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3.
Medicine (Baltimore) ; 98(34): e16816, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441853

RESUMO

The erythrocyte sedimentation rate (ESR) is a routine test for inflammation. Few studies have investigated the potential influence of lifestyle factors and common metabolic abnormalities on the ESR. This study investigates the influence of demographic factors, alcohol consumption, smoking, physical activity, obesity, and metabolic syndrome on the ESR in adults.This cross-sectional study covered 1472 individuals (44.5% males; age range, 18-91 years) randomly selected from the population of a Spanish municipality. The ESR was measured using a standardized method. We assessed habitual alcohol consumption in standard drinking units, along with tobacco smoking, regular physical exercise (by questionnaire), body mass index, and variables defining metabolic syndrome. Multivariate analyses were performed, including mean corpuscular volume and hemoglobin concentration in the models.The ESR was higher in females than in males, and increased steadily with age. Median ESR of females was 2-fold higher than that of males, and median ESR of individuals aged >65 years was 2-fold higher than that of individuals in the youngest category (ages 18-35 years). Body mass index, presence of metabolic syndrome, and smoking were independently and positively associated with higher ESR values. Light alcohol drinkers and individuals with high regular physical activity displayed lower ESR values than did alcohol abstainers and individuals with low physical activity, respectively.ESR varies greatly with age and sex, and corresponding reference values are proposed. Lifestyle factors (physical activity, smoking, and alcohol consumption) and common metabolic abnormalities (obesity and related metabolic syndrome) may also influence ESR values.


Assuntos
Sedimentação Sanguínea , Comportamentos Relacionados com a Saúde , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Índice de Massa Corporal , Estudos Transversais , Exercício , Feminino , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Fatores de Risco , Fatores Sexuais , Fumar/epidemiologia , Fatores Socioeconômicos , Espanha/epidemiologia , Adulto Jovem
4.
Artigo em Inglês | MEDLINE | ID: mdl-31033198

RESUMO

OBJECTIVE: to compare the accuracy of Birmingham Vasculitis score (BVAS) v.3, and Five Factors Score (FFS) v.1996 and v.2009, to assess survival in ANCA-associated Vasculitis (AAV). METHODS: 550 patients with AAV (41.1% GPA, 37.3% MPA, 21.6% EGPA) diagnosed between 1990-2016 were analyzed. ROC curves and multivariable Cox analysis were used to assess the relationships between the outcome and the different scores. RESULTS: Overall mortality was 33.1%. The mean BVAS at diagnosis was 17.96±7.82, and was significantly higher in non-survivors than in survivors (20.0±8.14 vs. 16.95±7.47, p<0.001). The mean 1996FFS and 2009FFS were 0.81±0.94 and 1.47±1.16, respectively, and were significantly higher in non-survivors than in survivors (1.17±1.07 vs. 0.63±0.81, p<0.001; 2.13±1.09 vs. 1.15±1.05, p<0.001). Mortality rates increased accordingly to the different 1996FFS and 2009FFS categories. In multivariate analysis BVAS, 1996FFS and 2009FFS were significantly related to death (p=0.007, p=0.020, p<0.001), but the stronger predictor was the 2009FFS (HR 2.9, 2.4-3.6). When the accuracy of BVAS, 1996FFS and 2009FFS to predict survival was compared in the global cohort, ROC analysis yielded AUC values of 0.60, 0.65 and 0.74, respectively, indicating that 2009FFS had the best performance. Similar results were obtained when comparing these scores in patients diagnosed before and after 2001, and assessing the 1-year, 5-years and long-term mortality. Correlation among BVAS and 1996FFS was modest (r=0.49, p<0.001), but higher than between BVAS and 2009FFS (r=0.28, p<0.001). CONCLUSION: BVAS and FFS are useful to predict survival in AAV, but 2009FFS has the best prognostic accuracy at any point of the disease course. SIGNIFICANCE AND INNOVATION: This is the first study comparing the BVAS, 1996FFS and 2009FFS accuracy to assess survival in patients with AAV, and the first to validate 2009FFS in these patients. This article is protected by copyright. All rights reserved.

