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Medicine (Baltimore) ; 99(1): e18622, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895819


BACKGROUND: The purpose of the study was to determine the risk factors of post-surgery myasthenia crisis (PMC) among myasthenia gravis (MG) patients. METHODS: A meta-analysis to synthesize all eligible literatures was conducted to analyze PMC predictors among MG patients. RESULTS: A total of 15 trials with 2626 patients were included for the meta-analysis. As a result, patients with history of MC (RR = 3.36, 95%CI: 2.46-4.59, P < .001), generalized MG (RR = 0.39, 95%CI: 0.26-0.59, P < .001), bulbar symptom (RR = 3.59,95%CI:2.53-5.09, P < .001), thymoma (RR = 2.10, 95%CI:1.37-3.21, P = .001), post-surgery morbidity presence(RR = 2.59, 95%CI:1.90-3.54, P < .001), high-dose pyridostigmine usage (SMD = 0.480, 95%CI: 0.35-0.61 P < .001) tended to develop PMC. Large dose of steroid may reduce the incidence of PMC (RR = 0.41 95%CI: 0.18-0.94, P = .036). Regular steroid use (P = .066), immunosuppressive therapy (P = .179), gender (P = .774), and age at thymectomy (P = .212) had no impact upon PMC development. CONCLUSION: History of PMC, thymoma, generalized MG, bulbar symptom, and concomitant complication are the risk factors of PMC.

Miastenia Gravis/cirurgia , Complicações Pós-Operatórias/etiologia , Timectomia , Humanos , Exacerbação dos Sintomas
Braz Oral Res ; 33: e113, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800864


The objective of this study was to compare the scores of the Helplessness, Magnification, Rumination, and Catastrophizing factors of the Pain Catastrophizing Scale (PCS) between samples with different pain characteristics. The psychometric properties of the PCS were evaluated in 1,151 Brazilian adults (78.9% female; 38.6 (SD = 10.8) years): 335 had no pain, 390 had been in pain for less than 3 months, 250 had been in recurring pain for more than 3 months, and 176 had been in continuous pain for more than 3 months. Confirmatory factor analysis (CFA) was conducted to verify the fit of the PCS models. Convergent validity and reliability were evaluated. Multi-group analysis was used to estimate the invariance of the factorial model. The global score for the PCS factors was obtained using the regression weight matrix for estimating factor scores from CFA. Analysis of variance was used to compare scores between samples. After excluding three items, the tri-factorial model showed adequate fit. The model parameters were invariant (Δχ2(λ,i,ß,Res); p≥0.05). Individuals experiencing pain showed higher scores for catastrophic thoughts. Individuals with pain for less than 3 months had the highest scores for Rumination (p < 0.001). The PCS showed valid, reliable, and invariant results for the sample of Brazilian adults in no pain or with different pain conditions. The PCS adequately discriminated individuals in pain from those without pain. Among those in pain, Rumination was the only discriminating factor.

Catastrofização/psicologia , Desamparo Aprendido , Medição da Dor/psicologia , Dor/psicologia , Ruminação Cognitiva , Exacerbação dos Sintomas , Adulto , Análise de Variância , Brasil , Estudos Transversais , Análise Fatorial , Feminino , Humanos , Masculino , Medição da Dor/métodos , Escalas de Graduação Psiquiátrica , Psicometria , Valores de Referência , Reprodutibilidade dos Testes , Inquéritos e Questionários
Medicine (Baltimore) ; 98(41): e17428, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593096


RATIONALE: Cerebral venous sinus thrombosis (CVST) represents one of the most alarming forms of hemostatic abnormalities that may occur in patients with inflammatory bowel diseases (IBDs). PATIENT CONCERNS: Here we report a case of a 25-year-old male with ulcerative colitis, who developed such thromboembolic complication during flare of the disease. CVST in our patient was clinically manifested by headache and nausea. DIAGNOSIS: Angio-magnetic resonance imaging scan of the head revealed segments of contrast filling defects/absence indicating right dural venous sinus thrombosis of the transverse sinus. INTERVENTION: Immediate treatment with low-molecular-weight heparin has been introduced and led to full remission of symptoms and total recanalization of the thrombotic cerebral regions. OUTCOMES: Currently (over 2 years after diagnosis) the patient is in remission of the disease, and no further thromboembolic complications have been observed. LESSONS: Our case study highlights the clinical difficulties and challenges associated with diagnosis and treatment of CVST, as well as presents the current state of knowledge about this complication among patients with IBDs. Physicians taking care of IBD patients should be aware of this alarming hemostatic abnormality.

