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OBJECTIVE: Psychogenic nonepileptic seizures (PNES) are one of the most common differential diagnoses of epilepsy. This study provides an overview of diagnostic and treatment services for patients with PNES across Latin America. METHODS: In 2017-2018, clinicians practicing in Latin America with responsibilities for patients with PNES were contacted to respond to a survey regarding the management of this disorder developed by the International League Against Epilepsy (ILAE) PNES Task Force. RESULTS: Three hundred and sixty responses from 17 Latin American countries were analyzed. Most respondents were neurologists (81%) under 40â¯years of age (61%). Fifty-seven percent of professionals stated that they personally diagnose PNES, but only 33% stated that they provide follow-up, and only 20% that they recommend treatment. Many participants (54%) characterized themselves as either unfamiliar with the diagnosis or inexperienced in arranging treatment. Most respondents reported having access to brain magnetic resonance imaging (MRI; 88%) and routine electroencephalogram (EEG; 71%), 64% have the access to video-EEG longer than 8â¯h, and 54% of professionals performed video-EEG to confirm PNES diagnoses. Although cognitive-behavioral therapy was recognized as the treatment of choice (by 82% of respondents), there was little access to it (60%). In contrast, a high proportion of respondents reported using antidepressant (67%), antiseizure (57%), and antipsychotic medications (54%) as treatments for PNES. SIGNIFICANCE: This study reveals several deficiencies in the diagnosis and treatment of patients with PNES in Latin America. The barriers are reinforced by lack of knowledge among the specialists and poor healthcare system support. There is inadequate access to prolonged video-EEG and psychotherapy. An inappropriate use of antiseizure medicines seems commonplace, and there are low follow-up rates by neurologists after the diagnosis. Multidisciplinary guidelines are required to improve the approach of patients with PNES.
Assuntos
Epilepsia , Transtornos Psicofisiológicos , Eletroencefalografia , Epilepsia/diagnóstico , Epilepsia/epidemiologia , Epilepsia/terapia , Humanos , América Latina/epidemiologia , Convulsões/diagnóstico , Convulsões/terapia , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Patients with drug-resistant epilepsy (DRE) account for most of the burden of epilepsy, and they have poor prognosis in seizure control, higher morbidity, and mortality. OBJECTIVES: The objective of the study was to develop a prognostic model of drug resistance in adult patients with generalized epilepsy from Colombia. METHODS: In this case-control study of patients with generalized epilepsy, patients were separated into two groups: one group with DRE (cases) according to the new International League Against Epilepsy (ILAE) definition after a complete evaluation performed by an epileptologist and the other group without DRE (control). Variables were analyzed to identify statistical differences between groups and were then selected to construct a prognostic model from a logistic regression. RESULTS: One hundred thirty-three patients with generalized epilepsy were studied. Thirty-eight (28.5%) patients had DRE, and 95 (71.5%) did not have DRE. History of status epilepticus, abnormal findings from neurological examination, aura, any degree of cognitive impairment, epileptic seizures at any moment of the day, and any comorbidity were risk factors. The presence of seizures only in the waking state and idiopathic etiology were protective factors. A prognostic model was constructed with previously reported risk factors for DRE and other variables available in the population of this study. In the multivariable analysis, the history of status epilepticus (odds ratio (OR): 5.6, confidence interval (CI): 1.1-20.0, pâ¯=â¯0.031), abnormal findings from neurological examination (OR: 5.7, CI: 2.3-13.9, pâ¯=â¯0.000), and aura (OR: 6.1, CI: 1.8-20.8, pâ¯=â¯0.003) were strongly associated with DRE. CONCLUSIONS: In adult patients with generalized epilepsy, aura, abnormal findings from neurological examination, and history of status epilepticus were predictive factors for DRE.
