RESUMEN
According to the World Health Organization, 98% of fatal dengue cases can be prevented; however, endemic countries such as Colombia have recorded higher case fatality rates during recent epidemics. We aimed to identify the predictors of mortality that allow risk stratification and timely intervention in patients with dengue. We conducted a hospital-based, case-control (1:2) study in two endemic areas of Colombia (2009-2015). Fatal cases were defined as having either 1) positive serological test (IgM or NS1), 2) positive virological test (RT-PCR or viral isolation), or 3) autopsy findings compatible with death from dengue. Controls (matched by state and year) were hospitalized nonfatal patients and had a positive serological or virological dengue test. Exposure data were extracted from medical records by trained staff. We used conditional logistic regression (adjusting for age, gender, disease's duration, and health-care provider) in the context of multiple imputation to estimate exposure to case-control associations. We evaluated 110 cases and 217 controls (mean age: 35.0 versus 18.9; disease's duration pre-admission: 4.9 versus 5.0 days). In multivariable analysis, retro-ocular pain (odds ratios [OR] = 0.23), nausea (OR = 0.29), and diarrhea (OR = 0.19) were less prevalent among fatal than nonfatal cases, whereas increased age (OR = 2.46 per 10 years), respiratory distress (OR = 16.3), impaired consciousness (OR = 15.9), jaundice (OR = 32.2), and increased heart rate (OR = 2.01 per 10 beats per minute) increased the likelihood of death (AUC: 0.97, 95% confidence interval: 0.96, 0.99). These results provide evidence that features of severe dengue are associated with higher mortality, which strengthens the recommendations related to triaging patients in dengue-endemic areas.
Asunto(s)
Diarrea/diagnóstico , Ictericia/diagnóstico , Náusea/diagnóstico , Síndrome de Dificultad Respiratoria/diagnóstico , Dengue Grave/diagnóstico , Taquicardia/diagnóstico , Adolescente , Adulto , Anticuerpos Antivirales/sangre , Estudios de Casos y Controles , Colombia , Virus del Dengue/inmunología , Virus del Dengue/aislamiento & purificación , Diarrea/mortalidad , Diarrea/fisiopatología , Diarrea/virología , Enfermedades Endémicas , Femenino , Cefalea , Humanos , Inmunoglobulina M/sangre , Ictericia/mortalidad , Ictericia/fisiopatología , Ictericia/virología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Náusea/mortalidad , Náusea/fisiopatología , Náusea/virología , Síndrome de Dificultad Respiratoria/mortalidad , Síndrome de Dificultad Respiratoria/fisiopatología , Síndrome de Dificultad Respiratoria/virología , Medición de Riesgo , Dengue Grave/mortalidad , Dengue Grave/fisiopatología , Dengue Grave/virología , Análisis de Supervivencia , Taquicardia/mortalidad , Taquicardia/fisiopatología , Taquicardia/virologíaRESUMEN
Self-explanation while diagnosing clinical cases fosters medical students' diagnostic performance. In previous studies on self-explanation, students were free to self-explain any aspect of the case, and mostly clinical knowledge was used. Elaboration on knowledge of pathophysiological mechanisms of diseases has been largely unexplored in studies of strategies for teaching clinical reasoning. The purpose of this two-phase experiment was to investigate the effect of self-explanation of pathophysiology during practice with clinical cases on students' diagnostic performance. In the training phase, 39 4th-year medical students were randomly assigned to solve 6 criterion cases (3 of jaundice; 3 of chest pain), either self-explaining the pathophysiological mechanisms of the findings (n = 20) or without self-explaining (n = 19). One-week later, in the assessment phase, all students solved 6 new cases of the same syndromes. A repeated-measures analysis of variance on the mean diagnostic accuracy scores showed no significant main effects of study phase (p = 0.34) and experimental condition (p = 0.10) and no interaction effect (p = 0.42). A post hoc analysis found a significant interaction (p = 0.022) between study phase and syndrome type. Despite equal familiarity with jaundice and chest pain, the performance of the self-explanation group (but not of the non-self-explanation group) on jaundice cases significantly improved between training and assessment phases (p = 0.035) whereas no differences between phases emerged on chest pain cases. Self-explanation of pathophysiology did not improve students' diagnostic performance for all diseases. Apparently, the positive effect of this form of self-explanation on performance depends on the studied diseases sharing similar pathophysiological mechanisms, such as in the jaundice cases.