Anticoagulantes/uso terapêutico , Colite Ulcerativa/complicações , Heparina de Baixo Peso Molecular/uso terapêutico , Trombose dos Seios Intracranianos/tratamento farmacológico , Adulto , Colite Ulcerativa/tratamento farmacológico , Humanos , Quimioterapia de Indução , Masculino , Trombose dos Seios Intracranianos/etiologia , Exacerbação dos Sintomas
J Drugs Dermatol ; 18(8): 828-830, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31424716


A 56-year-old Caucasian male with a history of chronic plaque psoriasis, primary sclerosing cholangitis status-post liver transplant on tacrolimus, and ulcerative colitis on infliximab developed a progressive erythematous eruption with associated fatigue, anorexia, myalgias, and arthralgias. On two separate occasions, his skin biopsy demonstrated a lichenoid interface dermatitis (LID). Despite multiple courses of oral prednisone, topical steroids, and a short course of hydroxychloroquine, his symptoms continued to relapse and remit. When a temporal association between increasing his infliximab dose and the global progression of his disease was identified, he was ultimately diagnosed with a TNF-α inhibitor-induced psoriasis flare. Despite the patient's long-standing history of psoriasis, a plausible psoriasis rebound reaction after systemic steroids was not strongly considered in light of his histopathology. Though lichenoid interface dermatitis is a commonly reported histologic finding in patients on TNF-α inhibitors, it has scarcely been reported in patients with psoriasiform eruptions clinically.

Erupção por Droga/diagnóstico , Infliximab/efeitos adversos , Erupções Liquenoides/diagnóstico , Psoríase/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Biópsia , Diagnóstico Diferencial , Erupção por Droga/etiologia , Erupção por Droga/patologia , Humanos , Erupções Liquenoides/patologia , Masculino , Pessoa de Meia-Idade , Psoríase/diagnóstico , Pele/efeitos dos fármacos , Pele/patologia , Exacerbação dos Sintomas
Muscle Nerve ; 60(6): 693-699, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31469909


INTRODUCTION: The etiology of acute exacerbations of myasthenia gravis (MG) is not well understood and further characterization can lead to improved preventative measures. This study aims to characterize factors contributing to MG exacerbations. METHODS: A total of 127 MG patient charts were reviewed retrospectively (2011-2016) to obtain demographics, immunizations, pharmaceutical records, contributing factors of each MG exacerbation, emergency department (ED) visits, hospitalizations, and duration. RESULTS: There were 212 exacerbations requiring 106 ED visits and 141 hospitalizations (average admission 6.5 days). Highest contributors were infections (30%) and medications that may worsen MG (19%), with 24% unattributed. Infection related exacerbations were associated with 44.3% of ED visits and 39.7% of hospitalizations. Patients prescribed beta-blockers were associated with more exacerbations (P < .01). Patients prescribed medications that may worsen MG had a higher exacerbation frequency shortly after administration. DISCUSSION: Infections and cautioned medications are frequently factors in acute MG exacerbations needing urgent medical attention and warrant caution.

Antagonistas Adrenérgicos beta/uso terapêutico , Antibacterianos/uso terapêutico , Glucocorticoides/uso terapêutico , Miastenia Gravis/fisiopatologia , Exacerbação dos Sintomas , Idoso , Idoso de 80 Anos ou mais , Azitromicina/uso terapêutico , Progressão da Doença , Serviço Hospitalar de Emergência , Feminino , Fluoroquinolonas/uso terapêutico , Gentamicinas/uso terapêutico , Hospitalização , Humanos , Magnésio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Estudos Retrospectivos , Fatores de Risco
Radiología (Madr., Ed. impr.) ; 61(4): 333-336, jul.-ago. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185311


La enfermedad de Crohn es una patología de etiología autoinmunitaria, con afectación predominante del aparato digestivo. Se trata de una enfermedad que se diagnostica a edad temprana y presenta un curso crónico con reagudizaciones. Estos brotes se suelen manejar de forma similar a un abdomen agudo en los pacientes que acuden a los servicios de urgencias, y no existe un consenso sobre cuáles serían las pruebas de imagen más adecuadas. Debido a esta controversia, se ha decidido realizar una revisión de la bibliografía actual sobre cuáles serían las pruebas de imagen indicadas (ya sea por rendimiento diagnóstico o por menor exposición a radiación ionizante) en el brote agudo de pacientes con enfermedad de Crohn

