RESUMEN
El sangrado uterino anormal tiene una etiología variable, que va desde causas estructurales hasta causas funcionales, que se describen clásicamente en el acrónimo PALM-COEIN. No obstante, hay una pobre sensibilización de este síntoma como un marcador de enfermedades graves. En esta revisión se describe la relación de la hemorragia uterina anormal como síntoma clave o de presentación de malignidad hematológica, así como la posible relación con la hemofilia adquirida secundaria a neoplasia hematológica como causal del evento hemostático. Se realizó búsqueda en la literatura, con la mayoría de los artículos obtenidos de Medline, 24 de los cuales cumplieron con los objetivos para resolver la pregunta de investigación. Se encontraron diferentes malignidades hematológicas asociadas a sangrado uterino anormal, de las cuales la hemofilia adquirida y la trombocitopenia como potenciales causales de esta; la mayor correlación fue con leucemia, seguido de linfomas, y en menor cuantía la asociación con mieloma múltiple.
Abnormal uterine bleeding has a variable etiology, ranging from structural to functional causes, classically described by the acronym PALM-COEIN. However, there is poor awareness of this symptom as a marker of serious disease; in this review, we describe the relationship of abnormal uterine bleeding as a key symptom or debut of hematologic malignancy, as well as its possible relationship to acquired hemophilia secondary to hematologic neoplasia as causative of the hemostatic event. A literature search was performed, with most of the articles obtained from Medline, 24 of which met the objectives to solve the research question. Different hematological malignancies associated with abnormal uterine bleeding were found, of which acquired hemophilia and thrombocytopenia were found as potential causes; the highest correlation was with leukemia, followed by lymphomas, and to a lesser extent the association with multiple myeloma.
Asunto(s)
Humanos , Femenino , Hemorragia Uterina/etiología , Enfermedades Hematológicas/complicaciones , Leucemia/complicaciones , Hemofilia A/complicacionesRESUMEN
OBJECTIVE: This study analyzed the systemic and oral abnormalities in individuals with Kabuki syndrome (KS) that might be investigated to enhance the early diagnosis and treatment by a multidisciplinary team, minimizing the consequences to the individual's health. STUDY DESIGN: Clinical examination was conducted on 15 individuals to investigate orodental alterations such as tooth abnormalities and cleft lip and/or palate, and the patient records were also reviewed to investigate systemic diseases such as cardiopathies, infectious and immunologic diseases, nephropathies, and delayed neuropsychomotor development. RESULTS: All individuals with KS presented cleft lip and/or palate, 11 (73.34%) tooth abnormalities, 5 (33.34%) congenital cardiopathies, 12 (80%) infectious or immunologic diseases, 1 (6.67%) nephropathy, and 14 (93.34%) had an intellectual disability. CONCLUSION: Individuals with KS often have dental anomalies such as hypodontia, cleft or palate, and systemic disorders such as congenital heart disease and infectious diseases. Intellectual disability is present in most cases. These alterations should be investigated as early as possible to prevent the increase in morbidity in these individuals.
Asunto(s)
Anomalías Múltiples , Cara/anomalías , Enfermedades Vestibulares , Humanos , Femenino , Masculino , Enfermedades Vestibulares/complicaciones , Niño , Preescolar , Adolescente , Anomalías Dentarias , Adulto , Discapacidad Intelectual/complicaciones , Lactante , Fisura del Paladar/complicaciones , Enfermedades Hematológicas/complicacionesRESUMEN
OBJECTIVE: This study is the first to analyse the prevalence of oral candidiasis in onco-haematological patients by physical and oral cytopathological examinations. METHODS: This is a cross-sectional and observational study with a retrospective sample composed of participants hospitalised in the haematology clinic, who were diagnosed with haematological diseases. All participants received an oral mucosal examination and scraping from oral mucosa. RESULTS: Of the 62 participants, 56.5% were male and 82.3% were white, with mean age of 57 years. Lymphoma was the most common haematological disease (24.2%). In total, 48.4% of the sample was diagnosed with oral candidiasis. Of the participants with oral candidiasis, 13 (21.0%) had a clinical diagnosis. Cytopathological analysis revealed 17 more (27.4%) cases without oral lesions indicative of candidiasis. Erythematous candidiasis (P = 0.02), pseudomembranous candidiasis (P < 0.001), clinical candidiasis (P < 0.001), fibrous hyperplasia (P = 0.032), and coated tongue (P = 0.012) showed a correlation with a candidiasis cytopathological diagnosis. CONCLUSIONS: Oral candidiasis is common among patients with haematological disease, and the cytopathological examination proved to be a useful tool, confirming clinical diagnosis of candidiasis and identifying subclinical cases. These data are of great relevance considering the possible complications that these patients may develop, such as longer hospitalisations, worsening of the general condition or even death due to candidemia.