Asunto(s)
Competencia Clínica , Diagnóstico , Estudiantes de Medicina/psicología , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/fisiopatología , Comprensión , Enfermedad , Educación Médica/métodos , Femenino , Humanos , Ictericia/diagnóstico , Ictericia/fisiopatología , Masculino , Autoevaluación (Psicología) , Adulto JovenRESUMEN
Abstract Objective: To evaluate the nutritional status of children with persistent cholestasis and to compare the anthropometric indices between children with and without liver cirrhosis and children with and without jaundice. Methods: Children with persistent cholestasis, i.e. increased direct bilirrubin or changes in the canalicular enzyme gamma-glutamyl transferase (GGT), were included. The anthropometric measures were weight (W), height or length (H), arm circumference (AC), triceps skinfold thickness (TST), arm muscle circumference (AMC), and body mass index (BMI). Results: Ninety-one children with cholestasis, with current median age of 12 months, were evaluated. W/age (A) and H/A indices below −2 Z-scores were observed in 33% and 30.8% of patients, respectively. Concerning the W/H index and BMI, only 12% and 16% of patients, respectively, were below −2 Z-scores. Regarding AC, 43.8% of 89 evaluated patients had some depletion. Observing the TST, 64% of patients had depletion, and 71.1% of the 45 evaluated patients had some degree of depletion regarding the ACM index. Conclusion: Evaluation using weight in patients with chronic liver diseases may overestimate the nutritional status due to visceromegaly, subclinical edema, or ascites. Indices that correlate weight and height, such as W/H and BMI, may also not show depletion because of the chronic condition in which there are depletion of both weight and height. TST, AC, and ACM are parameters that better estimate nutritional status and should be part of the management of patients with liver diseases and cholestasis.
Resumo Objetivo: Avaliar a situação nutricional de crianças com colestase persistente e comparar os índices antropométricos entre crianças com e sem cirrose hepática e crianças com e sem icterícia. Métodos: Foram incluídas crianças com colestase persistente, ou seja, aumento da bilirrubina direta ou alterações na enzima canalicular, gamaglutamiltransferase (GGT). As medidas antropométricas foram peso, estatura ou altura, circunferência do braço (CB), espessura da prega cutânea do tríceps (TST), circunferência muscular do braço (CMB) e índice de massa corporal (IMC). Resultados: Foram avaliadas 91 crianças com colestase, com idade média de 12 meses; 33% e 30,8% dos pacientes apresentaram índices P/I e A/I com escore Z abaixo de –2, respectivamente. Com relação ao índice P/A e IMC, somente 12% e 16% dos pacientes, respectivamente, apresentaram escore Z abaixo de –2. Com relação à CB, 43,8% de 89 pacientes avaliados apresentaram alguma depleção. Observando a TST, 64% dos pacientes que apresentaram depleção, 71,1% dos 45 pacientes avaliados apresentaram algum grau de depleção com relação ao índice de CMB. Conclusão: A avaliação do peso em pacientes com doenças hepáticas crônicas poderá superestimar a situação nutricional devido a visceromegalia, edema subclínico ou ascite. Os índices que correlacionam peso e altura, como P/A e IMC, também podem não mostrar depleção devido à doença crônica em que há depleção tanto do peso quanto da altura. A TST, BC e CMB são parâmetros que estimam melhor a situação nutricional e devem fazer parte de gestão de pacientes com doenças hepáticas e colestase.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Trastornos de la Nutrición del Niño/fisiopatología , Colestasis/fisiopatología , Ictericia/fisiopatología , Cirrosis Hepática/fisiopatología , Grosor de los Pliegues Cutáneos , Estatura , Peso Corporal , Trastornos de la Nutrición del Niño/etiología , Índice de Masa Corporal , Evaluación Nutricional , Colestasis/complicaciones , Enfermedad Crónica , Ictericia/complicaciones , Cirrosis Hepática/complicacionesRESUMEN
