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2.
Med Clin (Barc) ; 125(6): 205-9, 2005 Jul 09.
Artigo em Espanhol | MEDLINE | ID: mdl-16022832

RESUMO

BACKGROUND AND OBJECTIVE: Several thousands deaths were attributed to a heatwave during the summer of 2003 in Europe. The aim of this study was to analyze its consequences in an emergency department. PATIENTS AND METHOD: We performed a descriptive observational study of the patients admitted to our emergency unit between 15 July and 31 August, 2003. We also carried out a comparative study of these patients with those admitted during the same period of 2002. RESULTS: A total of 5197 patients were admitted in our unit during the summer of 2003, in comparison with 4672 in the same interval in 2002. An increase in rates of total fever (17% versus 12%; p < 0.001), non-infectious fever (29% versus 26%; p < 0.001), decompensation of a chronic cardiovascular or respiratory disease (14% versus 11%; p < 0.001), admission (28% versus 22%; p < 0.001), and mortality (2% versus 1%; p < 0.001) were registered during the summer of 2003, in comparison with the previous year. A multivariate study showed a higher risk of death in patients older than 70 years (p < 0.01), in fragile dependent people (p < 0.05), and upon the presence of abnormal blood levels of creatinine (p < 0.05) on arrival at the emergency department. We also found an association between daily maxim temperature and number of daily emergency visits (R2 = 0.15; p < 0.001), total percentage of patients with fever (R2 = 0.26; p < 0.001), percentage of patients with non-infectious fever (R2 = 0.07; p = 0.01), percentage of decreases (R2 = 0.04; p < 0.05), and percentage of hospital admissions (R2 = 0.15; p < 0.001). CONCLUSIONS: The summer 2003 heatwave resulted in an elevation of the total number of emergency visits and hospital admissions, and higher mortality and morbidity rates, especially in old people. In the future, preventive measures must be taken to limit the health consequences of any heatwaves to come.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Febre/epidemiologia , Temperatura Alta , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Fatores de Risco , Estações do Ano , Espanha/epidemiologia
3.
Med. clín (Ed. impr.) ; 125(6): 205-209, jul. 2005. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-038751

RESUMO

Fundamento y objetivo: Durante la ola de calor del verano de 2003 se registraron varios miles de fallecimientos en Europa. Se analizan las consecuencias de esta ola de calor en una sección de urgencias de medicina de un servicio de urgencias hospitalario. Pacientes y método: Estudio descriptivo de las características de los pacientes visitados en una sección de urgencias de medicina entre el 15 de julio y el 31 de agosto de 2003, y se compara con las de los que fueron atendidos durante el mismo intervalo en 2002. Resultados: El número total de pacientes atendidos en el verano de 2003 fue de 5.197, frente a los 4.672 del año anterior. Durante 2003 aumentó, con respecto al año 2002, el porcentaje total de pacientes con fiebre (el 17 frente al 12%; p < 0,001), fiebre de causa no infecciosa (el 29 frente al 26%; p < 0,001), descompensación de enfermedad crónica (el 14 frente al 11%; p < 0,001), ingresados (el 28 frente al 22%; p < 0,001) y fallecidos (el 2 frente al 1%; p < 0,001). Los factores predictivos independientes de mortalidad para los pacientes con fiebre visitados durante la ola de calor de 2003 fueron la edad superior a 70 años (p < 0,01), la dependencia para las actividades de la vida diaria (p < 0,05) y la alteración de las concentraciones de creatinina a su llegada a urgencias (p < 0,05). Además, encontramos una asociación lineal con significación estadística entre la temperatura máxima diaria y el número de visitas diarias a urgencias (R2 = 0,15; p < 0,001), así como con el porcentaje total de pacientes que se visitaron por fiebre (R2 = 0,26; p < 0,001), fiebre de causa no infecciosa (R2 = 0,07; p = 0,01), fallecidos (R2 = 0,04; p < 0,05) e ingresados (R2 = 0,15; p < 0,001). Conclusiones: Durante la ola de calor del verano de 2003 se produjo un aumento del número de visitas a urgencias y de ingresos hospitalarios, así como una mayor tasa de morbimortalidad, especialmente en las personas de edad avanzada. Las autoridades sanitarias deberían llevar a cabo medidas preventivas para limitar las consecuencias sobre la salud pública que pudieran derivarse de futuras olas de calor