Asunto(s)
Candidiasis Bucal , Candidiasis , Infecciones por VIH , Enfermedades Hematológicas , Candidiasis/complicaciones , Candidiasis Bucal/complicaciones , Candidiasis Bucal/diagnóstico , Candidiasis Bucal/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/complicaciones , Enfermedades Hematológicas/complicaciones , Enfermedades Hematológicas/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Contexto y objetivo: las anomalías hematológicas se encuentran entre las complicaciones más comunes de la infección por el VIH. También se han realizado bastantes estudios sobre las alteraciones en el perfil de lípidos, aunque los resultados en gran medida no han sido concluyentes. El presente estudio se llevó a cabo para evaluar el recuento de células CD4 y el perfil de lípidos en los pacientes infectados por el VIH y el SIDA en la población india y los correlaciona con los controles sero-negativos. Materiales y métodos: El presente estudio fue diseñado como un estudio transversal, con base en un hospital, para evaluar el recuento de células CD4 y el perfil de lípidos en los pacientes infectados por VIH y SIDA en la población india y los correlaciona con los controles sero-negativos. La evaluación del perfil de lípidos se realizó utilizando Erba EM 360, un analizador automático impulsado por un fotómetro de rejilla de difracción, mientras que los recuentos de células CD4 se evaluaron utilizando el Contador de ciclo de Partec. Análisis estadístico utilizado: Los datos se analizaron con SPSS versión 15.0 (SPSS Inc., Chicago, IL, EE. UU.). La comparación de dichos parámetros se realizó mediante el análisis de varianza (ANOVA) y la prueba post-hoc de Games-Howell. Se consideró estadísticamente significativo un valor de p <0,05. Resultados: Los niveles de colesterol total y lipoproteínas de baja densidad (LDL) disminuyeron significativamente, mientras que los triglicéridos y las lipoproteínas de muy baja densidad (VLDL) aumentaron significativamente en los pacientes infectados por VIH y SIDA en comparación con los controles sero-negativos. Conclusión: El colesterol total, las LDL, los triglicéridos y las VLDL se alteraron significativamente en los pacientes infectados por VIH y con SIDA en comparación con los controles sero-negativos
Context and Aim: Hematological abnormalities are amongst the most common complications of infection with HIV.There have been quite a few studies on the alterations in lipid profile, too, though the results have largely been inconclusive. The present study was carried-out to assess CD4 cell counts and lipid profile in the HIV infected and AIDS patients in the Indian population and correlates them with the sero-negative controls. Materials and Methods: The present study was designed as a cross-sectional, hospital-based study to assess CD4 cell counts and lipid profile in the HIV infected and AIDS patients in the Indian population and correlates them with the sero-negative controls. Evaluation of lipid profile was done using Erba EM 360, an automated analyzer powered by a diffraction grating photometer while CD4 cell counts were evaluated using Partec Cyflow Counter. Statistical analysis used: The data was analyzed using SPSS version 15.0 (SPSS Inc., Chicago, IL, USA). Comparison of the said parameters was done using Analysis of Variance (ANOVA) and post-hoc Games-Howell test. p-value of <0.05 was considered statistically significant. Results: The levels of total cholesterol and low-density lipoproteins (LDLs) were significantly decreased while triglycerides and very low density lipoproteins (VLDLs) were significantly increased in the HIV infected and AIDS patients when compared with the sero-negative controls. Conclusion: Total cholesterol, LDLs, triglycerides and VLDLs were significantly altered in the HIV infected and AIDS patients when compared with the sero-negative controls
Asunto(s)