Assuntos
Técnicas de Apoio para a Decisão , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Colômbia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
People with epilepsy (PWE) are less physically active compared with the general population. Explanations include prejudice, overprotection, unawareness, stigma, fear of seizure induction and lack of knowledge of health professionals. At present, there is no consensus on the role of exercise in epilepsy. This paper reviews the current evidence surrounding the risks and benefits associated with physical activity (PA) in this group of patients. In the last decade, several publications indicate significant benefits in physiological and psychological health parameters, including mood and cognition, physical conditioning, social interaction, quality of life, as well as potential prevention of seizure presentation. Moreover, experimental studies suggest that PA provides mechanisms of neuronal protection, related to biochemical and structural changes including release of ß-endorphins and steroids, which may exert an inhibitory effect on the occurrence of abnormal electrical activity. Epileptic discharges can decrease or disappear during exercise, which may translate into reduced seizure recurrence. In some patients, exercise may precipitate seizures. Available evidence suggests that PA should be encouraged in PWE in order to promote wellbeing and quality of life. There is a need for prospective randomized controlled studies that provide stronger clinical evidence before definitive recommendations can be made.
Assuntos
Epilepsia/psicologia , Exercício Físico/psicologia , Qualidade de Vida/psicologia , Esportes , Consenso , Humanos , Convulsões/complicaçõesRESUMO
Introduction: Chronic obstructive pulmonary disease (COPD) is a major global health problem causing high morbidity and mortality. Easy to apply, cost-effective, and available COPD severity measures are required in rural areas. Objective: To assess the validity and reliability of the COPD Severity Score (COPDSS) in Colombian patients attended in primary care. Materials and methods: A cross-sectional study was conducted in a sample of 100 patients diagnosed with COPD according to GOLD guidelines. Convergent validity was assessed by correlating the COPDSS results with other important variables such as those assessed through the Chronic Respiratory Disease Questionnaire (CRQ) and the forced expiratory volume in one second (FEV1). Results: The COPDSS showed a significant correlation with the FEV1 (r=-0.33), with the CRQ (r=-0.57) and its dimensions: Dyspnea (r=0.51), fatigue (r=0.53), emotional function (r=0.43), and disease control (r=0.50). The factor analysis identified a single factor with a cumulative variance of 59.1%. The internal consistency analysis showed an adequate Cronbach's alpha of 0.76. Conclusions: The use of the COPDSS as an assessment test for COPD patients in Colombia showed adequate validity, reliability, and easy application in primary care.
Introducción. La enfermedad pulmonar obstructiva crónica (EPOC) es un importante problema de salud mundial con una alta morbimortalidad. Se requiere la medición de la gravedad de la enfermedad mediante una herramienta de fácil aplicación, bajo costo y fácil disponibilidad en áreas rurales. Objetivo. Evaluar la validez y confiabilidad del puntaje de valoración de la gravedad de la EPOC (Chronic Obstructive Pulmonary Disease Severity Score, COPDSS) en una población de atención primaria en Colombia. Materiales y métodos. Se hizo un estudio de corte transversal en una muestra de 100 pacientes con diagnóstico de EPOC según las guías GOLD. La validez concurrente se evaluó correlacionando los resultados del COPDSS con otras variables de importancia como las del cuestionario sobre la enfermedad respiratoria crónica (Chronic Respiratory Disease Questionnaire, CRQ) y el volumen espiratorio forzado en el primer segundo (Forced Expiratory Volume in one second, FEV1). Resultados. El COPDSS presentó una correlación significativa con el FEV1 (r=-0,33), con el CRQ (r=-0,57) y sus dimensiones: disnea (r=0,51), fatiga (r=0,53), función emocional (r=0,43) y control de la enfermedad (r=0,50). En el análisis factorial se determinó un solo factor con una varianza acumulada de 59,1 %. El análisis de coherencia interna mostró un alfa de Cronbach de 0,76, valor este considerado adecuado. Conclusiones. Se observó que el uso del COPDSS como cuestionario de valoración de la gravedad de pacientes con EPOC en Colombia tenía validez y confiabilidad adecuadas y que es de fácil aplicación en la atención primaria.
