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1.
Placenta ; 88: 36-43, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31670095

RESUMO

INTRODUCTION: There are considerable variations in villous morphology within a normal placenta. However, whether there is a reproducible spatial pattern of variation in villous vascular density is not known. Micro-CT provides three-dimensional volume imaging with spatial resolution down to the micrometre scale. In this study, we applied Micro-CT and histological analysis to investigate the degree of heterogeneity of vascularisation within the placenta. METHOD: Ten term placentas were collected at elective caesarean section, perfused with contrast agent and imaged whole with Micro-CT. Eight full depth tissue blocks were then taken from each placenta and imaged. Sections were taken for histological analysis. Data was analysed to investigate vascular fill, and vascular density in relation to location from cord insertion to placental edge at each scale. RESULTS: Whole placental imaging revealed no spatially consistent difference in villous vessel density within the main placental tissue, although there was a great degree of heterogeneity. Both block imaging and histological analysis found a large degree of heterogeneity of vascular density within placentas, but no strong correlation between villous vascular density and block location (rs = 0.066, p = 0.7 block imaging, rs = 0.06, p = 0.6 histological analysis). DISCUSSION: This work presents a novel method for imaging the human placenta vascular tree using multiscale Micro-CT imaging. It demonstrates that there is a large degree of variation in vascular density throughout normal term human placentas. The three-dimensional data created by this technique could be used, with more advanced computer analysis, to further investigate the structure of the vascular tree.

2.
Med. U.P.B ; 38(2): 158-167, 17 de octubre de 2019.
Artigo em Espanhol | LILACS | ID: biblio-1023411

RESUMO

Los metanálisis de comparación de múltiples tratamientos permiten estudiar, a partir de revisiones sistemáticas, las comparaciones realizadas de forma directa o indirecta, sobre diversos tipos de intervenciones, con datos de varios ensayos clínicos que, por su homogeneidad en los resultados, pueden agruparse en un resultado común y expresable de manera cuantitativa. Otros nombres que recibe son: metanálisis en red, metanálisis de comparación mixta o metanálisis indirectos. Al permitir la comparación de varios tratamientos facilitan una mejor estimación del efecto de las intervenciones, lo que guía de forma más certera al clínico en sus decisiones y en la aplicación de la información en el cuidado de sus pacientes. El objetivo de esta revisión es guiar al lector para que realice de manera organizada y adecuada la lectura crítica (según recomendaciones JAMA) de los metanálisis de comparación de múltiples tratamientos. Este artículo está orientando a los autores y a los editores, y contiene información sobre cómo deben interpretarse y comunicarse estos estudios.


Multiple treatment comparison meta-analyses are systematic reviews that allow to make direct or indirect comparisons of different interventions from the data collection results of randomized clinical trials, grouping them in a common outcome or conglomerate which is expressed quantitatively. Other names given are network meta-analyses, or mixed treatment comparison meta-analyses or indirect meta-analyses. The use of the comparison of several treatments allows a greater estimation of the intervention effect. This is a guide for the physician to make more accurate decisions and to apply better care criteria to their patients. This literature review should help the reader to perform an organized and adequate critical reading (according to the JAMA recommendations) of the multiple treatment comparison meta-analyses. The article is addressed to authors and editors, and it contains information on how this type of studies should be interpreted and communicated.


Os metanálise de comparação de múltiplos tratamentos permitem estudar, a partir de revisões sistemáticas, as comparações realizadas de forma direta ou indireta, sobre diversos tipos de intervenções, com dados de vários ensaios clínicos que, por sua homogeneidade nos resultados, podem agrupar-se num resultado comum e de expressão de maneira quantitativa. Outros nomes que recebe são: metanálise em rede, metanálise de comparação mista ou metanálise indiretos. Ao permitir a comparação de vários tratamentos facilitam uma melhor estimação do efeito das intervenções, o que guia de forma mais certeira ao clínico em suas decisões e na aplicação da informação no cuidado de seus pacientes. O objetivo desta revisão é guiar ao leitor para que realize de maneira organizada e adequada a leitura crítica (segundo recomendações JAMA) dos metanálise de comparação de múltiplos tratamentos. Este artigo está orientando aos autores e aos editores, e contém informação sobre como devem interpretar-se e comunicar-se estes estudos.


Assuntos
Terapêutica , Metanálise como Assunto , Prática Clínica Baseada em Evidências
3.
Med. U.P.B ; 38(2): 168-176, 17 de octubre de 2019.
Artigo em Espanhol | LILACS | ID: biblio-1023412

RESUMO

Aunque poco común, la intoxicación por cianuro acarrea una mortalidad alta, sobre todo, cuando no se administra el tratamiento oportuno. La exposición a este tóxico puede darse por inhalación o por ingestión oral. Lo que se ha descrito sobre el manejo de esta intoxicación está basado en reportes de casos y pequeñas series, dado que en la literatura no se encuentran estudios que den un sustento claro. Dentro de estos reportes, y según los aspectos fisiopatológicos, son especialmente relevantes: el nitrito de sodio, el nitrito de amilo, el tiosulfito de sodio y la hidroxicobalamina, como arsenal terapéutico de esta intoxicación.