Humanos , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Recuento de Linfocito CD4 , Dislipidemias , Enfermedades Hematológicas/complicacionesRESUMEN
Invasive fungal disease (IFD) is frequent in patients with haematologic malignancies and in recipients of haematopoietic cell transplantation (HCT). An epidemiologic study conducted in Brazil reported a high incidence of IFD in haematologic patients, and invasive fusariosis was the leading IFD. A limitation of that study was that galactomannan was not available for at least half of the study period. In order to characterise the epidemiology and burden of IFD in three cohorts, HCT, acute myeloid leukaemia (AML) or myelodysplasia (MDS), and acute lymphoid leukaemia (ALL), we conducted a prospective multicentre cohort study in four haematologic Brazilian centres. From August 2015 to July 2016, all patients receiving induction chemotherapy for newly diagnosed or relapsed AML, MDS or ALL, and all HCT recipients receiving conditioning regimen were followed during the period of neutropenia following chemotherapy or the conditioning regimen. During a 1-year period, 192 patients were enrolled: 122 HCT recipients (71 allogeneic, 51 autologous), 46 with AML, and 24 with ALL. The global incidence of IFD was 13.0% (25 cases, 11 proven and 14 probable). Invasive aspergillosis (14 cases) was the leading IFD, followed by candidemia (6 cases) and fusariosis (3 cases). The incidence of IFD was 26.1% in AML/MDS, 16.7% in ALL, 11.3% in allogeneic HCT, and 2.0% in autologous HCT. The burden of IFD in haematologic patients in Brazil is high, with a higher frequency in AML and ALL. Invasive aspergillosis is the leading IFD, followed by invasive candidiasis and fusariosis.
Asunto(s)
Enfermedades Hematológicas/complicaciones , Infecciones Fúngicas Invasoras/epidemiología , Adolescente , Adulto , Anciano , Antifúngicos/uso terapéutico , Brasil/epidemiología , Niño , Preescolar , Costo de Enfermedad , Femenino , Enfermedades Hematológicas/epidemiología , Enfermedades Hematológicas/microbiología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Incidencia , Lactante , Infecciones Fúngicas Invasoras/clasificación , Infecciones Fúngicas Invasoras/tratamiento farmacológico , Infecciones Fúngicas Invasoras/microbiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Receptores de Trasplantes/estadística & datos numéricos , Trasplante Autólogo/efectos adversos , Adulto JovenRESUMEN
High serum levels of vitamin B12 or cobalamin, also called hypervitaminemia B12, is a frequently underestimated biological abnormality. According to the literature, some of the entities related to this finding are solid neoplasia (primary or metastatic) and acute or chronic hematological diseases. Other causes include liver disorders, monoclonal gammapathy of undetermined significance, renal failure and, less frequently, excess of vitamin B12 intake, inflammatory or autoimmune diseases, and transient hematological disorders (neutrophilia and secondary eosinophilia). This article reports on causes of hypervitaminosis B12, our experience and a review of the literature.
Los altos niveles de vitamina B12 o cobalamina, también denominado hipervitaminosis B12 es una anormalidad analítica frecuentemente subestimada. De acuerdo con la literatura algunas de las entidades relacionadas con este hallazgo son las neoplasias sólidas (primarias o metastásicas) y las enfermedades hematológicas agudas o crónicas. Otras causas incluyen la afección hepática, la gammapatía monoclonal de significación indeterminada, la insuficiencia renal y, con menor frecuencia, un exceso de consumo de vitamina B12, enfermedades inflamatorias o autoinmunes y los trastornos hematológicos transitorios (neutrofilia y eosinofilia secundaria). Este artículo informa sobre causas de hipervitaminosis B12, nuestra experiencia y hace una revisión de la literatura.