5.
Clin Exp Rheumatol ; 35 Suppl 106(4): 89-97, 2017 Sep-Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28980905

RESUMO

OBJECTIVES: The low overall prevalence of systemic sclerosis (SSc) and the low proportion of male patients have resulted in a scarcity of studies assessing sex differences in Ssc patients, and contradictory results have often been show among those studies that have been performed. METHODS: A prospective study was conducted with the Spanish RESCLE register to analyse the influence of gender on survival of SSc patients. RESULTS: In total, 1506 SSc patients (1341 women, 165 men) were recruited from 21 centres. Older age at onset (OR 1.02), shorter time from onset to diagnosis (OR 0.96), smoking (OR 2.57), interstitial lung disease (ILD) (OR 1.58), less predisposition to sicca syndrome and to antinuclear antibody positivity (OR 0.29 and 0.43, respectively), and higher compliance with the ACR 1980 criteria (OR 1.79) were independently associated with the male sex. During follow-up, 30.4% of men versus 14.6% of women died (p<0.001). Survival at 10 years from the onset of symptoms was 75.3% for men and 92.9% for women (p<0.001), and the difference remained after selecting only SSc-related deaths (85.6% vs. 96.1%, p<0.001). The mortality predictive factors were diffuse SSc (OR 2.26), ILD (OR 1.82), digital ulcers (OR 1.38), tendon friction rubs (OR 1.74), male sex (OR 1.53), increased age at onset (OR 1.13) and isolated PH (considering only deaths from diagnosis), both in the overall (OR 3.63) and female cohorts (OR 3.97). The same risk factors were observed in the male cohort, except for isolated PH and ILD. CONCLUSIONS: The present study confirms the existence of epidemiological, clinical, laboratory and prognostic gender differences in systemic sclerosis patients.


Assuntos
Escleroderma Sistêmico/mortalidade , Causas de Morte , Estudos de Coortes , Feminino , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/epidemiologia , Caracteres Sexuais
6.
Br J Clin Pharmacol ; 83(12): 2661-2670, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28735510

RESUMO

AIMS: To evaluate if rivaroxaban, an oral factor Xa (FXa) inhibitor, could modify the expression in vitro of inflammatory and oxidative stress biomarkers in abdominal aortic aneurysmal (AAA) sites showing intraluminal thrombus. METHODS: AAA sites with intraluminal mural thrombus were obtained from six patients undergoing elective AAA repair. In addition, control abdominal aortic samples were obtained from six organ donors. AAA sites were incubated in the presence and absence of 50 nmol l-1 rivaroxaban. RESULTS: AAA sites showing thrombus demonstrated higher content of FXa than control. Interleukin-6 levels released from AAA [Control: median: 23.45 (interquartile range: 16.17-37.15) vs. AAA: median: 153.07 (interquartile range: 100.80-210.69) pg ml-1  mg tissue-1 , P < 0.05] and the expression levels of nitric oxide synthase 2 were significantly higher in AAA than in control. The protein expression level of NADPH oxidase subunits gp67-and gp91-phox, but did not gp47-phox, were also significantly higher in the AAA sites than in control. Addition of rivaroxaban to AAA sites explants significantly reduced the release of interleukin-6 [median: 51.61 (interquartile range: 30.87-74.03) pg ml-1  mg tissue-1 , P < 0.05 with respect to AAA alone] and the content of nitric oxide synthase 2, gp67 and gp91-phox NADPH subunits. The content of matrix metallopeptidase 9 was significantly higher in the AAA sites as compared to control. Rivaroxaban also reduced matrix metallopeptidase 9 content in AAA sites to similar levels to control. CONCLUSIONS: FXa inhibition by rivaroxaban exerted anti-inflammatory and antioxidative stress properties in human AAA sites, suggesting a role of FXa in these mechanisms associated with the pathogenesis of AAA.


Assuntos
Aneurisma da Aorta Abdominal/metabolismo , Coagulação Sanguínea/efeitos dos fármacos , Inibidores do Fator Xa/farmacologia , Rivaroxabana/farmacologia , Adulto , Idoso , Anti-Inflamatórios/farmacologia , Antioxidantes/farmacologia , Aneurisma da Aorta Abdominal/sangue , Aneurisma da Aorta Abdominal/etiologia , Biomarcadores/metabolismo , Estudos de Casos e Controles , Feminino , Humanos , Técnicas In Vitro , Mediadores da Inflamação/metabolismo , Interleucina-6/metabolismo , Masculino , Metaloproteinase 9 da Matriz/metabolismo , Pessoa de Meia-Idade , NADPH Oxidase 2/metabolismo , Óxido Nítrico Sintase Tipo II/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Fosfoproteínas/metabolismo
7.
Semin Arthritis Rheum ; 47(1): 46-52, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28233572