OBJECTIVE: To evaluate the nutritional status of children with persistent cholestasis and to compare the anthropometric indices between children with and without liver cirrhosis and children with and without jaundice. METHODS: Children with persistent cholestasis, i.e. increased direct bilirrubin or changes in the canalicular enzyme gamma-glutamyl transferase (GGT), were included. The anthropometric measures were weight (W), height or length (H), arm circumference (AC), triceps skinfold thickness (TST), arm muscle circumference (AMC), and body mass index (BMI). RESULTS: Ninety-one children with cholestasis, with current median age of 12 months, were evaluated. W/age (A) and H/A indices below -2 Z-scores were observed in 33% and 30.8% of patients, respectively. Concerning the W/H index and BMI, only 12% and 16% of patients, respectively, were below -2 Z-scores. Regarding AC, 43.8% of 89 evaluated patients had some depletion. Observing the TST, 64% of patients had depletion, and 71.1% of the 45 evaluated patients had some degree of depletion regarding the ACM index. CONCLUSION: Evaluation using weight in patients with chronic liver diseases may overestimate the nutritional status due to visceromegaly, subclinical edema, or ascites. Indices that correlate weight and height, such as W/H and BMI, may also not show depletion because of the chronic condition in which there are depletion of both weight and height. TST, AC, and ACM are parameters that better estimate nutritional status and should be part of the management of patients with liver diseases and cholestasis.
Asunto(s)
Trastornos de la Nutrición del Niño/fisiopatología , Colestasis/fisiopatología , Ictericia/fisiopatología , Cirrosis Hepática/fisiopatología , Estatura , Índice de Masa Corporal , Peso Corporal , Niño , Trastornos de la Nutrición del Niño/etiología , Preescolar , Colestasis/complicaciones , Enfermedad Crónica , Femenino , Humanos , Lactante , Ictericia/complicaciones , Cirrosis Hepática/complicaciones , Masculino , Evaluación Nutricional , Grosor de los Pliegues CutáneosRESUMEN
Para descobrir quais as doenças que mais comumente cursam com a icterícia em pacientes internados no Hospital Universitário Antônio Pedro (HUAP) e correlacioná-las com marcadores bioquímicos foram utilizados dados extraídos de prontuários de pacientes internados durante os anos de 2005 a 2007. 0s dados foram analisados usando métodos estatísticos como qui-quadrado e teste Z. Utilizamos a análise das dosagens de aspartato-aminotrans ferase (AST), alanina-aminotransferase (ALT), fosfatase alcalina (FA), gama-glutamiltransferase (gama-GT), bilirrubina (Bb) total e suas frações direta e indireta. Os sinais e sintomas mais comuns na amostra estudada foram: dor abdominal, vômitos e colúria, que estão presentes em cerca de 60% das queixas dos pacientes estudados. Na população entre nove e 85 anos de idade, a análise sugere que AST e ALT nos chamam atenção para uma possível lesão hepática associada aos casos de icterícia. Enquanto que FA e GGT são marcadores de colestase. A bilirrubina direta tem média mais elevada no grupo de pacientes entre nove e 85 anos e a bilirrubina indireta atinge níveis maiores no grupo com até dois meses de vida. As dosagens bioquímicas são armas muito importantes na pesquisa etiológica dos casos de icterícia.