Asunto(s)
Trastornos Nutricionales/sangre , Trastornos Nutricionales/etiología , Vitamina B 12/sangre , Lesión Renal Aguda/sangre , Lesión Renal Aguda/complicaciones , Enfermedades Hematológicas/sangre , Enfermedades Hematológicas/complicaciones , Humanos , Hepatopatías/sangre , Hepatopatías/complicaciones , Neoplasias/sangre , Neoplasias/complicaciones , Vitamina B 12/efectos adversosRESUMEN
Los altos niveles de vitamina B12 o cobalamina, también denominado hipervitaminosis B12 es una anormalidad analítica frecuentemente subestimada. De acuerdo con la literatura algunas de las entidades relacionadas con este hallazgo son las neoplasias sólidas (primarias o metastásicas) y las enfermedades hematológicas agudas o crónicas. Otras causas incluyen la afección hepática, la gammapatía monoclonal de significación indeterminada, la insuficiencia renal y, con menor frecuencia, un exceso de consumo de vitamina B12, enfermedades inflamatorias o autoinmunes y los trastornos hematológicos transitorios (neutrofilia y eosinofilia secundaria). Este artículo informa sobre causas de hipervitaminosis B12, nuestra experiencia y hace una revisión de la literatura.
High serum levels of vitamin B12 or cobalamin, also called hypervitaminemia B12, is a frequently underestimated biological abnormality. According to the literature, some of the entities related to this finding are solid neoplasia (primary or metastatic) and acute or chronic hematological diseases. Other causes include liver disorders, monoclonal gammapathy of undetermined significance, renal failure and, less frequently, excess of vitamin B12 intake, inflammatory or autoimmune diseases, and transient hematological disorders (neutrophilia and secondary eosinophilia). This article reports on causes of hypervitaminosis B12, our experience and a review of the literature.
Asunto(s)
Humanos , Vitamina B 12/sangre , Trastornos Nutricionales/etiología , Trastornos Nutricionales/sangre , Vitamina B 12/efectos adversos , Lesión Renal Aguda/complicaciones , Lesión Renal Aguda/sangre , Enfermedades Hematológicas/complicaciones , Enfermedades Hematológicas/sangre , Hepatopatías/complicaciones , Hepatopatías/sangre , Neoplasias/complicaciones , Neoplasias/sangreRESUMEN
Introducción: Las complicaciones infecciosas se han convertido en la causa de mortalidad más frecuente en los pacientes con afecciones hematológicas sometidos a regímenes terapéuticos agresivos. Objetivo: Caracterizar la infección por Acinetobacter baumannii en pacientes con afecciones hematológicas. Métodos: Se realizó un estudio ambispectivo y descriptivo en el servicio de hematología del Hospital Clínico Quirúrgico Hermanos Ameijeiras, entre enero de 2010 y diciembre de 2016. La muestra se conformó con 29 pacientes que cumplieron los criterios de inclusión establecidos. Resultados: La edad promedio fue de 48,3±14,8 años, con predominio del sexo masculino (65,5 por ciento). Resultaron más frecuentes los casos con linfomas (48,3 por ciento). En cuanto al estado de la enfermedad se apreció que prevalecieron por igual (34,5 por ciento) los grupos de pacientes con enfermedad en su inicio y en remisión completa. La neutropenia febril (48,3 por ciento) y la sepsis respiratoria (31,1 por ciento) fueron las manifestaciones clínicas más detectadas. Los enfermos con algún grado de neutropenia resultaron los más frecuentes (55,1 por ciento), principalmente aquellos con neutropenia severa y muy severa. La resistencia a los carbapenémicos entre los infectados fue de 58,6 por ciento. 24,1 por ciento de los casos fallecieron y la resistencia a los carbapenémicos se asoció significativamente (p<0,05) a esta mortalidad. De los procederes invasivos empleados en estos pacientes, predominó la colocación de catéter centro-venoso (58,6 por ciento). Conclusiones: La infección por A. baumannii es más frecuente en pacientes con afecciones hematológicas malignas y que recibieron tratamiento mielodepresor así como en aquellos que presentaron neutropenia severa/muy severa, manifestándose clínicamente de forma mayoritaria como una neutropenia febril; es muy importante señalar que la mortalidad por este agente biológico resultó elevada, principalmente si existe resistencia a los carbapenémicos(AU)