RESUMO

OBJECTIVE: To perform a systematic review of all cases of the association between Kikuchi's disease (KD) and systemic lupus erythematosus (SLE), and to ascertain the clinical and laboratory characteristics of this association (KD-SLE). METHODS: We conducted a systematic search of the scientific literature until 31 January 2016. For study purposes, only patients aged >14 years, with histologically proven KD, definite SLE and adequate clinical data were included. To compare KD-SLE against isolated KD and SLE, we selected 2 large series of patients with KD and 4 series of SLE patients. RESULTS: The search found 158 adults with proven KD-SLE. Of these, 113 with sufficient clinical information were included; 86 were women (female:male ratio = 5.0); mean age at diagnosis was 34 years (range: 14-56 years); and an ethnic distribution of 50.5% Asian, 34% Caucasian, and 15% other. KD-SLE patients differed significantly from patients with isolated KD, presenting with a higher frequency of high fever (90%), severe KD (88%), and extranodal manifestations. When compared to patients with SLE, those with KD-SLE presented with a higher frequency of fever and systemic symptoms and a lower frequency of lupus nephritis (22%). SLE had been diagnosed before KD in 18% of cases, simultaneously in 51%, and after KD in 31%. No significant differences were found in terms of time of diagnosis. CONCLUSIONS: While KD-SLE patients share many clinical and laboratory manifestations with SLE, they differ in a lower frequency of lupus nephritis. The relative time of diagnosis of each disease did not affect the clinical expression of KD-SLE.


Assuntos
Linfadenite Histiocítica Necrosante/complicações , Lúpus Eritematoso Sistêmico/complicações , Adolescente , Adulto , Feminino , Linfadenite Histiocítica Necrosante/diagnóstico , Linfadenite Histiocítica Necrosante/fisiopatologia , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/fisiopatologia , Nefrite Lúpica/complicações , Nefrite Lúpica/diagnóstico , Nefrite Lúpica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Distribuição por Sexo , Estatísticas não Paramétricas , Adulto Jovem
8.
Medicine (Baltimore) ; 96(8): e6083, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28225490

RESUMO

The aim of this study was to describe the clinical characteristics of ANCA-associated vasculitides (AAV) at presentation, in a wide cohort of Spanish patients, and to analyze the impact of the vasculitis type, ANCA specificity, prognostic factors, and treatments administered at diagnosis, in the outcome.A total of 450 patients diagnosed between January 1990 and January 2014 in 20 Hospitals from Spain were included. Altogether, 40.9% had granulomatosis with polyangiitis (GPA), 37.1% microscopic polyangiitis (MPA), and 22% eosinophilic granulomatosis with polyangiitis (EGPA). The mean age at diagnosis was 55.6 ±â€Š17.3 years, patients with MPA being significantly older (P < 0.001). Fever, arthralgia, weight loss, respiratory, and ear-nose-throat (ENT) symptoms, were the most common at disease onset. ANCAs tested positive in 86.4% of cases: 36.2% C-ANCA-PR3 and 50.2% P-ANCA-MPO. P-ANCA-MPO was significantly associated with an increased risk for renal disease (OR 2.6, P < 0.001) and alveolar hemorrhage (OR 2, P = 0.010), while C-ANCA-PR3 was significantly associated with an increased risk for ENT (OR 3.4, P < 0.001) and ocular involvement (OR 2.3, P = 0.002). All patients received corticosteroids (CS) and 74.9% cyclophosphamide (CYC). The median follow-up was 82 months (IQR 100.4). Over this period 39.9% of patients suffered bacterial infections and 14.6% opportunistic infections, both being most prevalent in patients with high-cumulated doses of CYC and CS (P < 0.001). Relapses were recorded in 36.4% of cases with a mean rate of 2.5 ±â€Š2.3, and were more frequent in patients with C-ANCA-PR3 (P = 0.012). The initial disease severity was significantly associated with mortality but not with the occurrence of relapses. One hundred twenty-nine (28.7%) patients (74 MPA, 41 GPA, 14 EGPA) died. The mean survival was 58 months (IQR 105) and was significantly lower for patients with MPA (P < 0.001). Factors independently related to death were renal involvement (P = 0.010), cardiac failure (P = 0.029) and age over 65 years old (P < 0.001) at disease onset, and bacterial infections (P < 0.001). An improved outcome with significant decrease in mortality and treatment-related morbidity was observed in patients diagnosed after 2000, and was related to the implementation of less toxic regimens adapted to the disease activity and stage, and a drastic reduction in the cumulated CYC and CS dose.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/mortalidade , Anticorpos Anticitoplasma de Neutrófilos/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/fisiopatologia , Comorbidade , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Recidiva , Estudos Retrospectivos , Espanha/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
9.
Transpl Immunol ; 36: 9-13, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-27102446