To find out which diseases most commonly lead to jaundice in hospitalized patients in HUAP and correlate them with biochemical markers. We used data from medical records of patients hospitalized during the years 2005 to 2007. The data were analyzed using statistical methods to test and chi-square-Z. We used the analysis of the strengths of AST, ALI, FA, GGT, Bb and its fractions total direct and indirect. The most common signs and symptoms in the sample studied were abdominal pain, vomiting and choluria that are present in about 60% of complaints from patients. In the population between nine and 85 years of age, the analysis suggests that AST and ALT in calling attention to a possible liver damage linked to cases of jaundice. While FA and gamma-GT are markers of cholestasis. The direct bilirubin is highest average in the group of patients between nine and 85 years and indirect bilirubin levels higher in the group with up to two months of life. The biochemical doses are very important weapons in the etiological research of cases of jaundice.
Asunto(s)
Humanos , Masculino , Femenino , Hepatopatías/clasificación , Hepatopatías/etiología , Ictericia/complicaciones , Ictericia/diagnóstico , Ictericia/etiología , Ictericia/fisiopatología , Distribución por Edad , Bilirrubina/metabolismo , Técnicas de Laboratorio Clínico , Hiperbilirrubinemia/complicaciones , Biomarcadores , Distribución por SexoRESUMEN
OBJETIVO: Estudar a influência da icterícia obstrutiva sobre a capacidade reprodutiva e desenvolvimento fetal em ratas. MÉTODOS: Foram utilizadas 60 ratas sexualmente maduras e sabidamente férteis distribuídas em dois grupos: grupo 1 (n=30)- submetidas a ligadura do ducto biliopancreático e grupo 2 (n=30) -controles. A partir do 23? dia pós-operatório, as ratas foram acasaladas e seus ciclos estrais avaliados diariamente por meio de esfregaços vaginais, que permitiram determinar o dia da cópula e a idade gestacional em que foram mortas. Realizou-se estudo histológico dos corpos lúteos nos ovários de todas as ratas e analisou-se macroscopicamente a morfologia externa dos fetos. RESULTADOS: Observou-se que 23 ratas controle (92 por cento) e 11 ratas ictéricas (39,3 por cento) desenvolveram prenhez (p=0,0002). As 17 ratas com hiperbilirrubinemia e sem prenhez (60,7 por cento) apresentaram somente corpos lúteos com aspecto involutivo em seus ovários e sofreram modificações em seus ciclos estrais, permanecendo vários dias em proestro ou estro. As ratas prenhes com hiperbilirrubinemia não apresentaram alterações em seus corpos lúteos, porém os seus fetos eram anormais. CONCLUSÃO: Em presença de hiperbilirrubinemia, a fertilização é viável, a capacidade reprodutiva é muito reduzida, os ciclos estrais tornam-se irregulares, o epitélio vaginal permanece cornificado, os corpos lúteos ovarianos regridem, os corpos lúteos gravídicos não são alterados aumentando progressivamente durante a prenhez e o desenvolvimento fetal é gravemente alterado.
OBJECTIVE: To assess the influence of jaundice on the reproductive capacity and fetal development in rats. METHODS: 60 sexually mature rats were divided into two groups: Group 1 (n=30) - submitted to ligature of the biliopancreatic duct and Group 2 (n=30) -control- submitted only to sham operation. 23 days later, the animals were matted with sexually mature males for copulation. Vaginal smears were daily collected in order to verify the presence of spermatozoids and copula. The morphologic aspect of the ovaries and the corpi lutea diameter were studied. The morphology of the embryos of rats that became pregnant were assessed. Serum bilirubin levels were also determined. RESULTS: It was observed that 23 rats of the control group (92 percent) and 11 jaundiced rats (39.3 percent) became pregnant (p=0,0002). The 17 rats with hyperbilirubinemia that did not become pregnant (60.7 percent) present only involutive corpi lutea and had suffered modifications in their estrous cycles, remaining some days in proestro or estro. The pregnant rats with hyperbilirubinemia did not presented corpi lutea alterations, however their embryos were abnormal. CONCLUSION: In jaundice rats fertilization is viable, the reproductive capacity is intensive reduced, the estrus cycles becomes irregular, the corpi lutea is presented in regression, the gravidic lutea is not modified increasing gradually during the pregnancy and the fetal development is seriously impaired.