Crohn's disease is an autoimmune disease that predominantly affects the gastrointestinal tract. Crohn's disease is diagnosed at a young age and runs a chronic course with acute flare-ups. When patients with Crohn's disease present with flare-ups at the emergency department, they are usually managed in a way similar to patients with acute abdomen; there is no consensus about the most appropriate imaging work-up for patients with flare-ups of Crohn's disease. Thus, we decided to review the literature about the imaging tests indicated (whether related to their diagnostic performance or to lower exposure to ionizing radiation) for acute flare-ups in patients with Crohn's disease

Humanos , Dor Abdominal/diagnóstico por imagem , Doença de Crohn/diagnóstico por imagem , Doenças Inflamatórias Intestinais/diagnóstico por imagem , Tratamento de Emergência/métodos , Exacerbação dos Sintomas , Diagnóstico por Imagem/métodos
World J Gastroenterol ; 25(19): 2327-2337, 2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31148904


BACKGROUND: Acute exacerbation in patients with chronic hepatitis B virus (HBV) infection results in different severities of liver injury. The risk factors related to progression to hepatic decompensation (HD) and acute-on-chronic liver failure (ACLF) in patients with severe acute exacerbation (SAE) of chronic HBV infection remain unknown. AIM: To identify risk factors related to progression to HD and ACLF in compensated patients with SAE of chronic HBV infection. METHODS: The baseline characteristics of 164 patients with SAE of chronic HBV infection were retrospectively reviewed. Independent risk factors associated with progression to HD and ACLF were identified. The predictive values of our previously established prediction model in patients with acute exacerbation (AE model) and the model for end-stage liver disease (MELD) score in predicting the development of ACLF were evaluated. RESULTS: Among 164 patients with SAE, 83 (50.6%) had compensated liver cirrhosis (LC), 43 had progression to HD without ACLF, and 29 had progression to ACLF within 28 d after admission. Independent risk factors associated with progression to HD were LC and low alanine aminotransferase. Independent risk factors for progression to ACLF were LC, high MELD score, high aspartate aminotransferase (AST) levels, and low prothrombin activity (PTA). The area under the receiver operating characteristic of the AE model [0.844, 95% confidence interval (CI): 0.779-0.896] was significantly higher than that of MELD score (0.690, 95%CI: 0.613-0.760, P < 0.05) in predicting the development of ACLF. CONCLUSION: In patients with SAE of chronic HBV infection, LC is an independent risk factor for progression to both HD and ACLF. High MELD score, high AST, and low PTA are associated with progression to ACLF. The AE model is a better predictor of ACLF development in patients with SAE than MELD score.

Insuficiência Hepática Crônica Agudizada/patologia , Doença Hepática Terminal/patologia , Hepatite B Crônica/patologia , Cirrose Hepática/patologia , Exacerbação dos Sintomas , Insuficiência Hepática Crônica Agudizada/virologia , Adulto , Progressão da Doença , Doença Hepática Terminal/virologia , Feminino , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/virologia , Humanos , Cirrose Hepática/virologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
Nat Commun ; 10(1): 2686, 2019 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-31217423


Inflammatory bowel disease (IBD) includes Crohn's disease and ulcerative colitis. Each disease is characterized by a diverse set of potential manifestations, which determine patients' disease phenotype. Current understanding of phenotype determinants is limited, despite increasing prevalence and healthcare costs. Diagnosis and monitoring of disease requires invasive procedures, such as endoscopy and tissue biopsy. Here we report signatures of heterogeneity between disease diagnoses and phenotypes. Using mass cytometry, we analyze leukocyte subsets, characterize their function(s), and examine gut-homing molecule expression in blood and intestinal tissue from healthy and/or IBD subjects. Some signatures persist in IBD despite remission, and many signatures are highly represented by leukocytes that express gut trafficking molecules. Moreover, distinct systemic and local immune signatures suggest patterns of cell localization in disease. Our findings highlight the importance of gut tropic leukocytes in circulation and reveal that blood-based immune signatures differentiate clinically relevant subsets of IBD.