RESUMO

New strategies for tacrolimus administration that conserve its immunosuppressive effect but avoiding fluctuations in tacrolimus circulating levels are needed. The aim was to analyze if subcutaneous biodegradable tacrolimus-loaded microspheres injection promoted a significant immunosuppressive response in rats. Rats received two subcutaneous tacrolimus-loaded microspheres injections at different days, the first injection was done at day 0 and the second injection was done 12 days after. Plasma circulating levels of tacrolimus, interleukin-2 (IL-2) and calcineurin phosphatase (PP2B) activity in mononuclear cells were measured. Tacrolimus plasma levels were significantly increased from the day after tacrolimus-loaded microspheres injection and remained increased during 10days. Compared to control, plasma IL-2 levels and PP2B activity in mononuclear cells were significantly decreased during ten days. At day 12, a new subcutaneous injection of tacrolimus-loaded microspheres was performed and two days after injection, tacrolimus plasma levels were again increased and both IL-2 plasma levels and PP2B activity decreased. A single subcutaneous tacrolimus-loaded microspheres injection was enough to reduce tacrolimus-related immunosuppressive parameters. These results open the possibility of new therapeutic strategies to administrate calcineurin inhibitors reducing the variability of their circulating levels related to gastrointestinal drug absorption/metabolism modifications.


Assuntos
Rejeição de Enxerto/prevenção & controle , Imunossupressores/uso terapêutico , Microesferas , Transplante de Órgãos , Tacrolimo/uso terapêutico , Animais , Sistemas de Liberação de Medicamentos , Humanos , Imunossupressão , Injeções Subcutâneas , Masculino , Modelos Animais , Ratos , Ratos Endogâmicos WKY , Resultado do Tratamento
10.
Clin Exp Rheumatol ; 34(3): 466-72, 2016 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26940538

RESUMO

OBJECTIVES: This is the first Spanish multicentric inception lupus cohort, formed by SLE patients attending Spanish Internal Medicine Services since January 2009. We aimed to analyse drug therapy during the first year of follow-up according to disease severity. METHODS: 223 patients who had at least one year of follow-up were enrolled upon diagnosis of SLE. Therapy with prednisone, pulse methyl-prednisolone, hydroxychloroquine, immunosuppressives and calcium/vitamin D was analysed. RESULTS: Prednisone was given to 65% patients, at a mean (SD) daily dose of 11 (10) mg/d. 38% patients received average doses >7.5 mg/d during the first year. Patients with nephritis and with a SLEDAI ≥6 were treated with higher doses of prednisone. 81% of patients were treated with hydroxychloroquine, with higher frequency among those with a SLEDAI ≥6 (88% vs. 68%, p<0.001). The use of immunosuppressive drugs and methyl-prednisolone pulses was higher in patients with a baseline SLEDAI ≥6, however, differences were no longer significant when patients with lupus nephritis were excluded. The use of calcium/vitamin D increased with the dose of prednisone, however, 43% of patients on medium-high doses of prednisone did not take any calcium or vitamin D. CONCLUSIONS: This study gives a real-world view of the current therapeutic approach to early lupus in Spain. The generalised use of hydroxychloroquine is well consolidated. There is still a tendency to use prednisone at medium to high doses. Pulse methyl-prednisolone and immunosuppressive drugs were used in more severe cases, but not as steroid sparing agents. Vitamin D use was suboptimal.


