, el porcentaje de éxito y el índice de recidiva de la lesión tras un primer tratamiento, son determinantes a la hora de elegir la modalidad terapéutica de elección. Se presentan tres casos clínicos de ránula sublingual con el fin de comparar las diferentes opciones terapéuticas en función de la edad de presentación de la lesión. Se presenta además el análisis de los resultados de la revisión bibliográfica hecha al respecto


Sublingual ranula is a salivary retention pseudocyst located in the floor of the mouth with develops from mucous extravasation and accumulation that settles in the surrounding soft tissue, owing to any ruptured sublingual gland excretory ducts after trauma or obstruction. Intraoral examination shows an oval and fluctuating swelling which has soft consistency and bluish discolouration. It usually has an asympyomatic clinic but an increase of its size may affect patients swallowing and speech. Because of this, surgical treatment is recommended. Complementary diagnostic tools such as cervical magnetic resonances or computerized tomographs are required in order to confirm the clinical diagnosis. Marsupialization and intraoral removal of the ranula with the sublingual gland are the main therapeutic options. Patient’s age or success and recurrence rates are decisive in order to choose the best therapeutic method. Three ranula case reports are presented in order to compare different therapeutic methods depending on patient’s age. In addition, the results of the literature review are included


Assuntos
Humanos , Masculino , Feminino , Criança , Pessoa de Meia-Idade , Rânula/cirurgia , Glândula Sublingual/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Resultado do Tratamento
13.
Nutrition ; 29(3): 497-501, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23398919

RESUMO

OBJECTIVE: To determine the association of in-hospital mortality in patients with enteral feeding to their glycemic status (normoglycemia, new hyperglycemia, or diabetes) and their levels of serum albumin. METHODS: This was an observational, retrospective, descriptive, and longitudinal study. The data were from patients hospitalized at Hospital de Clínicas "José de San Martín" during a 4-y period who had received enteral feeding during the hospitalization period. P < 0.05 was considered statistically significant. RESULTS: Of the 1004 included patients, 558 (55.6%) had normoglycemia, 219 (21.8%) had known diabetes, and 227 (22.6%) had newly diagnosed hyperglycemia. The crude mortality rates during hospitalization were more pronounced for the hyperglycemic and diabetic patients. The univariate relative risks for trend were 1.34 and 1.56 for the diabetic and hyperglycemic subjects, respectively. At univariate analysis, in-hospital mortality was associated with age, known diabetes, newly diagnosed hyperglycemia, and albumin level. Hypoalbuminemia (<2.55 g/dL) also was significantly associated with mortality (univariate odds ratio ≈2.7). At multivariate analysis, in-hospital mortality was associated with age, newly diagnosed hyperglycemia, hypoalbuminemia (<2.55 g/dL), and known diabetes. No interactions between hypoalbuminemia and known diabetes or newly diagnosed hyperglycemia were detected at multivariate analysis. CONCLUSION: The results of this study showed that newly diagnosed hyperglycemia can be considered an independent prognostic factor of in-hospital mortality in patients with enteral feeding and that there is no interaction between newly diagnosed hyperglycemia and serum albumin levels.


Assuntos
Nutrição Enteral/mortalidade , Mortalidade Hospitalar , Hiperglicemia/mortalidade , Hipoalbuminemia/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
14.
Cient. dent. (Ed. impr.) ; 9(1): 17-20, ene.-abr. 2012. ilus
Artigo em Espanhol | IBECS | ID: ibc-104940

RESUMO

Se realiza una revisión sobre el diagnóstico diferencial entre ameloblastoma y quisteradicular residual. El ameloblastoma es un tumor benigno, del epitelio odontogénico, al igual que el quiste residual, que a su vez debe estar relacionado con un diente y aexodonciado en la arcada. En el caso que se presenta, el diagnóstico de presunción fue un ameloblastoma y el diagnóstico de certeza anatomopatológico final, reveló que se trataba de un quiste radicular residual. Se trataba de un varón de 66 años, que acudió a Consulta en el Hospital Universitario de Madrid-Torrelodones para rehabilitar con implantes las zonas edéntulas que presentaba, se solicitó una ortopantomografía, que reveló una lesión radiolúcida, de bordes definidos con tamaño aproximado de 10x3cm, localizado en el cuerpo mandibular derecho, sin manifestaciones clínicas. Se realiza la exéresis de la lesión bajo anestesia general, y se rellena la cavidad con un aloinjerto óseo desmineralizado para rehabilitar posteriormente con implantes (AU)


A review is made on the differential diagnosis between ameloblastoma and residual radicular cyst. The ameloblastoma is a benign tumour of the odontogenic epithelium, like the residual cyst which in turn must be related to a tooth already extracted in the arch. In the case that is presented, the certain final anatomopathological diagnosis revealed that it was a residual radicular cyst. The case dealt with a male of 66 years of age, who went to the Office of the Hospital Universitario de Madrid-Torrelodones to rehabilitate the edentulous areas with implants; an orthopantomograph was requested, which revealed a radiolucent lesion, with defined borders and a size of approximately 10x3 cm, located in the right mandibular body, without clinical symptoms. The excision of the lesion was performed under general anaesthesia and the cavity filled with a demineralized bone allograft to later rehabilitate with implants (AU)