Asunto(s)
Animales , Femenino , Ratas , Desarrollo Fetal , Ictericia/complicaciones , Ictericia/fisiopatología , Ovario/anatomía & histología , Reproducción , Ratas Endogámicas LewRESUMEN
OBJECTIVE: To assess the influence of jaundice on the reproductive capacity and fetal development in rats. METHODS: 60 sexually mature rats were divided into two groups: Group 1 (n=30) - submitted to ligature of the biliopancreatic duct and Group 2 (n=30) -control- submitted only to sham operation. 23 days later, the animals were matted with sexually mature males for copulation. Vaginal smears were daily collected in order to verify the presence of spermatozoids and copula. The morphologic aspect of the ovaries and the corpi lutea diameter were studied. The morphology of the embryos of rats that became pregnant were assessed. Serum bilirubin levels were also determined. RESULTS: It was observed that 23 rats of the control group (92%) and 11 jaundiced rats (39.3%) became pregnant (p=0,0002). The 17 rats with hyperbilirubinemia that did not become pregnant (60.7%) present only involutive corpi lutea and had suffered modifications in their estrous cycles, remaining some days in proestro or estro. The pregnant rats with hyperbilirubinemia did not presented corpi lutea alterations, however their embryos were abnormal. CONCLUSION: In jaundice rats fertilization is viable, the reproductive capacity is intensive reduced, the estrus cycles becomes irregular, the corpi lutea is presented in regression, the gravidic lutea is not modified increasing gradually during the pregnancy and the fetal development is seriously impaired.
Asunto(s)
Desarrollo Fetal , Ictericia/complicaciones , Ictericia/fisiopatología , Ovario/anatomía & histología , Reproducción , Animales , Femenino , Ratas , Ratas Endogámicas LewRESUMEN
BACKGROUND: Acute liver failure (ALF) is a condition with rapid deterioration of liver function resulting in hepatic encephalopathy and/or coagulopathy in patients with previously normal liver. Complicated forms of certain infectious diseases like falciparum malaria, leptospirosis, dengue fever, ricketsial fever, typhoid fever, haemophagocytosis, herpes simplex virus, cytomegalovirus, tuberculosis or amoebic liver abscess can present with altered mentation and/or bleeding manifestations in presence of jaundice and mimic ALF due to acute viral hepatitis (AVH). METHODS: We describe our experience in last 2 years with 28 patients of ALF due to above mentioned conditions (ALF-ID) and compared them with 28 patients with ALF due to AVH (ALF-AVH). RESULTS: In ALF-ID, typhoid fever was present in 1, haemophagocytosis in 1, ricketsial infection in 4 (scrub typhus = 2, endemic typhus = 2), amoebic liver abscess in 4, leptospirosis in 5, dengue fever in 5 and falciparum malaria in 8 patients. In ALF-AVH, hepatitis E and B co-infection was responsible in 1, hepatitis A and E co-infection in 1 and hepatitis E, B and C co-infection in 1, hepatitis E in 18, hepatitis A in 2 and hepatitis B in 5 patients. Differentiation of various forms of ALF-ID from ALF-AVH depends on various clinical, haematological and biochemical parameters, in addition to specific diagnostic tests. Patients with ALF-AVH had mortality rate of 50% (14/28) and ALF-ID had mortality rate of 25% (7/28). CONCLUSIONS: In developing countries, ALF-mimicking infections should be looked for in differential diagnosis of ALF. Early identification and treatment of these infections is important in reducing mortality.