Citometria de Fluxo/métodos , Doenças Inflamatórias Intestinais/imunologia , Mucosa Intestinal/imunologia , Leucócitos/imunologia , Espectrometria de Massas/métodos , Adulto , Idoso , Biópsia , Separação Celular , Colonoscopia , Feminino , Humanos , Doenças Inflamatórias Intestinais/sangue , Doenças Inflamatórias Intestinais/patologia , Mucosa Intestinal/patologia , Intestinos/imunologia , Intestinos/patologia , Masculino , Pessoa de Meia-Idade , Exacerbação dos Sintomas , Adulto Jovem
Rev. patol. respir ; 22(2): 59-65, abr.-jun. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-FGT-2141


La enfermedad respiratoria exacerbada por aspirina (EREA) es un síndrome inflamatorio de la vía aérea que se acompaña de asma, poliposis nasal y sinusitis crónica que suele requerir cirugía frecuentemente y en muchos casos, ciclos de corticoides sistémicos para controlar la enfermedad. Aunque su patogenia permanece aún desconocida, se cree que el principal causante pueda ser un metabolismo patológico del ácido araquidónico aparte de que existen múltiples factores externos que juegan un papel determinante en su desarrollo. Por otro lado, a pesar de que los pacientes refieran el antecedente de cualquier tipo de reacción previa a la aspirina o a algún otro antiinflamatorio no esteroideo (AINE), el diagnóstico definitivo ha de hacerse con una provocación protocolizada a la aspirina. Evitar la administración de aspirina y de otros AINEs es la primera medida terapéutica para estos pacientes. Sin embargo, dado que el uso de estos fármacos suele ser habitual, es preciso realizar un diagnóstico de certeza ante la mínima sospecha. La desensibilización a la aspirina puede ser una óptima opción terapéutica que además mejore el devenir clínico del paciente

The aspirin-exacerbated respiratory disease (AERD), is an inflammatory syndrome of the airway that is accompanied by asthma, nasal polyposis and chronic sinusitis that usually requires surgery and in many cases, cycles of systemic corticosteroids to control the disease. Although its pathogenesis remains unknown, it is believed that the main cause may be a pathological metabolism of arachidonic acid, apart from the fact that there are multiple external factors that play a determining role in its development. On the other hand, although patients refer history of any previous reaction to aspirin or some other non-steroidal anti-inflammatory drug (NSAIDs), the definitive diagnosis must be made with a protocolized challenge to aspirin. Avoiding the administration of aspirin and other NSAIDs is the first therapeutic measure for these patients. However, since the use of these drugs is usually habitual, it is necessary to make a diagnosis of certainty at the slightest suspicion. The desensitization to aspirin can be an optimal long term therapeutic option that also improves the clinical evolution of the patient

Humanos , Aspirina/efeitos adversos , Doenças Respiratórias/induzido quimicamente , Asma/induzido quimicamente , Pólipos Nasais/induzido quimicamente , Sinusite/induzido quimicamente , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/fisiopatologia , Exacerbação dos Sintomas , Aspirina/uso terapêutico , Síndrome , Doença Crônica
Rev. esp. patol. torac ; 31(2): 124-131, jun. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183653


Objetivo: determinar si la lectura del software de equipos de ventilación no invasiva (VMNI) domiciliaria puede predecir una exacerbación mediante la evaluación de los siguientes parámetros: frecuencia respiratoria, número de respiraciones activadas por el paciente, fuga y cumplimiento. Metodología: estudio prospectivo observacional en el que se compararon variables del software del ventilador en pacientes ventilados en domicilio. Se detectaron las exacerbaciones que requirieron ingreso hospitalario por acidosis respiratoria y se compararon las variables recogidas en este grupo de pacientes en situación estable y en los 10 días previos al ingreso. Resultados: se analizaron 43 pacientes (18 con diagnóstico de enfermedad pulmonar obstructiva crónica (EPOC) y 25 con síndrome de obesidad-hipoventilación (SOH)). No se encontraron diferencias significativas en los parámetros estudiados en situación estable al comparar los pacientes que no ingresaron con los pacientes que precisaron un ingreso posteriormente. La tasa de exacerbación global fue de 32,55% (el 44% de los pacientes diagnosticados de EPOC y el 24% del total de los pacientes con SOH) Al comparar las variables del software en los pacientes exacerbados, en situación estable y previas al ingreso, encontramos diferencias significativas (p = 0,017) en la frecuencia respiratoria, que se mostró más elevada previo a la exacerbación, con una diferencia entre medianas de 2 (0,75 - 3,5). Respecto a las respiraciones activadas, no se encontró una significación estadística, aunque sí una tendencia a la significación (p = 0,055), de forma que existía un mayor porcentaje de respiraciones activadas por el paciente previo a la exacerbación, con una diferencia entre medianas de 8 (-1- 21). Conclusiones: el estudio de variables asociadas a la monitorización de la VMNI domiciliaria puede ser útil como predictor de exacerbaciones. En nuestro caso la frecuencia respiratoria fue la más sensible mostrando un aumento previo al ingreso hospitalario