Introduction: Infectious complications have become the most frequent cause of mortality in patients with hematological conditions subjected to aggressive therapeutic regimens. Objective: To characterize Acinetobacter baumannii infection in patients with hematological disorders. Methods: An ambispective and descriptive study was carried out in the hematology department at Hermanos Ameijeiras Clinical Surgical Hospital from January 2010 to December 2016. Twenty nine patients, who met the established inclusion criteria, formed the sample. Results: The average age was 48.3 ± 14.8 years, males were majority (65.5 percent). The lymphomas cases were more frequent (48.3 percent). Regarding the state of the disease, it was observed that the groups of patients with disease in its initial stage and in complete remission prevailed equally (34.5 percent). Febrile neutropenia (48.3 percent) and respiratory sepsis (31.1 percent) were the most detected clinical manifestations. Patients with some degree of neutropenia were the most frequent (55.1 percent), mainly those with severe and very severe neutropenia. The resistance to carbapenems among the infected subjects was 58.6 percent. The deceased cases represented 24.1 percent and resistance to carbapenems was significantly associated (p <0.05) with this mortality. Out of the invasive procedures used in these patients, central venous catheter placement was predominant (58.6 percent). Conclusions: A. baumannii infection is more frequent in patients with malignant haematological conditions and who received myeloablative treatment as well as in those who presented severe or very severe neutropenia, mainly exhibiting as a febrile neutropenia. It is very important to point out that mortality due to this biological agent was high, mainly if there is resistance to carbapenems(AU)
Asunto(s)
Humanos , Carbapenémicos/uso terapéutico , Sepsis/tratamiento farmacológico , Acinetobacter baumannii , Enfermedades Hematológicas/complicaciones , Epidemiología DescriptivaRESUMEN
BACKGROUND: Oral antineoplastic agents (OAA) have reached 30-50% of all antineoplastic treatments. Although they seem safer than parenteral therapy, many severe problems can occur if the dose is not adequately adjusted in special situations. Our objective is to create a comprehensive guide with dosage adjustment recommendations for OAA in cases of renal and hepatic impairment and hematologic toxicities. RESEARCH DESIGN AND METHODS: We analyzed all OAA approved by EMA in July 2017. We assessed data related to dose adjusted from the FDA's and EMA's summary of product characteristics. RESULTS: 53 OAA were analyzed. We identified 44 (83%) OAA requiring dosage adjustments in special situations: 20 (37.7%) in renal impairment, 37 (69.8%) in hepatic impairment, and 22 (41.5%) in patients with hematologic toxicity. The dose adjustment recommendations varied in 31 (58.5%) OAA between the FDA and EMA. Detailed recommendations for each OAA were collated into comprehensive tables. CONCLUSIONS: Most OAA have to be adjusted in special situations. Given the number of OAA available for different indications, this review can serve as an easy tool to help health professionals dose these complex treatments.
Asunto(s)
Antineoplásicos/administración & dosificación , Neoplasias/tratamiento farmacológico , Administración Oral , Antineoplásicos/efectos adversos , Relación Dosis-Respuesta a Droga , Enfermedades Hematológicas/complicaciones , Humanos , Enfermedades Renales/complicaciones , Hepatopatías/complicacionesRESUMEN
BACKGROUND: Vancomycin-resistant enterococci (VRE) are an important agent of colonization and infection in haematology patients. However, the role of virulence on VRE colonization and infection is controversial. AIM: To characterize the lineage, virulence and resistance profile of VRE infection and colonization isolates; as well as their impact on outcome of haematology patients using a regression logistic model. METHODS: Eighty-six isolates (80 Enterococcus faecium and six E. faecalis) from 76 patients were evaluated. Polymerase chain reaction for resistance and virulence genes, and pulsed-field gel electrophoresis and whole genome sequencing of the major clusters, were performed. Bivariate and multivariate analyses were carried out to evaluate the role of virulence genes on outcome. FINDINGS: All isolates harboured the vanA gene. Regarding the virulence genes, 96.5% of isolates were positive for esp, 69.8% for gelE and asa1 genes. VRE infection isolates were more virulent than colonization isolates and harboured more often the gelE gene (P = 0.008). Infections caused by VRE carrying asa1 gene resulted more frequently in death (P = 0.004), but only the predominant clone remained as protector in the multivariate model. The E. faecium strains were assigned to seven STs (ST78, ST412, ST478, ST792, ST896, ST987, ST963) that belonged to CC17. The E. faecalis sequenced belonged to ST9 (CC9). CONCLUSION: E. faecium was predominant, and infection isolates were more virulent than colonization isolates and harboured more often the gene gelE. Infections caused by VRE carrying the asa1 gene appeared to be associated with a fatal outcome.