Background and objective: Several thousands deaths were attributed to a heatwave during the summer of 2003 in Europe. The aim of this study was to analyze its consequences in an emergency department. Patients and method: We performed a descriptive observational study of the patients admitted to our emergency unit between 15 July and 31 August, 2003. We also carried out a comparative study of these patients with those admitted during the same period of 2002. Results: A total of 5197 patients were admitted in our unit during the summer of 2003, in comparison with 4672 in the same interval in 2002. An increase in rates of total fever (17% versus 12%; p < 0.001), non-infectious fever (29% versus 26%; p < 0.001), decompensation of a chronic cardiovascular or respiratory disease (14% versus 11%; p < 0.001), admission (28% versus 22%; p < 0.001), and mortality (2% versus 1%; p < 0.001) were registered during the summer of 2003, in comparison with the previous year. A multivariate study showed a higher risk of death in patients older than 70 years (p < 0.01), in fragile dependent people (p < 0.05), and upon the presence of abnormal blood levels of creatinine (p < 0.05) on arrival at the emergency department. We also found an association between daily maxim temperature and number of daily emergency visits (R2 = 0.15; p < 0.001), total percentage of patients with fever (R2 = 0.26; p < 0.001), percentage of patients with non-infectious fever (R2 = 0.07; p = 0.01), percentage of deceases (R2 = 0.04; p < 0.05), and percentage of hospital admissions (R2 = 0.15; p < 0.001). Conclusions: The summer 2003 heatwave resulted in an elevation of the total number of emergency visits and hospital admissions, and higher mortality and morbility rates, especially in old people. In the future, preventive measures must be taken to limit the health consequences of any heatwaves to come


Assuntos
Humanos , Serviços Médicos de Emergência/estatística & dados numéricos , Onda de Calor , Exaustão por Calor/epidemiologia , Golpe de Calor/epidemiologia , Indicadores de Morbimortalidade
4.
J Rheumatol ; 31(3): 495-9, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-14994393

RESUMO

OBJECTIVE: To analyze the clinical characteristics of patients from a Department of Autoimmune Diseases presenting chronic hepatitis C virus (HCV) infection, systemic autoimmune disease, and B cell lymphoma. METHODS: We analyzed the records of 100 consecutive patients with systemic autoimmune diseases and associated HCV infection seen in our department between 1994 and 2000. We retrospectively investigated the development of B cell malignancies after the diagnosis of HCV related autoimmune disease. RESULTS: Six patients with HCV related systemic autoimmune disease presented B cell non-Hodgkin's lymphoma (NHL). These patients fulfilled the diagnostic criteria for Sjögren's syndrome (n = 4) and polyarteritis nodosa (PAN; n = 2). Four patients were female and 2 male, with a mean age at lymphoma diagnosis of 62 years (range 45-78). The main immunologic markers were hypocomplementemia in all patients and cryoglobulinemia in 5 (83%). Primary extranodal localization of lymphoma was observed in 3 (50%) patients: prostate (n = 1), liver and ovary (n = 1), and ocular annexa (n = 1). Clinically, NHL was classified as indolent lymphoma in 3 patients and aggressive lymphoma in 3. NHL histologic types were diffuse large cell lymphoma (n = 4), extranodal marginal zone B cell lymphoma (n = 1), MALT lymphoma (n = 1), and lymphoplasmacytic lymphoma (n = 1). CONCLUSION: We describe 6 patients with a triple association of HCV infection, systemic autoimmune disease, and NHL. Characteristics of these patients included a high prevalence of cryoglobulinemia (that clearly contributes to fulfillment of diagnostic criteria for PAN) and an elevated frequency of primary extranodal involvement. We recommend careful evaluation of patients with B cell NHL to detect silent autoimmune or chronic viral diseases. This triple association reinforces the suspected links between autoimmunity, infection, and cancer.