Objective: to determine if the readings from the built-in software (BIS) used in non-invasive ventilation (NIV) at home can predict an exacerbation by evaluating of parameters like respiratory rate, percentage of respiratory cycles triggered by the patient, leaks and daily use. Method: an observational prospective study comparing the variables of the BIS obtained from patients using NIV at home. Exacerbations that required hospitalization for respiratory acidosis were detected, and the variables collected in this group of patients in a stable situation were compared with the variables collected 10 days prior to admission. Results: we analyzed 43 patients (18 with chronic obstructive pulmonary disease (COPD) and 25 with obesityhypoventilation syndrome (OHS)). There were no significant differences in the parameters studied in stable situation when we compared patients who did not need an admission with patients who required admission later. The overall exacerbation rate was 32.55% (44% of patients diagnosed with COPD and 24% of patients diagnosed with SOH). When comparing the software variables in the exacerbated patients, both in a stable situation and prior to admission, we found significant differences (p= 0.017) in the respiratory rate, which was higher prior to the exacerbation, presenting a difference between medians of 2 (0.75 - 3.5). Regarding respiratory cycles triggered by the patient no statistical significance was found, although a trend towards statistical significance was found (p = 0.055), so that there was a higher percentage of respirtory cycles triggered by the patient prior to exacerbation, presenting a difference between medians of 8 (-1 - 21). Conclusions: the study of variables associated with the monitoring of NIV at home may be useful as a predictor of exacerbations. In our case the respiratory rate was the most sensitive, showing an increment of their values prior to a hospital admission

Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Respiração Artificial/métodos , Exacerbação dos Sintomas , Acidose Respiratória/terapia , Doença Pulmonar Obstrutiva Crônica/terapia , Síndrome de Hipoventilação por Obesidade/complicações , Respiração Artificial/instrumentação , Estudos Prospectivos , Síndrome de Hipoventilação por Obesidade/terapia , Estudos de Coortes
Monaldi Arch Chest Dis ; 89(2)2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31122005


The aim of this study is to evaluate, in patients hospitalized for COPD exacerbation, how educational level, marital status and sex (social gender indicators) affect the prognosis (main effects) and how interact with each other in affecting prognosis (effect modification). Data for all patients discharged with a principal diagnosis of COPD with exacerbation (ICD-9 491.21) by Apulian facilities between 2013 and 2017 were retrieved from the National Hospital Discharge Register Database. A multivariable multi-stratified frailty cox proportional-hazard regression with interaction terms was fitted in order to assess the effect of sex, educational level and marital status on the time-to-event for home discharge through the estimation of hazard ratios. Adjusting for several hospitalization characteristics and for healthcare facilities, low educational level (<8 years of schooling) seems to be a risk factor in both sexes and in all marital status categories (HR 0.92, 95%CI 0.87-0.97, p=0.0020). Female sex seems to be a risk factor only in married patients (HR 0.83, 95%CI 0.78-0.88, p<0.0001). Marital status different from married seems to be a risk factor only in male patients, in particular single patients (HR 0.82, 95%CI 0.74-0.92, p=0.0009), separated or divorced patients (HR 0.71, 95%CI 0.58-0.86, p=0.0005) and widowed patients (HR 0.87, 95%CI 0.80-0.95, p=0.0018). Differently from findings about protective effect of education, the evidence of different effects of sex among civil statuses and of different effect of civil status among sexes is supposed to be a proxy for social gender health and healthcare inequalities.