Assuntos
Inquéritos Epidemiológicos/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Índice de Gravidade de Doença , Idoso , Colômbia , Estudos Transversais , Dispneia/diagnóstico , Emoções , Fadiga/diagnóstico , Feminino , Volume Expiratório Forçado , Hospitalização , Humanos , Masculino , Oxigenoterapia , Atenção Primária à Saúde , Doença Pulmonar Obstrutiva Crônica/classificação , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Reprodutibilidade dos Testes , Fatores de Risco , Espirometria , Avaliação de Sintomas , Capacidade VitalRESUMO
The current SARS-CoV-2 pandemic has caused a huge global public health problem. We report the case of a young adult patient with laboratory-confirmed SARS-CoV-2. We describe the identification of the virus and the clinical course, diagnosis, and treatment of the infection including her rapid clinical deterioration from the mild initial symptoms, which progressed to multilobar pneumonia requiring admission to the intensive care unit. This case highlights the importance of establishing a diagnosis based on the clinical findings and the patient's history bearing in mind the possibility of gastrointestinal symptoms in addition to respiratory ones. Besides, the presence of risk factors should be investigated; in this case, we proposed obesity as a possible risk factor. Furthermore, limitations in diagnostic tests and the possibility of co-infection with other respiratory pathogens are highlighted. We describe the imaging, laboratory findings, and treatment taking into account the limited current evidence.
La actual pandemia por SARS-CoV-2 ha ocasionado un enorme problema de salud pública mundial. Se reporta el caso de una paciente adulta joven con SARS-CoV-2 confirmado por laboratorio. Se describe la identificación del virus y el curso clínico, el diagnóstico y el tratamiento de la infección. La paciente tuvo un rápido deterioro clínico a partir de síntomas iniciales leves que progresaron a una neumonía multilobar que requirió su hospitalización en la unidad de cuidados intensivos. Se destaca la importancia de establecer un diagnóstico basado en la clínica y los antecedentes del paciente, y considerando los posibles síntomas gastrointestinales además de los respiratorios. Asimismo, debe indagarse sobre la presencia de factores de riesgo, en este caso, la obesidad. También se señalan las limitaciones en las pruebas diagnósticas y la posibilidad de infección concomitante con otros agentes patógenos respiratorios, así como los hallazgos en las imágenes diagnósticas, los exámenes de laboratorio y el tratamiento en el marco de la limitada información con que se cuenta actualmente.
Assuntos
Betacoronavirus/isolamento & purificação , Coinfecção/virologia , Infecções por Coronavirus/complicações , Enterovirus/isolamento & purificação , Infecções por Picornaviridae/complicações , Pneumonia Viral/complicações , Rhinovirus/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico , Terapia Combinada , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/terapia , Cuidados Críticos , Estado Terminal , Progressão da Doença , Infecções por Enterovirus/complicações , Infecções por Enterovirus/diagnóstico , Feminino , Humanos , Tempo de Internação , Pandemias , Infecções por Picornaviridae/diagnóstico , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/terapia , Respiração Artificial , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/terapia , SARS-CoV-2RESUMO
Not available.
Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Acidente Vascular Cerebral/etiologia , COVID-19 , Infecções por Coronavirus/sangue , Humanos , Pandemias , Pneumonia Viral/sangue , SARS-CoV-2RESUMO
Introduction: Deep brain stimulation is a safe and effective neurointerventional technique for the treatment of movement disorders. Electrical stimulation of subcortical structures may exert a control on seizure generators initiating epileptic activities. The aim of this review is to present the targets of the deep brain stimulation for the treatment of drug-resistant epilepsy. Methods: We performed a structured review of the literature from 1980 to 2018 using Medline and PubMed. Articles assessing the impact of deep brain stimulation on seizure frequency in patients with DRE were selected. Meta-analyses, randomized controlled trials, and observational studies were included. Results: To date, deep brain stimulation of various neural targets has been investigated in animal experiments and humans. This article presents the use of stimulation of the anterior and centromedian nucleus of the thalamus, hippocampus, basal ganglia, cerebellum and hypothalamus. Anterior thalamic stimulation has demonstrated efficacy and there is evidence to recommend it as the target of choice. Conclusion: Deep brain stimulation for seizures may be an option in patients with drug-resistant epilepsy. Anterior thalamic nucleus stimulation could be recommended over other targets.
