RESUMO
Intermediate uveitis is described as inflammation in the anterior vitreous, ciliary body and the peripheral retina. It is a subset of uveitis where the vitreous is the major site of damage. It has been reported to be associated with many local and systemic inflammatory and infectious diseases. An infrequent cause is the tubulointerstitial nephritis and uveitis syndrome. We report a case of an acute visual acuity loss related with renal failure in a 64 years old woman with Hashimoto disease. It was an acute tubulointerstitial nephritis and uveitis syndrome case.
Assuntos
Cegueira/etiologia , Nefrite Intersticial/complicações , Uveíte/complicações , Doença Aguda , Cegueira/diagnóstico por imagem , Feminino , Doença de Hashimoto , Humanos , Pessoa de Meia-Idade , Nefrite Intersticial/diagnóstico , Síndrome , Ultrassonografia , Uveíte/diagnóstico , Acuidade VisualRESUMO
BACKGROUND: The role of oral vitamin D3 supplementation for hospitalized patients with COVID-19 remains to be determined. The study was aimed to evaluate whether vitamin D3 supplementation could prevent respiratory worsening among hospitalized patients with COVID-19. METHODS AND FINDINGS: We designed a multicentre, randomized, double-blind, sequential, placebo-controlled clinical trial. The study was conducted in 17 second and third level hospitals, located in four provinces of Argentina, from 14 August 2020 to 22 June 2021. We enrolled 218 adult patients, hospitalized in general wards with SARS-CoV-2 confirmed infection, mild-to-moderate COVID-19 and risk factors for disease progression. Participants were randomized to a single oral dose of 500 000 IU of vitamin D3 or matching placebo. Randomization ratio was 1:1, with permuted blocks and stratified for study site, diabetes and age (≤60 vs >60 years). The primary outcome was the change in the respiratory Sepsis related Organ Failure Assessment score between baseline and the highest value recorded up to day 7. Secondary outcomes included the length of hospital stay; intensive care unit admission; and in-hospital mortality. Overall, 115 participants were assigned to vitamin D3 and 105 to placebo (mean [SD] age, 59.1 [10.7] years; 103 [47.2%] women). There were no significant differences in the primary outcome between groups (median [IQR] 0.0 [0.0-1.0] vs 0.0 [0.0-1.0], for vitamin D3 and placebo, respectively; p = 0.925). Median [IQR] length of hospital stay was not significantly different between vitamin D3 group (6.0 [4.0-9.0] days) and placebo group (6.0 [4.0-10.0] days; p = 0.632). There were no significant differences for intensive care unit admissions (7.8% vs 10.7%; RR 0.73; 95% CI 0.32 to 1.70; p = 0.622), or in-hospital mortality (4.3% vs 1.9%; RR 2.24; 95% CI 0.44 to 11.29; p = 0.451). There were no significant differences in serious adverse events (vitamin D3 = 14.8%, placebo = 11.7%). CONCLUSIONS: Among hospitalized patients with mild-to-moderate COVID-19 and risk factors, a single high oral dose of vitamin D3 as compared with placebo, did not prevent the respiratory worsening. TRIAL REGISTRATION: ClincicalTrials.gov Identifier: NCT04411446.
Assuntos
Tratamento Farmacológico da COVID-19 , Vitamina D , Adulto , Colecalciferol , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Vitamina D/uso terapêutico , Vitaminas/uso terapêuticoRESUMO
Tuberculosis is a chronic infectious disease endemic in Argentina most often localized in the lungs, caused by Mycobacterium tuberculosis. It usually afflicts poor population groups and has a significant impact on public health. COVID-19 is an acute viral disease caused by SARS-CoV-2 presenting with a typical respiratory localization, which eventually displays clinical and radiological similarities with pulmonary tuberculosis. Both entities can have a fatal outcome if they are not diagnosed and treated on time. We present a case series where pulmonary tuberculosis and COVID-19 were diagnosed simultaneously.
La tuberculosis es una enfermedad infecciosa crónica endémica en la República Argentina causada por Mycobacterium tuberculosis, cuya localización más frecuente es la pulmonar. Suele afectar grupos poblacionales carenciados y tiene gran repercusión sobre la salud pública. COVID-19 es una infección viral aguda caus 101-ada por SARS-CoV-2 que tiene típico compromiso respiratorio y, en ocasiones, puede presentar similitudes clínicas y radiológicas con la tuberculosis pulmonar. Ambas entidades pueden tener desenlace fatal si no son diagnosticadas y tratadas a tiempo. Presentamos una serie de casos en los que se diagnosticó tuberculosis pulmonar y COVID-19 en forma simultánea.