Cyanide intoxication is a rare condition. Yet, it leads to a high mortality, especially when proper treatment is not available. The exposure to this substance may occur via inhalation or oral ingestion. The basis of this intoxication´s treatment is on little case series and reports; this is due to the fact that the literature to support it remains scant and unclear. Based on physiopathological aspects, within this evidence the following are particularly relevant: sodium nitrile, amile nitrile, sodium tiosulphite, and hidroxicobalamin, as part of this intoxication´s treatment.


Embora pouco comum, a intoxicação por cianeto provoca uma mortalidade alta, sobre tudo, quando não se administra o tratamento oportuno. A exposição a este tóxico pode dar-se por inalação ou por ingestão oral. O que se há descrito sobre o manejo desta intoxicação está baseado em reportes de casos e pequenas séries, dado que na literatura não se encontram estudos que deem um sustento claro. Dentro destes relatos, e segundo os aspectos fisiopatológicos, são especialmente relevantes: o nitrito de sódio, o nitrito de amilo, o tiossulfato de sódio e a hidroxicobalamina, como arsenal terapêutico desta intoxicação.


Assuntos
Envenenamento , Acidose , Cianetos , Antídotos
4.
Med. U.P.B ; 38(1): 57-66, 13 de febrero de 2019.
Artigo em Espanhol | LILACS | ID: biblio-980301

RESUMO

El trauma vascular en las extremidades es una causa importante de mortalidad y morbilidad. Por su fisiopatología se conoce que esta lesión puede tener efectos sistémicos ocasionados por el choque hemorrágico, y efectos locales debido a la isquemia tisular. El manejo se inicia desde el primer contacto con el paciente, bien sea por personal médico o de atención prehospitalaria. El escenario puede variar desde un área de conflicto armado, la vía pública hasta un hospital y la prioridad inicial será el control del sangrado. En este artículo se exponen elementos para el diagnóstico y el manejo no quirúrgico del trauma vascular incluyendo el uso temprano de torniquete, el diagnóstico clínico, la identificación y el tratamiento de pacientes con trauma vascular, lo que permitirá salvar vidas y extremidades.


Over the years, vascular injury in extremities has been an important cause of mortality and morbidity. Because of the physiopathology of these injuries, it is known that they produce systemic effects due to the hemorrhagic shock and local effects due to tissue ischemia. Treatment begins from the first contact, whether by physicians or pre-hospital attention personnel, and the setting can range anywhere from an area of armed conflict to a public area to a hospital. Regardless of these variables, the priority will always be hemorrhage control. This article exposes key elements for diagnosis and non-surgical treatment of vascular injury in extremities including early use of tourniquets, clinical diagnosis, images and damage control resuscitation. Thus, adequate identification and treatment of patients with vascular injury allows us to salvage lives and limbs.


O trauma vascular nas extremidades é uma causa importante de mortalidade e morbilidade. Por sua fisiopatologia se conhece que esta lesão pode ter efeitos sistémicos ocasionados pelo choque hemorrágico, e efeitos locais devido à isquemia tissular. O manejo se inicia desde o primeiro contato com o paciente, bem seja pelo pessoal médico ou de atenção pré-hospitalar. O cenário pode variar desde uma área de conflito armado, a via pública até um hospital e a prioridade inicial será o controle do sangrado. Neste artigo se expõe elementos para o diagnóstico e o manejo não cirúrgico do trauma vascular incluindo o uso precoce de torniquete, o diagnóstico clínico, a identificação e o tratamento de pacientes com trauma vascular, o que permitirá salvar vidas e extremidades.


Assuntos
Ferimentos e Lesões , Diagnóstico , Hemorragia
5.
Med. U.P.B ; 37(2): 142-148, 22 de agosto de 2018.
Artigo em Espanhol | LILACS | ID: biblio-912091

RESUMO

A través del tiempo se ha hablado del hallazgo de bloqueo de rama izquierda del Haz de His como un posible equivalente ST, en el paciente que se presenta a los servicios médicos con dolor torácico. Es claro que en condiciones puntuales como inestabilidad hemodinámica o choque cardiogénico se cumple dicha premisa y el paciente debe ser manejado de manera invasiva urgente, sin embargo, hay otras condiciones que ameritan trabajo de campo adicional para abordar estos pacientes.


Over time, there has been discussion regarding the finding of left bundle branch block in the bundle of His as a possible ST-segment equivalent, in patients seeking medical attention with chest pain. It is clear that, in particular conditions such as hemodynamic instability or cardiogenic shock, this premise is met and patients must undergo emergency invasive procedures. However, there are other conditions that warrant further field work to treat these patients.


A través do tempo se há falado da descoberta de bloqueio do ramo esquerdo de Feixe de His como um possível equivalente ST, no paciente que se apresenta aos serviços médicos com dor torácico. É claro que em condições pontuais como instabilidade hemodinâmica ou choque cardiogênico se cumpre dita premissa e o paciente deve ser manejado de maneira invasiva urgente, embora, há outras condições que merecem trabalho de campo adicional para abordar estes pacientes.