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La mucopolisacaridosis tipo IV-A es un trastorno de almacenamiento lisosómico poco frecuente, cuya manifestación clínica más evidente es la disostosis múltiple. Alteraciones multiorgánicas se han descrito en este tipo de pacientes, sin embargo, las manifestaciones cardiovasculares no han sido descritas con gran énfasis. Esta investigación tuvo como objetivo principal describir los hallazgos ecocardiográficos en pacientes pediátricos con mucopolisacaridosis tipo IV-A con mutación c.90iG>T en el gen GALNS. Se realizó un estudio descriptivo de serie de casos que incluyó pacientes con diagnóstico confirmado (clínico, bioquímico y molecular) de mucopolisacaridosis tipo IV-A; los pacientes asistieron a una institución hospitalaria en Pereira, Colombia, entre 2012 y 2019, donde se valoraron parámetros ecocardiográficos. Se incluyeron diez pacientes con edades comprendidas entre 3 y 18 años, media de 10. Las anomalías cardiacas identificadas fueron regurgitación mitral trivial RM en 4 de 10 pacientes, dilatación del anillo aórtico en 9 de 10, dilatación de la aorta ascendente, dilatación del arco transverso y del istmo aórtico en 1 de 10, área subaórtica levemente engrosada sin estenosis e hipertrofia ventricular izquierda concéntrica leve en 1 de 10 pacientes. La función ventricular fue normal en todos los pacientes. Los hallazgos ecocardiográficos más frecuentes fueron dilatación del anillo aórtico y regurgitación trivial de la válvula mitral, adicionalmente, pueden encontrarse válvulas mitral y aórtica engrosadas e hipertrofia ventricular izquierda, por lo que es importante una valoración periódica por cardiología pediátrica.
Mucopolysaccharidosis IV-A is a rare lysosomal storage disorder, whose most evident clinical manifestation is multiple dysostosis. Multiorgan disorders have been described in this type of patients, however, the Cardiovascular manifestations have not been described with greater emphasis. The main objective of this research was to describe the echocardiographic findings in pediatric patients with type IV-A mucopolysaccharidosis with c.901G>T mutation in the GALNS gene. A descriptive case series study was carried out, which included patients with a confirmed diagnosis (clinical, biochemical and molecular) of mucopolysaccharidosis type IV-A; the patients were attended a hospital institution in Pereira, Colombia, between 2012 and 2019, where echocardiography parameters were evaluated. Ten patients with ages ranging from 3 to 18 years, average 10, were included. The cardiac abnormalities identified were trivial mitral regurgitation in 4 of 10 patients, aortic annulus dilation in 9 of 10, dilatation of the ascending aorta, dilatation of the transverse arch and aortic isthmus in 1 of 10, slightly thickened subaortic area without stenosis and mild concentric left ventricular hypertrophy in 1 of 10 patients. Ventricular function was normal in all patients. The most frequent echocardiography findings were dilatation of the aortic annulus and trivial regurgitation of the mitral valve, additionally, thickened mitral and aortic valves and left ventricular hypertrophy may be found, so periodic evaluation by pediatric cardiology is important.
Assuntos
Humanos , Ecocardiografia , Mucopolissacaridose IV , Cardiopatias , Doenças por Armazenamento dos Lisossomos , ColômbiaRESUMO
Objetivo: identificar las variables clínicas que impactan en la mortalidad de los pacientes con falla cardiaca implantados con desfibrilador automático. La terapia con cardiodesfibrilador implantable busca prevenir la muerte súbita cardiaca por arritmias malignas colapsantes. Material y métodos: estudio de cohorte retrospectiva. Se incluyó a pacientes con implante de desfibrilador entre los años 2010-2012, con dispositivo funcional, historia clínica y disponibilidad de seguimiento hasta el primer trimestre del 2014. Resultados: un total de 30 pacientes fueron incluidos, con una supervivencia del 77% a los cuatro años de seguimiento. El 82,7% de los pacientes presentó cardiopatía isquémica y el promedio de la fracción de eyección ventricular izquierda fue 27,8 ± 6,3. El tiempo