Assuntos
COVID-19 , Coinfecção , Tuberculose , Argentina/epidemiologia , Humanos , SARS-CoV-2RESUMO
SARS-CoV-2 causes the disease named COVID-19, which emerged in Wuhan, China, in December 2019 and developed into the current pandemic. The manifestations of SARS-CoV-2 infection are highly variable. The worst outcomes are usually associated with advanced age and known risk factors. Among these, it would be reasonable to consider conditions compromising the immune system, particularly the immunodeficiency associated to HIV. To date, however, there is no evidence of HIV infection worsening the evolution and prognosis of COVID-19. Pneumocystis jirovecii (previously-P. carinii) pneumonia, is a fungal disease that most commonly affects immunocompromised persons and can be life-threatening. Typically, patients at risk are those with any underlying condition altering host immunity. We present the case of a middle-aged woman with Raynaud's syndrome who was admitted with pneumonia. During hospitalization she was simultaneously diagnosed with infection by HIV, COVID-19 and P. jirovecci. The patient evolved favorably upon empirical treatment without requiring invasive maneuvers or ventilatory support. Outpatient follow-up after hospital discharge was uneventful.
El SARS-CoV-2 es el virus causante de la enfermedad COVID-19, desconocida antes del brote que ocurrió en diciembre de 2019 en Wuhan, China, y desencadenó la actual pandemia. Las manifestaciones de la infección por SARS-CoV-2 son muy variables entre los pacientes. Los peores desenlaces se suelen asociar a edad avanzada y factores de riesgo reconocidos. Entre estos sería razonable considerar los distintos tipos de inmunodeficiencia, en particular la producida por HIV. Sin embargo, no existen hasta el momento, estudios que demuestren que la infección HIV empeore la evolución y el pronóstico de COVID-19. La neumonía por el hongo Pneumocystis jirovecii (antes denominado P. carinii) afecta con mayor frecuencia a inmunodeprimidos y puede tener desenlace fatal. Exponemos el caso de una mujer de mediana edad con síndrome de Raynaud que ingresó con neumonía y durante la internación se le diagnosticó infección simultánea por HIV, SARS-CoV-2 y P. jirovecci. Evolucionó de forma favorable con tratamiento empírico sin requerir maniobras invasivas ni soporte ventilatorio, logrando el alta y seguimiento de forma ambulatoria.
Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por HIV/diagnóstico , Pandemias , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/diagnóstico , Pneumonia Viral , Betacoronavirus , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico , Coronavirus , Feminino , Humanos , Pessoa de Meia-Idade , SARS-CoV-2 , Síndrome Respiratória Aguda GraveRESUMO
Dengue is a mosquito-borne viral disease confined to the geographical areas where its vectors Aedes aegypti and Aedes albopictus are present. The transmission occurs mainly during the summer but it can extend to autumn months in warm climates. In our country, this year the seasonal transmission o f dengue overlapped with the COVID-19 pandemic, caused by SARS-CoV-2, a novel coronavirus responsible of serious respiratory conditions with eventual fatal outcomes. On the other hand, the HIV is a retrovirus that causes disease by weakening the immune system, favoring infections by numerous opportunistic pathogens. We present the case of an untreated HIV patient who developed simultaneous infection with dengue and SARS-CoV-2 with favorable evolution.
El dengue es una arbovirosis confinada a las áreas geográficas donde habitan sus vectores, los mosquitos Aedes aegypti y Aedes albopictus. La transmisión ocurre principalmente durante el verano, pero la persistencia del insecto en el ambiente puede extenderla hasta el otoño en climas templados y cálidos. En nuestro país, este año la trasmisión estacional del dengue se superpuso temporalmente con la pandemia de COVID-19, producida por el SARS-CoV-2, un coronavirus causante de afecciones respiratorias graves con eventual desenlace fatal. Por otro lado, el HIV es un retrovirus que debilita el sistema inmune favoreciendo las infecciones por numerosos patógenos oportunistas. Presentamos el caso de un paciente con infección HIV sin tratamiento que desarrolló infección simultánea por dengue y SARS-CoV-2 con evolución favorable.