Assuntos
Choque Cardiogênico , Dor no Peito , Insuficiência Cardíaca
6.
Chem Biol Interact ; 279: 145-158, 2018 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-29179950

RESUMO

Oxidative stress induced by Reactive Oxygen Species (ROS) was shown to be involved in the pathogenesis of chronic diseases such as cardiovascular pathologies. Particularly, oxidative stress has proved to mediate abnormal platelet function and dysfunctional endothelium-dependent vasodilatation representing a key factor in the progression of ischemic injuries. Antioxidants like carotenoids have been suggested to contribute in their prevention and treatment. Astaxanthin, a xanthophyll carotenoid produced naturally and synthetically, shows interesting antioxidant and anti-inflammatory properties. In vivo studies applying different models of induced ischemia and reperfusion (I/R) injury confirm astaxanthin's protective action after oral or intravenous administration. However, some studies have shown some limitations after oral administration such as low stability, bioavailability and bioefficacy, revealing a need for the implementation of new biomaterials to act as astaxanthin vehicles in vivo. Here, a brief overview of the chemical characteristics of astaxanthin, the carrier systems developed for overcoming its delivery drawbacks and the animal studies showing its potential effect to treat I/R injury are presented.


Assuntos
Antioxidantes/farmacologia , Espécies Reativas de Oxigênio/metabolismo , Traumatismo por Reperfusão/tratamento farmacológico , Animais , Xantofilas/química , Xantofilas/farmacologia
7.
Rev. toxicol ; 35(2): 119-123, 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-176874

RESUMO

El presente trabajo tiene como objetivo describir la epidemiología de los pacientes que se presentan con intoxicaciones agudas en los servicios de urgencias de los hospitales de alta complejidad en la ciudad de Medellín entre los años 2010 y 2013, con el propósito de mejorar el manejo de estos pacientes en los servicios de urgencias y contribuir con la actualización de protocolos y guías de atención institucional. Para ello, se realizó un estudio descriptivo retrospectivo de corte transversal, que analizó variables sociodemográficas y clínicas de los pacientes atendidos por intoxicación en los servicios de urgencias de instituciones de alta complejidad participantes de la ciudad de Medellín en un periodo de 4 años. Se realizó el análisis univariado y análisis bivariado con el fin de determinar la relación entre las variables. Como resultados, se incluyeron 244 pacientes intoxicados, con mediana para la edad de 28 años y rango intercuartílico igual a 26. La principal causa de toxicidad fue por intento suicida se presentó en el 60,2%(147) y 39,8%(97) fueron por intoxicaciones accidentales. Las sustancias más frecuentemente utilizadas fueron plaguicidas, analgésicos y psicofármacos. La proporción de letalidad fue de 3%(7), siendo más frecuente en los residentes en área rural (p<0,05). Conclusiones: La intoxicación con intención suicida es más frecuente que la accidental, afectando mayoritariamente a mujeres; implica sobre todo a plaguicidicas, rodenticidas y herbicidas, medicamentos de uso común (analgésicos) y medicamentos psiquiátricos (antidepresivos)


This work describe the epidemiology of patients presenting with acute poisonings to the emergency services of high level hospitals in the city of Medellín between 2010 and 2013, with the purpose of improving the management of these patients in the emergency services and contribute with updating protocols and institutional care guidelines. Methods: Cross-sectional descriptive study, which analyzed epidemiological variables of patients treated for poisoning in the emergency services of the participating institutions of the city of Medellin over a period of 4 years. The SPSS v.21 and Epida v.3.1 programs were used to perform univariate analyzes to characterize and describe the study population and bivariate analysis in order to determine the relationship between the variables. Results: 244 intoxicated patients were included, with median for age of 28 years and interquartile range equal to 26. Of all causes, 60.2% (147) were due to suicide attempt and 39.8% (97) accidental. The most frequently used substances were pesticides, rodenticides and herbicides, commonly used medicines and psychiatric medicines. The lethality proportion was 3% (7), being more frequent among residents of the rural area (p <0.05). Conclusions: Intoxication with suicidal intention is more frequent than accidental poisoning, affecting mainly women; It mainly involves pesticides, rodenticides and herbicides, commonly used medicines (pain killers) and psychiatric drugs (antidepressants)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Envenenamento/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Overdose de Drogas/epidemiologia , Colômbia/epidemiologia , Praguicidas/toxicidade , Analgésicos Opioides/toxicidade , Tratamento de Emergência/estatística & dados numéricos , Estudos Retrospectivos
8.
Oxid Med Cell Longev ; 2017: 8073798, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29090040