promedio de uso del desfibrilador fue de 2,1 años, la tasa de peligro mayor reportada fue del 6% para los días 759 y 760. Se encontró una asociación entre una duración del QRS mayor a 120 ms (HR= 7,7, IC 90%= 1,77- 33,6; p=0,022), fibrilación auricular (HR= 4,2, IC 90%=1,13-15,68; p=0,072) y el uso de beta-bloqueadores (HR= 0,15, IC 90%= 0,03 0,64; p=0,031) con el tiempo de supervivencia. Discusión: la prevención de muerte súbita está condicionada por la optimización farmacológica, así como las anomalías estructurales y de la conducción eléctrica, por lo cual se debe aumentar el seguimiento en estos casos y el ajuste de la terapia farmacológica. Conclusiones: el uso de beta bloqueadores en pacientes con falla cardiaca con fibrilación auricular y duración del QRS mayor de 120 ms es un factor protector..Au
Objective: to identify the clinical variables that impact on the mortality of patients with heart failure implanted with cardioverter defibrillator. Implantable cardioverter defibrillator therapy seeks to prevent sudden cardiac death by collapsing malignant arrhythmias. Material y methods: retrospective cohort study. Patients with a defibrillator implant from the year 2010 to the year 2012 were included, with functional device, clinical history and availability of follow-up until the first quarter of 2014. Results: a total of 30 patients were included, with a 77% survival at four years of follow-up. 82.7% of the patients presented with ischemic heart disease and the mean left ventricular ejection fraction was 27.8 ± 6.3. The mean time of use of the defibrillator was 2.1 years, the reported mayor danger rate was 6% for days 759 and 760. An association was found between a QRS mayor duration at 120 ms (HR = 7.7, 90% CI = 1.77-33.6, p = 0.022), atrial fibrillation (HR = 4.2, 90% CI = 1.13-15.68, p = 0.072), and beta- blockers (HR = 0.15, 90% CI = 0.03-0.64, p = 0.031) with survival time. Discussion: the prevention of death is conditioned by pharmacological optimization, as well as structural and electrical conduction anomalies, so the monitoring and adjustment of pharmacological therapy should be increased. Conclusions: the use of beta-blockers in patients with atrial fibrillation and QRS duration greater than 120 ms is a protective factor..Au
Assuntos
Humanos , Análise de Sobrevida , Desfibriladores ImplantáveisRESUMO
No disponible
Assuntos
Humanos , Infecções por Coronavirus/complicações , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave/patogenicidade , Doenças do Sistema Nervoso/epidemiologia , Infecções por Coronavirus/epidemiologia , Fatores de Risco , Pandemias/estatística & dados numéricosRESUMO
RESUMEN Objetivo: evaluar las tendencias de la mortalidad por VIH y sus factores asociados en el periodo 2002-2014 del municipio de Pereira. Materiales y métodos: estudio ecológico de serie temporal. Utiliza como fuente de información las bases de datos de certificados de defunción codificados por el Departamento Administrativo Nacional de Estadísticas. Las tendencias de la mortalidad se estimaron de acuerdo con las siguientes variables: edad, sexo, área de residencia y causa de muerte. Se realizó un análisis exploratorio con los datos en bruto, aplicando estadística descriptiva para el cálculo de porcentajes, medidas de tendencia central y variabilidad. Se aplicó regresión joinpoint para identificar tendencias en tasas ajustadas. Resultados: la mortalidad de los pacientes con infección por VIH en el periodo 2002-2014 fue en promedio de 11,9 por 100.000 habitantes. La mortalidad se mantuvo estable sin presentar variaciones estadísticamente significativas en el periodo evaluado (VPAP: 2,6; IC 95 %: -2,7 -8,1; p = 0,6), con una tendencia al aumento de 14,3 % por año, del año 2002 al año 2005, otra tendencia a la disminución de -1,1 % por año en el periodo 2005-2014. La mortalidad fue mayor en el sexo masculino, los pacientes de edad avanzada, aquellos con causas no infecciosas y que residen en la zona urbana. Conclusión: se presentó una alta mortalidad de los pacientes con infección por VIH y una tendencia sin variaciones significativas en el periodo 2002-2014 en la ciudad de Pereira, Colombia.