Assuntos
Hidroxicloroquina/uso terapêutico , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico , Prednisona/uso terapêutico , Adulto , Cálcio/uso terapêutico , Feminino , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Pessoa de Meia-Idade , Gravidade do Paciente , Padrões de Prática Médica/estatística & dados numéricos , Espanha/epidemiologia , Avaliação de Sintomas , Vitamina D/uso terapêutico
11.
PLoS One ; 11(2): e0149330, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26910567

RESUMO

BACKGROUND AND AIM: Serum IgG4 concentrations are commonly measured in clinical practice. The aim of this study was to investigate serum IgG4 concentrations in adults and their potential relationship with demographic, lifestyle, metabolic, and allergy-related factors. METHODS: Serum IgG4 concentrations were measured with a commercial assay in 413 individuals (median age 55 years, 45% males) who were randomly selected from a general adult population. RESULTS: Median IgG4 concentration was 26.8 mg/dL. Five out of the 413 individuals (1.2%) exhibited IgG4 concentrations >135 mg/dL, and 17 out of 411 (4.1%) exhibited an IgG4/total IgG ratio >8%. Serum IgG4 concentrations were significantly higher in males than in females and decreased with age. After adjusting for age and sex, serum IgG4 concentrations were not significantly influenced by alcohol consumption, smoking or common metabolic abnormalities (obesity and the related metabolic syndrome). Serum IgG4 concentrations were not significantly correlated with serum concentrations of proinflammatory cytokines and inflammation markers. Serum IgG4 concentrations were significantly correlated with IgE concentrations. Serum IgG4 concentrations tended to be higher in atopics (individuals with IgE-mediated sensitization to aeroallergens) than in non-atopics, particularly among atopics without respiratory symptoms. Serum IgG4 concentrations were not significantly correlated with total eosinophil blood count. Cases of IgG4-related disease were neither present at baseline nor detected after a median of 11 years of follow-up. CONCLUSIONS: Studies aimed at defining reference IgG4 values should consider partitioning by age and sex. Further studies are needed to confirm the potential influence of atopy status on serum IgG4 concentrations.


Assuntos
Envelhecimento/sangue , Hipersensibilidade/sangue , Imunoglobulina G/sangue , Caracteres Sexuais , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Espanha
12.
Semin Arthritis Rheum ; 45(3): 294-300, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26186806

RESUMO

OBJECTIVE: There are few data regarding the existence of clinical differences between patients with systemic sclerosis (scleroderma) exposed to silica (SSc-si) and "idiopathic" cases (SSc-id). Our goal is to describe the clinical characteristics of patients with SSc-si and see if they differ from the SSc-id cases. METHODS: We performed a systematic review of the literature by searching the MEDLINE, EMBASE and Web of Science databases. We also included our own series of patients diagnosed with SSc-si and SSc-id controls at the "Complejo Hospitalario Universitario de Vigo (CHUVI)" from 1985 to January 2013. RESULTS: The review of the literature disclosed 32 published series, with clinical data of 254 SSc-si patients (96% males). SSc-si represented 37.5-86% of the scleroderma males and 0-2.7% of the scleroderma females. Globally, more than expected proportion of diffuse forms (61%) and interstitial lung disease (81%) were observed in exposed patients. In the present series, the diagnosis of SSc exposure to silica was recorded in nine patients (9.5%), showing predominance of the diffuse form (77%, p = 0.001), positivity for anti-Scl70 (55%, p = 0.001), presence of ILD (78%, p = 0.048) and lower survival (9.2 versus 15.1, p = 0.023). Diffuse variant remained more prevalent analysing exposed versus non-exposed women (50% versus 8%, p = 0,000) and exposed versus non-exposed men (85.8% versus 50%, p = 0,000). CONCLUSION: Silica exposure is a predominant risk factor in male SSc populations. The review of the literature is consistent with an association of SSc-si and diffuse scleroderma. A trend toward lower survival was observed in our series in SSc-si group.


Assuntos
Doenças Pulmonares Intersticiais/etiologia , Exposição Ocupacional , Escleroderma Sistêmico/etiologia , Dióxido de Silício/toxicidade , Feminino , Humanos , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/epidemiologia , Masculino , Prevalência , Fatores de Risco , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/epidemiologia
13.
Med. clín (Ed. impr.) ; 143(7): 287-292, oct. 2014. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-127830