Asunto(s)
Enfermedades Transmisibles/complicaciones , Enfermedades Transmisibles/diagnóstico , Hepatitis Viral Humana/complicaciones , Hepatitis Viral Humana/diagnóstico , Fallo Hepático Agudo/diagnóstico , Fallo Hepático Agudo/etiología , Adolescente , Adulto , Anciano , Niño , Enfermedades Transmisibles/tratamiento farmacológico , Enfermedades Transmisibles/fisiopatología , Diagnóstico Diferencial , Femenino , Hepatitis Viral Humana/tratamiento farmacológico , Hepatitis Viral Humana/fisiopatología , Humanos , India , Ictericia/fisiopatología , Fallo Hepático Agudo/tratamiento farmacológico , Fallo Hepático Agudo/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
El siguiente estudio continúa la serie de publicaciones sobre decisiones clínicas en el diagnóstico, tratamiento y costo-utilidad en Hepatología, usando las herramientas de la Medicina Basada en Evidencia (MBE). En un escenario clínico en que se sospecha la presencia de ascitis, la real utilidad de los hallazgos clínicos no ha sido bien establecida. Usando un modelo de búsqueda basado en una pregunta clínica, tres estudios y un artículo de revisión son identificados. Uno de estos estudios es extensamente analizado, incluyendo criterio de validez interna (gold standard, criterios de selección de pacientes, reproducibilidad de los hallazgos y temporalidad), análisis de resultados y discusión de la aplicabilidad. Cuatro signos clínicos (flancos abultados, matidez en los flancos, matidez desplazable y signo de la ola) fueron examinados de manera independiente por tres gastroenterólogos. Los resultados muestran que, usando la ultrasonografía como gold standard, 21 por ciento de los pacientes tenía ascitis. La sensibilidad y especificidad de las maniobras examinadas fue de 50 por ciento a 94 por ciento, y 29 por ciento a 82 por ciento, respectivamente. La matidez en los flancos fue el más sensible y el signo de la ola el más específico. La metodología del estudio está limitada por el reducido número de pacientes, la falta de adecuados criterios de selección de casos y la ausencia de información acerca la temporalidad de los síntomas. Otros signos presentes en cirrosis son descritos y brevemente analizados, usando MBE. Concluimos que los signos del examen físico son útiles en el diagnóstico de ascitis, siendo la matidez en los flancos y el signo de la ola los más útiles. La ecotomografía se recomienda en casos de duda diagnóstica.
Asunto(s)
Humanos , Persona de Mediana Edad , Ascitis/diagnóstico , Cirrosis Hepática/diagnóstico , Examen Físico/métodos , Medicina Basada en la Evidencia , Esplenomegalia/fisiopatología , Ictericia/fisiopatología , Investigación Biomédica/métodos , Publicación Periódica , Reproducibilidad de los Resultados , Signos en Homeopatía , Sensibilidad y Especificidad , Signos y Síntomas , Telangiectasia/fisiopatologíaRESUMEN
La ictericia no hemolítica es una manifestación común en la práctica médica, con múltiples causas adquiridas o congénitas. Para establecer un tratamiento oportuno, el clínico debe realizar un diagnóstico causal, y diferenciar si la ictericia es hepatocelular o colestásica. En el primer caso, si es aguda o crónica, y en el segundo caso, si es intrahepática o extrahepática, benigna o maligna. Para el diagnóstico es necesario comenzar con una historia clínica y un examen completos. Luego se debe recurrir a las pruebas de laboratorio y, en algunos casos es necesario un estudio imaginológico para llegar a una conclusión. En este módulo se comentan los datos clínicos, de laboratorio y demás ayudas diagnósticas para el estudio del paciente con ictericia no hemolítica adquirida y las pautas para establecer el diagnóstico diferencial de las congénitas.