SUMMARY Objective: To evaluate trends in HIV mortality and its associated factors in the period 2002-2014 for the municipality of Pereira. Materials and methods: Ecological study, using as a source of information the databases of death certificates codified by the National Administrative Department of Statistics. The variables selected to estimate the trends were: age, sex, area of residence and cause of death. An exploratory analysis was carried out applying descriptive statistics for the calculation of percentages, measures of central tendency and variability. Joinpoint regression was applied to identify trends in adjusted rates. Results: The average mortality of patients with HIV infection in the period 2002-2014 was 11.9 per 100,000 people. Mortality remained stable without presenting statistically significant variations in the evaluated period (VPAP: 2.6, 95% CI: -2.7 -8.1, p = 0.6), with an increase of 14.3% per year from 2002 to the year 2005 and another tendency to decrease by -1.1% per year in the period 2005-2014. Mortality was greater in males, elderly patients, those with non-infectious diseases and residing in urban areas. Conclusion: There was a high mortality of patients with HIV infection and a trend without significant variations in the period of the years 2002-2014 in the city of Pereira, Colombia.
Assuntos
Humanos , Mortalidade , HIV , Síndrome da Imunodeficiência AdquiridaRESUMO
RESUMEN La tuberculosis es una de las principales causas de mortalidad en el mundo, a pesar de los múltiples controles y estrategias del tratamiento. La forma diseminada corresponde al 5 % de las presentaciones. Reportamos el primer caso en la literatura de una paciente adolescente con diabetes mellitus tipo 1 y tuberculosis diseminada quien presentó síntomas constitucionales asociados con un dolor lumbar, inicialmente interpretado como sacroileítis no infecciosa y una probable enfermedad inflamatoria intestinal.
SUMMARY Tuberculosis is one of the leading causes of mortality in the world despite multiple control and treatment strategies. Disseminated tuberculosis corresponds to 5% of cases. We report the first case in literature of an adolescent patient with type 1 diabetes mellitus and disseminated tuberculosis, who had constitutional symptoms associated with low back pain and was initially, interpreted initially as noninfectious sacroiliitis and a probable inflammatory bowel disease.
Assuntos
Humanos , Adolescente , Tuberculose , Diabetes Mellitus Tipo 1RESUMO
Resumen: Introducción. La enfermedad pulmonar obstructiva crónica (EPOC) es un importante problema de salud mundial con una alta morbimortalidad. Se requiere la medición de la gravedad de la enfermedad mediante una herramienta de fácil aplicación, bajo costo y fácil disponibilidad en áreas rurales. Objetivo. Evaluar la validez y contabilidad del puntaje de valoración de la gravedad de la EPOC (Chronic Obstructive Pulmonary Disease Severity Score, COPDSS) en una población de atención primaria en Colombia. Materiales y métodos. Se hizo un estudio de corte transversal en una muestra de 100 pacientes con diagnóstico de EPOC según las guías GOLD. La validez concurrente se evaluó correlacionando los resultados del COPDSS con otras variables de importancia como las del cuestionario sobre la enfermedad respiratoria crónica (Chronic Respiratory Disease Questionnaire, CRQ) y el volumen espiratorio forzado en el primer segundo (Forced Expiratory Volume in one second, FEV1). Resultados. El COPDSS presentó una correlación significativa con el FEV1 (r=-0,33), con el CRQ (r=-0,57) y sus dimensiones: disnea (r=0,51), fatiga (r=0,53), función emocional (r=0,43) y control de la enfermedad (r=0,50). En el análisis factorial se determinó un solo factor con una varianza acumulada de 59,1 %. El análisis de coherencia interna mostró un alfa de Cronbach de 0,76, valor este considerado adecuado. Conclusiones. Se observó que el uso del COPDSS como cuestionario de valoración de la gravedad de pacientes con EPOC en Colombia tenía validez y confiabilidad adecuadas y que es de fácil aplicación en la atención primaria.
Abstract: Introduction: Chronic obstructive pulmonary disease (COPD) is a major global health problem causing high morbidity and mortality. Easy to apply, cost-effective, and available COPD severity measures are required in rural areas. Objective: To assess the validity and reliability of the COPD Severity Score (COPDSS) in Colombian patients attended in primary care. Materials and methods: A cross-sectional study was conducted in a sample of 100 patients diagnosed with COPD according to GOLD guidelines. Convergent validity was assessed by correlating the COPDSS results with other important variables such as those assessed through the Chronic Respiratory Disease Questionnaire (CRQ) and the forced expiratory volume in one second (FEV1). Results: The COPDSS showed a significant correlation with the FEV1 (r=-0.33), with the CRQ (r=-0.57) and its dimensions: Dyspnea (r=0.51), fatigue (r=0.53), emotional function (r=0.43), and disease control (r=0.50). The factor analysis identified a single factor with a cumulative variance of 59.1%. The internal consistency analysis showed an adequate Cronbach's alpha of 0.76. Conclusions: The use of the COPDSS as an assessment test for COPD patients in Colombia showed adequate validity, reliability, and easy application in primary care.