Assuntos
Aedes , COVID-19 , Coinfecção , Vírus da Dengue , Dengue , Infecções por HIV , Animais , Dengue/complicações , Dengue/diagnóstico , Dengue/epidemiologia , Infecções por HIV/complicações , Humanos , Mosquitos Vetores , Pandemias , SARS-CoV-2RESUMO
Resumen El SARS-CoV-2 es el virus causante de la enfermedad COVID-19, desconocida antes del brote que ocurrió en diciembre de 2019 en Wuhan, China, y desencadenó la actual pandemia. Las manifestaciones de la infección por SARS-CoV-2 son muy variables entre los pacientes. Los peores desenlaces se suelen asociar a edad avanzada y factores de riesgo reconocidos. Entre estos sería razonable considerar los distintos tipos de inmunodeficiencia, en particular la producida por HIV. Sin embargo, no existen hasta el momento, estudios que demuestren que la infección HIV empeore la evolución y el pronóstico de COVID-19. La neumonía por el hongo Pneumocystis jirovecii (antes denominado P. carinii) afecta con mayor frecuencia a inmunodeprimidos y puede tener desenlace fatal. Exponemos el caso de una mujer de mediana edad con síndrome de Raynaud que ingresó con neumonía y durante la internación se le diagnosticó infección simultánea por HIV, SARS-CoV-2 y P. jirovecci. Evolucionó de forma favorable con tratamiento empírico sin requerir maniobras invasivas ni soporte ventilatorio, logrando el alta y seguimiento de forma ambulatoria.
Abstract SARS-CoV-2 causes the disease named COVID-19, which emerged in Wuhan, China, in December 2019 and developed into the current pandemic. The manifestations of SARS-CoV-2 infection are highly variable. The worst outcomes are usually associated with advanced age and known risk factors. Among these, it would be reasonable to consider conditions compromising the immune system, particularly the immunodeficiency associated to HIV. To date, however, there is no evidence of HIV infection worsening the evolution and prognosis of COVID-19. Pneumocystis jirovecii (previously-P. carinii) pneumonia, is a fungal disease that most commonly affects immunocompromised persons and can be life-threatening. Typically, patients at risk are those with any underlying condition altering host immunity. We present the case of a middle-aged woman with Raynaud's syndrome who was admitted with pneumonia. During hospitalization she was simultaneously diagnosed with infection by HIV, COVID-19 and P. jirovecci. The patient evolved favorably upon empirical treatment without requiring invasive maneuvers or ventilatory support. Outpatient follow-up after hospital discharge was uneventful.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/diagnóstico , Pneumonia Viral , Infecções por HIV/diagnóstico , Infecções por Coronavirus/diagnóstico , Pneumocystis carinii/isolamento & purificação , Pandemias , Coronavirus , Técnicas de Laboratório Clínico , Síndrome Respiratória Aguda Grave , Betacoronavirus , Teste para COVID-19 , SARS-CoV-2 , COVID-19RESUMO
Resumen El dengue es una arbovirosis confinada a las áreas geográficas donde habitan sus vectores, los mosquitos Aedes aegypti y Aedes albopictus. La transmisión ocurre principalmente durante el verano, pero la persistencia del insecto en el ambiente puede extenderla hasta el otoño en climas templados y cálidos. En nuestro país, este año la trasmisión estacional del dengue se superpuso temporalmente con la pandemia de COVID-19, producida por el SARS-CoV-2, un coronavirus causante de afecciones respiratorias graves con eventual desenlace fatal. Por otro lado, el HIV es un retrovirus que debilita el sistema inmune favoreciendo las infecciones por numerosos patógenos oportunistas. Presentamos el caso de un paciente con infección HIV sin tratamiento que desarrolló infección simultánea por dengue y SARS-CoV-2 con evolución favorable.
Abstract Dengue is a mosquito-borne viral disease confined to the geographical areas where its vectors Aedes aegypti and Aedes albopictus are present. The transmission occurs mainly during the summer but it can extend to autumn months in warm climates. In our country, this year the seasonal transmission of dengue overlapped with the COVID-19 pandemic, caused by SARS-CoV-2, a novel coronavirus responsible of serious respiratory conditions with eventual fatal outcomes. On the other hand, the HIV is a retrovirus that causes disease by weakening the immune system, favoring infections by numerous opportunistic pathogens. We present the case of an untreated HIV patient who developed simultaneous infection with dengue and SARS-CoV-2 with favorable evolution.
Assuntos
Humanos , Animais , Aedes , Dengue/complicações , Dengue/diagnóstico , Vírus da Dengue , Coinfecção , COVID-19 , Infecções por HIV/complicações , Dengue/epidemiologia , Pandemias , Mosquitos Vetores , SARS-CoV-2RESUMO
Resumen La tuberculosis es una enfermedad infecciosa crónica endémica en la República Argentina causada por Mycobacterium tuberculosis, cuya localización más frecuente es la pulmonar. Suele afectar grupos poblacionales carenciados y tiene gran repercusión sobre la salud pública. COVID-19 es una infección viral aguda caus 101-ada por SARS-CoV-2 que tiene típico compromiso respiratorio y, en ocasiones, puede presentar similitudes clínicas y radiológicas con la tuberculosis pulmonar. Ambas entidades pueden tener desenlace fatal si no son diagnosticadas y tratadas a tiempo. Presentamos una serie de casos en los que se diagnosticó tuberculosis pulmonar y COVID-19 en forma simultánea.