Asunto(s)
Humanos , Ictericia/diagnóstico , Ictericia/etiología , Ictericia/fisiopatología , Diagnóstico DiferencialRESUMEN
Biliary obstruction may be accompanied by systemic endotoxemia due to increased growth of enteric microbiota and failure of hepatic clearance mechanisms. This endotoxemia is related to increased postoperative morbidity and mortality. An increased growth of the aerobic flora has been demonstrated experimentally in the presence of biliary obstruction, and in previous studies we observed intestinal hypomotility of jaundiced loops in vitro. To determine the ileal motor response in the presence of jaundice caused by biliary obstruction and in the presence of endotoxemia, an in vitro study was carried out on ileal segments from 10 female Holtzman rats, 2-3 months old, weighing 200 to 300 g, divided into two groups (N = 5); A, washed loops of jaundiced rats, and B, washed loops of jaundiced rats to which endotoxin was added. On the seventh postoperative day, we evaluated the effect of exogenous endotoxin (E. coli 0111:B4, Sigma) on the motor response to acetylcholine of distal ileal segments isolated from both animal groups. A 4-cm ileal segment, located 10 cm from the ileal papilla, was removed and studied in an organ chamber in order to assess dose-response curves to acetylcholine. There was an increase in threshold dose in jaundiced loops with intraluminally injected endotoxin when compared with the loops without intraluminal endotoxin (291 +/- 188 vs 8.5 +/- 6.7 microM, P < 0.05). The maximum contraction was reduced in jaundiced loops with intraluminal endotoxin in relation to control loops (5.3 +/- 1.7 vs 18.7 +/- 4.8 mm, P < 0.05), and pD2 was also reduced in jaundiced loops with intraluminal endotoxin in relation to control loops (2.4 +/- 0.6 vs 3.7 +/- 0.5, P < 0.05). There was no statistical difference between jaundiced loops with and without intraluminal endotoxin when the maximal contraction doses were compared (86 +/- 66 vs 48 +/- 22 mM, P > 0.05). These results demonstrate that intraluminal endotoxin depressed enteric motility in jaundiced rats.
Asunto(s)
Endotoxinas/fisiología , Motilidad Gastrointestinal/fisiología , Ictericia/fisiopatología , Animales , Femenino , Técnicas In Vitro , Ratas , Ratas Sprague-DawleyRESUMEN
En el presente estudio se presentan 18 casos de síndrome de Gianotti-Crosti, que se documentaron de marzo de 1987 a noviembre de 1994, en el Hospital Regional No. 1 de Acapulco, y en el hospital General de Zona No. 14 de guadalajara del Instituto Mexicano del Seguro Social (IMSS). Se describen algunas características epidemiológicas, las manifestaciones clínicas y morfológicas y los hallazgos histipatológicos de laboratorio de la enfermedad
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Lactante , Preescolar , Humanos , Masculino , Femenino , Biopsia , Acrodermatitis/etiología , Acrodermatitis/fisiopatología , Virus de la Hepatitis B/patogenicidad , Citomegalovirus/patogenicidad , Ictericia/fisiopatología , Leucocitosis/etiología , Linfocitosis/etiología , Linfadenopatía Inmunoblástica/fisiopatología , Signos y SíntomasRESUMEN
Se presenta el caso clínico de una paciente con corioamnioitis y sepsis por E. coli en el tercer trimestre de su gestación, cuya manifestación clínica principal fue un síndrome ictérico. La ictericia durante el embrazo presenta un amplio espectro de posibilidades etiológicas, aunque las más frecuentes son enfermedades primariamente de hígado o de la vías biliares, algunos procesos sistémicos como las infecciones o la eclampsia pueden asociarse a este síndrome. Se propone que, aunque no es una causa frecuente, debe considerarse a la corioamnioitis entre las causas de ictericia en el embarazo
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Amebiasis/complicaciones , Corioamnionitis/etiología , Clindamicina/uso terapéutico , Gentamicinas/uso terapéutico , Ictericia/fisiopatología , Sepsis/etiologíaAsunto(s)
Humanos , Masculino , Femenino , Conducto Colédoco/fisiopatología , Quiste del Colédoco/complicaciones , Bolivia , Colangitis/fisiopatología , Procedimientos Quirúrgicos del Sistema Digestivo , Drenaje/estadística & datos numéricos , Ictericia/fisiopatología , Ultrasonografía/estadística & datos numéricosRESUMEN