Tempo de Internação/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Escolaridade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Estado Civil , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/terapia , Estudos Retrospectivos , Fatores Sexuais , Exacerbação dos Sintomas
Med. clín (Ed. impr.) ; 152(9): 333-338, mayo 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183657


Introducción y objetivo: La relación entre la contaminación ambiental y las enfermedades respiratorias ha sido ampliamente descrita, pero existen menos trabajos referentes a la contaminación y asma en nuestro medio. El objetivo del estudio fue analizar el efecto de la contaminación ambiental sobre las agudizaciones de asma. Material y métodos: Se trata de un estudio observacional. Se incluyeron en el análisis los ingresos hospitalarios diarios y las consultas a urgencias diarias en el Hospital Universitari Germans Trias i Pujol (Badalona, Barcelona) entre 2008 y 2016 de aquellos pacientes con diagnóstico de asma agudizada. Se obtuvieron los valores diarios de temperatura, humedad relativa, presión atmosférica y los niveles de NO2, SO2 y CO. Mediante regresión de Poisson simple se estudió la asociación entre estos factores y el número de hospitalizaciones y urgencias mediante regresiones simples para el mismo día y para entre uno y 4 días más tarde (lags 0 a 4). Se corrigió el efecto de las múltiples comparaciones. Resultados: Se asociaron con un incremento en las hospitalizaciones por asma la baja temperatura (lags 0 a 4) y los incrementos en los niveles de NO2 (lags 0, 1, 2 y 4) y presión atmosférica (lags 2 y 3). Al analizar las urgencias, estas se asociaron con la baja temperatura (lags 0, 1, 2, 3 y 4) y los incrementos en los niveles de NO2 (lags 2, 3 y 4). Conclusiones: La baja temperatura y la elevada concentración ambiental de NO2 se asocian con un incremento en las consultas a urgencias y hospitalizaciones por agudización de asma bronquial

Introduction and objective: Air pollution has been widely associated with respiratory diseases. Nevertheless, association between air pollution and exacerbations of asthma in our area has been less studied. To analyse the effect of air pollution on exacerbations of asthma in Badalona. Material and methods: This was an observational study conducted in Badalona. The number of daily hospital admissions and accident and emergency visits related to exacerbation of asthma between 2008 and 2016 was obtained. We used simple Poisson regressions to test the effects of daily mean temperature, atmospheric pressure, relative humidity, and NO2, SO2 and CO levels on asthma-related emergencies and hospitalisations the same day and 1-4 days after. All p-values were corrected for multiple comparisons. Results: The number of hospitalisations was associated with low temperature (lags 0 to 4) and higher levels of NO2 (lags 0, 1, 2 and 4) and atmospheric pressure (lags 2 and 3). The number of accident and emergency visits was associated with low temperature (lags 0 to 4) and higher levels of NO2 (lags 2, 3 and 4). Conclusions: The number of accident and emergency visits and hospitalisations for exacerbation of asthma is associated with higher levels of NO2 and with lower temperatures

Humanos , Masculino , Feminino , Adulto , Efeitos da Contaminação do Ar/efeitos adversos , Asma/etiologia , Exacerbação dos Sintomas , Asma/epidemiologia , Espanha/epidemiologia , Estudos Retrospectivos , Dióxido de Enxofre/efeitos adversos , Dióxido de Enxofre/análise , Dióxido de Nitrogênio/efeitos adversos , Dióxido de Nitrogênio/análise , Monóxido de Carbono/efeitos adversos , Monóxido de Carbono/análise
Arch Dermatol Res ; 311(6): 461-467, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31025101


Some researches with different designs investigated the seasonal pattern of psoriasis; however, the seasonal variation in public interest in psoriasis has not yet been examined. The monitoring of internet search activity has increasingly been used to gain insights into public interest in health-related topics. The aim of the investigation is to employ the Google Trends datasets to evaluate whether a seasonal trend exists in the internet searches of psoriasis by the general public. In the observational investigation, the Google Trends was queried for the [psoriasis] in the United States, the United Kingdom, Canada, Ireland, Australia, and New Zealand between January 2004 and December 2018. The cosinor analysis demonstrated a statistically significant seasonal pattern of searches for [psoriasis] in the United Kingdom (p < 0.001), Canada (p = 0.002), Ireland (p < 0.001), Australia (p < 0.001), and New Zealand (p < 0.001), and a trend towards a seasonal variation in searches in the United States (p = 0.079), with the zenith in late winter/early spring and through in late summer/early fall. A zenith in late winter/early spring and valley in late summer/early fall presented an approximately 6-month difference between hemispheres. Public interest in seeking psoriasis information through internet searches displayed a seasonal pattern, with the highest interest in the late winter/early spring. If a more comprehensive study validated the association of psoriasis flares with patterns in online searches, beyond investigating only seasonality in public interest, the internet data could be used to guide public health interventions and to manage the care of patients with psoriasis.