Assuntos
Humanos , Masculino , Idoso , Ameloblastoma/diagnóstico , Cisto Radicular/diagnóstico , Diagnóstico Diferencial , Radiografia Panorâmica , Transplante Homólogo , Cisto Radicular/cirurgia
15.
ISRN AIDS ; 2012: 638042, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-24052881

RESUMO

Objective. To describe the characteristics and interventions to control a large epidemiological Influenza A Outbreak. Methods. During the months of February to April 2006, a large outbreak of Influenza A was detected, which affected Health Care Workers and hospitalized patients in a large teaching Hospital in Guatemala City. Interventions to interrupt transmission were implemented and included barrier methods (N95 masks, respiratory isolation measures, etc.) and enhanced hand hygiene, vaccination of healthy Health Care Workers (HCW), restrictions for patient visits. Results. From February to April 2006, 59 hospitalized patients diagnosed with Influenza A. 19 AIDS patients (mortality: 71%) and 5/40 (12.5%) in other diseases: cancer (3), severe cardiac failure (1) and severe malnutrition (1). The attack rate at day 20 in doctors and medical students was 21% while in other HCW it was 10.5%. Within 3 weeks of the beginning of the plan, deaths were stopped and no more cases in HCW were detected after 3 additional weeks. Conclusion. A rapid, comprehensive plan for the control of nosocomial epidemic Influenza A outbreaks is essential to limit severe morbidity and mortality in hospitals who attend large immunocompromised populations, including AIDS patients. HCW regular vaccinations programs are mandatory.

17.
Cient. dent. (Ed. impr.) ; 8(3): 19-22, sept.-dic. 2011. ilus
Artigo em Espanhol | IBECS | ID: ibc-95995

RESUMO

El adenoma pleomorfo es el tumor benigno más frecuente de las glándulas salivales, tanto de las mayores como de las menores. A nivel de las glándulas salivales mayores la parótida es la glándula más afectada. En las glándulas salivales menores, si bien los tumores malignos son los más frecuentes, el paladar, el labio superior y la mucosa yugal son, por orden de frecuencia, las localizaciones donde más se aíslan este tipo de tumores. El tumor mixto representa entre el 40% y el 70% de todos los tumores de glándulas salivales, e incide principalmente en mujeres de entre la 4ª y 7ªdécada de la vida. Se presenta un caso clínico de un paciente varón, con un tumor mixto de glándula salival menor, localizado a nivel de la mucosa yugal derecha. Se analizaron los resultados de la búsqueda bibliográfica realizada al respecto, en la que se incluyen las características clínicas y epidemiológicas de este tipo de tumores, así como su manejo diagnóstico y terapéutico (AU)


The pleomorphic adenoma is the most frequent benign tumour of the major and minor salivary glands. At the level of the major salivary glands, the parotid is the most affected gland. In the minor salivary glands, although the malignant tumours are the most frequent, the palate, upperlip and the yugal mucous are, in order of frequency, the locations where this type of tumour is isolated most. The mixed tumour represents between 40% and 70% of all the salivary glandular tumours, and occurs principally in women between the 4th and 7th decade of life. A clinical case is presented of a male patient, with mixed tumour of minor salivary gland, located at the level of the right yugal mucous. The results of the conducted bibliographical search were analyzed in this regard, in which the clinical and epidemiological characteristics of this type of tumour are included, as is its diagnostic and therapeutic management (AU)


Assuntos
Humanos , Neoplasias das Glândulas Salivares/patologia , Adenoma Pleomorfo/patologia , Mucosa Bucal/patologia , Recidiva Local de Neoplasia
18.
Cient. dent. (Ed. impr.) ; 8(3): 35-40, sept.-dic. 2011. ilus
Artigo em Espanhol | IBECS | ID: ibc-95998

RESUMO

El quiste folicular o dentígero deriva del epitelio reducido del órgano del esmalte. Se presenta en la 2º y 4º década de la vida. Hay autores que manifiestan mayor frecuencia en el sexo femenino, mientras que otros exponen que afecta a ambos sexos por igual. Con respecto a la localización, es más habitual en mandíbula que en maxilar. Es el segundo quiste más frecuente seguido del radicular. Se asocia a dientes retenidos como el tercer molar, canino superior, segundo premolar inferior o supernumerarios como los mesiodens. Su patrón radiológico, es una imagen radiolúcida, unilocular, redondeada, con un límite nítido que engloba la corona del diente implicado, puede haber rizólisis en los dientes adyacentes y expansión de tablas óseas. Debido a su elevado potencial de crecimiento, puede producir asimetrías, alteraciones nerviosas por compresión, desplazar dientes e incluso malignizar a ameloblastoma, carcinoma mucoepidermoide oepidermoide. Por este motivo, la actitud terapéutica cobra importancia. Se podrá marsupializar, si tiene una gran extensión, para enuclearlo en una segunda cirugía, o realizar la exéresis del quiste directamente con el diente implicado para evitarrecidivas. Se exponen dos casos, el primero corresponde a un varón, de 7 años, derivado por su ortodoncista, tras realizar una radiografía panorámica para valorar una alteración en el patrón eruptivo, que revela un quiste en el maxilar superior. El segundo caso es una paciente de 25 años, sexo femenino, que acude a consulta en busca de un tratamiento implantológico para rehabilitar la zona edéntula del tercer cuadrante. Al realizar una prueba radiológica rutinaria se haya de forma casual, un quiste folicular que engloba al segundo premolar inferior izquierdo. Los casos que se presentan a continuación tienen como objetivos resaltar la importancia de un acertado diagnóstico en este tipo de patología así como escoger la actitud terapéutica más adecuada (AU)