Assuntos
Doenças Autoimunes/imunologia , Hepatite C Crônica/imunologia , Linfoma de Células B/imunologia , Adulto , Idoso , Crioglobulinemia/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Semin Arthritis Rheum ; 33(1): 19-28, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12920693

RESUMO

OBJECTIVE: To determine the prevalence and clinical characteristics of hematologic malignancies occurring in a large series of patients diagnosed with cryoglobulinemia, and to study their association and overlap with autoimmune and/or chronic viral diseases. METHODS: We retrospectively analyzed the occurrence of hematologic malignancies in 607 patients diagnosed with cryoglobulinemia in a single institution. Clinical, histologic, and serologic characteristics of patients were recorded on a protocol form. Hematologic malignancies were diagnosed according to the Revised European-American Lymphoma/World Health Organization classification criteria. RESULTS: Of the total cohort of 607 patients with cryoglobulinemia, we retrospectively identified 27 patients (5%) in whom a hematologic malignancy was diagnosed, including 24 (89%) lymphoproliferative and 3 (11%) myeloid malignancies. Fifteen (56%) were men and 12 (44%) women, with a median age at diagnosis of hematologic malignancy of 67 years (range, 44 to 88 years). The identified hematologic malignancies were non-Hodgkin lymphoma (n = 18), Hodgkin lymphoma (n = 2), chronic lymphocytic leukemia (n = 2), and 1 case each of multiple myeloma, Waldenström macroglobulinemia, Castleman disease, chronic myeloid leukemia and myelodysplastic syndrome. Of the 18 patients with non-Hodgkin lymphoma, there was a predilection for specific histologic types (diffuse large B-cell lymphoma in 8 cases and small lymphocytic lymphoma in 4) and a higher frequency of a primary extranodal origin in 6 (33%) cases. Conditions associated with hematologic malignancies were hepatitis C virus (HCV) infection in 14 patients (52%) and systemic autoimmune diseases in 13 (48%), with both HCV and systemic autoimmune disease in 6 cases (22%). CONCLUSIONS: Hematologic neoplasia associated with cryoglobulinemia is defined by a clear predominance of lymphoproliferative disorders (mainly non-Hodgkin lymphoma), with substantial extranodal involvement and an elevated presence of immunologic markers. HCV infection is the main etiologic factor associated with hematologic malignancies in patients with cryoglobulinemia, followed by specific systemic autoimmune diseases such as Sjögren syndrome and systemic lupus erythematosus, highlighting the close relationship between lymphoproliferation, autoimmunity, and viruses.


Assuntos
Crioglobulinemia/complicações , Neoplasias Hematológicas/complicações , Hepatite C Crônica/complicações , Lúpus Eritematoso Sistêmico/complicações , Síndrome de Sjogren/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Crioglobulinemia/patologia , Feminino , Neoplasias Hematológicas/patologia , Hepatite C Crônica/patologia , Humanos , Lúpus Eritematoso Sistêmico/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome de Sjogren/patologia
8.
Medicine (Baltimore) ; 82(2): 87-96, 2003 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12640185

RESUMO

To determine the clinical characteristics and outcome of patients with chronic hepatitis C virus (HCV) infection presenting severe autoimmune cytopenia unrelated to interferon alpha therapy, we analyzed characteristics and outcomes of 35 patients with HCV (16 from our departments and 19 from the literature). We considered active autoimmune hemolytic anemia (AHA) as a decrease of at least 2 g/dL in hemoglobin levels, an increase of at least 0.6 mg/dL in the serum unconjugated bilirubin level, a reticulocyte count >5%, and a positive direct Coombs test. Severe neutropenia was defined as a neutrophil count <0.5 x 10(9)/L, and severe thrombocytopenia as a platelet count <30 x 10(9)/L. We identified the following cytopenias: AHA (17 cases), severe thrombocytopenia (16 cases), aplastic anemia (2 cases), severe neutropenia (1 case), refractory sideroblastic anemia (1 case), and pure red cell aplasia (1 case). Three patients simultaneously presented 2 types of severe cytopenias. Twenty-seven patients (77%) were female and 8 (23%) male, with a mean age at diagnosis of cytopenia of 51.7 years (range, 18-84 yr). Immunologic markers were detected in 19 (68%) of 28 patients, the most frequent being hypocomplementemia in 16 (57%), cryoglobulins in 15 (54%), antinuclear antibodies in 12 (43%), and rheumatoid factor in 5 (18%). Other associated processes were autoimmune diseases in 14 (50%) of 28 and human immunodeficiency virus (HIV) coinfection in 3 (9%) of 32. We found clinical and immunologic differences between HCV patients with AHA and those with severe thrombocytopenia. Patients with HCV-related AHA showed a higher prevalence of associated autoimmune diseases (71%), cryoglobulins (67%), and cirrhosis (59%). All had a good response to corticosteroids, but a poor prognosis (47% mortality). In contrast, patients with HCV-related severe thrombocytopenia had a lower prevalence of associated autoimmune diseases (11%), a poorer response to corticosteroids (55%), and lower mortality (6%), with HIV/HBV coinfections in some patients. The 35 cases presented demonstrate that different types of immune-mediated cytopenias may be severe and clinically significant in patients with HCV infection. Hemolytic anemia and severe thrombocytopenia were the most frequent cytopenias observed. Most patients responded well to corticosteroids, although a higher rate of mortality was observed in those with liver cirrhosis.