Asunto(s)
Enterococcus faecalis/aislamiento & purificación , Enterococcus faecium/aislamiento & purificación , Infecciones por Bacterias Grampositivas/epidemiología , Enfermedades Hematológicas/complicaciones , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Adolescente , Adulto , Anciano , Niño , Preescolar , Electroforesis en Gel de Campo Pulsado , Enterococcus faecalis/clasificación , Enterococcus faecalis/efectos de los fármacos , Enterococcus faecalis/genética , Enterococcus faecium/clasificación , Enterococcus faecium/efectos de los fármacos , Enterococcus faecium/genética , Femenino , Genes Bacterianos , Genotipo , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/mortalidad , Humanos , Lactante , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Epidemiología Molecular , Reacción en Cadena de la Polimerasa , Prevalencia , Estudios Retrospectivos , Análisis de Supervivencia , Enterococos Resistentes a la Vancomicina/clasificación , Enterococos Resistentes a la Vancomicina/efectos de los fármacos , Enterococos Resistentes a la Vancomicina/genética , Factores de Virulencia/análisis , Factores de Virulencia/genética , Secuenciación Completa del Genoma , Adulto JovenRESUMEN
WHAT IS KNOWN AND OBJECTIVE: Antifungal prophylaxis is an option to reduce the incidence of invasive fungal infection (IFI) in haematological patients. To date, no network meta-analysis (NMA) of high-quality evidence (double-blind randomized controlled trials) has been performed on this subject. This systematic review and NMA aimed to evaluate the safety and efficacy of different antifungal agents used for prophylaxis of IFI in patients with haematological disorders. METHODS: A systematic review was performed according to PRISMA and Cochrane recommendations. The search for articles was conducted on PubMed, Scopus and the Web of Science. We searched for double-blind randomized clinical trials comparing antifungal agents for IFI prophylaxis head-to-head vs placebo in patients with any blood cancer. Network meta-analyses were conducted using Addis version 1.16.6. Evaluation of the quality of included RCTs was also performed. RESULTS: Twenty-five trials were included in the qualitative and quantitative analyses. Posaconazole stood out as the best IFI prophylaxis option and for avoiding IFI-related mortality. For the incidence of candidiasis outcome, the azoles were superior to placebo. Voriconazole and posaconazole were, respectively, the first and second best options. For the incidence of aspergillosis outcome, the probability rank suggested that voriconazole followed by liposomal amphotericin B is, possibly, the best choice. The quality of studies was considered good, with a mean Jadad score of 4.0. WHAT IS NEW AND CONCLUSION: The results of our work support prophylaxis with antifungal agents as reducing the risk of IFI in haematological patients. Overall, the second-generation azoles were found to be the best option for preventing IFI in this population.
Asunto(s)
Antifúngicos/uso terapéutico , Enfermedades Hematológicas/complicaciones , Infecciones Fúngicas Invasoras/prevención & control , Antifúngicos/efectos adversos , Aspergilosis/etiología , Aspergilosis/prevención & control , Candidiasis/etiología , Candidiasis/prevención & control , Humanos , Infecciones Fúngicas Invasoras/etiología , Prevención Primaria/métodos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
This study reports the results of an initiative to reduce central line-associated bloodstream infections (CLABSIs) among pediatric hematology/oncology patients, a population at increased risk for CLABSI. The study design was a pre-post comparison of a series of specific interventions over 40 months. Logistic regression was used to determine if the risk of developing CLABSI decreased in the postintervention period, after controlling for covariates. The overall CLABSI rate fell from 9 infections per 1000 line days at the beginning of the study to zero in a cohort of 291 patients encompassing 2107 admissions. Admissions during the intervention period had an 86% reduction in odds of developing a CLABSI, controlling for other factors. At the study team's institution, an initiative that standardized blood culturing techniques, lab draw times, line care techniques, and provided physician and nurse education was able to eliminate CLABSI among pediatric hematology/oncology patients.
Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/efectos adversos , Infección Hospitalaria/prevención & control , Enfermedades Hematológicas/complicaciones , Neoplasias/complicaciones , Infecciones Relacionadas con Catéteres/epidemiología , Cateterismo Venoso Central/métodos , Niño , Infección Hospitalaria/epidemiología , Femenino , Enfermedades Hematológicas/terapia , Humanos , Masculino , Neoplasias/terapia , Mejoramiento de la Calidad , Factores de RiesgoRESUMEN
La sobrecarga de hierro es una complicación frecuente en un número importante de enfermedades hematológicas que cursan con anemia y requieren transfusiones sanguíneas como parte de su terapia. Entre ellas se destacan la talasemia, la drepanocitosis, los síndromes mielodisplásicos, la anemia de Blackfan-Diamond, la anemia de Fanconi y la deficiencia de piruvato quinasa, La sobrecarga de hieroo tambiún se presenta en otras enfermedades tales como la hemocromatosis hereditaria, la hepatitis viral, el síndrome metabólico y determinados trastornos neurovegetativos. El diagnóstico de sobrecarga suele hacerse mediante la determinación del hierro sérico no unido a la transferrina, la ferritina sérica y un aumento de la concentración hepática de hierro. Las consecuencias más importantes del efecto tóxico de un exceso de hierro son las disfunciones cardíacas y endocrinas, debidas al efecto oxidante del hierro sobre las membranas celulares, con el consiguiente daño celular. Tales alteraciones contribuyen al incremento de la morbilidad y la mortalidad en estos pacientes. El tratamiento consiste básicamente en el usode agentes quelantes de hierro que facilitan la excreción del exceso del metal y reducen su efecto tóxico, Entre tales agentes se cuentan la deferrioxamina (de uso intravenoso). y móa recientemente el deferiprone (ambos de uso orak)
Iron overload is a frequent complication in patients with hematological diseases which develop anemía and require blood transfusion as a therapeutic measure. Thalassemia, drepanocytosis, myelodisplastic syndromes, Blackfan-Diamond anemia, Franconi anemia and pyruvate kinase deficiency are the most common of these diseases. Iron overload is the hallmark of hereditary hemochromatosis, and also complicates diseases such as viral hepatitis, the metabolic syndrome, and certain neurovegetative disfunctions. The diagnosis of iron overload is commonly established through the evaluation of serum iron, transferrin saturation, serum ferritin and liver iron concentration. Cardiac and endocrine dysfunctions are the most important consequences of the toxic efffect of iron accumulation; these are due to the oxidixing effect of iron upon the cellular membranes, followed by cellular damage. Such alterations contribute to the increased morbility and mortality rates in these patients. The treatment of iron overload is based mainly on the use of iron chelators which facilitate the excretion of iron excess and reduce its toxic effect. Deferrioxamine (for intravenous use), and more recently deferiprone and deferasirox (both for oral administration) are the drugs of choice
Asunto(s)
Humanos , Masculino , Femenino , Anemia/genética , Enfermedades Hematológicas/complicaciones , Sobrecarga de Hierro/patología , Sobrecarga de Hierro/sangre , Hemocromatosis/etiología , Talasemia/etiología , Transfusión Sanguínea/métodosRESUMEN
Fundamento: En los últimos tiempos se está realizando con mayor frecuencia el acceso venoso por vía media con la técnica descrita por English, lo que supone menor riesgo de neumotórax y de punción arterial, además de su fácil realización. Objetivo: caracterizar el empleo del acceso venoso central por vía yugular media con uso de Seldinger en pacientes con enfermedades hematológicas y/o tratamiento con anticoagulantes. Métodos: estudio descriptivo, realizado desde enero a diciembre del 2009, en la Unidad Quirúrgica del Hospital de Cienfuegos. Se realizó cateterismo venoso central por vía media con la técnica de English a 47 pacientes con enfermedades hematológicas. Las variables analizadas fueron: número de intentos, indicaciones y complicaciones.Resultados: se obtuvo éxito en 43 accesos venosos centrales (91,48 por ciento), de los cuales 35 se lograron al primer intento. En más de la mitad de los casos, la indicación fue el uso de citostáticos (55,31 por ciento). Se observaron complicaciones en 5 pacientes, siendo la más frecuente la punción arterial (6,38 por ciento).Conclusión: el acceso venoso central por vía media con Seldinger es una opción adecuada para pacientes con enfermedades hematológicas. En pacientes tratados con anticoagulantes minimiza las complicaciones. En general, es de fácil acceso y presenta un alto índice de éxito(AU)