The follicular or dentigerous cyst derives from the reduced epithelium of the enamel organ. It presents in the 2nd and 4th decade of life. There are authors that indicate greater frequency in females, while others express that it affects both genders equally. With respect to the location, it is more usual in the mandible than in the maxilla. It is the second most frequent cyst followed by the radicular cyst. It is associated with retained teeth such as the third molar, upper canine, second lower premolar or supernumerary teeth such as the mesiodens. It radiological pattern is a radio lucid image, unilocular, rounded, with a clear limit that encompasses the crown of the involved tooth, there may be rhizolysis in the adjacent teeth and expansion of osseous tables. Due to its highpotential for growth, it can produce asymmetries, nerve alterations by compression, move teeth and even become malignant ameloblastoma, mucoepidermoid or epidermoid carcinoma. For this reason, the therapeutic approach becomes important. It can be marsupialized, if it is of a large size, in order to enucleate it in a second surgery, or perform the exeresis of the cyst directly with the involved tooth in order to avoid recurrences. Two cases are presented; the first corresponds to amale, of 7 years of age, referred by his orthodontist after performing a panoramic x-ray to (..) (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Adulto , Cisto Dentígero/epidemiologia , Anormalidades Dentárias/epidemiologia , Distribuição por Idade e Sexo , Cisto Dentígero/cirurgia
19.
Cient. dent. (Ed. impr.) ; 8(3): 45-51, sept.-dic. 2011. ilus
Artigo em Espanhol | IBECS | ID: ibc-95999

RESUMO

Introducción: Los odontomas son uno de los tumores odontogénicos más frecuentes. Su etiología es desconocida, aunque se han implicado numerosos factores como traumatismos, infecciones y mutaciones genéticas entre otros. El diagnóstico diferencial debe establecerse con el fibroma amelobástico, el fibroodontoma ameloblástico y el odontoameloblastoma, siendo el tratamiento de elección de estos tumores la enucleación quirúrgica. El objetivo de este artículo es presentar el caso clínico de un paciente con un odontoma complejo mandibular, así como los resultados de la revisión bibliográfica hecha al respecto. Caso clínico: Se expone el caso de un paciente varón, que es remitido a nuestras consultas por el hallazgo casual de una lesión ósea mandibular derecha, radiopaca, amorfa, de 2 cm de diámetro, en relación con el cordal 48 incluido y sugerente de odontoma complejo, sin sintomatología dolorosa niinflamatoria acompañante. Tras un adecuado estudio radiológico y ante el diagnóstico de presunción de odontoma complejo, se procede a su extirpación quirúrgica y posterior análisis anatomopatológico para su diagnóstico de confirmación. Conclusiones: Los odontomas se clasifican en compuestos y complejos, siendo los primeros los más frecuentes. Su sintomatología es escasa o nula, por lo que su hallazgo es casual en la mayoría de las ocasiones. El tratamiento de elección es quirúrgico, con un pronóstico favorable y escasas recidivas (AU)


Introduction: The odontomas are one of the most frequent odontogenic tumours. Their etiology is unknown, although numerous factors have been implicated, such as traumatisms, infections and genetic mutations, among others. The differential diagnosis must be established with ameloblastic fibroma, ameloblastic fibroodontoma and odontoameloblastoma, with surgical enucleation being the treatment of choice of these tumours. The objective of this article is to present the clinical case of a patient with a complex mandibular odontoma, as well as the results of the bibliographical review made in this regards. Clinical case: The case is described of a male patient, referred to our offices because of the casual finding of a right mandibular bone lesion ,radiopaque, amorphous, of 2 cm in diameter, in relation to the included wisdom tooth 48 and suggesting complex odontoma, without painful symptoms or accompanying inflammation. After the appropriate radiological analysis and in view of the presumption diagnosis of complex odontoma, it was surgically removed and subsequent anatomopathological analysis was conducted for the confirmation of the diagnosis Conclusions: Odontomas are classified as compound or complex, with the former being the most frequent. Their symptoms are scarce or nil, for which their finding is casual in the majority of the occasions. The treatment of choice is surgery, with a favourable prognosis and few recurrences (AU)


Assuntos
Humanos , Masculino , Adulto , Odontoma/cirurgia , Neoplasias Bucais/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Hamartoma/cirurgia , Diagnóstico Diferencial , Ameloblastoma/diagnóstico
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