RESUMO

An imbalance in the reactive oxygen species (ROS) homeostasis is involved in the pathogenesis of oxidative stress-related diseases. Astaxanthin, a xanthophyll carotenoid with high antioxidant capacities, has been shown to prevent the first stages of oxidative stress. Here, we evaluate the antioxidant capacities of astaxanthin included within hydroxypropyl-beta-cyclodextrin (CD-A) to directly and indirectly reduce the induced ROS production. First, chemical methods were used to corroborate the preservation of astaxanthin antioxidant abilities after inclusion. Next, antioxidant scavenging properties of CD-A to inhibit the cellular and mitochondrial ROS by reducing the disturbance in the redox state of the cell and the infiltration of lipid peroxidation radicals were evaluated. Finally, the activation of endogenous antioxidant PTEN/AKT, Nrf2/HO-1, and NQOI gene and protein expression supported the protective effect of CD-A complex on human endothelial cells under stress conditions. Moreover, a nontoxic effect on HUVEC was registered after CD-A complex supplementation. The results reported here illustrate the need to continue exploring the interesting properties of this hydrophilic antioxidant complex to assist endogenous systems to counteract the ROS impact on the induction of cellular oxidative stress state.


Assuntos
Fibrinolíticos/uso terapêutico , Antioxidantes , Fibrinolíticos/farmacologia , Humanos , Estresse Oxidativo , Espécies Reativas de Oxigênio , Xantofilas/farmacologia , Xantofilas/uso terapêutico
9.
Biomed Mater ; 13(1): 015020, 2017 12 28.
Artigo em Inglês | MEDLINE | ID: mdl-28875946

RESUMO

After myocardial infarction, the heart's mechanical properties and its intrinsic capability to recover are compromised. To improve this recovery, several groups have developed cardiac patches based on different biomaterials strategies. Here, we developed polyvinylalcohol/dextran (PVA/Dex) elastic hydrogel patches, obtained through the freeze thawing (FT) process, with the aim to deliver locally a potent natural antioxidant molecule, astaxanthin, and to assist the heart's response against the generated myofibril stress. Extensive rheological and dynamo-mechanical characterization of the effect of the PVA molecular weight, number of freeze-thawing cycles and Dex addition on the mechanical properties of the resulting hydrogels, were carried out. Hydrogel systems based on PVA 145 kDa and PVA 47 kDa blended with Dex 40 kDa, were chosen as the most promising candidates for this application. In order to improve astaxanthin solubility, an inclusion system using hydroxypropyl-ß-cyclodextrin was prepared. This system was posteriorly loaded within the PVA/Dex hydrogels. PVA145/Dex 1FT and PVA47/Dex 3FT showed the best rheological and mechanical properties when compared to the other studied systems; environmental scanning electron microscope and confocal imaging evidenced a porous structure of the hydrogels allowing astaxanthin release. In vitro cellular behavior was analyzed after 24 h of contact with astaxanthin-loaded hydrogels. In vivo subcutaneous biocompatibility was performed in rats using PVA145/Dex 1FT, as the best compromise between mechanical support and astaxanthin delivery. Finally, ex vivo and in vivo experiments showed good mechanical and compatibility properties of this hydrogel. The obtained results showed that the studied materials have a potential to be used as myocardial patches to assist infarcted heart mechanical function and to reduce oxidative stress by the in situ release of astaxanthin.


Assuntos
Materiais Biocompatíveis/química , Dextranos/química , Hidrogéis/química , Álcool de Polivinil/química , 2-Hidroxipropil-beta-Ciclodextrina/química , Animais , Sistemas de Liberação de Medicamentos , Gelatina/química , Células Endoteliais da Veia Umbilical Humana , Humanos , Masculino , Teste de Materiais , Microscopia Confocal , Microscopia Eletrônica de Varredura , Estresse Oxidativo , Porosidade , Ratos , Ratos Wistar , Espécies Reativas de Oxigênio/metabolismo , Reologia , Solubilidade , Estresse Mecânico , Xantofilas/administração & dosagem
10.
Rev. colomb. radiol ; 28(1): 4593-4599, 2017. ilus
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-986928

RESUMO

Los aneurismas, pseudoaneurismas y divertículos cardiacos son dilataciones o evaginaciones de estructuras de la pared cardiaca: ventrículos, aurículas, septo interauricular, arterias coronarias, entre otros, de distintas causas y de morfología variable. Los avances en las diferentes modalidades diagnósticas han permitido una mayor precisión en la evaluación morfológica y funcional del corazón. Los aneurismas, pseudoaneurismas y divertículos cardiacos son manifestaciones frecuentes de diferentes condiciones, que pueden ser evaluados mediante técnicas como la resonancia magnética (RM) y la tomografía computarizada (TC) que se usan, cada vez con mayor frecuencia, para evaluar la configuración cardiaca. La resonancia magnética cardiovascular (RMC) es la técnica de elección para una mejor valoración anatómica cardiaca. El propósito de este artículo es ilustrar mediante casos clínicos el valor de estas modalidades diagnósticas no invasivas en la evaluación de los aneurismas, pseudoaneurismas y divertículos cardiacos.