Assuntos
Índice de Gravidade de Doença , Doença Pulmonar Obstrutiva Crônica , Atenção Primária à Saúde , Espirometria , Inquéritos e Questionários , ColômbiaRESUMO
La actual pandemia por SARS-CoV-2 ha ocasionado un enorme problema de salud pública mundial. Se reporta el caso de una paciente adulta joven con SARS-CoV-2 confirmado por laboratorio. Se describe la identificación del virus y el curso clínico, el diagnóstico y el tratamiento de la infección. La paciente tuvo un rápido deterioro clínico a partir de síntomas iniciales leves que progresaron a una neumonía multilobar que requirió su hospitalización en la unidad de cuidados intensivos. Se destaca la importancia de establecer un diagnóstico basado en la clínica y los antecedentes del paciente, y considerando los posibles síntomas gastrointestinales además de los respiratorios. Asimismo, debe indagarse sobre la presencia de factores de riesgo, en este caso, la obesidad. También se señalan las limitaciones en las pruebas diagnósticas y la posibilidad de infección concomitante con otros agentes patógenos respiratorios, así como los hallazgos en las imágenes diagnósticas, los exámenes de laboratorio y el tratamiento en el marco de la limitada información con que se cuenta actualmente.
The current SARS-CoV-2 pandemic has caused a huge global public health problem. We report the case of a young adult patient with laboratory-confirmed SARS-CoV-2. We describe the identification of the virus and the clinical course, diagnosis, and treatment of the infection including her rapid clinical deterioration from the mild initial symptoms, which progressed to multilobar pneumonia requiring admission to the intensive care unit. This case highlights the importance of establishing a diagnosis based on the clinical findings and the patient's history bearing in mind the possibility of gastrointestinal symptoms in addition to respiratory ones. Besides, the presence of risk factors should be investigated; in this case, we proposed obesity as a possible risk factor. Furthermore, limitations in diagnostic tests and the possibility of co-infection with other respiratory pathogens are highlighted. We describe the imaging, laboratory findings, and treatment taking into account the limited current evidence.
Assuntos
Rhinovirus , Infecções por Coronavirus , Pneumonia , Síndrome do Desconforto Respiratório do Recém-Nascido , Relatos de Casos , ColômbiaRESUMO
Resumen El cáncer de mama es una enfermedad con una importante incidencia y mortalidad entre las mujeres. Los factores genéticos en su génesis aún no han sido reconocidos completamente, pero se admite el importante papel que juegan los genes de predisposición como el BRCA1 y BRCA2, y otros genes de reciente aparición, en las formas hereditarias y principalmente en el fenotipo triple negativo. El cáncer de mama hereditario representa entre un 5-10 % del total de casos de esta patología. BRCA1 y BRCA2 son genes de gran tamaño, y su principal función es mantener la integridad cromosómica, reparando rupturas de doble cadena del ADN por medio de recombinación homóloga. Los otros genes de predisposición en su mayoría cumplen una función en el mantenimiento y reparación del DNA. Actualmente existen pruebas para detección de mutaciones de estos genes en pacientes en riesgo, las cuales permiten implementar intervenciones médicas tempranas, el respaldo psicológico a la persona y la obtención de un diagnóstico más confiable; lo cual a largo plazo podría reducir los altos costos del cáncer. Entre las terapias disponibles para estos pacientes se encuentran desde cirugías preventivas como la mastectomía bilateral y la salpingo-ooforectomía hasta tratamientos farmacológicos como el uso de tamoxifeno, anticonceptivos orales o los recientes inhibidores de la PARP (Poly ADP Ribose Poymerase). Esta revisión pretende hacer énfasis en las características biológicas, genéticas, diagnósticas y terapéuticas del cáncer de mama hereditario para todo el personal de salud.