Background: In recent years, venous access via middle approach with the technique described by English has been frequently used, leading to lower risk of pneumothorax and arterial puncture. In addition, it is easy to perform.Objective: to characterize the performance of central venous access via the middle approach to the internal jugular vein using the Seldinger guidewire in patients with hematologic diseases and/or anticoagulant therapy.Methods: a descriptive study was conducted from January to December 2009 in the Surgical Unit of the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos. Central venous access via middle approach using the technique described by English was performed in 47 patients suffering from hematologic diseases. Variables analysed were: number of attempts, indications and complications.Results: 43 central venous catheterizations were successful (91.48 percent), 35 of them were achieved in the first attempt. The use of cytostatics was indicated in more than half of the cases (55.31 percent). Complications were observed in 5 patients; arterial puncture was the most common (6.38 percent). Conclusions: central venous access via the middle approach using the Seldinger guidewire is a suitable option for patients with hematologic diseases. It minimizes complications in patients treated with anticoagulants. In general, it is easily accessible and has a high success rate(AU)
Asunto(s)
Humanos , Cateterismo Venoso Central/métodos , Cateterismo Venoso Central , Enfermedades Hematológicas/complicaciones , Enfermedades Hematológicas/cirugía , Estudios Retrospectivos , Epidemiología DescriptivaRESUMEN
Las urgencias que pueden surgir durante la evolución de las enfermedades hematológicas son diversas, tanto por el comportamiento de la enfermedad de base como por el momento en que se presentan. Pueden ser la primera manifestación de la enfermedad o aparecer en el curso de su evolución, y sus secuelas pueden ser menores si se diagnostican y tratan adecuadamente. Se hace una revisión de algunas de las alteraciones metabólicas y leucocitarias más frecuentes que se pueden presentar en el paciente oncohematológico(AU)
Emergencies which may appear during the evolution of hemopathies are diverse due to their basic behavior as well as according to the moment the disease comes into view. They may be the first sign of the disease or could appear during the course of its evolution. Consequences might be milder if diagnosed and treated properly. A revision of some of the most frequent metabolic and leukocyte alterations that could arise in the patient with an oncohematological disease is shown(AU)
Asunto(s)
Humanos , Masculino , Femenino , Urgencias Médicas/epidemiología , Urgencias Médicas/historia , Hematología/ética , Enfermedades Hematológicas/complicaciones , Enfermedades Hematológicas/prevención & control , Enfermedades Hematológicas/fisiopatología , Enfermedades Hematológicas/terapiaRESUMEN
Las urgencias que pueden surgir durante la evolución de las enfermedades hematológicas son diversas, tanto por el comportamiento de la enfermedad de base como por el momento en que se presentan. Pueden ser la primera manifestación de la enfermedad o aparecer en el curso de su evolución, y sus secuelas pueden ser menores si se diagnostican y tratan adecuadamente. Se hace una revisión de algunas de las alteraciones metabólicas y leucocitarias más frecuentes que se pueden presentar en el paciente oncohematológico
Emergencies which may appear during the evolution of hemopathies are diverse due to their basic behavior as well as according to the moment the disease comes into view. They may be the first sign of the disease or could appear during the course of its evolution. Consequences might be milder if diagnosed and treated properly. A revision of some of the most frequent metabolic and leukocyte alterations that could arise in the patient with an oncohematological disease is shown