Comportamento de Busca de Informação , Internet/tendências , Psoríase/patologia , Ferramenta de Busca/tendências , Austrália , Canadá , Humanos , Irlanda , Nova Zelândia , Estações do Ano , Exacerbação dos Sintomas , Reino Unido , Estados Unidos
Arq Neuropsiquiatr ; 77(3): 179-183, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30970131


OBJECTIVE: To determine the prevalence of bruxism and related factors in patients with multiple sclerosis (MS). METHODS: Diagnosed with relapsing-remitting MS under the 2010-revised McDonald diagnostic criteria, 182 patients without MS exacerbations during the previous three months were included in the patient group, and 145 healthy individuals made up the control group in the study. Demographic data of the participants in both groups were determined. In the patient and control groups, the diagnosis of definite bruxism was made using the International Classification of Sleep Disorders (Diagnosis and Coding Manual, Second Edition). RESULTS: Bruxism was found in 29.7% (n = 54) of the patients and in 12.4% (n = 18) of the controls, and the difference was statistically significant (p < 0.001). Of all patients, the onset of bruxism was found in 70.4% (n = 38) after the diagnosis and in 29.6% (n = 169) prior to the diagnosis of MS. Compared with those without bruxism, the mean age (p = 0.031) and the score of the Expanded Disability Status Scale (p = 0.001) were also significantly higher among MS patients with bruxism. Between MS patients with and without bruxism, no significant differences were found in terms of sex, marital status, educational status, employment, cigarette smoking, total number of exacerbations, number of exacerbations within the previous year, and drugs used. CONCLUSIONS: The frequency of bruxism was found to be higher in the patients with MS than in the controls. Bruxism is associated with age and the Expanded Disability Status Scale score in MS patients.

Bruxismo/epidemiologia , Esclerose Múltipla Recidivante-Remitente/epidemiologia , Adulto , Idade de Início , Bruxismo/etiologia , Bruxismo/fisiopatologia , Estudos de Casos e Controles , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/complicações , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Prevalência , Índice de Gravidade de Doença , Fatores Socioeconômicos , Estatísticas não Paramétricas , Exacerbação dos Sintomas , Turquia/epidemiologia
Psiquiatr. biol. (Internet) ; 26(1): 15-21, ene.-abr. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185022


El trastorno bipolar (TB) es una enfermedad mental grave, de carácter crónico y altamente incapacitante. La clínica principal se basa en severos cambios del ánimo que tienen una duración de semanas a meses. Las descompensaciones agudas de la enfermedad requieren con frecuencia una hospitalización, debido a la presencia de síntomas psicóticos, el alto riesgo de conductas suicidas, o las alteraciones de conductas de los pacientes. Los episodios maniacos o hipomaniacos son los que determinan el diagnóstico, los cuales estarán intercalados por episodios depresivos y periodos de recuperación total o parcial. En el caso de TBI observaremos episodios maniacos y, en TB II, episodios hipomaniacos. Estos cambios anímicos son los que provocan en el paciente un importante deterioro social, laboral y personal. En el presente trabajo nos centramos en 2subtipos de TB, el tipo I y el tipo II. Realizaremos una revisión bibliográfica sobre las variables clínicas, evolutivas y pronósticas

Bipolar disorder (BD) is a chronic and highly disabling mental illness. The clinical signs include severe alterations in the mood of the patient, which can last from few days to weeks. The decompensation of the disease often requires hospital admission because of the presence of psychotic symptoms, the high risk of suicidal, and alterations in behaviour. The manic or hypomanic episodes determine the diagnosis. It should be noted that the treatment is characterised by intermittent episodes where the patient feels depressive, and periods where the recovery can seem to be total. While manic episodes can be observed in the case of BD I, in BD II hypomanic episodes could appear. These changes in the mood of the patients are the main cause of a significant deterioration in the social, work and personal life. The present work focuses on the mentioned 2subtypes of BD, carrying out a review of the literature dealing with clinical, evolutionary, and prognostic variables

Humanos , Transtorno Bipolar/classificação , Transtornos Bipolares e Relacionados/diagnóstico , Prognóstico , Transtornos Psicóticos/diagnóstico , Avaliação de Sintomas , Exacerbação dos Sintomas , Transtorno Depressivo/diagnóstico , Diagnóstico Diferencial , Carência Psicossocial