Cardiac aneurysms, pseudoaneurysms, and diverticula are dilations or outpouchings of different cardiac structures: ventricles, atria, atrial septum, coronary arteries, among others, due to different causes and of variable morphology. Advances in different diagnostic modalities have allowed greater accuracy in the morphological and functional assessment of the heart. Cardiac aneurysms, pseudoaneurysms, and diverticula are common manifestations of different conditions that can be assessed by magnetic resonance imaging and computed tomography, which are increasingly used to evaluate cardiac configuration. Cardiovascular magnetic resonance (CMR) is the technique of choice for a better cardiac anatomic evaluation. This paper aims to illustrate, through clinical cases based on our experience in CediIMed, the value of these non-invasive diagnostic modalities in the evaluation of cardiac aneurysms, pseudoaneurysms, and diverticula.


Assuntos
Humanos , Aneurisma Cardíaco , Imagem por Ressonância Magnética , Falso Aneurisma , Tomografia Computadorizada Multidetectores
11.
Rev. colomb. radiol ; 28(1): 4609-4615, 2017. ilus
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-986931

RESUMO

El tracto de salida del ventrículo izquierdo (TSVI) es la estructura anatómica a través de la cual sale el flujo sistólico del ventrículo izquierdo (VI) hacia la aorta. El TSVI está conformado por tres componentes: subvalvular, el cual es delimitado por el septo interventricular en sus porciones membranosas y muscular basal y la valva anterior de la válvula mitral; el componente valvular, corresponde a la válvula aórtica, y el supravalvular. En esta revisión académica se evaluarán las patologías obstructivas del tracto de salida del ventrículo izquierdo, incluyendo entidades localizadas en el sector valvular aórtico (valvulares), en la aorta ascendente (supravalvulares) y en el tracto de salida del ventrículo izquierdo proximal al plano valvular (subvalvulares).


The left ventricular outflow tract (LVOT) is the anatomic structure through which the left ventricular stroke volume passes towards the aorta. The LVOT consists of three components: subvalvular component, which is delimited by the membranous and basal muscular portions of the interventricular septum; valvular component (the aortic valve); and supravalvular component. This academic review evaluates different obstructive pathologies of the LVOT, including entities located at the aortic valve level (valvular), in the ascending aorta (supravalvular), and in the proximal portion of the LVOT (subvalvular).


Assuntos
Humanos , Imagem por Ressonância Magnética , Coração , Ventrículos do Coração
12.
Rev. colomb. radiol ; 28(1): 4630-4635, 2017. ilus
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-987012

RESUMO

En los pacientes con VIH es frecuente la tuberculosis (TB) extrapulmonar; sin embargo, la incidencia de afectación esofágica es baja. Se requiere de una alta sospecha clínica para realizar un adecuado enfoque diagnóstico y para identificar al Mycobacterium TB como agente causal de infección. Los estudios por imagen, como la radiografía convencional de tórax, el esófagograma, la tomografía computarizada multicorte (TCM) y la endoscopia digestiva superior aportan información basada en hallazgos específicos que pueden orientar hacia el diagnóstico de TB ganglionar y esofágica. Sirven como guía para la toma de muestras de tejidos y la realización de estudios confirmatorios de presencia del bacilo, como las pruebas moleculares y cultivos. Se reseñan 2 casos de pacientes jóvenes, de sexo masculino, con diagnóstico de VIH/sida C3 con coinfección por TB, quienes desarrollaron compromiso ganglionar mediastinal y esofágico, con perforación secundaria y fístula mediastínica.


Extrapulmonary tuberculosis (TB) is frequent in HIV patients; nevertheless, the incidence of esophageal involvement is low and high clinical suspicion is required for a proper diagnostic approach in order to identify Mycobacterium TB as a causative agent of infection. Imaging studies such as conventional chest radiography, esophagogram, multislice computed tomography (MCT), and upper endoscopy provide information based on specific findings that can lead to the diagnosis of TB. They serve as a guide for tissue sampling and confirmatory molecular tests and cultures. This article presents two cases of young male patients diagnosed with HIV/AIDS C3 and co-infected with TB, who developed esophageal and mediastinal lymph node involvement, with secondary perforation and mediastinal fistula.


Assuntos
Humanos , Tuberculose , Fístula Esofágica , HIV
13.
Med. U.P.B ; 34(2): 165-170, jul.-dic. 2015.
Artigo em Espanhol | LILACS | ID: biblio-837049

RESUMO

La tuberculosis continúa siendo una causa importante de morbimortalidad en Colombia y el mundo, con un aumento en las formas extra pulmonares, de las cuales el compromiso intestinal ocupa el sexto lugar. Sus manifestaciones clínicas son inespecíficas y pueden simular múltiples condiciones, lo que hace de su diagnóstico un reto clínico. Este artículo describe el caso de una paciente con tuberculosis intestinal, a quien no se documentó un hallazgo confirmatorio, pero por la sospecha clínica y hallazgos paraclínicos sugestivos, se decide iniciar tratamiento antituberculoso, con respuesta clínica favorable luego de dos semanas.


Tuberculosis remains a major cause of morbidity and mortality in Colombia and the world, with an increase in extra-pulmonary forms, amongst which intestinal involvement ranks sixth. Clinical manifestations are nonspecific and can mimic many conditions that make diagnosis a clinical challenge. This article describes the case of a patient with intestinal tuberculosis, for whom a confirmatory finding was not documented, but due to clinical suspicion and paraclinical suggestive findings, it was decided to initiate TB treatment. The patient presented a favorable clinical response after two weeks of onset.