RESUMO

Fundamento y objetivo: La enfermedad invasiva por Streptococcus pneumoniae (EISP) presenta variaciones epidemiológicas en relación con la edad y el serotipo de neumococo aislado. Los objetivos del trabajo fueron analizar las formas clínicas y la mortalidad de EISP, los serotipos aislados y la tasa de resistencia a antimicrobianos en diferentes grupos de edad. Pacientes y método: Se estudiaron 141 pacientes con EISP diagnosticados entre 2002 y 2008 y se clasificaron en 4 grupos: ≤ 2 años, 3-14 años, 15-64 años y ≥ 65 años. Resultados: La neumonía que la manifestación más frecuente (71%) en todos los grupos de edad. En el grupo ≤ 2 años destacó una mayor prevalencia de meningitis (28 frente a 9%, p = 0,054) y en el grupo 3-14 años el empiema fue más frecuente (31 frente a 5%, p < 0,001). La mortalidad se asoció con la edad ≥ 65 años (odds ratio [OR] 7, intervalo de confianza del 95% [IC 95%] 1,9-28,9), la bacteriemia primaria (OR 7, IC 95% 1,9-28,9) y la intubación orotraqueal (OR 9, IC 95% 1,9-41,1). Los serotipos más prevalentes en ≤ 2 años fueron 14, 19A y 19F, el serotipo 1 en el grupo 3-14 años y el 3 en ≥ 65 años. En la población pediátrica se observó una mayor tasa de cepas no sensibles a penicilina (42 frente a 18%, p = 0,007). Conclusiones: La edad se relacionó con las formas clínicas, la mortalidad y la resistencia a antimicrobianos. La bacteriemia primaria constituyó uno de los factores asociados con una mayor mortalidad (AU)


Background and objective: Invasive pneumococcal disease (IPD) shows different epidemiological characteristics depending on age and pneumococcus serotype. The aims of the work were to analyze the clinical manifestations and mortality associated with IPD, the serotype isolated and the antibiotic resistance rates in different age groups. Patients and method: Retrospectively, 141 patients with IPD diagnosed between 2002 and 2008 were studied. Patients were classified in 4 age groups: 2 year-old, 3-14 year-old, 15-64 year-old and 65 year-old. Results: Pneumonia was the most common manifestation in all age groups (71%). Pneumococcal meningitis was more prevalent in patients 2 year-old (28 vs. 9%, P = .054) and empyema was more frequent in those between 3-14 year-old (31 vs. 5%, P < .001). Mortality was associated with age 65 year-old (odds ratio [OR] 7, 95% confidence interval [95% CI] 1.9-28.9), primary bacteremia (OR 7, 95% CI 1.9-28.9) and orotracheal intubation (OR 9, 95% CI 1.9-41.1). The more prevalent serotypes among patients 2 year-old were 14, 19A and 19F. The serotype 1 was most common in patients between 3-14 year-old and serotype 3 in those 65 year-old. A higher rate of non-susceptible penicillin strains was observed in pediatric population (42 vs. 19%, P = .007). Conclusions: Age was related to the clinical manifestations, mortality and antibiotic resistance rates. Primary bacteremia was one of the risk factors of mortality (AU)


Assuntos
Humanos , Infecções Estreptocócicas/epidemiologia , Streptococcus pneumoniae/patogenicidade , Pneumonia Pneumocócica/epidemiologia , Bacteriemia/epidemiologia , Resistência Microbiana a Medicamentos , Fatores de Risco , Mortalidade
14.
Clin Exp Rheumatol ; 32(3 Suppl 82): S30-3, 2014 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24709033

RESUMO

OBJECTIVES: The Xq28 region, containing IRAK and MECP2, represent a common susceptibility locus for a high number of autoimmune diseases. Our aim in the present study was to evaluate the influence of the IRAK1 and MECP2 autoimmunity-associated genetic variants in the giant cell arteritis (GCA) susceptibility and its clinical subphenotypes. METHODS: We analysed a total of 627 female biopsy-proven GCA patients and 1,520 female healthy controls of Spanish Caucasian origin. Two polymorphisms, rs1059702 and rs17345, located at IRAK1 and MECP2, respectively, were genotyped using TaqMan® allelic discrimination assays. RESULTS: No association with any of the analysed polymorphisms was evident when genotype and allele frequencies were compared between GCA patients and controls (rs1059702: allelic p-value=0.699, OR=0.96, CI 95% 0.80-1.17; rs17435: allelic p-value=0.994, OR=1.00, CI 95% 0.84-1.19). Likewise, the subphenotype analysis yield similar negative results. CONCLUSIONS: We have assessed for the first time the possible role of IRAK1 and MECP2 autoimmune disease-associated polymorphisms in GCA. Our data suggest that IRAK1 rs1059702 and MECP2 rs17435 genetic variants do not play a significant role in GCA susceptibility or severity.