Abstract Breast cancer is a disease with a significant incidence and mortality among women. Genetic factors in its genesis have not yet been fully recognized, but the important role of predisposing genes such as BRCA1 and BRCA2, and other newly discovered genes in hereditary forms and mainly in the triple negative phenotype are recognized. Hereditary breast cancer represents between 5-10 % of the total cases of this pathology. BRCA1 and BRCA2 are large genes, and their main function is to maintain chromosomal integrity, repairing double strand breaks of DNA by means of homologous recombination. The other predisposing genes, for the most part, play a role in the maintenance and repair of DNA. Currently, there are tests to detect mutations of these genes in patients at risk, implementing early medical interventions, psychological support to the person and obtaining a more reliable diagnosis; which in the long run could reduce the high costs of cancer. Among the available therapies for these patients are preventive surgeries such as bilateral mastectomy and salpingo-oophorectomy, pharmacological treatments such as the use of tamoxifen, oral contraceptives or the recent PARP inhibitors (Poly ADP Ribose Poymerase). The objective of this review is to emphasize the biological, genetic, diagnostic and therapeutic aspects of hereditary breast cancer for all health workers.
RESUMO
Comparar la supervivencia de pacientes con resincronizador cardíaco con o sin desfibrilador con la de pacientes con cardiodesfibrilador. Materiales y métodos: cohorte retrospectiva cuyo desenlace primario fue la mortalidad de origen cardíaco; la exposición fueron las terapias electrofisiológicas y la información se obtuvo de las historias clínicas y de otros registros médicos. Resultados: se estudiaron 70 pacientes de edad avanzada con dispositivos funcionales. El 82 % recibieron tratamiento farmacológico optimizado. No se encontró asociación significativa entre la probabilidad de supervivencia y la terapia de resincronización cardíaca con o sin cardiodesfibrilador versus la terapia con cardiodesfibrilador (log rank test p = 0,54), pero sí un mayor tiempo de supervivencia en los primeros (ANOVA p = 0,0012). La tasa de peligro fue 0,017 para el día 371 y del 0,15 para el día 2169. Durante el período de observación se presentaron 14 muertes, tres de ellas atribuibles a etiología no cardíaca. Conclusión: se observó que la terapia con resincronizador cardíaco se asoció de forma significativa con un mayor tiempo supervivencia...
To evaluate survival in patients with cardiac resynchronization with or without cardioverterdefibrillatorversus patients with implantable cardioverter-defibrillator alone. Materials and methods: Retrospective cohort, the primary end point was death from cardiac causes, the exposure was electrophysiological therapies, and the information sources were medical files and other records. Results: 70 elderly patients with functional devices; 82 % of them received optimized medical therapy. Nosignificant association was found between survival of patients with cardiac resynchronization therapy withor without defibrillator and cardioverter-defibrillator therapy alone (log rank test, p = 0.54), but the formerhad a longer survival time (ANOVA p = 0.0012). The hazard ratio was 0.017 for day 371 and 0.15 for day 169. Fourteen deaths occurred during the observation period, three of them from non-cardiac causes. Conclusion: Cardiac resynchronization therapy was associated with significantly longer survival time...
Comparar a sobrevivência de pacientes com ressincronizador cardíaco com ou sem desfibrilador em pacientes com desfibriladores. Materiais e métodos: corte retrospectivo de cujo principal resultado primário foi a mortalidade de origem cardíaca; a exposição foram as terapias e eletrofisiológicos e a informação foi obtida a partir da história clínica e outros registros médicos. Resultados: Foram estudados 70 pacientes idosos com dispositivos funcionais. 82 % receberam tratamento farmacológico otimizado. Não foi encontrado associação significativa entre a probabilidade de sobrevivencia e terapia de ressincronização cardíaca com ou sem cardiodesfibrilador versus a terapia cardiodesfibrilador (log rank test, p = 0,54 ), mas há um maior tempo de sobrevivência no primeiro (ANOVA, p = 0,0012 ). A taxa de risco foi 0,017 para o dia 371 e 0,15 para o dia 2169. Durante o período de observação, apresentaram 14 mortes, três deles atribuíveis a etiologia não cardíaca. Conclusão: constatou-se que a terapia com ressincronizador cardíaco foi significativamente asociado com um maior tempo de sobrevivência...