A tuberculose continua sendo uma causa importante de morbimortalidade na Colômbia e no mundo, com um aumento nas formas extra pulmonares, das quais o compromisso intestinal ocupa o sexto lugar. Suas manifestações clínicas são inespecíficas e podem simular múltiplas condições, o que faz de seu diagnóstico um objetivo clínico. Este artigo descreve o caso de uma paciente com tuberculose intestinal, a quem não se documentou uma descoberta confirmatório, mas pela suspeita clínica e descobertas laboratoriais sugestivas, se decide iniciar tratamento antituberculoso, com resposta clínica favorável logo de duas semanas.


Assuntos
Colite , Doença de Crohn , Intestino Grosso , Intestino Delgado , Tuberculose
14.
Rev. colomb. radiol ; 26(1)2015. imag, graf
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-994798

RESUMO

En diferentes estudios diagnósticos realizados en la práctica clínica encontramos de manera incidental divertículos o pseudodivertículos del tracto gastrointestinal. Este artículo presenta una revisión detallada de la patología diverticular del tracto digestivo superior y se analizan sus aspectos clínicos, epidemiológicos y los diferentes hallazgos por imagen, haciendo hincapié en su apariencia por tomografía computarizada multidetector (TCMD).


Diverticulum and pseudodiverticula of the gastrointestinal tract are incidentally found in different diagnostic studies performed in clinical practice. This article presents a detailed review of the diverticular disease of the upper gastrointestinal tract and its clinical, epidemiological aspects are discussed, as well as different imaging findings are discussed. A special emphasis is made on its appearance through Multidetector Computed Tomography (MDCT).


Assuntos
Humanos , Divertículo , Trato Gastrointestinal Superior , Tomografia Computadorizada Multidetectores
15.
Rev. colomb. radiol ; 26(3): 4260-4268, 2015. ilus
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-987959

RESUMO

En la actualidad la evaluación no invasiva de los pacientes con patología cardiaca se realiza a través de múltiples modalidades diagnósticas que cumplen un papel complementario entre sí. La ecocardiografía (EC) sigue siendo la modalidad diagnóstica no invasiva más utilizada en la evaluación de los pacientes con sospecha de patología cardiaca, pues permite una evaluación precisa de la morfología y la función del corazón. Además, es una modalidad accesible, económica y segura. A pesar de las múltiples ventajas descritas previamente de la EC, esta modalidad diagnóstica también tiene limitaciones. El propósito de esta revisión académica es ilustrar, a través de casos clínicos en equipos de RM de 1,5 y 3 Teslas, el valor de la resonancia magnética cardiaca (RMC) en aquellos casos en los que la EC, por sus limitaciones, no fue concluyente.


Currently, the non-invasive evaluation of patients with cardiac disease is performed through multiple diagnostic modalities, which together play a complementary role to each other. Echocardiography (EC) remains the most used noninvasive diagnostic modality in the evaluation of patients with suspected heart disease, allowing an accurate assessment of the morphology and function of the heart. In addition, it is accessible, economical and safe. Despite the previously described advantages of EC, this modality also has limitations. The purpose of our academic review is to illustrate through clinical cases from our experience with RM of 1.5 and 3 Tesla equipment, the value of Cardiovascular Magnetic Resonance (CMRI) in cases where EC was inconclusive.


Assuntos
Humanos , Imagem por Ressonância Magnética , Ecocardiografia , Técnicas de Imagem Cardíaca
16.
Med. U.P.B ; 32(1): 30-36, ene.-jun. 2013.
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-836830

RESUMO

Objetivo: determinar las diferencias en las variables cualitativas y cuantitativas de las características basales de los ensayos clínicos controlados con asignación aleatoria, según su tamaño de muestra. Metodología: estudio observacional, transversal que incluyó los ensayos clínicos con asignación aleatoria publicados en cuatro revistas médicas generales de alto factor de impacto. Según su tamaño de muestra, se dividieron en cinco estratos y se evaluó la diferencia entre variables cualitativas y cuantitativas de las características basales. Resultados: se analizaron 1000 variables de los pacientes que participaron en ensayos clínicos. Cuando se comparó cada uno de los grupos por tamaño de muestra con respecto al de ≥5000 pacientes, se encontró que las diferencias de medias disminuían a medida que los tamaños de muestra tenían mayor número de pacientes. Conclusiones: la diferencia de resultados de las características basales de los ensayos clínicos, es inversamente proporcional al tamaño de muestra y, por encima de 500 pacientes por grupo, las diferencias promedio serían menores al 1.2%.