Assuntos
Artérias/patologia , Autoimunidade/genética , Arterite de Células Gigantes , Quinases Associadas a Receptores de Interleucina-1/genética , Proteína 2 de Ligação a Metil-CpG/genética , Idoso , Biópsia , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Frequência do Gene , Predisposição Genética para Doença , Arterite de Células Gigantes/epidemiologia , Arterite de Células Gigantes/genética , Arterite de Células Gigantes/patologia , Humanos , Polimorfismo de Nucleotídeo Único , Espanha/epidemiologia
15.
Rheumatology (Oxford) ; 53(2): 321-31, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24162151

RESUMO

OBJECTIVE: To evaluate systemic involvement in primary SS in a large cohort of Spanish patients using the EULAR-SS disease activity index (ESSDAI) definitions. METHODS: Systemic involvement was characterized using ESSDAI definitions for the 10 clinical domains (constitutional, lymphadenopathy, glandular, articular, cutaneous, pulmonary, renal, peripheral nervous system, central nervous system and muscular). ESSDAI scores at diagnosis, during follow-up and cumulated at the last visit were calculated. RESULTS: The cohort consisted of 921 patients. After a mean follow-up of 75 months, 77 (8%) patients still had an ESSDAI score of zero at the last visit. Organ by organ, the percentage of patients who developed activity during the follow-up (ESSDAI score ≥ 1 at any time) ranged between 1.4% and 56%, with articular, pulmonary and peripheral neurological involvement being the most common. Logistic multivariate regression analysis showed the following features at diagnosis and had the closest association with systemic activity (statistically significant independent variables in at least two domains): cryoglobulinaemia in five domains; anaemia, lymphopenia and low C3 levels in three domains each and age <35 years in two domains. Sicca features, ANA and RF at diagnosis were not associated with a higher cumulated activity score in any clinical domain. CONCLUSION: Primary SS is undeniably a systemic disease, with the joints, lungs, skin and peripheral nerves being the most frequently involved organs. Cytopenias, hypocomplementaemia and cryoglobulinaemia at diagnosis strongly correlated with higher cumulated ESSDAI scores in the clinical domains. Clinically the ESSDAI provides a reliable picture of systemic involvement in primary SS.


Assuntos
Sistema de Registros , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/epidemiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Artropatias/epidemiologia , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Índice de Gravidade de Doença , Dermatopatias/epidemiologia , Espanha/epidemiologia
16.
Med Clin (Barc) ; 143(7): 287-92, 2014 Oct 07.
Artigo em Espanhol | MEDLINE | ID: mdl-24120104

RESUMO

BACKGROUND AND OBJECTIVE: Invasive pneumococcal disease (IPD) shows different epidemiological characteristics depending on age and pneumococcus serotype. The aims of the work were to analyze the clinical manifestations and mortality associated with IPD, the serotype isolated and the antibiotic resistance rates in different age groups. PATIENTS AND METHOD: Retrospectively, 141 patients with IPD diagnosed between 2002 and 2008 were studied. Patients were classified in 4 age groups: ≤ 2 year-old, 3-14 year-old, 15-64 year-old and ≥ 65 year-old. RESULTS: Pneumonia was the most common manifestation in all age groups (71%). Pneumococcal meningitis was more prevalent in patients ≤ 2 year-old (28 vs. 9%, P=.054) and empyema was more frequent in those between 3-14 year-old (31 vs. 5%, P<.001). Mortality was associated with age ≥ 65 year-old (odds ratio [OR] 7, 95% confidence interval [95% CI] 1.9-28.9), primary bacteremia (OR 7, 95% CI 1.9-28.9) and orotracheal intubation (OR 9, 95% CI 1.9-41.1). The more prevalent serotypes among patients ≤ 2 year-old were 14, 19A and 19F. The serotype 1 was most common in patients between 3-14 year-old and serotype 3 in those ≥ 65 year-old. A higher rate of non-susceptible penicillin strains was observed in pediatric population (42 vs. 19%, P=.007). CONCLUSIONS: Age was related to the clinical manifestations, mortality and antibiotic resistance rates. Primary bacteremia was one of the risk factors of mortality.