Assuntos
Anemia Aplástica/etiologia , Anemia Hemolítica Autoimune/etiologia , Hepatite C Crônica/complicações , Neutropenia/etiologia , Aplasia Pura de Série Vermelha/etiologia , Trombocitopenia/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia Aplástica/tratamento farmacológico , Antivirais/uso terapêutico , Contagem de Células Sanguíneas , Feminino , Glucocorticoides/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Interferon-alfa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Neutropenia/tratamento farmacológico , Prednisona/uso terapêutico , Aplasia Pura de Série Vermelha/tratamento farmacológico , Estudos Retrospectivos , Trombocitopenia/tratamento farmacológico
9.
Semin Arthritis Rheum ; 32(1): 56-63, 2002 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12219321

RESUMO

OBJECTIVE: To investigate if the serum immunologic profile, as delineated by serum circulating levels of Th1/Th2 cytokines and autoantibodies, is different in patients with Sjögren syndrome (SS) with and without hepatitis C virus (HCV) infection. METHODS: This study included 20 patients with HCV-related SS and 47 consecutive patients with primary SS. All fulfilled 4 or more of the modified 1996 European criteria for SS. Serum levels of interleukin (IL)-2 (pg/mL), srIL-2 (pM), tumor necrosis factor (TNF)-alpha (pg/mL), IL-6 (pg/mL), and IL-10 (pg/mL) were determined using enzyme immunoassay. We also analyzed the following immunologic tests: anti-nuclear antibodies (ANA), anti-mitochondrial antibodies (AMA), anti-parietal cell antibodies (PCA), anti-smooth muscle antibodies (SMA), anti-liver-kidney microsome antibodies type-1 (LKM-1), anti-Ro/SS-A, anti-La/SS-B, rheumatoid factor (RF), complement factors (C3 and C4), and cryoglobulins. RESULTS: Of the 20 patients with HCV-related SS, 18 were women and 2 men (mean age, 66 years). Patients with HCV-related SS had a different cytokine profile compared with patients with primary SS, with higher circulating levels of IL-6 (73.6 v 33.0 pg/mL, P =.045), IL-10 (6.7 v 3.1 pg/mL, P =.01), srIL-2 (124.6 v 72.7 pM, P =.001), and TNF-alpha (59.8 v 31.7 pg/mL, P =.003). The main immunologic features were ANA, detected in 75% of patients, RF in 63%, cryoglobulinemia in 50%, hypocomplementemia in 40%, SMA in 30%, PCA in 25%, anti-Ro/SS-A in 25%, AMA in 20% and anti-La/SS-B in 16%. When compared with primary SS patients, those with HCV-related SS had a higher prevalence of AMA (20% v 2%, P =.025), hypocomplementemia (40% v 11%, P =.015), and cryoglobulinemia (50% v 12%, P =.003). CONCLUSION: Although chronic HCV infection may mimic the main clinical, histologic and immunologic features of primary SS, patients with HCV-related SS showed some differentiated characteristics, including a predominant Th2 pattern and a higher frequency of cryoglobulinemia and hypocomplementemia (features closely related to HCV). This suggests that the SS observed in some HCV patients should be interpreted as one of the extrahepatic manifestations of chronic HCV infection.


Assuntos
Citocinas/sangue , Hepatite C Crônica/imunologia , Síndrome de Sjogren/imunologia , Células Th1/imunologia , Células Th2/imunologia , Autoanticorpos/análise , Ensaio de Imunoadsorção Enzimática , Feminino , Hepatite C Crônica/complicações , Humanos , Interleucina-10/sangue , Interleucina-2/sangue , Masculino , Síndrome de Sjogren/etiologia , Síndrome de Sjogren/fisiopatologia , Fator de Necrose Tumoral alfa/análise
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