Objective: To determine the differences in qualitative and quantitative variables in the baseline characteristics of the controlled clinical trials randomized by sample size. Methods: Observational, cross-sectional study including randomized clinical trials published in four high impact factor general medical journals. They were divided into five strata according to sample size; the differences between qualitative and quantitative variables of baseline characteristics were evaluated. Results: One thousand variables of patients participating in clinical trials were analyzed. By comparing each of the groups according to sample size with respect to the group of ≥ 5000 patients, it was determined that the mean differences decreased as the sample sizes included a greater number of patients. Conclusions: The differences in results of the baseline characteristics of clinical trials are inversely proportional to the sample size, and the average differences in groups above 500 patients would be less than 1.2%.


Objetivo: Determinar as diferenças nas variáveis qualitativas e quantitativas das características basais dos ensaios clínicos controlados com atribuição aleatória segundo seu tamanho de mostra. Metodologia: Estudo observacional, cross sectional que incluiu os ensaios clínicos com atribuição aleatória publicados em quatro revistas médicas generais de alto fator de impacto. Segundo o de tamanho de mostra deles, dividiram-se em cinco estratos, avaliou-se a diferença entre variáveis qualitativas e quantitativas das características basais. Resultados: Analisaram-se 1000 variáveis dos pacientes que participaram em ensaios clínicos. Ao comparar cada um dos grupos por tamanho de mostra com respeito ao de ≥5000 pacientes se encontrou que as diferenças de médias diminuíam à medida que os tamanhos de mostra tinham maior número de pacientes. Conclusões: A diferença de resultados das características basais dos ensaios clínicos, é inversamente proporcional ao tamanho de mostra e acima de 500 pacientes por grupo as diferencias média seriam menores a 1.2%.


Assuntos
Ensaio Clínico , Distribuição Aleatória , Tamanho da Amostra
17.
Transplant Proc ; 44(7): 2047-9, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22974905

RESUMO

Our lung transplant unit began activity in October 2008. We have performed 37 lung transplants with a hospital mortality of 2.7% (n = 1). The need for a greater number of donors and the presence of an already existent non-heart-beating donor (NHBD) program for abdominal grafts and tissues encouraged us to consider assessing lung grafts from these donors. It was necessary to develop a new multiorgan preservation methodology, "bithermia preservation." The clinical experience with which during the first year June 2010 to July 2011, including 15 NHBDs is presented herein. The chest x-ray was normal in 6 donors (40%) and 7 had pulmonary infiltrates. Bronchoscopy was normal in 8 donors (53%) but 3 had abundant bleeding airway secretions and signs of bronchoaspiration. Preservation procedures were performed in 6 donors. Pulmonary functional evaluation in 4 donors showed gas measurements to be adequate in 75% of cases. Three double-lung grafts were judged to be valid for implantation, among which we performed 3 lung transplantations, 1 bilateral and 2 unilaterals, while 2 grafts were offered to the National Transplant Organization for other units. No transplant suffered primary graft dysfunction; all 3 showed excellent function allowing early extubation in 2 cases. There was no in-hospital mortality. All 3 patients are alive and leading normal lives; none has bronchiolitis obliterans syndrome. In conclusion, the "bithermia preservation" methodology achieved adequate lung preservation in NHBDs, allowing liver, kidneys, and lungs to be obtained from the same donor.


Assuntos
Transplante de Pulmão , Doadores de Tecidos , Adulto , Broncoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica , Soluções para Preservação de Órgãos
18.
Rev. esp. cardiol. (Ed. impr.) ; 64(10): 876-882, oct. 2011. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-90973

RESUMO

Introducción y objetivos. El estudio ENRICA pretende medir la frecuencia y la distribución de los principales componentes de la historia natural de la enfermedad cardiovascular en España, incluyendo el consumo alimentario y otros factores de riesgo conductuales, factores de riesgo biológicos, daño precoz en órganos diana y morbilidad diagnosticada. Métodos. Estudio transversal realizado de junio de 2008 a octubre de 2010 sobre 11.991 personas representativas de la población no institucionalizada de 18 y más años de edad en España. La recogida de datos se hizo en tres etapas secuenciales: a) entrevista telefónica asistida por ordenador sobre estilos de vida, conocimiento y actitudes sobre factores de riesgo de enfermedad cardiovascular y sobre signos y síntomas de alerta de ataque al corazón e ictus, salud subjetiva y morbilidad; b) primera visita al domicilio, para obtener muestras de sangre y orina que se envían a un laboratorio central para las determinaciones analíticas, y c) segunda visita al domicilio, para realizar antropometría, medir presión arterial y completar historia dietética electrónica. De las personas de 65 y más años, se obtuvo información sobre limitaciones funcionales. Discusión. El estudio ENRICA ha mostrado en España la factibilidad de un gran estudio con entrevista y examen físico en los domicilios. Este estudio proporcionará información valiosa para orientar y evaluar las estrategias nacionales contra la enfermedad cardiovascular y otras enfermedades crónicas. Además, está previsto que en el segundo semestre de 2011 comience el seguimiento durante 3 años de los participantes en el estudio. Con ello se actualizará la información de estilos de vida y sobre variables biológicas obtenidas en un nuevo examen físico (ClinicalTrials.gov number, NCT01133093) (AU)