Assuntos
Bacteriemia , Farmacorresistência Bacteriana , Infecções Pneumocócicas , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/mortalidade , Prognóstico , Estudos Retrospectivos , Sorotipagem , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/isolamento & purificação , Adulto Jovem
17.
Rheumatology (Oxford) ; 52(2): 346-51, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23041597

RESUMO

OBJECTIVES: To establish the frequency and describe the characteristics of a cohort of patients with SF eosinophilia (SFE) and a long clinical follow-up. A systematic review of the literature on this topic was performed. METHODS: From November 2005 to May 2010, 982 consecutive arthrocentesis procedures performed at a tertiary care hospital were reviewed. Clinical and analytical data of patients with SFE at the time of diagnosis and during follow-up until 31 January 2012, were recorded. According to the percentage of eosinophils in SF, SFE was classified as minor (<10%) or major (>10%). Also, a literature search of all publications on eosinophilic synovitis found in MEDLINE, EMBASE and Web of Science without publication date restrictions was performed. RESULTS: Eosinophils in SF were found in 10 of 982 (1.02%) patients: minor SFE was recorded in three patients, all of them with haemorrhagic fluid and without peripheral eosinophilia. Major SFE was found in seven patients, and only two of them had peripheral eosinophilia. In six patients, an underlying cause of the arthritis was found. Only one patient was classified as having idiopathic SFE. Most SFE promptly resolved with NSAIDs without relapses or new deformities. The literature search identified 56 patients with SFE; 49 of them (88%) had major SFE and 7 (12%) had minor SFE. CONCLUSIONS: Eosinophils are infrequently found in SF, and in most cases peripheral eosinophilia was not detected. Most patients with SFE had a benign course with prompt resolution and few relapses.


Assuntos
Eosinófilos/imunologia , Líquido Sinovial/citologia , Sinovite/etiologia , Adulto , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Artrite/complicações , Estudos de Coortes , Eosinofilia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Sinovite/tratamento farmacológico , Sinovite/imunologia
19.
Eur J Intern Med ; 24(3): e30-4, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23246127

RESUMO

OBJECTIVE: Hereditary hemorrhagic telangiectasia (HHT) is a vascular disorder causing mucocutaneous telangiectases and visceral arteriovenous malformations (AVMs). Pulmonary hypertension (PH) is considered an uncommon complication of HHT whose impact on the survival of these patients is currently unknown. METHODS: From January 1995 to December 2008, 29 hospitalized patients with definite HHT were included and followed until January 2011. Data on demographics, clinical symptoms and survival were recorded. PH was classified according to echocardiographic probability. RESULTS: A CT angiogram was performed in 24 of the 29 patients with HHT and AVMs were detected in 16 of them (67%): hepatic in 58%, pulmonary in 33% and spinal in 3%; 37% had both pulmonary and hepatic AVMs. Transthoracic Doppler echocardiography (TTE) was performed in 21 patients. PH was considered possible in 4 (14%) and probable in 9 (31%). The mean age at diagnosis was lower in patients with PH than in patients without PH (54±16.5 years vs 73±8.8 years, p=0.002). PH was more prevalent in patients with AVMs (56 vs. 23%, p=0.036). The mean follow-up of the entire cohort was 6±4.4 years (range: 2 months-17 years), during this time 18 patients died (62%; mean age 73±8.1 years). Patients with PH died at a younger age (68±8.4 vs. 79±2.7 years, p=0.015) than those without PH. CONCLUSIONS: PH is a severe condition that significantly reduces survival on HHT patients. PH should be suspected in all HHT patients with dyspnea and hepatic AVMs.


Assuntos
Hipertensão Pulmonar , Circulação Hepática , Circulação Pulmonar , Telangiectasia Hemorrágica Hereditária , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/fisiopatologia , Ecocardiografia Doppler/métodos , Feminino , Seguimentos , Hospitalização , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/fisiopatologia , Estimativa de Kaplan-Meier , Masculino , Registros Médicos Orientados a Problemas , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologia , Telangiectasia Hemorrágica Hereditária/diagnóstico , Telangiectasia Hemorrágica Hereditária/epidemiologia , Telangiectasia Hemorrágica Hereditária/fisiopatologia
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