La presencia de ictericia en el postoperatorio de cirugíacardíaca es un problema cuya incidencia ha ido en aumento. Se diseñó un estudio prospectivo, longitudinal y observacional para tratar de encontrar las causas. Se recolectaron parámetros preoperatorios, transoperatorios y postoperatorios. Laobservación fue de seis semanas, se escogieron aleatoria e independientemente de su patología como único criterio de inclusión circulación extracorporea. Resultados: 43 pacientes, de los cuales desarrollaron ictericia 7 pacientes (16.3 por ciento), con un intervalo de confianza entre el 7 y 31 por ciento (basados en la distribución binomial) La distribución del sexo en todos los pacientes (n=43) fue: masculinos 25 (58 por ciento), femeninos 18 (42 por ciento); separados por grupos, la distribución fue la siguiente: no ictéricos 19 (53 por ciento) para masculinos y 17 (47 por ciento) femeninos vs ictéricos 6 (86 por ciento) masculinos y 1 (14 por ciento) femeninos. Dentro de los antecendentes con respecto a la ingesta de alcohol el grupo sin ictericia fue de 11 por ciento vs 57 por ciento -del grupo ictérico y con el antecedente de anestesia previa fue de 42 por cientovs 100 por ciento respectivamente. (p=0.05). El resto de variables cualitativas y cuantitativas fueron similares en ambos grupos, excepto en el tiempo de By-pass (90') y tiempo de pinzamiento de Ao. (60'), donde observamos una tendencia mayor aunque no significativa en los pacientes con ictericia. En este trabajo podemos concluir que el sexo, la edad, antecedente de ingesta de alcohol, exposición previa a agentes anestésicos además de un tiempo de by-pass mayor a 90' y pinzamiento de Ao mayor a 60' constituyen un riesgo mayor de presentar ictericia
Asunto(s)
Humanos , Masculino , Femenino , Complicaciones Posoperatorias , Cirugía Torácica/efectos adversos , Ictericia/cirugía , Complicaciones Posoperatorias/prevención & control , Cirugía Torácica , Bilirrubina/análisis , Bilirrubina , Ictericia/fisiopatologíaRESUMEN
La bilis de pacientes con enfermedad calculosa puede estar colonizada por bacterias. Este trabajo busca determinar la frecuencia de cultivos, tipo de germenes, factores de alto riesgo para la colonizacion y numero de bacterias que podria sugerir infeccion biliar. Se llevo a cabo un estudio prospectivo de 49 pacientes consecutivos sometidos a cirugia por enfermedad lisiatica de vesicula y/o via biliar. Los cultivos fueron positivos en 21 pacientes (43//), la bacteria predominante fue Scherichia coli en 48//. La frecuencia de colonizacion biliar en pacientes del grupo de alto riesgo fue de 67//, y de 35// en aquellos pacientes sin factores de riesgo. En 18// de los casos existian 3 o mas factores de riesgo. El recuento de colonias fue menor de 100.000 en 86// de los pacientes. Los resultados sugieren que la colonizacion bacteriana de la bilis podria ser mayor cuando existen factores de riesgo. Los microorganismos aislados son similares a los senalados por otros autores con la exepcion de Salmonella typhi que no fue identificada en este estudio. En el recuento de colonias no se logro determinar una cifra que nos pueda indicar especificamente infeccion biliar
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Bacterias/patogenicidad , Bilis/microbiología , Bolivia/epidemiología , Células Cultivadas , Colangitis , Colelitiasis/cirugía , Empiema/microbiología , Escherichia coli/crecimiento & desarrollo , Cálculos Biliares/microbiología , Ictericia/fisiopatología , Características de la Residencia , Factores de RiesgoRESUMEN
Histologicamente segun estudios hechos por Goncalvez y col. la necrosis e infiltrado inflamatorio se presento en todos los casos, mientras que la esteatosis en un 98 //. En los pacientes fallecidos se encontro con mas frecuencia la ictericia, hemorragia digestiva alta y la encefalopatia. La tasa de mortalidad especifica segun Dieter Gorenc y col., fue de 45,8/100.000. El estudio realizado en el Hospital de Clinicas permite demostrar tasas especificas de morbimortalidad en nuestro medio no estudiadas con anterioridad en este centro hospitalario, para hacer de este modo un estudio comparativo con el resto de paises latinos.