Introduction and objectives. The ENRICA study aims to assess the frequency and distribution of the main components of the natural history of cardiovascular disease in Spain, including food consumption and other behavioral risk factors, biological risk factors, early damage of target organs, and diagnosed morbidity. Methods. A cross-sectional survey of 11 991 individuals representative of the non-institutionalized population aged 18 years and older in Spain was conducted from June 2008 to October 2010. Data collection comprised 3 sequential stages: a) computer-assisted telephone interview to obtain information on lifestyle, knowledge and attitudes about cardiovascular disease risk factors, and the signs and symptoms of heart attack and stroke, subjective health, and morbidity; b) first homevisit, to collect blood and urine samples for analysis by a central laboratory, and c) second home visit, to measure anthropometric variables and blood pressure and to administer a computer-assisted dietary history; data on functional limitations are also collected from participants aged 65 years and older. Discussion. The ENRICA study has shown the feasibility of a large home-based health interview and examination survey in Spain. It will provide valuable information to support and evaluate national strategies against cardiovascular disease and other chronic diseases in Spain. Moreover, a 3-year prospective follow-up of the study participants, including a new physical exam, is planned to start in the second semester of 2011 and will update lifestyle information and biological variables. (ClinicalTrials.gov number, NCT01133093) (AU)


Assuntos
Humanos , Masculino , Feminino , Nutrição em Saúde Pública/educação , Fenômenos Fisiológicos da Nutrição , Transtornos Nutricionais/epidemiologia , Doenças Cardiovasculares/epidemiologia , Fatores de Risco , Conhecimentos, Atitudes e Prática em Saúde , Estilo de Vida , Programas e Políticas de Nutrição e Alimentação , Espanha/epidemiologia , Estudos Transversais/métodos , Intervalos de Confiança
19.
Rev Esp Cardiol ; 64(10): 876-82, 2011 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-21821340

RESUMO

INTRODUCTION AND OBJECTIVES: The ENRICA study aims to assess the frequency and distribution of the main components of the natural history of cardiovascular disease in Spain, including food consumption and other behavioral risk factors, biological risk factors, early damage of target organs, and diagnosed morbidity. METHODS: A cross-sectional survey of 11,991 individuals representative of the non-institutionalized population aged 18 years and older in Spain was conducted from June 2008 to October 2010. Data collection comprised 3 sequential stages: a) computer-assisted telephone interview to obtain information on lifestyle, knowledge and attitudes about cardiovascular disease risk factors, and the signs and symptoms of heart attack and stroke, subjective health, and morbidity; b) first home visit, to collect blood and urine samples for analysis by a central laboratory, and c) second home visit, to measure anthropometric variables and blood pressure and to administer a computer-assisted dietary history; data on functional limitations are also collected from participants aged 65 years and older. DISCUSSION: The ENRICA study has shown the feasibility of a large home-based health interview and examination survey in Spain. It will provide valuable information to support and evaluate national strategies against cardiovascular disease and other chronic diseases in Spain. Moreover, a 3-year prospective follow-up of the study participants, including a new physical exam, is planned to start in the second semester of 2011 and will update lifestyle information and biological variables. (ClinicalTrials.gov number, NCT01133093).


Assuntos
Doenças Cardiovasculares/epidemiologia , Estado Nutricional , Adolescente , Adulto , Idoso , Antropometria , Estudos Transversais , Interpretação Estatística de Dados , Dieta , Ingestão de Alimentos , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Projetos de Pesquisa , Risco , Fatores de Risco , Espanha/epidemiologia , Telefone , Adulto Jovem
20.
Curr Med Chem ; 18(12): 1785-805, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21466472

RESUMO

Clinical studies provide overwhelming evidence for the importance of proteolytic imbalance and the upregulation of diverse protease classes in diseases such as cancer and arthritis. While the complex nature of proteolytic networks has hampered the development of protease inhibitors for these indications, aberrant enzyme activity could be successfully exploited for the development of proteasesensitive drug delivery systems and fluorescent in vivo imaging agents. More recently, these concepts have also been translated into photomedical applications to develop dual modality prodrugs for the simultaneous treatment and imaging of disease. After an introductory overview of proteases and their role in cancer, we present and discuss different strategies to exploit upregulated protease activity for the development of drug delivery systems, fluorescent in vivo reporter probes, and photosensitizer-prodrugs with respect to their potential and limitations. The main approaches used for targeting proteases in all three areas can be roughly divided into peptide-based and macromolecular strategies. Both involve the use of a short, peptide-based protease substrate, which is either directly tagged to the therapeutic agent or dye/quencher pair, or alternatively, serves as a linker between the polymeric carrier and a functional unit. In the latter case, the pharmacokinetic properties of peptide-based protease-sensitive prodrugs and imaging probes can be further ameliorated by the passive targeting capacity of macromolecular drug delivery systems for neoplastic and inflammatory lesions.


Assuntos
Peptídeo Hidrolases/uso terapêutico , Diagnóstico por Imagem , Sistemas de Liberação de Medicamentos , Humanos , Neoplasias/diagnóstico , Neoplasias/tratamento farmacológico , Fármacos Fotossensibilizantes , Regulação para Cima
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