Abstract Tuberculosis is a chronic infectious disease endemic in Argentina most often localized in the lungs, caused by Mycobacterium tuberculosis. It usually afflicts poor population groups and has a significant impact on public health. COVID-19 is an acute viral disease caused by SARS-CoV-2 presenting with a typical respiratory localization, which eventually displays clinical and radiological similarities with pulmonary tuberculosis. Both entities can have a fatal outcome if they are not diagnosed and treated on time. We present a case series where pulmonary tuberculosis and COVID-19 were diagnosed simultaneously.
Assuntos
Humanos , Tuberculose , Coinfecção , COVID-19 , Argentina/epidemiologia , SARS-CoV-2RESUMO
El accidente cerebrovascular es la tercera causa de muerte y la primera de discapacidad en la Argentina. Los eventos isquémicos constituyen el 80% de los casos. Los accidentes vasculares cerebrales requieren la implementación de protocolos sistematizados que permitan reducir los tiempos en la atención, la morbilidad y mortalidad. En el consenso participaron especialistas de nueve sociedades médicas relacionadas con la atención de pacientes con enfermedad cerebrovascular. Se consensuó un temario separado en capítulos y para la redacción de los mismos se conformaron grupos de trabajo con miembros de diferentes especialidades médicas. Se discutió y acordó para cada tema el nivel de recomendación en base a la mejor evidencia clínica disponible para cada tópico. Se realizó una adaptación al ámbito local de las recomendaciones cuando se consideró necesario. El sistema de la American Heart Association se utilizó para redactar las recomendaciones y su grado de evidencia. La corrección y edición fue realizada por cinco revisores externos, que no participaron en la redacción y con amplia experiencia en enfermedad vascular. Finalizado el documento preliminar, se organizó una reunión general con todos los integrantes de los grupos de trabajo y los revisores para redactar las recomendaciones definitivas. El consenso abarca la atención del paciente con accidente cerebrovascular isquémico en la fase pre-hospitalaria, evaluación inicial en la central de emergencias, terapias de recanalización (trombolisis y/o trombectomía mecánica), craniectomía descompresiva, neuroimágenes y cuidados clínicos en la internación.
Stroke is the third cause of death and the first cause of disability in Argentina. Ischemic events constitute 80% of cases. It requires the implementation of systematized protocols that allow reducing the time of care, morbidity and mortality. Specialists from nine medical societies related to the care of patients with cerebrovascular disease participated in the consensus. A separate agenda was agreed upon in chapters and for the writing of them, work groups were formed with members of different medical specialties. The level of recommendation was discussed and agreed upon for each topic based on the best clinical evidence available for each of them. An adaptation to the local scope of the recommendations was made when it was considered necessary.The American Heart Association system was used to draft the recommendations and their level of evidence. The correction and editing were done by five external reviewers, who did not participate in the writing and with extensive experience in vascular pathology. Once the preliminary document was finalized, a general meeting was held with all the members of the working groups and the reviewers to reach final recommendations. The consensus covers the management of ischemic stroke in the pre-hospital phase, initial evaluation in the emergency center, recanalization therapies (thrombolysis and/ or mechanical thrombectomy), decompressive craniectomy, neuroimaging and clinical care in the hospital.
Assuntos
Humanos , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Isquemia Encefálica/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/epidemiologia , ArgentinaRESUMO
La uveítis intermedia es una enfermedad ocular caracterizada por la inflamación de la úvea, principalmente el vítreo anterior, la retina periférica y la pars plana. Diversas etiologías de carácter infeccioso, inflamatorio sistémico y local pueden asociarse a dicho fenómeno. Un cuadro infrecuente es el síndrome de nefritis túbulo-intersticial aguda asociado a uveítis. Presentamos el caso de una mujer de 64 años con antecedente de tiroiditis de Hashimoto, que desarrolló pérdida brusca de la agudeza visual en contexto de falla renal aguda. Se trata de una paciente con nefritis túbulo-intersticial aguda asociada a uveítis.
Intermediate uveitis is described as inflammation in the anterior vitreous, ciliary body and the peripheral retina. It is a subset of uveitis where the vitreous is the major site of damage. It has been reported to be associated with many local and systemic inflammatory and infectious diseases. An infrequent cause is the tubulointerstitial nephritis and uveitis syndrome. We report a case of an acute visual acuity loss related with renal failure in a 64 years old woman with Hashimoto disease. It was an acute tubulointerstitial nephritis and uveitis syndrome case.